OPERATING ROOM

MANAGEMENT
Ns. Retno Setyawati, M.Kep., SpKMB
 OPERATING ROOM (OR)
 The traditional surgical environment, or OR, is a unique
setting removed from other hospital clinical units. It is
controlled geographically, environmentally, and
bacteriologically, and it is restricted in terms of the
inflow and outflow of staff.
 Several methods are used to prevent the transmission of
infection.
 Filters and controlled airflow in the ventilating systems
provide dust control.
 Positive air pressure in the rooms prevents air from
entering the OR from the halls and corridors.
 Role of the perioperative Nurse

 Patient assessment before, during and after

surgery
 Patient and family teaching

 Patient and family support and reassurance

 Patient advocacy

 Performing as scrub or circulating nurse during

surgery
 Control of the environment
 Role of the perioperative Nurse
 Efficient provision of resources
 Coordination of activities related to patient care

 Communication, colaboration and consultation

with other healthcare team members

 Maintenance of asepsis

 Ongoing monitoring of the patient’s

physiological and psychological status

 Supervision and ancillary personnel
 Operating Room Team
The operating room team is subdivided according to the
functions of its members:
1. The sterile team consists of:
a. Surgeon
b. Assistants to the surgeon
c. Scrub nurse
2. The unsterile team includes:
a. Anesthesia provider
b. Circulator/ Runner nurse
c. Others, such as students, cleaners and those who may be
needed to set up and operate specialized equipment or
monitoring devices.
 Surgical Team Member
 SURGEON. The surgeon performs the operation, and
leads the surgical team. Surgeons have medical degrees,
specialized surgical training of up to seven years, and in
most cases have passed national board certification
exams.

 ANESTHESIOLOGIST. Anesthesiologists are

physicians with at least four years of advanced training in
anesthesia.
 Cont…
 CERTIFIED REGISTERED NURSE ANESTHETIST
(CRNA). The certified nurse anesthetist supports the
anesthesiologists, and in an increasing number of
hospitals, takes full control of the anesthesia for the
operation.

 OPERATING NURSE. The general nursing staff is a

critical feature of the surgical team. The nursing staff
performs comprehensive care, assistance, and pain
management during each surgical phase. The operating
nurse is the general assistant to the surgeon during the
Operating Room Team
SCRUBBING
Steps of drying the hands and arms Procedure of Drying Hands
GOWNING AND GLOVING
Removing the Gown
Removing the Gloves
 Phases of the perioperative period
A. Preoperative phase – from the time the decision is
made for surgical intervention to the transfer of the
patient to the operating room.
B. Intraoperative phase – from the time the patient is
received in the operating room until s/he is admitted
to the recovery room.
C. Postoperative phase – from the time of admission
to the recovery room to the follow-up home or clinic
evaluation.
 Perform a time-out
 Conduct a time-out immediately before starting the invasive
procedure or making the incision
 All relevant members of the procedure team actively
communicate during the time-out.
 During the time-out, the team members agree, at a minimum, on
the following:
 correct patient identity
 correct site
 procedure to be done
 When the same patient has two or more procedures: If the
person performing the procedure changes, another time-out
needs to be performed before starting each procedure.
 STERILIZATION
 Sterilization is the process by which all
pathogenic and nonpathogenic microorganisms,
including spores, are killed.

 Sterilization can be achieved with physical or

chemical methods. Physical methods generally
rely on moist or dry heat. Chemical methods on
the other hand, use gaseous or liquid chemicals
 The methods of sterilization in common
– Autoclaving or steam sterilization
– Exposure to dry heat
– Treatment with chemical antiseptics
 Autoclaving should be the main form of use

are: sterilization at the district hospital.

The Chain of
Infection
 Chemical Methods
 Ethylene oxide, gas is used to sterilize items that are
sensitive to heat or moisture.
Its effectiveness depends on four parameters which
include:
• Concentration of EO gas,
• Temperature,
• Humidity, and
• Time (duration of gas exposure)
 Gluteraldehyde 2% and formaldehyde 8% can also be

used as a chemical sterilizer

Physical Methods
 Heat is a dependable physical agent for the
destruction of all forms of microbial life,
including spores. It may be used moist or dry.
The most reliable and commonly used method
of sterilization is steam under pressure.
 Autoclaving
 All viruses including HIV, are inactivated by
autoclaving for 20 minutes at 121-131 C for 30
minutes if the instruments are in wrapped packs.
 It is often more practical to use a small autoclave

several times a day than to use a large machine

once.
 At the end of the procedure, the outside of the

packs of instruments should not have wet spots,

which may indicate that sterilization has not
occurred.
 Dry Heat
 It is suitable only for metal instruments and a
few natural suture material.
 They can be sterilized by dry heat for 1-2 hours

at 170 C.
 Boiling instruments is now regarded as an

unreliable means of sterilization and is not

recommended as a routine in hospital practice.
WATER AND ELECTRICITY
NEEDS
Antiseptics
Cont…
 Operative / procedure area
 Surgical procedures are performed in a location
that is spacious enough to accommodate all
personnel, fittings and equipment required for the
procedure without contamination.
 The lighting is adequate for the procedure

undertaken.
 The ceiling, walls and floors are made from

materials that can be easily cleaned and

disinfected as needed to meet infection control
requirements.
 Cont…
 The operating room is equipped with specialised
ventilation system of internationally acceptable standards
of air quality, including but not limited to adequate number
of fresh air exchange per hour, to prevent the spread of
airborne infectious disease and to minimise surgical site
infection.
 Where gaseous anaesthetic agents are used, appropriate gas
administration devices and exhaust systems are in place,
and relevant requirements on occupational safety should be
observed.
 Adequate area for scrub and gowning is provided for
operating room.
The flow of instruments through the central
sterile supplies department