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ConslJerotions Protection of the Potient in Surgery

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l;zf the gurley (stretcher) as close to the operating table as possible and locks the wheels. The patient ii instructed in how to move (if.alert and physically capa_ ble). Care is taken to protect all catheters t"liig, (e.g., intravenous linei and Foley catheterf""a while mov_ ing the patient. The second person stands on the opposite sideofthe operating room table to receive the pa_ tient and prevent falls. The restraint (shfety) st*ap i" fastened apovg tl-re patient's knees. Aa"l""t" fi"tp should be obtained to safely move the patienl to the operating table when the patient cannot move without assistance. POSITIONING

scriptions of the_position_(s) employed ana tt necessary, see the specific procedure.

ENVIRONMENTAT CONTROI.S

The p-atient's position is determined according to the procedure to be performed, the physical conditio"n of the nqt!en1, and the surgeon's preference in consultatiorr with the anesthetist. propei body alignment must be m_aintained. Adequate ussistanc" sfrJuta be obtained when tifting paticnts. The anesthetized patient is neuer moved without the anesthetist,s permission. Care is taken to avoid interference with respiration (e.g., by use of chest iolls when patient is prone). n"t"emities arra body prominences musi be adequateiy paddeJ and sup_ p-ortqq to avoid damage to the skin and nerves. There shorrld be no interference with the circulati"" G;; crossedlegs, restraints too tightly applied), and po.iti6n changes (e.g., lowering the ligs i"u- ntfroio*vi should be made slowly to allow the circulatory system io adjust, therebypreventing a drop in blood prlssur". ifr" piry.i_ cal condition (e.g., arthritis) of the patient may ptace limitations on the desired position and should bltlken into account.- Specral equipment and table attachments are deslgned tohelp maintain the patient's position. For deu

universal precautions be followed. All blood and body fluids are to be considered contaminated. This is particularly important in the preventioh of the spreading of the human immunodeficiency virus (HIV), acquired immunodefficiency syndrome (AIDS), and hepatitis B virus (HB$. Universal precautions are directed at the control of these diseases and any others by controlling cross infection. The cleansing and disinfection of eacf, in<lividual operating room, including furnishings and equipment, should be performed after each procedure. In addition, the entire surgical department, including its corridors, storage rooms, and other auxiliary areas, is cleaned according to an established schedule. Traffic patterns are developed to minimize intrusion into restricted areas. Airborne contaminants are reduced by traffic restriction, air-conditioning (utilizing highefficiency particulate air filters), and laminar airflow systems (e.g., used during joint replacement procedures). Through the use ofbarriers (i.e., restricting areas of the surgery department), the wearing of masks,
head and shoe coverings, and specially laundered clothing, the number of microorganisms in the surgical environment is reduced. By strict attention to "sciubbing" technique by personnel involved in the sterile field, ad-

potentially infectious and therefore recommend that

equip-ent

The Centers for Disease Control and prevention (CDC) have decided that all persons receiving t .ur" o" "utJf,

equate skin preparation of the surgical site, and the constant implementation of aseptic technique, the number of contaminants present about the surgical field is also reduced. Careful attention to the controlled steriLization of instrumentation and proper opening of packaged sterile supplies must be observed. The disposal of waste and the removal of laundry in specially labeled plastic bags or containers is mandatory. The wearing of sterile or unsterile gloves when cominlJ in contact with contaminated materials (e.g., instruments or sponges), frequent hand washing, and the changing of gloves when necessary (particularly when touching equipment or providing care between patients) are mandatory. The observance of restrictions regarding the changing of protective (waterproof) clothing, the use of protective head and shoe coverings, and the wearing of protective goggles when necessary is in-