Brooms/dust mops; damp dusting; counting endo bags; scrub person sitting; sterile storage; navel prep - Clinical Issues

AORN Journal,  April, 2002  by Ramona Conner

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Question: Is it recommended practice to sweep up trash and debris with a broom or a dry dust mop after a procedure In the OR before mopping or using the wet vacuum? If so, how are they cleaned?

Answer: Brooms or dry dust mops should not be used in the restricted or semi-restricted areas of the OR suite. Brooms cannot be cleaned and could easily harbor infectious organisms. Although dry dust mops can be cleaned, they increase airborne contamination by raising dirt and dust into the air. The surface of a dust mop is dry and not moistened with a disinfectant before use; therefore, it may spread contaminants to other areas of the floor rather than picking up the dirt and debris.

Wet vacuuming is the preferred method for floor cleaning in the OR, especially for procedures with large amounts of fluid and debris on the floor. If wet-vacuum equipment is not available, freshly laundered mops moistened with disinfectant may be used. If the floor is heavily soiled, it can be flooded with a detergent-disinfectant solution. One mop is used to apply solution, and one is used to take up solution. After one-time use, mop heads are removed and placed in a laundry hamper with other contaminated, reusable woven fabrics. A clean mop head and fresh decontaminating solution should be used for each procedure. (1) Mop handles may be stored in the housekeeping storage area until they are needed again. Clean mops and disinfectant solution should be used for each cleanup procedure. (2)

Question: Several of our staff members no longer clamp dust their OR before beginning the first procedure of the day. They state that damp dusting is old fashioned and requires too much time. I was taught that damp dusting was the first thing to be performed when opening a room in the morning. Am I simply clinging to an old routine? Does AORN still recommend the surgical suite be damp dusted before the first procedure of the day or is this an outdated practice?

Answer: Damp dusting continues to be a recommended practice and should be a part of the routine environmental cleaning procedure of the OR. Dust and lint are deposited on the horizontal surfaces of equipment, floors, and other surfaces of the OR over time. No matter how efficient the air-handling system, HEPA filters, traffic-control practices, and other precautions, a film of dust and lint quickly forms on flat surfaces. Cleaning these horizontal surfaces before the first procedure of the day helps reduce airborne contaminants that can travel on dust and lint. All horizontal surfaces in the OR (eg, furniture, surgical lights, equipment) should be damp dusted before the first scheduled surgical procedure of the day with a clean, lint-free cloth moistened with a facility-approved disinfectant. (3)

Question: We recently had a near-miss incident in which the tissue retrieval bag (ie, endo bag) was left in the wound of a patient and almost was not noticed before the patient was closed because it had not been included in the count procedure. I believe that we should include the tissue retrieval bag in the count procedure; however, many of my peers do not agree with me. They believe that the surgeon is responsible for ensuring no items remain in the wound, particularly during a procedure such as this, when an instrument count is not required. Should the tissue-retrieval bag used for removing the gallbladder during a laparoscopic cholecystectomy procedure be included in the count?

Answer: Tissue retrieval bags commonly used in laparoscopic procedures such as cholecystectomy and appendectomy should be counted as a miscellaneous item. Counts are performed to ensure that the patient is not injured as a result of a retained foreign object. (4) A retained tissue retrieval bag could cause serious harm to the patient, and every reasonable effort should be made to prevent retention of these types of foreign bodies. Although the surgeon certainly has a responsibility to remove any foreign objects from the surgical wound, accountability for counts is a primary responsibility of the perioperative nurse. There must be a coordinated team effort to avoid such errors that includes the surgeon, the perioperative RN, and the scrub person. Multiple procedures that provide a check-and-balance system, such as counting, need to be implemented to minimize the risk of human error.

The surgeon may not notice that the tissue bag was retained; therefore, it would be prudent to include the tissue retrieval bag in the count as a miscellaneous item to ensure that it is accounted for before the end of the procedure. Including the bag as a miscellaneous counted item helps prevent the oversight before the patient is injured and provides an additional opportunity to prevent a serious error. The perioperative nurse and the surgeon should collaborate to develop procedures that minimize potential human errors and mitigate the risk of a retained foreign body.

Question: Several of our staff members have been debating whether the scrub person, after setting up the sterile field, can sit while waiting for the surgeon to start the procedure. Several RNs in leadership positions think this is acceptable, stating that the back is considered contaminated. I was taught that this was not good practice unless the procedure called for sifting. Is it acceptable for the scrub person to sit?