This document outlines the principles, design, organization, and responsibilities within an operating room (OR) setting, highlighting the significance of maintaining aseptic techniques and efficient layout to ensure patient safety. It defines different areas of the OR, such as unrestricted, semi-restricted, and restricted zones, and describes the roles of both sterile and unsterile teams in surgical procedures. Key considerations for effective OR management include communication among team members, economical use of resources, and qualities necessary for OR personnel.

1. Operating Room/Theater Technique
(ORT)
By. Mr Gedion Zerihun
(BSc, MSc in Adult health nursing)
For BSc Comprehensive Nursing students
September,2023
Mizan-Aman,Eethiopia
10/5/2023 1

2. Learning objectives
At the end of the course, the trainees will be able to:-
Describe the three areas of the operation department
and the proper attire for each area
Describe the physical environment of the operating
room and the holding area
Describe the functions/responsibility/of the members of the operation team
2
10/5/2023

3. Introduction
3
10/5/2023

4. Definition of operating room
An operating room is a particular room where the surgery and the
surgical procedures are conducted
Is place/department/& its physical environment where surgical
interventions takes place
Is place where invasive procedures are conducted in collaborated &
integrated manner with multidisciplinary health teams
4
10/5/2023

5. Introduction
Operating room or the theater block is one of the important
special departments of a hospital
This is where we have to practice a high standard of aseptic
techniques and sterilization of supplies in order to reduce
the events of infection
This unit is designed as ‘’self contained block‘’ with a series
of rooms leading of a corridor with close doors that separates
it from the general wards
5
10/5/2023

6. Cont’d
The efficiency of the operating room depends much up on its physical
organization and the organization of its personnel
An intelligent design in the lay out of the operating room facilitates the
efficient movement of patients and staff and the economical use of space
Corridors of the operation theater should never be open because there is a
high traffic and bacterial contamination of the air
10/5/2023 6

7. Design of the operating room
Architects follow two principles in planning the physical layout of the
OR suite:-
Exclusion of contamination from outside the suite with sensible traffic
patterns within the suite
Separation of clean areas from contaminated areas within the suite
10/5/2023 7

8. Principles of operation room design
The basic design principles which are common to all operating rooms
must fulfill the following criteria :-
 The design must always be simple and easy to keep it clean
 The wall and floor surfaces should be smooth and made of nonporous
(washable) materials
 All electrical socket and conducts must be earthed
8
10/5/2023

9. Design…
Operation room are usually bright and faced north or south so that they
are not exposed to the sun for a long period of time in order to prevent
cross-contamination (the transfer disease causing microorganisms from
one source to another),
There should be separate rooms for clean or sterile instruments and soiled
ones
There should be sufficient space to ensure the safe transportation of
patient and staff
9
10/5/2023

10. Design…
Any cross traffics for people other than the workers of the unit are strictly
avoided
Special laundry facilities should be provided in the operating unit
The recovery room should be near the operating room, so that patients
can be transported safely and quickly following surgery
10
10/5/2023

11. Ventilation in theatre
Supply heated or cooled ,humidified, contamination free air to room.
Introduce air in to theatre & to remove contaminants liberated there.
Prevent entry of air from adjacent contaminated area.
There should be 25 times air exchange/hr.
11

12. Humidity:-
To prevent ventilating air not to be dry
The humidity must be b/n 50-60%
Controlled by an instrument called Hygrometer to measure the level
Heating:-
 The room temperature of operating room must be between 8.5oC and
22oC may exceed to 24oC
12

13. Space allocation in OR
The OR suite is divided into three areas that are designated by the physical
activities performed in each area.
A. Unrestricted Area
 Street cloths are permitted
 A corridor on the periphery accommodates traffic from out side,
including patients
 This area isolated by doors from the main corridor and from other
areas of OR suite
 It serves as an out side–to-inside access area
 Traffic, although not limited, is monitored at a central location
10/5/2023 13

14. Unrestricted zone includes:-
unrestricted zone: area in the operating room that interfaces with
other departments;
 Includes patient reception area and Holding area
Recovery room.
Plaster room
Change room for staff & other personnel
Various offices are located here (reception offices)
Seminar and teaching facilities.
10/5/2023 14

15. Cont’d…
B. Semi restricted area
Traffic is limited to properly attired (dressed) personnel
Body and head covering are required this area includes peripheral support
areas and access corridors to the operating rooms
The patient may be transferred to a clean inside stretcher on entry to this
area
The patient‘s hair must be covered
semi restricted zone: area in the operating room where scrub attire is
required; may include areas where surgical instruments are processed
10/5/2023 15

16. Cont’d
C. Restricted Area
Masks are required to supplement surgical attire
Sterile procedures are carried out in this area
The area includes the operation rooms, scrub sink areas and sub sterile
rooms or clean core areas where unwrapped supplies are sterilized
restricted zone: area in the operating room where scrub attire and surgical
masks are required; includes operating room and sterile core areas
16
10/5/2023

17. The operating room areas
A. The Supervisor’s office: has direct access to the out side of the
operating room.
 The supervisor may need to receive visitors and significant others who are not
dressed in scrub attire
B. Dressing room:- for operating room personnel have a door to the out
side corridors so that personnel may enter there, change into scrub attire
and go directly into the operating room.
C. The Holding Area :-this is the area where the health care givers
properly identify the patient and make sure that all preoperative cares are
carried out and other important data are in the patient’s chart
10/5/2023 17

18. Cont’d
D. Scrub areas:-are located in several places close the operating suites. Hot
and cold water pipe line supplies, Scrub brushes, caps, soaps, masks are
located at each scrub station
E. Sterilization Room :-it is adjacent to the operating room
The room is usually equipped with boilers (autoclaves ) for providing
sterile water for solutions and also water for the surgeon ‘s hand and to
clean instrument during surgery .
The room should be wide enough for lying trolleys comfortable, to
reduce humidity, heat and risk of infection and it must be well
ventilated.
10/5/2023 18

19. Cont’d
F. Utility room :-is a room where equipment to be cleaned and stored. Here
a packing room is attached with it and if not available the utility room
must be wide enough for dual purpose that is to prevent contamination
and humidity.
G. The sterile supply room:-serves as a supply depot for wrapped sterile
articles. This area should be dusted frequently with a damp cloth and
have storage cabinets with doors to minimize exposure of the supplies to
room air and dust .
.
10/5/2023 19

20. Cont’d
H. Supply And Storage Areas :-is a room where sterile equipment is
stored and supplied, here unsterile equipment must not be mixed and
stored .
 For extra equipment and supplies are used to store, these extra instruments and
supplies are used to stores these extra instruments and supplies for each unit.
I. The recovery room :-it is an intensively monitored setting that allows
observation, therapeutic intervention and observation of the patients as
they more fully recover form the effect of the surgical procedure and
anesthetics
 It has an access to the out side of the operating room for transporting patients back
to their rooms
10/5/2023 20

21. Cont’d
J. The operating suites ;are rooms where surgery is performed.
These rooms are wide enough to allow scrub personnel to move around
non sterile equipment with out their contamination.
Green line:- this line is a line where you can not pass before changing the
OR clothes
10/5/2023 21

22. Bird’s eye view of OR areas/room/
22
10/5/2023

23. OR team members
23
10/5/2023

24. Division of duties among the operating room staff
AS the physical design, there is a logical division of duties among the
operating room staff:-
The sterile team
The unsterile team
The sterile team consists of :
Surgeon
Assistant Surgeon
Scrub nurse
10/5/2023 24

25. Cont’d
 The unsterile team includes :
 Anesthesia provider (anesthetist) and its assistant
 Circulatory/runner nurse
 Others, such as students, cleaners and those who may be needed to
set up and operate specialized equipment or monitoring devices
10/5/2023 25

26. Responsibility of each member
Sterile team members :
 Wash (scrub) their hands and arms, put on a sterile gown and gloves
 The sterile field is the area of the operating room that immediately surrounds and
is specially prepared for the patient.
To establish a sterile field, all items needed for the surgical procedure are
sterilized.
After this process, the scrubbed and sterile team members function within
this limited area and handle only sterile items.
10/5/2023 26

27. Cont’d
Un sterile team members; on the other hand, don’ t enter the sterile field;
They function outside and around it.
They assume responsibility for maintaining sterile technique during the
surgical procedure, but they handle supplies and equipment that are not
considered sterile.
Following the principles of aseptic technique, they keep the sterile team
supplied, provide direct patient care, and handle other requirements that
may arise during patient care, and handle other requirements that may
arise during the surgical procedure.
10/5/2023 27

28. Cont’d
Responsibilities of the surgeon
 The surgeon must have the knowledge, skill, and judgment required
to successfully perform the intended surgical procedure.
 The surgeon‘s responsibilities include, but are not limited to, the
following
 Preoperative diagnosis and care
 Selection and performance of the surgical procedure
 Post operative management of care
10/5/2023 28

29. Cont’d
Responsibilities of the assistant Surgeons
under the direction of the operating surgeon, one or two assistants help
to :
Maintain visibility of the surgical site
Control bleeding
Close wounds and apply dressings
10/5/2023 29

30. Responsibilities of the scrub nurse
The ‘’scrubbed ‘’nurses learn how best to work with each surgeon and
other team members as a smooth working team.
He/she is guided and directed constantly by what the surgeon is doing
This means that the scrubbed nurse must have a constant attention to the
operation field
Before the operation
 Enquire from surgeon about type of incision and instruments required
Check the cleanliness of the OR
Prepare and check material for operations
10/5/2023 30

31. Responsibilities of the scrub nurse cont’d
Before the operation
Scrub, gown, and glove prior to surgeon
Prepare tables with adequate instruments
Help surgeon to drape patient
Check electrical apparatus and equipment
Count swabs, needles, together with circulating nurse before operating
begins
Respect aseptic roles all times
10/5/2023 31

32. Responsibilities of the scrub nurse cont’d
During operation
 Anticipate requests from surgeon
Handle instruments in correct way
Maintain order around surgical field and instruments table
Keep track and count of swabs together with circulating nurse
Perform final swab check
Apply dressing
10/5/2023 32

33. Responsibilities of the scrub nurse cont’d
After operation
 Participate in the safe transfer of patient to trolley
 Collect instruments for decontamination
 Place needles and blades in the safety box
 Clean instruments table
 Participate in cleaning and rearrangement of the operating room
10/5/2023 33

34. Responsibilities of the scrub nurse cont’d
Between operations :
Decontaminate, clean and dry soiled material
Reset and repack clean equipment
Prepare drapes and towels for sterilization
Check cleanliness and order of the operating room between operations
Other tasks
Order, check and restock the material
Check that material is in sufficient quantities and is functional
Ensure full cleaning of OR at least on monthly bases
10/5/2023 34

35. The circulatory nurse duties
Before operation
 Receive patient on arrival to OR
 Check patient’s card, name, consent, type and side of operation
 Enquire from surgeon about any special preparation
 Check and remove jewels
 Check patient’s clothes
 Take patient to operating room and place him or her on table
10/5/2023 35

36. The circulatory nurse duties cont’d
Before operation ….
Check electrical apparatus and equipment
Open packs and sets
Help scrub team to gown and glove
Perform first count swabs, needles together with scrub nurse
Respect asepsis rules at all times
Assist anesthetist if necessary
10/5/2023 36

37. The circulatory nurse duties cont’d
During operation
Anticipate requests from surgeon
Insert urinary catheters if necessary (with assistant
Keep track and count of swabs together with scrub nurse
Adjust light, diathermy apparatus, suction machine
Promptly address requests from the scrub team
Perform final swab check
Detect and report aseptic mistakes
Help applying dressing
10/5/2023 37

38. The circulatory nurse duties cont’d
After operation
Participate in the safe transfer of patient onto stretcher
Collect instruments for decontamination, place needles and blades in
the safety box
Clean instruments table
Participate in cleaning and rearrangement of the operating room
Be present from beginning until end of operation
38

39. The circulatory nurse duties cont’d
Between operations
 Decontaminate ,clean and dry soiled material
 Reset and repack clean equipment?
 Prepare drapes and towels for sterilization
 Sterilize sets and packs
 Check cleanliness and order of the operating room
Other tasks
 Order, check and restock the material
 Check that material is it quantities and is functional
 Ensure full cleaning of OR at least on monthly bases
39

40. Co-operation and economical use of hospital supplies, equipment
and time
The team approach to care should be a coordinated effort that is
performed with the cooperation of all care givers
Team member should communicate and should have a shared division of
duties to perform specified tasks as a united body
The failure of any one member to perform his or her role can seriously
impact the success of the entire team
Performing as a team requires that each member exert an effort to attain
the common goals in a competent and safe manner.
40

41. cont’d
A. Economical use of supplies and hospital equipment
 Most of the hospital equipment is being imported from abroad and it is
costly and, therefore economical and proper usage of it is mandatory
 As the cost of supplies and equipment increases ,the OR team
members should be conscious of ways to eliminate wasteful practices
 For example, through away disposable items only avoid throwing
away reusable items.
 The operation room is one of the most expensive departments of
hospital
41

42. Cont’d
The following procedures should be observed
Pour just enough antiseptic solution
Follow the procedures for draping
Do not open another packet of sutures for the last stitch unless
absolutely necessary
 Supplies should be opened only as needed ,not routinely ‘’just in case ‘’
they may be needed
Turn off lights when they are not needed
42

43. Cont’d
B. Time Economy
 Time is money; do not waste it. Know the policies and procedures,
and follow them efficiently
 Time is an important element in the OR. If time is wasted between
surgical procedures, the day ‘s schedule is slowed down and later
procedures are delayed, the patient and families become anxious
during these delays
43

44. Qualities of the Operating Room team
Pre requisites to join operation team
A. Stamina
B. Emotional stability
C. Respect
D. Stable health
E. Good Humor
F. Team spirit
44

45. A. Stamina
Since the job requires long hours of standing,
Lifting heavy instrument trays,
Positioning patients, and
Many other physical tasks,
The OR nurse should be in good physical condition and have the energy to
complete her/his daily work in a safe and efficient manner.
10/5/2023 45

46. B. Emotional stability
The operating room work is stressful.
The nature of the work can cause team members to be tense or to display aggressive
behavior while working.
The operating room nurse must be able to cope with her/his own tension and with that
of her/his teammates.
Occasionally, the surgeon may express feelings of stress by being verbally abrupt or
harsh.
While extremely inappropriate behavior should not be tolerated by the operating room
supervisor,
All team members must appreciate the responsibility that rests on the surgeon and not
become personally offended by occasional outbursts.
10/5/2023 46

47. C. Respect
Respect for the patient’s rights for privacy, for other team members,
and for her/himself is an important quality of the operating room nurse.
The operating room relies on chain of command for efficient and safe
patient care.
Those who experience problems in responding to authority should not
work.
10/5/2023 47

48. D. Stable health
The surgery department relies upon the daily presence of enough
employees.
If one person is ill, the workload of other team members is increased
because they must perform the work of the absentee.
Cases are generally not cancelled because of absenteeism.
Since the operating room is a stressful situation and because stress can
contribute to ill health, the nurse must be careful to guard against
illness and injury.
Particular importance are prevention of injury to the back and
maintenance of healthy skin and respiratory tract.
10/5/2023 48

49. E. Good Humor
In a difficult and demanding environment such as the operating
room, it is important to have a proper perspective on the day’s events and
to share in good spirit.
It is senseless waste of energy for a team member to allow one distressing
episode to influence an entire day’s work.
Team members who are consistently sullen can lower the morale of the
whole department, while those who are cheerful can raise everyone’s
spirit.
10/5/2023 49

50. F. Team spirit
The ability to work with team members toward a common goal is
very important in surgery.
The patient expects and should receive the undivided attention of all who
care for him/her.
To accomplish this, the nurse should recognize the importance of not
only of her/his own job, but also of those of the other team members.
She or he should either put personnel problems aside or bring them to the
attention of the supervisor, who might able to resolve them.
10/5/2023 50

51. Summary
? Describe the three areas of the operation department and the proper attire
for each area
? Describe the physical environment of the operating room and the holding
area
? Describe the functions/responsibility/of the members of the operation
team
? ortNew doc ORTOperating Room Design and Layout.mp4
10/5/2023 51

52. Surgical Conscience
10/5/2023 52

53. Learning Objectives
After completing this chapter, you will be able to:
 Discuss surgical Conscience.
 State situations that can undermine surgical conscience.
 Describe the role of law in relation to surgical interventions.
 Mention some of the areas of criminal responsibilities.
 List areas of negligence in the healthcare facilities.
10/5/2023 53

54. Surgical Conscience
A surgical conscience may simply be stated as a surgical Golden Rule:
Do unto the patient as you would have others do unto you.
In short, a surgical conscience is the inner voice for conscientious practice of asepsis
and sterile technique at all times.
Respect for the patient's religious beliefs must be observed
Respect the patient as an individual
10/5/2023 54

55. Surgical Conscience cont’
Fears and pain should be treated strongly
Patient needs care and attention
Respect for the patient's right to privacy
The patient must not be discussed outside the surgical department
Reporting of an incident is a major ethical responsibility in the operating room
E.g. medication error
Honesty is a major ethical standard
10/5/2023 55

56. Areas affected by surgical conscience
1. Patient protection
2. Aseptic Technique
Patient protection is an area of surgery that is strongly affected by surgical
conscience.
The operating room team must be aware of the dangers that exist for the patient.
10/5/2023 56

57. Patient protection includes;
Electrical hazards:
 Are a major risk in the operating room.
 Whenever the electrocautery is used, the patient must be grounded in order to
prevent shock or burns.
Moving and positioning:
The patient must be carried out with constant attention to:
 Proper padding and protection of bony surfaces,
 Prominent nerves, and Blood vessels.
10/5/2023 57

58. Patient protection includes; cont’
Environmental protection:
Unnecessary exposure of the patient’s body should not be allowed.
Protection from psychological insult:
The patient must not be allowed to overhear or misinterpret matters
discussed that are intended to be confidential.
10/5/2023 58

59. Patient protection includes; cont’
Anxiety and fear:
 Warm touch or understanding voice of a staff member is very
important.
Unnecessary time spent:
 Unnecessary time spent under anaesthesia because of poor planning
show poor surgical conscience.
10/5/2023 59

60. 2. Aseptic Technique
Whenever a break in the technique occurs, the patient is in danger of infection.
The practice of aseptic technique is the individual responsibility of each team
member.
Breaks in technique must be reported immediately
10/5/2023 60

61. Situations that undermine surgical conscience includes:
 Peer apathy (absence of feeling or emotion)
 Stress, fatigue, poor Health
 Personal problems
 Staff relations
10/5/2023 61

62. Situations that undermine surgical conscience includes:
Peer Apathy:
 When many of those of the operating staff become less attentive to the detail, other
staff members may feel, “No one else cares, so why should I?
Stress, fatigue, poor Health
 These factors can certainly affect a person’s awareness of his/her responsibilities to
the patient.
10/5/2023 62

63. Situations that undermine surgical conscience includes:
Personal problems:
Any team member who has personal problems is to be preoccupied
with it and consequently neglect the patient’s safety to some degree.
Staff relations:
It is common for surgery personnel to work better with some surgeons
than with others.
10/5/2023 63

64. The Legal Aspects of surgery
 Medical practice acts & nursing practice acts, usually define the practice of
medicine and nursing as diagnosing and treating disease.
 Practicing medicine and other health and health related professions without a
license is a crime.
10/5/2023 64

65. Criminal Responsibilities
 Criminal Responsibilities includes:
 Exceeding the scope of practice
 Patient property
 Hospital property
 Negligence
10/5/2023 65

66. Criminal Responsibilities
 Exceeding the Scope of Practice:
 The medical and nurse practice acts are generally part of the written documents of
the country’s criminal statutes.
 The acts make it a crime for unlicensed person to practice medicine or nursing.
 Patient Property:
 Patients occasionally arrive in the operating room with valuables, most commonly
wedding rings, bracelets, ear rings, and necklaces.
 Care should be taken to protect these items from loss or theft.
 This can prevent both loss and charges of theft.
10/5/2023 66

67. Criminal Responsibilities….
 Hospital Property:
 The taking of property that is not one’s own is considered theft.
 It cannot be assumed that these items may be taken without permission.
 Negligence:
 It is acts of carelessness.
 It is the failure to exercise the care that a reasonably prudent person would exercise
under similar circumstances.
 The operating team members must be aware of situations in which carelessness
could endanger the patient.
10/5/2023 67

68. Common Areas of Negligence
 Side rails and supports
 Burns
 Patient identification
 Loss of items within the patient
 Medications and solutions
 Explosion
 Abandonment of the patient
 Specimen
 Surgical consent
10/5/2023 68

69. Common Areas of Negligence…..
 Side Rails and Supports
All operating room personnel must ensure that:
 Unconscious or sedated patients are protected from falling out of stretchers, tables,
or beds.
 Burns:
 Avoid faulty grounding of electrocautory equipment.
 Double check patient grounding before starting any surgical case.
 Adjust the temperature of the solution for skin scrub preparation.
10/5/2023 69

70. Common Areas of Negligence…..
Patient Identification
 All patients must be correctly identified at least twice before surgery commences.
 The patient’s chart, I.D. bracelet, and I.D card should all agree.
 Loss of Items within the patient:
 The nurses with the team are responsible for a correct sponge, needle, and
instrument count.
Medications and solutions
 Wrong drug or solution is not administered to the patient inadvertently.
 Avoid any possibility of error.
10/5/2023 70

71. Common Areas of Negligence…..
 Explosion
 The danger of explosion from in-line oxygen or oxygen stored in tanks exists.
 Report it to the operating room supervisor immediately if there is doubt.
 Abandonment of the patient
 Patients, regardless of their level of sedation, should never be left unattended.
 Paediatric patients & Unconscious patients are in danger of cardiac or
respiratory arrest and must beclosely watched.
10/5/2023 71

72. Common Areas of Negligence…..
 Specimen
 The nurse should be sure that each specimen is properly identified, preserved, and
labeled.
 Surgical consent
 Make sure that the patient consents to the surgery or that the surgery did not go
beyond the scope of the written or verbal consent.
 This is done by making sure that the chart includes the written authorization for the
surgery signed by the patient or the patient’s guardian.
10/5/2023 72

73. Defamation
 Derogatory/disrespecting statements made about one person to another is
defamation.
 Defamation may not be considered as negligence, but it is still a concern
of all medical personnel.
10/5/2023 73

74. Hazards in the Operating Room
 Environmental Hazards
 The perioperative environment poses many hazards for both patients and
personnel.
 The potential for physical injury from electric shock, burns, fire, explosion,
exposure to blood borne pathogens, and inhalation of toxic substances is ever
present.
10/5/2023 74

75. Hazards in the Operating Room….
 Injuries can be caused by:
Using faulty equipment
Using equipment improperly
Exposing oneself or others to toxic or irritating agents, or
Coming into contact with harmful agents
10/5/2023 75

76. Hazards in the OR environment can be classified as
follows:
Physical: including back injury, fall, noise pollution, irradiation,
electricity and fire
Chemical: including anesthetic gases, toxic fumes from gases and
liquids, cytotoxic drugs and cleaning agents
Biologic: infection due to exposure to blood, body fluids and latex
sensitivity.
 Risk of contracting a nosocomial disease
10/5/2023 76

77. Catastrophic Events in the operating Room
Unanticipated intraoperative events occasionally occur.
 e.g., cardiac arrest in an unstable patient, massive blood loss during trauma
surgery, anaphylactic reactions )
 Immediate intervention is required by all members of the OR team.
Anaphylactic Reactions –is the whole body allergic reaction to the
allergens
Anesthetics, antibiotics, blood products and plasma expanders.
An anaphylactic reaction causes hypotension, tachycardia,
bronchospasmand possibly pulmonary edema.
10/5/2023 77

78. Catastrophic Events in the operating Room
 Malignant hyperthermia(MH) is a rare metabolic disease characterized
by hyperthermia with rigidity of skeletal muscles that can result in death.
It occurs in affected people exposed to certain anesthetic agents.
The definitive treatment of MH is prompt administration Skeletal
muscle relaxant drugs such dantrolene .
10/5/2023 78

79. Infection prevention in the operating room
 Learning Objectives
At the end of the session , the trainee will be able to:
1. Demonstrate infection prevention techniques.
2. Minimize the risk of transmitting serious infections
among patients and service providers.
3. Define aseptic technique
4. Define sterile technique.
5. Describe the modes of transmission of microorganisms
from the source to the susceptible host.
79

80. Introduction
The infection prevention (IP) practice are intended for the use in all types
of health care facilities –from large urban hospitals to small rural clinics
 The recommended infection prevention practices are based on the
following principles:
Consider every person potentially infectious and susceptible to
infection
Washing hands before and after any procedure is the most practical
procedure for preventing cross–contamination
80

81. Intro cont’
Recommended … principles….
Wearing gloves before touching any thing potentially infectious and wet
such as broken skin, mucous membrane, body fluids, body secretions
and execrations, or soiled instruments and other items –or before
performing invasive procedures
Using antiseptic agents for cleansing the skin or mucous membrane prior
to surgery, cleaning wounds, or doing hand rubs or surgical hand scrub
Process instruments and other items that come in contact with blood,
body fluids, secretions and excretions
 Disposing contaminated materials and contaminated waste properly
81

82. General preparation
Hand Hygiene
Is a general term referring to any action of hand cleansing
Proper hand hygiene and the use of protective gloves in the operating
room is a key component in minimizing the transmission of disease
causing microorganisms and maintaining an infection free environment
Appropriate hand/washing/hygiene must be carried out:
 Before coming in direct contact with patients
 Before putting on sterile surgical gloves or examination gloves
 After any situation in which hands may be contaminated such as
(handling contaminated objects, including used instruments; touching
mucous membranes, blood, body fluids ,secretions
 After removing gloves 82

83. Cont’d
Clothing
In restricted areas, staff are required to wear hospital –laundered OR
clothing (scrubs) made of woven reusable fabric (trousers, shirt)
Fresh OR cloth attire should be worn each day
Surgical attire should be changed or removed when it becomes soiled or
wet or after a high septic procedure
OR uniforms should be removed and deposited in a designated container
before leaving the OR
Surgical attire must be removed when leaving the operating room out
side)and fresh ones worn on reentry
83

84. cont’d
CAPS
Hair (including facial hair) must be completely covered by a cap that can
be laundered by the hospital
Hair is an important contaminant and major source of bacteria.
Caps should be removed before leaving the OR.
84

85. Cont…
Shoes
Only OR shoes should be worn: they must provide protection from liquid
and sharp items are preferred to normal shoes
OR shoes should be removed and deposited in a designated receptacle
before leaving the operating room
Removal of shoes can transfer microorganisms from shoes to hands
;hands should be washed after shoes removal
85

86. cont…
MASKS:
Masks are worn in the restricted area in the presence of open sterile
items or equipment or where contact with scrubbed personal is
possible
Mask should cover the nose and mouth completely and securely
Masks contain droplets expelled from the mouth and the throat
when talking, sneezing, and coughing
Masks also protect from exposure to pathogenic organisms spread in
the environment
Masks should be tied securely at the back of the head
86

87. Cont’d
Masks…
Masks that have been worn are contaminated with droplets should be
removed and discarded by handling only the ties
Handling of the mask after use can transfer microorganisms from mask to
hands: staff should wash their hands after handling and discarding a used
mask
Jewelry
All jewelers and watches should be removed or completely confined with
scrub attire. These items can harbor germs that are not removed during
hand washing and can contaminate the sterile field by unintentional
contact
It is recommended that earrings be removed, but they can be worn if
completely confined under the hair covering
87

88. Cont’d
Finger nails and polish
Finger nails should be kept clean and short as less than 3mm and nail
polish avoided
Other personnel protective equipment
 Eye wear provide solid side shields (‘’OR goggles ‘’)
 Non sterile gloves should be worn when contact with blood or body fluids is
expected and changed between patients
 Hands should be washed after glove removal
The patient
 Before entering the OR, the patient must take off his/her clothes in the receiving
area and wear a patient gown, a cap, foot covers, and a clean bed sheet.
88

89. Procedure of hand washing/scrubbing
Hand washing and surgical hand scrub
Hand hygiene:- refers to hand washing, antiseptic hand wash or
surgical hand antisepsis=surgical hand scrub=scrubbing
Surgical hand antisepsis =surgical hand scrub =scrubbing up:
mechanical hand wash with a broad spectrum antimicrobial agents and
a sterile brush performed prior to surgery by surgical team to eliminate
as many as transient microorganisms as possible and reduce resident
hand flora
89

90. Hand Hygiene
Surgical hand scrub
 The goal of the surgical hand scrub is to remove as much debris and
bacteria as possible from the hands and arms. The concept of clean
and dirty areas is important to any one attempting a surgical scrub
 The scrub begins at the finger tips (considered a clean area after the
scrub) and progress in one direction to the elbows (considered dirty)
90

91. Procedure of hand washing /scrubbing cont’d
The surgical scrub brush is only used on nails and not on skin to avoid
some abrasion of the skin
Hands and arms should be held away from the body (dirty )during the
surgical scrub to prevent contact with scrub attire (dirty)
Hands should be held higher than the elbows to prevent fluid from
running from the elbows (dirty )to the hands (clean) during the scrub and
during drying this position also keeps the hands and arms in prominent
view and helps to prevent accidental contamination by contact with
surrounding areas
91

92. Cont’d
Avoid splashing water, as a wet surgical attire can cause the transfer of
microorganisms from personnel to the sterile gown worn during surgery
Theoretically as a surgical scrub time, it is suggested for two hands that
one minute be spent on the nails two minutes on the fingers ,30 seconds
on the palms ,30 seconds on the backs of the hands and a final one minute
spent on the area of forearm and elbow. That makes at minimum 5
minutes
92

93. Procedure of hand washing /scrubbing cont…
Equipment
Scrub sink with running water tap
Sterile and reusable nail brushes
1 bar of a soap (the best scrubbing agents are antimicrobial scrub agents )
Preparation jewelry should be removed
Nails should be short ,clean and healthy
Skin of the scrubbed person should be free from cuts and abrasions
Hair should be contained with in an appropriate hair covering
Mask should be in place
Additional personnel protective equipment such as apron should be in
place
93

94. Procedure of hand washing /scrubbing cont…
Action/steps /
Open the drum that contains the sterile hand brushes and check if the
soap is ready
Turn on water tap and wet your hands and forearms.
1. Take soap(1st application)
Wash and rub the lateral side of your left little finger, then its medial side
:then the lateral and medial of each successive finger, then wash the back
and the palm of your left hand the process is repeated with the opposite
hand
94

95. Steps…
Then rub your left wrist and forearms higher than your elbows to anion
water to drip off the elbows.
2. Take soap (2nd application)
 Brush only your finger nail carefully for at least 1 minute
 The nail brush is discarded
95

96. Scrubbing cont’d
3.Take soap (3rd applications)
 Wash and rub your left hand and writs, then the right side
 Thoroughly rinse the suds from your hands while holding them higher
than your elbows
 Turn off water tap with elbow
 If any part of the hands pointed up ward and away from the scrub
attire, the sink, add minutes to that area of the skin to correct the
contamination
 With fingers and hands pointed upward and away from the scrub
attire, the scrub person enters the procedure room pushing the door
open with his/her back
96

97. Scrubbing cont’d
The gown and towels are packed with the towel on top; approach towel
and pick up the hand – towel without water dripping on the sterile pack
or table. open and take the sterile hand towel and dry each hand and
forearm separately
 Begin drying one of your hands while half the towel
97

98. Scrubbing cont’d
Proceed from the finger tips to above the elbows. Grasp the unused part
of the towel with your dry hand and release the wet half, and repeat the
drying process on your other hand
Try not to bring a wet (unsterile) part of the towel back to a dry area ,
drop the towel
Take and put your gown on, and then put the gloves on left hand first
98

99. Hand scrubbing
99

100. Hand scrubbing…
100

101. hand scrubbing…
101

102. Gowning and gloving
Gowning
The sterile gown is put on immediately after the surgical scrub
The scrubbing nurse handles the sterile gowns very carefully with out on
her body and slips into its sleeves gently over her theater dress
The circulatory nurse assists by pulling the gown over the shoulders
102

103. Gowning …
The gown is tied at the back by the circulating nurse
The hands at the wrist are tied by her self so that the cuffs of the gloves are fitted over
them
103

104. Kinds of Gown
104

105. Gowning ….
105

106. Gloving
Gloving :
Sterile gloves may be put in two ways
 Closed gloving technique
 Open gloving technique
106

107. Gloving cont…
Closed gloving technique
1.Lay the glove palm down over the cuff of the gown
2.The fingers of the glove face to ward you
3.Working through the gown sleeve, grasp the cuff of the glove and bring it
over the open cuff of the sleeve
4.Unroll the glove cuff so that it covers the sleeve cuff
5.Proceed with the opposite hand, using the same technique
6.Never allow the bare hand to contact the gown cuff edge or outside glove
107

108. 108

109. Gloving cont….
Open gloving technique
1.Pick up the glove by its inside cuff with one hand
2.Do not touch the glove wrapper with bare hand
3.Slide the glove onto the opposite hand
4.Leave the cuff down
5.Using the practically gloved hand, slide the fingers into the outer side of
the opposite glove cuff
6.Slide the hand into the glove and unroll the cuff
7.Do not touch the bare arm as the cuff is unrolled
8.With the gloved hand, slide the fingers under the out side edge of the
opposite cuff and unroll it gently, using the same technique
109

110. Open gloving technique
110

111. Operating room hygiene and cleaning
Cleaning
Removal of all foreign material (e.g. soil, organic material) from objects
It is normally accomplished with water, mechanical action and detergents
Cleaning must precede disinfection and sterilization procedures methods
111

112. Cleaning
1.Daily
Before the procedure of the day
Wipe down all equipment and surfaces in the operating room
Furniture, equipment, surgical lights must be damp –dusted with a cloth
moistened with a detergent/disinfectant.
Special attentions should be given to mop all the floors of the operating
room, corridors, sterilization room, changing rooms allow drying time
112

113. Cleaning cont….
2. Between Two operations
Empty rubbish bins and take dirty linen out
Clean the operating table with soap and water or detol
Change the rubber/plastic sheet for each patient trolleys must be wiped
between patients
Mop the floor with soap and water apply bleach on surfaces and floor
and allow to air dry
113

114. Cleaning cont…
3.At the end of the operation list
Empty and wash rubbish bins
Take remaining dirty linen to the laundry
Clean all furniture with soap and water or detol
Clean scrubup area
Mop floor with soap and water, rinse and apply bleach and allow to air
dry
Wash operating shoes
Restock the operating room (sutures, urinary bags ,antiseptics …)
114

115. Cleaning cont…
4. Weekly protocol
 Wash walls and cupboards and all the things you do not wash daily
5.Monthly protocol
Move the cupboards and wash every where
Cleaning and disinfection include:-
 All equipment surfaces
 All rooms and corridors
 Surgical furniture (OR light over the operating table need special
care)
 Anesthetic equipment sinks, staff toilets, showers, floors, walls
115

116. Cleaning cont’d
How to clean
Start the process from cleanest to most dirty from less contaminated to
more contaminated ,
e.g. after operation, clean the circulating nurse trolley before the
operating table, and the operating table before the floor
Proceed from up downwards, e.g., walls before the floor, the upper shelf
of the trolley before the lower shelf
116

117. Cleaning…
Use the double bucket system to preserve the deterioration,
contamination, inactivation of disinfectant solution, and lost effectiveness
All cleaning cloth, floor mops and buckets must be disinfected, rinsed
and stored dried to prevent their becoming a source of microbes
117

118. Processing instrument
Learning objectives
At the end of the study session, the trainees will be able to:-
 Identify the steps of processing instrument
 The rationale for decontamination before cleaning
 How to prepare chlorine solution for decontamination
 Some characteristics of chemical sterilization& Disinfection
118

119. Introduction
Surgical instruments are expensive and represent a major investment
Instruments can last for many years if they are handled or maintained
properly
It is the nurses responsibility to care for the proper handling and
maintenance of the instruments
119

120. Cont’d…
Handle instruments gently
Do not through them in to basins
Keep the sharp surfaces of cutting instruments away from other metal
surfaces that could dull them
Do not soak them in saline solution
120

121. Steps of processing instrument
Decontamination:- Process that makes inanimate objects safer to be
handled by staff before cleaning (i.e.,inactivates HBV, HCV and HIV, it
reduces the number of other microorganisms but does not eliminate them)
Cleaning:- Process that physically removes all visible dust, soil, blood or
other body fluids from inanimate
Objects as well as removing sufficient numbers of microorganisms to
reduce risks for those who touch the skin or handle the object
121

122. Terminology…
High-level disinfection (HLD):-Process that eliminates all
microorganisms except some bacterial endospores from inanimate objects
by boiling, steaming or the use of chemical disinfectants
Sterilization:- Process that eliminates all microorganisms (bacteria,
viruses, fungi and parasites) including bacterial endospores from
inanimate objects by high-pressure steam (autoclave), dry heat (oven),
chemical sterilants or radiation
122

123. Key Steps in Processing Contaminated Instruments, Gloves
and Other
123

124. Decontamination
Decontamination is one of the highly effective IP measures that can
minimize the risk of transmission of these viruses to healthcare workers,
especially cleaning and housekeeping staff, when they handle soiled
medical instruments, surgical gloves or other items
These measures are also important steps in breaking the infection
transmission cycle for patients.
Both processes are easy to do and are inexpensive ways of ensuring that
patients and staff are at a lower risk of becoming infected from
contaminated instruments and other inanimate objects
124

125. cont’d…
Immediately after use, all instruments should be placed in an approved
disinfectant such as 0.5% (Barakina/hypochlorite sodium)chlorine
solution for 10 minutes to inactivate most organisms, including HBV and
HIV
Do not mix soak metal instruments in water for more than one hour to
prevent rusting
Remove instruments from 0.5%chlorine solution after 10 minutes and
immediately rinse them with sterile cool water to remove residual
chlorine before being thoroughly cleaned
125

126. Chain of infection
126

127. Cont’d…
Decontamination is the first step in processing soiled surgical
instruments, surgical gloves and other items. It is important, before
cleaning, to decontaminate these items by placing them in a
0.5%(Barakina/hypochlorite sodium) chlorine solution for 10 minutes
This step rapidly inactivates HBV, HCV and HIV and makes the items
safer to handle by personnel who clean them
127

128. How to make solution for decontamination
A. The formula for making a dilute chlorine solution from any
concentrated hypochlorite solution
Check concentration(% concentrate) of chlorine solution you use
Determine total parts water needed by this formula:-
Total parts (TP) water=[%concentrated/%dilute]-1
Mix 1part of concentrated bleach with total parts of water required
128

129. Example
Make a dilute solution (0.5%) from 5% concentrated solution
Step 1 TP = [5%/0.5%]-1 =10-1=9
step2 take 1part of concentrated solution & add 9parts of water
B. The formula for making a dilute solution from a powder of any percent
available chlorine
Formula for making chlorine solutions form dry powders
129

130. 130

131. Cleaning
Cleaning is a process of physically removing infectious agents and other
organic matters on which they live and thrive but doesn’t necessarily
destroying infectious agents
This is important because dried organic material can entrap microorganisms,
including endospores, in a residue that protects them against sterilization or
disinfection
131

132. Cleaning …
Cleaning could be done using hand (bar) or powdered soap is
discouraged because the fatty acids in bar soap react with the minerals in
hard water leaving a residue or scum (insoluble calcium salt), which is
difficult to remove
Using liquid soap is good because it mixes easily with water than bar or
powdered soap
Cleaning is the removal of all visible dust, soil, and other foreign material
from the instruments
132

133. Sterilization and disinfection
Sterilization is the process by which all pathogenic and non pathogenic
microorganisms, including spores are killed.
Method of sterilization
Sterilization can be achieved with physical or chemical methods.
Physical methods generally rely on moist or dry heat.
133

134. Sterilization
Chemical methods use gaseous or liquid chemicals
Ethylene oxide gas is used to sterilize items that are sensitive to heat or
moisture. Its effectiveness depends on four parameters which include :
 Concentration of EO gas
 Temperature
 Humidity ,and
 Duration of (gas exposure)
Gluteraldehyde 2%and formalaldehyde 8% can also be used a chemical
sterilizer
134

135. Sterilization cont’d
Physical methods:- heat is a dependable physical agent for the destruction
of all forms of microbial life, including spores. It may be used moist or
dry. The most reliable and commonly used method of sterilization is
steam under pressure.
A . Moist heat(steam under pressure )or auto clave
Basically, an auto clave consists of a sterilizing chamber and to
exhaust steam, air and condensation from the chamber.
135

136. Sterilization…
3 parameters are important :
 Temperature
 Time/duration
 Pressure(saturation, humidity)
The minimum time for the entire cycle in the autoclave sterilizer is 25 to
30 min at 121 to 132 degree Celsius
136

137. Cont’d
Steam sterilization (Gravity):
Temperature should be 1210C (2500F); pressure should be 106kPa(15
lbs/in2); 20 minutes for unwrapped items; 30 minutes for wrapped
items.
Or at a higher temperature of 1320C (2700F), pressure should be
207kPa(30 lbs/in2);15 minutes for wrapped items
Allow all items to dry before removing them from the sterilizer
137

138. Sterilization con’t
Dry heat
 Dry heat kills micro organisms by oxidation provided that the
articles to be sterilized are exposed to a temperature of 1600C for one
hour is
This method is used for sterilizing sharps, sponges and bandages
The major disadvantage of dry heat are that is penetrate materials slowly
and unevenly
NB:- if you are not sure the time & duration of sterilization it is better
follow manufacturer manual
138

139. Disinfection
Disinfection:- eliminates pathogenic microorganisms on inanimate
objects, with the exception of bacterial spores.
This is generally achieved in health care settings by the use of liquid
chemicals or boiling
139

140. Methods of disinfection
Chemical disinfections
Formaldehyde (37% aqueous ;8% alcohol ) Kills microorganisms by
coagulating protein in the cells
The solution is effective at room temperature
 Hydrogen peroxide: interacts with cell membranes, enzymes, or nucleic
acid to disrupt the life functions of microorganisms
Alcohol: ethyl or isopropyl, 70% to 95%, kills microorganisms by
coagulation of cell proteins.
Chlorine compounds: kills microorganisms by oxidation of enzymes.
140

141. Preparing equipment
Prior to dispensing sterile supplies
 Check the outer wrapper or package for tears or holes and consider it
contaminated if they exist
 Confirm that an item’s sterility has not been compromised by
handling
 Inspect the indicators on the out side of the package to ensure that the
proper sterilization process was followed
 If indicated, verify manufacture’s label for sterility /expiry date/
 If sterility is in doubt, do not use the item
 Great care is needed in opening package to maintain sterility
141

142. Preparing equipment cont…
Packing
Un packed items, such as those sterilized in a flash auto clave must be
used immediately
Any items not to used immediately must be packed in order to
maintain sterile conditions, maintains item’s properties and integrity,
in such away that article can be extracted and used under aseptic
condition:
In fenestrated drums or boxes.
142

143. Cont’d
Small packages and small drums are preferable to large ones: the steam
will circulate better
Swab and drapes should not be compressed inside boxes or drums
In the pack, items used first, such as hands towels, must be placed on top.
143

144. Cont’d
Sealing and labeling :
Write contents and date of sterilization
Sterile storage guide line
Storage area must be clean and free of dust, close to working area
All sterile items should be stored under conditions that protect them
from the extremes of temperature and humidity
Package should be put into storage with out condensation inside the
drums or the box, wet packages must be resterilized
144

145. Shelf life
Shelf –life:15 days after the date of sterilization if the package is closed
correctly
The shelf life of an item (how long items can be considered sterile) after
sterilization is event-related
The highest shelves should be at least 45cm below the ceiling and 25cm
above the floor.
Items should be identified:
Expiry date should be checked regularly
Disposable items eliminate a potential source of contamination but
they also must be stored properly and they are generally expensive
145

146. Factors affecting shelf-life
Quality of the wrapper or container
Number of times a package is handled before use
Number of people who have handled the package
Whether the package is stored on open or closed shelves
Condition of storage area( e.g., humidity and cleanliness)
146

147. Cont’d
Use of plastic dust cover and method of sealing
Most packages are contaminated as a direct result of frequent or improper
handling or storage
Prevent events that can contaminate sterile packs, and Protect them by placing
the in plastic cover (bags)
147

148. Monitoring sterilization procedures
Sterilization procedures can be monitored routinely using a combination
of biological, chemical and mechanical indicators as parameters
 Different sterilization processes have different monitoring requirement
148

149. Biological Indicators
Monitoring the sterilization process with reliable biological indicators at
regular intervals is strongly recommended
The biological indicator types and minimum recommended intervals
should be:
Steam sterilizers:- A highly resistant but relatively harmless
(nonpathogenic) microorganism called Bacillus stearothermophilus is
used to test steam sterilizers undertaken weekly
149

150. Chemical Indicators
Chemical indicators include indicator tape or labels, which monitor
time, temperature and pressure for steam sterilization, and time and
temperature for dry-heat sterilization
Mechanical Indicators :-Mechanical indicators for sterilizers provide a
visible record of the time, temperature and pressure for that sterilization
cycle
This is usually a printout or graph from the sterilizer, or it can be a log
of time, temperature and pressure kept by the person responsible for
the sterilization process that day
150

151. Summary
Method Effectiveness
(kill or remove
microorganisms)
End Point
Decontamination Kills HBV and HIV and some
microorganisms
10 minute soak
Cleaning (water only) Up to 50% Until visibly clean
Cleaning (soap and
Rinsing with water)
Up to 80% Until visibly clean
Sterilization 100% High-pressure steam, dry heat or
chemical for recommended time
High-level disinfection 95% (does not inactivate some endospores) Boiling, steaming or chemical for
20 minutes
151

152. General surgical instrumentation
Learning objective
At the end of this study session, the trainee will be to:-
1. Identify the use and function of each type of surgical instrument
2. Demonstrate the appropriate methods for passing each type of
instrument
3. Explain the rationale and methods of decontamination of instruments
152

153. Introduction
Surgical instrumentation is critical to the surgical procedure
The performance of the OR team is enhanced when team members know
each instrument by name, how each item is safely handled, and how each
is used.
Preparing the instrument for appropriate processing will prolong its use
in patient care and decreases the costs for repair and replacement.
153

154. Classifications of Instruments
As an aid in memorizing instrument names, it is helpful to know the
basic categories of instruments.
They are classified according to their function, and most fall into one of
four groups
A. Cutting and Dissecting
B. Grasping and Clamping
C. Exposing and Retracting
D. Probing and Dilating
154

155. Cutting &dissecting
Cutting instruments have sharp edges/points.
They are used to dissect, incise, separate, penetrate, or excise tissue
This group includes: scissors, knives, biopsy punches, scalpels (blades),
saws, osteotomes, drills and curettes, needles, chisels, etc.
155

156. Example…
156

157. Example2
157

158. Cutting &dissecting
158

159. Cutting &dissecting
159

160. Grasping and Clamping
A clamp is an instrument that clasps tissue between its jaws
Clamps are available for use on nearly every type of body tissue, from
delicate eye muscle to heavy bone
The most common clamps are the haemostatic clamps, designed to grasp
blood vessels, crushing clamps, non crushing vascular clamps etc.
160

161. Grasping and Clamping
Grasping instruments are used to hold and manipulate structures
Needle holder, thumb forceps, tissue forceps, Alli’s forceps, bone
holders, tenaculi (tenaculm, singular)etc. are included in this category
161

162. Parts of a Clamp
As shown in the above figures an instrument has identifiable parts
The points of the instrument are its tips. The tips should approximate
tightly when the instrument is closed
The jaws of instrument hold tissue securely. Most jaws are serrated.
The box lock is the hinge joint of the instrument.
The shank is the area between the box lock and the finger ring.
162

163. parts…
163

164. Example… Different types of blade holders
(scalpel handles)
164

165. Different types of thumb forceps
165

166. Different types of clamps
166

167. C. Exposing and Retracting
Soft tissues, muscles, and other structures should be pulled aside for
exposure of the surgical site
Exposing and retracting instruments are those that hold tissue or organs
away from the area where the surgeon is working.
Retractors, like clamps, are available for use in all parts of the body
167

168. Example Retractors
168

169. Example…
169

170. Self-Retaining Retractors
Holding devices with two or more blades can be inserted to spread the
edges of an incision and hold them apart
170

171. Example…
171

172. D. Probing and Dilating
A probe is used to explore a structure or to locate an obstruction
Probes are used to explore the depth of a wound or to trace the path of a
fistula.
Dilators are used to increase/enlarge the diameter of a lumen, such as the
urethra, uterine cervix, or esophagus.
172

173. Example…
173

174. Receiving and positioning the patient
Learning objective
At the end of the session, the trainee will be able to:-
1. Mention some of the responsibilities of the OR team during receiving the
surgical patient.
2. Identify the safety hazards associated with moving a patient from one
surface to another.
3. Describe the effects of positioning on the patient’s body systems
174

175. Introduction
The patient is the reason for the existence of the health care team
She or he looks to the operating room team to fulfill her or his diverse
needs during the pre-, intra-, and postoperative phases of care. The
patient is always the focus of attention, not just when she or he is under
the operating room (OR)spotlight
175

176. Cont’d
Receiving the Surgical Patient
Positioning the Patient
Each operative position represents an agreement between the
surgeon and the anesthesia provider to the patient
The surgeon requires an accessible, stable operative area
176

177. Cont’d…
Patient positioning is determined by the procedure to be performed, with
consideration given to the surgeon’s choice of surgical approach and the
technique of anesthetic administration
Factors such as age, height, weight, cardiopulmonary status, and
preexisting disease(e.g., arthritis) also influence positioning and should
be incorporated into the plan of care
177

178. Timing of Patient Positioning and Anesthetic
Administration
The following states the time at which the patient is positioned and/or
anesthetized
 After transfer from the stretcher to the operating bed, in supine position the patient
may either be anesthetized in this position
 If the patient is having a procedure performed while in a face down (prone)
position and under general anesthesia, he/she is anesthetized and intubated on the
transport stretcher
 A minimum of four people are required to place the patient safely in the prone
position on the operating bed
178

179. Factors influencing time of patient position
Several factors influence the time at which the patient is positioned.
Some of these include:-
The site of the surgical procedure
The age and size of the patient
The technique of anesthetic administration and
If the patient is conscious, has pain on moving
179

180. Modifications for individual patient needs
As with every thing else, the patients individual needs are met during
positioning
Anomalies and physical defects are considered
Whether patient is conscious or unconscious avoid unnecessary exposure
The patient position should be observed objectively before skin
preparation & draping to see that it adheres to physiologic principles
180

181. Cont’d
Protective devices, positioning aids & padded areas should be reassessed
before draping because they could have shifted during the skin
preparation procedure or during insertion of catheter
 Careful observation of patient protection & positioning facilitates the
expected out come
181

182. Safety Measures
Injuries to the back, arms, or shoulders as a result of lifting patients or
moving equipment are common to the staff working in the OR
Several principles of body mechanics (using the body as a machine)
should be observed to minimize physical injury
182

183. Safety measures
Some of these principles include, but are not limited to, the following:-
Keep the body as close as possible to the person or equipment to be
lifted
Lift with the large muscle groups of the legs and abdominal muscles,
not the back
Lift with a slow, even motion, keeping pressure off the lumbar (lower
back) area
Bend forward with hip flexion and hand support
183

184. Equipment for Positioning
The following are list of special equipment for positioning a surgical
patient:
Shoulder Bridge (Thyroid Elevator)
Safety Belt (Thigh Strap Anesthesia Screen)
Lift Sheet (Draw Sheet)
Arm board, double Arm board
Wrist or Arm Strap
184

185. Equipment's…
Kidney Rests
Body (Hip) Restraint Strap
Metal Footboard
Headrests
Pressure-minimizing Mattress
Operating Bed
Shoulder Braces or Supports
Body Rests and Braces
185

186. Surgical Positioning
Positioning on the operating table
The position in which the patient is placed on the operating bed/table
depends on the surgical procedure to be performed as well as on the
physical condition of the patient
186

187. Common positioning
A. Supine:- cholecystectomy bowel and
bladder surgery and some
gynecological procedures
B. Trendelenburg
eg;-used for surgery on the lower
abdomen & the pelvis to obtain
good
C. lithotomy:-Nearly all perineal,
rectal, and vaginal surgical
procedures require this position
187

188. Common positioning
D. Modified sim’s/kidney
E. Prone position
F. Reverse trendelenburg position
Eg;-soft roll under shoulders for
thyroid, neck, or shoulder
procedures
188

189. Summary
1.List the preliminary considerations during positioning?
2.Mention at least three most commonly used operative positions?
189