1、手術室的管理1.有完善的各項規章制度并得到有效落實建立手術室核心工作制度:人員進出管理制度(參觀制度等;消毒隔離制度;查對制度;病人安全管理制度:包括接送轉運安全、手術病人評估、手術病人和手術部位的核對、手術體位安全等;標本處理制度;手術器械管理制度;交接班制度;感染手術管理制度;接臺手術管理制度;手術登記記錄制度等十項。其他工作制度包括:質量評價和考核制度;值班制度;差錯事故登記報告制度;手術器械及物品借用制度;職業安全防護制度;物品進出和管理制度;儀器管理制度;培訓制度;會議制度;業務學習制度等。2.有停水停電、緊急手術綠色通道、急用手術器械處理、多臺急診手術等各種突發事件的應急處理預案,

2、并定期進行模擬演練。3.手術室設護理質量管理與持續改進評價小組。有專職或兼職的質量監督員。定期對質量問題進行分析,提出改進措施,并有相關資料記錄,體現質量持續改進。4.建立各崗位、各專業手術工作流程與質量標準。5.術中護理記錄單應嚴格按照有關規范書寫和記錄。6.手術室的人員與物品進出管理:手術人員進入手術室:由專用通道更換消毒的衣褲、鞋子,帽子后進入手術室。手術人員不能戴手飾、搽亮甲油或戴假指甲。不允許有自已的衣服外露。潔凈區和清潔區工作的人員不得直接進入污物清洗區,出入時應洗手,必要時更鞋。其他人員進入手術室:嚴格控制進入手術室內的人員。除必要的手術醫生、護士、麻醉師外,應限制進入手術室的其

3、他人員,參觀人員必須經主管部門批準,并應控制人數(2-4人,按指定手術間參觀手術,不得隨意走動和出入,不得距手術臺過近,應與手術者和手術無菌臺保持30CM以上的距離。手術病人進入手術室:運送病人的內、外平車必須嚴格區分使用,外出平車嚴禁進入潔凈區,手術病人進出需在交換區進行內外平車架交換。平車每天清潔消毒并更換被服,工作人員外出,必須更換外出衣與外出鞋。手術使用的物品進出手術室:無菌物品經潔凈走廓進入手術室,所有進入潔凈區的物品、設備,均應拆除外包裝,擦拭干凈方可進入。手術結束后,器械用包布覆蓋或打包后方可通過清潔通道送出手術間。手術后的廢物就地有效封口或打包后,通過清潔通道,進入污染區。手術

4、室進出通道:手術室門、分區隔斷門保持關閉狀態,術前各項準備工作要提前做好,術中盡量減少人員在室內走動及出入手術室;勿在手術室內抖動各種敷料;巡回護士、麻醉醫生應在手術結束后再作整理工作。7.手術室的環境管理。保潔制度實施落實。清潔工人分工明確,有工作質量的要求、培訓及質量評價記錄。不同區域的清潔工具不能混用,需有明顯標志。手術室用物必須保持整齊、清潔,物面無塵,地面無碎屑、無污跡。定期清洗與保養,保持地板清潔、光亮。污染區:污染區地面干燥,清潔。清潔區:入室環境清潔,室內外鞋及物品分開放置,每日清潔;衛生間無異味。無菌區:每日保潔:當天手術結束后進行徹底清潔消毒,包括壁柜、無影燈、儀器、器械車

5、、手術床、操作臺面、地面。在無明顯污染情況下,物體表面用清水擦拭,內外走廓、輔助間地面每天濕式拖抹二次,(上午第一場手術開始后和當天手術結束后各一次。每周保潔:室內外環境衛生徹底清潔,包括天花板、窗戶、墻壁、空調機濾網等每周清潔擦拭一次。接臺手術之間的環境衛生。手術結束后迅速清理手術床、使用的物品,更換或清潔手術床、床單、手術臺、麻醉車、無影燈手柄、吸引器、工作臺表面、污物容器等,可疑被病人血液或體液污染的環境及物品進行有效消毒。潔凈手術室清理手術用物后,關閉手術間自凈15分鐘后,進行下一臺手術。術中感染性廢物、損傷性廢物等醫療廢物直接放入收集容器,手術切除的殘肢、組織按病理性廢物處理。傳染性

6、疾病手術的感染性廢物用雙層黃色塑料袋,保持手術過程的環境清潔、不污染,術后有效封口并注明疾病名稱送出手術間。術中被手術病人血液或體液污染的物面和地面,應用及時用醇類或含氯消毒液進行擦拭,消毒液的濃度根據感染類型進行選擇。清潔的順序應遵循從相對清潔到污染的原則,避免污染擴散。潔凈手術間(部空氣凈化管理。潔凈度級別達到設計要求,細菌濃度符合GB 15982醫院消毒衛生標準的標準。設施維護:回風口初級濾網每周進行清潔一次,必要時更換,終極濾網每年更換一次。手術室清潔工作應在每天手術結束后及凈化空調系統運行前進行。設施維護:回風口濾網每周進行清潔一次,必要時更換。粗效、中效、高效過濾器有更換記錄。手術

7、室清潔工作應在每天手術結束后及凈化空調系統運行時進行。環境空氣質量監測:每月對手術間的空氣、物體表面進行生物監測一次,工作人員洗手效果每月一次,取樣數量,結果符合要求,潔凈手術部綜合性能指標測定(靜壓差、截面風速、換氣次數、自凈時間、溫濕度、噪聲、照度、新風量、潔凈度級別和細菌濃度等技術指標醫院每年進行一次,結果符合相關規定要求。有記錄。8.手術器械及物品的管理。手術器械日常管理。所有在手術室使用的產品在進貨之前必須經過醫院采購部門負責驗三證(產品注冊證、經營許可證或生產許可證、生產廠家和經營廠家的營業執照,無菌器材除有以上證件外,每一滅菌批次須有無菌檢測合格報告;消毒劑還必須有衛生許可證,由

8、醫院采購部門驗證和購入,手術室統一領取和保管。手術器械分類登記管理,根據不同手術器械的性能要求,正確放置。備有足夠的各類手術器械及物品的數量,能滿足急診手術的需要,有手術器械準備指南和標識,包括名稱、包裝及滅菌方法。手術護士掌握各類手術器械的用途、清洗滅菌方法、保養方法等。手術器械包標識清晰、項目齊全,包括器械包名稱、與滅菌方法相符的合格的滅菌指示帶、滅菌時間、過期時間、器械打包人簽名,由消毒供應中心負責高壓蒸汽滅菌的器械包和敷料包還需要有滅菌爐次。腔鏡類手術器械管理:硬鏡與軟鏡的清洗、存放符合相關技術規范的要求。精密、易損壞及價格昂貴的手術器材專人保管、定期檢查及保養。外來手術器械必須重新清

9、洗、包裝、滅菌。用后須清潔。無菌手術器械及物品管理。手術器械及物品必須一用一滅菌,耐溫、耐濕物品首選高壓蒸汽滅菌方法,對于不能用高壓滅菌的物品應采用低溫氣體滅菌,盡量減少使用化學消毒劑浸泡滅菌的方法。禁止使用福爾馬林自然蒸發熏箱作為滅菌方法。無菌器械存放環境和條件符合衛生部消毒技術規范要求。術前無菌手術器械包必須在手術間環境和空氣清潔后放入。使用后器械清洗消毒管理。使用后手術器械置于密閉箱內送消毒供應室統一管理,若在手術室處置,則手術室的器械清洗、包裝及消毒滅菌質量必須符合廣東省醫療機構消毒供應室審核驗收標準。使用后腔鏡器械的清洗必須符合內鏡清洗消毒技術規范的有關要求。特殊感染(如破傷風、氣性

10、壞疽、朊毒體等手術必須制定一套嚴格的環境、物品、使用后器械和病人的消毒隔離措施。手術使用后布類和手術衣裝入膠袋內,有效封口并在袋外做好標記,作為醫療垃圾處理,一般感染按標準預防措施。消毒劑及滅菌設備管理。手術室使用的各種滅菌設備(高壓蒸汽滅菌爐、小型快速滅菌爐、環氧乙烷滅菌爐等應嚴格按照國家消毒技術規范的要求進行監測,所有滅菌儀每月至少做一次生物監測,每次檢測時,應同時送對照檢測菌管一只,高壓蒸汽滅菌儀,每日使用前做BD測試,并做好登記。快速滅菌器使用方法嚴格按照儀器用說明書?？焖贉缇挥糜诩毙杵餍禃r使用,不可作為常規滅菌方法?？焖贉缇笃餍挡荒苈懵兜膫魉?。使用的消毒劑、監測用的化學指示物等要

11、在有效期內使用。浸泡器械的消毒液每次使用前要進行化學監測,濃度達標才可使用,有記錄。9.病人安全管理9. Patient Safety Management手術病人術前安排。 Preoperative Arrangement for the Patient Scheduled for the Operation.護士長或組長負責手術病人、手術間、手術人員的工作安排。擇期手術按照手術類別、手術間潔凈度分級等要求分配和安排。 The head nurse or team leader shall take the responsibility of the working arrangement

12、for the patient, operation room and surgical staff. The selective operation shall be arranged in accordance with the surgical category and requirements for the cleanliness classification of the operating room.擇期手術應在術前一天送手術通知單,通知單內容包含:患者姓名、性別、年齡、住院號、病區、床號、感染情況、診斷、手術名稱、麻醉方式、手術主刀、助手。 For the selective

13、operation, the notice of the operation shall be provided on the day before the operation, the content of which includes: the patient's name, gender, age, hospital No., endemic area, bed number, infection condition, diagnosis, operation name, anesthesia way, operator during the operation and assi

14、stant.做好手術器械及物品的準備。 The surgical instruments and objects shall be well prepared.病人到手術室后,手術前病人的評估和查對。 After the patient is in the operating room, the preoperative assessment and inspection for the patient shall be conducted.核實病區術前準備項目:病人服裝應該清潔、無穿內衣褲、無活動假牙、無眼鏡或隱型眼鏡,不帶首飾、手表及錢財,不涂口紅、指甲油,術前醫囑護士是否簽名、術前用藥及

15、病人反應、如停留胃管、尿管或靜脈補液等其它引流管應觀察其是否通暢并妥善固定。 Verification for the Preoperative Preparation Items in the Endemic Area: clean patient's clothing without underclothes, denture, glasses or contact lens, jewelry, watch and money, lipstick and nail polish, nurse's signature shall be conducted in the med

16、ical order before the operation, preoperative medication and patient's Response, and circulation and fixation of the staying Gastric tube, catheter or intravenous fluid and other drainage tube.據病情種類和麻醉方式,認真評估病情、手術受壓部位皮膚情況及手術中可能采取的治療措施和備器械物品。必要時運用壓瘡量表進行評估,采取針對性的保護措施。 In accordance with the diseas

17、e type and anesthesia mode, the patient's condition, situation of the crushed skin in the operation and therapeutic measures that may be taken during the operation and relevant instruments shall be carefully assessed. If necessary, the pressure sore scale shall be used to conduct the assessment,

18、 and the corresponding protection measures shall be taken.查對內容:病人姓名、性別、年齡、住院號、診斷、手術名稱、手術部位、側向、手術方式、輸血八項的結果、藥物過敏試驗結果、術中使用藥物、術中標本的驗單、X光片及病房帶入的藥物等物品。需做過敏試驗的藥物要核對病歷過敏試驗結果,手術護士親自詢問核實病人的藥物過敏反應、手術部位和側向。 Checking Content: patient's name, gender, age, hospital No., diagnosis, operation name, operation si

19、te, side direction, operation mode, results of the eight transfusion items, result of the drug allergy test, drugs used during the operation, verification certificate of the specimen collected in the operation and x-ray film, medicine brought from the ward and other objects. For the medicine require

20、d to do allergy test, the allergy test result in the case history shall be verified, and the nurse responsible for the operation shall enquire and verify the patient's drug allergy reaction, operation site and side direction in person.查對時機:接病人時由病區護士與接手術的護士共同查對;進入手術室時由接手術病人的人員與巡回護士共同查對,進入手術間后,巡回護

21、士再次查對。 Verification Opportunity: the nurse in the endemic area shall do the verification with the surgical nurse together; When arriving in the operating room, the worker receiving the surgery patient shall do the verification with the circulating nurse together, and after arriving in the operating

22、room, the circulating nurse shall do the verification again.查對根據:通知單、病歷、病人手帶,影像資料、病人口述或病人家屬代口述。Verification Bases: letter of notice, case history, patient's hand strap, video data and patient's dictation or family's dictation of the patient.無菌手術器械質量確認與數量的清點Quality Confirmation and Amount

23、 Counting for Sterile Surgical Instruments嚴格遵守無菌技術操作原則,手術開始前、關閉體腔前、體腔完全關閉后,皮膚完全縫合后,對手術臺上所有的手術器械、敷料及特殊用物,進行器械數量、化學指示卡與移植物標識的核對。由巡回護士、洗手護士、醫生共同核對,按照手術護理單的器械欄目逐一進行核對記錄并分別簽名。對容易脫落的螺釘螺帽分別登記。 The operating principles for the aseptic technique shall be strictly obeyed, before the commencement of the operat

24、ion and the closure of the body cavity, after the complete closure of the body cavity and the complete suture of the skin, and for all surgical instruments, dressing and special objects on the operating table, the verifications of the device number, chemical indicative card and transplant identifica

25、tion shall be conducted. In accordance with the instrument column in the surgical nursing sheet, the circulating nurse, scrub nurse and doctor shall do the verification together, verify the records in sequence, and respectively sign their names. The screw and nut easy to fall shall be registered sep

26、arately.器械臺上器械擺放安全,使用方便,便于清點及確保不易污染。 The medical devices on the instrument table shall be safely placed, easy to use and count, and ensured not to be polluted easily.手術過程中增減的物品應及時清點并記錄,手術臺上失落的物品,及時放于固定位置,以便清點。 The objects increased and decreased during the operation shall be counted and recorded tim

27、ely, and the objects lost on the operating table shall be placed at fixed position timely, to facilitate counting.進入體腔內的紗布類物品,必須有顯影標記,不得剪開使用,引流管等物品剪下的殘端不得留在臺上,應立即棄去。 The objects such as gauze taken into the body cavity must be provided with the developing mark, and can not be cut off. The residual e

28、nds cut off from the drainage tube and other objects shall be discarded immediately, rather than left on the operating table.關閉體腔前發現點數物品與術前數不相符時,應及時告知主刀醫生并不得關閉體腔,認真查找。同時必須記錄及分析發生的可能原因及改進措施。 Before the closure of the body cavity, in the case that the number of the calculated objects is not consistent

29、 with the number before the operation, the operator shall be informed timely, the body cavity is not required to close up, and scrutinized search must be performed. Simultaneously, possible causes and improvement measures shall be recorded and analyzed.與當次手術無關的手術器械不得進入該手術間。 The surgical instruments

30、unrelated to the operation cannot be taken into the operation room.手術中用藥和用血的查對。 Check for the Drug and Blood Used in the Operation.根據醫囑用藥,用藥前應核對藥品名稱、濃度、劑量和有效期,并檢查藥品澄明度,有無沉淀、變色及包裝有無裂隙等。Medicine shall be taken in accordance with medical orders. Before using drugs, the name, concentration, dose and the

31、 validity period of the medicine shall be checked, and the clarity of the medicine shall be examined as well, that is, to verify whether precipitation or discoloration is found in the drug, and whether crack exists in the packaging.手術過程中執行口頭醫囑用藥時要當場復述確認藥品名稱、劑量、用藥時間、用藥途徑并做好記錄。術后及時通知醫生補開醫囑。In the proc

32、ess of operation, verbal medical orders shall be followed; in the process of using drugs, the name and dose of medicine, as well as the administration time and route shall be reposted, rectified and recorded on the spot. After operation, the doctor shall be informed timely to give medical orders.手術臺

33、上有兩種以上藥物時應使用不同的容器盛放,并做好標記,以免混淆。When two or more than two kinds of drugs are on the operating table, these drugs shall be placed in different containers, which shall be marked clearly, to avoid being mixed up.取血者要認真核對取血單上病人的姓名、住院號、血型與病歷是否相符和所取血液的種類。Phlebotomists shall verify whether the name of the p

34、atient, hospital number, blood type and case history on the blood taking list are consistent with the type of the blood taken.輸血前麻醉醫生和巡回護士共同仔細核對病人和供血者的姓名、住院號、血型、血瓶號、RH因子、交叉配血試驗結果和采血日期,并檢查血液質量,若發現血液顏色改變、沉淀、溶血,不得使用。Before transfusion, the name of the patient and the donor, hospital number, blood type,

35、 blood vial number, RH factor, cross-match blood test and blood sampling date shall be checked carefully by the anesthetist and circulating nurse, and the quality of blood shall also be examined, in the case that the color of the blood changes, or the phenomenon such as precipitation or hemolytic is

36、 found, the blood, therefore, can not be used.輸血過程中密切觀察病人反應,發現異常立即停止輸血,及時處理。In the process of transfusion, the response of the patient shall be placed under close observation, if unusual circumstance is discovered, the process of transfusion shall be stopped, and the abnormalities shall be treated w

37、ith timely.血袋在手術間保留至病人離開,注明科室、病人姓名及時間送血庫存放24小時。The blood bag shall be kept in the operation room until the patientleaves, the blood bag shall be indicated with the department, name of the patient and the time clearly, and then delivered to the blood bank to be stored for 24 hours.術中安全護理。 Safe Nursin

38、g in the Operation.術前病人的體位擺放正確。擺放體位時,清醒的病人可詢問其感覺,做好解釋工作,病人的肢體置于功能位,并能良好暴露手術視野,同時避免可能發生的皮膚壓瘡、靜脈回流受阻和神經損傷等并發癥。Before operation, the position of the patient shall be placed correctly. When the position is being placed, for the conscious patients, their feelings shall be inquired and the interpretation

39、work shall be conducted well. The patient's extremity shall be placed in the functional position and shall be exposed well to the surgical field, and simultaneously the possible pressure sores of the skin, venous obstruction, nerve injury and other complications can be avoided.根據病人手術時間、受壓部位、皮膚情況

40、使用抗壓軟墊和其它防護措施。The pressure-resist cushion and the other protective measures shall be used in accordance with the patient's operation time, pressure position and skin condition.安全約束病人。選擇合適的約束帶固定病人,術中觀察被約束部位的循環情況,在不影響手術的情況下適當活動病人的肢體,并對病人的肢端部位進行適當按摩,促進血液循環。調節室溫并注意給病人保暖。The patient shall be restrain

41、ed safely. The appropriate restraint strap shall be selected to fix the patient, and the cycling condition of the constrained position shall be observed during the operation. In the condition without influencing the operation, the patient's extremity shall be appropriately exercised, and the app

42、ropriate massage shall be conducted on the patient's acral position to promote the blood circulation. The room temperature shall be adjusted and attentions shall be paid to keep the patient warm.全身麻醉病人術畢復蘇期,予以適當約束,護士要在旁邊守護,防止病人墜床摔傷。配合麻醉醫師送病人至復蘇室。During the recovery period of the patient with the

43、 general anesthesia after the operation, the appropriate restraint shall be given. The nurse shall conduct side warding to prevent the patient falling off the bed and being hurt. The patient shall be sent to the post-anesthesia care unit in cooperation with the anesthetist.搬動和運送病人時動作要輕巧穩妥,防止推車翻倒。Dur

44、ing the moving and delivery of the patient, the action shall be light and stable to prevent the trolley turning over.嚴格按照操作技術規范使用電外科系統,正確選擇負極板的種類和放置的部位。使用高頻電刀時手術野必須保持干燥,不得有含酊消毒液殘留,以免起火燃燒。The electro surgical system shall be used strictly in accordance with the operation technological specification,

45、and for the negative plate, the right type and placing position shall be selected. During the using of the high-frequency electrotome, the surgical field shall be dry, and the tincture-containing disinfectant shall not be left to prevent the fire burning.術中需使用溫水時,必須使用嚴格控制水的溫度,37-42適宜水溫,免燙傷病人。(溫度是參照基

46、護書的,術中是指體內使用的溶液請再確認溫充范圍During the operation, when the warm water is used, the water temperature shall be strictly controlled, and the appropriate water temperature is from 37to 42 to prevent burning patients. (The temperature refers to the requirement of the basic nursing, and the operation process

47、means, for the solution used in body, the temperature-filling range shall be confirmed again10.手術標本管理10. Management of the Operation Specimen嚴格標本留取及送檢交接制度。 The specimen acquiring and submitting transfer system shall be strictly implemented.手術中切除的任何組織未經主刀醫生許可不得遺棄或私自取走。Without the operator permission,

48、 any tissue resected during the operation shall not be abandoned or secretly taken away.術中切下的組織隨時做好標記,防止弄錯病人、弄錯部位。非新鮮組織送檢的標本,要及時浸泡于10%福爾馬林液中。For the tissue resected in the operation, marks shall be made at any time to prevent mistaking the patient and position. The specimen taken from the non-fresh

49、tissue for inspection shall be soaked in the 10% formalin liquid in time.安全存放標本,確保標本不丟失、不變質、不毀損。The specimen shall be stored safely, and for the specimen, no losing, decomposition and damage shall be ensured.負責送標本的人員再次核對留取標本的名稱、數量及登記情況,確定無誤后送病理科。The name, number and registration situation of the res

50、erved specimen shall once be collated by the personnel responsible for sending specimens and be sent to the pathology department after determination without error.11.護理風險的管理11.Nursing Risk Management嚴格遵照有關法規和規章制度執行各項護理操作。The relevant regulations and rules shall be strictly followed to implement all

51、the nursing procedures.有完善的各手術專科護理操作流程及安全指引Provided with perfect operating procedure and safety instruction of various operative specific nursing手術護士接待病人及家屬時應熱情有禮,使用規范性的職業語言,對病人的疑問要熱情解答。The nurse in the operation room shall be enthusiastic and polite when the patient and their family are received, u

52、se normative professional language and passionately answer the patient's question.為清醒病人進行各項護理操作前應做好解釋工作,動作輕柔,并注意保護病人的隱私。Before all the nursing procedures for the conscious patient are conducted, the interpretation work shall be completed, the action shall be gentle and the patient's privacy shall be protected.術中應保持安靜、嚴肅,不得在手術間大聲談笑、喧嘩或隨意談論病人的病情與隱私。The quiet and seriousness shall be kept during operation, loudly chatting, shouting or talking about patient's condition and privacy can't be a