Juggling Patients, Physicians, Pathogens

Juggling Patients, Physicians, Pathogens
The View Within a Bustling Phoenix OR

By Kelli M. Donley

Good Samaritan Regional Medical Center looms over central Phoenix like amisplaced piece of Swiss cheese of Herculean proportion. The large off-whitebuilding with rounded edges and porthole-sized black windows stands out in thecity as an architectural point of interest.

However, the walls of this strange creation contain the true point ofinfection control interest. The OR's level 1 trauma center handles an average of50-60 cases per day--many highlighting the dangers of inner-city life. Due tothe central location of the hospital, OR patients are often gang-related andshooting victims. Car and construction accidents also keep healthcare workersjuggling patient, staff, and facility needs.

It is a uniquely designed OR, with 15 procedure rooms and one additionaltrauma room. The large round "clock" of an operating facility worksfluidly. Patients and physicians enter at "6 pm," while contaminatedequipment exits the area at "12 pm." The OR rooms encircle theclock--the center of the circle filled with operating room assistants shufflingequipment onto trays and nurses calculating patient and staffing schedules.

Within the area, there is an aura of tension--similar to what one would feelat a racetrack. Each of the 100-plus staff members working at any given time arenot only doing their jobs with precision and speed, but also calculating how toaccomplish their tasks more effectively. A passerby can see healthcare workerspushing one patient to the recovery area, while a team of operating roomassistants wait impatiently to prepare the room for the next patient in line.

Like a tag team, once the patient leaves the OR, the next group of employeesscurries to their posts to get the room ready. Adding to the stress, to maintainthe hospital's level 1 status, their trauma room must also always be open andready. No scheduled procedures can take place in this allotted space.

According to Patricia Menges, RN, CNOR, service line director of generalsurgery at the facility, the goal is to have a room cleaned and ready for thenext patient within a few minutes.

"It all depends on the case. We'd like to have the room clean within 30minutes, but a big case like a heart procedure takes more time. However, asimple case should be ready in 25 minutes," she said.

To get staff members motivated about keeping up the pace, Nancy McCullough,assistant director of the OR, created an incentives program to get employees towork as a team. A monetary reward has been set as an incentive to get OR staffmembers working together efficiently to improve turnover times. A large whitegrease board charts team members and their expected workload.

A compulsory aspect of this turnover is instrument processing. Rather thansending all instruments to CS, management created a small operatingsterilization unit within the OR. With interlocking hallways connecting theoperating theaters and the localized CS, instruments are kept from reentering asterile environment.

Healthcare workers in this sterilization area use Orthozyme and Enzol toclean the instruments before they are sent into the sterilizer. Staff in anadjoining room, on the other side of the instrument conveyor belt andsterilizer, categorize and organize the instruments, placing them methodicallyin the necessary instrument sets for the day's procedures.

After the bulk of the scheduled operations are complete, the bulk of thecleaning work begins. Environmental services employees work the 10:30 pm to 7 amshift, cleaning furniture, walls, floors, and other communal surfaces.

A variety of OR employees is responsible for keeping different elements ofequipment clean and prepared for the next procedure. Using quaternary compoundbased-TBQ, staff members wipe down operating rooms, equipment in the halls, andother surfaces that may be contaminated.

Lining the circular OR walkways are grandiose pieces of medical equipmentthat seemingly reach out toward each other in prehistoric brachiosaurus-fashion.Large arms of neurological-operating devices curve toward a rack of X-ray vests,placed next to huddle of monitors and a gaggle of sharps containers. Millions ofdollars worth of equipment, as necessary as the human talent in surgery, sitwaiting for the next procedure. However, during this hallways resting time, theequipment surfaces can become contaminated with dangerous pathogens.

"Anesthesia technicians keep their equipment ready to go, and X-raytechnicians are responsible for wiping down their machines between cases,"Menges said. "We keep monitors and defibrillators clean on our own. Anyequipment that has been out for repair or has been sitting out in the hall needsto be wiped down before being placed in the OR."

After the operating is complete and the room needs to be prepared for thenext patient, staff members use detailed directions on how to make sure the roomis cleaned to the highest caliber. This includes following regimented steps ineliminating sources of potential nosocomial infections.

"The mop only gets wet once," Menges said. "When our employeesare cleaning the floors, they make sure the mop does not go back into the waterbucket. After they are done mopping, the head is sent down to laundry to beprocessed. The trash and linens are also taken from the room and the bags arereplaced."

Simple rules, such as the mop example, help minimize the hospital-borneinfection rate at Good Samaritan. Teamwork, motivation, and compliance also helpmake this hospital's OR run effectively and successfully.