Professional Documents
Culture Documents
Document
.No. HWP3/13,
V- 1.0
Coverage
Proposed by
Reviewed by
10.1
points
Sakamma
( OT
Incharge)
Dr Prakash Kini
( Group Medical
Director),
Dr Raghavendra Hallur
(Asst Quality Manager)
Approved
by
Effective
date
Modifications
Dr K.P.Das
(Group
Advisor)
28st of
April 2013
Table of Contents
1
INTRODUCTION ....................................................................................................... 4
PURPOSE .............................................................................................................. 5
SCOPE.................................................................................................................. 5
RESPONSIBLITY ...................................................................................................... 5
7.2
7.3
7.4
7.5
7.6
7.7
7.8
7.9
7.10
Policy: Surgical Safety - Prevention of Wrong Procedure/Side/Site and Wrong Patient (time out
procedures):............................................................................................................ 12
7.11
7.12
7.12.1
Definition ................................................................................................... 15
7.12.2
Purpose .................................................................................................... 15
7.13
8
8.2
8.2.1
8.2.2
8.2.3
8.2.4
8.2.5
8.2.6
8.2.7
8.2.8
8.2.9
8.3
8.4
8.4.1
8.4.2
8.4.3
8.4.4
8.4.5
9.1
9.2
9.3
Instruments ................................................................................................... 29
9.4
Environment .................................................................................................. 30
9.5
9.6
10
Annexure ......................................................................................................... 33
10.1
INTRODUCTION
The operation theatre also called as operating room (OR) is a very important
high risk area in the hospital; It is also a high cost area which demands its
proper utilization.
Infection control practices and Quality Assurance activities of the OT have a
vital role in the quality of services provided in the hospital.
Operating theatre complex is one of the important high risk areas in the
hospital.
The complex involves the patient receiving zone, the preoperative area,
operative rooms, the dirty corridor, the clean and dirty utility rooms.
4 P URPOSE
To provide guideline instructions for Processes Related to Operation Theatre
Functioning
5 SCOPE
It covers the total functioning of the Operation Theatre with relation to
the patient and other OT specific processes
6 RESPONSIBLITY
7.1
Qualification of staff:
staff
a. Surgical care will be provided only by qualified surgeons holding Post
Graduate degree area as per MCI norms and experience in the
respective
History
such
as
HT/DM/
asthma/allergy etc.
Surgical and Anaesthesia history if any
Chest
Pain/IHD/B.
The consent is obtained from the patient and or the attendees as per the
hospitals Informed Consent policy prior to the surgery.
Details pertaining to the proxy consent could be sought in the Informed
consent Policy.
Note: There should be high risk consent for high risk cases. And the consent
should be taken for Sterilization and MTP procedures as per the law of land.
7.8
To ensure eliminate the risks endangering the lives and well being of
the surgical patients the WHO surgical Safety checklist has to be
followed to ensure that the team follows a few critical steps for its
effectiveness.
The format of the WHO surgical safety checklist: As per Annexure 1.
possible) that patient identity has been confirmed, that the procedure
and site are correct and that consent for surgery has been given.
The coordinator should visualize and verbally confirm that the
operative site has been marked (if appropriate) and should review with
the anaesthetist the patients risk of blood loss, airway difficulty and
allergic reaction and whether an anaesthesia machine and medication
safety check has been completed.
Ideally the surgeon should be present during this phase as the surgeon
may have a clearer idea of anticipated blood loss, allergies, or other
complicating patient factors
Before skin incision, each team member should introduce himself or
herself by name and role. If already partway through the operative day
together, the team can simply confirm that everyone in the room is
known to each other.
The team should confirm out loud that they are performing the correct
operation on the correct patient and site and then verbally review with
one another, in turn, the critical elements of their plans for the
operation, using the Checklist for guidance.
The team should also confirm that prophylactic antibiotics have been
administered within the previous 60 minutes and that essential imaging
is displayed, as appropriate.
Before leaving the operating room, the team should review the
operation that was performed, completion of sponge and instrument
counts and the labeling of any surgical specimens obtained. It should
7.12.1 Definition
Postoperative care is the management of a patient after surgery. This
includes care given during the immediate postoperative period, both in the
operating room and post anesthesia care unit (PACU), as well as during the
days following surgery.
7.12.2 Purpose
In the immediate postoperative period the patient is nursed in a recovery
area using one-to-one nursing and continuous monitoring.
The role of the recovery nurse is to ensure that the patient is protecting their
airway, breathing freely and perfusing adequately (airway, breathing and
circulation).
The recovery nurse should also monitor the patients pain as the anaesthetic
wears off and ensure that there are no early complications developing, such
as bleeding from the wound or loss of distal circulation and/or sensation.
Blood pressure, pulse and oxygen saturation are therefore monitored
regularly and the results charted. Trends seen on these charts reassure the
recovery nurse that the patient is recovering well or warn that a complication
is developing
ii.
iii.
iv.
v.
The surgical cap or hood is to be clean, free of lint and confine the hair.
The surgical cap or hood should be changed daily. .
vi.
vii.
viii.
Masks shall be worn at all times in the surgical suites and other areas
where open sterile supplies or scrubbed personnel are located. Masks
shall cover the nose and mouth and shall be discarded whenever
removed.
ix.
x.
xi.
Keep nails short and pay attention to them when washing your hands
most microbes on hands come from beneath the fingernails.
Do not wear artificial nails or nail polish.
Remove all jewellery (rings, watches, bracelets) before entering the
operating room suite.
HIV
Hepatitis B
Hepatitis C
MRSA
VRSA
VRE
Gas Gangrene
Any Multi Drug Resistant Pathogen
Infectious cases should be posted at the end of the day after all
surgeries
For infected cases universal precautions should be taken
Before procedure minimize the things present inside, keep the things
and trolley outside if it is not necessary.
Use disposal packs and gowns.
Use goggles to protect the eyes.
Shoe cover to avoid dripping of body fluids and blood.
Double gloves should be used
Needles should be handled very cautiously.
After the case the OT should be carbolized and Fogged as per the
protocol.
For H1N1, chicken pox, pulmonary tuberculosis any other active cases
require air borne/ droplet precautions patient and the attending staff
should wear N95 masks. Also during the transfer of patients.
Handling of Linen:
All the infected linens should be put in a separate yellow colour bag and be
labelled as Infectious
no Equipment
1
OT table
Disinfectant
70 % Isopropyl alcohol
Anaesthesia machine
70 % Isopropyl alcohol
Frequency
At the start of
the
day&Between
every case
Before induction
Monitor
accessories
Every case
Drug trolley
70 % Isopropyl alcohol
Beginning of the
day
Suction machines
70 % Isopropyl alcohol
Beginning of the
day
Suction bottles
Defibrillator
2%bacillocid
70 % Isopropyl alcohol
Every case
Beginning of the
day and if used
in
between
patients
8.2.9.1 Schedule :
Fogging will be done every week preferably at the end of all cases on
Saturday.
The OT should be thoroughly scrubbed before fogging.
8.2.9.2 Disinfectant
Fogging will be done with Aerox/ecoshield
8.2.9.3 Dilution:
8.2.9.4 Procedure:
Scrubbing:
o Send all linen for washing
o Wipe OT table, mattress,telephones ,ac grills, lights,
monitors with 2%bacillocid
o Wash (clean) and dry all furniture and equipment suction
holders, foot & sitting stools, Mayo stands, IV poles, basin
stands, X-ray view boxes, hamper stands, all tables in the
room, holes to oxygen tank, kick buckets and holder, and
wall cupboards).
o Wipe the doors and window panels with damp and dry
cloth to remove dust
o Scrub the floor with a hard brush
o Wipe the walls with 2% bacillocid solution.
o Mop the floor with 2% bacillocid solution.
o HVAC pre filters should cleaned by the people arranged by
maintenance
8.2.9.5 Fogging:
o Fill the disinfectant into the fogger machine as per the
dimensions of the Ot
o Seal all areas to prevent escape of fog
o Keep the machine in the centre of the room
o Switch the machine on for 30 min
o Keep the door closed for one hour
o Send air samples and swabs to microbiology laboratory as per
protocol.
8.2.9.6 Swabbing:
o Collect immediately after opening the room
o Don sterile mask and gloves
o Moisten the swab with sterile water .take care to prevent cross
contamination
o Wipe the surface to be sampled with vertical S strokes
o Place the swab in sterile container and cap immediately.
o Culture swabs will be sent in the following order:
1. Two from the floor/walls
2. Two from the Equipments as listed below on alternate basis.
Surface of OT table
Overhead Lights
Monitor Screen
A/C Grill
Warmer
Humidifier Water
Any other area if suspected
8.2.9.7 Air sampling of a working OT is done by the settle plate method
1. Two Blood Agar plates should be kept exposed for 1Hour, One
at the centre of the room and the other at any one corner of
the room.
9.3 Instruments
Used instruments are cleaned immediately by the scrub nurse and the
attender. Reusable sharps are decontaminated in Lysol / hypochlorite.They
are then sent for sterilization in the CSSD. The instruments are sent in the
instrument tray for autoclaving. They are then packed and re-autoclaved
before use.
9.4 Environment
Wipe used equipment, furniture, OR table etc., with detergent and water. If
there is a blood spill, disinfect with 1 % sodium hypochlorite before wiping.
Empty and clean suction bottles and tubing with disinfectant.
After the last case:
case:
The same procedures as mentioned above are followed and in addition the
following are carried out.
Wipe over head lights, cabinets, waste receptables, equipment, furniture
with 2 % bacillocid
Wash floor and wet mop with liquid soap and then remove water and wet
mop with 2 % bacillocid solution.
9.5 Weekly cleaning procedure
Remove all portable equipment.
Damp wipe lights and other fixtures with detergent.
Clean doors, hinges, facings, glass inserts and rinse with a cloth
moistened with detergent.
Wipe down walls with clean cloth mop with detergent.
10 Annexure