Head lice; formaldehyde storage; chewing gum in the OR; building design

AORN Journal, March, 2000 by Ramona Conner

The OSHA standard requires that employers

* provide protective clothing and equipment, including goggles, face shields, and gloves;

* provide emergency showers;

* provide eye wash facilities in the immediate work area (bottle-type eye washes are not acceptable);

* label all containers of formalin; and

* provide employee education and training.

A spill or other accident involving formalin in the OR would be difficult to contain. The risk of hazardous exposure of formalin to patients and health care personnel should be minimized in any way possible. In many facilities, the surgical specimen is taken in an empty container directly from the OR to a centrally located room where the prefilled specimen containers are kept. The specimen is placed in the container in the room where formalin can be used and safely stored and the risks of hazardous spills are minimized. For additional information on the OSHA standard, contact OSHA at (202) 219-8036 or visit the OSHA web site at www.osha.gov.

Question: We have several staff members and physicians who chew gum in the OR and during procedures. I do not think that this is a good practice, but I am not sure why. Is this acceptable? Does AORN have a recommendation regarding this practice?

Answer: AORN does not have an official recommended practice that addresses this issue; however, we believe the practice should be avoided. The movement of the jaw beneath the surgical mask causes friction between the skin and the mask. This friction can cause shedding of the epidermis, known as scuff. The scuff can become airborne, be transported to any area of the surgical field, and can fall into the open wound.

The surgical mask serves to collect bacteria from the nasopharyngeal airway of the wearer. With the chewing motion and excessive talking, exhaled droplets containing bacteria are more likely to be expelled into the environment.(17)

Question: We are in the process of building an ambulatory surgery center, and the architect has proposed puffing scrub sinks inside the OR. I have never heard of this, and I think it would be a problem from an infection control standpoint. People involved with the change also have proposed placing a door to the outside from the restricted OR corridor to exit patients in an emergency. I have serious concerns about this. They are planning to have the changing rooms near the admitting area with an exit into the admitting corridor and one exit into the sterile hall. They really do not want nurses' input, but they clearly need help! What is AORN's position?

Answer: You are absolutely correct that this would be a serious breach of basic infection control practices. Scrub sinks should never be located in the OR and should be arranged in an area to minimize incidental splatter on nearby personnel, medical equipment, or supplies. Scrub sinks should be recessed into an alcove out of the main traffic areas. The alcove must be located off the semirestricted or restricted areas of the surgical suite. Scrub sinks must be located outside the sterile core.(18)