This article will introduce the operating room and illustrate proper masking scrubbing gowning gloving and OR medical, much of the anxiety associated with this restricted area can be alleviated by understanding a few basic concepts, that are nearly universal to all operating room suites and sterile procedures in general.

The first is to ensure that you are both authorized and properly attired to be in any controlled area of the operating room suites. These include clean semi restricted areas where traffic is limited to authorized staff and patients, as well as those restricted zones that include the operating rooms themselves and adjacent sub sterile areas. These restricted areas are usually separated by clearly marked doors or designated behind lines on the ground that are usually red, when in these areas it's necessary to be dressed in a hospital specific surgical scrub suit, and wearing a surgical cap and shoe covers, a surgical mask is also required before entry into any sterile area such as an operating room.

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MAKSING

Various types of surgical caps masks and eye protection are available to be worn in the operating room such as this bouffant mask and separate disposable eyes shield, or this skullcap with similar masks and separate eye shield. However in this example we will be demonstrating donning of a mask with a built-in face shield, with any mask that ties around the head, it is typically easiest to first secure the upper ties near the top of the head, and then adjust the mask to fit snugly over the bridge of the nose and over the mouth and chin before securing the lower ties behind the neck. Pinching the mask on the nose to hold it in place while slightly pulling away the plastic face shield can help prevent fogging.

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SCRUBBING

Before scrubbing into any surgical procedure remembered remove all jewelry from your hands and wrists and store them securely, please be aware that placing items such as rings into the pockets of your scrubs can put them at risk of inadvertently falling out and becoming lost. It may be safer to tie important items to your scrubs if you're going to keep them and not secure them in a locker or other safe location. Before the first scrub of the day be sure to thoroughly wash your hands and forearms with soap and water.

It is necessary to perform a surgical hand scrub before gowning and gloving when participating in any sterile operating room procedure. The purpose of the surgical scrub is to remove debris and transient microorganisms from nails, hands and forearms. It is also used to reduce resident microflora as well as inhibit rapid rebound growth of microbes, there are multiple acceptable choices for scrubbing and disinfecting your hands and arms such as scrub brushes which are already impregnated with disinfectant solutions like iodine or alcohols such as chlorhexidine. As well as waterless hand sanitizers, which typically also contain alcohol. However, waterless hand sanitizers are not appropriate prior to the first scrub of the day.

Below the photo will demonstrate the step of the scrub, scrub which lasts between three and five minutes, having removed all jewelry and washed hands before the first scrub of the day, select the desired scrub brush and peel it open in order to remove the nail file and brush from its packaging, and dispose of the packaging into an appropriate trash bin. Use the nail file to clean under each nail of both hands. When finished, dispose of the nail file into an appropriate trash bin. Now with the water running, let the brush while squeezing the sponge in order to create foam, the time scrub now starts with the first two minutes focused on the hands, beginning with one hand and following with the other, scrub each side of each finger. Then scrub between each finger. Finally scrub the backs of the hands and the palms.

when the hands are finished continue to scrub each side of the arms to just above the elbow for the next minute. when the scrub is complete, dispose of the brush in the appropriate trash bin, do not leave any of the items used to scrub in the sink. Next, rinse your hands and arms from the fingertips to the elbows, ensuring to keep your hands above your elbows so that the contamination runs away from your hands and not towards them.

If your hands touch anything other than the brush after beginning the scrub, the scrub process must be extended by one minute for the contaminated area. Once the scrub is complete turn off the water and walk into the operating room, ensuring that your hands and arms do not come into contact with anything else, keep your hands and arms elevated and away from your chest but do not raise them above your shoulders.

GOWNING AND GLOVING

when entering the operating room after scrubbing, let the surgical tech know that your hands are wet, and they will hand you a sterile towel, dry each hand and arm separately using one end of the towel for each. While drying bend slightly at the waist so that the towel does not contact anything but your hands and arms, be sure to dispose of the towel in an appropriate trash bin or wherever instructed by the operating room staff. As a new student you will typically be assisted with gowning and gloving, when the surgical tech opens and presents your gown place your arms within each sleeve and allow the tech to adjust the sleeves in order to properly expose your hands. Be sure to keep your hands and arms elevated while donning the gown, the nurse will then secure and tie your gown in the back.

The surgical tech will then open and present your gloves, typically starting with the right, place each appropriate hand into the gloves, being careful to avoid touching anything but the inside of the glove with your exposed hand. Wait until you are fully gound and both gloves are on before you attempt to adjust your gloves to avoid contamination. To complete your gowning and gloving process firmly grasp the belt in tab with your right hand and separate the tab from the tie that is held with your left hand. Give the tab and belt to the surgical tech or nurse and turn toward your left until you've made a full circle, then firmly grasp the belt that is being held by the tab and pull it away until they separate, tie the belt and then keep your hands and arms elevated.

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In this article photo, we will again demonstrate the process of gowning and now double gloving. once more notice process of turning to the left, in order to tie the surgical gown when gloving is complete. Pay particular attention to how the arms and hands are kept from contamination by keeping them elevated and close to the chest.

MAINTAINING STERILITY

To maintain sterility, once you have scrubbed into a case, remember a few key principles, when you are gound and gloved your hands and arms are considered sterile up to the axillax’ the front of your gown is also consider sterile from the waist up to a few inches below the neck opening, please note that no other part of the gown is considered sterile. Therefore it’s important to always face the sterile field, as the back of the gown is not sterile and could inadvertently contaminate the field or another member of the team.

As well, if the gown is touched by an unsterile object it is then considered contaminated and must be removed, so you will have to repeat the process of scrubbing back into the case. As is demonstrated here, it is good practice to keep your hands and arms elevated above the waist and close to the chest when scrubbed in but not at the sterile field. When standing at the sterile field however it is safest to keep your hands on the draped field near the surgical site but do not bear weight on the patient as this could cause injury, when in doubt ask your attending surgeon or other member of the team where you should stand and place your hands.

As well if you’re on the side of the back table which holds the sterile instruments used for the case, it is very important to be mindful of its location and how to navigate around it without contaminating. Contamination of the back table could require breakdown of the entire set and setting up an entirely new table and instruments. This would cause at the least a substantial delay in the case and may even result in danger to the patient. As it's often necessary for staff to change positions or sides when operating, so don't be surprised if you are asked to move during a case or change positions with another member of the surgical team.

It is important though to understand how to perform this interchange in sometimes tight quarters, without contaminating yourself or others. Here we demonstrate how to properly change positions with another member the team by turning back to back. You will notice that turning toward the back table avoids contamination of either team member or the table as sterile fields are maintained.

One example common to medical students is adjusting the operating room lights without approval this should never be done without asking the attending surgeon first as it may unintentionally worsen their view of the operative field or cause distraction that could lead to harm for the patient.

Another example is taking instruments from the back table without asking the surgical tech for permission, this is a common mistake made by new medical students who are eager to be involved in the case and cut sutures. However, removing suture scissors or other instruments without asking, may cause confusion as to the location of the instrument or could even lead to an injury such as a needle stick or accident with another sharp instrument if the tech is focused elsewhere.

Even reaching for instruments on the surgical field in an honest effort to help could lead to inadvertent injury or contamination and should be avoided less asked. Remember that the surgical instruments Mayo stand and back table are the domain and responsibilities of the surgical tech.