Sales representatives; intermediate-level disinfection; gowning from back tables; cleaning laryngoscope blades; turnover time

AORN Journal, Dec, 2005 by Carol Petersen

QUESTION: Frequently, sales representatives come into the OR at our facility to instruct the surgeon on how to use new instruments or systems or perform new surgical techniques. The circulating nurse and the scrub person do not receive advance notice or education on how to use the new equipment of about a new procedure. When staff nurses expressed concern about this, we were told that as long as the sales representative was in the room for consultation and the surgeon knew what he or she was doing, advance education of staff members was unnecessary. We are very concerned that we are not receiving education before the procedure and would like to know what AORN recommends.

ANSWER: All perioperative team members should be instructed on new procedures, techniques, technology, and equipment before the surgical procedure. It may be hazardous to patients and perioperative team members when clinicians use equipment with which they are not familiar. Using complex technology incorrectly can cause patient injury and even death.

A healthcare industry representative with the training, knowledge, and expertise about new products and procedures can provide technical training and support for the entire surgical team. The training or instruction can take place during a formal inservice program or as one-on-one instruction. The industry representative may be present during a surgical procedure to provide technical support, as long as the situation adheres to the healthcare organization's policies and procedures and those policies are in accordance with accreditation requirements and in compliance with local, state, and federal regulations. (1)

Although the healthcare industry representative plays a valuable role by providing technical assistance, he or she should not provide direct patient care. The facility policy should specify conditions under which a health care industry representative may be present during a surgical or other invasive procedure. Each healthcare organization should develop a policy that clearly delineates the healthcare industry representative's activities in the room where the surgical or other invasive procedure is performed. (1)

As patient advocates, the primary responsibility of perioperative RNs is to protect the safety of patients undergoing operative or other invasive procedures. Perioperative RNs and other perioperative team members are responsible for acquiring knowledge on new procedures, techniques, technology, and equipment before their use in a surgical procedure.

QUESTION: During an open abdominal procedure, an instrument was dropped on the floor. The surgeon did not want to wait for the instrument to be flash sterilized and requested that we soak it in 70% alcohol for three minutes. I refused to do this and flash sterilized the instrument. The surgeon was upset about having to wait for the instrument and has asked for justification of my actions. Is it acceptable to soak an item in alcohol for an open procedure? Does alcohol tender the item sterile?

ANSWER: It is not recommended to soak an instrument in alcohol to achieve sterility. Alcohol is a disinfectant, not a sterilant. Sterility should be maintained throughout the procedure, and the item that was dropped on the floor should be cleaned and flash sterilized. Seventy-percent alcohol (ie, ethyl and isopropyl) is considered an intermediate-level disinfectant. (2) Soaking the dropped item in alcohol would provide only intermediate-level disinfection if it were soaked for 10 minutes.

The Spaulding classification system should be used to determine how an item is to be processed (ie, sterilization, high-level disinfection, intermediate-level disinfection, low-level disinfection). Items are classified as critical and should be sterile if they enter sterile tissue or the vascular system. Examples of critical items include such things as surgical instruments and

* cardiac and urinary catheters,

* cutting endoscope accessories,

* implants, and

* needles.

Items are classified as semicritical if they come in contact with nonintact skin or mucous membranes, and these items should receive a minimum of high-level disinfection. Items are considered noncritical if they come in contact only with intact skin, and these items need only intermediate-level or low-level disinfection. (3,4)

Intermediate-level disinfectants may be used as a housekeeping disinfectant for activities such as damp dusting. An item must be totally immersed in an intermediate-level disinfectant for a minimum of 10 minutes to achieve bacteriocidal, pseudomonacidal, and fungicidal effects. It takes a minimum of 15 minutes of total immersion in an intermediate-level disinfectant to achieve tuberculocidal and virucidal effects against most viruses. Intermediate-level disinfectants have no sporicidal effect and do not render ah item sterile. (5)

Soaking the instrument in alcohol for only three minutes before using it on sterile tissue may be considered a major break in aseptic technique and should prompt a wound classification change. The wound class is determined by the degree of probability that a wound may become infected. Following are wound classification definitions used by the Centers for Disease Control and