3. Objectives
At the end of this presentation the student will be able to :
• identify the physical organization of OR
• Differentiate the personnel organization in OR.
• perform the perioperative roles of anesthetics in the OR .
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4. Introduction
operating room /surgery center/
• is the unit of a hospital where surgical procedures are
performed.
• Is designed and equipped to provide specialized care to
patients with specific conditions.
• Is unit where all personnel wear protective clothing to
prevent the spread of germs.
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5. Organization of the Operating Room/OR/
The efficiency of OR depends much upon its:
physical organization
I. Design
II. Equipments.
III. facilities
Personnel organization
unsterile team
sterile team
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6. 1. Design of the OR
• types of designs : many , But
• the basic design principles w/h are common to all OR
must fulfill the following criteria :
1 . Wall and floor surfaces should be
- Smooth
- simple and easy to keep it clean.
2. There should be separate rooms to store clean ,
sterile and soiled equipment & supplies to prevent
cross contamination
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7. Design con..
3. There should be sufficient space to ensure the safe
transportation of pts and staff.
4. The arrangement of the department should be
convenient for the supervisor to control the incoming
and outgoing traffics.
5. The recovery room should be near the OR.
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9. Design con..
Operating table
• Simple standard couch
• Height adjustment
• Operating on the head and neck
• It may be moved out during cleaning
• It can be fixed into the floor with removable
top sections to permit the different positions
of the patient
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10. Design con..
Standard Equipment
• present in most OR’s
• Operating table
• Instrument table ("back table")
• Anesthesia machine
• IV stand
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11. Design con..
Electrical system
• Must have multiple electrical outlets available
from separate circuits.
• This decreases the chances for a blown fuse and
prevents loss of all power if a fuse is blown.
Lighting
• Good lighting
• Mobile lamps
• Operating lights
• Ring light
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12. Design con..
Supply/Equipment Rooms
• Anesthesia supply -holds anesthesia supply
items and extra equipment needed by
anesthesiologists.
Piped-in gas System
For the delivery of compressed air, oxygen,
nitrous oxide etc.... from a central source and
not from tanks in the individual ORs.
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13. Design con..
Vacuum System
• Provides suction used by anesthesia and surgical team
members during surgical procedures.
Ventilation System
• The ventilation system of the operating department permits:
1. Control of temperature (20-22ºC)and humidity (60%)
2. Air filtration to remove microorganisms
3. Rapid and non-turbulent air change in the operating room
4. Must ensure a controlled supply of filtered air to prevent
build-up of anesthetic gases.
5. To control humidity and suppress the build-up of static
electricity.
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14. Areas in the OR
1 Post-Anesthesia Care Unit (PACU) :
• located immediately adjacent to the OR
• Must be staffed by highly qualified nursing
personnel
who can quickly assess the patient's:
• cardiac, respiratory,
• physiologic status
and respond immediately with appropriate assistance.
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15. Areas in the OR Cont…
• Need documentation about pt condition
• Each recovering patient is assigned to a separate area
that is equipped with
oxygen, suction, electrical outlets, and extensive
monitoring equipment.
• An emergency cart is centrally located and equipped
with a defibrillator , airway maintenance supplies,
emergency drugs and other supplies.
• Emergency call buttons are located through out the
department
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16. Areas in the OR Cont…
2.Scrub /Sink area
must be located away from wrapped sterile
supplies
found in near to the operating suites.
Contains :
Caps, masks, antiseptic soap, scrub brushes and
eyeglass at each scrub station.
Universal Precautions may also be found in this
area.
Scrub sinks never ever , be used for the cleanup of
equipment or instruments.
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17. Areas in the OR Cont…
.
3.Anesthesia Supply Room
Is area where used to store all equipment like :
- Anesthesia machines,
- medications
- Airway devices:
LMA
OPA,
mask ,
ETT,
suction tubes …)
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18. Areas in the OR Cont…
4. Sterile Supply Room
• is a clean area and contains all sterilized and packaged
instruments and supplies needed for surgery.
• The supplies must be arranged neatly on shelves
• Supplies here are routinely checked for
"outdates" and for package integrity.
• should be dusted frequently with a damp cloth
• have storage cabinets with doors to minimize
exposure of the supplies to room air and dust.
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19. Areas in the OR Cont…
5.Storage areas
are used to store :
• extra instruments
• equipment's
• supplies for each unit
6.Workroom
is located away from the direct traffic of the operating suites.
It is divided into two separate areas
one for clean instruments & supplies
Other for soiled equipment
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20. Areas in the OR Cont…
7. Equipment Room
• is used to store large apparatus :
such as the operating microscope
image intensifier etc.
• The equipment stored here should be kept free of
dust and cleaned routinely just as in any other area of
the operating room.
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21. Surgical unit
Generally , the surgical unit is divided into four
designated areas :
1. unrestricted area
2.Transition zone
3. semi restricted area
4. Restricted area
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22. 1. Unrestricted area
Unrestricted area -is a point through which staff, patients and
materials enter the surgical unit (serve as an
outside –to- inside access area)
is outside the theater complex
street clothes are permitted
traffic is not limited ; a corridor on the periphery
accommodates traffic from outside
is isolated from the main corridor & other OR suite by
doors.
is control point to monitor the entrance of patients,
personnel, visitors, etc 22
23. 2. Transition zone
• where staff put on surgical attire
• Should allow only the authorized staff (who
perform or assist procedures ).
• Displaying a sign board in local language limiting
the entry of unauthorized persons .
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24. 3. Semi restricted area
Semi restricted area :Is a peripheral area of surgical unit which
includes:
preoperative and recovery rooms,
storage space for sterile and HLD items,
corridors leading to the restricted area , work areas
• Limit traffic to authorized staff and patients at all times
• Staff who work in this area should wear surgical attire and a cap:
to minimizes bacterial shedding,
to provide comfort & professional appearance
• The patient may be transferred to a clean inside stretcher on entry
to this area.
• Have door limiting access to the restricted area
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25. 4. Restricted area
Restricted area it is consists of the operating room and
scrub sinks.
• Limit traffic to authorized staff (staff who perform and
assist procedures) and patients at all times.
• Keep the door closed at all times, except during
movement of staff, patients, supplies and equipment
• Scrubbed staff must wear full surgical attire and
cover head and facial hair with a cap and mask.
Masks must cover the mouth and nose entirely, and be
tied securely
Staff should wear clean& closed shoes
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26. TRAFFIC FLOW AND ACTIVITY PATTERN
Microbial contamination is minimized by:
reducing the number of people permitted into an area
defining the activities that take place there.
• The traffic flow should be limited in:
procedure areas,
surgical units
work areas.
• The space, equipment, and need for a well defined traffic flow
and activity pattern become progressively more complex as the
type of surgical procedure changes (general to open heart
surgery ) surgical units .
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27. Traffic flow and activity pattern c..
• To minimize microbial contamination of specific areas :
Permit only the patient and the staff performing and
assisting the procedures .
Minimize the number of trainees .
patients has to wear
• hospital clothes for major surgery .
• their own clean/hospital clothes during minor surgery
Staff should wear attire and PPE appropriate for the
procedure they are performing.
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28. Traffic flow and activity pattern c..
• prepared 0.5% chlorine solution should be available for
the immediate decontamination of instruments and
other items after procedures .
• A leak-proof, covered waste container should be
available for the disposal of contaminated waste items.
• A puncture-resistant container should be available for
the safe disposal of sharps.
• Clean, high-level disinfected, and sterile supplies should
be stored and available in procedure rooms.
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29. Operating room personnel
• There is a logical division of duties among the OR staff.
• OR Team /staff./
surgeon, one or two assistants ,anesthesia provider
nurses (scrubbed, circulating nurse) , machine operator
, cleaner , etc
• each has specific functions.
• has the patient’s life in its hands.
• Works in team for the successful accomplishment of the
expected outcomes of the patient.
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30. Operating room personnel c..
• The team is subdivided according to the functions of its
members:
1. The sterile team consists of:
1. Surgeon
2.Assistants to the surgeon
3. Scrub nurse
2. The unsterile team includes:
a. Anesthesia provider
b. Circulator/ Runner nurse
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31. Qualities of the Operating Room personnel
1 .stamina /energy, resistance/
Since the job requires
- long hours of standing,
- lifting heavy instrument,
-positioning patients,
which requires good physical condition and have the
energy to complete daily work in a safe and efficient
manner.
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32. 2 .Emotional stability
• The OR work is stressful, w/c can cause team members
to be tense or to display aggressive behavior while
working.
• the OR nurse must be able to cope with self & /or
teammate tension .
• Even the surgeon may express feelings of stress by being
verbally abrupt or harsh.
• not become personally offended by occasional
outbursts.
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33. 3 .Respect
Respect for
• the patient’s rights & privacy,
• Team members,
• self (is an important quality of the OR nurse)
4 .Stable health
OR needs daily presence of employees.
Absenteeism 2ry to health problem increases the work load
on others.
So to prevent this one must be careful to guard against
illness and injury.
• prevention of injury to the back
• maintenance of healthy skin & respiratory tract
(common areas of illness).
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34. 5 .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 .
• knowing self & others jobs is important .
• put personnel problems aside or bring them to the attention
of the supervisor, who might able to resolve them.
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35. Responsibilities of Each Member
1 .Sterile team members
• wash (scrub) their hands and arms,
• put on (don) a sterile gown and gloves, and enter the
sterile field.
• handle only sterile items.
2 .Unsterile team members,
• do not enter the sterile field;
• they function outside and around sterile field
• handle supplies and equipment that are not
considered sterile.
• Supply sterile equipments for sterile team.
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36. A. Responsibilities of the Surgeon
• Preoperative diagnosis and care
• Selection and performance of the surgical procedure
• Postoperative management of care
B. Responsibilities of the Assistant Surgeons
• maintain visibility of the surgical site
• control bleeding
• close wounds and apply dressings
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37. Responsibilities of the Anesthesia Provider
• Anesthesia and surgery are two distinct, but inseparable disciplines;
they are two parts of one entity.
• Adequate communication between the surgeon and the anesthesia
provider is the patient’s greater safeguard.
• The anesthesia provider is an indispensable member of the OR
team.
• Functioning as a guardian of the patient, the anesthesia provider
should observe the principles of aseptic technique.
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38. The main activities of the anesthesia provider are:
• Monitoring vital functions and parameters
• Fluid and electrolyte administration
• Administering anesthetic agent/anesthesia
• Maintaining anesthesia at the required levels
• Managing untoward reactions to anesthesia
throughout the surgical procedure.
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39. Responsibilities of the Scrub Nurse
• Follow what the surgeon is doing.
• This means that the "scrubbed”nurse must have a
constant attention to the operation field.
• Reviews anatomy, physiology, and the surgical
procedure.
• Assists with preparation of the room
• Scrubs, gowns, and gloves self and other members of the
sterile surgical team. 39
40. Con..
• Maintains sterile and an orderly surgical field.
• Assists with the draping procedure. .
• Is constantly alert to any intraoperative dangers.
• Keeps the instrument table neat so that supplies can be
handed quickly and efficiently.
• Anticipates and meets the needs of the surgeon by
watching the progress of the surgery and knowing the
various steps of the procedure.
• Takes part in sponge,needle,& instrument counts
• Identifies and preserves specimens properly. etc
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41. Duties of Circulating
Preoperatively : on Patient Arrival to OR
1. Greets the patient on arrival and assesses his or her level of
consciousness.
2. verify with the patient, the site and side of the procedure.
3. Completes a preoperative care plan such as assessment, plan
implementation, evaluation of expected outcome of nursing care
during the perioperative period & explains the perioperative
phases to the patient.
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42. Con…
4. Answers any pts questions.
5 .Communicates to the Scrub nurse any conditions
that would directly affect his or her preparation for
this surgery.
6. Prepares the patient for any sights, smells or
sounds that might be disturbing
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43. Patient Arrival within the Surgical Suite
1. Assists in the safe transfer of the patient from the stretcher to the
operating table.
2. Assists anesthesia provider .
3. Directs or participates in the initial sponge, needle and instrument counts.
4. Applies patient grounding device when applicable.
5. Ensures that the patient is warm and comfortable while awaiting the start
of the surgery.
6. Offers emotional support to the patient before and during induction of
anesthesia.
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44. Circulating nurse
• In Intraoperative Phase
1. Assists anesthesia provider during induction.
2. Assists in the safe positioning of the patient
3. Maintains aseptic environment within the surgical suite
4. Receives non sterile ends of suction tubing, electrical cords,
power cables, electro cautery pencils, and other items that must
be connected to non sterile units
5. Ties the gowns of scrubbed personnel
6. Adjusts the surgical lights as needed
7. Prevents the unnecessary movement of personnel into and out of
the surgical suite
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45. Con..
8. Directs and participates in instrument counts
9. Aseptically opens and delivers any additional sterile supplies
needed by scrubbed team members
10. Documents :- supplies used during surgery
- intraoperative nursing care
- incidents that occur during surgery
11 .ensuring surgical specimens & place in the right media
12.notifies support personnel such as the x-ray technician as needed.
14 .Delivers any medications needed to the scrub nurse
15. Strictly follows procedure for Universal Precautions
16. Communicates to PACU any necessary equipment that will be
needed based on the patient physiologic needs
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46. Postoperative Duties of Circulating nurses
1. Assists the anesthetist during the pt emergence from GA.
2. Assists the surgical team in the transfer of the pt from the
operating table to the gurney(narrow bed on wheels used in
hospitals) .
3. Accompanies the patient with anesthesiologist to PACU
4. communicating relevant information to individual outside of
the OR,
5. Reports the identity and physical status of the patient &
necessary equipment needs PACU nurse
6.Reports any impairment resulting from the operative
procedure.
8. Reports the type and site of drains, catheters, and tubing.
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47. Item count
• Items(Sponge, Sharp, and Instruments) are counted
before and after use.
• It is performed for pt & personnel safety, infection
control, and inventory purposes.
• foreign body unintentionally left in pt wound site :
1. can be source of wound infection or disruption.
2. Formation of an abscess and development of fistula
between organs
3. reaction development immediate or delayed for
years
4. Sometimes difficult and costly to diagnose.
5. Removal of the object requires major surgery 47
48. Co-operation
• team work need coordination .
• Team members should communicate and should
have a shared division of duties .
• The failure of any one member to perform
her/his role can seriously impact the success of
the entire team.
• No one individual can accomplish the goal
without the cooperation of the rest of the team.
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49. Economical use of supplies & Equipment
Most of the hospital equipment :
• is being imported from abroad & costly
• economical and proper usage is mandatory.
• As the cost of supplies and equipment ↑
, the OR team members should be conscious of ways
to eliminate wasteful practices.
E.g. -Avoid throwing away reusable items
- throw away disposable items only.
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50. Economical use of supplies & Equipmentc..
• The OR is one of the most expensive departments of
a hospital.
• Adequate instruments and supplies are necessary
for patient care, and cost is not always the primary
consideration.
• Economy becomes a hazard when exercised beyond
the point of safety.
• Nevertheless, supplies do not need to be used
generously, for their availability
• “Just Enough Is Enough”.
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51. Time economy
• Time is money; do not waste it.
• Know the policies and procedures, and follow them
efficiently.
• Learn to do things right the first time and continue
to do them that way;
• time is wasted in correcting errors.
• Time is an important element in the OR.
• If time is wasted b/n surgical procedures, the day’s
schedule is slowed down and later procedures are
delayed.
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52. Time economy con..
• The patients and families become anxious during
these delays.
• reducing time
can ↓the prolonged administration of
anesthetic agents, and other medication.
Can ↓ hazards of surgery
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