The operating room is an area where high-risk surgeries are performed. It is imperative that a sterile environment is maintained to prevent risk of infections. It is important for anyone who works in the OR to understand the sterile and non-sterile environment and how to navigate between these areas so as not to cause a break in aseptic practice. Each organization will have their own practices and policies guiding the functioning of the OR. Users of this manual are thus advised to refer to their individual organizational policies.
Procedure
| Nursing Actions | Rationale | |
| 1 | Disinfect the entire operating room with disinfectant wipes as followed in the hospital policy. This used to be called carbolization of the OR. | Reduces risk of infection |
| 2 | Collect the needed equipment to set up your OR. Most of the equipment are the same but equipment in the room may vary according to the type of surgery conducted. The common equipment includes electrosurgical equipment such as cautery, suction machine, IV pumps and poles, rapid infusers, monitors for hemodynamic monitoring, sponge counters, Mayo stand for the surgical instruments, back table, patient warmer and fluid warmer. | Ensures a systematic and organized manner of doing procedures saves time and reduces traffic in and out of the room during surgery. |
| 3 | Ensure that all equipment is arranged in the order of use and that all equipment are in working condition. | Save time and increases efficiency |
| 4 | Drape the OR table with sterile impervious drapes | Ensures an aseptic environment. |
| 5 | Collect all the procedure packs with surgical instruments required for the surgery being conducted. | Saves time and increases efficiency. |
| 6 | Arrange the surgical instruments and sterile supplies in an organized manner on the Mayo table and the back table. | |
| 7 | Count the instruments and perform a soft count of supplies and enter the count in the log. | Counts are very important to ensure that all supplies are accounted for at the termination of surgery, (refer to information given at the end of procedure on counts). |
| 8 | Receive patient. | |
| 9 | Ensure that a time out has been conducted, and the site was marked | Time out is usually conducted by the patient and surgeon together before anesthesia and site marked and approved by both parties using a skin marking pen. Involvement of the patient and surgeon together prevents risk of errors. |
| 10 | Prepare surgical site as per hospital policy for surgery. Use clippers for hair removal if hospital policy permits. If using alcohol agents to disinfect skin, wait for the disinfectant to dry. | |
| 11 | Drape patient with sterile drapes. | Ensures continuity of sterile environment. |
| 12 | Ensure that all staff who enter the OR are capped and gowned as per regulations. | |
| 13 | Ensure that the sterile personnel (surgeon, scrub nurse and scrub technician) are scrubbing in as required by hospital policy and is wearing sterile gowns. | |
| 14 | Ensure that traffic is controlled and limited to sterile areas and only regulated personnel enter these areas. | |
| 15 | Introduce yourself to the surgical team and ensure a smooth conduct of procedure. |
REFERENCES
- Annamma Jacob, Rekha, Jhadav Sonali Tarachand: Clinical Nursing Procedures: The Art of Nursing Practice, 5th Edition, March 2023, Jaypee Publishers, ISBN-13: 978-9356961845 ISBN-10: 9356961840
- Omayalachi CON, Manual of Nursing Procedures and Practice, Vol 1, 3 Edition 2023, Published by Wolters Kluwer’s, ISBN: 978-9393553294
- Sandra Nettina, Lippincott Manual of Nursing Practice, 11th Edition, January 2019, Published by Wolters Kluwers, ISBN-13:978-9388313285
- Adrianne Dill Linton, Medical-Surgical Nursing, 8th Edition, 2023, Elsevier Publications, ISBN: 978-0323826716
- Donna Ignatavicius, Medical-Surgical Nursing: Concepts for Clinical Judgment and Collaborative Care, 11th Edition ,2024, Elsevier Publications, ISBN: 978-0323878265
- Lewis’s Medical-Surgical Nursing, 12th Edition,2024, Elsevier Publications, ISBN: 978-0323789615
- AACN Essentials of Critical Care Nursing, 5th Ed. Sarah. Delgado, 2023, Published by American Association of Critical-Care Nurses ISBN: 978-1264269884
- Ernstmeyer K, Christman E, editors. Nursing Fundamentals [Internet]. 2nd edition. Eau Claire (WI): Chippewa Valley Technical College; 2024. PART IV, NURSING PROCESS. Available from: https://www.ncbi.nlm.nih.gov/books/NBK610818/
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