Current Issues in Operating Theatres

Operating theatre teams around the world face fresh challenges every year. In this post we’ll explore some of the current issues in operating theatres, and examine the ways in which operating theatre teams are rising to meet these challenges.

Infection Control and Ventilation

The pandemic caused severe disruption to all surgical specialties. UK operating theatres cancelled elective surgical procedures while avoiding aerosol generating procedures (AGPs).

A recent paper in the Royal College of Surgeons annals reported on how operating theatres across the world had used negative pressure environments to reduce the spread of infectious airborne particles during AGPs. This paper went on to present an overview on how operating theatre ventilation systems can work to reduce both virus transmissions and surgical site infections (SSIs).

The paper concludes that, while there is not yet enough evidence to recommend that all operating theatres convert to negative pressure environments, all health settings should have negative pressure rooms available for high-risk patients.

Head here to read the latest research on operating theatre ventilation in the Royal College of Surgeons annals.

You can also read our guide to cleaning for infection prevention and control in operating theatres.

Improving Operating Room Efficiency

One of the current issues in operating theatres is how to improve efficiency while reducing turnaround time between procedures. A recent paper in Folio 3 Digital Health explored the possibilities of using Internet of Things (IOT) devices to improve operating room efficiency best practices.

“Smart” medical equipment allows for predictive maintenance, so teams can address any potential issues long before they become problems. IOT devices can also help reduce medical errors during surgical processes through allowing for faster and more powerful data sharing among the operating team.

Head here to read the full paper on the possibilities of IOT devices in operating theatres.

In June 2020, the NHS England Improvement Hub published a resource entitled The Productive Operating Theatre. This is a series of modules designed to help theatre teams work together to improve the quality of the patient experience and the safety of surgical services. The resource outlines ways in which theatres can make best use of available time and expertise.

Head here to access the full suite of Productive Operating Theatre resources.

Consumables and Equipment Management

A key focus area for improving operating theatre efficiency is good management of consumables and equipment. Investing in connected IOT devices might be a good long-term goal. But lower-tech solutions can help operating theatre teams make huge improvements to efficiency in the short-term too.

For example, we stock a range of absorbent floor mats designed to capture fluids during surgical procedures. They can help you to optimise your fluid management, which won’t just improve health and safety – it’ll also optimise your turnaround times between procedures.

Communication and Working Together to Overcome Challenges

The Association for Perioperative Practice recently ran an online survey asking theatre nurses to share their experiences of work, and the challenges they face in the theatre environment.

The charity aimed to highlight issues such as bullying, pressure, and support from senior members. As in an operating theatre environment, these issues don’t just result in unpleasant working environments. The working environment can affect patient safety and outcomes.

The WHO Surgical Safety Checklist, first published in 2010, contains numerous measures to help operating theatres foster a supportive environment based on mutual respect. For example, it outlines that all surgical procedures should start with a briefing, during which senior staff members should actively welcome queries and concerns from junior staff members.

Head here to read our full guide to the WHO Surgical Safety Checklist.

Improving the Running of Your Operating Theatre

At Cairn Technology, we’re here to help you run your operating theatre more efficiently and effectively. We have a number of products and services to help you do that, and a team of experts on hand to give you the advice you need.

For example, our absorbent floor mats can help you to optimise your fluid management to help your health and safety and turnaround times, as well as other surgical supplies for infection control and high-level performance.

Do You Have a Question About Current Issues in Operating Theatres?

Whether you want a consultation on effective infection control, or some advice on improving operational effectiveness in the theatre, our experts are here to help.

Get in touch to talk to one of our experts today.

 

 

What Key Factors Should Be Considered When Selecting PPE?

Personal Protection Equipment (PPE) can make a huge difference in preventing accidents and injuries in certain workplaces, and in preventing the spread of infection in healthcare settings.

Employers are responsible for providing PPE to their employees. You can find a guide to the Health and Safety Executive (HSE) regulations concerning PPE.

What to Consider When Selecting PPE

There are a number of factors to consider when selecting the PPE you need for different settings. This includes:

  • Harmful substance exposure
  • Risk Assessment hazards
  • PPE regulations
  • Who it’s for
  • How much you need

We’ll explore each of these in more detail to help you identify the key factors you need to be considering when selecting and purchasing PPE.

Essential Questions Regarding Substances

Thinking about your workplace – whether it’s a construction site or a hospital – consider the following:

  • What sort of harmful substances are there, and who might be exposed to them?
  • How long might these people be exposed to these substances?
  • How much of these substances are they likely to be exposed to?

Start With a Risk Assessment

Conduct a thorough audit of all of your operations to identify any potential hazards that might require the use of PPE.

Potential hazards might include:

  • Exposure to dust, fumes, aerosols, and other potentially harmful substances.
  • Excessive noise levels.
  • Infection from viruses and bacteria – this is always a risk in healthcare settings. But the COVID-19 pandemic forced many to consider the infection risks in other settings too.

Consider the PPE Regulations in Your Industry

The PPE you provide should be fit for purpose. But you need to match the level of protection you provide to the risks.

Personal Protective Equipment (Enforcement) Regulations 2018 is the statutory guidance for PPE. Among other things, it outlines that all PPE products must be either CE or UKCA marked, indicating that it meets certain regulations.

Talk to your suppliers about the PPE regulations in your industry, and they’ll be able to advise you on remaining compliant. And the better you can explain the task or job that demands PPE, the better they’ll be able to advise on appropriate equipment.

Who Needs to Use PPE?

Size, fit and weight are key things to think about here. All PPE should be comfortable, but the longer a person will have to use it, the more comfortable it’ll have to be. Also think about instances where people might use more than one item of PPE at the same time. All the PPE you provide should be fully compatible. It’s vital that no item of PPE impacts on the effectiveness of any other.

And PPE is essentially useless if it doesn’t fit, or if it’s not used correctly. You should instruct and train people on how to use any PPE you provide.

This is particularly critical in hospital and healthcare settings. Standard Infection Control Precautions in hospitals will often specify not just the type of PPE staff should use, but also how they apply it.

How Much PPE You’ll Need

Some items of PPE can be used again and again. Others are disposable – they’re designed to be used once, and then discarded. Supply and demand is often a critical factor when choosing PPE. One reason it’s so important to identify the potential hazards in your workplace is because it will inform you not just of what sort of PPE you need, but also of how much you need.

In a healthcare setting, workers might get through dozens of gloves and facemasks each day. To prevent the spread of infection, it’s important that they can always depend on a reliable supply of the PPE they need. So when choosing PPE, along with comfort and wearability, hospitals might account for availability, shipping times and costs, and storage requirements.

Need a Hand Choosing PPE for Your Workplace?

We offer many services that’ll help you equip your staff with the PPE they need – particularly in healthcare environments.

Our workplace exposure monitoring services can feed into your initial risk assessment. We can help you identify possible sources of infection and contamination, and our comprehensive reports include discussions and recommendations for keeping your staff safe.

We can also help you ensure both your staff and your PPE is up to scratch, with our specialist spill kit training for hospitals, and our face fit testing services for medical settings.

Finally, we also stock a huge range of specialist PPE equipment, including an extensive selection of absorbent mats for hospitals.

Want to talk about how we can help you choose the right PPE for your workplace? Get in touch to talk to one of our air purification experts today.

 

Cleaning for Infection Prevention and Control in Operating Theatres

Studies show that surgical site infections (SSIs) constitute around 20% of total hospital-acquired infections. So infection prevention and control in operating theatres is essential for ensuring the safety of the patient.

Sources of Infection in Operating Theatres

Most SSIs occur during the operative procedure, when the patient’s wounds are still open. Sources of infection can include:

  • Members of the operating team, and the clothing they wear.
  • The operating theatre environment, including the air quality.
  • The equipment used during the procedure.

Stringent protocols can make a huge difference in minimising the onset of SSIs. Every medical setting should have a robust set of infection control protocols in place, and every member of the operating staff should be familiar with these protocols.

Please note that this post should not be used in place of infection control protocols. Rather, it should be used as a general guide to the sort of items that might factor into your protocols.

Operating Room Environment Measures to Control Infection

The operating theatre should be aseptic, highly-sterile, and restricted. The following measures can help prevent and control infection in operating theatres:

  • Proper ventilation with 20 air changes each hour.
  • Separate doors for entry and exit. Sliding doors can minimise air currents as people enter and leave the room.
  • The operating theatre complex should be properly zoned based on the levels of cleanliness, the presence of microorganisms, and the types of procedures carried out. There should be separate areas for preparation and disposal, for scrubbing and gowning, and for the storage, sterilisation, assembly and washing of materials and equipment.

Staff Clothing

All surgical staff must carry out a surgical hand wash before the procedure. This involves applying an antimicrobial agent in a circular motion, from the tips of the fingers up to about 5cm above the elbow. This rubbing should take place for at least three minutes.

When it comes to operating theatre clothing, use “barrier techniques” where the chances of infection spread are highest. Ideally, all operating theatre clothing should be disposable, and where possible, made from soft, nonporous materials.

  • Head covers – All facial and head hair should be properly tied and covered. Long hair should be tied into a bun.
  • Masks – Masks work to prevent the transmission of infectious agents from the operating team to the patient’s open wounds. They also protect the operating team from splashes and sprays from the patient. The masks should be disposable, made from synthetic materials, and properly fitted.
  • Scrubs– Scrubs should be comfortable and, if not disposable, they should be easy to wash and clean. They should have as simple a design as possible, to reduce the areas where contaminants could develop.
  • Gowns – When it comes to gowns, there should be a set procedure for applying them to reduce the risk of contamination. It’s a two-person job, in which both people should avoid touching the outside of the gown.
  • Gloves – Again, there should be a set procedure for applying gloves. It begins with a thorough handwash in aseptic conditions, after which you should avoid, as much as is possible, touching the outside of the glove with your bear hands.

Operating theatres must also use drapes to contain the operating environment, and to cover all parts of the patient apart from the operative site.

Surgical Equipment Cleaning for Infection Prevention

All operating theatre machinery must be surveyed at least once a week. Any fault should be reported to the infection control team, who can then take appropriate measures to maintain the infection control protocols.

Any reusable surgical instruments must be thoroughly cleaned before use. The reprocessing procedure might involve:

  • Cleaning – To remove any organic matter on the surface of the equipment. Some equipment may require soaking prior to cleaning.
  • Disinfection and sterilisation – Disinfection involves using appropriate chemical disinfection agents to reduce the number of microorganisms present. Sterilisation involves removing all microbes from the surface of the equipment, including spores, using steam, dry heat, ethylene oxide, or other chemicals. It’s usually necessary to wrap or package equipment before sterilising it.
  • Storage – Once processed, all surgical equipment must be properly stored in a sterile environment, and only handled again once it’s ready to be used on patients.

The specific cleaning procedure will vary depending on the type of equipment. For example, some surgical equipment can be cleaned and dried in an automated washer. Some instruments may require cleaning in an ultrasonic unit, after which they’ll need to go through a separate rinsing and drying procedure before they’re sterilised ready for storage.

Floor and Surface Cleaning in Operating Theatres

From floor to ceiling, all surfaces should be washable and with a minimum of joints. This will help reduce the accumulation of dust and other particulates.

Absorbent mats can also make a huge difference. They can capture fluids during procedures, making it much easier to dispose of them afterwards. This can vastly improve your turnaround times with no need to compromise on hygiene standards. They also dry quickly, which can help prevent slips and falls.

Essential Support for Infection Prevention and Control in Operating Theatres

We offer many services and solutions that can help you stay on top of infection prevention and control in operating theatres.

Our services include:

  • Air purification
  • Face-fit testing
  • Washroom hygiene solutions
  • Fluid management solutions, including floor mats
  • Comprehensive infection control solutions, including cleaning equipment, disposal containers, and sanitising chemicals

Our experts are always on-hand to discuss your needs. So if you’d like some guidance on infection prevention and control in operating theatres, get in touch to talk to an expert today.

 

How Many Standard Infection Control Precautions Are There?

The Standard Infection Control Precautions (SICPs) are a series of “must do” practices intended to reduce the risk of infection in care settings.

There are 10 standard infection control precautions. SICPS are for every patient, for every care setting, and for every time. And all members of staff should abide by them.

In this post we’ll list them, and explore how each SICP can help prevent infection.

Patient Placement, and Assessing a Patient’s Infection Risk

As soon as patients arrive at a care area, you must assess their infection risk. You must also continuously review their infection risk throughout their stay. Ideally, you should make this assessment before you accept a patient from another care area.

Your assessment should determine where you place patients in accordance with their clinical or care needs. For example, you should isolate patients who show a high risk of cross-infection as soon as they arrive. You should then work to establish the underlying cause of their infection through testing clinical samples, and through ongoing screening.

Hand Hygiene

There are numerous protocols for good hand hygiene. It largely comes down to three things:

  • What you use to wash your hands. Staff should have access to alcohol based hand rubs (ABHRs) as close as possible to the point of care. When your hands are visibly soiled or dirty, or when you’re caring for patients with conditions involving vomiting or diarrhoea, you should use water and non-antimicrobial liquid soap. When visiting patients in their own home, use whatever hand soap they have available, before applying some ABHR.
  • How you wash your hands. It should take you at least 20 seconds, and there’s a specific technique to ensure you get as thorough a clean as possible. When visiting a patient in their own home, you should use your own supply of disposable paper towels to dry yourself. Surgeons and those who work in certain other clinical fields usually have to abide by even stricter hand hygiene protocols.
  • When you wash your hands. There are five points at which you should perform hand hygiene: Before you touch a patient; after you touch a patient; after you touch a patient’s immediate surroundings; before you undertake any clean or antiseptic procedures; and after any body fluid exposure risk.

Respiratory and Cough Etiquette

Catch it, bin it, kill it. When sneezing, coughing, wiping or blowing your nose, you should cover your nose and mouth with a disposable tissue, before promptly disposing of that tissue in a waste bin. And immediately after this, you should follow the hand hygiene procedures outlined above.

If you don’t have any tissues to hand, use your elbow or sleeve to cover your nose and mouth when coughing or sneezing.

As for patients, if they’re showing any symptoms of respiratory illnesses, you should encourage them to wear a face mask. However, this must be a high-standard surgical face mask. Also, it must be clinically safe for the patient to wear a mask, and they must give their consent to wearing one.

In any case, you can help promote good respiratory and cough etiquette among your patients through providing tissues, plastic bags for disposal, and hand hygiene facilities.

Personal Protective Equipment

The personal protective equipment (PPE) you wear should provide adequate protection against the risks associated with whichever task or procedure you’re undertaking. So before any task or procedure, assess your likely exposure to blood, body fluids, and potentially harmful chemicals.

There are separate protocols for all the various different types of PPE, including gloves, aprons, gowns, masks, and goggles. But some protocols apply to all PPE:

  • All PPE must be located close to the point of use.
  • You must store PPE in a clean and dry area until you need to use it, and you must adhere to any expiry dates on the packaging.
  • Unless specified by the manufacturer, all your PPE should be single-use only.
  • You must change your PPE immediately after seeing each patient, and immediately following each task or procedure.
  • You must correctly dispose of all PPE immediately after use.

Safe Management of Care Equipment

Most care equipment is reusable, and it can quite easily become contaminated with infectious agents including blood and other bodily fluids. This SICP is essentially all about ensuring that you keep all reusable care equipment clean and well-maintained.

There are also protocols for single-use care equipment – for example, you should never use the same needle or syringe on more than one patient. And before using any sterile equipment, you should check that the packaging is intact, with no obvious signs of contamination, and that the expiry date’s valid.

Safe Management of Care Environment

In short – keep your care environment clean and tidy. The care environment should be visibly clean. It should be well-maintained and kept in a good state of repair. There should be no non-essential items or equipment on the premises that could prevent effective cleaning.

On top of this, you must commit to a cleaning routine that meets the appropriate regulatory standards.

Safe Management of Linen

Keep your clean linen in a clean, designated area. If you don’t have a dedicated enclosed cupboard, then you can use a trolley – but only if the trolley is used strictly for this purpose, and only if it can be completely covered with an impervious covering that you decontaminate regularly.

You should immediately categorise any linen you use during patient transfer. And you should ensure a laundry receptacle is available as close as possible to the point of use for the immediate deposit of any used linen. Never overfill laundry receptacles, and never place used linen anywhere but in the receptacle. Also, never dispose of anything else in the laundry receptacle, whether it’s an empty drink can or a used needle.

There are specific protocols for safely handling “infectious linen” – that is, linen used by a patient who is known, or suspected, to be infectious. You should have a dedicated receptacle for infectious linen. But before you place this linen in a receptacle, you should put it in a water-soluble bag, then put this bag into a second, plastic bag. Make sure any receptacles or bags you use for infectious linen is clearly marked, and make sure you store any infectious linen in a designated, safe, lockable area.

Safe Management of Blood and Other Body Fluids

Any spilled bodily fluid can transmit viruses. So you should decontaminate any spillages immediately, ensuring that only staff with appropriate training undertake this task. In every care setting, it should be clear who’s responsible for decontaminating any blood or bodily fluid spillage.

Safe Disposal of Waste

In each care setting there are four separate “waste streams”, with a different colour coding for each:

  • Black/Clear – This waste has trivial risk, and mainly includes domestic waste. The protocols specify that you must separate this waste at source into recyclable and non-recyclable waste.
  • Orange/Light Blue – This is low-risk or “laboratory” waste – items that have been contaminated, or that you suspect to be contaminated, with blood and other bodily fluids. When it comes to liquid waste, such as blood, you must first add a self-setting gel or compound before you dispose of it.
  • Yellow – High-risk waste that carries a risk of infection, contamination, or other forms of harm. For example, “anatomical and human tissue which is recognisable as body parts” must be placed in the yellow waste stream for “ethical” reasons. Sharps boxes – that is, boxes of used needles and syringes – are usually placed in the yellow waste stream. Their boxes must be clearly labelled with the date of assembly, the point of origin, and the date of closure.
  • Red – The red waste stream is for “special waste”, including chemical waste.

Occupational Safety

The tenth SICP is all about prevention and exposure management. It’s all about taking immediate corrective action if you’re injured in the care setting, or if you’re exposed to blood and bodily fluids.

A lot of this comes down to effective disposal of sharps. Each care setting must have arrangements for the safe use and disposal of sharps, and they must provide appropriate training to all employees.

It’s also about understanding the risks of occupational exposure – when and how it might happen, and the steps you must take when an occupational exposure incident takes place.

We offer an expert workplace exposure monitoring service that will ensure you meet your COSHH obligations wherever your staff are exposed to hazardous substances in your care setting.

Our fully-accredited consultants will manage the work for you, eventually providing a comprehensive report that includes discussions and recommendations based on our findings.

Head here for more information on COSHH workplace exposure monitoring, to talk to an expert, or to get a quote.