Best practices in OR suite layout and equipment choices to reduce slips, trips, and falls

AORN Journal, Sept, 2007 by George Brogmus, William Leone, Lorraine Butler, Edward Hernandez

Same-level slips, trips, and falls (STFs) are second only to overexertion as a leading cause of workplace injury, accounting for nearly 14% of all workers compensation costs. (1) In health care facilities in 2005, same-level STFs accounted for 20% of all lost-time injuries (ie, injuries requiring at least one day away from work). (2) Although STFs occur in many places throughout a hospital, the perioperative suite is of special interest because of the critical nature of the work that occurs there. An STF that disables a worker is expensive in terms of direct and indirect costs, but a disabling fall to a member of an OR team can result in adverse patient consequences as well. A fall in the OR can cause direct patient injury, disrupt the surgical procedure, contribute to surgical errors, or delay the current surgery and future surgeries while other staff members attend to or replace the injured staff member.

Controlling same-level STFs is not a matter of improving on a single feature of a safety program; rather, it involves conducting a comprehensive evaluation of many elements and making corresponding improvement where needed. (3) This involves consideration of obvious elements, such as slip-resistant floor surfaces, slip-resistant footwear, contaminant control (eg, of liquid spills), and reduction of tripping hazards. It also involves consideration of more subtle, yet potentially critical elements such as floor cleaning methods, room and equipment lighting, room and equipment colors and markings, use of slip-resistant mats, stair and ramp design, incident investigation policies and procedures, training, and use of warning signs or barricades. All of these elements can play a role in preventing perioperative STFs.

One aspect of controlling perioperative STFs that has not been addressed specifically in the literature is the potential effect that perioperative suite layout and equipment choices can have on STF accident risks. The increased renovation of ORs to accommodate equipment for more minimally invasive surgery (MIS) procedures makes this a particularly relevant topic. This article examines some of the best practices in OR layout and equipment choices that are likely to help reduce the potential for STFs.

There are seven important issues that should be considered for reducing STFs in the OR. These include

* minimizing tripping hazards;

* maximizing view of the floor and equipment and enhancing floor and equipment lighting;

* ensuring adequate room space (eg, footprint, shape, volume);

* controlling contaminants, including the proximity and adequacy of waste containers;

* ensuring OR team efficiency;

* minimizing fatigue; and

* ensuring participative design (ie, designers such as architects, engineers, builders, and hospital administrators collaborate on OR design decisions with perioperative department end users such as surgeons, circulating nurses, and scrub technicians).

MINIMIZING TRIPPING HAZARDS

The three main sources of tripping hazards are cords and cables, low profile equipment and supplies, and protective and absorptive mats. Excluded from this list is a common tripping hazard in general industry that is or should be unlikely in the OR--floor incongruities greater than 1/4 inch. Such incongruities include dam aged floor surfaces and changes in elevation between different floor materials or rooms (eg, door thresholds). Some older ORs may have door threshold issues, but it is expected that in all but the most run-down ORs, floor surfaces will be in good condition.

Cords and cables are necessarily used in surgical environments (Figure 1), but these cords and cables should not stretch across walking paths. Even an OR that has articulating ceiling-mounted booms that should help keep cords off the floor and improve ergonomics may have cords lying across a potential walking path and equipment on the floor in that path. (4) The primary control for cords and cables is preplanning. In addition to thoughtful routing of cords and cables, techniques such as securing cords by bundling, taping or braiding, or suspending cords and cables from the ceiling can help minimize problems. Such routing and securing techniques benefit personnel, and ultimately the patient, in addition to reducing STFs. (5) Routing and securing cords benefits personnel by making it easier to check that all necessary cords are properly connected, and it benefits the patient because it is less likely that the patient will be injured or the procedure prolonged because someone trips on a cord. Increased use of telemetry and systems that integrate cables into the OR bed or overhead booms also helps reduce STFs.

Any low-profile equipment or supplies can be a potential tripping hazard, including buckets; rolling stools; step stools; support structures for equipment (eg, Mayo stand legs); and boxes of supplies. In addition, even though protective and absorptive mats play an important role, they also can become a tripping hazard. For secure placement, absorptive mats that are designed to be slip-resistant and stay in place should be selected over absorptive materials that are not slip-resistant. Furthermore, soiled absorptive mats should be removed if they present a tripping or slipping hazard. A mat that is oversaturated with fluids can lose its slip resistant properties. In addition, oversaturated absorptive mats can swell, presenting a tripping hazard.