Perioperative Nursing Roles and Aseptic Technique

Perioperative Environment: Nursing Roles and Aseptic Technique

• Understanding of three phases of perioperative care: Preoperative Setup, Intraoperative Care, and Postoperative Care.
• Roles in perioperative nursing: Scrub Nurse and Circulating Nurse, both essential for patient safety.

Nursing Roles

Scrub Nurse

• Registered Nurse (RN) or Registered Practical Nurse (RPN) working within sterile field.
• Directly assists surgical team; possesses in-depth knowledge of surgical procedures.
• Anticipates needs, assembles instruments, and verifies their condition.
• Responsible for maintaining asepsis and conducting surgical counts.

Circulating Nurse

• RN who maintains non-sterile duties and oversees overall OR environment.
• Conducts patient assessments and develops tailored care plans.
• Assists anesthetist, manages patient positioning, prepares for surgery, and handles documentation.
• Ensures safety protocols are followed and serves as a coordinator for nursing activities.

Collaboration of Roles

• Emphasis on teamwork to enhance patient safety and quality of care.
• Effective communication is vital for procedural efficiency.

Preoperative Set Up

• Preparation before patient arrival and commencement of surgery.
• Activities include checking surgical equipment, preparing the room, and verifying the surgical procedure pick list.

Intraoperative Care

• Begins once the patient is positioned and anesthesia administered.
• Involves collaboration between Scrub and Circulating Nurses, effective specimen management, and documentation.

Postoperative Care

• Initiated at the conclusion of the surgical procedure.
• Duties include cleanup, disposal of materials, documentation, and patient transfer to the post-op unit.

Aseptic Technique

• Critical in preventing Surgical Site Infections (SSIs) and maintaining sterilization protocols.
• Strict adherence to aseptic conditions, room airflow management, and appropriate use of prophylactic antibiotics is essential.

Infection Prevention Strategies

• Practice strict asepsis; minimize room traffic and personnel.
• OR should have positive pressure and specific air exchange rates to maintain sterility.

Sterile Environment Management

• Effective surgical scrub and establishment of a sterile field are mandatory.
• Sterile items should be handled minimally; personnel must maintain proper distance from sterile fields.

Wound Classification

• Classification of surgical wounds based on microbial exposure and infection risk:
  • Class I: Clean - Non-infected, no inflammation.
  • Class II: Clean Contaminated - Mucous membrane entry without infection signs.
  • Class III: Contaminated - Open wounds with infection signs, GI tract involvement.
  • Class IV: Dirty/Infected - Existing infections or infected wounds.

Microbiology Insights

• Staphylococcus (MRSA): 43% resistance.
• Enterococcus faecium (VRE): 62% resistance.
• Escherichia coli: 11% resistance.
• Pseudomonas aeruginosa: 10% resistance.

Transmission-Based Precautions

• Contact Precautions: Eye protection, gown, and gloves.
• Droplet Precautions: N-95 mask and eye protection.
• Airborne Precautions: Similar attire with increased distancing in negative or positive pressure environments.

Key Takeaways

• Perioperative nursing combines specific roles and teamwork to ensure patient safety, effective communication, and adherence to aseptic techniques to minimize infection risks.
• Strict protocols are in place to classify wounds and manage aseptic environments in the operating room.