 The team works to promote the best interest

of the patient every single minute – they must

work efficiently as a functioning single unit
 The members should be thoroughly familiar with
procedures, setups, equipment and policies &
should be able to cope with the unpredictable
 Each member should have a high morale, mutual
Understanding, trust, cooperation & consideration
 All OR personnel should have the proven skill,
knowledge, competency and ability to perform at an
optimal level at all times
 The perioperative team is subdivided according to the functions of its
members: 2. The nonsterile team
1. The Sterile Team
 Anesthesia provider
 Surgeon  Circulator
 First assistant  Perianesthesia nurse
 Scrub person  Others: students,sales representatives,
laboratory or x-ray personnel
STERILE TEAM
 members scrub their hands and arms, don a sterile
gown and gloves and enter the sterile field
 The STERILE FIELD is the area of the OR that
immediately surrounds & is specially prepared for
the patient
 To establish & maintain a sterile field, all items
needed for the surgical procedure are sterile &
handled in a sterile manner
NONSTERILE TEAM MEMBERS
 do not enter the sterile field;they function outside
and around it
 they assume responsibility for maintaining sterile
& aseptic techniques during the surgical procedure
 they handle supplies & equipment that are not
considered sterile
 Following the principles of sterile technique, they
keep the sterile team supplied, provide direct patient
care & handle situations that may arise during the
perioperative care period
 1. PERIANESTHESIA TEAM
 consists of registered nurses & trained patient care
assistants
 preoperatively the RN assesses the patient & documents
findings that is communicated to the intraoperative team
members
2. ANESTHESIA PROVIDER
 is an indispensable member of the perioperative team
 functioning as a guardian of the patient throughout the
entire care period, manages the patient’s physiology using
the principles of aseptic technique
 anesthesiologist is a doctor of medicine or doctor of
osteopathy certified by the board of anesthesiology;it could
be a qualified RN or dentist under the direct supervision of
the anesthesiologist or surgeon
 used to refer to the person responsible for inducing &
maintaining anesthesia at the required levels & managing
untoward physiologic reactions throughout the surgical
procedure & after the procedure until the patient regained
control of his or her vital functions
CIRCULATOR
 is preferably an RN; a qualified surgical technologist
may assist with circulating duties under the supervision
of an RN
 is vital to the smooth flow of events before, during &
after the surgical procedure
 the surgeon relies on the circulator to monitor and
coordinate all activities within the room & to manage
the care required for each patient
 controls the physical & emotional atmosphere in the
room which allows other team members to concentrate
on tasks without distraction
 should be always available at all times to respond to
emergencies in the perioperative environment
  the circulating nurse is vital to the provision of care that includes,
but is not limited to the following:
 Application of the nursing process in directing & coordinating all activities
related to the care & support of the patient in the OR
 Creation & maintenance of a safe & comfortable environment for the
Patient by implementing the principles of asepsis
 Provision of assistance to any member of the OR team in any manner for
Which the circulator is qualified
• Ensure that the sterile team is supplied with every item necessary
• Must know all supplies, instruments & equipment;obtain them quickly
& guard against inadvertent hazards in their use & care
 Identification of any potential environmental danger or stressful situation
involving the patient, other team members or both
 Maintenance of the communication link between events & team members
in the sterile field & persons who are not in the OR but are concerned with
the outcome of the surgical procedure
 Direction of the activities of all learners;must have the supervisory capability
& teaching skills necessary to ensure maintenance of a safe & therapeutic
environment for the patient
 BIOMEDICAL TECHNICIANS (BMET)
-an electro-mechanical technician or technologist who
ensures that all medical equipment is well maintained,
properly configured and safely functional

 NURSING AUXILLIARIES
-
1. SURGEON
 must have the knowledge, skill & judgment required to success-
fully perform the intended surgical procedure & any deviations
necessitated by unforeseen difficulties
 responsibilities include preoperative diagnosis & care, selection
& performance of the surgical procedure & postoperative care
 appropriate clinical skills and appropriate personal characteristics
are important attributes of a surgeon
2. FIRST ASSISTANT
 under the direction of the surgeon helps maintain visibility of the
Surgical site, control bleeding, close wounds & apply dressings
 handles tissues & instruments; their role vary with the type of
procedure or surgical specialty, the condition of the patient & the
type of surgical facility
 the need for assistant depend on: anticipated blood loss,
anesthesia time for the patient, fatigue factors affecting the OR
team and potential complications
 3. SCRUB PERSON
 is a patient care staff member of the sterile team; it may be filled
by an RN, a licensed practical/vocational nurse or an surgical assistant
 used throughout to designate this role & to elaborate on the
specific technical & behavioral functions of the individual performing
on the sterile team
 is responsible for establishing & maintaining the integrity,safety,
& efficiency of the sterile field throughout the surgical procedure
 knowledge of & experience with aseptic & sterile technique
qualify the scrub person to prepare & arrange instruments &
supplies and to facilitate the surgical procedure by providing
the required sterile instruments & supplies
 must anticipate, plan for and respond to the needs of the
surgeon & other team members by constantly watching the
sterile field
 manual dexterity & physical stamina are required to include
stable temperament, an ability to work under pressure, a
keen sense of responsibility & a concern for accuracy in
performing all duties
 Policies & Procedures
 Identification of the Patient
 Identification of the surgical site
 Protection of Personal Property
 Observation of the Patient
 Positioning of the Patient
 Aseptic & Sterile Technique
 Accountability of Accurate Counts
 Use of Equipment
 Prevention of Skin Injury
 Administration of Drugs
 Monitoring the Patient
 Preparation of specimen
 Patient teaching
 INTERDEPARTMENTAL
RELATIONSHIP
GOVERNING BODY
PATIENT CARE SERVICES
• EMERGENCY DEPARTMENT/
PERIOPERATIVE PERIOPERATIVE TRAUMA CENTER
ADMINISTRATIVE NURSE MANAGER • INTENSIVE CARE UNIT
• OBSTETRIC SERVICES
PERSONNEL
• PATIENT CARE DIVISION
CLINICAL
DIRECT CARE OF THE COORDINATOR PATIENT SERVICES DEPARTMENT
SURGICAL PATIENT • RADIOLOGY/NUCLEAR MEDICINE
HEAD NURSE • PHARMACY
PREADMISSION • BLOOD BANK
• PATHOLOGY DEPARTMENT
TESTING PERIOPERATIVE • CLINICAL LABORATORY
BUSINESS MANAGER
OPERATING DEPARTMENTAL SERVICE
ROOM ADVANCE
• MEDICAL RECORDS
PRACTICE NURSE • ENVIRONMENTAL SERVICES
AMBULATORY • FACILITIES ENGINEERING
SERVICES UNIT PERIOPERATIVE • CLINICAL BIOMEDICAL
EDUCATION ENGINEERING
POSTANESTHESIA • MATERIALS MANAGEMENT
COORDINATOR • CENTRAL PROCESSING
CARE UNIT DEPARTMENT
• LAUNDRY SERVICES
OR STAFF NURSES • HUMAN RESOURCES DEPARTMENT
 Surgical procedures were not always performed
within the confines of a formal hospital setting
 Suitable room with less traffic & ambient noise
usually the dining room & occasionally the kitchen
 Fumigated with sulfur dioxide for 12 hours then
scrub with 5% carbolic acid or hot soda solution

 As Colleges of surgeon are instituted operating

rooms were more disclosed in a separate room
intended for surgical procedures & study
  During the Civil War, medical soldiers do the
procedure on the camp field for proper lighting
 Later on, surgical procedures were done inside
the tents to observe aseptic technique

 Because of the theory that surgery contributes to

infection & other related complication, medical
soldiers of the Civil war made their OR more
sophisticated by making underground quarters
  Hospital settings were beginning to built up with
a separate room for the surgical procedures & the
introduction of surgical equipments & steel OR bed

 Significant advances were made in OR settings because of the introduction

of state of the art technologies that continues to improve in the modern era
 The design of the surgical suite offers a challenge to the planning team to
optimize efficiency by creating realistic traffic and workflow patterns for
patients, visitors, personnel and supplies
 Design should also allow for flexibility and future expansion
 The planning and design of the perioperative environment requires a multi-
disciplinary team or design team
 Principles are applied in the construction or renovation planning; it includes
Concepts of the following:
a. Strategic planning
b. Plans for emergencies
c. Exclusion of contamination from outside the suite with sensible
traffic patterns to and from the suite
d. Separation of clean areas from contaminated areas within the suite
during the building phase
e. Noise Control
 Most surgical suites are constructed according to a variation of one or more
of four basic designs:
1. Central corridor or hotel plan
2. Central core, or clean core plan with peripheral corridor or racetrack plan
3. Grouping or cluster plan with peripheral and central corridor
 Location: usually located in an area accessible to the critical care surgical
patient areas & the supporting service departments, the central service or
sterile processing department, the pathology department and the radiology
department
 Space Allocation: space is allocated within the surgical suite to provide for
the work to be done, with consideration given to the efficiency with which it
can be accomplished
 Traffic Patterns: type of design will predetermined traffic patterns;all
persons – staff, patients and visitors should follow the delineated patterns in
appropriate attire
Unrestricted Area: street clothes are permitted;this area is isolated by
doors from the main hospital corridor or elevators & from other
areas of the surgical suite
 Semirestricted Area: traffic is limited to properly attired, authorized
personnel scrub suits & head coverings are required attire;this area
includes peripheral support areas and access corridors to the ORs;
the patient’s hair is also covered
Restricted Area: masks are required to supplement OR attire where open
sterile supplies or scrubbed personnel are located;this area also
include scrub sink areas and substerile rooms or clean core areas
where unwrapped supplies are sterilized;hair covering is worn & masks
are donned as appropriate
 Transition Zones: both patients & personnel enter the semirestricted and
restricted areas of the surgical suite through a transition zone; this zone
inside the entrance to the surgical suite, separates the OR corridors from
the rest of facility
 Preoperative Check-In Unit
 unit is not available for admission of patients who arrive
shortly before surgical procedure, this facility must be
provided within the unrestricted area of the surgical suite
for patients to change from street clothes into gown
 this must ensure privacy compartmentalized with
individual cubicles or be an open area with curtains

 Preoperative Holding Area

 a designated room or area should be available for
Patients to wait in the surgical suite
 hair removal & insertion of IV lines, indwelling urinary
Catheters & gastric tubes may be done here
 anesthesia provider could insert invasive monitoring
lines & give regional blocks
 it requires good lighting;equipped with oxygen, suction,
& devices for monitoring & cardiopulmonary resuscitation
 there is also a nurse station for medication &
Interdepartmental communication
 Induction Room
 this is adjacent to each OR where the patient waits &
is prepared preoperatively before administration of
anesthesia

 Postanesthesia Care Unit

 it may be outside the surgical suite or it may be
Adjacent to the suite so that it may be incorporated into
The unrestricted area with access from both the semi-
Restricted area & an outside corridor
 it becomes a transition zone for the departure of
patients
  Waiting Area
 accommodate both patients and their families
that is conveniently located outside the surgical
suite adjacent to the recovery room

 Dressing Rooms & Lounges

 must be provided for both men & women to change from street clothes
into OR attire before entering the semirestricted area & vice versa
 lockers are usually provided where doors separate this area from
Lavatory facilities & adjacent lounges
 adequate space must be allocated to accommodate the needs of OR
personnel & support services
 the need for equipment, supply & utility rooms and housekeeping determines
support space requirements
 Central Control Desk
 Offices
 Conference Room / Classroom
 Support Services: Laboratory, Radiology Services
 Work Areas: Anesthesia Work & Storage Areas;Housekeeping
Storage Areas,Central Processing Area, Utility Room, General
Workroom
 Storage Areas: Sterile Supply Room,Instrument Room
  an enclosed area for preoperative cleansing of
hands and arms should be provided adjacent to each
OR
 paper towel dispensers & mirrors should be located
in this area;trash receptacles are limited to only those
items used within this room and should be emptied
several times per day
 each OR is a restricted area because of the need to maintain a controlled
environment for sterile & aseptic techniques
 SIZE: varies;it is desirable to have all ORs the same size so that they can be
used interchangeably to accommodate elective & emergency surgical
procedures
 SUBSTERILE ROOM: a group of two or three or four Ors may be clustered
around a central scrub area, work area and a small substerile room;
it contains sink, steam sterilizer, and/or washer-sterilizer
 DOORS: ideally, sliding doors should be used exclusively in the OR because
they eliminate air currents caused by swinging doors;it should not
remain open
 VENTILATION: must ensure a controlled supply of filtered air;air changes
and circulation provide fresh air and prevent accumulation of
anesthetic gases;room temperature is maintained within the range of
20 to 23 celsius
 FLOORS: before floors are conductive enough to dissipate static from
equipment and personnel;at present seamless polyvinyl chloride is
used upto the sides of the walls;slip-proof floor when wet
 WALLS & CEILING: all surface material should be hard, non porous, fire
resistant, waterproof, stainproof, seamless, nonreflective and easy to
clean;walls should be pastel color with paneling made of hard vinyl
materials that is easy to clean & maintain
 PIPED IN GASES, COMPUTER LINES & ELECTRICAL SYSTEMS: vacuum
for suction, anesthetic gas evacuation, compressed air, oxygen and/or
nitrous oxide may be piped into the OR; computer lines for monitors
or personal computers;electrical outlets should be readily available
 LIGHTING: general illumination is furnished by ceiling lights; room lights
are white flourescent but may be incandescent;recessed lights do not
collect dust;lighting should be evenly distributed throughout the room
without harsh shadows & to adequately evaluate the patient’s color
in order not to cause the organs to appear discolored
 X-RAY VIEW BOXES,CLOCKS, CABINETS/CARTS
 FURNITURE & OTHER EQUIPMENTS:stainless steel furniture is plain,
durable and easily cleaned.Each OR is equipped with the following:
 Operating bed with mattress covered with an impervious surface,
attachments for positioning the patient and armboards
 Instrument Tables
 Mayo Stand: it is a frame with removable rectangular stainless steel tray
 Small tables for gowns & gloves and/or the patient’s preparation
equipments
 Ring stand for basins
 Anesthesia machine and table for anesthesia provider’s equipment
 Sitting stools and standing platforms
 IV poles for IV solution bags
 Suction canisters, preferably portable on a wheeled base
 Laundry hamper frame
 Kick buckets in wheeled bases
 Wastebasket
 Writing surface