The Importance of Concentration

“Would you turn off that music? I can’t concentrate!” How many times have you heard that? There is no question that distractions are not good especially if we are doing tasks that require our full attention.

When I was a resident, one of the cardiac surgeons insisted we do coronary bypass procedures while listening to the 1812 Overture. His goal was for us to get the bypass grafts sutured in place before the cannons fired! Let me assure you—that was a bit distracting. It appears that distractions in the operating room may play a role in postoperative surgical site infections. There is no argument that postoperative wound infections are more frequent in patients with diabetes mellitus, in older patients, and in patients who take steroids or use nicotine.¹ A recent study by Beldi et al² evaluated the factors associated with the operating team and intraoperative antiseptic measures they practiced. Findings indicated that extensive antiseptic measures, such as double gloving and frequent glove changes, did not reduce the incidence of postoperative infection when compared to standard antiseptic measures. Patient and operative factors that resulted in more infections were operations requiring an intestinal anastomosis, operations lasting longer than 3 hours, and a high body mass index. While none of these is particularly surprising, what was surprising were the operative team factors. Change in the surgical team members during the procedure, visitors in the operating room, hectic movements, and loud noise were significantly associated with postoperative wound infections.²

Why would these factors be a problem in the operating room? Why would the substitution of a scrub nurse or loud noise result in more wound infections? Such distractions cause a lapse in the concentration of the operating surgeon and operating team resulting in multiple minor breaks in sterile technique. Major breaks in sterile technique are quickly noted and dealt with, but multiple minor ones will go unnoticed or unheeded. The cost is an increase in postoperative infections.

What does this have to do with wound care? In the first place, many of us end up taking care of patients who develop these infections. The morbidity to the patient and the cost of the care can be considerable. Secondly, it is important to ask: Could lapses of concentration in a wound center affect patients and their care? I assure you that if one is distracted while applying a compression bandage, the desired results may not be achieved. Each layer must be wrapped with the perfect technique and perfect tension or complications may result. What other errors may result from a lack of concentration?

We have always been told not to “sweat the small stuff.” At least in our professional lives, it appears that the “small stuff” may be critical if we expect to have good outcomes. As in the mentioned study, one or two small things that go overlooked may not begin as a problem, but soon can become a significant one.

What distracts you in your work? Do some of the conversations need to be minimized or eliminated? Can we minimize some of the hustle and bustle surrounding our patients? Do we need to turn down the music or eliminate noise? Anything that can improve concentration and minimize distractions can benefit patients and make us better providers. Wait, was that a cannon I just heard?