C H A P T E R 3

O P E R A T N G R O O M
Operating Room -- 1
Operating Room and Central Processing Division
1he operating room unctions to proide a controlled enironment or the perormance o surgical
procedures. Surgical wound inections are the second most common nosocomial inection and may
inole either the incision or adjacent structures. Most surgical wound inections result rom microbial
contamination ,endogenous or exogenous source, o the wound during surgery. Operating room
procedures are designed to proide the maximum reduction o exogenous microorganisms that could
contaminate the surgical wound. Personnel and their compliance with surgically aseptic procedures are a
critical component in the preention o surgical wound inections.
Infection Control Practices:

Lmployee Health
O Careul attention to employee health, saety, and personal hygiene will minimize the potential
or acquiring or transmitting disease.
O Personnel working in the OR shall be ree rom actie inection.
O \ill keep accinations current as accinations proide backup protection when there has
been a ailure in work practices.
O Indiiduals exhibiting signs and symptoms o an inection must report immediately to their
superisor. 1he superisor will reer them to Occupational lealth or ealuation and work
duty status.
O All personnel suspected o haing communicable inections shall be excluded rom working
in the OR until they hae been cleared by Occupational lealth.
O An employee who eels he,she has been exposed to a communicable disease or occupational
exposure ,i.e., needle stick or sharps injury, must report immediately to his,her superisor
who will send the employee to Occupational lealth. I the exposure occurred on PMs,
nights, or weekends, the indiidual will be ealuated in the Lmergency Room, but must report
to Occupational lealth the next working day.
O \ill become amiliar with and adhere to policies set orth in the Inection Control Manual.
O \ill use protectie barriers to reduce the risk o skin and mucous membrane exposure to
potentially inectious materials.
O \ill ollow hospital policy on Standard Precautions` or protection against blood borne
pathogens and demonstrate competence in the preention o transmissible inections.
O \ill use contact, droplet, or airborne precautions as appropriate when proiding care or
patients who are known or suspected to be inected or colonized with microorganisms.
O \ill report promptly any suspected communicable diseases, occupational injury, or inectious
exposures to Occupational lealth or ealuation, treatment, and ollow-up.
O \ill adhere to good hygiene practices. lair, body and nails should be clean at all times.
O Neither nail polish nor artiicial nails shall be worn. lingernails should be kept short and clean
and should not extend beyond the ingertips.
O \ill practice requent and thorough handwashing with appropriate soap beore and ater each
patient contact.
O \ill utilize work practices designed to minimize risk o exposure to pathogens.
O \ork practice controls include prohibition o eating, drinking, smoking, applying cosmetics
or lip balm, and handling o contact lenses in work areas where there is reasonable likelihood
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Operating Room -- 2
o occupational exposure to bloodborne pathogens. Actiities inoling hand-to-nose, hand-
to-mouth, or hand-to-eye action can contribute to indirect transmission.
O \ill report suspected trends or problems related to inection control to the Inection
Preention and Control Department.

Surgical Attire
O Scrub clothing is worn to promote a high leel o cleanliness and hygiene within the surgical
enironment because the human body is a major source o microbial contamination. Surgical
attire helps contain bacterial shedding and promotes enironmental control. 1he rationale behind
this practice is to preent the spread o inection rom sta to patient. Proper operating room
attire includes clean scrub suit ,with shirt tucked into pants to preent shedding o body scur,
donned in a designated dressing area prior to entering the semi restricted or restricted areas o the
acility.
O Appropriate, clean attire minimizes the introduction o microorganisms and lint rom
personnel to surgical patients and to the enironment. Controlled laundering o garments
contaminated by blood or body luids reduces the risk o transerring pathogenic
microorganisms rom the health care acility to home and amily. Other garments should be
contained completely within or coered by the surgical attire. Clothing that cannot be coered
by the surgical attire should not be worn.
O All personnel entering the restricted areas o the OR suite, decontamination, preparation,
sterilization and sterile storage areas will be attired in operating room scrub attire proided by
and donned at NMCP. lome laundering will not be done. 1aking preiously worn, soiled, or
contaminated surgical attire into the home can result in the spread o contamination to the
home enironment. No one in street clothes will be permitted in the suite at any time.
Parents,isitors are allowed in the restricted areas, with coeralls, mask, cap, and shoe coers.
O I indicated, a head coer and beard coer shall be worn to ully coer hair on head and ace.
1he head coer or hood should be designed to minimize microbial dispersal. lair acts as a
ilter and collects bacteria. A bald or shaed head is coered to preent the shedding o
squamous cells. Disposable bouant and hood-style coers are preerred. lead coer should
be applied beore the scrub suit so that hair does not touch the scrub suit while it is being
donned. Single use headgear should be remoed and discarded as soon as possible ater daily
use.
O Masks will be worn at all times in the operating rooms and sub-steriles. A single surgical mask
will be worn in surgical enironments where open sterile supplies or scrubbed persons are
located. A mask should ully coer both mouth and nose and be secured in a manner that
preents enting. A surgical mask is worn i sterile instruments are exposed, or i an operation
is about to begin or underway. Masks will be changed ater each case and not worn dangling
around the neck. Masks should be remoed careully by handling only the ties and discarded
immediately to aoid cross-contamination.
O Sterile gloes are worn or sterile procedures and medical, nonsterile gloes are recommended
or nonsterile actiities.
O Protectie eyewear, masks or ace shields must be worn when splashing or spraying is likely.
O Comortable supportie shoes should be worn or personal saety. Cloth shoes should not be
worn because they proide little protection rom spills or accidentally dropped items. Shoe
coers are considered part o PPL and should be worn when it can be reasonably anticipated
that splashes or spills may occur. loot attire has no proen signiicance in reducing the
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Operating Room -- 3
incidence o surgical site wound inections, the primary reason or its use is to acilitate
sanitation. Shoe coers must be discarded prior to leaing the surgical area.
O A surgical team wears sterile gowns ater a hand surgical scrub is perormed. Gowns must be
resistant to penetration by moisture. Gown ronts are considered sterile rom shoulder to
table leel on the ront and on the ront o the sleee ,axillary area is contaminated,. Sterile
gloes are worn by the surgical team. Gown and gloes must be changed when punctures,
contamination, or strike through occurs.
O Scrub suits must be changed when isibly soiled, contaminated, and,or penetrated by blood
or other potentially inectious materials. All attire will be resh each day and changed i it
becomes wet or soiled.
O \hen leaing the OR suite, a clean coer gown worn backwards and tied or buttoned lab
coat is to be worn oer the scrub suit. Caps, beard coers, masks, and shoe coers are to be
remoed and replaced with resh ones when returning to the operating room suite.
O All personnel entering the semi restricted and restricted areas o the surgical suite should
conine or remoe all jewelry and watches. Rings should be remoed because rings can
harbor organisms that cannot be remoed during hand washing. Other jewelry such as
watches, earrings, bracelets, necklaces, and piercings should be remoed or totally conined
within the scrub attire due to the possibility jewelry could all onto the sterile ield or into a
wound. Necklaces that are not conined could contaminate the ront o the sterile gown.
Jewelry must meet the Nay standard, which is 1 ring each hand, plus wedding,engagement
ring set. Only one watch and bracelet are authorized. One necklace can be worn, but not
isible. No jewelry is authorized while a person is scrubbed in on a surgical case or while
prepping or positioning a patient.
O lingernails should be kept short, clean, natural and healthy due to the subungual regions
harboring the majority o microorganisms ound on the hand. Nail polish that is obiously
chipped or worn longer than our days is associated with the presence o greater numbers o
bacteria. Artiicial Nails should not be worn. Studies hae shown that artiicial nails on healthy
hands increased the risk o surgical site inection.

Surgical Drapes
O Draping is the process o coering with sterile barrier materials the non-sterile area immediate
to and surrounding the operatie site. Drapes are used as barriers to preent microorganisms
outside the operatie area rom entering a wound.
O Draping is done primarily or the protection o the patient, the surgical site, and the sterile
ield.
O Draping creates an aseptic barrier between the surgical incision and the patient`s non-prepared
skin, guarding the wound rom bacteria.
O Sterile drapes are used to establish a sterile ield around or close to a surgical site.
O Disposable surgical drapes are used.
O Drapes should be resistant to the passage o blood and luids ,resistant to strike through,,
impermeable to moist microbial penetration, including iruses, resistant to tearing, puncture,
or abrasion, lint ree, lame resistant,lame retardant and antistatic, ree o toxic ingredients,
porous enough to maintain an isothermic enironment appropriate to body temperature and
easy to use.
O 1he disposable drapes are obtained sterile rom the actory in protectie wrappers. Prior to
use, the wrappers are checked closely or damage to ensure sterility.
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Operating Room -- 4
O Drapes are handled as little as possible and should not be waed or anned in the air.
O Drapes are held high enough to aoid touching non-sterile areas until they are oer the area to
be draped.
O Sterile gloed hands are protected rom contact with the patient by placing them under the
drape ,cuing, as each drape is placed.
O Do not moe or rearrange drapes once placed.
O Linens are receied, inspected, and processed in accordance with Joint Commission
requirements and AORN standards.
O Disposable drapes that most closely conorm to the needs o the procedure are chosen.
Drapes are used in accordance with actory recommendations.
O AAMI`s 1echnical Inormation Report outlines our categories o barrier ,draping, materials:
O Liquid resistant ,inhibits the penetration o liquids,
O Liquid barrier ,preents the isible penetration o liquids,
O Microbial barrier ,preents the penetration o microorganisms,
O Liquid proo ,preents the penetration o liquids and microorganisms,

Surgical Lnvironments
lloors, \alls and Ceilings
O 1he surace o all loors must not be porous but instead be suitably hard, wear resistant,
seamless, non-conductie, and easy to clean.
O lloor drains should not be installed. Drains in cystoscopy rooms should contain a non-splash
horizontal-low lushing bowl beneath the drain plate.
O \alls should be one continuous surace, easy to clean, and ree o seams.
O Ceilings should be a minimum o 10 eet high, hard, nonporous, ire resistant, waterproo,
stain proo, seamless, non-relectie, and easy to clean.

%emperature and Humidity
O 1emperature should be maintained between 68l to 3l ,20C to 23C, within the
operating room suite and general work areas in sterile processing.
O Decontamination area temperature should be maintained between 60l to 65l ,16C to
18C,
O Relatie humidity should be maintained rom 30 to 60 within the perioperatie suite,
including operating rooms, instrument processing areas, and sterilizing areas. A relatie
humidity o below 0 should be maintained in sterile storage areas.

Airborne Contamination and Ventilation Systems
O Airborne Contamination: One o the major goals o the surgical team is to reduce or
minimize the counts o bacteria-carrying particles in the air.
O Ventilation Systems: Should be designed so that airlow patterns will not allow air
contaminants to enter clean areas. Air should low rom areas o positie pressure to areas o
negatie pressure.
O 1he quality o air entering the operating rooms should be careully monitored.
O Air should be iltered through two ilters, the irst ilter should be rated as 30 eicient and
the second at 90 eicient.
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O P E R A T N G R O O M
Operating Room -- 5
O Operating Room entilation is maintained at positie pressure with respect to the corridors
and adjacent areas because positie pressure preents airlow rom less clean areas into more
clean areas. All air should be introduced rom the ceiling and exhausted at the loor.
O Operating Room doors should be kept closed except as needed or passage o equipment,
personnel or the patient to reduce the microbial leel in the air.
O A minimum o 20 o the incoming air ,three air changes per hour, should be rom the
outdoors.
O Operating rooms should hae a minimum o 15 air exchanges per hour with a recommended
range o 20 to 25 exchanges.
O Soiled decontamination and sterilizer loading,unloading should hae a minimum o 10 air
exchanges per hour.
O Sterile storage, preparation and packaging should hae a minimum o 4 air exchanges per
hour.
O lree standing ans, humidiiers, or dehumidiiers should not be used in the operating room or
sterile processing due to disrupted air-low patterns resulting in contamination o the sterile
ield.
O 1he soiled and decontamination area o the Central Processing Department should be
designed so that air lows into the area ,negatie pressure,, with a minimum o 10 air
exchanges per hour. Air rom rooms or areas under negatie pressure should be exhausted to
the outside ia a non-re-circulating system.

%raffic Control
General:
O 1he surgical suite is diided into three designated areas that are deined by the physical
actiities perormed in each area. Increasing enironmental controls and surgical attire as
progression is made rom unrestricted to restricted areas decreases the potential or cross-
contamination.
O 1he unrestricted area includes the central control point established to monitor the entrance o
patients, personnel, and materials. Street clothes are permitted in this area and traic is not
limited.
O 1he ront desk, patient hold, and supply are considered semi-restricted support areas. Street
clothes may be worn in these areas.
O Semi-restricted areas include the peripheral support areas o the surgical suite. 1his area
includes storage areas or clean and sterile supplies, work areas or Central Processing, scrub
sinks and corridors leading to the restricted areas o the surgical suite. 1raic in semi-
restricted areas is limited to authorized personnel and patients. Personnel are required to wear
surgical attire and coer all head and acial hair.
O 1he care o the patient during surgery requires moement o patients, personnel, and material
within the surgical suite. Planning and controlling these moements assist in the containment
o contamination. Only authorized personnel are allowed in the restricted areas.
Authorized` personnel are those assigned to Surgical Serices to include:
O Perioperatie Nurses and Surgical 1echnologists
O Anesthesiologists, their residents, CRNAs, SRNAs, and Anesthesia 1echnicians
O Surgeons, their residents, interns, and medical students
C H A P T E R 3
O P E R A T N G R O O M
Operating Room -- 6
O 1he restricted area includes the Operating Rooms ,ORs,, procedure rooms and clean core
areas. Proper surgical scrub attire, hair coerings, and name identiication are mandatory in
the restricted areas. Masks are required where open sterile supplies or scrubbed persons are
located. Unnecessary traic is not permitted. All doors must be kept closed except as needed
or passage o equipment, personnel, and patients. All sta traic to and rom an operating
room will be ia the sub-sterile door. 1alking and the number o personnel allowed to enter
the operating room, especially with a surgical procedure in progress, will be kept to a
minimum.
O Persons entering the semi-restricted or restricted areas o the surgical suite or a brie time or
a speciic purpose, such as parents or biomedical engineers, should coer all head and acial
hair and may don either reshly laundered surgical attire or a single-use coerall suit designed
to totally coer outside apparel.
O Patients should wear clean gowns, be coered with clean linens, and hair coerings.
O Surgical supplies prepared or surgical procedures outside the surgical suite ,e.g. in Central
Processing Department, CPD, should be transported to the surgical suite to maintain
cleanliness and sterility and to preent physical damage. Protect items rom contamination,
physical damage, and loss during transportation.
O Sterile supplies and equipment should be remoed rom external shipping containers and web
edged or corrugated cardboard boxes in the unrestricted area beore transer into the surgical
suite. Lxternal shipping containers may collect dust, debris, and insects during shipment and
may carry contaminants into the surgical suite.
O Soiled supplies, instruments, and equipment should not re-enter the clean core area.
Contaminated items should be in closed, coered carts or containers or transport to the
decontamination area.
O Decontamination areas and soiled linen areas should be separate rom personnel and patient
traic areas.
O Separate clean and sterile supplies and equipment rom soiled materials by space, time, and
traic patterns to decrease risk o inection.

bservation
O Obseration o surgical procedures or medical education purposes is an integral part o a
teaching institution. Visiting surgeons, hospital sta, nursing students and product
representaties may receie authorization or obseration,participation on a case by case
basis. Requests are submitted by the sponsor to the lead, Operating Room Serices ia the
Director, Surgical Serices no later than 24 hours in adance.
O All requests approed must also hae the approal o the indiidual room`s crew or nurse,
anesthesia personnel, and surgeon.
O It is the sponsor`s responsibility to inorm the patient o the obsering personnel.
Handling of Infectious Waste, Linen and Sharps
O Inectious waste and all potentially contaminated disposable items are disposed o in
accordance with hospital policy.
O Soiled linen will be placed in an imperious linen bag o suicient quality to contain
used,soiled linen.
O Needles, syringes, and sharps are to be disposed o uncapped and uncut, into puncture-
resistant sharps containers, being careul to aoid injury. Sharps used during a surgical
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O P E R A T N G R O O M
Operating Room -- 7
procedure are placed in a needle pad on the back table and discarded at the end o the
procedure in appropriate sharps containers.
Intra-operative Infection Control
Responsibility o circulator:
O land hygiene is the most important actor in preenting the spread o inection.
O Clean, non-sterile gloes should be worn when touching blood, body luids,
secretions, excretions, and contaminated items. Change gloes between tasks and
patient procedures.
O Limit traic in room.
O \alking outside the periphery o the sterile ield or leaing and returning to the OR
in sterile attire increases the potential or contamination.
O 1alking is kept to a minimum in the presence o the sterile ield to reduce the spread
o moisture droplets.
O \ear a protectie apron or coer gown i soiling with blood or body luids is
anticipated.
O A mask and eye protection or a ace shield is to be worn at any time patient care
actiities are likely to generate sprays or splashes o blood or body luids, secretions or
excretions. All primary scrub techs will wear eye protection.
O Maintain a clean enironment during procedures.
O Single-use items should be discarded ater use. Reusable equipment must be cleaned
and re-processed to ensure sae use or another patient.
O Linens soiled with blood, body luids, secretions, or excretions should be handled in a
manner to aoid skin and mucous membrane exposure, clothing contamination and
transer o microorganisms to other patients, personnel, and the enironment.
landling o Specimens:
O lealthcare workers should receie speciic instructions regarding the handling and
transportation o cultures and specimens.
O Retriee cultures and specimens rom the scrub technician wearing gloes or delier
specimen to container held by circulator. Label and appropriately process the
specimen.
O Contamination o the outside o culture and specimen containers with blood or other
body luids should be aoided. I the specimen container is remoed rom the ield,
the exterior o the container should be disinected with an approed hospital grade
disinectant beore the specimen is remoed rom the surgical suite.
O Because cultures and specimens are considered potentially inectious, all personnel
should use gloes when handling them.
O lands should be washed thoroughly ater gloes are remoed.
O Standard precautions should be employed and specimens should be put in leak-proo
containers to ensure sae handling, processing, storage, transport, and shipping.
Responsibilities o scrub technician:
O Remain gowned and gloed while breaking down and disposing o instruments,
utensils, trash, linens, and sharps.
C H A P T E R 3
O P E R A T N G R O O M
Operating Room -- 8
O Needles, scalpels, and other sharps should be handled in a manner to aoid injury.
Dispose o all sharps used on the surgical ield by placing into the red sharps
container.
O Discard suction tubing. A closed suction system is used. Suction liners are taped
shut and placed in inectious waste bags. \ear personal protectie attire i indicated.
Housekeeping Requirements.
Policy:
O All cases are considered potentially inectious`. No special quarantine` procedures
o operating rooms or operating room personnel inoled with septic` procedures
are practiced or considered necessary. Clean up between clean and,or dirty cases is
the same. 1he conine and contain` principle o operating room management shall
be practiced thereore maximally reducing the dissemination o contaminated
materials throughout the operating room suite.
O 1he patient should be proided a clean, sae enironment. lealth care-associated
inections ,lAI, hae been linked to external sources, which can include
enironmental suraces. 1he risk o inection rom pathogenic organisms on
enironmental suraces is due not only to their presence but to their ability to surie
on and be transerred to many suraces.
O Sanitation protocols or cleaning and disinection are required beore, during, and
ater each procedure. Lnironmental cleaning is the ramework and basis or all
aseptic practices.
O Measures should be taken to preent ermin inestation. Remoe ood sources and
any enironment that attracts pests and keep doors and windows closed.
Cleaning beore procedures:
O Proper cleaning reduces the amount o exogenous microorganisms, dust, and debris
in surgical enironments, and it helps to reduce airborne contaminants. Rooms
should be isually inspected prior to bringing in any carts or supplies.
O All suraces within the OR, including urniture, surgical lights and equipment should
be damp-dusted beore the irst scheduled surgical procedure o the day. Damp dust
with a lint-ree cloth and an approed hospital grade disinectant. Plasma screens and
monitors should be cleaned according to manuacturer`s guidelines.
O Lights and oerhead tracks become contaminated quickly with dust, debris, and
microorganisms, which can all onto sterile suraces or into wounds during surgical
procedures and should be cleaned on a daily basis beore the irst procedure o the
day.
O String and microiber mops and cleaning cloths should be changed ater each use.
Used cleaning mops or cloths should not be returned to the cleaning solution
container.
Cleaning during procedures.
O During a procedure the practice o conine and contain` should be practiced to limit
contamination. Use appropriate PPL when handling contaminated items.
O Accidental spills o contaminated debris in areas outside the surgical ield should be
cleaned promptly with an approed hospital grade disinectant.
O Soiled sponges are placed in a plastic lined bucket or plastic pouch and not on a
draped table or spread out on an imperious barrier on the loor.
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Operating Room -- 9
O All disposable sharps are considered inectious waste and should be placed in
puncture-resistant containers and labeled as biohazardous waste.
O Contaminated disposable items used in patient care are discarded in leak-proo, tear-
resistant containers.
Cleaning between and ater procedures.
O All trash is collected in sturdy plastic or imperious bags.
O Damaged or worn coerings should be replaced.
O Perorm in each indiidual operating room beginning with the irst case o the day
and between consecutiely scheduled surgical cases.
O Using appropriate disinectant and a clean cloth, damp dust all lights and ertical
suraces o all urniture and ixtures in the room. All reusable items such as
pneumatic tourniquet cus should be cleaned with an approed hospital grade
disinectant. All receptacles such as bins, kick buckets, and pails should be cleaned
and disinected.
O All horizontal suraces and suraces that hae come in immediate contact with the
patient, body luids, or with electrical or laser plume are cleaned with an approed
hospital grade disinectant.
O Clean any areas o the room, other than those speciied which hae become soiled
with blood, irrigation luids, etc., during the just completed case.
O Moe urniture as necessary, dispense cleaning solution oer the entire area o the
loor, and areas soiled with blood or bodily luids or gross contamination. Allow a 3-
5 minute contact time or disinectant. Using \et-Vac, remoe the cleaning solution
rom the loor.
O 1he OR bed is cleaned and all suraces and mattress pads are wiped with an approed
hospital grade disinectant. Particular attention is gien to all suraces o the OR bed,
mattress, and positioning aids where contamination with blood or luids may hae
occurred. 1he OR bed is moed to the periphery o the room so that access is gained
to the center o the room or cleaning.
O Moe all urniture to the other side o the room and repeat the preious steps on the
newly exposed loor area.
O Ater room is cleaned, gloes are remoed and hands are washed and the room is
prepared or the next patient.
O Replace all urniture to its correct location.
O Set out clean kick bucket, linens, coers on arm boards, clean linen hamper,
instrument breakdown tray, and suction bottle.
O Place clean linens on operating table.
1erminal cleaning:
Perorm in each indiidual operating room eery 24 hour period i the room has been
opened and used or a surgical case. 1he decontamination process begins at the highest-
leel ,light tracks, ceiling ixtures, and progresses downward ,kick boards and loor,.
O Unused rooms should be cleaned at least once eery 24 hours
O Using a clean cloth and appropriate disinectant, thoroughly wipe down operating
room lights and light tracks.
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O P E R A T N G R O O M
Operating Room -- 10
O Sponge mop the bulkheads using appropriate disinectant and water solution
prepared in buckets.
O Moe all urniture to one side o the room.
O Using the sprinkler can, sprinkle the cleaning solution on the loor. 1his solution
shall be allowed to remain on the loor ,3-5 minutes, while the urniture is being
cleaned.
O Using clean cloth and disinectant solution, wipe down all suraces o all urniture.
Room ixtures are also to be wiped down ,windowsills, x-ray iew box, tape
dispenser, operating lights, control box, etc.,.
O All room equipment is to be wiped down. Special attention should be gien to
electro-surgical generator, oot pedal, suction equipment, control table, sponge scale,
positioning gear table parts, wheels, and pads.
O Scrub bu the loor and wet acuum the loor.
O Moe all urniture to the opposite side o the room. Scrub bu and wet acuum the
remaining loor area as preiously described.
O Return all urniture to its correct location.
O Replace kick bucket, liners, coers on arm boards, clean linen hamper, instrument
breakdown tray, and suction bottle.
lield day:
1otal cleaning o any speciic area including hallways, loors, substeriles, scrub,utility areas,
and sterile storage areas. All areas and equipment in the surgical suite should be cleaned
according to an established schedule.
O All rerigerators and ice machines should be cleaned on a routine basis.
O Aerators on aucets should be cleaned and disinected weekly by remoing the
aerator, scrubbing with detergent and brush and immersing in disinectant.
O Lye wash stations should be cleaned and checked weekly to ensure that they are in
working order.
O Perorm ield day on eery area o the MOR suite ,inner and outer, once each week.
O Sponge mop the ceiling using appropriate disinectant solution.
O Dust all ent coers.
O Dust thoroughly the sterile supply cabinet inside and out within the operating room
and check all gear or proper expiration date.
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O P E R A T N G R O O M
Operating Room -- 11
Care of Patients with Tuberculosis in Operating Room
Patients with suspected or conirmed tuberculosis treated in the MOR require Airborne Precautions.
Only emergency or medically necessary surgery is perormed on a patient with suspected or conirmed
tuberculosis disease. Llectie operatie procedures on patients with tuberculosis should be delayed until
the patient is no longer inectious.
I at all possible, patients with tuberculosis should be scheduled at the end o the day to limit risk to other
patients and healthcare workers. Perorm the procedure with a minimal number o personnel.
lLPA respirators or N-95 respirators are indicated or all persons entering the OR room or respiratory
protection. Valeless lLPA respirators or N-95 respirators will be worn in the OR setting to protect the
sterile ield.
1he doors to the OR will be kept closed and the number o personnel allowed in the OR will be kept to a
minimum.
1uberculosis patients must be recoered in a negatie pressure entilation room and personnel will ollow
Airborne Precautions and wear N-95 respirators. Patients should then be transported to a negatie
pressure entilation room as soon as possible. 1he patient will hae both nose and mouth coered with a
regular surgical mask during transport.
Personnel perorming enironmental cleaning and disinection in the room o a patient who has an
airborne disease must use a properly it tested N95 mask or powered air puriying respirator until
complete air exchange has been achieed.
1he period o time required or the entilation system to achiee a 99.9 air exchange should be noted,
or example 28 minutes or a 15 air-exchanges-per-hour cycle.
Access to the room should be restricted until the 99.9 air exchange has been completed.

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Operating Room -- 12
Central Processing Division
1he Central Processing Diision ,CPD, recognized its responsibility or inection control, realizing that
this is an integral part o the total care o the patient. CPD`s primary goal is to proide the highest quality
o support so as to contribute to the total care o the patient. CPD will coordinate its actiities with all
departments in the hospital in order to proide the highest standard o care uniormly throughout the
hospital. CPD`s inection control guidelines proide or standardized policies and procedures or
receiing, decontaminating, packaging, sterilizing, storage, and issue o instrumentation and other medical
equipment. Sound principles o inection control will be practiced on a daily basis.
Personnel Policies
Clothing and other requirements:
O Scrub attire in accordance with NAVMLDCLNP1SVAINS1 1020.1 including water
proo apron, hair coer, gloes, eye protection,ace shields and masks ,as work requires,
shall be worn while working in the decontamination areas.
O Persons working in any other part o CPD, except the decontamination area, will wear
scrub attire, hair coers, and shoe coers ,with the exception o dedicated work area
shoes,.
O All personnel rom other departments desiring entrance to CPD will be properly attired
and request entrance. I not properly attired or i they hae no need to be in the area,
entrance will be denied.
O All repair and maintenance personnel will obsere the dress code or the area in which
they are working.
O Under no circumstances shall street clothes be worn in the CPD area.

lood and beerage consumption:
O lood and beerages will only be allowed in CPD oice spaces in coered containers.
O Smoking is prohibited in this acility.

Personal hygiene and hand washing:
O All personnel will practice requent and thorough hand washing with an appropriate soap.
O Personnel working in CPD shall be ree rom actie inection.
O All personnel shall adhere to good hygiene practices, such as daily bathing and wearing a
clean scrub uniorm.
O lingernails must be kept short ,not beyond ingertip, and clean.
O All personnel handling contaminated items will wear disposable gloes.
Lmployee illness,exposure:
O All personnel suspected o haing communicable inections shall be excluded rom
working in CPD until they hae been cleared by Occupational lealth.
O An employee who eels he,she has been exposed to a communicable disease ,i.e.,
occupational injury ia needlestick,sharps, or hazardous chemical exposure ,i.e.,
cleaning,decontamination solutions, should report immediately to his,her superisor
who will send the employee to the Lmergency Room or ealuation.


Lducation:
C H A P T E R 3
O P E R A T N G R O O M
Operating Room -- 13
O Basic training in aseptic technique or all CPD personnel must be proided and
documented in education iles.
O Periodic inection control programs will be proided and documented on no less than a
quarterly basis.
%raffic Control
llow
O All personnel will be taught the proper low o traic within CPD. Passage between the
areas is to be kept to a minimum and requires knowledge o proper dress codes.

Receiing,decontamination low pattern:
O Used trays and equipment must be returned ree o gross contaminants to the decon area.
1hese items should be transported to CPD in an imperious bag or equipment cart.
O All used trays will be jointly inentoried and a Gear Requisition,Receipt` orm will be
completed and signed by both the CPD and departmental representatie beore the gear
is accepted. A copy o this orm will be gien to the departmental representatie and a
copy kept or CPD iles.
O All instruments and equipment receied rom clinics and the MOR will undergo manual
decontamination and a minimum o a ten minute enzymatic soak. Instruments which are
grossly contaminated will ollow the enzymatic soak with processing in the ultrasonic
cleaner. Lastly, the instruments will be processed through the washer disinector.
O Linen bags and trash shall be emptied at the end o each shit. All tables and counters
shall be wiped down and the loor shall be wet acuumed at the end o each shit.
O Ater instrumentation and equipment has been decontaminated, it will be passed to the
clean area o CPD to be processed or sterilization.
Sterile Processing
Sterilization:
O Pre-acuum steam sterilizers, operate at 20 l and aboe 30 PSI with an exposure time
o 6 minutes.
O Packs that hae been remoed rom sterilizers will not be put away until they are cool to
the touch. \et and,or hot packages will transer bacteria and act as a wick.
O Sterrad sterilization utilizes hydrogen peroxide in gas orm ,orming ree radicals when
placed under speciic temperature, time, and pressure conditions, to sterilize
instrumentation. 1he cycle takes between 24 and 5 minutes and requires no aeration
phase.

Quality assurance,improement:
O 1esting and documentation shall be perormed daily, according to CPD`s
policies,procedures as well as the manuacturer`s instructions.
O A biological test ,spore test,Geobacillus Stearothermophilus or steam and Sterrad, will
be perormed on each load o gear or steam and Sterrad. 1esting will be perormed with
the irst load o the day on Sterrad. Incubation o these tests are read as ollows:
C H A P T E R 3
O P E R A T N G R O O M
Operating Room -- 14
O 3 hours on steam claes in CPD and MOR sub-sterile areas
O 1 hour on steam claes in the MOR sub-sterile areas
O 48 hours on Sterrad
O 1he steam clae is to be secured i a biological indication test ails. Medical Repair will be
notiied. lollowing the completion o repairs and three subsequent negatie biologics the
steam sterilizer may be brought back into serice.
O A acuum test ,Bowie Dick, will be perormed on each pre-acuum sterilizer and lash
sterilizer as the irst cycle o each day. An unsatisactory result requires the medical repair
technician on duty to be notiied to check or problems. Ater completion o repairs,
another acuum test will be perormed to ensure correction o the problem ,along with
the three consecutie negatie biologicals, prior to the sterilizer being used to sterilize
gear.
O Chemical testing will be perormed once daily on steam sterilizers as part o the challenge
pack ,irst pack o the day,, in eery lash load, and once a day with the biological test
pack on the Sterrad. In addition, each piece o instrumentation placed in a steam or
Sterrad sterilizer will contain its own external and internal chemical indicator.
O Sterile commercially prepared items will not be re-sterilized except under unusual
circumstances with proper recommendations rom the manuacturer.
O At no time will any dirty gear be allowed into the sterilization area o CPD.

Packaging, storage, and distribution:
O Items sterilized by the Central Processing Diision will hae an indeinite shel lie ,eent
related sterility, as long as the integrity o the packaging is not compromised and
enironmental criteria hae been maintained. No expiration date will be present.
O Package integrity is deined as:
O A package is considered un-sterile i the wrapper has been torn, punctured, or is wet
or moist ,or has the appearance that it was wet and then dried,, opened, mishandled,
or damaged in any other way.
O Packaged or wrapped items are not sterile i the tape is broken.
O Peel pack pouches are not sterile i they are not sealed correctly or i they are
excessiely wrinkled.
O Items with an external chemical indicator, which has not changed, are not sterile.
O Closed container systems that do not hae locks, ilters, external indicators, or lids
that do not it properly are not sterile.
O Items in a plastic dust protector, which is unsealed, are not sterile.
O I the package has not been handled and stored properly, it is not sterile ,see below
or speciic guidelines,.
Procedure:
O Sterile items may be used as long as the integrity o the package is not compromised.
O A sterilizer load sticker will be placed on each package or recall purposes only. It will
include the date the item was sterilized and also a load control number indicating the
sterilizer used and the load number.
O All items will be properly wrapped and processed in such a manner as to proide an
eectie barrier to microorganisms and allow aseptic presentation upon opening.
C H A P T E R 3
O P E R A T N G R O O M
Operating Room -- 15
O All items processed or sterilization will be wrapped in 2 ply Kimberly-Clark
Kimguard disposable sterilization wrap, paper,plastic peel-pouches, or placed in a
closed container system.
O Certain items may be dust-coered to maintain the integrity o the package. Dust
coer use will be determined by requency o use, storage, and handling conditions.
O Medications or materials within a package that deteriorate oer time will be dated
with an expiration date.
O Commercially prepared items that do not hae an expiration date rom the
manuacturer are sterile unless the package has been compromised. 1he loss o
sterility is eent-related, not time-related.
O It is important to ensure proper handling, transport, and storage o items in a manner
that does not compromise the packaging o the product.
O Sterile items obtained rom CPD should be coered or transport. Use o clean
transport carts or plastic bags is required.
O Items should be handled with care and only as needed. Personnel should wash their
hands prior to handling sterile items. Sterile items should not be carried under the
arms or cradled in the arms. I the item is too heay or transport, the item should be
coered in plastic and transported on a clean cart. Items should be properly stored
immediately ater transport and remain stored until used or patient care.
O Items that hae been dropped must be inspected or damage to the package. Unless
the package is heat-sealed in imperious plastic and the seal is still intact, the package
should be considered contaminated i it has been dropped.
O Storage spaces should not compromise the integrity o sterile packages in any way.
All storage spaces must be cleaned on a weekly basis.
O Outside shipping cartons are not allowed in either a clean storage area or a sterile
storage area and they should neer be used as storage containers in these areas.
1hese boxes are dirty rom the shipping process and they may contain insects. In
particular, corrugated cardboard boxes harbor dust and bacteria in the grooes and
are sources o ungal contamination and bacterial spores.

Sterile Storage Area Requirements:
O Room temperature: Less than or equal to 5l
O Room humidity: Less than or equal to 0
O Air moement: Positie ,out, air low with a minimum o 4 ,downdrat type, air
exchanges per hour or clean,sterile storage areas.
O 1raic: Limited to those personnel who need to be there.
O Space: Closed sheles are the preerred method o storage. Open doors slowly and
aoid crowding and stacking. I open sheles are used, they should be wire mesh or
kept dust ree. 1he sheles should keep sterile packages at least 8-10` rom the loor,
18` rom the ceiling or ceiling ixture, and 2` rom the outside walls. 1he sheles
should be kept away rom sinks, windows, doors, and exposed pipes and ents.
Lnsure a barrier between the bottom shel and the loor and that items on the top
shel are protected. Space between packages should be suicient to aoid
compression o supplies. Particular attention should be paid to the storage o
paper,plastic peel-pack pouches.
C H A P T E R 3
O P E R A T N G R O O M
Operating Room -- 16
O All sterile packages must be rotated on a 1
st
in, 1
st
out basis.
O Some items will remain on storage sheles or arying lengths o time. Items should
be ealuated as to the need to keep them sterile. I necessary, items may be placed in
plastic dust coers at the request o the departments sending items to be processed.
O All packages must be inspected beore using.
O A dating label must be applied to each package to be used only or recall purposes.
1his is not to be used as an expiration date.
O 1he user must inspect all packages beore the package is opened. I the package is
damaged, then item is not sterile and cannot be used. Always eriy that the external
indicator has been exposed to the sterilant.
CPD Lnvironment
Routine cleaning:
O CPD will be cleaned at the change o each shit. 1his will include re-stocking ital
supplies, sweeping the entire area, wet acuuming as necessary, wiping down lat suraces,
and emptying all trash.
O CPD ield days will be held. 1he senior technician on board will take charge and assign
the arious duties.
O Completely clean the sterilization room. 1he decontamination process begins at the
highest leel and progresses downward.
O Clean ceiling and walls with sponge mop.
O Clean lights and enting.
O \ipe down all urniture and carts with appropriate disinectant.
O Remoe all load stickers rom the loor.
O Bu and wet acuum loor with disinectant solution.
O Restock area.
O Completely clean the pack room.
O Clean ceiling and walls with sponge mop.
O Clean lights and enting.
O \ipe down all urniture and carts with appropriate disinectant.
O Remoe all load stickers rom the loor.
O Bu and wet acuum loor with disinectant solution.
O Restock area.
O Completely clean trash, linen, and receiing rooms.
O Clean ceiling and walls with sponge mop.
O Clean lights and enting.
O \ipe down all urniture and carts with appropriate disinectant.
O Remoe all load stickers rom the loor.
O Bu and wet acuum loor with disinectant solution.
O Restock area.
O Completely clean clinical supply room.
O Remoe all carts rom room.
O Clean ceiling and walls with sponge mop.
O Clean lights and enting.
C H A P T E R 3
O P E R A T N G R O O M
Operating Room -- 17
O Bu and wet acuum loor with disinectant solution.
Autoclae sterilizers will be cleaned weekly during the weekend shits. Sterilizers 1 and 2
will be secured lriday night to allow cooling prior to cleaning on Saturday. Sterilizers 3
and 4 will be secured Saturday night to allow or cooling prior to cleaning on Sunday.
Cleaning will be perormed in accordance with the cleaning solution`s manuacturer`s
directions. Sterilizers are to be returned to serice as soon as cleaning is completed.

Preentie maintenance:
O All equipment within the diision is ealuated and routinely maintained under the
Preentatie Maintenance Program. 1he lacility`s Department maintains and perorms
repairs on all structural aspects o CPD.

Recall of Material Sterilized by CPD
O Biological spore tests are run or each steam sterilizers and Sterrad sterilizer.
O I a positie test should occur, all sterilized equipment rom that load will be recalled and
reprocessed by the CPD sta.
O 1he CPD Diision Oicer shall initiate the recall and CPD personnel will contact each
area suspected o haing materials rom the ailed load.
O 1he CPD Diision Oicer shall submit any ollow-up reports required by the aected
departments. 1his report will relect inal disposition o any suspected item. I any
suspected items were used prior to recall, a list o patients and their physicians must be
included. All indiidual areas are responsible to ollow-up with patient`s physician. In
addition, the Inection Control Department should be notiied o these eents when they
occur.

C H A P T E R 3
O P E R A T N G R O O M
Operating Room -- 18
Guidelines for mmediate Use {Flash_ 8terilization
References
AORN Standards and Recommended Practices, 2011, Association or the Adancement o Medical
Instrumentation
Policy
O Immediate Use ,llash, sterilization should be used only when time does not permit
sterilization by the preerred wrapped procedure.
O 1he unwrapped method may be used in emergency situations or indiidual items ,i.e.,
dropped instruments,. Complete sets or trays o instruments may be immediate use
sterilized,lashed i the ollowing conditions are met:
O1here is an urgent need.
OProper decontamination, cleaning, inspection, and arrangement o instruments
prior to sterilization.
Procedure
O All contaminated instruments to be immediate use sterilized,lashed will be manually
decontaminated prior to placement in the steam sterilizer.
O Don protectie gear ,i.e., eye protection, gloes, apron i appropriate,.
O Rinse items under cold water.
O Spray instrument with enzymatic solution.
O Clean items with scrub brush under water to aoid aerosolization. Inspect or
cleanliness.
O Place items in immediate use,lash sterilization pan with chemical indicator. Metal or
nonporous items are sterilized or 3 minutes at 20 l ,135 C, in either the graity or
preac cycle. Items with lumens or complex items require a 10 minute 20 l ,135 C,
graity cycle or 4 minute 20 l ,135 C, preac cycle.
O I time permits, all instruments needed or another scheduled case should be taken to
CPD or decontamination and returned to OR or immediate use sterilization,lashing.
1his will take approximately 1 hour. Notiy CPD in adance or prompt serice.
O Immediate Use ,llash, sterilization should not be used or implantable deices except in
cases o emergency when no other option is aailable. In an emergency a rapid-action ,1
hour blue top, biological indication will be run with the load. lollowing sterilization, the
implant should be quarantined until the rapid-action biologic proides a negatie result.

Documentation
O Documentation o cycle inormation and monitoring results will be maintained in a ile to
proide tracking o the lashed item,s, to the indiidual patient.
O Documentation allows eery load o sterilized items used on a patient to be traced.
O Sterilization records should include inormation on each load, including:
C H A P T E R 3
O P E R A T N G R O O M
Operating Room -- 19
O1he item,s, processed,
O1he patient receiing the item,s,
O1he cycle parameters used ,eg, temperature, duration o cycle,
O1he date and time the cycle is run

Reised: Mar 2006, 20 Mar 2011