Portal de Periódicos da CAPES

The Key to Safety: A Healthy Workplace

2018; Wiley; Volume: 108; Issue: 2 Linguagem: Inglês

10.1002/aorn.12313

1878-0369

Stephanie S. Davis,

Disaster Response and Management

Living in Tennessee allows me to enjoy a long summer season with friends and family. To ensure that our exposure to the great outdoors is safe, we take actions like wearing a hat, drinking plenty of water, and applying sunscreen and bug spray. Adhering to rules like not running around a pool and never swimming alone also helps keep everyone safe from injury. In our workplaces, there also are steps we can take to help ensure we are safe from accidental harm. Surgical services comprises several departments and faces unique workplace safety challenges. When leading in these areas, it is necessary to perform audits and checks to be sure the safety protocols we have put in place are being followed. Awareness of the risks and data on accidents and injuries helps strengthen the resolve of each member of the team to decrease these incidents and make their workplace the safest place possible in which to deliver patient care. Some of the outcomes of occupational hazards are injuries and diseases that can lead to physical, emotional, and financial difficulties for the perioperative nurse. These hazards also can contribute to patient injuries and have financial effects on the health care organization through increased costs and a reduced ability to provide services. Occupational hazards have been identified as one of the major contributors to nurses leaving the profession, which contributes to the nursing shortage.1 It is our duty to try to mitigate these risks so that everyone working in our field is a safe as possible. As health care professionals, we are exposed to blood and other body fluids and airborne diseases as we care for patients. Often, our first means of disease transmission prevention is immunization against diseases such as influenza and hepatitis B. We also need to take the time to perform hand hygiene after every patient contact before moving on with our next task. Glove and gown interface fluid leakage is an important problem for perioperative professionals because direct contact with blood or other body fluids could be life threatening, especially when caring for patients with infectious diseases, such as hepatitis C, HIV, and viral hemorrhagic fevers such as Ebola.2 Contamination of hands and wrists could lead to colonization with drug-resistant bacteria or other germs that could be harmful to patients. Ensuring we are using the right gown for the procedure and wearing properly fitting gloves is key to maintaining our safety. Sharps injuries also are a common area of concern, especially in the intraoperative and central sterile processing environments.3 An estimated 380,000 sharps injuries occur in health care per year, and roughly one-third of these occur in the OR setting.4 Interventions such as using sharps with safety-engineered devices, passing sharps via a “neutral zone,” and placing used sharps in puncture-resistant containers can help to reduce these incidents.3 Surgical smoke from electrosurgical units and lasers is another environmental issue in the OR. Approximately 500,000 health care workers are exposed to surgical smoke each year.5 This smoke is created from thermal destruction of tissue. Smoke plumes may contain toxic gases and vapors such as benzene, hydrogen cyanide, formaldehyde, bioaerosols, dead and live cellular material, and viruses.6, 7 It is estimated that in an average day, the effect of breathing surgical smoke could be comparable to smoking 30 unfiltered cigarettes.8 Perioperative nurses are twice as likely as the general population to report experiencing respiratory problems.7 There is a need for more research on the transmission of disease through surgical smoke.7 However, anyone who has been in the OR and had to smell the plume would agree that evacuation of the smoke is preferable and would make the work environment more pleasant and possibly safer. Many of us are working to help resolve smoke exposure in our workplaces. An added benefit is that we can reduce the risk to our patients by protecting them from the hazards of surgical smoke while they are in our care. AORN has developed the Go Clear Award program to help educate perioperative teams about surgical smoke.9 This also is a way to recognize facilities that have put into place all the necessary evacuation devices for their staff members, surgeons, and anesthesia providers; provided the relevant education; and monitored compliance. Another area to consider is the risk of slips, trips, or falls. In today’s perioperative environment, we have more equipment than ever. This equipment typically must be plugged into an electrical outlet. The electrical cords are often in the work path and need to be covered with a brightly colored mat or other safety device that will stand out from the floor color. Around the scrub sinks, we often see floors wet with soap and water because of vigorous handwashing. If this is not mopped up quickly, it poses a slip hazard for anyone who walks close to the sink. Years ago, I remember one of my fellow nurses falling at the scrub sink and fracturing her patella. Walking by a puddle on the floor instead of stopping to wipe it up could lead to a team member or patient being injured. Constant reminders to our team members that these hazards exist can encourage safe practices. Moving patients is a task completed many times a day. Often our patients are under the influence of anesthesia and unable to assist with the move from a stretcher to an OR bed or vice versa. Moving an anesthetized patient should always be a team effort, not only for worker safety, but for the safety of the patient. Typically, it takes at least four individuals to move a patient safely: one person secures the head, one person stands on each side of the patient, and one person stands near the feet.10 Using an assistive device such as a roller, slider, or air mattress simplifies the task. A musculoskeletal injury to a staff member or shearing or tearing of the patient's skin can happen if moving protocols are not followed.10 Lifting heavy instrument pans and moving heavy equipment also is part of our daily work. Using good ergonomic practices to complete these tasks is necessary to protect ourselves from injury. Often, we are in a hurry and may not think about the consequences of not following safety protocols. It is worth waiting for lifting assistance to arrive, or using assistive technology, rather than making a decision that may harm ourselves, a team member, or a patient. AORN supports a safe workplace for every perioperative nurse. Our safety and the safety of our colleagues depends on our knowledge and adherence to safety protocols as we care for others. The old saying, “An ounce of prevention is worth a pound of cure” is relevant in our workplaces. Are you someone who follows the safety protocols in your workplace to the letter, or do you cut corners or encourage others to do so? In perioperative services, we depend on every member of the care team to do his or her part. Lead by example and be a champion for safety in your work environment. Editor's note: Go Clear Award is a trademark of AORN, Inc, Denver, CO. Stephanie S. Davis, MSHA, RN, CNOR, CSSM, is the AORN President and the vice president of Surgical Services for HCA Healthcare. She lives in Nashville, TN. Ms Davis has no declared affiliation that could be perceived as posing a potential conflict of interest in the publication of this article.