Total Joint Infections

Q: Are any facilities seeing more total joint infections with the use of the Bear Hugger versus other types of warming devices? This seems to be a hot topic in the media.

A: Not us.

A: I have not noted such trending with our total joint patients.

A: No.

A: No.

A: No increase or change in SSI with and without forced air warming. There are some studies out there that support that.

A: We have not so far.

A: No, we have not.

Labeling Peel Packs

Q: Should peel packs be labeled? When sending new employees for items, they sometimes are not completely knowledgeable about what they are looking for, and labeling peel packs can be very beneficial.

A: We label the bin for identification.

A: It is appropriate to label peel packs on the end of the pouch and not on the pouch itself. This is probably only necessary for seldom used items or items that look similar, but are not interchangeable in their use.

A: We label the peel packs.


Q: Should N-95 masks be worn on all LEEP procedures?

A: We do not use them.

A: We wear special LASER masks.

A: Yes. According to AORN guidelines for Laser Safety, V.c. page 144: Personnel should wear respiratory protection (i.e., fit-tested surgical N95 filtering face piece respirator or high-filtration surgical mask) during procedures that generate surgical smoke as secondary protection against residual plume that has escaped capture by local exhaust ventilation. Local exhaust ventilation is the first line of protection from surgical smoke.


Q: Is it necessary to pre-clean all instruments at point of use? Should this be done in the suite, in the hall, or just in the decontamination room?

A: We just had The Joint Commission review. The surveyor was an infectious disease physician. He stated that we need to use enzymatic spray and spray both sides of the instruments before they leave the OR – “at point of use.” We, of course, wait until the patient is out of the room.

A: The scrub should be keeping instruments as clean as possible in the field. They should have some type of pre-klenz solution to put on the instruments if they are going to be setting for a while without being cleaned.

A: In the room.

A: I take that to mean at the point of use. Endo is done directly within the suite. Dried debris is more difficult to remove. Then, it is transported without gross contamination.

A: We spray down with pre-soak solution in the room prior to transporting to the decontam area.