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OR Fact and Principle
OR FACT AND PRINCIPLE
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The following questions are answered here by members of the Editorial Committee.
Q. One of our doctors insists on turning the thermostat up to about 80 degrees. Are there dangers to this temperature other than personnel feeling iaint from the heat (as has happened to me) ?
A. Aside from considerations of comfort there are several other factors which must be considered when changing room temperatures. The science of air conditioning involves the maintenance of a required temperature and humidity by warming and/or cooling, filtering and circulating air. The number of persons in an area, the type and amount of motor and monitoring equipment and the location of the room, influence temperature and humidity in an area. For most people the temperature comfort zone is 68 to 72 degrees. Above this environmental level, perspiration starts to form to effect heat control at a personal level. The patient is barred from this by the weight of surgical drapes and further control is lost by exposure of the wound to the atmosphere. It is well established that a warm, humid environment promotes a high rate of bacterial growth. Therefore the concurrent rise in humidity and temperature creates a distinct hazard to the patient in terms of infection. Another possible danger to a high tempera-
July 1968
ture is the potential of explosions. A significant rise in the chance of electrostatic discharge will occur with even slight elevations in temperature. The operating room environment should be compatible with the patient’s condition and the needs of the team and adjusted accordingly.
Q. Is an RN necessary on the staff o f the cardiopulmonary lab? A. Many procedures are performed in the cardiopulmonary laboratory on a daily basis, such as arterial and venous blood studies, respiratory studies, esophageal electrocardiograms, pacemaker implants and cardiac catheterizations. The nurse’s general role is the same as for other units in the hospital: provision for the patient’s comfort and safety, observation and reassurance. It is in the process of accomplishing these functions that specific disciplines come into play and demonstrate the need for a professional registered nurse oriented to surgical techniques and cardiology. Although the majority of patients coming to this laboratory are there for diagnostic tests, there are many who are in acute distress. This is particularly true in patients requiring a transvenous pacemaker. They
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need the professional services of an experienced nurse. A nurse geared to cardiac diseases is more acutely aware of symptoms such as dyspnea, apnea and Stokes-Adam syndrome. It is during these emergencies that the RN is the vital link in the team concept of patient care. The nurse is the member of the team who should be diagnosing and correcting nursing problems. Organization and development of procedures to maintain aseptic technique is mandatory. In addition, teaching the value of this concept and practice to related personnel is important. Understanding the specific tests and untoward reactions experienced by the patient enables the nurse to apply certain principles which are necessary to eliminate his fears and anxieties. The preparation of intravenous fluids, administration of narcotics, and assistance in the treatment of cardiac arrests (which do occur in the laboratory) are additional reasons for the need of an RN in the cardiopulmonary lab.
Q. Can explosion-proof plugs be used below the five foot level? Can standard electrical plugs be used in the OR above the five foot level?
A. The pamphlet #56, “Standards of the National Board of Fire Underwriters for the use of Flammable Anesthetic,” may be obtained from the National Board of Fire Underwriters, 85 John Street, New York, N. Y. 10038. Page 39-2B states, “Electrical receptacles less than five feet above the floor shall be of the explosion-proof type. Receptacles more than five feet above the floor may be general purpose lock-in type. All attachment plugs for use in anesthetizing locations shall be designed for interchangeability with either explosive-proof or general purpose lock-in type receptacles for direct connection without the use of adapters.” Q. Please comment on the effectiveness and
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desirability of using fogging machines in lhe operating room.
A. Little can substitute for a good detergentgermicide, applied with old-fashioned elbow grease, in cleaning an operating room. Fogging can provide a false security. For the time involved, proof is yet to be set forth as to its effectiveness. Inhalation of the chemicals used in fogging machines, if not allowed time to dissipate before personnel re-enter the room, can be hazardous.
Q. If disposable items are sterilized commercially, is it necessary for the bacteriology laboratory of the hospital .to set up a control system for culturing items within a given lot?
A. It is suggested that items be purchased from a reputable company, being sure that the method of sterilization and the type of quality control is acceptable. It is important to know that the control of sterilization is checked by lot.
Q. Please comment on the advisability of taking throat cultures on OR personnel. A. Simple, single throat cultures are not particularly helpful as individual flora changes frequently. Regular, periodic culturing may reveal certain patterns within an individual suspected of being a carrier. To be meaningful, phage typing should be included in the search for carriers of staphylococcus.
Q . Do you recommend washing walls once a week or once a month? Who should do thishousekeeping or OR nursing service personnel?
A. Walls in the operating room should be cleaned daily from any gross soil. Routine wall washing should be carried out every two weeks. However, individual air conditioning filter systems and/or the amount of use of the room may alter this. The housekeeping department should be able to assume the responsibility for the spot and routine cleaning once procedures are standardized.
AORN Journal
0 0
The following questions are answered here by members of the Editorial Committee.
Q. One of our doctors insists on turning the thermostat up to about 80 degrees. Are there dangers to this temperature other than personnel feeling iaint from the heat (as has happened to me) ?
A. Aside from considerations of comfort there are several other factors which must be considered when changing room temperatures. The science of air conditioning involves the maintenance of a required temperature and humidity by warming and/or cooling, filtering and circulating air. The number of persons in an area, the type and amount of motor and monitoring equipment and the location of the room, influence temperature and humidity in an area. For most people the temperature comfort zone is 68 to 72 degrees. Above this environmental level, perspiration starts to form to effect heat control at a personal level. The patient is barred from this by the weight of surgical drapes and further control is lost by exposure of the wound to the atmosphere. It is well established that a warm, humid environment promotes a high rate of bacterial growth. Therefore the concurrent rise in humidity and temperature creates a distinct hazard to the patient in terms of infection. Another possible danger to a high tempera-
July 1968
ture is the potential of explosions. A significant rise in the chance of electrostatic discharge will occur with even slight elevations in temperature. The operating room environment should be compatible with the patient’s condition and the needs of the team and adjusted accordingly.
Q. Is an RN necessary on the staff o f the cardiopulmonary lab? A. Many procedures are performed in the cardiopulmonary laboratory on a daily basis, such as arterial and venous blood studies, respiratory studies, esophageal electrocardiograms, pacemaker implants and cardiac catheterizations. The nurse’s general role is the same as for other units in the hospital: provision for the patient’s comfort and safety, observation and reassurance. It is in the process of accomplishing these functions that specific disciplines come into play and demonstrate the need for a professional registered nurse oriented to surgical techniques and cardiology. Although the majority of patients coming to this laboratory are there for diagnostic tests, there are many who are in acute distress. This is particularly true in patients requiring a transvenous pacemaker. They
111
need the professional services of an experienced nurse. A nurse geared to cardiac diseases is more acutely aware of symptoms such as dyspnea, apnea and Stokes-Adam syndrome. It is during these emergencies that the RN is the vital link in the team concept of patient care. The nurse is the member of the team who should be diagnosing and correcting nursing problems. Organization and development of procedures to maintain aseptic technique is mandatory. In addition, teaching the value of this concept and practice to related personnel is important. Understanding the specific tests and untoward reactions experienced by the patient enables the nurse to apply certain principles which are necessary to eliminate his fears and anxieties. The preparation of intravenous fluids, administration of narcotics, and assistance in the treatment of cardiac arrests (which do occur in the laboratory) are additional reasons for the need of an RN in the cardiopulmonary lab.
Q. Can explosion-proof plugs be used below the five foot level? Can standard electrical plugs be used in the OR above the five foot level?
A. The pamphlet #56, “Standards of the National Board of Fire Underwriters for the use of Flammable Anesthetic,” may be obtained from the National Board of Fire Underwriters, 85 John Street, New York, N. Y. 10038. Page 39-2B states, “Electrical receptacles less than five feet above the floor shall be of the explosion-proof type. Receptacles more than five feet above the floor may be general purpose lock-in type. All attachment plugs for use in anesthetizing locations shall be designed for interchangeability with either explosive-proof or general purpose lock-in type receptacles for direct connection without the use of adapters.” Q. Please comment on the effectiveness and
112
desirability of using fogging machines in lhe operating room.
A. Little can substitute for a good detergentgermicide, applied with old-fashioned elbow grease, in cleaning an operating room. Fogging can provide a false security. For the time involved, proof is yet to be set forth as to its effectiveness. Inhalation of the chemicals used in fogging machines, if not allowed time to dissipate before personnel re-enter the room, can be hazardous.
Q. If disposable items are sterilized commercially, is it necessary for the bacteriology laboratory of the hospital .to set up a control system for culturing items within a given lot?
A. It is suggested that items be purchased from a reputable company, being sure that the method of sterilization and the type of quality control is acceptable. It is important to know that the control of sterilization is checked by lot.
Q. Please comment on the advisability of taking throat cultures on OR personnel. A. Simple, single throat cultures are not particularly helpful as individual flora changes frequently. Regular, periodic culturing may reveal certain patterns within an individual suspected of being a carrier. To be meaningful, phage typing should be included in the search for carriers of staphylococcus.
Q . Do you recommend washing walls once a week or once a month? Who should do thishousekeeping or OR nursing service personnel?
A. Walls in the operating room should be cleaned daily from any gross soil. Routine wall washing should be carried out every two weeks. However, individual air conditioning filter systems and/or the amount of use of the room may alter this. The housekeeping department should be able to assume the responsibility for the spot and routine cleaning once procedures are standardized.
AORN Journal