Ori Prereq Ch 5 - ST

Specimens

• Save all specimens, and always wear gloves when handlingspecimens or containers with specimens
• Each specimen bag must contain only one patient’s specimen(specimens from multiple patients should never be mixed in the same bag)
• Each specimen container must hold only one specimen and every individualspecimen container/tube must have a label adhered or it will be rejected(not loose in the bag)
• Label only one container at a time, and do NOT pre-label containers
• Circulator, scrub person, and surgeon are responsible for performing positive patient identification and naming anatomic specimens correctly

• Surgeon: Confirms name of the surgical specimen
• Circulator and scrub person: Performs the two-person specimen verification and collection (one preparing the ADT label, and one verifying its accuracy)

Specimens

Specimens

• Explants are not released directly to the patient/family
• If a patient wants an explant, a release form is filled out by circulator to accompany specimen to Anatomic Pathology who will later release it to the patient
• Forensic specimens are not released directly to the police
• These are released by Anatomic Pathology to a properly-identified legal authority to document chain of custody and the nature of the material released
• Bullets must not be marked by the surgeon (doing so can interfere with ballistics or other evidence)
• Oncologic breast specimens must be delivered within 30 minutes of removal and:
• Before 5:30pm on Tuesday, Thursday, and Friday
• Before 7:30pm on Monday and Wednesday

• For eStar/Epic orders, place a separate order for specimens going to different places (Anatomical Pathology and Clinical Pathology) or for specimens that need to go to the lab at different times (routine specimens and frozen specimens)

Intra-op Electronic Lab Ordering

• Note the label style for each lab and whether it should be written on

LRL

Wound Class

• Wound class documentation should be correct, consistent, and reliable
• Alert the circulator of any major breaks in sterile technique or entry into tracts/spillage of bowel contents

Wound Vacs

• When wound vacs are discontinued:

• The power cord must remain with the machine
• The canister is removed and placed in a biohazard bag (NOT the entire unit)
• The machine must be placed on the shelf in the soiled utility room in Main PACU (room 3125 E, NOT the core)

• These units and their specialty power cords are very expensive

Isolation

• In preparation for the case:

• Remove all unnecessary equipment
• Use sheets to cover all equipment that you cannot remove
• Close and tape all cabinets per policy
• Cannot open cabinets during the case (or all items within the cabinet are considered contaminated)
• Order isolation cart from Central Supply and place it in the hallway (“dirty” side)

Isolation

• During the case:

• Have proper signage displayed on all entrances to the OR suite
• Don appropriate PPE
• Keep isolation cart in the hallway (“dirty” side)
• The runner, assigned by the CSL or Board Charge Nurse, remains delivers anything from outside the room that the teams needs and monitors the blood cooler (if present) – they do not enter the OR

Isolation

• After transferring the patient to the OR bed and before rolling the stretcher/bed into the hallway:

• All bed linens are removed
• A plastic sheet is placed over the bed
• An isolation sticker is placed on the plastic

• After any isolation case, the room is cleaned with bleach wipes due to the sporicidal effect
• For airborne precautions:

• Wear an N95 respirator (individually-fitted) during the entire case (except during the time when the patient is intubated)
• The runner must only transfer items to in-room staff through the hallway (“dirty” side) door to avoid contamination in the core
• PSTs wear N-95 during room turnover
• All ORs must remain vacant for 18 minutes (99% room air change)

Chapter Complete!

References

[SOP] Handling of Surgical Specimens

[Policy] Submission of Surgical Specimens to Pathology

Vanderbilt Medical Laboratories Test Directory

[Policy] Isolation Precaution Procedures for Operating Room Patients

[Policy] Isolation – Infection Control Precautions to Prevent Transmission of Contagious Infections

[SOP] Isolation Room Cleaning

[SOP] Airborne Precautions

[SOP] Contact Precautions

[SOP] Droplet Precautions

[SOP] Infection Prevention Interventions to Prevent Transmission of COVID-19 Infection

Class II: Clean-Contaminated

Enters a tract* under controlled conditions, no unusual contamination occurs) Appendectomy, liver or kidney transplant, cholecystectomy, C-section, otolaryngology, gastric surgery, GU or GYN surgery, colorectal surgery (Class II as of 2012)

Wound Vac Return

References

[SOP] Handling of Surgical Specimens

[Policy] Submission of Surgical Specimens to Pathology

Vanderbilt Medical Laboratories Test Directory

[Policy] Isolation Precaution Procedures for Operating Room Patients

[Policy] Isolation – Infection Control Precautions to Prevent Transmission of Contagious Infections

[SOP] Isolation Room Cleaning

[SOP] Airborne Precautions

[SOP] Contact Precautions

[SOP] Droplet Precautions

[SOP] Infection Prevention Interventions to Prevent Transmission of COVID-19 Infection

References

[SOP] Handling of Surgical Specimens

[Policy] Submission of Surgical Specimens to Pathology

Vanderbilt Medical Laboratories Test Directory

[Policy] Isolation Precaution Procedures for Operating Room Patients

[Policy] Isolation – Infection Control Precautions to Prevent Transmission of Contagious Infections

[SOP] Isolation Room Cleaning

[SOP] Airborne Precautions

[SOP] Contact Precautions

[SOP] Droplet Precautions

[SOP] Infection Prevention Interventions to Prevent Transmission of COVID-19 Infection

References

[SOP] Handling of Surgical Specimens

[Policy] Submission of Surgical Specimens to Pathology

Vanderbilt Medical Laboratories Test Directory

[Policy] Isolation Precaution Procedures for Operating Room Patients

[Policy] Isolation – Infection Control Precautions to Prevent Transmission of Contagious Infections

[SOP] Isolation Room Cleaning

[SOP] Airborne Precautions

[SOP] Contact Precautions

[SOP] Droplet Precautions

[SOP] Infection Prevention Interventions to Prevent Transmission of COVID-19 Infection

References

[SOP] Handling of Surgical Specimens

[Policy] Submission of Surgical Specimens to Pathology

Vanderbilt Medical Laboratories Test Directory

[Policy] Isolation Precaution Procedures for Operating Room Patients

[Policy] Isolation – Infection Control Precautions to Prevent Transmission of Contagious Infections

[SOP] Isolation Room Cleaning

[SOP] Airborne Precautions

[SOP] Contact Precautions

[SOP] Droplet Precautions

[SOP] Infection Prevention Interventions to Prevent Transmission of COVID-19 Infection

References

[SOP] Handling of Surgical Specimens

[Policy] Submission of Surgical Specimens to Pathology

Vanderbilt Medical Laboratories Test Directory

[Policy] Isolation Precaution Procedures for Operating Room Patients

[Policy] Isolation – Infection Control Precautions to Prevent Transmission of Contagious Infections

[SOP] Isolation Room Cleaning

[SOP] Airborne Precautions

[SOP] Contact Precautions

[SOP] Droplet Precautions

[SOP] Infection Prevention Interventions to Prevent Transmission of COVID-19 Infection

References

[SOP] Handling of Surgical Specimens

[Policy] Submission of Surgical Specimens to Pathology

Vanderbilt Medical Laboratories Test Directory

[Policy] Isolation Precaution Procedures for Operating Room Patients

[Policy] Isolation – Infection Control Precautions to Prevent Transmission of Contagious Infections

[SOP] Isolation Room Cleaning

[SOP] Airborne Precautions

[SOP] Contact Precautions

[SOP] Droplet Precautions

[SOP] Infection Prevention Interventions to Prevent Transmission of COVID-19 Infection

Class III: Contaminated

Open, fresh wounds less than 4 hours old without perforation of viscera, acute non-purulent inflammation of tissue, surgical procedures with major breaks in sterile technique) Penetrating wounds (gun shot wounds) without perforation of viscera, bile spillage during cholecystectomy, diverticulitis, compound fractures, appendectomy for inflamed appendicitis

References

[SOP] Handling of Surgical Specimens

[Policy] Submission of Surgical Specimens to Pathology

Vanderbilt Medical Laboratories Test Directory

[Policy] Isolation Precaution Procedures for Operating Room Patients

[Policy] Isolation – Infection Control Precautions to Prevent Transmission of Contagious Infections

[SOP] Isolation Room Cleaning

[SOP] Airborne Precautions

[SOP] Contact Precautions

[SOP] Droplet Precautions

[SOP] Infection Prevention Interventions to Prevent Transmission of COVID-19 Infection

References

[SOP] Handling of Surgical Specimens

[Policy] Submission of Surgical Specimens to Pathology

Vanderbilt Medical Laboratories Test Directory

[Policy] Isolation Precaution Procedures for Operating Room Patients

[Policy] Isolation – Infection Control Precautions to Prevent Transmission of Contagious Infections

[SOP] Isolation Room Cleaning

[SOP] Airborne Precautions

[SOP] Contact Precautions

[SOP] Droplet Precautions

[SOP] Infection Prevention Interventions to Prevent Transmission of COVID-19 Infection

Class IV: Dirty/Infected

Open wound greater than 4 hours old, old traumatic wounds with retained devitalized tissue, existing clinical infection, perforated viscera prior to procedure I&D of abscess, delayed primary closure of wound after ruptured appendix, positive pre-op blood cultures, perforated bowel, peritonitis, wound debridement

Class I: Clean

Uninfected, no inflammation, did not enter a tract*, and closed primarilyMost cardiac and neuro cases, closed ortho cases, mastectomy, hernia, vascular, exploratory laparotomy, non-penetrating trauma, thyroidectomy/neck dissection

References

[SOP] Handling of Surgical Specimens

[Policy] Submission of Surgical Specimens to Pathology

Vanderbilt Medical Laboratories Test Directory

[Policy] Isolation Precaution Procedures for Operating Room Patients

[Policy] Isolation – Infection Control Precautions to Prevent Transmission of Contagious Infections

[SOP] Isolation Room Cleaning

[SOP] Airborne Precautions

[SOP] Contact Precautions

[SOP] Droplet Precautions

[SOP] Infection Prevention Interventions to Prevent Transmission of COVID-19 Infection