Operating Room It provides a sterile environment in which the operating team can perform surgery.

y. The operating team consists: 1. Chief surgeon: who directs the surgery 2. Surgeon Assistant: who help the chief surgeon 3. Anesthesiologist: who controls the supply of anesthetic and monitors person closely 4. Scrub Nurse: who passes the instruments to the surgeon 5. Circulating Nurse: who provides extra equipment to the operating team The operating room functions to provide a controlled environment for the performance of surgical procedures.

Aseptic Technique General: the term asepsis means the absence of any infectious agents. Importance: aseptic (sterile) technique is essential in an operating room; it may only be abandoned during an event of cardiac arrest where immediate action is essential. The operating room nurse should never abandon sterile technique except upon order of the surgeon, such as strictness in the maintenance of sterile technique is necessary because freshly cut, living tissue can become infected easily, therefore, it is essential that the operating room nurse and all other members of the OR team know the common sources of microorganisms in an operating room and the means by which these organisms reach the sterile field to contaminate it, also team members must know how to prevent contamination of a sterile field. Principles of Aseptic Technique 1. Only sterile items are used within sterile field. 2. Sterile objects become unsterile when touched by unsterile objects. 3. Sterile items that are out of vision or below the waist level of the nurse are considered unsterile. 4. Sterile objects can become unsterile by prolong exposure to airborne microorganisms. 5. Fluids flow in the direction of gravity. 6. Moisture that passes through a sterile object draws microorganism from unsterile surfaces above or below to the surface by capillary reaction. 7. The edges of a sterile field are considered unsterile. 8. The skin cannot be sterilized and is unsterile. 9. Conscientiousness, alertness and honesty are essential qualities in maintaining surgical asepsis.

Infection Control Practices Personnel and Student should: Become familiar with and adhere to policies set forth in the infection control manual Wear approved operating room attire Be free from active infection Report promptly suspected communicable diseases, occupational injury or infectious exposures. Adhere to good hygiene practices, such as daily bathing and wearing a clean scrub uniform daily. Practice frequent and thorough handwashing with appropriate soap; follow the hospital policy on universal/standard precaution and report suspected trends and problems to the infection control department. Goals and Objectives of Operating Room Training for Student Nurses Discuss the principles of aseptic technique Demonstrate surgical scrub, gowning and gloving Identify hazards in the surgical setting. Identify the role of the scrub person, circulating nurse and nursing student. Discuss ways the students can participate in the care of the patient and thereby become an active, useful member of the surgical team. Dress Code All persons who enter the semi-restricted and restricted areas of the surgical area should be in hospital laundered surgical attire intended for use only within the surgical area. All possible head and facial hair, including sideburns and neckline should be covered when in the surgical area. All persons entering an operating room area should wear a mask. All personnel entering the area should have all jewelry confined or removed. Watches or plain wedding bands are acceptable; earrings must be covered by a scrub cap. Nail polish and artificial should not be worn within the area. Protective barriers (gloves, masks, protective eyewear, and face shields) are provided by the hospital and should be utilized to reduce the risk of exposure to potentially infective agents. Shoes should be dedicated to the operating room and shoe covers are not required; if shoe covers are necessary, the wearer should remove them before leaving the operating room to avoid tracking blood and debris through the department.

Responsibility for Maintenance The maintenance of sterile technique is the responsibility of everyone having duties or even being in the operating room during an operative procedure; sterile technique cannot be maintained unless practiced by all team members. Surgical conscience (knowledge and application of principles of aseptic technique) a surgical conscience is the foundation upon which the skill and techniques employed by the operating room nurse are built. He must know the principles of sterile technique and must apply them. Breaks in technique may allow the entrance of infectious organisms that the tissues cannot destroy. Sources of Contamination 1. 2. 3. 4. 5. Members of the operating room (their dress, breath, skin, etc) The patient All items used in the wound and on the sterile set-up Dust in the air Other personnel in the operating room. Scrub Procedure The hands of the members of the operating room team are a potential reservoir for microorganisms for surgical site infection, but the pre-op scrub of the hands combined with the use of gloves minimizes the hands as a potential reservoir. The surgical team must keep fingernails short. Artificial nails are not permitted. The surgical team must scrub their hands and arms to the elbows with an antimicrobial hand scrub prep before each operation. Equipment: nail cleaner, sterile brush, antimicrobial surgical hand scrub. Scrubbing that includes hands and forearms should be done every procedure and take at least 5-10 minutes. All scrub procedures are done by stroke method. 1. Put on protective attire (scrub suit, cap, mask). Make certain all scalp and facial hair is appropriately covered. 2. Pull arm sleeves up to shoulder level. 3. Remove all types of hand, wrist or arm jewelry. 4. Wet hands and arms with water and dispense surgical hand scrub on the palm of the hand. 5. Obtain nail cleaner with hands. 6. Obtain brush from dispenser 7. Wet brush with water and dispense approximately 5cc of surgical soap onto brush 8. Scrub hand. 9. Scrub arm.

10. Using the same brush, scrub second hand and arm using the same techniques. 11. Rinse brush with water and drop in sink. 12. Rinse both hands and arms. 13. Keep hands close together and away from the body, allow water to drip from elbows a few seconds before moving away from the scrub area. 14. Walk to the operating room via the sub sterile by backing in to avoid contamination of the scrubbed hands and arms. 15. Reminder: Use a circular motion except where horizontal strokes provide increased brush skin contact; expose skin folds by extending the fingers and arms; pay particular attention to the area around and under fingernails; keep hands away from face; keep hands up; remain at scrub sink while scrubbing; guard against water. Splashing onto scrub clothing and skin from bulkhead, sink or from other persons scrubbing nearby to prevent contamination, if contamination occurs during the hand scrub, repeat the necessary steps of procedure to render area clean. 16. Pre-operative preparation of the patient. Pre-operative bathing is to be done by the patient. Betadine shower the night prior to surgery and on the morning of surgery. Hair removal (minimal or no hair removals is preferred) if necessary, will be completed in the operating room, unless otherwise directed. The preferred method is clipping. 17. Skin prep within operating room suite. 18. Betadine, chlorhexidine and dura prep are all used as prep solution in the operating room.