August 19, 2002
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SUR 110 INTRODUCTION TO SURGICAL TECHNOLOGY
History of Surgical Technologist
Post WWII created nursing shortage in ORs nationally Military Corpsman position created a position that caught on nationally and thus became the “operating room technician” (ORT) Not created to replace nurses, but to supplement the needed personnel to provide patient care 1969 nursing and surgeon organizations created the AORT (Association of Operating Room Technicians) 1974 LCC-ORT (Liaison Council on Certification for the Operating Room Technician) established and the certification exam was born to provide a means of establishing competency for the ORT 1978 ORT became the ST (surgical Technologist) which changed the names of the AORT to AST (Association of Surgical Technologists) and the LCC-ORT became the LCC-ST (Liaison Council on Certification of the Surgical Technologist) which is now the NBSTSA (National Board of Surgical Technology and Surgical Assisting)
JCAHO Joint Commission on Accreditation of Healthcare Organizations. Private organization. Evaluates US hospitals for their compliance with federal regulations. Issues fines if not in compliance.
DFS – Department of Facility Services
Similar to JCAHO, but state run department.
AST - Association of Surgical Technologists Responsible for the Core Curriculum Provides educational services. Our professional organization that we belong to.
the largest programmatic accreditor in the health sciences field. CAAHEP reviews and accredits educational programs.
ARC-ST – Accreditation Review Committee on Education in Surgical Technology
Directly oversees academic accreditation for the ST field.
NBSTSA – National Board of Surgical Technology and Surgical Assisting
Responsible for our credentials (ST, CST, CFA) and administering the CST exam.
Emergent – a “must do now to save the life of the pt.” case. Urgent – a “ must do soon” case Elective - procedure is beneficial to the patient but does not need be done at a particular time Optional – give me an example!
Reasons For Surgery
Diagnostic Palliative - treatment that provides symptomatic relief but not a cure Prophylactic - Preventative Restorative
General Obstetrics/gynecology (OB-GYN) Genitourinary Otorhinolaryngology (ENT) Orthopedics Peripheral Vascular Cardiothoracic Neurosurgery Ophthalmology Plastics/Reconstructive Oral/Maxillofacial
Primary Goal of Surgery
Return the patient back to their best possible state of physical and mental health
Pre-operative – pre-op to incision Intra-operative – incision to dressing application Post-operative – dressing application to patient leaving the unit.
Surgical Technologist Professional
Definition (JCAH)-”An allied health professional who works closely with surgeons, anesthesiologists, registered nurse, and other surgical personnel delivering patient care and assuming appropriate responsibilities before, during, and after surgery.”
Expectations of Scrub Tech
Provide quality patient care by giving assistance to the operating surgeon he/she is working with. #1 Task: Anticipate the surgeon and patient needs during the operative procedure. To accomplish #1 Task, the ST will “learn to think like the surgeon.” ST will be knowledgeable in “anatomy, pathophysiology, and microbiology.” ST will be one of a team of OR staff who “monitor the surgical environment.”
Competencies/Roles of the ST
Founded by 3 principles: Education, competency, legal requirements of a health care professional Certification Follows state laws and hospital policies
Level 1 Entry Level (less than 1 year experience/certified/independently scrubs basic procedures) Level 2 Proficient (more than 1 year experience/can perform most surgical procedures) Level 3 Expert (superior and broad knowledge base/role model/leader)
The OR Team
Definition of Team- A group of people working together to achieve a common goal. For the OR team, that goal is to provide the highest quality of patient care, while promoting surgeon satisfaction as well as each team member’s own satisfaction.
Responsibilities of the OR Team
Patient positioning Grounding pad Skin prep Sterility maintenance Aseptic environment maintenance Blood loss surveillance Keeping track of medications administered on sterile field
Surgical Team Members Duties
Preoperative Case Management Intraoperative Case Management Postoperative Case Management
Preoperative Case Management
PPE OR preparation Obtaining supplies, instruments, and equipment Creation, maintenance, and monitoring of surgical sterile field Scrubbing and donning sterile OR attire Organizing sterile field Counting supplies and instrumentation Assisting other sterile team members as they enter the sterile field Providing exposure of the operative site via prepping and draping
Intraoperative Case Management
Sterile field maintenance and monitoring Providing instrumentation, supplies, and equipment to the surgeon and his or her assistant as needed in the proper order Preparation of and handling medications within the sterile surgical field Counting supplies and instrumentation Handling and caring for specimens Preparation of and application of sterile surgical dressing
Postoperative Case Management
Sterile field maintenance and monitoring until patient is safely transported from the OR suite Taking down or disassembling the sterile field Removal, handling, and maintenance of supplies, instruments, and equipment according to institutional policy within or from the OR Preparation of the OR for the next operative procedure
Sterile: STSR Surgeon Surgical Assistant
Nonsterile: Circulator Anesthesia provider Other: Anesthesia RN assist Radiology tech Pathologist Anesthesia tech Nursing assistant/clinical tech Perfusionist Perfusionist tech
Circulator-A registered nurse (RN) with the ability to move about the room and leave if necessary to acquire needed items. Duties: Position patient Skin prep/initial scrub prep Communication between sterile and nonsterile areas Opening of supplies before and during surgical procedure Assistance to other team members not involved directly with the sterile field.
Scrub tech duties: Help with OR room/suite preparation Helps with opening supplies/instruments Surgical hand scrub Putting on/donning sterile gown and gloves Working within the boundaries of the surgical sterile field Preparing/passing needed instruments/supplies to surgeon and his/her assistant Monitoring/maintaining the sterile field Assisting as needed (prn) on the surgical field
Primary Surgeon-physician/medical doctor (MD) performing the operative procedure. He or she is ultimately in charge.
Primary Surgeon Duties
Determines need for and the type of surgical procedure to be performed Discussed surgical procedure and its risks with the patient and family Offers alternatives to surgery to the patient if available Performs actual surgical procedure Provides and plans care for the patient post-operatively
Assistant to the Surgeon
Assistant (to the surgeon): other surgeons Physician’s assistant (PA) Registered nurse Registered nurse first-assist (RNFA) Surgical technician (may be concurrent with primary duties) Surgical technician first assist (STFA)
Surgeon Assistant Duties
Aides with patient positioning Assists with draping the patient Aides surgeon by providing visualization of the operative site by retraction, suctioning and sponging Aides to achieve hemostasis May close body planes or suture body planes Determines type of dressing and may apply or direct application of dressing
Anesthesiologist-responsible for sedating or anesthetizing patient. Often act as a supervisor of this action. Certified registered nurse anesthetist (CRNA)-An RN with extensive critical care experience and a master’s degree in anesthesia specialization. Will be the person actually performing the anesthesia in most facilities today.
Other: Anesthesia RNs Anesthesia technicians (techs) Nursing assistants/Clinical technician Housekeeping Sales representatives (Reps) X-ray/radiology technician Electroencephalography technician (EEG tech) Laser/Video Technicians also called Minimally Invasive Surgical Technicians (MIST team) Cell saver technicians Perfusionist CPD Central Processing Department
Patient Care Departments Divided into 2 types: 1. Direct Contribute directly to patient care 2. Indirect Contribute indirectly to patient care
Direct Patient Care Departments
See Text Table pg. 21
Nursing Care Units Diagnostics Laboratory Pharmacy Physical Therapy (PT)/Occupational Therapy (OT)
Indirect Patient Care Departments
Hospital administration Maintenance/Engineering Housekeeping Food/Nutrition Services Purchasing/Central Supply Services Medical Records
Institutional organization Departmental organization See Text Figure pg. 20
Job Description Components
Job Title Requirements Nature of Position Duties Accountability Immediate Supervisor
Financial Reimbursement for Surgery
5 Methods in the United States: Private Insurance HMO PPO Medicare Medicaid
Works by insurance premiums paid by individual insured, deductibles paid, insurance company pays agreed upon or contracted percentage of costs incurred for health care
Health Maintenance Organization Contractual arrangement between hospital and physician involved in patient’s health care Payments are limited to set pre-agreed upon amounts Hospitalization is determined based on the patient’s diagnosis and or surgical procedure being performed
Preferred Provider Organization Set up same as HMO
Federal government administers Patient care reimbursed to following: Qualified over 65 years of age Eligible for social security disability payments for 2 years minimum Working and their families who require organ transplants or kidney/renal dialysis Part A: reimburses hospitals Part B: reimburses physicians and other departments such as lab, radiology, etc.
State and federal funding Provided to low-income families who meet the criteria
The Lifestyle of a Surgical Technologist
Foreign environment: cold, quiet, dark, isolated Will know more than 95% about the human body than the general population and anyone who lived prior to the 20th century Take part in surgical procedures the public see as miraculous Work life alien to family and friends Must face and deal with emotional and psychological events few will ever face Must be prepared to be available when called upon
Impact on you, the Surgical Technologist
May have to leave family at inconvenient times If “on call” cannot have drinks with your friends or family Obligated to protect yourself from communicable disease in order to protect your patients Will be privy to things about other’s lives (patient) that cannot be shared with your family or friends May find that family and friends do not want to “hear” about your work that you consider exciting and at times humorous
Personal and Professional Live as a Surgical Technologist 2 key principles: Professional obligations proceed personal freedom at times Will be isolated from the public
Physical strain Emotional strain Psychological strain Obligations/personal considerations Confidentiality Commitment to patient safety
Class Rules History Surgery classifications/timeframes ST definition/roles Competencies/job descriptions OR team/roles Direct verses Indirect Departments Hospital/Departmental Organization Lifestyle of the ST
" The nose of the Bulldog is slanted back, so that he can still breathe without ever letting go."
ABTCC Blood Borne Pathogens Training
Occupational Safety Health Administration • OSHA • Standards/Law set in place to protect workers from blood borne pathogens • Defines universal precautions and how they are carried out
Universal Precautions • All body fluids, tissues, and blood are treated as if known to contain infectious HIV, Hepatitis B, Hepatitis C, or any other blood borne pathogen
Purpose • Protect the student • Protect the patient’s in the student’s care • Protection prevents disease and death to a student or patient • Must be adhered to in clinical settings visited by students of the allied health programs
PPE Personal Protective Equipment • Provided by the college • Provided by employers/clinical sites • Safety is the student’s ultimate responsibility once the student has been properly trained in its use
Blood Borne Pathogens • Microscopic pathogens present in human blood that can cause disease and death in humans • Includes HIV, Hepatitis B, Hepatitis C • Is not limited to these
Other Infectious Materials or Fluids • Anything that has a human’s body secretions on it • Body fluids can include: tissue, cerebrospinal fluid, urine, feces, synovial fluid, peritoneal fluid, pleural fluid, pericardial fluid, semen, vaginal secretions, amniotic fluid, saliva, or anything that presents with visible blood or that could contain blood
What is Infectious? • Everything that could contain blood visible or not • Every body fluid is treated as potentially infectious
How Can I Be Exposed? • • • • • • • • • • • • •
Needle sticks Open cuts/sores Eye splashes Dermatitis Puncture wound Hang nails Mouth splashes Abrasions Scalpel cut Human bites Acne Chafing Nasal splashes
Definitions • Contaminated- the presence of blood or any infectious material on an item or surface • Decontamination- use of chemical or physical means to remove or destroy an infectious source rendering it safe for handling, use or disposal, therefore incapable of transmitting disease
Hepatitis B Vaccination • Must begin this immediately if you have not already • Required for all health care program students • Can sign a declination form if refuse to receive this • Will provide immunity to Hepatitis B • Immunity prevents risk of transmission of Hepatitis B to you, patients, family members, and classmates should you acquire the disease
Compliance with Blood Borne Pathogen Training • Engineering controls (what you use) • Work Practice Controls (what you do) • Personal protective equipment =PPE (what you wear)
PPE • Disposable gloves: clean or sterile • Face masks • Face shields • Goggles • Shoe covers • Sterile gowns • Lab coats
Disposal of Contaminates • Items with large amounts of blood material should be “red bagged” • Check individual hospital policy for specific amounts. • Sharps or anything that could become broken or sharp goes in a plastic sharps container
Safe Practices • Do not recap needles • Do not bend or break needles • Wear gloves • Discard sharps in a sharps container not garbage bag • Use approved products
Needle Sticks • Types: • Clean • Dirty
• Result of: • Infection such as staph or tetanus • Hepatitis B • Hepatitis C • HIV
Hand washing • • • • • • • • • • •
Single most effective safety mechanism Treat sink and faucets as contaminated Use paper towels to adjust controls Hold hands lower than arms to prevent water from flowing from your cleaner part, your arms down to the contaminated part, your hands Wet forearms, wrists and fingers Soap and scrub vigorously minimum of 30 seconds to one minute Clean nails prn Rinse from arms down to fingers Dry well Turn off faucet with dry paper towels Are other products that can be used in place of soap and water
Unsafe Work Practices • Do not eat, drink, or smoke in areas where exposure to pathogens can occur • Do not apply cosmetics or handle contact lenses where exposure to pathogens can occur • Do not store food or drinks in areas where infectious material are present • Contaminated personal clothing should not be laundered at home, but laundered here at the college
Cleaning up Blood Spills • Do not touch blood or body fluid spills unless have proper PPE • Plant operations can be contacted at 365 to clean up the spill • Spill must be contained using disposable materials • Wash hands after removing gloves
Cleaning up Broken Glass • Use brush, tongs, dust pan, and broom • Do not pick up glass with your hands • Place broken glass in a sharps container • Wash your hands after a clean up
Disposal of Clean Trash • Biohazardous waste costs thousands of dollars to dispose of in incineration costs (10 x’s the cost of normal trash!) • Non-biohazardous waste must be disposed of in regular trash receptacles • Examples: wrappers, pads, clean gauze, needle caps, non-contaminated gloves, paper towels, wrappers, etc.
Exposure Incidents • Any contact with infectious materials that results from student’s duties in class, lab, or clinical • Contact security immediately EXT 135 • Complete incident report (see ST handbook) • Off campus report within 24 hours • Activate student accident insurance EXT 109 • Testing of source may be involved
Immediate First Aid • Cut or needle stick, force site to bleed on way to a sink • Wash area well with soap and water • Apply a disinfectant • Cover with a Band-Aid or bandage • If severe go to the emergency room • Eye splash, use eye wash immediately • Nose or mouth splash, rinse immediately with water • Exposure to intact skin, wash with soap and water immediately
• The End!