This chapter discusses the types and uses of rubber goods. Various types of rubber goods are required in operating theatre work. These are costly items in a hospital budget. Their proper care, use, and storage, therefore, are as much a matter of hospital economics as of having efficient equipment on hand. Many rubber items in hospitals are being replaced by disposable plastics, and innovations, such as gas sterilizers and disposable gloves are reducing the complicated care of rubber goods. Chemical disinfection should not be used, as elastic quality prevents adequate penetration; some rubber may absorb chemicals and then irritate tissue. Sterilization of rubber bands around instruments, or rubber tubing along with instruments, or while the rubber is attached to an instrument should be avoided. The rubber prevents the sterilizing steam from reaching the instrument. Rubber goods should be tested prior to sterilization, and efficiency should be verifies prior to use at operative field. There are points to be considered during storage of rubber goods that include: (1) rubber goods should be dried before storing; (2) should be stored in dry, cool area; and (3) proper person should be notified when stock supplies of rubber goods are below working inventory.

This chapter discusses the uses of drugs and solutions. Drugs and solutions are required for the basic cleaning of the operating theatre, the preparation of the surgical setup, the scrub procedure of the operative team, the skin preparation of the patient, as medications used during the operation, and for cleaning of the theatre and equipment after the operation. Hospitals vary in their choice of drugs and solutions, yet basic needs must be met, both in relation to the performance and quality of the drugs involved. Each institution has a routine procedure to render the operative site surgically clean. Procedure and choice of solutions varies with the type of surgery and age of patient. It is logical to have the necessary equipment located by the side of the drug. The equipment should always be restocked in preparation for the next emergency. A care should be exercised while handling drugs for radiography at the operative field, for example, cholangiogram. One must be sure that adaptor fits securely on syringe.

This chapter explains the importance of sterilization and various requirements during the process of sterilization. Sterilization implies the destruction of all forms of microbial life. An article can, therefore, only be regarded as sterile when all microorganisms both on its surface and in its substance have been killed. Disinfection is used to describe the process by which many of the more common pathogenic microorganisms are killed. Some microorganisms can be destroyed comparatively easily. The greatest problem of all is the destruction of the resistant spores formed by some organisms. Dressings and fabrics present a slightly different problem, to sterilize them the steam must penetrate the material itself. If air remains in the pack, the steam will mix with the air, the temperature of this steam/air mixture is lower than that of the steam and its efficiency as a sterilizing agent is therefore less. High vacuum autoclaves in which the air is first drawn from the chamber and the load itself are used. Thus, complete and rapid penetration of the steam can occur and the temperature throughout the load will be constant.

This chapter explains the importance of personal attitude in day-to-day life. Personal attitude influences all aspects of hospital relationships–;from a friendly morning greeting to economy of hospital equipment. Good posture, cleanliness, and neatness, all are indications of a person's self-respect. Surgical operations are carried out in team fashion, and the need for harmony is paramount. Consideration of others is exemplified by tolerance, kindness, gentleness, and even the kind word and smile, which is welcomed by everyone. In comparison, arrogance breeds defensiveness in others and, thus, defeats group function. Cooperation is a give-and-take that is a sine qua non for group function. There is no place for selfishness in this situation. One admires those surgeons and nurses who always maintain a professional attitude while at work, and thereby, promote good rapport among co-workers. During surgery, the personal feelings and responses to people or circumstances must not be shown.

This chapter discusses different aspects of a surgical team. A successful operation depends on the smooth, efficient performance of the surgical team. The team for routine operative procedures varies in number–;usually from five to seven people–;but the number increases when special machines are used requiring doctors and technicians, or when the presence of a cardiologist, pathologist, etc., is indicated. Some teams may include a sponge nurse who assists the suture nurse or scrub assistant. Others will not require the second assistant doctor. The qualities of an effective team are mutual trust, good communication between the members of the team, knowledge of procedures, and skill. The surgeon depends on the nursing team to provide the necessary instruments, equipment, and supplies, and he assumes that they know the way to use them and care for them. In addition, he expects the team to be well-organized and confident.

This chapter describes the characteristics and requirements of a four clue system. There are four clues that intend to help in solving problems and in becoming a member of a surgical team. One needs to study the operation by reference to surgical books and conference notes, and to develop a method of thinking that prepares for deviations in routines, new procedures, and complications that may arise. One must concentrate on solving a procedure, from the selection of instruments to the application of the dressing. The four clues include: (1) surgical approach; (2) surgical procedure; (3) surgical complications; and (4) surgical closure. A particular operation should be chosen and one must go through these steps, visualizing what will be done, and think of the way to prepare to meet the demands. There is a need to understand steps of the surgical procedure at operative site and prepare for various unforeseen complications.

This chapter discusses different types and reasons for positioning of a patient. There are specific positions in which the patient must be placed so that the desired surgery can be performed. Each type of operation has its individual demands, and so has each patient. The positioning procedures are patterned to best fulfil these requirements. Improper positioning necessitates the moving of the patient during procedures. This means time loss and the possibility of contamination. There are four main points to consider when placing patients in position for surgery–;anatomy, comfort, safety, and respiratory freedom. A nurse and two helpers must be in attendance when transferring a patient to the operating table. The stretcher should be placed next to the locked table. One person should stand at the side of the stretcher, holding it closely against the table; the other person should stand on the opposite side of the theatre table, ready to receive the patient. This prevents the patient from falling between the stretcher and table, and from falling off the far side of the table.

This chapter describes different types of hazards and ways to prevent. It presents some rules that should be observed in hospital theaters. To prevent explosions and fire one must wear cotton clothing, as wool and nylon garments are potential dangers. It is important to make sure that humidity is at least 55% to avoid any accident because of explosion or fire. The chapter also discusses some points to prevent radiation hazards: (1) when X-rays are being taken, all staff must be protected adequately with lead aprons, shields or gloves, particularly during angiography; (2) all staff who are constantly working in X-ray theatres should wear some monitoring device that must be checked regularly; (3) any losses or breakages of radioactive sources in the operating theatre must be reported at once to hospital radiation safety officer; and (4) when sealed sources of gamma rays are being inserted, that is, radium needles, gold seeds, cesium or cobalt, the sources should not be touched by hand, they should be removed from their protective containers with long-handled forceps just before use, sterilized in lead protected containers, and transferred to a sterile covered lead trolley.

This chapter discusses the importance and need to take care of specimens. One must be careful with specimens removed from patients. The sister is entrusted with the handling, saving, labeling, and final disposition from the operating theatre of specimens that may be important for further diagnosis and treatment. Cultures demand the same attention and care from the theatre nurse. They are taken to assist with the patient's diagnosis and treatment; hence, it is not to the patient's advantage if they are improperly prepared, allowed to remain for long periods of time at improper temperature, are lost, are unlabeled, or if the forms are illegible or incomplete. Method set up should be used in theatre for recording of all cultures taken in the suite. Safe and immediate delivery to the laboratory of the culture should be assured. The individual tube or container should be labeled with the name of patient and hospital number.

This chapter explains different types of responsibilities of an anesthetist. A conference with the anesthetist preceding the operation will alert the nurse to the requirements of the patient, and she will be in a better position to assist the anesthetist in this vital role in surgery. Anesthetists usually have the special supplies they need in their machines, but they depend upon the nurse to see that the anesthesia stands are correctly supplied. Conductivity must be the rule at all times, even if the patient requires local anesthesia, or if a nonexplosive gas mixture is to be employed. There are several opinions as to whether the patient hears or remembers conversation during the stage of losing consciousness and during the unconscious stage. In any event, it is important that nurses and assistants be aware that the surgical patient experiences an emotional trauma whether he receives a general anesthetic or a local one.