2 Lecture Hygiene, operational block

1. Bukhara state medical instituteTheme :Hygiene of surgical patients. The principles of carrying out and the organization of work in a operational block. The principles of carrying out and the organization of work in dressing rooms. Prepared by: Phd of the department of General surgery RakhimovAzizjonYakhyoyevich

2. Hygiene is a series of practices performed to preserve health. According to the World Health Organization (WHO). • The hygienic condition of a surgical patient's body has the major value in prophylaxis and treatment of purulent postoperative complications. This is the basic compound part of the patient hygienic regimen. What is it ?

3. There are two basic kinds of the patient hygienic regimen: the common regimen and bed regimen. • The common regimen doesn't limit moving of patients. The same order is to the persons, suffering not severe diseases, having satisfactory condition (for example the patients requiring for observation during preparation for the scheduled operation, recovering patients). • The bed care provides the staying of the patient in bed. There can be three kinds: • strict bed; • usual bed and • active bed.

4. Patients at such a regimen lay in bed in a certain position. Change of position should be made by the medical personnel. Independent active turns of a trunkare forbidden. • Feeding and physiological needs are carried out with the help of medical workers. The basic purpose of this regimen – is the prevention of complications, the creation of conditions for tissue regeneration, and the greatest possible function reduction of the affected organ. strict bed

5. Usual bed care is appointed to the majority of patients with sharp surgical diseases and traumas, and also in the first days after many operations. Patients are allowed to turn sideways, to accept a convenient position. Some patients can rise in bed and sit. Usual bed

6. Patients may get up the bed, leave the ward to go to the canteen and toilet. active bed

7. The primary aim of clinical hygiene body actions is the maintenance of the skin cleanness. • Patients must wash his hands and face with soap in the morning and the evening, clean teeth, comb the hair daily. If a patient has a grave condition these procedures must be provided by sisters and nurses. Body hygiene of the patient with the common regimen

8. The important hygienic action is wiping off the body of the patient in grave condition. It is recommended to carry out one time daily. The procedure is the following: the nurse wipes all body from hands to foot with the wet warm sponge. • Every 7-10 days patients must take a hygienic bath or douches. Body hygiene of the patient with the common regimen

9. Hygienic (morning) and respiratory gymnastics are obligatory. The respiratory gymnastics will be, that the patient makes on 5-6 deep breaths of 1 time within each hour. Breaths can be carried out in bed without movements or in a combination of movements of hands, legs, trunks. Hygiene of a body of the patient with a bed care

10. The personnel actively helps the patient with bed care at the washing of hands and face, rinsing off a mouth, and cleaning of teeth. At strict bed care, it is necessary not less often than 3 times a week to carry out washing the patient body. Hygiene of a body of the patient with a bed care

11. Patients with bed care require special care of the perineum area. At defecation, they should use a rubber or metal bedpan. Individual bedpans are placed on a special shelf under the patient’s bed. For patients who can sit, but are not capable to move, are used a portable bedpan in the armchair form and a chair with the hole on the chair-bottom. Hygiene of a body of the patient with a bed care

12. Body wiping is made by a damp towel or napkin. It is possible to use a disinfectant solution. First wipe a neck, skin behind ears, back, waist, forward surface of a thorax, axillary areas, limbs, then skin folds in groin areas and perineum. After wiping skin in the same order dry up a towel.

13. Eyes at the patients who are taking place in an unconsciousness, wash out with the help of the sterile napkin with a warm solution of boric acid. Ears clear of earwax. For this purpose in acoustic duct by a pipette, it is dropped solution of hydrogen peroxide. In an ear put for some minutes and then take out together with earwax a cotton ball. Hygiene of a body of the patient with a bed care

14. In case of need remove crusts from the nose of the patient. With this purpose in nasal passages enters the gauze turunda with mineral oil or any other oil. In 2-3 minutes turunda with the crusts take from nasal passages. Hygiene of a body of the patient with a bed care

15. The great value in the care of the oral cavity. Patients with the severe condition can not do usual hygiene procedures often. They can have dry mouth, evident dental deposit; it worsens the drain function of the mouth. As the consequences are gingivitis, stomatitis, and, perhaps, acute parotiditis. It is necessary to wipe the patient’s mouth (teeth, tongue, gums) with the help of gauze and antiseptics (weak liquid of potassium permanganate, 0.5% water chlorhexidine). If the patient can he must gargle. Hygiene of a body of the patient with a bed care

16. Operation Theatre

17. Read this slide first! Purpose This PowerPoint is intended for use as a guide to help medical students learn the people and equipment commonly found in operating rooms. Please feel free to use these slides as the basis of a meeting with your school’s Surgery Interest Group.

18. Evolution Of OT

19. Modern OT: inside view

20. An operating room (OR), also called surgery center, is the unit of a hospital where surgical procedures are performed Definition :

21. The operational block is placed separately from wards. The best conditions may be created in the separate premise connected with the basic bulk by a transition or the lift and connected to resuscitation unit. The modern operational block should include operational theatres, preoperative, sterilizing, material, an equipment room, rooms for medical staff. Every operational theatre should have one operational table. Its area should make up 36-48 m2 at the height of room not less than 3,5 m. It’s expediently even in the rather small departments to have separate operational for emergency and for purulent operations. The operational block is among the premises with the limited access. Structure

22. - zone of a sterile mode (operational, preoperative, sterilizing) • - zone of a strict mode (rooms for storage of tools and devices, rooms for the personnel) • - zone of the limited mode (technical zone for technical equipment) • - zone of the common mode (cabinets of the head, the senior sister, a room for dirty operational cloth, etc.). For maintenance of sterility in the operational block 4 zones are allocated:

23. The ceiling, floor and walls of an operational theatre should rounded to pass each other, to avoid congestions of a dust in the corners and to facilitate cleaning. A ceiling must be painted with white oil-colour, walls and floor are covered with tile. In operational it is necessary to have big light windows focused on the north. Structure

24. Students must put on medical masks in a corridor and the bootee they have to put on at a preoperative room. • Students must not have wool cloth under apron. Long hair must be hidden under cap. • In the operational theatre there must not be any divagation, talks and noise. • It is not allowed to come in and out very often. Notes for students

25. Students must take allocation in a specified place. They do not allow to touche operational sheets, doctors gowns and especial operational table. • It is disallow to pick up instruments or cotton fallen down on the floor. • Students must get off bootee before to come out threw operational block. Notes for students

26. Preparing for Operating Room Know the case Review pathophysiology and basics of procedure Review possible complications of procedure Put on shoe covers, surgical cap, and mask at entrance to perioperative area Be cordial to the OR front desk staff so that you are alerted when the patient is sent for, or if there are schedule changes your team needs to know about! Review the Student Resource Task Force module titled Shadowing in the OR for helpful tips about good OR behavior!

27. In the Operating Room Introduce yourself to the circulating nurse and scrub tech as soon as you help bring the patient back in Know and remember your glove size After introducing yourself to the scrub tech, inform them of your glove size before scrubbing in Write your name on a white board A nurse will need to add your name as a member in the room Help tie gowns

28. Do not pick up any item from a table with blue drapes unless asked directly Try to time scrubbing as soon as you are unable to contribute to the room, and before the attending/resident scrubs Ask and confirm with the attending/resident where to stand As the case is wrapping up, double check with either RN/Anesthesia to bring the bed back in You can bring new blankets from the warmer and bring the positioner at the end In the Operating Room

29. Navigate through the following slides sequentially. Or you may click on the blue circles to be taken to more detailed information. Click the “back” button to be taken to your original slide. Equipment Surgical Lights Medical Receptacle (“Kick Bucket”) Electrocauterizing Equipment Scrub Sink and Sterile Gown/Gloves Suctioning Equipment Lines and Outlets Imaging Sterile Back Table Anesthesia Machine Anesthesia Cart Mayo Stand Operating Table • Positioners • Gel Pads • Towels • Drapes • Patient Warmer 1 6 2 7 3 8 4 9 5

30. Personnel D D • Surgeon +/- Resident/Medical Student (All Sterile Team) • Anesthesiologist (Unsterile Team) • Circulating Nurse/Circulator (Unsterile Team) • Opens non-sterile instruments, retrieves supplies • Ties surgical gowns for others • Ensures OR is prepared before surgery • “Time-out" procedure • Paperwork and coordination • Scrub Technician or Nurse (Sterile Team) • In charge of instruments/Mayo stand • Maintains sterile field – if they say you are not sterile, DO NOT question! Scrub out! • Keeps accurate count of all instruments/gauze used • Organizes tissues for biopsy A A B C C D A D A B A

31. Operating Room Set-Ups Thoracic Suite with Intraoperative Imaging Surgeon +/- Resident/Medical Student (All Sterile Team) A Laparoscopic Surgery A A D D Scrub Technician or Nurse D

32. Operating Room Set-Ups Robotic Surgery Vascular Combined Suite C A A Surgeon +/- Resident/Medical Student (All SterileTeam) • Circulating Nurse/Circulator (UnsterileTeam) C A

33. Name That Equipment! (click on the space bar to see the answer) 2 3 1 Sterile Back Table 4 1 Anesthesia Machine 5 2 3 Anesthesia Cart 4 Mayo Stand Operating Table 5

34. Name That Person/Equipment! (click on the space bar to see the answer) 6 Name That Equipment! D B A Mayo Stand 4 4 Operating Table and Positioners 5 8 5 6 Surgical Lights Electrocauterizing Equipment 8 Name That Person! Suction Equipment Surgeon/Resident A Anesthesiologist (Unsterile Team) B Scrub technician D

35. Name That Person/Equipment! (Click on the space bar to see the answer) 6 A Surgeon/Resident A A Anesthesiologist (UnsterileTeam) B B 2 2 8 Anesthesia Machine 6 Surgical Lights 8 Electrocauterizing Equipment

36. Sterile Back Table 1 Role: Scrub technician or scrub nurse This is used prior to a procedure to arrange, count, and prepare instruments.

37. Anesthesia Machine and Cart 2 3 Role: Anesthesiologist/Nurse anesthetist An anesthesia machine delivers a mixture of oxygen and anesthetic gas to a breathing system. An anesthesia cart holds equipment and medications for anesthesia, sedation, and reversal. It also contains equipment for respiratory support and resuscitation.

38. Mayo Stand 4 Role: Scrub technician or scrub nurse The Mayo stand is used to arrange appropriate instruments prior to the procedure. During the procedure, the scrub technician/nurse will use the Mayo stand to remove or add instruments requested by the surgeon.

39. Operating Table and Patient Equipment 5 • The patient is positioned on the operating table during the procedure. This can be adjusted using levers on the table, gel pads, and other positioners. • Positioner (a.k.a. “roller board”): • After placing a sheet around it, use this to place under the patient for transfer to OR bed or off. Pull the sheet to roll the patient. A team effort! • It’s usually against a wall in the OR. Blanket Warmer Patient Positioner / Roller Board

40. Surgical Lights 6 Role: Surgeon The handles at the center of light are given sterile covers to use to position the light as needed. Because it is sterile, the cover must be replaced if anything unsterile (including your head) touches it. Surgeons can adjust the overhead surgical lights to provide desired lighting for the surgical field. Covers are disposed of following a procedure.

41. Medical Receptacle 7 Role: Scrub technician or nurse (perioperative), circulating nurse (postoperative) The receptacle is used by operating room personnel to collect disposable items such as sponges during the procedure. An OR nurse or technician can use the bucket items in the final count to ensure all items are accounted for. Below, a ring stand used for keeping bowls or basins is also pictured.

42. Electrocauterizing Equipment 8 Role: Surgeons use the cauterizer, but a scrub nurse or circulating nurse may change settings as requested Electrocauterizing equipment is used to cut, coagulate, and desiccate tissue with limited blood loss.

43. Scrub Sink and Sterile Gown/Gloves 9

44. Suction Equipment The purpose of the suction set-up is to remove fluids (both irrigating and body), tissue and gases from the surgical field. The equipment is set up in a manner in which containers stay in sight but out of the way. Fluid will automatically flow into subsequent containers as they fill. All fluid is measured and recorded at the end of the procedure. The force of suction can be controlled from mild to heavy with the regulator. Tubing goes from the regulator to the canister and then to the surgical field.

45. Lines and Outlets • Red Outlets: • Power failure outlets, powered by generators. Critical equipment connected such as anesthesia machine. • High power needs supplied by outlets everywhere including those on the floor. • Premium gases: • Air is YELLOW • Oxygen is GREEN

46. Imaging

47. DRESSING ROOM

48. Dressing in surgical department are intended to perform the bandaging and some other manipulations to the patents. • It is a measure of prevention of purulent infection distribution in the surgical department there are two dressings: "clean" and "purulent". Definition

49. For dressing with one table the area of 20-22 m2 is provided. The dressing floor and walls should be cover with a tile). The ceiling must be painted with an oil-colour). This measure is done to diminish the dirt and be easily washed with disinfecting substances. Colour of floor, walls and ceiling should be tender), it may be white or with green, blue tinctures). Usually in dressing the bactericidal ultra-violet lamp is present. This lamp is switched on after bandagings to kill microbes in the air. Stucture

50. operational universal table • common sterilized table (table for sterile instruments and dressings) • small tool and dressing table for direct dressing job • supports for drum sterilized boxes • glass cases for drugs • overhead light • tanks (vessels, plastic cases) for chemical disinfection of instruments, gloves, cottons and so on. • certain sets for wound treatment (for example lasers) The equipments