Mac’s Safety Space: Looking forward is looking back…

Or is looking back looking forward?

First off, I want to wish you all the very brightest and most prosperous New Year—it’s been a while since a new year has totally delivered on its promise, but I (as always) choose to remain optimistic until proven otherwise.

That said, I did want to start the year with a final touch on the first six months of 2023 and some of the cautionary tales we have not yet covered in this space (though it surely has been covered elsewhere).

It just now occurred to me that, due to the vagaries of when stuff happens, we often get a full dose of the first six months of the survey year, but sometimes not so much of the second “6”. While it is tough to ascertain whether history repeats itself in six-month increments, I guess we’ve been chasing these dragons long enough to know that the more things change the more things stay the same, at least when it comes to the survey of the physical environment.

And while some might hold their breaths at the turn of the year, it is useful to note that the “respirations” in critical areas (e.g., procedure rooms, sterile processing areas—soiled and sterile, sterile medication compounding spaces, etc.) are still somewhere on the frequent flyer list (not exactly sure how these shake out numerically, but they are inevitably tabulated as moderate-to-high risk findings). From temperature to humidity to air pressure relationships, there are a lot of moving parts that contribute to the effective management of the survey process, not the least of which being the folks who occupy those spaces. Technology has not yet gotten to the point where folks can “dial in” their own comfort settings when it comes to these critical environments.

Interestingly enough, this very topic was covered in the December issue of Perspectives (in the Consistent Interpretation column); this piece is a little more interesting than usual in that it focuses more on how folks in the field have stubbed their collective toes on some of this stuff. There is one note for which I take a little bit of exception; the finding being interpreted relates to the lowering of temperature in an OR to less than 68 degrees and then failing to return the temperature to the required range when the procedure was completed. The “guidance/interpretation” for this is that after the completion of the procedure, the temperature must be returned to the “normal” range. However, there might be instances in which you would not return the temperature to normal range, such as a surgeon doing the same procedures back-to-back or perhaps back-to-back cases in which low temperatures for the room would be advantageous. If that is the case, make sure that you have good documentation of the continued temperature excursion so you don’t get thumped during survey.

That said, as we noted a few months ago, there is some movement relative to establishing a structure for the operational management of ventilation systems equipment and perhaps a more end-user-friendly approach to compliance. With any luck, it is just a matter of time before some sort of logic prevails in the management of temperature and humidity as a function of what does and does not constitute a risk to patients. I don’t know that we’re going to get a lot of grace relative to air pressure relationships, but we may get to a place in which the safety and facilities folks can more meaningfully interact with the folks who are too hot, too cold, too whatever. As a related aside, if you want to start the conversation sooner rather than later, ASHE has a couple of quick guides on ventilation; one for facilities folks and one for clinicians. Clearly this is going to continue to be important, so conversation and collaboration is probably the way to go!

About the Author: Steve MacArthur is a safety consultant with Chartis Clinical Quality Solutions (formerly known as The Greeley Company) in Danvers, Mass. He brings more than 30 years of healthcare management and consulting experience to his work with hospitals, physician offices, and ambulatory care facilities across the country. He is the author of HCPro's Hospital Safety Director's Handbook and is contributing editor for Healthcare Safety Leader. Contact Steve at