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Must Read For Surgery Clerkship Procedure Manual
Must Read For Surgery Clerkship Procedure Manual
Table of Contents
1 INTRODUCTION .............
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4 PURPOSE ............
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5 SCOPE ............
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6 RESPONSIBLITY ............
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7.10 Policy: Surgical Safety - Prevention of Wrong Procedure/Side/Site and Wrong Patient (time out
procedures): ............
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8.2.8 Disinfection in Operation Theatre:
8.2.9 OT Fogging protocol: ............
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1 INTRODUCTION
The operation theatre also called as operating room (OR) is a very important
high risk area in the hospital; It is also a high cost area which demands its
proper utilization.
Infection control practices and Quality Assurance activities of the OT have a
vital role in the quality of services provided in the hospital.
Operating theatre complex is one of the important high risk areas in the
hospital.
The complex involves the patient receiving zone, the preoperative area,
operative rooms, the dirty corridor, the clean and dirty utility rooms.
2. Clean
C lean zone
zone : this includes drug store; clean utility;
staff room; doctors room; reception;
4. Disp
Disposal
osal zone: This is th
the
e outer
outermost
most zzone
one an
and
d
comprises of the dirty corridor around the OT
complex. Soiled linen and unsterile instruments are
4 PURPOSE
P URPOSE
5 SCOPE
S COPE
6 RESPONSIBLITY
7 DEPARTMENT POLICY AND PROCEDURES
Qualification of staff:
staff
a. Surgical care will be provided only by qualified surgeons holding Post
Graduate degree area as per MCI norms and experience in the
respective
During scheduling there should enough gap to follow the cleaning and
infection control practices
• Priority will be given to the emergency cases in between the elective
cases.
The following particulars will be entered in the case posting register,
The person performing the surgery will be responsible for the entire consent
process.
The consent is obtained from the patient and or the attendees as per the
hospital’s Informed Consent policy prior to the surgery.
1.1.4. The site for all procedures that involve incisions, percutaneous
punctures, or insertion of instruments must be marked taking into
consideration
1.1.5. All site markings must be made in conjunction with checks made
on the patient’s diagnostic imaging results i.e. X-rays, scans,
electronic imaging or other appropriate test results, ensuring these
match the patient’s medical notes and identity band.
a. Prior to the transfer of the patient the ward nurse informs the OT nurse
about the patient details and confirms the scheduled
sc heduled time for surgery
forty five minutes prior to the scheduled time of surgery.
b. The ward nurse prior to the transfer of the patient ensures that the
nurse’s preoperative checklist is dully filled and all the patient details as
required by the surgeons are arranged in the proper order.
c. The patient is identified by at least two identification parameters.
d. The patient is transferred to the OT as per the hospital’s transfer policy.
a. The patient is received in the preoperative patient holding area of the
theatre.
b. The patient is identified at the entry of the OT complex by the OT staff
nurse
c. The OT nurse evaluates the patient’s details and checks the
preoperative nursing checklist filled by the ward nurse to ensure the
patients preparedness and confirms the patient’s identity by orally
confirming with patient and checking the ID bands and the medical
records.
d. The patient is transferred to the Pre operative room where the
concerned surgeon and anaesthetist undertake immediate
preoperative evaluation.
7.10 Policy: Surgical Safety - Prevention of Wrong Procedure/Side/Site and
Wrong Patient (time out procedures):
ward to the
prior to the initiation
OT, at theoftime of patient’sinside
the procedure entrance to the OT,etc
the theatres suite and
To ensure eliminate the risks endangering the lives and well being of
the surgical patients the WHO surgical Safety checklist has to be
followed to ensure that the team follows a few critical steps for its
effectiveness.
possible) that patient identity has been confirmed, that the procedure
and site are correct and that consent for surgery has been given.
Ideally the surgeon should be present during this phase as the surgeon
operation on the correct patient and site and then verbally review with
one another, in turn, the critical elements of their plans for the
operation, using the Checklist for guidance.
The team should also confirm that prophylactic antibiotics have been
administered within the previous 60 minutes and that essential imaging
is displayed, as appropriate.
Before leaving the operating room, the team should review the
3. When the patient is fully conscious and follows the command, the
patient is shifted to the concerned ward, with written order of the
4. When the patient is deemed fit for discharge from the recovery room,
the recovery nurse should confirm with the ward nurse for the bed and
start shifting of patient.
7.12.1 Definition
7.12.2 Purpose
The role of the recovery nurse is to ensure that the patient is protecting
pr otecting their
airway, breathing freely and perfusing adequately ( airway, breathing and
c irculation).
irculation).
The recovery nurse should also monitor the patient’s pain as the anaesthetic
wears off and ensure that there are no early complications developing, such
as bleeding from the wound or loss of distal circulation and/or sensation.
recovery nurse that the patient is recovering well or warn that a complication
is developing
a. Purpose:
Purpose
Keep nails short and pay attention to them when washing your hands –
most microbes on hands come from beneathb eneath the fingernails.
Do not wear artificial nails or nail polish.
Start timing. Scrub each side of each finger, between the fingers, and
the back and front of the hand for two minutes.
Proceed to scrub the arms, keeping the hand higher than the arm at all
times. this helps to avoid recontamination
r econtamination of the hands by water from
the elbows and prevents bacteria-laden soap and water from
contaminating the hands.
Wash each side of the arm from wrist to the elbow for one minute.
Repeat the process on the other hand and arm, keeping hands above
elbows at all times. If the hand to
touches
uches anything except th
the
e brush at
any time, the scrub must be lengthened by one minute for the area that
has been contaminated.
Rinse hands and arms by passing them through the water in one
direction only, from fingertips to elbow. Do not move the arm back and
forth through the water.
Proceed to the operating room suite holding hands above elbows. At
all times during the scrub procedure, care should be taken not to
splash water onto surgical attire.
Once in the operating room suite, hands and arms should be dried
using a sterile towel and aseptic technique before putting on gown and
gloves.
Procedure:
Hands must be washed thoroughly before gowning
•
Pick up the gown holding it well away from the trolley and your own
•
body.
Hold the neck band and unroll until the sleeves
• sleev es are seen.
Slide both hands and arms into the sleeves at the same time.
•
Remember:
Do not keep the hands lower than the waist line.
•
The gown is carefully removed by the scrub nurse leaving the gloves
•
on.
The gown with the inside folded out is placed in the appropriate bin.
•
The gloves are then removed by holding the inside of the cuff and
•
1. HIV
2. Hepatitis B
3. Hepatitis C
4. MRSA
5. VRSA
6. VRE
7. Gas Gangrene
8. Any Multi Drug Resistant Pathogen
Infectious cases should be posted at the end of the day after all
surgeries
For infected cases universal precautions should be taken
Before procedure minimize the things present inside, keep the things
and trolley outside if it is not necessary.
Use disposal packs and gowns.
g owns.
Use goggles to protect the eyes.
Shoe cover to avoid dripping of body fluids and blood.
Double gloves should be used
Needles should be handled very cautiously.
After the case the OT should be carbolized and Fogged as per the
protocol.
For H1N1, chicken pox, pulmonary tuberculosis any other active cases
require air borne/ droplet precautions patient and the attending staff
should wear N95 masks. Also during the transfer of patients.
Handling of Linen:
All the infected linens should be put in a separate yellow colour bag and be
labelled as Infectious
8.2.8.1 At the beginning of the day:
Monitor
accessories with 70 % Isopropyl alcohol Every case
8.2.8.3 Terminal Cleaning
Pack the linen into double yellow bags and label as infected and sent to
the laundry.
Wash bed pans with detergent and water dry then wipe with 1%
Wipe all IV poles, suction machines, beds, pillows, cots, switch boards,
door
Wash the toilets and hand wash sinks with soap and water
Mop the floor with detergent and water followed by bacillocid special at
2%dilution.
8.2.9.1 Schedule :
8.2.9.2 Disinfectant
8.2.9.3 Dilution:
o Aer
Ae ox:: 250ml in 750 of water per 1000cu ft
Aerox
rox:
o Ecoshield : 200 ml in 800ml of water per 1000cuft
8.2.9.4 Procedure:
Scrubbing:
o Send all linen for washing
o
Wipe OT table, mattress,telephones ,ac grills, lights,
monitors with 2%bacillocid
o Wash (clean) and dry all furniture and equipment suction
wall cupboards).
o Wipe the doors and window panels with damp and dry
cloth to remove dust
o Scrub the floor with a hard brush
o Wipe the walls with 2% bacillocid
bac illocid solution.
o Mop the floor with 2% bacillocid solution.
o HVAC pre filters should cleaned by the people arranged by
maintenance
8.2.9.5 Fogging:
8.2.9.6 Swabbing:
o
Moisten the swab with sterile water .take care to prevent cross
contamination
o Wipe the surface to be sampled with vertical S strokes
•
Surface of OT table
Overhead Lights
•
Monitor Screen
•
A/C Grill
•
Warmer
•
Humidifier Water
•
1. Two Blood Agar plates should be kept exposed for 1Hour, One
at the centre of the room and the other at any one corner of
the room.
2. After Exposure the lid should be closed and sealed with
8.2.9.8 Document:
Formula:
Formula: Number of cases Rescheduled/Number of surgeries performed X
100
Formula:
Formula: Number of cases where the procedure was followed/ Number of
surgeries performed X 100
For
Formul
mula:
a: Number of patients who did receive prophylactic antibiotic(s)/
Formula:
Number of surgeries performed X 100
Formula-
Formula- Number of unplanned return to OT/ Number of surgeries
performed X 100
Formula:
Fo rmula:
rmula: Number of surgical site Infections in a given month/ Number
of surgeries performed in that month X 100
Theatre complex should be absolutely clean at all items. Dust should not
Operating rooms are cleaned daily and the entire theatre complex is cleaned
light reflectors, other light fittings, slabs etc with soap solution. This should
the service corridor (behind the theatre) and place them in trolleys to be
taken for sorting. The dirty linen is then sent to the laundry. Use gloves while
9.3 Instruments
Used instruments are cleaned immediately by the scrub nurse and the
are then sent for sterilization in the CSSD. The instruments are sent in the
instrument tray for autoclaving. They are then packed and re-autoclaved
before use.
9.4 Environment
Wipe used equipment, furniture, OR table etc., with detergent and water. If
there is a blood
b lood spill, disinfect with 1 % sodium hypochlorite before wiping.
The same procedures as mentioned above are followed and in addition the
with 2 % bacillocid
• Wash floor and wet mop with liquid soap and then remove water and wet
• Clean doors, hinges, facings, glass inserts and rinse with a cloth
Stainless steel surfaces – clean with detergent, rinse & clean with warm
•
water.
Wash (clean) and dry all furniture and equipment (OT table, suction
•
holders, foot & sitting stools, Mayo stands, IV poles, basin stands, X-ray
view boxes, hamper stands, all tables in the room, holes to oxygen
solution
Before spraying the area is swept and the area is mopped with clean water.
Evenly does the spray close the room and allow it to dry for 1 hour. After 1
hour mop the floor with plain water with a clean mop cloth.
routinely
Urgent repairs should be carried out at the end of the days list
•
10 Annexure
10.1 Annexure 1: Surgical Safety Checklist: