Perioperative Environment PDF

Perioperative Environment NURSING ROLES AND ASEPTIC TECHNIQUE Learning Outcomes Understand the three phases of perioperative patient care. Distinguish between the scrub and circulating nurse roles. Understand surgical asepsis and the operating room environment. Describe aseptic principles t...

Perioperative Environment NURSING ROLES AND ASEPTIC TECHNIQUE Learning Outcomes Understand the three phases of perioperative patient care. Distinguish between the scrub and circulating nurse roles. Understand surgical asepsis and the operating room environment. Describe aseptic principles to perioperative nursing practice. Understand best practices to prevent Surgical Site Infections. Describe best practices for transmission-based precautions. Classify the types of Surgical Wounds. Perioperative Nursing Roles Two Nursing Roles: 1. Scrub Nurse 2. Circulating Nurse Together they form an important partnership in ensuring patient safety! Scrub Nurse Registered Nurse or Registered Practical Nurse Works within the sterile field Directly assists the surgical team Assembles required instruments and supplies In-depth knowledge of each step of the surgical procedure Able to anticipate each instrument and supply Circulating Nurse Registered Nurse Non-scrubbed person Completes patient assessment Develops patient specific nursing care plans using the nursing process Assists the anesthetist Patient positioning Surgical prep Documentation Additional room management responsibilities Collaboration of Roles Three phases of perioperative nursing care: 1. Preoperative Set Up 2. Intraoperative Care 3. Postoperative Care Teamwork enhances the quality and safety of patient care Effective communication = procedure efficiency  Phase 1: Preoperative Set Up Prior to the start of the surgical case Prior to the arrival of the patient in the OR Check case cart Surgical Procedure pick list Room set up Scrub Nurse Surgical scrub What are the first items you will Don sterile gown and gloves pass off to the circulating nurse Set up surgical table after getting into position? Verifies instruments are in working order Surgical count Gown and glove surgeon/assistants Assist with draping Circulating Nurse Sets up OR furniture and equipment Opens sterile supplies for scrub nurse Complete surgical count Complete patient assessment Assist the anesthetist Position and prep Assist surgical team into position Surgical Safety Checklist Phase 2: Intraoperative Care Begins after __________ Surgical case management Scrub/Circulating Nurse Collaboration Specimen Management Documentation Surgical Count Scrub Nurse Surgical Consciousness **Maintain asepsis!! Anticipate needs of the surgical team Knowledge of instrumentation and equipment Specimen management Appropriate initiation of surgical counts Effective Communication Circulating Nurse Direct coordinator of nursing activities Anticipate needs of surgical team Assist the anesthetist with direct patient care OR Documentation Safe specimen management Effective communication Phase 3: Postoperative Care End of surgical case Clean up and discard drapes and table set up Documentation Complete room turnover Which phase of the Surgical Safety Checklist will be complete? ________________ What will you discuss? Scrub Nurse Provide/Apply sterile dressings Discard surgical drapes Safe disposal of sharps Dismantle set up Sign Count Sheet Assist with turnover Circulating Nurse Complete Post-op skin assessment Complete OR documentation Assist anesthetist with extubation Transfer patient to post-op unit Other Roles Registered Nurse First Assistant (RNFA) Works collaboratively with the surgeon Dissects tissues Assists with exposure of tissues/organa Hemostasis and suturing Wound management ORNAC – 5 years full time as an RN  Aseptic Technique Imperative to Preventing Surgical Site Infections! Definitions Healthcare-Associated Infection (HAI): Infection acquired by the patient while receiving treatment in hospital Surgical Site Infection: Infection at the site of surgery Infection Prevention Maintain strict asepsis Room air exchange Prophylactic antibiotics ______ minutes before surgical incision Adhere to transmission-based precautions Minimize personnel Aseptic Environment Minimize traffic in and out of the room OR doors should remain closed OR is positive pressure Air exchange 1 x 3-4 mins (20 exchanges/hour) Negative pressure rooms require _____ for a full room air exchange cycle Ensuring Sterility Effective surgical scrub Establish a sterile field Maintaining good surgical conscience Awareness of environment Sterile parameters Sterile indicators Team members passing _________________ when moving within the sterile field Sterile Set Up – Scrub Role Verify chemical indicators Minimize handling of sterile items Set up in an efficient/organized manner Gowns are sterile ______ inches below the neck and _____ inches above the elbow If sterility of an item is questioned – assume unsterile! Sterile Set Up- Circulating Role Open sterile packages and equipment Verify chemical indicators Pour solutions without splashing Passing between two sterile areas is prohibited Circulating personnel must remain ______ inches away from sterile set up FLIPPING ITEMS IS NOT SUPPORTED BY ORNAC! Microbiology Pathogen % of Isolated Resistant Staphylococcus 43% (MRSA) Enterococcus faecium 62% (VRE) Escherichia coli 11% Psudeomonas aeruginosa 10% Transmission-Based Precautions Contact Precautions What additional precaution OR attire are required? Eye Gown Gloves Mask protection Negative Positive Gloves N-95 Mask Pressure Pressure Droplet Precautions What additional precaution OR attire are required? Eye Gown Gloves Mask protection Negative Positive Gloves N-95 Mask Pressure Pressure Airborne Precautions What additional precaution OR attire are required? Eye Gown Gloves Mask protection Negative Positive Gloves N-95 Mask Pressure Pressure Wound Class Specific to all surgical procedures Extent of microbial exposure (contamination) Risk of wound infection Applies to infection control measures Class I: Clean Non-infected No inflammation Respiratory, Alimentary, GU tracts not entered Example: _______ Class II: Clean Contaminated Respiratory, Alimentary, and GU tracts are entered No sign of infection No break in aseptic technique Mucous membranes Example: _______ Class III: Contaminated Open wounds Incisions with obvious signs of infection GI tract is entered No breaks in aseptic technique Example: _________ Class IV: Dirty/Infected Infected wound Infected incision Perforation Existing infection Example: ______ References Rothrock, J. (2022). Alexander’s Care of the Patient in Surgery. (17th ed). Elsevier. ORNAC Standards (2023)