Perioperative Practices - Assignment Example

Perioperative practice is a specialized field of health care requiring various types of surgical, anesthetic, technical, clinical expertiseto provide quality health care to patients. This paper implies to understand various aspects of perioperative care such as the design of operating suites, operating theatre environment, safety and hygienic procedures adopted, hospital personnel duties. Through this, an understanding of the perioperative practices can be achieved. Potential risk factors such as accidental hazards, risk of infections, fire breakout, and their control measures have been outlined. Perioperative practices Perioperative care of patients is related to the interventions to provide care prior to, during, and immediately after surgery; it effectively includes three phases of hospitalization, i.e. preoperative, intraoperative, and postoperative phases. Besides a safe and hygienic environment, many other factors such as the design of operating suites, operating rooms, safety mechanisms, materials used in construction of operating suites, lighting and ventilation, temperature and humidity control etc play vital role in providing good perioperative care to the patients and ensure safe and healthy work environment for the hospital personnel. This can help establish a caring and empathetic impression with patients on their perioperative journey (Wicker & O’Neill, 2006). The goal of providing quality care to all patients that reduces suffering, enhances quality of life, or provides dignity and support to the terminally ill patients can be accomplished (Woodhead & Wicker, 2005). The surgical suite consists of specific areas in which selected tasks are performed. These are procedure rooms or operating rooms, sterile and non-sterile storage areas, and ancillary support areas including preoperative holding/admission area, recovery rooms, and pathology labs. The overall floor plan of a operating suite is divided into specific zones meant, not only, for different perioperative procedures, but also for traffic control and asepsis. To assist asepsis through traffic control, four zones in the operating department are generally created: operative zone which comprises the operating theatre and preparation room, and this area is aseptic and restricted to operating room personnel with proper attire; restricted zone meant for washing, scrub-up, anaesthesia, and utility and traffic control meant to prevent unauthorized entry and access; limited access zone containing space for recovery, mobile X-ray store, dark room, staff rest, and cleaner room; and general access zone meant for ancillary functions such as general public and staff changing, porter base, transfer area, and stores, with provisions for entrance and exit from the surgical suite for personnel, equipment and patients. Special waiting rooms for family members of the patients must be adjacent to physician-consulting suites, parking area, and to postanaesthesia care units (PACU). The ideal location of PACU is next to operating suite to allow anaesthesiologists and surgeons to be close by, and help in attending to the patient without any delay, if required (Glidden & Craig, 2002). To ensure good workflow and cleanliness, separate zones for traffic control of patients, staff, supplies and disposal have to be created by adopting certain simple measures (Kirk & Ribbans, 2004). The design must be able to support the services’ needs through established traffic patterns and a unidirectional traffic flow is designed for patients and other members from entrance to exit. The most sensitive and critical aspect of perioperative care is the operating environment and procedures. The operating department environment must provide a safe, efficient, user-friendly environment that is as free from all forms of contamination as possible. An operating department consists of operating suites along with common additional facilities such as changing and rest rooms, reception, transfer and recovery areas. Every operating suite includes operating theatre, with anesthetic room, preparation room, disposal area, washing and gowning area, along with a well-planned exit area intended for circulation space as well. All surgical operations and some diagnostic procedures are carried out in the operating theatre. The operating theatre area should be strictly restricted from any traffic and protected from contamination. Clean and sterile supplies and equipment movement should be separated as much as possible from contaminated supplies, equipment and waste by space and time (Shields & Werder, 2002). Potential risk factors impending operation theatre such as possibility of infection, accidental hazards due to fire or explosion, inappropriate use of drugs, etc have to be identified and appropriate planning to address these issues should be in place. Infection control is one of the key elements in operating rooms Nosocomial infections including surgical site infections, urinary infections, respiratory infections, vascular catheter infections, septicaemia, skin and soft tissue infections, sinusitis, endometritis etc caused by various types of pathogenic bacteria, viruses, and fungi that are either a part of the body or transmitted by other patients have to be controlled (Gruendemann & Mangum, 2001). Operating theatre rooms should be conveniently accessible from intensive care units, accident emergency wards and operating suites. Ventilation must consist of directional air flow to maintain necessary humidity, temperature and air circulation. Temperature control at 20-22 0C and humidity control with 20-40 air changes per hour is desired in ideal conditions, and air conditioning should be adjusted appropriately. In addition, regular air change can eliminate air contamination which can be accomplished by pumping air through filters and then passed out through vents in the walls. An average of 20-40 air changes per hour is good enough, or can be even higher (Kirk & Ribbans, 2004). Certain patterns of air flows are maintained in some parts of the operating suites, specially designed to minimize contamination to almost zero; for instance, in operating theatre and around the operating table, high vertical laminar flow of air is blown from above the table and expelled down to the floor at the rate of 400-600 per hour is maintained. Kirk and Ribbans (2005) pointed that the most acceptable type of filters is the high efficiency particulate air (HEPA) filters and guarantees 99.97% efficiency. Lighting in the operating suites and other areas such as the wards and corridors has to be gentle and should allow for easy illumination without any glaring effect. Overhead lighting and ventilation in operating theatre is ideal. Provision for some amount of natural daylight is also necessary which can be obtained from windows fitted in the corridors. The general artificial lighting in the operating rooms should permit correct colour interpretation of the patient’s skin. Lighting at the surgical site should not exceed five times that of general room lighting. Light must be of such quality that the pathologic conditions are recognizable. Overhead lighting at surgical site should provide appropriate contrast to the depth and relationship of all anatomic structures; be able to provide light pattern that has a diameter and focus appropriate for the size of the incision; be shadowless; produce appropriate colour quality to clearly show the diseased and normal conditions of organs; be freely adjustable to any position or angle; produce minimum heat to prevent injuring and drying of exposed tissues; and be easily cleanable and maintainable Necessary backup power supply is a must to avoid hindrances in operating procedure. Besides this, another equally important aspect of illumination is that required within the body cavity. This light source may be through fibre optic bundle, incandescent bulbs, and other indirect lighting methods with that of specula may be used (Phillips, Berry & Kohn, 2003). All required equipment and materials for homeostasis such as warming blankets, aluminum foil, water bath, etc have to be ready to take care of conditions such as hypothermia during prolonged surgical procedures. Storage of essential items in the operating room should be designed in such a manner that the main supply, equipment and gas cylinder has to be separate. Main supply storage includes sterile instruments and material; this area should be closer to the limited access zone. The bulky mobile equipments have to be stored in centrally located place that is easily accessible. Emergency gas cylinders of oxygen and other required gases have to be stored in a safe place in the storage area. In addition to all these measures, all unnecessary equipment and materials must be discarded immediately after their use (Davey & Ince, 1999). Other instruments have to be decontaminated properly. The three viable methods of sterilisation are steam sterilisation, dry heat and low-temperature chemical sterilisation with ethylene oxide, peracetic acid or plasma sterilisers (Shields & Werder, 2002). Besides these measures, asepsis in patients’ care in terms of perioperative preparation is of utmost importance to perioperative nursing. Preparation of operation site with disinfectants such as betadine or any other alcoholic cleanser followed by the application of an incise drape with iodophor is required. Before preparation of operation site, bathing or showering, if possible, should be done with antiseptic preparations. Another important measure to note is administration of prophylactic antibiotics for prevention of any surgical site infections. Various surgical scrub preparations used are Chlorhexidine, Iodophors, and Triclosan. Draping is done to prevent the passage of microorganisms between sterile and non sterile areas, done from operative site to the periphery. Thus, absolute asepsis has to be maintained throughout the perioperative care (Radford, County & Oakley; 2004). The operating theatre rooms should contain only movable fittings which will help in proper cleansing. The operating tables need to be heavy and stable, easily manoeuvrable, comfortable for the patient, and highly adjustable in terms of positioning the patient for a particular operative procedure (Kirk and Ribbans, 2004). The walls, floor and ceiling should be of materials which allow easy and continued cleansing with disinfectants. The most common material used in flooring and walls is seamless polyvinyl chloride. Suitable finishes with sprayed plastic paints, plastic laminate, steel or glass sheets on the walls should be used. The wall should have semi matt finish, and not glossy finish, to reduce reflection of light. Antiseptic such as Cresol is used for preparation of theatre and dressing trolleys before use and for disinfecting basins and baths after use. The operating room should be illuminated appropriately; care should be taken to avoid any severe reflection of light that may disturb the work round the table (Hutt & Thomson, 1968). The floor of operating departments should be slip resistant and be able to withstand rolling loads of operating tables and mobile X-ray machines. The floor should be machine scrubbed periodically to remove accumulated deposits and films. The operating room should be well-equipped with all necessary equipment, instruments, cleansing agents, and other materials, along with cleansing areas and spray baths nearby. The operating room should be located at a convenient location, near to the entrance of ambulance (Phillips, Berry & Kohn, 2003). Surgical asepsis can be ensured through sterile techniques and practices. These are utmost necessary in any surgical setting at any point in time. Protective surgical asepsis encompasses the fundamental principles of infection control through good hygiene, sanitation and asepsis. These fundamental principles, as identified by Gruendemann and Mangum (2001) include absolute decontamination of surgical site; proper decontamination of surgical instruments and equipment, appropriate attire, and thorough sanitation and cleaning of surgical areas and surfaces; appropriate cleansing and scrubbing with antimicrobial agents. In cases of inability to destroy the harmful pathogens, appropriate shielding and separation methods such as physical space and distance by barriers such as walls, traffic patterns, protective clothing, handwashing, sterilization and decontamination of instruments. Disposal of contaminated items, materials, sharps, and waste is a mandate (Gruendemann & Mangum, 2001). Fire can be a potential hazard that can attack hospitals at any time due to many reasons. Drugs, being composed of various types of chemical substances, can be a high risk factor for catching fire. Appropriate fire safety protocols have to be followed and hospitals should be well equipped with fire extinguishers and staff should be trained on their usage. Fire fighting equipment should include fire extinguishers installed at strategic locations, automatic sprinkler extinguisher system installed in basements and on all floors in the hospital, fire detection systems, adequate water supply through hydrants, etc. Different types of fire extinguishers are used based on the type of fire: carbondioxide extinguishers are common in hospital wards, usually used for electrical and oil fires. Foam extinguishers may be used for blanketing effect in case of fire due to oil, grease, or electric devices. Pyrene extinguishers may be used in case of fire due to electric equipment. For other types of fires, pressurized water and halogenated compressed gas fire extinguishers are used for combustibles such as paper, cloth, wood and electrical or laser fire, respectively. Hence great care is required when working in an environment which contains flammable substances that can trigger sparks from faulty electrical equipment or build up static electricity (Hinwood, 1992). All the fire safety equipment must be regularly tested for proper functioning. Safety and security of hospital’s possessions is also very important in terms of protection of official possessions, infrastructure, data and information, storage systems of products and official data, drugs, etc. Security of any place requires the effort of many different functions like the security officers, premise design, security alarms, etc; security cameras or security monitoring devices form an important aspect of this function as they provide guidance and form the evidence of insecure intrusions or security lapses. Security monitoring devices include closed circuit television monitoring (CCTV), security and fire alarms. Security cameras in hospitals serve various functions such as monitoring patients, determining status and position of employees and visitors, monitoring hallways, entrance and exit doors, traffic monitoring and control. Apart from security functions, CCTV systems are being extensively used in operating theatres to perform surgeries. For this, high maintenance with suitable light source, light cables, monitors and recording equipment are required (Blandy, Notley & Reynard, 2004). In conclusion, perioperative practices play a vital role in patient care. Effective perioperative practices encompass activities towards safety, hygiene, surgical and/or clinical treatment, and morale boosting of the patients that can be achieved only through effective planning and communication among personnel; appropriate designing of operating and other departments of the hospital. Besides setting up safe and hygienic environment and practices, hospital personnel must be alert to conditions that may cause errors; steps should be taken to minimize risks. References Blandy, J.P, Notley, R.G and Reynard, J. (2004).Transurethral resection. Edition 5. Taylor & Francis Publications. http://books.google.co.in/books?id=5BFHQf_758YC&pg=PA32&dq=CCTV+operation+theatre&lr=#v=onepage&q=CCTV%20operation%20theatre&f=false Davey, A & Ince, C.S. (1999) Fundamentals of Operating Department Practice. Published by Cambridge University Press. http://books.google.co.in/books?id=YiBLp2z7tmEC&pg=PP6&dq=Davey,+A.+and+Ince,+C.+(2000)+Fundamentals+of+Operating+Department+Practice.+Greenwich+Medical+Media#PPA20,M1 Gruendemann, B.J and Mangum, S.S (2001). Infection prevention in surgical settings. Edition 6. Elsevier Health Sciences. http://books.google.co.in/books?id=gQHtDWH1UpgC&pg=PA143&dq=asepsis+in+perioperative+practices Glidden, R.S & Craig, G.P. (2002). NMS Clinical Manual of Anesthesiology. Published by Lippincott Williams & Wilkins. http://books.google.co.in/books?id=MG4Y6z5kzNkC&dq=PACU+location+operating+suites&source=gbs_navlinks_s Hinwood, B.G. (1992). A textbook of science for the health professions. Edition 2. Published by Nelson Thornes. http://books.google.co.in/books?id=lWGESsimCggC&pg=PR21&dq=A+Textbook+of+Science+for+the+Health+Professionals+Chapman+Hall#PPA71,M1 Hutt, C.W & Thomson, H.H. (1968). Principles and practices of preventive medicine. Edition 17. Published by Taylor & Francis. http://books.google.co.in/books?id=gCwOAAAAQAAJ&pg=PA470&dq=Material+used+for+theatre+walls+and+ceiling+in+hospitals&lr=#PPA470,M1 Kirk, R.M. and Ribbans, W.J. (2004) Clinical Surgery in General: RCS Course Manual. Edition 4. Published by Elsevier Health Sciences. http://books.google.co.in/books?id=DybeETygEV8C&pg=PA183&dq=Operation+theater+design+and+environment Mercier, C. (1997). Infection Control: Hospital and Community. Edition 2. Published by Nelson Thornes. http://books.google.co.in/books?id=nL-0bgT3JD4C&pg=PP1&dq=Infection+Control:+Hospital+and+Community&lr=#PRA1-PA56,M1 Phillips, N.F, Berry, E.C and Kohn, M.L. (2003). Berry & Kohns operating room technique. Edition 10. Published by Elsevier Health Sciences. http://books.google.co.in/books?id=20Z5eUI-OTAC&pg=PA221&dq=types+of+fire+extinguishers+perioperative+care&lr Radford, M, County, B and Oakley, M. (2004). Advancing perioperative practice. Published by Nelson Thornes. http://books.google.co.in/books?id=nTmmCVsBC3QC&pg=PA123&dq=types+of+fire+extinguishers+perioperative+care&lr=#v=onepage&q=drape&f=false Shields, L and Werder, H. 2002. Perioperative nursing. Published by Cambridge University Press. http://books.google.co.in/books?id=xrTDtw2nAAEC&printsec=frontcover#PPT28,M1 Wicker, P and O’Neill, J. (2006). Caring for the perioperative patient. Published by Wiley- Blackwell. http://books.google.co.in/books?id=BasiL3veOawC&printsec=frontcover&dq=Caring+for+the+Perioperative+Patient.&lr=#PPA18,M1 Woodhead, K & Wicker, P. (2005) A textbook of perioperative care. Edition 2. Published by Elsevier Health Sciences. http://books.google.co.in/books?id=YcxA99ChIUQC&pg=PA19&dq=perioperative+practice+Abstract#PPA4,M1 Read More