HELP!!! Ob OR Standards

enfermeraSG · Jan 9, 2007

Hi there, I am a scrub tech in L & D and we are having some trouble finding out what the standards are for the OR.
We recently had a supervisor decide that we were going to have the OR open/draped every shift at all times no matter what. Usually we say we can have the OR open for 12 hours as long as its draped. Now some are saying 24 hours (which I strongly disagree) so I decided to investigate.
All the resources I found about length of time open say use asap and dont drape. Most importantly there must be someone monitoring the instruments at all times. This was from the AORN website. My nursing director says we are under a different 'umbrella' than AORN, as an example, we let a family member in during c/s unlike main surgery does.
Does anyone have any resources I could check out or tell me what the standards are at your hospital?
Thanks!!!!

I have never heard of a unit claiming to have "different" O.R. standards than AORN calls for. I mean, it is an OR and the goal is to protect the pt from infection, injury, etc. We are expected to follow AORN guidelines on our L&D unit just like the main OR, and JCAHO expects us to as well. I would think that if your facility can produce something in writing where the AORN says your type of unit is the exception to certain rules, that's the only time I would feel comfortable. In regards to the family member being present, they do put on paper gowns, booties, mask, etc to protect the environment. That is not the same as compromising the sterile field by leaving a set open for 24hrs draped. Good luck! SG

CIRQL8 · Jan 9, 2007

I must disagree with your supervisor. An OR is an OR is an OR. C-Section or laparotomy, it doesn't matter. The patients are all human and as susceptable to infection as the other. A C-Section is not a contaminated case. (Maybe w/ miconium -forgive my spelling- it possibly is, does anyone know for sure?) All precautions should be taken to ensure a safe and aseptic procedure. The L&D department here sickens me. They do not follow aseptic/surgical technique in their area as we do in the OR - and the OB's seem to not mind! A couple of examples: The prep is done top to bottom, side to side, not circumfrentially. Also, the scrubbed nurse drops her hand below waist level often, and the count is limited to what is on the Mayo stand.

Case should be open as close as possible to the time of incision. An open case should not be left unattended. Aseptic technique must be followed. Counts should be approriate for your facility. Closing count should be peformed at uterine closure and again at abdominal closure. The skin closure count should also be done.

Really, there should be no difference between main and OB operating. Public health, I'm sure, doesn't see a difference.

Marie_LPN, RN, LPN, RN · Jan 10, 2007

The L&D department here sickens me. They do not follow aseptic/surgical technique in their area as we do in the OR - and the OB's seem to not mind! A couple of examples: The prep is done top to bottom, side to side, not circumfrentially.

We're still battling this where i work, and now the OR staff is back (for the 3rd time in 3 years) for C-sections instead of scrubbed L and D staff. Too many wrong counts, wrong technique, wrongs masks, wrong gowning and gloving, and we're talking about (some) people that have been through a course to train them best practice.

Last time i was around L and D scrub staff, i overheard one of the techs say "The OR people are just doing this because they always want things their way." Yep, that's why the C-section site infection rate was so high while y'all where exclusively doing your own C-sections."

TrudyRN · Jan 10, 2007

Wow, this is really scary. I think you should keep a sterile pack on the table, ready to rip open stat when needed. It should take just a very few seconds to open it. Have the instruments ready - sterile but wrapped. These, too, can be ripped open STAT. Why have the room open?

Marie_LPN, RN, LPN, RN · Jan 10, 2007

Wow, this is really scary. I think you should keep a sterile pack on the table, ready to rip open stat when needed. It should take just a very few seconds to open it. Have the instruments ready - sterile but wrapped. These, too, can be ripped open STAT. Why have the room open?

This is what we do, everything set out, ready to open.

CRIMSON · Jan 10, 2007

Wow.....they actually have you open a sterile pack and leave draped? What was the name of that hospital? I want to make sure that I don't have procedures there.

When I worked L&D and scrubbed C-sections. We had our rooms sterile with packs/instruments ready on standby but definitely NOT open. We could have the packs open and set before patient was sedated fully. A stat Csection is fast.

Even in small derm surgeries a pack never is allowed to sit open to contaminent hazard.

Just used to sterile meaning sterile and right out of the sterile pack.

..... :uhoh3:

Chrissy24RN · Jan 10, 2007

This is all great feedback and I appreciate everyones response. We do have the c-section pack and instruments ready but for some reason some of the scrub techs are saying they dont feel comfortable having the OR not open. I feel that if they can't get that OR open quick...well they need to work in a slower paced environment. Also, it is appropriate to go in the OR and pull gloves/sutures/prepare the baby warmer...but I definately created some 'waves' at work by starting this whole thing. The problem is that I need some concrete info to present to my nursing director to prove this to her. Besides AORN....does anyone have any resources I can check out to build a case. Also, anyone know if draping is good/bad? I have read that it is bad but want to hear suggestions.

Last, I just want to say that we have NOT had any infections from this but that is definatly what I am trying to prevent. I dont want one to happen to change things! We are a great unit and fabulous hospital. Just need to work out the kinks!!!!

Thanks again!

Chrissy24RN · Jan 10, 2007

I have never heard of a unit claiming to have "different" O.R. standards than AORN calls for. I mean, it is an OR and the goal is to protect the pt from infection, injury, etc. We are expected to follow AORN guidelines on our L&D unit just like the main OR, and JCAHO expects us to as well. I would think that if your facility can produce something in writing where the AORN says your type of unit is the exception to certain rules, that's the only time I would feel comfortable. In regards to the family member being present, they do put on paper gowns, booties, mask, etc to protect the environment. That is not the same as compromising the sterile field by leaving a set open for 24hrs draped. Good luck! SG

That is a great point about the family members. We actually have them change into a pair of clean scrubs and don cap/mask/shoe covers....I wish I could have thought of that quickly when my nursing director mentioned that! Thanks for your help!

SmilingBluEyes · Jan 10, 2007

we are held to AORN standards...you should have a copy on your unit, if not get one.

deehaverrn · Jan 11, 2007

I don't have the standards right now but rest assured they exist. Try searching OR standards, also JCAHO I'm sure has them.

We did this (open and drape) with cases years ago when we'd pull for someone with fetal decels and then they'd recover, so we'd drape to keep it available. But we have since stopped.

I still maintain that we shouldn't even have OR suites and PACU in the obstetrical unit. There are standards (check PACU anesthesia online) that state that these auxilary rooms must be held to same standards as any regular OR and PACU. However it is virtually impossible to keep an entire Obstrical staff fully competant in both these areas. For example, on my unit we don't even have ACLS certification and aren't required to maintain any competencies in Cardiac monitoring. I don't feel it is safe, and I think we are subjecting our patients to a lower standard of care. But I have fought a losing battle, and this is also why I am never sent to any joint meetings with the OR or PACU administration.

luv l&d · Jan 12, 2007

We have "caught "a few scrub techs doing this very thing (keeping the OR open "just in case") but they were on the night shift and told the RN's that it was ok. I am a scrub, and an RN and when we caught wind of what they were doing.... Needless to say it does not happen these days. We do alot of high risk and can do an "emergent" (used to be call a crash, a rose by any name...)in 6 minutes. not pretty but usually sterile. alway have to do an xray after, but all of us are pretty confident that our counts are ok, so that we have not had to go back in. I can't believe you are not held to the same standard as the OR and PACU, and yes all the RN's on L and D are ACLS and NRP certified.