Principles of Wound Healing

3:30 pm Principles of Wound Healing Harriet Hop/' MD

3:55 pm Surgical Conscience in the Radiology Suite Virginia R. Johnson, RN, BSN

Development of a Surgical Conscience

Prepping begins at the site of the incision with a circular motion in ever-widening circles to the periphery Each 'round' requires a new sponge Recommended prep time is approximately 2 to 5 minutes Correct open-gloving technique must be used

Sterile Gowning and Gloving

Constant attention to detail

Good hand-washing in place of a surgical scrub

Knowledge and application of the principles of asepsis and sterile technique

Sterile gown is lifted upward and allowed to unfold, keeping the inside of the gown toward the body

Communication within the team

Step away from the sterile field while unfolding to avoid contaminating the table

Experience

Adherence to Proper Dress Code

Insert arms and allow the back to be fastened securely

Wear clean scrubs each day

Closed gloving technique is the best method to use

Change scrubs if they become wet or soiled

Sterile persons keep hands in sight at or above waist or level of the sterile field

Wear shirts tucked in Cover all hair completely by cap or hood Use and wear the surgical mask properly (single use only)

Gowns are considered sterile only in front from chest to level of sterile field, and the sleeves from above elbows to cuffs Change contaminated gloves inunediately

Sterile Field Principles Tables are sterile only at table height

Cover areas that get contaminated inunediately Postprocedure, remove gown first-then gloves

Edges and sides of the drape are considered unsterile Sterile persons touch only sterile items Sterile integrity of the packaging should be checked on all items used prior to dispensing Sterile field is created as close as possible to time of use Sterile areas should be kept in continuous view Sterile persons should stay within the sterile field Movement and or traffic should be kept to a minimum (air turbulence) Unsterile persons should maintain a distance of at least 1 foot from the sterile field Unsterile persons should not walk between two sterile areas Place basins at edge for easier access in pouring fluids

Skin Preparation of the Patient Shaving should be completed prior to entering the room Prepped area should be a wider margin than the actual area anticipated Prep solution used should be broad-spectrum antimicrobial Prep solution should not be allowed to run off the skin area and pool under the patient Sufficient drying time for agents such as iodine is preferred

Draping Impervious, disposable drapes are convenient and safe Once placed, the drape is not moved or shifted Protect the gloved hand by cuffing the drapes-do not allow the gloved hand to come in contact with the skin Know the correct order of the drape placement

General Information Sterile dressings should be applied before drapes are removed to reduce the risk of the incision being touched by contaminated hands or objects There is no compromise with sterility-an item is either sterile or not A single break in technique can compromise the whole procedure and thus the life of the patient Every individual is accountable for his or her own role in infection control and observance of aseptic technique

Summary The most common errors that result in breaks in technique occur in attire, hand-washing, sterile field preparation, prepping, gowning and gloving, draping, and general sterile field awareness. Surgical conscience requires constant vigilance, responsibility and knowledge of aseptic technique.

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