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 patient safety.

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

DateItem

Description Name LocationRetur

n 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?