AST Guideline - Environmental Practices in the Operating Room

12 FDA between 2003 and 2006 that involved reprocessed SUDs, but only 65 actually did involve a reprocessed SUD, and the adverse events were comparable to events reported for new devices. 42 Guideline VII Surgery departments should complete a comprehensive review of its OR kits and surgeon preference cards as part of an OR kit reformulation program. 1. Certain supplies are routinely placed in OR and anesthesia kits, such as custom back table packs and patient skin preparation kits, and thrown away because they are never used during a specific procedure or procedures. 27 This concept referred to as “overage” is a significant source of RMW and drives up costs. 27 The surgery department should review its OR kits to remove the excess supplies in order to reduce RMW and costs. 21 A. The review and streamlining of the custom kits should include standardizing the number and types of each item in each kit which can result in decreased inventory, reduced cost of the kits, and reduced amount of waste that translates into lowering waste disposal fees. B. The review of the custom kits should involve the surgeons, CSTs, and RNs. 2. Surgery departments should work closely with the surgeons and commercial businesses that provide the kits to eliminate the unneeded, excess items that are routinely disposed of as waste rather than being used during procedures. 32 A. CSTs should work with the surgeons in reviewing preference cards to identify unneeded or excess items, as well as identify items that are needed in the OR during the procedure, but should not be opened unless requested by the surgeon. (1) The surgery staff should audit the surgical procedures prior to revising surgeon preference cards to identify items that are not needed, items that should be in the OR unopened, and items that were opened in excess (e.g., suture packets). 32 (2) The review of the preference cards should focus on reducing and standardizing the number and types of items needed for surgical procedures. (3) Two recommendations the surgery department should consider is to only list those items on the preference card that are used more than 90% of the time and/or identify items used 50% or less of the time and mark on the preference card as “hold”. 2 Guideline VIII The surgery department should implement fluid management procedures to improve the handling and disposal of liquid medical wastes. 1. It is recommended that surgery departments decrease staff exposure to bloodborne pathogens and minimize RMW disposal costs by installing fluid management systems in the department. 32 An article published in 2004 by Healthcare Purchasing News estimated that between 30% - 60% of HDO’s continue to have surgical staff manually open the canisters and pour the contents down the drain. 6 Even though the canisters have been emptied of their contents the empty plastic