Sleeves in the OR

[ruggster]

Recently at work we have begun to implement the new AORN standards including wearing jackets in the OR around open sterile supplies. I as a circulator don't generally have an issue with new expectations coming down the pike but after this being implemented several months ago, am a bit concerned with this.

Prior to this new requirement, when I washed my hands, I washed all the way up to my elbows. Now when I wash my hands, I wash my hands to the sleeve of my jacket and that is it.

The problem is that when a patient comes into the room and we have to help them over on the bed from the stretcher or back, many times my forearms are coming into contact with the patient while rolling. The next patient receives the same treatment but I have likely not changed my jacket or washed my forearms/sleeves.

In an ideal world, I would have had the time and replaced my jacket with a clean one but in actual practice, I don't.

How do others feel about this new expectation? It was put into place to prevent the spread of contamination and infection but in reality and practice, is it?

I understand that there are a lot of practices that I may not agree on the effectiveness but I still follow them and will support their implementation but this is one that I just can't seem to wrap my head around the efficacy of it.

Anyway, if you have a moment to share your ideas or thoughts, I would love to hear them. Thanks

[TakeTwoAspirin, MSN, RN, APRN]

When opening items to the sterile field I take my jacket off. Likewise for when I am moving or positioning the patient. About the only time I wear a jacket is when I finally have finished setting up the room, positioning the patient, and getting everything plugged in and I have a minute or two to sit and document.

If there is any chance that my sleeve(s) have come into contact with any fluids or open wounds etc., then the jacket should come off and be replaced with a clean one.

[Rose_Queen, BSN, MSN, RN]

Have a jacket, but usually only wear it during the middle of the case where pretty much all I'm doing is documenting. There just aren't' enough around to even change them every day, let alone every case. For a while, we had disposables because we had a shortage of reusable, but now we don't have those either. We recently were told no cloth hats, no jewelry, no long sleeves unless covered by a jacket. Doesn't make sense because people are wearing the cloth jackets for weeks.

[CapeCodMermaid, RN]

I thought this was going to be a thread about tattoos.

[patadv]

A freshly laundered jacket should be worn daily and changed sooner if contaminated. It should be worn at all times when in restricted or semi-restricted areas in order to contain skin squames that are shed by OR personnel. "The major source of bacteria dispersed into the air comes from health care providers' skin." "Every individual loses a complete layer of skin every four days (about 10,000,000 squames every day). With just the movement of walking, this may cause a loss of 10,000 squames per minute." - quotes from AORN Standards 2011 edition

[CheesePotato, BSN, RN]

Ah yes....AORN. Both the defender and the bane of our existence.

Considering it is a debatable fact (depends on which study you read on which week when the moon is full on the second Tuesday of each month) that our masks are generally no longer effective after twenty minutes of continuous wear, I find the worry about skin cells to be...well...shall I say a touch laughable? Oh, and let us not forget the number of times surgeons kindly remove their masks while the patient wound is still uncovered....or hell, maybe not even closed. Need I even start on Anesthesia/Vendor traffic? ::sigh:: Gotta love my docs....but they are the reason I have a bottle of wine chronically chilling in my fridge.

Make no mistake. I take infection quite seriously in my own special rabid manner, however, I refuse to wear a jacket when opening supplies as I cannot account for location of sleeves AND I will not subject myself to wearing a coat so tight that I look like a hippo squeezed into a periwinkle gunny sack and must be extricated from it at the end of the day via hydraulic spreader....or the use of good old fashioned Crisco.

For some reason, this all reminds me a lot of when "perineal fallout" used to be a concern in the OR. Yeah...because rampaging pubic hair kills.

Mmhm.

[pyocianik]

Well... why don't you just take your jacket off when manipulating the patient and opening sterile supplies and put it back on afterwards?

I usually don't use one unless it's getting cold in the room.

[Libitina]

We HAVE to be bare below the elbows right across the NHS. Some theatre staff will sometimes wear a 'warm-up' jacket if the case is a long one and they're sat around for a while. They take it off though for any patient contact.

[Geani]

I agree with you, this practice is a bit strange, as you said, you touch the patient and its bed with your sleeves and than go to the next patient, I am wondering how AORN decided that this standard would be good for the patient. In a hospital where I worked at some stage in the past, there was an issue with a female doctor, belonging to a certain religion who did not permit her to use short sleeves around males. She had to go and scrub in early, before the other doctors or nurses were there so she couldn't be seen with short sleeves. We had a little bit of trouble with her because she wanted to keep her long sleeves on during washing. And now the standards changed?

[OR-RN2011]

No the Dr/PA/Tech's etc who scrub in remove the jackets before washing. They don't wear it when scrubbed in . The circulating nurse/reps etc wear the jacket.

[ohisurgery]

It is almost impossible to prep the patient before or put the dressing on after without the jacket sleeve touching the patient. These are probably the 2 most important times for the nurses' arms to be covered. The solution is long sleeve scrubs which are tight around the arms as Medline makes, or providing underarmour long sleeve tops. These also solve the problem of male nurse's chest hair protruding from the top the of the scrubs. Scrub That Operating Room Jacket: Medline Introduces Industry's First Long-Sleeved OR Scrub | Medline Industries, Inc.

[NedRN]

Considering how many OR personnel reach over the field when opening supplies, wearing a jacket is probably the better evil.