The operating room should not only be connected with the operating department, but also be close to the blood bank, intensive care unit and anesthesia resuscitation room. Master the link management of four kinds of surgical incision infection routes, namely: operating room air; Articles required for operation; Doctors and nurses' fingers and patients' skin prevent infection and ensure the success rate of surgery.
I. Design and equipment of operating room
(A) the design of the operating room
Sitting north facing south, it is located in the higher part of the building. Based on the principle of keeping the air clean and preventing nosocomial infection, the ground and walls can be cleaned. We should reasonably divide three areas: unrestricted area, semi-restricted area and restricted area. There should be three channels: staff channel, patient access channel and sewage outlet channel. Materials should be fireproof, moisture-proof and not easy to change color, and easy-to-clean materials should be used. Modern operating rooms should be designed with air purification devices, central oxygen supply and central suction devices.
(2) Equipment in the operating room
In addition to the general operating room equipment, there are also closed-circuit television, air conditioning and advanced electrotome (imported). In order to ensure that the operation will not be affected by unexpected power failure, the hospital should be equipped with power generation facilities. Don't pollute the floor of the operating room, it is best to use modern carts such as exchange cars.
(3) The layout of the operating room should be concise, and the cabinets should be made of moisture-proof and solid materials for easy cleaning. All items should be fixed, kept in order, and strive to unify and standardize the rooms.
Second, the operating room staffing and hospital operating beds
The ratio of operating room nurses to operating beds should be 2.5: 1, and teaching hospitals should be 3: 1. The setting of operating table is: 50 beds in the operating department should be set at 1 operating table, and the health personnel should be 0.5: 1. Head nurse 1 ~ 2.
Third, the operating room rules and regulations
The operating room is a place where surgeons, anesthesiologists and operating room staff work together, with a large turnover of personnel. In order to ensure the orderly work, not only each operation has rules, but also a certain work system, so that all operations can be successfully completed.
(A) the operating room general working system
1. All staff entering the operating room must wear shoes, hats, clothes and masks, and change their clothes and shoes when leaving the operating room.
2. Visitors, students and interns outside the hospital must be approved by the medical education department or the nursing department, and should have a fixed place.
3. Elective surgery in each department should be delivered to the operation notice before 10: 30 the morning before the operation. Emergency rescue surgery can be informed orally first, and then supplemented by surgery.
4. The operation shall be carried out according to the time of the operation notice, and must be in place on time, and shall not be changed at will. Contact the nurse in special circumstances.
5. Pick up the patient 30 minutes before operation, with medical records, and check the patient's name, gender, age, bed number, diagnosis, surgical site, drug sensitivity test, preoperative medication, etc. After the patient enters the room, the visiting nurse should review it again and pay attention to the cleaning range of the patient's surgical site. Jewelry, dentures and watches are not allowed to be brought into the operating room.
6. Strict aseptic operation technology. Sterile surgery and bacterial surgery should be carried out separately, and special disinfection and sterilization should be carried out for special infections.
7. Keep the room serious and quiet. Don't talk loudly, chat or read newspapers during the operation.
8. Strictly implement indoor sanitation cleaning, isolation and disinfection detection system, and implement medical safety precautions.
9. The operating room should be equipped with all kinds of emergency surgical kits and rescue equipment at any time, and surgical instruments should not be checked out. If it is detected, it must be approved by the medical education department.
10. Operating room instruments should be disinfected on the basis of cleanliness. All kinds of medicines and instruments should be stored in a fixed way, and valuable instruments should be kept by special personnel, and counted, repaired and maintained every month. The drug signs of the anesthesia drama are obvious, and the special person locks it for safekeeping. Ordinary drugs should be counted and recorded every day, checked once a month, and someone is in charge.
1 1. Responsible for the preservation and inspection of specimens collected during operation, requiring doctors to fill in pathological specimens and inspection forms in time, register for inspection, and urge timely inspection.
(B) operating room hospital infection management system
1. Management of burglary personnel
(1) All staff entering the operating room must change their clothes, hats, trousers and shoes, and personal belongings are not allowed to be brought into the working area.
(2) When entering the restricted area, the personnel entering the room must wear a dome and a mask.
(3) Employees shall have a physical examination once a year and be injected with hepatitis B vaccine as required. People with infectious diseases are not allowed to work in the room.
(4) Before the surgical patient enters the room, clean clothes, trousers, hats and foot covers must be replaced.
(5) The push wheel entering the operating room must be disinfected before entering the semi-restricted area.
(6) Workers must change their work clothes, hats, pants and shoes when going out.
Step 2 Access the system
(1) Non-medical personnel and non-surgical personnel are not allowed to enter without permission.
(2) Trainees and interns must abide by the above provisions, and interns must be led by teachers, and may not enter the operating room alone.
(3) Visitors must change their clothes, hats, trousers, shoes and masks after obtaining the consent of the medical education department or the nursing department, and are not allowed to walk around the designated area.
(4) In addition to daily cleaning and sanitation, one day per week is designated as Health Day, and the operating room is thoroughly cleaned and disinfected.
(5) After soaking the special slippers with disinfectant every day, clean and dry them for later use, and wipe the shoe cabinets with disinfectant once a day.
(3) Disinfection and isolation system in operating room
1. Strictly divide the restricted area (sterile area), semi-restricted area (clean area) and unrestricted area (contaminated area). The intervals are clearly marked, and the principle of three channels is strictly observed. The operating rooms are divided into sterile, non-sterile and polluted operating rooms.
2. Wash your hands carefully, in strict accordance with the disinfection methods and steps of hand washing, and train the fingers of surgeons and hand washing nurses once a month, which should be well documented.
3. Soak the liquid and alcohol, measure the specific gravity daily, change the container and disinfectant 1 ~ 2 times a week, and make records.
4. Surgery doctors and nurses should strictly implement aseptic operation procedures after wearing sterile gloves.
5. The visiting nurses should be fully prepared to minimize going out and walking, and the door of the operating room should not be opened casually.
6. Operators should wash their hands, disinfect their arms, change sterile surgical gowns and gloves between operations, and wipe the surface and ground with disinfectant.
7. Do a good job of terminal disinfection of all kinds of articles.
8. Operating room ultraviolet requirements: power ≥30W/m3, lamp distance from the ground < < 2.5m, equipped with ultraviolet reflector, radiation intensity > > 70uw/cm2.
9. All patients who need surgery should check their liver function and a full set of hepatitis B antigen antibodies before operation, and those who are positive should be treated according to the technical requirements of infectious disease isolation.
(4) general infection surgery
1. Instruments, dressings, syringes, gloves, drainage bottles, etc. Should be soaked, disinfected and treated as usual.
2. The operating room window ventilation, use disinfectant to wipe the operating table, cart, object surface and mop the floor, and use ultraviolet rays to disinfect the air.
(five) special infection surgery, isolation surgery
1. Based on the principle of on-site operation, it is best to use disposable dressings, instruments and syringes, and the isolation board is hung at the door.
2. Inflammable articles such as gauze and dressing during the operation should be burned.
3. Instruments, syringes and enamel plates should be soaked in 0.5% peracetic acid for 30 minutes, and then treated after being sterilized by high-pressure steam twice. The package should be marked with a red sign of infectious disease.
4. Unused articles should be packaged in a centralized way, labeled with red infectious diseases, and treated routinely after autoclaving.
5. Everything that comes into contact with patients, including carts and bedding, should be put in the operating room (the cloth should be loose, and the box with cover should be opened), fumigated and disinfected by formaldehyde heating method, and sealed for 24 hours at 12.5ml/m3.
(six) the management of sterile goods
1. Sterile articles should be placed in the sterile room for centralized management, and the room should be ventilated and dry, and the environment should be clean, free of sundries, flies and dust, with screen doors and screens.
2. The cleaning and ventilation of aseptic goods cabinet should be checked by special personnel. Sterile packaging should be arranged in sequence and clearly marked. There are no expired goods. Sterile goods are valid for 7 days and mouldy for 5 days.
3. The volume of aseptic packaging shall not exceed 30×30×40cm, the packaging size is appropriate, the container is not damaged, and the specified chemical reagents are put in the middle of large and medium-sized packaging and the folded part of the packaging.
4. The dosage of disinfectant for soaking equipment is sufficient, and the connector is opened. Change it once a week, clearly mark it, and conduct bacterial culture once a month, which is well documented.
5. Soak the dressing in an alcohol barrel, and disinfect it with iodine and alcohol bottles, once a week 1 ~ 2 times.
6. The alcohol soaking solution shall be tested once a day, and the specific gravity shall be kept between 0.70 and 0.75, and recorded and signed.
7. Soap water, finger brushes, disinfection towels and other things are disinfected every 24 hours.
Fourth, postoperative treatment of HAA positive patients
(1) before operation
1. The surgeon must contact the head nurse or indicate it on the operation notice, set up a special operating room for the operation, and hang a red isolation sign at the door of the room, and someone will be responsible for the inspection.
2. Prepare all surgical supplies before operation, including soaking boxes for surgical instruments, brushes and soaking liquid for staff to wash their hands.
(2) During the operation
1. Staff should wear isolation gown and shoe covers in the operating room. They should not leave the operating room unless there is a special emergency. If you need to add items, please ask the outdoor staff for help.
2. In the process of operation, the staff should strengthen their awareness of self-prevention. If the gloves are damaged, they should be replaced immediately, and sharp tools such as needles and knives should be properly placed to avoid damage.
(3) After the operation
1. When the staff leaves the operating room, wash their hands with 0.2% peracetic acid 1 ~ 2 minutes.
2. The uncontaminated dressings and instruments in the operating room should be repackaged after autoclaving for later use.
3. After the operation, all contaminated items should be treated separately, and they should not be taken out of the operating room without treatment.
(1) The instruments, suction tubes, syringes and cloths stained with blood after operation were soaked in 0.5% peracetic acid for half an hour and then taken out. Cleaning the instrument, air drying, and then autoclaving; After the cloth is squeezed dry, it is packed and sent to the laundry room; Clean the syringe and send it to the supply room; After cleaning the straw, boil it for 15 minutes and dry it for later use.
(2) The dirt bucket and suction bottle should be soaked in 0.5% solution of 20% peracetic acid for half an hour, then the sewage should be poured into the sewage pool, and the suction bottle should be soaked in 0.5% peracetic acid solution for half an hour before use.
4. Operating room floor, operating table, infusion stand, etc. Wipe with 0.5% peracetic acid.
5. Fumigate the operating room with peracetic acid or formalin, seal it for 6-8 hours and then ventilate it.
Patients with sexually transmitted diseases are also treated according to the above requirements after operation.
Verb (abbreviation of verb) aseptic precautions
(1) Strictly distinguish between sterility and bacteria.
Sterile articles are contaminated once they come into contact with bacteria, and shall not be used as sterile articles again.
1. After aseptic preparation, the operator has bacteria areas below the waist, above the shoulders, underarms and back. Don't touch these parts with your hands or sterile articles, and don't hang your hands below your waist. The instrument of transfer should not be carried out behind the scenes.
2. There are bacteria areas under the instrument table and the operating table (the instrument falls under the table and cannot be used again even if it does not touch the ground; The part of the line hanging from the desktop is also treated as pollution).
3. If the gloves are damaged or come into contact with the bacteria area, they should be replaced immediately.
When visitors touch forearms and elbows, they should be covered with sterile sleeves.
5. When the operator needs to change positions, one person should take a step back and switch to back-to-back, and the front of the body should not be brushed behind others.
(2) Keep the sterile cloth dry. When laying sterile cloth, there should be more than four layers of instrument table and surgical incision.
(3) protect the incision. Disinfect skin before incision and suture, and protect incision with gauze pad or special plastic film after incision.
(4) protect the abdominal cavity. Before cutting the gastrointestinal tract, gallbladder, bile duct and other hollow organs, the surrounding tissues should be covered with gauze pads to prevent the contents from overflowing and polluting the operating field.
Six, the operating room safety system
1. Operating room electrical equipment, such as electrotome and lamp plug, should be checked regularly.
2. After the operation, the surgical nurse should cut off all power plugs.
3. Highly toxic drugs should be locked and kept by special personnel.
4. The personnel on duty should patrol every room in the operating room, and be responsible for the safety inspection of oxygen, aspirator, water, electricity, doors, windows and doors.
5. The personnel on duty shall not enter the operating room at will.
6. All personnel at all levels working in the operating room should act according to the routine to ensure the safety of patients.
7. If you find any unexpected situation, you should immediately report to the relevant departments and report to the hospital department.
Seven, the operating room head nurse responsibilities
1. Under the leadership of the director of nursing department, be responsible for the administration and business management, nursing work and operation arrangement of this room, and keep it clean and quiet.
2. According to the operation tasks and nursing staff, carry out scientific division of labor, closely cooperate with doctors to complete the operation, and attend in person when necessary.
3. Supervise and urge personnel at all levels to seriously implement various rules and regulations and technical operation procedures, and strictly abide by aseptic operation procedures. Do a statistical analysis of wound healing.
4. Organize the professional study of nurses and health workers, and guide the further study and practice of nurses.
5. Supervise the staff to do a good job of disinfection, carry out bacterial culture of air and hands according to regulations, and identify the disinfection effect.
6. Seriously implement the inspection and succession system to prevent mistakes.
7. Responsible for the application and reimbursement of drugs, instruments, dressings and sanitary equipment in the operating room, check the preparation of emergency surgical supplies at any time, and check the management of toxic, hemp, drama drugs and expensive instruments.
8. Supervise the retention of surgical specimens and timely inspection.
9. Responsible for receiving visitors.
The deputy head nurse assists the head nurse in charge of the corresponding work.
Eight, the operating room nurse responsibilities
1. Under the leadership of the head nurse, as an instrument or roving nurse, responsible for preoperative preparation and postoperative finishing.
2. Seriously implement various rules and regulations and technical operation procedures, supervise and inspect the aseptic operation of surgical personnel, pay attention to patient safety, and prevent mistakes and accidents.
3. Take part in sanitary cleaning, keep the operating room clean and quiet, adjust the temperature and humidity, and keep the indoor temperature and humidity appropriate.
4. Be responsible for dressing, keeping warm and accompanying patients after operation, and keeping and submitting surgical specimens.
5. According to the division of labor, do a good job in packaging, disinfection and drug storage of instruments and dressings, and make registration and statistics.
6. To guide the work of advanced studies, practice nurses and health workers.
Nine, hand washing nurse responsibilities
1. Know the condition before operation, and be aware of it. Wash your hands 15 minutes in advance, lay the instrument table, and discharge the surgical instruments by classification. Rinse all kinds of catheters with normal saline before use.
2. Counting instruments, gauze strips, gauze pads, needles, threads, etc. (Thoracic, abdominal and deep tissue surgery) and visiting nurses. Before the operation, before and after closing the body cavity, all items should be counted to prevent them from being left in the body cavity.
3. Hand washing nurses should not only have a high sense of responsibility, but also have a sense of advance, strictly implement aseptic operation, pay close attention to the progress of surgery, and deliver instruments correctly, actively and timely.
4. Keep the operation site, instrument table and lifting table dry, clean and sterile, and separate the instruments and dressings used.
5. Specimens taken during the operation, such as puncture fluid, biopsy materials, bacterial culture, etc., should be properly kept, handed over to the doctor after the operation, and sign the specimen register.
6. Clean surgical instruments, dry them, oil them and pack them. Precious instruments and precision instruments should be handed over to the nurses in the instrument room in time and put away in their original positions. If it is found that the instrument cannot be used during operation, it should be marked and replaced by the nurse in the instrument room after operation.
7. The gauze used in gastrointestinal surgery should be discarded in time, and the anastomosis should be disinfected with PVP-I cotton ball. Contaminated instruments should be placed separately.
X. duties of visiting nurses
(a) preoperative preparation (wet cloth to wipe the dust once)
1. Greet the patient before operation, introduce yourself to the patient, comfort the patient, and check the patient's name, bed number, diagnosis, blood type, operation name, operation site, subcutaneous test, preoperative medication and skin preparation.
2. Check whether the operating room rescue equipment, instruments and articles are complete and make emergency preparations.
3. Check whether the electrotome, aspirator, footstool, bipolar electrocoagulation, shadowless lamp and other items are safe and in good performance.
4. Assist in anesthesia, assist the hand washing nurse to lay the table, assist the doctor to put on the surgical gown, and wash off the talcum powder on the gloves with sterile saline.
5. Do a good job in venipuncture, blood transfusion and infusion.
6. Check the surgical materials, such as instruments, dressings, sutures, etc. , and hand washing nurse * * *, and record the signature on the operation list.
(2) Intraoperative cooperation
1. Locate according to the operation requirements, expose the operation field, and avoid damaging limbs.
2. Pay attention to the progress of the operation at any time, observe whether the infusion and blood transfusion are smooth, foresee the items needed by the patient, provide them as soon as possible, carry out oral orders, pay attention to the monitoring results of vital signs, and cooperate with the rescue.
3. Pay attention to avoid talking and laughing during the operation, and never leave the operating room.
4. Supervise operators and visitors to strictly carry out aseptic operation.
5. If there is no hand-washing nurse, the visiting nurse shall properly keep the intraoperative specimens and sign them.
(3) postoperative care
1. Wipe the blood, bandage the wound and escort the patient to the door of the operating room.
2. Open the window to ventilate and put things back.
3. Supervise the hygienist to do a good job in the operating room.
XI。 The duties of night nurses
1.
Do a good job in the handover system, including: patient's name, bed number, diagnosis, operation name, anesthesia, patient's blood type, operation progress, transfusion, equipment, dressing, needle, thread, etc.
2. Put away all kinds of instruments for the next day's operation, including cloth bags, clothes, gauze, gloves, syringes, vaseline and paraffin oil.
3. Check whether the instrument table, lifting table and infusion stand used in the next operation in the operating room are complete.
4. Check and supplement PVP-I cotton balls, alcohol and iodine every night; Measure the specific gravity of alcohol every day, filter alcohol every Tuesday and Friday and record it; Replace PVP-I hand sanitizer and hand bucket every Friday night.
5. Supervise the air disinfection in the operating room twice a day (60 minutes in the morning and 60 minutes in the evening).
6. Replace the sterile holding forceps, be responsible for air fumigation and disinfection in the operating room on Saturday, replace PVP-I, blade jar, soaking forceps barrel and soaking box, and add suture and blade; Change 2% dialdehyde solution on duty every Saturday.
7. During the day, HAA positive operating rooms and in vitro operating rooms were fumigated and disinfected with 40% formaldehyde. If there is an extracorporeal operation the next day, ice cubes should be prepared, and the articles in the extracorporeal chamber (electric blanket, electrotome, aspirator, infusion stand, interventional board, blood transfusion device) should be arranged, and the infusion should be opened.
8. When dealing with emergency surgery, are not allowed to leave the operating room without authorization, are not allowed to string post.
9. Be responsible for the safety of the operating room, close the doors and windows, fluorescent lamps and lock the doors.
10. Supervise workers to do a good job in operating room hygiene, keep the operating room clean and tidy, and clean the dressing room, duty room and office.
1 1. Check the submission of pathological specimens and sign them.
12. Responsible for fumigation and disinfection of power tool heads and special surgical instruments.
Twelve, equipment room nurse responsibilities
1. Clean and tidy the sterile room and instrument room every morning, and check the disinfection date of sterile surgical kits.
2. Inspect and test emergency surgical instruments at night, and urge workers to send high-pressure disinfection according to the situation.
3. The special precision instruments used in the operation are soaked and disinfected by hand washing nurses, and the number is counted.
4. Receive the notice of the next day's operation before 0: 00/0: 30, and prepare the special instruments and various dressings and sutures for the next day's operation according to the notice.
5. Check and inspect the instrument after operation, and keep it clean and in good condition. If there is any damage, it should be replaced. If there is blood, the hand washing nurse should be washed and oiled again. If there is a shortage, the hand washing nurse should be urged to get it back in time.
6. According to the notice of operation, put away the position of the next day, electrotome, single headlight and tourniquet.
7. Prepare the instruments needed for emergency operation.
8. After the operation, tidy up the electrosurgical cutter head, and check and supplement disposable articles (such as infusion set, blood transfusion, cleaning bag, syringe, opal, film, thread, urine bag, cotton swab, etc.) in the sterile room. ).
9. Clean the spare equipment in the equipment cabinet once a week.