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Perioperative role not primary nursing
6. Disinfection of equipment. Although we agree that high-level disinfection can be used for disinfecting FFEs for GI endoscopy (after careful physical cleaning) between uses, data from CDC studies on glutaraldehyde disinfection of respiratory equipment indicate that 30 minutes of contact time are significantly superior to 10 minutes. Consequently, we would suggest that i f FFEs are disinfected with glutaraldehyde, the contact time should be at least 30 minutes, followed by adequate rinsing. 7. Provision for adequate rinsing, drying, and storage of endoscopic equipment. After high-level liquid-chemical disinfection, thorough rinsing of endoscopic instruments is imperative. The disinfection process, per se, will greatly reduce the risk of patient-to-patient disease transmission. However, the rinsing process should not add to the microbial burden of the equipment; rinsing should be done with sterile water, water with at least 10 mgil (ppm) of available chlorine, or tap water followed by a final rinse of 70% to 90% ethyl or isopropyl alcohol. The equipment should then be thoroughly dried by a method that does not cause recontamination, and then it should be stored in such a manner also to prevent recontamination. 8. Provision o f adequate space a n d equipment for processing of equipment sets. Units for endoscopy in health care facilities are relatively new, and many have expanded greatly in recent years. Unfortunately, many units have been supplied with small, underequipped supporting areas, particularly for processing equipment. Endoscopes should not be immersed in sinks during cleaning, disinfection, or rinsing. Among necessities, supportirig space should contain special plumbing, trays, tanks, and brushes; "clean" and "dirty" areas; and adequate storage. All of this space should be adjacent to the endoscopy area. 9. Improvement of personnel training. Most manufacturers of endoscopic equipment provide inhouse training, which should be fully utilized by their customers. Because of the extremely delicate and complex structure of FFEs, only highly trained personnel should conduct cleaning and sterilization or disinfection procedures; inadequate procedures may not only cause failure of a disinfection or sterilization process, but may also damage instruments.
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10. Coordination with infection control personnel. Finally, we recommend that staff members of endoscopy units regularly consult with hospital infection control personnel. The infection control staff can help not only by monitoring and updating current procedures, but also by indicating needs for prospective surveillance. Walter W Bond Research microbiologist Martin S Favero Deputy director Hepatitis Laboratories Division Bureau of Epidemiology Center for Disease Control Phoenix, Ariz Donald C Mackel Deputy chief Epidemiologic Investigations Laboratory Branch George F Mallison Assistant director Bacterial Diseases Division Bureau of Epidemiology Center for Disease Control Atlanta
Perioperatiwe role not primary nursing In the April AORN Journal, the article "A framework for primary OR nursing" by Latz, Mayer, and Bailey presented concepts for primary nursing in the OR. Although our nursing practice in the OR may be focused on the patient's total needs, as defined by the perioperative role, it is not possible at this time to call ourselves primary nurses. During a patient's hospitalization, there cannot be two primary nurses (as presented in the author's model) since one patient may have only one primary nurse. The National League for Nursing publication Primary Nursing: One NurseOne Client, Planning Care Together states that under primary nursing, the total care of an individual patient is the responsibility of one nurse, not multiple nurses who share the care responsibilities of the patient within a single shift. Certainly we may collaborate with the primary nurse when we carry out the preoperative
AORN Journal, August 1979, Vol30, No 2
assessment and the postoperative evaluation or, if necessary,even during the intraoperative period. We will be practicing according to the perioperative role and providing comprehensive individualized patient care, but to call it primary nursing would be a fallacy. Janet R Hinnant, RN Charleston. SC
On ‘cuteness’ in nursing Your June editorial, “It may be cute, but what does it say about nursing?” really gave me a lift. I was beginning to think that I was the only nurse left who felt that way. When I think of the time involved to become an RN and see the time required to remain knowledgeable, I am saddened to see the professionalism I worked so hard for set aside for a cute little joke. Thanks again, you made my day. Barbara Miller, RN Plantation, Fla The June Journal arrived today and my hat is off to you. Congratulations for an excellent editorial (“It may be cute, but what does it say about nursing?”). As my eyes passed over the titles of workshops cited, I hoped I wouldn’t see one of my own. I certainly agree with your editorial and am happy you’ve said it-and in a public way. I think the same is true with respect to behavior and conversation in the clinical area. In fact, professionalism is one of the classes I include in my orientation program. Connie O’Brien, RN Houston
Dirty case cleanup I enjoyed reading the education column on OR cleanup in the June Journal. I can empathize with Colleen Harvey’s frustration over the number of inquiries Headquarters gets concerning dirty case cleanup. I used to get very discouraged about the reluctance to change until someone pointed out that it takes 20 years to implement a change. It has been 10 years since OR nurses were introduced to the concept of one cleanup procedure for all cases. Just think, we have only 10 more years to go. Phyllis E Wells, RN Wilmington, Del
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National study begun on sickle cell disease The Sickle Cell Disease Branch, Division of Blood Diseases and Resources of the National Heart, Lung, and Blood Institute, has begun a five-year comprehensive study on the clinical course of sickle cell disease. The study is to determine the natural history of the disease by clinical evaluation of sickle cell patients. Although sickle cell anemia and related conditions involving sickle hemoglobin have been recognized for many years and numerous clinical and laboratory manifestations have been described, the clinical course of sickle cell disease is poorly documented. Most of the available data are anecdotal, retrospective, and lack statistical validity, the Sickle Cell Disease Branch said. Twenty-three hospitals across the United States are participating in the study. Investigators at these hospitals will recruit 3,500 patients, including newborns, children, adolescents, and adults.
Booklet outlines role of nursing in hospice care A booklet describing the essential characteristics of hospices for the care of the terminally it1 has been published by the American Cancer Society. The Hospice Concept outlines the role of nursing in hospice care. The control of symptoms through pharmacologic, psychologic, and spiritual means is also discussed. According to the publication, interdisciplinary care is an integral part of the hospice concept. A hospice team may include occupational, physical, and speech therapists, a pastor, a social worker, and a variety of medical consultants, all under the direct supervision of a primary physician. Hospice care extends to all family members throughout the patient’s illness and often continues for a time after the death of the patient. The illustrated booklet, which lists selected hospices in the United States, is available from local divisions of the American Cancer Society.
AORN Journal, August 1979, Vol30, No 2
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10. Coordination with infection control personnel. Finally, we recommend that staff members of endoscopy units regularly consult with hospital infection control personnel. The infection control staff can help not only by monitoring and updating current procedures, but also by indicating needs for prospective surveillance. Walter W Bond Research microbiologist Martin S Favero Deputy director Hepatitis Laboratories Division Bureau of Epidemiology Center for Disease Control Phoenix, Ariz Donald C Mackel Deputy chief Epidemiologic Investigations Laboratory Branch George F Mallison Assistant director Bacterial Diseases Division Bureau of Epidemiology Center for Disease Control Atlanta
Perioperatiwe role not primary nursing In the April AORN Journal, the article "A framework for primary OR nursing" by Latz, Mayer, and Bailey presented concepts for primary nursing in the OR. Although our nursing practice in the OR may be focused on the patient's total needs, as defined by the perioperative role, it is not possible at this time to call ourselves primary nurses. During a patient's hospitalization, there cannot be two primary nurses (as presented in the author's model) since one patient may have only one primary nurse. The National League for Nursing publication Primary Nursing: One NurseOne Client, Planning Care Together states that under primary nursing, the total care of an individual patient is the responsibility of one nurse, not multiple nurses who share the care responsibilities of the patient within a single shift. Certainly we may collaborate with the primary nurse when we carry out the preoperative
AORN Journal, August 1979, Vol30, No 2
assessment and the postoperative evaluation or, if necessary,even during the intraoperative period. We will be practicing according to the perioperative role and providing comprehensive individualized patient care, but to call it primary nursing would be a fallacy. Janet R Hinnant, RN Charleston. SC
On ‘cuteness’ in nursing Your June editorial, “It may be cute, but what does it say about nursing?” really gave me a lift. I was beginning to think that I was the only nurse left who felt that way. When I think of the time involved to become an RN and see the time required to remain knowledgeable, I am saddened to see the professionalism I worked so hard for set aside for a cute little joke. Thanks again, you made my day. Barbara Miller, RN Plantation, Fla The June Journal arrived today and my hat is off to you. Congratulations for an excellent editorial (“It may be cute, but what does it say about nursing?”). As my eyes passed over the titles of workshops cited, I hoped I wouldn’t see one of my own. I certainly agree with your editorial and am happy you’ve said it-and in a public way. I think the same is true with respect to behavior and conversation in the clinical area. In fact, professionalism is one of the classes I include in my orientation program. Connie O’Brien, RN Houston
Dirty case cleanup I enjoyed reading the education column on OR cleanup in the June Journal. I can empathize with Colleen Harvey’s frustration over the number of inquiries Headquarters gets concerning dirty case cleanup. I used to get very discouraged about the reluctance to change until someone pointed out that it takes 20 years to implement a change. It has been 10 years since OR nurses were introduced to the concept of one cleanup procedure for all cases. Just think, we have only 10 more years to go. Phyllis E Wells, RN Wilmington, Del
356
National study begun on sickle cell disease The Sickle Cell Disease Branch, Division of Blood Diseases and Resources of the National Heart, Lung, and Blood Institute, has begun a five-year comprehensive study on the clinical course of sickle cell disease. The study is to determine the natural history of the disease by clinical evaluation of sickle cell patients. Although sickle cell anemia and related conditions involving sickle hemoglobin have been recognized for many years and numerous clinical and laboratory manifestations have been described, the clinical course of sickle cell disease is poorly documented. Most of the available data are anecdotal, retrospective, and lack statistical validity, the Sickle Cell Disease Branch said. Twenty-three hospitals across the United States are participating in the study. Investigators at these hospitals will recruit 3,500 patients, including newborns, children, adolescents, and adults.
Booklet outlines role of nursing in hospice care A booklet describing the essential characteristics of hospices for the care of the terminally it1 has been published by the American Cancer Society. The Hospice Concept outlines the role of nursing in hospice care. The control of symptoms through pharmacologic, psychologic, and spiritual means is also discussed. According to the publication, interdisciplinary care is an integral part of the hospice concept. A hospice team may include occupational, physical, and speech therapists, a pastor, a social worker, and a variety of medical consultants, all under the direct supervision of a primary physician. Hospice care extends to all family members throughout the patient’s illness and often continues for a time after the death of the patient. The illustrated booklet, which lists selected hospices in the United States, is available from local divisions of the American Cancer Society.
AORN Journal, August 1979, Vol30, No 2