OPERATING ROOM ORIENTATION MANUAL

Goals & Objectives After 30 minutes of orientation, the JMS should be able to:

Discuss the principles of aseptic technique Demonstrate surgical scrub, gowning, and gloving dentif! ha"ards in the surgical setting dentif! the role of the scrub person, circulating nurse, and medical student Discuss wa!s the JMS can participate in the care of the patient and thereb! become an active, useful member of the surgical team Lockers

#oc$ers are available for !our use during the hours between 0%00&'(00 while !ou are in the operating room) *ou must bring !our own loc$) #oc$s must be removed b! '(00) An! loc$s not removed between '(00&0%00 are sub+ect to being cut and contents removed for later disposition)

UTMB Surgical O erati!g Suites

"RESS #O"E $ SURGI#AL ATTIRE ') All persons who enter the semirestricted and restricted areas of the surgical suite should be in hospital laundered surgical attire intended for use onl! within the surgical suite at ,-M.) /) All possible head and facial hair, including sideburns and nec$line, should be covered when in the surgical suite) 3) All persons entering an operating room or centerwell area should wear a mas$) 0) All personnel entering the suite should have all +ewelr! confined or removed) 1atches and plain wedding bands are acceptable) 2arrings must be covered b! the scrub cap) 3) 4ail polish and artificial nails should not be worn within the suite) 5) 6rotective barriers 7gloves, mas$s, protective e!ewear, and face shields8 are provided b! the hospital and should be utili"ed to reduce the ris$ of e9posure to potentiall! infective agents) %) Shoes should be dedicated to the :; and shoe covers are not required) f shoe covers are necessar!, the wearer should remove them before leaving the operating room to avoid trac$ing blood and debris through the department) SURGI#AL %AN" S#RUB ') A five 738 minute anatomical timed scrub will be used for all surgical hand scrubs)

/) <ingernails must be free of polish=enamel and of medium length) 4o +ewelr! is permitted on the hands and arms while performing as a member of the surgical team) 3) >>;emember to put !our mas$ on prior to starting !ou scrub)>> 0) 1ash hands and arms with solution to / inches above the elbow) 3) ?lean fingernails with file) -a$e sterile brush in right hand) 1et brush with water and soap) Scrub fingernails of left hand) 5) Start scrubbing fingers of left hand, one at a time, treating each finger as four& sided@ palm, $nuc$les, and bac$ of hand) ;epeat with right hand) %) Scrub right wrist and continue up arm to / inches above elbow) ;epeat with left arm) Discard brush) ;inse both hands and arms under running water $eeping hands above level of elbow so that water runs off the elbows and not the hands)

Glovi!g Proce&ure $ O e! ') Avoid contact of sterile gloves with ungloved hands during closed&glove procedure) /) <or closed&glove method, never let the fingers e9tend be!ond the stoc$inette cuff during the procedure) ?ontact with ungloved fingers constitutes contamination of the glove)

3) <or open&glove method, touch onl! the cuff of the glove with ungloved hand, and then onl! glove to glove for other hand) 0) f contamination occurs during either procedure, both gown and gloves must be discarded and new gown and gloves must be added)

3) 1hen removing gloves after a procedure is finished, the gloves are removed after the gown is removed inside out, using glove&to&glove, then s$in&to&s$in technique)

Glovi!g Proce&ure $ #lose& Poi!ts to Re'e'ber about Ase tic Tec(!i)ue A&(ere!ce to t(e Pri!ci les o* Ase tic Tec(!i)ue Re*lects O!e+s Surgical #o!scie!ce,

-, T(e atie!t is t(e ce!ter o* t(e sterile *iel&, ., O!l/ sterile ite's are use& 0it(i! t(e sterile *iel&, A) 29amples of items used) .) Aow do we $now the! are sterileB 71rapping, label, storage8 1, Sterile erso!s are go0!e& a!& glove&, A) Ceep hands at waist level and in sight at all times) .) Ceep hands awa! from the face) ?) 4ever fold hands under arms) D) Downs are considered sterile in front from chest to level of sterile field, and the sleeves from above the elbow to cuffs) Dloves are sterile) 2) Sit onl! if sitting for entire procedure) 2, Tables are sterile o!l/ at table level, A) An!thing over the edge is considered unsterile, such as a suture or the table drape) .) ,se non&perforating device to secure tubing and cords to prevent them from sliding to the floor) 3, Sterile erso!s touc( o!l/ sterile ite's or areas4 u!sterile erso!s touc( o!l/ u!sterile ite's or areas, A) Sterile team members maintain contact with sterile field b! wearing gloves and gowns) .) Supplies are brought to sterile team members b! the circulator, who opens wrappers on sterile pac$ages) -he circulator ensures a sterile transfer to the sterile field) :nl! sterile items touch sterile surfaces) 5, U!sterile erso!s avoi& reac(i!g over sterile *iel&4 sterile erso!s avoi& lea!i!g over u!sterile area, A) Scrub person sets basins to be filled at edge of table to fill them) .) ?irculator pours with lip onl! over basin edge) ?) Scrub person drapes an unsterile table toward self first to avoid leaning over an unsterile area) ?uff drapes over gloved hands) D) Scrub person stands bac$ from the unsterile table when draping it to avoid leaning over an unsterile area) 6, E&ges o* a!/t(i!g t(at e!closes sterile co!te!ts are co!si&ere& u!sterile, A) 1hen opening sterile pac$ages, open awa! from !ou first) Secure flaps so the! do not dangle) .) -he wrapper is considered sterile to within one inch of the wrapper) ?) n peel&open pac$ages, the edges where glued, are not considered sterile)

7, Sterile *iel& is create& as close as ossible to ti'e o* use, A) ?overing sterile tables is not recommended) 8, Sterile areas are co!ti!uousl/ ke t i! vie0, A) Sterilit! cannot be ensured without direct observation) An unguarded sterile field should be considered contaminated) -9, Sterile erso!s kee 0ell 0it(i! sterile area, A) Sterile persons pass each other bac$ to bac$ or front to front) .) Sterile person faces a sterile area to pass it) ?) Sterile persons sta! within the sterile field) -he! do not wal$ around or go outside the room) D) Movement is $ept to a minimum to avoid contamination of sterile items or persons) --, U!sterile erso!s avoi& sterile areas, A) ,nsterile persons maintain a distance of at least ' foot from the sterile field) .) ,nsterile persons face and observe a sterile area when passing it to be sure the! do not touch it) ?) ,nsterile persons never wal$ between two sterile fields) D) ?irculator restricts to a minimum all activit! near the sterile field) -., "estructio! o* i!tegrit/ o* 'icrobial barriers results i! co!ta'i!atio!, A) Stri$e through is the soa$ing through of barrier from sterile to non&sterile or vice versa) .) Sterilit! is event related) -1, Microorga!is's 'ust be ke t to irre&ucible 'i!i'u', A) 6erfect asepsis is an idea) All microorganisms cannot be eliminated) S$in cannot be sterili"ed) Air is contaminated b! droplets)

%A:AR"S IN T%E SURGI#AL SUITE Electrical ?auter! ,nits, Defibrillators, :; .eds, numerous pieces of equipment All equipment must be chec$ed for electrical safet! before useEE A!est(etic ;aste

Ra&iatio! #eaded aprons and shields available for use during procedures) Laser Sa*et/ 6rotective e!ewear for patient and operating team) Doors remain closed with sign & FDanger, #aser in ,se)F Sterile water available in the room and on sterile field) Smo$e evacuation s!stem is to be emplo!ed when applicable) Surger! high filtration mas$s should be worn during procedures that produce a plume) Ge!eral Sa*et/ Appl! good bod! mechanics at all times when transferring patients) :perating room beds and gurne!s will be loc$ed before patient transfer) :perating safet! belts will be used for all patients) 4ever disconnect or connect electrical equipment with wet or moist hands) Discard all needles, ra"ors, scalpel blades and bro$en glass into special identified containers) UNI<ERSAL PRE#AUTIONS SUMMAR= Although the ris$ of contracting A G in the healthcare setting is e9tremel! low, there are other bloodborne pathogens which pose a much more significant ris$) 6recautions should be followed to reduce the ris$ of e9posure to bloodborne pathogens) 2ach healthcare wor$er should assess their possible ris$s and ta$e precautions to reduce these ris$s) ,niversal 6recautions are designed to protect healthcare wor$ers from occupational e9posure and should be followed when potential for e9posure might occur) ,niversal blood and=or bod! fluid precautions should be consistentl! used for A## patients) <undamental to the concept of ,niversal 6recautions is treating all blood and=or bod! fluids as if the! were infected with bloodborne pathogens and ta$ing appropriate protective measures, including the following: '8 Dloves should be worn for touching blood and=or bod! fluids, mucous membranes, non&intact s$in, or items=surfaces soiled with blood and=or bod! fluids) Dloves should be changed after contact with each patient and hands washed after glove removal) -hough gloves reduce the incidence of contamination, the! cannot prevent penetrating in+uries from needles and other sharp instruments) /8 Downs or aprons should be worn during procedures that are li$el! to generate splashes of blood and=or bod! fluids onto clothing or e9posed s$in) 38 Mas$s and protective e!ewear should be worn during procedures that are li$el! to generate droplets of blood and=or bod! fluids into the mucous membranes of the mouth, nose, or e!es) 08 4eedles and sharps should be placed directl! into a puncture&resistant lea$proof container which should be as close as possible to the point of use) 4eedles should not be recapped, bent, bro$en, or manipulated b! hand)

38 Aands and s$in surfaces should be washed after contact with blood and=or bod! fluids, after removing gloves, and between patient contact) 58 Dloves should be worn to cleanup blood spills) .lood spills should be wiped up and then an 26A registered tuberculocidal disinfectant applied to the area) -he disinfectant should have a one minute contact time and the area rinsed with tap water) f glass is involved, wear double gloves or heav! gloves) 6ic$ up the glass with broom and dust pan, tongs, or a mechanical device) %8 Aealthcare wor$ers with e9udative lesions or weeping dermatitis should not perform direct patient care until the condition resolves) (8 Disposable resuscitation devices should be used in an emergenc!) H8 :ccupational 29posures: Definition & 6uncture wounds & 4eedlestic$s=?uts & Splashes into the e!es, mouth, or nose & ?ontamination of an open wound '08 :ccupational 29posures: & 1ash the area immediatel! with soap and water & f splashed in the e!es mouth or nose have them properl! flooded or irrigated with water & 4otif! supervisor as soon as possible & ?all 2mplo!ee Aealth ?enter at 700H8 %%/&33(/ for information regarding blood and=or bod! fluid e9posure management SAMPLE E<ALUATION >ORM

#OMPARATI<E "I<ISION O> "UTIES Scrub Nurse?Tec(!icia! A) 6reoperative ') ?hec$s the card file for surgeonIs special needs=requests) /) :pens sterile supplies) 3) Scrubs, gowns, and gloves and sets up sterile field) :btains instruments from flash autoclave if necessar!) ?hec$s for proper functioning of instruments=equipment)

0) 6erforms counts with circulator) .) 6reincisional ') ?ompletes the final preparation of sterile field) /) Assists surgeon with gowning=gloving) 3) Assists surgeon with draping and passes off suction=cauter! lines) ?) During the 6rocedure ') Maintains orderl! sterile field) /) Anticipates the surgeonIs needs 7supplies= equipment8) 3) Maintains internal count of sponges, needles and instruments) 0) Gerifies tissue specimen with surgeon, and passes off to circulator) D) ?losing 6hase ') ?ounts with circulator at proper intervals) /) :rgani"es closing suture and dressings) 3) .egins clean&up of used instruments) 0) Applies sterile dressings) 3) 6repares for terminal cleaning of instruments and nondisposable supplies) 5) ;eports to charge nurse for ne9t assignment) #irculati!g Nurse A) 6reoperative ') Assists in assembling needed supplies) /) :pens sterile supplies) 3) Assists scrub in gowning) 0) 6erforms and records counts) 3) Admits patient to surgical suite) .) 6reincisional ') -ransports patient to procedure room) /) Assists with the positioning of the patient) 3) Assists anesthesia during induction) 0) 6erforms s$in prep)

3) Assists with drapes@ connects suction and cauter!) ?) During the 6rocedure ') Maintains orderl! procedure room) /) Anticipates needs of surgical team) 3) Maintains record of supplies added) 0) ;eceives specimen and labels it correctl!) 3) Maintains charges and :);) records) 5) ?ontinuall! monitors aseptic technique and patients needs) D) ?losing 6hase ') ?ounts with scrub at proper intervals) /) <inali"es records and charges) 3) .egins clean&up of procedure room) 0) Applies tape) 3) Assists anesthesia in preparing patient for transfer to 6A?,) 5) -a$es patient to 6A?, with anesthesia and reports significant information to 6A?, nurse) %) Disposes of specimen and records) () ;eports to charge nurse for ne9t assignment)

Me&ical Stu&e!t A) 6reoperative > ntroduce self to nursing personnel) >> f Fscrubbing inF on case, informs scrub person of glove and gown si"e) .) 6reincisional > Assists with transfer of patient to :; bed) > .rings patient a warm blan$et) > 6erforms patient catheteri"ation if necessar!) > 6erforms s$in prep) >> f Fscrubbing inF on case, begin scrub earl!) >> f Fscrubbing inF on case, assists surgeon and=or scrub person with draping when appropriate) ?) During the 6rocedure

> Answers ph!sician pagers) > ;uns specimen to lab, when appropriate) D) ?losing 6hase > Assists with undraping of patient) > Assists in preparing patient for transfer to 6A?,: & .rings patient a warm blan$et) & .rings patient bed=stretcher into room) & Assists with transfer of patient from :; bed to stretcher=bed)