Midterm Week 3 (Preparing the Sterile Field & Pt for Surgery) Flashcards
What is the primary goal/greatest responsibilities for all members of the perioperative team?
It is an expected _____ of every surgical patient
For pt to be free from signs and symptoms of infection (SSI’s)
Outcome
General Hand Hygiene =
= refers to decontamination of the hands by one of 2 methods
1) Handwashing with antimicrobial/plain soap and water
2) Purell
Surgical Hand Antisepsis =
= refer to the antiseptic surgical scrub or antiseptic hand rub performed before donning sterile attire preoperatively
Does Surgical Hand Antisepsis make our skin sterile?
NO - skin can never be rendered sterile, can be made surgically clean
What is the importance of proper Traffic Patterns?
Microbial levels in the air are directly proportional to?
To decrease SSI’s bc the air may contain microbial laden dust, lint, skin squames, respiratory droplets
of people moving about in the room -> minimize personnel traffic
1) Unrestricted Area =
= Area that is isolated by doors from main hospital corridor, permits access for communication with department and hospital personnel
Traffic Patterns in the Unrestricted Area =
Clothing =
Traffic is not limited
Street Clothes
Locker rooms, Surgical Scheduling Office, Operative room supervisor’s office are examples of?
Unrestricted Areas
2) Semi-Restricted =
= Support areas of the surgical suite
Traffic Patterns in the Semi- restricted Area =
Clothing =
= Traffic is limited to properly attired personnel
= Scrub Attire, Caps
Corridors outside of the OR, Storage areas for clean and sterile supplies, Clean cores and sub-sterile rooms as designated by the facility are examples of?
Semi-Restricted Areas
3) Restricted Area =
= areas where procedures are performed and where there are unwrapped sterile supplies
Traffic Patterns in the Restricted Area =
Clothing =
= Traffic is limited to those with appropriate OR attire
= Scrub Attire, Caps, AND MASKS
Operating Room, Procedure Room, Scrub area, Clean cores and sub-sterile rooms as designated by the facility are examples of?
Restricted Areas
Surgical Attire (2)
- low-linting (don’t have dust/fibers on them), contain shed skin squames, provide comfort, and promote a professional appearance
- tightly woven, stain resistant, durable, provide comfort in terms of design, fit, breathability, and weight of fabric
Proper Footwear =
Safe footwear with or without shoe coverings
Only if you have OR designated shoes, may you not have to wear shoe coverings
Fanny pack, brief cases and backpacks should not be taken into what areas?
Semi-restricted or Restricted
Proper Head Covering =
= Must be durable, contain all hair including beards, disposable or laundered daily
Nonsterile apparel designated for the OR practice setting includes? (5)
- Two piece pantsuits
- Cover Jackets
- Head Coverings
- Shoes
- Masks, Protective Eyewear
Purposes of the Surgical Scrub (4)
- Removes soil, debris, natural skin oils, hand lotion, and microorganisms from the dermis of the hands and forearms of STERILE team members.
- Decreases # of microorganisms on skin to near zero
- Suppresses growth
- Reduces microbial contamination of operative wound by skin flora
2 Types of Surgical Hand Antisepsis
1) Mechanical Cleansing
2) Chemical Disinfection
Mechanical Cleansing =
= uses friction of a brush in combination with water, soap or detergent
Chemical Disinfection =
= causes removal of microbes via antimicrobial or antiseptic solution (surgical purell)
Surgical Scrub Materials (3)
1) Scrub Sinks
2) Mechanical Brushes
3) Alcohol based surgical hand antisepsis
Scrub Sinks (3)
- Knee-foot operated
- Deep and Wide to prevent splashback
- Used as single-use for scrubbing/hand-washing not for cleaning/rinsing contaminated instruments
Alcohol Based Surgical Hand Antisepsis
- ____ spectrum
- ____ acting and ____
- Non-_____ and Non-_____
- _____ action leaves antimicrobial residue on skin to temporarily prevent ____ of microorganisms or transient bacteria
- Broad
- Fast, effective
- Irritating, Sensitizing
- Prolonged, growth
Surgical Hand Prep with Alcohol Based Surgical Hand Antisepsis Process (3)
1) Use sufficient product to keep hands and forearms wet throughout prep
2) Start at the fingertips rubbing in under the nails (soaking the fingernails in first), start distally, work up, in-between the web of the fingers, along the front and back of the hand, going up to the wrist and elbow, then repeat
3) Allow to dry completely
Mechanical Surgical Scrub Methods (2)
1) Timed Method
2) Numbered Stroke Method
Timed Method =
= 3-5 minutes, prescribed amount of time for scrubbing each hand, arm, and elbow
Numbered Stroke Method =
= Designated number of brush strokes for the nails, each finger (all four sides), palm, back of hand, forearm (all 4 sides/divided forearm into 2)
Order of Mechanical Surgical Scrub
- Fingernails
- Fingers
- Hand
- Forearm
- Elbow (never go from elbow back down distally)
Reasons for Gowning and Gloving (3)
- Allows personnel to create and work within the sterile field
- Prevents contamination of surgical supplies and equipment
- Protects the wearer and other personnel from contaminants
Gowning Methods (2)
1) Self Gowning
2) Assisted Gowning
Self Gowning =
Gowning performed alone; most often is the first sterile team member for a procedure
Assisted Gowning =
Gowning by or for other personnel
Gloving Methods (3)
1) Closed Technique
2) Open Technique
3) Assisted-Gloving
Closed Technique =
= Preferred/Most common technique in preparing for a procedure; prevents outside of sleeve or gloves from touching the skin or hands, which are covered with the sleeves of the gown when gloves are put on
Open Technique =
= Generally used during a procedure or when no gown is required; allows wearer to touch inside of glove with bare hands, which are uncovered
Assisted Gloving =
= Gloving by or for other personnel
Prepping
1) Bacteria found _____ on body, but found more in what areas?
- Everywhere, greatest on moist areas (axilla, skin folds, webs of feet, perineal/perianal area)
CDC/AORN guidelines for Hair Removal =
1) Patients should be instructed not to (2)
2) Alternatives to hair removal (2)
= should not be removed unless hair interferes with operation, if removed should be with electric clippers
1) Shave, Depilatory creams
2) Braiding, using non-flammable gel
If hair must be removed
- When? Where?
- How much?
- Using what?
- Day of, outside of OR
- Only the hair that interferes with surgery
- Clipped using electric, battery operated clipper, resusable head
How do you apply the antiseptic skin agent on the patient?
In concentric circles moving toward the periphery, area large enough to extend incision or create new incisions or drain sites if necessary
Skin Prepping Agents (5)
1) Alcohol
2) Chlorhexidine Gluconate (CHG)
3) Povidone-Iodine
4) CHG w/ Alcohol
5) Iodophor w/ Alcohol
Mechanical Brushes
- Designed effectively for ____ ____
- Packaged with or without?
- Should not cause?
- ___ use
- Can be ___-___ combination
- _____ packaged
- Impregnated with?
- Designed for effectively removing microbes
- Packaged with or without nail cleaners
- Should not cause skin abrasion
- Single-use (disposable)
- Can be brush-sponge Combination
- Individually packaged
- Impregnated with antiseptic-detergent agents
1) Alcohol =
= Flammable; does not penetrate organic material, optimum concentration 60-90%, Do not use on eyes, ears, or mucous membranes
2) Chlorhexidine Gluconate (CHG) =
= Prolonged skin contact may cause irritation in sensitive individuals; use with caution on mucous membranes.
Do not use on eyes or ears, use with caution on mucous membranes
3) Povidone-Iodine =
= Prolonged skin contact may cause irritation; avoid use in neonates; inactivated by blood. Acceptable for use on mucous membranes, eyes and ears- moderate ocular irritant.
4) CHG with Alcohol =
= Flammable. Do not use on eyes, ears, or mucous membranes
5) Iodophor without Alcohol =
= Sensitivity to povidone-iodine (shellfish allergies are not a contraindication). Flammable. Do not use on eyes, ears, or mucous membranes.
Note on Prepping Agents: Apply according to what?
= according to the manufacturer’s directions for use, in order to achieve the expected level of bacterial kill. Not all one-step preps have the same application instructions. For example, iodine povacrylex/alcohol directions state: paint a single uniform coat, allow to dry, while chlorhexidine/alcohol preps actually have two sets of directions: scrub for 30 seconds on a dry site and two minutes on a moist site, allow to dry.
Surgical Drapping =
= the procedure of covering the patient and surrounding areas with sterile materials to create and maintain a barrier that will prevent passage of microorg. betwn sterile and non-sterile areas
How are drapes placed over the patient?
Drapes are strategically placed over the patient so that only the incisional site is exposed
Once the drapes have been placed, who can come in contact with the sterile field?
Once established, only personnel who have completed a surgical hand scrub and have donned sterile gowns and gloves may come in contact with this sterile field
When Draping
1) Handly ____, as _____ as possible, do not s____
2) Avoid ____ movement, why?
3) Hold drapes in _____ manner, at what level until draped on patient?
4) What if the end of the drape falls below waist level?
5) Should be carefully ____ and allowed to gently fall into position by _____
6) Place the drape from the _____ -> _____*
7) Always drape from a _____ area -> _____* area by draping ____ side first. Never do what?
8) So how should you drape the opposite side of the OR bed?
1) carefully, little, shake
2) rapid, bc air currents on which dust, lint, and other particles can migrate
3) compact, higher than waist lvl and OR bed
4) Do not retrieve it, discard it without contaminating gloves or other sterile items
5) unfolded, gravity
6) incision area -> periphery*
7) sterile -> nonsterile*, near/ never reach across an unsterile area to drape
8) Walk around the bed to drape
3 Key Aseptic Practices*
1) Proper Surgical Attire
2) Maintaining Sterile Field
3) Traffic Control
Sterile Area in the OR includes (6)
- Back Table
- Mayo Stand
- Surgical Team
- OR bed with sterile drapes
- Draped radiological equipment
- Gowns *
Gowns are only sterile where?
- In front from the chest to level of sterile field
- Sleeves from above the elbows to the cuffs
What parts of the gown are not sterile? (5)
Neckline, Shoulders, Underarms, Sleeve cuffs, Gown back
Moving Within a Sterile Field*
1) Stay ___ feet* from sterile field
2) Do not walk where?
3) How do you pass the field if you are an un-scrubbed person?
4) Do not ____ your back to the field, you may brush up against it with your scrubs
5) How must two sterile members pass each other?
1) 3 feet
2) between 2 sterile areas
3) Face the sterile field
4) Turn
5) Back to Back
Maintaining a Sterile Field
1) When should the sterile field be prepared?
2) Sterile supplies should be opened for only ___ pt at time
3) Before prepping the sterile field periop team members should do what?
4) What items may come in contact with the sterile field?
1) As close as possible to time of use
2) 1
3) perform surgical hand scrub and don sterile gown and gloves
4) only sterile items
Sterile Conscience =
= the honesty and moral integrity necessary to strictly adhere to the principles of asepsis & the practices of sterile technique
The foundation for the practice of aseptic and sterile technique is the possession of?
Surgical Conscience -> that dictates taking immediate corrective action to remedy a break in sterile technique whether alone or with others & without fear of embarrassment of criticism.
Operating Room Sanitation
- When is the OR cleaned?
- Prior to the days schedule, during procedure, between procedures, and periodically weekly or monthly
Cleaning Procedures for operating suites (2)
1) Between Cases (Turn over)
2) End of Day (Terminal Cleaning)
How to clean the OR?
Start on the highest surface and work your way down
Main Nursing Diagnosis
Risk for Infection
Nursing Responsibilities
- Periop nurse is responsible for _____ and _____ sterile field and for ___ aseptic practice by all members of surgical team.
- An understanding of ___ sources, ____ modes of reducing/eliminating microorganisms in the surgical setting is a priority for RN
- creating, maintaining, monitoring
- infection, transmission
Nursing Responsibilities
- _____ agents, pts report of skin ___ from antiseptic agents
- Pt a_____
- C______ to specific antiseptic agents
- Surgical ____ to be _____
- Presence of _____ _____, including b____
- _____ status
- Large, open wounds
- Review of ______ written information
- _____ preference
- Antiseptic, irritation
- Allergies
- Contraindications
- site, prepped
- organic matter, blood
- neonatal
- manufacturer’s
- surgeon
