COST CUTTING (CONT)

O.T. Envoirment(cont)
Asepsis



Some surgeons only scrub their nails, and then thoroughly soap
and wash down their hands and arms unto their elbows a number of
times for 5 minutes.
Always wash the foam from your hands while holding them higher
than your elbows so that the water drips down into the sink.

- Turn off the taps with your elbows
- Hold the folded towel with the fingers of both hands, then let
it drop open, so that you don't touch anything with the open
towel.
- Dry your hands on one corner, then dry your forearms.
- Try not to bring a wet(now unitarily) part of the towel back to
a dry area of your arms and hands.
3.3.3 GOWNING
- Hold the gown away from your body, high above the floor.
- Allow it to drop open and put your arms into the arm holes
while keeping your arms in front. The inside of the gown is
facing you
- Then flex your elbows and abduct your arms to allow the arms to
enter the gown fully.
- Wait for the nurse to help you.She will hold the inner sides
of the gown at each shoulder and pull them over your shoulders
and will tie the tapes of the gown at the back.
3.3.4 GLOVING
- Dust your hands with powder and rub them together to spread it.
- Be careful to touch only the inner surface of the gloves.
- Hold the inner aspect of the turned down cuff of a glove with
the fingers of one hand, and pull it on to your opposite hand

- Leave its cuff for the moment.
- Put the fingers of your already gloved hand under the outward
turned cuff of the other glove, and pull it on to your bare
hand
- Turn down the outward turned ends of both your gloves onto your
ends of your gown.
- It is a good routine to wash your gloved hands in sterile water
to remove any powder.
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CUT THE COST

3.3 ASEPTIC TECHNIQUE
3.3.1 Entering the Theatre:
* Entry to the theatre should be limited to the surgical team and
the O.T. staff.
- Masks and caps must be worn before entering the O.T.
- Those that enter the theatre must change, in the changing room
in to OT shoes, and OT suit, not to leave the OT. area in these
shoes, and clothes.
- Change back to street clothes before leaving O.T.

3.3.2 SCRUBBING UP
Adjust the elbow tap lever so that the flow of water is without
splashing.The most tropical countries only a cold water tap is
necessary.
- Wet your hands, apply a little soap or detergent, and work up a
good foam by rubbing with your hands and adding more detergent
as required.
- Scrub your hands and forearms to 5 cm above your elbows for one
complete minute.
- With the flow wash your hands and forearms free of soap.
- Then take a sterile brush from the bowl and put soap on it.
- Scrub the lateral side of your left thumb, then its medial side,
then the lateral and medial sides of each of the finger
seprately.
- Scrub your nails, and then the back and front of your left
hand
- Follow the same routine on your right hand. Scrub for 5 minutes
in all.
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PREVENT DOWNSIDE

3. O.T. WORK ENVIORMENT
Surgical intervention is one reason for hospital admission.
Planned surgery has less risk of infection,
However emergency surgery, because of urgency has a higher risk.

SOURCE OF INFECTION

3.1 Infection will occur unless high standards of
-Preoperative (skin prep,scrubbing,asepsis.)
-Intra-operative, and
-Postoperative rules are observed in the care
of instruments and patients.

- The occurrence of post operative infection, and cross-infection will rise, if rules asepsis are not observed,
Resulting in anything from minor irritation, to a major
disaster (SEPTICEMIA, DIC.and SHOCK).
Standard rules, and procedures need to be defined, by hospital Director/Infection Control Committees, and observed by the surgical teams.
3.2 Most cases of infection can be avoided by:
- Careful aseptic technique.
- Attention to rules, and procedures, for sterilization of
instruments and dressings.
- Today in addition to problems of common bacterial pathogens,
surgeons, are having to address the problems of viral agents
Such as Hepatitis B, C. and HIV infection, these are prevalent in the population, and have very serious LONG TERM consequences for hospital staff/other patients if transmission occurs.
- Infection is not always a problem of patients infecting doctors
and other patients an
- INFECTED SURGEON, or a MEMBER of his team, can infect the patient. It is therefore important, that all members of the surgical team be aware of the potential DANGER of personal infection, and to know how to avoid infection, and treat them. and
Not to take part in OT duties till the infection has cleared.
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MORE DOWNSIDE 2

2.3 HOSPITAL WARDS
Source of infection

The bed linen is a source, and to limit this it is changed frequently and washed.
Blankets are another source, washed and reissued to fresh patients.
Mattresses are covered with plastic sheet, and cleaned with antiseptic solution after patient use.

2.4 CENTRAL STERILE SUPPLY DEPARTMENT
A Central Sterile Supply Department equipped with autoclaves is
Essential.
Instruments in packs are prepared for each procedure in the wards, and are supplied to all locations, in appropriate number so that no instrument or pack is used for more than one procedure.
Disposable instruments and packs have simplified this further.
* Strict precautions of wash cleaning hands, forearms by scrubbing and
wearing sterile gloves and gowns, masks and caps must be observed
for major ward procedures.
*Hand washing is a standard routine after seeing each patient.
* Ward furniture including treatment rooms must be cleaned with
antiseptic solution frequently.
* An infection control committee should be functioning to
investigate, identify, and isolate any source of infection in case of outbreak of hospital infection, to prevent cross infection.
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