© AORN, Inc, 2006 OCTOBER 2006, VOL 84, NO 4 • AORN JOURNAL • 653

ix years after the Institute ofMedicine released its report onmedical errors,1 the health careindustry has moved fromdenying the scope of the prob-

lem to accepting the importance oferror reporting and the inevitability oferror transparency. Senior leaders andstaff members are beginning to under-stand the enormity of the issues sur-rounding medical errors and the conse-quences to patients. This has resulted ina proliferation of patient safety im-provement projects with widespreadparticipation by health care profession-als and facility-based committees.AORN also has been proactive regard-ing patient safety efforts.

Workplace safety for OR personnelhas been on AORN’s strategic list ofpriorities for more than 10 years, andseveral occupational hazards have beenidentified as posing a risk to periopera-tive staff members. These include haz-ards that are• biological (eg, smoke plume, protein

allergens in latex gloves, exposure toinfectious microorganisms);

• ergonomic (eg, back injuries, repet-itive motion, lifting heavy instru-ments);

• chemical (eg, disinfecting/sterilizingagents, formalin, anesthetic gases);

• physical (eg, lasers, fire, radiation); • psychological (eg, long call hours,

fatigue); and • cultural (eg, verbal abuse, noncon-

formity with a code of conduct). In compliance with federal, state, andlocal regulations, safety committeeshave been established in health carefacilities to review current and potentialwork-related injuries.

Workplace committees and patientsafety committees, while serving a vitalrole in addressing issues within theirown frame of reference, typically do

not focus on the relationship betweenworking conditions in the health caresetting and patient safety. There is avital link between these two areas, andif workplace safety and patient safetyresources were consolidated, it couldhave a greater impact on the desiredoutcomes of having competent, healthyemployees who can pro-vide quality care forpatients in a safe andeffective manner.

WORKPLACE ANDPATIENT SAFETY ISSUESMany safety issues

affect both health careproviders and patientsin different ways. Ex-amples include physicalinjuries, hand hygiene,and fire safety.

Physical injuries. Anyoccupational injuryresulting from an unsafeworkplace negativelyaffects a health careorganization by increas-ing costs and reducingthe facility’s ability toprovide services. A back injury sus-tained by a health care employee maynot appear to directly affect the well-ness of his or her patients, but it mayresult in the employee not being avail-able for work. The employee’s manag-er may have to temporarily fill theposition with supplemental staff (ie,registry, travelers) who may not bewell-versed in departmental policyand procedures. This could lead topatient injuries.

Hand hygiene. The practice of goodhand hygiene among health care work-ers is widely accepted to be the singlemost important means for preventingthe spread of infection among patients.2

Is there a relationship betweenworkplace and patient safety?

P A T I E N T S A F E T Y F I R S T

Linda K. Groah,RN; Lorraine J.Butler, RN

SWorkplace andpatient safetycommittees

typically do notfocus on the relationship

between workingconditions andpatient safety.

654 • AORN JOURNAL

OCTOBER 2006, VOL 84, NO 4 Patient Safety First

Despite this supporting evi-dence, however, rates of com-pliance with hand hygieneprograms in hospitals arereported to be at 25% to 50%.3

Facilities have implementedseveral approaches to im-prove hand washing compli-ance, including staff membereducation, feedback on infec-tion rates, and increasing theavailability of waterless prod-ucts. These efforts haveproven largely unsuccessfulby themselves.3 If, however,the discussion of handhygiene were to be expandedto include the perspective ofworkplace safety, the scope ofthe discussion could include areview of new products aswell as information regardingthe risk of noncompliance toemployees, such as increasedstaff member respiratoryinfection rates that are linkedto poor hand hygiene in theworkforce.

Fire safety. One of themost devastating experiencesthat affect both patients andperioperative team membersis the incidence of fires thatoccur in the OR. The majorityof fires in the OR ignite on orin the patient.4

As part of an active work-place safety program, all peri-operative staff membersshould participate in a firedrill at least quarterly. The firedrill should involve all mem-bers of the team carrying outspecifically identified assign-ments. These assignmentsshould include pulling the fire

alarm, using fire-fightingequipment (eg, fire extinguish-ers), turning off piped-ingases, and unplugging electri-cal power cords. Videotapingthe fire drill and discussing itas a team permits team mem-bers to critique their effective-ness and to correct any defi-ciencies. Participating in these

discussions also encouragesemployees to expand theirunderstanding regarding howemployee wellness and patientsafety are directly connected.

A STRONG SAFETY CULTUREBy consolidating workplace

and patient safety efforts, em-ployees will begin to establisha foundation on which tobuild a strong safety culturethat focuses simultaneously onpatient safety and employeewell-being. Facility leaderscannot independently promotepatient safety without promot-

ing workplace safety. Improv-ing the overall safety of thehealth care system demandscollaboration and participationof all stakeholders. This can beachieved by breaking downthe silos of workplace safetyand patient safety and com-bining their strategies into aworkplace and patient safetycommittee. ❖

LINDA K. GROAHRN, MSN, CNOR, CNAA, FAAN

NURSE EXECUTIVE AND

CHIEF OPERATING OFFICER

SAN FRANCISCO KAISER

SAN FRANCISCO

LORRAINE J. BUTLERRN, BSN, MSA, CNOR ADMINISTRATIVE DIRECTOR

PERIOPERATIVE SERVICES

METHODIST HOSPITAL OF CLARION

HEALTH PARTNERS

INDIANAPOLIS

NOTE1. Institute of Medicine, To Err isHuman: Building a Safer HealthSystem, L T Kohn, J M Corrigan,M S Donaldson, eds (Wash-ington, DC: National AcademyPress, 2000).2. E L Larson, “APIC guidelinefor hand washing and hand anti-sepsis in healthcare settings,”American Journal of InfectionControl 23 (August 1995) 251-269.3. T Lundstrom, J Bartley, GPugliese, “Advancing patientand health care worker safety bypreventing infections,” in ThePatient Safety Handbook, B JYoungberg, M Hatlie, eds (Sud-bury, Mass: Jones and Bartlett,2004) 432.4. L Groah, Perioperative Nursing,third ed (Stamford, Conn:Appleton & Lange, 1996) 35.

A strong safety culture needs to

include a consolidation of workplace andpatient safety

efforts.