Behind the Scenes: Patient Safety in the Operating Room and Central Materiel Service During Deployments

Abstract

The United States Army perioperative nurses face unique patient care situations during overseas deployments. In this report, the experiences at the U.S. Army's 28 th Combat Support Hospital in Iraq are described. The lessons learned from these situations can assist in patient safety in future operations. The challenges to the nursing staff of performing "housekeeping" tasks while simultaneously accomplishing a number of other patient care tasks are reviewed. The surgical suite structural requirements for the operating room (OR) and for central materiel service (CMS), and the adaptation of the workflow capabilities through CMS to ensure the best possible sterile products are discussed. Cleaning becomes very difficult in deployed environments because of the mass casualty episodes as well as the relentless wind and sand. The effects of fatigue, sleep deprivation, and stress threaten maintenance of standards and attention to detail. Steam sterilization and glutaraldehyde soaking are useful as sterilization methods when adapted to this harsh environment. With this environment, it was necessary to extend the length of sterilization times, adapt pressure bags to rinse lumens, and realign the work flow to ensure better cleaning and sterilization practices. Cultures of the OR and CMS demonstrated the efficacy of our efforts. Room air exchanges, temperatures, water quality, and other structural requirements were measured on a routine basis and problems were aggressively addressed. The work and traffic flow practices were designed specifically to provide an aseptic environment and functional equipment. Staff safety and well being were given priority in order to maintain standards.

Evaluation of Potential Environmental Contamination Sources for the Presence of Multidrug-Resistant Bacteria Linked to Wound Infections in Combat Casualties

“…22,23 Despite reports of challenges to maintain an adequate sterile environment within ORs under austere conditions, the limited environmental sampling of OR surfaces in an Afghanistan field hospital did not reveal gram-negative bacteria contamination. 24 Comparative environmental sampling in modular field-type ORs that are used in the deployed combat environment and fixed-facility ORs in the United States also demonstrated no significant contamination. Although studies have demonstrated a correlation between length of surgery and aerosolization of bacteria during wound care of burn patients with MRSA infections, we did not show appreciable aerosolization of bacteria during surgery, except maybe in the case of burn patients.…”