Introduction to the Health Care Facility

Introduction to the Health Care Facility
Chapter 5 Introduction to the Health Care Facility

Operating Room Design Principles
Infection control Physical separation Clean areas Contaminated areas Containment Confinement Operating rooms are designed to allow for a controlled traffic flow and to keep the general public out of the operating room suite. Careful separation between clean and dirty items must be strictly maintained in the operating room to prevent cross-contamination of objects. Elsevier items and derived items © 2010, 2007 by Saunders, an imprint of Elsevier Inc.

Environmental National medical engineering standards for Electrical circuits Gases Lighting Environmental controls within the operating room must conform to strict guidelines. Discuss the specific environmental controls. Elsevier items and derived items © 2010, 2007 by Saunders, an imprint of Elsevier Inc.

Efficiency Physical effort Materials Time Space Equipment must be stored within the operating room in a manner that allows for its easy and efficient use. Commonly used items must be easily obtainable by the staff. Elsevier items and derived items © 2010, 2007 by Saunders, an imprint of Elsevier Inc.

Floor plans Transitional area Central core Which floor plan do you think is the most efficient, and why? Provide floor plans of some of your clinical affiliates and have the students determine what the design is. Elsevier items and derived items © 2010, 2007 by Saunders, an imprint of Elsevier Inc.

What are some benefits and liabilities of this design?
Refer students to Figure 5-1 in the text to illustrate the “race track” design. What are some benefits and liabilities of this design? (Modified from Phillips N: Berry and Kohn’s operating room technique, ed 10, St Louis, 2004, Mosby.) Elsevier items and derived items © 2010, 2007 by Saunders, an imprint of Elsevier Inc.

What are some benefits and liabilities of this design?
Refer students to Figure 5-2 in the text to illustrate the central corridor design. What are some benefits and liabilities of this design? (Modified from Phillips N: Berry and Kohn’s operating room technique, ed 10, St Louis, 2004, Mosby.) Elsevier items and derived items © 2010, 2007 by Saunders, an imprint of Elsevier Inc.

Traffic patterns Unrestricted Semirestricted Sterile or restricted Locker rooms Traffic follows a preset, restricted flow within the operating room to reduce the spread of disease. Elsevier items and derived items © 2010, 2007 by Saunders, an imprint of Elsevier Inc.

Unrestricted areas Transitional area Personnel Attire Lounge The unrestricted area of the operating room has the least restrictions on attire and equipment handling. More clothing and equipment handling restrictions must be observed in the transitional areas of the operating than in the unrestricted areas. What are the clothing requirements in transitional areas? Elsevier items and derived items © 2010, 2007 by Saunders, an imprint of Elsevier Inc.

Semirestricted area Patient holding area Attire Check-in point Surgical offices Central communication What areas of the operating room are found in the semirestricted zone? What operating room attire must be worn here? Elsevier items and derived items © 2010, 2007 by Saunders, an imprint of Elsevier Inc.

Semirestricted area (cont.) Corridors Lead directly to the OR suites Scrub sink areas Located directly outside of the OR suite Equipment and supply rooms Storage Entering the semirestricted area requires close attention to attire and equipment handling. Any breach in dress or equipment care could compromise the sterility of the sterile core. The semirestricted area must be kept neat and clean to prevent injuries in moving supplies and equipment. This is a place where operating rooms tend to store extra equipment, such as the hallway. The staff must be able to move freely through the hallways without having their path impeded by storage items. Many operating rooms have fire doors in the hallways. These doors must ALWAYS be clear of any supplies and equipment or patient stretchers. The doors automatically close in the event of an emergency Elsevier items and derived items © 2010, 2007 by Saunders, an imprint of Elsevier Inc.

Semirestricted area (cont.) Utility workroom and central processing decontamination area Separation is key Clean processing room Assembly and sterilization Why must the decontamination area be kept physically separated from the instrument reprocessing and wrapping area? What would be the potential threat to the patient if these areas were not separated but were allowed to function side by side? Elsevier items and derived items © 2010, 2007 by Saunders, an imprint of Elsevier Inc.

Semirestricted area (cont.) Anesthesia workroom Contains anesthesia supplies and equipment Postanesthesia care unit (PACU) Postoperative recovery unit The PACU and the anesthesia workroom are considered semirestricted environments. That explains why parents may be allowed to visit their minor children in the PACU. To keep the general public out and ensure a controlled traffic flow, the PACU and the anesthesia workroom are part of a well-controlled semirestricted environment. Elsevier items and derived items © 2010, 2007 by Saunders, an imprint of Elsevier Inc.

Operating Room (Surgical) Suite
Equipment and furniture Operating table Adjustable Padded Has removable arm boards Has leg holders Has cassette attachment for x-ray exams All ancillary operating room equipment must be kept clean by visual inspection. All surgical furniture and equipment must be nonporous. Elsevier items and derived items © 2010, 2007 by Saunders, an imprint of Elsevier Inc.

Operating tables are made of stainless steel. They are narrow to facilitate the surgeon reaching the surgical site. They have a small amount of padding to increase patient comfort. Why is it important to be able to manipulate the operating table into a variety of positions? Provide examples of operating tables that are specialty specific, such as a fracture table and an eye stretcher. Operating table. (Courtesy of STERIS Corp, Mentor, Ohio.) Elsevier items and derived items © 2010, 2007 by Saunders, an imprint of Elsevier Inc.

Equipment and furniture Back table Holds instruments used for surgery Covered with sterile drapes The back table must be positioned at waist height and be large enough to accommodate a variety of instrument sets. The back table is designed as a holding area for surgical instruments needed for the procedure but not in immediate use. The surgical technologist prepares the back table and arranges the instrumentation according to need and use. Elsevier items and derived items © 2010, 2007 by Saunders, an imprint of Elsevier Inc.

Back tables are available in various sizes. Some are narrow, and some are wide. Some are longer than others. Depending on the surgery to be performed and the number and the size of instruments required, the surgical technologist must choose an appropriately sized back table to hold the instrumentation. Back table. (Courtesy of Pedigo Products, Vancouver, Wash.) Elsevier items and derived items © 2010, 2007 by Saunders, an imprint of Elsevier Inc.

Equipment and furniture Mayo stand Adjustable stand supported by two legs Holds instruments Covered with sterile drapes The Mayo stand is available in a variety of sizes. Some are wider and longer than others. Choose the appropriate stand according to the type of procedure and instruments to be held on it. Elsevier items and derived items © 2010, 2007 by Saunders, an imprint of Elsevier Inc.

The surgical technologist must keep the Mayo stand organized during the surgical procedure. Mayo stand. (Courtesy of Pedigo Products, Vancouver, Wash.) Elsevier items and derived items © 2010, 2007 by Saunders, an imprint of Elsevier Inc.

Equipment and furniture Kick bucket Disposal of soiled sponges Single ring stand Holds a basin Double ring stand Holds two basins The kick bucket should contain a liner so bloody sponges are caught in the liner and not in the bucket itself. The kick bucket should be placed near the surgical technologist for easy disposal of soiled sponges. Garbage does NOT go in the kick bucket. The kick bucket is for soiled sponges and other lightweight nonsharp items ONLY. The most commonly used ring stand is the single ring stand. It is used to support a sterile single basin intraoperatively. Elsevier items and derived items © 2010, 2007 by Saunders, an imprint of Elsevier Inc.

Equipment and furniture Preparation table Step stool Blanket warmers Clocks Time of day Stop watch The preparation table is used by the nonsterile surgical technologist, circulating room nurse, or anesthesiologist to “prep” the patient for surgery. This includes spinal anesthesia administration, urinary catheterization, and surgical prep. The step stools are used to raise the scrubbed persons or any observers in the OR so that they can see into the patient’s wound. The prep table and the step stools must be wiped down after each case since they can collect microorganisms from the patient and the environment. Stop watches are used for a variety of reasons in the OR. Before using a stop watch to time a procedure, make sure it has been reset to zero. Elsevier items and derived items © 2010, 2007 by Saunders, an imprint of Elsevier Inc.

Equipment and furniture X-ray viewing boxes Computers Communication systems Intercom Phone Supply cabinets In-room supply storage In-room supply cabinets must be restocked by the assigned room staff at the end of the day. Elsevier items and derived items © 2010, 2007 by Saunders, an imprint of Elsevier Inc.

Environmental controls Airflow Air pressure Air exchanges HEPA (high efficiency particulate air) filters Laminar airflow What agency sets the environmental controls for the operating room? What is the purpose of the positive pressure differential? Elsevier items and derived items © 2010, 2007 by Saunders, an imprint of Elsevier Inc.

Environmental controls Humidity 50%-55% Temperature 68º to 73º Fahrenheit Electricity At the start of the day, the assigned room staff must complete a safety inspection of the room, which includes checking the humidity, the temperature, and the grounding system within the room. How are emergency power outlets identified in your clinical affiliate operating rooms? Elsevier items and derived items © 2010, 2007 by Saunders, an imprint of Elsevier Inc.

Environmental controls In-line gas and suction Lighting Overhead lighting Headlight What department would be called for a problem with the in-line gases and suction? Elsevier items and derived items © 2010, 2007 by Saunders, an imprint of Elsevier Inc.

Special procedures room Specialized rooms containing equipment for a specific specialty Integrated OR system May provide centralized control of equipment Provide examples of special procedures that require special rooms. Provide some benefits for the integrated OR. Elsevier items and derived items © 2010, 2007 by Saunders, an imprint of Elsevier Inc.

Other working areas Surgical offices Patient holding areas Scrub sink areas Substerile area Sterile instrument room Where is information on the preoperative checklist verified? Is the substerile area a restricted area? Why? Elsevier items and derived items © 2010, 2007 by Saunders, an imprint of Elsevier Inc.

Other working areas (cont.) Equipment storage area Utility workroom and decontamination area Clean processing Anesthesia workroom Postanesthesia care unit Surgery waiting area What is the purpose of a case-cart? Who prepares it and when? Provide examples of some of the physiological risks of the patient emerging from anesthesia. Elsevier items and derived items © 2010, 2007 by Saunders, an imprint of Elsevier Inc.

Hospital Departments and Functions
A team approach Pathology Nuclear Medicine and Interventional Radiology Infection Control Biomedical Engineering Materials Management Central Supply Pharmacy Provide examples of the pathologists’ responsibilities. Why are surgical technologists sometimes required to assist in interventional radiology? What standards and recommendations does the infection control department base its policies on? Elsevier items and derived items © 2010, 2007 by Saunders, an imprint of Elsevier Inc.

Hospital Department and Functions
A team approach Blood Banking Risk Management Switchboard Medical Records Maintenance Environmental Services Provide examples from your own clinical experience of events requiring risk management. Elsevier items and derived items © 2010, 2007 by Saunders, an imprint of Elsevier Inc.

Personnel in Health Care
Administration and policy Principles of administration, organization, and physical layout are similar for different facilities Accreditation Process Reimbursement The Joint Commission (TJC) standards Provide examples of settings in which surgery is performed. How does hospital accreditation benefit patients? Elsevier items and derived items © 2010, 2007 by Saunders, an imprint of Elsevier Inc.

Health care policy Creates a standard that protects the patient Must be available to the staff in written form May be pertinent to specific areas Employees are required to read policies Hospital policy manuals must be made available for all staff to reference at any time. It is the employee’s responsibility to read and become familiar with the hospital’s policies. Elsevier items and derived items © 2010, 2007 by Saunders, an imprint of Elsevier Inc.

Management and structure Board of Directors Responsibilities Medical staff Delivers patient services Administration To whom does the chief executive officer (CEO) of a hospital report? How does a physician obtain privileges from a hospital? Provide examples of the administrative responsibilities. Elsevier items and derived items © 2010, 2007 by Saunders, an imprint of Elsevier Inc.

Organizational Chart Chief Executive Officer Vice President Director of Perioperative Services Preoperative Operating Room Postanesthesia Care Manager Manager Care Manager It is very important that all employees follow the organization’s chain of command. Skipping steps in the chain leads to communication breakdowns. Elsevier items and derived items © 2010, 2007 by Saunders, an imprint of Elsevier Inc.

Chain of command Vertical alignment Horizontal alignment Outline the chain of command of one of your clinical affiliates for the students. Have the students outline the chain of command of their college institution, and then demonstrate the chain of command (as a comparison) for one of the local community hospitals. Elsevier items and derived items © 2010, 2007 by Saunders, an imprint of Elsevier Inc.

Staff roles Licensed professional staff Surgeon Assistant surgeon Anesthesia care provider Registered nurse Licensed practical nurse How can role confusion lead to patient safety risks? Elsevier items and derived items © 2010, 2007 by Saunders, an imprint of Elsevier Inc.

Staff roles Allied health personnel Certified surgical technologist Certified surgical technologist – certified first assist Certified surgical assist Certified anesthesia technologist Physician assistant Provide examples of the differences between the certified surgical technologist and the certified surgical technologist—certified first assistant. Elsevier items and derived items © 2010, 2007 by Saunders, an imprint of Elsevier Inc.

Administrative and educational Health facility management Chief operational officer (CEO) Perioperative nurse manager Operating room manager Ancillary staff Unit secretary Surgical orderly or aide Central sterile processing technician Provide examples of the responsibilities of the perioperative nurse manager. Provide examples from your own clinical experience of educational programs or in-services provided by the operating room educator. What training would a unit secretary need for the operating room? Elsevier items and derived items © 2010, 2007 by Saunders, an imprint of Elsevier Inc.

Introduction to the Health Care Facility

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