OPERATION THEATRE ETIQUETTE

Presenter
Dr. Sajal
Debnath
Resident Phase-
A
Dept. Of Paediatric
Surgery MMCH
 ZONES OF OT COMPLEX
Outer zone- Rest of the hospital outside the theatre complex
Clean zone- Theatre complex outside the operating area Aseptic
zone- Operating area
Disposal zone- Separate exit for contaminated /used linen,
instruments .
 BEFORE
OPERA TION
Arrive on time, aiming to be about 15 mins early is best.
Before going to theatre, the registrar or consultant will go and see the
patients to take them through the consent form and mark them for the
operation if necessary. It is best to go with them if you can.
Pay attention to the consent process, as you will learn the answers to
some common intra-operative interrogation questions, including what
the procedure involves and any common or serious
complications.
Then time to go and get changed. After changing room work, make sure
you know which theatre you need to go.
 BEFORE
OPERA TION
Scrubbing, gloving and gowning-
It is good practice to wait to be invited to scrub in. You can always ask
permission to scrub in and assist.
Three main different coloured scrub solutions available: povidone-iodine
(Betadine), chlorhexidine (Hibiscrub) and triclosan (SkinSan).
First scrub of the day must always be a full five-minute scrub. After this, any
subsequent ones can be an abbreviated three-minute scrub, provided
have not done anything in between procedures that could grossly
contaminate your hands (e.g. going to the toilet or eating lunch).
 SCRUBBING, GLOVING AND
GOWNING-
If you accidentally touch anything non-sterile at any point, you
have to start all over again!
Most hospitals now promote double-gloving for surgical
procedures, as it provides increased protection against needlestick
injuries and blood-borne virus transmission.
 PREPPING, DRAPING AND THE
STERILE FIELD
Whilst waiting for the patient to be prepped and draped, stand with
your hands clasped in front of you at chest or waist height to stop
yourself from touching anything dirty.
Always ask the consultant where they would like you to stand, they
might want their assistant opposite them or next to them depending on
the procedure.
 PREPPING, DRAPING AND THE
STERILE FIELD
Once the patient is draped, you can approach the table.
It is important to be aware of the sterile field and what you are
allowed to touch.
Things you can touch include the front of your gown above your
waist, the prepped surgical field, the draped area and any
instruments the scrub nurses give you.
Things you can’t touch include everything outside of this area.
 ROLE AS AN ASSISTANT
Speak clearly to other members of the team – don’t whisper as nobody will be able to hear you through your
mask.
Being an assistant is easy. If you do exactly what you are asked to do and nothing else. Your main
responsibilities are likely to include:

🢝 Holding retractors – swap hands at regular intervals to prevent fatigue and cramps
🢝 Cutting stitches and ties – always ask how long they want you to leave the ends, and whatever you do,
don’t cut the knot!
🢝 Using suction (be gentle) and maybe the diathermy (be careful)
🢝 Holding the camera during laparoscopic cases – try to stay as steady as you can, and keep the surgeon’s
instruments in the centre of the screen so they can see what they’re doing
🢝 If you are asked to do something you don’t hear, don’t understand or don’t know how to do, don’t just guess.
Ask the surgeon to explain exactly what they need.
 ROLE AS AN
ASSIST
If you accidentally touchANT
anything non-sterile at any point, you will
need to change your gloves, gown or possibly completely rescrub.
Be honest if this happens, as the patient will be at increased risk of
infection if you become desterilised and then go on to contaminate
other things with your dirty gloves, such as surgical instruments or their
internal organs.
If you drop something or something falls off the table onto the
floor – don’t pick it up! Apologise and say clearly “mop on the
floor” or “forceps on the floor” so a member of the floor team can
come and pick it up. This is very important to make sure nothing goes
missing for the count.
 AFTER THE
OPERA
When the operation TION
is finished, need to de-scrub properly.
🢝 First, remove gown by turning it inside out and rolling it into a
ball before placing it in either the green laundry bin (for reusable
gowns) or the orange clinical waste bin (for disposable gowns).
🢝 Next, check your gloves for holes, remove them by turning them
inside out to prevent blood from flicking everywhere, and place
them in the orange clinical waste bin.
🢝 Check your hands for any bloodstains or cuts that could indicate a
torn glove or needlestick injury.
🢝 Finally, remove your mask and place it in the orange bin too.
🢝 Then go and wash your hands thoroughly for a minute or so –
this is important for infection control.
 AFTER OPERATION
The surgeons will then prepare and
any microbiology/histopathology label samples, write
note. the operation
Thank the team for having you and say goodbye before leaving. Try
and follow up patients after their operation.
Follow up the results of any histopathology or microbiology from
samples taken in theatre. This will give you a better understanding of
normal post-operative recovery and common surgical conditions.
 LOGBOOKS

Keep a logbook of operations you go to. Remember that your list

needs to be confidential, so don’t put patient names on it.
It is very satisfying to keep a log of procedures you’ve seen,
assisted with and performed under supervision – even little things like
stitching up a wound count
COMMON BEHAVIOUR
IN OPERATION
THEATRE
 BEHAVIOUR WHEN PRESENT IN OT
All staff entering theatre should wear scrubs & hats
Please introduce yourself to the nurse in charge of the theatre.
All mobile communicating should only be used for essential
/emergency communication and should be turned to silent.
Always introduce yourself to patient & staff.
Keep doors closed to maintain positive air pressure.
If a patient is being induced by the anaesthesist – do not enter the
anaesthetic room. This is a high task orientated process that require
complete concentration.
Do not use the anaesthetic room as corridor.
Keep a good distance( at least 30 cm) from surgical drapes if you are not
scrubbed.
 -Leaving the operating area in surgical attire is forbidden.
-If a sterile instrument comes in contact with an instrument of doubtful
sterility, it Will lost its sterility.
- Donot do anything without documentation.
Movement should be kept to a minimum.
Do feel free to questions as what & why they (staff) are doing
thing.In general, staff love to be asked questions about theatre work
and will tell everything they know.
The patient should not be left unattended at any time. If you see a
patient who has been left anattended remain with them until a
theatre practitioner arrives.
If you observe any actual or potential break in sterile procedure
even if you are unsure, speak to the practitioner in charge.
Please speak up if you have any concerns about patient safety. All
staff to be mindful of potential damage to equipment.
Any representatives (Equipment company etc) can attend theatre only
at invitation of the surgeon or anaesthesist and following agreement
from the theatre team leader.
-A good surgeon knows how to
operate.
A better surgeon knows when to
operate.
The best surgeon knows when not
to operate.
THANK
YOU