OT PROTOCOL

OBJECTIVES
• To understand the operating room procedures
• To identify the role of operating room personnel
• To apply the knowledge in record keeping and
documentation
• To categorize and dispose biomedical waste
• To predict biohazards and use Universal safety
precautions
• To define the working of Recovery/PACU
 Minor surgery
• Minor surgery is any invasive operative
procedure in which only skin or mucus
membranes and connective tissue is resected.
• Eg Sebaceous cyst excision
 Major surgery
• Major surgery is any invasive operative
procedure in which a more extensive
resection is performed
– body cavity is entered
– organs are removed
– anatomy is altered.
– if a mesenchymal barrier is opened (pleural
cavity, peritoneum, meninges)
 PREPARING OT LIST
Prioritize the patient
– Age
– Types of operations
– Emergencies
– Infected cases should be done at the end
– Comorbid illness Eg Diabetes
• Abbreviations should be avoided e.g. D&C
• Cancellations should be informed prior
• Signature of the consultant
OT list should reach on TIME….
 Preparation includes….
• Operation theatre
• Patient
• Recovery/PACU
 OT Preparation
Cleaning
• On hour prior to start of
the first case, wipe all
equipment, furniture,
room lights, suction
points, OT table,
surgical light with soap
solution.
 OT Preparation
• Anesthesia drugs,
machines, ventilators,
central gas supply and
cylinders checked by
the OT technicians
• All sutures and drugs
are taken from
Pharmacy by OT nurse.
• All instruments required
are procured from CSSD
 Patient preparation
• Consent/PAC/NPO status
• Surgical site preparation
• Premedication
• Checklist
• Special instructions
• Quick assessment
 Pre-operative Check of Patient
• Identification of the
patient
• Consent to an operation
• prescribed medications
• Pre-medication
• Allergies
• Empty bladder
• Remove dentures/
jewellery
Wheeling the patient inside OT
• The patient is taken to
the OT on a patient
trolley with side rails in
position.
• The patient should be
accompanied by a nurse
and a stretcher barrer.
• OT nurse receives the
patient in a polite and
friendly way
Surgical team
 Teams
Unsterile team:
• Anesthetist/Technician/
Floor nurse/Attender

Sterile team:
• Surgeon team/scrub
nurse
Operating room scrubs (shirt and pants)
Cover jacket
Comfortable shoes and shoe covers
Eye protection
Hair covers
Personnel protective equipment
Surgical Safety checklist…
 Surgical procedure
• Anesthesia given
• Parts draped
• Procedure
• Counts/ instruments
checked
• Closure
• Anesthesia reversed
• Shifing
Hazards

• Anesthetic gases
• Formaldehyde can
cause skin irritation and
rash.
• Bone cement In
pregnant adults
• Radiation Hazards
 Bio Hazards
Special Precautions for
Known Infectious Cases
• HIV
• Hepatitis B / C
• MRSA/VRSA
• VRE
• Gas Gangrene
• Any Multi Drug
•
Resistant Pathogen
•
 Universal Safety Precautions
• Use disposal packs
• Use goggles to protect the
eyes.
• Shoe cover to avoid dripping
of body fluids and blood.
• Double gloves should be
used
• Needles should be handled
very cautiously.
• After the case the OT should
be carbolized and Fogged as
per the
protocol.
 Documentation- Surgical notes
• Operation notes
 Record keeping

1. Anesthesia registers
2. Surgical register
3. Register for consumables
4. Pharmacy register
5. Specimen register for
biopsies
6. Transfusion register
7. Cancellation register
Biomedical waste management
 Terminal cleaning
• Housekeeping staff to
take all standard
precautions
• Linen are folded into a
bundle and sent to the
laundry.
• Wipe all IV poles, suction
machines, beds, pillows,
cots, switch boards, door
• Mop the floor with
detergent and water
followed by bacillocid
special at 2%dilution.
 Used instruments
• Used instruments are
cleaned immediately by
the scrub nurse and the
attender.
• Reusable sharps are
decontaminated in Lysol
/ hypochlorite and sent
for sterilization in the
CSSD.
 Recovery
• Circulating nurse/OT
technician should inform
recovery room nurse

• Level of consciousness and

vital signs to be monitored
in every 15 mins or earlier
as instructed.
• When the patient is fully
conscious and follows the
command, the patient is
shifted to the postoperative
ward
PACU
• Shiting
PADs score
POSt op
Pain scales
• Receiving notes
• Transfer to ward and discharge.
THANK YOU