GaseousClay

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thats the title of the latest article on front page of the AN. Our hospitals and more places I know are following more guidelines where nobody can walk in and out of the OR once a case starts. Mainly for orthopedic procedures. What are your thoughts on this and are the clipboard nazis at your hospitals enforcing this? In addition to the jackets, bouffants, beard covers, etc....
 

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The stupidity simply never stops. I wish I could get paid to make moronic mandates for the masses.

If patients are still getting infections why are people making dumb rules allowed to create new guidelines that still don't make sense?

There's bacteria everywhere dipshts. They even live inside you!
 
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It is ironic that some of the surgeons that are the biggest sticklers for this are doing less than optimal hand washing.
Think of how low the infection rate would be if we could just get everyone to wash their hands properly?
 
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dipriMAN

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Post the article if you have time, would be interested to see what it says.

These ridiculous guidelines are partly aided by pointless academic studies that are published. I just searched OR traffic and got many observational studies done by people looking at how many times an OR door is opened during a case as if that’s a meaningful outcome to anyone.
 

DocVapor

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It is ironic that some of the surgeons that are the biggest sticklers for this are doing less than optimal hand washing.
Think of how low the infection rate would be if we could just get everyone to wash their hands properly?
Lol, my first thought too. Only time I ever see an ortho standing in front of the scrub sinks anymore it's because that's where they can work on their bromances with the reps and not get in the way of working OR personnel.
 
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repititionition

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pt wheeled in to room: they do not have a mask on
pt transfers self to OR table, etc: they have not washed hands, nor do they do not have gloves on

many other potential sources of contamination BY the PATIENT themselves, yet we focus on self-flagellation first.
 

drmwvr

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my last TKA, sans hat, beer and sunglasses....no one made a peep....

upload_2019-1-3_18-21-20.png
 
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Psai

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pt wheeled in to room: they do not have a mask on
pt transfers self to OR table, etc: they have not washed hands, nor do they do not have gloves on

many other potential sources of contamination BY the PATIENT themselves, yet we focus on self-flagellation first.
No, no it's the anesthesiologist's eyelashes from going in and out of the OR that are the major source of infection. The patient is obviously sterile and cannot be the cause.
 
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nimbus

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We have 1 surgeon who has 90+ percent of our postop total knee infections and explants. Because of this, he restricts in-out traffic and he is meticulous about prepping, draping and regloving after draping. Still his rates seem to continue to be higher. He does have multiple reps in the room while the other surgeons have none. His operative times are also much longer than the other surgeons.
 
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nimbus

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Have they done a study to correlate anesthesiologist flatulence to surgical site infections? We are missing some bigger opportunities to help our patients! Do the clipboard nurses even know to monitor for this!?

You know that means no more chili in the lounge. Do you really want to go there?
 

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pgg

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Stop putting beans in your chili.
Get that crazy talk out of here.

Also, poor glycemic control is clearly correlated with surgical site infections, so we need to lift the rule prohibiting us from eating in the OR. Why else would anesthesia machines have a factory-installed hot plate on them in between the iso and sevo vaporizers, if not to keep our coffee warm?
 

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GaseousClay

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https://www.anesthesiologynews.com/Multimedia/Article/11-18/Poor-Cleaning-High-Traffic-To-Blame-for-OR-Bacterial-Contamination/53311

ridiculous nonsense the surgeons and AORN are now spewing especially when they do intraop x-ray and have reps going in and out multiple times. But anesthesia is the main problem and us sneaking in for breaks is the root cause of all infections.
Has anybody actually looked closer at this? Just do the same study and do a sub-group analysis just looking at anesthesia I/Os. Put this to bed once and for all?

Although I guess if we do the study and turn out to be wrong we can’t exactly keep complaining about how ridiculous it is that they blame us for it.
 

TraumaLlamaMD

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Nursing/techs get just as many breaks as anesthesia if not more, from what I’ve seen (both circulator and scrub get breaks). Is AORN acknowledging this?
 
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The data did not support limiting traffic in two ORs I worked in previously so they mostly removed those policies limiting traffic of staff and reps. They did move to hospital laundered scrubs and no personal caps without a bouffant (the devil itself). I'm starting to wonder if we need to have a legitimate sit down session with everyone in an OR explaining how bacteria moves. You would think that these people actually believe that these bacteria literally jump from someone's arm to the floor and crawl onto the base of the bed, climb onto the patient, then climb up and around the drapes, and then get into the wound and infect it. I mean really? How could this happen in the short time it takes a good surgeon to do a knee? It's either on the patient already or on the tools but none have to do with me telling the rep to gtfo of the way for the 6th time.
 
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We have 1 surgeon who has 90+ percent of our postop total knee infections and explants. Because of this, he restricts in-out traffic and he is meticulous about prepping, draping and regloving after draping. Still his rates seem to continue to be higher. He does have multiple reps in the room while the other surgeons have none. His operative times are also much longer than the other surgeons.


At what stage are these infections? Who’s taking care of the instruments, OR’s, after care in the hospital. How many other surgeons use the same instruments, rooms, hospital rooms? What’s the bacteria? I love a good mystery!!
 

narcusprince

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The writing is on the wall. Operative times correlate with surgical infection risk. The slower the surgeon the longer the tourniquet times the higher the infection risk. I have worked with a joint surgeon who could do a total knee 35-45 min skin to skin no tourniquet. Are infections related to tourniquet use versus non use?
 
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jthedestroyr

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thats the title of the latest article on front page of the AN. Our hospitals and more places I know are following more guidelines where nobody can walk in and out of the OR once a case starts. Mainly for orthopedic procedures. What are your thoughts on this and are the clipboard nazis at your hospitals enforcing this? In addition to the jackets, bouffants, beard covers, etc....

We have a guy like this, but you know maybe it's the fact his cases for flaps standardly go 10-12+ hours easily and it's not even out of the normal that this guy may take 18hr.

Now tell me this, you're operating on someone that long and you're surprised to see a huge uptick in SSI.

It isnt rocket science to see the correlation between operating that long consistently and infection risks.
 
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IlDestriero

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It is ironic that some of the surgeons that are the biggest sticklers for this are doing less than optimal hand washing.
Think of how low the infection rate would be if we could just get everyone to wash their hands properly?
I used to work with a “famous” superstar surgeon who never scrubbed at all. He used some custom spray can **** and that’s it. Whatever. They weren’t getting line infections.
“XX is coming back for a wound washout.” Ok...
 

epidural man

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When I was in Ass-crackistan, their was dust everywhere. We had an electronic fly swatter to try and minimize the flies over the open bellied patient. We didn't have a single post-op infection.

I just got back from an InterFaceKids.Org mission in Mexicali (you should all try doing this - it was neat) and those kids never have infections. We are resterilizing everything (ET Tubes suction tubing, etc) for repeat use. The patient isn't even draped - just sterile towels. The room isn't positive pressure. There are about 200 students standing around watching - and many get to help suture and stuff. It's so not clean.

Yet at my hospital, we now have to open sterile gauze for each new case - because having a pack of opened gauze from case to case is apparently very risky.
 
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When I was in Ass-crackistan, their was dust everywhere. We had an electronic fly swatter to try and minimize the flies over the open bellied patient. We didn't have a single post-op infection.

I just got back from an InterFaceKids.Org mission in Mexicali (you should all try doing this - it was neat) and those kids never have infections. We are resterilizing everything (ET Tubes suction tubing, etc) for repeat use. The patient isn't even draped - just sterile towels. The room isn't positive pressure. There are about 200 students standing around watching - and many get to help suture and stuff. It's so not clean.

Yet at my hospital, we now have to open sterile gauze for each new case - because having a pack of opened gauze from case to case is apparently very risky.
Military hospital or civilian hospital in Afghanistan?
 
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When I was in Ass-crackistan, their was dust everywhere. We had an electronic fly swatter to try and minimize the flies over the open bellied patient. We didn't have a single post-op infection.

I just got back from an InterFaceKids.Org mission in Mexicali (you should all try doing this - it was neat) and those kids never have infections. We are resterilizing everything (ET Tubes suction tubing, etc) for repeat use. The patient isn't even draped - just sterile towels. The room isn't positive pressure. There are about 200 students standing around watching - and many get to help suture and stuff. It's so not clean.

Yet at my hospital, we now have to open sterile gauze for each new case - because having a pack of opened gauze from case to case is apparently very risky.
What do you think those places did to not get infections that we could do here?
 

epidural man

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epidural man

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What do you think those places did to not get infections that we could do here?
I don't know - but I do think we have gone overboard trying to stop it without any clue or data on what REALLY makes a signicant impact (besides patient factors as was suggested). I guess my point is regarding post - op infections...I think we are kind of in the same situation back when people used to think that oily rags in the corner spontaneously created mice (because when you put rags in the corner, mice would somehow show up).
 
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epidural man

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What do you think those places did to not get infections that we could do here?
Think about the unbelievably high cost for chasing this pipe dream that we have no idea where it leads or what it does.

We use single use laryngyscopes. Our bronchoscopes are single use. Our glidescope stylets are single use. New package of gauze each case? We have single use tape. Every medicine bottle is single use despite multi-use vials being shown to be very safe. We have to use a single needle, single syringe - ONE TIME. I have to put chlorhexidine caps on all the medicine ports on the IV tubing. I'm sure there is a ton more stuff, but all this adds up to an incredible cost....and for what? It is unbelievably ridiculous. Thanks JC.
 
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Think about the unbelievably high cost for chasing this pipe dream that we have no idea where it leads or what it does.

We use single use laryngyscopes. Our bronchoscopes are single use. Our glidescope stylets are single use. New package of gauze each case? We have single use tape. Every medicine bottle is single use despite multi-use vials being shown to be very safe. We have to use a single needle, single syringe - ONE TIME. I have to put chlorhexidine caps on all the medicine ports on the IV tubing. I'm sure there is a ton more stuff, but all this adds up to an incredible cost....and for what? It is unbelievably ridiculous. Thanks JC.
I like to think a lot of waste is nursing driven. I dunno why, maybe they feel they are doing more for patients or maybe it’s a way to exert power over doctors to compensate for some perceived slight when they make more and more rules, despite having no evidence or science to back up their decisions.
 

woopedazz

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Acorns gonna Acorn.
EDIT: Just realised ACORN is an Australian clipboard thing. The Australian College of Perioperative Nurses (ACORN) - where the capitalised letters don't equal the abbreviation and nothing makes sense.
 

epidural man

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From the article "In summary, we encourage anesthesia professionals to embrace these new principles, practices, and opportunities to improve patient care."

To which I would answer - show me that these new principles and practices improve patient care. Showing me that there is a few specs of bacteria in my IV line proves absolutely nothing. IN fact, maybe those small pieces of bacteria turn out to be helpful. I could make that argument just as well. Prove to me that sticking an almost sterile blade into the dirtiest part of the human body is better than sticking a less clean blade into that same area makes a difference.
 

nimbus

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From the article "In summary, we encourage anesthesia professionals to embrace these new principles, practices, and opportunities to improve patient care."

To which I would answer - show me that these new principles and practices improve patient care. Showing me that there is a few specs of bacteria in my IV line proves absolutely nothing. IN fact, maybe those small pieces of bacteria turn out to be helpful. I could make that argument just as well. Prove to me that sticking an almost sterile blade into the dirtiest part of the human body is better than sticking a less clean blade into that same area makes a difference.

Agree. It is impossible to eliminate surface colonization and it is all a show. No matter how often you wipe down the outside of an anesthesia machine or cart, the interior drawers, medication bins and supply bins and their contents are NEVER wiped down at any place I’ve ever worked. It is too inconvenient. Single use everything won’t help either if the medication drawer contains 10 vials of propofol (and 100+ other vials) which have surface contamination and sits there for weeks.
 
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pgg

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Counterpoint - the joint replacement program at the hospital in southeast Asia I worked at for a few months last year had an implant infection rate over 20%.

I saw more hardware explants and washouts and redo joints (because attempt #1 got infected) in my ~2.5 months there than in the rest of my career combined.

Generally thin and healthy patients. Worst universal precaution measures and infection control procedures I've ever seen.

They needed a tactical strike team of Joint Commission clipboard commandos in a bad way.
 
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Agree. It is impossible to eliminate surface colonization and it is all a show. No matter how often you wipe down the outside of an anesthesia machine or cart, the interior drawers, medication bins and supply bins and their contents are NEVER wiped down at any place I’ve ever worked. It is too inconvenient. Single use everything won’t help either if the medication drawer contains 10 vials of propofol (and 100+ other vials) which have surface contamination and sits there for weeks.
We need single use anesthesia machines and carts... duh! Also hand hygiene before every time we give a medication. And also a new syringe and freshly drawn up meds from a new vial every time we want to administer something. A bad outcome should be a never event!
 

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It seems like a lot of the infection control measures we get stuck with are analogous to ERAS pathways: take a whole bunch of interventions that have questionable (or no) efficacy on an individual level, bundle them together, and point to better outcomes.

It’s not that there’s nothing to this approach (I’m glad our total joint infection rates are well under 20%)... But the obvious downside is that the bar has become very low for adding another thing to the bundle, and the downsides of each thing (environmental waste/time-wasting/annoying/expensive) are not fairly being weighed against the value that said thing adds to the bundle
 
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