Immediate Action: Address the Protocol Violation Before Surgery Proceeds
The nurse should politely but firmly inform the surgeon to follow the proper hygiene protocol immediately, before the procedure continues (Option B). Patient safety takes absolute priority over hierarchical concerns, and proper surgical antisepsis is a fundamental requirement to prevent surgical site infections that directly impact patient morbidity and mortality.
Why Immediate Intervention is Critical
Surgical hand antisepsis must be performed before donning sterile surgeon's gloves using either antimicrobial soap and water, or soap and water followed by an alcohol-based surgical hand-scrub product with persistent activity 1
Hand hygiene before clean/aseptic procedures (such as mastectomy surgery) is essential to prevent introduction of pathogens into sterile body sites, which can lead to surgical site infections 2
Proper hand hygiene technique requires at least 2-3 minutes of scrubbing to reduce bacterial counts to acceptable levels for surgical procedures 1
Failure to follow proper antisepsis protocols directly increases the risk of surgical site infections, which significantly impact patient morbidity, mortality, and quality of life 1, 2
The Nurse's Professional Obligation
Healthcare workers have a professional duty to speak up when patient safety is compromised, even when this involves addressing a physician's behavior 3, 4
Timely identification and correction of protocol violations reduces adverse events that result from these violations 3
Nurses who observe protocol violations should discuss them immediately with the responsible healthcare worker to allow for correction before harm occurs 3
Delaying intervention until after surgery (Option A) is inappropriate because it allows a preventable breach in sterile technique to proceed, directly exposing the patient to increased infection risk 1, 3
How to Address the Situation Professionally
Use respectful, direct communication: "Dr. [Name], I notice the surgical hand antisepsis protocol hasn't been completed. We need to pause so you can perform the proper hand hygiene before we proceed."
Frame it as a patient safety issue, not a personal criticism: Focus on the protocol requirement rather than the individual's behavior 5, 4
Be prepared to escalate if the surgeon refuses: If the surgeon dismisses the concern, the nurse should involve the charge nurse or surgical supervisor immediately before the procedure continues 3, 4
Why Other Options Are Inadequate
Option A (reporting after surgery) fails to prevent the harm and allows a known infection risk to proceed, which is ethically unacceptable when immediate correction is possible 3, 4
Option C (telling another doctor) introduces unnecessary delay and diffusion of responsibility when the nurse can and should address the issue directly with the surgeon 3
Common Pitfalls to Avoid
Do not assume someone else will address the problem: Direct communication with the person violating the protocol is most effective 3
Do not wait for a "better moment": Protocol violations in the operating room must be corrected immediately before the sterile field is compromised 1, 3
Do not be intimidated by professional hierarchy: Patient safety supersedes concerns about challenging a physician 5, 4
Document the incident regardless of outcome: Whether the surgeon complies or refuses, documentation protects both the patient and the nurse 3
Supporting Evidence on Professional Dynamics
Different healthcare professionals judge protocol violations differently, with physicians historically viewing violations as less inappropriate than nurses 5
This difference in perspective makes it even more critical for nurses to advocate for protocol adherence, as they may be more attuned to infection control risks 5
Increased adherence to safety protocols is associated with better identification and reporting of adverse events, creating a culture of safety 4