How to Eliminate Cord Chaos & Contamination in the OR, Part 1: Safety Risks of Poor Cord Management

This is Part 1 in a 3-part series on strategic cord management in the operating room. In Part 1, we’ll offer an overview of the safety risks of poor cord management.

Surgical teams rely on many tools to deliver lifesaving and life-improving care, and most of those tools have cords. In fact, arthroscopic, orthopedic, sports medicine, and ENT procedures often require multiple cords and even added cords throughout surgery.

As critical as these tools are, they can prove difficult to manage, as cords are often a tangled mess that hinder efficiency, waste money, and even jeopardize safety. This series details how to eliminate cord chaos and contamination in the operating room for safer, more efficient, and cost-effective surgeries, starting with an overview of the safety risks of poor cord management.

Safety Risks of Poor Cord Management

Poor cord management in the surgical suite creates three unnecessary safety risks: contamination, prolonged anesthesia, and fire hazards.

1. Contamination

Tangled cords are problematic because even though they are sterile when placed in the sterile field, surgeons tend to pull on them to get slack. That can cause the cords to fall outside the sterile field, then be pulled back in, contaminating the field.

Similarly, long apparatuses such as bovies, burners, and shavers can fall out of the sterile field and introduce contamination if they’re pulled back in.

Metal clamps are often affixed to PT drapes to help manage cords, but they’re sharp and can tear the drapes when pulled, compromising sterility. That’s a big reason why the Association of periOperative Registered Nurses (AORN) and the Association of Surgical Technologists (AST) recommend using non-metal clamps.

Finally, tangled cords can flick fluids onto caregivers during clean-up. Caregivers must carefully separate cords to avoid contamination, but it can prove difficult when they’re under pressure to quickly turnover the OR for the next procedure.

These risks aren’t just theoretical. According to the Centers for Disease Control and Prevention, there are more than 110,000 Surgical Site Infections (SSIs) associated with inpatient surgeries annually. SSIs extend hospitals stays by an average of 9.7 days and increase the risk of mortality by 2 to 11 times, as 75% of SSI-associated deaths are directly attributable to the infection.

2. Prolonged Anesthesia

Contaminated tools and cords must be replaced during surgeries. In some cases, the entire field must be replaced, and falling instruments delay surgeries by an average of 7.6 minutes, increasing the amount of time patients must be anesthetized.

Multiple studies suggest a link between anesthesia duration and risk of complications. For example, a study of 2,196 patients concluded that longer anesthesia is associated with an increase in perioperative complications and mortality (National Center for Biotechnology Information), while another study of more than 3,800 patients found that prolonged anesthesia duration is associated with increased odds of complications, longer hospital stays, and a greater chance of returning to the OR (NCBI). Yet another study suggests a link between prolonged anesthesia and neurotoxicity in the elderly, and recommends limiting the duration of anesthesia whenever possible (NCBI).

3. Fire Hazards

The American Association of Nurse Anesthesiology estimates that there are 550 to 600 operating room/surgical fires each year, and most are preventable.

According to the American Society of Anesthesiologists, surgical fires require three elements:

• An ignition source, such as electrosurgical units, lasers, and fiberoptic light sources (which have cords)
• A fuel source, such as surgical drapes, alcohol-based skin prep, and patient hair
• An oxidizer, such as oxygen, nitrous oxide, or even room air

Surgical energy is the ignition source in 90% of operating room claims, and the most common form of surgical energy is monopolar radiofrequency energy, also known as the bovie. Certain cords can also be ignition sources, such as light cords that generate heat.

Proper Cord Management Mitigates Safety Risks

Proper cord management can significantly reduce the risk of contamination, prolonged anesthesia, and fires.

• Contamination: Strategic cord management keeps cords organized and in the sterile fields where they belong
• Anesthesia: Smart cord management eliminates delays caused by compromised sterility, reducing anesthesia duration
• Fires: Good cord management reduces cross-contact between fuel sources, oxidizers, and ignition sources, reducing the risk of fire

Next Step

Discover how cord management increases operating room efficiency in Part 2 of this series.