Preoperative preparations
Staff
Health and
safety policies
The following health and safety policies
should be implemented for all theatre staff:
•
all staff should have a chest X-ray before commencing work;
•
appropriate vaccination schedules, e.g. hepatitis B, and tetanus
immunisation policies should be in place;
•
policies for staff protection when handling patients with a high-risk
transmittable disease, e.g. hepatitis B or C, human immunodeficiency virus
(HIV);
•
protocols for accident procedure;
•
protocols for incident procedure;
•
ionising irradiation guidelines with instructions for use for the X-ray
image intensifier. All staff who use such instruments must be in possession of
the Irradiation Protection Certificate;
•
policy with regard to the adequacy of exhaustible anaesthetic gases;
•
guidelines for the use of a laser;
•
infection control policy with regular monitoring.
Staff
facilities
•
Changing area — this should be adequate inside with secure lockers, and
with clean and adequate supplies of clean clothing, which should be of a
close-woven coloured material with trousers for both sexes which should have
elasticated ankles. Appropriate disposal bags for dirty linen, adequate
toilets and washing facilities including hand basins and showers. Caps, masks
and aprons should be available. Staff should have their own comfortable,
regularly cleaned, antistatic footwear.
•
Masks — these are important for staff protection and for
operations
involving splashing, such as drilling, there
should
be visor protection of the eyes. They are of questionable value in reducing
infection rate. They should be:
—
fabric not cotton;
—
not touched by hands;
—
not put in pockets;
—
destroyed after single use.
Equipment
•
Trolleys should be clean, have safety rails and have oxygen cylinders
with well fitting tubes and masks, all of which are regularly checked so that
empty cylinders are replaced. Trollies must be able to be tipped into the
Trendelenburg position in case of regurgitation of gastric contents.
•
The operating table should be cleaned with regular checks to see that it
can be raised and lowered smoothly with the appropriate gears for Trendelenburg
tilt, lateral tilt and an adequate braking system. Accessories should be clean
and available and fit well, and it is particularly important to ensure that
stirrups fit well.
—
Settlement of negligence claims in this area is very
costly.
•
The lights should be modern and easily movable by members of the
scrubbed team and by other theatre personnel.
•
The suction apparatus should be clean and thoroughly checked, with spare
suction tubes and catheters available.
•
Anaesthetic machines should be in good working order —many of them are
now supplied on a loan basis with a strict policy as to the correct connections
and nontransferable piping. They must be regularly serviced and a record of
this must be maintained.
—
All electrical equipment should be regularly checked and marked
accordingly.
—
A fire policy, regular fire drills and weekly testing of fire doors are
essential safety precautions.