Surgical Technologist Prepares the OR for a Case
Main Text
Table of Contents
Establishing a sterile field, opening and organizing equipment and supplies, and preparing the operating room (OR) for a case are the foundations for ensuring an environment conducive to a safe and efficient operation. Surgical donning of gown and gloves is an integral component of infection control in the OR. Healthcare professionals must adhere to strict protocols to protect both patient and healthcare worker safety. Proper training, vigilance, and attention to detail are crucial in maintaining a sterile environment before and during surgical procedures. This article explores key considerations for healthcare professionals as they open up surgical equipment, establish and maintain a sterile field, doff and don gowns and gloves, and prepare the OR for a surgical procedure.
Infection control is paramount in the high-stakes environment of the operating room (OR). Surgical site infections lead to serious complications for patients and are a significant concern for healthcare providers. Proper surgical doffing and donning procedures are essential to minimize the risk of contamination and maintain a sterile environment.1, 2 The role of surgical technician plays a crucial role in preparing for a surgical case in the OR.
Envelope-folded Packs: Always check the integrity of each pack prior to opening it. When opening an envelope-folded package, adhere to the following:
- Open away from yourself first, then towards yourself.
- Open both sides, selecting the left or right side based on the orientation of the fold. Gently position your hand beneath the fold and unfurl the package in the direction of your hand placement.
- Remember to never cross over the sterile supply.
Gown: This will also be envelope-folded; slightly pulling each tab will help it to lay flat from memory.
Gloves: Open your top glove first, then your indicator so that it is the first glove you have easier access to when you go to gown.
Always check the integrity of the indicators on the exterior of the caskets to ensure the color has changed. Open the casket with the unsterile side towards yourself. If your caskets have additional filters inside, always check them for indicator change and that they are intact.
Be mindful to not touch the outer wrapper below your gown when picking it up so the wrapper stays sterile when your gloves fall off the gown and onto it.
Once you are gowned/gloved, while turning with an unsterile person, remove the left tie and hand the card (with the right tie still in it) to a non-sterile person for them to walk around you. Pull the tie out of the card they are holding without touching it and tie your gown to the left hip.
Tying with two sterile individuals: when you turn with another sterile member of the surgical team, both parties can touch either tie/card and complete the turn.
If your facility has reusable gowns and the person you are turning with is unsterile, you can take the wrapper from your gloves and place the right tie into the paper wrapper and hand it to the unsterile person to walk around you; then pull it out without touching the paper again and tie it to your left hip.
Removing instruments: Make sure to visualize and check the indicator strip inside the casket and make sure that there is nothing unexpected within the pan. The inner pan needs to be lifted straight up to ensure you don’t come in contact with the sides of the pan (unsterile). Lastly, look inside the bottom of the casket to ensure it is also clean/sterile.
Organization: How the back table is organized will depend on surgical technologist, surgeon, and institutional preferences as well as what case is being performed. However, the layout for a basic table setup can be seen in the accompanying video.
Counting:
Soft Goods: Remove the paper wrapper only when you are going to immediately start counting them; separate each item completely from the next so the non-sterile counting individual can easily see them.
Instruments: Keep the stringer in place until you have completed the instrument count; it is best practice to state the instrument first, then count the total so that the documenting individual knows that you are moving to the next instrument.
Remove your outer gloves first, break the tie at the side, break from the waistline, and pull from the back forward rolling down towards your hands. It is possible that your gloves will come off with your rolled gown, but if not, when you go to remove them, make sure to remove one dirty glove by the other dirty-gloved hand, and then your clean hand to your opposite clean hand, and pull them off.
One of the most important responsibilities of a surgical technologist is to establish and maintain the sterile surgical field. Opening and organizing equipment and supplies and readying the OR for an upcoming case involves attention to detail, vigilance, and adherence to strict protocols. Surgical donning of gloves and gowns for yourself and others is an essential part of infection control. Maintaining sterility and organization are the most important factors in providing a safe and efficient setting for a surgical procedure. This sets up everyone, most importantly the patient, for success.
Nothing to Disclose.
Citations
- Garg K, Grewal A, Mahajan R, Kumari S, Mahajan A. A cross-sectional study on knowledge, attitude, and practices of donning and doffing of personal protective equipment: an institutional survey of health-care staff during the COVID-19 pandemic. Anesth Essays Res. 2020 Jul-Sep;14(3):370-375. doi:10.4103/aer.AER_53_20.
- Furtado SV, Perikal PJ, Narayanaswamy M, Ravikumar TV, John L, Harish K. Assessing efficacy of instructor based orientation to donning doffing protocols and modifications to doffing area infrastructure in reducing SARS-CoV-2 infection among doctors assigned to COVID-19 patient care. Infect Prev Pract. 2023 Jun;5(2):100279. doi:10.1016/j.infpip.2023.100279.
Cite this article
Beausoleil L. Surgical technologist prepares the OR for a case. J Med Insight. 2023;2023(383). doi:10.24296/jomi/383.
Procedure Outline
Table of Contents
- Check Outer Integrity
- Opening the Package
- Opening the Basin
- Opening the Gown
- Opening the Gloves
- Checking Integrity
- Opening the Casket
- Checking Integrity
- Organizing
- Counting
Transcription
CHAPTER 1
Hi, I am Lauren Beausoleil.I work at Massachusetts General Hospitalas a certified surgical technologist.Today we're gonna be going through how to open a basic packto set up for any case.
CHAPTER 2
In the morning, typically, we will come inand check the outer integrity of our packs,make sure there's no holes, and then start by opening.
And in our packs here, our basin is wrapped separately,so we'll add it to the ring stand.Each pack and suppliesthat you're gonna open are gonna be an envelope fold,so you'll break the seal and always opening every sterileitem away from you first and then towards yourself.In our packs, our gown is separate.We'll use to set up the tableand as you can see the different color of blue.There's a fold to keep your hands on the unsterile side,pulling it towards yourself.And then from the other side of the table.Like that.
We'll do the same thing with the ring stand and the basin.Once you have both open, they can then come in contactwith each other to keep no gapsbetween your sterile fields.
Our gown - again, an envelope fold away from yourself.And a lot of these have memory to them.A slight tug on either side will keep it fromfalling back up for you.Also keep in mind that you want the edge to be coveredwith the wrap so that there's no way you can contaminateyourself when you go to gown and glove.
Opening up gloves.By placing them on top. Again, making sure that nothinglands within the outer one inchbecause that's considered not sterile in this setting.And then we go and set up.
CHAPTER 3
So this would be opening up a sterile kit.Our count sheets are located on the outside of our caskets,so we would take this off for future use.
Then, again, checking the integrity of the clipsto make sure that both indicators are changedand intact still, breaking both of them off.
Then depending upon your casket system,pop off both sides.And then when removing the cover,you would always keep the sterile field away from yourself.So keeping the non-sterile side closest to youby then reaching towards the middle,pulling up away from yourself.
Inside these particular ones, you would checkand make sure that none of the paper has holes.Also, you can see that the indicator haschanged on both of them.
CHAPTER 4
So depending upon your instruments, some haveto be processed differently.This one has to go in a Sterrad system,so it is peel-packed.Breaking the seals - also an envelope fold.So you would go away from yourself, to your right,to the left, and then towards yourself.
CHAPTER 5
After you scrubbed, come inand grab your gown, making sure not to touch the bottom.And then at the top, there's two pocketsthat will become your sleeves.So let it, stepping back, drop down.You always wanna make sure that your hands areinside the cuff of your gownbecause the end of it is not sterile.Open.Fold it over.Once you've placed both of them, you're then ableto put your second pair on more freelybecause you're now completely sterile.And then on your gown, you have a sterile side of it.In order to close it, you separate.Give the card to somebody else.And you can tie it.At which point then you're readyto start setting up your table.
CHAPTER 6
This will be organizing and setting up your back table.So each pack is slightly different,but you'll have gowns, towels,and other sterile supplies that you would need for the case.It's much easier if you find your Mayo cover first.If you lay it flat out on your table,it nicely will tell you that your left handand your right hand to go.Sliding it up and over.It's always nice to have another layer on top of itto protect it.All right.In organizing your back table, it is helpfulto always do the same thing, as I was taught years ago,the saying of, "Touching everything oncewill help make your process faster."You obviously will get faster as time goes along,but additionally, the more familiar you are with the packsthat you're using - everything has a home.So my towels will go into my basin.Set these up.The pitcher will go inside another basinso that there's no spillage from it.And strike through on your back table.This pack comes with sponges for us.Your suction. And your suction tip can goto the Mayo stand.Depending upon your facility,the back table setup will have some slight variations,but our sharps go about in the middle of our tableswith our needle counter.Trash bag.For all trash during your case.I try not to put trash from my table setup into it.It just makes it easier as your day goes on to have lesspretrash in it because it can get heavydepending upon the length of your case.This will go in here.Our packs have labels in them for us already.We have 0, 2-0, and 3-0 silk ties,and then also two blades.The first one, every pack will have a 10 blade.Obviously being mindful when opening themthat it is a sharp.And then your light handle covers.This is all trash.And then once all of your small things have been organized,you then need to create a towel rollfor your instrument set.Depending upon the size of instruments,and what you're gonna be using, will vary the lengthof the roll needed.Once that's all set,grab all your instruments to set up on your table.We would reach in to find the indicator,make sure the indicator has changedand that you don't see anythingthat does not belong inside your kit.Reach inside of your pan to grab your handles.Lifting straight up to not hit your sides.And then also looking in to make sure that nothingis at the bottom that's not supposed to be there.Come over to place your pan on your back tableto start organizing what's inside of it.Once your instruments are on your back table, reach inside.Most of our forceps, knife handles,and suctions are in a nice wrap fold for us.And any instruments that can be separated like thisPoole suction - when it's processed,it cannot be put together the way that I just did.Otherwise it will not be sterile.Your knife handles.And then inside here...Arrange your instruments in the order of the count sheet.Our clip appliers.And then our basic general hasa few different instruments,but you have your wide malleableand a thin malleable,a large abdominal retractor,two Weitlaners,and then two Riches.Your forceps.
Once your back table is organized,you're then ready to count.Here we start with our soft goods first.So you would break the wrap on it.And as you go to count, you wanna make surethat you completely separate one from the rest of the bunchso that you can - you and both yourselfand your circulator can see the separation sothat you know there's nothing else hiding.So we would go one, two, three, four, five,six, seven, eight, nine, ten sponges, or Ray-Tecs.After your sponges,we have blades for one, two. No sutures.Scratch pad for one.That is countable items open for right now.Next would be our instrumentation.You want to make sure to not removewhatever system you guys have holding all your instrumentstogether until you're ready to count with your circulator.We would start off with knife handles, for ours,we have one, two, three.Moving to your stringer - scissorsfor one, two, three, four, five, six, seven.As you can see the separation between in each instrument sothat you can, again, both yourselfand your circulator, who's not sterile,can see the definition between the two.Needle drivers for one, two, three, four, five,six, seven, eight, nine, ten.Snaps for one, two, three, four, five, six.Kellys for one, two, three, four, five, six.Schnidts for one, two, three, four, five,six, seven, eight, nine, ten, eleven, and twelve.Babcocks for one, two.Allises - one, two, three, four, five, six, seven, eight.Kochers for one, two, three, four.Moynihan's for one, two.Right angles - one, two, three, four.Sponge sticks for one and two.Towel clips - one, two, three, four, five, and six.Forceps - we have one, two, three, four, five,six, seven, eight, nine, ten, eleven.Retractors - we have one, two, three, four, five,six, seven, eight.Clip appliers for one, two, three, four.And then we have one, two blue clips.And suction tips - there's one, two, and three.For this table setup,that would conclude your counting process.So when taking sterile supplies from someone else,they will fold it out, providing it to you,and then you can take it to your fields.Same with the suture.Thank you.So counting as sterile supplies,both of these are countable items.So you would have sutures or needles for one, two.And lap pads - one, two, three, four, and five.That concludes setting up your back table.
CHAPTER 7
So in order to doff off your sterile stuff,take off your outer glovesthat would be dirty from your case.Then break your tie on the side, grab by your hipsto roll the rest of it off.Roll down and away from yourself.And then if your gloves are still on,you would take the sterile side to the inside,and then skin side to skin.