Concorde Career College, Department of Surgical Technology
1
Recognize and understand the designs of the OR suite
Determine the physical components of the OR Learn OR furniture and their names and functions Review the type of air-handling system required
in the OR Indicate cleaning procedures Distinguish among the support services that work
with the OR Recognize the hazards in the OR Analyze the role of the ST in the protection of self
patients and others from the hazards of the OR
2
The location of the OR in the hospital is made to be easily accessible to and from surgical patient support departments
It is located and designed in an area where traffic is limited and the general public does not have access
3
4
HOTEL – ORs are arranged along a central corridor
SPECIALTY – variation of the racetrack or hotel
RACETRACK – involves a series of ORs around a clean central core
5
RESTRICTED Proper O.R. attire required Mask required
SEMI-RESTRICTED Proper O.R. attire required
UNRESTRICTED Street clothes allowed
Separated by walls, doors, and red lines
6
Semirestricted areas
Restricted areas Scrub suit Hair cover Shoe covers
and/or mask may be required
Jewelry, cosmetics, artificial nails are restricted
7
8
Semi-restricted
Unrestricted
Restricted
9
Red Line = semi restricted and restricted
Green Line = Unrestricted
10
ELCTRICAL OUTLETS – 110/220, must be 5’ above the floor. Explosion proof, red outlets are connected to the emergency generator
SUCTIONS OUTLETS – each OR must have at least 2 suction outlets; one for the surgical team, one for anesthesia
GAS OUTLETS (color coded) – oxygen – green; nitrogen –nitrogen – blackblack, nitrous oxide – blue, air- yellow, carbon dioxide – grey; outlets--- walls, ceiling, or mobile tanks; emergency shut off valve in exterior hall
11
12
LIGHTS – regular overhead, OR spot lights VIEWING BOX – to view diagnostic images OPERATING TABLE – narrow, padded and
flexible, traditional beds are manual, modern is electrical, mobile; features: Break points or bendable – knee, waist, and
head Removable sections at the head and foot Height can be adjusted Wide base to prevent tipping Rails along side for attachments ▪ Other OR beds- cysto, fracture- radiolucent
13
14
CLOCKS AND TIMERS – wall mounted, easily readable face, and a sweeping second hand; additional timer
COMMUNCATION SYSTEM – telephone; intercom system for intra-department (room to room; front desk) and inter-department use (pathology, radiology) some are foot operated
COMPUTER TERMINAL – for the circulator to fill out intra-op record, lab reports, order supplies for the room
OTHER – closed circuit TV
15
16
17
19
MAYO STAND – usually spans across patient; holds immediate necessary instruments; two wheeled and can be used to set up gowns and gloves.
20
KICKBUCKET – four wheeled stands very low to the floor; can be maneuvered by a foot; lined with biohazard bags; holds soiled counted
sponges; NOT FOR TRASH!
21
RING STAND – four wheeled with one or two rings waist high; used to hold basins; basins hold case related sterile fluids
Used for skin prep, urinary catheterization, medical handling, etc.
23
SUCTION SETS – low wheel based stands which hold suction canisters; sterile tubing form the surgical field will be hooked up to this by the circulator; the suction sets is hooked up to a wall suction outlet
Monitoring equipment
Supplies
32
37
LINEN HAMPER – holds soiled linensTRASH CONTAINER – may be 2 per
room; one lined with a clear trash bag for clean trash and one lined with a biohazard bag for contaminated trash; some facilities are equipped with a metal detector to find instruments that may have been discarded accidentally
38
SMOOTH, POUROUS FREEEASY TO CLEANNON REFLECTIVEPLEASANT IN COLOR WATERPROOFFIREPROOFNONGLARE
39
DOORS RECESS INTO WALL (if poss.)
DOORS SHOULD BE KEPT CLOSED
40
Provide clean airRemove air-borne contaminates that
are produced in the roomRemove waste anesthesia – besides
scavenger line Remove toxic fumes and vaporsComfortable working environment
41
Produces positive pressureUnidirectional flow of air20 air exchanges per hourFiltered by High-efficiency
Particulate Air (HEPA) FiltersAt least 20% of the air change per
hour be fresh outside air
42
An air exchanger system pulls air from the outside of the OR and pushes stale air from inside the OR out at frequent intervals thus becoming the air exchanger system.
43
TEMPERATURE – should be kept between 65 and 75°F
RELATIVE HUMIDITY - should be kept between 20-60%
44
SAME DAY or DAY SURGERY – patient arrives here, changes clothes, awaits surgery
LABORATORY – perioperative lab values
RADIOLOGY – x-ray films, fluroscopePATHOLOGY – processing specimensENVIRONMENTAL SERVICES-
cleaning 45
Within the surgical services department
Entrance to OR suite for patientsShould be shielded from noise and
views of the ORs IVs startedPreop interviews
46
Patient is recovered from anesthesia and surgery
47
Usually above or below surgical services, or adjacent
Decontamination of soiled instruments
Assembly of instrument sets Sterilization of instrumentation andDistribution of supplies
48
ERGONOMICS
SLIPPERY FLOORS
STANDING STOOLS
CROWDED O.R.’S
49
Physical Noise, ionizing radiation, electricity,
injury to body, fire, explosionBiologic
Laser/electrosurgical plume, pathogens, latex sensitivity, sharps injury
50
Chemical Disinfecting agents, waste anesthetic
gas, vapors and fumes
51
OCCUPATIONAL SAFETY AND HEALTH ADMINISTRATION- OSHA
AMERICAN SOCIETY FOR TESTING AND MATERIALS - ASTM
ASSOCIATION FOR THE ADVANCMENT OF MEDICAL INSTRUMENTATION – AAMI
NATIONAL FIRE PROTECTION AGENCY - NFPA
52
SOURCES X-ray machines▪ Portable▪ Fluoroscope (C-ARM)
PROTECTION – Time, shielding, and distance ▪ Lead aprons▪ Lead gloves▪ Lead glasses▪ Thyroid shield▪ Radiation badge
53
LASER Light Amplification by the Simulated
Emission of Radiation Laser plume
Found to contain DNA of HPVCO2 laser can cause corneal burns
54
Nd: Yag laser can cause retina blindness
High filtration mask and appropriate goggles are worn to protect the OR team
55
Fire Laser and Bovie burns
R.A.C.ER- rescue, A-alert, alarm, C-contain, E-
extinguish,evacuate
56
57
Ignition
Fuel
Oxygen
58
Ignition
ESU
Laser
Fiber-Optic Beam
Static Electricity
59
Class A – water
Class B- dry chemical
Class C- halon
60
Protect the patient
Contain the fire
Move anesthesia machine
61
Electrical current
Electrical burns
Static electricity
62
SOURCES Any body fluid or any item contaminated
with body fluids
PROTECTION PPE
63
Universal precautions Applies to blood, certain fluids that contain
blood Standard states that blood and all body
fluids should be treated as potentially infectious
PERSONAL PROTECTIVE EQUIPMENT – PPE▪ Gloves▪ Masks▪ Eye protection
64
SHARPS Suture, hypodermic needles, blades,
bovie tips, sharp instruments
CAUSES▪ Loading and passing suture, unsecured
sharps on field, recapping needles, catching falling items, poor sharp container management
65
PREVENTION▪ Assume responsibility for you own safety▪ PPE▪ Never losing track of a sharp▪ Secure needles ▪ Leaving needles in package until use▪ Secured in a needle holder▪ Placed properly in needle board
66
MANAGEMENT Postexposure prophylaxis –PEP
▪ Prophylaxis- prevention of a disease or condition
▪ Antibiosis- making the environment hostile to an organism
67
68
Smoke from burning tissue
Precautions
▪ High volume smoke evacuator
▪ Laser face masks
69
Patient and personnel allergies
Latex free cart Patients with Spina Bifida are high risk
70
71
Polymethyl Methacrylate (PMMA) Bone Cement
Formalin: preservative for specimens in pathology
Glutaraldehyde (Cidex): liquid disinfectant and sterilizing agent
72
73
74
75
Page 91 Table 5-1
76