Each morning, everybody establishes their pretreatment roles for the
day. Somebody's the loader, somebody's the sprayer, somebody's
transporting the cart — it can be the same people, or you can rotate
different people in different roles. Our OR circulators now structure
the teams every day by saying, "Okay, how are we going to do this
today?" This is especially important for orthopedic or spine surgeries,
where sometimes you might have 20 trays for one surgery. In these
situations at our facility now, usually the circulator sprays, and the
scrub and anesthesia techs load.
We also informed surgeons of the required changes and advised
them that turnover times might increase slightly so they knew what to
expect.
Implement the pretreatment process, but continue to audit.
Have you ever cleared the air with someone, and then they go
right back to what they were doing before? Same applies here. Just
because you've implemented your pretreatment process doesn't mean
the problem will go away. Monitor it in real-life situations. We did, and
we continued to find issues.
During our 3-month implementation phase, we encouraged CSP to
report all incidents while relieving their "don't snitch" concerns by
stressing that OR staff wouldn't be punished, just reeducated. (Now
that it's an established practice, it's an expectation of their role and
would result in punishment.) CSP staff examined all case carts they
received to see if instruments were in the opened unhinged position,
if instruments that come apart were taken apart and if they could see
the "blue spray" pre-cleaner (we use OptiPro Gel).
When they saw an error, they reported it to the lead CSP tech, who
then immediately reported it to the OR leadership team. That real-
time communication from CSP was vital because we knew the exact
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Infection Prevention
IP
