HospitalInspections.org

Based on document reviews, observations and interviews, the hospital failed to comply with the operating room policies and procedures related to surgical attire and personal electronic devices for one (1) of one (1) observed surgical procedures.


Findings:

MaineGeneral Medical Center "Surgical Services Departmental Procedures" policy, last reviewed on 02/2023, states in part, "To define what is acceptable, allowable attire in the Operating Rooms and to maintain environmental control within the Surgical Department. Adapted from AORN [Association of Perioperative Registered Nurses] Guidelines for Perioperative Practice: Guideline for Surgical Attire - 2021 Edition." ... "Fingernail polish free from chipping may be worn in the operating room by personnel. Artificial nails or gels, which harbor organisms and prevent effective hand washing, will not be worn in the operating room by OR personnel. This includes bonding, tips and wrapping, gels and shellac."

MaineGeneral Medical Center "Hand Hygiene" policy, last reviewed 8/23, states in part, "All providers/staff/students/volunteers that provide direct patient care or have contact with patient care supplies, equipment or food will comply with this hand hygiene policy." ..."Fingernails: Studies note artificial and/or long natural fingernails harbor microorganisms, creating a reservoir, which may increase the risk of infection in the patient in the acute care setting."

The policy defines artificial fingernails as, "Substances or devices applied or added to the natural nail to augment or enhance the wearer's own nails. This includes, but is not limited to: acrylic, gels, bonding, tips, wraps, shellacs, tapes or overlays. Nail piercing jewelry of any kind is also included in the definition for the purposes of this policy." ..."Natural fingernails: Defined as natural nails without an artificial covering other than nail polish. Maintenance of natural fingernails on employees who may not wear artificial fingernails: Nails must be trimmed so they are no longer than 1/8 to 1/4 inch past the tip of the finger. They may need to be shorter to avoid puncturing gloves or injuring patients in certain situations as determined by the employee's manager. Polish, if worn, must be in good repair without cracks or chips." ... "Artificial Fingernails: The following employees will not be allowed to wear artificial fingernails. Direct patient care providers (*Category IA CDC recommendation). Employees who have contact with patient care supplies or equipment (i.e. Central Sterile or Lab) ...Please Note: Either natural or artificial fingernail piercing's with or without jewelry embedded is prohibited. Either natural or artificial fingernails that interfere with performance of one's job duties as determined by the employee's manager is prohibited."

MaineGeneral Medical Center "Personal Electronic and IoT Devices" policy, last reviewed on 1/23, states in part, "Personal electronic devices (PEDs) are not to be used in patient care areas at any MaineGeneral facility unless that usage is directly related to conducting MaineGeneral business. No personal PEDs may be used while traveling throughout the facility (hallway, elevators, and stairwells). PEDs may only be used for personal use in designated areas during break times. These areas may include the cafeteria, breakrooms, etc. Some departments may have more specific guidelines regarding the storage and usage of PEDs while at work. PEDs include but are not limited to mobile devices such as Kindles, Nooks, iPads, tablets, cellular phones, smartphones, pagers, Bluetooth, laptops, voice recorders and gaming devices."

1. Fingernail / Hand Hygiene

On 3/20/2024 at 6:00 AM, the Perioperative Nursing Supervisor was observed in the peri-operative area. She was noted to have artificial nails that extended past the pad of the finger. When asked if she performed patient care, she stated, "At times." The Perioperative Nursing Supervisor confirmed that she has "bonded gel nails".

On 3/20/2024 between 7:40 AM and 10:30 AM, an operation was observed and revealed the following:
-The Surgical Services Nurse Manager had a nail application on her fingernails that had flaked and lifted in some areas; and
-The Surgical Services Nurse Manager was observed placing a gown on surgical staff, who then proceeded to the sterile area.

On 3/21/2024 at 9:18 AM, the Surgical Services Nurse Manager confirmed that she had a nail application that bonded to the natural nail.

2. Personal Electronic Devices

On 3/20/2024 between 7:40 AM and 11:00 AM, the Surgical Services Department was observed and revealed the following:
- Medical Doctor ("MD") #1 was observed retrieving his cell phone from his shirt pocket and made multiple calls from the operating room;
- Surgical Technician #1 was observed to carry her personal cell phone in her pant pocket under her sterile gown, which she confirmed; and
- a Laboratory Technician was observed using her cell phone while in the post anesthesia care unit hallway.

On 3/21/2024 at approximately 9:18 AM, the Surgical Services Nurse Manager and the Administrative Director of Surgical Services confirmed that surgical services personnel are allowed to carry and use their personal cell phones in the restricted areas of the Surgical Services Department. They stated that all surgical services personnel are to "wipe down their cellphone with a wipe that is designed to clean cell phones." However, this cleaning process was not observed at any time.

On 3/21/2024 at approximately 9:20 AM, the Administrative Director of Surgical Services stated there is no written policy or procedure for wiping down cellphones in the Surgical Services Department.

On 3/21/2024 at approximately 9:25 AM, Administrative Director of Surgical Services, was interviewed regarding cell phone use within the Surgical Services Department, and confirmed that there are no specific cellphone policies for this department. Current Association of Perioperative Registered Nurses ("AORN") guidelines, dated 2023, address this topic in Managing Distractions and Noise during Perioperative Care. These guidelines have not been implemented by Surgical Services Department at MaineGeneral Medical Center despite the Administrative Director of Surgical Services, stating that they follow current AORN guidelines.

On 3/21/2024 at 2:58 PM, a telephone interview was conducted with MD #1. He confirmed that he utilized his cell phone in the operating room stating, "I was not aware I could not use it [cellphone] in the operating room." When asked about the process of wiping the cell phone down at the beginning of the day while in the restricted area, he responded "I am not aware of that process."