The operating room should be connected with the operating department, and also close to the blood bank, the intensive care room and the anesthesia resuscitation room. Grasp the link management of four ways of surgical incision infection, namely: air in operating room; Articles needed for the operation; Doctors and nurses' fingers and patients' skin prevent infection and ensure the success rate of surgery.
I. design and equipment of operating room
(I) design of operating room
It is located in the higher part of the building, with the principle of keeping the air clean and preventing nosocomial infection, and the floor and walls can be washed. It is necessary to divide the three areas reasonably: there are unrestricted areas, semi-restricted areas and restricted areas. There should be three channels: the staff channel, the patient access channel and the sewage outlet channel. Materials should be fire-proof, moisture-resistant, and not easy to be colored, and it is advisable to use materials that are easy to clean. Modern operating room should be designed with air purification device, central oxygen supply, central suction and other devices.
(II) Operating room equipment
In addition to the general operating room equipment, there should be closed-circuit television, air conditioner and advanced electrotome (imported). In order to ensure that the operation will not be affected by unexpected power failure, the hospital should be equipped with power generation facilities. Don't pollute the ground of the operating room, it is best to use modern carts such as exchange cars.
(3) The layout of the operating room should be as simple as possible, and the cabinets should be made of moisture-resistant and firm materials to facilitate cleaning. All items should be fixed, kept in order, and strive to be unified and standardized among rooms.
ii. staffing of operating room and hospital operating beds
the ratio of operating room nurses to operating beds should be: 2.5:1 and teaching hospitals 3: 1. The setting of operating table is: 5 beds in the operation department should be equipped with one operating table, and the health worker should be .5:1. Set up 1 ~ 2 head nurses.
Third, the rules and regulations of the operating room
The operating room is a place where surgeons, anesthesiologists and operating room personnel work together, with a large turnover of personnel. In order to ensure the orderly work, not only are there rules for each operation, but also certain working systems, so that all the operations can be successfully completed.
(1) General working system of operating room
1. All staff entering the operating room must wear shoes, hats, clothes and masks, and when leaving the operating room, they should change their clothes and shoes.
2. Those who visit, study and practice outside the hospital must be approved by the medical education department or nursing department, and should have a fixed place.
3. For elective surgery in each department, the notice of operation should be sent before 1: 3 a.m. on the day before surgery. For emergency rescue surgery, oral notice can be given first, and then the notice of operation can be supplemented.
4. The operation shall be carried out according to the time of the operation notice, and must be in place on time, and shall not be changed at will. Contact the nurse in special circumstances.
5. Pick up the patient 3 minutes before operation, with medical records, and check the patient's name, gender, age, bed number, diagnosis, surgical site, drug sensitivity test and preoperative medication in detail. After the patient enters the room, the visiting nurse should review it again and pay attention to the cleaning scope of the patient's surgical site. Jewelry, dentures and watches are not allowed to be brought into the operating room.
6. Strict aseptic operation technology. Aseptic surgery and bacterial surgery should be carried out in separate rooms, and special disinfection and sterilization should be carried out for special infections.
7. Keep the room serious and quiet, and do not talk loudly, chat or read newspapers during the operation.
8. Strictly implement indoor sanitation and cleaning treatment, isolation and disinfection detection system, and implement medical safety precautions.
9. The operating room should always have all kinds of emergency surgical kits and rescue equipment, and the surgical instruments should not be checked out. If checked out, it should be approved by the Medical Education Department.
1. The operating room instruments should be disinfected on the basis of cleanliness, and all kinds of medicines, instruments and materials should be placed in a fixed position, and valuable instruments should be kept by special personnel, and counted, repaired and maintained every month. Drug signs of narcotic dramas are obvious, and special personnel shall lock them for safekeeping. Ordinary drugs shall be counted and recorded every day and checked once a month, and special personnel shall be in charge.
11. Be responsible for keeping and submitting the specimens collected during the operation, ask the doctor to fill in the pathological specimens and the submission form in time, and make registration for submission, and urge the timely submission.
(II) Management system of hospital infection in operating room
1. Management of people entering the room
(1) All staff entering the operating room must change clothes, hats, pants and shoes, and are not allowed to bring personal belongings into the work area.
(2) people entering the room must wear a dome and a mask.
(3) The staff should have a physical examination once a year, and be injected with hepatitis B vaccine according to the regulations. Those suffering from infectious diseases are not allowed to work in the room.
(4) surgical patients must change clean clothes, pants, hats and foot covers before entering the room.
(5) Wheels entering the operating room must be disinfected before entering the semi-restricted area.
(6) The staff must change their work clothes, hats, pants and shoes when going out.
2. Visiting system
(1) Personnel who are not in this room and non-surgical personnel are not allowed to enter without permission.
(2) The trainees and interns must abide by the above regulations, and the interns must be led by the teaching teacher, and they are not allowed to enter the operating room alone.
(3) Visitors must change clothes, hats, pants, shoes and masks after obtaining the consent of the medical education department or the nursing department, and move around the designated area, and are not allowed to walk around at will.
(4) In addition to cleaning and sanitation every day, one day per week is fixed as a health day to thoroughly clean and disinfect the operating room.
(5) After soaking the special slippers with disinfectant every day, clean and dry them for later use, and wipe the shoe cabinets with disinfectant once a day.
(III) Disinfection and isolation system of operating room
1. Strictly divide the restricted area (sterile area), semi-restricted area (clean area) and unrestricted area (polluted area), and clearly mark the intervals, strictly abide by the principle of three channels, and divide the operating room into sterile, non-sterile and polluted operating rooms.
2. Wash your hands carefully, strictly follow the disinfection methods and steps of hand washing, and cultivate the fingers of surgeons and hand washing nurses once a month, which should be well documented.
3. measure the specific gravity of soaking liquid and alcohol daily, and change the container and disinfectant once or twice a week, and keep records.
4. Surgeons and instrument nurses should strictly implement aseptic operation procedures after wearing sterile gloves.
5. Visiting nurses should be fully prepared, try to reduce going out and walking, and don't open the door of the operating room casually.
6. The operators who receive the platform should wash their hands, disinfect their arms, change sterile surgical gowns and gloves, and wipe the surface and ground with disinfectant.
7. Do a good job in terminal disinfection of all kinds of articles.
8. Requirements for ultraviolet rays in operation room: power ≥3W/m3, distance between lamps and the ground < ＜2.5m, equipped with ultraviolet reflector, and radiation intensity > ＞7uw/cm2.
9. Before operation, all patients who need surgery should be checked for liver function and full set of hepatitis B antigens and antibodies, and those who are positive should be treated according to the requirements of infectious disease isolation technology.
(4) general infection surgery
1. Instruments, dressings, syringes, gloves, drainage bottles, etc. should be soaked and disinfected and treated as usual.
2. Open the window in the operating room for ventilation, wipe the operating bed, cart, surface and floor with disinfectant, and disinfect the air with ultraviolet rays.
(5) Special infection surgery and isolation surgery
1. On the principle of on-site surgery, it is better to use disposable dressings, instruments and syringes, and hang isolation cards at the door.
2. All the gauze, dressing and other combustible articles during the operation should be burned.
3. Instruments, syringes and enamel trays should be soaked in .5% peracetic acid for 3 minutes, sterilized by high-pressure steam twice before treatment, and the bags should be labeled with red infectious diseases.
4. The unused items are packed in a centralized way, labeled with red signs of infectious diseases, autoclaved and routinely treated.
5. All articles that come into contact with patients, including carts and bedding, should be placed in the operating room (the cloth should be loose, and the box with cover should be opened), fumigated and disinfected with formaldehyde heating method, and sealed at 12.5ml/m3 for 24 hours.
(VI) Management of Sterile Articles
1. Sterile articles should be placed in a sterile room for centralized management, with ventilation, dryness, clean environment, no sundries, no flies and no dust, and screen doors and screens.
2. The cleaning and ventilation of the aseptic goods cabinet should be checked by a special person. The aseptic packages should be arranged in sequence and clearly marked. There are no expired goods. The validity period of aseptic goods is 7 days, and the mildew season is 5 days.
3. The volume of aseptic package should not exceed 3×3×4cm, the size of the package is appropriate, the container is not damaged, and one specified chemical reagent should be placed in the middle of large and medium-sized packages and the folded part of the package.
4. The amount of disinfectant for soaking instruments is sufficient, the joints are opened, and they should be replaced once a week, clearly marked, and bacteria cultured once a month, which should be well documented.
5. Fill and soak the dressing in alcohol barrels, and disinfect iodine and alcohol bottles once or twice a week.
6. The alcohol soaking solution is tested once a day, and the specific gravity is kept between .7 and .75, with records and signatures.
7. Soap water, finger brushes, disinfection towels and other articles should be disinfected every 24 hours.
iv. postoperative treatment of HAA-positive patients
(1) before operation
1. The surgeon must contact the head nurse or indicate on the operation notice that a special operating room should be set up for the operation, and a red isolation sign should be hung at the door of the room, and a special person should be responsible for the tour.
2. Prepare all surgical supplies before operation, including soaking boxes of surgical instruments, brushes, and soaking liquid for staff to wash their hands.
(II) During the operation
1. Workers should wear isolation gown and shoe covers in the operating room. They should not leave the operating room without special emergency. If items need to be added, they can ask outdoor personnel for help.
2. During the operation, the staff should strengthen their awareness of self-prevention. If the gloves are damaged, they should be replaced immediately, and sharp instruments such as needles and knives should be properly placed to avoid injury.
(3) After the operation
1. Wash hands with .2% peracetic acid for 1-2 minutes when leaving the operating room.
2. The uncontaminated dressings and instruments in the operating room should be repackaged for later use after autoclaving.
3. After the operation, dispose of all contaminated items separately, and do not take them out of the operating room without treatment.
(1) The instruments, suction tubes, syringes and cloth stained with blood after operation were soaked in .5% peracetic acid for half an hour and then taken out. Clean the instrument, dry it, and then autoclave it; Cloth is squeezed dry and then packaged and sent to the laundry room; The syringe is cleaned and then sent to the supply room; After cleaning the suction tube, boil it for 15 minutes and dry it for use.
(2) The dirt bucket and suction bottle should be soaked in .5% solution with 2% peracetic acid for half an hour, then the sewage should be poured into the sewage pool, and the suction bottle should be soaked in .5% peracetic acid solution for half an hour before use.
4. mop the floor of the operating room, operating table and infusion stand with .5% peracetic acid.
5. Fumigating the operation room with peracetic acid or formalin, sealing for 6-8 hours and then ventilating.
patients with sexually transmitted diseases should also be treated according to the above requirements after operation.
V. Precautions for Sterility
(1) Strictly distinguish the boundary between sterility and bacteria
Sterile articles are polluted once they come into contact with bacteria, and shall not be used as sterile articles.
1. after aseptic preparation, the operator has bacteria areas below the waist, above the shoulders, under the armpits and back. Hands or sterile articles should not touch these parts, and hands should not droop below the waist. The transfer instrument should not be carried out behind the back.
2. There are bacteria areas under the instrument table and the operating table (any instrument that falls below the table cannot be used again even if it has not touched the ground; The part of the line hanging from the desktop is also treated as contaminated).
3. gloves should be replaced immediately if they are damaged or come into contact with areas with bacteria.
4. When forearms and elbows are contacted by visitors, they should be covered with sterile sleeves.
5. When the operator needs to change positions, one person should take a step back and turn around back to back, and the front of the body should not be brushed against the back of others.
(2) keep the sterile cloth dry. When laying a sterile cloth sheet, the instrument table and the surgical incision should have more than four layers.
(3) protect the incision. Disinfect the skin before incision and suture, and protect the incision with gauze pad or special plastic film after incision.
(4) protect the abdominal cavity. Before cutting the hollow organs such as gastrointestinal tract, gallbladder and bile duct, the surrounding tissues should be covered with gauze pads to avoid the contents overflowing and polluting the operating field.
VI. Operating room safety system
1. Electrical equipment in the operating room, such as electrotome and lamp plug, should be checked regularly.
2. After the operation, the operation nurse should cut off all power plugs.
3. Toxic drugs should be locked and kept by special personnel.
4. The personnel on duty should patrol every room in the operating room, and be responsible for the safety inspection of oxygen, aspirator, water, electricity, doors and windows, and the door safety.
5. Non-duty personnel are not allowed to enter the operating room at will.
6. All personnel at all levels working in the operating room should act according to the routine to ensure the safety of patients.
7. If you find any unexpected situation, you should immediately report to the relevant departments and report to the hospital department.
VII. Responsibilities of the head nurse in the operating room
1. Under the leadership of the director of the nursing department, be responsible for the administrative and business management, nursing work and operation arrangement of this room, and keep it clean and quiet.
2. According to the task of operation and the situation of nursing staff, carry out scientific division of labor, closely cooperate with doctors to complete the operation, and attend in person if necessary.
3. urge all levels of personnel to seriously implement various regulations and technical operating procedures, and strictly abide by aseptic operating procedures. Do a good job in statistical analysis of wound healing.
4. Organize the professional study of nurses and health workers, and guide the further study and practice of nurses.
5. urge the staff to do a good job of disinfection, carry out bacterial culture in the air and hands according to regulations, and identify the disinfection effect.
6. Seriously implement the system of checking and hand-over to prevent mistakes.
7. Be responsible for claiming and reimbursing drugs, instruments, dressings and sanitary equipment in the operating room, and check the preparation of emergency surgical supplies at any time, and check the management of toxic, hemp and drama drugs and valuable instruments.
8. Supervise the retention of surgical specimens and timely inspection.
9. Be responsible for receiving and visiting.
the deputy head nurse assists the head nurse to take charge of the corresponding work.
VIII. Responsibilities of operating room nurses
1. Work as an instrument or a visiting nurse under the leadership of the head nurse, and be responsible for pre-operation preparation and post-operation sorting.
2. Conscientiously implement various rules and regulations and technical operating procedures, supervise and inspect the aseptic operation of surgical personnel, pay attention to patient safety, and prevent errors and accidents.
3. Take part in sanitary cleaning, keep the operating room clean and quiet, adjust the temperature and humidity, and keep the indoor temperature and humidity suitable.
4. Be responsible for dressing, keeping warm, escorting patients after operation, and keeping and submitting surgical specimens.
5. according to the division of labor, do a good job in packaging and disinfection of instruments and dressings, and keep medicines, and do a good job in registration and statistics.
6. To guide the work of nurses and health workers in further education and practice.
9. Responsibilities of hand-washing nurses
1. Understand the condition before operation and be aware of it. Wash your hands 15 minutes in advance, lay the instrument table, and classify and discharge the surgical instruments. Rinse all kinds of catheters with normal saline before use.
2. Check instruments, gauze strips, gauze pads, needles, threads, etc. (chest, abdominal cavity, deep tissue surgery) with visiting nurses. Before the operation, before and after closing the body cavity, the items should be counted once to prevent them from being left in the body cavity.
3. Hand-washing nurses should have a high sense of responsibility, but also have a sense of advance, strictly implement aseptic operation, pay close attention to the progress of surgery, and deliver instruments correctly, actively and promptly. <