INDIANAPOLIS – It’s important for a healthcare laundry manager to know how to launder and handle reusable surgical fabrics, but it might also be helpful for them to understand how the fabrics are used in the operating room and who’s using them.
That was the basis of a lively seminar presentation by Judy Kaifas, R.N., PrePaK nurse consultant for Standard Textile Co.
Speaking during the American Reusable Textile Association’s Insider’s Guide to Processing and Marketing Reusable Medical Textiles seminar, Kaifas “brought” attendees into the O.R., dressing a volunteer patient on a hospital bed to demonstrate gowning procedures and other O.R. protocols involving the selection, placement and use of surgical linens.
Kaifas works with surgery staff and suggests cost-effective, clinically applicable reusable surgical linen products for their particular situations.
Staff you’ll find in the O.R. include the surgeon, scrub nurse, first assistant, circulating nurse, anesthesiologist and maybe others depending upon the complexity of the case.
“The first three, those are the ones that will need your product,” Kaifas says. “Those are the ones that will scrub and will need to be in a sterile gown.” The others mentioned don’t “need” sterile gowns, but they often use them anyway, unnecessarily increasing the number of gowns your laundry has to process for the hospital, Kaifas says.
“Anesthesia personnel are classic abusers of this. They will actually pull a sterile gown from a cupboard in the room, put it on and use it as a warmup jacket. They may have available to them, in their locker room, warmup jackets but they choose not to grab those.”
Kaifas displayed a diagram of the O.R. layout for open-heart surgery, including the operating table, various instrument tables, a heater/cooler and a defibrillator. All of them need to be covered with sterile linen, and most with liquidproof barrier linen. “That’s a lot of sterile linen they need, and that’s a lot that you can provide.”
Surgical towels are a nurse’s favorite product in the O.R., Kaifas says. “We love our towels for many, many different legitimate uses.”
These include drying the hands of surgical staff, padding back tables and/or mayo stands, squaring off around a fenestration (a fixed opening incorporated into a surgical drape to facilitate access while operating), wrapping surgical instrumentation, padding between basins and for instrument rolls/tie books.
Unfortunately, surgical towels are sometimes used as mops to soak up spills and thus become heavily stained.
“Then, as the good O.R. nurse that I am, I look at that and know that there’s no way you in the laundry can get that clean, so I’ll help you out. I’ll throw it out. I’m not helping you, really, but I think I am, because nobody ever told me about laundry.”
It’s not unusual for surgeons to draw on towels or even surgical drapes, illustrating the procedure they’re about to do, especially if they work in a teaching hospital.
Reusable surgical gowns are truly a better value than disposables, Kaifas says.
Sterile gowns establish a barrier that minimizes the passage of organisms between nonsterile and sterile areas. Although an entire gown has been sterilized, O.R. personnel only consider a gown to be sterile from the nipple line to the level of the sterile field, and 2 inches above the elbow to the cuff on the sleeves.
“The reason for that is we can’t keep our eyes on the other areas, so we have to assume that it’s contaminated,” Kaifas says.
Barrier fabrics are used to prevent the occurrence of strike-through – blood or other body fluid seeping through the fabric. Three things are needed for strike-through to occur: time, pressure and fluid.
“If you don’t have all three at the same time, you will not have strike-through,” Kaifas says. “Should you have strike-through on a gown or on a drape, it’s important for your information to help your clients to find out how it was used. Was it indeed a strike-through issue, or was it an inappropriate use?
“If they have a case where they’re using a lot of irrigation, they’ll need a liquid-proof gown. ... If they choose not to put on that liquid-proof gown and they have strike-through, it’s not your gown’s fault. They chose an inappropriate product.”
Surgical wrappers protect the contents of surgical packs from becoming contaminated and allow for aseptic presentation of pack contents. Certain larger sizes may also serve as back table covers, when not anticipated to be in contact with liquids. Wrappers can sometimes be used as an ancillary drape to cover areas away from the surgical site.
Universal draping systems are promoted as an alternative to a fixed fenestration program of surgical drapes, Kaifas says. Universal component parts are utilized for a high percentage of cases, eliminating the need for a broad array of procedure-specific drapes, thus reducing the SKUs in inventory.
Kaifas says only nonpenetrating towel clamps should be used when employing reusable surgical drapes, because other clamps will damage the textiles.
Universal precautions for infection control often lead O.R. personnel to discard textiles unnecessarily, she says.
“You have to work with the hospital, identify what their infectious waste policy is and make sure the O.R. understands that your products need to be placed in that hamper and it comes to you and is treated appropriately.”