You don't always have to count in the OR
You don't always have to count in the OR
Sponge, instrument counts depend on procedure
A "sacred cow" of same-day surgery is gone. Perioperative nurses don't always need to count sponges or instruments before and after cases, according to the 1996 Standards & Recommended Practices of the Denver-based Association of Operating Room Nurses (AORN). (See ordering information, this page.)
Instead, the counts should occur "on all procedures in which the likelihood exists that a sponge could be retained," according to the "Recommended Practice for Sponge, Sharp, and Instrument Counts." Counting sharps, such as suture needles and scalpel blades, is still recommended for all procedures.
AORN's revised recommended practice takes a common sense approach and recognizes that in many procedures, such as laparoscopic ones, there is no surgical opening large enough to create a danger of leaving sponges or instruments in a patient, says Julie Thompson, RN, MSN, CNOR, perioperative nursing specialist at AORN.
Eliminating unnecessary counts will save time in the OR, Thompson says. But she stresses, "You still need to count sharps at all times on all procedures."
In other changes, AORN's recommended practices state:
* Double-thickness, sequential wrapping, which is the traditional wrapping method, is not always necessary.
Double thickness without sequential wrapping or double thickness that is bonded together is acceptable "provided aseptic presentation can be maintained and packaging is used according to manufacturers' written instructions." The revised recommended practice opens the door for manufacturers who change the method of packaging.
It is up to individual facilities to set policies and procedures related to which packaging material best serves their clinical needs, Thompson says.
Regardless of which type of wrapping is chosen, same-day surgery managers need to have documentation that the method maintains "a tortuous path for contaminants after the sterilization process and accommodates aseptic presentation," Thompson says.
Sequential wrapping creates a package within a package. Same-day surgery managers should obtain information about the packaging material from individual manufacturers, she says.
* Same-day surgery facilities should use isolation techniques, when necessary, to prevent transmission of infectious agents, according to the "Recommended Practice for Safe Care Through the Identification of Potential Hazards in the Surgical Environment."
For example, patients with a suspected or known case of tuberculosis should be treated according to the isolation guidelines of the Atlanta-based Centers for Disease Control and Prevention (CDC)1, the recommended practice says.
That would include delaying elective procedures on TB-positive patients until the patients are no longer infectious, performing procedures in an OR that has an anteroom, keeping doors to the OR suite closed, keeping traffic to a minimum, performing surgery on TB-positive patients at the end of the day when the least number of personnel are present, and providing an isolation room in the post-anesthesia care unit, Thompson says. (For more information about TB guidelines, see SDS, May 1995, p. 61.)
Reference
1. Garner, JS et al. Guidelines for isolation precautions in hospitals. Infection Control and Hospital Epidemiology 1996; 17:53-80. *
Subscribe Now for Access
You have reached your article limit for the month. We hope you found our articles both enjoyable and insightful. For information on new subscriptions, product trials, alternative billing arrangements or group and site discounts please call 800-688-2421. We look forward to having you as a long-term member of the Relias Media community.