Surgical Asepsis and Ideal surgical team manners for HOBSS.pdf
- 1. SURGICAL ASEPSIS AND IDEAL SURGICAL TEAM MANNERS
- 2. PRETEST 1. The Definition of Asepsis is: A. Soiled or infected with organisms B. Capable of producing disease C. Absence of microorganisms
- 3. 2. Cross-contamination is defined as: A. Producing or capable of producing disease. B. Transmission of microorganisms from patient to patient and from inanimate objects to patients. C. Severe toxic state resulting from infection with pyogenic organisms.
- 4. 3. Which task or function during a surgical procedure is designed as being within the scope of the practice of the scrub nurse? A. Closing the surgical wound B. Setting up the sterile field C. Administering blood products
- 5. 4. For which member of the surgical team is a “surgical scrub” unnecessary? A. Anesthetist/anesthesiologist B. Surgical technologist C. Scrub nurse
- 6. 5. Which is the best technique for you to use when rinsing your hands and forearms after a surgical scrub? A. Rinsing is not performed after a surgical scrub because it will reduce the antimicrobial activity of the cleansing solution. B. Rinsing should start at the elbow with the water running down back down to the hand. C. Rinsing should start with the hand positioned such that water runs off the elbow rather than down to the hands.
- 7. ANSWERS TO PRETEST 1. Correct answer is (a.)Absence of microorganisms. 2. Correct answer is (b.)Transmission of microorganisms from patient to patient and from inanimate objects to patients. 3. Correct answer is (b.) Setting up the sterile field. 4. Correct answer is (a.)Anesthetist/anesthesiologist. 5. Correct answer is (c.) Rinsing should start with the hand positioned such that water runs off the elbow rather than down to the hands.
- 8. IN MODERN SURGERY THREE key BATTLES for surgery: Battle against PAIN Battle against BLOODLOSS Battle against INFECTION
- 9. Only sterile items are used within the sterile field Sterile persons are gowned and gloved Tables are sterile only at table level Sterile persons touch only sterile items or areas Unsterile persons avoid reaching over the sterile field The edges of anything that encloses sterile contents are considered unsterile
- 10. The sterile field is created as close as possible to the time of use Sterile areas are continuously kept in view Sterile persons keep well within the sterile area Sterile persons keep contact with sterile areas to a minimum Unsterile persons avoid sterile areas Destruction of the integrity of microbial barriers results in contamination
- 11. ONLY STERILE ITEMS ARE USED WITHINTHE STERILE FIELD Discard any contaminated items: If a sterile package is found in a contaminated area. If uncertain about the actual timing or operation of the sterilizer. If an unsterile person comes into close contact with a sterile table. If a sterile table or unwrappedsterile items are not under constant supervision.
- 12. Discard any contaminated items: If the integrity of the packaging material is not intact. If a sterile package wrapped in a material other than plastic or another moisture-resistant barrier becomes damp or wet. If a sterile package wrapped in a pervious woven material drops on the floor or other areas of questionable cleanliness. ONLY STERILE ITEMS ARE USED WITHINTHE STERILE FIELD
- 13. STERILE PERSONS ARE GOWNED AND GLOVED Observed gowning practices. Self-gowning and gloving should be done from a separate sterile surface to avoid dripping water onto sterile supplies or a sterile table. The stockinette cuffs of the gown are enclosed beneath sterile gloves. Sterile persons keep their hands in sight at all times and at or above waist level or the level of the sterile field.
- 14. STERILE PERSONS ARE GOWNED AND GLOVED Observed gowning practices. The back of the gown is considered contaminated. The gown is considered sterile only to the highest level of the sterile tables.
- 15. STERILE PERSONS ARE GOWNED AND GLOVED Area of protection
- 16. TABLES ARE STERILE ONLY ATTHE TABLE LEVEL Sterile table. Only the top of a sterile, draped table is considered sterile. The edges and sides of the drape extending below table level are considered unsterile.
- 17. STERILE PERSONS ONLY TOUCH STERILE ITEMS OR AREAS Sterile team members maintain contact with the sterile field by means of sterile gowns and gloves. The unsterile circulator does not directly contact the sterile field. Supplies are brought to sterile team members by the circulator, who opens the wrappers on sterile packages.
- 18. UNSTERILEPERSONSAVOID REACHINGOVERTHESTERILEFIELD The scrub person sets basins or glasses to be filled at the edge of the sterile table. The circulator holds only the lip of the bottle over the basin when pouring solution into a sterile basin in order to avoid reaching over the sterile area.
- 19. EDGESOF ANYTHINGTHAT ENCLOSESSTERILECONTENTS ARE CONSIDEREDUNSTERILE The inside of a wrapper is considered sterile to within 1 inch of the edges. The circulator opens top flap away from self. Then turns the sides under. The last flap is pulled toward the person opening the package, thereby exposing the package contents away from the unsterile hand.
- 20. THESTERILE FIELD ISCREATED ASCLOSE AS POSSIBLETOTHE TIMEOF USE Sterile tables are set up just prior to the surgical procedure. It is virtually impossible to uncover a table of sterile contents without contamination. Covering sterile tables for later use is not recommended.
- 21. STERILEAREASARE CONTINUOUSLYKEPT INVIEW Sterile persons face sterile areas. Someone must remain in the room to maintain vigilance when sterile packs are opened. Sterility cannot by ensured without direct observation. An unguarded sterile field should be considered contaminated.
- 22. STERILE PERSONSKEEPWELL WITHINTHESTERILEAREA Sterile persons stand back at a safe distance from operating bed when draping the patient. Sterile persons pass each other back to back at a 360-degree turn. Sterile persons turn their backs to an unsterile person or area when passing. Sterile persons face a sterile area to pass it.
- 23. UNSTERILEPERSONSAVOID STERILE AREAS Unsterile persons maintain a distance of at least 1 foot from any area of the sterile field. Unsterile persons face and observe a sterile area when passing to be sure they do not touch it. Unsterile persons never walk between two sterile areas. The circulator restricts to a minimum all activity near the sterile field.
- 24. THERE IS NO COMPROMISE WITH STERILITY IT’S CONSIDERED STERILE OR UNSTERILE.
- 25. THE SURGICAL TEAM Surgeon Surgical assistant Anesthesiologist or the certified RN anesthetist Circulating nurse Scrub nurse
- 26. CIRCULATING NURSE Coordinates, overseas and is involved in the patients nursing care in the OR. Monitors traffic in the room. Assess the amount of urine and blood loss Reports findings to the surgeon and anesthesia provider Ensures that the surgical team maintains sterile technique and a sterile field
- 27. CIRCULATING NURSE Anticipates the patients and surgical teams needs, providing supplies and equipments as needed. Communicates information regarding the patients status with family members during long or unique procedures
- 29. SCRUB NURSE Sets up the sterile field, drapes the patients and handles sterile supplies, sterile equipment and instruments to the surgeon Maintains an accurate count of sponges, sharps, instruments, and amounts of irrigation fluid and drugs used.
- 30. IMPORTANT ISSUES Promote measures that maintain the patients normal temperature of 36.6 C t 37.5 C (98 F to 99 F) Ensure that OR temp. is between 25 c and 26.6c Warm all intravenous and irrigating solutions. Monitor the patients temperature continuously Remove all wet gowns and drapes promptly and replace with dry ones to prevent heat loss
- 31. IMPORTANT ISSUES Promote measure that decrease risk of infection Maintain sterile procedures and techniques during surgery Apply sterile dressing to all wounds Non scrubbed personnel refrain from touching or contaminating anything that is sterile
- 32. ENSURE SAFETY IN OR Remove any potential contaminants Keep room noise and talk at a minimum Recheck electrical equipments for proper operation Count and record sutures, needles, instruments and sponges. Remain at the patients side during anesthesia induction.
- 33. ENSURE SAFETY IN OR Verify proper positioning of the patient to protect nerves, circulation, respiration, and skin integrity. Always pad pressure areas Ensure that newly requested items are quickly supplied to the anesthesia or scrub team by the circulating nurse.
- 34. PERFORM OTHER ACTIONS AS APPROPRIATE Act in the role of a patients advocate, providing privacy and protection from harm Follow established procedure and protocol Document all OR care Promote ethical behaviors (respect, confidentiality) Apply grounding pad.
- 35. TIME OUT A protocol preventing wrong site, procedure, person or surgery. Must occur in the location where the procedure is done. All the members of the surgical team are involved.
- 36. POSITIONING OFTHE PATIENT The responsibility is shared by the nurse, surgeon and anesthetist. The nurse must be aware of the position required for each surgical procedure and it’s physiological changes.
- 37. GOOD POSITIONING IS IMPORTANT TO: Adequate exposure of the operative area Make the patient accessible for anesthesia and IV access Minimize interference of circulation due to pressure on a body part Provide protection from injury to nerves due to improper positioning of arms and hands Provide for the patients individuality and privacy by proper draping