EVERYTHING we are going to talk about today is ultimately based on what will provide the patient with the best care possible. All of the work place practices and rules we will review are designed to result in the minimum risk to our patients. Bibliography Essentials of Perioperative Nursing 2nd Ed. Cynthia Spry Aspen Publications 1997 Berry & Kohn s Operating Room Technique 9th Ed Nancymarie Fortunato Mosby 1996 Comprhensive Perioperative i Nursing Volumre 1 Principles i Barbara J. Gruendemann, Billie Fernsbner Jones and Bartlett Publishers 1995 Alexander s Care of the Patient in Surgery 11th Ed. Margaret H. Meeker, Jane C. Rothrock, Mosby 1999 1
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Rationale for wearing Scrubs / Hats: To provide a more controlled environment for storage of sterile supplies. Rationale for shoe covers: shoe covers defined by OSHA a PPE therefore worn when there is likelihood of contact with blood or body fluids no proven significance that foot attire reduces incidence of post-op infections Ideally have shoes that stay at work FYI Sterile processing doesn t wear shoe covers. Rationale for wearing Lab Coats Protect scrubs when in an uncontrolled environment Highly recommended when leaving the second floor for areas such as the cafeteria, to prevent things from being spilled on your scrubs Reference: AORN Standards 2001 Recommended Practice for Surgical Attire pp. 175-179 3
Masks are intended to contain and filter droplets of microorganisms escaping from the mouth and nose while talking, sneezing or coughing. Masks should completely cover both the nose and mouth. They be secured with one set of ties above the ears and the other below the ears around the neck. Masks should not be saved for later use by hanging around the neck or tucking in the pocket. Both expose the inside of the mask to the environment, or you hands, increasing the risk of spreading germs. Mask must be changed regularly, preferably after each case. Over time the moisture in your exhaled breath may compromise the integrity of the mask. 4
Removal of masks and shoe covers promote a professional appearance Scrubs stored in lockers have been reported to have higher levels of bacteria then freshly laundered scrubs. This bacteria is then potentially transferred to the sterile supplies you are handling. Which then can be transported from the sterile supplies in the OR, to the patient, increasing their risk of infection. Visibly soiled or wet scrub clothing is to be changed immediately. Visible soil can also be potentially transferred to the sterile supplies you are handling. Wet clothing can interfere with the integrity of an items packaging,. This then compromises the sterility of the item within the packaging. When leaving the building you are leaving a controlled environment. Therefore to reduce the likelihood of bacterial contamination you should wear a closed and buttoned lab coat. Also must be worn if going down to retrieve supplies from Central Stores or the loading dock. 5
Wearing scrubs in from home exposes them to an uncontrolled / unknown environment. Thereby reducing the overall control of the OR environment by potentially introducing bacteria, viruses, etc into the OR environment. Major difficulty in permitting home laundering of scrubs is monitoring that they are laundered after each wearing. Also difficult to monitor the transportation practices of staff. Hospital laundries are monitored to make sure that ph, dilution, wash temperature, and drying temperatures are within specified parameters. Sitting on the floor you pick-up dust and bacteria that can be transferred to the sterile supplies. Jewelry has the potential ti to harbor microorganisms i that t can then be transferred to the packages of sterile supplies. Thus introducing extra bacteria and extra risk to the patient. Jewelry also has the potential to harbor moisture from hand lotion, and washing hands, if not completely dry. Also jewelry with sharp edges, i.e. rings, watches, have to potential to create holes in the packages of sterile items, or result in patient injury when moving them. 6
Unrestricted Areas Areas where patients enter and exit. Areas where we can easily interact with members of other departments without requiring them to change into scrubs Street clothes are permitted Semi-restricted Areas Traffic limited to authorized personnel Surgical scrub attire must be worn All head and facial hair should be covered by a hat or hood Food or drink MAY NOT be in these areas Examples storage areas for clean / sterile supplies instrument processing areas Restricted Areas Personnel must wear full surgical attire, including hat Masks are required when sterile supplies are OPEN Food or drink MAY NOT be in these areas 7
Suggest Patterns don t set dirty, bloody instruments next to sterile supplies contaminated instruments transported down the outside corridors case carts and sterile items are transported down the inner corridor limit unnecessary entries and exits to rooms with cases in progress (don t enter rooms unnecessarily, or take shortcuts through rooms) preferably entire rooms with cases in progress through the scrub area or sub sterile room 8
Surgical Conscience is the basis of all OR Nursing practice. Therefore you need to have a basic understanding asepsis and sterile technique. These concepts will guide how you will move about in an OR room, while a case is running. 9
It is possible to have the back of a warm-up jacket accidentally touch a sterile field and you not be aware of it. Therefore a warm-up jacket should ALWAYS be buttoned up when working around a sterile field. Not doing so would result in the field being contaminated. 10
If packaging is old, discolored, brittle don t use the item. Items of doubtful sterility should not be picked for cases. They should be removed from the shelves to avoid another person from picking the item, as well as to maintain accurate counts of usable inventory. It will also enable your supervisor to to track khow packaging is damaged dand identify corrective actions, such as needing bigger bins or additional bins. 11
The key to avoiding contaminating a field when opening large sterile items is balancing them and securing the tails. If the tails of the wrapper touch the sterile field, it is no longer sterile. Remember when opening things on a table to create a sterile field, the standard safety margin at the edges of the wrapper is one inch. For example opening a foley kit or prep tray, the outside ONE inch edge of the wrapper is ALWAYS considered unsterile. 12
Always maintain a safe distance from the sterile field. Surgeons do not always look behind them before turning away from the table. As staff get more comfortable with your knowledge of sterile technique they will be more comfortable with you being close to the sterile field. If you walk between sterile items / fields you usually end up with your back towards one of them. You can t see what is behind you, and you are more likely to contaminate something. When you keep all items / tables together you are less likely to to have someone in the room contaminate them. Often our Ors have lots of people in them. Not all of them watch where things are as they should. 13
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