Introduction ORT

INTRODUCTION TO
OPERATION TECHNIQUE
Introduction to OR Technique July, 2021 © Haramaya University, CHMS,

By:- Ame Mehadi (BSc, MSc) Department of Emergency and Critical Care Nursing
By Ame Mehadi (BSc, MSc EMCCN, HDP)
Lecturer and Head, Dep’t of Emergency & Critical Care Nursing
Trainer, WHO Basic Emergency Care & Perioperative Nursing Training
Director of Nursing & Midwifery Service
of Emergency & Critical Care Nursing

School of Nursing & Midwifery
Collage of Health & Medical Sciences

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

By:- Ame Mehadi (BSc, MSc-EMCCN) Department of Emergency and Critical Care Nursing
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

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.
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.

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

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.

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.
Lighting in the Theatre Click ion to add picture
►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.

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 X-ray
least possible delay.

►near such support activities as ICU,RR, ICU Laboratory
Lab. Pharmacy, X-Ray & CMS/CSR

► in a passage with only one outlet, or at least away OR
from those areas of the hospital through which most
of the traffic flows. Recovery
room.
CMS or
CSR
►sufficiently isolated
 to prevent annoyance, anxiety, & disturbance Pharmacy
to other pts.
►near easily reached elevators
 for transportation of pts or supplies.
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
►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.
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.

B. Clean/Semi Restricted/Semi Sterile Zone
 This zone includes
►peripheral support areas and  Attires
►access corridors to the OR.  are clothes don or worn by each member of the
►Scrubbing room. OR staff
 Basic OR attires include:-
►Gowning area
 Cape or hood – used for covering the hair
►Anesthetic room  Mask – used for covering of mouth & nose
►Exit lobby.  T-shirts and trousers- for covering the trunk and
lower body parts
►Clean movements
 Shoes- for covering the feet
►Rest area.
 purpose
►Sterile store.
 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 is performed.
 is the main OR itself.
 is completely restricted
 is where sterile procedures are carried out.
 is where surgical scrubbing is done
 Lay up/surgical preparations for items
 Masks are required to supplement surgical attire/OR attires
 Masks, caps, shoes & trousers are required
 Sterile instruments are used
 Sterile team members wear (don) sterile gown and gloves.

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 near by(post anesthesia care unit).

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


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.
 Wall Clock  X-ray Viewing Boxes
►time is critical during surgery, ►The surgeon may need to view an
►each OR should have easily readable X-ray before or during the
wall clock. procedure.
►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.

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

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

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

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

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

OR Essential Equipment Checklist
 Anesthesia Machine  Surgical Lights - ceiling mounted
 Anesthesia Cart  Surgical Microscope
 Anesthesia Circuits  AED/Defibrillator
 Anesthesia Monitor - CO2 and Agents  Vital Signs Monitor
 Laryngeal Mask Airways  EKG Machine
 Surgical Table  Video Monitors and Cameras
 Patient Stretcher  C-Arms
 Patient Stirrups  Ultrasound Machines
 Positioning Pillows  Endoscopy Tower
 Restraint Straps and Patient Positioners Laryngoscopes
 Surgical Headlight  Electrosurgical Unit
OR Essential Equipment Checklist
 Smoke Evacuator  Mayo Stand(s)
 Sequential Compression Device  Ring Stand
 Surgical Tourniquet  Prep Table
 Nerve Stimulator  Utility Cart
 Blood Warmer  Stools (Rolling, Step, etc.)
 Warming Air Units  Linen Hamper
 Central Gas and Suction  IV Accessories
 Desk/Computer  Needle Counters
 Medical Cabinetry  Kick Buckets
 Back Instrument Table  Biohazard Waste Cans
 Exchange Cart  Sponge Counter Units/Bags
 Hand Table
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 IV fluids
►Adrenaline a. Crystalloids – are fluids with lower
►Aminophyline molecular weight.
►e.g.
►Analgesics like morphine
► 5% Dextrose in water (DW) [sugar +
►Anti-emetic drugs water]
 Chlorpromazine ► 0.9% Normal saline (N/S) [salt + water]
► 5% Dextrose in saline (DNS) [sugar + salt]
 Promethazine
► Ringer lactate (R/L) [water + electrolytes-
►Anticholinergic drugs like k, Ca, Mg etc.
atropine b. Colloids – are fluids with higher molecular
 decrease secretion, increase HR weight
► Are plasma expanders –used for
►Sodium bicarbonate –for acidosis hemorrhagic (bleeding) pts.
Introduction to OR Technique
 e.g. Dextran, plander,July,
plasmin.
2021 © Haramaya University, CHMS,

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INTRODUCTION TO

Introduction to OR Technique July, 2021 © Haramaya University, CHMS,

Lecturer and Head, Dep’t of Emergency & Critical Care Nursing

Trainer, WHO Basic Emergency Care & Perioperative Nursing Training

Director of Nursing & Midwifery Service

of Emergency & Critical Care Nursing

Introduction to OR Technique July, 2021 © Haramaya University, CHMS,

Introduction to OR Technique July, 2021 © Haramaya University, CHMS,

Introduction to OR Technique July, 2021 © Haramaya University, CHMS,

Introduction to OR Technique July, 2021 © Haramaya University, CHMS,

Introduction to OR Technique July, 2021 © Haramaya University, CHMS,

 Designing and planning consideration of

Introduction to OR Technique July, 2021 © Haramaya University, CHMS,

Introduction to OR Technique July, 2021 © Haramaya University, CHMS,

Introduction to OR Technique July, 2021 © Haramaya University, CHMS,

Introduction to OR Technique July, 2021 © Haramaya University, CHMS,

Introduction to OR Technique July, 2021 © Haramaya University, CHMS,

least possible delay.

Lab. Pharmacy, X-Ray & CMS/CSR

Introduction to OR Technique July, 2021 © Haramaya University, CHMS,

►The average number of OR needed is indicated by

►Operative load can also be broadly interpreted to include

Introduction to OR Technique July, 2021 © Haramaya University, CHMS,

►Three Zone Division

Introduction to OR Technique July, 2021 © Haramaya University, CHMS,

Introduction to OR Technique July, 2021 © Haramaya University, CHMS,

Introduction to OR Technique July, 2021 © Haramaya University, CHMS,

Introduction to OR Technique July, 2021 © Haramaya University, CHMS,

Introduction to OR Technique July, 2021 © Haramaya University, CHMS,

Introduction to OR Technique July, 2021 © Haramaya University, CHMS,

Introduction to OR Technique July, 2021 © Haramaya University, CHMS,

B. Dressing rooms (B)

Introduction to OR Technique July, 2021 © Haramaya University, CHMS,

Introduction to OR Technique July, 2021 © Haramaya University, CHMS,

Introduction to OR Technique July, 2021 © Haramaya University, CHMS,

F. The sterile supply room (F)

H. The recovery room (H)

I. The operating suites (I)

Introduction to OR Technique July, 2021 © Haramaya University, CHMS,

Introduction to OR Technique July, 2021 © Haramaya University, CHMS,

Introduction to OR Technique July, 2021 © Haramaya University, CHMS,

Introduction to OR Technique July, 2021 © Haramaya University, CHMS,

Introduction to OR Technique July, 2021 © Haramaya University, CHMS,

Introduction to OR Technique July, 2021 © Haramaya University, CHMS,

Introduction to OR Technique July, 2021 © Haramaya University, CHMS,

Introduction to OR Technique July, 2021 © Haramaya University, CHMS,

Introduction to OR Technique July, 2021 © Haramaya University, CHMS,

Introduction to OR Technique July, 2021 © Haramaya University, CHMS,

Introduction to OR Technique July, 2021 © Haramaya University, CHMS,

Introduction to OR Technique July, 2021 © Haramaya University, CHMS,

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