A Critical Step Missed During Design!

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Recently, I read a great article in the Wall Street Journal's May 29th issue, titled “The Operating Room of the Future.” The article highlighted the expanded operating room with more technology (such as imaging equipment) that allows for minimally invasive treatments – or when necessary, more invasive surgeries – without the need to move the patient and team to a different OR. The additional technology allows physicians to tap into big data during and after procedures to get guidance and analysis in real time. I'm sure everyone agrees that these current trends of minimally invasive outpatient surgeries, faster recovery times and fewer complications are benefits to both patients and the medical teams treating them. I'm even more certain that healthcare facilities are very supportive of increasing the number of patients that take advantage of this technology and new way of treatment. 

No silver bullets.

I want to urge all members of the design team to add more healthcare professionals to the discussion BEFORE construction begins. There is more to evaluate. Operating rooms are critical areas that turnover quickly from one case to the next. Typically, those responsible for doing this work to get the time down to around 9 or 10 minutes. Pathogens can’t be seen and a quick turnover between patients leaves potential risk for the next. To ensure this can be disinfected and prepared effectively and efficiently requires evaluation. BEFORE construction begins. Manufacturer partners, environmental services, infection preventionists, and facilities professionals must evaluate the time it takes to effectively clean, disinfect and when necessary sterilize equipment before the next patient.

Pathogens can’t be seen and harbor on handles, on cords, in cracks, creaves, and damaged surface areas. In many cases, the disinfectants used in this environment can damage equipment. Within the article, there are only two minimal references to infection prevention – the terrazzo floor and a photo caption stating, “…it aims to be more versatile, reduce infection risks, and improve the surgical team’s views and workflow.”  How is it going to reduce infection risk? A terrazzo floor is not a silver bullet solution, and there is so much more to infection prevention.

According to a recent report from the Center for Disease Control (CDC), Surgical Site Infections (SSI) were the most common healthcare-associated infections (HAI), representing 31% of all HAIs among hospitalized patients.  This means someone from Infection Prevention needs to be at this table. Now. Before it’s too late.

Cleaning is only step one.

Cleaning, disinfecting and sterilizing surfaces within the operating room environment are absolutely critical. Invasive procedures leave patients at higher risk of infection. This should not be taken lightly! Look at and think about the many different surface materials, textiles, and assemblies in this environment. Medical devices, carts, cords, supply carts, X-ray equipment, lights, walls, floors, countertops just to name a few. Looking at this environment with the requirement for cleaning/ disinfecting and sterilizing BEFORE finalizing the design and during the mock-up evaluation phase is critical so you have a clear picture of what will be required to provide a sterile environment for the next case.  So, before construction begins, the below question needs to be forefront in everyone’s mind:

Can this OR, with all of this technology, be cleaned, disinfected and sterilized (microbes killed and removed) quickly in the 10–20 minutes allotted between cases?

Manufacturers can provide answers to these questions:

  • What disinfectant products are required? (Not all surface materials and products can be cleaned and disinfected in the same way with the same products.)

  • What are the manufacturer warnings for disinfectant products?

  • Are they all compatible with the combined surface materials used on any one product?

  • Was a surface disinfection compatibility testing performed in conjunction with the specific disinfectant products currently being used in the facility? Can the product be required?

Infection Prevention experts must evaluate and make recommendations for:

  • Changes to products, processes, or protocols may be required to provide a safe, sterile environment for the next patient based on this new technology and configuration.

  • Testing protocols to validate infection prevention effectiveness that includes a microscopic evaluation of surface integrity.

  • Specific roles for each team member to support effective infection prevention.

  • Comprehensive plans to ensure the safety of every single person in that OR.

Everyone has the goal to mitigate HAI’s and ultimately save lives. A proactive approach not only includes the development of technology and the design of the OR space. It also must include an understanding of what infection prevention process, products, and protocol will be required.  The only way to do that is to bring in the teams to test and validate before construction, and again before the OR opens to patients.