So many times a television team attended operations at Atlas General Hospital. We talked mostly to surgeons who were explaining what their job was. In addition to surgeons, assistant surgeons, anesthesiologists, anesthetists, and technicians, the core surgical team is comprised of a chief scrub nurse and a circulating nurse. They come 40 minutes before the scheduled surgery and here’s what their job is.
Surgical hand washing
Maja Jovanovic – scrub nurse: “First and foremost is a cap, a mask and we start surgical washing. Everything you have, especially jewelry, must be taken off to prevent infection and to stop entering any kind of dirt under these sterile conditions. So surgical washing has its own reason why it is done here. Surgical washing consists of mechanical washing, mechanical washing with soap and then disinfection. There is disinfection and there is a sterilization, which everyone who work here is familiar with, but many people mix these two things and say, my hands are sterile.
Hands can never be sterile because you know how the sterilizing process goes. So the hands are mechanically clean and disinfected. This is the process of disinfection and how it is done depends on the manufacturer’s recommendation. At the moment we are washing with Manorapid which is the best on the world market. Surgical hand washing takes three minutes of disinfection and maintaining humidity. The scrub nurse is an equally important part of the surgical team chain. For one operation, you need to have a washed scrubed nurse and a circulating nurse. When we have finished hand washing, we enter the operating room finishing with surgical hand washing”.
Preparation of the chief scrub nurse for the operating room
Maja Jovanovic – scrub nurse: “Now there is a colleague in the operating room, an auxiliary scrub nurse, or a circulating scrub nurse, who is in charge of the chief scrub nurse. That is, when they say chief or auxiliary, people understand it differently. We are constantly changing depending on surgery. I’m in charge of orthopedics and the other one in neurosurgery. The branches are close, so we form a team and agree on all that will play a role in the operation. The most important thing in the operating room is the job of the scrub nurse, to provide aseptic working conditions. Sterile means the complete absence of bacteria, microorganisms and their spores. And now we provide that sterility in the operating room. Atlas Hospitals operate on the highest world standards, so we use everything for single use. From surgical coats to laundry “.
Maja Jovanovic – scrub nurse, Dr. Gordan Gavrilovic – knee surgery
The hands are disinfected and not sterile, so there should be no disinfected-sterile touch but sterile-sterile only. There is no less than the absolute sterile, which is especially important for orthopedics as a branch of surgery. Of course it is not welcomed anywhere, because when the infection gets into the bone then we are in big trouble. As a washed scrub nurse, I am ready to go now to provide sterile working conditions. We start garnishing the operating room and garnishing means to provide sterile conditions. As I said, we use disposable non-permeable laundry so that there is no more garnishing with abnormal quantities to secure it all. This is much better, simpler, and more functional.
Sandra Dabic – scrub nurse: “ Me, as a circulating nurse should accompany my chief scrub nurse. I need to know exactly when to open something to her so that they do not have idle time in the work itself. ”
Instrument integrity and sterility control in the operating room
Maja Jovanovic – scrub nurse: “ That’s right, Sandra, that’s very important in our work. That there is a team that works, that is playful, that there will be no excess words, running and going out of the operating room. Here, you just see how she opens it in the condition of asepsis. We can proudly say that everything is up to world standards at Atlas Hospital. As you can see, the instruments are packed in the Integra. Everything is used for single operation, everything is for single use, so we can be proud of the conditions. There must be sterility controls in each kit, which is proof that the instruments are sterile and ready for surgery. ”
Sandra Dabic – scrub nurse: “This indicator is put into a separate book, one notebook that we keep. This is proof that the instruments have undergone a sterilization process. ”
How many years does it take to become a scrub nurse
Maja Jovanovic – scrub nurse: “We are preparing operating room for an arthroscopic knee ligamentoplasty and now I am preparing instruments, we have an instrument table, an auxiliary table. So this is a washed instrument work and the auxiliary all the time provides the washed working conditions, opening sterile consumables such as gloves, gauze, laundry, implants if needed and these would be the basics of some instrument work, of course when the team is skilled and when professionals work everything seems easy. To become a scrub nurse it is a long work in terms of specialization where you need it depending on surgery, but I can say at least five years ahead of orthopedic surgery to make everything look like this and more”.
Sandra Dabic – scrub nurse: “When we graduate from high school, we should all have a 6 month internship. I was fortunate enough to go through both the clinic and the surgical block and ward in those 6 months. And that’s when I decided I wanted to be a scrub nurse. Higher education is completed first, so specialization and basically this job is taught in the operating room itself. When I came as a kid at 18, I had my mentor. The person who was in charge of me and trained me for a year. That training included everything from behavior, dressing, movement, handling of the sterilized material, and team behavior. So today, Maja and I are the ones who train the younger generations. ”
Sandra Dabic-scrub nurse, Dr Milenko Savic, spine surgery
Is scrub nurse as important as everyone else in the operating room?
Maja Jovanovic – scrub nurse:“Everyone sees a scrub nurse as an assistant of a surgeon, someone who adds instruments, that is far from that job. The scrub nurse is part of the surgical team as well as the surgeon, assistant, circulating nurse. We cannot work without the other.”
Sandra Dabic – scrub nurse: “How much time we spend with surgeons, after a number of years, we become friends. We know their psychology and they know our psychology. Often, during the operation, we complement and assist each other. Surgeons do not need to tell us what they need, we already know it in advance. ”
Movement of scrub nurses in the operating room
Sandra Dabic: “What matters is the movement in the operating room. Maja is the chief scrub nurse, in charge of the instrumental and her auxiliary desk and the work of the surgeon. Me, as a circulating nurse, need to know how to navigate because she cannot take care of me while working. I have to accompany her and the entire surgical team, to notice when she needs something and to know how to handle certain appliances. ”
The surgeons entered the operating room. Arthroscopic surgery of the anterior cruciate ligaments was performed.
Sandra Dabic – scrub nurse: “At the end of the operation we need to put everything back in place, so the entire instrumentation needs to be washed: it is machine washed and it has a process of washing, drying, disinfection, counting instruments, and making records of the material that was used. All consumables used and the recessed materials used for that patient needed. So we always stay after the surgeon. We come before the surgeon and stay after him”.
Nurses, like the entire surgical team, do not have working hours because one never knows how long the surgery will take. Work is very stressful. In order to pursue this profession, you need knowledge, experience, concentration, but above all, love.
Sandra Dabic : “This job has to be loved, really, really loved in order to do it proprerly.. This does not mean that someone just wash themselves and stand at the operating table. The scrub nurse is part of the team and operations, whether it will last 5-10 minutes or 15-20 hours- depending on the surgery, the scrub nurse is the one standing side by side with the surgeon. ”
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