Ambulatory Surgery Method for performing surgical procedures Patient is admitted and discharged from a surgical facility on the same day Includes outpatient surgery in a hospital setting, a surgicenter, or medical office. Hospitalization is not required unless unexpected complications occur. Disadvantage is the short time the health care team has for assessing the patient’s postoperative condition. Important for outpatient facility to develop a follow-up procedure to track the patient’s condition after leaving.
Outpatient Surgery Generally limited to procedures requiring less than 60 minutes to perform. Many surgeries are performed in free-standing surgicenters or surgical centers that are part of a hospital complex. Insert Figure from Frazier/Malone MA, p. 578
Categories of Surgery Elective: Considered medically necessary, but can be performed when the patient wishes Emergency: Required immediately to save a life or prevent further injury or infection Optional: May not be medically necessary, but the patient wishes to have it performed
Categories of Surgery Outpatient: does not require an overnight stay in a hospital Urgent: to be performed as soon as possible, but is not an immediate or acute emergency
Medical versus Surgical Asepsis Medical asepsis—the elimination of organisms that have left the body Surgical asepsis—the practice of creating and maintaining a sterile environment, in which organisms are destroyed before entering the body Insert Figure 42-1 from PCMA 2e
Medical versus Surgical Asepsis Medical Asepsis Surgical Asepsis Clean technique usedSterile technique used Controls microorganismsAbsence of microorganisms Basic hand hygiene usedSurgical scrub performed Clean equipment and supplies Sterile equipment and supplies Clean fieldSterile field
Principles of Surgical Asepsis Surgical asepsis is necessary for any invasive procedure Requires: Sterile scrub Sterile gloves Sterile technique when handling material “Clean for clean” and “sterile for sterile” Insert Figure 42-2E PCMA 2e
Guidelines for Surgical Asepsis A sterile item can only touch another sterile item A sterile item on a sterile field must be within your field of vision and above your waist Airborne microorganisms contaminate sterile fields The edges of a sterile field are contaminated Sterile gloves must only touch sterile items Sterile packets may be touched on the outside with bare hands Be honest if you make an error or suspect you have made an error
Sterile Scrub and Hand Hygiene Insert Figure 42-2A from PCMA 2e
Steps to Surgical Hand Hygiene/Sterile Scrub 1.Remove jewelry and gross dirt from beneath fingernails 2.Assemble equipment 3.Stand at sink without allowing your body to touch it 4.Remove lab coat and roll sleeves above the elbows. Keep your hands and arms above waist 5.Regulate running water temperature to warm, not hot 6.Place hands under running water with hands pointed upward. Allow water to run from fingertips to elbows
Steps to Surgical Hand Hygiene/Sterile Scrub 7. Apply a circle of soap and lather well 8. Vigorously scrub hands and wrists with scrub brush (5 minutes per hand) 9. Raise hands, bending at elbows, and rinse off soap, fingertips to elbows 10. If performing a second lather, use 3 minutes per hand Insert Figure 42-2C from PCMA 2e
Steps to Surgical Hand Hygiene/Sterile Scrub 11. Use sterile towel to pat hands dry, from finger- tips to wrists to elbows 12. Turn off faucet with fresh towel or foot lever 13. Glove immediately. Keep hands above waist and folded together until procedure begins Insert Figure 42-2F from PCMA 2e
Personal Protective Equipment Insert Figure 42-3 from PCMA 2e
Steps to Surgical Gloving 1.Assemble equipment and check seal and expiration date on pack 2.Place pack on a flat surface at waist height with cuffed end of gloves toward you 3.Open outside wrapper; leave opened wrapper in place 4.Open inner wrapper without reaching over or touching the inside of the pack Critical Thinking Question: Why is it important not to reach over the pack when opening the inner wrapper? Critical Thinking Question: Why is it important not to reach over the pack when opening the inner wrapper?
Steps to Surgical Gloving 5.Using the thumb and fingers of the left hand, pick up the glove on the right side of the pack by grasping the folded inside edge of the cuff 6.Pull the glove onto the right hand using only the thumb and fingers of the left hand 7.Place fingers of the right-gloved hand under the cuff of left glove and pull onto left hand and up over left wrist 8.With gloved right hand, place fingers under the cuff of left glove and pull up over left wrist 9.After the gloves are in place, fingers can be adjusted with gloved hands
Steps to Removing Gloves 1.Remove the first glove by grasping the edge of that glove (with fingers of the other gloved hand) and pull the first glove over the hand inside out. 2.Discard the first glove into the proper biohazard waste container. 3.Remove the other glove by grasping the edge of the cuff with your fingers (from the ungloved hand) and pull the second glove down over the hand, inside out. 4.Discard the gloves appropriately.
Sterile Packaging Each autoclaved pack may contain one or more items Packs are set up on Mayo stand The inside of the packet’s wrapper is the sterile field Insert Figure source of pick up from PCMA 2e
Steps for Opening a Sterile Packet Insert Figure 42-5D from PCMA 2e
Steps for Opening a Sterile Pack Perform hand hygiene. Assemble equipment. Adjust the Mayo stand to correct height. Place packet on the Mayo stand with the folded edge on top. Position the packet on the stand so that the top flap will fold away from you. Remove the tape or fastener and check the sterilization indicator and date. Discard in a waste container. Pull the corner of the pack that is tucked under and lay this flap away from you.
Steps for Opening a Sterile Pack With both hands, pull the next two flaps to each side. Grasp the corner of the last flap, without reaching over the sterile field, and open the flap toward your body without touching it. The inside of this outer wrapper is now your sterile field. If you need to arrange items within this field, use sterile forceps. If an inner packet needs to be opened with an instrument setup, then someone wearing sterile gloves must open it.
Steps for Dropping a Sterile Packet onto a Sterile Field Insert Figure 42-6 from PCMA 2e
Steps for Dropping a Sterile Packet onto a Sterile Field Assemble equipment; check expiration date and sealed condition of packet. Locate the edge on the prepackaged item and pull apart by using the thumb and forefinger of each hand. Do not let your fingers touch the inside of the packet. Pull the packet apart by securely placing the remaining three fingers of each hand against the outside of the packet on each side. Holding the item securely about eight to ten inches from the sterile field, gently drop the packet contents inside the sterile field.
Steps for Transferring Sterile Objects Insert Figure 42-7 from PCMA 2e
Sterile Transfer Used to move items around on the sterile field or to place instruments onto a sterile field Must put on sterile gloves or use transfer forceps Do not reach across or turn your back on the sterile field unless it is covered with a sterile towel Critical Thinking Question: Why is it important not to turn your back on the sterile field? Critical Thinking Question: Why is it important not to turn your back on the sterile field?