Pain Management: Types, Characteristics, and Responses PDF

exhausted and may truly be asleep PAIN or merely trying to sleep. Some An unpleasant sensory and emotional people use sleep as an escape experience associated with actual or potential mechani...

exhausted and may truly be asleep PAIN or merely trying to sleep. Some An unpleasant sensory and emotional people use sleep as an escape experience associated with actual or potential mechanisms. tissue damage, or described in terms of such 4.​ Pain is a result, not a cause; Fact: damage (American Pain Society). Unrelieved pain can create other problems such as anger, anxiety, PAIN PERCEPTION immobility and delay in healing. ​ the conscious experience of 5.​ Real pain has an identifiable cause; discomfort. Fact: There is always a cause of ​ Children and elderly perceived pain pain, but it may be very obscure and differently than Adults must be assessed carefully. ​ Infants (1-2 days old) are less 6.​ Very young or very old people do not sensitive to pain. A full behavioral have as much pain; Fact: Age is not response to pain is apparent at 3-12 a determinant of pain, but it may months of age influence expression of pain. 7.​ Nurse should rely on their own Pain threshold - the level at which someone definition of pain and cultural beliefs experiences pain. He has a high pain about pain; Fact: It is a mistake to threshold. impose one’s own definition, cultural beliefs and values to another PAIN TOLERANCE person’s pain. Let the patient tell you ​ the maximum intensity or duration of what pain means. pain that a person is willing to Characteristics of Pain endure once the threshold has been reached. ​ Pain is subjective and personal ​ varies greatly among people and in ​ Physiologic pain may sometimes the same person over time; broaden to encompass emotional ​ a decrease in pain tolerance is hurt evident in the ELDERLY ​ Pain is a symptom not a disease ​ WOMEN appear to be more tolerant entity to pain than MEN ​ Pain is uniquely experienced by each individual and can not be Pain Tolerance is DECREASED: adequately define, identify or ​ With repeated exposure to pain; measure by an observer; ​ By fatigue, anger, boredom, ​ Pain is a valuable diagnostic apprehension; anxiety & fear indicator, it usually indicates tissue ​ Sleep deprivation damage or pathology ​ Pain is usually reported as a severe Pain Tolerance is INCREASED: discomfort or uncomfortable ​ By alcohol consumption; sensation ​ Medication, hypnosis; Components of Pain ​ Warmth, distracting activities; ​ Strong beliefs or faith ​ stimuli ​ perception Misconceptions and Myths about Pain ​ response 1.​ The nurse or physician is the best ​ intensity judge of a patient’s pain; Fact: Only ​ threshold the patient can judge the level and ​ tolerance distress of the pain; pain Barriers to Pain management should be a team approach. ​ Reluctant to report pain due to low 2.​ Pain is part of aging; Fact: Pain expectation of obtaining relief; does not accompany aging unless a ​ Lack of insurance and high cost of disease process or ailments is medications; present. ​ Pain is a sign of weakness; 3.​ If a person is asleep, they are not in ​ Afraid of side effects from pain; Fact: People in pain become medications;  ​ Poor clinician-patient ​ Remote onset communication. ​ Uncharacteristic of primary injury or disease Types of Pain ​ Nonspecific and generalized 1.​ According to Source ​ Severity is out of proportion to the ​ Nociceptive Pain stage of the injury or disease ​ Somatic pain (Superficial & Deep) ​ Responds poorly to drug therapy ​ Superficial somatic pain or ​ Requires increase in drug therapy Cutaneous pain ​ Persists beyond healing stage ​ Deep somatic pain ​ Suffering intensifies ​ Visceral pain Characteristics of Patients Experiencing ​ Neuropathic Chronic Pain: ​ Psychogenic pain 2.​ According to Characteristics ​ Depression (Onset, intensity & Duration) ​ Increased or decreased appetite and 3.​ Acute Pain – usually of short weight duration (less than 6 months) and ​ Poor physical tone often described in sensory term such ​ Social withdrawal and life role as sharp, stabbing and shooting and changes accompanied by observable physical ​ Decrease concentration responses. ​ Poor sleep ​ Recent onset ​ Preoccupation with physical ​ Symptomatic of primary injury or manifestation disease Intermittent Pain – produces a physiologic ​ Specific and localized response similar to acute pain. ​ Severity is associated with acuity of the injury or disease process Persistent Pain – allows for adaptation ​ Responds favorable to drug therapy (functions of the body are normal but the pain and requires gradual decrease in is not relieved) drug therapy. ​ Diminishes with healing Referred Pain - used to describe discomfort ​ Suffering decreases as pain that is perceived in a general area of the body, decreases. but not in the exact site where an organ is anatomically located. Psychological & Behavioral Response to Acute Pain: 1.​ Myofascial Pain – trigger points, small hyperirritable areas within a m. ​ Fear in which n. impulses bombard CNS ​ General sense of unpleasantness or & are expressed at referred pain. unease 2.​ Sclerotomic & Dermatomic Pain – ​ Anxiety deep pain; may originate from sclerotomic, myotomic, or Physical Response to Acute Pain: dermatomic nerve irritation/injury. ​ Increased HR, RR & BP ​ Transmission of Pain ​ Pallor or flushing , dilated pupils ​ TRANSDUCTION ​ Diaphoresis ​ TRANSMISSION ​ Increased blood sugar ​ PERCEPTION ​ Decreased gastric motility & gastric ​ MODULATION secretion Structure and Functions of the Pain System ​ Decreased blood flow to the viscera, kidneys and skin PERIPHERAL NERVOUS SYSTEM – carries ​ Nausea pain impulses to and from the CNS 1.​ Chronic Pain – is a major health concern. Divided into three (3) types: The afferent portion is composed of: ​ Chronic Nonmalignant pain – low 1.​ Nociceptors – naked nerve endings back pain to rheumatoid arthritis (thermal, chemical and mechanical) ​ Chronic Intermittent pain – migraine, 2.​ A – Delta fibers – rapid rate, transmit headache ACUTE SHARP PAIN ​ Chronic Malignant pain – cancer  3.​ C – Fibers – slower rate and ​ Impulses then proceed through produce chronic type of pain transmission cells to the brain 4.​ Afferent nerve fibers ​ Fibers from the brain send inhibiting 5.​ Spinal Cord network information to the Substantia Gelatinosa (SG) in dorsal horn of AUTONOMIC NERVOUS SYSTEM - regulates spinal cord w/c serves as a gate for involuntary functions control of pain 1.​ SYMPATHETIC NERVOUS ​ Gate - located in the dorsal horn of SYSTEM the spinal cord 2.​ PARASYMPATHETIC ​ Smaller, slower n. carry pain 3.​ NEUROTRANSMITTERS impulses ​ Larger, faster n. fibers carry other The CNS comprises the spinal cord and the sensations brain ​ Impulses from faster fibers arriving 1.​ The SPINAL CORD – transmits @ gate 1st inhibit pain impulses painful stimuli to the brain and motor (acupuncture/pressure, cold, heat, responses and pain perception to chem. skin irritation the periphery. Three (3) Factors Involved in Opening and 2.​ The BRAIN – processes and Closing the Gate: interprets transmitted pain impulses 1.​ The amount of activity in the pain Factors Affecting Response to Pain fibers. 1.​ Physiologic Factors – age, 2.​ The amount of activity in other genetics, quality peripheral fibers. 2.​ Affective factors – mood, fear, 3.​ Messages that descend from the depression, anxiety brain. 3.​ Psychosocial factors – family, Conditions that Open the Gate: personal spiritual, cultural beliefs, occupation 1.​ Physical Conditions 4.​ Cognitive – past experience, ○​ Extent of injury knowledge, values, expectations ○​ Inappropriate activity level 2.​ Emotional Conditions Pain Control Theories ​ Anxiety or worry INTENSITY THEORY - State that pain is the ​ Tension result of excessive stimulation of sensory ​ Depression receptors. 3.​ Mental Conditions ​ Focusing on pain PATTERN THEORY - Describes that painful ​ Boredom and non-painful sensation s are transmitted by nonspecific receptors through a common Conditions that Closes the Gate: pathway to higher centers of the brain. 1.​ Physical conditions SPECIFICITY THEORY - Describe four types ​ Medications of cutaneous sensation: touch, warmth, cold ​ Counter stimulation (e.g., heat, and pain. It focuses on the direct relationship message) between the pain stimulus and perception but 2.​ Emotional conditions does not account for adaptation to pain and the ​ Positive emotions psychosocial factors that modulate the ​ Relaxation, Rest stimulus. 3.​ Mental conditions ​ Intense concentration or distraction GATE CONTROL THEORY (Melzack & Wall ​ Involvement and interest in life 1965) - activities ​ Nerve fibers carry touch and pain Pain Assessment impulses from receptors on the skin to the spinal cord *Effective pain management begins with a ​ Nerve cells in the SG of the spinal comprehensive assessment which allows the cord receive these touch and pain health care provider to characterize the pain, impulses clarify its impact and evaluate other medical and psychosocial problems. The assessment determines whether additional evaluation is composed of 20 words descriptors needed to understand the pain. grouped into 4 namely: ​ Sensory (1-10) Goals of Comprehensive Pain ​ Affective (11-15) Assessment ​ Evaluative (16) ​ Obtain a full description of the pain; ​ Miscellaneous (17-20) ​ Determine whether the description Simple Descriptive Pain Intensity Scale – from fits a well-known pain syndrome; No pain to Worst possible pain ​ Determine whether there is structural disease of the body that may help 1.​ 0 – 10 Numeric Pain Intensity Scale the pain; 2.​ Visual Analog Scale (VAS) / Linear ​ Try to understand the mechanisms Scale (tissue, nerve injury, psychological 3.​ Wong – Baker FACES Pain Rating processes) that maintain the pain; Scale ​ Describe the negative effects on Pain Management physical and psychosocial functioning caused by the pain; ​ - refers to the techniques used to ​ Understand the medical and prevent, reduce or relieve pain. psychiatric problems that co-exist with the pain and might need Goals in Managing Pain: treatment at the same time 1.​ Reduce pain Pain Assessment – Health History 2.​ Control acute pain 3.​ Protect the patient from further injury ​ Pattern : onset & duration while encouraging progressive ​ Area : location exercises. ​ Intensity: level ​ Nature : description 5 General Techniques for Achieving Pain Mgt: PQRST Format 1.​ Blocking brain perception. ​ Provocation – How the injury 2.​ Interrupting pain transmitting occurred & what activities ¯ ­the pain chemicals at the site of injury. ​ Quality - characteristics of pain --> 3.​ Combining analgesics with adjuvant Aching (impingement), Burning drugs. (nerve irritation), Sharp (acute 4.​ Using gate-closing mechanisms. injury), Radiating within dermatome 5.​ Altering pain transmission at the (pressure on nerve) level of the spinal cord. ​ Referral/Radiation – ​ Referred – site distant to damaged Pain Management Methods tissue that does not follow the ​ About half of hospitalized patients course of a peripheral n. who have pain are under-medicated. ​ Radiating – follows peripheral n.; ​ Children are at particular risk of poor diffuse pain control methods. ​ Severity – How bad is it? Pain scale ​ Medications are given as: PRN – “as ​ Timing – When does it occur? p.m., needed” a.m., before, during, after activity, all the time. Pharmacological or Drug Interventions 2.​ Medical History and Physical * Adjuvant Drug Therapy Examination (H & P) – helps the nurse to understand the unique pain ​ The so-called adjuvant analgesics are experience of the client and to defined as drugs that are on the market for formulate a plan to resolve the pain. indications other than pain but may be analgesic in selected circumstances. They ​ - provides baseline data to allow include a very large number of drugs in assessment of the patient’s progression numerous drug classes (Thiessen, 2003). through a pain experience. Examples of Adjuvant Analgesics 3.​ Pain Assessment Tools 4.​ McGill Melzack Pain Questionnaire – ​ Antidepressants (Amitriptyline or a multidimensional assessment tool Elavil, Clomipramine, Desipramine)  ​ Anticonvulsants (Pregabalin, Ex. Buprenorphine, Butorphanol, Nalbuphine, Gabapentin, Carbamazepine, Dezocine Phenytoin, Topiramate) Side Effects associated with Opioid Drugs ​ Local Anesthetic Agents (Mexiletine, Tocainide, Flecainide) ​ Constipation ​ GABA Agonists (Baclofen) ​ Nausea ​ N-methyl-D-aspartate (NMDA) ​ Itch Antagonists - (Dextromethorphan, ​ Urinary retention Ketamine, Amantadine, Memantine) ​ Dry mouth ​ Corticosteroids (prednisone, ​ Sexual Dysfunction Dexamethasone, ​ Sleepiness, fatigue, dizziness and Methylprednisolone) mental clouding ​ * Non opioid Analgesics Non drug Interventions ​ Includes acetaminophen or 2.​ Heat and Cold Therapy paracetamol, dipyrone and nonsteroidal anti-inflammatory drugs or NSAIDs). The As a general rule of thumb, use ice for acute NSAIDs are nonspecific analgesics and can injuries or pain, along with inflammation and potentially be used for any type of acute or swelling. Use heat for muscle pain or stiffness. chronic pain. * Heat Therapy Because they are both analgesic and Heat therapy works by improving circulation anti-inflammatory, NSAIDs are particularly and blood flow to a particular area due to useful for pain related to joint problems and increased temperature. other musculoskeletal disorders. ​ Types of Heat Therapy Examples of NSAIDs ​ Dry heat (or “conducted heat ​ * Salicylates like Aspirin, therapy”) includes sources like Diflunisal,Trisalicylate & Salsalate heating pads, dry heating packs, and ​ * Proprionic acids like ibuprofen, even saunas. This heat is easy to naproxen, ketoprofen, fenoprofen, apply. oxaprozin ​ ​ Moist heat (or “convection ​ * Acetic acids like indomethacin, heat”) includes sources like steamed diclofenac, ketorolac, tolmetin, towels, moist heating packs sulindac, etodolac ​ , or hot baths. Moist heat may be ​ * Oxicams like piroxicam slightly more effective as well as ​ * Naphthlyalkanones like require less application time for the nabumetone same ​ * Fenamates like mefenamic acid, meclofenamic acid ​ * Pyrazoles like phenylbutazone ​ When NOT TO USE Heat Therapy * Opioid Analgesics ​ There are certain cases where heat therapy should not be used. If the The most effective analgesics (Ellison, area in question is either bruised or 1998). This includes all drugs that interact with swollen (or both), it may be better to opioid receptors in the nervous system. These use cold therapy. receptors are the sites of action for the ​ Heat therapy also shouldn’t be endorphins, compounds that already exist in applied to an area with an open the body and are chemically related to the wound. opioid drugs that are prescribed for pain. ​ People with certain pre-existing conditions should not use heat 1.​ Opioid antagonists – have no therapy due to higher risk of burns or analgesic effect and are used to complications due to heat block the effects of opioid drugs. application. These conditions Ex. Naloxone, Naltrexone, Nalmafene include: ○​ diabetes 1.​ Opioid Agonist-antagonist - have ○​ dermatitis analgesic effect. ○​ vascular diseases ○​ deep vein thrombosis  ○​ multiple sclerosis (MS) ​ If cold therapy hasn’t helped an injury or swelling within 48 hours, ​ Risk of Heat Therapy inform your doctor. ​ Utilize only warm water not “hot” Transcutaneous Electrical Stimulation water because of possibility of burn. (TENS) ​ Heat applied directly to a local area, like heating packs, should not be The device is an electrical unit that delivers used for more than 20 minutes at a different frequencies and intensities of time. stimulation to the skin through electrodes. To ​ If swelling increased, stop the increase the chance that TENS can help, the treatment immediately. patient is given a TENS device and then ​ If pain doesn’t lessen after a week or instructed to apply a variety of different types of the pain increases within a few days, stimulation during a trial period. Patients vary a consult the doctor. great deal in the type of TENS that works. * Cold Therapy 1.​ Acupuncture - not sure how it works. Could include: - is also known as cryotherapy. It works by ​ Counter-irritation – may close the reducing blood flow to a particular area, which spinal gating mechanism in pain can significantly reduce inflammation and perception. swelling that causes pain, especially around a ​ Expectancy joint or a tendon. It can temporarily reduce ​ Reduced anxiety from belief that it nerve activity, which can also relieve pain. will work. ​ Ways to Apply Cold Therapy ​ Distraction ​ Trigger release of endorphins 1.​ ice packs or frozen gel packs 2.​ ice massage Acupressure - is a method of sending a signal 3.​ ice baths to the body via needles or other means, to turn 4.​ cryostretching, which uses cold to on its own self-healing or regulatory reduce muscle spasms during mechanisms.Percutaneous Electrical Nerve stretching Stimulation (PENS) 5.​ cryokinetics, which combines cold ​ - combines electro-acupuncture and treatment and active exercise and TENS which uses acupuncture like needle can useful for ligament sprains probes as electrodes placed at dermatomal 6.​ whole-body cold therapy chambers levels corresponding to local pathology. ​ When NOT TO USE Cold Therapy Non invasive Techniques / Psychological ​ People with sensory disorders that Pain Control Therapy prevent them from feeling certain * Mind / Body Therapy sensations should not use cold therapy at home because they may - Mind/body therapy address these issues and not be able to feel if damage is being provide a variety of benefits, including a done. This includes diabetes, which greater sense of control, improved coping can result in nerve damage and skills, decreased pain intensity and distress, lessened sensitivity. changes in the way pain is perceived and ​ You should not use cold therapy on understood, and increased sense of well being stiff muscles or joints. and relaxation. These approaches may be very ​ Cold therapy should not be used if valuable for adults and children with pain you have poor circulation. (Rusy, 2000). ​ Risk of Cold Therapy * Cognitive – Behavioral Therapy ​ If applied too long or too directly, can ​ - addresses psychological result in skin, tissue or nerve component of pain including damage; attitudes, feelings, coping skills and ​ If patient has cardiovascular or heart a sense of control over one’s disease, consult the doctor first prior condition; to use of cold therapy; ​ - effective in reducing pain and disability when used as part of a  therapeutic treatment for chronic * Exercises pain. - have a variety of benefits that produce better ​ - provides educational information stamina and function. Exercise may reduce the and diffuse feelings of fear and risk of secondary pain problems like muscle helplessness; strains, and may also lead to improved ​ - helps patient to find a more realistic confidence and sense of well-being. and balanced view of the pain problem; ​ - includes teaching of life skills and coping skills that can assist the patient in productive problem solving and the prevention or minimization of future pain episodes. * Imagery – is the use of imagined pictures, sounds, or sensations for generalized relaxation or for specific therapeutic goals, such as the reduction of pain. These images can be initiated by the patient or guided by a practitioner. The sessions in which imagery is used can be individual or group. * Relaxation- systematic relaxation of the large muscle groups. * Biofeedback- provides biophysiological feedback to patient about some bodily process the patient is unaware of (e.g., forehead muscle tension). * Hypnosis - relaxation + suggestion + distraction + altering the meaning of pain. ​ - during hypnosis, changes like those found in meditation can occur, such as a slowing of the pulse and respiration, and an increase in alpha brain waves. ​ - Medical hypnosis has been shown to be helpful in reducing both acute & chronic pain. * Prayer Changes in the concept of health and illness, a broadening view of healing and curing, and interest in other cultural systems of medicine have created a growing openness to the spiritual dimensions of health *Physical Therapy - are useful in teaching patients to control pain, to move in safe and structurally correct ways, to improve range of motion, and to increase flexibility, strength and endurance. " Active" and "passive" modalities can both be used, but active modalities, such as therapeutic exercise, are particularly important when the goal is to improve both comfort and function. Surgery as a Science – branch of medicine ​ Exploration – invasive examination concerned with disease or conditions requiring ​ Diversion – creation of a stoma or amenable to operative or manual Pathologic conditions requiring Surgical procedures. Intervention ​ It is a total care of illness with an extra 1.​ Obstruction – impairment on the modality of treatment, the surgical procedure. flow of vital fluids Surgery as an Art - comprises 2.​ Perforation – rupture of an organ perioperative patient care encompassing such 3.​ Erosion – wearing off of a surface or activities as preoperative preparation, intra membrane operative judgment & management, and 4.​ Tumor – abnormal growth post-operative care of patients. Surgery related Terminologies ​ Surgery as a discipline, combines 1.​ Operating Room / Operating physiologic management with an interventional Theatre – room in a health care aspect of treatment. facility in which patients are Surgery prepared for surgery, undergo surgical procedures and recover Definition of Surgery - branch of medicine from anesthetic procedures required concerned with disease or conditions requiring for surgery. or amenable to operative or manual 2.​ Perioperative - is a term used to procedures. The discipline of surgery is both describe the entire span of surgery, an art and a science. including before and after the actual Objectives of Surgery operation. 3.​ Perioperative nursing – includes 1.​ Correction of deformity and defects; activities performed by the registered 2.​ Repair of injuries; nurse during the pre operative, intra 3.​ Alter form or structure; operative, and post-operative 4.​ Diagnosis & Cure of disease phases of patient’s care. process; 4.​ OR nurse - duly licensed registered 5.​ Relief of suffering; nurse legally responsible for the 6.​ Prolongation of life. nature and quality of the nursing Common Indications of Surgery care patients. 5.​ Surgical Conscience - awareness ​ Incision – open tissue or structure which develops from a knowledge by sharp dissection based on the importance of strict ​ Excision – remove tissue or adherence to principles of aseptic structure by sharp dissection and sterile techniques. ​ Diagnostics – biopsy tissue sample 6.​ Asepsis – freedom from infection or ​ Repair – closing of a hernia absence of microorganism. ​ Removal – FBE 7.​ Aseptic Technique – methods by ​ Reconstruction – creation of new which contamination of breast microorganisms is prevented. ​ Termination – abortion of a 8.​ Disinfection - process of destroying pregnancy all pathogenic microorganisms ​ Palliation – relief of an obstruction except spore bearing ones. ​ Aesthetics – facelift 9.​ Sterilization - process of killing all ​ Harvest – skin grafting micro-organisms including spores. ​ Procurement – donor organ 10.​Surgical Intervention - therapeutic ​ Transplant – placement of a donor process rendered to restore or organ maintain health (i.e. the ability to ​ Bypass / shunt – vascular rerouting function). ​ Drainage / evacuation – incision of 11.​Surgical Procedure - invasive abscess incision into the body tissues or a ​ Stabilization – repair of a fracture minimally invasive entrance into a ​ Staging – checking of cancer body cavity for either therapeutic or progression diagnostic purpose during which ​ Parturition - caesarean section ​ Extraction – removal of a tooth  protective reflexes or self-care malformed or damaged by trauma or abilities are potentially compromised. disease. 12.​Antiseptic - substance which Conditions treated by Surgery combat sepsis and cause bacteriostasis. ​ Congenital – inborn deformity 13.​Anesthesia - insensibility to pain ​ Acquired – conditions resulting from and trauma with or without loss of trauma or injury. consciousness. 14.​Informed consent - is a legal Three (3) Categories of Surgical Procedure document that provides evidence of ​ Invasive surgery patient’s agreement to allow a ​ Minimally Invasive surgery procedure to be performed on ​ Non Invasive surgery him/her ; Classifications of Surgical Procedure ​ - a signed consent is legally regarded as VALID for a period of about 6 1.​ According to Purpose months or for as long as the patient ​ a.1. Diagnostic consents to the same procedure. ​ ​ a.2. Exploratory Institutional policy may vary. ​ ​ a.3. Curative / Reparative / Restorative 1.​ Abdomin (o) ​ – abdomen ​ a.4. Palliative 2.​ Aden (o) ​ – gland ​ a.5. Cosmetic 3.​ Angi (o) ​ – vessel 4.​ Arthr (o) ​ – joint 2. According to Urgency 5.​ Broncho – bronchus ​ b.1. Emergency – immediate ; condition 6.​ Card, Cardi (o) – heart is life threatening requiring surgery at once. 7.​ Cephal (o) - head 8.​ Chole, Chol (o) - bile ​ b.2. Urgent or Imperative – client 9.​ Chondr (o) - cartilage requires prompt attention within 24 to 30 hours. 10.​Colo ​ - colon Ex. Acute GB infection 11.​Cost (o) ​ - rib ​ b.3. Planned or Required – planned for 12.​Crani (o) ​ - skull a few weeks or months after decision and the 13.​Cele - tumor, hernia client requires it at some point. Ex. Cataract 14.​Centhesis - puncture removal 15.​Ectomy - surgical excision 16.​Itis - inflammation ​ b.4. Elective – client will not be harmed 17.​Litho - stone / calculus if surgery is not performed but will benefit if it is 18.​Ostomy ​ - creation of a new performed. Ex. Revisions of scar opening 19.​Rhapy - repair ​ b.5. Optional – personal preference 20.​Oscopy ​ - examination using and usually aesthetic purposes. Ex. a lighted instrument Liposuction 21.​Plasty - plastic repair According to Location 22.​Pexy - to fix or suture in place c.1. External Reasons for Surgical Intervention c.2. Internal ​ To preserve life According to Extent or Risk Involved ​ To maintain dynamic body (Magnitude) equilibrium ​ d.1. Major – life threatening ​ To undergo diagnostic procedures ​ To prevent infection and to promote d.2. Minor – non life threatening healing Surgical Risks Patients ​ To obtain comfort ​ To ensure the ability to earn a living 1.​ Obesity – increase incidence of ​ To alter cosmetic appearance morbidity and mortality due to low ​ To restore or reconstruct a part of recovery after surgery. the body that is congenitally  2.​ Fluid – electrolyte Imbalance & 2.​ Key Elements of Perioperative Nutritional problems – can cause Nursing Practice delay and poor wound healing ​ Caring 3.​ Age – too young or too old ​ Conscience 4.​ Person with disability ​ Discipline 5.​ Patients with current disease or ​ Technique illness Concept of Surgical Conscience 6.​ Patients with concurrent or prior pharmacotherapy ​ (Surgical Golden Rule) - “ Do Unto The 7.​ Nature and location of condition Patient As You Would Have Others Do Unto 8.​ Magnitude and urgency of the You.” surgical procedure 9.​ Mental attitude of the patient towards Philosophy of Operating Room Nursing surgery ​ To give service that aims to provide 10.​Caliber of the professional staff and comprehensive support physically, morally, health care facilities psychologically, spiritually and socially to a Potential Effects of surgery to the Patient patient undergoing surgery. 1.​ Stress response is elicited; Goals of Operating Room Nursing 2.​ Defense against infection is lowered; ​ To provide a safe, supportive and 3.​ Vascular system is disrupted; comprehensive care to patient; 4.​ Organ functions are disturbed; ​ To assist the surgeon by functioning 5.​ Body image maybe altered; effectively as a member of the 6.​ Lifestyle is changed surgical team; Legal Liability, Accountability & Ethical ​ To create and maintain an aseptic / Issues sterile environment all the times. ​ Safeguard the patient in the OR against Objectives of Operating Room Nursing hazards. Protect the nurse, technologist, ​ To help the patient return as rapidly surgeons, anesthesiologist and the hospital. as possible to the best physical and Prevention focuses on Quality Assurance. mental health attainable. ​ ​ Q – quality improvement as an ​ In case the patient did not return to ongoing process. his health, pain and discomfort ​ ​ U ​ - understanding should be eased and she/he should regulations, standards, policies and be allowed to die in peace and with procedure. dignity ​ ​ A​ - accountability for one’s Perioperative Nurse own actions. ​ ​ L ​ - legal rights of the 1.​ Definition of Perioperative Nurse - patients is a nurse who provides patient care, ​ ​ I ​ - individualized patient manages, teaches and studies the care care of patients undergoing invasive ​ ​ T ​ - technical competency or non-invasive procedures. He/she ​ ​ Y ​ - your surgical & ethical possesses a depth and breadth of conscience knowledge that allows for the coordination of care of the surgical To be liable is to be legally bounded, patient. responsible and answerable. 2.​ Responsibilities of a Perioperative Perioperative Nursing Nurse ​ Prioritizes interventions based on a 1.​ Definition of Perioperative comprehensive body of scientific Nursing - Perioperative nursing knowledge and variations in patient’s practice includes activities performed responses; by the professional registered nurse ​ Uses critical thinking skills in during the preoperative (before), applying the nursing process, acting intraoperative (during) and as a patient advocate, and postoperative (after) phases of the exercising judgment in a patient’s surgical experience. professionally accountable manner;  ​ Provides specialized nursing care to patients before, during and after their surgical & invasive procedure; ​ Works closely with all members of the surgical team; ​ Helps plan, implement and evaluate treatment of the patient; ​ Designs, coordinates, and delivers care to meet the identified physiological, psychological, sociocultural and spiritual needs of the patients. Expected Attributes of a Perioperative Nurse ​ Considerate ​ Informative & sincere ​ Versatile ​ Analytical ​ Creative & resourceful ​ Humanistic ​ Ethical ​ With sense of humor ​ Objective ​ Enduring ​ Impartial, non-judgmental, open-minded ​ Manual and intellectual dexterity ​ Intellectually eager and curious to learn Personal Attributes of a Perioperative Nurse ​ Empathic ​ Conscientious ​ Efficient and well organized ​ Flexible and adaptable ​ Sensitive & Perceptive ​ Understanding, reassuring, supportive ​ Skilled listener, keen observer and abled communicator Three (3) Phases of Perioperative Care ​ What to expect during surgery (anesthesia/deep sleep; numbness; 1.​ Preoperative phase- begins with no pain) the decision to perform surgery and ​ What to expect AFTER surgery: continues until the client reaches the ​ PACU/Recovery Room operating area. ​ Limitations in movement 2.​ Intraoperative phase– begins with ​ Post-op pain the placement of patient on the ​ Post-op medication operating table, including the entire ​ Early ambulation surgical procedure and extends until ​ Dressing change and wound healing transfer of the client to the recovery ​ Post-op complications room. The implementation component of the nursing process is Transfer and Endorsements: performed here. TRANSFER: 3.​ Postoperative phase– begins with admission to the RR (recovery room) ​ Ambulatory or via wheelchair / PACU (Post Anesthesia Care Unit) ​ relaxed via stretcher and continues until the client ​ critical on stretcher receives a follow – up evaluation at home or is discharged to a ENDORSEMENT: rehabilitation unit. Evaluation ​ accomplish and endorse pre-op component of the nursing process is checklist completed in this phase. ​ **Surgical Safety checklist PRE-OP ASSESSMENT Sterile Packages: 1.​ Demographic Data Setting Up for Surgery 2.​ Health History 3.​ Clearances (CP, Neuro, Endo, Pedia GOLDEN RULE: Sterile to sterile; clean to etc) clean 4.​ Relevant diagnostic & lab tests If clean instrument/supply touches the sterile 5.​ Allergies area, it is considered contaminated, remove 6.​ Current Medications contaminated field/instruments 7.​ Insurance 8.​ Vital signs Perioperative Patient Care Team (Operating 9.​ Social support Room Team) 10.​Baseline Functional Patterns 1.​ Sterile Team INFORMED CONSENT 2.​ Surgeon – a physician who realistically appreciate his or her own 1.​ Name of Patient cognitive skills & personal 2.​ Name of Surgical Procedure characteristics & can intervene 3.​ Name of Surgeon effectively in a patient’s illness or 4.​ Potential Risks injury. 5.​ Potential Benefits 6.​ Signature of Patient ​ Must have the knowledge, skill and 7.​ Signature of Witness judgment required to successfully performed the intended surgical procedure. PRE_OP NURSE PLANNING ​ 1.a. Who can be the head surgeon? 1.​ Skin Preparation 2.​ Dietary Restrictions ​ Licensed MD 3.​ Pre-Op Patient Education ​ DO (osteopath) ​ DDS or Oral surgeon (Doctor of Reinforce patient's knowledge on: Dental Surgery) ​ General Anesthesia/ IV Sedation ​ DMD (Doctor of Dental Medicine) ​ Local Anesthesia ​ DPM (Doctor of Podiatric Medicine) ​ Pain Control ​ 1.b. Attributes of a Surgeon ​ Surgical Complications ​ Advance Directives ​ compassionate interpersonal behavior; ​ accountability;  ​ humanistic concern; responsibility and concern for ​ appropriate clinical skills in data accuracy in performing all duties. gathering; Non sterile Team ​ good decision making & problem solving skills; 1.​ Anesthesiologist – is an MD or DO, ​ critical thinking ability certified by the Phil. Board of Anesthesiology, who specializes in ​ 1.c. Major Responsibilities of a Surgeon administering anesthetics to produce ​ Pre operative diagnosis and care; various states of anesthesia. ​ Selection & performance of the 1.a Major Responsibilities of surgical procedure; Anesthesiologist ​ Post operative management; 2.​ Assistants to Surgeon (First ​ Choice and application of assistant / Second assistant ) - appropriate anesthetic agents & qualified surgeon or a resident in an suitable techniques of administration accredited surgical education & monitoring of physiologic program. functions; ​ Maintenance of fluid & electrolyte NURSE is free to refuse to perform as balance & blood replacement during first assist out of concern for the well being of the surgical procedure; the patient and for his/her professional ​ Minimize the hazards of shock, accountability. electrocution and fire; ​ 2.a Major Responsibilities of Assistants ​ Responsible for overseeing the to Surgeon positioning & movement of patients; ​ Able to use and interpret correctly a ​ Must perform duties under the direct wide variety of monitoring devices; supervision of a certified surgeon; ​ Oversee the PACU to provide ​ Help maintain visibility of the surgical resuscitative care until each patient site, control bleeding, close wounds, has regained control of vital apply dressings, handle tissues and functions; uses instruments. ​ Participate in the hospital’s program 3.​ Scrub Nurse – Instrument & of CPR as teachers & team Suture Nurse members. As well as consultants ​ ​ - nursing staff member of and managers for problems of acute the sterile team; and chronic respiratory insufficiency ​ ​ - RN, LPN (licensed requiring inhalation therapy & other practical nurse) or LVN (licensed fluid, electrolyte and metabolic vocational nurse), ST (surgical disturbances requiring IV therapy; technologist) ​ They are integral staff member of ​ 3.a Major Responsibilities of a Scrub Pain Therapy clinics. Nurse 2.​ Circulating Nurse - a RN or ST (surgical technologist) who functions ​ Responsible for maintaining the under the supervision of an RN. integrity, safety and efficiency of the sterile field throughout the 2.a Major Responsibilities of a procedure. Circulating Nurse ​ Responsible for preparing and ​ Nursing judgment & decision-making arranging the sterile instruments and skill are requisites to assessing, supplies for the surgical procedure; planning, implementing ​ Anticipates, plan for and respond to ​ and evaluating the plan of care the needs of the surgeon by before, during & after surgical constantly watching the sterile field; operation. This is the professional ​ Should have knowledge, skills and perioperative role; experience with aseptic and sterile ​ Creation & maintenance of a safe & techniques; comfortable environment for the ​ Should have manual dexterity, patient through implementing the physical stamina, stable principles of asepsis, demonstrate a temperament, able to work under strong sense of surgical conscience; pressure, with keen sense of  ​ Constant flexibility in identifying ​ produce minimum heat to prevent potential environmental danger, injuring exposed tissues; stressful situation & meet the ​ be easily cleaned unexpected, act in an efficient, 1.​ 2 Principles in designing an rational manner at all times; Operating Room ​ Maintenance of the communication ​ Exclusion of contamination from link between events & team outside the suite with sensible traffic members at the sterile field & pattern within the suite. persons not in the OR but concerned ​ Separation of clean areas from with the outcome of the operation; contaminated areas within the suite ​ Provision of assistance to any Types of OR Designs member of the OR team in any manner in which the circulator is ​ Central Corridor or Hotel plan; qualified; ​ Central Core or Clean core plan; ​ Direction of the activities of all ​ Peripheral corridor; learners. The CN must have the ​ Combination central core & supervisory capability & teaching peripheral corridor or Racetrack skills needed to ensure maintenance plan; of a safe & therapeutic environment ​ Three corridor layout; for the patient. ​ Grouping or cluster plan 3.​ Nurse Anesthetist - refers to a qualified RN, anesthesiologist ​ The OR suite should be large enough to assistant (AA), dentist, or physician allow for correct technique yet small enough to who administers anesthetics. minimize the movement of patients, personnel and supplies. Provision must be made for Perioperative Environment traffic control. The type of design will predetermine traffic patterns. Signage should 1.​ Physical Facilities be posted properly. 2.​ Location - located accessible to the critical care surgical patient areas & Three (3) Areas / Division of Operating the supporting service department, Room Suite CSR, Radiology, pathology, etc. 3.​ Ventilation - must ensure a ​ Unrestricted or Unsterile Area controlled supply of filtered air. Air ​ * Vestibular or Exchange Area changes and circulation provide (Transition Zone) fresh air & prevent accumulation of anesthetic gases in the room. ​ Semi restricted or Semi sterile Area ​ AIR CONDITIONING is ideal and ​ Restricted or Sterile Area valuable; it controls humidity; ​ * Sub sterile Room ​ positive pressure system ​ filter air at 20 changes / hour 1.​ Unrestricted / Unsterile Area - this ​ temperature from -18oC - 24oC area is isolated by doors from the ​ humidity 50-55% main hospital corridor or elevators 3.​ Door - ideally, sliding doors should and from other areas of the OR be used. They eliminate the air suite. currents caused by swinging doors. ​ - serves as an 4.​ Floor - must be suitably hard, OUTSIDE-to-INSIDE access area, i.e. durable for heavy equipment vestibular/exchange area. especially during transport from one room to another & easy to clean. ​ - Street clothes are permitted. 5.​ Lighting - General illumination is furnished by ceiling lights in white 2.​ Semi-restricted / Semi sterile Area fluorescence bulbs which are evenly - personnel should be wearing OR distributed throughout the room. scrub suit with cap. ​ Should be shadowless; ​ - this area includes peripheral ​ be freely adjustable to any position support areas and access corridors to the or angle by vertical or horizontal OR like PACU, SICU, offices for anesthesia range of motion; department & administrative OR nursing personnel, etc.  3.​ Restricted / Sterile Area - ​ - part of unrestricted area with personnel should be wearing access from both semi restricted areas. complete OR scrub suit including ​ Post-op holding area - a mask. designated room for patients to wait ​ - this area performs sterile in the OR suite that shields them procedures. from distressing sights and sounds; ​ - includes OR suite room, scrub sink areas, sub sterile rooms - provides privacy like where unwrapped supplies are individual cubicles with curtain. sterilized. ​ - operating rooms is more desirable Peripheral Support Areas if all have the same size, so they can ​ Central Administrative control – be used interchangeably to this area is maybe within the accommodate elective & emergency unrestricted or semi restricted areas. cases. It must accommodate Offices for administrative personnel equipment like laser, microscope, are best located where they have an video equipment, c-arm, portable access to both areas. light, etc. ​ Sterile supply room – for storing ​ The adequate size of an sterile linens, sponges, gowns and operating room is at least 20x20x10 feet (400 instrument packs. sq ft or 37 m2) of floor space or maximum of ​ Work and storage areas – clean 20x30x10 feet (600 sq ft or 60 m2). and sterile supplies must be separated from soiled items and ​ - other rooms are designated for trash. special procedures like endoscopy, TURP, etc ​ General work room – must be centrally located to the OR suite for Substerile Room – wrapping / packaging of supplies for ​ work area or packing area sterilization. ​ steam sterilizing room ​ Utility room – contains a ​ washer – sterilizer area washer-sterilizer, sinks, cabinet, & all ​ storage room for supplies necessary aids for cleaning. ​ record room ​ Housekeeping Storage area – stores all cleaning supplies & Vestibular / Exchange Areas (Transition equipment. Equipment used within Zone) – inside the entrance to the OR suite, the restricted area is kept separated separates the OR corridors from the rest of the from that used to clean the other facility. areas. ​ Pre-operative check-in unit - this is ​ Anesthesia work & storage areas an unrestricted area of the OR for – serves as storage of anesthesia patient to change from street clothes equipment & supplies, also provides to gown; space for drugs and anesthetic agents. ​ - must ensure privacy, create a feeling of warmth & security, with lockers for Furniture and other Equipment Inside the safeguarding patient’s clothes & with lavatory Operating Room facilities. ​ OR Table – divided into head, body ​ Dressing rooms and Lounges - and leg sections. Attachment Access is from an unrestricted area includes knee strap, arm strap, arm to change from street clothes to OR board, anesthesia screen, metal attire before entering the footboard, etc. semi-restricted areas or vice versa. ​ Instrument table or Back table Clothes hanging areas must be ​ Mayo table – placed above and provided for both males and across the patient and contains females. Shoe rack is advisable for instruments that are in constant use the OR scrub suit. during operation. ​ PACU (formerly RR) - maybe ​ Small table for patient’s preparation outside the OR or adjacent to the equipment (skin prep table) OR suite. ​ Ring stand for basin (s).  ​ Anesthesia table and machine humans by insect bites. Person ​ Sitting stools and foot infected may experience fever, chills, stools/standing platforms headaches, rashes, etc. ​ IV stands and hangers for IV ​ Virus - smallest known living solutions infectious agents that grows in living ​ Suction machine, bottles and tubing cells. ​ Cautery machine Conditions that Favors the Bacterial Growth ​ Kick buckets in wheeled bases ​ Basin in wheeled bases for soiled 1.​ Food – bacteria grow well in leftover sponges and gloves foods. ​ Communication system / Intercom 2.​ Moisture – bacteria grow well in ​ Defibrillator moist places. ​ Negatoscope 3.​ Temperature - high temp (170’F) ​ Wall Clock with second hand kills most bacteria. At normal human ​ White board for recording of sponge, body temp (98.2’F), bacteria thrive instrument and sharps counting easily on & in the human body. Low ​ Blood warmer machine attached to temp (32’F) do not kill bacteria but IV pole retard their growth & activity. ​ Other monitoring machines 4.​ Oxygen – ​ Cabinets / carts – for storing ​ ​ aerobic – w/ O2 supplies and drugs ​ ​ anaerobic – w/o O2 5.​ Matter – Review of Infection Control ​ ​ saprophytes – live on dead 1.​ Definition of Infection Control – is matter or tissue. the most basic and important ​ ​ parasites – live on living procedure in nursing care, and it will matter or tissue. deter-mine the quality of care given 6.​ Light – darkness favors the in a facility. development of bacteria where they 2.​ Microorganisms - are living things become active and multiply rapidly. so tiny that can not be seen by the Light is the worst enemy where naked eye. bacteria become sluggish and die ​ Also called microbes or germs. rapidly. ​ always present in the environment 7.​ Infection and on the body. 8.​ Definition of Infection - The ​ not all micro organisms are harmful. invasion and growth of Some are helpful. MO can also disease-causing microorganisms in serve both good and harmful the body. purposes. ​ ​ Local – involves a ​ micro organisms that cause disease certain body part. is called ​ ​ Systemic – involves the whole body. Types of Microbes Nosocomial Infection - infection that is ​ Bacteria (bacterium) - single-celled required as a result of being in the health care microscopic organisms that facility environment. multiplies rapidly. Some are beneficial to humans while others Cross Infection - occurs when one patient or can cause infection. staff passes the pathogens to another patient, ​ Fungi (fungus) - microscopic, staff or visitors. single celled or multi-celled plants Community Acquired Infection- these are that live either on plants or animals. natural disease process that developed or - can infect the mouth, vagina, skin, were incubating before the patient is admitted feet & other body parts. to the hospital. ​ Protozoa (protozoan) - single-celled, microscopic animals, Signs and Symptoms of Infection usually living in water and can cause disease. ​ fever ​ Rickettsiae - found in fleas, lice, ​ pain and tenderness ticks and other insects; spread to ​ fatigue and loss of energy ​ loss of appetite (anorexia)  ​ nausea and vomiting ​ d.4. Common vehicle ​ increased PR & RR transmission – occurs when pathogens are ​ diarrhea and rashes transmitted by contaminated items like food, ​ redness & swelling of a body part water, medications, hospital equipment and ​ discharge or drainage from the machines. affected part. d.5. Vector – borne transmission – ​ sores in mucous membrane occurs when intermediate hosts such as Chain of Infection infected rats, flies or mosquitoes, transmit the microorganisms. Causative Agent or Source - is the pathogen that causes the infection or disease (bacteria, 1.​ Portal of Entry - is the means by virus, fungi, protozoa). which the pathogens enter the body such as: Reservoir – is the place where the causative ​ ​ * cuts or breaks in agent is able to live and reproduce. the skin or mucous membrane; ​ - Humans with active disease ​ ​ * respiratory tract; ​ - Humans who are carriers ​ ​ * gastrointestinal ​ - Animals tact ​ - Fomites or objects ​ * genito-urinary tract; ​ - Environment ​ ​ * circulatory system; ​ ​ * passage from Portal of Exit - is the means by which the mother to fetus pathogens leave the reservoir like human secretions. Susceptible Host - is the individual who harbors the pathogens where they reproduce ​ ​ * urine, feces and cause infection. ​ ​ * saliva, tears ​ ​ * drainage, Factors that Affect the Infection Rate excretions ​ Malnutrition ​ ​ * blood ​ Obesity Mode/Route/ Method of Transmission - the ​ Age – too young and too old way the pathogen is transmitted from one ​ Presence of chronic disease and reservoir to the new host’s body. impaired defense mechanism ​ Certain type of operation 5 Main Routes Body’s Defense against Infection d.1. Contact Transmission – most important and most frequent route. 1.​ Skin – body’s most important defense. ​ Direct – contact = direct 2.​ Mucous membrane – mucus body-surface-to-body-surface contact & secretions transfer of pathogens. 3.​ Cilia ​ Indirect – contact = involves 4.​ Coughing and sneezing contact with a contaminated objects like 5.​ Tears needles, instruments, un-washed hands and 6.​ Stomach acid gloves 7.​ Fever 8.​ Phagocytes ​ d.2. Droplet Transmission – 9.​ Inflammation occurs when droplets containing 10.​Immune response microorganisms are sent flying a SHORT DISTANCE through the air & are deposited on Asepsis the eyes, nose or mouth (sneezing, coughing, 1.​ Definition of Asepsis - freedom and droplets). from infection or infectious materials. ​ d.3. Airborne transmission – 2.​ Medical Asepsis or Clean occurs when evaporated droplets containing Technique - practices and pathogens remain in the air for LONG procedures to maintain a clean PERIODS OF TIME and are carried along by environment by removing or air currents. destroying the pathogens.  Surgical Asepsis or Sterile Technique - Standard Precaution - formerly known as practices and procedures that keep an area or UNIVERSAL PRECAUTION, protect health object totally free from all microorganisms. care workers from contact with blood and body fluids of all patients. Common aseptic practices Purpose of Standard Precaution ​ Perform daily personal hygiene. ​ Habitual hand washing ​ To prevent transmission of ​ Covering nose and mouth when infection from blood-borne pathogens. coughing and sneezing Rationale of Standard Precaution ​ Proper waste segregation and disposal ​ Is that health care worker may ​ Practice the three (3) R – reuse, not know who is and is not infected. recycle, reduce ​ Proper wearing of the Personal Practices Protective Barriers or Equipment ​ Hand washing (PPE). ​ Wearing of appropriate PPE Surgical aseptic technique principles. ​ Environment cleaning and spills management ​ All objects used in a sterile field must ​ Proper handling of waste and waste be sterile. disposal ​ Surgical gowns are considered ​ Do not recap, bend or break used sterile in front from shoulder to table needles. level. The sleeves are sterile to 2 inches above the elbow. Sterilization and Disinfection ​ Sterile items that are out of vision or Definition of Disinfection - a cleaning below the waist level of the nurse process that destroys most microorganisms are considered unsterile. through the use of certain chemicals or boiling ​ The edges of a sterile field are water. considered unsterile. ​ The skin cannot be sterilized and is ​ - uses a DISINFECTANT, an unsterile. agent that kills growing microorganisms. ​ Sterile objects can become unsterile Methods of Disinfection thru prolonged exposure to airborne microorganisms. Physical Disinfectants ​ Movement within or around a sterile ​ Boiling of water (212’F or 100’C). field must not cause contamination Minimum boiling period is 30 of the sterile field. minutes. ​ A sterile barrier that has been ​ Horizontal and vertical scrubbing permeated must be considered with soap and water. contaminated. ​ * UV Radiation and fumigation with ​ Items of doubtful sterility should be chemicals are NO LONGER considered unsterile. recommended because of the ​ Sterile objects should be touch by limitation of their practical sterile personnel only. If touches by usefulness. anything unsterile, both are considered contaminated. Chemical Disinfectants ​ If unsterile, use a pick up forcep to get or pick sterile objects. Observe ​ Alcohol (70%-90%) ethyl or proper handling of the forcep. Fluid isoprophyl – used as a flows in the direction of gravity. housekeeping disinfectant and can ​ The outside package is NOT be used in semicritical instruments. STERILE and can be handle and Hazard : volatile and it will harden touch by bare hands. The edges of and swell plastic tubing. the sterile fields are considered ​ Chlorine compounds – has limited unsterile once the package is use in hospital. Ex. Sodium opened. hypochlorite 0.5-1% ​ Dispose all sharps in designated ​ Phenolic compounds – kills puncture-resistant containers. microorganisms by coagulation of  protein. Major choice when dealing ​ All wrapped articles to be sterilized with fecal contamination. should be packed in materials that ​ Formaldehyde (either in solution or meet the standards/criteria in the gas form) – is sporicidal in minimum recommended practice for of 12 hours. in-hospital packaging materials. ​ Glutaraldehyde – agent of choice ​ Chemical indicators, also known as for sterilization. Good also for sterilization process indicators instruments that can not be steam should be used to indicate that items sterilized. Recommended soaking have been exposed to a sterilization time is 15-30 minutes. process. ​ The efficacy of the sterilization Definition of Sterilization - a cleaning process should be monitored at a process that kills all microorganisms, including regular interval with reliable spores. biological indicators. ​ - uses a chamber or equipment ​ Every package should be labeled known as STERILIZER, to attain either with the date of sterilization, physical or chemical sterilization. autoclave number & the sterilizer used. Methods of Sterilization ​ Sterilized items should be carefully Physical Means handled and only when necessary. They should be stored in ​ * Steam under pressure (moist heat/ well-ventilated, limited access area autoclave) – easy, safe, surest method, fastest, with controlled temperature and least expensive and leaves no harmful humidity. residues. ​ Flash sterilization should be used for emergency sterilization of clean, Disadv: dangerous and subject to human unwrapped instruments and porous errors. items only. ​ *Radiation – has a very low temperature ​ Performance record for all sterilizers effect on materials but penetrates materials should be maintained as well as the very well. preventive maintenance should be performed according to individual Chemical Means policies on a scheduled basis by ​ * Immersion / Soaking in Glutaraldehyde qualified personnel. – penetrates into crevices of instruments; non ​ Policies and procedures for corrosive, non staining, safe, does not damage sterilization and disinfection should the lenses. Disadvantages includes it mild but be written and reviewed periodically. irritating odor, it has low toxicity so rinse the This should be readily available objects with sterile water prior to use. within the practice setting for easy reference. ​ – soaking solution should be changed every 28th day of use. Considerations in Selecting the Method of Sterilization OR Disinfection 1.​ Cidex, Zephiran erile water prior to use. ​ availability / efficiency of sterilizing agent / disinfectant; Guidelines on Sterilization & Disinfection ​ physical properties of the item; ​ IN HOUSE PACKAGING ​ urgency of need; MATERIALS - materials used for IHP ​ standards of practice; and wrapping of sterile supplies ​ hazard of toxic residue; should: ​ infection control; ​ All items to be sterilized should be ​ manufacturer’s recommendation; prepared to reduce the bio burden. ​ decontamination requirements; ​ All articles to be sterilized should be ​ packaging requirement; arranged so all surfaces will be ​ ease of transport and storage; directly exposed to the sterilizing ​ environmental / disposal agent for the prescribed time and requirements; temperature. ​ cost containment Operating Room Attire ​ Should be easy to don and remove ​ Should be an effective barrier to 1.​ Description - consists of body microorganisms. covers, such as a two-piece pantsuit, head cover or cap/turban, mask, Dress Code shoe cover or booties, goggles, and 1.​ Location of dressing room; apron. 2.​ Street clothes are NEVER worn 2.​ Purpose beyond the unrestricted area; ​ Provide effective barriers that 3.​ Only approved, clean, and/or prevent the dissemination of freshly laundered or attire is worn microorganisms to the patient. within the semi restricted areas. ​ Protect personnel from infected This applies to all, both professional, patients and against exposure to nonprofessional and visitors alike; communicable diseases and 4.​ OR ATTIRE should not be worn hazardous materials. outside the OR suite. This protects ​ Has been shown to reduce particle the OR environment from count of shedding from the body micro-organisms inherent in the from over 10,000 particles per outside environment and protects minute to 3000 per minute, or from the outside from contamination 50,000 microorganisms per cubic normally associated with the OR. foot to 500 microorganisms per cubic 5.​ Before leaving the OR suite, foot. everyone should change to street Criteria for Operating Room Attire clothes. ​ Should be an effective barrier to ​ * lab gown, smock gown microorganisms. Both reusable ​ (THIS PRACTICE IS NOT woven and disposable nonwoven ENCOURAGED) materials are used. Design and composition should minimize 6.​ A clean, fresh scrub suit should be microbial shedding. put on after return for reentry to the ​ Should be closely woven material suite. void of dangerous electrostatic 7.​ OR ATTIRE should be hung or put properties. The garment must meet in a locker for wearing a second the fire protection standards, time. If disposable, discard in the including resistance to flame. trash after one use. ​ Nylon and other static 8.​ Personal hygiene must be spark-producing materials are reemphasized. forbidden as outer garments. 9.​ Person with an acute infection such ​ Should be resistant to blood, as cold or sore throat should not be aqueous fluids, and abrasions to permitted within the or suite. prevent penetration by 10.​Persons with cuts, burns or skin microorganisms. lesions should not scrub or handle ​ Designed should be for maximal skin sterile supplies because serum may coverage. seep from the eroded area. ​ Should be hypoallergenic, cool and 11.​Sterile team members who are comfortable known carriers of pathogens should ​ Should be non-generative of lint. Lint routinely bathe and scrub with can increase the particle count of appropriate antiseptic agent & contaminants in the OR. shampoo their hair daily. ​ Should be made of pliable material 12.​Fingernails should be kept short. to permit freedom of movement for Nail polish is not allowed. Studies the practice of sterile technique. have shown that artificial nails and ​ Should be able to transmit heat and other enhancers harbor water vapor to protect the wearer microorganisms esp. fungi & ​ Should be colored to reduce glare gram-negative bacilli. under lights. Various types of clothes 13.​Jewelries including rings & watches in colorful prints that fulfill the should be removed before entering necessary criteria are both attractive the semi restricted & restricted and functional. areas. Necklaces & chains can grate  on the skin, increasing