Surgical Case Management Preoperative

Objectives Describe the role of the STSR in caring for the surgical patient. Demonstrate the initial steps for starting a procedure. Demonstrate techniques of opening and preparing supplies and instruments needed for any operative procedure while using sterile technique. Discuss appropriate actions to take when the sterile field is breached. List proper O.R. attire for various surgical procedures.

Preoperative Phase Occurs prior to initiation of the procedure. –Incision –Insertion of scope

Preoperative Phase Duties: –Donning attire and PPE –Preparing the OR –Gathers supplies and equipment –Creates and sets up sterile field –Hand scrub/gown and glove –Drapes patient

Preoperative Phase Surgical technologist’s role in surgery requires the application of many theories. –Principles of Asepsis –Surgical Conscience –Standard Precautions –Critical Thinking/Anticipation –Communication and Teamwork

Principles of Asepsis Goal – Reduction of microbes to an absolute minimum on the sterile field. 1.Creating a sterile field for each procedure. 2.Sterile team members must be appropriately attired before entering the sterile field. 3.Movement in and around the sterile field must not compromise the sterile field.

Breach of the Sterile Field Remove the contaminated item –Most common action. –Remove and replace the contaminated item. –Must fix all contaminations. –Circulator and STSR work as a team.

Breach of the Sterile Field Cover the contaminated item or area. –Items that are contaminated, but cannot be removed. –Impervious drape may be placed over the area.

Breach of the Sterile Field Disregard the contamination –Only due to immediate life/limb emergency. –As soon as emergency passes, take appropriate corrective measures. Antibiotics

Breach of the Sterile Field When in doubt, Throw it out!!!

Standard Precautions Defined by CDC in 1996 All patients are considered potentially infectious. Blood, body fluids, secretions, excretions, non intact skin, and mucous membranes. STSR must be familiar with policies and appropriate PPE.

Standard Precautions Modes of transmission. –Environmental Fomites, vectors, and air. –Surgical team Hair, Skin, Body fluids –Resident/Transient flora Human error

A POSitive CARE approach Acronym for a systematic method for surgical problem solving. Involves critical thinking skills.

A POSitive CARE approach A = Anatomy P = Pathology O = Operative procedure S = Specific variations C = Caring attitude A = Application R = Role E = Environmental concern

Critical Thinking 1.Identify the goal or problem. 2.Gathering and evaluating as much information as possible. 3.Generating one or more responses and considering the implications. 4.Implementing the best response. 5.Assessing the results of the actions taken and making adjustments if needed.

Anticipation Uses the critical thinking model to predict the needs of the patient and surgical team. –Surgeons preference card –Pay attention to the procedure

Communication Speak respectfully and professionally. Focus communication on patient and procedure. Express needs clearly. If unsure, ask. Repeat complicated orders, names of medication, and count information. Ask questions about actions that you are concerned about. Always tell the truth. (Surgical conscience)

Surgical Attire All members of the surgical team requires the wear of specific attire to keep both the patient and the staff safe. 3 examples: –O.R. Attire –Protective Attire –Scrub (sterile) Attire

O.R. Attire Worn in semi-restricted/restricted areas. Keeps microbial count to a minimum. –Scrub suit –Hair cover –Mask –Shoe cover

O.R. Attire Scrub suit –Reduces particle shedding into the OR. –Tuck in shirts and drawstrings. –Changed daily or when soiled. –Lab coats worn outside semi-restricted areas. Patient transport Hospital cafeteria

O.R. Attire Hair cover –Must cover all hair of the head and face. Bouffant, Skullcap, Hoods, Space helmets. –Disposable, single use item. –Reusable hair covers must be laundered daily.

O.R. Attire Mask –Worn in all restricted areas, when sterile supplies are open. –Fit snuggly over mouth and nose. Should be off or on –Contains and filters moisture from the mouth and nose. –Change between procedures/patients.

O.R. Attire Shoe covers –Worn in semi-restricted/restricted areas. –PPE to protect the wearer from gross fluid contamination. –Removed when soiled or leaving surgical suite. –Dedicated O.R. shoes.

Protective Attire Worn with the O.R. attire to protect the wearer. Nonsterile gloves –Worn when coming in contact with broken skin or body fluids.

Protective Attire Protective eyewear –Protects both STSR and circulator from fluid splashes. –Many varieties, find one that protects, is comfortable, and provides maximum visibility. Prescription glasses Laser goggles

Protective Attire Radiation protection –Devices that limit radiation exposure. Portable lead screen Lead apron Thyroid shield Lead glasses Lead gloves

Scrub (Sterile) Attire Worn by sterile surgical team members. Sterile gown and gloves

Scrub (Sterile) Attire Sterile gown –Front of gown from mid chest to waist and sleeves from 2” above elbow are considered sterile. –Stockinette cuffs are considered unsterile.

Scrub (Sterile) Attire Sterile gloves –Worn by all sterile team members. –Various styles and sizes. –Specialty gloves –Double gloving Better protection from sharps and body fluids. Usually wearer will don a larger size first, covered by their normal size.

Preparing the O.R. STSR will prepare for the day by: –Obtaining assigned surgery schedule. –Review surgeon’s preference cards. –Preparatory cleaning of the O.R. Room –Verify and arrange all necessary furniture, equipment, and supplies.

Preparing the O.R. Arrange back table, mayo stand, and ring stand to create a sterile field: –Furthest area away from the door. –12-18 inches away from the wall. O.R. bed centered under surgical lights. Lights positioned and checked for function.

Preparing the O.R. Ensure liners for linen, trash, and biohazardous waste are setup. Suction equipment are checked and new liners are placed. Kick buckets are positioned in place. Case carts are checked for correct supplies and instrumentation. STSR and circulator create the sterile field.

Preparing the O.R. Create and maintain the sterile field. Open sterile supplies. –Verify all sterilization indicators. –Check expiration dates and package integrity. Center back table pack on the back table and open aseptically.

Add sterile supplies aseptically as needed.

Preparing the O.R. STSR create a sterile field on the mayo stand to gown and glove. STSR will perform the surgical hand scrub. After scrubbing the STSR will don a sterile gown and gloves.

Preparing the O.R. STSR will continue with preparing the sterile field. –Dress the mayo stand. –Organizing the back table. –Organizing the mayo stand. –Initial count is performed.

Preparing the O.R. STSR will: –Assist with the gowning and gloving of team members. –Arrange drapes in order of use, and assist surgeon with draping the patient. –Work with the circulator to position sterile tables around draped patient.

Review Pre operative routines Asepsis Standard precautions Critical thinking O.R. Attire Preparing the O.R.

Surgical Case Management QUESTIONS