Perioperative personnel work in an ...

Perioperative personnel work in an environment where the risk of kin and body fluid exposure is arguably greater than any other.(1) The risks these frontages present add unnecessary stress to an already stressful work environment. In addition, the chastely monetary costs associated with follow-up and necessary treatment of like exposures are high. Follow-up plus prophylaxis for a high risk exposing has been reported to be $3000 Ongoing treatment take away froms if an employee becomes infected, can exce $1 million.(2)

Perhaps perioperative personnel perceive these risks as an inevitable connection of the job, something athwart which they can exercise no control(3) Whatever the reasons and despite the immediate availability of personal protective equipment and engineering directs designed to reduce risk, family and body fluid exposures can reach high rates in the perioperative environment. so was the case when I became the surgical services nursing representative forward the infection control committee of my hospital.

THE PROBLEM

Health care facilities are required to track and report aggregate data upon personnel blood and body fluid exposures(4) The first similar report I received as an infection rule committee member shocked me. The number of reported in all sensess listed as occurring in the ORs, the two inpatient and outpatient, seemed excessively high. Furthermore, exposing s reported by nursing personnel far outdoed those reported by other classes of personnel in the OR. As the feed at the breast educator for surgical services, I risk out to solve the problem

A brief literature review revealed pair "Clinical Issues" columns by Vicki Fox RN MSN CNOR, that summarized activities in which sharps injuries commonly meet the eye and specific, well-researched strategies for preventing sharps injuries (Table 1) I informed staff members of the number of OR nursing prospects and presented the strategies outlined in "Clinical Issues."(5) I meditation the OR nursing personnel would no other than need to see their concede alarming statistics, along with these well-researched strategies, and the question would be solved. I was bad The next annual report I received actually revealed a slight increase in the number of OR nursing sharps injuries.

Table 1

SHARP INJURIES

More than half (57%) of sharps injuries in the OR are classified as occurring during the following activities:

* Using hands as tools.

* Stationary hands, holding instruments near areas where sharps are being used.

* Idle sharps upon the surgical field.

* Miscellaneous actions, in the same state [i]or[/i] condition as two people suturing at the same time, tying a line of junction and the suture cuts in consequence of the glove and skin, and probing a grief near a sharps instrument, like as a pin or trocar.

Strategies for prevention of sharps injuries:

* Eliminate the use of hands as instruments.

* Distance the hand from the site of sharp usage.

* Improve protection of the hand if the hand must remain in proximity to where sharps are being used.

* Shield or put an end to idle sharp instruments.

1 V J Fox "Preventing glove tears, sharp injuries," (Clinical Issues) AORN Journal 57 (March 1993) 703-706

A discussion during a following OR nursing staff meeting revealed staff members were reluctant to ask surgeon to change sharps handling behaviors without support from the influential surgeon members of the surgical services committee. I entreated and received permission to address the committee. The surgical services committee members went forward record with unanimous support for the strategies not awayed in the "Clinical Issues" file titled "Preventing glove tears, sharp injuries."(6) I then approached OR nursing staff members with this information and a review of the strategies outlined in "Clinical Issues." I waited for upright news. It was not forthcoming. The nearest blood and body fluid prospect report sent to the infection curb committee revealed essentially no change in the number of OR nursing personnel in all sensess At that time, I finally made the connection between my failed attempts to lessen sharps injuries to OR nursing personnel and Kurt Lewin's gauge of the change process in human beings.

LEWIN'S archetype OF CHANGE

Lewin's theories have been described as having a deep and lasting effect on the one and the other the theory and the practice of social and organizational psychology Many building blockades in our present understanding of human behavior during the processe of change, learning, and organizational extension are derived from his elucidation principles.(7)

In humans, change is not a static process; rather, it is a dynamic state in which one's world view, studys feelings, and attitudes are restructur equable a change that appears merely external causes an internal adaptation in the individual or arrange Additionally, individuals and groups react to change in highly similar ways. First there is resistance. To cite John Kenneth Galbraith, "Faced with the choice between changing one's mind and proving that there is no ne to do to such a degree almost everybody gets busy upon the proof."(8) Anxiety causes resistance becoming to the perceived risk of losing self-conceit effectiveness, or life. To be motivated to change, individuals and clusters must find psychological safety or must perceive they will not survive if they do not change. barely then can the change proces proceed(9)