Perioperative Care

The operating room -a restricted environment often hidden behind closed doors, isolated from other ward/hospital areas-is an area full of mystery and intrigue for students and other health professionals. Patients come to the operating room for a variety of surgical procedures, which fall into the following categories: diagnostic, ablative, palliative, constructive, reconstructive or transplantation. The environment of the operating room, although restricted, provides patient care using a holistic approach, and individualised care based on the patient's current health status and the type of surgical procedure to be undertaken. A patient's journey through the operating room is well described through the three phases of care; preoperative, perioperative and post-operative. Care of the surgical patient within the operating room encompasses the multidisciplinary team working collaboratively, to ensure they practise according to national and state governmental regulations, speciality nursing association standards of practice, local healthcare policies, clinical practices and industry standards. Within the operating room, the multidisciplinary team consists of a surgeon, anaesthetist, anaesthetic nurse, instrument nurse (scrub nurse) and circulating nurse (scout nurse). Work undertaken within this setting is patient focused, clinically and technically based. The environment is controlled by strict infection-control protocols, with the ultimate goal of minimising infection risk and cross-contamination for patients undergoing surgery. It is vital that all personnel who enter this specialised area are familiar with clinical competencies related to infection control and prevention. This chapter provides an overview of nursing responsibilities in the operating room, focused on asepsis principles and practices within the context of the perioperative environment. Various aspects of clinical practice are described, from asepsis in the perioperative environment to the importance of establishing and creating an aseptic field. Particular attention is given to the clinical skills necessary for health professionals to maintain aseptic technique, the indications for and use of personal protective equipment (PPE); the process of surgical hand antisepsis (scrubbing) and surgical hand rubbing; and correct surgical gowning and gloving procedures. An outline of the considerations and steps involved in prepping and draping a surgical patient in preparation for a surgical procedure is also provided.