Chapter 13: The OR Flashcards
What are the 5 principles of conduct in an OR?
- Sharing goals
- Having clear roles
- Mutual trust
- Effective communication
- Agreeing with measurable processes and outcomes
What is included in a surgical briefing and debriefing?
- Sign-In - Confirm patient, consent, procedues and site
- Briefing - Safety checks, steps of procedure, specific measures (antibiotics)
- Sign-Out - Name of procedure, swab count, sharps count, confirm samples to be submitted
- Debriefing - Review the procedure, any near-misses, if any different steps should have been taken, disclose the patient plan
What benefits are provided by a surgical checklist?
- Decrease intra-op surgeon delay >80%
- Improve patient surgical outcomes
- Decrease intra-op adverse effects
- Decrease post-op mortality
- Overall reduction in hospital mortality
What is the recommended way for sterile team members to change position?
Back-to-back or face-to-face with adequate space between them
What is the recommended ventilation within an OR?
- Horizontal, laminar air flow
- Minimum of 15 air exchanges per hour
- 30-60% humidity
- Temperature 20-23C
Laminar airflow has been associated with a 61% decrease in room bacteria and 92% decrease at the wound site compared to conventional ventilation
Define surgical asepsis:
Complete absence of contamination by pathogenic organisms
Define antiseptic and disinfectant:
- Antiseptic - prevents or reduces the growth or action of pathogenic organisms on living tissue (Alcohols, Iodine)
- Disinfectant - Agents, usually chemical, that destroy most pathogenic organisms but not spores on inanimate objects. (Quaternary ammonium compounds, phenols, chlorine and compounds)
What are the properties of an ideal drape?
- Blood and fluid resistant
- Lint free
- Anti-static
- Able to maintain an isothermic environment
What is the recommended gold-standard hand prep?
Well-formulated waterless hydroalcohol solutions (2 min!)
What are benefits of disposable gowns?
- Less permeable to bacteria (cloth permeates at 30 min)
- More economical
- Decrease surgical infection rate
What are the three options for gloving?
- Closed
- Open
- Assisted
Assited gloving it the most sterile way. Closed and open gloving have been shown to cause contamination of the gown, particularly of the cuff, in 100% of cases compared to 0% with assisted
Why are alcohol scrubs superior?
Rapid killing of bacteria and takes ~6hr for regrowth
Doing a medicated soap first may actually worsen dermatitis (which is harder to decontaminate)
When scrubbing with soap, where should you use the brush part?
Only on the fingertips.
Where is glove penetration most common?
The non-dominant hand
Post op perforation rate of gloves?
Double gloves?
Single: 12.7 -31%
Double: 3.8-13% for inner gloves
