Essential Practices for Operating Room Attire, Hand Hygiene, and Sterilization Techniques

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: • Envelope Fold • Square Fold • Peel Packs • 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