Hygiene of medical professional and operational block structure

1. Bukhara state medical institute
Theme : 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
Rakhimov Azizjon Yakhyoyevich

2. What is it ?
• 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.

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.
3

4. strict bed
• 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 trunk are
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.
4

5. Usual bed
• 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.
5

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

7. Body hygiene of the patient
with the common regimen
• 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.
7

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.
8
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.
9
Hygiene of a body of the
patient with a bed care

10. Hygiene of a body of the
patient with a bed care
• 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.
10

11. Hygiene of a body of the
patient with a bed care
• 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.
11

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.
12

13. Hygiene of a body of the
patient with a bed care
• 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.

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!
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
18

19. Modern OT: inside view
19

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

21. Structure
• 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.

22. For maintenance of sterility in the
operational block 4 zones are allocated:
• - 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.).

23. Structure
• 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.

24. Notes for students
• 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.

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. 1
9
2
3
4
5
6
7
8
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
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.

30. Personnel
B
C
D
A
A
D
A
C
A
D B
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
D

31. Scrub Technician or Nurse A Surgeon +/- Resident/Medical Student (All Sterile Team)
Operating Room Set-Ups
D
A
A
D
D

32. C
A
A
Surgeon +/- Resident/Medical Student
(All Sterile Team)
Circulating Nurse/Circulator (Unsterile Team)
Operating Room Set-Ups
A C

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

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

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

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

37. 2 Anesthesia Machine and Cart
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. 4 Mayo Stand
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. 5 Operating Table and Patient Equipment
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. 6 Surgical Lights
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. 7 Medical Receptacle
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. Role: Surgeons use the cauterizer, but a scrub nurse or circulating nurse
may change settings as requested
8 Electrocauterizing Equipment
Electrocauterizing equipment is used to cut, coagulate, and desiccate tissue with
limited blood loss.

43. 9 Scrub Sink and Sterile Gown/Gloves

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
Premium gases:
• Air is YELLOW
• Oxygen is GREEN
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.

46. Imaging

47. DRESSING ROOM
47

48. Definition
• 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".
48

49. Stucture
• 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.

50. The equipments
• 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)

51. Type of work in "clean"
dressing
• dressing of patient with clean wounds
• punctures and drainages of pleural cavity
• novocain blockades
• puncture biopsy
• primary treatment of wounds

52. Type of work in "purulent"
dressing
• dressing of patient with purulent wounds
• opening of suppurative processes (abscesses, phlegmons)
• drainages of purulent cavities
• small amputations (for example fingers)
• necrectomies

53. Taking care of Wounds a Priority
One to be familiar
• When applying or
changing dressings, an
aseptic technique is used
in order to avoid
introducing infections
into a wound. Even if a
wound is already
infected, an aseptic
technique should be used
as it is important that no
further infection is
introduced.
5
3

54. DRESSING ROOM BIOSAFETY A
PRIORITY
•Position the
patient
comfortably
and make sure
the
surrounding
area is clean
and tidy
before you
start. 5
4

56. Preparing oneself to do Dressing
with safety
• Wash your hands and put
on an apron.
• Clean the trolley using
soap and water, or
disinfectant, and a cloth.
Start at the top of the
trolley and work down to
the bottom legs of the
trolley using single strokes
with your damp cloth.
• Place the sterile
dressing/procedure pack
on the top of the trolley.

57. Change the Surgical
Bandage
• Before changing Dressing you
must wash your hands. Why?
Now that you have your dirty
bandage off, it is important to
clean your hands again
before touching your incision.
The bandage
and your hands will both have
bacteria on them at this point
so washing again is essential.

58. Cleaning the Incision
•Use soap and water
to gently clean the
incision, you do not
have to use
antibacterial soap.
Do not scrub the
incision, remove
scabs, or attempt to
clean the sutures or
staples.

59. Changing a regular dressing over
incision
•Wash your
hands before
starting the
dressing
change.

60. Major principles for wound dressing
• Use Standard Precautions
at all times.
• When using a swab or
gauze to cleanse a wound,
work from the clean area
out toward the dirtier
area. (Example: When
cleaning a surgical
incision, start over the
incision line, and swab
downward from top to
bottom). Change the swab
and proceed again on
either side of the incision,
using a new swab each
time.

61. Work with aseptic methods to change
the dressings
•Open the sterile
dressing pack on top
of the trolley. Open
the sterile field using
the corners of the
paper.
•Open any other sterile
items needed onto the
sterile field without
touching them.

62. Disposing the Old
Dressing
•Remove the
old dressing
by only
touching the
edges. Throw
away the old
dressing in
the garbage.

63. Wash your hands again.
6
3

64. Prepare to take a New Dressing
replacing the old dressing
•Open a sterile
dressing package
by holding the
upper two edges
of the package
and pull sideways,
rather than
tearing the
package open.

65. Prepare yourself next action to replace
the Old dressing
• Keep the new dressing
inside the sterile package
until you are ready to put
it over your incision.
• Touch only the edges of
the new dressing. Do not
touch any part of the
dressing that will be on
the incision.
• Tape all sides of the
dressing securely.

66. The Nurses should follow the Instructions for
Biosafety
•If there is a
drainage tube, be
sure to cover this
area with the
dressing.
•Follow any special
instructions your
doctor or nurse
gives you.

67. Cleaning and Irrigating the
Surgical Wounds
• When irrigating a
wound, warm the
solution to room
temperature, preferably
to body temperature, to
prevent lowering of the
tissue temperature. Be
sure to allow the irritant
to flow from the
cleanest area to the
contaminated area to
avoid spreading
pathogens.

68. Taking care of the incision
site
•Wash your hands
before caring for
your incision.
•Do not apply any
creams, salves,
ointments or
powders unless you
have been told to
do so.

69. Follow your surgeon's directions for sutures
or staples, Steri-Strips® or special
dressings. If you had:
•sutures or staples:
they will be removed
at your follow-up
appointment
•Steri-Strips (thin
paper- like strips over
the incision): they will
begin to fall off as the
incision heals. They
do not need to be
replaced.

70. After the procedure
• Fold up the dressing/procedure pack and place all
contaminated material in a bag designated for clinical
waste, making sure all sharps are removed and
disposed of in a sharps container.
• Remove gloves and place in waste bag.
• Wash your hands.
• Clean the trolley with soap and water or disinfectant
solution as before.
• Record (document) on the patient's chart your wound
assessment, the dressing change and the care you have
given.

71. Monitoring the Wound
• Report any unusual
changes
in your wound. Call your
doctor if you see signs of
infection, or if any strange
things occur around the
wound.
• Again, if you have a bad
smelling odour coming from
your wound, pus coming
out
of the wound, or excessive
amounts of pain, call your
doctor.

72. Surgical Wound Monitoring from Home
Recent Advances with Technology
•A smartphone app
called Wound
Care is successfully
enabling patients to
remotely send images
of their surgical
wounds for monitoring
by nurses.

73. Surgical Wound Monitoring from
Home Recent Advances with
Technology
•The app was developed by researchers from the
Wisconsin Institute of Surgical Outcomes Research
(WiSOR), Department of Surgery, University of
Wisconsin, Madison, with the goal of earlier
detection of surgical site infections and
prevention of hospital readmissions. The study
results appeared on the website of the Journal of
the American College of Surgeons.

74. Teach Dressing management
to patients
•Provide the patient
with some dressing
management
education and
answer any
questions before
you go.
•Report any changes
to a senior nurse or
doctor.

75. NOTE
• In small departments sometimes there is only one
dressing. In this case patients after operations
with clean wounds are dressed in the first turn
and only then - the patients with purulent
processes and postoperative purulent
complications.