Or Concepts

7/30/2019 Or Concepts

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ASEPTIC TECHNIQUESCRUBBING ,GOWNING

AND GLOVING


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Proper aseptic techniques is one of the mostfundamental and essential principles of infection

control in the clinical and surgical settings Aseptic Techniques are those which:

Remove/reduce or kill microorganisms fromhands and objects

Employ sterile instruments and other items Reduce patients risk of exposure to

microorganisms that cannot be removed


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Aseptic technique also encompasses practicesperformed immediately before and during asurgical procedure to reduce postoperativeinfection:

Hand washing Surgical Attire Surgical scrub, sterile gowning & gloving Patients surgical skin prep

Using surgical barriers, including sterile surgicaldrapes

Maintaining a Sterile Field Using safe operative technique

Maintaining a safe environment in the OR


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Common Terms used in OR:

Peri Operative Nursing

Includes all nursing activities carried out by the nurseduring the pre, intra and post operative phase.

Pre Operative phase- before the surgical procedure

- begins when the decision is made to undergo surgicalintervention and ends up when the patient istransferred to the operating table.

- nursing assessment is done during this phase

Intra Operative phase

- during the surgical procedure

- begins from the transfer of the patient tothe operating table and extends to the timethe patient is admitted to the recoveryroom.


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- The implementation process takes place Post Operative phase

- after the surgical procedure- begins with the admission of the patient to the

recovery room

- evaluation takes place during this phase

Analgesia- lessening of or insensibility to pain/absence of pain

Anesthesia

- a state characterized by loss of sensation- absence of normal sensation

Antiseptics

- an agent that inhibits the growth of somemicroorganisms.


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Asepsis- a condition in which living pathogenic organisms are absen

Consent- permission give voluntarily by a person on his own will.

Disinfection- the act of destroying pathogenic microorganisms or toinhibit their growth and vital activity.

Homeostasis- the process through which such body equilibrium ismaintained.

Medical Asepsis- practices that limit the transmission of microorganisms andtheir growth and spreading action.


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Resident Bacteria

- microorganisms that usually resides on the skin, mucous

membranes, respiratory and GI tract. They cling to theskin by adhesion and absorption and should be removedby a brush.

Sterile

- aseptic; without microorganisms and their spores Sterilization

- process that destroys all microorganisms including spores

- complete elimination of microorganisms accomplished bysurgical, chemical or other means.

Surgery

- branch of medicine concerned with the treatment ofdisease, injury and deformity by manual or operativemethods.


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Surgical Asepsis

- is a kind of practices that keep an area or object

free from all microorganisms. ( Sterile Technique) Surgical Conscience

- an awareness which develops from knowledge

based on the importance of strict adherence to the

principles of aseptic and sterile technique. Surgical Team

- is a group of highly trained individuals who must

work together as coordinated team for the welfare

and safety of the patient undergoing the surgery. Transient Bacteria

- normally picked out by hands in the usual activities

of daily living which are relatively few on clean and

exposed areas of the skin.


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OPERATING ROOM ENVIRONMENT CONTROL

The surgical suite should be

designed in such a way as to

minimize and control the spread

of infectious organismsAIM


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OPERATING ROOM COMPLEX DIVIDED INTO3 AREAS

ACCESS CONTROL


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Areas outside the theatre complex including

control point to monitor the entrance of

patients, personnel, visitors, etc

Street clothes are permitted in the area

Traffic is not limited


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Peripheral support areas within theatre complex,

includes corridors leading to operating rooms,

work areas (storage) etc.

All persons must wear scrub attire which should

be made of low linting material that minimizes

bacterial shedding, comfortable, clean andprovides a professional appearance

2. SEMI - RESTRICTED AREA


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Includes operating rooms, scrub areas and ante-rooms

Personnel must wear full surgical attire, hair coverings,

masks where open sterile supplies and scrubbed

persons are present

Masks are worn to reduce the dispersal of microbial

droplets from the mouth and naso-pharynx of

personnelhigh filtered

Masks must cover the mouth and nose entirely, and betied securely to prevent venting

Metal strip in the top hem of the masks produces a firm

contoured kit over the bridge of the nose


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To provide effective barriers that prevent

the dissemination of microorganisms topatients

To protect personnel from contaminationfrom blood and body fluids of patients

Proper attire is a part of asepticenvironmental control

Protects personnel against exposure tocommunicable diseases and hazardous

material


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Proper attire must be worn within the semirestricted andrestricted areas of the OR suite

Clean fresh attire is donned daily on arrival to the OR andintermittently when necessary if suit becomes wet or

grossly soiled-source of cross-contamination. OR attire should not be worn outdoors-this protects the OR

environment from microorganisms inherent in the outdoorenvironment and vice-versa.

Before leaving the institution everyone should change tostreet clothes/uniforms

On occasion a cover gown may be worn over OR attireoutside the suite

The practice of wearing cover gowns is Not encouraged


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Hair is a gross contamination

Cap or hood is put on before the scrub suit toprotect the garment from contamination by hair.

All facial and head hair is completely covered in

the semi restricted and restricted areas. Light weight caps/hoods made of disposable, lint-

free fabric

Reusable caps should be freshly laundered daily

Skull caps do not cover the entire head, and haircan be shed from the inferior edges.


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Unprotected street shoes can increase floorcontamination

Shoes restricted to wear in the OR are preferable

in reducing microbial transfer from the outsideinto the OR suite

Shoe covers may be worn as needed to protectfrom blood and body fluid

Some surgeons wear plastic or rubber boots

during procedures wherein extensive fluidirrigation and/or blood loss can be anticipated

Shoe covers can inadvertently become soiled andharbor microorganisms and should be removedbefore leaving the OR


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ASEPTIC TECHNIQUE

METHODS BY WHICH CONTAMINATION WITH

MICROORGANISIMS IS PREVENTED (ALTERNATETERM: ASEPTIC PRACTICE TO MAINTAIN ASEPSIS).


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ASEPSIS

ABSENCE OFMICROORGANISM THAT

CAUSE DISEASE; FREEDOMFROM INFECTION.


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STERILEFREE OF MICROORGANISMS. INCLUDING ALL SPORES.

STERILISATIONTHE PROCESS OF KILLING OR INACTIVATING ALL

MICROORGANISMS.

UNSTERILEINANIMATE OBJECT THAT HAS NOT BEEN SUBJECTED TO A

STERILISATION PROCESS.

SURGICALLYCLEANMECHANICALLY CLEANED BUT NOT STERILE.


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PRINCIPLES OF ASEPSIS

ARE THE EFFORTS TAKEN TO KEEP THE PATIENT ASFREE FROM HOSPITAL MICROORGANISM AS POSSIBLE.

IT IS AMETHOD USED TO PREVENT CONTAMINATIONOF WOUNDS AND OTHER SUSCEPTIBLE SITES BYORGANISMS THAT COULD CAUSE INFECTION


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HOW??

THROUGH ENSURING THAT ONLY STERILE EQUIPMENTSAND FLUIDS ARE USED DURING INVASIVE

MEDICAL/SURGICAL PROCEDURES.


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CATEGORIES OF ASEPSIS MEDICAL OR CLEAN ASEPSIS

SURGICAL OR STERILE ASEPSIS


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FCTORS COULD INFLUENCE INFECTION

PROCESS AGE.

NUTRITIONAL STATUS.

IMMUNO SUPPRESIVE DRUGS.

PATIENT UNDERGOING SURGERY ORINVASIVE PROCEDURES.

NUMBER OF MICROORGANISMS PRESENT.

VIRULANCE OF THE MICROORGANISMSPRESENT.


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DEFINITION:

It is the process of removing as

many microorganisms as possiblefrom the hands & arms bymechanical washing & chemicalantisepsis before participating in

an operation.


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Transient organisms

Resident organisms


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Transient organisms

Resident organisms


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PURPOSES OF HAND WASHING

To remove soil, debris, natural skin oil, handlotions, and transient microorganisms fromthe hands.

To reduce number of residentmicroorganism on skin.

To suppress the growth of the residentmicroorganisms.

To reduce the hazard of microbialcontamination of the operative wound by

skin flora. To reduce the risk of infection among otherhealth care workers.

To reduce the risk of transmission ofinfectious organisms to yourself


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PREPARATION FOR

SURGICAL SCRUBSkin & nails should be kept clean &

in good conditions & cuticles cut.

Fingernails should not reach beyond

the fingertip to avoid glove puncture.

Fingernail polish should not be worn.

Artificial devices must not covernatural fingernails.

Inspect hands for cuts & abrasions.

Remove all finger jewelry.


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Be sure all hair is covered by

headgear. Pierced-ear stud must becontained by the head cover.

Adjust disposable mask snugly &comfortably over nose & mouth.

Clean eyeglass if worn. Adjusteyewear or face shield comfortably inrelation to mask.


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AGENTS FOR ANTISEPSIS

A broad-spectrum antimicrobial agent.

Fast-acting and effective.

Nonirritating and nonsensitizing.

Prolonged-acting.


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AGENTS FOR ANTISEPSIS

Chlorohexidine gluconate.

Iodophors.

Triclosan.

Alcohol.

Hexachlorophen.

Areas to which attention be paid when


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washing the hands

Mostfrequently

missed

frequentlymissed



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washing the hands

Mostfrequently

missed

frequentlymissed


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GLOVING1. Pick up one glove by the cuff using your

thumb & index finger.2. Touching only the cuff, pull the glove

onto one hand & anchor the cuff overyour thumb.

3. Slip your gloved fingers under the cuff ofthe other glove. Pull the glove over yourfingers & hand, using a stretching side-

to-side motion.4. Anchor the cuff on your thumb. With your

fingers still under the cuff, pull the cuffup & away from your hand & over the

knitted cuff of the gown.


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5. Repeat the preceding step to glove

your other hand.

5. The gloving process is complete.


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TO GOWN & GLOVE THE SURGEON1. Pick up a gown from the sterile linen

pack. Step back from the sterile field &let the gown unfold infront of you. Holdthe gown at the shoulder seams with thegown sleeves facing you.

2. Offer the gown to the surgeon. Once thesurgeons arms are in the sleeves, let go

of the gown. Be careful not to touchanything but the sterile gown. Thecirculator will tie the gown.


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3. Pick up the right glove. With the thumb

of the glove facing the surgeon, placeyour fingers & thumbs of both hands inthe cuff of the glove & stretch it outward,making a circle of the cuff. Offer the

glove to the surgeon. Be careful that thesurgeons bare hand does not touch yourgloved hands.

4. Repeat the preceding step for the leftglove.


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All articles used for a surgical procedures aresterilized prior to surgery.

Gowns are considered sterile only from waist toshoulder level in front and sleeves.

Personnel who aresterile only touch sterile articles;personnel who are not sterile only touch unsterileitems.

Sterile touching sterile remaining sterile.

Sterile touching unsterile contaminates all.


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Arms not to be folded under axillae.

Ifin doubt about the sterility of any item, consider itunsterile.

Nonsterile personnel must avoid reaching over asterile field, sterile personnel must avoid leaningover a sterile field.

The area approximate 2.5cm around the edge of the

sterile field is considered unsterile.

Sterile personnel must be close to the sterile area,unsterile personnel must be away from the sterilearea.


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Moisture may cause contamination.

Pouring should be done at the edge of the table.

When passing in a sterile field, remember sterile to

sterile.

The sterile field must be kept insight all the time.

The gloved hands must be kept insight all the time.

Once in position, drapes are never moved or shifted.

Avoidcoughing, sneezing or unnecessary talkingover a sterile field.

THE SPONGE & INSTRUMENT


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THE SPONGE & INSTRUMENT

COUNT

Counting procedure is a method of accountingfor items placed on a sterile table for use duringoperation. Sharps & instruments are counted 4times or more.

Cases that need a count: Laparotomy Operation within the chest cavity Extraperitoneal operations

Substernal thyroidectomies Deep vaginal operation Iliac bone graft Operation of the hip joint or femur Operation on the spine

RESPONSIBILITIES FOR THE


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RESPONSIBILITIES FOR THE

COUNT

1st

count: Scrub nurse count the instruments, spongesand needles before the start of the surgery right after allthe equipments has been arranged and prepared with the

circulating nurse.

2nd count:Counting of sponges with the surgeon rightafter draping the patient and before incision.

3rd count:by the circulating nurse & scrub nurse togetherwith the surgeon before closure of the organ involved.

4th

count: by the circulating nurse & scrub nurse togetherwith the surgeon before closure of the surgical wound.

5th count:before washing and packing the instruments forsterilization.

DUTIES & RESPONSIBILITIES OF


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DUTIES & RESPONSIBILITIES OF

A OPERATING ROOM NURSE

General Responsibility: Check if the inform and surgical consent has been

signed.

The patient has been placed in NPO for 8hrs. Remove all jewelries, clothing, dentures and any nail

polish

Assess if the patient has any pacemaker

Check vital signs before transporting the patient to the

Operating Room ( done in the ward). Assess patient for any signs of anxiety

Advise patient to take a bath before surgery (if possible)

Prepare patient physically, emotionally, psychologically,spiritually and culture preferences.

DUTIES & RESPONSIBILITIES OF A


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DUTIES & RESPONSIBILITIES OF A

SCRUB NURSE & CIRCULATING

NURSE

SCRUB NURSE:

Preoperative

Checks the card file for surgeons specialneeds/requests

Scrubs, gowns, & gloves & sets up sterilefield. Checks for proper functioning of

instruments/equipment.

Performs counts with circulator.


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Preincisional

Completes the final preparation of thesterile field.

Assists surgeon with gowning/gloving.

Assists surgeon with draping & passes off

suction/cautery lines.

During the Procedure

Maintains orderly sterile field.

Anticipates the surgeons needs(supplies/equipment)

Maintains internal count of sponges, needles& instruments

Verifies tissue specimen with surgeon.


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Closing phase

Counts with circulator at proper intervals.

Organizes closing suture & dressings.

Assist in applying sterile dressings.

Prepares for terminal cleaning of

instruments & nondisposable supplies.Reports to charge nurse for next

assignment.


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CIRCULATING NURSE: Preoperative

Assists in assemblingneeded supplies.

Opens sterile supplies. Assists scrub in gowning.

Performs & records counts. Admits patient to surgical suite.

Preincisional Transports patient to procedure room.

Assists with the positioning of the patient. Assists anesthesia during induction. Performs skin prep. Assists with drapes, connects suction & cautery.


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During the procedure

Maintains orderly procedure room. Anticipates needs of surgical team. Maintains record of supplies added. Receives specimen & labels it correctly. Maintains charges & O.R records. Continually monitors aseptic technique & patients

needs.

Closing Phase Counts with scrub at proper intervals. Finalizes records & charges. Begins clean-up of procedure room. Applies tape. Assists anesthesia in preparing patient for transfer. Disposes of specimen & records. Reports to charge nurse for next assignment.


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Responsibility of a Recovery

Room NurseTo provide care until the patient isfully awake, conscious, with stablevitals monitored every 15 minutesfor the first two hours with no signsof hemorrhage, 30 minutes for thenext hour and every hour until the

patient is transported to ward

To provide psychological support to

the ost o erative atient

Peri Operative Case


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Peri Operative Case

Conference

Is done by student(s) who are assigned in the morningshift. They will assess the patient before going to theiroperating room exposure and must know the following:

Pre - Op

Patient profile and History

Anatomy and Physiology

Pathophysiology

Intra Op:

Brief Discription of the Operation to bePerformed

Packs ( Laparatomy, EENT, Neurological,Orthopedic)

Instuments ( ex. AP set, Lap set, craniectomy

set and etc.)


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continuation intra -op

Suture ( Atraumatic [ATR])ex. Vicryl 0 ( round), Chromic Gut 3-0

Silk 2-0 ( cutting), vicryl 3-0

Sutures may be absorbable or non absorbable. Oncethey are sutured inside the body they are consider

absorbable sutures. All sutures are atraumatic sutures.

Skin Preparation will always depend on what type ofoperation the patient will undergo. ( abdominal,neurological, orthopedic, EENT or minor

surgery)

Type of Anesthesia/Anesthetic Agent


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Anesthetic :General: ( induction position flat on bed)

1. Propofol 7. Isoflurane/Sevoflurane

2. Fentanyl 8. Fentanyl

3. Succinyl Hydrochloride 9. Nitrous Oxide

4. Atracurium/Rocuronium

5. Thiopental

6. Midazolam

SUB-ARACHNOID block : ( lateral position or Cposition)

1. Bupivacaine/ Isobaric ( through epiduralcatheter)

2. Tetracaine/ Bupivacaine ( Heavy by spinalneedle)

Side effects of SAB are: Hypotension, Spinal Headache, N

&V,hypothermia


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Nursing Intervention:

Peri Operatively Check if the inform and surgical consent has been

signed.

The patient has been placed in NPO for 8hrs. Remove all jewelries, clothing, dentures and any nail

polish

Assess if the patient has any pacemaker

Check vital signs before transporting the patient to the

Operating Room ( done in the ward). Assess patient for any signs of anxiety

Advise patient to take a bath before surgery (if possible)

Prepare patient physically, emotionally, psychologically,spiritually and culture preferences.

Intra Operatively

Transports patient to the operating room theater


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Transports patient to the operating room theater.

Assists with the positioning of the patient.

Scrubs, gowns, & gloves & sets up sterile field.

Checks for proper functioning ofinstruments/equipment.

Performs counts with circulator.

Completes the final preparation of the sterile field.

Assists surgeon with gowning/gloving.

Assists surgeon with draping & passes offsuction/cautery lines.

Maintains orderly of the sterile field.

Anticipates the surgeons needs (supplies/equipment)

Maintains internal count of sponges, needles &instruments

Verifies tissue specimen with the surgeon.


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Counts with circulator at proper intervals and informsurgeon once the instruments used are complete.

Organizes closing suture & dressings.

Assist in applying sterile dressings.

Prepares for terminal cleaning of instruments & nondisposable supplies.

Reports to charge nurse for next assignment.

Post Operatively ( PACU)

Position the patient according to what type of anesthesia

General ( Semi/ High Fowlers); SAB ( Flat on bed for6hrs.)

Apply adequate oxygenation for GA patient and ThermalBlankets for SAB patient.

Assess for any signs of bleeding and check patientsincision site and for any attachments ( ex. Foley bag,

jackson pratt)

Monitor patient vital signs ( every 15 mins [2hrs]; 30 minsfor next hour and every hour once stable.


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Keep patient safety all the time

Report to the surgeon and anesthesiologist

for any unusualities.


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THANK YOU!!!


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