1. SUR 111 LAB I

2. Resources  Textbook pages 148, 167-174, 310-313  Study guide skill assessments:12-1 and 7-1 through 7-5

3. Outline  OR Attire  Basic Handwash  Instrument and Supply Preparation for Sterilization: 1. Envelope Fold 2. Square Fold 3. Peel Packs 4. Container Systems

4. (12-1) OR Attire  Purpose:  Keep microbial count to minimum  Protect staff and patient

5. OR Attire  Variations in Attire:  AORN Standards  Facility policy  School policy  Examples:  Fit (tucked, strings in), shoe covers, make-up, cologne, nails, jewelry, name badges, hair cover, shoe type

6. OR Attire  Consists of but not limited to:  Scrub suit  Shoe covers  Hair cover (bouffant or other)  Mask

7. OR Attire  Variations Based on Traffic Patterns:  Unrestricted  Semi-restricted  Restricted

8. Other OR Attire Considerations  Masks: type and appropriately tied  Eyewear  Gloves: Clean or sterile  Sterile: Open gloving or closed gloving  Surgical gown

9. (7-1) Basic Handwash  Purpose:  Reduce number of pathogenic microorganisms on hands and wrists to reduce risk of transmission to patient or self

10. Basic Handwash  When?:  Before reporting to work station  Before leaving work station  Before and after personal hygiene  Before and after eating  Before and after patient contact or care  Any time hands soiled

11. Basic Handwash  Gather Equipment:  Proper attire  Sink  Antiseptic soap  Towels  Nail cleaner/brush  Lotion if necessary

12. Basic Handwash  No jewelry  Inspect hands for intactness and nails for need of nail cleaner  Turn on faucet, adjust temperature  Wet hands and wrists not allowing scrub suit or body to touch sink  Apply soap  Lather in circular motion with moderate friction, interlace fingers  Cleanse minimum of 30 seconds to 2 minutes  Rinse hands pointing down  Avoid splashing  Dry with patting or blotting motion  Turn off faucet with a dry paper towel unless is foot controlled, then turn off before drying  Do not touch paper towel dispenser

13. Preparation for Sterilization  Principle of Asepsis: All items that enter the sterile field must be sterile  Sterile is the absence of all microorganisms  Contaminated is the presence of microorganisms

14. Preparation for Sterilization  Depending on the size and weight of the item there are different methods of preparation for sterilization  Items may be supplies, instruments or equipment  Dirty or contaminated items such as instruments are taken to a decontamination area after used in surgery  There they are cleansed of gross soil/debris (bioburden), sent through a washer-decontaminator (or washer-sterilizer), inspected, reassembled and prepared for re-use by a method of sterilization appropriate to the item’s composition

15. Preparation for Sterilization  Methods of Preparation:  Envelope Fold  Square Fold  Peel Packs  Container System

16. (7-2) Envelope Fold  Purpose:  Used for packaging smaller items for sterilization  Facilitates delivery of item to a sterile field though can be style of fold to open on to a clean dry surface  Needs:  OR attire  Basic handwash  Gather supplies:  Item to wrap, appropriate size wrapper (must cover item), internal indicator, external indicator, labeling items

17. Envelope Fold  Place wrapper diagonally  Item in center  Place internal indicator  First flap nearest you fold over until covered, create a 2-3” tab  Left flap, as far as possible, cover, create 2-3” tab  Right flap, as far as possible, should overlap second flap, create 2-3” tab  Final flap, bring towards self, miter or create flap and tuck

18. Envelope Fold  If this is the first of two wrappers repeat above  Secure final flap with appropriate external chemical indicator tape  Label  Place in designated area for storage until placed in the appropriate sterilizer  Clean up work station

19. (7-3) Square Fold  Purpose:  Used for packaging larger items for sterilization  Facilitates opening item on to a clean flat surface  Needs:  OR attire  Basic handwash  Gather supplies:  Item to wrap, appropriate size wrapper (must cover item), internal indicator, external indicator, labeling items

20. Square Fold  Place wrapper square or rectangular  Item in center  Place internal indicator  First flap nearest you fold over until covered, create a 2-3” tab  Second edge or farthest away, bring towards self, miter or create flap and tuck  Left end fold over, miter edge  Right flap, fold over, secure with external indictor tape

21. Square Fold  If first of two wrappers, hold in place and repeat previous steps  Secure final wrap with external chemical indicator tape  Label  Store in appropriate place  Clean up work station

22. (7-4) Peel Packs  Purpose:  Single use or small count items to facilitate delivery to sterile field or sterile team member  OR attire  Wash hands  Assemble supplies:  Item to wrap, appropriate size peel package, internal indicator, external indicator (usually incorporated into packaging), heat sealer if not self-sealing, labeling items

23. Peel Packs  Item and internal indicator placed in peel package  Protect tips if necessary to prevent tearing through packaging  Orient item to prevent opening damage  Expel air  Seal with self-sealing tape or heat sealer  Double package according to facility policy  Label  Store  Clean up station

24. (7-5) Container System  Purpose:  Preferred Instrument Packaging Method  Facilitates preserving instrument sterility and the opening of instrument sets  Instrument sets should not be wrapped due to their weight and bulk which can breech or compromise a wrapper’s integrity rendering item contaminated  OR Attire  Wash Hands

25. Container System  Assemble equipment and supplies:  Assembly will normally take place prior to this (Skill 10-1)  Instrument set  Internal indicator  Appropriate size container, lid  Filters for lid or container  External indicator (may be incorporated into locks)  Locks or sealers  Labeling item prn