Chapter 3 : Creating an Environment for Surgery
Healthcare facilities are the environments of controlled hazards.
The hazards introduced into the environment not only by the sick patients but also by naturally occurring condensation include:
The airflow, temperature and humidity in the hospital environment can help to maintain excellent Indoor Air Quality (IAQ) and can help to control the growth of molds, bacteria, viruses and other pathogens.
The purpose of the precautions of infection and aseptic technique is to prevent the transmission of infection.
Infection is the most important and preventable cause of impaired wound healing.
Infection control measures are intended to protect:
Topics covered in this snack-sized chapter:
Indoor Air Quality (IAQ) for infection control and comfort can have a significant effect on patient’s care and health outcomes.
Infection can be controlled by using the following measures:
- Other People in the health care setting.
- The use of barrier protection such as gloves and aprons.
- The safe handling and disposal of “sharps” and medical waste.
High quality heating, ventilation and air conditioning (HVAC) systems are integral to an effective infection control strategy.
Microorganisms can reach the tissues during an operation or manipulation of the surgical wound.
Microorganisms are carried and transmitted by the following:
- Cleaning and sterilization.
- People, including the patient.
The aseptic treatment of a wound is an attempt to prevent contamination by bacteria from all these sources during the operation and throughout the initial phase of healing.
Bacteria can never be absolutely eliminated from the operating field but aseptic measures can reduce the risk of contamination.
Aseptic technique includes attention to innumerable details of operating technique and behavior.
Anyone entering the operating room, for whatever reason, should first put on:
- Inanimate objects, including instruments, sutures, linen, swabs, solutions, mattresses and blankets.
- An impermeable mask to cover the mouth and nose.
- A cap or hood to cover all the hair on the head and face.
Following equipment is essential to surgical care:
- A clean pair of shoes or clean shoe-covers.
Surgical instruments and equipment used in the operating room should be dedicated to their use and should not be removed.
It is essential that all personnel check the medications and equipment they will be using prior to beginning a case or procedure.
The operating theatre is a room specifically for use by the anesthesia and surgical teams and must not be used for other purposes.
A treatment room has an equipment similar to an operating theatre, but on a smaller scale.
Both rooms require:
- Anesthesia and life support equipment.
- Good lighting and ventilation.
- Dedicated equipment for procedures.
- Equipment to monitor patients as required for the procedure.
Ensure that the procedures are established for the correct use of the operating room and that all staff is trained to follow them:
- Drugs and other consumables such as sutures for routine and emergency use.
- Keep all doors to the operating room closed, except as needed for the passage of equipment, personnel and the patient.
- Store some sutures and extra instruments in the operating room to decrease the need for people to enter and leave the operating room during a case.
- Keep the operating room uncluttered and easy to clean.
- Between cases, clean and disinfect the table and instrument surfaces.
- At the end of each day, clean the operating room.
Count supplies (instruments, needles and sponges).
- Leave the operating room ready for use in case of an emergency.
Aim is to ensure that materials are not left behind or lost.
Pay special attention to small items and sponges.
Create standard list of equipment for use as a checklist.
Also make a check list of the instruments for a specific case.
Before each operation all members of the surgical team will scrub.
- On completing the procedure
- Remove all jewellery and trim the nails
Scrub your hands and arms up to the elbows.
After scrubbing hold up your arms to allow water to drip off your elbows.
Turn off the tap with your elbow.
After scrubbing your hands
- Use soap, a brush (on the nails and finger tips) and running water to clean thoroughly around and underneath the nails.
- Dry them with a sterile towel and make sure that towel does not become contaminated.
Patient should bathe the night before an elective operation.
Just before the operation, wash the operation site and area surrounding it with soap and water.
Prepare the skin with antiseptic solution, starting in the center and moving out to the periphery.
Chlorhexidine gluconate and iodine are preferable to alcohol and are less irritating to skin.
The solution should remain wet on the skin for at least two minutes.
All biological waste must be carefully stored and disposed safely.
Contaminated materials such as:
- Hold your hands and forearms away from your body and higher than your elbows until you put on a sterile gown and gloves.
A container for the safe disposal of sharp objects should be:
- Disposable needles are also potentially hazardous and must be treated accordingly.
- Opening large enough to pass needles and scalpel blades.
- Secured to a surface to ensure stability during use.