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2) Management resources includes the

following except: A.MoneyB.MembershipC.MachineD.Materials

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3) A good leader is all of the following,except: A.Able to inspire followers

B.Able to judge peopleC.Able to lift staff moraleD.Able to motivate people

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4) A manager is all of the following, except:

A.Officially appointedB.Relates to people according to their rolesC.Relates to people personallyD.Implement predetermined policies

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Scrub duties

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Perform surgical hand scrub.

Gown and glove using closed glovetechnique.

Re-gown and glove when breaks intechnique occur.

Assist the 1st scrub in setting up case(back table, mayo stand and O.R. basins).

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Arrange instruments and supplies (back

table, mayo stand and O.R.).

Count needles, instruments and sponges.

Check instruments for proper functions

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Prepare electric cautery, suction and lighthandles for proper use.

Prepare necessary sutures. Pass instruments to surgeon and

assistant. Retract, sponge, and suction during case

as necessary. Proper identification and handling of

specimen.

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Anticipate the surgeon and assistantneeds.

Anticipate the operative procedure needs.

Help apply wound dressing.

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Clean operating room and discard suctionprior to case.

Gather all supplies, instruments andequipment necessary for case.

Arrange O.R. furniture properly.

Open and flip sterile supplies for thesurgical procedure

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Assist with IV therapy.

Assist the anesthesiologist.

Assist with the skin preparation.

Tie gowns of the scrub nurse and surgeon.

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Provide scrub personnel with sitting stoolsand foot stools as necessary.

Turn and help adjust lights as necessary.

Supply the scrub nurse with necessarysupplies

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Receive and label specimen properly.

Log and deliver specimen to pathologyproperly.

Help apply wound dressing.

Pull case for following procedure

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SCRUBBING, GOWNING ,SKIN PREPARATION, DRAPING& COUNTING OF INSTRUMENT

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Before each operation, all members of the

surgical team that is, those who willtouch the sterile surgical field, surgicalinstruments or the wound should scrubtheir hands and arms to the elbows.Scrubbing cannot completely sterilize theskin, but will decrease the bacterial loadand risk of wound contamination from thehands.

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Every hospital should develop a written

procedure for scrubbing that specifies thelength and type of scrub to be undertaken.It is usual that the first scrub of the day islonger (minimum 5 minutes) than anysubsequent scrubs between consecutiveclean operations (minimum 3 minutes).

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When scrubbing

Remove all jewelry and trim the nails Use soap, a brush (on the nails and finger

tips) and running water to clean thoroughlyaround and underneath the nails

Scrub your hands and arms up to theelbows

After scrubbing, hold up your arms to allowwater to drip off your elbows

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HANDWASHING
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SURGICAL HANDWASHING
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EQUIPM EN TS
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Perform a surgical hand wash before performingany surgical or other highly invasive procedure.

Surgical hand washing provides a higher level of decontamination than routine hand washing.

You can use the same aqueous antiseptic

solutions and alcohol-based products that youuse for routine hand washing (refer to your localpolicy).

The main differences are that you need todecontaminate your wrists and forearms andincrease the time taken.
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Clean each hand and forearm using rotationalrubbing.

Hold your hands higher than your elbows whileyou do this, so that water and debris drip awayfrom your hands into the sink.

You may use sterile disposable nailbrushes toclean the fingernails (refer to your local policy).

You do not need to scrub your skin, especially if you use an alcohol-based product.

You may use a brush for the first surgical handwash of the day1.

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Wash your hands and forearms with anaqueous antiseptic solution for 3 to 5minutes and dry your hands andforearms completely.

Wash your visibly clean hands and

forearms with an alcohol-based productfor three minutes. Use an antiseptic hand wash for three

minutes, dry your hands and forearmscompletely and then apply an alcohol rubor gel for 4 to 5 minutes.

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After applying the alcohol-based product

as recommended, allow your hands andforearms to dry completely before donningsterile gloves.

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ALWAYS ENSURE

THE WATER TEMPERATURE ISCOMFORTABLE

THE FLOW OF WATER IS GENTLE TO AVOI EXCESSIVE SPLASHING

HANDS ARE ALWAYS HELD HIGHERTHAN THE ELBOW

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NEVER

VIGOROUSLY SHAKE HANDS AND ARMS

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THE SCRUB

THERE ARE 3 DISTINCT PHASES TO AFORMAL SCRUB

THIS SHOULD TAKE APPROXIMATELY5 MINUTES TO PERFORM CORRECTLY

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THE SCRUB PHASE 1

WASH YOUR HANDS AND FOREARMSUP TO THE ELBOW USING A SKIN

ANTISEPTIC FOR 1 MINUTE ALWAYS RINSE FROM FINGER TIP TOELBOWS USING THE FLOW OF WATER

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THE SCRUB PHASE 2

WET THE NAIL BRUSH WITH ANTISEPTIC

SCRUB ONLY THE NAILS FOR 2MINUTES Scrub each nail individually, not all finger nails

in a bunch

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DISCARD THE NAIL BRUSH

RINSE FINGERS

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THE SCRUB PHASE 3

A FURTHER WASH UP TO THE WRISTONLY

THIS FINAL PHASE TAKES ABOUT 2MINUTES
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Scrub, Gown,and GloveProcedures

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SURGICAL GOWNING
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SURGICAL GLOVING

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SURGICAL MASKS

A surgical mask protects health careproviders from inhaling respiratorypathogens transmitted by the dropletroute.

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Hands must be thoroughly washed:

before wearing the mask; before removing the mask after use, and

after discarding the mask. There are many different types (Surgical

mask-2 ply, 3 ply; N95, N99 etc) of masksavailable. Their use is recommended basedon type and degree of protection

required.There are also many differentbrands of masks available.

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CONE MASK

The classic cone mask has a soft knittedhead band that offers greater comfort and

a secure fit. The classic cone mask isconvenient to use and provides excellentfiltration at over 95% efficiency

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Elastic ear loops

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Ways to Wear Masks

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Wrong way to wear a mask

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SURGICAL SHOE COVERS

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SURGICAL GLASSES &

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SURGICAL GLASSES &VISOR

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Bouffant Cap
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SURGICAL GOWNS
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SKIN PREP

The patient should bathe the night beforean elective operation. Hair in the operativesite should not be removed unless it will

interfere with the surgical procedure.Shaving can damage the skin so clippingis better if hair removal is required; it

should be done in the operating room.

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Just before the operation, wash theoperation site and the area surrounding it

with soap and water. Prepare the skin withantiseptic solution, starting in the centreand moving out to the periphery. This area

should be large enough to include theentire incision and an adjacent workingarea, so that you can maneuver during theoperation without touching unpreparedskin

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DRAPING THE PATIENT

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DRAPING

The procedure of covering a patient andsurrounding areas with a sterile barrier tocreate and maintain a sterile field during a

surgical procedure PURPOSE - is to eliminate the passage of

microorganisms between nonsterile and

sterile areas.

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DRAPING

Scrub, gown and glove before coveringthe patient with sterile drapes. Leaveuncovered only the operative field and

those areas necessary for themaintenance of anaesthesia. Secure thedrapes with towel clips at each corner

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Draping exposes the area of the operativefield and provides a sterile field for theoperative staff to work. This is designed tomaximize surgical exposure and limitpotential for contamination. There aremany approaches to draping, some of which depend on the kind of drapes beingused

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Do not place drapes until you are gownedand gloved, so as to maintain the sterilityof the drapes. It is important to securegood exposure and a large sterile area.When laying out the drapes, the edges

and folds (which hang below the operatingtable) are considered to be non-sterile.

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TYPES OF DRAPES

Disposable drapes are generally paper or plastic or a combination and may or maynot be absorbent.

Nondisposable drapes are usually double-thickness muslin. Drapes, of course, mustbe sterile.

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STEPS IN DRAPING

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When disposable drapes are used the

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When disposable drapes are used, thetowels usually have a removable strip withan adhesive on the folded edge. The thirdstep in draping is placing the four steriletowels around the line of incision. Thescrub unfolds first towel, passes the towel

drape to the surgeon with the strip sidefacing the scrub, and then removes theadhesive strip. The surgeon places thetowel within the scrubbed area on the near side of the line of incision, leaving onlyenough exposed skin for the incision.

Th d l i l d i h

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The second towel is placed in the sameway, except the towel is placed on the

lower side (toward feet) of the line of incision. The third towel is passed thesame way, except the towel is placed on

the upper side (toward head) the line of incision. The last towel is passed to thesurgeon with the adhesive strip facing thesurgeon and is placed on the far side of the line of incision. The adhesive areaholds the towel drapes in place.

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NOTE: The only procedure changes that are made

with non-disposable, muslin drapes (for example, hand towels) are as follow. Thetowels are cuffed by the scrub about 3inches and the folded edge goes next tothe line of incision. The first three towelsare cuffed toward the scrub; the fourthtowel is cuffed toward the surgeon. The

towels are held in place by towel clipsrather than by adhesive.

Fi ll th b ill l t th i l d

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Finally, the scrub will select the surgical drape(lap sheet). This lap sheet has a fenestration

(opening) in the drape for the incision. The scrubplaces the opening directly over the skin areaoutlined by the drape towels and in the directionindicated for the foot or head of the table. The

lap sheet will have an arrow or some other indication to identify the head or foot portion of the drape. Drop the folds over the sides of thetable, then open it downward over the patient's

feet and upward over the anesthetist screen.

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Aseptic technique must be observed at alltimes in the draping process.

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(4) Hold the drape high until it is directlyover the proper area, then drop (openfingers and release sheet) it down where itis to remain. NEVER ADJUST ANYDRAPE. If the drape is incorrectly placed,leave it in place and place another drapeover it.

(5) Protect the gloved hands by cuffing theend of the sheet over them. Do not let thegloved hand touch the skin of the patient.

(6)I f ldi g h t f th ti

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(6)In unfolding a sheet from the operativesite toward the foot or head of the table,

protect the gloved hand by enclosing it inthe turned back cuff of the sheet.

(7) If a drape becomes contaminated,discard it immediately.

( ) f h d f d f ll b l

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(8) If the end of a drape falls below waistlevel, do not handle it further. Drop it anduse another drape.

(9) If in doubt about sterility, discard thedrape.

(10) If a hole is found in a drape after it islaid down, cover the hole with another drape or discard the entire drape.

SPONGE AND INSTRUMENT

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SPONGE AND INSTRUMENTCOUNTS

It is essential to keep track of the materialsbeing used in the operating room andduring any complicated procedure in order

to avoid inadvertent disposal or thepotentially disastrous loss of sponges andinstruments in the wound.

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It is standard practice to countsupplies (instruments, needles,

screws and sponges): Before beginning a case

Before final closure

On completing the procedure

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The aim is to ensure that materials are not leftbehind or lost. Pay special attention to small

items and sponges.

Create and make copies of a standard list of equipment for use as a checklist to checkequipment as it is set up for the case and thenas counts are completed during the case.Include space for suture material and other

consumables added during the case.

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When trays are created with theinstruments for a specific case, such as aCaesarean section, also make a checklistof the instruments included in that tray for future reference.

INSTRUMENTS

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INSTRUMENTS

S i l l l bl d

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Surgical scalpel blades
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Sh
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Shape:

Straight - The needle is straight andusually has a cutting surface.

Half-curve or Ski - the needle is straightand curves near the point.

Curved - The needle is formed in an arc of 1/4, 3/8, 1/2, or 5/8 of a circle

NEEDLES

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NEEDLES

SURGICAL BLADE HANDLE
http://www.vetmed.auburn.edu/~hendera/graphics/needgen.jpg

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SURGICAL BLADE HANDLE

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http://www.vetmed.auburn.edu/~hendera/graphics/needgen.jpg

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Surgical Needle Holder

Needle Holders are used to suture deepareas where hands cannot reachcomfortably or where high precision and

clear visibility is required. The holders maybe with or without a catch. All needleholders have a firm grip.
http://images.google.com.ph/imgres?imgurl=http://www.trola.com.pk/images/surgical/mayo-hegar-needle-holder.jpg&imgrefurl=http://www.trola.com.pk/surgical.htm&h=303&w=177&sz=6&hl=en&start=4&um=1&tbnid=h1W_AciZW5GoXM:&tbnh=116&tbnw=68&prev=/images%3Fq%3DSURGICAL%2BNEEDLE%2BHOLDER%26gbv%3D2%26svnum%3D10%26um%3D1%26hl%3Den

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http://images.google.com.ph/imgres?imgurl=http://www.trola.com.pk/images/surgical/mayo-hegar-needle-holder.jpg&imgrefurl=http://www.trola.com.pk/surgical.htm&h=303&w=177&sz=6&hl=en&start=4&um=1&tbnid=h1W_AciZW5GoXM:&tbnh=116&tbnw=68&prev=/images%3Fq%3DSURGICAL%2BNEEDLE%2BHOLDER%26gbv%3D2%26svnum%3D10%26um%3D1%26hl%3Denhttp://images.google.com.ph/imgres?imgurl=http://www.landmark-surgical.co.uk/titanium/nhryder.jpg&imgrefurl=http://www.landmark-surgical.co.uk/titanium/titanium.html&h=195&w=450&sz=11&hl=en&start=58&um=1&tbnid=s_Ks1SST1H3syM:&tbnh=55&tbnw=127&prev=/images%3Fq%3DSURGICAL%2BNEEDLE%2BHOLDER%26start%3D40%26gbv%3D2%26ndsp%3D20%26svnum%3D10%26um%3D1%26hl%3Den%26sa%3DNhttp://www.mspiercing.com/ProductImages/m-piercing-needle-holder-232.jpg

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Sponge Forceps
http://images.google.com.ph/imgres?imgurl=http://www.landmark-surgical.co.uk/titanium/nhryder.jpg&imgrefurl=http://www.landmark-surgical.co.uk/titanium/titanium.html&h=195&w=450&sz=11&hl=en&start=58&um=1&tbnid=s_Ks1SST1H3syM:&tbnh=55&tbnw=127&prev=/images%3Fq%3DSURGICAL%2BNEEDLE%2BHOLDER%26start%3D40%26gbv%3D2%26ndsp%3D20%26svnum%3D10%26um%3D1%26hl%3Den%26sa%3DNhttp://www.mspiercing.com/ProductImages/m-piercing-needle-holder-232.jpg

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Sponge Forceps

Sponge forceps or sponge holding forcepsare often used in gynecologicalprocedures. They may be straight or

curved and have smooth or serrated jaws.The jaws are rounded and provide anatraumatic grip.

SPONGE FORCEP

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SPONGE FORCEP

Dressing Forceps

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Dressing Forceps

Dressing forceps are also a type of tissueforceps. They are used for dressingwounds and pealing off the dressing. Theyhave scissor-like handles for grasping lint,drainage tubes, etc. Dressing Tweezersmay be curved or straight tipped withserrated beak. In some cases it may be

smooth.

Dressing Forceps

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Dressing Forceps

Suture Forceps

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Suture Forceps

Needle holder forceps hold needles whilesuturing. Suture Forcep is also called aneedle holder forceps. The typical needleholder has two short, rather blunt, serratedbeaks with a groove in each beak. Thegrooves provide space for the placementand retention of the needle. At the end of the handles, there is a locking mechanism

that lets the secure the suture needle inthe correct position so as the needleappears to be an extension of the needleholder.

Suture Forceps

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Suture Forceps

Tubing Forceps

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Tubing Forceps

Also termed as vessel cannulation forcepsor tubing introducer forceps, they areuseful when a fine plastic tube/ micro

catheters have to be introduced into asmall blood vessel of almost equal size for medication or diagnostic purposes .

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The hollowed beak holds the tubingwithout deforming it. The tip of the tubingis directed exactly into the vessel opening

with a sturdy hand so as not to cause anydamage to the vessel from unwantedmovement.

Tubing Forceps

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Tubing Forceps

Brain Forceps

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Brain Forceps

Also called Obstetrical Forceps , they are Smoothlyshaped and curved, obstetrical forceps. The instrumenthas two blades and a handle designed to aid in thevaginal delivery of a baby.

Though there are many different kinds of brain forceps,the most commonly used ones are thin metal curvinginto a ring at its tip. This tip fastens the baby's head toprotect from damage during the delivery. The use of these forceps is as safe /dangerous as any other surgical tool or drug. They are used for saving babies'lives, when delivery is prudent during fetal distress

Brain Forceps

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Brain Forceps
http://bmj.com/content/vol318/issue7193/images/large/lab08.f7.jpeg

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SIMPSON Obstetrical Forceps
http://bmj.com/content/vol318/issue7193/images/large/lab08.f7.jpeg

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SIMPSON Obstetrical Forceps

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NAEGELE Obstetrical Forceps

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NAEGELE Obstetrical Forceps

Surgical Hemostats

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Surgical Hemostats

They are also called blood vessel forcepsand are used for controlling hemorrhage.They are also called Hemostats. They look

like needle-holder forceps. The maindifference is that the beaks of thehemostatic forceps are longer and more

slender.

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Hemostatic forceps may have both curved andstraight tips or beaks, and there is a lockingdevice on the handle to keep them closed asthey are used as vessel clamps. They have

transverse serration on beak tips. They have abox hinge and a locking mechanism by thefinger rings. all the hemostatic forceps aredesigned to grab, hold, and crush

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Used for holding blood vessels, and for blunt dissection.

Used to control hemorrhage by clamping

or constricting blood vessels. Used to remove bits of bone chips or partsof teeth, from the oral cavity during thetooth removal.

Surgical Hemostats

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Surgical Hemostats

Towel Clamps

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Towel Clamps

Towel-clamp forceps are used to maintainsurgical towels and drapes in the correctposition during an operation. They secure

drapes to the patients skin and may beused for holding the tissue as well. Theyare locking type forceps with curved ends.The beak may be pointed or blunt and flat.They may even overlap in closed position.

Towel Clamps

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Towel Clamps

Towel Clips

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Towel Clips

Crile Hemostat

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Kelly Hemostats

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Kelly Hemostats

Allises

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Babcocks

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Grasping Forceps

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Grasping Forceps

Grasping forceps are used to remove stonesand retrieve foreign objects under direct vision.These forceps are three pronged with hookedtips. This typical design allows the objects to bereleased easily. The hooks facilitates securegrasping of both large and small objects. Theprong wires are rounded to allow atraumaticmanipulation. They can be easily passedthrough the flexible endoscopes.

Grasping Forceps

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Mixter Forceps

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Mixter forceps are the threading forcepsused for hemostatic purposes. HemostaticForceps are used to wrap the thread

around the vessel to stop bleeding. Itsbeak is such that it grips the thread well.

Mixter Forceps

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Mosquito Forceps

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Mosquito forceps are used for moredelicate tissues. They are very fine andsmall hemostats used during the surgery

to control the bleeding of finer vessels.

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Splinter Forceps

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Splinter forceps are fine tipped forcepsused to remove the finest splinters fromthe body. The may be curved or straight

and may also have an attachedmagnifying glass for better vision. It is anessential first aid instrument.

Splinter Forceps

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Tongue Forceps

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Tongue forceps are sturdy tools used for holding the tongue while piercing it. Theycan be locked for a secure grip. They may

be slotted or the standard type. Once thepiercing is done and the baebell is inplace, the forcep can be removed

Tongue Forceps

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Tilley's forceps

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tongue depressor

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The wooden ones are disposable and alsothe most common. Metallic instrumentscan be used is more force is required.

There are different sizes of metallic tonguedepressor, and small ones can be used inchildren or infants.

Tissue Forcep

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Debakey Tissue Forceps

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Plain Tissue Forceps

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pLong and Short

Russian Tissue Forceps

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Long and Short

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Adison Tissue Forceps

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Toothed and Plain

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SURGICAL SCISSOR -CURVED

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CURVED

Bandage Scissor

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Mayo ScissorsC d d St i ht

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Curved and Straight

Metzenbaums "Mets"Large and Medium

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Large and Medium

Retractors

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Harrington Retractor

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Richardson Retractors

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Malleable Ribbon

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Balfour Retractor

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Bladder Blade for Balfour Retractor

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Goulet Retractor

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Gelpi Perineal

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local anaestietic spray

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Documents

NCM 107-A # 2