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An emergency is taking place in the OR: the physician needs bronchoscopy instruments now to remove a foreign body from the patient's airway. Are the bronchoscopy instruments immediately available? Bronchoscopy and airway instruments need to be accessible, easy to recognize, organized, and clean to facilitate a smoothly run surgical procedure. A problem in any of these areas could lead to trouble during a bronchoscopy procedure.
Perioperative nurses ultimately are responsible for ensuring that the surgical environment is clean and organized.1 Nurses need to continually improve patient and personnel safety in addition to specifically assessing infection control practices, instrument security, and staff member preparedness with regard to procedures and instruments.
At Children's Hospital of Denver, the bronchoscopy instruments reside in a wheeled cart with eight drawers that each contain a variety of instruments. These instruments are very expensive, and some are fragile and need protection within the drawers. The containers that the bronchoscopy instruments reside in within each drawer became an area of concern when staff members from the facility's infection control department identified a potential infection risk associated with them. To ensure patient safety and increase success in providing excellent nursing care, the perioperative RN ear, nose, and throat service leaders, began searching for a new storage environment for bronchoscopy instruments.
INSTRUMENT STORAGE ENVIRONMENT CONSIDERATIONS
The facility cares for pediatric patients ranging from the healthy to the critically ill. We have three bronchoscopy carts that contain semicritical instruments and supplies (ie, items that come in contact with nonintact skin or mucous membranes2) that are needed for emergency airway procedures. The carts are transported into several different ORs on a weekly basis.
The carts are exposed to a variety of microorganisms that can range from normal flora to staphylococci, pneumococci, methicillin-resistant Staphylococcus aureus, and viral organisms that cause respiratory papillomatosis. Health care practitioners need to be cognizant of whether semicritical instruments and their storage environment are clean or contaminated. Keeping instruments and their storage environments clean requires a rigorous adherence to sterilization and disinfection practices before, during, and after instrument use to protect patients and health care personnel from health care-associated infections.3 Semicritical items, such as bronchoscopy instruments, should be cleaned and decontaminated immediately after use, be dried completely according to standards before being placed in...