Removing Jewelry

Q: What is one to do when a surgeon, PA, midwife or general practitioner scrubs in to assist on an emergency surgery wearing a ring?

A: Kindly ask them to remove their rings and state Best Evidence Based Practice, AORN standards and hospital policy. Offer them a safe and secure place for their belongings. If they are unwilling to comply, complete an incident report under the basis of potential harm and not following standard practice/policy. This way the incidents can be tracked and the offenders can be counseled by their peers.

A: Insist that they remove it.

Laser Safety

Q: As part of the pre-employment physical for circulators and scrub techs, do you require these employees to have an eye exam? I did not find where AORN recommended an eye exam on hire as part of laser safety protocol. What are you doing for laser safety?

A: No, we do not require the eye examination for personnel working with lasers (anyone of our staff may be assigned to a laser procedure). ANSI may have stronger language beyond recommending an eye examination, AORN uses “should” instead of a definitive “will” and allows individual facilities to determine if the eye examination is required or recommended.

“Under the Guideline for LaserSafety, Recommendation IV, IV.d. Medical surveillance (eg, baseline eye exam, post-procedure exposure exam) should be considered for health care personnel where class 3B and class 4 lasers are used, if requested by the employing health care organization. A baseline eye examination provides historical information in the event of a laser injury.

IV.d.1. The baseline exam should be performed before working with lasers, as directed by the health care organization policy and procedure.

A: When I started at Johns Hopkins hospital I had to have an eye exam during the hiring process.

Cleaning Rigid Containers

Q: What is the current practice in your facilities regarding cleaning/disinfection of rigid container systems? For example, if you are setting up a case prior to patient arrival, what is the process for the opened and now empty rigid containers? Do they get sent to decontam along with used instruments, or are they considered to still be “clean” and returned to SPD to be reused?

A:Cleaned and sent to central.

A: If the container is out of the room before the procedure starts then the container is returned to SPD and wiped down with alcohol. If it is left in room after the procedure starts the container is sent to Decontam and run through the washer.

A: They get sent down to decontam in our large enclosed case cart with all the other instruments at the end of the case.

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