Tag Archives: AFPP

Human factors, Human factors, Operating Room, Perioperative Practice

✈️From Pilots to Perioperative Practice: Why Organisation and Readiness Save Lives in the OR

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Instrument nurses anticipate, troubleshoot, and act quickly under the direction of the surgeon and surgical team. This readiness is not spontaneous—it’s practised, structured, and supported by systems that make efficiency possible.

Which is why it’s essential that supplies are restocked, accessible, and organised in a way that supports those using them. When instruments and equipment are easy to locate, workflows become smoother, communication clearer, and patient care safer.

Healthcare facilities are unique. Multiple surgeries often take place at the same time, across different specialties and with varying surgeon preferences. Balancing and anticipating the requirements of each case can be challenging. The ability to maintain surgical flow depends on robust systems that support real-time visibility of supplies, streamline communication, and ensure that all teams can access what they need—when they need it.

In critical moments, seconds matter. Organisation, preparation, and anticipation aren’t just about tidiness—they’re about saving time, reducing stress, and optimising outcomes.
The best teams don’t just react; they prepare.

Evidence Supporting Organised Workflows in the OR

🧩 Human Factors & Cognitive Load

Operating rooms are complex, high-stakes environments where even small inefficiencies increase cognitive load and the likelihood of error. Research in the Journal of the American College of Surgeons (2018) found that structured equipment layouts improve situational awareness and reduce team stress, particularly during intraoperative crises.

🏥 ACORN, AORN, EORNA, AfPP & ORNAC Standards

Global perioperative standards—including those from ACORN, AORN, EORNA, AfPP, and ORNAC—all recognise that organised, accessible, and standardised supplies underpin surgical safety and efficiency.
These organisations advocate for environmental readiness, equipment control, and preparation practices that enable clinicians to respond effectively when events change rapidly.

  • AORN Guidelines for Perioperative Practice (2024) highlight the impact of organised sterile fields on reducing inefficiency and risk.

  • ACORN Standards for Perioperative Nursing (2023) emphasise stock control, setup, and environmental preparation as foundational to safe surgical care.

  • EORNA Best Practice for Perioperative Care (2023) promotes safety through standardised processes and structured preparation.

  • AfPP Standards and Recommendations for Safe Perioperative Practice (2022) outline best practice in equipment accountability and intraoperative safety.

  • ORNAC Standards, Guidelines and Position Statements (2021) provide comprehensive frameworks for perioperative readiness across Canadian healthcare settings.

⏱ Efficiency and Patient Safety

Studies indicate that missing or misplaced instruments can delay procedures by 10–20 minutes per case (BMJ Quality & Safety, 2019), compounding anaesthesia time and risk exposure. Efficient organisation reduces these delays and enhances both safety and morale.

🧭 Crisis Resource Management (CRM)

Borrowed from aviation, CRM focuses on anticipation, communication, and structured preparation. Maintaining a “ready environment” mirrors a pilot’s pre-flight checklist: ensuring all essential items are accessible before takeoff—or incision.

Conclusion

Efficiently stocked and accessible supplies don’t just support the team—they protect the patient.
Organisation in the operating room isn’t housekeeping—it’s clinical readiness, situational awareness, and patient safety in action.
In a busy theatre environment, where multiple procedures occur simultaneously, robust systems that streamline stock management, standardisation, and communication are key to keeping teams safe, focused, and efficient.

Short Reference List 

Perioperative Education, Professional Development

🌟 Building Competence in the OR Takes Time—And Pays Off

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Instrument and circulator nurses and technologists perform some of the most complex, high-pressure roles in healthcare. Their work demands clinical competence, situational awareness, and theory-based practice—skills that take time, mentorship, and structured exposure across multiple surgical specialties to develop.

For example:

  • 🩺 Perioperative nurses: structured programs (AORN Periop 101, ACORN transition programs, UK AfPP Frameworks, EORNA and ORNAC competency guidelines) typically span 6–12 months of intensive training, with an additional 12–24 months to build independent multi-specialty proficiency.

  • 🧰 Surgical technologists/instrument nurses: require 12–24 months of formal education plus continuing clinical mentorship to achieve advanced practice levels.

Healthcare facilities that invest beyond orientation—offering rotational learning, mentorship, and team-training—see measurable benefits:
✅ Stronger safety culture and teamwork
✅ Reduced surgical complications and near-misses
✅ Improved staff confidence, engagement, and retention

When organisations fail to train and rotate junior or novice staff appropriately, senior “all-rounders” end up carrying the load. This imbalance leads to burnout, turnover, and risk to patient safety.

By contrast, structured perioperative education—aligned with AORN, ACORN, AfPP, EORNA, and ORNAC standards—builds teams that are competent, confident, and collaborative, ultimately delivering higher standards of surgical care.

Investing in time-based competence is not a cost—it’s patient safety assurance.

📚 Selected References

  • AORN (US): Perioperative 101 Program & RN Residency Guidelines (6–12 months structured training).

  • ACORN (Australia): Standards for Perioperative Nursing Practice (2024)—competency-based education and role delineation.

  • AfPP (UK): Perioperative Career Framework (2022)—progressive skill development across roles.

  • EORNA (Europe): Core Curriculum for Perioperative Nursing (2019)—emphasises mentorship and safety culture.

  • ORNAC (Canada): Standards, Guidelines and Position Statements (2021)—education and safe practice framework.

  • Team-training outcomes: WHO Surgical Safety Checklist (NEJM 2009); VA Medical Team Training Program (JAMA 2010)—linked to lower surgical mortality and improved teamwork.

🩺 #PerioperativeNursing #OperatingRoom #SurgicalTeamwork #ClinicalEducation #PatientSafety #NurseLeadership #ScrubNurse #CirculatorNurse #SurgicalTechnologist #HealthcareCulture #BurnoutPrevention

Healthcare Safety, Healthcare Systems, Infection Prevention, Perioperative Nursing, Quality Assurance, Surgical Nursing Infection Prevention Operating Room Education Perioperative Practice Clinical Guidelines Nursing Education Patient Safety, Surgical safety

Surgical Site Infections: Reducing the Burden Through Teamwork and Collaboration

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Introduction

Surgical Site Infections (SSIs) are among the most common healthcare-associated infections worldwide. They cause preventable patient suffering, extend hospital stays, and place billions of dollars of pressure on healthcare systems.

Across Australia, the USA, the UK, and Canada, the numbers tell the same story: SSIs remain costly and impactful. Yet, it is important to acknowledge that perioperative professionals — operating room nurses, surgical technologists, and Operating Department Practitioners (ODPs) — are already doing their best in highly complex environments.

The opportunity lies not in asking individuals to “do more,” but in creating collaborative systems and workflows that allow best practices to be followed seamlessly, every time.

The Global Burden of SSI

  • Australia: Around 16,500 SSIs annually in public hospitals, costing A$323 million in direct care and up to A$2.9 billion in broader indirect costs. Each infection adds about 20 extra hospital days costing approximately A$18,814, per case.

  • United States: SSIs account for 20% of all healthcare-associated infections, costing the system US$3.3 billion annually. Each infection adds ~9–10 extra hospital days and US$20,000–25,000 per admission .

  • United Kingdom: Risk varies by surgery — 0.5% in hip replacements, up to 19.9% in biliary procedures. On average, 5% of surgical patients experience SSIs. The cost of treating a wound infection ranges from £2,500–£4,900, with NHS England recording nearly 40,000 SSI cases annually .

  • Canada: SSIs occur in 2–5% of surgeries, with an average cost of CAD $28,000 per case and 7–11 additional hospital days. Surveillance shows SSI rates are improving in some specialties, but the burden remains high .

The Human Impact

For patients, an SSI is more than a complication. It means longer recovery, repeat surgeries, lost income, and sometimes life-threatening sepsis. Families bear emotional and financial strain, while healthcare staff experience frustration when complications could have been prevented.

Behind every statistic is a patient who deserved better.

The Role of Perioperative Professionals Are Aligned

👩‍⚕️ Operating Room Nurses

  • Safeguard the sterile field and ensure aseptic handling.

  • Advocate for patients by confirming antibiotics, prep, and environmental readiness.

  • Monitor surgical counts and documentation that prevent error and infection.

🔧 Surgical Technologists (Scrub Techs)

  • Handle sterile instruments, sutures, and implants with precision.

  • Anticipate contamination risks and act quickly to address them.

  • Model best practice during critical moments under surgical pressure.

🎓 Operating Department Practitioners (ODPs)

  • Support both anaesthetic and scrub teams to maintain safety at every phase.

  • Ensure antibiotics, warming, and oxygenation protocols align with guidelines.

  • Act as communication bridges across disciplines, enhancing teamwork.

From Individual Vigilance to Team-Based Prevention

Perioperative teams are already vigilant. The real challenge is ensuring that systems support them to succeed.

  • Collaboration, not silos: Every team member — nurse, ODP, tech, anaesthetist, surgeon — must share accountability for infection prevention.

  • Seamless best practice integration: SSI bundles (antibiotic timing, antisepsis, normothermia, glucose control) should be built into workflows so they don’t feel like “extra tasks.”

  • Culture of speaking up: Hierarchy must never block action. Every voice in the OR matters when safety is at stake.

  • Continuous learning: Regular audits, debriefs, and education ensure evolving practices are embedded without adding stress.

Conclusion: A Shared Responsibility

Operating room professionals already give 100% to every patient, every day. The way forward is not to expect more from individuals but to enable teams to work more collaboratively, with systems and processes that make the safest practices and the easiest to follow.

By embedding best practices seamlessly into workflows, empowering all voices, and reinforcing teamwork, we can significantly reduce surgical site infections.

Together, through collaboration and by supporting quality assurance to maintain clinical standards, we can protect patients, strengthen surgical teams, and ease the financial and emotional burden of SSIs worldwide.

📑 References

  1. Royle R., Gillespie B. M., Chaboyer W., et al. The burden of surgical site infections in Australia: A cost-of-illness study. Journal of Infection and Public Health, 2023. (2018–19). https://www.sciencedirect.com/science/article/pii/S1876034123000989

  2. CDC. National Healthcare Safety Network (NHSN) Patient Safety Component Manual: Surgical Site Infection (SSI) Event. 2025. CDC SSI Manual PDF

  3. Anderson DJ, et al. Strategies to Prevent Surgical Site Infections in Acute Care Hospitals. Infection Control & Hospital Epidemiology, 2022.https://pubmed.ncbi.nlm.nih.gov/37137483/

  4. Guest J.F., Fuller G.W., Griffiths B. Cohort study to characterise surgical site infections after open surgery in the UK’s NHS. BMJ Open. 2023;13:e076735. https://pmc.ncbi.nlm.nih.gov/articles/PMC10748996/

  5. Jenks PJ, et al. Clinical and economic burden of surgical site infection (SSI) and prediction of risk. BMJ Open, 2014;4:e003765.https://pubmed.ncbi.nlm.nih.gov/24268456/

  6. PHAC (Public Health Agency of Canada). Device and surgical procedure–related infections in Canadian hospitals, 2011–2020. Canada Communicable Disease Report (CCDR), 2022. https://pmc.ncbi.nlm.nih.gov/articles/PMC10278973/

  7. CPSBC & ORNAC. Surgical Site Infection Surveillance and Standards in Canada. College of Physicians and Surgeons of BC / ORNAC, 2020. https://www.cpsbc.ca/files/pdf/NHMSFAP-AS-Environmental-Cleaning-Operating-Procedure-Rooms-and-Sterile-Core.pdf

  8. StatPearls. Postoperative Wound Infections. SSIs affect ~0.5%–3% of inpatient surgeries. https://www.ncbi.nlm.nih.gov/books/NBK560533/#:~:text=Approximately%200.5%25%20to%203%25%20of,develop%20a%20surgical%20site%20infection.
  9. Rezaei, A. R., Zienkiewicz, D., & Rezaei, A. R. (2025). Surgical site infections: A comprehensive review. Journal of Trauma and Injury, 38(2), 71–81.https://doi.org/10.20408/jti.2025.0019
Infection Control, Perioperative Nursing, Perioperative Practice, Surgical Best Practice

🚫 Artificial Nails in the Operating Room: More Than a Policy—It’s a Patient Safety Imperative

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In perioperative environments, details matter—especially those that impact infection prevention and patient safety. While acrylic and artificial nails may be fashionable, in the sterile world of the OR and Sterile Processing Department (SPD), they pose a real risk.

🔬 Evidence of Patient Harm

Healthcare workers wearing long or artificial nails have been directly linked to serious infections and even fatalities in patients:

📍 NICU Outbreak (USA)

  • Pathogen: Pseudomonas aeruginosa

  • Impact: 46 infected infants; 16 deaths

  • Source: Nurses with long and artificial nails

  • Outcome: Outbreak ceased after nail-length restrictions were implemented

📍 Spinal Surgery Fungal Infections

  • Pathogen: Candida albicans

  • Impact: Multiple patients developed postoperative osteomyelitis

  • Source: OR technician with artificial nails

  • Outcome: No further cases after technician was removed

🔬 Lab-Based Evidence

Studies show that:

  • Up to 87% of healthcare workers with artificial nails harbored pathogenic organisms, even after scrubbing.

  • Natural nails showed significantly lower colonization rates.

💰 The Financial Toll

Preventable infections don’t just harm patients—they’re expensive:

  • Cost per hospital-acquired infection:
    AUD $18,000–$42,000+

  • 10-case outbreak could cost a hospital $400,000+, not including litigation or reputational damage.

  • Surgical site infections (SSIs) cost hospitals about $20,000 per patient

  • MRSA-related SSIs can exceed $60,000 per case, with longer hospital stays and higher risk of complications

  • Even just 5–10 avoidable cases linked to policy breaches (like wearing acrylic nails) could cost a hospital hundreds of thousands of dollars

  • Infections linked to lapses in infection control—like poor nail hygiene—carry a major financial burden:

  • Hospital-acquired infections (HAIs) cost the U.S. healthcare system an estimated $28–45 billion annually 📉

📜 What the Guidelines Say

✅ AORN (USA)

“Artificial nails should not be worn by perioperative team members who have direct contact with patients.”

✅ ACORN (Australia)

“Staff in the perioperative environment must not wear artificial fingernails or nail enhancements.”

Both standards emphasize natural nails ≤ ¼ inch in length, free from polish chips or artificial coatings.

🔄 Best Practice for OR & SPD Teams

  • Keep nails natural, short, and clean

  • Avoid all artificial enhancements (acrylic, gel, overlays)

  • Practice strict hand hygiene and glove integrity checks

🧠 Bottom Line

Nail hygiene in the surgical space isn’t about appearance—it’s about protecting patients. Even one overlooked fingernail can change a life.

 

 

 

 

 

 

 

 

 

 

 

📚 References

  1. Moolenaar, R. L., et al. (2000). A prolonged outbreak of Pseudomonas aeruginosa in a neonatal intensive care unit: did staff fingernails play a role? Infection Control and Hospital Epidemiology, 21(2), 80–85.
    https://doi.org/10.1086/501745

  2. Hedderwick, S. A., et al. (2000). Pathogenic organisms associated with artificial fingernails worn by healthcare workers. Infection Control and Hospital Epidemiology, 21(8), 505–509.
    https://doi.org/10.1086/501795

  3. Centers for Disease Control and Prevention (CDC). (2002). Guideline for Hand Hygiene in Health-Care Settings. MMWR Recommendations and Reports, 51(RR-16), 1–45.
    https://www.cdc.gov/handhygiene/

  4. Association of periOperative Registered Nurses (AORN). (2023). Guideline for Hand Hygiene.
    https://www.aorn.org/guidelines

  5. Australian College of Perioperative Nurses (ACORN). (2023). Standards for Perioperative Nursing in Australia.
    https://www.acorn.org.au/standards

  6. Alberta Health Services. (2020). Artificial Nails and Nail Polish in Healthcare Settings – Fact Sheet.
    https://www.albertahealthservices.ca/assets/info/hp/hh/if-hp-hh-artificial-nails-in-healthcare.pdf

  7. World Health Organization (WHO). (2009). WHO Guidelines on Hand Hygiene in Health Care.
    https://www.who.int/publications/i/item/9789241597906

  8. Scott, R. D. (2009). The Direct Medical Costs of Healthcare-Associated Infections in U.S. Hospitals and the Benefits of Prevention. CDC.
    https://stacks.cdc.gov/view/cdc/11550

  9. Kaye, K. S., et al. (2009). The Cost of Surgical Site Infections in the United States. Infection Control and Hospital Epidemiology.
    https://www.wired.com/2009/12/one-surgical-infection-with-mrsa-61000

  10. Magill, S. S., et al. (2014). Multistate Point-Prevalence Survey of Health Care–Associated Infections. New England Journal of Medicine, 370, 1198–1208.
    https://www.cdc.gov/hai/data/portal/index.html

  11. Graves, N., Halton, K., & Lairson, D. R. (2007). The economics of infection control: Hospital-acquired infections and patient safety. Current Opinion in Infectious Diseases, 20(4), 337–341.
    https://doi.org/10.1097/QCO.0b013e3282638e25

  12. Gillespie, B. M., et al. (2021). The Burden of Surgical Site Infections in Australia: A Cost of Illness Study. Australian and New Zealand Journal of Surgery, 91(3), 387–392.
    https://doi.org/10.1111/ans.16339

  13. Infection Control Today. (2001). Artificial Nails Undermine Infection Control.
    https://www.infectioncontroltoday.com/view/artificial-nails-undermine-infection-control

  14. CIDRAP. (2023). Study: Healthcare-Linked Infections Cost US $10 Billion a Year.
    https://www.cidrap.umn.edu/clostridium-difficile/study-healthcare-linked-infections-cost-us-10-billion-year

 

 

 

 

 

Clinical Governance, Healthcare Technology, Perioperative Education, Professional Development, Surgical Best Practice

📚 Why Time and Education Matter in Instilling Best Practice

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Embedding best practices into clinical skills requires deliberate time investment, structured education, and ongoing reinforcement. Research indicates that:

  • 🔍 Deliberate practice over time improves clinical performance.
    Ericsson et al.’s seminal work on skill acquisition demonstrates that expert performance arises from structured, repetitive practice—not merely experience. In surgical settings, this entails building skills through repeated exposure to procedural norms, instrument setup, and workflow protocols.
    (Ericsson KA et al., 1993. Psychological Review)

  • 🕒 Operating rooms are complex environments with high cognitive demands.
    A prospective observational study by Göras et al. (2019) found that surgical teams performed an average of 64 tasks per hour, with nearly half involving communication. Multitasking accounted for 48.2% of the time, and interruptions occurred at a rate of 3.0 per hour, predominantly due to equipment issues. These findings highlight the necessity for structured education and time allocation to manage the complexities of the OR effectively.
    (Göras C et al., 2019. BMJ Open)

  • 🧠 Simulation and structured education improve retention of best practices.
    A study in the Journal of the American College of Surgeons found that OR team members who engaged in simulation-based education were more likely to adhere to best practice protocols, such as surgical safety checklists and aseptic setup techniques.
    (Barsuk JH et al., 2009. J Am Coll Surg)

  • 📈 Structured learning platforms help consolidate complex clinical knowledge.
    Digital tools that reinforce policy-based workflows (like ACORN, AORN, AFPP) assist learners in absorbing, applying, and reflecting on clinical procedures in real-time. Platforms like ScrubUp bridge the gap between formal education and day-to-day clinical needs.

Final Thought (Updated):

By investing time in education and reinforcing evidence-based standards, we don’t just teach a skill—we nurture clinical judgment, adaptability, and professionalism. Whether it’s the first surgical tray setup or a case pivot under pressure, clinicians trained with time and structure are best equipped to deliver safe, efficient care.

References:

https://psycnet.apa.org/record/1993-40718-001

https://pubmed.ncbi.nlm.nih.gov/31097486/

https://pubmed.ncbi.nlm.nih.gov/19667306/