Center for the Study of Ethics in the Professions at IIT

Standard I

Teamwork is essential for perioperative patient care and Is contingent upon interpersonal skills.

Interpretative Statement

Good interpersonal skills and surgical conscience provide an atmosphere to enhance the job performance of the surgical technologist.

Criteria

1. Interpersonal skills are measured by observation of behavior.

a. Effectiveness of communications.

b. Acceptance of criticism.

c. Willingness to help others.

2. Interpersonal relationships should be characterized by trust, honesty, confidence, and respect.

3. The ability to meet expectations and to function may be dependent upon communication with team members.

a. Share pertinent patient data.

b. Share needs for instrumentation, etc.

c. Seek pertinent information to maintain high degree of efficiency.

4. The surgical technologist practitioner recognizes limits of individual responsibility within framework of job description, while working toward mutual goals of the organization.

5. The surgical technologist practitioner adheres to the AST Code of Ethics at all times in relationship to all members of the health care team.

6. The surgical technologist practitioner develops a professional attitude that will promote responsibility as an individual and as a member of the health care team.

Standard II

Preoperative planning and preparation for surgical intervention are individualized to meet needs of each patient and his or her surgeon.

Interpretative Statement

The process of formulating in advance the direction the surgical technologist practitioner must follow in preparing for the surgical procedure involves the collection of data concerning the patient and the surgeon's preferences for the procedure.

Criteria

1. The data collection may be accomplished through diversified means such as interview, review of records, assessment, or consultation with other members of the team.

2. Current health status deviations and/or problems are identified.

3. Preoperative diagnosis, common complications, and operative pathology relating to specific surgical procedures are understood through fundamental knowledge of basic sciences and procedures applicable to the surgeon's plan for surgical intervention.

4. Surgical procedure manuals or cards that enumerate surgeon's preferences are current.

Standard III

The preparation of the surgical suite/clinical area and all supplies and equipment will ensure environmental safety for patients and personnel.

Interpretative Statement

Environmental safety and infection control are achieved by adhering to sound technical scientific principles and guidelines to minimize hazards.

Criteria

1. Wear required attire correctly.

2. Select and prepare necessary supplies and equipment.

3. Check all equipment for working order and report or correct unsafe conditions. Inspect emergency equipment and supplies for condition and quantity.

4. Assure physical preparation of clinical area, i.e., damp dust and place furniture.

5. Verify exposure to a sterilization process and integrity of sterile packaging. Open supplies aseptically.

6. Establish and maintain sterile field.

7. Identify and report to designated personnel conditions that may exist and could negatively affect the health, safety, and well-being of patients or personnel.

a. Adhere to recommended isolation precautions.

b. Check electrical, laser, and radiation equipment in the operating room.

8. Demonstrate correct body mechanics.

9. Comply with all policies, procedures, an recommended practices pertaining to the use, care, and maintenance of supplies and equipment.

10. Identify principles and demonstrate techniques of disinfection, sterilization, and environmental control.

Standard IV

Application of basic and current knowledge is necessary for a proficient performance of assigned functions.

Interpretative Statement

Knowledge of and assistance with a surgical procedure are demonstrated by meeting the anticipated needs of the surgeon and other team members.

Criteria

1. Identify breaks in aseptic technique and correct and/or report same to the proper authority.

2. Display dexterity in the use of surgical instruments throughout the procedure.

3. Prepare and know the specific uses of all needed equipment and supplies, including solutions and drugs.

4. Continually maintain a neat and orderly sterile field as dictated by the sequence of the procedure.

5. Use economy in time, motion, and material in assisting the surgical team.

6. Differentiate between contaminated and clean/sterile areas.

7. Participate in counting procedures per established policy.

8. Appropriately prepare all specimens for laboratory analysis.

9. Identify unusual or emergency situations and use sound judgment in instituting established procedures to correct them in a calm and efficient manner.

Standard V

Each patients rights to privacy, dignity, safety, and comfort are respected and protected.

Interpretative Statement

Professional behavior of the surgical techonologist practitioner reflects a surgical conscience that includes the legal, ethical, and moral responsibilities to each individual patient. Every practitioner is accountable for his or her acts of commission and omission that contribute to outcomes of surgical intervention.

Criteria

1. The patient is transported, positioned, and restrained without bodily injury.

2. Every surgical technologist practitioner is morally and ethically responsible and legally accountable to patients for performance.

3. Physical, psychological, and spiritual needs of the patients are met.

4. The patient is respected as an individual.

5. The surgical technologist practitioner should be familiar with the Patient's Bill of Rights and statutes governing allied health practice.

6. The patient is monitored to identify deviations from expected responses requiring immediate action.

7. Events must be factually documented and records legible.

8. Patient records are verified as complete.

9. Records verify that patient care has been rendered in accordance with policy and procedure.

10. The surgical technologist practitioner should recognize the limits of individual responsibility to self, profession, and employer.

Standard VI

Every patient is entitled to the same application of aseptic techniques within the physical facilities.

Interpretative Statement

The surgical suite/clinical area is restored to a safe environment for subsequent patient care following completion of a surgical procedure.

Criteria

1. Assist with appropriate preparation of instruments and equipment for decontamination or terminal sterilization.

2. Conscientiously carry out contamination control measures.

3. Replenish necessary supplies and equipment.

Glossary

Clinical area: physical facilities designed for practice of technology applicable to surgical intervention

Criterion: a measurable term used to evaluate the degree to which a standard is met

Health care team: all persons directly and indirectly involved with patient care

Intraoperative period: begins when the surgeon starts the procedure and ends when the patient is transported from the clinical area

Pertoperative period: encompasses preoperative, intraoperative, and postoperative phases of surgical intervention

Postoperative period: begins when patient is transported from the clinical area and ends when the clinical area is environmentally safe for subsequent patient care

Preoperative period: begins with scheduling of patient for surgical intervention and ends when the surgeon begins the procedure

Process standard: a standard that focuses on implementing techniques, using acknowledged principles and theories of the natural and behavioral sciences, necessary to provide conformance to requirements of the job.

Standard: a criterion used by general agreement to determine whether something is as it should be; an established norm determined by opinion, authority, research, and/or theory, an agreed upon level of excellence in performance

Surgical conscience: professional behavior that demonstrates understanding and application of principles of surgical technology and legal, ethical, and moral responsibilities to patients and team members for which each practitioner is accountable.

Supporting Documents

The following documents support the goals of these standards.

AST Resolutions and Position Statements

Standards of Practice Resolution

Adopted by the AST House of Delegates, 1986

Whereas, The Standards of Practice Committee of the Association of Surgical Technologists, Inc., is involved in developing standards for the practice of the surgical technologist practitioner;

Whereas, These standards should be based on sound technical scientific principles;

Whereas, The Centers for Disease Control has developed guidelines for infection control and the Association of Operating Room Nurses, Inc., has published recommended practices for the operating room based on these principles; therefore, be it

Resolved, The Association of Surgical Technologists, Inc., endorses the AORN recommended technical practices and CDC guidelines, and the Association of Surgical Technologists, Inc., encourages all its members to adhere to these recommended practices as they apply to the clinical practice of surgical technology.

Role Definition Resolution

Adopted by the AST House of Delegates, 1986

A primary function of the surgical technologist practitioner is as the "scrub technologist" in the

surgical suite and other clinical areas. The surgical technologist practitioner may be assigned other functions as permitted by the hospital and/or employer policy. The performance of these functions should be according to the experience and scope of educational preparation of the individual surgical technologist and applicable legal guidelines.

Role of the Scrub Person Resolution

Adopted by the AST House of Delegates, 1988

Whereas, Surgical technology practice incorporates both behavioral and technical components of surgical technology, and

Whereas, Surgical technologists have performed the role of the scrub person for more than forty years; and

Whereas, Surgical technologists have defined Standards of Practice for the role of the scrub person; and

Whereas, The activities of the role of the scrub person are considered an integral part of surgical technology practice; therefore, be it

Resolved, The surgical technologist who performs the role of the scrub person is practicing surgical technology.

First Assisting Position Statement

Adopted by the AST House of Delegates, 1988

As defined by the American College of Surgeons, the first assistant provides aid in exposure, hemostasis, and other technical functions that will help the surgeon carry out a safe operation with optimal results for the patient. This role will vary considerably with the surgical operation, specialty area, and type of facility.

The Association of Surgical Technologists, Inc., recognizes the first assistant and scrub technologist roles are differentiated by education. First assistants must be educated in the use of surgical instruments on tissues versus the handling of instruments.

Certified surgical technologists with additional specialized education or training may function as first/surgical assistants to the surgeon at the operating table in those situations or facilities where more completely trained assistants are not available.

Practice privileges of those acting as first/surgical assistants should be based upon verified credentials reviewed and approved by the appropriate credentialing committee.

Accreditation Resolution

Adopted by the AST House of Delegates, 1988

Whereas, The Association of Surgical Technologists, Inc., supports the surgical technology program accreditation process administered by the Accreditation Review Committee for Educational Programs in Surgical Technology (ARCST), a collaborative effort of the Association of Surgical Technologists, the American College of Surgeons, and the American Hospital Association, under the auspices of the American Medical Association's Committee on Allied Health Education and Accreditation (CAHEA);

Whereas, The Association has historically supported and continues its support of the accreditation process; and

Whereas, The Association believes in the value of accreditation to the benefit of the public, the health care community, educational institutions, and the surgical technology students; therefore, be it

Resolved, That the Association of Surgical Technologists, Inc., recommends CAHEA accreditation as a goal for all surgical technology programs; and

Resolved, That all prospective surgical technology students take the CAHEA accreditation status of an educational institution into consideration when selecting a surgical technology program.

Certification Resolution

Adopted by the AST House of Delegates, 1988

Whereas, The Association of Surgical Technologists, Inc., has historically supported and continues to support the certification process;

Whereas, The Association believes in the value of certification to the individual surgical technology practitioner and to the benefit of the public, the health care community, and health care institutions; and

Whereas, The Association fully supports the surgical technology national certifying examination of the Liaison Council on Certification (LCC), an administratively independent body consisting of and a collaborative effort of representative Certified Surgical Technologists, a surgeon, a registered nurse, and the public; therefore, be it

Resolved, That the Association of Surgical Technologists, Inc., strongly supports and recommends the LCC's national certifying examination in surgical technology to all surgical technologists; and

Resolved, That all prospective health care institution employers take into consideration the certification status of all surgical technologists when hiring and seek to achieve a goal of certification for presently employed surgical technologists.

Association of Surgical Technologists Code of Ethics

Adopted by the AST Board of Directors, 1985

1. To maintain the highest standards of professional conduct and patient care.

2. To hold in confidence, with respect to patient's beliefs, all personal matters.

3. To respect and protect the patient's legal and moral right to quality patient care.

4. To not knowingly cause injury or any injustice to those entrusted to our care.

5. To work with fellow technologists and other professional health groups to promote harmony and unity for better patient care.

6. To always follow the principles of asepsis.

7. To maintain a high degree of efficiency through continuing education.

8. To maintain and practice surgical technology willingly, with pride and dignity.

9. To report any unethical conduct or practice to the proper authority.

10. To adhere to the Code of Ethics at all times in relationship to all members of the health care team.

Other AST Documents

AST Philosophy

The Association of Surgical Technologists believes it is important to instruct the surgical technologist in the provision of quality care to patients undergoing surgery; to guide the essential and continuing education of surgical technologists; and to contribute to general education through a broad program of educational activities.

The Essentials of an Accredited Program

The Essentials and Guidelines of an Accredited Educational Program for the Surgical Technologist were developed through the collaborative efforts of the American College of Surgeons, the American Hospital Association, the Association of Surgical Technologists, and the Association of Operating Room Nurses. These organizations along with the American Medical Association adopted the Essentials in 1972. The Essentials establish standards of appropriate quality for surgical technology educational programs and provide recognition for educational programs that meet or exceed the minimal standards outlined in the Essentials.

AST Publications

The Core Curriculum for Surgical Technology, Second Edition, defines the parameters of surgical technology and serves as a basis for establishing educational programs, writing course outlines and objectives, and developing course presentations.

The Surgical Technologist, official publication of AST, is a bimonthly journal whose editorial emphasis is on the technical, scientific, and other substantive matters related to surgical technology.

Study and Test Skills for Health Professionals contains exercises and techniques designed to develop comprehension and retention of technical material for study or testing purposes.

The 1988 Directory of Certified Surgical Technologists, published by the Liaison Council on Certification for the Surgical Technologist, contains the names, certification numbers, and expiration dates of every current and valid certified surgical technologist since the inception of the profession's certifying examination.

AST publishes the following brochures about the profession of surgical technology: Profile of the Surgical Technologist, Job Description: Certified Surgical Technologist, Surgical Technology Programs Accredited by CAHEA, and Your Job Security. The Liaison Council on Certification has brochures on certification available: certification: You Should Care (for surgical technologists) and Certification and the Surgical Technologist (for employers).

Job Description: Certified Surgical Technologist

Definition

A primary function of the surgical technologist practitioner is as the "scrub technologist" in the surgical suite and other clinical areas. The surgical technologist practitioner may be assigned other functions as permitted by the hospital and/or employer policy. The performance of these functions should be according to the experience and scope of educational preparation of the individual surgical technologist and applicable legal guidelines.

Education

High school graduate, or equivalent, and graduate of an accredited surgical technology program or another avenue of entry otherwise acceptable to the Association of Surgical Technologists, Inc.

Credentials

Certification of entry-level knowledge is achieved through a national exam administered by the Liaison Council on Certification, the certifying body of the Association of Surgical Technologists, Inc. Certified surgical technologists

(CSTs) maintain their certification by accruing 72 CE contact hours in a consecutive 6-year period or by successfully retaking the certifying exam at the conclusion of the 6-year period.

Goals

1. Development of ideals and a professional attitude that will promote responsibility as an individual and also as a member of the health care team.

2. Application of knowledge of the basic concepts necessary for the performance of the duties expected of the CST.

3. Development of a code of professional behavior that will reflect the ethical, legal, and moral responsibilities of each individual.

4. Coordination of team efforts to offer the most qualified team support to the surgical patient, the surgeon, and all members of the surgical team.

5. Awareness of the patient as an individual, with specific psychological, physical, and spiritual needs.

6. Education of the general public as to what a CST is and what his or her specific duties on the health care team entail.

Objectives

1. Apply the principles of asepsis in a knowledgeable manner to provide optimum patient care.

2. Identify emergency situations and use sound judgment in instituting established procedures. Correct situations in a calm and efficient manner.

3. Develop initiative in order to inquire and explore new surgical procedures and subjects relating to the operating room and to the surgical patient.

4. Provide a safe, efficient environment for the surgical patient.

5. Respect the patient's inherent right to privacy, dignity, and safety.

6. Understand the actions and use of anesthetic agents in order to be able to care for the patient in an intelligent manner.

7. Develop and improve skills in assisting the surgeon and in the organization of work by learning to use economy in time, motion, and materials.

8. Identify the structure and function of body parts; recognize common disorders of the body.

9. Function under all aspects of surgical techniques, both routine and special surgical procedures, and perform them in a professional manner.

10. Relate operating room technique to the total hospital environment.

11. Understand the services provided by the surgeon in relation to the patient's restoration to health and return to the community.

12. Prepare and know the specific uses of all equipment and supplies used for surgical procedures.

13. Realize the importance of teamwork, consideration, and cooperation.

14. Anticipate the needs of the surgeon in order to expedite the procedure, thus minimizing the patient's exposure to trauma.

15. Recognize limits of individual responsibility.

16. Recognize and clearly understand that each individual is totally responsible for her or his own actions.

17. Differentiate sterilization methods for special equipment and instruments necessary for specific surgical procedures.

18. Display dexterity In the use of surgical instruments and knowledge of the step-by-step procedure for specific surgical procedures.

Job Knowledge

1. Principles of asepsis and sterile technique 2. Anatomy and physiology 3. Medical terminology

4. Microbiology 5. Pathology; care and handling of specimen

6. Procedures in OR; special positioning of patients

7. Environmental dangers 8. Manual dexterity 9. Professional ethics 10. Cost containment 11. Complications of surgical procedures 12. Pharmacology 13. Instrumentation 14. Communications 15. Sutures 16. Prosthetics 17. Solutions 18. Anesthesia

Surgery Knowledge

1. Eye, ear, nose, throat surgery

2. General surgery

3. Gynecological surgery

4. Vascular surgery

5. Neurosurgery

6. Orthopaedic surgery

7. Urologic surgery

8. Rectal surgery

9. Plastic repair and reconstruction

10. Transplant surgery and organ procurement

11. Thoracic surgery

Equipment in Surgery

Knowledge and the ability to use or assist in the use of equipment, such as the following:

1 . Sterilizers

2. Electrosurgical machines

3. EKG monitors

4. Suction machines

5. Endoscopic equipment

6. Pacemaker equipment

7. Orthopaedic tourniquets

8. Microscopes

9. Air-powered equipment

10. Operating tables

11. Lasers

Scrub Technologist

Surgical technology practice incorporates both behavioral and technical components of surgical technology. Surgical technologists have performed the role of the scrub person for more than forty years and have defined Standards of Practice for the role of the scrub person. The activities of the role of the scrub person are considered an integral part of surgical technology practice; therefore, the surgical technologist who performs the role of the scrub person is practicing surgical technology.

Duties

1. Check supplies and equipment needed for surgical procedure; has knowledge of surgical preference.

2. Scrub, gown, and glove.

3. Set up sterile table with instruments, sutures, blades, electrosurgical equipment, suction, prosthesis, and solutions : needed -for procedure.

4. Count sponges, nee and instrumentation with circulator prior to procedure and before incision is closed.

5. Gown, glove surgeons, assistants, etc.

6. Help in draping sterile field.

7. Pass instruments. etc., to surgeon during procedure.

8. Prepare sterile dressings, etc.

9. Maintain highest standard of sterile tech nique during procedure.

10. Clean and prepare instruments for terminal sterilization.

11. Assist other members of team with terminal cleanup of room in readiness for next patient.

Circulating Certified Surgical Technologist

The surgical technologist practitioner may be assigned other functions as permitted by the hospital and/or employer policy. The performance of these functions should be according to the experience and scope of educational preparation of the individual surgical technologist and applicable legal guidelines.

Duties

1 . Open the sterile field.

2. Has the knowledge and ability to communicate on all levels.

3. Able to check patient's chart, identify patient, bring patient to the assigned OR, ensuring confidence of patient.

4. Transfer patient to operating table.

5. Correctly position patient after securing the proper equipment.

6. Prep the patient prior to draping by surgical team.

7. Apply electrosurgical grounding pads, tourniquets, etc., before procedure begins.

8. Supply sterile field with anything necessary during procedure.

9. Keep accurate records throughout the procedure.

10. Take sponge, needle, and instrument count with scrub prior to operation and before incision is closed.

11. Make sure dressings are secure after surgery.

12. Help transport patient to recovery room.

13. Assist in cleaning of room in readiness for next patient.

14. Properly care for and handle specimens.

15. Assist anesthesia personnel.

First Assistant

As defined by the American College of Surgeons, the first assistant provides aid in exposure, hemostasis, and other technical functions that will help the surgeon carry out a safe operation with optimal results for the patient. This role will vary considerably with the surgical operation, specialty area, and type of facility.

The Association of Surgical Technologists. Inc., recognizes the first assistant and scrub technologist roles are differentiated by education. First assistants must be educated in the use of surgical instruments on tissues versus the handling of instruments.

CSTs with additional specialized education or training may function as first/surgical assistants to the surgeon at the operating table in those situations or facilities where more completely trained assistants are not available.

Practice privileges of those acting as first/surgical assistants should be based upon verified credentials reviewed and approved by the appropriate credentialing committee.

A Patient's Bill of Rights

The American Hospital Association presents a Patient's Bill of Rights with the expectation that observance of these rights will contribute to more effective patient care and greater satisfaction for the patient, his physician, and the hospital organization. Further, the Association presents these rights in the expectation that they will be supported by the hospital on behalf of its patients, as an integral part of the healing process. It is recognized that a personal relationship between the physician and the patient is essential for the provision of proper medical care. The traditional physician-patient relationship takes on a new dimension when care is rendered within an organizational structure. Legal precedent has established that the institution itself also has a responsibility to the patient. It is in recognition of these factors that these rights are affirmed.

1. The patient has the right to considerate and respectful care.

2. The patient has the right to obtain from his physician complete current information concerning his diagnosis, treatment, and prognosis in terms the patient can be reasonably expected to understand. When it is not medically advisable to give such information to the patient, the information should be made available to an appropriate person in his behalf. He has the right to know, by name, the physician responsible for coordinating his care.

3. The patient has the right to receive from his physician information necessary to give informed consent prior to the start of any procedure and/or treatment. Except in emergencies, such information for informed consent should include but not necessarily be limited to the specific procedure and/or treatment, the medically significant risks involved, and the probable duration of incapacitation. Where medically significant alternatives for care or treatment exist, or when the patient requests information concerning medical alternatives, the patient has the right to such information. The patient also has the right to know the name of the person responsible for the procedures and/or treatment.

4. The patient has the right to refuse treatment to the extent permitted by law and to be informed of the medical consequences of his action.

5. The patient has the right to every consideration of his privacy concerning his own medical care program. Case discussion, consultation, examination, and treatment are confidential and should be conducted discreetly. Those not directly involved in his care must have the permission of the patient to be present.

6. The patient has the right to expect that all communications and records pertaining to his care be treated as confidential.

7. The patient has the right to expect that within its capacity a hospital must make reasonable response to the request of a patient for services. The hospital must provide evaluation, service, and/or referral as Indicated by the urgency of the case. When medically permissible, a patient may be transferred to another facility only after he has received complete information and explanation concerning the needs for and alternatives to such a transfer. The institution to which the patient is to be transferred must first have accepted the patient for transfer.

8. The patient has the right to obtain information as to any relationship of his hospital to other health care and educational institutions insofar as his care is concerned. The patient has the right to obtain information as to the existence of any professional relationships among individuals, by name, who are treating him.

9. The patient has the right to be advised if the hospital proposes to engage in or perform human experimentation affecting his care or treatment. The patient has the right to refuse to participate in such research projects.

10. The patient has the right to expect reasonable continuity of care. He has the right to know in advance what appointment times and physicians are available and where. The patient has the right to expect that the hospital will provide a mechanism whereby he is informed by his physician or a delegate of the physician of the patient's continuing health care requirements following discharge.

11. The patient has the right to examine and receive an explanation of his bill regardless of source of payment.

12. The patient has the right to know what hospital rules and regulations apply to his conduct as a patient.

No catalog of rights can guarantee for the patient the kind of treatment he has a right to expect. A hospital has many functions to perform, including the prevention and treatment of disease, the education of both health professionals and patients, and the conduct of clinical research. All these activities must be conducted with an overriding concern for the patient, and, above all, the recognition of his dignity as a human being. Success in achieving this recognition assures success in the defense of the rights of the patient.*


Bibliography

AST resolutions, position statements, and publications. Littleton, CO, Association of Surgical Technologists, Inc.

AORN Standards and Recommended Practices for Perioperative Nursing. Denver, CO, Association of Operating Room Nurses, 1988.

The Essentials and Guidelines of an Accredited Educational Program for the Surgical Technologist. Chicago, IL, American Medical Association, 1978.

1989 AMH Accreditation Manualfor Hospitals. Chicago, Joint Commission on Accreditation of Healthcare Organizations, 1988.

US Dept of Health and Human Services: Condition of participation: Surgical services, section 482.51. Federal Register 1986; 51 (June 17):22048.

*Reprinted with permission of the American Hospital Association. 01975 by the American Hospital Association, 840 North Lake Shore Drive, Chicago, Illinois 60611.

During the 1970s the American Hospital Association's Board of Trustees had a Committee on Health Care for the Disadvantaged, which developed the Statement on a Patient's Bill of Rights. That document was approved by the AHA House of Delegates on February 6,1973, and has been published in various forms. This reprinting and reclassification conforms with the current classification system for AHA documents. The contents are unchanged.