What is the last thing you should do when preparing a surgical room?

Chapter 1. Infection Control

The operating room (OR) is a sterile, organized environment. As a health care provider, you may be required to enter the OR during a surgical procedure or to set up before a surgical procedure. It is important to understand how to enter an OR area and how the OR area functions to maintain an sterile environment.

Members of the surgical team work hard to coordinate their efforts to ensure the safety and care of their patients. The surgical team is in charge of the OR and makes decisions regarding patient care procedures. The OR environment has sterile and non-sterile areas, as well as sterile and non-sterile personnel. It is important to know who is sterile and who not, and which areas in the OR are sterile or non-sterile.

Sterile OR Personnel

Surgeon
Surgical assistant
Scrub nurse

Non-sterile OR Personnel

Anesthesiologist
Circulating nurse
Technologist, student, or observer

There are specific requirements for all health care professionals entering the OR to minimize the spread of microorganisms and maintain sterility of the OR environment. Prior to entering the OR, show your hospital-issued ID and inform the person in charge of the purpose of your visit. Refer to Checklist 10 for the specific steps to take before entering an OR.

Checklist 10: Entering the OR



1. Bring all required supplies to the OR. Sterilize or disinfect them as required.	This step prevents the need to unnecessarily leave the restricted area. Movement in the OR should be kept to a minimum to avoid contamination of sterile items or persons.
2. State the purpose of your visit to OR personnel and show your ID.	This step allows for clear communication with the health care team.
3. Artificial nails should not be worn, and nail polish should be fresh (not more than four days old) and not chipped.	Artificial nails, extenders, and chipped nail polish harbour more microorganisms than hands and can potentially contaminate the sterile area.
4. Remove all jewellery. Wedding bands may be permitted under agency policy.	Jewellery harbours additional microorganisms and must be removed prior to a surgical hand scrub.
5. Don surgical attire (top and bottom). Surgical attire must be worn only in the surgical area. Tuck top into pants.	Surgical attire must be worn only in the surgical area to avoid contamination outside the surgical area.
6. Cover shoes according to agency policy.	Shoe covers will protect work shoes from accidental blood or body fluid spills in the OR. Shoe covers must not be worn outside the OR area.
7. Perform a surgical hand scrub according to agency policy.	Surgical hand scrubs reduce the bacterial count on hands prior to applying sterile gloves. Hands are kept above waist at all times.
8. Prior to entering the restricted or semi-restricted area: Apply mask. Apply head covering to cover earrings, beard, and sideburns. Once in the OR, introduce yourself to the surgical staff and inquire about the sterile area and non-sterile areas.	Mask must cover nose, mouth, and chin for a proper seal. Mask should be changed if it becomes wet or soiled. A surgical mask or N95 mask may be required, depending on whether the patient is on additional precautions. Knowing what area is sterile/non-sterile will prevent accidental contamination of sterile fields and delays in surgery. Sterile persons/area The sterile field should be created as close as possible to the time of use. Covering sterile fields is not recommended. Sterile areas should be continuously kept in view. An unguarded sterile field is considered contaminated. Sterile persons should keep well within the sterile area. Sterile persons should pass each other back to back or front to front. A sterile person should face a sterile area to pass it and stay within the sterile field. Non-sterile person/area A non-sterile person should stay at least one foot away from the sterile field, and face the sterile field when passing it. A non-sterile person should not walk between two sterile fields or reach over the sterile field.
Data source: Kennedy, 2013; ORNAC, 2011; Perry et al., 2014; Rothrock, 2014

Why should the sterile field always be kept in sight by the scrub nurse or circulating nurse?
Name three health care providers who are considered sterile in the OR area.

What do I expect in the Operating Room?
The physical layout varies from one facility to the next, but once you arrive in the operating room you will notice that there is a lot of activity in the area. You will also notice that everyone is dressed in the same way. Do not be alarmed! When it is time for the surgery to begin you will be taken either by walking or by a stretcher to the operating room. You may notice bright lights instruments, equipment, and an environment that is so clean we call it “sterile.” You will notice the operating room team members putting masks on their faces, as they enter the operating room to help keep the room free of germs.

Will I remain on the stretcher for surgery?
No. The nurse will help you to move onto the operating table, which will feel hard and sometimes cool. Since the operating room table is narrow a safety strap will be placed across your lower abdomen, thighs or legs. Your arms will be placed and secured on padded arm boards to prevent them from falling off the table.

What questions will they ask me?
The same questions asked of you while you were prepared for your surgery will be asked once more for your safe care. These questions include such things as your name, whether you have any allergies, when you last had something to eat or drink, what type of procedure you are planning on having, and the name of your surgeon.

What will the anesthesiologist do?
A nurse anesthetist or the anesthesiologist will attach a blood pressure cuff, ECG leads (sticky pads with little “nubs” on the end that will be used to monitor your heart during surgery), and a pulse oximeter (a plastic clip attached to your fingertip and used to measure the amount of oxygen in your blood during surgery.) If you are receiving a general anesthetic, you may be given a mask and asked to breathe deeply. The nurse anesthetist or anesthesiologist may inject anesthetic into your I.V. to relax you and make you comfortable. Some patients report the medication burns slightly or feels “tight” at the site of the intravenous.

What is a time out?
A “Pause” or “Time Out” will take place just before starting your surgery/procedure by everyone in the room with you. This is a final proof that everyone agrees they have the correct patient, procedure, side, site, position and the presence of any implants or special equipment if needed.

How long will I be in surgery?
Your time in the operating room will depend on the type of surgery/procedure you are having. The whole team will be in the operating room to help your surgeon provide you with the best care and make sure you are safe and comfortable during your surgery/procedure.

Will my family receive updates while I am in the Operating Room?
While you are in surgery your family may receive updates on the length or progress of your surgery. Once your surgery is complete the surgeon will speak to your family. The anesthesia provider will see that you awaken safely and take you to the Post Anesthesia Care Unit.

When you are in the operating room, your surgical team will use the Time-Out checklist to share important information about you and your upcoming surgery. During this time, the team will be very quiet and attentive to make sure that everything is correct.

To improve communication during your surgery, all the members of your surgical team will introduce themselves to each other by name and role.

Your surgeon, anesthesiologist, and nurse will review your surgical consent together one final time to make sure that everything is correct.

During Time-Out, each member of your surgical team will review with the others his or her respective plan for your procedure. For example, the surgeon will review the surgical plan with the nurse, and make sure all is ready, including any devices or implants, or special considerations.

The nursing team will review the nursing plan—double-checking the planned procedure and needed instruments, equipment, implants, and anything special you might need during your surgery.

Also during this time, the anesthesiologist will review the anesthesia plan to make sure everything is ready for you, and ensure that special equipment is available, if needed.

In many cases, antibiotics are given before surgery to reduce the chance of infection. If it has been determined that antibiotics are needed in your case, the team will confirm that the drugs have been given prior to starting surgery.