2. PRETEST
1. The Definition of Asepsis is:
A. Soiled or infected with organisms
B. Capable of producing disease
C. Absence of microorganisms
3. 2. Cross-contamination is defined as:
A. Producing or capable of producing disease.
B. Transmission of microorganisms from patient to patient and from
inanimate objects to patients.
C. Severe toxic state resulting from infection with pyogenic organisms.
4. 3. Which task or function during a surgical procedure is designed as
being within the scope of the practice of the scrub nurse?
A. Closing the surgical wound
B. Setting up the sterile field
C. Administering blood products
5. 4. For which member of the surgical team is a “surgical scrub”
unnecessary?
A. Anesthetist/anesthesiologist
B. Surgical technologist
C. Scrub nurse
6. 5. Which is the best technique for you to use when rinsing your
hands and forearms after a surgical scrub?
A. Rinsing is not performed after a surgical scrub because it
will reduce the antimicrobial activity of the cleansing
solution.
B. Rinsing should start at the elbow with the water running
down back down to the hand.
C. Rinsing should start with the hand positioned such that
water runs off the elbow rather than down to the hands.
7. ANSWERS TO PRETEST
1. Correct answer is (a.)Absence of microorganisms.
2. Correct answer is (b.)Transmission of microorganisms from
patient to patient and from inanimate objects to patients.
3. Correct answer is (b.) Setting up the sterile field.
4. Correct answer is (a.)Anesthetist/anesthesiologist.
5. Correct answer is (c.) Rinsing should start with the hand positioned
such that water runs off the elbow rather than down to the hands.
8. IN MODERN SURGERY
THREE key BATTLES for surgery:
Battle against PAIN
Battle against BLOODLOSS
Battle against INFECTION
9. Only sterile items are used within the sterile field
Sterile persons are gowned and gloved
Tables are sterile only at table level
Sterile persons touch only sterile items or areas
Unsterile persons avoid reaching over the sterile field
The edges of anything that encloses sterile contents are considered unsterile
10. The sterile field is created as close as possible to the time of use
Sterile areas are continuously kept in view
Sterile persons keep well within the sterile area
Sterile persons keep contact with sterile areas to a minimum
Unsterile persons avoid sterile areas
Destruction of the integrity of microbial barriers results in contamination
11. ONLY STERILE ITEMS ARE USED
WITHINTHE STERILE FIELD
Discard any contaminated items:
If a sterile package is found in a contaminated area.
If uncertain about the actual timing or operation of the
sterilizer.
If an unsterile person comes into close contact with a
sterile table.
If a sterile table or unwrappedsterile items are not under
constant supervision.
12. Discard any contaminated items:
If the integrity of the packaging material is not intact.
If a sterile package wrapped in a material other than plastic
or another moisture-resistant barrier becomes damp or wet.
If a sterile package wrapped in a pervious woven material
drops on the floor or other areas of questionable cleanliness.
ONLY STERILE ITEMS ARE USED
WITHINTHE STERILE FIELD
13. STERILE PERSONS ARE GOWNED AND
GLOVED
Observed gowning practices.
Self-gowning and gloving should be done
from a separate sterile surface to avoid
dripping water onto sterile supplies or a
sterile table.
The stockinette cuffs of the gown are
enclosed beneath sterile gloves.
Sterile persons keep their hands in sight
at all times and at or above waist level or
the level of the sterile field.
14. STERILE PERSONS ARE GOWNED AND
GLOVED
Observed gowning practices.
The back of the gown is considered
contaminated.
The gown is considered sterile only to
the highest level of the sterile tables.
16. TABLES ARE STERILE ONLY ATTHE
TABLE LEVEL
Sterile table.
Only the top of a sterile, draped
table is considered sterile.
The edges and sides of the
drape extending below table
level are considered unsterile.
17. STERILE PERSONS ONLY TOUCH
STERILE ITEMS OR AREAS
Sterile team members maintain contact with
the sterile field by means of sterile gowns and
gloves.
The unsterile circulator does not directly
contact the sterile field.
Supplies are brought to sterile team members
by the circulator, who opens the wrappers on
sterile packages.
18. UNSTERILEPERSONSAVOID
REACHINGOVERTHESTERILEFIELD
The scrub person sets basins or
glasses to be filled at the edge of
the sterile table.
The circulator holds only the lip of
the bottle over the basin when
pouring solution into a sterile basin
in order to avoid reaching over the
sterile area.
19. EDGESOF ANYTHINGTHAT
ENCLOSESSTERILECONTENTS
ARE CONSIDEREDUNSTERILE
The inside of a wrapper is considered
sterile to within 1 inch of the edges.
The circulator opens top flap away from
self. Then turns the sides under.
The last flap is pulled toward the person
opening the package, thereby exposing
the package contents away from the
unsterile hand.
20. THESTERILE FIELD ISCREATED
ASCLOSE AS POSSIBLETOTHE
TIMEOF USE
Sterile tables are set up just prior to the surgical procedure.
It is virtually impossible to uncover a table of sterile contents without
contamination.
Covering sterile tables for later use is not recommended.
21. STERILEAREASARE
CONTINUOUSLYKEPT INVIEW
Sterile persons face sterile areas.
Someone must remain in the room to maintain vigilance when sterile packs
are opened.
Sterility cannot by ensured without direct observation. An unguarded
sterile field should be considered contaminated.
22. STERILE PERSONSKEEPWELL
WITHINTHESTERILEAREA
Sterile persons stand back at a
safe distance from operating bed
when draping the patient.
Sterile persons pass each other
back to back at a 360-degree turn.
Sterile persons turn their backs to
an unsterile person or area when
passing.
Sterile persons face a sterile area
to pass it.
23. UNSTERILEPERSONSAVOID
STERILE AREAS
Unsterile persons maintain a
distance of at least 1 foot from any
area of the sterile field.
Unsterile persons face and observe a
sterile area when passing to be sure
they do not touch it.
Unsterile persons never walk
between two sterile areas.
The circulator restricts to a
minimum all activity near the sterile
field.
24. THERE IS NO COMPROMISE WITH
STERILITY
IT’S CONSIDERED STERILE OR
UNSTERILE.
25. THE SURGICAL TEAM
Surgeon
Surgical assistant
Anesthesiologist or the certified RN anesthetist
Circulating nurse
Scrub nurse
26. CIRCULATING NURSE
Coordinates, overseas and is involved in the patients nursing
care in the OR.
Monitors traffic in the room.
Assess the amount of urine and blood loss
Reports findings to the surgeon and anesthesia provider
Ensures that the surgical team maintains sterile technique and a
sterile field
27. CIRCULATING NURSE
Anticipates the patients and surgical teams needs, providing
supplies and equipments as needed.
Communicates information regarding the patients status with
family members during long or unique procedures
28.
29. SCRUB NURSE
Sets up the sterile field, drapes the patients and handles sterile
supplies, sterile equipment and instruments to the surgeon
Maintains an accurate count of sponges, sharps, instruments,
and amounts of irrigation fluid and drugs used.
30. IMPORTANT ISSUES
Promote measures that maintain the patients normal
temperature of 36.6 C t 37.5 C (98 F to 99 F)
Ensure that OR temp. is between 25 c and 26.6c
Warm all intravenous and irrigating solutions.
Monitor the patients temperature continuously
Remove all wet gowns and drapes promptly and replace with dry
ones to prevent heat loss
31. IMPORTANT ISSUES
Promote measure that decrease risk of infection
Maintain sterile procedures and techniques during surgery
Apply sterile dressing to all wounds
Non scrubbed personnel refrain from touching or contaminating
anything that is sterile
32. ENSURE SAFETY IN OR
Remove any potential contaminants
Keep room noise and talk at a minimum
Recheck electrical equipments for proper operation
Count and record sutures, needles, instruments and sponges.
Remain at the patients side during anesthesia induction.
33. ENSURE SAFETY IN OR
Verify proper positioning of the patient to protect nerves,
circulation, respiration, and skin integrity.
Always pad pressure areas
Ensure that newly requested items are quickly supplied to the
anesthesia or scrub team by the circulating nurse.
34. PERFORM OTHER ACTIONS
AS APPROPRIATE
Act in the role of a patients advocate, providing privacy and
protection from harm
Follow established procedure and protocol
Document all OR care
Promote ethical behaviors (respect, confidentiality)
Apply grounding pad.
35. TIME OUT
A protocol preventing wrong site, procedure, person or surgery.
Must occur in the location where the procedure is done.
All the members of the surgical team are involved.
36. POSITIONING OFTHE PATIENT
The responsibility is shared by the nurse, surgeon and
anesthetist.
The nurse must be aware of the position required for each
surgical procedure and it’s physiological changes.
37. GOOD POSITIONING IS
IMPORTANT TO:
Adequate exposure of the operative area
Make the patient accessible for anesthesia and IV access
Minimize interference of circulation due to pressure on a body
part
Provide protection from injury to nerves due to improper
positioning of arms and hands
Provide for the patients individuality and privacy by proper
draping
