Tag Archives: perioperative nursing

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.

📷 

✅ 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.