Operating NURSE

 

Princile of Sterility   

Only sterile items are used within sterile field. Sterile objects become unsterile when touched by unsterile objects. Sterile items that are out of vision or below the waist level of the nurse are c onsidered unsterile.  Sterile objects can become unsterile by prolong exposure to airborne microorgani sms.  Fluids flow in the direction of gravity. Moisture that passes through a sterile object draws microorganism from unsterile  surfaces above or below to the surface by capillary reaction. The edges of a sterile field are considered unsterile.   The skin cannot be sterilized and is unsterile.

Conscientiousness, alertness and honesty are essential qualities in maintaining  surgical asepsis Definition Aseptic technique is a set of specific practices and procedures performed under carefully controlled conditions with the goal of minimizing contamination by pat hogens. Purpose Aseptic technique is employed to maximize and maintain asepsis, the absence of p athogenic organisms in the clinical setting. The goal of aseptic technique is to protect the patient from infection. Description All patients are potentially vulnerable to infection. Certain situations further increase vulnerability, such as disturbance of the body's natural defenses, suc h as occurs with extensive burns or an immune disorder. Typical situations that call for aseptic measures include surgery and the insertion of intravenous lines , urinary catheters, and drains. The concept of asepsis can be applied in any clinical setting. Pathogens may int roduce infection to the patient through contact with the environment, personnel, or equipment. The environment contains potential hazards that may spread pathog ens through movement, touch, or proximity. Interventions such as controlling air flow by restricting traffic in the operating room, isolating a patient to prote ct airborne contamination, or using low-particle generating garb help to minimiz e environmental hazards. A second element requiring careful attention is equipment or supplies. Medical e quipment can be sterilized by chemical treatment, radiation, gas, or heat. Perso nnel can take steps to ensure sterility by assessing that sterile packages are d ry and intact and checking sterility indicators such as dates or colored tape th at changes color when sterile. Besides overall attention to the clinical environment and equipment, clinicians need to be attentive to their own practices and those of their peers in order to avoid inadvertent contamination. A key difference between the operating room and other clinical environments is t hat the operating area has high standards of sterility at all times, while most other settings are not designed to meet such standards. However, the principles of aseptic technique can be applied in other clinical settings. The application of aseptic technique in such settings is termed "medical asepsis" or "clean tech nique" rather than "surgical asepsis" or "sterile technique" required in the ope rating room. Aseptic technique is most strictly applied in the operating room because of the direct and often extensive disruption of skin and underlying tissue. Aseptic tec hnique helps to prevent or minimize postoperative infection. The patient is prep ared or prepped by shaving hair from the surgical site, cleansing with a disinfe ctant such as iodine, and applying sterile drapes. In all clinical settings, handwashing is an important step in asepsis. In genera l settings, hands are to be washed when visibly soiled, before and after contact with the patient, after contact with other potential sources of microorganisms, before invasive procedures, and after removal of gloves. Patients and visitors

 

should also be encouraged to wash their hands. Proper handwashing for most clini cal settings involves removal of jewelry, avoidance of clothing contact with the sink, and a minimum of 10-15 seconds scrubbing hands with soap, warm water, and vigorous friction. A surgical scrub requires use of a long-acting, powerful, antimicrobial soap, ca reful scrubbing of the fingernails, and a longer period of time for scrubbing. I nstitutional policy usually designates an acceptable minimum length of time requ ired. Thorough drying is essential, as moist surfaces invite the presence of pat hogens. Contact after handwashing with the faucet or other potential contaminant s should be avoided. The faucet can be turned off with a dry paper towel, or, in many cases, through use of foot pedals. Despite this careful scrub, bare hands are always considered potential sources of infection. An important principle of aseptic technique is that fluid (a potential mode of pathogen transmission) flow s in the of gravity. With this following in mind, hands are heldscrub. below elbows du ring the direction surgical scrub and above elbows the surgical Sterile surgical clothing or protective devices such as gloves, face masks, gogg les, and transparent eye/face shields serve as a barrier against microorganisms and are donned to maintain asepsis in the operating room. This practice includes covering facial hair, tucking hair out of sight, and removing jewelry or other dangling objects that may harbor unwanted organisms. This garb must be donned wi th deliberate care to avoid touching external, sterile surfaces with nonsterile objects including the skin. This ensures that potentially contaminated items suc h as hands and clothing remain behind protective barriers, thus prohibiting inad vertent entry of microorganisms into sterile areas. Personnel assist the surgeon to don gloves and garb and arrange equipment to minimize the risk of contaminat ion. Donning sterile gloves requires specific technique so that the outer glove is no t touched by the hand. A large cuff exposing the inner glove is created so that the glove may be grasped during donning. It is essential to avoid touching nonst erile items once sterile gloves are applied; the hands may be kept interlaced to avoid inadvertent contamination. Any break in the glove or touching the glove t o a nonsterile surface requires immediate removal and application of new gloves. Asepsis in the operating room or for other invasive procedures is also maintaine d by creating sterile surgical fields with drapes. Sterile drapes are sterilized linens placed on the patient or around the field to delineate sterile areas. Dr apes or wrapped kits of equipment are opened in such a way that the contents do not touch non-sterile items or surfaces. Aspects of this method include opening the furthest areas of a package first, avoiding leaning over the contents, and p reventing opened flaps from falling back onto contents. Other principles that are applied to maintain asepsis include: • All items in a sterile field must be sterile. • St Ster eril ile e pac packa kage ges s or or f fie ield lds s ar are e op open ened ed or cr crea eate ted d as as c clo lose se as po poss ssib ible le to ti time me of actual use. • Moist areas are not considered sterile. • Con onta tami mina nate ted d i ite tems ms mu mus st be be r rem emov oved ed im imm media ediate tely ly fro from t th he s st ter eril ile e fie field ld. . • On Only ly ar area eas s tha that t can can be se seen en by th the e cl clin inic icia ian n are are co cons nsid ider ered ed st ster eril ile, e, i. i.e. e., , th the e b ack of the clinician is not sterile. • Go Gown wns s ar are e co cons nsid ider ered ed st ster eril ile e onl only y in th the e fro front nt, , fro from m c che hest st to wa wais ist t an and d fr from om th the e hands to slightly above the elbow. • Tab able les s ar are c con onsi side dere red d ste ster ril ile e onl only y at at o or r a abo bove ve the the lev level el of t the he tab table le. . • Nonsterile items should not cross above a sterile field. • Th Ther ere e sh shou ould ld be no ta talk lkin ing, g, la laug ughi hing ng, , co coug ughi hing ng, , or or sn snee eezi zing ng ac acro ross ss a s ste teri rile le fi fie e ld. • Per erso sonn nnel el wi with th col colds sho houl uld d av avoi oid d wor work king ing whi whil le il ill o or r a app pply ly a d dou oub ble mas ask. k. • Ed Edge ges s of st ster eril ile e are areas as or fi fiel elds ds (g (gen ener eral ally ly th the e out outer er in inch ch) ) are are no not t co cons nsid ider ered ed s terile. • Wh When en in do doub ubt t abo about ut st ster eril ilit ity, y, di disc scar ard d the the po pote tent ntia iall lly y con conta tami mina nate ted d ite item m and and be beg g in again. • A sa safe fe sp spac ace e or or m mar argi gin n of sa safe fety ty is ma main inta tain ined ed be betw twee een n st ster eril ile e an and d no nons nste teri rile le ob jects and areas.

 

• Wh When en po pour urin ing g flu fluid ids, s, on only ly th the e li lip p an and d in inne ner r c cap ap of th the e po pour urin ing g co cont ntai aine ner r is is co cons ns idered sterile. The pouring container should not touch the receiving container, and splashing should be avoided. • Tears in barriers are considered breaks in sterility.   Proper removal of used gloves. (Delmar Publishers, Inc. Reproduced by permission .) In the operating room, staff have assignments so that those who have undergone s urgical scrub and donning of sterile garb are positioned closer to the patient. Other "unscrubbed" staff members are assigned to the perimeter and remain on han d to obtain supplies, acquire assistance, and facilitate communication with outs ide personnel. Unscrubbed personnel may relay equipment to scrubbed personnel on ly in a way that preserves the sterile field. For example, an unscrubbed nurse m ay open a package of forceps in the sterile fashion soor that or shefield. never The touches the sterilized inside portion, scrubbed staff thehe sterile unco ntaminated item may either be picked up by a scrubbed staff member or carefully placed on to the sterile field. Asepsis in the operating room is maintained by allowing only scrubbed personnel into the sterile field and checking all equipment and packaging for breaks in st erility, such as expired sterilization date, moisture, or torn wrappings. Clinic ians observe aseptic technique by strictly avoiding practices that may introduce microorganisms. Arms of scrubbed staff are to remain within the field at all ti mes, and reaching below the level of the patient or turning away from the steril e field are considered breaches in asepsis. Clinical areas outside of the operating room generally do not allow for the same strict level of asepsis.   Surgeons scrubbing their hands and arms before surgery. (Photograph by Doug Mart in. Science Source/Photo Researchers. Reproduced by permission.) However, avoiding potential infection remains the goal in every clinical setting . Observation of medical aseptic practices will help to avoid nosocomial infecti ons, or those acquired in the hospital. General habits that help to preserve a c lean medical environment include: • Sa Safe fe re remo mova val l of of h haz azar ardo dous us wa wast ste, e, i. i.e. e., , pro promp mpt t dis dispo posa sal l of of c con onta tami mina nate ted d nee needl dles es o r blood-soaked bandages to containers reserved for such purposes. • Prompt removal of wet or soiled dressings. • Pr Prev even enti tion on of ac accu cumu mula lati tion on of bo bodi dily ly fl flui uid d dra drain inag age, e, i. i.e. e., , reg regul ular ar ch chec ecks ks an and d em em ptying of receptacles such as surgical drains or nasogastric suction containers. • Av Avoi oida danc nce e of of b bac ackw kwar ard d dra drain inag age e flo flow w tow towar ard d pat patie ient nt, , i.e i.e., ., ke keep epin ing g dra drain inag age e tub tubin in g below patient level at all times. • Immediate clean-up of soiled or moist areas. • La Labe beli ling ng of al all l flu fluid id co cont ntai aine ners rs wi with th da date te, , tim time, e, an and d ti time mely ly di disp spos osal al pe per r ins insti tit t utional policy. • Maintaining seals on all fluids when not in use. These general practices are important for keeping the environment as free of mic roorganisms as possible. In addition, specific situations outside of the operati ng room require a strict application of aseptic technique. Some of these situati ons include: • wound care • drain removal and drain care • intravascular procedures • vaginal exams during labor • insertion of urinary catheters • respiratory suction For example, a surgical dressing change at the bedside, though in a much less co ntrolled environment than the operating room, will still involve thorough hand-w ashing, use of gloves and other protective garb, creation of a sterile field, op ening and introducing packages and fluids in such a way as to avoid contaminatio n, and constant avoidance of contact with nonsterile items. The isolation unit is another clinical setting that requires a high level of att

 

ention to aseptic technique. Isolation is the use of physical separation and str ict aseptic technique for a patient who either has a contagious disease or is im munocompromised. For the patient with a contagious disease, the goal of isolatio n is to prevent the spread of infection to others. In the case of respiratory in fections (i.e., tuberculosis), the isolation room is especially designed with a negative pressure system that prevents airborne flow of pathogens outside the ro om. The severely immunocompromised patient is placed in reverse isolation, where the goal is to avoid introducing any microorganisms to the patient. In these ca ses, attention to aseptic technique is especially important to avoid spread of i nfection in the hospital or injury to the patient unprotected by sufficient immu ne defenses. Entry and exit from the isolation unit involves careful handwashing , use of protective barriers like gowns and gloves, and care not to introduce or remove potentially contaminated items. Institutions supply specific guidelines that practices precautions. for different types of isolation, i.e., respiratory versus bodydirect fluid isolation Preparation Novice and less-experienced clinicians require thorough training and supervision in the principles and practices of aseptic technique. Maintaining asepsis requi res practice and vigilance. Health care team roles In a multidisciplinary setting, one role of the nurse or other allied health pro fessional is to assist the doctor in caring for the patient while maintaining as epsis, i.e., by supplying equipment to the surgeon in a sterile fashion. Nursing staff independently practice aseptic techniques in many day-to-day procedures, such as urinary catheter insertion, dressing changes, and respiratory suction. E ven personnel experienced with aseptic technique must constantly monitor their o wn movements and practices, those of others, and the status of the overall field to prevent inadvertent breaks in sterile or clean technique. It is expected tha t personnel will alert other staff when the field or objects are potentially con taminated. Health care workers can also promote asepsis by evaluating, creating, and periodically updating policies and procedures that relate to this principle . Principles of STERILE technique PRINCIPLES 1. Only sterile items are used within the sterile field. 2. Gowns are considered sterile only from waist to shoulders level in front and the sleeves. 3. Tables are sterile only at table level. 4. Persons who are sterile touch only sterile items or areas; persons who are no t sterile touch only unsterile items or areas. 5. Unsterile persons avoid reaching over a sterile field; sterile persons avoid leaning over an unsterile area. 6. Edges of anything that encloses sterile contents are considered unsterile. 7. Sterile field is created as close as possible to time of use. 8. Sterile areas are continuously kept in view. 9. Sterile persons keep well within the sterile area. 10. Sterile persons keep contact with sterile areas to a minimum. 11. Unsterile persons avoid sterile areas 12. Destruction of integrity of microbial barriers results in contamination. 13.Microorganisms must be kept to an irreducible minimum

Read more: http://wiki.answers.com/Q/What_are_the_principl http://wiki.answers.com/Q/What_are_the_principles_of_aseptic_techniqu es_of_aseptic_techniqu e#ixzz22102wJ1l aseptic means the absence of microorganisms,so as not to produce infections sterile means free from all live bacteria or other microorganisms and their spor es

 

So,aseptic refers more to the procedure but sterile means without any bacteria o r microorganisms By definition, aspetic means free of pathogenic microorganisms. Whereas Sterile means absence of all the microorganisms. Read more: http://wiki.answers.com/Q/What_is_the_differenc http://wiki.answers.com/Q/What_is_the_difference_between_strict_asept e_between_strict_asept ic_technique_and_sterile_clean_technique#ixzz2210uHi00 Scrub Nurse • A sc scru rub b nur nurse se wo work rks s in in th the e sa sani niti tize zed d are area a of th the e sur surge gery ry. . He is "s "scr crub ubbe bed d in, in," " p utting on sterile masks and clothing before approaching the surgical station. Th e scrub nurse hands the surgical tools and other supplies to the doctor performi ng the operation. A scrub nurse maintains the sanitation of the operating area, making sure everything stays sterile reduce thethe likelihood Scrub nurses are also responsible forto the care of surgeon.of Ifcontamination. her glasses ar e foggy, or if she is sweating, the scrub nurse is in charge of taking care of t hose problems, allowing the surgeon to continue her work unhindered. During the surgery, the scrub nurse is also responsible for monitoring the healt h of the patient. This involves keeping track of the patient's vital signs. If t here are potential problems, it is the scrub nurse's job to alert the doctor. Circulating Nurse • A ci circ rcul ulat atin ing g nu nurs rse e ope opera rate tes s as as a go go-b -bet etwe ween en fo for r the the op oper erat atin ing g ro room om an and d th the e re rest st of the hospital. She is not scrubbed in. A circulating nurse does the initial a ssessment of the patient as he is wheeled into the operating room and makes sure that the patient is comfortable. The circulating nurse also assists the surgeon and scrub nurse as they clean up and prepare for the surgery. During the surger y, circulating nurses hand packages of supplies to the scrub nurse as necessary. If something is required from outside of the room, or if the surgeon needs a me ssage passed on to another staff or family member, it falls to a circulating nur se. After the surgery, the circulating nurse counts opened packages and used supplie s, to make sure the numbers add up correctly. This is to ensure that there were no supplies accidentally left inside the patient during the surgery. • Shared Duties • Bo Both th sc scru rub b nur nurse ses s and and ci circ rcul ulat atin ing g nur nurse ses s are are re resp spon onsi sibl ble e for for ke keep epin ing g the the op oper erat ati i ng room running smoothly. Each is responsible for patient care; the circulating nurse takes care of the patient before the operation and the scrub nurse monitor s the health of the patient during the operation. They also share the task of pr eparing the room for surgery; the scrub nurse prepares the sterile area while th e circulating nurse makes sure back-up supplies are available in case they are n eeded. Read more: Responsibilities of a Circulating & Scrub Nurse | eHow.com http://www .ehow.com/list_6105333_responsibilities-circul .ehow.com/list_6105333 _responsibilities-circulating-scrub-nurse.html#ix ating-scrub-nurse.html#ixzz2211Zfy zz2211Zfy wE DUTIES Of SCRUBNURSE Before an operation  Ensures that the circulating nurse has checked the equipment  Ensures that the theater has been cleaned before the trolley is set  Prepares the instruments and equipment needed in the operation  Uses sterile technique for scrubbing, gowning and gloving  Receives sterile equipment via circulating nurse using sterile technique Performs initial sponges, instruments and needle count, checks with circulating  nurse When surgeon arrives after scrubbing  Perform assisted gowning and gloving to the surgeon and assistant surgeon as soo

 

n as they enter the operation suite  Assemble the drapes according to use. Start with towel, towel clips, draw sheet and then lap sheet. Then, assist in draping the patient aseptically according to routine procedure  Place blade on the knife handle using needle holder, assemble suction tip and su ctiontube  Bring mayo stand and back table near the draped patient after draping is complet ed  Secure suction tube and cautery cord with towel clips or allis Prepares sutures and needles according to use  During an operation  Maintain sterility throughout the procedure   

’s safety Awareness of the patient Adhere to the policy regarding sponge/ instruments count/ surgical needles Arrange the instrument on the mayo table and on the back table Before the Incision Begins Provide 2 sponges on the operative site prior to incision   Passes the 1st knife for the skin to the surgeon with blade facing downward and a hemostat to the assistant surgeon  Hand the retractor to the assistant surgeon Watch the field/ procedure and anticipate the surgeon’s needs   Pass the instrument in a decisive and positive manner Watch out for hand signals to ask for instruments and keep instrument as clean a  s possible by wiping instrument with moist sponge Always remove charred tissue from the cautery tip   Notify circulating nurse if you need additional instruments as clear as possible  Keep 2 sponges on the field

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Save and care for tissue specimen according to the hospital policy Remove excess instrument from the sterile field Adhere and maintain sterile technique and watch for any breaks

End of Operation  Undertake count of sponges and instruments with circulating nurse  Informs the surgeon of count result  Clears away instrument and equipment  After operation: helps to apply dressing  Removes and siposes of drapes  De-gown  Prepares the patient for recovery room  Completes documentation  Hand patient over to recover room Duties of CIRCULATING Before an operation  Checks all equipment for proper functioning such as cautery machine, suction mac hine, OR light and OR table  Make sure theater is clean  Arrange furniture according to use  Place a clean sheet, arm board (arm strap) and a pillow on the OR table  Provide a clean kick bucket and pail  Collect necessary stock and equipment  Turn on aircon unit  Help scrub nurse with setting up the theater  Assist with counts and records During the Induction of Anesthesia Turn on OR light   Assist the anesthesiologist in positioning the patient Assist the patient in assuming the position for anesthesia   Anticipate the anesthesiologist’s needs

 

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If spinal anesthesia is contemplated: Place the patient in quasi fetal position and provide pillow Perform lumbar preparation aseptically Anticipate anesthesiologist’s needs After the patient is anesthetized  Reposition the patient per anesthesiologist’s instruction  Attached anesthesia screen and place the patient’s arm on the arm boards Apply restraints on the patient   Expose the area for skin preparation Catheterize the patient as indicated by the anesthesiologist   Perform skin preparation During Operation  Remain in theater throughout operation      

Focus the OR light every now and Connect diatherapy, suction, etc.then Position kick buckets on the operating side Replenishes and records sponge/ sutures Ensure the theater door remain closed and patient’ s dignity is upheld Watch out for any break in aseptic technique End of Operation  Assist with final sponge and instruments count Signs the theater register   Ensures specimen are properly labeled and signed After an Operation  Hands dressing to the scrub nurse Helps remove and dispose of drapes   Helps to prepare the patient for the recovery room  Assist the scrub nurse, taking the instrumentations to the service (washroom)

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Ensures that the theater is ready for the next case  

SUTURES AND NEEDLESTerminologies:Suture NEEDLESTerminologies:Suture – any materials used to sew, stitch or hold tissue together until healing occurs. Ligature – commonly known as tie, is a material that is tied around a blood vessel to occlu de the lumen.  Primary Suture line  – refer to the main layers of the tissue which must be stitched in closing an inci sion.  Stay or Tension Sutures  – sutures placed in an incision as a secondary measure of reinforcement wherecough ing or undue pressure or strain may cause the incision to separate.  Tensile Strength – the amount of tension of pull that strand will withstand before in breaks when k  notted.  Suture Ligature  – a ligature which is threaded on a needle  Uses of a Suture :  •  To tie off a clamped vessels to prevent bleeding.  •  To approximate tissue until healing is complete.  Types of Suture:Absorbable  –  these sutures are digested by body enzymes during the wound healing  – process. The most commonly used absorbable sutures are surgical gut (catgut) col  lagen andsynthetic Non-absorbable   –

 

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this is collagen derived from the submucosa of sheep intestines or the serosa of beef intestines.It is digested by body enzymes and absorbed by  –  tissues; thus no permanent foreign body remains. The rate of absorption is influ enced by:  Types of Surgical GutSurgical Gut  – this is collagen derived from the submucosa of sheep intestines or the serosa of beef intestines. It is digested by body enzymes and absorbed by tissues; thus n o permanent foreign body remains.The rate of absorption is influenced by:1.Type of TissueSurgical gut is absorbed much more rapidly in serous or mucous membrane and absorbed slowly insubcutaneous fat.2.Condition of the TissueIt can be used in the presence of infection and even the knots are absorbed. However, absorptio n takesplace much more rapidly in the presence of infection.3.General Health Sta tus of thetissue, patientSurgical gut be absorbed more rapidlypatients in undernourished or diseased but in old ormay debilitized or delibitated it may remai n for a long time.4.Types of surgical gutPlain gut is untreated but chromic gut is treated to provide greater resistance to absorption.A. Plain- It is digested relatively quickly, usually in 5-10 days because the collagen strands are untrea ted to resistabsorption.- It is used to ligate small vessels and to suture subcu taneous fat.- It is natural yellowish tan in color.B.Chromic  – It is treated in a chromium salt solution to resist absorption by the tissues   – It is used to ligation of larger vessels.   – It is used usually absorbed in 14-120 day   –  It is dark in color.