OR BASICS

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OR BASICS
Nancy Kotti Perioperative Nurse Educator Sue
Ellen Abney Clinical Nurse Specialist- OB
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OCCUPATIONAL EXPOSURE PREVENTION

• THE OR IS RECOGNIZED FOR A HIGH INCIDENCE OF
  OCCUPATIONAL EXPOSURES AND PERCUTANEOUS INJURIES

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WHO IS GETTING INJURED?

• RESIDENTS ARE THE 1 CATEGORY FOR NEEDLE STICK
  INJURIES AT MCGHI

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OCCUPATIONAL EXPOSURE PREVENTION

• STANDARD PRECAUTIONS MUST BE USED ON ALL
  PATIENTS, BUT STANDARD PRECAUTIONS DO NOT PREVENT
  SHARPS INJURIES

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STANDARD PRECAUTIONS

• Standard Precautions are wearing gloves/ gowns/
  masks/ eye protection when there is a potential
  for exposure to blood body fluids
• Change gloves after each patient contact
• Wash hands after glove removal between patients
• Wear gloves to clean up spills or when touching
  items soiled with blood or body fluids

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BEST WAY TO PREVENT THE SPREAD OF INFECTION

• ALWAYS WASH YOUR HANDS BETWEEN CASES SINCE THIS
  IS THE BEST SOURCE OF INFECTION CONTROL
• ALCARE FOAM IS AVAILABLE IN EACH ROOM ON THE
  ANESTHESIA CARTS
• SCRUB SINKS CAN BE USED FOR BASIC HANDWASHING
  BETWEEN CASES

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PERSONAL PROTECTIVE EQUIPMENT (PPE)

• LEAD APRONS/ GLOVES
• EYEWEAR
• FACE SHIELD or GOGGLES
• LASER EYEWEAR
• GLOVES
• STERILE or NONSTERILE
• GOWNS/ MASKS (when appropriate)

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3 MAIN BLOOD BORNE PATHOGENS

• HBV
• -average rate of seroversion 6-30
• Hep B vaccine is recommended for anyone
  involved in surgery
• HCV
• -average incidence seroconversion 1.8
• HIV
• -average incidence of seroconversion .3

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MOST COMMON DEVICES CAUSING INJURY IN THE OR

• SUTURE NEEDLES
• SCALPEL BLADES
• RETRACTORS, SKIN/ BONE HOOKS
• SURGICAL WIRES/ PINS/ TROCARS
• SPLASHES INTO OPEN WOUNDS/ EYES

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WHAT ARE WE DOING?

• SAFER TECHNIQUES
• -SAFE ZONE
• -EDUCATION
• -COMMUNICATION
• SAFETY DEVICES
• -SAFETY GLIDE HYPO NEEDLES
• -BLUNT SUTURE NEEDLES

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SAFE ZONE

• SHARP ITEMS (SUTURE NEEDLES, SCALPELS,) THAT ARE
  CONTAMINATED WITH BLOOD/ BODY FLUIDS MUST BE
  PLACED IN A SAFE ZONE FOR THE SCRUB TECH TO
  HANDLE
• THIS IS A DESIGNATED AREA SUCH AS A BASIN, TRAY
  OR MAGNETIC MAT

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WHAT TO DO IF YOU ARE INJURED/ EXPOSED

• WASH THE AREA WITH SOAP WATER OR RINSE EYE
  THOROUGHLY
• REPORT EXPOSURES ASAP
• OBTAIN A SOURCE PATIENT DATA FORM FROM
  CIRCULATING NURSE (WITH MRN OF PATIENT)
• REPORT TO STUDENT HEALTH/ EMPLOYEE HEALTH OR ER
  (AFTER HOURS)

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WHAT TO DO IF YOU ARE INJURED/ EXPOSED

• BLOOD WILL BE OBTAINED FROM SOURCE PATIENT SENT
  TO THE LAB FOR HBV, HCB, AND HIV
• PROPHYLAXIS AVAILABLE FOR HIV EXPOSURE
• FOLLOW UP WITH STUDENT HEALTH/ EMPLOYEE HEALTH

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MAINTAINING ASEPSIS IN THE OR

• PROPER OR ATTIRE
• TRAFFIC CONTROL
• ENVIRONMENTAL SANTITATION PRACTICES

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OR ATTIRE SCRUBS

• ALL SCRUBS MUST BE HOSPITAL LAUNDERED
• CHANGE SCRUBS ASAP WHEN SOILED
• SCRUBS MUST NOT BE WORN OUTSIDE FACILITY
• SHIRTS AND DRAWSTRINGS OF PANTS MUST BE TUCKED IN
• NO LONG SLEEVE SHIRTS- IF UNDERSHIRT WORN, MUST
  BE S/S CREW NECK UNDER SCRUB TOP

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OR ATTIRE HATS/SHOES

• ALL HAIR MUST BE CONTAINED IN CAP
• PIERCED EARRINGS MUST BE CONTAINED IN CAP
• BEARDS MUST BE COVERED WITH A SPECIAL TYPE OF HAT
  (HOOD)
• SHOES IF WORN OUTSIDE MCG MUST BE COVERED WITH
  SHOE COVERS
• SHOE COVERS/ HATS/ MASKS MUST BE REMOVED BEFORE
  LEAVING THE OR
• NO OPEN TOE SHOES

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OR ATTIRE MISC.

• SCRUB PERSON MUST WEAR PROTECTIVE EYEWEAR/
  FACESHIELD
• MASKS MUST COMPLETELY COVER NOSE AND MOUTH
• HANDS-MUST HAVE SHORT, CLEAN NAILS- NO ARTIFICIAL
  NAILS
• NAIL POLISH SHOULD NOT BE WORN (IF IT IS WORN, IT
  MUST BE FREE OF CHIPS AND CRACKS
• WATCHES AND A PLAIN WEDDING BAND ARE ACCEPTABLE
  IF NOT SCRUBBED

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AREAS OF THE OPERATIVE SUITE (TRAFFIC PATTERNS)

• UNRESTRICTED- STREET CLOTHES PERMITTED
• SEMI-RESTRICTED- MUST HAVE SCRUB ATTIRE CAP
• RESTRICTED-MASKS REQUIRED

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FOOD/ DRINK

• NO food or drinks in Patient Care Areas
• Food/ Drinks must be consumed in Staff Lounges

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OR DOOR ACCESS

• OR Locker Rooms are on the 2nd floor of the
  hospital (Room 2100R)
• Womens OR (LD) Locker Rooms are on the 7th
  floor in the staff lounge of LD
• Key pad code can be obtained from your resident
  or clinical coordinator

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SCRUB ACCESS

• SCRUBS MUST BE OBTAINED FROM SCRUB MACHINES BY
  UTILIZING RED STICKER OR GUEST CARD
• SCRUB MACHINES ARE LOCATED OUTSIDE LOCKER ROOMS
  IN MAIN OR AND WOMENS OR
• SCRUBS PACKAGED BY SIZE CODES
• CODES ARE LISTED ON MACHINES

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SCRUB ACCESS (cont)

• MED STUDENTS ARE ALLOCATED 2 CREDITS FOR SCRUBS
• PHYSICIANS/ STAFF ARE ALLOCATED 3 CREDITS
• SCRUB RETURN BINS ARE LOCATED NEAR LOCKER ROOMS
• SCRUBS MUST BE RETURNED TO RECEIVE ANOTHER CREDIT

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PREPARATION OF THE SURGICAL TEAM

• SURGICAL SCRUB
• GOWNING GLOVING

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PREPARATION FOR SURGICAL HAND SCRUB

• NAILS SHORT, CLEAN, IN GOOD CONDITION
• JEWELRY MUST NOT BE WORN- SECURE JEWELRY BY TYING
  IN PANTS DRAWSTRING
• HANDS SHOULD BE INSPECTED FOR BREAKS IN THE SKIN
• NO OPEN WOUNDS
• MASK MUST BE PUT ON BEFORE STARTING SCRUB

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LENGTH OF SCRUB

• ALL SURGICAL SCRUBS ARE OF 5 MINUTE DURATION-
  WITH 2 ½ MINS OF TIME SPENT ON EACH HAND ARM

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GLOVE/ SOAP ALLERGIES

• LATEX FREE POWDER FREE GLOVES AVAILABLE IN ALL
  ORS
• SCRUB SOAPS AVAILABLE AT MCG ARE BETADINE CHG
  (HIBICLENS)
• IF ALLERGIC TO BOTH SCRUB SOAPS, CONTACT NANCY
  KOTTI, OR EDUCATOR, AT 721-1865 OR IN GROUPWISE
  (E-MAIL)

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ALCARE FOAM (FOR SCRUB)

• FOAM HAS BEEN APPROVED FOR SCRUB USE IN CASES
  LESS THAN ONE HOUR ONLY
• MUST DO 3 MIN PRE SCRUB WITH SOAP/ WATER
• USE ACCORDING TO SCRUB INSTRUCTIONS, AND FOAM
  MUST DRY ON THE SKIN- DO NOT WIPE OFF WITH TOWEL
• ALCARE IS AN ACCEPTABLE METHOD FOR GENERAL HAND
  HYGIENE ON NURSING UNITS

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PARAMETERS OF A STERILE GOWN

• GOWNS ARE CONSIDERED STERILE FROM WAIST LEVEL TO
  CHEST LEVEL INCLUDING SLEEVES TO 2 ABOVE ELBOW
• STOCKINETTE CUFFS MUST BE COVERED BY STERILE
  GLOVES
• STERILE PERSONS MUST HAVE HANDS IN SIGHT AT ALL
  TIMES

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PARAMETERS OF A STERILE GOWN

• HANDS ARE KEPT AWAY FROM THE FACE, AND ELBOWS
  REMAIN CLOSE TO THE SIDE
• NEVER FOLD ARMS UNDER AXILLA
• BACK OF GOWN IS CONSIDERED CONTAMINATED

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PRINCIPLES OF ASEPSIS

• BLUE AREAS ARE STERILE AREAS
• KEEP 1 FT DISTANCE FROM STERILE AREAS IF NOT
  SCRUBBED
• KEEP TALKING AND MOVEMENT TO A MINIMUM

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PRINCIPLES OF ASEPSIS FOR SCRUBBED PERSONNEL

• REMAIN AT STERILE FIELD WHILE SCRUBBED
• AVOID CHANGING LEVELS (SITTING/ STANDING/
  SITTING)
• TO SWITCH PLACES WHILE SCRUBBED, MOVE BACK TO
  BACK WITH THE PERSON WITH WHOM YOU ARE SWITCHING

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IN SUMMARY

• THE OR IS AN EXCITING PLACE TO WORK, BUT IT
  ALWAYS REQUIRES GOOD COMMUNICATION AND ATTENTION
  TO DETAIL TO PROVIDE FOR THE SAFETY AND WELFARE
  OF EVERY PATIENT
• Please go
• to Post-test!