Perioperative Nursing Roles and Aseptic Technique

Perioperative Environment Overview

• Perioperative patient care consists of three phases: Preoperative, Intraoperative, and Postoperative.
• Nursing roles in the perioperative environment include scrub and circulating nurses, each with distinct responsibilities.
• Collaboration and effective communication between nursing roles enhance patient safety and procedural efficiency.

Nursing Roles

Scrub Nurse

• Works within the sterile field, directly assisting the surgical team.
• Responsible for assembling required instruments and supplies.
• Possesses in-depth knowledge of surgical procedures and anticipates the needs of the surgical team.
• Performs surgical counts and maintains aseptic conditions.

Circulating Nurse

• Functions as a non-scrubbed individual who manages the overall operating room environment.
• Conducts patient assessments and develops personalized nursing care plans.
• Assists the anesthetist with patient positioning, surgical preparation, and documents all relevant care activities.
• Coordinates room management and ensures surgical safety protocols are followed.

Three Phases of Perioperative Care

• Preoperative Set Up: Involves preparing the operating room, checking surgical equipment, and ensuring the environment is ready before the patient's arrival.
• Intraoperative Care: Focuses on managing the surgical case, maintaining asepsis, and ensuring effective communication among nursing and surgical staff.
• Postoperative Care: Encompasses cleaning the operating room, completing documentation, and transferring patients post-surgery.

Aseptic Technique and Infection Prevention

• Aseptic technique is crucial for preventing Surgical Site Infections (SSIs).
• Highlights include maintaining strict asepsis, adhering to transmission-based precautions, and using prophylactic antibiotics prior to incision.
• Operating rooms should have controlled air exchange and minimized traffic to maintain a sterile environment.

Surgical Wound Classification

• Class I: Clean: Non-infected; no signs of inflammation; no entry of respiratory, alimentary, or genitourinary tracts.
• Class II: Clean Contaminated: Where tracts are entered but no infection or breaks in aseptic technique occur.
• Class III: Contaminated: Open wounds or incisions with signs of infection; GI tract entered with no aseptic breaks.
• Class IV: Dirty/Infected: Wounds already infected, with signs of existing infection.

Microbiology and Resistance

• Notable resistant pathogens include:
  • Staphylococcus (MRSA) at 43% resistance
  • Enterococcus faecium (VRE) at 62% resistance
  • Escherichia coli at 11% resistance
  • Pseudomonas aeruginosa at 10% resistance

Best Practices for Aseptic Techniques

• Establish and maintain a sterile field, utilize effective surgical scrub protocols.
• Adhere to sterile parameters, including distance when passing items within sterile areas.
• Ensure safe handling and disposal of sharps and unsterile items.

Transmission-Based Precautions

• Contact Precautions: Use of gowns, gloves, and masks as necessary.
• Droplet Precautions: Similar attire with emphasis on potential airborne transmission.
• Airborne Precautions: Ensures isolation and protection, requiring specific PPE including N-95 masks.

Additional Notes

• Registered Nurse First Assistants (RNFA) collaborate directly with surgeons to assist in dissection, hemostasis, and suturing.
• Continuous monitoring and adherence to aseptic technique are imperative in the operating room to safeguard patient outcomes.

This quiz explores the essential roles within the perioperative environment, focusing on the scrub and circulating nurse functions. It also covers key concepts in surgical asepsis, best practices for preventing infections, and the classification of surgical wounds. Test your understanding of these crucial aspects of perioperative nursing practice.