Operating Room Ergonomics PDF

Operating room ergonomics What Is the Operating Room? The Operating Room (OR) is a large, sterile room where surgeons operate on patients. It is equipped with surgical tables, monitors, and other equipment necessary for surgery. There are many types of operating rooms depending on the type of surge...

Operating room ergonomics What Is the Operating Room? The Operating Room (OR) is a large, sterile room where surgeons operate on patients. It is equipped with surgical tables, monitors, and other equipment necessary for surgery. There are many types of operating rooms depending on the type of surgery. The room is typically cool and quiet, and the air is sterile and clean. The operating complex has several rooms for changing, supplies and equipment. Most of the operating rooms have a separate room for scrubbing and preparing the sterile tables. Most operating rooms have a sluice that connects the operating room to the corridors of the OR complex to optimize the airflow in order to support infection prevention. The operating room has several other rooms for hand washing, changing, supplies and equipment. For a surgical procedure to be successful, everything is carefully coordinated among the operating room staff from start to finish. Operating Room staff: The operating team members usually consist of: A. Sterile division: it includes the surgeon, assistants to the surgeon, and the scrub team are a part of the sterile division. As a part of the sterile division, you are required to perform surgical handwashing and wear sterile gloves, gowns, and masks. You are only authorized to handle sterile equipment and must remain in the sterile field area of the OR. 158 B. Unsterile divisions: it includes the nurse anesthetist, anesthesiologist, circulating nurse, radiology technicians, medical device representative, and additional staff are a part of the non-sterile division. Operating room design and layout 1) The surgical table is placed centrally in the room, giving the surgical team easy access to the patient on the surgical table. 2) The anesthesia machine is placed at the end of the table where the patient's head is positioned and close to the OR door providing quick access for the anesthetic team in case of an emergency and anesthetic care that is convenient and efficient. 3) The suction device can be used to evacuate blood, body fluids, and smoke during surgery. This makes the suction device a necessary component of surgical procedures and anesthetic care provision. 4) A refrigerator is used to preserve specimens and store medications at desired temperatures. 5) Next, there are the mounted lights and booms that are used to provide lighting during the procedure. These are adjustable and can be moved around to specific locations during the surgical procedure. Mounting the lights provide additional space for operating room staff and additional equipment that may be needed. At least one operating light is installed directly above the surgical table. 6) Back tables are also used during every procedure. These tables are covered in sterile blue cloth and are used to hold the surgical instruments needed for the procedure. 159 7) All operating rooms consist of an anesthesia cart, oxygen, and additional anesthetic gases. 8) The OR contains additional space and tables for other surgical supplies and emergency equipment that may be needed at any given time. The temperature of the Operating room is usually cold. The patient is kept warm using warmed blankets and/or mattress. Working under an operating light with protective gears on might cause the team to sweat, which can, in turn, compromise sterility. One of the advantages of cool temperature in the Operating room is microorganisms grow slower when subjected to lower temperatures Operating room zones The Operating Room is divided into different zones (sterile, clean, protective, and disposal) to prevent air contamination and regulate materials' transportation. A. The sterile zone The sterile zone consists of the Operating rooms and clean preparation areas. In this zone, the highest level of aseptic conditions needs to be maintained. The ventilation system helps maintain air pressure gradient, minimizing airflow from the corridor to the OR. B. The clean zone The clean zone consists of the store areas, preoperative/holding room, recovery room, or PACU and OR staff rooms. It surrounds the sterile 160  area and connects it to the protective area. Only staff wearing appropriate surgical wear should enter the clean area. C. The protective zone The protective zone includes dressing rooms, reception, and waiting areas. The zone surrounds the clean zone and forms a protective area between the clean zone of the OR and the rest of the hospital. D. The disposal zone The disposal zone includes the decontamination rooms and disposal corridors. The soiled instrument uses linen. Operating debris is removed via the disposal zone. Patient skin antisepsis and draping To avoid surgical site infections, the skin is cleaned and disinfected around the incision site. The agents used for this purpose should be applied rapidly, have a fast onset of action and a long duration of action. The alcohol-based agents are more effective than the aqueous ones, though aqueous agents are preferred if the patient’s skin is sensitive to alcohol. A. Skin disinfection Disinfection of the patient's skin can be done with chlorhexidine or povidone. Visible areas like the face and neck can be scrubbed with uncolored chlorhexidine. The newly applied chlorhexidine should not be touched. Perineal and the mucosal regions are preferably cleaned with povidone. B. Draping 161 After the disinfectant has completely dried up, the small rectangle drapes are placed on the sides. A large drape is placed on the caudal side over the feet. The middle is determined, and the drape is pasted towards the lateral side. Another large drape is placed on the cranial side towards the anesthesiologist to separate the anesthesiologist from the surgical area. The middle is determined, and the drape is pasted from the middle towards the lateral side. Operating room hazards Operating room hazards can include everything from surgical tools that can cause injury to personnel to the potential for infections. 1) Sharp objects These objects include scalpels, scissors, and needles. Without proper precautions, these sharp objects can result in a serious injury to the patient or medical personnel. 2) Infections Using contaminated instruments during surgery can cause an infection to spread through the patient's body. These infections are often life- threatening and require immediate attention. To prevent the spread of infection, healthcare providers should only use sterile instruments. Additionally, all instruments that come in contact with the patient's body should be properly disinfected. 3) Strains When a patient is malpositioned on the operating table, this can easily result in muscle strain or compromised nerves. If a patient is 162  undergoing surgery and complains of pain, this might be caused by malpositioning on the operating table. 4) Fire Although rare in modern ORs, a fire outbreak can still occur. ORs are designed considering the correct location of fire extinguishers, installation of fire alarms, and gas shut-off valves. 5) Inadequate ventilation If the air quality within the operating room becomes too poor, it can become toxic and dangerous for patients. Scrubbing and gowning The surgical scrub is an important procedure required to reduce the risk of contamination by microorganisms during operative procedures. The surgical scrub involves first decontaminating the hands, then donning a sterile surgical gown and pair of sterile gloves. Preparing to scrub You should be dressed appropriately to enter the operating theatre. Although this may vary from hospital to hospital, generally you must wear: 1) Surgical scrubs (bare below the elbows & removing watches and rings) 2) Footwear such as clogs 3) Theatre hat (with hair tied up if necessary) 4) ID badge 163  Ensure you ask the Lead Surgeon whether or not they would mind you scrubbing in, then make your way to the scrub area. You must open your gown and gloves before you scrub, so as not to contaminate your hands. Finally, put on a surgical mask and eyewear protection. Make sure you are comfortable, as you cannot adjust these once you are scrubbed. Surgical scrub Pre-scrub wash 1.Run the tap to an adequate temperature and flow (to avoid water splashing). Then test the water before starting to scrub to ensure the temperature is comfortable. 2.Open the package containing the nail brush/scrub sponge and nail pick, then lie it on the back of the scrub sink still in the opened package. Scrubbing procedure During each of the following steps keep hands (clean area) above the elbows (dirty area) allowing water to drain away, making sure to avoid splashing surgical attire. 164 Each step of surgical ‘scrubbing’ consists of five strokes rubbing backwards and forwards. Step 1 Wet the hands and forearms. Apply the specified amount of appropriate antimicrobial solution. Work the cleaning solution into the hands palm to palm, creating a lather. Step 2 Rub the right palm over the back of the left and vice versa with the fingers interlaced. Step 3 Rub hands palm to palm, with fingers interlaced. Step 4 Perform rotational rubbing backwards and forwards with clasped fingers of the right hand into the left palm hand and vice versa. Step 5 Perform rotational rubbing of the right thumb clasped in the left hand and vice versa. 165 Step 6 Rub the fingertips of the left hand on the palm of the right hand and vice versa. Step 7 Continue with the rotating action down opposing arms, working to just below the elbows. Step 8 Rinse and repeat steps 1-7 keeping hands raised above elbows at all times. The second wash should only cover two-thirds of the forearms to avoid compromising the cleanliness of the hands. Local policy may include repeating these steps a third time but to wrists only. The scrub procedure should last for 5 minutes, with further scrubs during the day lasting 3 minutes. Step 9 Rinse the hands under running water, allowing the water to run from fingertips to elbows. Turn the tap off (if necessary) with your elbow and keep your hands up, allowing water to drip from your elbows. Step 10 Pick up one hand towel from the top of the gown pack and step back from the surface. 166  Grasp the towel and open it fully. Do not allow the towel to touch any unsterile object or unsterile parts of your body. Hold your hands and arms above your elbow, and keep your arms away from your body. Step 11 Holding one end of the towel with one hand dry the fingers of the opposite hand using a blotting rotational motion. Move to the dry area of the towel and continue in this manner down the forearm to the elbow. Ensure you do not retrace from the forearm back up to the hands and do not wipe the skin dry. This may contaminate your hands with micro-organisms from your proximal forearm – you will be asked to re-scrub. Repeat with the other towel from the pack for the other hand and arm. If you accidentally touch the tap or any surrounding objects, you must re-scrub. Gowning 1.With one hand, pick up the entire folded gown from the wrapper by grasping the gown through all layers, being careful to touch only the inside top layer which is exposed. 2.Once your hands are securely pinching the gown in these slots, step back from the shelf and allow the gown to drop. 3.Make sure the gown does not touch any surrounding unsterile objects. 167 4.Grasp the inside shoulder seams and open the gown with the armholes facing you. 5.Carefully insert your arms partway into the gown one at a time, keeping hands at shoulder level away from the body. 6.Slide the arms further into the gown sleeves and when the fingertips are level with the proximal edge of the cuff, grasp the inside seam at the cuff hem using thumb and index finger. Be careful that no part of the hand protrudes from the sleeve cuff. 7.A theatre assistant will fasten the gown behind you, positioning it over the shoulders by grasping the inside surface of the gown at the shoulder seam. The theatre assistant’s hands should only ever be in contact with the inside surface of the gown. 8.The theatre assistant then prepares to secure the gown at the neck and upper back. Gowns differ in how they are secured, but most with have either ties, buttons or velcro tabs. Gloving Step 1 168  Open the inner glove packet that you previously dropped onto your sterile field. Step 2 Pick up one glove by the folded cuff edge with your sleeve-covered hand. Step 3 Place the glove on the opposite gown sleeve facing palm down, with the glove fingers pointing towards you. The palm of the hand inside the gown sleeve must be facing upward toward the palm of the glove. Place the glove’s rolled cuff edge at the seam that connects the sleeve to the gown cuff. Grasp the bottom rolled cuff edge of the glove with the thumb and index finger of the hand the glove is on top of. Step 4 While holding the glove’s cuff edge with one hand, grasp the uppermost edge of the glove’s cuff with the opposite hand. Step 5 Continuing to grasp the glove, stretch the cuff of the glove over the hand. Using the opposite sleeve covered hand, grasp both the glove cuff and sleeve cuff seam and pull the glove onto the hand. Pull any excessive amount of glove sleeve from underneath the cuff of the glove. 169 Step 6 Using the hand that is now gloved put on the second glove in the same manner. Check to make sure that each gown cuff is secured and covered completely by the cuff of the glove. Step 7 Adjust the fingers of each glove as necessary so that they fit appropriately. Key points Keep your hands in your sleeves so that you do not touch the glove on the outside of the gown with your bare hands. Keep your hands above your waist and in front of you Ensure you do not touch anything around you that is not sterile – this includes your face, mask, and hat! Final tie 1.There is a cardboard slip holding two ties together across the front of the gown. 2.Detach the cardboard slip from the short tie, ensuring you keep hold of the short tie in your left hand. 3.Now pass the cardboard slip to the theatre assistant, ensuring not to make direct contact with their hand. 4.They will pass the tie around your back – now take the tie, and let them pull the cardboard off the tie so that you can tie a bow at your waist. 170