Chapter 12: The OR and The Surgical Field

INTRODUCTION

The surgical field is the sterile field that is set up by the scrub tech and consists of the draped patient, the back table, and any equipment that is draped out, such as microscopes, slush machines, and c-arms. The scrub tech will open the field, supplies, and instruments and then scrub in. Once they are scrubbed they will self-gown and glove and begin the setup process (Figure 12.1). The goal is to create and maintain a sterile environment for the patient.

Whether you are scrubbing in or coming to observe for a case in the operating room, there are a few things that everyone has to do before “crossing over” into the actual operating rooms:

1. In the operating room dressing area, change into hospital-issued OR scrubs. No shirt should be worn under the scrub top—nothing should be hanging out from the sleeves or neck.

2. Remove jewelry and put it somewhere secure so you don’t lose it. Allowing earrings and necklaces in the OR is a hot topic of debate, so always check with your facility. If earrings are allowed, be sure they are secure and are covered by your hat. No one wants to search through an open abdomen for your earring because the back fell off (yes, it has happened).

3. Dedicated OR footwear or shoe covers should be worn. You don’t want to bring anything from home into the OR and you certainly don’t want to take anything from the OR into your home.

4. Put on a clean hat. The hat must cover all hair and for that reason many facilities no longer allow skullcaps. And don’t forget a mask.

5. Do not bring bags or other personal belongings into the operating room. It is a clean environment, and bags and other items bring microorganisms in.

6. When you enter the OR, introduce yourself to the circulating nurse (at a minimum). If you haven’t met the surgeon before, it’s your responsibility to introduce yourself and tell them why you are there.

IF YOU ARE OBSERVING

If you are not going to be putting a gown and gloves on but are coming to watch the case, there are some important tips to remember:

1. Non-scrubbed staff should stay at least 12 inches away from the sterile field at all times. If it’s blue and you’re not scrubbed, it’s not for you.

2. Never cross between two sterile fields. For example, if you need to go to the other side of the room, don’t cut between the instrument table and the draped OR bed. Always go completely around.

3. Do not turn your back to the sterile field. Always ...