Perioperative use of the hands-free technique: a semistructured interview study

AORN Journal,  August, 2006  by Bernadette Stringer,  Ted Haines,  C.H. Goldsmith,  Jennifer Blythe,  Kenneth A. Harris

• E-mail
• Print
• Link

HOW THE HFT IS IMPLEMENTED. Respondents indicated that the HFT was implemented in a variety of ways. At times, neutral zones were established on conveniently placed Mayo stands. At other times, basins placed on Mayo stands were used as neutral zones, and sometimes basins that were passed back and forth were identified as neutral zones. Some surgeons preferred that stable parts of the surgical field be designated as safe zones, whereas others wanted magnetic pads placed on these sites. One surgeon who used the HFT most of the time reported that placement of the Mayo stand depended primarily on nurse preference, except during laparoscopic surgery when instruments had to be deposited on the surgical site because the scrub person stands away from the site.

Nurses reported establishing neutral zones using similar methods to those of surgeons. One scrub person specified that sharp instruments were placed in trays so that the sharp ends pointed away from the surgeon. Four nurses used towel-lined basins as neutral zones. Three nurses passed basins containing sharp instruments to surgeons, and one nurse described using "a basin lined with a towel, with the scalpel placed inside." At the beginning of each procedure, this nurse picked up the basin from the Mayo stand and passed the knife

   in the basin to the surgeon, who
   places the basin down on the sterile
   area of the patient. The surgeon
   returns the scalpel blade into the
   basin [placed] at the edge of the incision
   site. I return [the blade] to the
   back table in the basin. We only use
   the HFT for the knife.

BARRIERS AND FACILITATORS TO USING THE HFT. The HFT was used most of the time by almost half of the respondents (ie, four surgeons and five nurses) when patients were known or suspected to be infected with hepatitis or HIV. Nurses reflected on this differential treatment by stating,

* "If we have a high-risk patient, [we] don't take as many chances,"

* "... we use HFT for hepatitis cases and stuff like that," and

* "We're extra careful when we have known that the patient had HIV or hepatitis."

The most common reason given by surgeons for using the HFT in these circumstances was for their safety and that of their coworkers. One surgeon stated, "I've been stabbed before [during such cases]."

The two surgeons who used the HFT most of the time reported that a decrease in surgical time was one possible facilitator to its use. Surgeons also said that nurses who had spontaneously decided to implement the HFT were another important facilitator to its use. The two surgeons and one nurse who commonly used the technique identified the following barriers to HFT use:

* a surgeon's unwillingness to shift his or her gaze from the surgical field;

* a perioperative nurse's lack of knowledge about the technique;

* a lack of available equipment for HFT implementation (ie, magnetized rubber mats);

* inability to establish a neutral zone in a convenient location;