1. Introduction ORT.pptx

July, 2021 © Haramaya University, CHMS,
Department of Emergency and Critical Care Nursing
Introduction to OR Technique
By:- Ame Mehadi (BSc, MSc)
INTRODUCTION TO
OPERATION TECHNIQUE

Trainer, WHO Basic Emergency Care
& Perioperative Nursing Training
School of Nursing
Collage of Health & Medical
Sciences

By:- Ame Mehadi (BSc, MSc-EMCCN)
Objective
At the end of this chapter, the learner will be able to:
►Describe specific areas within the OR.
►Identify major equipment in the OR.
►Discuss how env’tal layout contributes to aseptic technique.
►Differentiate the OR personnel
►Identify basic principles of aseptic technique

Terminology
OPERATING DEPARTMENT:
►A unit consisting of one or more operating suites together with
ancillary accommodations such as;
 Changing room
 Reception room
 Transfer room
 Rest room
 Recovery room
 Circulatory room
5

Terminology
OPERATING SUITE:
►comprises of the operating theatre/room together with an
immediate ancillary areas such as;
 Anesthetic rooms
 Sterile lay up or preparation room
 Disposal room
 Scrub up and gowning areas
 Exit room.
OPERATING THEATER:
►is where surgical operations and certain diagnostic procedures are
carried out.
6

Operating Theatre
Includes
►operating room(OR) or the surgical suite
 is the entire area in which
• surgeries are performed and
• materials are prepared and stored for surgery.
 specifically for use by the anesthetist and surgical teams &
 must not be used for other purposes.
►recovery room(RR)
 is a place where the pt stays until he/she recovers from anesthesia after surgery.
7

Operating Theatre……
 Both rooms require:
►Good lighting & ventilation
►Dedicated equipment
►Monitoring Equipment
►Sutures and extra equipment
►Drugs
8

Operating Room
 is where surgery is performed
 is organized & designed differently from other
wards.
 is a special room with the wall & ceiling is made
up of washable ceramics.
 is equipped with special instruments
 Designing and planning consideration of
physical facility of a theatre:
► determination of the numbers of OR.
► future surgical needs of the community.
► future development in surgical technology.

The major consideration during designation
Doors
Surgical support system
►e.g.
►Temperature,
►Humidity,
►Ventilation
►Lighting
Communication and information.
Administration units.
10

The major consideration …….
Doors
►Ideally should be sliding doors.
►Sliding doors
 eliminate the air currents caused by swinging doors.
 disturbs MOs that have previously settled in the room with each swing of the door.
►The microbial count is usually at its peak at the time of the skin incision because this
follows disturbance of air by:
 gowning, draping,
 personnel mov’ts and
 opening and closing of doors.
►During the surgical procedure, the microbial count rises every time doors swing open
from either direction.
►Also, swinging doors may touch a sterile table or person.
►The risk of catching hands, equipment cords, IV line tubing, or other supplies is high.
11

Lighting in the Theatre
►Can be
 Natural light
 Service light
 Artificial light
►Lights should be
 overhead
 freely movable,
 shadowless and
 less heat emitting.

Ventilation in the Theatre
►purpose:
 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.
 Should be 25 times air exchange/hr.
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 OR must be b/n 18.5 and 22oC may exceed to 240C.

The basic design principles
The design must be
►simple and easy to clean & keep it clean
►suitable to prevent cross contamination:
 there should be separate rooms for
• Clean
• Sterile and
• Soiled instruments
 there should be sufficient space
• to ensure safe transportation of patients and staff.
 The layout of department be convenient enough for the supervisors,
►to control incoming and out going traffics.
14

OR Design
All OR must fulfill the following common basic design principles criteria:
1. must always be simple design and easy to clean
2. smooth wall and floor surfaces made of nonporous materials.
3. separate rooms for clean or sterile and soiled instruments
4. sufficient space to ensure safe transportation of pts & staff.
5. convenient layout for the supervisor to control the traffics
6. recovery room attached to the OR.

Organizational Areas in the OR
LOCATION
►centrally located so that easily & quickly
reached from all areas of the hospital, thus
 enabling personnel to transfer pts with the least
possible delay.
►near such support activities as ICU,RR, Lab.
Pharmacy, X-Ray & CMS/CSR
► in a passage with only one outlet, or at least away
from those areas of the hospital through which most
of the traffic flows.
►sufficiently isolated
 to prevent annoyance, anxiety, & disturbance to
other pts.
►near easily reached elevators
 for transportation of pts or supplies.
OR
X-ray
Laboratory
CMS or
CSR
Pharmacy
Recovery
room.
ICU

Organizational Areas…
PHYSICAL LAYOUT
a. Arrangement of rooms within a surgical suite
►should allow efficient workflow.
 E.g., traffic must move smoothly and without interruption into, through,
and out of the suite.
►Proper arrangement of the rooms
 reduces the flow of excess traffic,
 saves much unnecessary walking,
 conserves time and effort.

b. Size of the Suite - determined by numerous factors:
►the operative load or the number of cases to be done per day.
►the types of surgery to be done, is even more specific.
►The number and frequency of emergency cases.
►The average number of OR needed is indicated by
=
the number of operative cases to be done daily
the number of cases that can be done daily in one OR
►Operative load can also be broadly interpreted to include
 the amount of work to be done per day, outside of actual cases.

There is a great deal of
►preparatory work necessary for each surgical procedure
as well as
►the routine tasks to maintain the suite.
If most supplies are prepared and sterilized in CMS,
►the OR suite needs to maintain only a small preparation and sterilization area;
otherwise, it may need a large one.
c. Size of Individual OR
►should have sufficient floor space
 that avoid breaks in aseptic technique due to overcrowding.
►shouldn’t be larger than necessary, thus
 reducing the amount of unnecessary times spent walking.

Organizational Areas……..
c. Zonal division
►are designated by the physical activities performed in each area.
►Three Vs Four Zone Concept
►Three Zone Division
 more common and includes
• Unrestricted area,
• Semi-restricted area and
• Restricted area.
►Four Zone Division
 Protective zone/limited access area/unrestricted area
 Clean/Semi Restricted/Semi sterile zone
 Sterile/restricted Zone
 Disposal Zone

Four Zone Division Concept
►not necessarily used for all hospitals,
►but whenever feasible the OR is segregated into four areas for traffic
control.
The purpose of such control is
►to assure maximum protection against infections.
Traffic control design
►needs determination of specific traffic patterns.
►dependent on the entrances and exits for both personnel & materials.
►is aided by designation of the four-zone concept (as shown below):

Four-zone concept

A. Protective Zone
 is unrestricted Area but limited Access Area.
 street cloths permitted.
 A corridor on the periphery accommodates traffic from outside, including patients.
 isolated by doors from the main corridor and from other areas of the suite.
 Usually separated by red or green line from the next area.
 It serves as an outside-to-inside access area.
 Exit from clean zone and sterile zone
 Transfer or change over section.
 is 1st stage of entry to an operation department
 Includes:
►Recovery room.
►Plaster room
►Change room
►Various offices (e.g. reception offices)
►Seminar and teaching facilities.
23

B. Clean/Semi Restricted/Semi Sterile Zone
It is a transitional zone from unrestricted to restricted area
Traffic is limited to properly attired/dressed personnel
The pt transferred to a clean side & stretcher is on entry to this area.
Approach sterility to operating theatre.
Approach to sterile preparation room.
Head, face and entire body coverings are required
The pt’s hair must be covered.
24

B. Clean/Semi Restricted/Semi Sterile Zone
This zone includes
►peripheral support areas and
►access corridors to the OR.
►Scrubbing room.
►Gowning area
►Anesthetic room
►Exit lobby.
►Clean movements
►Rest area.
►Sterile store.
25
 Attires
are clothes don or worn by each member of the
OR staff
Basic OR attires include:-
Cape or hood – used for covering the hair
Mask – used for covering of mouth & nose
T-shirts and trousers- for covering the trunk
and lower body parts
Shoes- for covering the feet
 purpose
to prevent dissemination of MOs from
sebaceous glands, sweat glands, hair follicles
as well as other body orifices.

C. Sterile/Restricted Zone
 is the place where actual surgery and other sterile procedures are performed.
 is the main OR itself.
 is where complete surgical attire/OR attires including masks, caps, shoes & trousers are
required
 is where sterile instruments are used
 is sterile team members wear (don) sterile gown & gloves.
26

C. Sterile/Restricted Zone…...
 The zone includes:
►the operating rooms.
►sterile preparation rooms.
►scrubbing rooms, scrub sink areas.
►substerile rooms or clean core area(s) where unwrapped supplies are
sterilized.
►Recovery rooms or PACU is by.
27

D. The Disposal Zone
The least clean area of the whole department
The zone includes:
►The disposal room
►Interim storage area
►The disposal corridor
28

Illustration of areas within the OR
A. The supervisor’s Office (A)
► has direct access to the outside of OR.
B.Dressing rooms (B)
► for OR personnel have a door to the outside corridors so that
personnel may enter there, change into scrub attire and go
directly into OR.

Illustration ......
C. The holding area (C)
► is an area designated for the parking of stretchers with
patients awaiting surgery.
► 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.

Illustration …….
D.Scrub sink areas (D)/Scrub (room) area:
► is an area where sterile OR team members perform surgical
hand washing or scrubbing before performing surgical
procedures
► are located in several places close the operating suites.
► Scrub brushes, Caps, Soaps, masks are present at each
scrub station.

Illustration of areas within the OR
E. The workroom (E)
► is located so as to be away from the direct traffic of the
operating suites.
F. The sterile supply room (F)
► serves as a supply depot for wrapped sterile articles.
► Sterilizing room – room where instruments are sterilized

Illustration ……..
G. Storage areas (G)
► for extra equipment and supplies
► are used to store extra instruments and supplies for each unit.
H. The recovery room (H)
► has an access to the outside of the OR for transporting patients back
to their rooms.
I. The operating suites (I)
► are rooms where surgery is performed.

Organizational areas …
Anesthesia room
►Anesthesia preparation area
►Is a room where patients are prepared for anesthesia
►IV line –cannula insertion
►Pre-operative medication given
 Atropine sulphate –to decease secretion
 Morphine – to decrease pain and anxiety

By Ame M.

Major equipment required in Major OR
Pipe line suction apparatus
Sterile hand lotion bowl, unopened packet
Diathermy machine (electrosurgical unit)
Cautery cable with knife and needle packed
Mobile supplementary operating light fitting
Swabs count board.
X-ray viewing screen
Swab or sponge checking rack.
Operating table
Anesthetic machines
O2 cylinder.
Medication table/supply shelf.
37

Wall Clock
►time is critical during surgery,
►each OR should have easily readable
wall clock.
►is used to time tourniquet
applications, administration of
medications, the duration of
cardiac & respiratory arrests and
to note the time of events such as
childbirth.
X-ray Viewing Boxes
►The surgeon may need to view an
X-ray before or during the
procedure.

Operating Table
►used to put the patient in different positions
according to the need of surgery.
►should be fully adjustable in all directions to
create postures needed for various surgical
positions.

Mayo Stands
►This stand is used to hold
instruments that will be used
frequently during a particular case.
Back Table
►The back table is used to place extra
supplies and instruments used
during surgery.

Ring Stand
►The ring stand is used to hold basins
which contains normal saline or
sterile water during surgery.
Kick Bucket
►The kick bucket (a bucket on
wheels) is used to place soiled
sponges during surgery.

Supply Cabinets
►These cabinets are used to store
frequently used items such as
drapes, dressings, solutions, sutures,
etc.
►Cabinets with doors are preferred to
those without so as to reduce
exposure of the content to dust.
STOOLS
►Revolving Stools
►Straight Stool (Footstool

Anesthesia Equipment
Gas Anesthesia Apparatus.
►Pressure regulators for both
oxygen and nitrous oxide.
►Inhaler tubes.
►Oronasal mask.
►Rebreathing bag.
►Water manometer (indicates the
rate of flow of gases).
►Carbon dioxide absorber unit.
►Tanks of O2 and nitrous oxide.
 The anesthetist's table

Anesthesia Equipment
Anesthesia machine
►Used to give oxygen and inhalational
anesthetic agents

Electrocardiography (ECG)
machine
►Used to monitor the electrical
activity of the heart.
Respironics Esprit
►Used to monitor and support
respirations.

Electro-cautery (cautery machine)
►Used for cutting tissues and
stopping of bleeding by sealing
blood vessels.
Suction machine
►Used to suck body fluids

OR Essential Equipment Checklist
Anesthesia Machine
Anesthesia Cart
Anesthesia Circuits
Anesthesia Monitor - CO2 and Agents
Laryngeal Mask Airways
Surgical Table
Patient Stretcher
Patient Stirrups
Positioning Pillows
Restraint Straps and Patient Positioners
Surgical Headlight
Surgical Lights - ceiling mounted
Surgical Microscope
AED/Defibrillator
Vital Signs Monitor
EKG Machine
Video Monitors and Cameras
C-Arms
Ultrasound Machines
Endoscopy Tower
Laryngoscopes
Electrosurgical Unit

OR Essential Equipment Checklist
Smoke Evacuator
Sequential Compression Device
Surgical Tourniquet
Nerve Stimulator
Blood Warmer
Warming Air Units
Central Gas and Suction
Desk/Computer
Medical Cabinetry
Back Instrument Table
Exchange Cart
Hand Table
Mayo Stand(s)
Ring Stand
Prep Table
Utility Cart
Stools (Rolling, Step, etc.)
Linen Hamper
IV Accessories
Needle Counters
Kick Buckets
Biohazard Waste Cans
Sponge Counter Units/Bags

Recovery room (RR)
RR is a place where the pt stays until he/she recovers from anesthesia
after surgery.
ICU and RR are not the same.
ICU is a place where care is given for critically ill patients with any
medical or surgical problem.

Materials required in RR
1. Oxygen and means of delivery + ambubag
2. Monitoring devices: ECG, BP apparatus
3. Suction machine
4. Dressing set
5. Tongue depressor-spatula
6. Kidney dish
7. Emergency drugs
8. IV fluids

Materials required in RR
 Emergency drugs
►Adrenaline
►Analgesics like morphine
►Anti-emetic drugs
 Chlorpromazine
 Promethazine
►Anticholinergic drugs like atropine
 decrease secretion, increase HR
►Sodium bicarbonate –for acidosis
IV fluids
a. Crystalloids – are fluids with lower
molecular weight.
►e.g.
► 5% DW [sugar + water]
► 0.9% NS [salt + water]
► 5% DNS [sugar + salt]
► R/L [water + electrolytes-k, Ca, Mg etc.
b. Colloids – are fluids with higher
molecular weight
► Are plasma expanders –used for
hemorrhagic (bleeding) pts.
 e.g. Dextran, plander, plasmin.

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