Transcript August 19, 2002

Week 1
SUR 110
INTRODUCTION TO
SURGICAL TECHNOLOGY
On matters of style, swim with the current,
on matters of principle,
stand like a rock.
Thomas Jefferson
Outline
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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
Blood Borne Path Training
Class Rules
 The “I told you in 110” story (in other words,
these rules will apply throughout this program)
 We are a family.
 Personal Hygiene (+ no jewelry in SUR 111
lab/clinical)
 TAKE NOTES IN CLASS!!!! All covered material
AND material stated in the syllabus are testable.
 CCLD – Tad Williams - Otherland
Class Rules
 Show Respect – when another person is talking, you are
not!
 Turn off your cells and pagers (MINIMUM - put them on
vibrate).
 No Texting/IM’ing, paging, talking or making calls while
in class.
Class Rules
 Bathroom breaks will be given. Please stay in class
until the class breaks as a whole. It is very disruptive
to the class if a student gets up and leaves in midlecture. Plus, you’ll most likely miss a test question
while you’re gone! (students- give me a hint!)
 Do not eat or drink in the classroom. Leave your
food/drinks outside the door (this is a Biohazard
room). DO NOT LEAVE YOUR DRINK OR FOOD
WRAPPERS OUTSIDE THE DOOR AT THE END OF THE
DAY. CLEAN UP YOUR OWN MESS.
Class Rules
 All homework is due as you walk in the door
at the beginning of class. If you are not in
class by the time it supposed to begin, you
will not be able to turn in your homework or
take the test. Therefore you will receive a
zero for each missed assignment due that
day.
 No late homework or test makeup's are
allowed.
Class Rules
 You will have a test at the beginning of each
Monday class. All tests are cumulative. Most
tests will be in the computer lab.
 Once the test is graded, if you have a question
about a answer that you feel has been graded
incorrectly, email me the reason you think the
question has been graded incorrectly. Be sure to
send supporting evidence (i.e. page 14 says in
the ST book says….)!
Class Rules
 Show up early, not late. The door will be closed
at 1500 (or at the beginning of whichever SUR
class your in that day) and will not reopen until
the last person completes his/her test. We are
preparing you for the punctuality of the O.R.
 This means that if you are late to class, you will
not only not be able to turn in your homework,
you will also miss a test and a receive a zero for
both assignments.
Class Rules
 If you have a class before this one, just let me
know. Other instructors might effect your ability
to make it to class on time.
 Do not count on being able to park close to our
building – Rhododendron. You may have to walk.
 Set your clocks to the room clock before you
leave today.
Class Rules
 Check your email and BB often. I communicate
quite a bit via the computer.
 I will send out information via your student
email account. This is the only account we can
use for electronic communication via the
computer.
 You will held responsible for all information
passed to you via email.
Class Rules
 All work is to be completed in BLACK ink;
graded in RED ink (there will be times we will
grade tests/homework in class).
 Obtain 2 large notebooks. 1 for SUR 110 and
1 for SUR 111. You will need to keep all
returned paperwork and be able to keep it
separate.
Class Rules
 Always feel free to asks questions. This
includes emailing me questions. I will
respond as quickly as possible. Tuesdays and
Fridays I am in the O.R. scrubbing cases, so it
will take me a little longer to back to you on
those days.
 Any questions about class rules?
History of Surgical Technologist
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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)
Organizations
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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.
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DFS – Department of Facility Services
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Similar to JCAHO, but state run department.
Organizations
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AST - Association of Surgical Technologists
Responsible for the Core Curriculum
 Provides educational services.
 Our professional organization that we belong to.
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CAAHEP –
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the largest programmatic accreditor in the
health sciences field. CAAHEP reviews and
accredits educational programs.
Organizations
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ARC-ST – Accreditation Review Committee on
Education in Surgical Technology
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Directly oversees academic accreditation for the ST
field.
NBSTSA – National Board of Surgical
Technology and Surgical Assisting
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Responsible for our credentials (ST, CST, CFA) and
administering the CST exam.
Surgery classifications
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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
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Diagnostic
Palliative - treatment that provides symptomatic
relief but not a cure
Prophylactic - Preventative
Restorative
Surgical Specialties
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General
Obstetrics/gynecology (OB-GYN)
Genitourinary
Otorhinolaryngology (ENT)
Orthopedics
Peripheral Vascular
Cardiothoracic
Neurosurgery
Ophthalmology
Plastics/Reconstructive
Oral/Maxillofacial
Primary Goal of Surgery
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Return the patient back to their best possible
state of physical and mental health
Operative Timeframes
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Pre-operative – pre-op to incision
Intra-operative – incision to dressing application
Post-operative – dressing application to patient
leaving the unit.
Surgical Technologist
Professional
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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
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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
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Founded by 3 principles:
Education, competency, legal requirements of a
health care professional
Certification
Follows state laws and hospital policies
Competency
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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
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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
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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
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Preoperative Case Management
Intraoperative Case Management
Postoperative Case Management
Preoperative Case Management
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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
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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
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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
OR Roles
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Sterile:
STSR
Surgeon
Surgical Assistant
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Nonsterile:
Circulator
Anesthesia provider
Other:
Anesthesia RN assist
Radiology tech
Pathologist
Anesthesia tech
Nursing assistant/clinical
tech
Perfusionist
Perfusionist tech
Circulator
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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.
Surgical Technologist
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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
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Primary Surgeon-physician/medical doctor
(MD) performing the operative procedure. He
or she is ultimately in charge.
Primary Surgeon Duties
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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
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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
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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
Anesthetist/Anesthesiologist
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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
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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
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Direct Patient Care Departments
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See Text Table pg. 21
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Nursing Care Units
Diagnostics
Laboratory
Pharmacy
Physical Therapy (PT)/Occupational Therapy (OT)
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Indirect Patient Care
Departments
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Hospital administration
Maintenance/Engineering
Housekeeping
Food/Nutrition Services
Purchasing/Central Supply Services
Medical Records
Hospital Organizations
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Institutional organization
Departmental organization
See Text Figure pg. 20
Job Description Components
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Job Title
Requirements
Nature of Position
Duties
Accountability
Immediate Supervisor
Financial Reimbursement for
Surgery
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5 Methods in the United States:
Private Insurance
HMO
PPO
Medicare
Medicaid
Private Insurance
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Works by insurance premiums paid by individual
insured, deductibles paid, insurance company
pays agreed upon or contracted percentage of
costs incurred for health care
HMO
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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
PPO
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Preferred Provider Organization
Set up same as HMO
Medicare
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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.
Medicaid
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State and federal funding
Provided to low-income families who meet the
criteria
The Lifestyle
of a
Surgical Technologist
Considerations
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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
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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
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Critical Considerations
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Physical strain
Emotional strain
Psychological strain
Obligations/personal considerations
Confidentiality
Commitment to patient safety
Summary
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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."
Winston Churchill
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?
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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
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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
Biohazard Symbol
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!