Brand New Operating Rooms - Brand New SNAFUS

Our wonderful new operating  suite of 11 rooms labeled "A" thru "K" had been under construction since 1971 and now 3 years later was open for business. They had been designed by an architect that had no previous OR design experience, but he would eventually marry the OR  supervisor who wisely departed before the grand opening ceremony. We all knew how he got the job. Not a single staff nurse was consulted about the design. A love-struck inexperienced architect being influenced by a blow hard supervisor with no recent clinical experience; What could go wrong?

The rooms had all sorts of grand features including a conveyor belt system running underneath the rooms for linen and garbage removal. In operation, the only thing this system did was make unpredictable very loud bangs and BOOMS during such critical surgical events like aneurysm clippings or aortic clamping. Of course the agitated surgeons vented their angst by screaming at the scrub nurse who had nothing to do with the racket. The conveyor belt system was up and running a grand total of  3 days before it was mothballed for good. We hiked back up to our old abandoned  tiled temple of an operating room suite and retrieved our faithful old wheeled trash bins and carts. They worked like a charm as they had for the 60 previous years.

The next dilemma was the room nomenclature. Our old rooms were numbered "1" thru "12" which was a simple, time tested measure. When someone said room "4" everyone was on the same page. Over the new OR intercom room "B" sounded just like room "D"  We should have taken a tip from police officers and given each letter a uniform call sign. We started making up novel call names for the letters. "I'm in room "H" as in hemorrhage and need all the packed cells I can get!" was probably typical. We came up with some really descriptive call signs for the lettered rooms, but soon learned it was better to avoid monikers denoting surgical complications. Some of the less imaginative surgeons were becoming agitated.

Our new locker rooms were located one floor above the actual operating rooms. To access the ORs, a short elevator ride was necessary. Stepping out of the elevator was akin to the curtain raising on an X  rated theater production. The elevator opened directly in front of the huge window looking into a cysto room giving the elevator occupants a shocking (to some nonmedical personnel) prime time view of someone up in stirrups awaiting God knows what of a urological  procedure.  I always thought urology instruments were some of the most frightening looking and thought provoking. I used to wonder, "How is that huge resectoscope going to fit in that tiny little opening?"

 The surgeons and nurses did not bat an eyelash as the elevator doors unveiled the cysto room sights, but some of the schedulers and secretaries were shocked. Soon one of the administrative personnel constructed a make shift curtain from a surgical drape partially obscuring the view from the elevator landing.  The chief of urology was appalled and ripped the drape from the window bellowing, "This is a teaching hospital. Not a top secret research lab. If anyone doesn't want to see what's going on here they can drape their eyes."  I guess that was an old, foolish attempt at the "transparency" business we hear ad nauseum today. The drape was never replaced, but in a compromise move, the OR table was moved so as to be at a right angle to the door.

This next SNAFU haunts me to this very day. There was a time tested sterilization procedure in the old tiled temple for our instrument trays. They were carefully wrapped, tagged with autoclave tape and sterilized in one gigantic autoclave in central supply. This autoclave was nearly the size of an Eldorado and carefully monitored with each firing recorded on graph paper.

The neophyte OR designer came up with a concept that bordered on genius if you listened to the OR supervisor now turned architect's fiancé. Each operating room "A" thru "K" was equipped with a puny little double-doored autocalve. The unwrapped instrument trays were shoved into the mini-autoclaves from the outside hall and sterilized for a 3 minute cycle which was consistent with how we had "flash" sterilized individual instruments in the old tiled temple. This mini autoclave stroke of genius idea created a painful hot potato scenario for the hapless scrub nurse.

When the autoclave door was opened in the operating room after a 3 minute cycle, the nurses were first greeted with a blast of steam and the scrub nurse then had scalding hot instruments to handle. I can tell you from personal experience that latex surgical gloves have virtually no insulating property. This issue was especially acute with heavy instruments like retractors and speculums. We tried to cool the scalding hot instruments with irrigant but this was like treating cancer with a band aid.

After a few weeks in operation, it was noticed that our infection rate in the new operating rooms had soared. Of course it was the nurses fault. Administration even cultured our nostrils and told us to sharpen up our aseptic technique.

 I am no expert on thermodynamics but always wondered about the time it took for the instrument trays to reach an effective temperature, figuring that if they were hard to cool, they were hard to heat.. One day a representative from the autoclave manufacturer showed up and told the supervisors that the autoclaves were never designed to sterilize a complete instrument tray in 3 minutes and that the autoclaves were being used in a way that was inconsistent with their design.

I have never witnessed as much finger pointing and she said-he said monkey business following the autoclave SNAFU. The correction was to extend the autoclave cycle to 10 minutes after reaching the correct temperature. I don't think it was ever nailed down where the 3 minute cycle idea initiated.

When the 4 story  Rich Insurance Dude Pavilion was constructed in 1970, the planners envisioned a hospital high rise in the sky probably inspired by the Sears Tower.  A ton of money was spent on a heavy duty foundation to support this hospital skyscraper of the future. A few years ago when I returned for a visit, I noticed the skyscraper concept never got off the ground, To this day, the pavilion is a measley  4 stories tall  and they are back to sterilizing their surgical instruments in a central location. Not all big-time plans work out as planned.