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Or Fact and Principle
OR FACT
AND PRINCIPLE Lucy .lo Atkinson, R.N.
Q. What is the recommended place for performing the shave skin preparation of a patient? Should it be performed b y an operating room nursing team or other personnel? A. The current thinking 04 operating room nurses is to perform the shave skin preparation of the surgical patient immedijately prior to surgery. However, due to the contamination hazard of loose hair, it is deemed unadvisable to do the shave preparation in the operating room itself. Where the shave is performed is dependent upon the physical facilities in the hospital. If patient holding rooms, waiting rooms, or induction rooms are available within the operating room suite, the shave skin preparation can be performed in one of these areas by a member of the operating room nursing staff before the patient is taken into the operating room. If physical facilities are not available in the operating room suite, the shave skin preparation must be performed in the patient’s room before the scheduled time of surgery. It is unadvisable to take a preoperative surgical
January 1967
a: patient into a postoperative recovery room. The sight and sound of patients recovering from anesthesia could be a traumatic experience for a preoperative patient. In many hospitals the shave prep is done the evening prior to surgery by “prep technicians,” who are members of the operating room staff. Non-professional employees can be trained to perform this task. Male and female personnel can be assigned. usually during the evening tour of duty, to do all the shave preps for the following day’s elective surgery schedule. If this assignment does not require a full-shift time element, these employees can also be assigned to the operating room to assist with the preparation of supplies and equipment for the next day’s surgery schedule. The training and assigning of a limited number of persons to the shave prep fosters control, accountability, and more rapid and direct communication. If the shave prep is inadequate or incorrect, supervisory action can quickly be taken. Continued
31
FOR PATIENT PROTECTION
PONCHO VEST Provides a safe reliable method of securing o patient in a chair. Made of heavy sailcloth. Child sizes, infant, small, medium and large. CAT. No. 4181 .$4.80 Adult sizes, smoll, medium and large. CAT. No. 4181A .$b.60 Available in fast-drying Nylon for oddtional charge of .51.10
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POSEY FOOTBOARD Fib ANY hospital bed mattress. No bolts to attach to bed. Can be used with side rails. Perpendicular adjustment, no losing parts. Porey Anti-Rotation Supports (adiurtable, removable, cushioned) may be used with tmetion. Posey Footboard, CAT. No. F-58, each .$36.00 Posey Anti-Rotation Supports, CAT. No. F-58A. each .M.M
..............................
...............
SEND YOUR ORDER TODAY
Write for Free Illustrated Catalog About Other Porey Hospital Equipment
Continued from page 31 In this era of nursing shortages, it is deemed poor utilization of personnel to have
one’s professional nurses, either on the unit nursing staff or the operating room nursing staff, perform a function that can be adequately learned and perforlmed by non-professional personnel. A manual of anatomic sketches oan be compiled that specifies the stand,ard routines or the speoific shave preparation requirements of individual surgeons. Such a manual will be useful for the “prep technicians” as a resource reference. The Prep Manual, written by Mavis 0. Pate, sold by Edward Weck & Co., may serve as a guide to the design of one’s own manual or may be adapted to one’s needs.
Q. I have been asked how to decontaminate a septic room on the wards. I have suggested washing the room with Wescodyne,TRtaking the mattress out to air, and not sealing a room for 24 to 48 hours. What are your opinions on this matter? A. Some iodophors, such as Wescodyne,TR are bactericidal and bactexiostatic agents combined with detergents for cleaning action. These are satisfaotory detergent-germicides for decontaminating the floors, walls, and furniture of a room follfowing the discharge or removal of a patient in idation. Mattresses should be aired if no other method of decontamination is available. This is a prolonged procedure, however, and truly effective only if the mattress is “aired” in sunshine. The mattress should be covered with plastic. A plastic mattress cover can be mechanically cleansed with a detergentgermiaide, rendering it ready for immediate USe.
J. T. POSEY COMPANY Dept. AORN 39 5. SANTA ANITA AVE. PASADENA, CALIF. 91 107
32
Unless a fogging technique is used, there is no need to close a contaminated room for any longer than necessary to clean mechanically the floor, walls, and furniture with an effective detergent-germicide. The detergent germicide utilized for this procedure, how-
AORN Journal
ever, must be a bactericidal agent effective against the known contaminating organism. A room is cleaner immediately following a decontamination procedure than it will be after it remains idle for a period of time. In the interest of patient and personnel safety and comfort a room must be aerated for a period of time because of the irritating and/ or toxic effect of diffusion of some germicides used in fogging machines. Your theory is sound. What applies to the rigid aseptic environment of the operating room is applicable to the ward situation. Unfortunately, too few nurses on the wards appreciate this fact. It is heartening to know that you have at least been asked for an opinion.
Q. We are using a variety of paper material for the wrapping of sterile supplies. I would appreciate information about the acceptable qualities and standards of paper suitable for sterilization of supplies. A. The essential quality of any paper suitable for wrapping sterile supplies is permeability. Many paper products are primarily waterproof covers that impede the passage of steam, just as they prevent the transmission of water. Paper accepted as a wrapper for sterile supplies should have a manufacturer’s guarantee that steam is able to penetrate it within normal sterilizing cycles. Paper wrappers should also be inspected in front of a bright light. Holes and visible porosity are no protection against contamination in handling and storage. A single layer of creped paper is a bacteriologically safe wrapper for sterilizing supplies from the standpoints of penetration of steam during sterilization and subsequent handling and storage. The Dennison Wrap line of autoclavable wraps is commercially available through many surgical supply dealers. Several different styles of paper and nylon sterilizing bags are also commercially available.
January 1967
33
AND PRINCIPLE Lucy .lo Atkinson, R.N.
Q. What is the recommended place for performing the shave skin preparation of a patient? Should it be performed b y an operating room nursing team or other personnel? A. The current thinking 04 operating room nurses is to perform the shave skin preparation of the surgical patient immedijately prior to surgery. However, due to the contamination hazard of loose hair, it is deemed unadvisable to do the shave preparation in the operating room itself. Where the shave is performed is dependent upon the physical facilities in the hospital. If patient holding rooms, waiting rooms, or induction rooms are available within the operating room suite, the shave skin preparation can be performed in one of these areas by a member of the operating room nursing staff before the patient is taken into the operating room. If physical facilities are not available in the operating room suite, the shave skin preparation must be performed in the patient’s room before the scheduled time of surgery. It is unadvisable to take a preoperative surgical
January 1967
a: patient into a postoperative recovery room. The sight and sound of patients recovering from anesthesia could be a traumatic experience for a preoperative patient. In many hospitals the shave prep is done the evening prior to surgery by “prep technicians,” who are members of the operating room staff. Non-professional employees can be trained to perform this task. Male and female personnel can be assigned. usually during the evening tour of duty, to do all the shave preps for the following day’s elective surgery schedule. If this assignment does not require a full-shift time element, these employees can also be assigned to the operating room to assist with the preparation of supplies and equipment for the next day’s surgery schedule. The training and assigning of a limited number of persons to the shave prep fosters control, accountability, and more rapid and direct communication. If the shave prep is inadequate or incorrect, supervisory action can quickly be taken. Continued
31
FOR PATIENT PROTECTION
PONCHO VEST Provides a safe reliable method of securing o patient in a chair. Made of heavy sailcloth. Child sizes, infant, small, medium and large. CAT. No. 4181 .$4.80 Adult sizes, smoll, medium and large. CAT. No. 4181A .$b.60 Available in fast-drying Nylon for oddtional charge of .51.10
...........
.................... ................
POSEY FOOTBOARD Fib ANY hospital bed mattress. No bolts to attach to bed. Can be used with side rails. Perpendicular adjustment, no losing parts. Porey Anti-Rotation Supports (adiurtable, removable, cushioned) may be used with tmetion. Posey Footboard, CAT. No. F-58, each .$36.00 Posey Anti-Rotation Supports, CAT. No. F-58A. each .M.M
..............................
...............
SEND YOUR ORDER TODAY
Write for Free Illustrated Catalog About Other Porey Hospital Equipment
Continued from page 31 In this era of nursing shortages, it is deemed poor utilization of personnel to have
one’s professional nurses, either on the unit nursing staff or the operating room nursing staff, perform a function that can be adequately learned and perforlmed by non-professional personnel. A manual of anatomic sketches oan be compiled that specifies the stand,ard routines or the speoific shave preparation requirements of individual surgeons. Such a manual will be useful for the “prep technicians” as a resource reference. The Prep Manual, written by Mavis 0. Pate, sold by Edward Weck & Co., may serve as a guide to the design of one’s own manual or may be adapted to one’s needs.
Q. I have been asked how to decontaminate a septic room on the wards. I have suggested washing the room with Wescodyne,TRtaking the mattress out to air, and not sealing a room for 24 to 48 hours. What are your opinions on this matter? A. Some iodophors, such as Wescodyne,TR are bactericidal and bactexiostatic agents combined with detergents for cleaning action. These are satisfaotory detergent-germicides for decontaminating the floors, walls, and furniture of a room follfowing the discharge or removal of a patient in idation. Mattresses should be aired if no other method of decontamination is available. This is a prolonged procedure, however, and truly effective only if the mattress is “aired” in sunshine. The mattress should be covered with plastic. A plastic mattress cover can be mechanically cleansed with a detergentgermiaide, rendering it ready for immediate USe.
J. T. POSEY COMPANY Dept. AORN 39 5. SANTA ANITA AVE. PASADENA, CALIF. 91 107
32
Unless a fogging technique is used, there is no need to close a contaminated room for any longer than necessary to clean mechanically the floor, walls, and furniture with an effective detergent-germicide. The detergent germicide utilized for this procedure, how-
AORN Journal
ever, must be a bactericidal agent effective against the known contaminating organism. A room is cleaner immediately following a decontamination procedure than it will be after it remains idle for a period of time. In the interest of patient and personnel safety and comfort a room must be aerated for a period of time because of the irritating and/ or toxic effect of diffusion of some germicides used in fogging machines. Your theory is sound. What applies to the rigid aseptic environment of the operating room is applicable to the ward situation. Unfortunately, too few nurses on the wards appreciate this fact. It is heartening to know that you have at least been asked for an opinion.
Q. We are using a variety of paper material for the wrapping of sterile supplies. I would appreciate information about the acceptable qualities and standards of paper suitable for sterilization of supplies. A. The essential quality of any paper suitable for wrapping sterile supplies is permeability. Many paper products are primarily waterproof covers that impede the passage of steam, just as they prevent the transmission of water. Paper accepted as a wrapper for sterile supplies should have a manufacturer’s guarantee that steam is able to penetrate it within normal sterilizing cycles. Paper wrappers should also be inspected in front of a bright light. Holes and visible porosity are no protection against contamination in handling and storage. A single layer of creped paper is a bacteriologically safe wrapper for sterilizing supplies from the standpoints of penetration of steam during sterilization and subsequent handling and storage. The Dennison Wrap line of autoclavable wraps is commercially available through many surgical supply dealers. Several different styles of paper and nylon sterilizing bags are also commercially available.
January 1967
33