Tag Archives: perioperative nursing

Perioperative Safety, Surgical Best Practice

Electrosurgery & Cautery Safety: Protecting Patients Through Vigilance, Communication, and Best Practice

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⭐ A Personal Note on Perioperative Practice

Every day in the operating room, perioperative professionals carry an extraordinary level of awareness and responsibility. Our roles — whether as nurses, surgeons, anaesthesiologists, surgical technologists, ODP’s or surgical assistants — require us to think about far more than the technical steps of a procedure.

We are constantly managing:

  • the safety and comfort of our patient

  • the surgeon’s needs and the flow of the operation

  • sterility, equipment, instrumentation, and positioning

  • oxygen levels, fire risks, energy devices, and electrosurgical safety

  • implants, allergies, comorbidities, medications, and documentation

  • communication across multiple teams

  • and the unexpected events that can arise at any moment

This level of complexity is part of what makes perioperative practice so unique — and so demanding. Electrosurgical and airway safety are only one piece of our daily responsibilities, yet they require constant vigilance and teamwork. A single decision, moment of inattention, or missed communication can have serious implications for patient safety.

What keeps patients safe is not any one person, guideline, or device.
It is the collective, coordinated awareness of every member of the surgical team.

This blog reflects the real clinical reality we face every day:
that perioperative care is a blend of technical skill, professional judgement, continuous learning, and shared responsibility. These high levels of awareness are the quiet work we do every single day to protect our patients — often without them ever knowing.

Electrosurgery is an essential tool in modern surgery, enabling effective cutting, coagulation, and hemostasis. But despite its benefits, electrosurgery carries real risks — including patient burns, fire hazards in oxygen-rich environments, alternate-site current injuries, and complications involving metal implants and external monitoring devices such as CGM sensors.

Improving safety requires situational awareness, strong communication, proper equipment use, and ongoing education. This blog highlights key risks, best practices, international standards, and emerging considerations for perioperative teams.

🔎 Understanding the Risks of Electrosurgical Burns

Electrosurgery-related burns arise from:

  • Poor grounding pad adhesion

  • Incorrect pad placement over hair, scars, or bony prominences

  • Insulation failure of laparoscopic instruments

  • Capacitive or direct coupling

  • Alternate current pathways involving metal implants such as hip or knee replacements, plates, and screws

These injuries can be deep, severe, and require further surgery — nearly all preventable.

Fire Risk in Oxygen-Enriched Settings

During head, neck, and airway procedures — especially under sedation — oxygen accumulates under drapes. In combination with electrocautery, this forms the fire triangle:

Ignition (ESU) + Oxygen + Fuel (drapes, alcohol prep)

Consequences may include facial burns, airway injury, and equipment damage.

🔒 Oxygen & Airway Safety (AST & ASA Best Practice)

Safe electrosurgery near the airway is a team responsibility shared by surgeons, anaesthesiologists, nurses, and surgical technologists. Both the Association of Surgical Technologists (AST) and the American Society of Anesthesiologists (ASA) provide clear guidance to reduce surgical fire risk in oxygen-enriched environments.

AST Key Recommendations

  • Keep oxygen concentration below 30% whenever possible.

  • If higher oxygen is required, avoid open delivery systems and consider ETT or LMA.

  • Stop or reduce supplemental oxygen or nitrous oxide for at least one minute before activating electrosurgery, battery-powered cautery, or lasers during head, neck, and upper-chest procedures.

ASA Practice Advisory

  • Surgeons must alert anesthesia before activating any ignition source.

  • Anesthesia must alert surgeons if oxygen concentration is elevated or if an oxygen-enriched atmosphere is present.

  • Reduce oxygen to the lowest level that maintains safe saturation whenever clinically feasible.

Why this matters

These recommendations help all perioperative professionals minimise ignition risk, coordinate timing, and maintain safe oxygen practices when using electrosurgery near the airway.

Metal Implants & External Metal Devices

Perioperative teams must confirm the presence and location of:

  • Joint replacements

  • Orthopaedic plates, screws, rods

  • Cardiac/neurostimulators

  • Metal-backed electrodes

  • Diabetic glucose-monitoring systems with metal components

These items may unintentionally divert electrical current and cause burns.

⭐ Global Consensus

Every major organisation agrees:

Electrosurgery safety is a non-negotiable core competency for all perioperative practitioners — nurses, surgical technologists, and assistants.

This includes:

  • ESU physics

  • Pad placement

  • REM monitoring

  • Implant/CGM identification

  • Fire prevention

  • Airway safety

  • Insulation failure recognition

  • Oxygen management

  • Documentation and communication

What the data actually shows (2020–2025)

There is no single global registry that counts “all ESU burns” per year, so we have to pull from several reliable signals: medico-legal claims, sentinel event reports, and national safety alerts. All of them agree on one thing: burns and fires from electrosurgery are real, ongoing, and under-reported.

United Kingdom (NHS Resolution – diathermy burns)

NHS Resolution FOI data for England & Wales show clinical negligence claims where diathermy burns were the primary cause:

  • 2018/19 – 40 claims

  • 2019/20 – 26 claims

  • 2020/21 – 22 claims

  • 2021/22 – 17 claims

  • 2022/23 – 23 claims

  • 2023/24 – 21 claims

So from 2020/21 to 2023/24, there were around 20–25 closed claims per year specifically for diathermy burns in England and Wales alone. These are only cases serious enough to progress to a claim, so they almost certainly underestimate the true number of burns.

United States (energy-device injuries & surgical fires)

For the US, data sources point to both burn injuries and surgical fires where ESUs are the main ignition source:

  • A MAUDE database analysis of surgical energy-based device injuries (1994–2013) found 3,553 injuries and 178 deaths; thermal burns were 63% of injuries (~2,353 cases), and dispersive-electrode burns were a major mechanism. PubMed+1

    • This is older but still the key reference used in guidelines; there’s no newer 2020–2025 MAUDE summary yet.

  • A national review of surgical fires in the US from 2000–2020 identified 565 surgical fire events causing harm over 20 years (median 25 per year); in 82% of these, an electrosurgical device was the ignition source. ScienceDirect

  • A 2024 continuing-education article summarising Joint Commission data reports that from 1 Jan 2018 to 29 March 2023, 85 sentinel events related to fires or burns during surgery or procedures were reported, and notes that around 70% of surgical fires are caused by electrosurgical devices based on ECRI data. ast.org+2pedsurgeryupdate.com+2

Again, these are only the tip of the iceberg (fires and serious burns that get reported centrally), not every minor or moderate ESU burn is reported.

Australia (NSW & Victoria – incidents and sentinel events)

Australia doesn’t publish a national annual count of ESU/diathermy burns, but safety alerts and sentinel-event frameworks show clear concern:

  • NSW Health Safety Notice SN 013/23 reports a laparoscopic case where degraded insulation on a diathermy electrode caused a bowel burn requiring further surgery. NSW Health

  • The updated Safety Notice SN 020/25 notes that 10 additional incidents involving insulated laparoscopic instruments were reported across NSW since the original notice, prompting a strengthened response. NSW Health

  • Safer Care Victoria’s 2024 Sentinel Event Guide explicitly lists “in theatre diathermy accident or burn or where there is an explosion or fire” as a reportable sentinel event – meaning even a single case is treated as very serious. Better Safer Care

So, while we don’t have a neat “X per year” number for Australia, we do have clear evidence of ongoing patient harm, enough to drive repeat safety notices and inclusion as a sentinel event.

📌 IMPORTANT: Continuous Glucose Monitoring (CGM) in Surgery

With increasing community use, many patients arrive for surgery wearing CGM sensors, such as:

  • FreeStyle Libre

  • Dexcom

  • Medtronic Guardian

These devices contain metallic components, which can behave like unintended electrodes during monopolar electrosurgery, posing burn and interference risks.

⚠️ Device Interaction & Burn Risk

  • Manufacturers instruct removal before diathermy.

  • Research demonstrates increased tissue heating around metal implants/sensors with monopolar ESU.

  • Case reviews recommend positioning CGM away from the diathermy arc and considering alternative devices.

  • Mechanism mirrors documented ECG-electrode burns.

🧑‍⚕️ Perioperative Recommendations

  • Ask all diabetic patients about CGM use.

  • Document location and remove before ESU use.

  • If not removable:

    • Keep the device outside the current pathway

    • Place dispersive pad to route current away

    • Prefer bipolar or ultrasonic devices

Include in the surgical time-out:

“Is the patient wearing a CGM or metal glucose sensor?”

📝 CGM Safety Action Plan for Surgery

1. Inform the Healthcare Team. Patients must tell their surgeon, anaesthetist, and perioperative nurse if they wear a CGM device.

2. Remove the Device Before Surgery. Stop the current sensor session and remove all wearable components before entering the OR.

3. Monitor Glucose with Fingerstick While Removed. Use a standard glucose meter for monitoring and treatment decisions while CGM is off.

4. Replace the Sensor After Surgery. Apply a new CGM sensor after the procedure and confirm accuracy using a fingerstick glucose test.

5. Follow Manufacturer Guidance. Refer to official Dexcom, FreeStyle Libre, or Medtronic instructions for removal and replacement.

🧑‍⚕️ Best Practice Principles for Safe Electrosurgery

1. Pre-operative Screening & Communication

  • Identify metal implants, CGM sensors, and piercings.
  • Communicate clearly during team briefings.

2. Correct Grounding Pad (Dispersive Electrode) Placement

  • Apply to clean, dry, hair-free skin
  • Choose large muscular areas
  • Avoid scars, prostheses, bony areas
  • Recheck after repositioning
  • Document placement

3. Return Electrode Monitoring (REM): Audible Alarms Matter

  • REM provides an audible tone confirming contact.
  • Loss of contact triggers a loud alarm and cuts monopolar output.
  • ESUs may be placed out of view — making audible cues essential.
  • Audible alarm can be turned up or down, volume button is usually situated at the back of the ESU.

4. Safe Use Near the Airway

  • Minimise open oxygen
  • Use lowest flow possible
  • Allow oxygen to disperse before activation
  • Apply suction under drapes
  • Keep sterile water ready

5. Choosing the Safest Energy Modality

  • Prefer bipolar
  • Use advanced bipolar or ultrasonic devices when implants/CGM present
  • Avoid monopolar cautery near oxygen-rich environments

6. Education, Competency & Culture

Structured, ongoing training reduces preventable harm from burns and fires.

All perioperative staff, connecting ESU leads should be aware of Patient Safety and ESU protocols.

🌍 International Standards & Best Practices for Electrosurgery Safety

Safe ESU use is considered a mandatory competency worldwide. Major perioperative organisations outline strict expectations for education and practice.

AORN — USA

AORN’s Guideline for Safe Use of Energy-Generating Devices requires:

  • Mandatory ESU/energy-device education
  • Competency verification
  • Fire-prevention protocols
  • Standardised ESU setup and REM response
  • Annual competency review

ACORN — Australia

ACORN’s Standards for Perioperative Nursing include Electrosurgical Safety as a core clinical standard:

  • Monopolar/bipolar principles
  • Safe pad placement
  • Preventing alternate-site burns
  • Airway & oxygen management
  • Novice nurse education through Fundamentals of Intraoperative Nursing

AfPP — United Kingdom

AfPP’s standards emphasise:

  • Training & competency assessment
  • Equipment checks and risk management
  • ESU safety as part of routine clinical audits

ORNAC — Canada

ORNAC’s guidelines identify ESU safety as:

  • A foundational competency for perioperative RNs
  • A required component of approved perioperative education programs
  • A standard requiring annual review and validation

EORNA — Europe

EORNA’s Best Practice for Perioperative Care includes a full electrosurgery section covering:

  • Generator checks
  • REM
  • Burns from implants, piercings
  • Fire and oxygen risk
  • Safe handling of energy devices

AST / NBSTSA — Surgical Technologists (USA)

Surgical technology bodies require competency in:

  • ESU setup
  • Pad placement
  • Cautery-pencil safety
  • Insulation-failure identification
  • Fire prevention
  • Alternate current pathway risks

References

  1. AORN. Guideline for Safe Use of Energy-Generating Devices. In: Guidelines for Perioperative Practice. Association of periOperative Registered Nurses, USA.
  2. ACORN. Standards for Perioperative Nursing in Australia – Electrosurgical Safety Standard; Fundamentals of Intraoperative Nursing education resources. Australian College of Perioperative Nurses, Australia.
  3. AfPP. Standards and Recommendations for Safe Perioperative Practice. Association for Perioperative Practice, United Kingdom.
  4. ORNAC. Guidelines for Perioperative Nursing Practice in Canada. Operating Room Nurses Association of Canada.
  5. EORNA. Best Practice for Perioperative Care – Electrosurgical Safety section. European Operating Room Nurses Association.
  6. AST / NBSTSA. Core Curriculum for Surgical Technology and NBSTSA Certification Examination Content Outline – Surgical Energy and Electrosurgical Unit (ESU) Safety. Association of Surgical Technologists / National Board of Surgical Technology and Surgical Assisting.
  7. NHS Resolution (UK). FOI 6813 – Diathermy burns / reaction to prep – hospital-acquired infection claims data (2018/19–2023/24).
  8. NHS Resolution (UK). FOI 6278 – Diathermy burns – clinical negligence claims/incidents (2017/18–2022/23).
  9. NSW Health. Safety Notice SN 013/23 – Risk of burn injury from degraded insulated laparoscopic instruments. New South Wales Health, Australia.
  10. NSW Health. Safety Notice SN 020/25 – Further incidents involving insulated laparoscopic instruments. New South Wales Health, Australia.
  11. Safer Care Victoria. Victorian Sentinel Event Guide 2024 – In-theatre diathermy accident or burn, explosion or fire as a reportable sentinel event. Safer Care Victoria, Australia.
  12. U.S. Food and Drug Administration (FDA). MAUDE database analysis of energy-based surgical devices – injuries, deaths and proportion of thermal burns.
  13. ECRI Institute. Surgical Fires in the Operating Room – root causes and contribution of electrosurgical devices as ignition sources.
  14. The Joint Commission. Sentinel Event Data Summary (2018–2023) – Fires and burns during surgery and procedures.
  15. Canadian Medical Protective Association (CMPA). Intraoperative burns: learning from medico-legal cases – analysis of 53 intraoperative burn cases (2012–2016).
  16. CMPA. Surgical fires: managing the risks – summary of 54 medico-legal cases related to surgical fires in Canada.
  17. Health Canada. Medical Device Recall Notices – Patient return electrode pads used with electrosurgical units (2023–2024).
  18. Ontario Ministry of Labour, Immigration, Training and Skills Development. Alert: Preventing Surgical Fires in Hospital Operating Rooms (updated 2025).
  19. Abbott Diabetes Care. FreeStyle Libre Sensor – Important Safety Information (diathermy and high-frequency electrical treatment warnings).
  20. Dexcom. Dexcom Continuous Glucose Monitoring System – Safety Information (guidance regarding electrosurgery and imaging).
  21. Medtronic. Guardian / Medtronic CGM Systems – MRI and diathermy safety guidance.
  22. Studies examining tissue heating around metallic implants and glucose sensors during monopolar electrosurgery, demonstrating increased local temperature near metal.
  23. Electrosurgical safety literature describing ECG-electrode and external-electrode burn mechanisms caused by high current density and unintended alternate pathways.
  24. Case reports and reviews of electrosurgical pad burns, insulation failures, alternate-site burns and oxygen-related fires in head and neck / airway surgery.
  25. SAGES. Fundamentals of the Use of Surgical Energy (FUSE) – educational program highlighting common knowledge gaps in surgical energy safety among surgeons and perioperative clinicians.
  26. Association of Surgical Technologists (AST). Guidelines for Best Practices: Safe Use of Energy Devices. AST Standards of Practice for Surgical Technology and Surgical Assisting. (Includes recommendations for oxygen management, reducing oxidizer concentration, and pausing oxygen flow ≥1 minute before using electrosurgery or lasers during head, neck, and upper-chest procedures.)
  27. American Society of Anesthesiologists (ASA). Practice Advisory for the Prevention and Management of Operating Room Fires. ASA Task Force on Operating Room Fires. (Provides guidance for ignition-source control, team communication, and safe oxygen practices during electrosurgery and airway procedures.)
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 Leadership, Operating Room Workflow, Patient Safety, Perioperative Nursing, Staff Wellbeing

Why Interruptions in the Operating Room Put Safety, Efficiency, and Staff Wellbeing at Risk

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The Hidden Cost of Interruptions in the OR: Why Focus Matters

Imagine this: mid-operation, a circulator is executing the instrument count and prepping for the next step. Suddenly, someone enters asking a question unrelated to the task. A phone rings. A colleague requests “just one small check” that could wait. In that instant, the smooth flow fractures, attention shifts, and the risk for error rises.

Operating rooms are high-stakes environments. Interruptions, distractions, and disruptions (DIDs) occur frequently. Research shows these DIDs are linked to slower operative times, degraded team performance, errors, and staff burnout【see references】.

Evidence: How Interruptions Affect Workflow

  • A meta-analysis of 27 studies found that interruptions accounted for about 22% of total operative time.

  • Observations show surgical teams complete 64 tasks per hour, nearly half involving communication — many of which are interruptions.

  • In 1,015 surgeries observed, there were 697 interruptions during surgical counts, averaging 8.7 interruptions per hour.

  • Noise and distractions contribute to burnout and emotional exhaustion among OR nurses.

Why These Disruptions Matter

Interruptions in the operating room:

  • Increase task switching costs and cognitive load.

  • Erode team coordination and communication.

  • Lead to errors in counts, instruments, and protocols.

  • Raise stress, fatigue, and burnout risk.

Downstream Risks

Domain Impact
Time & Efficiency Slower turnovers, lost OR capacity
Errors & Safety Incorrect counts, protocol breaches, retained items
Patient Outcomes Higher complication risk, reduced safety
Staff Wellbeing Burnout, fatigue, turnover
Team Dynamics Miscommunication, conflict, mistrust

Global Professional Standards on Disruptions & Surgical Counts

Leading perioperative associations across the world are clear: minimise interruptions and protect focus during critical workflows like surgical counts.

  • AORN (USA) – Guidelines for Perioperative Practice emphasise that surgical counts should occur in a distraction-free environment, with interruptions minimised.

  • ACORN (Australia) – Standards for Perioperative Nursing in Australia state that all team members must respect the surgical count process, with policies to reduce non-clinical disruptions and noise.

  • ORNAC (Canada) – Standards, Guidelines, and Position Statements highlight that accuracy in counts depends on staff focus, and interruptions jeopardise patient safety.

  • AST (USA) – Standards of Practice for Surgical Technology require that a “no-disruption zone” be established during counts, ensuring clear focus and communication.

  • AfPP (UK) – Standards & Guidance for Perioperative Practice mandate that surgical counts are conducted in an environment free of unnecessary distractions.

Across these global guidelines, the message is consistent: Interruptions increase the risk of errors, delay workflow, and compromise patient safety.

Standards Exist for a Reason — But Why Aren’t They Always Respected?

Every major perioperative association — AORN, ACORN, ORNAC, AST, AfPP — has clearly written standards to protect surgical counts and minimise disruptions. These are not optional. They are evidence-based frameworks designed to:

  • Prevent retained surgical items.

  • Support team communication and accuracy.

  • Protect staff from unnecessary stress and fatigue.

  • Ensure patients receive safe, high-quality care.

👉 In short, the standards are there to be followed, and supported by all operating room professionals.

So why aren’t they always respected?

  • Cultural norms: Hierarchy or habit can override policy.

  • Time pressure: Case turnover speed may be prioritised over protocol.

  • Resource gaps: Understaffing forces multitasking and shortcuts.

  • Awareness: Staff may not always be trained or reminded.

  • Leadership enforcement: Without strong backing, policies risk becoming “paper standards.”

⚠️ The result? Standards meant to safeguard patients and professionals are diluted by daily realities.

This is why leadership support, accountability, and a culture of patient safety are essential for making standards meaningful.

Strategies to Protect Workflow

  1. “No interruption zones” / Sterile cockpit periods

  2. Structured communication windows

  3. Training in human factors & non-technical skills

  4. Role clarity & leadership support

  5. Noise and environment control

The Financial Cost of Interruptions

Interruptions in the operating room aren’t just a human factor issue — they carry real financial consequences for hospitals.

  • Every minute in the OR is expensive.

    • In the U.S., the average cost of OR time ranges from $36 to $100 per minute, depending on procedure and facility type (Macario, 2010; Childers & Maggard-Gibbons, 2018).

    • In Australia and the UK, estimates range from AUD $29–$52 per minute (ACORN, 2023; NHS data).

  • Turnover inefficiencies add up.

    • If nearly 1 in 4 minutes of OR time is lost to interruptions or inefficiencies, this could mean thousands of dollars per case in wasted resources.

    • For a hospital performing 10,000 surgeries annually, even a 5-minute delay per case can translate to $1.8–$5 million in annual lost capacity or added costs.

  • Knock-on effects:

    • Delays can push surgeries past rostered hours, increasing overtime pay.

    • Prolonged turnover times reduce surgical throughput, limiting revenue opportunities.

    • Staff burnout and turnover from constant disruption create downstream costs in recruitment, onboarding, and agency nurse reliance.

👉 Bottom line: Interruptions don’t just affect workflow — they directly erode hospital finances, efficiency, and workforce sustainability. Investing in structured communication, role clarity, and leadership enforcement of standards can save hospitals millions annually, while protecting patients and staff.

Conclusion & Call to Action

Interruptions aren’t minor inconveniences — they directly impact patient safety, staff wellbeing, and hospital efficiency. By adopting structured communication, enforcing no-interrupt periods, and promoting supportive leadership, we can protect workflow and reduce risk.

Will your team commit to one small change this week to minimise OR interruptions?

📚 References

  1. McMullan RD et al. Operating room distractions and patient safety. Int J Qual Health Care.

  2. Göras C et al. Tasks, multitasking and interruptions in the OR. BMJ Open.

  3. BMC Nursing. Interruptions during surgical counts.

  4. Zhang Y et al. Noise annoyance & burnout in OR nurses. PLOS One.

  5. JAMA Network Open. Nurse burnout and patient safety, satisfaction, and quality of care.

  6. Macario A. What does one minute of operating room time cost? J Clin Anesth. 2010;22(4):233–6.

  7. Childers CP, Maggard-Gibbons M. Understanding costs of care in the operating room. JAMA Surg. 2018;153(4):e176233.

  8. ACORN. Standards for Perioperative Nursing in Australia (2023).

  9. NHS Improvement. Reference costs: elective surgery per minute estimates.

  10. AORN. Guidelines for Perioperative Practice (2024). Association of periOperative Registered Nurses.

  11. ACORN. Standards for Perioperative Nursing in Australia (2023). Australian College of Perioperative Nurses.

  12. ORNAC. Standards, Guidelines and Position Statements (12th edition, 2021). Operating Room Nurses Association of Canada.

  13. AST. Standards of Practice for Surgical Technology (2022). Association of Surgical Technologists.

  14. AfPP. Standards & Guidance for Perioperative Practice (2022). Association for Perioperative Practice, UK.

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 Quality & Safety, Perioperative Practice

Why Caring for Surgical Instruments Matters: Safety, Efficiency & Smarter Costs

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🔍 Introduction

Surgical instruments are designed to be precise and effective. Whether it’s a scalpel, forceps, or clamps, these tools must be clean, sterile, and in optimal condition to perform their functions. Any deviation from these standards can compromise a surgery’s success.

Neglecting proper maintenance can result in dull blades, rusted surfaces, or—worse—the presence of harmful microorganisms. This not only jeopardizes patient health but also tarnishes the trust patients place in healthcare providers.

Instruments that don’t cut, grip, or function as intended don’t just slow down the procedure—they create clinical risk, frustrate teams, and undermine the flow of surgery. The solution? Consistent, evidence-based maintenance practices that protect performance and patient care.

1. Patient Safety & Clinical Outcomes

  • Poor-quality or poorly maintained instruments are directly linked to adverse safety incidents.

  • Between 2004–2010, the NHS reported over 2,000 surgical incidents involving instrument failure, leading to reoperations, retained fragments, and moderate to severe harm.

  • The U.S. FDA documents hundreds of similar events annually—ranging from infection and tissue injury to fatal outcomes caused by instrument malfunction or debris.

  • Instruments that are dull or contaminated increase the risk of postoperative infections, tissue trauma, and delayed healing—all of which can compromise recovery and the patient experience.

  • Cleanliness and condition aren’t cosmetic—they are foundational to safe surgical practice.

2. Operational Efficiency & Surgical Flow

  • A blunt scissor or malfunctioning clamp can delay critical steps in surgery.

  • When surgical flow is interrupted, anesthesia time increases, procedural accuracy may decline, and tension among staff can escalate.

  • Tray inefficiencies (e.g., including instruments never used) add to setup, sterilization, and audit burdens.

  • Optimizing trays and removing redundant tools can reduce setup time by up to 40% and cut processing costs by 30–60%.

3. Cost Containment & Lifecycle Savings

  • Repair vs. replace: Repaired instruments can cost 30–40% less per use compared to always replacing them.

  • Facilities that implemented preventive maintenance programs reported annual savings of up to $250,000, simply by reducing waste, delay, and loss.

  • Each minute of OR time costs an average of $36–$46 USD. A malfunctioning instrument that causes a 3-minute delay could cost $100+ per case—not counting the clinical risks involved.

4. Infection Control & Regulatory Alignment

  • Instruments with dried biological material or rusted surfaces are more difficult to clean and sterilize—posing infection risks.

  • Compliance with infection control policies, such as those from AORN, ACORN, and WHO, require validated reprocessing and functional assurance for every tool.

  • Instruments must be traceable, inspected, and documented—especially following a reported breach or surgical incident.

✅ What Effective Instrument Care Looks Like

Best Practice Impact
Scheduled sharpening, function testing Ensures sharpness, grip, and safe operative performance
Tray optimization & instrument rationalization Reduces waste, speeds up processing, cuts costs
Strict cleaning & inspection protocols Minimizes infection risk and instrument failure
Documentation & traceability systems Supports quality audits and incident tracking
Collaboration between SPD and OR teams Flags instruments before cases, avoids intra-op delays

🧠 Conclusion

Caring for surgical instruments is not a backroom task—it’s a frontline safety measure.

  • 🛡️ Patients deserve sterile, sharp, safe instruments.

  • 🔄 Teams deserve tools they can trust.

  • 💰 Facilities benefit from cost control, efficiency, and reduced risk.

Investing in instrument care is a small effort with a massive return—one that protects patients, supports surgical teams, and sustains clinical excellence.

🔗 References

  1. Association of periOperative Registered Nurses (AORN). (2022). Guidelines for Perioperative Practice. AORN, Inc.

  2. Australian College of Perioperative Nurses (ACORN). (2023). Standards for Perioperative Nursing in Australia.

  3. Microlin Surgical. (2021). Instrument Maintenance Cost and Lifecycle Analysis. Retrieved from https://www.microlinesurgical.com

  4. Bausch & Lomb Instruments. (2020). Managing Surgical Instruments for Optimal Performance. Retrieved from https://www.bauschinstruments.com

  5. Applied Physics Medical. (2021). How Surgical Instruments Impact Patient Outcomes. Retrieved from https://appliedphysicsmedical.com

  6. Rick Schultz. (2019). The Instrument Whisperer: Why Instrument Quality Matters. Healthcare Purchasing News.

  7. Sullivan Healthcare Consulting. (2020). How a Large Academic Medical Center Uncovered $250,000 in Annual Cost Savings. Retrieved from https://sullivanhealthcareconsulting.com

  8. Journal of Arthroplasty. (2021). Cost Analysis of Operating Room Time and Efficiency. https://www.arthroplastyjournal.org

  9. Duke University Medical Center. (2022). Analysis of Surgical Instrument-Related Adverse Events in U.S. Hospitals. Retrieved from https://dukespace.lib.duke.edu

  10. Infection Control Today. (2022). Best Practices in Surgical Instrument Reprocessing. https://www.infectioncontroltoday.com

  11. World Health Organization (WHO). (2009). Surgical Safety Checklist and Infection Control Guidelines. https://www.who.int

  12. OR Today Magazine. (2019). The Real Cost of an OR Minute. Retrieved from https://ortoday.com

Perioperative Practice Nursing Innovation Digital Health Clinical Education Workflow Optimization, Workflow Optimization

✈️Pilots, Procedures & The Power of Memory in the Operating Room

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As a veteran operating room nurse, I’ve often drawn comparisons between flying a plane and supporting surgery. Both roles are high stakes, demand precision under pressure, and require a team working in sync. But one question I often reflect on is this:

How do we decide what we remember—and what we forget—in the operating room?

Why can I instantly recall how to respond to a hemorrhage, but still forget where one surgeon prefers the tower placed or what setting to select on a specific piece of equipment?

🔄 The Pilot’s QRH vs. The Nurse’s Experience

Pilots are trained to memorize what’s known as memory items—a set of actions committed to memory for emergency situations. These are rehearsed over and over again until they become automatic. Only after the immediate threat is addressed do they consult the Quick Reference Handbook (QRH), a structured guide of procedures for troubleshooting and recovery.

Operating room nurses, by contrast, often learn on the job. We rely on exposure, mentorship, repetition, and experience. There’s no QRH for us. What we do have are mental maps, team communication, and countless moments of trial, error, and reflection. We build memory not in a simulator, but in real-time.

But should we? Could a structured, role-specific handbook for scrub and scout nurses, with memory prompts and decision trees, accelerate learning and reduce error?

🧠 Why We Remember Some Things and Forget Others

Cognitive science tells us that memory is shaped by emotion, repetition, relevance, and pattern recognition. We remember what we do often, what is associated with stress (like a surgical fire), and what aligns with a pattern we already understand.

Research shows that procedural memory—the kind used to tie shoelaces or scrub for surgery—forms in a part of the brain called the basal ganglia. This is also responsible for what we call “autopilot” behavior—like driving home without consciously recalling the route (MIT Neuroscience, 2019).

That’s why, after more than a decade in the OR, I can anticipate when a surgeon will ask for suction, or when the scout will need to open extra swabs. It’s not guessing—it’s pattern recognition + procedural memory.

But memory is selective. According to Harvard psychologist Daniel Schacter, we remember what we encode deeply, often emotionally or via repetition—but forget details that lack personal salience or aren’t retrieved often. (Schacter, The Seven Sins of Memory).

So it’s no surprise that I can forget the tower attachment or settings a certain surgeon prefers—I’m not emotionally attached to that information, nor is it reinforced frequently in context.

🧪 Simulation: What We Can Learn from Pilots

Pilots undergo regular simulator training to test their responses to rare but critical scenarios—engine fires, cabin depressurization, bird strikes. These simulations are realistic, stress-inducing, and reinforce both memory and teamwork.

Operating rooms are beginning to adopt similar high-fidelity simulation-based education. In centers like Northwestern Simulation or Cedars-Sinai’s OR360, OR teams train together in lifelike crisis scenarios—practicing not only tasks, but communication, leadership, and debriefing.

“Fly the plane, silence the bell, read the checklist.”
—Classic pilot mantra

“A great OR team runs like a cockpit crew—clear roles, constant communication, and a shared goal: safety.”
—Dr. K. Rosten, OR educator

🧠 What If OR Nurses Had a QRH?

What if nurses had a Quick Reference Handbook tailored to their role, specialty, and learning stage? Imagine a scrub nurse’s QRH including:

  • Memory checklists for laparoscopic cholecystectomy setup

  • Key “emergency items” for hemorrhage, retained sponge, power failure

  • Surgeon-specific reminders (tower height, implant sets, special instruments)

  • Crisis role reminders for scout nurses (e.g., airway emergency support flowchart)

This wouldn’t replace training or mentorship—but it would complement it, much like the QRH supplements the pilot’s training.

🧩 Final Thoughts

Learning in the operating room is layered. It happens through experience, observation, and repetition—but it’s also selective. Some things stick. Some don’t. And that’s normal.But what if we gave our brains the same scaffolding we give our pilots?

“In the operating room, just like in the cockpit, it’s not about memorizing everything—it’s about knowing what matters most, and what to do when everything goes wrong.”

I’m still learning. Still embedding. Still forgetting the occasional monitor and print settings. But I’ve come to respect that our memories are shaped not just by what we do, but by how we practice.

Platforms like ScrubUp help support surgical teams by providing accessible, step-by-step checklists and case preparation tools — enhancing safety, recall, and role clarity under pressure.

🛠️ We Need Systems That Support the Whole Surgical Team

In the operating room, we work in an environment surrounded by cutting-edge technology—robotic arms, real-time imaging, automated charting systems—all designed to support the surgeon, the anesthetist, and ultimately, the patient. But where are the systems that support us—the operating room nurses, surgical technologists, scrub scouts, and circulators? We absorb knowledge on the go. We adjust to new teams daily. We troubleshoot unfamiliar equipment mid-case. We remember thousands of details—until one slips through under pressure.

It’s time we shift the focus.

✅ Let’s invest in role-specific checklists,
✅ Develop quick-reference tools,
✅ Embrace simulation and scenario-based training,
✅ And co-design workflow systems that reflect the real responsibilities of the surgical team.

We don’t just need more equipment in the OR.
We need better systems to support the people who keep it running.

Let’s work collectively—across roles, disciplines, and institutions—to build that future.

✅ References

  1. Schacter, D. L. (2001). The Seven Sins of Memory: How the Mind Forgets and Remembers. Harvard University Press.

  2. MIT News. (2019). Scientists reveal how habits can be broken

  3. AORN. (2022). Perioperative Emergency Checklists and Cognitive Aids.

  4. AirFacts Journal. (2021). Checklist vs. Memory Items: Knowing What Comes First.

  5. Northwestern Simulation. Surgical Skills Lab Overview

  6. PPRuNe Aviation Forum. 737 Memory Items Discussion

Nursing Workforce, Operating Room Leadership

🧱 When Rostering Feels Like Jenga: The Unseen Burden of Building OR Teams

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💥 Introduction: Rostering Is No Small Feat

In a perfect world, every surgical team is consistent—familiar nurses, trusted techs, the surgeon’s “dream team.” But in the real world? Staffing the OR is a high-stakes game of Jenga.

Nurse managers must balance:

  • Leave, breaks, and unexpected absences

  • Maternity cover, new grads, and on-the-fly replacements

  • Skill levels, specialty experience, and surgeon preferences

One wrong piece—and the entire surgical list could collapse.

🧠 The Real Cost of Unseen Stress

While CEOs review performance metrics, the behind-the-scenes chaos of managing staff schedules is rarely noticed—until it impacts patients, delays cases, or increases staff burnout.

According to BMC Health Services Research (2019), communication breakdowns and inadequate team familiarity significantly contribute to flow disruptions in the OR, which can ultimately affect patient safety and surgical efficiency.

🔄 Enhancing Surgical Team Competency Through Cross-Specialty Rotations

In the dynamic environment of the operating room, consistent team composition is often challenged by factors such as staff breaks, holidays, maternity leave, sudden illnesses, and the necessity to train new personnel. These variables can disrupt the continuity that surgeons rely upon for optimal performance.

To mitigate these challenges, structured cross-specialty rotations have been identified as a valuable strategy. A comprehensive review published in the Journal of Surgery and Research underscores several benefits of such rotations:

  • Broadened Clinical Exposure: Trainees gain experience across various surgical disciplines, fostering a more versatile skill set.

  • Enhanced Teamwork: Exposure to different specialties promotes better understanding and collaboration among multidisciplinary teams.

  • Improved Patient Outcomes: A diverse training background equips surgical staff to handle a wider array of clinical scenarios effectively.

Moreover, the British Journal of Surgery emphasizes that cross-specialty training is instrumental in preparing surgeons for the complexities of modern patient care, which often requires a collaborative, multidisciplinary approach.

💡 Implementing Supportive Systems

To fully leverage the benefits of cross-specialty rotations, it’s crucial to establish systems that:

  • Facilitate Knowledge Sharing: Ensure that critical information is accessible to all team members, regardless of their primary specialty.

  • Support Continuous Learning: Provide ongoing educational resources to keep staff updated on best practices across specialties.

  • Promote Flexibility: Develop adaptable protocols that accommodate the dynamic nature of surgical team compositions.

By embracing these strategies, we can create a resilient surgical workforce capable of delivering high-quality care, even amidst staffing fluctuations.

🎯 Let’s Recognize the Real MVPs

To every perioperative manager playing roster Jenga…
To every team that flexes, fills gaps, and keeps surgery moving…
We see you. You’re not just building rosters—you’re holding the OR together.

🧱 The Nurse Manager’s Jenga: Balancing OR Staffing & Schedules

Section 1: The Daily Challenges

  • Staff Availability: Managing unexpected absences due to illness or emergencies.

  • Shift Preferences: Accommodating individual staff scheduling preferences.

  • Skill Mix: Ensuring the right combination of skills for each shift.

  • Compliance: Adhering to labor laws and organizational policies.

 

Section 2: The Impact on OR Efficiency

  • Delayed Surgeries: Scheduling issues leading to postponed procedures.

  • Increased Overtime: Staff working extra hours to cover gaps.

  • Burnout Risk: Elevated stress levels among staff due to scheduling conflicts.

  • Patient Satisfaction: Potential decline in patient experience due to staffing issues.

 

Section 3: Strategies for Stability

  • Advanced Scheduling Tools: Utilizing software to optimize shift planning.

  • Cross-Training Staff: Preparing staff to handle multiple roles as needed.

  • Open Communication: Maintaining transparent dialogue about scheduling needs.

  • Regular Reviews: Assessing and adjusting schedules proactively.Proactive Healthcare Staffing

“Supporting our nurse managers in their balancing act ensures a stable and efficient operating room environment.”

Hospital Efficiency, Perioperative Nursing, Sterilization & Infection Control, Surgical Equipment, Surgical safety

The Intricate Workflow of Sterile Processing

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The SPD operates through a series of well-defined stages, each critical to maintaining instrument integrity and patient safety:

  1. Decontamination: Used instruments are transported to the decontamination area, where they undergo thorough cleaning to remove organic and inorganic materials. This process often involves manual scrubbing, ultrasonic cleaning, and the use of washer-disinfection .specialtycareus.com

  2. Inspection and Assembly: Post-cleaning, instruments are meticulously inspected for cleanliness and functionality. They are then assembled into sets according to specific surgical procedures, ensuring that each tray contains the necessary tools in proper working order .specialtycareus.com

  3. Sterilization: Assembled instrument sets are subjected to sterilization processes, commonly using steam sterilization at temperatures of 121°C (250°F) or 134°C (270°F). The choice of sterilization method depends on the instrument’s material and design .

  4. Storage and Distribution: Sterilized instruments are stored in controlled environments to maintain sterility until they are needed in surgical procedures. The SPD ensures timely distribution to operating rooms, aligning with surgical schedules .

Navigating the Challenges of Loan Instrument Sets

The integration of vendor-loaned instrument sets introduces additional complexity to the SPD’s operations. These sets, often comprising up to 10 +/- trays for a single procedure, require the same rigorous decontamination and sterilization processes as hospital-owned instruments. However, they frequently arrive with limited lead time, pressuring SPD staff to expedite processing without compromising standards .blog.pdchealthcare.com+2ospecsconsulting.com+2sterileally.com+2readysetsurgical.com+1healthtrustpg.com+1

Proper management of loan sets necessitates:presentations.patientsafety-me.com+6infectioncontroltoday.com+6sterileprocessingtech.org+6

  • Advance Communication: Coordinating with vendors to ensure timely delivery and provision of detailed instrument lists and sterilization instructions .aorn.org

  • Thorough Documentation: Maintaining accurate records of sterilization cycles, including biological and chemical indicator results, to verify compliance with safety protocols .specialtycareus.com

  • Staff Training: Ensuring SPD personnel are trained to handle the specific requirements of various loaner instruments, including disassembly and reassembly procedures .readysetsurgical.com+5blog.pdchealthcare.com+5presentations.patientsafety-me.com+5

Specialized Sterilization: Handling Heat-Sensitive Instruments

Certain medical devices, such as flexible endoscopes, are sensitive to the high temperatures of standard steam sterilization. For these instruments, ethylene oxide (EtO) gas sterilization is employed. EtO is effective in sterilizing complex devices without causing damage, making it suitable for items with intricate channels and heat-sensitive materials .

However, EtO sterilization presents challenges:aqrdm.org

  • Extended Processing Time: The EtO sterilization cycle can take up to 12 hours, including aeration time to remove residual gas .

  • Health and Safety Concerns: EtO is a known carcinogen, necessitating stringent safety measures to protect staff and patients .

As a result, some facilities are exploring alternative methods, such as vaporized hydrogen peroxide, which offers effective sterilization with shorter cycle times and fewer health risks .verywellhealth.com+1steris.com+1

The Critical Role of the SPD in Surgical Efficiency

The efficiency of the SPD directly impacts surgical schedules and patient outcomes. Delays in instrument processing can lead to postponed surgeries, increased patient wait times, and elevated healthcare costs. Therefore, the SPD’s ability to manage complex workflows, adapt to the demands of loan instruments, and employ appropriate sterilization methods is vital to the overall success of surgical services .

In conclusion, the Sterile Processing Department is a cornerstone of patient safety and surgical efficacy. Through meticulous processes and adaptability to evolving challenges, SPD professionals ensure that every instrument meets the highest standards of cleanliness and functionality, thereby upholding the integrity of healthcare delivery.sterileprocessingtech.org+5steris.com+5sterileally.com+5

🔖 Reference List

  1. Macario, A. (2010). What does one minute of operating room time cost? Journal of Clinical Anesthesia, 22(4), 233–236. https://doi.org/10.1016/j.jclinane.2010.02.003

  2. Centers for Disease Control and Prevention. (2019). Ethylene oxide sterilization. https://www.cdc.gov/infection-control/hcp/disinfection-sterilization/ethylene-oxide-sterilization.html

  3. SpecialtyCare. (n.d.). The Importance of the Sterile Processing Department in Hospitals. https://specialtycareus.com/hospital-sterile-processing

  4. STERIS. (n.d.). What is sterile processing? https://www.steris.com/healthcare/knowledge-center/sterile-processing/what-is-sterile-processing

  5. OSPECS Consulting. (2021). Vendor-loaned instrument reprocessing reality. https://ospecsconsulting.com/healthmarket-digest-vendor-loaned-instrument-reprocessing-reality

  6. Infection Control Today. (2020). Challenges associated with loaner instrumentation. https://www.infectioncontroltoday.com/view/challenges-associated-loaner-instrumentation

  7. Association of periOperative Registered Nurses (AORN). (n.d.). Sample Policy: Loaned Instruments. https://www.aorn.org/docs/default-source/aorndocuments/toolkits/perioperative-efficiency/instrument-turnover/sample-policy-loaned-instruments.pdf

  8. Verywell Health. (2023). Vaporized hydrogen peroxide: A safer sterilization alternative. https://www.verywellhealth.com/vaporized-hydrogen-peroxide-sterilize-medical-devices-8553818

Clinical Best Practices, Education, Education & Training, Infection Prevention, Operating Room, Operating Room Education, OR Nursing, Perioperative Education, Skin Antisepsis, Surgical Nursing

Reducing SSIs Through Best Practice Skin Preparation: What Every OR Nurse Should Know

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Best Practice for Surgical Skin Preparation: Reducing the Risk of Surgical Site Infections (SSIs)

Surgical skin preparation is one of the most critical steps in preventing Surgical Site Infections (SSIs)—a complication that not only affects patient recovery but places a significant financial burden on healthcare systems worldwide.

🦠 Why Surgical Site Infections Matter

SSIs are among the most common types of healthcare-associated infections and can occur in up to 5% of surgical procedures. Their consequences extend beyond the immediate surgical outcome:

  • In Australia, SSIs add an average $18,814 to the direct cost of treatment per patient.

  • In the United States, SSIs cost the healthcare system $3.3 to $10 billion annually.

  • A single infection following a hip or knee replacement can add $12,689 USD in direct costs.

  • SSIs significantly prolong hospital stays, often requiring readmission, further tests, and additional treatment.

Given the clinical and economic impact, preventing SSIs is not only a patient safety priority—it’s a healthcare imperative.

🧼 What Is Surgical Skin Preparation?

Surgical skin preparation involves cleansing the skin at and around the surgical site to reduce the microbial count to the lowest possible level. The goal is to create a sterile field that minimizes the risk of microbial contamination during the procedure.

Key Principles of Best Practice:

  • Clean to Dirty: Begin at the cleanest area—typically the planned incision site—and work outward in concentric circles or squares.

  • No Double Dipping: Use a fresh swab for each pass. Never return a used applicator to the antiseptic solution.

  • Wide Coverage: Prep a generous area to accommodate any extension of the surgical incision.

  • High-Risk Zones Prepped Last: Areas such as the groin, umbilicus, open wounds, stomas, orifices should be cleaned last and with separate sponges.

  • Reverse Technique for Contaminated Areas: For high-risk zones, start at the cleaner periphery and move inward to the more contaminated center.

The AORN (Association of periOperative Registered Nurses) recommends selecting an alcohol-based prepping agent based on the anatomical location and patient assessment. Alcohol-based preps should not be used near mucosa, eyes, or ears. Iodine-based alternatives are safer in such cases.

📊 Why It’s Done This Way – The Evidence Behind the Method

The technique of prepping from clean to dirty and using separate applicators for contaminated zones is designed to:

  • Prevent cross-contamination within the sterile field.

  • Maintain the lowest possible bacterial load at the incision site.

  • Ensure compliance with infection control standards such as those outlined by AORN, ACORN, and WHO guidelines.

👩‍⚕️ Educating the Next Generation of Perioperative Professionals

Understanding why and how we perform surgical skin preparation is critical for novice operating room staff. Proper technique supports not only patient safety, but also team trust, procedure efficiency, and hospital sustainability.

Visual guides help reinforce learning by showing the correct prepping zones and motion patterns for various surgical sites.

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✅ Final Thoughts

Following best practice in surgical skin preparation isn’t just a procedural checklist item—it’s a frontline defense against infection. When done correctly, it protects patients, reduces complications, and ensures that the operating team upholds the highest standards of care.

Stay vigilant, prep with purpose, and lead with best practice.