THE PERIOPERATIVE PATIENT CARE TEAM 2.
The nonsterile team
HISTORICAL BACKGROUND
Early surgical practitioners did not have qualified teams
to rely on when a patient needed surgery
American Civil War (1861-1865), the Confederate
Medical Departments of the Army and Navy were
staffed by medical officers, hospital stewards, matrons,
nurses and ward masters
 Medical schools in the North offered a program
of study that consisted of 5months of lectures
followed by the Southern medical schools;
Medical College of Georgia increased the study
period to 9 months ;Medical Graduates increase
in number from35 in 1850 to 133 in 1861 to
meet the needs of war
 Training of nurses during the Civil War was
sponsored by religious orders
 In the North, Dr. Elizabeth Blackwell, friend of
Florence Nightingale supported formal training
for nurses & tried to bring it into the formal
hospital setting
 Clara Barton play a major role in the Civil war by
founding the American branch of International
Red Cross
 1872, after the war, Dr. Susan Dimock went to
Kaiserswerth, Germany Implemented the
Nightingale teaching methods in New England
THE PERIOPERATIVE TEAM
 The team works to promote the best interest of
the patient every single minute – they must
work efficiently as a functioning single unit
 The members should be thoroughly familiar
with procedures, setups, equipment and
policies & should be able to cope with the
unpredictable
 Each member should have a high morale,
mutual Understanding, trust, cooperation &
consideration
 All OR personnel should have the proven skill,
knowledge, competency and ability to perform
at an optimal level at all times
 The perioperative team is subdivided according
to the functions of its members:
1. The Sterile Team
 Surgeon
 First assistant
 Scrub person
 Anesthesia provider
 Circulator
 Perianesthesia nurse
 Others: students, sales
representatives, laboratory or x-ray
personnel
STERILE TEAM
 members scrub their hands and arms, don a
sterile gown and gloves and enter the sterile
field
 The STERILE FIELD is the area of the OR that
immediately surrounds & is specially prepared
for the patient
 To establish & maintain a sterile field, all items
needed for the surgical procedure are sterile &
handled in a sterile manner
NONSTERILE TEAM MEMBERS
 do not enter the sterile field; they function
outside and around it
 they assume responsibility for maintaining
sterile & aseptic techniques during the surgical
procedure
 they handle supplies & equipment that are not
considered sterile
 Following the principles of sterile technique,
they
 keep the sterile team supplied, provide direct
patient care & handle situations that may arise
during the perioperative care period
NONSTERILE TEAM MEMBERS
1. PERIANESTHESIA TEAM
 consists of registered nurses & trained patient
care assistants
 preoperatively the RN assesses the patient &
documents findings that is communicated to
the intraoperative team members
2. ANESTHESIA PROVIDER
 is an indispensable member of the
perioperative team
 functioning as a guardian of the patient
throughout the entire care period, manages the
patient’s physiology using the principles of
aseptic technique
 anesthesiologist is a doctor of medicine or
doctor of
  osteopathy certified by the board of
anesthesiology; it could be a qualified RN or
dentist under the direct supervision of the
anesthesiologist or surgeon
 used to refer to the person responsible for
inducing & maintaining anesthesia at the
required levels & managing untoward
physiologic reactions throughout the surgical
procedure & after the procedure until the
patient regained control of his or her vital
functions
CIRCULATOR
 is preferably an RN; a qualified surgical
technologist may assist with circulating duties
under the supervision of an RN
 is vital to the smooth flow of events before,
during & after the surgical procedure
 the surgeon relies on the circulator to monitor
and coordinate all activities within the room &
to manage the care required for each patient
 controls the physical & emotional atmosphere
in the room which allows other team members
to concentrate on tasks without distraction
 should be always available at all times to
respond to emergencies in the perioperative
environment
NONSTERILE TEAM MEMBERS
 the circulating nurse is vital to the provision of
care that includes, but is not limited to the
following:
 Application of the nursing process in
directing & coordinating all activities related
to the care & support of the patient in the
OR
 Creation & maintenance of a safe &
comfortable environment for the Patient by
implementing the principles of asepsis
 Provision of assistance to any member of
the OR team in any manner for Which the
circulator is qualified
 Ensure that the sterile team is supplied with
every item necessary
 Must know all supplies, instruments &
equipment; obtain them quickly & guard
against inadvertent hazards in their use &
care
 Identification of any potential
environmental danger or stressful situation
involving the patient, other team members
or both
 Maintenance of the communication link
between events & team members in the
sterile field & persons who are not in the
OR but are concerned with the outcome of
the surgical procedure
 Direction of the activities of all learners;
must have the supervisory capability &
teaching skills necessary to ensure
maintenance of a safe & therapeutic
environment for the patient
 BIOMEDICAL TECHNICIANS
 NURSING AUXILLIARIES
STERILE TEAM MEMBERS
1. SURGEON
 must have the knowledge, skill & judgment
required to success- fully perform the intended
surgical procedure & any deviations
necessitated by unforeseen difficulties
 responsibilities include preoperative diagnosis
& care, selection & performance of the surgical
procedure & postoperative care
 appropriate clinical skills and appropriate
personal characteristics are important
attributes of a surgeon
2. FIRST ASSISTANT
 under the direction of the surgeon helps
maintain visibility of the Surgical site, control
bleeding, close wounds & apply dressings
 Handles tissues & instruments; their role vary
with the type of procedure or surgical specialty,
the condition of the patient & the type of
surgical facility.
 the need for assistant depend on: anticipated
blood loss, anesthesia time for the patient,
fatigue factors affecting the OR team and
potential complications
3. SCRUB PERSON
 is a patient care staff member of the sterile
team; it may be filled by an RN, a licensed
practical/vocational nurse or an surgical
assistant.
 used throughout to designate this role & to
elaborate on the specific technical & behavioral
functions of the individual performing on the
sterile team
 is responsible for establishing & maintaining the
integrity, safety,& efficiency of the sterile field
throughout the surgical procedure
 knowledge of & experience with aseptic &
sterile technique qualify the scrub person to
prepare & arrange instruments & supplies and
to facilitate the surgical procedure by providing
the required sterile instruments & supplies
 must anticipate, plan for and respond to the
needs of the surgeon & other team members by
constantly watching the sterile field
 manual dexterity & physical stamina are
required to include stable temperament, an
ability to work under pressure, a keen sense of
responsibility & a concern for accuracy in
performing all duties
RECOMMENDED PRACTICES
 Policies & Procedures
 Identification of the Patient
 Identification of the surgical site
 Protection of Personal Property
 Observation of the Patient
 Positioning of the Patient
 Aseptic & Sterile Technique
 Accountability of Accurate Counts
 Use of Equipment
 Prevention of Skin Injury
 Administration of Drugs
 Monitoring the Patient
 Preparation of specimen
 Patient teaching
ADMINISTRATION OFPERIOPERATIVE PATIENT
CARE
PHYSICAL FACILITIES
HISTORICAL BACKGROUND
 Surgical procedures were not always performed
within the confines of a formal hospital setting
 Suitable room with less traffic & ambient noise
usually the dining room & occasionally the
kitchen.
 Fumigated with sulfur dioxide for 12 hours then
scrub with 5% carbolic acid or hot soda solution
 As Colleges of surgeon are instituted operating
rooms were more disclosed in a separate room
intended for surgical procedures & study
 During the Civil War, medical soldiers do the
procedure on the camp field for proper lighting
 Later on, surgical procedures were done inside
the tents to observe aseptic technique
 Because of the theory that surgery contributes
to infection & other related complication,
medical soldiers of the Civil war made their OR
more sophisticated by making underground
quarters
 Hospital settings were beginning to built up
with a separate room for the surgical
procedures & the introduction of surgical
equipments & steel OR bed
 Significant advances were made in OR settings
because of the introduction of state of the art
technologies that continues to improve in the
modern era
PHYSICAL LAYOUT
 The design of the surgical suite offers a
challenge to the planning team to optimize
efficiency by creating realistic traffic and
workflow patterns for patients, visitors,
personnel and supplies
 Design should also allow for flexibility and
future expansion
 The planning and design of the perioperative
environment requires a multi-disciplinary team
or design team
 Principles are applied in the construction or
renovation planning; it includes Concepts of the
following:
a. Strategic planning
b. Plans for emergencies
c. Exclusion of contamination from
outside the suite with sensible traffic
patterns to and from the suited.
 d. Separation of clean areas from
contaminated areas within the suite
during the building phase
e. Noise Control
PHYSICAL PLANT DESIGN
 Most surgical suites are constructed according
to a variation of one or more of four basic
designs:
1. Central corridor or hotel plan
2. Central core, or clean core plan
with peripheral corridor or
racetrack plan
3. Grouping or cluster plan with
peripheral and central corridor
 Location: usually located in an area accessible
to the critical care surgical patient areas & the
supporting service departments, the central
service or sterile processing department, the
pathology department and the radiology
department
 Space Allocation: space is allocated within the
surgical suite to provide for the work to be
done, with consideration given to the efficiency
with which it can be accomplished
 Traffic Patterns: type of design will
predetermined traffic patterns;all
Persons – staff, patients and visitors should follow
the delineated patterns in appropriate attire
 Unrestricted Area: street clothes are permitted;
this area is isolated by doors from the main
hospital corridor or elevators & from other
areas of the surgical suite
 Semirestricted Area: traffic is limited to
properly attired, authorized personnel scrub
suits & head coverings are required attire;this
area includes peripheral support areas and
access corridors to the ORs; the patient’s hair is
also covered
 Restricted Area: masks are required to
supplement OR attire where open sterile
supplies or scrubbed personnel are located; this
area also include scrub sink areas and
substerile rooms or clean core area where
unwrapped supplies are sterilized; hair covering
is worn & masks are donned as appropriate
 Transition Zones: both patients & personnel
enter the semirestricted and restricted areas of
the surgical suite through a transition zone; this
zone inside the entrance to the surgical suite,
separates the OR corridors from the rest of
facility
TRANSITION ZONES
 Preoperative Check-In Unit
 unit is not available for admission of
patients who arrive shortly before
surgical procedure, this facility must be
provided within the unrestricted area of
the surgical suite for patients to change
from street clothes into gown
 this must ensure privacy
compartmentalized with individual
cubicles or be an open area with
curtains
 Preoperative Holding Area
 a designated room or area should be
available for Patients to wait in the
surgical suite
 hair removal & insertion of IV lines,
indwelling urinary Catheters & gastric
tubes may be done here
 anesthesia provider could insert
invasive monitoring lines & give
regional blocks
 it requires good lighting; equipped with
oxygen, suction, & devices for
monitoring & cardiopulmonary
resuscitation
 there is also a nurse station for
medication & Interdepartmental
communication
 Induction Room
 this is adjacent to each OR where the
patient waits & is prepared
preoperatively before administration of
anesthesia
 Postanesthesia Care Unit
 it may be outside the surgical suite or it
may be
 Adjacent to the suite so that it may be
incorporated into The unrestricted area
with access from both the semi-
Restricted area & an outside corridor
 it becomes a transition zone for the
departure of patients
 Waiting Area
 must be provided for both men & women
to change from street clothesinto OR attire
 before entering the semirestricted area &
vice versa
 lockers are usually provided where doors
separate this area from Lavatory facilities &
adjacent lounges
PERIPHERAL SUPPORT AREAS
 adequate space must be allocated to
accommodate the needs of OR personnel &
support services
 the need for equipment, supply & utility rooms
and housekeeping determines support space
requirements
 Central Control Desk
 Offices
 Conference Room / Classroom
 Support Services: Laboratory,
Radiology Services
 Work Areas: Anesthesia Work &
Storage Areas; Housekeeping
 Storage Areas, Central Processing
Area, Utility Room, General
 Workroom
 Storage Areas: Sterile Supply
Room, Instrument Room
 SCRUB ROOM
 an enclosed area for preoperative
cleansing of hands and arms should be
provided adjacent to each OR
 paper towel dispensers & mirrors
should be located in this area; trash
receptacles are limited to only those
items used within this room and should
be emptied several times per day
 OPERATING ROOM
 SIZE: varies; it is desirable to have all
ORs the same size so that they can be
used interchangeably to accommodate
elective & emergency surgical
procedures
 SUBSTERILE ROOM: a group of two or
three or four Ors may be clustered
around a central scrub area, work area
and a small substerile room; it contains
sink, steam sterilizer, and/or washer-
sterilizer
 DOORS: ideally, sliding doors should be
used exclusively in the OR because they
eliminate air currents caused by
swinging doors;it should not remain
open
 VENTILATION: must ensure a controlled
supply of filtered air; air changes and
circulation provide fresh air and prevent
accumulation of anesthetic gases; room
temperature is maintained within the
range of 20 to 23 celsius
 FLOORS: before floors are conductive
enough to dissipate static from
equipment and personnel; at present
seamless polyvinyl chloride is used up
to the sides of the walls; slip-proof floor
when wet
 WALLS & CEILING: all surface material
should be hard, non porous, fire
resistant, waterproof, stainproof,
seamless, nonreflective and easy to
clean; walls should be pastel color with
paneling made of hard vinyl materials
that is easy to clean & maintain
 PIPED IN GASES, COMPUTER LINES &
ELECTRICAL SYSTEMS: vacuum for
suction, anesthetic gas evacuation,
compressed air, oxygen and/or nitrous
oxide may be piped into the OR;
computer lines for monitors or personal
computers; electrical outlets should be
readily available
 LIGHTING: general illumination is
furnished by ceiling lights; room lights
are white flourescent but may be
incandescent; recessed lights do not
collect dust; lighting should be evenly
distributed throughout the room
without harsh shadows & to adequately
evaluate the patient’s color in order not
to cause the organs to appear
discolored
 X-RAY VIEW BOXES,CLOCKS,
CABINETS/CARTS
 FURNITURE & OTHER EQUIPMENTS:
stainless steel furniture is plain, durable
and easily cleaned. Each OR is equipped
with the following:
 Operating bed with mattress covered
with an impervious surface,
 Attachments for positioning the patient
and armboards
 Instrument Tables
 Mayo Stand: it is a frame with
removable rectangular stainless steel
tray
 Small tables for gowns & gloves and/or
the patient’s preparation

 Equipment

 Ring stand for basins

 Anesthesia machine and table for

anesthesia provider’s equipment

 Sitting stools and standing platforms

 IV poles for IV solution bags

 Suction canisters, preferably portable

on a wheeled base

 Laundry hamper frame

 Kick buckets in wheeled bases

 Wastebasket

 Writing surface