Lecture 1, work organization in surgical department

Question 1

Biosecurity

Answer 1

A set of measures to prevent introduction and spread of infectious diseases

Question 2

Which areas are restricted?

Answer 2

Operating rooms

Sterile supply rooms

Scrub sink area

Question 3

Requirements of restricted area

Answer 3

Scrub suit

Hair covering

Mask

Clean shoes/shoe covering

Question 4

Which areas are semirestricted?

Answer 4

Hallways between operating rooms

Instrument and supply processing area

Storage areas

Utility rooms

Nurse’s workstation

Question 5

Requirements of semirestricted area

Answer 5

Scrub suit

Hair covering

Mask

Clean shoes/shoe coverings

Question 6

Unrestricted area and requirements

Answer 6

Rest of the clinic:
Central control point monitoring the entrance into the restricted areas

Anesthesia and preparation rooms

Dressing rooms

Lounges

Offices

Requirement:
Scrub suit

In unrestricted area:
- patients clipped and vacuumed
- initial surgical preparation
- soiled linen and trash kept in this area

Question 7

Traffic patterns

Answer 7

Unrestricted area -> semirestricted -> restricted -> unrestricted

Operating rooms limited to essential personnel and equipment

Traffic in and out of rooms minimized - reduces the movement of airborne contaminants

Positive air pressure: air flows from the cleanest to least clean areas (high->low air pressure)

Movement of contaminated and sterile equipment separated

Question 8

Operating room requirements

Answer 8

• large enough
• only necessary equipment
• soft white light with requlated intensity, no heating effect, 360
• adjustable surgical table (warming if possible)
• ventilation, optimal airflow
• 17-20 C, <50% humidity
• easily cleanable surfaces

Question 9

Scrub sink area

Answer 9

• Centrally located
• Ideally motion-sensitive
• Only for scrubbing hands, never to clean equipment/dispose of body fluids
• Antiseptic soap, scrub brushes, fingernail cleaners

Question 10

Gowning and gloving area

Answer 10

• Seperate from the scrub sink area
• May be inside the operating room or just outside

Question 11

Nurse’s workstation, instrument and supply processing area, storage

Answer 11

Nurse’s workstation (also instrument processing):

• Centrally located in surgical area
• Cleaning, sterilization of instruments
• Surgery log, surgery (anesthesia) protocols
• Autoclave, refrigerator, blanket warmer, formalin containers etc.
• Should be divided into two seperate areas to prevent cross-contamination

Storage:

• Everything used in surgery, but unnecessary for the current procedure
• Can be combined with nurse’s workstation

Question 12

Anesthesia and patient preparation room

Answer 12

• Necessary equipment and drugs organised
• Transportable crash cart advisable
• 17-20 C & < 50%

Question 13

Minor (septic) procedures operating room

Answer 13

• A seperate room adjacent to the anesthesia preparation area
• Minor contaminated surgical procedures

Equipment:
* Operating table
* Spotlight
* Gas, suction lines
* Suture material, instrument packs
* Antiseptic preparation materials

Question 14

Patient recovery room

Answer 14

• Oxygen supply
• Warming possibilities
• Monitoring
• 21-25 C

Question 15

Surgery planning

Answer 15

*Sterile (theres no such surgery)
*Clean-contaminated
*Contaminated
*Dirty

*Emergency surgeries

Question 16

Maintenance of operating room

Answer 16

At the beginning of each day
* Cleaning of flat surfaces with disinfectant

After each procedure
* Cleaning, washing, disinfecting
* Operating and instrument table, instruments, bins
* Sterilization with UV light

After the last procedure of the day
* Cleaning, washing, disinfecting
* Examination of walls, ceiling and floor
* Equipment checked and restocked if necessary

Maintanance of other rooms in the surgery unit also vital