Guest editorial

OR nurses' concerns about air-powered units The increasing use of air-poweredinstruments has brought advantages to the surgeon and patient, but some problems for personnel involved. Their use has greatly benefited the surgical patient and the surgeon by cutting down on the operating room procedure time, keeping the patient under anesthesia for a shorter period of time, and making the procedure safer-if the tools are appropriately used by the operator. But these advantages have not come without some sacrifice. A heavy responsibility is placed on personnel involved in the use of air-powered tools. It is imperative that each individual coming in contact with these instruments understands the method and requirements of cleaning, maintenance, repair, and proper sterilization of the units and attachments. This adds a new dimension to the operating room nurse's responsibility. I would like to mention some aspects the OR nurse A Jane McCluskey, RN, is assistant director of nursing practice, Genesee Hospital, Rochester,NY. She is a graduate of Children's Hospital School of Nursing, Buffalo, NY, and has attended the University of Rochester. She serves on the Board of Directors of the Association for the Advancement of Medical Instrumentation (AAMI). This article is a speech she gave at the AAMI meeting in Washington, DC on March 16,1978. McCluskey is treasurer on the AORN Board of Directors.

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has to think about before she considers the process of sterilization. First, there must be a recognized need for the purchase of such instrumentationbecause it involves considerable expense, not only in the initial purchase, but also in the upkeep and updating of attachments. Therefore, instrumentation must be selected with care. If possible, there should be some standardization of the equipment so that any future parts can be added to the basic unit to meet the needs of the surgical specialty it serves. This usually limits the number of systems that need to be purchased. We who work in the clinical areas believe there could be more compatibilityor adaptability among different manufacturers' sources or fittings. Although we realize competition in design is healthy, this situation does cause some problems. The OR manager would also welcome more compatibility between systems to lower the inventory as well as overall cost. Another concern is our desire for simplicity in design so the assembly of parts is quick and convenient. Because of the complexity in design, in-depth in-service on the equipment by the manufacturer's representative is needed before installation not only for the nursing and technical staff, but also for the physicians. This education should be an ongoing program to orient new personnel and to resolve problems as they arise. For many years, OR supervisors wore the hats of the mechanic, the plumber, and the general maintenance man. This is no longer true because today the supervisor is performing her true role-that of patient care, not "thing" care. We are fortunate now to have the biomedical technician as part of the OR team. He is a definite ally and can coordinate the

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maintenance of practically all instrumentation as well as instruct the staff in operation of tools. Staff must be taught to have respect for the care of all instrumentationto afford the patient and staff maximum benefit and protection. At the Association for the Advancement of Medical Instrumentation meeting in March, L S Baker created quite a furor by stating that nurses are "hostile" to the biomedical technician. Ironically, the OR nurse has asked for placement of the biomedical technician in the OR suite. If there is any hostility, it is more apt to be aimed at the equipment if the nurse is not thoroughly oriented to it. An effective OR manager plans to orient the biomedical technician to basic aseptic technique and proper decorum in the sterile environment so he feels comfortable and secure with the surgical team. Each one must understand his role and how it interfaces within the surgical area. Another concern of the OR nurse is whether the equipment purchased is warranted so there is assurance of function. The biomedical technician should be given the manual of instructions and the basic schematics as reference material. Records of service and repairs serve as a reference for future purchase or justification for a change in vendor. For example, the biomedical technician in my hospital would certainly call my attention to an electrosurgical unit that was out for repair several times in a few months. He would actively pursue the cause and assist me in evaluating whether it was the type of equipment we want in our OR. Loaner availability, repair contracts, and replacement possibilitiesshould be investigated. With all of these considerationsto be explored, we make serious deliberations before we select the air-powered units for the OR instrumentation system. Once our choice is made, we have to plan for the cleaning and sterilization of the equipment on a case-to-case, day-to-day basis. The foremost problem in the sterilization of airpowered units is the lack of standardized information regarding either steam or ethylene oxide (EO) sterilization. We depend on the manufacturer's information, and cooperation from industry is essential. If at all possible, sterilization capabilities should be clearly marked on the item to reduce the chance of improper care and handling. We would also

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appreciate having the method of sterilization indicated on the manufacturer'sproduct literature so we can consider this in evaluatingwhat system we want to buy. A great deal has been publishedon the care, cleaning, and maintenance of air-powered tools, but relatively little has dealt with sterilization. To my knowledge, there is only one published paper on steam sterilization of airpowered tools that is backed by scientific data.' There is little available on ethylene oxide sterilization except the article by McGlothlen and Weida.2 As you know, the Environmental Protection Agency is considering the control of the use of EO as a sterilant for items used in hospitals. We cringe at the thought of how we would handle many of our items if EO sterilization was drastically curbed. A large percentage of all the equipment used by patients demands this process. Such a ban or tight control would significantly affect the delivery of good health care. It would also omit certain specialty procedures and affect the utilization of OR time. Determining the method of sterilization for air-powered instruments depends on the type of equipment we have. If we have equipment that can be disassembled, it is safe to sterilize it by steam. There seems to be a controversy about the exposure time for these tools, but in my facility we steam sterilizeour disassembled units unwrapped at 270 F (132 C) at 30 Ibs pressure for ten minutes. Single pieces of equipment are placed in apen pans at the same pressure and temperaturefor three minutes. The only disadvantageto this method is that units have to be reassembled at the sterile table at the time of the procedure. This can take time. Most hospitals cannot invest in multiple systems of air-powered units, so steam sterilization is desirable because it keeps the inventory down and puts the equipment back into the sterile area more rapidly. However, if the air-powered units or tools cannot be disassembled, the unit. should be sterilized as per the manufacturer's instructions. We must be assured that the unit is sterile internally as well as externally. With EO sterilization,we must have a larger inventoryof equipment because the process time is much longer. Also, since the units are wrapped, there are controversies regarding the neces-

AORN Journal, August 1978, Vol28, N o 2

sity of aerating a unit wrapped in cloth. In this case, the need for aeration is not based on whether the instrument is wrapped in cloth, but on the absorption of EO by lubricant oils and nonmetal parts. Many people outside of the OR do not realize how many times a week nurses have to explain why EO-sterilized equipment cannot be used as soon as it is sterilized. Many surgeons state, “Iwill assume responsibility for it.” We hear this often. However, this should never be allowed. If any staff member has a problem with requests or demands for early deliverance of unaerated supplies, it should be taken immediatelyto the infection control committee for support for proper aeration to assure no residual. Depending on the individual hospital, the number of units can drastically affect the scheduling of the work load. In large, active facilities, the many procedures necessitating air-powered techniques mandate that sufficient equipment be available so cases move quickly or can be done simultaneously. Turnover time for instrumentsis increased because these units need hand cleaning and special attention and cannot withstand the treatment of the washer sterilizer, ultrasound, or immersion cleaning. In summary, the OR nurses’ concerns about air-powered instruments and their uses are limitations of the methods of sterilization the amount of air-powered equipment budgeted 0 the number of specialty services and the type of procedures done in the suite the size of the daily work load the need for expedient assembly of units 0 the desire for improved safety features, particularly for drills, burrs, and air hoses 0 more adaptability of new attachments to current systems 0 availability of loan equipment when a part is out for repair better in-sewicefrom the manufacturer for staff. Perhaps if technology continues to progress, we can challenge all manufacturers of airpowered units to be more definitive in the care and sterilization of such instrumentation.

instruments by steam,” Hospital Topics (March 1973)51-57. 2.G McGlothlen, D A Weida, “Recommendations for EO gas sterilization of air-powered surgical instruments,“ AORN Journal 21 (January 1975) 87102.

Unvaccinated persons may still risk polio There is a group of unvaccinatedpersons in the United States still at risk of contracting poliomyelitis, says a report in the May 26 Journal of the American Medical Association. The number of new polio cases has fallen to very few-only seven in 1975-as the result of mass polio vaccinations carried out with Salk vaccine from 1955 to 1961 and with the Sabin oral vaccine subsequently, Frederick C Basilico, MD, VA Hospital, West Roxbury, Mass, and James L Bernat, MD, Dartmouth-Hitchcock Medical Center, Hanover, NH, point out. However, some new cases are associated with the vaccine itself, they state. The physicians describe the case of a 30-year-old New England farmer who contracted polio after his 4-month-old son received the oral vaccine. The farmer, who had not been vaccinated, was left with a partially crippled leg. The vaccine-associatedcases are Seen only with the oral vaccine and not with the Salk vaccine, Drs Basilico and Bernat say. Discussing the impact of booster polio vaccinations from 1 to 14 years after the initial series, James W Bass, MD, US Army Medical Corps, Tripler Army Medical Center, Honolulu, and colleagues state that polio booster vaccination 5 to 6 years after the last series may augment immunity. Dr Bass’s findings support the recommendations that boosters should be given to children just before school entry and offered to persons who plan to travel in areas where the disease is still prevalent, he says.

A Jane McCluskey, RN Notes 1. K Kereluk, et al, “Sterilization of air-powered

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AORN Journal, August 1978,Vol28, NO 2

OR nurses' concerns about air-powered units.

Guest editorial OR nurses' concerns about air-powered units The increasing use of air-poweredinstruments has brought advantages to the surgeon and pa...
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