AORN JOURNAL
SEITEMBER 1992, VOL 56, NO 3
care institutions in today’s uncertain economy, tion to the area under the tape. If the colorhospital reputation and physician loyalty are coded tape chips or peels off during surgery important considerations, but physician satisand the instruments have not been sterilized for faction should be promoted through progresthe appropriate amount of time, the instrument sion, not regression. Rather than promote a may not be sterile. physician bonding system, we should promote MARYO’NEALE,RN, BS, CNOR a system of collaboration in which the knowlPERIOPERATIVE NURSE SPECIALIST edge, skills, and clinical competence of health CENTERFOR PRACTICE care professionals are mutually valued and respected. If nurses allow this professional Surgical Masks socialization to continue, it will result in a loss of autonomy and a change in the interpretation am quite concerned about the viewpoint presented by William C. Beck, MD, FACS, and expectation of nursing roles. FIES, in the April 1992 guest editorial, “The ROSETROJKoVIcH, RN, CNOR STAFFNURSE/NEUROLQGY surgical mask: Another ‘sacred cow’?” Dr Beck reports on “an excellently designed ENGLEWOOD (NJ) HOSPITAL and executed study on 3,088 consecutive Flash Sterilization patients.” He explains when masks were used and noted that patients were excluded if they he article “Flash sterilization: Is it safe for were undergoing open heart, orthopedic, neuroroutine use?” is good overall. I was dislogic, or outpatient procedures. The study found turbed, however, when I read that the author a postoperative wound infection rate of 4.7% flash sterilizes articles with instrument tape on when masks were worn and a 3.5% postoperathem for only three minutes. I thought the use tive infection rate when no masks were worn. of instrument tape required that the flash sterilFrom these results, the researchers conclude that ization time increase from three minutes to 10 masks provide no benefit for the patient. minutes and that only metal instruments with I am an orthopedic surgeon; thus, my no tape could be flash sterilized for three minpatients would have been excluded from this utes. study. It is my opinion that infection rates of CLARENCE FENTON, RN, BS, CNOR 3.5% and 4.7% are totally unacceptable in CLINICAL NURSE EDUCATOR/OR, ASU, PACU modem operating rooms. Proper asepsis is part technique and part attiBRIGHTON MEDICAL CENTER PORTLAND, ME tude. I do not perform surgery in an atmosphere that would be considered jovial, I believe the Response. The recommended exposure time surgical team’s number one concern is the pergiven by the Association for Advancement of son lying on the OR bed. I am not there to have Medical Instrumentation for metal instruments a good time but to perform a job and perform it only (ie, no porous items or items with lumens) well. I do believe in every standard set by is three minutes at or above 270 O F (132.2 “C) AORN concerning sterile technique, including in a gravity-displacement sterilizer. Examples the recommendations for space around tables of porous items are rubber, towels, plastics, and and the proper wearing of masks, gowns, and colored tape. When nonporous items and gloves. I even believe in “space suits’’ when porous items are combined, the minimum expoperforming total joint replacements. There is no sure time is 10 minutes at or above 270 OF room for slack in an OR. As a surgeon, I am truly the “captain of the (132.2 “C) in a gravity-displacement sterilizer. Instruments with color-coded tape are conship.’’ When an infection occurs and one of my patients is faced with a markedly altered sidered porous and require longer exposure lifestyle, it is I who must sit a few feet from the time to ensure steam penetration and steriliza-
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SEITEMBER 1992, VOL 56, NO 3
care institutions in today’s uncertain economy, tion to the area under the tape. If the colorhospital reputation and physician loyalty are coded tape chips or peels off during surgery important considerations, but physician satisand the instruments have not been sterilized for faction should be promoted through progresthe appropriate amount of time, the instrument sion, not regression. Rather than promote a may not be sterile. physician bonding system, we should promote MARYO’NEALE,RN, BS, CNOR a system of collaboration in which the knowlPERIOPERATIVE NURSE SPECIALIST edge, skills, and clinical competence of health CENTERFOR PRACTICE care professionals are mutually valued and respected. If nurses allow this professional Surgical Masks socialization to continue, it will result in a loss of autonomy and a change in the interpretation am quite concerned about the viewpoint presented by William C. Beck, MD, FACS, and expectation of nursing roles. FIES, in the April 1992 guest editorial, “The ROSETROJKoVIcH, RN, CNOR STAFFNURSE/NEUROLQGY surgical mask: Another ‘sacred cow’?” Dr Beck reports on “an excellently designed ENGLEWOOD (NJ) HOSPITAL and executed study on 3,088 consecutive Flash Sterilization patients.” He explains when masks were used and noted that patients were excluded if they he article “Flash sterilization: Is it safe for were undergoing open heart, orthopedic, neuroroutine use?” is good overall. I was dislogic, or outpatient procedures. The study found turbed, however, when I read that the author a postoperative wound infection rate of 4.7% flash sterilizes articles with instrument tape on when masks were worn and a 3.5% postoperathem for only three minutes. I thought the use tive infection rate when no masks were worn. of instrument tape required that the flash sterilFrom these results, the researchers conclude that ization time increase from three minutes to 10 masks provide no benefit for the patient. minutes and that only metal instruments with I am an orthopedic surgeon; thus, my no tape could be flash sterilized for three minpatients would have been excluded from this utes. study. It is my opinion that infection rates of CLARENCE FENTON, RN, BS, CNOR 3.5% and 4.7% are totally unacceptable in CLINICAL NURSE EDUCATOR/OR, ASU, PACU modem operating rooms. Proper asepsis is part technique and part attiBRIGHTON MEDICAL CENTER PORTLAND, ME tude. I do not perform surgery in an atmosphere that would be considered jovial, I believe the Response. The recommended exposure time surgical team’s number one concern is the pergiven by the Association for Advancement of son lying on the OR bed. I am not there to have Medical Instrumentation for metal instruments a good time but to perform a job and perform it only (ie, no porous items or items with lumens) well. I do believe in every standard set by is three minutes at or above 270 O F (132.2 “C) AORN concerning sterile technique, including in a gravity-displacement sterilizer. Examples the recommendations for space around tables of porous items are rubber, towels, plastics, and and the proper wearing of masks, gowns, and colored tape. When nonporous items and gloves. I even believe in “space suits’’ when porous items are combined, the minimum expoperforming total joint replacements. There is no sure time is 10 minutes at or above 270 OF room for slack in an OR. As a surgeon, I am truly the “captain of the (132.2 “C) in a gravity-displacement sterilizer. Instruments with color-coded tape are conship.’’ When an infection occurs and one of my patients is faced with a markedly altered sidered porous and require longer exposure lifestyle, it is I who must sit a few feet from the time to ensure steam penetration and steriliza-
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