OPERATING ROOM NOTES

PREPARED BY: DIANNE BERNADETTE AQUINO RN

OPERATING ROOM
An operating room (OR), also called surgery center, is the unit of a hospital where surgical
procedures are performed.
Purpose
An operating room may be designed and equipped to provide care to patients with a range of
conditions, or it may be designed and equipped to provide specialized care to patients with
specific conditions.
Description
OR environment
Operating rooms are sterile environments. All personnel wear protective clothing called scrubs,
as well as shoe covers, masks, caps, eye shields, and other coverings to prevent the spread of
germs. The operating room is brightly lit and the temperature is very cool; operating rooms are
air-conditioned to help prevent infection.
2 AREAS IN THE OPERATING ROOM
STERILE AREA
A sterile field is an area created by placing sterile surgical drapes around the patient's surgical
site and on the stand that will hold sterile instruments and other items needed during surgery.
NON STEARILE AREA
Non-sterile members are allowed to move only in the non-sterile zone and handle equipment
which is not considered sterile.
STERILE OR PERSONNEL
Surgeon
Surgical assistant
Scrub nurse
NON-STERILE OR PERSONNEL
Anesthesiologist
Circulating nurse
Technologist, student, or observer

ASEPTIC TECHNIQUE
Process of removing as many microorganisms as possible from the hands and forearms by
mechanical washing and chemical antisepsis before participating in a surgical procedure.
Performed prior to donning sterile gloves or sterile gowns and gloves for surgical or other
invasive procedures.
Principles of Aseptic Technique in Operating Room
 All materials that enter the sterile field must be sterile.
 If a sterile item comes in contact with an unsterile item, it is contaminated.
 Contaminated items are removed immediately from the sterile field. If the unsterile item
is small (e.g., unopened suture), once it is removed, the area is marked off (i.e., covered
with a sterile drape). If the entire field is contaminated, it should be set up again with all
new materials.
 The surgical team working in the operative field must wear sterile gowns and gloves.
Once dressed for procedure, they must recognize that the only parts of the gown
considered sterile are the front from chest to table level and sleeves to 2 inches above
elbow.
 A wide margin of safety must be maintained between sterile and unsterile fields.
 Tables are considered sterile only at tabletop level. Items extending beneath this level
are considered contaminated.
  The edges of a sterile package are considered contaminated once the package has been
opened. If a sterile package (e.g., package of sutures) is placed on the sterile field, that
entire package remains sterile even when opened.
 Microorganisms travel on airborne particles and will enter the sterile field with excessive
air movements and currents.
 Microorganisms travel by capillary action through moist fabrics, resulting in
contamination.
 Microorganisms harbor on the patient’s and team members’ hair, skin, and respiratory
tracts and must be confined by appropriate attire.
ROLE OF CIRCULATING NURSE
Responsible for managing the nursing care of the patient within the OR and coordinating the
needs of the surgical team with other care provider necessary for completion of surgery
Observes the surgery and surgical team from broad perspective and assists the team to create
and maintain a safe and comfortable environment for the patient
Asses the patient’s condition before, during and after the operation to ensure an optimal
outcome for the patient
Must be able to anticipate the scrub nurse’s needs and be able to open sterile packs, operate
machinery and keep accurate records
DUTIES OF A STUDENT CIRCULATING NURSE
 Assists doctors/staff/students in tying their gowns
 Helps the staff in cleaning the OR after every procedure
 Make sure theater is clean
 Assist with counts and records
 Replenishes and records sponge/ sutures
 Helps remove and dispose of drapes
 Helps the staff to prepare the patient for the recovery room
 Ensures that the theater is ready for the next case
 Fill up the surgical safety checklist and recites infront of the whole OR team
ROLE OF SCRUB NURSE
Works directly with surgeon within the sterile field, passing instruments, sponges and other
items needed during the procedure
Members of the surgical team who prepares and preserves a sterile field in which the
operation can take place
Responsible for the sponge counts, the blades and needles and instruments check throughout
the operation
Has a job requiring anticipation, quick reaction and conscientious observation as well as
knowledge of anatomy and of operative procedures

DUTIES OF A STUDENT SCRUB NURSE

 Prepares the instruments and equipment needed in the operation
 Uses sterile technique for scrubbing, gowning and gloving
 Receives sterile equipment via circulating nurse using sterile technique
 Performs initial sponges, instruments and needle count, checks with circulating nurse
 Assemble the drapes according to use. Start with towel, towel clips, draw sheet and then
lap sheet. Then, assist in draping the patient aseptically according to routine procedure
 Place blade on the knife handle using needle holder
 Prepares sutures and needles according to use
 Maintain sterility throughout the procedure
 Passes the 1st knife for the skin to the surgeon with blade facing downward
 Hand the retractor to the assistant surgeon
 Watch out for hand signals to ask for instruments and keep instrument as clean as
possible by wiping instrument
 Remove excess instrument from the sterile field
 count of sponges and instruments with circulating nurse
 Clears away instrument and equipment
What is a Surgical Drape?

Surgical drapes are used in the course of surgical procedure to prevent contact with
unprepared surfaces and limit the chance of transmission of pathogens to both patients and
staff. Surgical drapes can be reusable or disposable, and made of cloth or paper. The purpose
of draping the surgical patient is to isolate the surgical site from the different areas of the
patient’s body and non-sterile areas of the operating room table.

4 SURGICAL TOWELS
1 DRAW SHEET
1 LAP SHEET
BASIC INSTRUMENTS INSIDE THE OR
SCISSORS
MAYO STRAIGHT- SUTURE SCISSOR
METZENBAUM SCISSORS- FINE DISSECTING AND CUTTING
-FOR SOFT TISSUES
KELLY- CURVE
STRAIGHT
ALLIS FORCEP
HEMOSTAT OR MOSQUITO
THUMB FORCEP
TISSUE FORCEP
DEBAKEY FORCEP
BLADE HOLDER
NEEDLE HOLDER
 REGION 1 MEDICAL CENTER
SURGICAL SAFETY CHECKLIST

SIGN IN
(BEFORE INDUCTION OD ANESTHESIA)

GOOD _______ OR TEAM,

OUR PATIENT IS MS._______________ AGE: __________

FROM: _______________

WHO WILL UNDERGO_______________

WITH CONSENT SIGNED AND SECURED

PULSE OXIMETER ON PATIENT AND FUNCTIONING WITH INITIAL VS AS FOLLOWS

BP: _______ PR: _______ RR: ________ 02 SAT: ______

WITH NO KNOW ALLERGIES.
DR.______________ IS THERE DIFFICULT AIRWAY OR ASPIRATION RISK?
DR._______________IS THERE RISK OF MORE THAN 500ML BLOOD LOSS?
I AM _________________ STUDENT NURSE FROM URDANETA CITY UNIVERSITY NOW SIGNING IN.

TIME OUT
(BEFORE SKIN INCISION)
TO ALL OPERATING ROOM TEAM PLS INTRODUCE YOURSEL AND YOUR ROLE.
AGAIN THIS IS PATIENT ______________ WHO WILL UNDERGO __________
Dr._________________ WHAT ARE THE CRITICAL OR UNEXPECTED STEPS? OPERATIVE DURATION? ANTICIPATED
BLOOD LOSS?

DR._________________ARE THERE ANY PATIENT SPECIFIC CONCERNS?

MAAM/SIR.______________ HAS STERELITY BEEN CONFIRMED?

ANTIBIOTICS ______________ GIVEN @____________AM/PM

SIGN OUT
(BEFORE THE PATIENT LEAVES THE OR)
THIS IS _________________ (PROCEDURE DONE)

INSTRUMENT,SPONGES AND NEEDLE COUNTED CORRECTLY

SPECIMEN _________ SECURED ON THE SPECIMEN BOTTLE AND LABELED CORRECTLY.

MAM_____________(STAFF) IS THERE ANY EQUIPMENT TO BE ADDRESSED?

DR._______________( SURGEON/ANESTH) WHAT ARE THE KEY CONCERN AND MANAGEMENT OF THE PATIENT?

THANK YOU……