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Goals & Objectives After 30 minutes of orientation, the JMS should be able to:
y y y y y
Discuss the principles of aseptic technique Demonstrate surgical scrub, gowning, and gloving Identify hazards in the surgical setting Identify the role of the scrub person, circulating nurse, and medical student Discuss ways the JMS can participate in the care of the patient and thereby become an active, useful member of the surgical team
Lockers Lockers are available for your use during the hours between 0700-1800 while you are in the operating room. y You must bring your own lock. y Locks must be removed by 1800. y Any locks not removed between 1800-0700 are subject to being cut and contents removed for later disposition.
UTMB Surgical Operating Suites
3. All persons who enter the semirestricted and restricted areas of the surgical suite should be in hospital laundered surgical attire intended for use only within the surgical suite at UTMB. the wearer should remove them before leaving the operating room to avoid tracking blood and debris through the department. 2. All personnel entering the suite should have all jewelry confined or removed. . Watches and plain wedding bands are acceptable. 6.DRESS CODE . Earrings must be covered by the scrub cap. All persons entering an operating room or centerwell area should wear a mask. 4. Shoes should be dedicated to the OR and shoe covers are not required. masks. 5. 7. All possible head and facial hair. If shoe covers are necessary. and face shields) are provided by the hospital and should be utilized to reduce the risk of exposure to potentially infective agents. protective eyewear. including sideburns and neckline.SURGICAL ATTIRE 1. should be covered when in the surgical suite. Nail polish and artificial nails should not be worn within the suite. Protective barriers (gloves.
treating each finger as foursided. 6. 3. **Remember to put your mask on prior to starting you scrub. palm. 5.SURGICAL HAND SCRUB 1. Take sterile brush in right hand. Fingernails must be free of polish/enamel and of medium length. scrubs. knuckles. Repeat with left arm.** Wash hands and arms with solution to 2 inches above the elbow. . Clean fingernails with file. A five (5) minute anatomical timed scrub will be used for all surgical hand 2. Rinse both hands and arms under running water keeping hands above level of elbow so that water runs off the elbows and not the hands. Repeat with right hand. No jewelry is permitted on the hands and arms while performing as a member of the surgical team. and back of hand. Scrub right wrist and continue up arm to 2 inches above elbow. Scrub fingernails of left hand. Discard brush. 7. one at a time. Wet brush with water and soap. Start scrubbing fingers of left hand. 4.
and then only glove to glove for other hand.Gloving Procedure . Contact with ungloved fingers constitutes contamination of the glove. 2. . never let the fingers extend beyond the stockinette cuff during the procedure. For open-glove method. touch only the cuff of the glove with ungloved hand. 4. the gloves are removed after the gown is removed inside out. For closed-glove method. Avoid contact of sterile gloves with ungloved hands during closed-glove procedure. 3. using glove-to-glove. then skin-to-skin technique. 5. If contamination occurs during either procedure.Open 1. When removing gloves after a procedure is finished. both gown and gloves must be discarded and new gown and gloves must be added.
How do we know they are sterile? (Wrapping. Gowns are considered sterile in front from chest to level of sterile field.Gloving Procedure . Keep hands away from the face. 1. Tables are sterile only at table level. C. such as a suture or the table drape. Supplies are brought to sterile team members by the circulator. Sterile persons touch only sterile items or areas. Keep hands at waist level and in sight at all times. storage) 3. Gloves are sterile. Only sterile items touch sterile surfaces. unsterile persons touch only unsterile items or areas. 4. The circulator ensures a sterile transfer to the sterile field. A. E. 2. A. label. B. Never fold hands under arms. Only sterile items are used within the sterile field. . Sterile persons are gowned and gloved. A. 5. B. The patient is the center of the sterile field. Sterile team members maintain contact with sterile field by wearing gloves and gowns. B. and the sleeves from above the elbow to cuffs. D. A. who opens wrappers on sterile packages. Use non-perforating device to secure tubing and cords to prevent them from sliding to the floor.Closed Points to Remember about Aseptic Technique Adherence to the Principles of Aseptic Technique Reflects One's Surgical Conscience. Anything over the edge is considered unsterile. Examples of items used. B. Sit only if sitting for entire procedure.
Cuff drapes over gloved hands. They do not walk around or go outside the room. A. are not considered sterile. Scrub person sets basins to be filled at edge of table to fill them. C. Sterile persons keep well within sterile area. Sterile areas are continuously kept in view. Unsterile persons avoid reaching over sterile field. 7. . Movement is kept to a minimum to avoid contamination of sterile items or persons. Circulator pours with lip only over basin edge. B. 10. Unsterile persons avoid sterile areas. A. The wrapper is considered sterile to within one inch of the wrapper. Edges of anything that encloses sterile contents are considered unsterile. 9. Covering sterile tables is not recommended. Sterile field is created as close as possible to time of use. Scrub person stands back from the unsterile table when draping it to avoid leaning over an unsterile area. 8. A. B. Sterility cannot be ensured without direct observation. Scrub person drapes an unsterile table toward self first to avoid leaning over an unsterile area. the edges where glued. Sterile person faces a sterile area to pass it. B. An unguarded sterile field should be considered contaminated. 11. sterile persons avoid leaning over unsterile area.6. A. A. When opening sterile packages. D. In peel-open packages. C. Sterile persons pass each other back to back or front to front. Sterile persons stay within the sterile field. D. Secure flaps so they do not dangle. A. Unsterile persons maintain a distance of at least 1 foot from the sterile field. C. open away from you first.
Operating safety belts will be used for all patients. Doors remain closed with sign . Laser Safety Protective eyewear for patient and operating team. Microorganisms must be kept to irreducible minimum."Danger. C. Strike through is the soaking through of barrier from sterile to non-sterile or vice versa. Smoke evacuation system is to be employed when applicable. Sterility is event related. A. 12. Destruction of integrity of microbial barriers results in contamination. numerous pieces of equipment All equipment must be checked for electrical safety before use!! Anesthetic Waste Radiation Leaded aprons and shields available for use during procedures. OR Beds. Circulator restricts to a minimum all activity near the sterile field. Unsterile persons face and observe a sterile area when passing it to be sure they do not touch it. . 13." Sterile water available in the room and on sterile field. Air is contaminated by droplets. HAZARDS IN THE SURGICAL SUITE Electrical Cautery Units. General Safety Apply good body mechanics at all times when transferring patients. All microorganisms cannot be eliminated. D. A. Operating room beds and gurneys will be locked before patient transfer.B. Skin cannot be sterilized. Never disconnect or connect electrical equipment with wet or moist hands. B. Unsterile persons never walk between two sterile fields. Surgery high filtration masks should be worn during procedures that produce a plume. Defibrillators. Perfect asepsis is an idea. Laser in Use.
or manipulated by hand. Universal Precautions are designed to protect healthcare workers from occupational exposure and should be followed when potential for exposure might occur. non-intact skin. Each healthcare worker should assess their possible risks and take precautions to reduce these risks. The . Gloves should be changed after contact with each patient and hands washed after glove removal. scalpel blades and broken glass into special identified containers. or eyes. Needles should not be recapped. and between patient contact. Precautions should be followed to reduce the risk of exposure to bloodborne pathogens. 4) Needles and sharps should be placed directly into a puncture-resistant leakproof container which should be as close as possible to the point of use. Though gloves reduce the incidence of contamination. 5) Hands and skin surfaces should be washed after contact with blood and/or body fluids. they cannot prevent penetrating injuries from needles and other sharp instruments. Blood spills should be wiped up and then an EPA registered tuberculocidal disinfectant applied to the area. nose. or items/surfaces soiled with blood and/or body fluids. including the following: 1) Gloves should be worn for touching blood and/or body fluids. broken. razors. mucous membranes. Fundamental to the concept of Universal Precautions is treating all blood and/or body fluids as if they were infected with bloodborne pathogens and taking appropriate protective measures. 3) Masks and protective eyewear should be worn during procedures that are likely to generate droplets of blood and/or body fluids into the mucous membranes of the mouth. bent. 6) Gloves should be worn to cleanup blood spills.Discard all needles. Universal blood and/or body fluid precautions should be consistently used for ALL patients. UNIVERSAL PRECAUTIONS SUMMARY Although the risk of contracting HIV in the healthcare setting is extremely low. after removing gloves. there are other bloodborne pathogens which pose a much more significant risk. 2) Gowns or aprons should be worn during procedures that are likely to generate splashes of blood and/or body fluids onto clothing or exposed skin.
Splashes into the eyes. mouth. or nose .Puncture wounds .If splashed in the eyes mouth or nose have them properly flooded or irrigated with water .disinfectant should have a one minute contact time and the area rinsed with tap water.Call Employee Health Center at (409) 772-5582 for information regarding blood and/or body fluid exposure management SAMPLE EVALUATION FORM . 9) Occupational Exposures: Definition . tongs. If glass is involved.Contamination of an open wound 10) Occupational Exposures: . wear double gloves or heavy gloves. Pick up the glass with broom and dust pan. 8) Disposable resuscitation devices should be used in an emergency.Wash the area immediately with soap and water . 7) Healthcare workers with exudative lesions or weeping dermatitis should not perform direct patient care until the condition resolves.Needlesticks/Cuts . or a mechanical device.Notify supervisor as soon as possible .
COMPARATIVE DIVISION OF DUTIES Scrub Nurse/Technician A. Preoperative .
needles and instruments. Preoperative 1. Preincisional . and passes off to circulator. 3. 3. Checks for proper functioning of instruments/equipment. 3. Circulating Nurse A. Assists scrub in gowning. Completes the final preparation of sterile field. gowns. Performs counts with circulator. 2. 4. Organizes closing suture and dressings. Counts with circulator at proper intervals. Begins clean-up of used instruments. Opens sterile supplies. 2. 2. Closing Phase 1. Reports to charge nurse for next assignment. Performs and records counts. 4. Verifies tissue specimen with surgeon. Applies sterile dressings. 3. Assists in assembling needed supplies. 5. Assists surgeon with draping and passes off suction/cautery lines. Prepares for terminal cleaning of instruments and nondisposable supplies. Maintains orderly sterile field. Anticipates the surgeon's needs (supplies/ equipment). B. Assists surgeon with gowning/gloving. 4. 2. 6. Admits patient to surgical suite. and gloves and sets up sterile field. 3. Opens sterile supplies. D. Obtains instruments from flash autoclave if necessary. B. 4. 2.1. Scrubs. 5. During the Procedure 1. Checks the card file for surgeon's special needs/requests. Preincisional 1. Maintains internal count of sponges. C.
** If "scrubbing in" on case. Preoperative * Introduce self to nursing personnel. Performs skin prep. 4. Applies tape. 4. records. Medical Student A. Assists anesthesia during induction. 3.1. * Brings patient a warm blanket. connects suction and cautery. 2. Counts with scrub at proper intervals. During the Procedure 1. Transports patient to procedure room. Maintains record of supplies added. * Performs patient catheterization if necessary. Preincisional * Assists with transfer of patient to OR bed. Closing Phase 1. D. Disposes of specimen and records. 5. 2.R. Takes patient to PACU with anesthesia and reports significant information to PACU nurse. 5. 3. 3. 2. Finalizes records and charges. 5. Assists anesthesia in preparing patient for transfer to PACU. Maintains orderly procedure room. * Performs skin prep. Assists with drapes. Continually monitors aseptic technique and patients needs. Begins clean-up of procedure room. B. Anticipates needs of surgical team. Reports to charge nurse for next assignment. Receives specimen and labels it correctly. Assists with the positioning of the patient. 8. 4. 6. 6. C. 7. Maintains charges and O. . informs scrub person of glove and gown size.
when appropriate. begin scrub early. . ** If "scrubbing in" on case. .Brings patient a warm blanket. * Runs specimen to lab. D. assists surgeon and/or scrub person with draping when appropriate. During the Procedure * Answers physician pagers.** If "scrubbing in" on case. C.Assists with transfer of patient from OR bed to stretcher/bed. * Assists in preparing patient for transfer to PACU: .Brings patient bed/stretcher into room. Closing Phase * Assists with undraping of patient. .
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