Principles in Operation Theatre

Principles in OT

1. Principles in operation Theatre Presented by : Dr Mubash ir Deptt . Of surgery Moderator : Dr Divya Prasad Assistant professor Deptt . Of surgery

2. There Is No Compromise with Sterility It’s Considered either Sterile or Unsterile.

3. T h e O p e r a t i n g T h ea t e r complex S t e rile core Cl e a n Z o n e T r a ns i t i o n a l Zone Restricted area Semi – R e s t ri c t e d Area Aseptic zone Outer zone

4. Traffic patterns of Operati ng Theatre  The use of aseptic principles requires regulation of traffic and flow patterns of the personnel, patient, equipment, and supplies in operating theatre  Aim : to protect the safety and privacy of patients and the cleanliness and integrity of th e environment .

5. U nr e s t r i c t e d A r e a  OUTERZONE - Areas for receiving patients , toilets , administrative function, Corridors outside surgical suite

6. U nr e s t r i c t e d A r e a  E n t r ance  R e c e pt io n desk

7. T r a n s i t i on a l Z o n e  Lo c k er room

8. C l ea n Z on e       Changing room Patient transfer area Stores roo m Nursing s taff room Anaesthetist room Recovery room

9. A S EP T I C Z O N E Scrub area . Preparation room . Operation theatre . Area for instrument packing and sterilization.

10. S t e r i l e C or e

11. P ut t i n g o n s urg i c a l attire  In the semi & restricted area:  Scrub suit : shirt & trousers  Hair covering: surgical cap/hood  Masks : disposable/ re-useable  Goggle (optional ): protective  Shoe covers are compulsory

12. PREOPERATIVE PREPARATION PRINCIPLES OF STERILE TECHNIQUE   The patient is the center of the sterile field. It includes the areas of the patient, the operating table and furniture covered with sterile drapes, and the personnel wearing the OR attire . Strict adherence to sound principles of sterile technique and recommended practices is mandatory for the safety of the patient . It reflects one’s surgical con s cience.

13. 1 . ONLY STERILE ITEMS ARE USED WITHIN THE STERILE FIELD . If in doubt about the sterility of anything consider it not sterile. Known or potentially contaminated items must not be transferred to the field. a. If sterile package is found in a nonsteril e workroom / falls to the floor ; it must be discarde d. b. If unsterile person comes into close contact with a sterile table and vice versa .

14. 2. GOWNS ARE CONSIDERED STERILE ONLY FROM THE WAIST TO THE SHOULDER LEVEL, IN FRONT AND THE SLEEVES.  The following practices must be observed: Sterile persons must keep hands in sight or above waist level. Hands are kept away from the face. Elbows are kept close to sides. Hands are never folded under arms . Items dropped below the waist level are considered unsterile and must be discarded.

15. TABLES ARE STERILE ONL Y AT TABLE LEVEL . Only top of a table with sterile drape is considered sterile. Edges and sides of drape extending below the table level are considered unsterile. Anything falling or extending over table edge , such as a suture piece , is unsterile. In unfolding sterile drape, the part that drops below table surface is not brought back up to the table level.

16. 4. STERILE FIELDS ARE CREATED AS CLOSE AS POSSIBLE TO TIME OF USE. Degree of contamination is proportionate to the length of time sterile items are uncovered an d exposed to the environment . Sterile tables are set up just prior to the operation.

17. 5 . STERILE AREAS ARE CONTINUOUSLY KEPT IN VIEW.  Inadvertent contamination of sterile areas must be readily visible . To ensure this principle: a. Sterile persons must face sterile areas. b. When sterile packs are opened in a room , or a sterile field is set up, someone must remain in the room to maintain vigilance.

18. THE OPERATING ROOM ATTIRE   Consists of the scrub dress, head cover , mask , shoes or shoe cover , Sterile gown and gloves . Provides effective barriers that prevent the dissemination of microo rganisms . Scrub dress – worn only in the operating suite. Head cover – is used to cover hair completely .

19. 3.Shoes – should be clean, washable and soft soled . 4. Mask – is put on by all personnel before coming into the OR and must be worn over nose and mouth. 5.Sterile gown – are worn over scrub attire for scrubbed members. 6. Sterile gloves – are worn to complete the attire for scrubbed members.

20. The Surgical Scrub Definition. The surgical scrub is the process of removing as many microorganisms as possible from the hands and arms by mechanical washing and chemical antisepsis before participating in a surgical procedure.  Despite this , skin is never 100% sterile .

21. The Timed Method All surgical scrubs are approximately 5 minutes in length. A ll are performed using a surgical scrub brush and an antimicrobial soap solution . The Methodology of the Scrub

22. Surgical Scrub Procedure 1. Wet the hands and forearms and Apply antiseptic agent 2. Wash the hands and arms thoroughly to 2 inches above the elbows several times. 3. Rinse thoroughly under running water with the hands upward .

23. 4. Take a sterile brush or sponge and apply antiseptic agent . 5. Scrub each individual finger, including the nails, and the hands, a half minute for each hand . 6. Again scrub each individual finger, including the nails and the hands with the brush, half a minute for each hand .

24. Rinse the hands and brush, and discard the brush. Reapply the antimicrobial agent and wash the hands and arms for 3 minutes. Interlace the fingers to clean between them. Be sure to keep both arms in the upright position . Do not let water run down to hands , it must drip off elbows The Final Rinse

25. What are the WHO 5 moments of hand hygiene ?

26. Drying the Hands and Arms Reach down to the opened sterile package containing the gown, and pick up the towel. Be careful not to drip water onto the pack. Be sure no one is within arm’s reach. Open the towel full- length, holding one end away from the nonsterile scrub attire. Bend slightly forward.

27. Dry both hands thoroughly but independently. 4. Carefully reverse the towel , still holding it away from the body . Dry the arm s on the unused end of the towel .

28. Gowning and Gloving Techniques 1. Reach down to the steril e package and lift the folde d gown directly upward. 2. Step back awa y from the table into an unobstructed area to provide a wid e margin of safety whi le gowning . 3. Holding the folded gow n, carefully locate the neckline.

29. Holding the inside front of the gown just below the neckline wit h both hands, let the gown unfold , keeping the inside of the gown toward the body. Do not touch the outside of the gown with bare hands. 6. Holding the hands at shoulder level , slip both arm s into the armhol es simultaneously .

30. 6. The gown is pulled on, leaving the cuffs of the sleeves extended over the hands. The back of the gown i s securely tied by assistant.

31. Gloving by the Closed Glove Technique 1. Using the right hand and keeping it within the cuff of the sleeve, pick up the left glove from the inner wrap of the glove package by grasping the folded cuff.

32. Extend the left forearm with the palm upward . Place the palm of the glove against the palm of the left hand - fingers of gloves pointing towards forearm.

33. 3. Grasp the back of the cuff in the left hand and turn it over the open end of the left sleeve and hand . The cuff of the glove is now over the cuff of the gown , with the hand still inside the sleeve.

34. 4. Grasp the top of the left glove and underlying gown sleeve with the covered right hand.Pull the glove on over the extended left fingers until it completely covers the hand.

35. 5. Glove the right hand in the same manner , by Us ing the gloved left hand

36. Gloving the Right Hand

37. Scrubbing, Gowning , and Gloving Complete

38. FORMALDEHYDE FUMIGATION Commonly used to sterilize the OR. For an area of 1000 cubic feet REQUIREMENT 500 ml of 40% formaldehyde in one litre of water Stove or hot plate for heating Formalin 300 ml of 10% Ammonia Fumigation of OT complex

39. PROCEDURE

40. MOPPING OF FLOORS 3 bucket system 1st Bucket with water : -dirty mop is rinsed 2nd Bucket with fresh water for rinsing ; -Mop rinsed again in this water 3rd Bucket with low level disinfectant -Mop is immersed in the solution and the floor mopped liberally .

41. MICROBIOLOGICAL MONITORING Swabbing and culture for bacteria in OR Frequency -Once a month Areas swabbed – In all ORs Operation table at the head end Over head lamp Four Walls. Floor below the head end of the table Instrument trolley AC duct Microscope

42. MICROBIOLOGICAL MONITORING Quality of air in OR Settle plate method Frequency ( Once a month) Procedure One plate of blood agar and sabouraud dextrose agar (SDA) is placed in the center of the OR (Close to operation table) and the lid is kept open for 30 min.

43. S URGICAL S AFETY C HECKLIST (F IRST E DITION ) Before induction of anaesthesia Before skin incision Before patient leaves operating room SIGN IN TIME OUT SIGN OUT PATIENT HAS CONFIRMED CONFIRM ALL TEAM MEMBERS HAVE NURSE VERBALLY CONFIRMS WITH THE IDENTITY INTRODUCED THEMSELVES BY NAME AND TEAM: SITE ROLE PROCEDURE THE NAME OF THE PROCEDURE RECORDED CONSENT SURGEON, ANAESTHESIA PROFESSIONAL AND NURSE VERBALLY CONFIRM THAT INSTRUMENT, SPONGE AND NEEDLE SITE MARKED/NOT APPLICABLE PATIENT COUNTS ARE CORRECT (OR NOT SITE APPLICABLE) ANAESTHESIA SAFETY CHECK COMPLETED PROCEDURE HOW THE SPECIMEN IS LABELLED PULSE OXIMETER ON PATIENT AND FUNCTIONING ANTICIPATED CRITICAL EVENTS (INCLUDING PATIENT NAME) DOES PATIENT HAVE A: SURGEON REVIEWS: WHAT ARE THE WHETHER THERE ARE ANY EQUIPMENT CRITICAL OR UNEXPECTED STEPS, PROBLEMS TO BE ADDRESSED KNOWN ALLERGY? OPERATIVE DURATION, ANTICIPATED NO BLOOD LOSS? SURGEON, ANAESTHESIA PROFESSIONAL YES AND NURSE REVIEW THE KEY CONCERNS ANAESTHESIA TEAM REVIEWS : ARE THERE FOR RECOVERY AND MANAGEMENT DIFFICULT AIRWAY/ASPIRATION RISK? ANY PATIENT-SPECIFIC CONCERNS? OF THIS PATIENT NO YES, AND EQUIPMENT/ASSISTANCE AVAILABLE NURSING TEAM REVIEWS: HAS STERILITY (INCLUDING INDICATOR RESULTS) BEEN RISK OF >500ML BLOOD LOSS CONFIRMED? ARE THERE EQUIPMENT (7ML/KG IN CHILDREN)? ISSUES OR ANY CONCERNS? NO YES, AND ADEQUATE INTRAVENOUS ACCESS HAS ANTIBIOTIC PROPHYLAXIS BEEN GIVEN AND FLUIDS PLANNED WITHIN THE LAST 60 MINUTES? YES NOT APPLICABLE IS ESSENTIAL IMAGING DISPLAYED? YES NOT APPLICABLE THIS CHECKLIST IS NOT INTENDED TO BE COMPREHENSIVE. ADDITIONS AND MODIFICATIONS TO FIT LOCAL PRACTICE ARE ENCOURAGED.

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