[RN_Amy]

Hi all... just a few quick questions.... I have seen some questionable practice of late and was just curious as to what happens at your place of work....

At your facility do ALL staff in theatre wear masks?

Also, with ortho cases... do staff have to wear a balaclava?

Are staff other than the scout nurses allowed in and out of theatre throughout an ortho case?

Does anyone have any links to articles that have studied the correlation between the wearing of masks by all staff in the OR versus post op infection and/or other complications?

I have just started working casually at a number of facilities and the norm differs immensly....

Thanks everyone....

[suzanne4]

Everyone must wear a mask when there is an open case in the room. If you are cleaning after the case or restocking when no case in the room, then no mask is required.
Ortho cases normally have very restricted traffic, essentially means no one in or out until closing has started. Room is set up but packs are not opened until the patient is in the room to cut down on contaminants. Most ortho teams wear the full hood set-up with air pump behind them. We don't allow the circulators to go in and out, which I believe are similar to your scout nurses. Several of the hospitals where I have worked actually had small doors that could be opened for supplies to be delivered to when you phoned out for them, buy the nurse never leaves......not even for a "potty" break during those cases.
I have never been in an OR where masks were not worn.

[shodobe]

We always wear masks during procedures except during urology cases such as cystos and such, no reason to. As for ortho, where I work we do not wear hoods or even use laminar flow anymore. There are so many opinions on their use one has to think the ortho community doesn't have a clue what's right. We tape off the OR door and go in and out of a door that goes into a small room between ORs. The circulator can go on "potty" breaks though when relieved. We have always opened cases before the patient goes into the room and we have a virtual "0" infection rate. Mike

[carcha]

There is a lot of literature on this too numerous to mention, however some years ago it was deemed unnecessary for the circulating staff to wear a mask. Theres so much on this I really dont have to go into it as you'll find it. In our facility no circulating nurse wears a mask. All scrub nurses, and teams do but no circulating nurses.

[stevierae]

A lot of places where I have worked don't use "total joint protocol" anymore. The hoods hang in a storeroom, gathering dust. We do try to keep excess traffic down, just like in any other case--we are not fanatical about it. The circulator gets a break and lunch just like in any other room. There is no outside circulator these days. If we have laminar flow, we always use it; that is, it's on for any case, not just total joints. Masks, yes we wear as long is surgery is underway or preparing to get underway (with a patient and/or sterile instuments in the room) and when opening sterile instruments--but to go in and out of empty rooms to restock or whatever; no, we don't wear masks.

I think that the recognizance that pre-op antibiotics, delivered within a certain time frame, was far more important than all these "sacred cows" is what led to these changes. About time, I'd say.

I could never, ever support waiting until a patient was in the room to start opening. I was taught that all unnecessary noise be stopped or at least controlled during induction of anesthesia, and particularly during the danger and excitement phases. I always ask my scrub to stop banging instruments around, or to try to be just a bit quieter, when I bring my patient to the room. I also ask the rest of the team to either keep their voices down, or take their loud conversations outside.

Also, the circulator's place during induction is up at the head of the bed, assisting anesthesia. I also don't think it is fair to the scrub or the surgical team to make them rush to open, scrub and set up, then have to count--it makes the whole room feel stressed out.

What if they opened and found that a sterile indicator had not turned, and had to tear down the entire set up and start anew? That would be really unacceptable with a patient already under anesthesia. Better to catch that far in advance of the patient's entry into the room, and act accordingly.

[mcmike55]

I think our hospital goes along with the majority on this topic.
We wear masks setting up, and during the case, removing them after dressings are on, etc.
We, as a general rule don't wear them during uro cases, though the doc and scrubs do, partially for protection, being that close to the "splash zone" you know.
Ortho wise, full masks all the time. We had one of our two ortho docs leave recently. The one still here doesn't have us wear the hoods. We still have them, but currently they are dust catchers. We don't wear masks for closed reductions, and often for simple external fixators.

Stupid question: I'm full of 'em. What's a "balaclava" ??
Sounds like a desert pastry!

[Chrislynn2003]

I do a lot of ortho where I work. For our total joint cases, most of the surgeons and PA's (and some scrubs) where the hoods. We open up everything before the patient comes in (otherwise way too stressful). Even though traffic should be restricted, the implant reps go in and out of the room several times and there is always someone coming in for one reason or another. For all other ortho cases, hoods are not worn and masks and face shields(or safety goggles) are required for every type of case ( unless it's a closed reduction or sometimes during a bronchoscopy), but I always wear a mask cause it's habit.

Christine

[Marie_LPN, RN]

No matter what the procedure, when you walk into any of our ORs, it is policy to wear a mask.