1. The basic rules of the behavior in the operating room, scrubbing-gowning-gloving, preparation of the operation area

kick bucket?

for soiled sponges and instruments

stands at the side of operating table

electrocauter placement?

either side of operating table

microwave oven?

heating of the infusion solutions, which is importent for the rinse of the operating fields

schimmelbush container?

sterile boxes that contain sterile gowns, drapes and sponges

placed on a stand at the side of the operating room, and can be opened by a foot pedal

before entering OR - gowning?

Person entering operating room should wear face masks and surgical cap, which should cover the hair completely

taking on the cap is followed by the single use mask, which should cover mouth and nose, white side to face and green to outside

upper knitters recommended to tie at the crown, while the lowers at the nape

operating room attire and shoes for OR has to be worn

elbows and down should not be covered by scrub clothes

fix long hair back → then cover w. cap as adviced

nails should be cut at home the day before

arms and hands should be free from nail polish, jewelery etc

scrubbing?

two phase procedure

1st: mechanical cleaning

• 2-3 dose of liquid soap to the hand, opening tap w. elbow

• rich foam

• rub each side of each finger, between fingers, to the back and palm of the hands, and the forearms from the wrist to the elbow

• rinse foam of hands and arms w. water, and keep the hands above the level of elbows allowing water to drain of the elbows

• close tap by elbows

• wipe hands and arms by paper towels

2nd: disinfection

• sterillium, desmanol, skinman soft, descoderm

• 2-3 pushes of disinfectant

• rub hands and arms thoroughly from the tip of the fingers to the elbow w. the antiseptic for 1 min

• repeat process 4 times, but the disinfectant area on the forearms will be smaller and smaller, disinfectan exerts its effect on the hands for 5 min

gowning procedure in OR?

hold the gown at the edge of the neck piece away from your body and allow it to unfold gently while holding it sufficiently high so it won’t touch the floor

gently shake the gown, insert both arms into the armholes, keeping your arms extended

cuffs of gown can be pulled over the wrist

scrub nurse assist you by pulling the gown up over the shoulders and ties it at the back

there is a knitter on the right side of the gown, put this knitter w. right hand to the left side

gloving procedure in OR?

scrub nurse holds one of the gloves so that the palm of the glove faces you

from the position of the thumb you can find out which hand to fit

put two fingers of your right hand into the opening, pull the inner side of the glove toward you so that a wide opening is created, slip your left hand into the glove

when you put on the right hand glove, place the fingers of your gloved left hand under the right glove cuff to widen the opening and slip their right hand into the glove

when both gloves are on, you can adjust the gloves to find their right position

disinfection of the patient’s skin

disinfection of the patient’s skin is performed after the surgical hand scrub and before gowning

scrub nurse gives a sterile container w. three gauze sponges, and sponge forceps

assistant pours disinfectant

washing is begun at the incision place and circular outwards, throw away gauze ball after and do not return inward with the same gauzeball

repeat, but minimize the area so you never reach non-washed area

the disinfected area must be large enough for the lengthening of the incision during surgery

isolation of the operating area?

after skin disinfection the operating area must be isolated from the non-disinfected skin surfaces and body areas by the application of sterile drapes and other sterile accessories

the first sheet isolates the patient’s leg

the second sheet isolates the patient’s head

then two side-sheets follows, which should also isolate both sides of the operating table

backhaus towel clips fix the isolation sheets to the skin

schaedel towel clips fix the sheets to eachother

if the isolation becomes wet during operation, it must be covered by a new layer w.o. removing the original one