Objective and Management of OT

Objective and Management of OT

Operation consent

Before performing a non-emergent surgery, the patient must give their voluntary, written informed consent. Such written agreement shields both the patient against unapproved surgery and the surgeon from accusations of performing an unapproved procedure.

Many ethical principles are integral to informed consent.

• The surgeon must clearly explain the procedure's details before the patients sign the consent form.
• The surgeon must also explain to the patient the advantages, alternatives, potential hazards, complications, disfigurement, disability, removable body parts, and what to anticipate in the immediate and long-term post operative phases.
• The nurse alerts the doctor if the patient needs more information to make a decision on their own.
• Additionally, the nurse confirms that the consent form has been signed prior to administering psychoactive premedication because obtaining consent while the patient was taking drugs that can impair judgment and decision-making capacity may void the consent.

If the patient is of legal age and is mentally competent, he or she directly signs the permission. Permission must be acquired from a responsible family member (ideally the patient's next of kin) or legal guardian when the patient is a juvenile, unconscious, or incapable.

Without the patient's informed consent, the surgeon may have to do an operation in an emergency to save the patient's life. A second opinion may be obtained when a patient has questions but is unable to research other options for therapy. An operating permit should never be forced or pushed onto a patient. A person's legal right and privilege is to refuse to have surgery.

By making sure that the consent forms are properly worded and by offering multimedia elements to support dialogue, the consent process can be improved.

Criteria for informed consent

• Voluntary consent: Valid consent must be freely given without coercion.
• Incompetent Patient; Legal definitions: Individual who is not autonomous and cannot give or withhold consent (e.g. individuals who are mentally retarded, mentally ill or comatose).
• Informed subject: Informed consent should be in written. It should contain the following.
  • Explanation of its procedure and its risk
  • Description of benefits and alternatives
  • An offer to answer questions about procedure
  • Instruction that the patient may withdraw consent
  • A statement informing the patient if the protocol differs from customary procedures.
• Patient should able to comprehend: information must be written and delivered in language understandable to the patient. Questions must be answered to facilitate comprehension if a material is confusing.

Counting instrument and swabs

Before closing, all the sponges, pads, tools, and needles should be numbered to ensure that nothing is left within the body. If this is not done, it can lead to several issues, the patient may become extremely ill, and in extreme cases, they may even lose their lives. Numerous medico-legal issues may arise. Depending on who is helping, the nurse or assistant should do this.

Labeling and dispatch of specimen in time

Depending on the circumstances of the patient, a lot of specimens are routinely collected during an autoscopy. There are various types of specimens, including those used for crime scene investigation, biological or serological analysis, histopathological analysis, and toxicological analysis.

Sterilization

The act of efficiently killing or removing transmissible agents, such as fungi, bacteria, viruses, spores, etc. from a surface, piece of equipment, item of food or medicine, or biological culture medium is known as sterilization. Sterilization is the process of eliminating or killing all microbiological life, including their endospores, from a substance or an object. Heat, chemicals, irradiation, high pressure, or filtration are all methods for sterilizing.

Classification

• Physical sterilization includes:
  • Heat sterilization
  • Moist heat sterilization
  • Dry heat sterilization
• Radiation
• Chemical sterilization includes:
  • Ethylene oxide
  • Chlorine bleach
  • Glutaraldehyde and formaldehyde
  • Hydrogen peroxide

• Heat sterilization: moist heat sterilization (autoclaving)

Autoclaving

• A broad technique for autoclave heat sterilization.
• Steam from autoclaves is frequently heated to 121–134 degrees Celsius. A holding period of at least 15 minutes at 121 degrees Celsius or 3 minutes at 134 degrees Celsius is necessary to achieve sterility.
• Liquid and tools bundled in layers of cloth typically require more time to sterilize since they may take longer to achieve the necessary temperature.
• All fungus, bacteria, viruses, and bacterial spores will be rendered inert by proper autoclave treatment, which can be quite a resistance.

Precaution

• All items must be dry-clean only.
• The container and wrapper must permit the penetration of steam into the goods.
• Neither the container nor the drum should be packed too tightly.
• To allow steam to enter the contents, cans and jars must be opened and turned to the side.
• hot air oven for dry heat
• Dry heat often requires a greater temperature to sterilize than moist heat because it is less penetrating and requires a longer exposure time. Dry heat application is inexpensive and simple.

Radiation sterilization

• This method is expensive. But nowadays it is used for the sterilization of plastic items such as disposable saline sets, catheters, Ryles tube, disposable syringe etc. which will not withstand heat sterilization and sharp instruments such as hypodermic needles and scalpel blades.
• Methods exist to sterilize using radiation such as x-ray, gamma rays, etc.

Maintenance of aseptic technique, sterilization of equipment and supplies

All practices and methods used to prevent contamination of a sterile product are collectively referred to as aseptic technique. The proper use of sterile materials and equipment, such as syringes and needles made of glass or plastic, is another crucial aspect of the aseptic production of sterile products.

1. Technique of scrubbing, gowning and gloving

• Scrubbing
  • Surgical scrub: Surgical scrub is the removal of as many bacteria as possible from the hands and arms by mechanical washing and chemical disinfection before taking part in a surgical procedure.
• Purposes
  • Helps to prevent the possibilities of contamination and infection of the operative wound by bacteria on the hands and arms.
• Types
  • Complete scrub
    • It usually takes 10-15 minutes. This time may vary in different hospitals, depending upon the frequency of the scrubs.
  • Short scrub
    • It usually takes 5-10 minutes. This scrub is done following a clean case if the hands and arms have not been contaminated.
• Preparation before doing surgical scrub
  • Attend to your personal needs.
  • Adjusts your cap and mask properly. The hair should be confined inside the cap. The mask should cover the nose, mouth, cheek and chin.
  • Roll up sleeves of the uniform 3 inches above the elbow if sleeves are long.
  • Remove your jewelry.
  • Check on your fingernails. They must be kept clean and short to reduce the bacteria count and to prevent the puncturing or tearing of gloves.

Scrub-up technique

• Make a record of when you first began cleaning.
• To get rid of surface debris and bacteria, wash your hands and arms with soap and water.
• With your right hand, pick up the sterile brush so that it is facing up.
• Brush should be well wetted with soap and water before being used to scrub the wrist, palm, and dorsum of each finger. After 212 minutes, rinse.
• Take the brush and place it in your left hand. Apply soap and water once again to it and proceed as in step 4 to clean it (5 minutes for both hands)
• Take the brush and place it in your right hand. Brush the left arm from the wrist up to two inches above the elbow after thoroughly soaking it in soap and water once again. Rinse and repeat for 2 1/2 minutes.
• Move the brush to your left hand and repeat steps 6 through 10 for a total of ten minutes, from the tips of your fingers to 2 inches above your elbow (5 minutes for each arm).
• Place the brush in the designated container for used brushes. Wash your hands and arms thoroughly, being careful to direct the water flow from the hands down to the elbows.

Points to remember in surgical scrub

• The high bacterial count should discourage anyone with a cut or burn from scrubbing.
  However long or potent the antiseptics, the hands and arms can never be made sterile. A surgical scrub works best when it is vigorously moved. You might use a brief horizontal or circular stroke.
  Utilize a lot of antiseptics.

Gowning

The sterile gown is put on immediately following the surgical scrub.

Purposes: The sterile gown is worn in order to permit the wearer to come within the sterile field and carry out sterile technique during an operative procedure.

Unassisted (Self-service)

• Grab the gown at the center or ask the circulating nurse to give it to you.
• In order to have a suitable working area, move one or two feet away from the sterile field.
• The gown's hemline can be seen when it is unfolded. With this little bit, dry your hands and arms. Each hand and arm should be dyed using one side of the folded garment.
• Locate the armhole as you continue to unfold the gown.
• Hold your hands and arms straight and obliquely upward while slipping one hand into each armhole. The traveling nurse will make it right.
• When you come to a stop, move your body to the right, then to the left. As you swing, the circulating nurse will catch the end's belt.

Assisted

• The scrub nurse performs this after donning the gown and gloves to become entirely sterile.
• You can either take the gown right off the table or from the circulating nurse.
• Slowly unfold the garment and give the surgeon the hemline piece.
• The surgeon will continue to unfold the garment as he dries his hands and arms.
• Your gloved hands should make contact with the right side section of the gown beneath the protective cuff when serving it.
• Show the surgeon the armholes and opening.
• Leave it as soon as the surgeon put his hands through the armholes. The traveling nurse will make it right.

Points to remember in gowning

• After the surgical scrub, this is done.
• When cleaning the hands and arms, pat them dry using an oscillating motion. Beginning with the hand, move to the arms.
• Never dry your hands, then your arms, and then your hand.
• Do not turn your back on the sterile field when serving the gown to avoid infection.

Gloving

This is done after gowning technique.

Purpose: Gloves are worn to complete the sterile dress in order that the one who wears them may handle sterile equipment.

Part of glove

• Palmer surface
• Dorsal surface
• Finger surface
• Cuff
• Wrist

Type of glove technique: open method of glove technique.

Unassisted (Self-Service)

• Holding the left hand at the everted cuff edge, take the right-handed gloves. Remove yourself from the sterile area.
• Before completely entering the hand, check the finger holes. Keep the everted cuff in place.
• Right-handed wearers should tuck the glove under the everted cuff. In order to properly enter the left hand, start by looking inside the finger holes. Keep the cuff folded.
• Create a pleat at the gown's cuff and press it firmly into place with your right thumb.
• Right-handed people should tuck their four fingers beneath the glove's fold and bring the glove up over the pleated cuff of the sleeves. Firmly fasten the gloves.
• Replicate with your right hand.

Assisted (Serving Other)

• To make insertion easier and to check for holes, get the right-hand glove and blow it up first.
• The palmer surface or the thumb portion of the glove should face the person receiving it or the surgeon while serving it.
• The cuff should be one inch wide. Four fingers should be inserted inside the everted cuff.
• Well outstretch the glove. extend your thumb.
• Permit the surgeon to examine the holes in the fingers.
• Release and pull upward when the surgeon jerks his hand downward so that the glove cuff covers the gown cuff.
• For the left hand, follow the same steps.