Health & Safety in Operating Theatres – Hazards & Precautions

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Just like any other working environment, working in an operating theatre comes with numerous occupational hazards. However, in an operating theatre, these hazards can mean life or death. Even the smallest accident could seriously jeopardise the patient’s safety.

The question of health & safety in operating theatres is a deep one. Organisations such as the National Institute for Health and Care Excellence (NICE) regularly produce extensive documents advising on theatre safety on both an operational and a managerial level.

So in this post, we’ll provide an essential overview of the sort of hazards theatre staff may face, and the sort of precautions that could help them manage risk. Please note that in this post we’ll focus on staff safety rather than patient safety.

Also be sure to check out our introduction to improving quality and efficiency in operating theatres.

Common Hazards in Operating Theatres

Speaking as broadly as possible, we might categorise the common hazards staff face in operating theatres as follows:

  • Accidents, including slips, trips, and falls.
  • Exposure to hazardous substances.
  • Contamination and infection.

Let’s look at each of these hazards in turn, along with some of the precautions that could help prevent accidents.

Accidents in Operating Theatres – Slips, Trips and Falls

Just like in any other workplace, operating theatre staff can slip on spilled fluids, or trip and fall on a loose wire or a misplaced bit of equipment.

One of the many recommendations made in the NHS Productive Operating Theatre strategy concerns the layout of operating theatres. They advise removing any non-essential items from the area, and assigning each object a set place in the room.

These recommendations are primarily in place to ensure operational efficiency. If everyone knows where everything is, then operations can proceed with fewer interruptions.

But a well-ordered operating theatre is also a much safer operating theatre. If there are no non-essential items in the area, and if everything is in its right place, then in theory there’ll be no obstacles for theatre staff to trip over as they carry out their work.

The Importance of Good Theatre Hygiene

The guidelines also recommend regularly cleaning and maintaining the operating theatre environment. This is mainly for patient safety, to reduce the risks of infection. But it can also contribute to staff safety. Promptly cleaning any fluids spilled on the floor makes it less likely that anyone will slip and fall.

The right equipment can make a huge difference here. For example, non-drip absorbent operating theatre floor mats can soak up any spilled fluids before they become a health and safety hazard. Then, after the operation, they can simply be picked up, discarded and replaced. This will reduce the turnaround time between operations while also removing the need to mop, so staff won’t have to worry about wet and slippery surfaces.

Exposure to Hazardous Substances

Operating theatre procedures make use of a number of substances which can pose a health hazard  if staff are exposed to them for long periods.

A key culprit in the operating theatre is Isoflurane, which anaesthetists use to maintain a state of general anaesthesia. If inhaled in its vapor form, Isoflurane can cause headaches, dizziness, and fatigue. But long-term exposure can lead to chronic health conditions, including renal, hepatic, and reproductive disorders.

Like all potentially hazardous substances, so long as it’s properly stored, and so long as your equipment is properly maintained, then Isoflurane should pose no problems. But as the substance is so volatile, even the smallest spillage or leak poses a health hazard.

Prevention, and the Cure

Another key recommendation in the NHS Productive Operating Theatre strategy is to stay on top of your equipment maintenance. Again, this is primarily to ensure patient safety, as you cannot depend on faulty equipment to do the job you need it to do. But it’s also to ensure staff safety, to ensure that, for example, any leaks are fixed before they pose a problem.

Wearing adequate PPE when handling or cleaning substances will also help you manage this hazard. But for total peace of mind, get a workplace exposure monitoring report for any area of your hospital where staff are exposed to hazardous substances.

A comprehensive report will include clear and actionable recommendations, so you’ll know exactly where the risks lie and exactly what to do to protect your staff.

Contamination and Infection in Operating Theatres

Infection control measures in operating theatres put the patient’s needs first, as surgical site infections (SSIs) account for around 20% of all hospital-acquired infections.

But of course, any measure that protects patients from infection will also protect staff from infection.

Operating theatres must be aseptic, highly-sterile, and restricted environments. Achieving this requires good air ventilation, strategic zoning, and numerous infection control precautions.

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

PPE also plays a huge part in protecting both staff and patient from infection. It’s not just a question of selecting the right PPE for the task at hand. Just as important is applying and removing the PPE in the correct order.

Health and Safety in Operating Theatres – Essential Support, Solutions, and Guidance

We offer many services and solutions that can help you stay on top of health and safety in the operating theatre.

Our services include:

  • Air purification
  • Face-fit testing for PPE effectiveness
  • Workplace exposure monitoring services
  • Washroom hygiene solutions
  • Fluid management solutions, including absorbent floor mats
  • Cleaning equipment, disposal containers, and sanitising chemicals

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

 

How to Remove PPE in the Correct Order

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Personal Protection Equipment (PPE) is an integral part of effective infection control in all healthcare settings.

We covered the various types of PPE that exist in our guide to infection control in operating theatres. We also explored some of the protocols concerning PPE in our guide to standard infection control precautions.

In this post we’ll explain how to remove PPE in the correct order to help prevent and control infection. Please note that we intend for this to act as a general introduction to the guidelines, and why they exist. For a complete guide to how to remove PPE in the correct order, please consult your hospital’s infection control protocols.

How To Remove PPE in the Correct Order

You should remove PPE in an order that minimises the risks of cross-contamination. You should remove PPE in a designated area, and dispose of it using designated receptacles.

For this guide, let’s assume you’re wearing the standard PPE healthcare workers used for infection control throughout the COVID-19 pandemic: an apron or gown, a visor (or goggles) for eye protection, a face mask, and gloves.

The Order For Removing PPE

  • Start With The Gloves. First, grasp the outside of one glove with the opposite gloved hand. Peel it off slowly, holding the removed glove in your other gloved hand. Then slide the fingers of your ungloved hand under the remaining glove at the wrist, before peeling it off. Discard of the gloves as orange clinical waste, then perform the standard hand hygiene protocol.
  • Next comes the gown. Break the straps at the neck, allowing the gown to fold forward on itself. Then break the waste straps at your back. Fold the gown in on itself, then fold or roll it into a bundle before discarding. Take care not to touch the outside surface of the gown, and clean your hands again having discarded it.
  • Eye protection comes next. Don’t touch the front of the eye protection. Only touch it by the headband, or the sides. If your eye protection’s disposable, place it in the orange clinical waste receptacle. If it’s reusable, place it in the appropriate receptacle for decontamination. Having disposed of the eye protection, clean your hands again.
  • Finally, your face mask. If you’re wearing an elasticated mask, remove it by pulling the loops over your ears. If you’re wearing a tied mask, untie or break the lower straps first, then the upper straps. In either case, only hold the mask by the loops or straps, and discard them as orange clinical waste. After this, wash your hands once more.

Please note – these are general guidelines for general health practitioners. Different healthcare settings, such as operating theatres, require different types of PPE, and there will be different protocols for both applying and removing this PPE.

Best Practice for Infection Control in Healthcare Settings

PPE is only effective if it fits correctly. We offer a specialist face fit testing service to help you ensure that your entire healthcare team can depend on their facial coverings for maximum protection. Head here for more information about Face Fit Testing.

We also stock a comprehensive range of infection control products for hospitals and other healthcare settings. Head here to browse our range of infection control solutions.

Improve Quality & Efficiency in Operating Theatres

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Improving quality and efficiency in operating theatres brings a range of benefits in both the short-term and the long-term:

  • Reduced turnaround time between procedures.
  • Improved patient care and infection control.
  • Happier and more motivated staff.
  • Huge financial savings – The NHS Institute for Innovation and Improvement estimates that a more productive operating theatre can help the average trust save more than £7 million.

How Much Do Operating Theatres Cost to Run?

Various sources suggest that operating theatres cost between £560 and £1,200 an hour to run. However, there is no recent data available and most sources date back to around 2015. Costs are likely to have risen significantly since then, especially when you take increases in energy costs into account. Improving quality and efficiency in operating theatres comes down to making the absolute most out of all available time and resources. It’s also about understanding the costs associated with downtime.

How to Create a More Productive Operating Theatre

A productive operating theatre is optimised to improve a patient’s experience and outcomes. There are three key areas to focus on to achieve this:

  • Team performance and staff wellbeing
  • Safety and reliability of care
  • Value and efficiency

First, you need to assess how your operating theatre is managing right now.

How to Audit your Current Operating Theatre Practices

Start with a comprehensive audit of your operating theatre practices. The NHS Productive Operating Theatre strategy recommends that financial leaders should commit to a walk-around of their operating theatres to better understand the issues that frontline staff face every day.

The aim is to assess the operational status of each theatre in your trust. Here are some areas to focus on:

  • Is all the necessary equipment available and working?
  • Are the right staff in the right place at the right time?
  • Do operating lists start on time? If not, how often are they delayed, and by how much time are they delayed on average?
  • How often does the theatre face cancellations and delays?
  • Do operating lists finish on time?

Obviously, all theatres will encounter unexpected issues from time to time. But when they do, the operating team should be equipped to identify and escalate issues in a timeless and efficient manner. And when faced with a problem, all plans should be flexible enough that you can make small adjustments to get the day back on schedule.

What Does a Well-Organised Theatre Look Like?

In a well-organised operating theatre, everything and everyone is in the right place at the right time, and ready to go whenever needed.

To work towards a well-organised theatre, the NHS Institute for Innovation and Improvement recommends a system called 5S: Sort, set, shine, standardise, sustain.

  • Sort – Remove any non-essential items from the area.
  • Set – Assign each object an ideal area in the room and organise all the necessary materials and equipment so that it’s easy to access.
  • Shine – Regularly clean and maintain the operating theatre environment.
  • Standardise – Once you establish procedures for maintaining orderly, clean and functional work areas, decide how similar areas can be arranged in the same way.
  • Sustain – Commit to regular audits to ensure that everyone maintains the high standards you set.

How to Reduce Waste in Operating Theatres

The NHS Institute for Innovation and Improvement identifies seven key sources of waste in operating theatres:

  • Defects and rework. If you don’t provide the correct information in the first place, or if your processes are faulty, the operating team will have to repeat certain procedures to ensure they’re done right.
  • If things are not within easy reach, or if they’re not easily accessible, operating teams will have to spend more time than necessary searching for what they need. Also, if the operating theatre isn’t properly organised, people will have to move, walk, and travel much more than necessary.
  • Either people produce more than what is needed, or they produce things earlier than necessary for the next process.
  • Are you moving any materials that really don’t require moving?
  • If staff don’t get the equipment, information, or support they need when they need it, they’ll have no choice but to wait. And when they’re waiting, they’re not working.
  • In an inefficient operating theatre, there’ll be more stock than necessary, too many processes taking place at once, and too many patients waiting in a queue.
  • Over-processing. Everything every member of the team does in an operating theatre should add value. In an inefficient operating theatre, there’ll be an excess of unnecessary steps that don’t add value, they only serve to waste time, motion, and resources.

Improving Patient Preparation and Turnaround

Poor patient preparation can cause a lot of stress, anxiety and uncertainty for both the patient and their relatives. But on an operational level, poor patient preparation can also result in late starts, costly changes to the list order, multiple delays, and even potentially harmful errors and mistakes.

In a well-organised operating theatre, every patient will arrive in the theatre prepared for surgery:

  • At exactly the right time.
  • With an identity band in place, and with all their notes complete and accessible.
  • Fully-informed and consented.
  • With their operation site marked.

Efficient patient turnaround means that not a single second is wasted between the end of one surgical procedure and the start of the next. This can involve several processes occurring at the same time, including:

  • Handing over the patient to recovery staff.
  • Clearing away instruments and cleaning the operating theatre environment.
  • Setting up all instruments and equipment for the next procedure, including the anaesthetic equipment.
  • Performing the check-in and sign-in procedures for the next patient.

Operating Theatre Consumables and Equipment

As we’ve seen, a crucial aspect of a productive operating theatre is that everyone needs to be able to access the equipment they need, when they need it. Nobody should ever have to stop a process to search for the necessary equipment, and nobody should ever find that their equipment is broken, faulty, or out of date just when they’re about to use it.

Also, the theatre team should always have all the equipment they need to cover the number of scheduled procedures. And there should never be any issues concerning skills and competency when using new equipment.

The choice of equipment in an operating theatre can also make a huge difference to efficiency. For example, the right sort of absorbent operating theatre floor mats can help manage health and safety risks while simultaneously improving operational efficiency. As non-drip mats can be picked up and discarded, doing away with the need to mop floors, operating teams can significantly reduce the turnaround times between procedures without compromising on hygiene standards.

Improving Quality and Efficiency in Operating Theatres – Full Guidance

The Productive Operating Theatre 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.

You can download a suite of modules covering every aspect of a productive operating theatre, including equipment and consumables, patient preparation and turnaround, the handover procedure, and effective teamwork and procedure scheduling.

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

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.

 

Current Issues in Operating Theatres

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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?

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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.

 

Introduction to the WHO Surgical Safety Checklist – 5 Steps

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The World Health Organisation (WHO) first published their Surgical Safety Checklist in 2010. It’s a series of five critical steps that surgical teams should perform before and after surgical procedures to reduce the risk of certain adverse events.

The WHO claims that the Surgical Safety Checklist has reduced surgical complications and mortality by over 30%. Any surgical team around the world can perform the checklist in under two minutes. It’s designed to be affordable and sustainable, so that even surgical teams in low and middle income countries can adopt it.

What Are The 5 Steps to Safer Surgery?

The 2008 WHO Surgical Safety Checklist is essentially a process for improving communication between surgical teams. It involves five steps:

  1. Briefing
  2. Sign in
  3. Time out
  4. Sign out
  5. Debriefing

Step 1 – Briefing

The aim of the briefing is to confirm the order of the operating list, to delegate tasks and to confirm that everyone knows their role during the procedure.

The whole surgical team should receive a thorough, focused and supportive briefing before any procedure. They should feel free to ask any questions and raise any concerns they might have. Senior staff members should actively welcome queries from junior staff members.

The briefing should take place in a quiet room with a closed door, so as to ensure patient confidentiality. Any member of the team can lead the briefing, and they must encourage an atmosphere of open communication.

The briefing should begin with all members of the team introducing themselves. When discussing the patient, they should be referred to by name. Next should be an overview of the operating list – and all members of the team should have received a copy of this before the briefing. In this way, they can consider any questions or concerns in advance.

Step 2 – Sign In

The aim of the sign in is to ensure that all necessary preparations for surgery have been made, and that it’s safe to introduce anaesthesia. So all other activity must stop before the sign in, to allow the anaesthetist and Operating Department Practitioner (ODP) to give it their full attention.

The sign in process is a series of questions:

  • Has the patent confirmed their identity, site, procedure and consent?
  • Is the site marked?
  • Is the anaesthesia machine and medication check complete?
  • Does the patient have a known drug allergy?
  • Does the patient have a difficult airway, or an aspiration risk?
  • Is there any risk of blood loss?

These questions should be read aloud, and where necessary, the patient should be involved in the discussion. If any item in the list needs clarifying, then it must be done immediately, and the sign in process should be repeated from the beginning.

Anaesthesia should only commence once the sign in is complete, with all discrepancies resolved.

Step 3 – Time Out

The aim of the time out is to ensure that the surgical team is undertaking the correct procedure on the correct patient, and that all the correct measures are in place to prevent harm.

As with the sign in, all activity must stop to allow the team to focus on the time out. It should begin once the patient has been safely positioned with all necessary monitoring attached.

This is another series of questions which, again, should be read aloud – from the list, and not from memory:

  • Confirm that all team members are present, and that all have been introduced by name and role.
  • Confirm the patient’s name, procedure, and incision site.
  • Anticipate critical events for the surgeon, the anaesthetist, and the nursing team.
  • Ensure that all essential imaging is displayed, including X-rays, CT scans, and MRI, to reduce the risk of wrong-site surgical marking.

Surgery should only commence once the time out process has been successfully completed.

Step 4 – Sign Out

The aim of the sign out is to ensure that the surgical procedure has been completed in its entirety and documented accordingly. This step also ensures the patient’s ongoing safety beyond the theatre.

Again, all activity must stop to allow the whole team to focus on the sign out, and the sign out must be completed before any member of the team leaves the operating theatre. The patient should also remain in the theatre until any discrepancies have been resolved.

It’s once again a case of reading a series of questions aloud from a list. A surgical nurse should begin by verbally confirming the name of the procedure, before conducting thorough instrument, sponge and needle counts.

Then comes the specimen labelling process, and the nurse should read all specimen labels aloud, including the patient’s name. They should also confirm whether there are any equipment problems to address.

Finally, the surgeon, anaesthetist and nurse should confirm the key concerns for the patient’s ongoing recovery and management.

Step 5 -Debrief

The aim of the debrief is to allow the surgical team to review their performance, to identify achievements along with any areas that may need improvement.

Like the initial briefing, the debriefing should be attended by everyone. The atmosphere should be professional yet open, welcoming, and supportive.

If any actions are identified, there should be a clearly identified person appointed to deal with it. This way, everyone will know their responsibilities, which will make it much more likely that any problems will be addressed.

More Resources for Safer Surgeries

You can download a copy of the Surgical Safety Checklist from the WHO’s website. The WHO’s site also has a number of instructional videos outlining how to use the checklist, and how not to use it.

We also have a guide to standard infection control precautions in healthcare settings, and a guide to cleaning for infection prevention and control in operating theatres.

Finally, head here to read our guide to selecting the correct surgical instrument for procedures.

Want to talk about how we can help you ensure operational effectiveness in the theatre? Get in touch to talk to one of our experts today.

 

Cleaning for Infection Prevention and Control in Operating Theatres

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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?

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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.

Will Workplaces Change Forever Post-Covid-19 Pandemic?

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As businesses begin to reopen and people return to work, the question is, will workplaces in the UK ever be the same again?

Office Design

Office design has been big business for years, with firms trying to make the maximise capacity in increasingly clever and cool ways. Breakout areas for staff to collaborate away from their desks have been popular, along with communal lunch areas and recreational facilities to provide a break from intensive and intricate tasks.

Social distancing rules now mean that offices simply cannot be so densely populated, and that staff should be mixing as little as possible, with hot desking a complete no no.

Start and Finish Times

There are other perils of the workplace, the first being the entrance and exit. Large number of workers starting and finishing at the same time and accessing the workplace through the same entrance is a social distancing headache.

The immediate answer as suggested in a recent article in The Economist¹ is introducing office shifts, staggered start and finish times, some staff working from home but is this realistic in the long term?

The press widely reported the viewpoint of Jes Staley, Chief Executive of Barclays when he said that big, expensive city offices, “…may be a thing of the past.” He added that the bank was evaluating how much office space it needed.²

Cleaning and making a safe place to work

Big or small, there will always be a need for offices as workplaces. Once inside, office based staff must have confidence that it is a safe place to work. Cleaning must be more often, more thorough and using appropriate products. All high traffic touch points must be cleaned with virucidal disinfectant, and staff must take responsibility for their own personal hygiene with regular hand washing and sanitising becoming the norm.

Employers must take all possible steps to reduce the risk of infection. A recent article by Comparative Immunologist and Professor of Biology, Erin Bromage³, shows how breathing the same air in an enclosed space increased the chance of exposure and infection. Air purification can remove up to 99.99% of viruses from the air, along with bacteria, allergens, and outdoor pollutant as such as diesel particular which become trapped indoors. This is a simple but effective step that all businesses could take to safeguard their workforce. An air purifier, such as the Blue Air Classic can simply be plugged in and within an hour, the air in the room is clean.

The short answer to the question will workplaces in the UK ever be the same is no, it is unlikely. However, we will have leaned valuable lessons not just in the fight against COVID-19, but in the responsibility of businesses to provide a safe working environment.

1. https://www.bbc.co.uk/news/business-52467965

2. https://www.economist.com/business/2020/05/09/dont-stand-so-close-to-me

3. https://www.erinbromage.com/post/the-risks-know-them-avoid-them?fbclid=IwAR3-Xd9U7-62VWsy0hFq6XgUWpCwK_Z5jr1zPMSfrMtukAkZLlJ_oFZ5t7w

Return To Work After Covid: Duty of Care & Sanitation

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Throughout the Covid-19 pandemic, there’s been a range of different rules and recommendations for the workplace. It was often difficult to make concrete plans until the government released their own plans and recommendations at different stages. But many business owners and managers are already thinking about how it might work and what procedures they’ll want to keep for the long term.

Duty of Care in the Workplace

What is apparent is that employers will have a duty to provide a safe working environment in which their team feels confident. This will be done through a combination of staggered work times, distancing in the workplace, strict sanitation rules and enhanced cleaning programmes.

Infection Control and Sanitation at Work

As infection control specialists, we have supported the medical and care sectors for decades, with advice, cleaning schedules and high level cleaners and disinfectants. We are a tried and tested partner in the prevention and containment of infection.

More recently this has extended to businesses, and we’ve been using our expertise to keep things moving pre-lockdown and now getting them back to work.

Cleaning Products for Viruses in the Workplace

You’ll want to ensure the cleaning products you use in the workplace are adequate and able to disinfect surfaces effectively and with long-lasting protection. Our virusidal, microbial and sporicidal Virusolve+ products are independently lab tested and proven to be effective against a wide range of common viruses, bacteria and even superbugs. This includes COVID-19, ‘Flu, Norovirus, MRSA, C.Diff, Hepatitis, E.Coli, Salmonella, and many, many more.

Not only that, in its ready to use form Virusolve+ is non hazardous. It is Defra approved for use in food preparation areas, and CQC approved. It also has a residual effect which can continue to work for up to seven days. It is the ideal product to use in a workplace to keep staff safe and comes as a liquid, spray or in a wipe format.

Installing Hand Sanitiser in the Workplace

Now workers are back in the office, hand sanitiser will be a crucial way to help stop the spread of viruses and bacteria in the office. The Virusan hand sanitiser we recommend comes as a liquid or gel and these products will be vital in workplaces to ensure good personal hygiene practices. Again, businesses can rest assured that these are hospital grade products, and of the correct standards to safeguard staff.

As government plans unfold and change, new requirements will become apparent, but for businesses planning now, please contact us for infection control advice and guidance.

Email: info@cairntechnology.com Tel: 0845 226 0185