Theatre prep + etiquette Flashcards
What’s the advantage of using a waterproof drape?
It prevents the patient from becoming cold + wet - thus maintaining thermoregulation
When should you only wear scrubs?
In theatre
Why should scrubs be coloured co-ordinated?
To differentiate between the levels of surgical personnel, within the theatre suite
What should be considered when washing scrubs, after a surgical procedure?
They are washed seperately, in a seperate washing area
What should be considered, in regards to footwear, when in theatre?
They are used only within theatre, no where-else - at any time
Consider foot covers also, as good practice
Foot-covers can be used in an emergency too
In an emergency, what is the minimal amount of PPE that should be worn, when rushing into theatre?
Disposable + sterile:
1. Gowns
2. Sterile gloves
(Prep-scrubs under gown only)
1. Hair-nets
1. Foot-covers
Bare socks - if desperate, says Lucy!
State the difference between prep-scrubs and theatre-only scrubs
Prep-scrubs = only to be worn in prep, when preparing patients for surgery
+
Theatre-only scrubs = Only worn in theatre - NOT within prep!
If you need something in an emergency, and you are already in theatre, who can you ask?
The circulating surgical nurse!
How can scrubs contribute towards contamination in theatre?
They can harbour micro-organisms, and therefore act as a fomite
What is, arguably, the 2 most important sterile items to wear in the OR?
+
Who wears them?
Sterile:
1. Gloves
1. Gown
+
All sterile personnel
Why should you (as gold standard) wear seperate, disposable gowns in the surgical prep area?
To prevent the transmission of fomites to vulnerable, sedated patients from risk of SSI etc
What are the 2 main reasons why masks be worn in the OR?
- To prevent the spread of HAIs
+ - Act as eye protection
From patients that are infectious, harbour any HAIs or zoonotic disease
What should you always be aware of, in regards to the sterile field?
Where you are, in relation to it
Where does the Sterile Field begin and end?
Beings = At the surgical site
+
Ends = At the instrument trolley
If you absloutely must move the drapes, during surgery, as directed by the vet - where can you touch it?
Underneath
Define what is meant by the term ‘Sterile Field’
The Sterile Field = the area within the window (SS) , created by the drapes
+
The drapes themselves
SS = Surgical Site
What are the 5 main aspects, that are included within the Sterile Field?
- Surgical site
- Drapes (All areas)
- Surgical tabletop
- Surgical instruments
- Instrument tray
The exception to the rule..
What is the only non-sterile aspect within the surgical field?
The edges of the drapes!
If anything falls off the surgical field, what should be done?
It must be disposed of
+
NOT re-used
If you need to dispose of something, such as blood-soaked swabs, from the surgical area, where must it be disposed of?
(In theatre)
In the Kick bucket
What must you do if you break sterility, and touch something that is not sterile, what 2 minimal steps must you take before re-entering the theatre?
You MUST - as a minimum:
2. Re-scrub
+
1. Re-glove
Is the back or front of the gown considered sterile?
The Front
Explain why the back of the surgical gown is not considered sterile?
Because when it is sterilised, the sterile part of the gown (the front) is folded inside when packed and sterilised
+
The back of the gown has to be touched by the surgical assistant, to tie it - breaking sterility
What area of the sterile gown, is actually considered ‘sterile’?
The chest portion of the front of the gown, where the sterile gloved-hands are held and NO other area
Where should your hands be placed when you have been donned and gloved?
With your hands clasped, in-front of your chest
+
Must not move from this position, unless instructed otherwise
Why should your hands not touch any part of the gown or put your hands by your side when donned?
Because the portion outside of the chest area and gloves are not considered sterile
State the 3 things you must do when moving in the OR?
- Move slowly
- Walk back-to-back
- Vocalise when you move, to inform everyone of your presence
What way should you face when you are moving around the SS?
SS = Surgical site
With your front facing the SS
What should you never block, for the VS, in the OR?
Their light source/the lamp
Where should you always stand, in relation to the VS, during a surgical procedure?
Opposite them, on the other side of the SS
What should Non-sterile assistants not touch?
Any sterile personnel or everything that is considered sterile!
Sterile Personnel = Sterile assistant, VS etc
How should you act within the theatre?
(4 things)
- Act calmly
- Act slowly
- Thinking before you act
- Not leaning over the SS
How do you avoid unintentional contamination as non-sterile assistant?
By keeping your hands clasped
or
behind your back!
What should you do if you accidentally contaminate the surgical field?
Speak up!
It is better to address it immediately, than risk a patient’s life or increase the risk of post-op surgical infections
Where should you stand, as a non-sterile assistant?
In the corner of the room
+
Away from all sterile personnel + equipment
Where should you stand when there is a teaching moment, in the OR?
Behind the VS
+
At the head of the surgical table with the anaesthetist
+
Remember to not lean forwards!
Why apart from the obvious, should you not sneeze and cough in theatre?
4 reasons..
Think about a particular pathogen that likes to live in the mms + nose!
To protect the patient from:
Cross-contamination
+
Surgical Site Infections
+
Prevent post-op infections
+
Limit spread of HAIs.. in particular MRSA!
MRSA = Methicillin Resistant Staphylococcus Aureus
What 5 things should you be aware of when talking in theatre?
All discussions are kept professional
+
Subjects should be patient + case related
+
Keep talking to a minimum - to reduce the chance of mistakes, or disrupt the VS’s concentration
+
Save any relative questions to the end
+
Don’t interupt or disrupt the VS during emergencies
Should the VS touch the mayo trolley?
No, as it increases the risk of contamination
In some refferal practices, are scrub nurses able to pass sterile items to the VS?
Yes
How should you open seal and peel pouches?
In an aseptic manner:
Holding the edges of the openings and peel them up + away from each other, folding them outwards - without touching the sterile person
What should you check with the VS before breaking sterility, after seeming to have completed the surgical procedure?
Ask/confirm with the VS if they have finished + you are allowed to break sterility
What should you not do before confirming if it is okay to break sterility?
Do not remove equipment from the sterile field or move the patient unless asked to do so
What is considered the 6 main basic components of the surgical suite?
1.The surgical suite (itself)
2.Recovery kennels
3.Surgical changing rooms
4.Instrument washing + packing
5.Imaging suite
6.Preparation area
Name the 4 classifications of surgical procedures
- Clean
- Clean contaminated
- Contaminated
- Dirty
What is meant by a ‘Clean’ surgical procedure
+
Give an example of one
A surgical procedure which is not contaminated.
Example = Ovariohysterectomy or Orchidectomy
What is meant by a ‘Clean contaminated’ surgical procedure
+
Give an example of one
A surgery where a body cavity is entered under controlled conditions + with limited contamination.
Example = Median-sternotomy
Median-sternotomy, also known as a ‘Sternal split’ = allows the VS to access both halves of the chest cavity
What is meant by a ‘Contaminated’ surgical procedure
+
Give an example of one
A gross spillage or break into a body cavity, using a sterile technique.
Examples = oral surgery or abdominal surgery - with spillage
What is meant by a ‘Dirty’ surgical procedure
+
Give an example of one
A surgery including infected or necrotic tissues or bodily fluids.
Examples = Dentals + Abscesses
What is the ideal design of the theatre suite set to achieve?
Preventing cross-contamination by seperating areas
Dirty theatres, dental suites
Why should non-surgical personnel not go beyond prep area?
Preventing personnel from leaving + re-entering clean rooms
+
To limit unnecessary traffic + cross contamination
How should surgical personnel, rooms, equipment and instruments be coded?
Colour coded
What 5 procedures can you carry out in the prep room?
- Induction of anaesthesia
- Surgical prep (Clip + scrub)
- Placing Intravenous catheters
- Taking blood samples
- Triage, minor or emergency care (general practice)
Some general practices may have a dental area in prep also
State some equipment that should be kept in the prep area
- Endotracheal tubes
- Pre-medication + induction pharmceuticals
- Anaesthetic circuits + monitoring equipment
- Crash box + cash area
- Surgical prep equipment: Clippers, hoover, lint rollers
- PPE
- Sharps + clinical waste bins
- Positioning aids: troughs + sand bags
- Tables: fixed, on wheels or access to moveable trolleys
- Fixed sinks for dirty procedures
- Good lighting or moveable spotlight
Where should skin prep be found?
Just outside of theatre, NEVER inside the OR
How should theatre doors be designed?
They should be:
* Without handles
+
* They should be automatic or have a push mechanisms
Where should PPE, sterilised surgical instruments and consumebles be stored and why?
In Sterile stores
+
To avoid contamination + water droplets
How should equipment be stored within the Sterile storage area?
Should be near cleaan area/prep or corridor and has:
- Adequate shelving
- Easily accessible
- Logical order
- Glass doors
- Items can be clearly identified
- In-date (order)
- Well stocked
Where should the changing area be?
Near the clean area of theatre
What should be kept within the changing area?
Clean:
* Scrubs
* Shoes
* Masks
* Hats
- Seperate laundry bins - to limit cross contamination
Allows staff to change into surgical scrubs before entering the clean area
How should the changing area be cleaned?
In accordance to the surgical suite cleaning protocols
How should sinks be designed in the prep area?
They should be:
* No touch taps
* Operated by foot, knee, elbow or infrared (motion sensor)
+
* Mixer taps
What should be mounted to the wall, around the sink, in prep?
A skin cleansing solution
+
disposable paper towels
+
Preferably sterile single use, impregnated Hibiscrub or Iodine nail brushes/picks
Below the sink: rubber mats, to reduce trip hazard
Be aware that rubber mats increase the likelihood of miro-organisms
What should a sink be free from, in prep area?
+
What material should a sink be made out of?
Clutter
+
Stainless steel or any other form of antimicrobial surface
What type of flooring should be used in skin prep?
Non-slip flooring
Where should you donn and put gloves on?
In a clear area, just outside of theatre
Where should the recovery area, ideally be located?
Adjacent to theatre, but seperate from normal wards
+
Often found in prep areas, in the general practice
Ideally, where should critical patients be housed, to recover?
In High dependency units
or
Intensive care units
For how long should patients be monitored for, post-operatively?
Until the patient is:
* Fully recovered
* All parameters are within their normal limits
* They are conscious
* Apparent gag-reflex
What room temperature should the recovery area be, for patients?
22-24 degrees celcius
What important ‘cart’ should be avaliable and easily accessible in the recovery area?
Crash cart
Give an example of 2 types of equipment that should be kept in the recovery area
- Head supports
- Heating aids
What ‘ratio’ of RVN to patient, should there be?
According to the pp…
1:1
What large pieces of equipment can be portable in large hospitals and refferal centres?
Portable x-ray machines
Where should the ‘Imaging’ room be located?
- Close to theatre, with easy access
- Preferably = beside or in-between several theatres
Why is it important to have the imaging room so close to theatre?
For the VS to take pre-op + post-op imaging/x-rays of the patient
Especially in orthopeadics
What 3 potential types of facilities can an imaging room hold?
- Radiography
- Ultrasonography
- Endoscopy
Why were/are wall-mounted x-ray viewers seen as an increased risk for infection?
Because of the dust + other particles that can harbour on the machine
What 2 things should be considered in regards to the layout of the operating room?
It is:
1. Spacious
1. Room to manoeuvre without compromising sterility
What should be considered in regards to the construction materials used in the operating room?
All surfaces are antimicrobial
What 3 things should be considered in regards to the equipment in the operating room?
- Each piece of equipment is individual to that theatre - i.e; one per theatre
- They are easy to clean
- They are made of antimicrobal materials, where possible
What 4 things should be considered in regards to the environment of the operating room?
- Air conditioning or use of a suitable air-flow system is in place
- It is clean
- It is dust-free
- At the appropriate temperature
Remember - increased temperature = increased bacterial colonization
Why is it important to have an operating table which is electrically or manually able to adjust it’s height?
- To reduce back injuries of staff
- Necessary for CPR
- Adjust to patient size
- Allow for more efficent treatment of care
CPR = CardioPulmonary Resuscitation
What is a Tilt table useful for?
Treating Diaphramatic hernias
+
For patients at risk of Aspiration - due to V+ or regurgitation
What 2 types of modifications can some operating tables have?
- Self-heated
- Drainage troughs = for dental + post mortem tables
What 2 types of surface materials should operating tables have?
Stainless steel or rubber
State 1 disadvantage of using a stainless steel top for an operating table
It requires another layer, such as rubber on top, to prevent hypothermia + increase patient comfort
Patient comfort = less stress = decreased sedation pre-op time
Adding another layer = more expense
State 2 benefits of using a rubber top for an operating table
- It’s removable
- Easy to disinfect + clean
Name the 4 types of positioning aids
- Sandbags
- Foam pads
- Ties
- Troughs
State 2 benefits (each) of using sandbags + foam pads for patient positioning aids
- Usually have a plastic covering, which is easy to clean
- They come in various shapes + sizes
Why are ties considered dangerous positioning aids?
Because they must only be tied on the table, when they are anaesthetised
They cannot be tied to the table as if they are sedated and they wake up, disoriented + scared, they will injure themselves
State 3 benefits of using Troughs for patient positioning aids
- They are usually covered with plastic + easy to clean
- They can be filled with foam, so they are comfortable for the patient
- They can come in various shapes + sizes
True or False
Anaesthetised or recovering patients should be monitored at all times, when using patient transport systems.
True
What is the vital thing you MUST remember when using patient transport systems?
To maintain the patient’s airway at ALL time
What are the 2 things you can do, to help maintain the patient’s airway when using patient transport systems?
- Pull the neck forward
+ - Extend the tongue
Where should you place the patient’s tongue, when extending the tongue, to maintain the airway?
Place the tongue under the lower jaw
What is the purpose of extending + placing the tongue under the lower jaw - specifically?
It helps prevent the tongue from falling back into the mouth + blocking the airwary
What can you use to help position patient’s in sternal recumbency - especially brachycephalic breeds?
A foam wedge, to help maintain the airway
True or False
You shouldn’t lift dogs that over 15kg by yourself
Truee
What posture should you maintain when you lift patients?
Bend your knees
+
Keep your back straight
State 8 materials/pieces of equipment can be used for transporting patients in the VP
- Blankets
- Towels
- Stretchers
- Hoists
- Carriers
- Cat trollies
- Slings
- Y-harnesses
State the 2 common types of stretchers
- Nylon
- Framed
Name an advantage and an disadvantage for using a blankets + towels for transporting patients
Advantages:
1. Removes some strain from staff
1. Keeps animal comfortable
2. Inexpensive
3. Easily accessible
4. Multi-use
Disadvantages:
1. Not secure
Name a benefit for using stretchers for transporting patients
Benefits:
1. Easy to clean
1. Machine washable
Nylon:
1. Have padded handles, for less strain for staff
Framed
1. Aids patient positioning
Name a benefit for using hoists for transporting patients
- Great for moving recumbent patients
- Provides rehabilitative support
What patient transport system should be used for cats, when they are conscious?
Carriers
Name an advantage + disadvantage for using a carriers for transporting patients
- Advantage: They are secure
- Disadvantage: Doesn’t provide great visability to monitor the patient
Name a benefit for using a cat trollies for transporting patients
- You’re can attach it to cat baskets/carriers
- Allows for easy transportation
Name a benefit for using a slings + y-harnesses for transporting patients
- Easy to access
- Great for supporting larger animals, such as large dogs
What is Diathermy equipment?
And what is it used for?
Equipment used for cutting + coagulating tissues
by the use of heat application
Briefly explain how diathermy equipment works
Tissues are cut using a high-frequency electrical current, which produces heat within the tissue - at the point of application.
As waveforms change, so will the corresponding tissue effects.
State the function of the continous waveforms
Cutting tissue
State the function of the interrupted waveforms
Coagulation
What is the most important thing that diathermy equipment can do?
It’s rapid control for controlling blood haemorrhaging
What 2 things does diathermy equipment reduce?
It reduces:
1. Surgical time
1. Need for surgical materials
True or false.
Diathermy equipment can either Monopolar, Bipolar or Tripolar.
False.
There is only monopolar + bipolar.
When using monopolar diathermy equipment, does the patient need to be ‘earthed’?
Yes
When using bipolar diathermy equipment, does the patient need to be ‘earthed’?
No
How does monopolar diathermy equipment achieve coagulation?
By using a finger switch pencil
+
The cutting action of monopolar is achieved by a continuous low voltage electric current waveform action which vaporises the tissues on contact
Where does the earth wire sit in relation to the patient, when using Monopolar D-Eq?
The earthwire sits within the plate
+
Sits underneath the patient
+
connected to the diathermy unit
How does the earth-wire transfer the current?
Through a harmless plate, often through the floor of theatre
Why do you need good contact between the earthing plate and the patient?
To prevent the current from passing along the patient and to the VS
Where does the current pass through in Bipolar D-Eq?
Through the tips of the forceps + across the tissue
How is the current in bipolar D-Eq stimulated?
By the use of a foot pedal
How is coagulation achieved, when using bipolar D-Eq?
Applying the forceps directly to the site of haemorrhaging
What should be applied to the pads, when using D-Eq?
Contact gel
What is the benefit of using stainless steel pads, when using Bipolar D-Eq?
It’s easy to clean
What do you not need if you have sticky pads, when using Bipolar D-Eq?
No contact gel
What 2 things should you MUST NOT do when cleaning any Diathermy equipment?
- Do not use surgical spirit
- Do not submerse the cables throughly
What is suction apparatus used for?
Suctioning fluids + bloods
Why are portable suction apparatuses great for dentals?
To help prevent aspiration during procedures
(If aspiration occurs, less bacteria will be in the mouth and aspirated contents reducing the chances of pneumonia)
Are suction tips classed as sterile or un-sterile?
+
Can they be reused?
They are sterile
+
They must not be reused
Can you get single and double bottled suction apparatuses?
Yes
Name a benefit of suction apparatuses
They’re easy to clean
What is scavenging?
The collection + removal of anaesthetic gases in the OR
What is a key factor for any surgical suite?
Think air flow…
Good ventilation or scavenging set
Give an example of active air flow?
The use of a suction apparatus
What are the 2 types of airflow called, in the theatre?
- Active
- Passive
Explain how to clip a patient in preparation for a surgical procedure
Patient should be clipped in the prep room
Select appropriate clipper blades (Usually size 40)
Check for any damage, rust or visable soiling
Consider the possibility that the blades have been used before for previous patients - if in doubt = use clean ones or clean the current ones
Remove any loose hair
Use a smaller set of clippers, if necessary, to gain access to the smaller hairs, around the clipped area - using adhesive tape or an adhesive roller
Clean the clipper blades using a
Remember = never clip a patient in theatre!
Give an example of passive air flow?
‘Feed down’ tubes
(No suction)
What is the minimal number of air changes, there must take place in the theatre, over 12+ hours?
6 changes, every 12+ hours
When cleaning the OR, what type of dusting should you do every day?
Damp-dusting
When should you turn on the active ventiliation, for surgery?
Prior to each surgery
How often should anaesthetic circuits be cleaned?
Every day
How should you clean anaesthetic circuit?
Submerge it in disinfectant
- Sterilise regulary
- Includes the anaesthetic bag
What are the 3 biggest contamination factors in the surgical suite?
- Foot traffic
- Incorrect cleaning
- Innapropriate lay out/storage
How often should spray bottles, filled with disinfectant solutions, be changed?
Spray bottles should be replenished weekly
How often should theatre specfic heads be changed?
Weekly
