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Longhairs and liners
The experts research
longhairs and liners
Q. What can we do fo make our long haired surgeons cover their hair in the OR?
A. Your question involves more than the "long haired surgeon." The problem i s one including surgeon and other staff with long hair, involving both men and women, doctors, nurses, anesthesiologists, housekeepers and others who work in the OR. The problem i s not just long hair but also the real problem i s asepsis. facial hair Hair has long been recognized as a POSsible source of contamination and danger to asepsis in the operating room. This i s true no matter whose hair i t is. So the responsibility is borne equally by everyone in the OR.
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a: Refer the problem to one or all of the following, depending upon your lines of communication and authority: director of nursing, surgery committee of the medical staff, infection control committee or hospital administration. Be prepared to provide recent studies done on this subject - all of which offer proof that hair i s a hazard to patient safety in the OR and that special precaution needs to be taken by those who work in this area. Your solution may be to permit only the hood or helmet type covering as appropriate covering for all OR staff: doctor, nurse, anesthesiologist, technician, housekeeper, etc. REFERENCES
The problem of hair coverage should be governed by overall policies of attire in the OR and should apply to all equally. Your chief of surgery should share the responsibility for developing and implementing such guidelines. If, in fact, he fails to do so or is one of the offenders, there are several other avenues open to you.
January 2972
I . Dineen. P: Prevention of infection: Bulletin of the American College of Surgeons (December) 1970. 2. Walter, CW: Multiple factors t o consider in hospital infection control: Hospital Topics (October) 1970.
3. Ginsberg, F: Hair, long or short, must be COVered in the OR: Modern Hospital (July) 1971.
4. H o w do you
. .. : Point
of View Vol 8 No 5.
149
Q. Is it really necessary fo buy static free
moist. If there is any movement of the
or conductive pail liners? We are now using plastic liners and have been putting water in the bottom of our kick buckets to ground them - is this a safe practice?
bucket during surgery, the person moving
A. Of greatest importance i s the fact, that if plastic liners are used, they must be positioned prior to anesthesia and not removed during anesthesia. Since the plastic liners are waterproof, you are going through useless motion if your purpose in putting water in the bucket is to establish a conductive pathway. However, there are several reasons why plastic liners may be used in the operating room. Most waste material put in the bucket i s
the bucket is grounded. When the circulating nurse i s removing the sponges for a count, she removes the sponge with a metal forcept thereby establishing a conductive pathway from the bucket to the floor. Plastic liners are more economical than the other two types mentioned. REFERENCES W a l t e r , CW, MD and Errera, DW, RN: OR question box: OR Yearbook and Purchasing Guide: Hospital Topics Vol 18, p 82, 1967.
-AORN Professional Advisory Cornrn iffee
Cause of hemorrhagic shock Changes in circulation at the small capillary level have been investigated as o cause of hemorrhagic shock in surgical patients. The results were presented in a scientific exhibit at the Clinical Congress of the American College of Surgeons by Watts. R. Webb, MD, FACS. of the State University of New York, Upstate Medical Center, Syracuse. " O f the deaths that are now occurring in American surgery in the intensive care units in the surgical patients, perhaps one-third are directly attributable t o pulmonary complications unrelated %the initial trauma or surgery and perhaps another third have pulmonary complications that contribute ultimately t o death," said Dr. Webb. " I n order t o evaluate the cause and progression of the congestive atelectasis or respiratory distress syndrome so often seen in patients desperately ill from trauma, shock and other maior problems, we've investigated the pulmonary circulatory changes at the capillary level. " W e have been able to record pressures on both sides of the pulmonary capillary and t o demonstrate that the lung in response t o shock develops spasm of the pulmonary render leading t o congestion in the capillaries and thus in the alveoli."
With the aid of a specially constructed microscope, it has been possible to take moving pictures of the circulation within the substance of the lung. It has been possible t o follow a single air sac with its capillary structure for several hours during shock. Dr. W e b b found the capillary changes are completely different in the t o p and bottom surface of the lung. The t o p part shows very early clumping or sludging of the red cells and almost complete cessation of the flow. The bottom portion. which i s already strutted with blood, continues blood flow during the period of hemorrhagic shock. But with the restoration of blood volume, i t shows even a greater capillary congestion.
A comparison in the management of gall bladder disease was reported by Vergil N. Slee. MD, FACS. Discharge summaries of 3,583 cholecystectomy patients from unirerrity 60spitals and of 2,652 from non-university hospitals were compared. University hospitals did more x-rays, electrocardiograms, bacteriological and blood chemistry tests. They d i d fewer serological +ests for syphillis, however, University hospitals used fewer antibotics and gave transf usions more frequently. Wound infections were more common in this group.
150
AORN Journal
longhairs and liners
Q. What can we do fo make our long haired surgeons cover their hair in the OR?
A. Your question involves more than the "long haired surgeon." The problem i s one including surgeon and other staff with long hair, involving both men and women, doctors, nurses, anesthesiologists, housekeepers and others who work in the OR. The problem i s not just long hair but also the real problem i s asepsis. facial hair Hair has long been recognized as a POSsible source of contamination and danger to asepsis in the operating room. This i s true no matter whose hair i t is. So the responsibility is borne equally by everyone in the OR.
-
a: Refer the problem to one or all of the following, depending upon your lines of communication and authority: director of nursing, surgery committee of the medical staff, infection control committee or hospital administration. Be prepared to provide recent studies done on this subject - all of which offer proof that hair i s a hazard to patient safety in the OR and that special precaution needs to be taken by those who work in this area. Your solution may be to permit only the hood or helmet type covering as appropriate covering for all OR staff: doctor, nurse, anesthesiologist, technician, housekeeper, etc. REFERENCES
The problem of hair coverage should be governed by overall policies of attire in the OR and should apply to all equally. Your chief of surgery should share the responsibility for developing and implementing such guidelines. If, in fact, he fails to do so or is one of the offenders, there are several other avenues open to you.
January 2972
I . Dineen. P: Prevention of infection: Bulletin of the American College of Surgeons (December) 1970. 2. Walter, CW: Multiple factors t o consider in hospital infection control: Hospital Topics (October) 1970.
3. Ginsberg, F: Hair, long or short, must be COVered in the OR: Modern Hospital (July) 1971.
4. H o w do you
. .. : Point
of View Vol 8 No 5.
149
Q. Is it really necessary fo buy static free
moist. If there is any movement of the
or conductive pail liners? We are now using plastic liners and have been putting water in the bottom of our kick buckets to ground them - is this a safe practice?
bucket during surgery, the person moving
A. Of greatest importance i s the fact, that if plastic liners are used, they must be positioned prior to anesthesia and not removed during anesthesia. Since the plastic liners are waterproof, you are going through useless motion if your purpose in putting water in the bucket is to establish a conductive pathway. However, there are several reasons why plastic liners may be used in the operating room. Most waste material put in the bucket i s
the bucket is grounded. When the circulating nurse i s removing the sponges for a count, she removes the sponge with a metal forcept thereby establishing a conductive pathway from the bucket to the floor. Plastic liners are more economical than the other two types mentioned. REFERENCES W a l t e r , CW, MD and Errera, DW, RN: OR question box: OR Yearbook and Purchasing Guide: Hospital Topics Vol 18, p 82, 1967.
-AORN Professional Advisory Cornrn iffee
Cause of hemorrhagic shock Changes in circulation at the small capillary level have been investigated as o cause of hemorrhagic shock in surgical patients. The results were presented in a scientific exhibit at the Clinical Congress of the American College of Surgeons by Watts. R. Webb, MD, FACS. of the State University of New York, Upstate Medical Center, Syracuse. " O f the deaths that are now occurring in American surgery in the intensive care units in the surgical patients, perhaps one-third are directly attributable t o pulmonary complications unrelated %the initial trauma or surgery and perhaps another third have pulmonary complications that contribute ultimately t o death," said Dr. Webb. " I n order t o evaluate the cause and progression of the congestive atelectasis or respiratory distress syndrome so often seen in patients desperately ill from trauma, shock and other maior problems, we've investigated the pulmonary circulatory changes at the capillary level. " W e have been able to record pressures on both sides of the pulmonary capillary and t o demonstrate that the lung in response t o shock develops spasm of the pulmonary render leading t o congestion in the capillaries and thus in the alveoli."
With the aid of a specially constructed microscope, it has been possible to take moving pictures of the circulation within the substance of the lung. It has been possible t o follow a single air sac with its capillary structure for several hours during shock. Dr. W e b b found the capillary changes are completely different in the t o p and bottom surface of the lung. The t o p part shows very early clumping or sludging of the red cells and almost complete cessation of the flow. The bottom portion. which i s already strutted with blood, continues blood flow during the period of hemorrhagic shock. But with the restoration of blood volume, i t shows even a greater capillary congestion.
A comparison in the management of gall bladder disease was reported by Vergil N. Slee. MD, FACS. Discharge summaries of 3,583 cholecystectomy patients from unirerrity 60spitals and of 2,652 from non-university hospitals were compared. University hospitals did more x-rays, electrocardiograms, bacteriological and blood chemistry tests. They d i d fewer serological +ests for syphillis, however, University hospitals used fewer antibotics and gave transf usions more frequently. Wound infections were more common in this group.
150
AORN Journal