Operating Room Protocol - Operating Room Bethlehem - home

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Operating Room
Protocol

Operating Room Protocol


This protocol is for all students and new
residents who will be doing a clinical
rotation in the Operating room.


Please review the presentation which will
review OR routines and safety material.


Some of your course requirements include
scrubbing in on surgical procedures. If so,
you will be responsible for reading and
demonstrating the scrub routine.









After reviewing the following material
including the surgical hand scrub routine,
contact Barb Puzzella,RN,OR education
coordinator at 4473 or the PHA nurses at
4465 to arrange a scrubbing & gowning
session and tour of the dept. This
does not
always

occur on the same day you complete
this session








The OR is located on the 1
st

floor of the
Centennial wing across from the radiology
department. Access into the female locker room
is from the main hallway. Access into the male
locker room is after the 1
st

set of double doors. A
swipe card is required to get into
both

locker
rooms.

Ring the bell for entry past the set of electric
doors.







Located beyond the double doors are the OR
control office, pre
-
op patient holding areas for
ambulatory & in house patients and the PACU.


Beyond the 2
nd

set of double doors is the
restricted area where the surgical suites are
located. Lab coats are not permitted in this area.
Scrubs and hair coverings must be worn. Shoe
covers are optional

Place your belongings in an
empty locker or one
labeled “med/nursing
students” Locks are not
provided, limit your
valuables.


You will access the OR
suites through the lounge
area. You must have
scrubs on and hair
covered.
White lab
coats are not allowed in
this restricted area.


Sign your name on the
Student/Observer Sign
-
In
Board on the wall outside
of the OR Lounge.




IMPORTANT


Scrub attire from other institutions is not
permitted in the St. Luke’s Operating Room. You
must wear scrubs supplied by our institution.


Long sleeves are not permitted under scrub
attire. Blue jackets are available in the OR
lounge to wear over Scrub attire.


Minimal jewelry.


Congregating in the Patient Holding Area is
unacceptable. Chart review should be done with
respect for patient privacy. The PHA nurses can
assist you with questions you may have.

Located at each scrub sink you will find masks. In practice
with standard precautions, protective eye wear is required.

If you do not have eye
goggles, there are masks
available with fluid shields.

Before entering the OR suite,
be sure to have your mask
tied securely with both
strings.

During every surgical
procedure there is an RN in
the circulator role & an RN
or CST in the scrub role.

Introduce yourself to the OR staff. You should be
wearing your name tag for identification.


Write your name with
education credentials &
your glove size on the
grease board in the OR
room.


Take a gown and gloves
out of the closet and with


sterile technique open


it and hand it to the scrub
person. If you are unsure
how to do this, ask for
instructions or give it to
the circulator
-

she will
direct you or open it for
placement on the sterile
field

Surgical Hand Antisepsis


This is accomplished by
the traditional hand scrub
or

use of the new
waterless products.


Hand antisepsis is
performed pre
-
operatively
by the scrub team
members to eliminate
transient bacteria and
reduce resident hand
flora.


Traditional Surgical

Scrub Routine

















Before Beginning To Scrub


1. Remove all jewelry.


2. Apply facemask. Tie two strings on top of head and
other two behind neck. Pinch noseband to assist in
holding mask in position.


3. Check hair to be sure it is covered by cap or hood.


4. Apply protective eyewear (i.e. face shield, goggles).


5. Write name, credentials and glove size on white
grease board in OR.










Scrub Technique
-

5 Minute Scrub


1. Select scrub sponge.


2. Check sterility of sponge package by squeezing
package; if it fills with air, package is sterile. If not,
discard and obtain another package.


3. Remove top cover and place sponge
package

on sink
sill.


4. Wet both hands and arms from fingertips to elbows
with water, using in and out motion.


5. Wash both hands and arms with an antimicrobial soap
until lather appears. This is a preliminary wash to
remove gross bacteria.
Do not remove soap,
germicidal action is taking place.


6. Pick up finger pick, under the water clean fingernails
and cuticle beds; throw pick into trash can.


7. Rinse water from hands and arms
-

keep elbows bent
in order for water to drain from clean to dirty area.

5 minute scrub brush technique

5 minute scrub brush technique

continued


8. Pick up sponge, wet it and apply soap to both hands
and arms.
(Be sure soap is applied to these areas;
germicidal action takes place in other areas while
scrubbing one area.)


9. Begin 5 minute scrub:


a. Scrub
one

hand for 90 seconds (pay attention to nails,
nail beds, and spaces between the fingers.)


b. Scrub
second

hand in same manner; 90 seconds.


c. Scrub
first arm

from
wrist

to
forearm
; 30 seconds.


d. Scrub
second arm

from
wrist

to
forearm
; 30 seconds.


e. Scrub
first arm

from
forearm

to
elbow

(1” above); 30
seconds


f. Scrub
second arm

from
forearm

to
elbow

(1” above);
30 seconds


10. Rinse hands and arms under water using in and out
motion.


Scrub Technique
-

3 Minute Scrub



1. Follow same routine as for
5 minute scrub, except
NO

preliminary wash and cleaning
of nails.


2. Apply soap to hands and
arms from sponge.


3. Scrub each hand for 1
minute.


4. Scrub each whole arm (1”
above elbow) for 30 seconds.


5. Discard sponge and rinse
hands and arms under water
using in and out motion.




Open your scrub brush & place it on the sink shelf

Do a preliminary hand wash

(Notice the scrub brush is not used yet)

then rinse.

Clean
underneath

your nails under running water.

Begin to start the scrub routine.

Look at the clock & start to time yourself



For a 5 minute routine


scrub each hand 1 ½ minutes,

30 seconds each forearm area, 30 seconds each elbow
area.

Remember


wash 1 hand then the other hand,

go back to 1st hand and scrub the forearm then the other

forearm, go back to 1
st

hand/arm scrub elbow area then the other side
elbow area

With hands pointed up, so water runs away from your hands,

rinse your hands & arms.

Rinse one arm at a time, let excess water run off arms before leaving
the sink area.

Enter the OR but do not use your hands, use your hip.

Waterless Antiseptic Agent



First use of each day: clean under your nails with the nail
cleaner and wash you hands & arms with approved
hospital wash agent at the scrub sink. Dry hands with
paper towel.


Apply Avagard agent to clean, dry hands & nails


Dispense 1 pump into the palm of 1 hand and work under
the fingernails. Spread remaining hand prep over the
hand and up to just above the elbow


Repeat the same procedure on the other hand


Dispense a final pump of the hand prep into either hand
& reapply to all aspects of both hands until
completely
dry.


Enter the OR using your hip. You will not need a towel to
dry for the waterless agent described here.


If you have used the water scrub method, accept the towel
from the scrub person and pat dry your hand then arm.
Bend at the waist to avoid contamination of the towel

Use the opposite ½ of the towel for your other hand & arm.
The scrub staff will present your gown. Slowly slide arms
through arm sleeves.


The circulator will tie the inside & back of your
gown. The scrub person will glove you. Remove
the ticket, leaving it attached to the longer string.

Hand the ticket to the circulator and turn. She/he
will pass you the long string,
do not touch the ticket
again.

Tie the two strings together…..

You are now ready to move into the sterile field
under the direction of the sterile team.

Surgical aseptic principles

:
Asepsis

: the absence of infectious
organisms. To avoid infection, surgical
procedures are done in a manner that
minimizes or eliminates the patient’s
exposure to exogenous organisms


Only sterile items are used within the
surgical field


Items of doubtful sterility are considered
unsterile


Whenever a sterile barrier is permeated,
it is considered contaminated.

Surgical aseptic principles


Sterile gowns are considered sterile in front from
shoulder to level of the sterile field & at the
sleeves from 2” above the elbow cuff



The back of the gown is not considered sterile.



Scrubbed persons should not allow their hands
or any sterile item to fall below the level of the
sterile field or waist level.




Sterile persons touch only sterile items or areas;
unsterile persons touch only unsterile items or
drapes.


Movement within or around a sterile field must
not be contaminated. Scrubbed persons stay
close to the sterile field & if they change
positions , they turn face to face or back to back
while maintaining a safe distance between
themselves & other objects.


Only the horizontal surface of the table is
considered sterile.

Surgical Conscience


Vigilance must be maintained over the
surgical field. If you

think

you
contaminated yourself


tell the circulator
and change. (gown/glove) If someone
tells you that you did contaminate yourself


don’t disagree



change.

Application of these basic principles depend
on your understanding and conscience.


Traffic control


The surgical area is
divided into 3 areas:


Unrestricted
-
outside of
the surgical suites,
control area & patient
holding areas


Semi restricted
-
peripheral support
areas within the
surgical suite. Scrubs
& hair covering
required.


Restricted
-
Operating
rooms, core area and
scrub sinks


Surgical attire



People are a major source of
bacteria in the surgical suite.


All person entering the semi
restricted and restricted area
should wear clean, hospital
laundered surgical attire.


Head cover & mask complete
the attire. Surgical attire should
be changed when wet or soiled.


Hair must be confined as well as
covered


Masks should be worn in areas
when sterile supplies are open.

Standard precautions

Developed by CDC
-
incorporate features of Universal
Precautions with Body Substance Isolation



Standard precautions apply to blood, all body fluids and
secretion & excretions


whether they contain visible
blood.



Hand hygiene
-

single most important factor in
preventing the spread of infection. Wash your hands
after visibly soiled and upon glove removal.


Alcohol based antimicrobial products may be used
between patient contacts. Located in patient holding
areas, OR lounge, & every OR.


Gloves are to be worn when touching blood, body
fluids
,
secretions, excretions and contaminated items.


Standard precautions


Masks, eye protection, face shields and gowns are to be
worn any time patient care activities are likely to
generate sprays or splashes of blood or body fluids,
excretions or secretions.


Gowns & gloves should be removed at the end of the
case in one motion, peeling the gloves off with the gown.


Sharps such as needles & scalpels should be handled
in a manner to avoid injury. Needles should not be
recapped. All sharps should be handled, removed and
disposed of in proper containers.


Creation of a neutral zone
-
where instruments are put
down & picked up, rather than passed hand to hand.


OR Fire Prevention


The operating rooms are an oxygen enriched
environment.


Reported fires & “near misses”


Estimated 1000 fires per year and 3000 near misses
per year


Fire extinguishers are located in each OR and
outside in the halls


A fire exit signs and charts are located on the
walls within the OR




Fire Triangle




3

Elements

Necessary for

A

FIRE

The OR provides these 3

elements to produce a

Fire.






Team responsibility


RACE


Rescue


Alarm


Contain


Extinguish/Evacuate


Nursing staff


usual control over most fuel
sources


Surgeons


usual control over ignition sources


Anesthesia


control over 02

Ignition Sources

Two major sources:


Electrosurgical units


including hand held


Lasers


Light sources
-
sufficient heat to cause charring of
the drapes

Any piece of electrical equipment can short out & lead to
sparks and arcing.

Intact insulation is key to prevent shorts & arcing.








FIRE EXITS


THERE ARE five (5) FIRE EXITS OUT OF THE DEPARTMENT:



THE BEST MEANS OF EVACUATION FOR PATIENT AND
STAFF SAFETY IS HORIZONTALLY TO THE EAST AND
NORTH WINGS


1. STAIR TOWER M
-

ACROSS FROM ROOM 15


2. STAIR TOWER L


BETWEEN THE TRAUMA


STORAGE ROOM AND ROOM 10


3. STAIRS TO OUTSIDE


ACROSS FROM ROOM 1


Closet


4. STAIR TOWER G


BY ROOM 5 AND 6 AT THE DOOR


TO THE CATH LAB


5. STAIR OUTSIDE ROOM 18 TO THE OUTSIDE CW


STAIRWELL

1


FIRE PULL STATIONS


THERE ARE FOUR (4) FIRE ALARM PULL STATIONS
LOCATED IN THE DEPARTMENT:



LOCATED ACROSS FROM ROOM 15.


LOCATED AT CORNER OF ROOM 10 & ROOM 8


LOCATED AT THE END OF THE HALL NEXT TO
ROOM 1 CLOSET.


LOCATED ACROSS FROM ROOM 5 AT THE CATH
LAB ENTRANCE HALLWAY


Reference page

Rothrock, Jane. (2003) Infection Prevention and Control. In
Alexander’s Care
of the Patient in Surgery


AORN (2003)
Maintaining a Sterile Field
. In
Standards, Recommended
Practices and
Guidelines


OR Fire Safety

retrieved from
www.allmedexcjamge.com,/Reference_Links/OR_Fire_Safety.shtml






updated 11/08/bp

You have completed the education for the
surgical area.

Complete the post test as directed if you are
scrubbing on surgical procedures.

Call ext 4473 or ext 4465