Operating Room exposure is one of the most stressful experiences for newcomers. Student nurses, even with the assistance of the clinical instructor, seem to act as if they have not yet seen blood, shiny instruments and others. Some faint due to nervousness, others avoid receiving orders from their CI due to fear of committing mistakes. Only few can maintain a sturdy composure on their first OR experiences.
Presence of mind is the key factor to a successful operation. Surgeons, anaesthesiologists, and nurses wear that green gown and stand for several hours not just for learning purposes, but, most importantly, to save the life of that unconscious person lying in front of them.
To prevent rapid development of infection, the basic surgical approach was introduced-the Operating Room Technique. OR personnel are prone of committing errors on surgical asepsis when they are in a hurry or in their “first blood”.
A mnemonic is hereby developed to enhance absorption among students through easy to recall words and phrases. If this shows a remarkable effect, it would be of great help in creating a colorful first Operating Room exposure among students.
There are two common words that come into laymen’s mouth when they hear the words: operating room, incision, and scalpel; these are “OPERATION” and “OUCH!” Out of these words, my OR technique will now then be presented in 13 basic principles.
–Only sterile persons can go near the sterile field.
- The sterile field is not necessarily pointing out the whole operating room, rather, the area of operation and its immediate extension (from the operative site to approximately 1-2 meters behind the surgeon, the assistant surgeon, the anaesthesiologist, foot part.
Persons to conduct the operation should be on sterile suit.–
- Sterile suit includes a clean scrub suit set (with turban, mask, and OR shoes), sterile gown and gloves.
- A basic surgical team includes the surgeon (captain), assistant surgeon/s, anaesthesiologist/s, scrub nurse/s, and circulating nurse/s.
Everything on top of a properly draped table are considered sterile.–
- There are one or more table/s to be used in an operation.
- A properly draped table is sterile; everything on it must be sterile.
- A single unsterile item can contaminate the whole set on the table.
Range of sterile parts of a gown is from the waist to the shoulder and sleeves.–
- The back portion and below the waist level are considered unsterile though it came from a sterile packaging.
-Anything below the table level is considered unsterile.
- All materials accidentally dropped or had in contact with anything below the table line should not be reused in the operative site. Put it in a corner for future use (counting).
- Always inform or notify the circulating nurse of any dropped object for replacement if necessary.
– Time is a valuable factor.
- Timing is important for documentation and legal purposes. It includes induction of anesthesia, start of operation, “specimen out”, end of operation, and end of anesthesia.
- The shorter the time of operation and the shorter the time between the preparation of equipment and the start of the procedure, the better.
-In case of doubt on the sterility of an item, ask for a replacement.
- All personnel should be on constant watch of the materials used during the operation.
- Use only items that came from a sealed packaging. It must be opened up near the instrument nurse.
-Only sterile areas should face the sterile field.
- When moving from one place to another, members of the surgical team should do the “back-to-back” maneuver to avoid contaminating each other.
-Never stop counting.
- The instrument and circulating nurses should perform synchronous counting of instruments, needles, blades, sponges, and others before the incision, during the operation, and before closing or suturing. This is done to make sure that nothing is to be left inside the operative site.
-Omit, replace, or cover wet areas.
- Microorganisms multiply more rapidly on moist surfaces.
- This is to hold their number to the least possible.
- Avoid placing reusable instruments in contact with wet articles.
-Used materials should be properly placed.
- Blade/s should be in a corner of the table (sharp facing outward).
- Needles and sponges should be within sight for easy counting.
-Coordination is vital.
- Anticipating what to do next and/or what to serve next is important. This is to lessen the load and speed up the procedure.
H -Hold position as much as possible.
- This is to prevent accidental contamination of articles.
-These were just some of the fundamentals in OR principles. It MUST be strictly followed for the sake of the patient. Surgical conscience should always be present, admitting of errors is better than compromising the result of the whole operation.