Preserve Sterility in the OR while Easing Workflow

Operating room leadership is responsible for ensuring a safe and efficient OR environment. Among the challenges facing many OR leaders today are increases in both the volume of surgical procedures and in the rate of staff turnover (specifically, registered nurses and surgical technologists). The data shown below point to the widespread extent of such challenges.

This brief article will consider some of the challenges routinely faced by OR leaders and then look at several strategies that can help protect sterility and streamline workflow in hospitals and ambulatory surgery centers (ASCs).

Current Challenges Faced in the OR

• Breaks in sterile technique – Occasionally, even the best perioperative team may experience a break in sterile technique; the root cause of the break could be anything from a simple execution issue (e.g., an insecurely clipped sheet) to a miscommunication leading to error.
• Time-consuming / wasteful implementation – Facilities employ different practices and products to protect the sterile surgical field; although OR leadership designs protocols to ensure adherence to proper sterile technique, the efficiency of these measures can vary in terms of labor and materials.
• Staffing constraints – Staffing shortages and staff turnover can have a deleterious effect on an organization’s ability to maintain sterility and efficiency in the operating room; staffing-related challenges may emerge as teams find themselves shorthanded or working in less familiar roles.
• Inefficient movement of personnel, equipment, etc. – It takes careful scheduling and planning to make sure everyone and everything is together in the right room at the right time; however, it’s also important to note that the failure to optimize staff ergonomics within the OR (via measures such as the smart positioning of equipment, handy placement of surgical instruments, and ready access to necessary supplies) can create frustrating obstacles for the team.
• Unpredictability of individual cases – Regardless of how well a hospital or ASC is run, every patient case is unique and therefore carries with it the chance of unforeseen circumstances developing; preoperative, intraoperative, and postoperative delays, in addition to unexpected periods of heavy activity, are always a possibility.

The strategies discussed in the next section can help overcome these OR challenges.

Strategies for Preserving Sterility and Easing Workflow

Strategies for preserving sterility and easing workflow include leveraging advances in devices designed to protect sterility, consistently implementing proper sterile field protocols for equipment/instruments, and exercising environmental controls.

Before discussing these strategies, let’s review the basics of sterile technique.

Back to the Basics of Sterile Technique

Sterile technique for the OR comprises a set of practices established to safeguard the surgical field from microbial contaminants that can lead to surgical site infections (SSIs). It is imperative that all personnel completely understand their facility’s protocols for maintaining sterility and demonstrate full adherence while performing their duties.

The specific details of practices associated with sterile technique as implemented at various facilities may vary a little bit but will always be reflective of guidelines published by authoritative entities such as certifying organizations and regulatory bodies. The proper use of sterile gowns, gloves, masks, caps, and protective wrappers, for instance, represents a common foundational element of sterile technique.

Now, let’s move on to strategies for preserving sterility and easing workflow in the OR.

Utilizing Advances in Devices Designed To Protect Sterility

Recent advances in the design of single-use medical devices can help perioperative staff not only preserve the sterility of the surgical field but can improve workflow thanks to simple, standardized application. Innovative disposable products for the OR include Sterile-Z^® Covers and C-Armor^® Drapes, both manufactured by TIDI Products.

Sterile-Z Back Table Covers are easy-to-use sterile drapes that are designed to be deployed and removed from the OR back table while maintaining sterile technique in accordance with guidelines such as those published by the Association of periOperative Registered Nurses, AORN.¹

Sterile-Z Back Table Covers may provide staff extra time to perform other work-related tasks or take a well-deserved break, secure in the knowledge that sterile instruments and implants on the back table are properly covered and protected. (AORN states there is no evidence to show that contamination of a covered sterile field can be detected or prevented through physical attendance or direct observation,¹ so direct observation is not necessary once covered.²)

Note that Sterile-Z Mayo Stand Covers are also available, as are Sterile-Z Patient Drapes designed for use during intraoperative 3D imaging.

Another innovative OR product is the patented C-Armor Drape, an easy-to-deploy and easy-to-retract protective barrier designed to preserve the sterile field during procedures that involve multiple C-arm swings. This standardized draping solution is intended to improve staff efficiency and can save facilities both time and materials. Only one C-Armor Drape is typically needed per case, regardless of the number of times the C-arm position is changed.

Implementing Sterile Field Protocols for Equipment and Instruments

Maintaining a logically organized surgical environment is of paramount importance in the effort to preserve sterility and streamline workflow. Required equipment and instruments should be located within the OR in a manner that complies with approved sterile technique and supports staff function.

Activities like the placement, positioning, unpackaging, draping/undraping, and covering/uncovering of tools should be choreographed in advance to ensure easy and comfortable execution. Innovative products can complement these measures. Sterile-Z Covers, for example, are optimized for simple application and removal that complies with sterile technique. Intended for use during procedural delays and periods of increased activity, these covers can also help mitigate the effects of unexpected case developments by freeing up personnel.

All OR leaders should strive to stay abreast of the latest policies and procedures pertaining to preservation of the sterile field and be sure they conduct a comprehensive review of applicable guidelines on at least an annual basis.

In addition to the AORN guidelines referenced in the previous section, relevant publications include “Guidelines for Best Practices for Establishing the Sterile Field in the Operating Room” by the Association of Surgical Technologists, AST.³

Exercising Environmental Controls

Lastly, it should be recognized that foot traffic and air turbulence in the OR are considered risk factors for surgical site infections.⁴ The AST guidelines for best practices recommend monitoring and controlling traffic in and out of the OR when the team starts to open sterile items.³ 

Proper planning, such as making sure all needed supplies are readily accessible in the OR, can help limit this traffic and streamline staff workflow.

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