Image courtesy of AORN cover story
Image courtesy of AORN cover story
IPs, Don’ t Fear the OR / SPD: Experts Offer Advice for Collaborating With Complex Departments
By Kelly M. Pyrek
Pushing past the double doors leading to the operating suite or the sterile processing department can feel like passing the point of no return to an infection preventionist( IP) who is either a novice or comes from a non-clinical background, or both. Even some veteran IPs may feel some degree of trepidation at the prospect of observing in areas of the hospital that may seem complex and mysterious.
The Operating Suite
Infection preventionists may feel apprehensive in the operating room( OR) due to the high stakes involved in patient safety and the potential for unseen threats, such as breaches in aseptic technique. Additionally, a lack of psychological safety in some hospital cultures can discourage them from speaking up about safety concerns, leading to fear of conflict or repercussions.
Although now somewhat dated, Barnes( 2014) provided a nice outline of the universal and evergreen areas in which IPs can offer the OR their unique expertise, including infection prevention and control, performance improvement and implementation science, leadership and program management, and assistance with technical aspects including automated and manual surveillance.
Related to surgical procedure observations Barnes( 2014) notes,“ In a best practice model, the IP might make routine observations of surgical procedures at the invitation of the perioperative department. Each observation ideally would begin with an introduction of the IP to the team by the perioperative manager. The IP might work with the OR manager in advance to identify the key prevention practices or products to include on a checklist that the IP can use to guide the observation. Examples include proper application of surgical skin preparation solution, use of a dual-agent skin prep, proper timing of preoperative antibiotics and re-dosing for prolonged cases, and keeping the Foley drainage bag off the floor. Following the procedure, the IP might provide a debriefing session with the perioperative manager and ideally, the surgeon. The debriefing should include not only observed best practices, but also areas of opportunity for reducing infection risk. This meeting would also afford the IP an opportunity to ask questions regarding the surgical procedure; surgical instrument design, especially designs that make instruments difficult to clean; point-of-use decontamination; OR and instrument reprocessing workflow; and other aspects to help improve learning and communication.”
When it comes to surgical site infection( SSI) prevention, Barnes( 2014) points out that,“ If the SSI rate spikes for any procedure, perioperative personnel should collaborate with the IP to analyze the SSI data, determine where there is opportunity to improve SSI prevention practices, and develop a plan of action. This process should include an examination of whether basic prevention practices are reliably and consistently implemented and whether there are products or practices that should be added. The IP should track evolving evidence supporting prevention products and practices and advise perioperative staff members regarding which products or practices could be introduced to reduce the risk of infection, such as nasal decolonization of pathogens.”
Further, IPs can offer the OR assistance with the root cause analysis( RCA) process which can identify areas of opportunity and reinforce reliable design. As Barnes( 2014) explains,“ A root cause can be defined as the‘ most basic causal factor or factors which, if corrected or removed, will prevent recurrence of a situation.’”
The RCA should focus primarily on systems and processes, not individual performance. A typical RCA incorporates the following elements: a determination of the human and other factors most directly associated with the sentinel event and the processes and systems related to its occurrence; an analysis of the underlying systems and processes through a series of‘ why’ questions to determine where redesign might reduce risk; an inquiry into all areas appropriate to the specific type of event; identification of risk points and their potential contributions to this type of event; and a determination of potential improvement in processes or systems that would tend to decrease the likelihood of such events in the future, or a determination, after
14 • www. healthcarehygienemagazine. com • march-april 2026