MAKES ME CRY-EVERY TIME

I read a post on LinkedIn every day about a HAI or SSI. It's frustrating. And frightening. Today I read Mary Millard's personal account of surviving her HAI. I've read it many times. Every time I do, it makes me cry. Every time. That could be any one of us contracting an infection from the very place we go to save our life- not complicate it or possibly end it.

In addition to my still active career as a CRNA for 38 years, my "thing" is the overhead surgical lights and their potential contribution to contamination of the surgical field. When I saw debris fly up from the field during a Total Knee, hit the unsterile lens of the OR light and fall back smack in the open wound, I had a true eureka moment. How many times has this happened and no one notices? With this contamination to the patient, even with our multi-modal efforts to suppress and prevent SSIs, what if this patient gets an infection? Will this light get REALLY clean before it could possibly cross contaminate the next patient? Then the ripple effect of an SSI roars through my mind: repeat hospitalizations and surgeries, the hospital may not be reimbursed (it's a "never event"). But the HUGE price that is paid is by the patient (a lifetime of pain and disability?) and their family. I know this firsthand. My mother had a SSI (or as I describe them Surgically Acquired Infections), from her Total Knee procedure. Enduring that experience with her, the weeks to get her well, made me even more committed to bringing attention to a very simple solution to prevent the OR lights from harboring potentially infectious material or contributing to contamination of the surgical sterile field- STERILE SURGICAL LIGHT DRAPES!! So simple!!

We go to such great lengths to control the environment for surgeries, particularly Joint Replacements: room temperature, patient temperature, blood sugar control, traffic control, humidity control, proper antibiotic dose and time, sterile gowning, gloving, sterile head covering (to protect staff or patient? BOTH!) and all the practices specific to anesthesia personnel, etc. Mind boggling the multitude of steps we take. But we do it. Why? Because EVERYTHING MATTERS. EVERY PATIENT. EVERY TIME.

Surface contamination plays a HUGE role in HAIs and SSIs. Many times, just disinfection of a surface, a good wipe off, is all that's needed to meet the requirements or expectations for what procedures will take place in that in environment. Adequate surface decontamination has its own set of multiple steps to reach a satisfactory goal: the right chemical for that surface applied the right way for the right amount of time by the right people, just to name a few steps, always with the thought in mind to not damage the surface with the very process you're trying to clean it with. If damaged, it can then become a reservoir for bacteria!

In the OR, the pressure is on; turnover time is a big deal- everybody watches, everybody knows, and everybody has to be accountable for the part they play from "wheels out" to "wheels in". We're all aware an empty OR isn't making any money. Speed is important. And so is the result of the efforts. The lens of the OR light will never be sterile no matter how hard or with what you wipe it. You have a small sterile point of contact by grasping the sterile light handle cover that allows you to manipulate your light, but be careful! Once you grab that handle, the first thing you do is LOOK AWAY- down toward the field where you want to direct the light. Are you positive you remained sterile? Would you hold the implant you're about to put in that patient to that handle cover, in that close a proximity to an unsterile surface, and look away and move the light around? Even of your answer is NO, just think, you're doing it with your sterile glove and going right back to the surgery. Only if you cover the lights with sterile barrier light drapes will that surface (the lens you're so close to), and subsequently that patient on the table, be protected.

I've attached a picture to put in perspective how close you really are to an UNSTERILE surface when you grab that light handle cover. It's well described in publications the concerns of overhead lights contributing to contamination of the surgical field with statements and evidence such as: the lights are not sterile, residual particulates from previous surgery may fall onto the sterile field if we move them at all and especially if they bump into each other, positive bacterial cultures grown from swabbing OR lights, positive cultures from an unoccupied OR after cleaning with just moving the lights about, "until sterile lighting is invented" (one of my favorite comments), etc. Surgical light drapes are simple, effective, fast (on AND off), safe, and most importantly to budgets, cheap.

WHY NOT?

*Special thanks to Mary Millard for sharing her story.