Faculty of Nursing & Health Science

advance nursing
Nurse 337

OR report

fall 2020
presented by:Mohammad Hmidan

What Is the Operating Room?

• It is a place in a building enclosed and set apart for occupancy or for the

performance of certain procedures.

• The members of the OR team include the surgeons, anesthesia staff, and the

nursing staff. Members of the surgical team are the surgeon, surgical

assistants, and scrub nurse, circulatory nurse responsible for the instruments,

gowning the surgical team, and maintaining a sterile field, and technician.

• Structure of the O.R in H clinc:

• The operation ward in H clinc hospital is located in the second floor of the

hospital.

• There is two main entrance for the O.R in H clinc hospital. The two doors

only opens through a security code and therefore only who has this code can

enter the room such as: Doctors, nurses and cleaners.

• After entering from the main door of O.R, There are three divided areas

based on varying degrees of cleanliness:

• Unrestricted: clean area where nurses receive patients from different wards.

• Semi restricted: located between restricted and unrestricted areas and the

team should wear the ward’s cloths, overshoes and head cover.
• Restricted: op rooms, the team should use sterile cloths (sterile gown, head

cover, overshoes, sterile gloves and facemask).

• -There are two change rooms one for men and the other one are for women.

• - The operation room in H clinc hospital is divided to 2 operation rooms.

Each one of the operation room is well prepared with equipment that needed

according to the surgery that is going to be done.

• There is a recovery room, prepared with equipment's needed to monitor

patients after their operation. It has cardiac monitors, medication, blood

pressure monitoring device and other equipment's. Patient is monitored from

5m-10m-15m until he /she awake and then the patient is transferred back to

his/her ward

• There are many stores in this department include:

• Tow store for operation equipment's, sterile equipment's, medications, tools

and fluid.

• There are one elevators for handling equipment's from the sterilization.

• - There is also another room called washing room (sterilization room) for

washing the dirty equipment's after they have been used in the surgery. The
 equipment's are collected and covered, then it transferred to the washing

room for washing and then to be sterilized later in the sterilization ward.

• Structure of ideal OR

• The characteristics of the ideal O.R:

• - Closed building (room) without any windows. (Available)

• - It has special ventilation. (Available)

• - It has an easy access. (Available)

• - There is a special entrance for the patients pre-operatively and post-

operatively. (available)

• - There is a special room for the infectious cases. (Not available)

• - It includes a room for the sterilization. (Available)

• - It has rooms specialized for orthopedic surgeries, gynecology surgeries,

and neurology surgeries and open heart surgeries. (Not available)

• - It has a clean corridor for the clean equipments, and a dirty corridor for the

dirty equipments. (Not available)

• - It has an elevator for the clean equipments separated of the elevator for the

dirty equipments. (not available)

• - Good lights, humidity, temperature and ventilation of the O.R, supplies,

equipments and other machines for the surgeries should be available in the

operative room. (Available)

• - It should also include the availability of qualified team. (Available)

• The operation room parts:

• The numbers of operation rooms in the hospitals vary from one to another

according to the requirement of the hospital itself. The recommended size is

6.5m x 6.5m x 3.5m. The O.R includes different parts such as:

• 1- The doors:

• - The doors of each O.R should be spring loaded flap type. The sliding doors

are preferred more because no air currents are generated from them. All

fittings in O.R should be flush type and made of steel.( Not available)

• 2- The surface and the flooring:

• - It must be slip resistant, strong and impervious with minimum joints.

(Available)

• 3- The walls:
• - The walls of the operation room should be covered by either laminated

polyester or smooth paint that provides seamless wall, because the tiles can

break and epoxy paint can chip out. The collusion corners of the walls have

to be covered with steel or aluminum plates, and the color of paint should

allow reflection of light and yet soothing to eyes. The light color can include

either light blue or green, a washable paint will be ideal. A semi-matt wall

surface reflects less light than a highly gloss finish and is less tiring to the

eyes. (Available)

• 4- The operation table:

• - There should be one operation table for each operation room. (Available)

• 5- The electric point:

• - There should be adequate electric points on the walls of a height of 1.5m of

the floors. (Available)

• 6- The x-ray illuminators:

• - There should be x-ray film illuminators preferably recessed into the wall.

(Available, portable x-ray)

• 7- The scrub area:

 • - It should be planned to fit at least 2-3 persons in each operation room.

(Available)

• 8- The ventilation of O.R:

• The ventilation of O.R should be on the principle that the direction of air

flow is from the operation theatre (room) to the main entrance .There should

be no interchange air movement between one O.R and another. Efficient

ventilation will control temperature and humidity in O.R it will lead to the

dilution of contamination caused by micro-organisms and anesthetic agents.

The recommendations for the ventilation include:

• - The positive air pressure system in operation room, it should ensure a

positive pressure of 5cm O from ceiling of O.R downwards and outwards to

push out air from operation room.

• - The temperature should be between 20ºC-24ºC. The temperature should

not be adjusted for the comfort of O.R personnel but for the requirement of

the patient, especially in pediatric, geriatric, burns, and neonatal cases.

(Available)

• 9- The lightening:
• - The general lighting: Color corrected fluorescent lamps it should be either

recessed or surface ceiling mounted; to produce even illumination of at least

500 Lox at working height and with minimal glare are preferred. The means

of dimming may be needed during endoscopies, to minimize eyes fatigue

and weakness.(Available)

• 10- Other parts:

• - There should be other separated corridors for the staff to use other than

going into an operation room. (Not available)

•  

• - There should be a preparation room in clean zone.(Not available)

• - The corridors of the operation room should have an adequate width for

movement. (Available)

• - The oxygen, gas and the suction should be connected with central facility.

(Available)

• - It should include a proper drainage system. (Available)

• - It should include safety while working in O.R. (Available)

• Nursing Role:
• Circulate Nurse Role:

• Circulator: the nurse who is the scrubbed assistant to prepare for the

operation and is available throughout the procedure.This term is used in

many hospitals to refer to the runner. (Available)

• The responsibilities of the circulating nurse::

• To give direct nursing care to the patient (pre, during and post operation)

• To protect the patient from harm.

• To anticipate and supply the needs of the scrub nurse.

•  responsible for ensuring that the OR is set up correctly.  

• Before the surgery:

• Checks that the O.R has been cleaned and that the suction, cautery

equipment and lights are in working.

• Ensure that the temperature and humidity controls are correctly set.

• Collects necessary stocks, sterile water, and fiber –optic light source.

• Opens instruments and bowl-packs and other necessary equipments for the

scrub nurse.
• Prepares sterilized gowns and gloves for the team and assists tying gowns

• Assist with count and records.

• During the surgery:

• Transferring the patient to the operating table.

• Positioning the patient for surgery.

• Connect cattery and suction leads.

• Adheres strictly to local policy for disposable used swaps.

• Fills bowls with sterile water, if requested.

• Insure that all O.R’s doors remain closed.

• Places swab-collecting bowls conveniently for the scrub nurse.

• Anticipates the requirement of the team.

• Before THE END of the operation;

• Assist with the count and records swabs, needles and instruments.

• Prepare for the wound dressing.

• SCRUB NURSING ROLE:

• The scrub nurse: he or she is the member of the surgical team, who

prepares the sterilized instruments and equipment ready for the operation.

• BEFORE THE OPERATION:

• 1. Ensures that the circulating nurse has checked the equipment

• 2. Ensures that the theater has been cleaned before the trolley is set

• 3.Prepares the instruments and equipment needed in the operation

• 4.Uses sterile technique for scrubbing, gowning and gloving

• 5.Receives sterile equipment via circulating nurse using sterile technique

• 6.Performs initial sponges, instruments and needle count, checks with

circulating nurse

• DURING THE OPERATION

• 1. Maintain sterility throughout the procedure

• 2.Awareness of the patient’s safety

• 3.Adhere to the policy regarding sponge/ instruments count/ surgical needles

• 4.Arrange the instrument on the mayo table and on the back table

• End of operation:
• 1.Undertake count of sponges and instruments with circulating nurse

• 2.Informs the surgeon of count result

• 3.Clears away instrument and equipment 

• After  operation:

• 1. helps to apply dressing

• 2.De-gown

• 3.Prepares the patient for recovery room

• 4.Completes documentation

• 5.Hand patient over to recover room

• Recovery nurse:

• most important of the recovery following up with other nurse with good

experience of ICU and continuously check respiration ( saturation ) , vital

signs , and checking of the wound for any oozing or hematoma or any signs

of bleeding .

• Safety precaution that were carried out when the patient was admitted to

surgery:
• Safety precaution for staff: All team in operating room wear gloves, gown,

head cover, mask, and all protective devices to prevent infection to patient

and themselves.

• 1- Consent form was signed by patient as protection to team.

• 2- Check list to make sure that all the necessary pre-operative routine was

done.

• 3- Check patient name to confirm that correct patient admitted to correct

surgery.

• 4- Explain the surgery to the patient.

• 5- Surgical team should be free of any infection (upper respiratory

infections, dermatitis, and any unhealed wound, infection of the mouth or

eyes)

• 6- Temperature should be within human body temp. To prevent

hypo/hyperthermia. Humidity should also be appropriate.

• 7- Operation room should be close ventilator system, no window to control

infections.

• 8- Side rails of the trolley and the breaks should be closed when transferring

the patient to OR table.

• 9- During the surgery, the team reduces their talking and movement to help

the surgeon to keep concentrate.

• 10- Check all equipment that surgeon may use in the surgery such as suction

and cattery to prevent any potential hazards.

• Potential hazards of the intra-operative experience for the patient, and

nursing care to prevent those hazards:

• 1- Hypo/ Hyperthermia:

• - Keep the patient covered with sheets during the operation, only the

operating part is kept exposed.

• - Be sure that the temp of operation room is suitable.

• - Prevent hyper or hypothermia and always monitor the pts temperature for

any change.

• - Hyperthermia could always be a side effect of anesthesia. This is the

anesthetist's responsibility with the assistance of the circulator nurse to take

appropriate measures.

• 2- Bleeding from the site and potential risk for internal bleeding:

• - Blood typing and cross matching should be done before surgery.

• - Blood units should be readily available for use if needed.

• - Anticoagulants, if taken, should be stopped few days before surgery.

• - The amount of blood loss should be estimated, and observe the site of

surgery for excessive bleeding.

• -The surgical, anesthetic and nursing personel involved in an operation

should all be aware of the potential for major blood loss before the

procedure and be prepared for it

• 3- Neurovascular damage due to inappropriate position and prolonged

pressure:

• - Pay attention to the pressure area. Limb should be fixed well but also

relaxed, the pt should also be well positioned.

• 4- For getting the gauze in the wound:

• - Counting should be done accurately at right intervals by both the circulator

and scrub nurse.

• - Notes should be written on a board.

• - The wound should never be closed if there is suspicion of missing gauze.

• - Look for the missing item inside the wound, outside at the bed side, and at

the floor.

• -If not found, x-ray the patient to make sure that all is clear.

• 5- Respiratory problems from the use of anesthesia.

• - Monitor and record vital signs  to detect early signs of respiratory

depression

• - Administer Oxygen to the patient as needed.

• - Deep breathing exercises.

• - Suction as needed.

• -opioids may experience nausea and vomiting after eating and then suffer

aspiration. To prevent this, don’t give patients solid foods until they can

tolerate clear liquids and nausea and vomiting have subsided.

• 6- Infection:

• - Patients should take shower before going to OR.

• - The team should be restricted from wearing the surgical suite outside OR.

• - Sterile instruments should be opened and handled in a sterile technique.

• - Sharps should be discarded in the sharp box only, and it should be closed.

• - Contaminated instruments should be taken from a special window that

opens on the dirty corridor. The window should never be opened during

surgery, only after it.

• - The operating rooms should be sterilized before and after each surgery

with chlorine or other antiseptics.

• - Ventilation should be between 18-24 & humidity between 50-55%.

• - Filter should be checked and tested. Air pressure should be positive inside

OR than the outside so as not to allow the outside air to come inside to the

sterile operating room.

• - Reduce moving and unnecessary crowding in OR as much as possible.

• - Keep doors closed as much as possible.

• 7- Risk for burn from the cattery:

• - Diathermy should be used with caution by experts.

• - Put diathermy plate under big muscles not under boney ones, or excessive

hair.

• 8- Hypotension:
• - Monitor vital signs and blood pressure.

• - Encourage patient to drink prescribed fluid amounts, or administer I.V

solutions.

• - Obtain and maintain a large-bore intravenous (IV) catheter. Parenteral fluid

replacement is indicated to prevent shock.

• 9- Allergy to some medication:

• - Check pt's chart before the operation.

• - Close monitor for any sign of anaphylactic shock.