Limit Foot Traffic in Your ORs

DOOR AJAR Excessive foot traffic disrupts laminar flow and sends contaminates into the sterile field.

Installing a door alarm that sounds whenever a staff member enters the operating room helps limit the unnecessary foot traffic that increases surgical site infection risk, according to a study published in the journal Orthopedics.

One-third of OR door openings are for unessential reasons, such as social visits, according to the study's authors. They say signs that attempt to restrict OR access often go unnoticed or are ignored and locked doors create safety concerns and impede staff members who have legitimate reasons for disrupting surgery. The study's authors, who believed audial alerts would prove more effective than signs and locks, compared the number of times an OR door was opened during a series of hip and knee replacements performed with and without an alarm in place.

The alarm sounded a 2-tone chime every time the door was opened and repeated the chime every 3 seconds until the door was closed. During 50 consecutive surgeries without the alarm, the door was opened an average of 88 times per case and remained open for 14 minutes per procedure. During the 50 cases with the alarm installed, the number of door openings dropped to 69 and the door remained open for 10 minutes per surgery.

The numerous factors that impact infection rates during total joint surgery — obesity, diabetes, smoking, operative time, surgical technique — include traffic flow into and out of operating rooms. Opening the OR door disrupts the room's laminar flow, which could send bacteria into the sterile field instead of pushing it away from the patient's open wound. One study has reported that any increase in the number of door openings raises the risk of contamination in the OR by as much as 70%.

Keeping OR doors closed as much as possible during surgery is a legitimate issue with no clear solution, say the researchers, who note the warning chimes they tested proved effective until alarm fatigue set in. "Despite the limited long-term effect of this alarm, it should bring further attention to excessive operating room traffic," they write. "Continuing education and awareness may be necessary to maintain the results found in this study."

Daniel Cook

Nurse Sues Doctor Over Brazilian Butt Lift That Left Her Paralyzed

PARALYZED Due to compressed nerves during a butt lift, Rolanda Hutton may never walk again.

An Oklahoma-based nurse recently filed a lawsuit against her Dallas-based plastic surgeon, claiming she will never walk again after a botched Brazilian butt lift.

Rolanda Hutton, 44, underwent the procedure in January "for a little enhancement," and not, as she maintains, "to be a video vixen." The procedure, led by Sameer Jejurikar, MD, of the Dallas Plastic Surgery Institute, involved transferring fat from other parts of Ms. Hutton's body into her buttocks. But during operation, Ms. Hutton alleges that Dr. Jejurikar over-injected into her gluteal muscles. The undesired result was excessive pressure from the added fat, which compressed Ms. Hutton's sciatic nerve. In the days of recovery afterward, she suffered neuropathy, kidney-function damage, permanent nerve damage and eventually paralysis from the waist down. She has supposedly been informed that she'll never walk again.

Ms. Hutton is now seeking $5 million in damages to cover all current and future healthcare costs, home and transport modifications, and the salary of 20+ future years as a nurse, which she can no longer earn.

Ms. Hutton claims when she began to experience and report debilitating post-operative weakness and numbness in her legs, as well as an inability to stand, Dr. Jejurikar and his staff did not respond appropriately and diagnosed her symptoms as temporary. Two two days passed before she was admitted to Texas Health Presbyterian Dallas. Had Ms. Hutton been taken to the ER straightaway, she believes, the nerve damage could have been addressed and her paralysis prevented by decompression surgery.

Neither Dr. Jejurikar nor the Dallas Plastic Surgery Institute could be reached for further comment.

Joe Madsen

For Pediatric ACL Reconstruction, Surgical Centers Top Hospitals

FOCUSED FACTORIES ASCs allow leaner staffs with fewer intraoperative changes to hone specific skills more efficiently.

When it comes to ACL reconstruction in pediatric patients, outpatient facilities are performing with more efficiency overall than their hospital-based counterparts, according to a study published in Orthopedics. Efficiency, the study says, means taking less time in the OR, using fewer members of staff and requiring fewer support-staff changes throughout the procedure.

ACL repairs in surgical centers beat hospital procedures by an average of 30 minutes, according to the study.

As far as staff members, the hospital used about 3 times the amount of hands on deck, and support-staff changes occurred 6 times as often among techs and 2.5 times as often among nurses.

Commenting on the study, orthopedic surgeon Shital N. Parikh, MD, reasons that the main factor behind the increased efficiency is "the availability of consistent, skilled and experienced specialty-specific teams." For orthopedic surgery in particular, Dr. Parikh observes that "higher volume, vastly different and numerous procedures and varied implant/instrument needs benefit from an orthopedic-specific team."

Joe Madsen

InstaPoll: Who Would You Hire: New Grad or Experienced Nurse?

When filling a surgical nurse position, would you rather hire a new nursing school graduate, a nurse with perioperative experience or a veteran nurse who's never worked in the operating room? Tell us how in this week's InstaPoll how concerned you are about staff diverting drugs at your facility.

Nearly half (46%) of surgical facility leaders are "moderately" concerned and 15% are "extremely" concerned about staff diverting drugs, according to the 285 respondents to last week's InstaPoll.

How Concerned Are You About Staff Diverting Drugs?

  • extremely 15%
  • moderately 46%
  • not at all 39%

Dan O'Connor

News & Notes

  • Vaping no better than smoking Vaping is just as dangerous as smoking tobacco when it comes to increased risk of surgical and anesthesia complications, according to the American Association of Nurse Anesthetists. E-cigarettes — hailed as a healthier alternative to tobacco cigarettes — contain nicotine, which can impede wound healing, increase infection risk and heighten post-op discomfort. Patients should be encouraged to quit vaping at least a few weeks before and after surgery, says the AANA.
  • FDA approves device to ease opioid withdrawal The FDA has approved an electrical nerve stimulator that's placed behind patients' ears to help reduce the symptoms of opioid withdrawal. The NSS-2 Bridge, available only by prescription, can be used for up to 5 days during the acute phase of withdrawal. A battery-powered chip emits electrical pulses that stimulate branches of certain cranial nerves, helping to ease symptoms such as sweating, gastrointestinal upset, agitation, insomnia, and joint pain.
  • Glucose test could reduce post-op complications Patients with high levels of the glucose-monitoring compound, fructosamine, were more at risk for infection, readmission and reoperation following joint surgery, says researchers at Thomas Jefferson University. Testing for fructosamine can give doctors an indication of who needs intervention before surgery and could prevent post-op complications, researchers said. The level of fructosamine in the blood is a reflection of glucose levels over the previous 2-3 weeks.