Orientation to the Operating Room Flashcards
Acuity
The complexity of care given in the operating room.
Agency
An establishment engaged in providing health care.
Airborne precautions
Precautions that reduce the risk of an airborne transmission of infectious airborne droplet nuclei particle.
Alcohol-based preparations
Products used for hand antisepsis that increasingly are being used as an alternative to the traditional surgical hand scrub using detergent-based antiseptic agents. Formulations include foams and liquid rinses. These products do not remove soil; therefore, application must be preceded by a soap and water wash when used by surgical team members.
Ambient air
The surrounding environmental air.
Anatomical brush stroke scrub method
A scrub method that uses a prescribed number of brush strokes applied lengthwise with the brush or sponge for each surface of the fingers, hands, and arms, to include 30 strokes on the nails and 20 strokes on all other surfaces.
Anteroom
An outer room that leads to another room and that often is used as a waiting room.
Artificial nails
Substances or devices applied or added to the natural nails to augment or enhance the wearer’s own nails. They include, but are not limited to, bondings, tips, wrappings, and tapes.
Assessment
A continuous activity to collect and document data about the patient’s health status.
Barrier material
Material that prevents the penetration of microorganisms, particulates, and fluids.
Biomedical services personnel
Those individuals in an institution that are trained and qualified to check, troubleshoot, and repair medical equipment.
Cellulosic
A substance made from cellulose or derived from cellulose, such as linen and paper products.
Cleaning
Removal of all foreign material from objects; must precede disinfection and sterilization procedures. A process using friction, detergent, and water to remove organic debris.
Competency
The knowledge, skills, and abilities necessary to fulfill the professional role functions of a registered nurse in the operating room.
Confine and contain
A principle that recommends prompt cleanup of items contaminated with blood, tissue, or body fluids.
Contact precautions
Precautions designed to reduce the risk of transmission of epidemiologically important microorganisms by direct or indirect contact.
Contaminated
The presence of potentially infectious pathogenic microorganisms on animate or inanimate objects.
Critical item
Instruments or objects that are introduced directly into the human body, either into or in contact with the blood stream or normally sterile areas of the body; an item that enters sterile tissue or the vascular system.
Decontamination
Any physical or chemical process that serves to reduce the number of microorganisms on any inanimate object to render that object safe for subsequent handling.
Diagnosis
The identification of patient problems, actual or potential, that are amenable to intervention by the perioperative nurse.
Disinfection
A process that destroys some forms of microorganisms, excluding bacterial spores.
Droplet precautions
Precautions that reduce the risk of large particle droplet transmission of infectious agents.
Electrosurgery
The cutting and coagulation of body tissue with a high radio frequency current.
Electrosurgical unit (ESU)
For the purposes of this document, the ESU is defined as the generator; the foot switch with cord (if applicable); and the electrical plug, cord, and connections.
End-of-procedure cleaning
Cleaning that is performed at the end of one surgical procedure before the start of another surgical procedure in the same room
Event-related sterility
Shelf life based on the quality of the packaging material, storage conditions during transportation, and amount of handling of item.
Exogenous
From a source other than the patient (e.g., personnel, equipment, the environment, instruments, supplies).
Exposure incident to pathogens
Specific eye, mouth, or other mucous membranes; non-intact skin; or parenteral contact with blood or other potentially infectious materials that results from the performance of an employees duties.
Facilities
Buildings and fixed and movable equipment.
Fire/flame retardant
A material that does not support combustion without an external source of heat such as a laser.
Foam surgical scrub products
Scrub agents that are mixed with air as they are dispensed through a specialized nozzle. Some may be applied by rubbing onto dry skin, others by applying to wet skin.
Goal
An expected outcome; a statement of what the nurse expects to observe, hear, or see demonstrated by the patient at a given point in time.
Hands-free or no-touch technique
Instrument transfer between the scrub person and the surgeon that ensures that neither ever touches the same sharp instrument at the same time. Instruments can be placed in a neutral zone between the scrub person and the surgeon.
Healthcare personnel
Individuals directly involved with patient care.
Heat-sealed patch
A patch sealed by heat and occasionally referenced as a “double-vulcanized patch.”
High level disinfection
A process that destroys all microorganisms, with the exception of high numbers of bacterial spores. High-level disinfectants have the capability of inactivation of hepatitis B virus, HIV, and Mycobacterium tuberculosis. High-level disinfectants do not inactivate the virus-like prion that causes Creutzfeldt-Jakob disease.
High risk
Patients at risk if the aspect of care is not provided correctly and in a timely manner.
Hospital disinfectant
A chemical germicide with label claims for effectiveness against Salmonella choleraesuis, Staphylococcus aureus, and Pseudonomas aeruginosa. Hospital disinfectants may be either low-level, intermediate-level, or high-level disinfectants.
Infectious waste
Medical waste (eg, blood, body fluids, sharps) that is capable of producing infectious diseases.
Instruments
Surgical tools or devices designed to perform a specific function, such as cutting; dissecting, grasping, holding, retracting, or suturing.
Intermediate-level disinfection
A process that inactivates Mycobacterium tuberculosis, vegetative bacteria, most viruses, and most fungi, but does not necessarily kill bacterial spores.
Intraoperative
The time begins when the patient is transferred to the operating room bed and ends when he or she is admitted to the post-anesthesia area.
Invasive procedures
The surgical entry into tissues, cavities, or organs or repair of major traumatic injuries.
Laser
A device that produces an intense, coherent, directional beam of light by stimulating electronic or molecular transitions to lower energy levels. An acronym for “light amplification by stimulated emission of radiation.”
Laser-generated airborne contaminants
Particles, toxins, and steam produced by vaporization of target tissues; surgical smoke
Latex allergy
A systemic or local allergic response to various latex proteins to which the individual has been sensitized.
Leaded apron
A leaded-rubber material worn to protect personnel from scattered radiation.
Low-level disinfection
A process that kills most bacteria, some viruses, and some fungi, but cannot be relied on to kill resistant microorganisms such as tubercle bacilli or bacterial spores.
Maximum permissible exposure
The level of laser radiation to which a person may be exposed without hazardous effects or adverse biologic changes in his or her eyes or skin.
Monopolar electrosurgery
A surgical procedure in which only the active electrode is in the surgical wound-electrosurgery that directs electrical current through the patient’s body and requires the use of a dispersive electrode.
Nominal hazard zone
The space in which the level of the direct, reflected, or scattered radiation used during normal laser operation exceeds the applicable maximum permissible exposure. Exposure levels beyond the boundary of the nominal hazard zone should be below the appropriate maximum permissible exposure level of the laser. Special eye and skin precautions must be enforced.
Noncritical
Instruments or items that come in contact with the patient, but in most instances only with unbroken skin.
Nonviable tissue
Tissue that is nonliving.
Nonwoven materials
Combination of processed cellulosic and synthetic fibers randomly oriented in sheets and held with binders, or fabrics produced by bonding fibers. They are designed as single-use materials.
No-touch technique
The use of an extension such as a sponge forceps, rather than hands, to handle or touch contaminated items or to handle sterile items.
Nursing diagnosis
A concise, explicit statement of the patient’s health status, based on nursing assessment and amenable to nursing intervention.
Nursing intervention
Those activities performed by the nurse to meet expected patient outcomes.
Nursing process
A systematic approach to nursing practice utilizing problem solving techniques. The major components of the nursing process, are assessment, diagnosis, outcome identification, planning, implementation, and evaluation.
Occupational dose
Limits of radiation in a year.
Annual exposure limits are:
total-dose equivalent (internal and external combined): 5 rem
lenses of eyes: 15 rem; and
skin, extremities, or individual organs: 50 rem.
Operating room
The environment in which the patient’s surgical procedure is performed.
Operating room nurse
A registered nurse who assumes the perioperative role in providing care to patients experiencing surgical intervention.
Operating room services
All activities related to the functions of the operating room.
Organic debris
Blood, tissue, and body fluids.
Packaging systems
A generic term meant to include all types of packaging such as woven or non-woven wraps, pouches, and rigid container systems.
Peel package
A flexible bag or receptacle used to package items for sterilization.
Peer review
The examination and evaluation by associates of a nurse’s clinical nursing practice. Individuals are evaluated by written standards.
Perioperative
Surrounding the operative and other invasive experience (i.e., before, during, and after).
Perioperative nursing care
The nursing activities that address the needs of patients, their families, and significant others that occur preoperatively, intraoperatively, and postoperatively.
Perioperative period
Time commencing with the decision for surgical intervention and ending with a follow-up home/clinic evaluation. This period includes the preoperative, intraoperative, and postoperative phases.
Personal protective equipment
Personal protective equipment for standard precautions includes intact gloves, gowns, masks, and eye protection (e.g., face shields, goggles, glasses with side shields).
Personnel
Paid or unpaid health care workers, students, volunteers, physicians, and others who may have direct patient contact or opportunity for exposure to patients or devices, supplies, or equipment used for patients.
Pneumatic
Pertaining to gas or air; filled with compressed gas or air.
Positioning device
Any device or piece of equipment used for positioning the patient and/or providing maximum anatomic exposure.
Postoperative
The time begins with admission to the post anesthesia care area and ends with a resolution of surgical sequelae.
Potentially infectious material
Blood; all body fluids, secretions, and excretions except sweat, regardless of whether they contain visible blood; nonintact skin; mucous membranes; and airborne, droplet, and contact-transmitted epidemiologically important pathogens.
Preoperative
The time begins when the decision for surgical intervention is made and ends with the transference of the patient to the operating room bed.
Process
Activities of the nurse or the process of nursing. Includes those functions carried out by practitioners, such as assessment, planning, treatments, indications for procedure and treatments, technical aspects of performing treatment, and management of complications.
Pulse duration
The duration of a laser pulse; usually measured as the time interval between laser pulses.
Rad
Radiation absorbed dose.
Reassessment
A review of each or any stage of the nursing process because of changing data. This may require a new assessment and a modified care plan.
Regulated medical waste
Sharps (both used and unused), cultures and stocks of infectious agents, carcasses and bedding of animals inoculated with infectious agents, select isolation waste from patients having diseases caused by so-called Class 4 etiologic agents, pathological waste, and human blood.
Reposable
An instrument that has limited use or an instrument with a combination of reusable and disposable components.
Resident microorganisms
Microorganisms persistently isolated from most people’s skin. These microorganisms are considered to be permanent residents of the skin and are not readily removed by mechanical friction.
Rigid container system
Specifically designed heat-resistant metal, plastic, or anodized aluminum receptacles used to package items, usually surgical instruments, for sterilization. The lids and/or bottom surfaces contain steam or gas permeable, high-efficiency microbial filters.
Scatter radiation
Radiation is scattered when an x-ray beam strikes a patient’s body, as it passes through the patient’s body, and as it strikes surrounding structures (e.g., walls, OR furniture).
Scrub attire
Clothing worn in the OR that consists of a two-piece pantsuit made especially for the practice setting.
Semi-critical item
An item that comes in contact with mucous membranes or with skin that is not intact.
Sequential wrapping
A double-wrapping procedure that creates a package within a package.
Sharps
Sharps include, but are not limited to, suture needles, scalpel blades, hypodermic needles, electrosurgical needles and blades, safety pins, and instruments with sharp edges or points.
Simultaneous wrapping
Wrapping with two sheets of wrap at the same time using typical wrapping methods.
Sponges
Sponges are items (i.e., gauze pads, cottonoids, peanuts, dissectors, laparotomy sponges) used to absorb fluids, protect tissues, and/or apply pressure or traction.
Standard
A criterion used by general agreement to determine whether something is as it should be. An agreed-upon level of excellence. An established norm determined by opinion, authority, research, and/or theory.
Standard precautions
The primary strategy for successful nosocomial infection control and reduction of worker exposure; precautions used for care of all patients regardless of their diagnosis or presumed infectious status.
Sterilization
The process of destroying all microorganisms on a substance by exposure to physical and chemical agents; the complete elimination of all forms of microbial life.
Sterilization process monitoring device
(formerly known as a chemical indicator): A device used to monitor certain parameters of a sterilization process by means of a characteristic color change (e.g., chemically treated paper, pellet sealed in a glass tube, pressure-sensitive tape).
Strike-through
Penetration of microorganisms, particulates, or fluids through a fabric.
Substerile area
Acts as a service area between two or more operating or procedure rooms and may be equipped with a immediate use sterilizer, warming cabinet, sterile supply storage, and small sink
Superheating
Occurs when dehydrated fabrics are subjected to steam sterilization. The temperature of the fabric exceeds that of the surrounding steam. The package or product becomes too dry and causes destructive effects on the strength of the cloth fibers. This may lead to a biological false positive test.
Surgical attire
Nonsterile surgical apparel items designated for the OR practice setting that include the two-piece pantsuit, cover jackets, head coverings, shoes, masks, protective eyewear, and other protective barriers.
Surgical hand scrub
The process of removing as many microorganisms as possible from the hands and forearms by mechanical washing and chemical anti-sepsis before participating in a surgical procedure.
Surgical hand scrub agent
A broad-spectrum, fast-acting, persistent, and nonirritating preparation containing an antimicrobial ingredient designed to significantly reduce the number of microorganisms on the intact skin.
Surgical suite
An area including the operating rooms that may also contain support facilities.
Terminal cleaning
Cleaning that is performed at the completion of surgical practice settings’ daily surgery schedules. Terminal cleaning is performed in surgical procedure rooms and scrub/utility areas, which include, but are not limited to, surgical lights and external tracks, fixed and ceiling-mounted equipment, all furniture (including wheels and casters), equipment, handles of cabinets and push plates, ventilation face plates, horizontal surfaces (e.g., tops of counters, autoclaves, fixed shelving), the entire floor, kick buckets, and scrub sinks.
Transient microorganisms
Microorganisms isolated from the skin but not demonstrated to be consistently present in the majority of people. Such microorganisms are considered to be transient but are of concern because they can be readily transmitted on hands unless removed by mechanical friction and soap and water washing.
Transmission-based precautions
Second tier of precautions designed to be used with patients known or suspected to be infected or colonized with highly transmissible or epidemiologically important pathogens for which additional precautions are needed to prevent transmission in the practice setting.
Ultrasonic cleaner
A processing unit that transmits ultrasonic waves through the cleaning solution in a mechanical process known as cavitation. The sound waves produce tiny air bubbles on instrument surfaces. When the air bubbles implode, they produce a scouring action that cleans the instrument surfaces. Ultrasonic cleaning is particularly effective in removing soil deposits from hard-to-reach areas.
Used items
Items that are opened for a surgical procedure that may or may not have come in contact with a patient’s blood, tissue, or body fluids during surgery.
Useful life
The anticipated life of a product, such as a woven material, affected by the number of washing cycles and sterilization processes that can occur and yet maintain an acceptable barrier.
Vestibular area
Area inside the entrance to the surgical suite separating the corridors of the surgical suite from those of the facility.
Viable tissue
Tissue capable of living
Washer/decontaminator
A processing unit that cleans by a spray force action known as impingement. This machine combines a vigorous agitation bath with jet stream air to create underwater turbulence. This unit cleans, decontaminates, and removes excess debris from instruments.
Washer/disinfector
An automated processing unit that pre-rinses, washes and lubricates, high-level disinfects, and dries a wide variety of surgical products.
Washer/sterilizer
A processing unit that cleans by a spray-force action known as impingement. This machine combines a vigorous agitation bath with jet-stream air to create underwater turbulence. A sterilization cycle follows the washing cycle.
Waste stream
Flow of discarded materials and fluids that eventually return to the land, water system, and air.
Wicking
Absorption of a liquid by capillary action along a thread or through the material.
Woven fabric
Nondisposable, reusable, memory-free, flexible fabric.
AORN
Association of registered nurses
AdvaMed
Advanced Medical Technology Association - represents more than 1,100 manufacturers of medical devices
NOS
Natural orifice surgery
Sales process
preplan, meet, gather information
Propose action
Implement
Follow-up
Purchasing process
Justify, compare, acquire, evaluate
Nursing process
Assess, plan, implement, evaluate
IOM
Institute of medicine
Time Out introduced in 2004
requires surgical team to double-check before anesthesia to restate the type of surgery, patients name and side to be operated on.
CE
Continuing education
HIPAA
The Health Insurance Portability & Accountability Act of 1996
What did HIPAA do?
New privacy standards
Patient’s rights to their own health records
Improve care by restoring trust
Improve efficiency of delivery by creating a framework for privacy
Device approval process.
Must be approved by FDA
Complex process involves presenting the FDA with an Investigatory Device Exemption (IDE), completing clinical studies, and summarizing the effectiveness of the device.
If approved, the FDA will give a PMA, PreMarketing Approval or an equivalency of a 510(k)
Patients Safety Act or Patients Bill of Rights of 1973
Considerate and respectful care Know identity of Drs, RNs, etc. Refuse treatment Have an advanced directive Privacy, confidentiality Review own records
Do’s
Call for an appointment.
Check with the OR Director or Materials Management to find out about policies for sales reps visiting the OR, Endoscopy Suite, or Central Service Department.
Arrive on time and be flexible.
Be prepared.
Wear a name tag.
Have proof ready so you can verify your attendance at an OR orientation course.
Develop a meaningful relationship.
BE A GOOD LISTENER - a good first step.
Take good notes.
Listen for what is not being said.
Ask questions to clearly understand your customer’s needs and requirements.
Know your product’s use and applications. How does it compare to the competition?
Answer questions fully. If you don’t know the answer, get back with answer within an agreed time frame or sooner (is best).
Emphasize product strong points as they relate to Customer needs.
Get to know the staff members who will use the products.
Get permission to observe surgery where your products could face the greatest challenges and do the most good.
Learn the terminology, jargon.
Understand and abide by patient confidentiality rules and policies.
Abide by the organization’s policies regarding industry representatives in the OR.
Be certain to teach the Customer how to get the most performance out of the product during its introduction and/or in-service. Customers can “make or break” a sale by their skill in using the product in response to a problem. Their quick and efficient response to a problem, using the product, will help sell it.
Don’ts
Don’t waste your precious face time with the Customer making the mistake of “talking down” the competition.
Don’t wander around the OR to observe other procedures that do not involve you.
Don’t stay beyond your appointment time.
Don’t touch a patient or assist with a procedure.
Don’t open sterile packages.
Don’t invite yourself into the physician’s lounge or talk on the lounge telephone.
Don’t call physicians by their first names.
Don’t give information that you are not sure about.
Don’t assume the physician is the only decision-maker for purchases.
Don’t use the phone without permission.
NPO
Nothing by mouth (Latin - Nil per os)
STAT
Immediately
PRN
As needed
Oscopy
Looking into
Ectomy
Removal of
Otomy
Making a hole into (often a temporary hole) Tracheotomy
Ostomy
Making a more permanent hole. Colostomy or Ileostomy - making a more permanent hole in the ileum
Plasty
Repair of
Standard Precautions divided into two tiers.
1st All human blood Body fluids, secretions, excretions, except sweat Nonintact skin Mucous membranes
2nd
Airborne precautions
Droplet precautions
Contact precautions
RP I: “Health care workers should use standard precautions when caring for all patients in the perioperative setting.”
RP II: “Hand hygiene should be performed before and after each patient contact.”
RP III: “Protective barriers must be used to reduce the risk of skin and mucous membrane exposure to potentially infectious materials.”
RP IV: “Health care practitioners should double-glove during invasive procedures.”
RP V: “Contact precautions should be used when providing care for patients who are known or suspected to be infected or colonized with microorganisms that are transmitted by direct or indirect contact with patients or items and surfaces in patients’ environments (eg, herpes simplex, impetigo, infectious diarrhea, smallpox, methicillin-resistant Staphylococcus aureus [MRSA], and vancomycin-resistant enterococci [VRE])”
RP VI: “Droplet precautions should be used when caring for patients who are known or suspected to be infected with microorganisms that can be transmitted by infectious large particle droplets (i.e., larger than 5 microns in size) and generally travel short distances of three feet or less (eg, diphtheria, pertussis, influenza, mumps, pneumonic plague).”
RP VII: “Airborne precautions should be used when caring for patients who are known or suspected to be infected with microorganisms that can be transmitted by the airborne route (eg, rubella, varicella, tuberculosis (TB), and small pox).”
RP VIII: “Health care workers should be immunized against epidemiologically important agents according to CDC recommendations.”
RP IX: “Work practices must be designed to minimize risk of exposure to pathogens.”
RP X: “Personnel must take precautions to prevent injuries caused by needles, scalpels, and other sharp instruments.”
RP XI: “Activities of personnel with infections, exudative lesions, nonintact skin, and/or bloodborne diseases should be restricted when these activities pose a risk of transmission of infection to patients and other health care workers. Identification, evaluation by a physician, and assessment of fitness for work performance in the perioperative setting should be required.”
RPXII: “Policies and procedures that address responses to threats of intentionally released pathogens (eg, anthrax, botulism) should be written, reviewed periodically, and readily available within the practice setting.”
RP XIII: “Policies and procedures that address responses to epidemic or pandemic pathogens (eg, severe acute respiratory syndrome {SARS}, avian flu, influenza) should be written, reviewed periodically, and readily available within the practice setting.”
RP XIV: “Personnel should demonstrate competence in the prevention of transmissible infections.”
RP XV: “Policies and procedures should be written, reviewed periodically, and readily available within the practice setting.”
HCV
Hep C Virus known as “stealth bomber”
Diseases of note in the hospital
HIV Hep B Hep C TB Creutzfeldt-Jakob Disease (Mad Cow) Staphylococcal Bioterrorism
Operations Manager
Responsible for financial management of the department
RN with MSN and /or MBA; Non-RN, MBA
MSN
Masters of science in nursing
Clinical Manager
responsible for nursing practice and logistics
OR Director
Sometimes manages both operations and clinical manager and/ or performs both responsibilities
OR supervisor
sometimes refers to OR Director or Manager
Vice President Perioperative Services
(can have other titles)
Chief/Chairman of Surgery (Surgeon)
Different surgeons may serve as “specialty” chiefs or chairmen (Ortho, ENT, Cardiac, Neuro, GU, GYN, Pediatrics, etc
ENT
Ear, nose and throat
GU
Genitourinary - pertaining to the genital and urinary systems.
GYN
Gynecologist
OB
Obstetrics - the branch of medicine and surgery concerned with childbirth and the care of women giving birth.
Chief/Chairman Anesthesia
In charge of Anesthesia
Head Nurse, Team Leader, Charge Nurse, Clinical Coordinator
may be responsible for the OR or a specialty service
Educator/Clinical Specialist
responsible for staff education and orientation
Materials Manager
deals with inventory, purchases, evaluation of products/equipment, etc.
PERSONNEL AT SURGICAL FIELD: Surgeon
- MD (Medical Doctor) or DO (Doctor of Osteopathy)
- Fellow
- Resident
- Private practice or hospital-employed
Anesthesia Provider
one who administers and maintains anesthesia (topical, local, regional, general), monitors vital signs
- MD or DO
- CRNA (Certified Registered Nurse Anesthetist)
First Assistant
assists with surgical procedure (retracts, dissects, provide hemostasis, suctions, irrigates, sutures, dresses the wound)
- Physician (surgeon, general practitioner, etc.)
- RNFA (Registered Nurse First Assistant)
- CRNFA (Certified RNFA)
- PA (Physicians Assistant - may not come from medical background before PA training)
- Surgical Technologist First Assistant
- Fellow
- Resident
- Medical Student
“Scrub” person
person who prepares and “passes” instruments and equipment at the sterile field
- Registered Nurse
- Surgical Technologist
- CNOR (Certified Nurse in the Operating Room)
- CST (Certified Surgical Technologist)
Circulating Nurse
Should ALWAYS be a Registered Nurse. May be CNOR (Certified Nurse in the Operating Room). Manages patient care using the nursing process of assessment, nursing diagnosis, outcome identification, planning, implementation and evaluation. Anticipates and provides for the needs of all team members. Manages patient/procedure operative records.
Visitor names
(such as sales reps, service or clinical associates, etc.) may be requested by the Circulating Nurse for listing on the patient’s records. (depending on hospital policy).
Orderly, Patient care aide
transports patients, assists with patient transfer to and from surgery bed (lifting and positioning assistance), runs errands, etc.
Housekeeping staff
cleans room between procedures, etc.
Instrument technician
manages clean and soiled equipment logistics for circulating person
Video, endoscopy technician
cares for equipment
Radiology technician
manages radiology equipment and takes films, etc.
Biomedical engineer
services and maintains equipment
Surgical Scheduler
takes scheduling information for surgical procedures
Desk Coordinator
assists with secretarial duties and coordinating the surgery schedule
Infection Control Professional (RN, Epidemiologist)
responsible for infection statistics and infection prevention. Considered expendable in many small health care facilities. Sometimes not particularly familiar with the surgical environment.
scrub suit
A two-piece scrub suit requires the shirt to be tucked into the pants or the shirt should fit closely to the body while worn outside of the pants.
long sleeved “warm up” jacket
should be worn by non-scrubbed persons to capture “fallout”. The jacket should be snapped closed in front to prevent the jacket from brushing against the sterile surgical field.
bouffant hair cover or hood style hat
is worn to cover all possible head and facial hair. A skull cap must not be worn because it does not cover the hair on the side of the head, side burns, or the hair at the nape of the neck.
surgical mask
is worn to contain and filter droplets of microorganisms from the wearer’s nose and mouth. A mask also protects the wearer from splash contamination. The mask is worn where open sterile items and sterile attired persons are present or where persons are scrubbing. A mask is removed by touching tie strings only. A MASK SHOULD NEVER BE DANGLED AROUND THE NECK FOR FUTURE USE!!!
To remove a face mask:
o Remove gloves, wash your hands and use a waterless antiseptic agent, such as an alcohol-based handrub
o Handle the face mask by the ties or strings and discard it in the appropriate container.
o Wash your hands.
Patient flow through surgery
Pre-admission testing Outpatient surgical admissions Holding room area Surgery room PACU - post anesthesia care unit Inpatients taken to hospital room Outpatients discharged.
ICU
Intensive Care Unit
CCU
Coronary Care Unit
SICU
Surgery Intensive Care Unit
NICU
Nursery Intensive Care Unit
CS
Central Service
CSR
Central Supply Room
SPD
Supply Processing and Distribution
CPD
Central Processing Department
SSD
Central Sterilizing and Supply Department
GI Lab or Endoscopy Suite
.
Radiology Dept.
.
Cardiac Cath Lab
.
Lithotripsy Departmetn
.
Dialysis Department
.
Unrestricted Area
where the central control is located that monitors the entrance and departure of patients, personnel, visitors, and materials into the surgery department. Usually includes the Post Anesthesia Care Unit (PACU), surgical scheduling office, locker rooms, and the Supervisor’s office. Street clothes are permitted in this area.
SEMI-RESTRICTED AREA
where the peripheral support areas for the surgical suite are located. Examples include the clean and sterile storage areas, soiled and clean processing areas, corridors to restricted areas, and substerile rooms (when procedures are not being performed). This area is limited to personnel and patients. Scrub attire (two-piece pants suit or one-piece coverall) and head and facial hair covers must be worn in this area.
RESTRICTED AREA
where sterile supplies have been unwrapped or procedures are being performed. Examples are operating rooms, clean cores, substerile areas, scrub sink areas, and where steam sterilizers for “flash sterilization” (emergency) are located. Scrub attire, head and facial hair cover, and surgical masks must be worn.
Should masks be worn by persons at the scrub sink?
Yes
AORN Quotes
RP I: “Traffic patterns should be designed to facilitate movement of patients and personnel into, through, and out of defined areas within the surgical suite. Signs should clearly indicate the appropriate environmental controls and surgical attire required.”
RP II: “Operating room suites should be secure.”
RP III: “Movement of personnel should be kept to a minimum while invasive and noninvasive procedures are in progress.”
RP IV: “The movement of clean and sterile supplies and equipment should be separated from contaminated supplies, equipment, and waste by space, time, or traffic patterns.”
RPV: “During construction and renovation, specific traffic patterns should be established and maintained in accordance with applicable state regulations.”
RP VI: “Policies and procedures for traffic patterns for patients, personnel, supplies, and equipment should be developed, reviewed periodically, revised as necessary, and kept readily available in the practice setting.”
Positive air pressure
During procedure
Negative air pressure
After procedure in clean-up areas
Asepsis
means the absence of disease-causing microorganisms (or germs).
Medical asepsis
procedures used to reduce the number of microorganisms and prevent their spread - for example, hand washing or performing hand hygiene with an alcohol rub.
Surgical asepsis
procedures used to eliminate any microorganisms as in sterilization. Also refers to sterile (aseptic) technique, ie. to maintain a “sterile” field/environment
“Surgical Conscience”
reminds them about the principles of asepsis
What practices are followed to provide an acceptable environment to perform surgical procedures?
Within a sterile field, all items must be sterile and handled only by scrubbed, sterile team members.
Movement within the restricted area must be kept to a minimum during invasive and noninvasive procedures. By reducing excessive movement, microbial shedding will be minimized, thus decreasing the airborne contamination of wounds
Doors are kept closed, not locked, to decrease turbulent airflow. The air pressure in the operating room or procedure room needs to be “positive” in relation to the semirestricted areas.
Minimizing the amount of talking and the numbers of people and their movements, limit airborne contamination
Separate the clean and sterile supply and equipment movement from the contaminated supply and equipment movement through space, time, and traffic patterns.
Confine and contain contaminated devices and supplies.
No external shipping cartons are allowed within the semirestricted and restricted areas (due to the dust, debris, insects that can be harbored in these cartons and boxes).
Clean items are taken to the Clean Core or the procedure room.
Soiled items are taken to a peripheral corridor to go to the decontamination area.
Items needing decontamination, soiled linen, and trash are kept separate from personnel and patient traffic areas.
Special traffic patterns must be determined for construction, renovation, and maintenance projects
Sterile Field
The area or zone that contains the sterile draped patient, sterilized equipment, and persons in sterile attire.
What does the sterile field include?
Sterile draped patient on the surgical bed
Persons in sterile attire within the sterile field
Top surface of the sterile draped “back table” where the bulk of open sterile supplies are located
Sterile draped instrument table
Sterile draped “mayo stand” where sterile items “in use” are dispensed by the scrub person
Other sterile draped tables as needed
sterile basin “ring stands”
sterile draped microscope
sterile draped C-arm
Sterility Practices
Aseptic technique is used to introduce sterilized items to, and maintain, a sterile field
The circulating nurse opens and presents sterile items for the scrubbed person
The scrub person prepares sterile items on the sterile field
Sterile areas of the surgical gown:
Front - from chest to level of sterile field
Sleeves - two inches above elbow to top of cuff
Unsterile areas of the surgical gown (considered areas of friction)
Back of gown because it is not under constant supervision
Neckline
Shoulders
Under the arms
Cuff area under sterile gloves
Sterile gloved hands are kept in front of the scrubbed person, sometimes wrapped in a sterile towel when not in use
Gloved hands are never dropped below the waist
What is in the sterile field?
Sterile draped patient on the surgical bed
Persons in sterile attire within the sterile field
Top surface of the sterile draped “back table” where the bulk of open sterile supplies are located
Sterile draped instrument table
Sterile draped “mayo stand” where sterile items “in use” are dispensed by the scrub person
Other sterile draped tables as needed
sterile basin “ring stands”
sterile draped microscope
sterile draped C-arm
Sterility practices
Aseptic technique is used to introduce sterilized items to, and maintain, a sterile field
The circulating nurse opens and presents sterile items for the scrubbed person
The scrub person prepares sterile items on the sterile field
Sterile areas of the surgical gown:
Front - from chest to level of sterile field
Sleeves - two inches above elbow to top of cuff
Unsterile areas of the surgical gown (considered areas of friction)
Back of gown because it is not under constant supervision
Neckline
Shoulders
Under the arms
Cuff area under sterile gloves
Sterile gloved hands are kept in front of the scrubbed person, sometimes wrapped in a sterile towel when not in use
Gloved hands are never dropped below the waist
Principles of asepis
Sterile field should be “opened”/established as close to the time of use as possible
Sterile field should be maintained and monitored CONSTANTLY (The potential for contamination increases with time and the absence of monitoring.)
Covering sterile supplies with a sterile drape is not recommended - the possibility of contamination when undraping is high
Sterile items must be opened and dispensed in a manner that will not contaminate them. Sterile items are preferably “presented” to the scrub person, or placed securely on the sterile field. The furthest end is opened first. The wrapper edges are secured when opening.
“Flipping” (opening an item while tossing it onto the sterile surgical field) is not preferred as the item may roll off the sterile field, become contaminated, or displace something else on the field.
Event-related sterility principles are used. Time-related sterility is becoming outdated (expiration date on sterile item)
Sterile Items That Need to be Opened for Surgery
Back table drape pack Wrapped instrument trays Rigid sterilization container systems Basins sets Individual wrapped instruments Peel pouches
Pouring Sterile Liquids
Carefully and slowly
No splashing
Pour entire contents of bottle
No recapping (due to chance of contamination)
Pouring may be done into a sterile basin on a ring stand or into a bowl that has been placed at the edge of the back table
Draping the Patient
Done to establish an aseptic or surgical barrier that minimizes the passage of microorganisms between sterile and unsterile areas
Handle drapes as little as possible
Hold drape high and drape from the surgical site to the periphery to minimize risk of contaminating the prepped surgical site. The drape is cuffed around the sterile hand to prevent accidental contamination of the glove or gown sleeve.
Do not move or shift the drape once it’s in place (chance of contamination)
Movement about the Sterile Field
Is limited
Do not walk between two sterile fields
STERILE persons needing to change positions at the surgical table will pass each other “back to back” or “belly to belly”
Preferably nobody sits except when entire procedure will be performed sitting (ie., hand surgery, cataract extractions)
AORN Recommended Practices for Maintaining a Sterile Field
RP I: “Scrubbed persons function within a sterile field.”
RP II: “Sterile drapes should be used to establish a sterile field.”
RP III: “Items used within the sterile field should be sterile.”
RP IV: “All items introduced to a sterile field should be opened, dispensed, and transferred by methods that maintain sterility and integrity.”
RP V: “A sterile field should be maintained and monitored constantly.”
RP VI: “All persons moving within or around a sterile field should do so in a manner that maintains the sterile field.”
RP VII: “Policies and procedures for maintaining a sterile field should be written, reviewed annually, and readily available in the practice setting.”
Should you maintain quiet when you enter the OR?
Yes. The patient may be awake and/or anesthesia is being induced (the anesthesia provider needs quiet at this time.)
Upon entering the OR
The scrub person is drying his or her hands and applying sterile attire
The circulating nurse is busy:
Greeting the patient
Identifying the patient and reviewing chart
Verifying the surgical site
Answering questions from the patient
Moving the patient to the surgical table and securing the patient with a safety strap
Opening up sterile table packs to establish sterile field
Tying up scrub persons gown
Opening sterile products onto the sterile field
Providing scrub person with needed additional sterile items
Assisting scrub person with instrument, sponge and needle count
Arranging and plugging in needed equipment
Assisting anesthesia with induction
Assisting surgeon in positioning patient
Other surgical team members are drying their hands
Scrubbed and circulating persons are assisting others on the surgical team with gowning and gloving
The circulating nurse is prepping the operative site and placing the electrosurgery grounding pad on the patient, if needed
The sterile team is draping of the patient (drapes are cuffed over sterile hands when applying to decrease the chance of contamination of the gloves or sleeves.)
The circulating nurse is still very busy:
Moving unsterile equipment near the sterile field and making connections (electrosurgical or laser unit, suction for fluid collection, etc.)
Adjusting the surgical lighting
Assisting with the draping of microscopes, C-arms, etc.
Electro surgery grounding pad
Make sure it’s in place if needed.
“Time out” period
Is this the right patient?
Is this the right surgical site?
Is this the right procedure?
Emergencies in the OR
Always expect the unexpected!
GET OUT OF THE WAY - listen to the nurse, and get out of the room immediately if asked
Do not attempt to help, for liability reasons
CODE BLUE - means CARDIAC ARREST. This would not necessarily be paged in the surgery suite because the team is there to manage the patient
A crash cart with all of the emergency medications, supplies, and equipment will be brought into the room, if needed. A nurse or physician will document everything.
Other emergencies occur, so be alert
If fire occurs what should you do?
R - rescue
A - alarm
C - confine
E - extinguish and evacuate
Types of fires and extinguishers.
Class A fires
Paper, cloth, wood, etc.
Pressurized water fire extinguisher
Class B fires
Oil, gas, flammable liquids
Carbon dioxide or dry chemical (ABC) fire extinguisher
Class C fires
Electrical
Halon fire extinguisher (doesn’t leave residue but this type of extinguisher is being removed from the market because it affects the ozone layer)
Use of fire extinguisher
P - pull
A - aim
S - squeeze
S - sweep
Laser
Light Amplification by Stimulated Emission of Radiation (laser). A laser is a device that uses light energy (photons) to cut and coagulate tissue.
Active electrode
a handpiece that directs the electrical current to the target tissue site. (Angled blades, roller balls, pencils, laparoscopic devices, biopsy forceps, etc.)
Dispersive electrode
a pad that is applied to the patient to gather and receive the electrical energy that flows through the patient from the active electrode. The energy is then returned to the generator.
Radiation Hazards
Radiation cannot be observed or felt.
Radiation can alter cellular structures and exposure may cause cancer, genetic mutations, spontaneous abortion, congenital anomalies, or cataracts.
Lead aprons and protective devices (thyroid collars, gloves) must be worn whenever X- rays or fluoroscopy is used. These devices must be tested periodically to ensure protection is adequate.
Limit exposure to radiation by leaving the room when radiation is being emitted.
Exposure can be monitored by film badges worn by personnel who are frequently exposed to radiation.
Confidentiality
Confidentiality
DO NOT DISCUSS your experience in the operating room in public areas.
Never use patient names of identifiers. You NEVER know who will be around to overhear you. Indiscretion could involve you in a lawsuit.
Awareness During Anesthesia
Always assume that the patient can hear you even though he or she appears to be asleep.
Keep conversations to a minimum.
Maintain professionalism.
Nursing Organizations
Professional Nursing Organizations
NOLF Nursing Organization Liaison Forum (part of ANA that represents over 75 specialty nursing organizations) - known today as the “Alliance”
AACN American Association of Critical Care Nurses
AAMI Association for the Advancement of Medical Instrumentation
AANA American Association of Nurse Anesthetists
ANA American Nurses Association
AORN Association of periOperative Registered Nurses
APIC Association for Professionals in Infection Control and Epidemiology
ARNA American Radiological Nurses Association
ASHCSP American Society for Healthcare Central Service Personnel (of the American Hospital Association)
ASHMM American Society for Healthcare Materials Management
ASORN American Society of Ophthalmic Registered Nurses
ASPAN American Society of PeriAnesthesia Nurses
ASPRSN American Society of Plastic and Reconstructive Surgical Nurses
AWHONN Association of Women’s Health, Obstetric, and Neonatal Nurses (formerly NAACOG)
DNA Dermatology Nurses Association
ENA Emergency Nurses Association
IAHCSMM International Association of Healthcare Central Service Material Management
NAON National Association of Orthopedic Nurses
NSNA National Student Nurses Association
RNS Respiratory Nursing Society
SGNA Society of Gastroenterology Nurses and Associates
SOHN Society of Otorhinolaryngology and Head-Neck Nurses
SUNA Society of Urological Nurses and Associates
The Alliance The Nursing Organizations Alliance, formerly NOLF, part of ANA that represents over 75 specialty nursing organizations
Professional Physician Organizations
AMA American Medical Association
AOA American Osteopathic Association
ACS American College of Surgeons
ACOS American College of Osteopathic Surgeons
AAGL Formerly American Association of Gynecological Laparoscopists
SLS Society of Laparoendoscopic Surgeons
ASA American Society of Anesthesiologists
ASLMS American Society for Laser Medicine and Surgery
AUA American Urologic Association
AOA American Orthopedic Association
ACOG American College of Obstetricians and Gynecologists
Credentialing Organizations for Continuing Education
ANCC American Nurses Credentialing Center (Commission on Accreditation)
ACME Alliance for Continuing Medical Education NLN National League for Nursing
AORN (Organization you should know)
Association of periOperative Registered Nurses
1949 (1954)
approx.42,000
RNs, Industry reps and others as associate members, student membership category
Nov 14 week OR Nurse Week
Nurse Week
Nov 14th week
SGNA (Organization you should know)
Society of Gastroenterology Nurses & Associates
1974
8000 members
APIC (Organization you should know)
Association for Professionals in Infection Control & Epidemiology
1972
11,000 members
