SUR 110INTRODUCTION TO SURGICAL TECHNOLOGY

Week 1

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)

Organizations

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.

Organizations

AST - Association of Surgical Technologists Responsible for the Core

Curriculum Provides educational services. Our professional organization that

we belong to. CAAHEP –

the largest programmatic accreditor in the health sciences field. CAAHEP reviews and accredits educational programs.

Organizations

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.

Surgery classifications

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

Surgical Specialties

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

Operative Timeframes

Pre-operative – admission to incision Intra-operative – incision to dressing

application Post-operative – dressing application

to patient discharge.

Surgical TechnologistProfessional

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

Competency 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

OR Roles 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 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 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

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

Anesthetist/Anesthesiologist

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 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 care2. 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

Hospital Organizations

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

Private Insurance

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

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

Preferred Provider Organization Set up same as HMO

Medicare 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

State and federal funding Provided to low-income families who

meet the criteria

The Lifestyle of a

Surgical Technologist

Considerations

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

Critical Considerations

Physical strain Emotional strain Psychological strain Obligations/personal considerations Confidentiality Commitment to patient safety

Summary

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

ABTCCBlood 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

PPEPersonal 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

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!