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INTRODUCTION

  • OR Basics for Students

  • Sterile Technique

  • Entering the OR

  • Surgical Hand Scrub

    • Brush Hand Scrub

    • Brushless Hand Scrub

    • Waterless Surgical Scrub (Handrub)

  • Gowning and Gloving

  • Preparing the Patient

    • Materials

    • Technique

  • Patient Positioning

  • Draping the Patient

  • The Universal Protocol and the “Time-Out”

  • Finding Your Place

  • Common Surgical Incisions

  • Universal Precautions

  • Latex Allergy

  • ASA Physical Status Classification System

  • Basic Surgical Instruments

Chapter update by Caitlyn Costanzo, MD, and Gerald Isenberg, MD, FACS

OR BASICS FOR STUDENTS

Prepare before you enter the operating room (sometimes referred as the “theatre” in the British Commonwealth countries) by knowing the patient thoroughly and having a basic understanding of what is planned. Review the medical history and read up on the basic anatomy and the procedure to be performed. Students are often quizzed on anatomy demonstrated in the OR during the operation. Avoid stereotyping the nurses as “cranky,” the surgeons as “egotistical,” and the medical students as “clueless” by learning the OR routine. Be alert, attentive, and, above all, patient. It is important to introduce yourself to the members of the operating room team when you are new to the operating room. Tell the scrub nurse and circulating nurse if you have never scrubbed into a procedure, and they will help you follow correct procedures.

STERILE TECHNIQUE

The members of the OR team include the surgeons, anesthesia staff, and the nursing staff. Members of the surgical team are the surgeon, surgical assistants, students, and scrub nurse or technician responsible for the instruments, gowning the surgical team, and maintaining a sterile field. The circulating nurse acts as a go-between between the sterile and nonsterile areas.

Sterile areas include the front of the gown to the waist, gloved hands and arms to the shoulder, draped part of the patient down to the tabletop, covered part of the Mayo stand (the small table where the most commonly used instruments are kept), and the top of the back table where additional instruments are kept. The sides of the back table are not considered sterile, and anything that falls below the level of the patient table is considered contaminated.

ENTERING THE OR

In the OR, everything is geared toward maintaining a sterile field. Use of sterile technique begins in the locker room. Change into scrub clothing. Remove your T-shirt, tuck the scrub shirt into the pants, and tuck the ties of the scrub pants inside the pants. In some hospitals scrub clothes are allowed on the wards, provided they are covered by a coat or other form of gown; check your hospital’s requirements, as there may be restrictions. If you wear scrub clothing out of the OR, be sure that it is not bloodstained.

Pass into the surgical anteroom to get your mask, cap, and shoe covers. The ...

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