The Surgical Environment Objectives Describe roles and responsibilities

The Surgical Environment

Objectives Describe roles and responsibilities of the Surgical Team. Identify proper surgical attire and PPE (Personal Protective Equipment). Describe proper traffic patterns in the Perioperative setting. Identify basic surgical equipment.

Roles and Responsibilities Registered Nurse Surgical Technicians Anesthesia Technicians SPA (Surgical Procedure Assistants) Surgical Secretaries/ Unit Clerks Surgical Schedulers

Surgical Attire ◦ Scrubs- Must be laundered in an accredited laundry that monitors the washing temperature ◦ Head Covers- Covers all hair, sideburns, beards ◦ Mask- Changed after each case, do not leave hanging around your neck. Must be worn when sterile supplies are open ◦ Shoe Covers- Removed when leaving restricted area ◦ Jackets- Long sleeves to cover arms and prevent hair and dead skin from contacting the patient ◦ Protective Eyewear- Used when scrubbing, must have side protection ◦ Nonsterile Gloves- Used when coming in contact with patient body fluids, Wash hands after removing gloves ◦ Surgical Sterile Gown- Used when scrubbing ◦ Sterile gloves- Used for sterile field and asepsis

Detailed Explanation of Roles and Responsibilities of the Perioperative Nurse Various Roles: ◦ Manager/Director ◦ Clinical Practitioner—(scrub nurse, circulating nurse, clinical nurse specialist) ◦ Roles and responsibilities include, but are not limited to: Patient and family teaching. Assessment of patient before, during and after surgery. Patient and family support.

Roles Mentor other nurses. Act as a role model for nursing students and nursing colleagues. Act as a patient advocate. Perform scrub and/or circulating duties. Control the environment. Provide efficient control of resources. Maintain asepsis.

Roles Supervision of ancillary personnel. Ongoing patient monitoring of physiological and psychological status. Participate in professional organization—(AORN). Participate in research that supports the perioperative nurse role and practice. Explore opportunities for current and future perioperative nurse roles.

Scrubs AORN Recommended Practices for Surgical Attire: Recommended Practice I: All individuals who enter semirestricted and restricted areas of the surgical suite should wear freshly laundered surgical attire intended for use only within the surgical suite. ©Kimberly Clark, used by permission

Head covers/“caps”/“surgeon’s caps” “Bouffant Cap” “Surgeon’s Hat” ©Kimberly Clark, used by permission AORN Recommended Practice II: Personnel should cover head and facial hair including, side burns and necklines, when in semi-restricted and restricted areas of the surgical suite.

Masks Pictured mask with shield (eye protection). ©Kimberly Clark, used by permission AORN Recommended Practice III: All individuals entering restricted areas of the OR suite should wear a mask when open sterile items and equipment are present.

Shoe Covers ©Kimberly Clark, used by permission AORN Recommended Practice VI: Protective barriers must be made available to reduce the risk of exposure to potentially infectious materials.

Protective Eyewear All eyewear must have side protection. Normal eye glasses do not provide adequate protection. ©Kimberly Clark, used by permission

Gloves Several Types: Non-latex Gloves Eudermic Microthin Latex Gloves All pictures ©Medline, used by permission

Jewelry and Watches in Surgery AORN Recommended Standard IV: “All personnel entering the semi-restricted and restricted areas of the surgical suite should confine or remove all jewelry and watches. ” No dangling earrings, studs only. Earrings must be contained inside the surgical cap. Microsoft Clipart

Fingernails AORN Recommended Practice V: “Fingernails should be kept short, clean, natural and healthy. ” Artificial nails should not be worn. Microsoft Clipart

Traffic Patterns AORN Recommended Practices—effective January 1, 2011. Numerous settings are out there—AORN only recommends these practices as guidelines. Recommended Practice I: “Traffic patterns should be designed to facilitate movement of patients and personnel into, through, and out of defined areas within the surgical suite. Signs should clearly indicate the appropriate environmental controls and surgical attire required. ”

Traffic Patterns in the Surgical Suite Three types: ◦ Unrestricted ◦ Semi-restricted ◦ Restricted

Unrestricted This area includes a central point of control that is established to monitor entering patients, personnel and materials. Street clothes are permitted, and traffic is not limited. Entrance to the surgical suite is to be restricted to authorized personnel based on facility policy. Microsoft Clipart

Semi-Restricted Includes the peripheral support areas of the surgical suite, including work areas, storage, scrub sink areas, and corridors leading to restricted areas of the surgical suites. Personnel are required to wear surgical scrubs, and cover all head/facial hair. Microsoft Clipart

Restricted Areas such as ORs, procedure rooms, and the “clean core”. Surgical attire and head covering is required. Masks are required when sterile supplies are open or scrubbed persons are present. Microsoft Clipart

Movement from Unrestricted to Restricted Areas Entering a semi-restricted area, the patient should wear a clean gown, a hat, and have clean linen. Movement is kept to a minimum. Doors are kept closed except during turnover. Positive pressure air exchanges 20 per hour. Traffic in and out of OR is limited. Talking increases the airborne microorganisms and should be kept to a minimum.

Movement of Surgical Supplies AORN Recommended Practice IV: “The movement of clean supplies and equipment should be separated from contaminated supplies, equipment and waste by space, time or traffic patterns. ” Surgical Supplies are kept sterile during the preparation stage. All External Shipping Containers are removed before bringing into the semi-restricted and restricted area (cardboard boxes). In the Clean Core, supplies are contained in closed carts or containers. Soiled linen, trash, and red bag items are kept separate to decrease infection

Construction/Renovation Traffic Patterns AORN Recommended Practice V: “During construction and renovation, specific traffic patterns should be established and maintained in accordance with applicable state regulations. ” Develop specific traffic patterns during construction. Multi-disciplinary assessment should be completed to determine infection. Barrier precautions and traffic patterns should monitored throughout construction.

Policies and Procedures for Traffic Patterns AORN Recommended Practice VI: “Policies and procedures for traffic patterns for patients, personnel, supplies, and equipment should be developed, reviewed periodically, revised as necessary and kept readily available in the practice setting. ”

Basic Equipment OR Table/ bed with safety strap and arm boards Mayo Stand Surgical Instrument Table Prep Table Single Ring Stand Double Ring Stand Kick Bucket Electrocautery

Basic Equipment Trash/Linen Hamper Anesthesia Machine Anesthesia cart/ Pyxis IV Pole Lifts to stand on

OR Table Versant Advantage, Inc. , 2006

Surgical Instrument Table ©Pedigo, used by permission

Single Ring Stand ©Pedigo, used by permission

Double Ring Stand ©Pedigo, used by permission

Electrocautery ©Conmed, used by permission

Trash/Linen Hamper ©Pedigo, used by permission

Anesthesia Machine Images. MD, 2006