Med Basics OR

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Published on February 4, 2008

Author: Calvin1

Source: authorstream.com

OR BASICS:  OR BASICS Nancy Kotti Perioperative Nurse Educator Sue Ellen Abney Clinical Nurse Specialist- OB OCCUPATIONAL EXPOSURE PREVENTION:  OCCUPATIONAL EXPOSURE PREVENTION THE OR IS RECOGNIZED FOR A HIGH INCIDENCE OF OCCUPATIONAL EXPOSURES AND PERCUTANEOUS INJURIES WHO IS GETTING INJURED?:  WHO IS GETTING INJURED? RESIDENTS ARE THE #1 CATEGORY FOR NEEDLE STICK INJURIES AT MCGHI OCCUPATIONAL EXPOSURE PREVENTION:  OCCUPATIONAL EXPOSURE PREVENTION STANDARD PRECAUTIONS MUST BE USED ON ALL PATIENTS, BUT STANDARD PRECAUTIONS DO NOT PREVENT SHARPS INJURIES STANDARD PRECAUTIONS:  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 BEST WAY TO PREVENT THE SPREAD OF INFECTION:  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 PERSONAL PROTECTIVE EQUIPMENT (PPE):  PERSONAL PROTECTIVE EQUIPMENT (PPE) LEAD APRONS/ GLOVES EYEWEAR FACE SHIELD or GOGGLES LASER EYEWEAR GLOVES STERILE or NONSTERILE GOWNS/ MASKS (when appropriate) 3 MAIN BLOOD BORNE PATHOGENS:  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% MOST COMMON DEVICES CAUSING INJURY IN THE OR:  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 WHAT ARE WE DOING?:  WHAT ARE WE DOING? SAFER TECHNIQUES -”SAFE ZONE” -EDUCATION -COMMUNICATION SAFETY DEVICES -SAFETY GLIDE HYPO NEEDLES -BLUNT SUTURE NEEDLES “SAFE ZONE”:  “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 WHAT TO DO IF YOU ARE INJURED/ EXPOSED:  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) WHAT TO DO IF YOU ARE INJURED/ EXPOSED:  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 MAINTAINING ASEPSIS IN THE OR:  MAINTAINING ASEPSIS IN THE OR PROPER OR ATTIRE TRAFFIC CONTROL ENVIRONMENTAL SANTITATION PRACTICES OR ATTIRE: SCRUBS:  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 OR ATTIRE: HATS/SHOES:  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 OR ATTIRE: MISC.:  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 AREAS OF THE OPERATIVE SUITE (TRAFFIC PATTERNS):  AREAS OF THE OPERATIVE SUITE (TRAFFIC PATTERNS) UNRESTRICTED- STREET CLOTHES PERMITTED SEMI-RESTRICTED- MUST HAVE SCRUB ATTIRE & CAP RESTRICTED-MASKS REQUIRED FOOD/ DRINK:  FOOD/ DRINK NO food or drinks in Patient Care Areas Food/ Drinks must be consumed in Staff Lounges OR DOOR ACCESS:  OR DOOR ACCESS OR Locker Rooms are on the 2nd floor of the hospital (Room # 2100R) Women’s OR (L&D) Locker Rooms are on the 7th floor in the staff lounge of L&D Key pad code can be obtained from your resident or clinical coordinator SCRUB ACCESS:  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 WOMEN’S OR SCRUBS PACKAGED BY SIZE CODES CODES ARE LISTED ON MACHINES SCRUB ACCESS (cont):  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 PREPARATION OF THE SURGICAL TEAM:  PREPARATION OF THE SURGICAL TEAM SURGICAL SCRUB GOWNING & GLOVING PREPARATION FOR SURGICAL HAND SCRUB:  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 LENGTH OF SCRUB:  LENGTH OF SCRUB ALL SURGICAL SCRUBS ARE OF 5 MINUTE DURATION- WITH 2 ½ MINS OF TIME SPENT ON EACH HAND & ARM GLOVE/ SOAP ALLERGIES:  GLOVE/ SOAP ALLERGIES LATEX FREE & POWDER FREE GLOVES AVAILABLE IN ALL OR’S 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) ALCARE FOAM (FOR SCRUB):  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 PARAMETERS OF A STERILE GOWN:  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 PARAMETERS OF A STERILE GOWN:  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 PRINCIPLES OF ASEPSIS:  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 PRINCIPLES OF ASEPSIS FOR SCRUBBED PERSONNEL:  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 IN SUMMARY:  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!

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