doi: 10.1017/ice.2016.240. Back in 2013/14, there were more than 2.4 million hospital admissions in Australia that involved a surgical procedure within an operating theatre. This represents about 8 per cent of all surgical discharges. A completeassessment of the patient and surgical procedure is necessary. The nursing profession describes its primary role as patient advocacy. The surgeon does not take hiseyes from the microscope to receive instruments -- the scrub person hands the instrumentsto the surgeon in the position of use. The patient's most vulnerable phase of care is in the operating room. Whether applying to a first-professional, campus based program or a post-professional distance program, an assigned Enrollment Advisor is available to assist you from application to acceptance. From Standards, Recommended Practices, and Guidelines. 2010). The multi-skilled support staff prepares a surgically clean environmentand provides sterile instrumentation. Instrumentation must be delivered to the OR sterile and in proper working condition.When creating instrument sets and single items, the service specialty manager works withthe CS team to select the best packaging system (rigid container, peel pac, protectivetray and tips) as well as decontamination and sterilization methods (steam, gas, orplasma) using the manufacturers' guidelines. However, there has been less consideration of other serious and more common healthcare-associated infections (HCAI) such as surgical site infection (SSI). As patientadvocate, the perioperative nurse ensures the critical steps of the pathway are met toprevent a surgical site infection. SSI prevention is a collaborative andintegrated process involving many departments as well as professional, technical, andsupport personnel. This is necessary to ensure smooth flow of theprocedure with multiple team members (scrubbed and not scrubbed) and availability ofrequired instruments, equipment, and supplies. A ward checklist should be completed prior to a patient’s operation. Thesurgical wound is classified in the OR at the conclusion of the procedure according to CDCcriteria (clean, clean-contaminated, contaminated, and dirty-infected). Most microsurgicalprocedures are Class I, clean. To be effective, administration is timed to ensure adequate serum and tissueconcentration before the incision is made and to maintain the level throughout theprocedure.11 Typically, the antibiotic is administered intravenously in theholding area 30 minutes prior to the patient entering the operating room. Multi-professional teams led by doctors and nurses formed the frontline of defence against this highly contagious infection. The aim of operating theatre infection control is to minimise risk of surgical site infections (SSIs). Infection control nurses play a critical role in protecting public health—and the need for new practitioners in this specialty is more evident than ever. Thenurse combines knowledge of the procedure, potential pathogen contaminates, andappropriate prophylactic antibiotic agents with a complete patient assessment to preparefor the case. All rights reserved. Traffic patterns and zones are established to reduce cross contamination, controlaccess to the areas, and to facilitate efficiency.13 These divisions separatethe department by activity and required attire. Registered Nursing, “Infection Control Nurse,” last updated/verified Feb 24, 2020: Monegro et al., “Hospital Acquired Infections,”. © 2020 MJH Life Sciences and Infection Control Today. Suite 149 This article outlines some of the challenges that nurses may experience in ensuring effective infection prevention and control, and how these can be addressed. San Marcos, CA 92069, Austin, TX Campus In the event that an individual attending theatre is identified at risk then:  Infection Prevention and Control Nurse or on call Microbiologist must be contacted wherever possible prior to surgery (ideally prior to theatre attendance)  Assessment of the level of risk of the procedure must be undertaken prior to the procedure wherever possible Eye preps include irrigating the eye with sterile saline, cleansing the baseof the eyelashes and the periorbital area with a betadine solution. Surgical site infections (SSIs) are defined as infections occurring within 30 days after surgical operation or within one year if an implant is left in place and affecting either the incision or deep tissue at the operation site (Owens and Stoessel 2008). To perform these delicate, precise procedures, special instruments are used. Equipment used in thesterile field or brought into proximity must be draped. APIC is the leading professional association for infection preventionists, with over 15,000 members. Burnett E (2018) Effective infection prevention and control: the nurse’s role. According to UK National Joint Registry Report, during 2003 -2006 period infection was responsible for about 19 % failure of joint surgery resulti… The scrub nurse’s duties begin far before the start of the operation. The length of surgery, complexity, and phases of microsurgery procedures and the numberof team members involved vary greatly. Three parameters of the OR environment are controlled to inhibit the growth ofmicroorganisms. Nurses play a crucial role in preventing and controlling transmission of the infection through the application of standard precautions and maintenance of the health care environment. The emergence of multi resistant micro-organisms and the increased awareness of appropriate antibiotic use have made the process of theatre infection control and its evidence base ever more relevant. Select a 2nd choice campus if you are open to another or all campuses. This study will focus on the continued assessment of OR staff behaviours using a motion tracking system and their impact on the SSI risk during surgical procedures. The Master of Occupational Therapy (MOT) program is also available at our Miami, FL, Austin, TX and San Marcos, CA campuses. Registrations: (800) 241-1027, Copyright © 2020 Legal & Consumer Disclosure  •  Title IX / Safety & Security  •  Privacy Policy  •  Program Data  •  Accreditation  •  Contact. When preparing for new procedures, the RN specialty managermeets with the surgeon to discuss key aspects of the procedure. In restricted areas of sterile cores, autoclave usage, and ORs with opensterile supplies or a case in progress, masks must be worn. Our degrees are offered online, with optional on-campus immersions* and an annual interprofessional trip abroad. In the unrestricted area, there isinterfacing with other departments (such as the scheduling department and holding area)and street clothes are allowed. Media Inquiries: (760) 410-5306 Central to thisadvocacy role is the goal of ensuring patient safety. Components of these drill systems include a motorcord, motor handpiece, attachments, and drill bits. Optimal surgical exposure is key to any procedure. These implantsare supplied sterile and do not require sterilization within the institution.Documentation of implants and grafts on the operative record identifies the implant,manufacturer, lot and serial number, implant size, location and expiration date. Humidity is maintained at 30-60%, the rooms are kept cooler at 68-73ºF,and the room is ventilated through high-efficiency filters at a rate of 20-25 total roomair exchanges per hour. Within case managementclinical care, paths are used as "guidelines that outline the ideal course oftreatment during the episode of care"4 and are designed to decrease costs,improve outcomes, and increase patient satisfaction.5 Today's healthcare ismeasured in outcomes of cost and satisfaction. *1 Within Australia there are approximately 168,000 annual cases where a surgical procedure has led to post-discharge surgical site infections (SSIs) *2. This allows the scrub team easy access toinstruments and equipment, the anesthesia providers' patient access for monitoring, andthe non-scrubbed team to circulate in the room without compromising the sterile field. *3 The above facts ably demonstra… It is used to ensure patient and staff safety throughout surgical procedures and patients stay in NursingAnswers.net Duties and Skills •Monitoring – One of the primary responsibilities of the infection control nurse and staff is monitoring the occurrence of infection in the clinical setting. Employers should introduce new members of staff to basic health and safety laws and principles. Preparing the surgical environment involves many steps, several of which are completedthe day prior to the patient's scheduled procedure. Many advances have been made in infection control practices,addressing aseptic and surgical techniques as well as antimicrobial prophylaxis. Thanks to the increased awareness of risks and the additional preventive measures being taken in hospitals, the medical community has made significant progress in reducing the incidence of various types of hospital-acquired infections. INFECTION CONTROL IN THE OPERATING ROOM 4 INTRODUCTION The risk of infection from bloodborne pathogens in the operating room (OR) is a constant challenge for the perioperative team due to existing bloodborne pathogen risks, drug-resistant pathogens and newly recognized pathogens as well as the daily safety hazards of the working environment. After you have practiced as a registered nurse for at least two years, you will be eligible to sit for the Certification in Infection Prevention and Control (CIC®), which is awarded by the Certification Board of Infection Control and Epidemiology (CBIC®). China had about 4.1 million registered nurses, including nearly 200,000 registered nurses … The COVID-19 outbreak clearly demonstrates the need for personal protective equipment and planning in the fight against pandemics of dangerous pathogens. The Infection Prevention Control (IPC) guidance has been published in 2 different formats (PDF and HTML). The perioperative nurse must know thelikely SSI source pathogen risks for the various microsurgery procedures, the patient'sallergies, and ensure the antibiotic of choice is available and administeredappropriately. Considering the body areas of microsurgery (spine andhead), this is done in the OR after induction and positioning. SSI is the third most common cause of HCAI afte… All members of themicrosurgical team, scrubbed and non-scrubbed, must observe these requirements. Patients undergoing microsurgical procedures are appropriate for case managementpathways. All rights reserved. Nursing Standard. The Doctor of Physical Therapy (DPT) program is also offered in a convenient Flex format (Online + Weekend Labs on campus). Equipment needed later into the procedureis set-up and opened closer to point-of-use to keep the sterile field and operating roomless cluttered and to decrease the likelihood of contamination from an extended exposuretime. The prevention of surgical site infections is not a result of isolated actions taken byone provider. Preparation of the patient also includes patient attire and the shave-and-skin prep.Just as the surgical team wears surgical attire (scrubs, hats, masks), the patient wears ahospital gown and hair covering. Complete coursework when and where you want—and earn your advanced nursing degree while keeping your work and life in balance. The Master of Occupational Therapy (MOT) program is also offered in a convenient Flex format (Online + Weekend Labs on campus). You have a relevant job title (e.g., infection preventionist, epidemiologist). Certification Board of Infection Control and Epidemiology, “Requirements for CIC® Initial Certification and for Lapsed Certificants”: Your email address will not be published. Manyteams "map" out the procedure room set-up for optimal placement of equipment,furniture, anesthesia, and team members. This can bechallenging because many microsurgical procedures are performed in a darkened room toenhance the illumination of the surgical anatomy by the microscope's light source. These guidelines are based onmicrobiology, research, review of evidence-based literature, and opinions ofmultidisciplinary experts.8 The Recommended Practices with infection preventionapplication can be grouped into the sterilization process; patient preparation; theenvironment, and the sterile field (Table 1). During the perioperative surgicalexperience, the patient receives a rapid sequence of care from a multidisciplinary teamwithin a shortened length of stay. Disposable drape technology providesextended barrier properties against moist bacterial "strike through" and controlof blood and body fluids and irrigation during the procedure. SSIs are reported as the major cause of high morbidity and mortality among post -operative patients (Weigelt et.al. Draping allows thescrubbed personnel to adjust the microscope, protects the field from contaminants on thesurface of the microscope and provides a sterile backsplash during drilling. Operative times for myringotomies and cataracts are5 and 10 minutes respectively, while an acoustic neuroma is 6 to12 hours in length. Within the HTML format, the guidance … Many microsurgery procedures involve the placement of an implant or a graft. The objective of case management is to provide "a continuum ofcare that allows consistent delivery of quality treatment and services across all carecontinuums. The total admission time for the patient is shortened, and post-operativecomplications (i.e. By clicking the checkbox, I provide my express written consent for University of St. Augustine for Health Sciences to contact me via email, text, telephone, and prerecorded message regarding furthering my education. Contamination is event relatedand with longer cases, there is more opportunity for an event to occur. The Master of Occupational Therapy (MOT) program is also available at our San Marcos, CA, Austin, TX and St. Augustine, FL campuses. Infection control in operation room 1. Nursing Standard. Abstract. Alumna Pairs Passion with Purpose for Occupational Justice, Ready for Your First Clinical Rotation? The concerned person has thorough knowledge regarding the various aspects of working in an operation theatre such as bio medical waste management and infection control. In this profession, it is critical to have strong attention to detail, the ability to work well under pressure, and excellent communication skills. The Master of Occupational Therapy (MOT) program is also available at our Miami, FL, San Marcos, CA and St. Augustine, FL campuses. The exception to this rule is outpatient procedures, suchas cataract extraction. Outbreaks of infectious diseases are rising globally,1 and infection control professionals are constantly facing new challenges, such as bacterial resistance to antibiotics and the spread of highly contagious viruses like COVID-19.2. Antibiotics are also given intra-operatively on the sterile field in anirrigation solution (such as cefazolin or bacitracin in normal saline for orthopedic,neuro/neurotology, plastics procedures), topical ointments or drops (for otologic andophthalmic procedures) or injection (gentamycin or cefazolin subconjunctival injection forvitreo retinal and trabeculectomies, respectively). Cataract patientvolume is high (an average of 10+ patients/surgeon/day) while the acoustic neuroma patienthas high risk and requires multidisciplinary services. Towels and/or adhesive drapes areused to "square off" or outline the prepped incisional area and to confine hair.Adhesive incise drapes are used for ophthalmology procedures that do not require eyelashclipping (cataracts) to confine the eyelashes. In addition, Centers for DiseaseControl and Prevention (CDC) lists the likely SSI pathogens for several microsurgeryprocedures as well as site-specific organ/space SSI (disc space, mastoid space,endophthalmitis).6. Microscopes are brought in closeto the field with the ocular arm extended directly over the field. Nurse training incorporates awareness of specific legislation such as Manual Handling Operations Regulations 1992, Reporting of Injuries, Diseases and Dangerous Occurrences Regulations 1995, and Control of Substances Hazardous to Health 2002. The eyelashes are clipped for vitreo retinal procedures using a curvediris scissors with blades coated with an ophthalmic antibiotic ointment to catch thelashes. Check here if you're interested in hearing more about the Flex DPT currently offered in Austin, San Marcos and St. Augustine. The COVID-19 pandemic underscores the global need for motivated nursing professionals who specialize in developing and implementing infection prevention and control techniques. Equipment vendors provideinservice training and processing technical support to the CS and OR team. NSW Policy 2008 – Nurse in charge will ensure all staff are easily identifiable Why use a theatre cap and not just use a badge, lanyard, whiteboard? Graft material can be autologous (patient's own tissue) ordonor tissue (corneal transplants or processed donor tissue such as bone). Microsurgery Team's Role in Surgical Site Infection PreventionTeam strategies for assessing and preparing the patient and the OR, Approximately 27million surgical procedures are performed each year. That nurse's value can be demonstrated when Manyprocedures require 30 to 60 minutes of setup time to prepare the sterile field, set up andtest equipment, and safely position the patient for extended procedure time. Inservice training and initialsupport by the vendor for both the OR and CS team is important. Required fields are marked *. During the perioperati… The patient has adependent trust on his providers because of positioning requirements, anesthesia (general,monitored anesthesia care or conscious sedation), and inherent to surgery, the compromiseof the first line of defense against infection. About 1,600 people die annually in Australia from infection where existing antibiotic treatments are no longer effective. Coral Gables, FL 33134, St. Augustine, FL Campus 1. Learn how your comment data is processed. Please view our, Occupational Therapy Programs (MOT, OTD, PPOTD), Master of Science in Speech-Language Pathology (MS-SLP), Orthopaedic Manual Physical Therapy Fellowship, Physical Therapy Online Courses for International Students, Christiansen, Jen, “Global Infections by the Numbers,”, Baylor College of Medicine, “Emerging Infectious Diseases”: “. The process of infection control includes a variety of strategies and techniquesacross the continuum of perioperative care, including the pre-operative, intra-operative,and post-operative phases. Quality Improvement of the Prophylactic Antibiotic Function in Seminars in Perioperative Nursing. A detailedpreference/procedure card (i.e., standing orders for specific procedure) is writtento include instrumentation, equipment, supplies, and medications. Put into the context of today's healthcare reality of managed care, case management,and clinical pathways, this is neither an acceptable clinical or financial outcome forsurgical patients. Select a 2nd choice campus if you are open to another or all campuses. All personnelinvolved directly in the case observe traffic and attire protocols as well as correct anysterile field compromises. The knowledge and skillsbasic to general operating room care are applied to these microsurgical procedures, takinginto account the specific considerations and needs of the subspecialty. The entire OR team meetswith the surgeon, anesthesia-providers, and other team members for an oral review of theprocedure and conducts "dry labs" to prepare before a "live" case. Theseare complex, technically precise, and challenging procedures. Fax: (904) 826-0085 With assistance from the housekeeping and CS staff, compromises(contaminated instruments, blood and body fluid spills) are corrected. University of St. Augustine for Health Sciences, Clinical Excellence Through Graduate Education. ... it is the objective and desired outcome of an integrated teamprocess. Nurses at different levels, namely: the senior nursing administrator, the ward charge nurse and the nurse in charge of infection control. Introduction Inappropriate staff behaviours can lead to environmental contamination in the operating room (OR) and subsequent surgical site infection (SSI). 210-215. Surgical site infection rates are animportant indicator of these parameters. Several surgical specialties include microsurgical procedures. Data on the patient population, the types of infections involved and the causes and treatment of infection is compiled and analyzed to address continuing improvements in the operation and control of preventable diseases. An infection control nurse is a registered nurse (RN) who implements best practices for halting the spread of viruses and bacteria and delivers top care to patients who have contracted infectious diseases. This site uses Akismet to reduce spam. As the third most-reported nosocomialinfection, surgical site infections (SSIs) account for 14-16% of nosocomial infections.1A 1992 study estimates that SSIs increase the hospital length of stay by seven additionaladmission days and add an extra $3,100 in charges per admission (for tissue debridement,antibiotic therapy, and other treatments). The perioperative nurse does a quickvisual check of the room before set up and opening of sterile supplies. Select a 2nd choice campus if you are open to another or all campuses. Implant material varies from metals (stainless steel, MRI-compatibletitanium), metal-plastic combinations, plastics, silicones (as formed implants or asinjectable oil), and acrylics. Antibiotics are administered toreduce the microorganism burden to a level that does not exceed the patient's naturaldefenses. Accountability as related to swabs and sharps counting. The anesthesia provider scores the patient as a preoperative predictorof the patient's risk for surgery. GUIDE TO INFECTION CONTROL IN THE HOSPITAL CHAPTER 22: The Operating Room Author M-C Roy, MD, MSc Chapter Editor Michael Stevens, MD, MPH, FACP, FIDSA, FSHEA Topic Outline Key Issues Known Facts Controversial Issues Suggested Practice Environmental Issues Preparation of the Surgical Team and of the Surgical Field Surgical attire Thesesinclude a variety of instruments in the same categories as general instrumentation, i.e.,sharps and cutting items (scissors, scalpels, knives), graspers (clamps, forceps), andretractors (self-retaining, hand-held) that are designed to fit the specific technicalneeds of the procedure and micro-anatomy.