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OR Fact and Principle
OR FACT AND PRINCIPLE Lucy Jo Atkinson, R.N.
Q. How do you remove broken glass and other debris without using some type of broom? A. The vacuum cleaners designed for floor care in the operating room will pick up glass, suture and other debris on the floor. If this equipment is not available, a hand broom dampened with a detergent-germicide can be used.
Q. Can we use a vacuum cleaner to remove accumulations of dust from the drawers in which we store sterile supplies? This storage area is a part of our workroom and close to the operating rooms. A. Dust may harbor pathogenic organisms. Since these organisms do not multiply in the dry state, dust serves as a mode of transmission of them. Therefore, it is essential to keep dust to an irreducible minimum in all areas of the hospital. Since dry sweeping or dusting should be prohibited throughout the hospital, cleaning clothes dampened with a detergent-disenfectant or germicide are recommended for all dust control procedures to clean furniture and cupboards thoroughly. Storage cupboards and drawers should be cleaned at least weekly.
A regular, domestic vacuum cleaner, such as you would use in your home, would be considered a dry method of cleaning. Vacuum
April 1968
0 0 machines, designed for use in the operating room suite, control the direction of the outflow of exhaust air to minimize the propulsion of dust and dirt into the air. These commercial units are also designed to catch and hold trapped dust and dirt in filters. Rather than to risk the possibility of dispersing dust particles throughout the air in your workroom through the use of dry vacuum, a system of weekly damp dusting of all storage cupboards and drawers Ehould control the dust problem. If you have wooden drawers, you may find that an adhering plastic liner facilitates cleaning.
If the accumulation of dust is a major problem in your sterile supply storage area, you should analyze the cause of your problemthe source of the dust. If linen is folded in an adjacent workroom, how much lint is generated into the room during this process? Could linen be folded outside of the operating room suite? Are measures taken during the laundering process to decrease the lint on the OR linen, such as separating blankets, turkish towels, etc., or adding a textile lubricant to the final rinse? Is the ventilation of the workroom and storage area controlled through an air-conditioning system or is dust and dirt blown in through open windows or from adjacent corridors? Are the filters in the air vents changed routinely? Consultation
89
with your laundry manager, housekeeper and maintenance engineer may help solve your problem.
Q. How oflen should filters i n the OR ventilation system be changed?
A. The ventilation system should draw air relatively free from bacteria from the outside, force it through bacterial air filters and into the operating rooms. The gradual clogging of the filters reduces the air flow. How rapidly the filters will become clogged varies with the quality of the outside air being pulled into the system and the volume of recirculating air going through the system. If your hospital is in a metropolitan area where the air is heavily polluted with dirt particles, your filters will become clogged more rapidly than those in a hospital in a rural community. The airconditioning system for the operating suite should be separate from any other air-conditioning system in the hospital. Even with a slightly positive pressure system in the operating room, the recirculation of air from the clean operating rooms to unclean areas will accumulate enough dust particles to clog the filters over time. It is impossible to make a definitive statement as to how often the filters need to be changed because of the dependent variables mentioned above. In addition, the type and location of the filters vary with the type of equipment being used. A daily preventive maintenance check of the ventilation system should include inspection to determine that there is no abnormal pressure or temperature in the operating suite. A pressure drop, measured with a manometer, is the only certain way to determine that dry-type interception and super-interception filters need to be changed.
Q. Is there a procedure to tesl the eflectiueness of the exhaust air outlet to assure the removal of explosive gases? A. The ventilation system must provide positive pressure in the operating room. This can
90
be felt by the air currents coming under the door into the corridor. This mechanical ventilation reduces the explosion hazard hy diffusion of gases, but not enough to assure protection against explosions. The NFPA Code does not require mechanical ventilation as mandatory in anesthetizing locations on the basis that flammable anesthetic mixtures are diluted in air to a nonflammable range brfore reaching a vertical height of one foot from the source. Mechanical ventilation aids in the control of airborne bacteria. It would be wise to test the air sanitization effectiveness of your system. This can be done by setting culture plates in the room about 30 minutes after all operating, cleaning and other activity has been completed for the day. Send these plates to the laboratory the next mornins. Up to five organisms per cubic foot would be an acceptable report.
Q. What is the correct temperature and humidity in the OK? A. The temperature should range from 72 to 78 degrees Farenheit and the relative humidity should range from 50 to 60 per cent. Temperature and humidity should be controlled the year round. An air-conditioning system provides a heating and cooling apparatus and a method of humidification. The ventilation system should be capable of producing 10 to 20 changes of air per hour.
Q. If the ventilation system is not working properly and the room air becomes stagnant, should we open a window or a door or operate in the hot, humid environment? A. Excessive room temperature may cause excessive sweating as well as discomfort and inefficiency among the surgical team members. To reduce the risk of spreading skin bacteria to the patient, it is desirable to reduce sweating to a minimum. High temperatures map also result in physical harm to the patient under anesthesia. Continuid on page 93
AORN Journnl
Continued from page 90
NOW AVAILABLE
If the ventilation system is not functioning properly, it is perferable either to open a door or window rather than to operate in a stagnant, hot, humid room. Outside air does contain insignificant numbers of pathogenic bacteria, nevertheless, air currents should not be directed into an open wound. High temperature lowers the relative humidity and thus increases the risk of static explosions. Any feasible means must be taken to reduce this hazard if flammable anesthetic agents are in use.
Q. We cannot regulate our air-conditioning temperature. The surgeons and nurses complain that it is too hot or too cold. The hospital administrator has not taken steps to improve h e system. What would you suggest to solve our problem? A. Refer your hospital administrator to pages 37 and 38 of the Hospital Monograph Series No. 12, Control of Infections in Hospitals, published by the American Hospital Association. The author states, “The thermostats should be capable of control by the operating room staff .” The welfare of the patient and personnel is jeopardized when room temperatures are above or below the range of 72 to 78 degrees F. Even the extremes of this range may be uncomfortable for some individuals and, therefore, should be adjusted within this range to the comfort of the individuals in the room.
-
OPERATING ROOM TOPICS An Anthology of Selected Articles from AORN Journal for use as a supplement to the manual, ’Teaching the Operating ?oom Technician.’
The Anthology provides the OR nurse with detailed descriptions, photographs and diagrams of new and highly specialized techniques for such fundamental OR problems as decontamination, care of instruments, and handling of emergencies. Articles on such surgical specialties as EENT, cardiovascular surgery, urology, neuro and plastic surgery include new operations, new instruments and technical devices as well as ways of increasing efficiency and patient comfort. Besides clinical articles, some material of a more general nature is included, e.g., legal implications for the OR nurse and the use of audiovisual aides in nurse instruction. This anthology is recommended as a companion piece to the manual and to OR nurse practitioners as a convenient source of valuable clinical information.
To: AORN Journal
515 Madison Ave.
Q. What garb do you recommend that the circulating nurse wear over her scrub dress if she is cold? A. Any neat, clean, snug-fitting cotton garment. Surgical gowns may be worn, but they should be fastened at the neck and waist so that they cannot flop and swish during movement. Long or short lab coats, buttoned, look neater. Some nurses wear cotton sweaters which look neat, but how often are they washed? Whatever is worn over a scrub dress should be changed and laundered as frequently as the dress itself.
++
April 1968
New York, N. Y. 10022
’lease send me
copies of
__._________
3PERATING ROOM TOPICS 4n Anthology of Selected Articles from hORN Journal at $4.00 each. enclose $_________.__._______.
____________ _ _ _ _
itate_ _ _ _ _ _ _ . _ . _ _ _ _ Zip _______._.....___ ____ ~
93
Q. How do you remove broken glass and other debris without using some type of broom? A. The vacuum cleaners designed for floor care in the operating room will pick up glass, suture and other debris on the floor. If this equipment is not available, a hand broom dampened with a detergent-germicide can be used.
Q. Can we use a vacuum cleaner to remove accumulations of dust from the drawers in which we store sterile supplies? This storage area is a part of our workroom and close to the operating rooms. A. Dust may harbor pathogenic organisms. Since these organisms do not multiply in the dry state, dust serves as a mode of transmission of them. Therefore, it is essential to keep dust to an irreducible minimum in all areas of the hospital. Since dry sweeping or dusting should be prohibited throughout the hospital, cleaning clothes dampened with a detergent-disenfectant or germicide are recommended for all dust control procedures to clean furniture and cupboards thoroughly. Storage cupboards and drawers should be cleaned at least weekly.
A regular, domestic vacuum cleaner, such as you would use in your home, would be considered a dry method of cleaning. Vacuum
April 1968
0 0 machines, designed for use in the operating room suite, control the direction of the outflow of exhaust air to minimize the propulsion of dust and dirt into the air. These commercial units are also designed to catch and hold trapped dust and dirt in filters. Rather than to risk the possibility of dispersing dust particles throughout the air in your workroom through the use of dry vacuum, a system of weekly damp dusting of all storage cupboards and drawers Ehould control the dust problem. If you have wooden drawers, you may find that an adhering plastic liner facilitates cleaning.
If the accumulation of dust is a major problem in your sterile supply storage area, you should analyze the cause of your problemthe source of the dust. If linen is folded in an adjacent workroom, how much lint is generated into the room during this process? Could linen be folded outside of the operating room suite? Are measures taken during the laundering process to decrease the lint on the OR linen, such as separating blankets, turkish towels, etc., or adding a textile lubricant to the final rinse? Is the ventilation of the workroom and storage area controlled through an air-conditioning system or is dust and dirt blown in through open windows or from adjacent corridors? Are the filters in the air vents changed routinely? Consultation
89
with your laundry manager, housekeeper and maintenance engineer may help solve your problem.
Q. How oflen should filters i n the OR ventilation system be changed?
A. The ventilation system should draw air relatively free from bacteria from the outside, force it through bacterial air filters and into the operating rooms. The gradual clogging of the filters reduces the air flow. How rapidly the filters will become clogged varies with the quality of the outside air being pulled into the system and the volume of recirculating air going through the system. If your hospital is in a metropolitan area where the air is heavily polluted with dirt particles, your filters will become clogged more rapidly than those in a hospital in a rural community. The airconditioning system for the operating suite should be separate from any other air-conditioning system in the hospital. Even with a slightly positive pressure system in the operating room, the recirculation of air from the clean operating rooms to unclean areas will accumulate enough dust particles to clog the filters over time. It is impossible to make a definitive statement as to how often the filters need to be changed because of the dependent variables mentioned above. In addition, the type and location of the filters vary with the type of equipment being used. A daily preventive maintenance check of the ventilation system should include inspection to determine that there is no abnormal pressure or temperature in the operating suite. A pressure drop, measured with a manometer, is the only certain way to determine that dry-type interception and super-interception filters need to be changed.
Q. Is there a procedure to tesl the eflectiueness of the exhaust air outlet to assure the removal of explosive gases? A. The ventilation system must provide positive pressure in the operating room. This can
90
be felt by the air currents coming under the door into the corridor. This mechanical ventilation reduces the explosion hazard hy diffusion of gases, but not enough to assure protection against explosions. The NFPA Code does not require mechanical ventilation as mandatory in anesthetizing locations on the basis that flammable anesthetic mixtures are diluted in air to a nonflammable range brfore reaching a vertical height of one foot from the source. Mechanical ventilation aids in the control of airborne bacteria. It would be wise to test the air sanitization effectiveness of your system. This can be done by setting culture plates in the room about 30 minutes after all operating, cleaning and other activity has been completed for the day. Send these plates to the laboratory the next mornins. Up to five organisms per cubic foot would be an acceptable report.
Q. What is the correct temperature and humidity in the OK? A. The temperature should range from 72 to 78 degrees Farenheit and the relative humidity should range from 50 to 60 per cent. Temperature and humidity should be controlled the year round. An air-conditioning system provides a heating and cooling apparatus and a method of humidification. The ventilation system should be capable of producing 10 to 20 changes of air per hour.
Q. If the ventilation system is not working properly and the room air becomes stagnant, should we open a window or a door or operate in the hot, humid environment? A. Excessive room temperature may cause excessive sweating as well as discomfort and inefficiency among the surgical team members. To reduce the risk of spreading skin bacteria to the patient, it is desirable to reduce sweating to a minimum. High temperatures map also result in physical harm to the patient under anesthesia. Continuid on page 93
AORN Journnl
Continued from page 90
NOW AVAILABLE
If the ventilation system is not functioning properly, it is perferable either to open a door or window rather than to operate in a stagnant, hot, humid room. Outside air does contain insignificant numbers of pathogenic bacteria, nevertheless, air currents should not be directed into an open wound. High temperature lowers the relative humidity and thus increases the risk of static explosions. Any feasible means must be taken to reduce this hazard if flammable anesthetic agents are in use.
Q. We cannot regulate our air-conditioning temperature. The surgeons and nurses complain that it is too hot or too cold. The hospital administrator has not taken steps to improve h e system. What would you suggest to solve our problem? A. Refer your hospital administrator to pages 37 and 38 of the Hospital Monograph Series No. 12, Control of Infections in Hospitals, published by the American Hospital Association. The author states, “The thermostats should be capable of control by the operating room staff .” The welfare of the patient and personnel is jeopardized when room temperatures are above or below the range of 72 to 78 degrees F. Even the extremes of this range may be uncomfortable for some individuals and, therefore, should be adjusted within this range to the comfort of the individuals in the room.
-
OPERATING ROOM TOPICS An Anthology of Selected Articles from AORN Journal for use as a supplement to the manual, ’Teaching the Operating ?oom Technician.’
The Anthology provides the OR nurse with detailed descriptions, photographs and diagrams of new and highly specialized techniques for such fundamental OR problems as decontamination, care of instruments, and handling of emergencies. Articles on such surgical specialties as EENT, cardiovascular surgery, urology, neuro and plastic surgery include new operations, new instruments and technical devices as well as ways of increasing efficiency and patient comfort. Besides clinical articles, some material of a more general nature is included, e.g., legal implications for the OR nurse and the use of audiovisual aides in nurse instruction. This anthology is recommended as a companion piece to the manual and to OR nurse practitioners as a convenient source of valuable clinical information.
To: AORN Journal
515 Madison Ave.
Q. What garb do you recommend that the circulating nurse wear over her scrub dress if she is cold? A. Any neat, clean, snug-fitting cotton garment. Surgical gowns may be worn, but they should be fastened at the neck and waist so that they cannot flop and swish during movement. Long or short lab coats, buttoned, look neater. Some nurses wear cotton sweaters which look neat, but how often are they washed? Whatever is worn over a scrub dress should be changed and laundered as frequently as the dress itself.
++
April 1968
New York, N. Y. 10022
’lease send me
copies of
__._________
3PERATING ROOM TOPICS 4n Anthology of Selected Articles from hORN Journal at $4.00 each. enclose $_________.__._______.
____________ _ _ _ _
itate_ _ _ _ _ _ _ . _ . _ _ _ _ Zip _______._.....___ ____ ~
93