OPERATING

ROOM
TECHNIQUES
presented by:
LEONARDO C.
MATUNDING,RN,MN

LEONARDO C. MATUNDING , RN,MN 1

Scrubbing
Drying Of Hands
Gowning
Gloving
Preparing Patient’s Skin For
Surgery
Common Surgical Instruments
OR TECHNIQUES
LEONARDO C. MATUNDING , RN,MN 2
MEDICAL ASEPSIS (CLEAN TECHNIQUE)
- Prevent the spread of disease from one person to the another.
- Hand washing is the most important medical asepsis technique. 

SURGICAL ASEPSIS (STERILE TECHNIQUE)

- Use of effective sterile technique. No organisms are carried to the client.
- Microorganisms are destroyed before medical asepsis technique. 

Note: sterile to sterile remains sterile. Sterile to clean or dirty

becomes contaminated.

LEONARDO C. MATUNDING , RN,MN 3

 Related Dirty – object that
Contaminated –
Clean - implies
has not been that many of the
Terms In cleaned or
object was clean
or sterilized
harmful
Asepsis sterilized for
removal of
before it touched
microorganisms
has been
a dirty object.
microorganism. removed.

LEONARDO C. MATUNDING , RN,MN 4

 Methods of
DISINFECTION STERILIZATION
Sterilization

Autoclaving
Process of exposing
articles to steam
Process resulting under pressure or
in the destruction
of pathogens but
to chemical Purpose: prevent
disinfectants long
not necessarily enough to kill all spread of
their spores. microorganisms and
spores.
Radiation microorganisms
and infection

Gas
sterilization
with ethylene
oxide 

LEONARDO C. MATUNDING , RN,MN 5

 General
Principles
Microorganisms Microorganisms
are transferred move from one
from one object to
Microorganisms surface to another as a
move through another result to
space on air whenever a gravity when a
current. non-sterile non-sterile
object touches item is held
another above another
surface. item.
LEONARDO C. MATUNDING , RN,MN 6
 General
Principles

Microorganism
Microorganism
s are released
s travel rapidly
Microorganism into the air on
along any
s move slowly droplet nuclei
moisture
along a dry whenever a
through a
surface. person
wicking
breathes or
action.
speaks.

LEONARDO C. MATUNDING , RN,MN 7

 Principles Of Aseptic Technique

Non-sterile
Persons
persons
who are
avoid
sterile Gowns are
reaching
touch only If in doubt considered
over a
sterile about the Tables are sterile only
sterile
articles, sterility of sterile only from waist
field.
person who anything, at the table to shoulder
Sterile
are not consider it level. level in
persons
sterile not sterile. front and
avoid
touch only the sleeves.
leaning
non-sterile
over a non-
articles.
sterile area.

8
 Principles Of Aseptic Technique

The edges
of anything Sterile
Sterile Non-sterile
that persons
persons persons Moisture
encloses keep
keep well keep away may cause
sterile contact
within the from contaminat
contents is with sterile
sterile sterile ion.
not area to a
area. areas.
considered minimum.
sterile.

9
 PRINCIPLES OF ASEPTIC
TECHNIQUE
 Persons who are sterile touch only sterile
articles, person who are not sterile touch
only non-sterile articles.
 If in doubt about the sterility of anything,
consider it not sterile.
 Non-sterile persons avoid reaching over a
sterile field. Sterile persons avoid leaning
over a non-sterile area.
 Tables are sterile only at the table level.
 Gowns are considered sterile only from waist
to shoulder level in front and the sleeves.
LEONARDO C.
MATUNDING,RN,MN
10
 PRINCIPLES OF ASEPTIC
TECHNIQUE
 The edges of anything that encloses
sterile contents is not considered
sterile.
 Sterile persons keep well within the
sterile area.
 Non-sterile persons keep awa from
sterile areas.
 Sterile persons keep contact with
sterile area to a minimum.
 Moisture may cause contamination.
LEONARDO C.
MATUNDING,RN,MN
11
STERILE FIELDS
 The first principle of surgical asepsis 
states that all materials in a sterile
field must be sterile. All objects added
to your sterile field must also be
sterile. If you put your hands into the
sterile field, they must be covered
using sterile gloving technique and the
gloves should also begin in sterile
packaging.
The second principle states that
a sterile barrier that has been
compromised by punctures, tears
or moisture has to be considered
contaminated. If a sterile field
has been set up and it is
accidentally torn, the openings
can allow microorganisms to
invade and contaminate.
12
STERILE BORDERS

 The third principle states that  The fourth principle states that
once a package is opened, a 2.5 tables draped as part of a sterile
cm (1 inch) border around the field are considered sterile only at
edge is considered unsterile. For the table level. Therefore the table
example, many procedures contain legs, underside of the table, or any
setup of sterile packaging that is
shelves below the table level are to
opened before sterile gloves are
be considered unsterile.
applied. During this time the 1
inch unsterile border is the only
section that can be touched.

13
STERILITY QUESTIONS
 The fifth principle examines 
questions or doubts. It states
that if there are any questions
or doubts about an object's
sterility, the object should be
considered unsterile.
The sixth principle states that
sterile people and objects
should only come into contact
with sterile fields, and
unsterile people and objects
should only come into contact
with unsterile areas, such as
the 2.5 cm border.
14
MOVEMENT AND RANGE OF VISION
 The eighth principle says that
 The seventh principle
states that movement
around or in the sterile
field must not compromise
or contaminate the sterile
field. While performing
procedures requiring a
sterile field, it is important
to remember that correct
sterile technique must
anything out of your range of vision
or below waist level is considered
contaminated and unsterile. For
instance, if an object is dropped
below the waist, it is no longer
sterile. The backside of the body,
which is out of your range of vision, is
also considered unsterile. Therefore,
you should never turn your back on
your sterile field and bring all tables
needed in procedures up to your
waist level 15
AIR EXPOSURE

 The ninth and last principle of

surgical asepsis states that a
sterile object or field can become
contaminated by lingering
exposure to air. While performing
a sterile procedure, one should
stay organized and finish the
procedure as quickly as possible.

16
 All of the equipments
that will be needed
PERFORMING should be assembled
THE before a procedure.
STERILE Thus the nurse avoids
PROCEDURE the sterile area
unattended because the
equipment is missing.

LEONARDO C. MATUNDING , RN,MN 17

 Sterile items are
PERFORMING packaged in paper or
THE plastic containers and
STERILE are impervious to
PROCEDURE microorganism as long as
they are dry and intact.

LEONARDO C. MATUNDING , RN,MN 18

 Sterile supplies have
PERFORMING chemical tapes
indicating that a
THE
sterilization process has
STERILE taken place. The tapes
PROCEDURE changes color during the
sterilization process.

LEONARDO C. MATUNDING , RN,MN 19

 SCRUBBING
AREA

LEONARDO C. MATUNDING , RN,MN 20

CA
P

LEONARDO C. MATUNDING , RN,MN 21

 DISPOSABLE
BRUSH

LEONARDO C. MATUNDING , RN,MN 22

 Brush-Stroke
LEONARDO C. MATUNDING , RN,MN
Method
23
 Put on surgical attire including cap &
mask

Examine hands & forearms for cuts &

abrasions

Remove watches, bracelets & all

finger jewelry

Nails should be clipped and

unpolished

LEONARDO C. MATUNDING , RN,MN 24

 PRE SCRUB
Lather
hands Rinse
n & arms Clean Using
hands
fingernai pick up
thorou ls under
and arms
forcep,
ghly thorough
er running
ly under
remove
up to 2 water
running
brush
with nail from
inches water
t above
cleaner
keeping
dispense
under r, rinse
hands up
the running
allowing
brush &
ds elbow water
water to
apply
and antisepti
with discard
drop
c
s antise after use
from the
solution.
elbows
ptic
agent.
LEONARDO C. MATUNDING , RN,MN 25
SCRUBBING
Scrub nails of hands, 30
strokes L & 30 strokes R

Scrub all sides of each

finger, 5 strokes per
side. Start from the
thumb up to the small
finger.

Scrub the dorsal surface of

the hands in 20 strokes
of circular motion

LEONARDO C. MATUNDING , RN,MN 26

SCRUBBING
Scrub palmar surface of hands in 20
strokes of circular motion

Mentally divide the arm into 3 up to

2 inches above the elbow. Brush
20 strokes for each 3rd of the arm

Repeat 2,3,4&5 for the other arm

and hand, then drop the brush.

LEONARDO C. MATUNDING , RN,MN 27

RINSE Rinse hands and arms
separately without
touching anything,
keeping hands above
elbows

Keep hands in front,

above the waist and not
higher than the axilla
and move to location of
sterile towels.
LEONARDO C. MATUNDING , RN,MN 28
 DRYING
OF
HANDS
From the opened
sterile pack, pick up
folded top end corner
of towel
29
 DRYING
OF
HANDS
Away from table, open towel
in full length by holding
towel on one end in a
slightly bent position to
avoid touching attire
LEONARDO C. MATUNDING , RN,MN 30
DRYING Pat dry fingers, in
between fingers,
OF back and palm of
hands and in
HANDS oscillating motion
dries arm ( Avoid
contaminating
hands in the areas
proximal to elbow )
LEONARDO C. MATUNDING , RN,MN 31
 DRYING
OF
HANDS
Reverse the towel to
start drying the
other hand using the
same procedure
before.
LEONARDO C. MATUNDING , RN,MN 32
 DRYING
OF
HANDS

Discard or drop
towel.
LEONARDO C. MATUNDING , RN,MN 33
GOWNING

Reach down to the

sterile pack and lift
the folded gown
directly upward &
bring away from
table in an
unobstructed area

34
 GOWNING

Hold the pre-folded gown,

carefully locating neck
band & sleeves holding it
at shoulder level.

Allow it to unfold gently.

Do not shake gown.

LEONARDO C. MATUNDING , RN,MN 35

 Place hands
inside the
armholes and
guide each arm
through the
sleeves by
raising and
spreading the
arms.

Do not allow
hands to slide
GOWNING outside the gown
cuff.
LEONARDO C. MATUNDING , RN,MN 36
 GOWNING

Position hands at
shoulder level and
allow circulating
nurse to securely tie or
fasten the gown at the
neck and waist at the
back only.
LEONARDO C. MATUNDING , RN,MN 37
 CLOSED
Open the sterile GLOVIN
inner wrapper G
containing sterile
gloves while hands
are covered by gown
sleeves
Using the left hand inside gown, pick
up folded edge of right glove with
thumb & index finger
Lay glove on the sleeves of the cuff of
the right arm, thumb-side down,
with glove opening positioned
toward the fingers
LEONARDO C. MATUNDING , RN,MN 38
 Position the
CLOSED palm on the
GLOVIN right hand
G upward inside
the sleeve.

Grasp the fold of the

glove through the
gown cuff and firmly
anchor it using the
left hand.

LEONARDO C. MATUNDING , RN,MN 39

 CLOSED
GLOVIN
G
With the left
hand still inside
the sleeve, grasp
the upper side
of the gloves
cuff and stretch
it over the cuff
LEONARDO C. MATUNDING , RN,MN
of the gown. 40
CLOSED
GLOVIN
G
Pull the
sleeves up to
draw the cuff
over the wrist
and extend
the fingers of
the right hand
into the
gloves’
fingers.
LEONARDO C. MATUNDING , RN,MN 41
CLOSED Place the fingers of
GLOVIN the right gloved hand
G under the cuff of the
remaining left glove
Place glove over the
cuff of the second
sleeves. Extend the
fingers into the
gloves while pulling
the glove up over
the cuff
42
 CLOSED
GLOVIN
G

Adjust gloves and

sleeves
Place gloved hands
inside the front
pocket of the
gown
LEONARDO C. MATUNDING , RN,MN 43
OPEN GLOVING

LEONARDO C. MATUNDING , RN,MN 44

OPEN GLOVING

LEONARDO C. MATUNDING , RN,MN 45

OPEN GLOVING

LEONARDO C. MATUNDING , RN,MN 46

 WORKIN
G
IN
STERILE
ATTIRE
LEONARDO C. MATUNDING , RN,MN 47
WORKIN
Keep your hands in
G front of you and above
waist level, below axilla
IN Do not turn your back

STERILE on sterile field

Pass front to front or

ATTIRE back to back with
others in sterile attire
48
Working Change attire when contaminated

in Change or cover attire if wet

Sterile
Attire Warn others of your movements

LEONARDO C. MATUNDING , RN,MN 49

OPERATING
ROOM
SCENE

LEONARDO C. MATUNDING , RN,MN 50

 POSITIONS

Sim’s Position, Posterior View

Knee-Chest Position

Lithotomy Position

Trendelenberg’s Position

Surgical Position for Nephrectomy

Surgical Position for Spinal Fusion

LEONARDO C. MATUNDING , RN,MN 51

FIVE MAIN LAYERS OF THE ABDOMINAL TISS
UE
: SKIN. Skin is the largest organ in the body and the most prominent layer of

the abdomen. This serves as the first line of defense against microorganisms.
 SUBCUTANEOUS. This is also known as the fatty layer since most of the body’s
stored fats is found here.
 FASCIA. This covers the layer of abdominal muscles. It tends to constrict
the muscles to help in the proper contraction. This is the toughest among the
five layers.
 MUSCLE. As the name says, this is the layer that contains the muscles. There
are groups of muscles in this layer that are responsible for the shape of
the abdomen and can be stretched due to age or pregnancy.
 PERITONEUM. This is a thin one-cell thick membrane that lines the abdominal
cavity and indirectly covers some of the most vital organs in the abdomen.

LEONARDO C. MATUNDING , RN,MN 52

LEONARDO C. MATUNDING , RN,MN 53
 SKIN
PREPARATION

LEONARDO C. MATUNDING , RN,MN 54

 SKIN
PREPARATION

LEONARDO C. MATUNDING , RN,MN 55

 SKIN
PREPARATION

LEONARDO C. MATUNDING , RN,MN 56

SKIN
PREPARATION

LEONARDO C. MATUNDING , RN,MN 57

 SKIN PREPARATION

LEONARDO C. MATUNDING , RN,MN 58

 SKIN
PREPARATION

LEONARDO C. MATUNDING , RN,MN 59

 TYPES OF SPONGES
1. OPERATING SPONGES
2. ABDOMINAL PACK
3. MEDIUM PACK
4. SQUARE PACK
5. PROSTATIC PACK
6. NASAL PACK

60
7. CHERRY BALLS
8. EYE PATCH
9. PEANUT
10.COTTONOIDS
11. COTTON BUDS
12. SURGICEL

LEONARDO C. MATUNDING , RN,MN 61

 TYPES OF INSTRUMENTS
DISSECTING or CUTTING

GRASPING or HOLDING

CLAMPING or OCCLUDING

RETRACTING or EXPOSING

LEONARDO C. MATUNDING , RN,MN 62

 TYPES OF INSTRUMENTS
SUTURING or STAPLING

SUCTIONING

ASPIRATING

VIEWING

LEONARDO C. MATUNDING , RN,MN 63

SHARPS

Metzenbaum
Mayo
Suture
scissors
Scalpel

CUTTING INSTRUMENTS

LEONARDO C. MATUNDING , RN,MN 64

SHARPS

blades

DISSECTING INSTRUMENTS

LEONARDO C. MATUNDING , RN,MN 65

 CLA •Kelly
•Mosquito
MP •Medium Curves
•Straight Clamps
S •Ochsners

SURGICAL INSTRUMENTS

LEONARDO C. MATUNDING , RN,MN 66

 • Richardson
• Army Navy
RETRACTOR
• Malleable
S
• Deaver
• Self - Retaining

RETRACTING INSTRUMENTS

LEONARDO C. MATUNDING , RN,MN 67

 GRAS •Tissue Cushings
•ThumbAdson
PERS •De Bakey Russian

SURGICAL INSTRUMENTS

LEONARDO C. MATUNDING , RN,MN 68

 GRASPERS

Bipolar
Electrosurgical
Forceps

SURGICAL INSTRUMENTS

LEONARDO C. MATUNDING , RN,MN 69

ASPIRATING INSTRUMENTS

LEONARDO C. MATUNDING , RN,MN 70

UCTIONING INSTRUMENTS

LEONARDO C. MATUNDING , RN,MN 71

 Babcock Allis

GRASPING INSTRUMENTS

LEONARDO C. MATUNDING , RN,MN 72

GRASPING INSTRUMENTS

LEONARDO C. MATUNDING , RN,MN 73

NEEDLE
•Needles
S&
•Cutting
SUTURE
•Round
S

SURGICAL INSTRUMENTS

LEONARDO C. MATUNDING , RN,MN 74

 Absorbable Non Absorbable
Plain Catgut Silk
Vicryl Ethibond, Ethilon
Monocryl Prolene
Dexon Ti-Cron
Plain Chromic Nurolon

SUTURES

LEONARDO C. MATUNDING , RN,MN 75

Absorbable
SUTURES

LEONARDO C. MATUNDING , RN,MN 76

Non-Absorbable
SUTURES

LEONARDO C. MATUNDING , RN,MN 77

Non-Absorbable
SUTURES

LEONARDO C. MATUNDING , RN,MN 78

Non-Absorbable
SUTURES

LEONARDO C. MATUNDING , RN,MN 79

 Staple Remover

LEONARDO C. MATUNDING , RN,MN 80

 basin

LEONARDO C. MATUNDING , RN,MN 81

 DMC
Set-Up

LEONARDO C. MATUNDING , RN,MN 82