192 - Danger in the OR: Are You Following the AORN Recommendation on Transporting Dirty Instruments?
Description: Description of the Problem and Team:Our current practices in transporting contaminated instruments from the Operating Room (OR) to dirty utility room, do not meet the Association of periOperative Registered Nurses (AORN) and Joint Commission (JC) requirements. A team that includes OR leadership and frontline staff; Circulating Nurses, Surgical Technologist (ST) and Perioperative Assistant, looked at how we can provide safe patient care by following AORN and JC guidelines. · Preparation and planning: · Literature review was conducted on cleaning of instruments at the point of use, transporting contaminated instruments, and effect of improper care of contaminated instruments on surgical site infection, patient and worker safety. ·
Assessment: · OR layout: · The 15 suite OR was built in the 1930’s. Each suite only has 1 egress (entrance/exit) that leads to 1 hallway. · The hallway has limited space to park case cart with sterile supplies and empty cart for contaminated items. · Current OR practices: · The case cart is used to transport sterile trays and packs only. Instruments and packs for all cases in each room are stored in this cart. · After the case, ST transports dirty instruments in open or genesis containers on a walker table to dirty utility room. · There is no identification if instruments are used, contaminated or sterile. · Dirty and sterile instruments are transported and stored in one hallway. Patients, sterile supply and instruments are susceptible to contamination. · Current practices do not meet regulatory requirements from JC. · Implementation: · Collaborated in-services of ST and RN on instrument cleaning: · Intra-procedure cleaning with water soaked sponges. · Post-procedure cleaning including sorting and disassembly of instruments, containment and transportation to dirty utility room. · Identified hospital designated containers and non-permeable cover for the walker table. This prevents the OR and central processing personnel from contact with contaminated instruments and prevent airborne microorganism during transport. · Use of Biohazard sign to label contaminated instrument trays. · Audit to sustain compliance · 20 audits per month for 3 months · Outcome: · 100% compliance on new process. · Decreased bloody instruments and garbage in trays. · Decreased staff injury related to contaminated instruments in OR and Central processing. · Implications for OR nursing: Our main issue arise from having an old OR not designed to handle current practices and volume challenges in the OR. Having 1 hallway that serves as entrance and exit for sterile and contaminated items poses a huge challenge in providing safe patient care. Having a well designed process in transporting contaminated items promotes safe patient care and workforce safety.