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Staff Safety in Ambulatory Surgery Centers


By Elizabeth Even, RN, Associate Director, Standards Interpretation

There are few areas where precision and accuracy matter more than within an ambulatory surgery center (ASC). 

It is difficult to identify another location that is under such intense time pressure and scrutiny. Surgical center procedures must be correct and time efficient. When patients enter an ASC, they are likely amid hundreds of thousands of dollars of life saving equipment, medications and instrumentation.  

However, even the best equipment and technology available is useless without a highly trained health care team standing around the operating room (OR) table. Many would argue that staff members are the most precious resource in health care. This is especially true in surgical environments where patient conditions may change rapidly and care decisions must be made quickly. 

Financial Toll of Safety Lapses
Because of the incredibly important role staff play in health care, ensuring a safe work environment is vital. In addition to suffering from scheduling crunches, health care organizations also must endure the cost of lost staff due to both turnover and time off following a workplace injury. 

The price tag can be staggering. According to Becker’s Hospital Review, health care injuries cost health care organizations billions of dollars every year in addition to millions of days of lost work. The article ranks surgical injuries high on the list. Common culprits lurking in an ASC that can cause staff injury include:

  • lengthy cases
  • awkward postures
  • sharp instruments
  • heavy instrument trays 

Dangers Lurking in ASCs
When individuals are pressed for time, they naturally resort to find quick ways to “get it done.” In the ASC, this may mean holding a patient for positioning during surgery instead of seeking an alternative that may be more time consuming. In many situations, it is quicker to move a patient from a stretcher to an operating table with the help of a few staff members or to position them by holding them yourself than to utilize alternative options. However, taking these shortcuts is precisely what may lead to injured staff and ultimately cost health care organizations big dollars down the road.  

Needlestick and sharp injuries are also very common and occur at a higher rate in an ASC than other areas. According to the Centers for Disease Control and Prevention (CDC), hospital employees are victims of about 385,000 sharps injuries each year. According to the Association of periOperative Registered Nurses (AORN), 30 percent of estimated needlestick and other sharps-related injuries occur in an OR, specifically while passing suture needles and scalpels.  

Risk Mitigation Manual
The Joint Commission standards and elements of performance, located in the Infection Control chapter of the Comprehensive Accreditation Manual for Ambulatory Care (CAMAC), can help health care organizations assess their own risks for injury and determine how to best mitigate those risks.  

One area that is frequently assessed for risk is the physical environment of the surgery center. The Environment of Care chapter of The Joint Commission’s ambulatory accreditation manual, guides organizations as they establish and maintain a safe, sanitary and functional environment. The standards address a broad range of environmental issues from handling hazardous materials and equipment maintenance to fire drills and ensuring suitable lighting. According to The National Institute for Occupational Safety and Health (NIOSH) hierarchy of controls, substitution of a hazard is the most effective way to ensure workplace safety.  

Engineering Controls
Engineering controls are third on NIOSH’s hierarchy and can be highly effective while not affecting workflow or requiring any extra effort on the part of the health care worker by ensuring that the environment is appropriately designed and maintained.  

Examples such as negative airflow in rooms and HVAC filtration units keep staff safe by minimizing their respiratory exposure while caring for patients with respiratory infections.  

Risk to Mental Well-Being
Mental health can be at risk in an ASC as well. The COVID-19 pandemic has highlighted the incredible importance of the mental wellness of all staff. Much research has been published about the culture of safety in health care and this has never been more important than while working on the frontlines during a pandemic. 

 “We are all in this together,” has been the sentiment communicated in many articles written about health care staff throughout the past year. But what is meant by “culture of safety”?  To some the phrase may conjure up an image of an irate surgeon throwing instruments during a tirade. The reality is much more complex. Ignoring or belittling co-workers, grueling scheduling and intimidation are all less obvious ways that may create a toxic work environment. The Joint Commission’s standards and elements of performance (EPs) address the importance of maintaining a culture of safety in the Leadership chapter in the ambulatory accreditation manual.   

Patient safety is at the very heart of The Joint Commission’s mission. Staff reporting to a safe work environment is foundational to patient safety. Health care leadership can accomplish this with:

  • well-developed and maintained physical environment
  • safe equipment
  • clear policies and procedures 
  • strong culture of safety in which all staff feel empowered to speak up 

Joint Commission standards and EPs in the ambulatory accreditation manual can aid organizations on their journey to excellence and zero harm. True leaders know that every single member of the care team from the front desk receptionist to the surgeon performing the case all play an imperative part in the overall care delivery every day. We truly are “all in this together.”

Elizabeth Even, MSN, RN, CEN, is associate director, Clinical Standards Interpretation Group, for The Joint Commission. She is also on staff in the emergency department at Northwestern Memorial Hospital. Prior to this position she managed the emergency department at Northwestern Memorial Hospital and was a clinical educator at Northwestern University Feinberg School of Medicine.  She also has experience in home health and working as a nurse at Wrigley Field in Chicago.