INFECTION CONTROL 5

The Operation Site

Shaving

The operation area should be clean before the operation, and you have to check this in the ward before sending the patient to the OT (Figs 1.12A to E).

•     Shave the area on the morning of the operation, or as part of operation.

Preparation

Prepare the skin as soon as the patient is anesthetized.

•     Start with a soap solution, and follow this with spirit

•     If there is a low sensitivity to iodine in the community, use alcoholic iodine

•     Take a sterile swab on a holder start in the middle of the operation site, and work outwards

•     Discard both swab and holder, and repeat the process with a second swab (some surgeons use a third)

•     The last is spirit which will evaporate to leave the skin dry

•     Be sure to prepare a wide enough area of skin

•     In an abdominal operation this should extend from the patient’s nipple line to below his groin.

Draping

The skin has been prepared

•     Place the first towel across the lower part of the operation site

•     Place another towel at right angle on the nearer edge of the operation site 

•     Apply a towel clip at the point of crossing of the two towels

•     Place another towel at the far edge of the operation site

•     The final towel goes across the top end of the site. All the corners should have towel clips to prevent them from slipping, they can go through the skin if the operation is under GA

•     In an abdominal operation an abdominal sheet covers the abdomen on top of the towels. This sheet has an opening in its middle to provide access to the operation site [double toweling]

•           If any area close to the operation site becomes contaminated at any time during the operation, place another sterile towel over the contaminated site.

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INFECTION CONTROL 4

GOWNING

Hold the gown away from your body, high so as that it does not touch the floor.

•     Allow it to open up and put your arms into the arm holes while keeping your arms extended. The inside of the gown is facing you

•     Then flex your elbows and abduct your arms (Fig.)

•     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 (Fig.) and will tie the tapes of the gown at the back .

GLOVING

Dust your hands with powder and rub them together to spread it.

•     Be careful to touch only the inner surface of the gloves.

•     Grasp the inner aspect of the turned down cuff of a glove, and pull it on to your opposite hand (Fig)

•     Leave its cuff for the moment

•     Put the fingers of your already gloved hand under the inverted cuff of the other glove, and pull it on to your bare hand (Figs 1.10 to 1.11A and B)

•     It is a good routine to wash your gloved hands in sterile water to remove the powder.

EYE PROTECTION

Masks and protective eyewear or face shields should be worn during procedures that are likely to generate droplets of blood or other body fluids, to prevent exposure of mucous membranes of the mouth, nose and eyes.

      They are lightweight, adjustable and do not obstruct vision. An educational programe is necessary to introduce surgeons to these new barriers.

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INECTION CONTROL 3

Scrubbing Up

All taking part in the surgical procedure and the OT team must scrub. The scrub rooms are situated before the entrance to the OT. 

Adjust the elbow taps to deliver water without splashing . 

In 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

•     Scrub your hands and forearms to 5 cm above your elbows for one complete minute

•     Wash your forearms

•     Then take a sterile brush and put soap on it (Fig. 1.2)

•     Scrub the lateral side of your left thumb, then its medial side, then the lateral and medial aspects of each successive finger

•     Scrub your nails, and then the back and front of your left hand 

•     Follow same routine with your right hand. Scrub for 5 minutes in all.

      Some surgeons only scrub their nails, and then thoroughly wash and rinse their hands and arms upto their elbows a number of times for 5 minutes. Rinse the suds from your hands while holding them higher than your elbows (F

•     Turn off the taps with your elbows 

      Dry your hands with a sterile towel before you put on a sterile gown

•     Dry your hands first, then your forearms

•     Grasp 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 (unsterile) part of the towel back to a dry area of your arms and hands.

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INFECTION CONTROL 2

Aseptic Technique

Entering the Theater

Entry to the theater should be limited to the surgical team and the OT staff only.

 Visitors if allowed should conform to the same rules listed below:

•     Those that enter the theater must change, in the changing room into OT shoes and OT suit

•     Masks and caps must be worn before entering OT and gowning

•     All these items must be available in the changing rooms.

Theater Rules

The air in the OT is clean and filtered. This is required since surgical wounds are open to the air in the OT.

      It is desirable that the minimum number of people should be in the operating theater, to provide safe and efficient management of the patient. The bacteriological count in theater is related to the number of persons and their movement in the operating room. These rules of entry limits the infection rate.

      Visitors may not be allowed to enter restricted areas and watch the procedure from a visitors gallery

Any questions be sent to drmmkapur@gmail.com

All posts are stored in archives for access and review.

Visitors that follow may post contributions to the site.

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