Operating Room
Orientation
For
Medical Students
Angela L. Lawrence, BSN,
RN, MPA, CNOR
After today you should
be able to:
Describe surgical attire
Discuss “OR etiquette”
List principles of aseptic
technique
Discuss safety considerations
In Separate Groups we
will:
Find the Locker Rooms
Obtain scrubs from the Pyxis
Scrub Station
Meet Angela at the Main OR
Front Desk
(Where’s the desk?)
Tour the Operating Room (the
10¢ tour)
Observe scrubbing, gowning and
gloving procedure (Any
volunteers??)
Surgical Attire
Green Scrub suit (obtain from
Pyxis)
(What about tee shirts? What about
jewelry? Nail polish?)
Hospital photo ID badge
Hat or hood
Shoe covers (Optional PPE)
Mask (when sterile setup is present)
Eye protection (Required PPE)
OR Etiquette/Customs
Introduce yourself to OR nurse
Write your name (legibly) on the
white board
(there’s one in each Operating
Room)
Offer to obtain your gown or
gloves, PRN
Principles of Aseptic
Technique
1. Scrubbed persons function within the
sterile field.
Scrubbed persons:
Scrub, gown and
glove
Sterile touches only
sterile
Sterile areas of
gown:
• In front from 2”
below neck to table
level
• Sleeves from 2”
above elbow to
stockinette cuff
Principles of Aseptic
Technique
2. Sterile drapes should be used to
establish a sterile field.
Drape from
incision area to
periphery
The sterile field is
the top surface of
the draped tables
and the patient
Any point below
the sterile level is
unsterile
Anything
permeating the
sterile field
contaminates it,
including moisture
Principles of Aseptic
Technique
3. All items used in a sterile
field should be sterile.
Anyone opening and dispensing
an item is accountable for its
sterile integrity
Shelf life of a packaged item is
event-related
Principles of Aseptic
Technique
4. All items introduced onto the
sterile field should be opened,
dispensed and transferred by
methods that maintain sterility
and integrity.
Check outer wrapper for integrity
Inspect indicators on outside
Check dates, if applicable
If sterility is in doubt, do not use the
item
Principles of Aseptic
Technique
5. A sterile field
should be
maintained and
monitored
constantly.
Scrubbed persons will keep
the sterile field in direct
view at all times and not
turn his/her back to the
sterile field.
Principles of Aseptic
Technique
6. All Personnel moving within or
around a sterile field should do so
in a manner to maintain the
integrity of the sterile field.
When scrubbed persons move around
each other they should keep:
Unsterile to unsterile (“back
to back”)
or
Sterile to sterile (“belly to
belly”)
Principles of Aseptic
Technique
7. Policies and procedures for
maintaining sterile field should be
written, reviewed annually and readily
available within the practice setting.
Where do you find them?
Surgical Conscience
Builds on principles of
asepsis
Allows no compromises in
aseptic technique
Requires regulation of ones
own practice
Demands recognition and
correction of breaks in
technique including
reporting ones own breaks
in technique
Doing the right thing even
when no one is watching!
Our Ultimate
Goal: Patient
Safety
More Safety
Considerations etc.
Do Not touch anything on the
Mayo Stand
Do Not Argue if someone says
“It’s contaminated.”
Masks are either tied properly on
your face or in the trash.
Dual Frame of Reference:
Anything touching the patient should
be sterile, anything that has touched
the patient is contaminated.
Introduction to the
Universal Protocol for
Preventing Wrong Site,
Wrong Procedure, and
Wrong Person
Surgery™
The Universal Protocol applies to
all surgical and nonsurgical
invasive procedures. Evidence
indicates that procedures that
place the patient at the most risk
include those that involve
general anesthesia or deep
sedation, although other
procedures may also affect
Introduction to the
Universal Protocol for
Preventing Wrong Site,
Wrong Procedure, and
Wrong Person
Surgery™
Hospitals can enhance safety by
correctly identifying the patient, the
appropriate procedure, and the
correct site of the procedure.
Introduction to the
Universal Protocol for
Preventing Wrong Site,
Wrong Procedure, and
Wrong Person Surgery™
The Universal Protocol is based on
the following principles:
Wrong-person, wrong-site, and
wrong-procedure surgery can and
must be prevented.
Introduction to the
Universal Protocol for
Preventing Wrong Site,
Wrong Procedure, and
Wrong Person Surgery™
A robust approach using multiple,
complementary strategies is
necessary to achieve the goal of
always conducting the correct
procedure on the correct person,
at the correct site and on the
correct side.
Introduction to the
Universal Protocol for
Preventing Wrong Site,
Wrong Procedure, and
Wrong Person
Surgery™
Active involvement and use of
effective methods to improve
communication among all
members of the procedure team
are important for success.
To the extent possible, the patient
and, as needed, the family are
involved in the process.
Time Out:
Is performed immediately prior to
incision or when a Regional
Block is performed.
The Attending Physician,
Anesthesia care provider,
Circulating RN, and Scrub person
must be present.
All members of the team should
be actively involved in the time
out. If any member is not paying
attention during the time out,
stop, gain their attention and
restart the time out.
Time Out:
The circulator will document this
verification in the electronic
medical record
Time Out:
A complete TIME OUT is
performed prior to the start of
subsequent procedures and
includes the NEW attending
physician.
Exceptions are not routine.
Should an exception exist, in the
event of an urgent surgery, the
TIME OUT, in its entirety, must
be performed as soon as possible
Time Out:
The following items are to be
stated in the time out:
The following will be verbalized:
Correct procedure
Correct side/ site
Correct position
Antibiotic started, if
applicable
Prep dried
Endoscope Use
Scope tracking is now a required
element by the Joint Commission.
Tracking is imperative and has
major implications for both
Medicare our reimbursement and
accreditation!
The resident/medical student must
sign the EGD cart out when it
leaves the unit and when it is
returned. This includes all scopes
that are utilized outside the OR.
EGD Tower and Instrument Tray Sign Out Sheet
Date Item Description Name Location Return Date Initial
White Bag Contents
Each group will
Meet at the Main OR Front Desk
Discuss the OR schedule board
Tour the Operating Room Suites
Observe scrubbing demonstration
Observe gowning and gloving
demonstration
Questions?
