The operating room should be connected with the surgical department, but also with the blood bank, clinical nursing room, anesthesia recovery room and other proximity. Grasp the surgical incision infection four ways of link management, namely: the operating room air; surgical items needed; doctors and nurses fingers and the patient's skin, to prevent infection, to ensure the success rate of surgery.
I, the design of the operating room and equipment
(a) the design of the operating room
Sitting south to north, located in the building of the higher, to keep the air clean, to prevent nosocomial infections for the principle of the ground, the walls can be washed. To three zones are reasonably divided: that is, there are non-restricted areas, semi-restricted areas, restricted areas. There should be three channels: staff channel, patient access channel, dirt exit channel. The material should be fireproof, moisture resistance, not easy to color, to have easy to clean and other properties of the material is appropriate. Modern operating room should be designed with: air purification devices, central oxygen supply, central suction and other devices.
(B) operating room equipment
In addition to the general operating room with conventional equipment, there should be closed-circuit television, air-conditioning, high-level electric knife (imported), in order to ensure that no accidental power outage affects the operation, the hospital should be equipped with power generation facilities. Do not make the operating room floor pollution, it is best to use the exchange of carts and other modern carts.
(c) the layout of the operating room should strive to be simple, the cabinet should be made of moisture-resistant, solid material to facilitate cleaning. All items should be fixed settings, keep the storage in order, and strive for uniformity and standardization of each room.
Two, operating room staffing and hospital surgical beds
The ratio of operating room nurses and surgical beds should be: 2.5:1, teaching hospitals 3:1. surgical beds set up: 50 beds to set up 1 surgical beds in the Department of Surgery is appropriate, the hygienist 0.5:1 is appropriate. Set up a nurse 1 to 2 people.
Three, operating room regulations
Operating room is the operating room physicians, anesthesiologists and operating room personnel *** with the workplace, the flow of personnel, in order to ensure orderly work, not only the operation of the procedures, but also a certain system of work, in order to enable the smooth completion of the operation of various disciplines.
(a) the operating room general work system
1. All staff who enter the operating room, you must wear operating room shoes, hats, clothes and masks, leaving the operating room, you should change the outwear and shoes.
2. Visitors from outside the hospital for visiting, study and internship must be approved by the Medical Education Department or the Nursing Department and should have a fixed location.
3. For elective surgeries in all departments, the surgical notification form should be sent before 10:30 a.m. on the day before the surgery. For emergency rescue surgeries, verbal notification can be given first, and the surgical notification form can be added later.
4. Surgeries are performed according to the time of the surgical notification form and must be on time. Contact the nurse for special cases.
5. Pick up the patient 30 minutes before the operation, bring along the medical record, and check the patient's name, gender, age, bed number, diagnosis, surgical site and drug sensitivity test, preoperative medication in detail. After the patient into the room, the roving nurse should review once, pay attention to the patient's surgical site clean range, jewelry, dentures, watches shall not be brought into the operating room.
6. Strict aseptic operation techniques. Aseptic surgery and bacterial surgery should be carried out in separate rooms, special infections shall be special sterilization treatment.
7. Keep serious and quiet in the room, prohibit loud noise, no chatting, reading newspapers during surgery.
8. Strict implementation of indoor sanitation and hygiene treatment and isolation, disinfection and testing system, the implementation of medical safety precautions.
9. The operating room should always be equipped with a variety of emergency surgical kits and rescue equipment, surgical equipment shall not be borrowed, such as borrowing needs to be approved by the Medical Education Department.
10. Operating room instruments should be sterilized on the basis of cleanliness, all kinds of drugs and instruments should be placed in a fixed position, valuable instruments in the custody of a person, monthly inventory, repair and maintenance. Narcotic poisonous products marked obvious, locked and stored by a person, ordinary drugs daily inventory and records, monthly inspection, a person in charge.
11. Responsible for the custody and delivery of specimens collected during the operation, ask the doctor to fill out the pathology specimens in a timely manner, delivery of specimens, and make a good delivery of the registration, and urge the timely delivery of specimens.
(B) operating room hospital infection management system
1. Management of personnel entering the room
(1) All staff entering the operating room must change clothes, hats, pants, shoes, and are not allowed to bring personal belongings into the work area.
(2) The staff entering the room must wear a dome cap and a mask when entering the restricted area.
(3) Staff members have a physical examination once a year, are vaccinated against Hepatitis B according to regulations, and those who suffer from infectious diseases are not allowed to enter the room to work.
(4) surgical patients before entering the room, must change clean clothes, pants, hats and wear footwear.
(5) Cart wheels entering the operating room must be sterilized before entering the semi-restricted area.
(6) Staff must change into work clothes, caps, pants and shoes when going out.
2. Visiting system
(1) Non-room staff and non-surgical personnel are not allowed to enter without permission.
(2) Further training and internship personnel must follow the above provisions, and internship personnel must be led by the instructor and may not enter the operating room alone.
(3) Visitors must change their clothes, cap pants, shoes, masks and move around in the designated area with the consent of the Medical Education Department or the Nursing Department, and must not walk through the area arbitrarily.
(4) In addition to the daily cleanliness and hygiene must be done, one day a week is fixed as a hygiene day, thoroughly clean and disinfect the operating room.
(5) special slippers daily soaked in disinfectant, cleaned and dried for spare parts, shoe cabinets with disinfectant wipe , once a day.
(C) sterilization and isolation system in the operating room
1. Strictly divided into restricted area (sterile area), semi-restricted area (clean area), non-restricted area (contaminated area), the interval has a clear sign, and strict compliance with the principle of the three-channel, the operating room according to the aseptic, non-sterile, contaminated surgical separation of rooms.
2. Careful hand washing, in strict accordance with the disinfection of hand washing methods and steps, monthly finger culture of the surgeon, hand washing nurses once a month, to be documented.
3. Soaking solution and alcohol, daily measurement of specific gravity, weekly replacement of containers and disinfectant 1 to 2 times, to be documented.
4. The surgeon and instrumentation nurses should strictly carry out aseptic operation procedures after wearing sterile gloves.
5. Roving nurses should be well prepared, minimize going out and walking around, and the door of the operating room should not be opened casually.
6. Receiving table operating personnel between two operations to wash their hands, disinfect their arms and change the sterile surgical gowns and gloves, and wipe the surface of the object and the ground with disinfectant.
7. To do a good job of the final sterilization of all kinds of items.
8. Surgical ultraviolet requirements: power ≥ 30W/m3, lamps from the ground <2.5m, with ultraviolet reflector, radiation intensity > 70uw/cm2.
9. Where the need for surgery patients are preoperative check of liver function, Hepatitis B complete set of antigenic antibody, positive patients are treated according to the requirements of the isolation of infectious diseases technology.
(D) general infection surgery
1. Instruments, dressings, syringes, gloves, drainage bottles, etc. should be immersed and sterilized according to the routine treatment.
2. The operating room is ventilated with open windows, surgical beds, trolleys, object surfaces are wiped with disinfectant, the floor is mopped, and the air is disinfected with ultraviolet light.
(E) special infection surgery, isolation surgery
1. In-situ surgery as a principle, the use of disposable dressings, instruments, syringes is good, the door hanging isolation sign.
2. Intraoperative gauze, dressings and other combustible items should all be incinerated.
3. Instruments, syringes, enamel trays should be immersed in 0.5% peroxyacetic acid for 30 minutes, autoclaved twice before disposal, and the bag should be labeled with a red infectious disease sign.
4. Unused items are packed centrally, labeled with the red infectious disease symbol, and autoclaved for routine processing.
5. All objects used in contact with patients, including trolleys and bedding, are placed in the operating room (cloths should be loose and boxes with lids should be opened) and fumigated and disinfected with formaldehyde heating method, 12.5ml/m3 closed for 24 hours.
(F) the management of sterile goods
1. Sterile goods should be placed in the sterile room centralized management, indoor ventilation, dry, clean environment, no debris, no flies, no dust, there should be screen doors and windows.
2. Clean and ventilated aseptic articles cabinet should be checked by a person, aseptic packages in order, clearly marked, no expired articles, aseptic articles are valid for 7 days, 5 days in the moldy season.
3. The volume of the sterile package should not exceed 30×30×40cm, the size of the package cloth is suitable, the container is not broken, the middle of the large and medium-sized packages and the reverse folding of the package cloth are put in the prescribed chemical reagents.
4. Soak the instrument disinfectant enough, joints open, replaced once a week, clearly marked, bacterial culture once a month, to be documented.
5. Dressing irrigation, soaking hand alcohol bucket, iodine, alcohol bottle to be sterilized, 1 to 2 times a week.
6. Alcohol soaking solution test once a day, the specific gravity to maintain between 0.70 to 0.75, and have records, signatures.
7. Soap and water, finger brushes, disinfectant towels and other items used are disinfected every 24 hours.
Four, HAA-positive patients postoperative treatment
(a) before surgery
1. The surgeon must contact the head nurse or indicate in the surgical notification form, set up a special operating room for surgery, the door of the room should be hung with a red isolation sign, and a person in charge of the rounds.
2. Preoperative preparation of all surgical supplies, including surgical instruments soak box, brush, staff hand-washing soak.
(2) During surgery
1. Staff should wear isolation gowns and shoe covers in the operating room, and should not leave the operating room without special emergencies; if they have to add items, they can ask for help from outdoor personnel.
2. During the operation, the staff should strengthen the sense of self-prevention, such as gloves should be replaced immediately if they are damaged, and the sharp instruments such as needles and knives should be placed properly to avoid injury.
(3) After surgery
1. Staff should wash their hands with 0.2% peroxyacetic acid for 1 to 2 minutes when leaving the operating room.
2. Uncontaminated dressings and instruments in the operating room should be rewrapped and prepared for use after autoclaving.
3. After surgery, all contaminated items should be disposed of separately and should not be taken out of the operating room without treatment.
(1) after surgery has been stained with blood instruments, suction tubes, syringes, cloth with a special bucket in 0.5% peroxyacetic acid soaked in half an hour and then removed. The instruments are cleaned, dried and then autoclaved; the cloths are squeezed dry and packed to be sent to the laundry room; the syringes are cleaned and sent to the supply room; the suction tubes are cleaned and then boiled for 15 minutes and then dried and prepared for use.
(2) dirt barrels, suction bottles should be 20% peroxyacetic acid into a 0.5% solution soaked for half an hour, and then pour the sewage into the cesspool, suction bottles should be scrubbed and soaked in 0.5% peroxyacetic acid solution for half an hour before use.
4. The floor of the operating room, operating beds, infusion racks, etc. are mopped with 0.5% peroxyacetic acid.
5. The operating room is fumigated with peroxyacetic acid or formalin, sealed for 6 to 8 hours and then ventilated.
Patients with venereal diseases are also treated according to the above requirements after surgery.
V. Aseptic precautions
(A) strictly distinguish the boundaries of sterile and bacterial
Aseptic articles are contaminated once they come into contact with bacterial articles, and shall not be used as aseptic articles again.
1. After aseptic preparation of the surgeon, the area below the waist, above the shoulders, under the armpits and on the back are all sterile. Neither hands nor sterile objects should touch these areas, nor should hands drop below the waist. Passing instruments must not be done behind the back.
2. The instrument table and the area below the operating table are sterile areas (any instrument that falls below the table, even if it has not hit the ground, is not to be reused; the part of the cord that hangs down from the tabletop is also considered to be contaminated).
3. Gloves should be replaced if they are torn or if they come into contact with the sterile area.
4. Forearms and elbows should be covered with sterile cuffs when they are touched by visitors.
5. When surgical personnel need to switch positions, one person should step back and turn around back to back to switch, and the front of the body should not be rubbed over the back of others.
(ii) Keep sterile cloths dry. When laying sterile cloth sheets, there should be four or more layers between the instrument table and the surgical incision.
(iii) Protect the incision. The skin should be re-sterilized before incision and suturing, and the incision should be protected with a gauze pad or special plastic wrap after skin incision.
(iv) Protecting the abdominal cavity. Before incision of gastrointestinal, gallbladder, bile ducts and other hollow organs, gauze pads should be used to cover to keep the surrounding tissues and avoid spillage of contents to contaminate the surgical field.
VI. Safety system in the operating room
1. Electrical equipment in the operating room, such as electric knives, plug lights, etc., should be checked regularly.
2. At the end of surgery, the surgical nurse should cut off all power plugs.
3. Highly toxic drugs should be locked and kept by a person.
4. The staff on duty should patrol every room in the operating room and be responsible for the safety check of oxygen, suction, water, electricity, doors and windows and the safety of the main door.
5. Non-duty personnel should not enter the operating room at will.
6. All personnel at all levels working in the operating room should act in accordance with the routine in order to protect the safety of patients.
7. If an accident is found, it should be reported immediately to the department concerned and to the hospital department.
Seven, the operating room nurse duties
1. In the nursing department under the leadership of the director, responsible for the administrative and business management of the room, nursing and surgical arrangements, to maintain clean and quiet.
2. According to the tasks of surgery and nursing staff, scientific division of labor, close cooperation with the doctor to complete the operation, if necessary, personal participation.
3. Supervise all levels of personnel to conscientiously implement the regulations and technical procedures, and strictly require compliance with aseptic operating procedures. Do the statistical analysis of wound healing.
4. Organize nurses and hygienists' business study, and guide the work of advanced training and internship nurses.
5. Supervise the subordinate staff to do a good job of disinfection, according to the provisions of the air and hand bacterial culture, identification of disinfection effect.
6. To conscientiously implement the checking and shift handover system to prevent errors.
7. Responsible for the operating room drugs, instruments, dressings, sanitary equipment, such as requisition, reimbursement, and at any time to check the preparation of emergency surgical supplies, check the poison, anesthesia, drugs and valuable instruments management.
8. Supervise the retention and timely delivery of surgical specimens.
9. Responsible for the reception of visits.
Deputy nurse manager to assist the nurse manager responsible for the corresponding work.
Eight, the operating room nurse duties
1. Under the leadership of the head nurse as instruments or tour nurse and other work, and is responsible for pre-surgery preparation and post-surgery finishing work.
2. To conscientiously implement the rules and regulations and technical procedures, supervise and check the aseptic operation of the surgical staff, pay attention to patient safety, and prevent errors and accidents.
3. Participate in health cleaning, keep the operating room clean and quiet, regulate the temperature and humidity, and maintain appropriate indoor temperature and humidity.
4. Responsible for the dressing, warmth, escorting and storage of surgical specimens after surgery and sending them for examination.
5. According to the division of labor to do a good job of instruments, dressings, packaging and disinfection and drug storage work, and do a good job of registration and statistics.
6. To guide the work of trainee and intern nurses and hygienists.
9, hand-washing nurse duties
1. Preoperative understanding of the condition, to do a good job. Wash your hands 15 minutes in advance, spread the instrument table, and classify and discharge the surgical instruments. All kinds of catheters are rinsed with saline before use.
2. Count instruments, gauze strips, gauze pads, needles, threads, etc. (thoracic, abdominal, and deep tissue surgery) with the visiting nurse. Before surgery, count items once before and after closing the body cavity to prevent leaving them in the body cavity.
3. Hand-washing nurses should have a high degree of responsibility, but also have a sense of forethought, strict implementation of aseptic operation, pay close attention to the progress of the operation, so that the correct, proactive, agile delivery of instruments.
4. Keep the surgical field, instrument table, lift table dry, clean, sterile, with the instruments, dressings placed separately.
5. The specimens removed during surgery, such as: puncture fluid, biopsy, bacterial culture, etc., should be properly stored, handed over to the doctor after surgery, and signed on the specimen register.
6. Cleaning of surgical instruments, drying oil packaging, valuable instruments and precision instruments should be handed over to the instrument room nurse in a timely manner, according to the original position put, such as the operation found that the instrument can not be used that is to make a mark, after the operation to the instrument room nurse replacement.
7. The gauze used in gastrointestinal surgery should be discarded in time, and the anastomosis should be sterilized with PVP-I cotton balls. Contaminated instruments should be placed separately.
X. Roving Nurse's Duties
(1) Pre-operative Preparation (Wet rags to wipe the dust once)
1. Greeting the patient before the operation, introducing themselves to the patient, comforting the patient and checking the patient's name, bed number, diagnosis, blood type, name of the operation, site of the operation, subcutaneous test, pre-operative medication and preparation of the skin.
2. Checks whether the resuscitation equipment, instruments, and items in the operating room are complete, and makes emergency preparations.
3. Check whether the objects used are safe and have good performance, such as electric knife, suction device, footstool, bipolar electrocoagulation, shadowless lamp.
4. Assists in anesthesia, assists hand-washing nurse in laying table, assists surgeon in donning surgical gown, rinses talcum powder from gloves with sterile saline.
5. Perform venipuncture, blood transfusion, and infusion.
6. Count the number of surgical supplies, such as instruments, dressings, stitches, etc., with the hand-washing nurse***, and record them on the surgical inventory sheet and sign it.
(II) Intraoperative cooperation
1. Place the body position according to the surgical requirements, expose the surgical field, and avoid injury to the limb.
2. Pay attention to the progress of surgery at any time, observe the fluids and blood transfusion, anticipate the patient's needs, and supply them as early as possible, carry out verbal instructions, pay attention to the results of vital signs monitoring, and cooperate with resuscitation.
3. Pay attention to the intraoperative avoid talking and laughing, do not leave the operating room.
4. Supervise the operator and visitors to strictly implement aseptic operation.
5. If there is no hand-washing nurse, the visiting nurse should keep the intraoperative specimen properly and sign it.
(C) Postoperative care
1. Cleans blood, dresses wounds, and escorts patient to operating room door.
2. Open windows for ventilation and return things to their original place.
3. Supervise the hygienist to maintain good hygiene in the operating room.
Eleven, the night nurse duties
1.
Conscientiously do a good job of the shift handover system, the contents of the shift handover include: the patient's name, bed number, diagnosis, the name of the operation, anesthesia, the patient's blood type, progress of the operation, the transfusion of fluids, transfusion of blood, the instruments, dressings, needles, threads and other verification.
2. Placement of various instrument packs, cloth packs, clothes, gauze, gloves, syringes, petroleum jelly and paraffin oil for the next day's surgery.
3. Check whether the instrument table, elevating table and infusion rack for the next day's surgery are complete in the operating room.
4. Check and replenish PVP-I cotton balls, alcohol and iodine every night; measure the specific gravity of alcohol every day, filter the alcohol on Tuesdays and Fridays and record it; and change the PVP-I soaking liquid and hand bucket every Friday night.
5. Supervise the air disinfection of the operating room twice a day (morning and evening UV irradiation for 60 minutes each).
6. Replacement of sterile holding forceps, Saturday shift is responsible for air fumigation and disinfection of the operating room, replacement of PVP-I, blade canisters, forceps soaking bucket, soak box, addition of suture needles, blades; monthly door-keeping Saturday shift replacement of 2% dialdehyde solution.
7. Daytime HAA-positive surgical room and next day's extracorporeal surgical room were fumigated and disinfected with 40% formaldehyde, and the next day there were extracorporeal surgeries to be iced, and the supplies for the extracorporeal room were set up (electric blankets, electrosurgical knives, suction devices, infusion racks, insertion boards, and transfusion sets), and prepared for open transfusion.
8. To cope with emergency surgery, are not allowed to leave the operating room without authorization, not crosstalk.
9. Responsible for the safety and security of the operating room, close the doors and windows, fluorescent lights, locked doors.
10. Supervise workers to do a good job of operating room hygiene, keep the operating room environment clean, clean up the locker room, duty room, office.
11. Check pathology specimen delivery and sign.
12. Responsible for fumigation and sterilization of electrosurgical heads and special surgical instruments.
XII, instrument room nurse duties
1. Every morning to do a good job in the sterile room and instrument room cleaning and organizing work, check the date of sterilization of sterile surgical bag.
2. Check and verify the emergency surgical instruments in the evening and urge workers to send them for autoclaving according to the situation.
3. Special precision instruments for surgery are handed over to the hand-washing nurse for immersion and sterilization, and counted.
4. Receive the next day's surgical notification form by 10:30 a.m. and prepare special instruments for the next day's surgery and all kinds of dressings and sutures according to the surgical notification form.
5. Check and inspect the finished surgical instruments and make them clean and intact, replace them if they are damaged, and return them to the hand-washing nurse for re-cleaning and oiling if there is any bloodstain. If there is a lack of them, the hand-washing nurse should be urged to retrieve them in a timely manner.
6. According to the surgical notification form, put the position of the next day, electric knife, single-head light, tourniquet.
7. Prepare instruments for emergency surgery.
8. Organize the electrosurgical head after surgery, check and replenish the disposable items in the sterile room (e.g., infusion set, blood transfusion set, clean bag, syringe, oop, film, thread, urine bag, cotton swabs, etc.).
9. Clean spare instruments in the instrument cabinet once a week.