Download Operating/Procedure Room Observation Tool

OPERATING/PROCEDURE ROOM
OBSERVATION TOOL
Date of observation: ______
Operating/Procedure Room # ________
Procedure(s): ______________________
Time:
From ________ To ________
Observer:
____________________
Patient Identifiers: ______________________________
Any answer that is in a RED box requires an action plan
Compliant
YES
STANDARDS
Compliant
NO
N/A
DESCRIPTION/COMMENTS
I. Operating/Procedure Room Environment
1.
2.
3.
4.
5.
Operating/procedure room appears clean, dust free, uncluttered
Operating/procedure room facility in good repair (e.g., no holes in walls,
floors or ceiling)
Solid ceiling; no tiles
Are non-essential items stored uncovered in operating/procedure
rooms?
Interim (between cases) environmental cleaning performed directionally,
from top to bottom
YES
NO
YES
NO
YES
NO
YES
NO
YES
NO
Dust located: _______________________________
II. Room Procedure Observation
1.
2.
3.
4.
Was floor mopped in between cases?
Doors closed, doors not propped open; traffic in and out of room kept to
minimum during case
Number of personnel in room kept to a minimum
Were there personnel in operating/procedure room not directly involved
in case?
YES
NO
YES
NO
YES
NO
YES
NO
# door openings/per hour: _______________
Might choose to list reasons for opening
and/or collect specific data:
 Door openings from hall prior to incision
 Door openings from sterile core before
incision
 Door openings from hall after incision
 Door openings from sterile core after
incision]
# personnel in room during case: ________
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III. Perioperative Patient Care
1.
2.
3.
4.
Pre-op antibiotic given by anesthesia personnel within 60 minutes prior
to incision (Note: 120 minutes for Vancomycin /Fluoquinolines)
IV injection ports swabbed prior to access
Hair removal performed before entering operating/procedure room
(planned hair removal only; occasionally additional hair must be clipped
or done in the operating/procedure room)
Pre-op skin prep:
a. Was op-site cleaned prior to scrub?
b. Dual agent prep used (i.e., Chloraprep or Duraprep)
Product used for skin prep at operative site: __________________________
c. Is application technique appropriate for product used?
 Side to side (Chloraprep)
 In concentric circles, beginning in the middle and then out to
periphery (Betadine)
d. Perineal area prepped and covered with impervious drape?
e. Is operative site allowed to air dry prior to incision?
How long did site dry prior to incision?_________________
f. Is operative site dried with a towel or 4x4s prior to incision?
g. Is adhesive incise drape used?
YES
NO
YES
NO
YES
NO
YES
NO
YES
NO
AORN guidelines recommend clipping occur
in non-OR site; consider action plan
Describe application method:
YES
NO
YES
NO
YES
NO
YES
YES
NO
NO
IV. Attire (for anyone entering semi-restricted and restricted surgical site areas)
1.
2.
3.
4.
5.
Surgical caps/hood cover all head hair
a. Nursing
b. Anesthesia
c. Surgeons
Chest and beard hair fully covered
Do any operating/procedure room staff members appear to have long
fingernails?
Do any operating/procedure room staff members appear to have
artificial fingernails?
Dress code followed:
a. No rings; other jewelry (e.g. watches, earrings, bracelets, necklaces,
piercing) should be removed or totally confined within scrub attire
b. No fanny packs
c. Wearing long sleeves (approved cover jacket)
d. No turtlenecks
e. Clean (not visibly wet or soiled) operating/procedure room scrub
suit
f. Shirts of scrub suit tucked in or close fitting
YES
YES
YES
YES
YES
NO
NO
NO
NO
NO
YES
NO
YES
NO
YES
NO
YES
NO
YES
YES
YES
NO
NO
NO
YES
NO
YES
NO
Natural nails short
1.02 OPERATING/PROCEDURE ROOM OBSERVATION TOOL
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g.
h.
i.
All non-scrubbed personnel wearing long sleeved jackets that are
buttoned or snapped
Undergarments completely covered by scrub suit
No fleece
YES
NO
YES
YES
NO
NO
V. Sterile Field
1.
2.
Mask covers nose and mouth and is tied securely
Mask in place when entering operating/procedure room and sterile
packs open and when in sterile core
3. Sterile items left open no more than 60 minutes prior to patient entering
room and should be constantly monitored during that time period
4. Scrubbed persons maintain sterility of sterile gown, gloves, supplies (e.g.,
while waiting for procedures to be done such as X-Rays?)
5. Chemical indicators must be checked when instruments are opened,
before they are placed on the sterile field
6. Items introduced into sterile field are opened, dispensed, and transferred
by methods to maintain sterility/integrity
7. Items/devices dropped below level of the operating/procedure room
table are considered contaminated
8. Is the drape between anesthesia and patient above the level of
anesthesiologist’s nose and mouth?
9. Do anesthesia personnel lean over drape during procedure?
10. Surgical equipment (e.g. cables, tubing) should be secured to sterile field
with non-perforating devices
11. Nonsterile equipment (e.g., mayo stands, C arms) should be covered with
sterile barrier materials; only sterile items should touch sterile surfaces;
sterile barrier material should be applied to any equipment adjacent to
the sterile field
12. All personnel moving in/around sterile field do so in manner to maintain
sterility, for example:
a. Staff do not turn back to sterile field
b. Scrubbed personnel pass front to front or back to back
c. Hands remain above waist
d. Separation of sterile team from non-sterile team maintained
e. Unscrubbed personnel do not pass between two sterile fields
YES
NO
YES
NO
YES
NO
YES
NO
Yes
NO
YES
NO
YES
NO
YES
NO
YES
NO
YES
NO
YES
NO
YES
NO
VI. Anesthesiology
1.
2.
3.
Drainage bags (e.g., foley) kept off the floor
Aseptic practice used for IV tubing, fluids, medications – injection ports
swabbed prior to access
Sterile equipment including IV solution/tubing is assembled
immediately prior to use
YES
NO
YES
NO
YES
NO
1.02 OPERATING/PROCEDURE ROOM OBSERVATION TOOL
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4.
5.
6.
7.
8.
Aseptic practice used for all invasive procedures (e.g., epidurals, blocks,
IV insertion)
Was antibiotic infusion mentioned/checked prior to incision?
Was antibiotic infusion repeated if surgery is longer than 4 hours?
Anesthesia cart appears clean; handsanitizer readily available
Re-usable personal equipment (e.g., stethoscope) cleaned between cases
YES
NO
YES
YES
YES
YES
NO
NO
NO
NO
Note: type of ATB may require repeat dose
VII. Medications/Solutions
1.
Are medications and solutions: (circle one)
a. Single-dose
b. Multi-dose
What solutions/medications are multi-dose?___________________________
2. Are solutions supplied in large containers?
3. Are any medications or solutions expired?
4. Is the wound irrigated?
If yes, list solution used for irrigations: ___________________________
5. List any topical medications used: __________________________________
6. What is used to close the wound? (circle one)
a. Sutures
b. Staples
c. Derma-bond
7. What dressing is placed on the wound?_______________________________
8. Are any solutions mixed in the operating/procedure room?
If yes, list:__________________________
9. Are any containers refilled?
If yes, list:________________________________
10. Are any solutions supplied or used as a spray?
YES
YES
NO
NO
YES
NO
If YES, observing technique should be part of
action plan
YES
NO
YES
NO
VIII. OSHA/Bloodborne Pathogen Standard
1.
2.
3.
4.
Appropriate eye protection used
Sharps containers not overfull
Sharps are passed in a basin or by using neutral zone rather than by hand
Sharps safety devices utilized where available
YES
YES
YES
YES
NO
NO
NO
NO
Devices used: ________________________________
IX. General Infection Prevention and Control
1.
2.
3.
4.
Do members of the surgical team appear to have upper respiratory
infection (e.g., cough, sneezing)?
Do any operating/procedure room staff appear to have
hand/forearms/skin/fingernail open lesions or infections?
Was conversation in sterile field limited to only necessary conversation?
Sterile team removes gloves and washes hands at end of case
YES
NO
YES
NO
YES
YES
NO
NO
1.02 OPERATING/PROCEDURE ROOM OBSERVATION TOOL
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5.
6.
7.
8.
9.
Were gloves changed between dirty and clean procedures?
Was hand hygiene performed when gloves changed?
Is a hand antisepsis product available?
Clean, sterile, and soiled items are kept separate
Used sterile instruments/equipment transported to CSP for
decontamination and sterilization
YES
YES
YES
YES
NO
NO
NO
NO
YES
NO
X. Sterilization
1.
2.
3.
4.
5.
6.
7.
8.
Are instrument trays checked by nurse for breaks prior to placing on
sterile field?
Are biologicals performed and within normal limits for sterilizers?
Do processes appear efficient in SPD with items/areas tidy and well
labeled?
Are instruments pre-cleaned or soaked soon after use?
Were items sterilized using immediate-use steam sterilization (ISS)?
If yes, list reason for using ISS: __________________________________________
Were instruments sterilized using ISS delivered to sterile field without
contamination?
Was water splashed on the sterile field when instruments sterilized using
ISS were delivered?
Was the item that was sterilized using ISS contaminated by circulating
nurse?
YES
NO
YES
NO
YES
NO
YES
NO
YES
NO
YES
NO
YES
NO
YES
NO
XII. HVAC Systems (If not optimal, action plan required)
1.
2.
3.
Room humidity: ____________ (Between 30-60% is optimal)
YES
NO
Temperature: ___________________ (Between 68-73 degrees is optimal)
YES
NO
Air exchanges/hour: ___________ (Min. 15/hour required, 20-25 is optimal)
YES
NO
XIII. Hand Scrub (Observe one individual scrubbing)
1. Physician___Nurse_____Tech_____SA__________ (Select one)
2. Product used: ______________________________
3. Scrub brush used with product
YES
NO
4. Does the healthcare worker clean under his/her fingernails?
YES
NO
5. Is scrub accomplished from hands to forearm to elbow?
YES
NO
6. Does the surgical scrub last 3-5 minutes?
YES
NO
7. When the scrub is finished, are fingers held up so water runs down
YES
NO
toward elbows?
8. If waterless product is used as the first scrub of the day, is it a water
YES
NO
aided scrub?
9. If waterless product is used, does the staff member apply product to hand
YES
NO
and then up arms to elbow?
10. Are hand scrub products “topped off?”
YES
NO
1.02 OPERATING/PROCEDURE ROOM OBSERVATION TOOL
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RESOURCE
Developed by the Oregon Patient Safety Commission; adapted from tools by BJC Healthcare, Kaiser Permanente, Duke University, University
Hospital North Carolina, and Oregon Health and Sciences University.
DISCLAIMER: All data and information provided by the Oregon Patient Safety Commission is for informational purposes only. The Oregon Patient Safety
Commission makes no representations that the patient safety recommendations will protect you from litigation or regulatory action if the recommendations
are followed. The Oregon Patient Safety Commission is not liable for any errors, omissions, losses, injuries, or damages arising from the use of these
recommendations.
1.02 OPERATING/PROCEDURE ROOM OBSERVATION TOOL
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