INTRODUCTION TO

OPERATING
ROOM TECHINIQUE

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 Learning Objectives
At the end of this chapter, learners will be able to:
Define perioperative nursing and operative room nurse.
 Describe the phases of perioperative period.
Describe types of surgery
 Show specific areas in the operating room.
 Identify the role of each members of the operating
room team.
 Describe how environmental layout contributes to aseptic
technique.
Understand the role of counting and counting procedures.

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 Definition of Perioperative Nursing

 Perioperative Nursing:- is
i a specialized field that
encompasses the care provided to patients before, during,
and after surgical procedures.
 It is the nursing care given before (pre operative period),
during (intra operative period) and after surgery (post
operative period).
 This nursing care is critical in ensuring patient safety,
comfort, and optimal outcomes throughout the
surgical experience.
 The perioperative nurse provides comprehensive
nursing care in this period, which will help to
optimize patient outcomes, minimize complications.

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• Perioperative nurses work collaboratively with
surgeons, anesthesiologists, and other healthcare
professionals to deliver comprehensive care tailored
to each patient's needs.

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Perioperative Nursing
Phases

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 Preoperative phase

 Preoperative phase – it is the time period that begins

when the decision is made for surgery until the client is
transferred to the operation table.
 Nursing management in pre-operative phase

• The nursing management in the preoperative period

is essential to ensure the safety and well-being of
patients undergoing surgery.

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• By providing comprehensive nursing care in the
preoperative period, nurses can help optimize
patient outcomes, minimize complications, and
ensure a smooth transition into the surgical setting.

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 Assessment: Conduct a comprehensive preoperative
assessment, including the patient's medical history,
current medications, allergies, vital signs, physical
examination, and laboratory tests. Identify any
potential risks or complications that may impact the
surgical procedure.

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 Patient Education: Provide thorough education to
the patient about the upcoming surgery, including
what to expect before, during, and after the
procedure. Explain the purpose of the surgery,
potential risks and benefits, postoperative care
instructions, and what to expect during recovery.

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 Preparation: Ensure that the patient is adequately
prepared for surgery by following fasting guidelines,
discontinuing medications as directed by the
healthcare provider, and completing any necessary
preoperative tests or procedures. Verify informed
consent has been obtained.

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 Psychosocial Support: Address any fears or anxieties
the patient may have about the surgery. Offer
emotional support and reassurance, and involve
family members or support persons as needed to
provide comfort and assistance.

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 Medication Management: Administer preoperative
medications as prescribed, such as premedication for
anxiety or prophylactic antibiotics. Ensure that all
medications are documented accurately and safely
managed.

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 Infection Prevention: Implement infection control
measures to reduce the risk of surgical site
infections. Ensure that the patient follows proper
hygiene practices and that skin preparation protocols
are followed before surgery.

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 Nutritional Support: Assess the patient's nutritional
status and provide guidance on maintaining
adequate nutrition before surgery. Address any
dietary restrictions or special considerations based

on the type of surgery being performed.

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 Collaboration: Collaborate with the surgical team,
anesthesiologist, and other healthcare providers to
ensure a coordinated approach to care.
Communicate effectively to address any concerns or
changes in the patient's condition.

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 Documentation: Document all assessments,
interventions, patient education, and communication
accurately in the patient's medical record. Ensure
that all preoperative checklists and protocols are

completed according to institutional guidelines.

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 Intra-operative phase –it is the time period from
which the client is transferred to the operation table
and continues till the patient is transferred to the
post operative recovery area.

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 Nursing management in intra-operative period
• The nursing management during the intraoperative
period is critical to ensure the safety, comfort, and
well-being of patients undergoing surgery.
• By providing attentive and skilled nursing care during
the intraoperative period, nurses play a crucial role
in promoting patient safety and positive surgical
outcomes.

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 Monitoring: Monitor the patient's vital signs, oxygen
saturation, ECG, and other relevant parameters
throughout the surgical procedure. Communicate
any changes in the patient's condition to the surgical
team promptly.

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 Assistance to Surgeons: Provide assistance to the
surgical team as needed, including passing
instruments, handling specimens, and performing
other tasks to support the surgical procedure.
Anticipate the needs of the surgeon and maintain a

sterile field.

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 Safety Measures: Implement safety protocols to
prevent surgical site infections, medication errors,
and other potential complications. Follow aseptic
techniques, adhere to surgical site marking
protocols, and verify patient identification and
surgical site before incision.

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 Communication: Maintain open communication with
the surgical team, anesthesia providers, and other
healthcare professionals involved in the procedure.
Report any concerns or unexpected findings

promptly to ensure timely intervention.

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 Patient Advocacy: Advocate for the patient's safety,
comfort, and rights throughout the surgical
procedure. Ensure that the patient's dignity and
privacy are respected, and address any questions or
concerns they may have during surgery.

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 Documentation: Document all intraoperative
activities, events, medications administered, and
communication accurately in the patient's medical
record. Ensure that all relevant information is
recorded for continuity of care and legal purposes.

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 Postoperative phase - begins once the surgery is
completed and continues until the client is
discharged from the care of the surgeon.

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• The nursing management in the postoperative
period is essential for promoting the patient's
recovery, preventing complications, and ensuring a
smooth transition from the operating room to the
post-anesthesia care unit (PACU) or surgical ward

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 Monitoring: Continuously monitor the patient's vital
signs, level of consciousness, pain level, respiratory
status, and surgical site for any signs of
complications. Assess for signs of bleeding, infection,
respiratory distress, or other postoperative issues.

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 Pain Management: Implement a comprehensive
pain management plan to address the patient's
postoperative pain. Administer analgesics as
prescribed, assess pain levels regularly, and adjust
the pain management regimen as needed to ensure
the patient's comfort.

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 Fluid and Electrolyte Balance: Monitor the patient's
fluid intake and output, electrolyte levels, and
nutritional status to prevent dehydration, or other
complications. Encourage oral intake as tolerated
and administer intravenous fluids as needed.

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 Mobility and Activity: Assist the patient with early
mobilization, range of motion exercises, and
ambulation to prevent complications such as deep
vein thrombosis (DVT), atelectasis, or pressure
ulcers. Encourage gradual increase in activity level
based on the patient's condition.

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 Wound Care: Monitor the surgical incision site for
signs of infection, dehiscence, or delayed healing.
Follow proper wound care protocols, change
dressings as needed, and educate the patient on
wound care techniques to promote healing and
prevent infections.

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 Respiratory Support: Monitor the patient's
respiratory status closely, especially after anesthesia
and surgery. Encourage deep breathing exercises,
coughing

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 Nutritional Support: Assess the patient's nutritional
status and dietary needs postoperatively. Offer
small, frequent meals and encourage adequate fluid
intake to support healing and prevent complications

related to malnutrition or dehydration.

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 Patient Education: Provide thorough education to
the patient and family members on postoperative
care instructions, medication management, signs of
complications to watch for, follow-up appointments,
and self-care strategies for a successful recovery at
home.

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 Psychosocial Support: Offer emotional support,
reassurance, and encouragement to the patient
during the postoperative period. Address any fears,
anxiety, or concerns they may have about their
surgery, recovery process, or future care needs.

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 Discharge Planning: Collaborate with the healthcare
team to develop a comprehensive discharge plan
that includes instructions for home care, follow-up
appointments, medication reconciliation, and
referrals to other healthcare providers or support
services as needed.

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 Perioperative Nursing Skills

 Technical Skills

• Clinical Proficiency: Understanding surgical procedures,

anatomy, and the use of surgical instruments is vital.
 Perioperative nurses must be familiar with aseptic
techniques and infection control protocols to ensure
patient safety during surgery.

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• Monitoring: continuous monitoring of patients' vital
signs and physiological status during surgery is
crucial.
 Proficiency in using monitoring devices (e.g., ECG,
pulse oximetry) and interpreting data accurately is
essential for timely interventions

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• Emergency Preparedness: perioperative nurses must
be well-versed in emergency protocols to respond
effectively to situations such as cardiac arrest or
severe allergic reactions.
o This requires a calm demeanor and quick decision-
making under pressure

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 Clinical skills

• Monitoring patients as they recover from anesthesia,

managing vital signs, pain levels, and potential
complications.
• Pain Management: Implementing effective pain relief
strategies post-operatively, including medication
administration and non-pharmacological methods
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• Documentation: Accurate record-keeping of surgical
procedures, patient status, and any intraoperative
events is necessary for continuity of care and legal
compliance

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 Interpersonal Skills

• Communication: Effective communication with the

surgical team, patients, and their families is
fundamental for ensuring clarity regarding
procedures and post-operative care instructions

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• Patient Advocacy: Serving as an advocate for
patients involves addressing their concerns.
• Team Collaboration: Working seamlessly with
surgeons, anesthesiologists, and other healthcare
professionals is essential for coordinated patient
care

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 Cognitive Skills

• Critical Thinking: The ability to analyze situations

quickly and make informed decisions is crucial in the
fast-paced perioperative environment.
• Nurses must assess patient information rapidly to
support the surgical team effectively

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• Attention to Detail: Precision is vital in the operating
room; small oversights can lead to significant
complications. Perioperative nurses must follow
protocols meticulously to ensure safety

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 Personal Attributes(soft skills)

• Emotional Resilience: The ability to cope with the

high-stress environment of the operating room while
maintaining a positive attitude is essential for both
personal well-being and effective patient care

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• Compassion and Empathy: Providing emotional
support to patients who may be anxious or fearful
about surgery fosters trust and enhances the overall
patient experience

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• Patience: Exceptional patience is necessary for
navigating the complexities of patient care and
adapting to evolving situations in the perioperative
setting

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 Challenges in Pediatric Perioperative Nursing

• Communication barriers: Children may struggle to

express their pain or anxiety effectively.
• Parental Involvement: Engaging parents in the care
process can significantly enhance a child's comfort
level. Well-informed parents can provide emotional
support and assist in managing their child's recovery
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• Psychological and Emotional Factors
 Preoperative anxiety is prevalent among pediatric
patients due to fear of the unknown, separation from
parents, and the surgical environment.
 This anxiety can manifest in various ways, including
agitation and resistance during induction of anesthesia

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 Case study

• Kebedech, who is a 10-year-old girl comes to the

emergency department. She is presented with
severe pain, necessitating immediate surgical
intervention. What is your role as a perioperative
nurse?

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Surgery
 Surgery is a critical field in medicine that involves the
treatment of diseases and injuries through operative
procedures.
 Any procedure performed on the human body that
uses instruments to alter tissue or organ integrity.

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The Surgical Team
 Surgical Attire
• Gowns
• Gloves
• Masks
• Hair Covering
• Protective eyewear
 Types of surgery
Surgical procedures are classified based on:
1.Urgency
2.Risk
3.Purpose

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Surgery based on urgency of the procedure
I. Emergency
II.Urgent
III.Elective

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Emergency surgery:- must be done
immediately to preserve life, a body part or
function.
• Examples: control of hemorrhage, repair of
trauma, extensive burns , skull fractures,
intestinal obstruction

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Urgent surgery:- must be done with a
reasonably short time frame to preserve
health. Usually done with in 24-48 hours.
• Examples: removal of gallbladder stone

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 Elective surgery:- is performed when surgical
intervention is the preferred treatment for a condition
that is not imminently life threatening or to improve
the client’s life.

• It is a procedure that is pre planned.

• Examples: hernia repair, cataract extraction,

tonsillectomy
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Surgery based on risk
I. Major surgery
II.Minor surgery

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 Major surgery:- requires hospitalization and
specialized care, is usually prolonged, has a higher
degree of risk, involves major body organs or life
threatening situations, has a greater risk for post
operative complications

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• Examples:laparotomy,nephrectomy,
hysterectomy, radical mastectomy.

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Minor surgery:- is usually brief, carries low risk
and results in few complications.
 Minor surgeries are usually elective.

examples: teeth extraction, cataract extraction

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 Surgery based on purpose

Diagnostic surgery:- surgeries to make or

confirm diagnosis.
Examples: biopsy

Ablative surgery:- surgeries to remove a

diseased body part
Examples: appendectomy, amputation

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 Palliative surgery:- surgeries to relieve or reduce
intensity of an illness. It is not curative

Examples: colostomy

 Reconstructive surgery:-
surgery: Restore function or
appearance to traumatized or malfunctioning tissues.
Examples: breast reconstruction, cleft lip and palate
repair
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 Cosmetic surgery-
surgery Performed to improve personal
appearance. Example: Breast Augmentation,
Liposuction, Rhinoplasty

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Transplantation surgery:- surgeries to replace
organs or structures that are diseased or
malfunctioning

Examples: kidney, liver, heart transplantation

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 Location:
Location Based on the area of the body on which the
surgery occurs (e.g abdominal, heart surgery).
 Extent of surgery :

 Simple-
Simple Only the most overtly affected areas
involved in the surgery.
 Radical-
Radical Extensive surgery beyond the area obviously
involved; is directed at finding a root cause.
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 Operating room
 OR is a special environment within a health care
facility, where surgical procedures are performed on
patients to diagnose and treat disease or injury.
 It is a highly restricted area that is subject to strict
sterility.
 Is also a particular room where the surgery and the
surgical procedures are conducted.

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 Operating room…
• The operating room work is a teamwork where two or
more persons recognize common goals and
coordinate their efforts to achieve this goal.
• Interdependence characterizes a team, without the
other members, the goals cannot be met. The failure
of any one member to perform her or his role can
seriously affect the success of the entire team.

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 Organization of areas in the OR
• operating room is the place where we have to
practice a high standard of aseptic techniques and
sterilization of supplies in order to reduce the events
of infection.
• This unit is designed with a series of rooms leading
of a corridor with close doors that separates it from
the general wards.

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 Organization of areas in the OR…
• The efficiency of the operating room depends on its
physical organization and the organization of its
personnel.
• Corridors of the operation theater should never be
open b/c there is a high traffic and bacterial
contamination of the air.
• ORs have different design, in different countries.

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 Basic design principles
The basic design principles which are common to all
operating rooms must fulfill the following criteria :
 The design must always be simple and easy to keep it
clean.

 Wall and floor surfaces should be smooth and made of

washable materials.

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 Basic design principles…
 Operation rooms are usually bright and faced north to
south so that they are not exposed to the sun for a long
period of time

 There should be separate rooms for clean or sterile

instruments and soiled ones.

 All electrical sockets must be earthed.

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 Basic design principles…
 There should be sufficient space to ensure the safe
transportation of patient and staff.
 Any cross traffics for people other than the workers of
the unit are strictly avoided .

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 Special laundry facilities should be provided in the
operating unit .
 The recovery room should be near the operating
room ,so that patients can be transported safely and
quickly following surgery.

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 Areas in the OR
 The OR is divided into three areas based on the
activities performed .

A. Unrestricted Area
 This area is isolated by doors from the main
corridor and other areas of OR suite.
 It serves as an out side –to-inside access area.
 although traffic is not limited in this area, it is
monitored at a central location.
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 B. semi restricted area

 Traffic is limited to properly attired (dressed)

personnel.
 Body and head coverings are required.

 The patient may be transferred to inside with

stretcher to this area.
 The patient ‘s hair must be covered.

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 C. Restricted Area

 Sterile procedures are carried out in this area.

 The area includes the surgical bed, scrub sink areas

and sub sterile rooms or clean core areas where
unwrapped supplies are sterilized.

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Surgical bed

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The OR areas are also partitioned based on the tasks as
follows

A. The Supervisor’s office: has direct access to the out

side of the operating room.

The supervisor may need to receive visitors and

significant others who are not dressed the scrub attire

B. Dressing room: for operating room personnel have a

door to the out side corridors so that personnel may enter
there ,change into scrub attire and go directly into the
operating room. 84
 Cont…
C. The Holding Area: this is the area where the health
care givers properly identify the patient and make
sure that all preoperative cares are carried out and
other important data are in the patient’s chart .

D. scrub areas: are located in several places close to

the operating suites. Hot and cold water pipe line
supplies ,Scrub brushes ,caps, soaps, masks ,are
located at each scrub station .
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E .Sterilization Room :it is adjacent to the operating
room.
The room is usually equipped with boilers
(autoclaves ) for providing sterile water for solutions
and clean instrument during surgery .
 The room should be wide enough for lying trolleys
comfortable, to reduce humidity, heat and risk of
infection and it must be well ventilated.
F. Utility room : is a room where equipment to be
cleaned and stored . 86
G. The sterile supply room:-serves as a supply deposit
for wrapped sterile articles. this area should be dusted
frequently with a damp cloth and have storage
cabinets with doors to minimize exposure of the
supplies to room air and dust.

H. Supply And Storage Areas .

• Extra equipments and supplies are used to store.

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 Cont…

I. The recovery room :-it is an intensively monitored

setting that allows observation, therapeutic
interventions and observation of the patients as they
become fully recovered form the effect of the surgical
procedure and anesthetics.

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J. The operating suites: are rooms where surgery is
performed.

These rooms are wide enough to allow scrub

personnel to move around non sterile equipment
without their contamination.

Green line :- this is a line where you can not pass

before changing the OR clothes..

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Operating room equipments and
furniture

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A. Wall Clock
Since time is often critical during surgery, each room
should have a wall clock that is easy to read.
The clock is used to time tourniquet applications,
administration of medications , the duration of cardiac
and respiratory arrests and to note the time of events
such as childbirth.

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B. X-ray Viewing Boxes
The surgeon may need to view an x-ray before or during
the procedure.

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C. Lights
The overhead lights should specially designed to
provide a range of intensity.

They should be freely movable, Shadow less

and less heat emitting

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D. The Operating Table
The table should be fully adjustable in all directions to
create postures needed for various surgical positions.

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E. Mayo Stand
This stand is used to hold instruments that will be used
frequently during a particular case

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F. Back Table
The back table is used to place extra supplies and
instruments used during surgery.

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G. Ring Stand
The ring stand is used to hold normal saline or
sterile water during surgery

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H. Kick Bucket
The kick bucket is used to place soiled sponges during
surgery.

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I. Supply Cabinets
These cabinets are used to store frequently used items
such as drapes, dressings, solutions, sutures, etc.

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J. Anesthesia Equipment
Equipments , including the oxygen machine, patient
monitor, anesthesia supply cart, and is located in
each room.

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Anesthesia equipment

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Operating room team and
relationship

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Operating room and its function (relation ship)

 The sterile team consists of :

 Surgeon

 Assistant Surgeon

 Scrub nurse

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 Cont…
 The unsterile team includes :
 Anesthesia provider (anesthetist)

 Circulatory/runner nurse

 Others ,such as students ,cleaners and those who may

be needed to set up and operate specialized
equipment or monitoring devices.

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107
 Responsibility of each member
Sterile team members :
 Wash (scrub) their hands and arms , put on a
sterile gown, capping , use masks and gloves
respectively.
 To establish a sterile field ,all items needed for
the surgical procedure are sterilized .
After this process ,the sterile team members
function within this limited area and handle
only sterile items. 108
 Responsibility cont…
Unsterile team members
 Doesn’t enter the sterile field, they function outside and
around it.
 They assume responsibility for maintaining sterile
technique during the surgical procedure, but they handle
supplies and equipment that are not considered sterile .
 They keep the sterile team supplied ,provide direct
patient care , and requirements that may arise during the

surgical procedure .
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 Responsibility cont…

Responsibilities of the surgeon

 The surgeon must have knowledge ,skill ,and
judgment required to successfully perform the
intended surgical procedure.

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 Responsibilities of the surgeon…
 The surgeon‘s responsibilities include ,but are
not limited to, the following
• Preoperative diagnosis and care
• Selection and performance of the surgical

procedure
• Post operative management.

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 Responsibility cont…
Responsibilities of the assistant Surgeons

Under the direction of the operating surgeon ,one or

two assistants help to :
 Maintain visibility of the surgical site

 Control bleeding

 Close wounds

 And apply dressings .

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 Responsibility cont…
Responsibilities of the scrub nurse
 The scrub nurse learns how best to work with each
surgeon and other team members as a smooth
working team.
 He/she is guided and directed constantly by what
the surgeon is doing .
 The scrub nurse must have a constant attention to
the operation field.

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 Responsibilities of the scrub nurse…

Before the operation

 Enquire the surgeon about type of incision and
instruments required
 Check the cleanliness of the OR
 Prepare and check material for operations.
 Scrub, gown, and glove prior to surgeon

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 Before the operation…
 Prepare tables with adequate instruments

 Help surgeon to drape patient

 Check electrical apparatus and equipment

 Count swabs ,needles, together with circulating

nurse before operating begins
 Respect aseptic roles all times.

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 Responsibilities of the scrub nurse…
During operation
 Anticipate requests from surgeon

 Handle instruments in correct way .

 Apply dressing

Keep track and count of swabs together with

circulating nurse.
Perform final swab check

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117
 Responsibilities of the scrub nurse…

After operation
• Participate in the safe transfer of patient to trolley

• Collect instruments for decontamination

• Place needles and blades in the safety box

• Clean instrument table

• Participate in cleaning and rearrangement of the

operating room.
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 Responsibilities of the scrub nurse…

Other tasks
• Order ,check and restock the material

• Check that material is in sufficient quantities and is

functional .
• Ensure full cleaning of OR at least on monthly bases

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 Responsibility cont…
The circulatory nurse duties
Before operation
 Receive patient on arrival to OR

 Check patient’s card ,name ,consent form , type and side of

operation .
 Enquire the surgeon about any special preparation

 Check and remove jewelleries

 Check patient’s clothes

 Take patient to operating room and place him or her on table

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 Before operation…

 check electrical apparatus and equipment

 open packs and sets

 help scrub team to gown and glove

 perform count together with scrub nurse

 assist anesthetist if necessary

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 Responsibility cont…
During operation
• Anticipate requests from surgeon

• Insert urinary catheters if necessary (with assistant )

• Keep track and count of swabs together with scrub nurse

• Adjust light ,suction machine and other apparatus

• Promptly address requests from the scrub team

• Perform final swab check

• Detect and report aseptic mistakes

• Help applying dressing

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 Responsibility cont…
After operation
 participate in the safe transfer of patient on to trolley and
recovery
 Collect instruments for decontamination, place needles
and blades in the safety box
 Clean instruments table

 Participate in cleaning and re arrangement of the

operating room
 Be present from beginning until end of operation 123
 Responsibility…

Between operations
 Decontaminate ,clean and dry soiled material.

 Reset and repack clean equipment

 Prepare drapes and towels for sterilization

 Sterilize sets and packs

 Check cleanliness and order of the operating room

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 Responsibility…

Other tasks
 Order, check and restock the material

 Check that material is it quantities and is functional

 Ensure full cleaning of OR at least on monthly

bases

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Responsibilities of the anesthesia providers:
•Anesthesia and surgery are two distinct, but inseparable
disciplines; they are two parts of one entity.
•Adequate communication between the surgeon and the
anesthesia provider is the patient’s greater safeguard.
•Functioning as a guardian of the patient, the anesthesia
provider should observe the principles of aseptic technique.

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 Responsibilities of the anesthesia providers…
• The main activities of the anesthesia provider are:
 Administering anesthetic agent/anesthesia

 Monitoring vital signs

 Fluid and electrolyte administration

 Maintaining anesthesia at the required levels

 Managing untoward reactions to anesthesia

throughout the surgical procedure.

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Qualities of the operating room
team members

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A. Stamina:
 Since the job requires long hours of standing, lifting
heavy instruments, positioning patients ,and many
other physical tasks, the OR personels should be in
good physical condition and have the energy to
complete his/her daily work in a safe and efficient
manner.

129
 Qualities….

B. Emotional stability:
The operating room work is stressful.

The nature of the work can cause team members to be

tense or to display aggressive behavior while working.
The OR team must be able to cope with his/her own
tension and that of team members.

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 Qualities….
C. Stable health:
The surgery department needs upon the daily presence
of its employees.
 If one person is ill, the work load of other team
members is increased because they must perform the
work of the absentee.

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 Qualities…
D. Respect:
Respect for patient rights for privacy, for other team members ,
and for him/herself is an appropriate quality of the OR team.

E. Good humor:
In a difficult and demanding environment such as the OR,
which results a senseless waste of energy for the team members ,

it is important to have proper perspective on the day events and

to share good spirit.

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 Qualities…
F. Team spirit:
The ability to work with team members towards a
common goal is very important in surgery.
The patient expects and should receive the undivided
attention of all who give care for him/her.

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Item count

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 Sponge, Sharp, and Instrument Count

Items are counted before and after use.

The operating team members should be accountable

for the performance of quality patient care.
The surgeon and patient rely on the accuracy of this
accountability by the team.

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 Cont…
Item counts are performed for patient and personnel
safety, infection control and inventory purposes.
An item left in the wound after closure is a possible
cause for a lawsuit following a surgical procedure.
A foreign body unintentionally left in a patient can be
the source of wound infection or disruption.

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 Consequences of foreign body left in the
patient’s body will result
 Formation of an abscess and development of fistula
between organs.
 Foreign body reaction may be immediate or delayed
for years.
 Sometimes difficult and costly to diagnose.

 Removal of the object usually requires major surgery.

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 Cont..
A contaminated sponge or needle that is unaccounted
for at the close of procedure could also in advertently
come in contact with the personnel who clean the room.

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 Cont…
 Counting ensures that expensive instruments such as
towel clips and scissors are not accidentally thro
away or discarded with the drapes.
 Injury to laundry and housekeeping personnel by the
contaminated sharp edges of surgical instruments,
blades, and needles is a potential risk.
 Surgical instruments also can cause major damage to
equipment in the laundry service.
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 Counting Procedure
A counting procedure is a method of counting for
items put on the sterile table for the surgical procedure.
Sponges, sharps, and instruments should be counted
for all surgical procedures.
This includes any material introduced into the patient
during the procedure.
A counting procedure is made three times in a
surgical procedure.
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 A. First Count
 The person who assembles and wraps items for
sterilization will count them.

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 B. Second Count
• The scrub nurse and the circulator together count all
items before the surgical procedure begins and during
the surgical procedure as each additional package is
opened and added to the sterile field.
• These initial counts provide the baseline for
subsequent counts.
• Any item initially placed in the wound is recorded.

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 C. Third count
Counts are taken in three areas before the surgeon
starts the closure of a body cavity or a deep/large
incision: It is conducted in three areas.
 Field Count- Either the surgeon or the assistant
surgeon assists the scrub nurse with the surgical field
count.
• Additional items are counted at this time.

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 Third count…
 Table Count. The scrub nurse and the circulating
nurse together count all items on the Mayo stand and
instrument table.
• The surgeon and assistant surgeon may close the
wound, while this count is in process.

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 Third count…
 Floor Count. The circulating nurse counts sponges

and any other items that have been from the floor or
passed off the sterile field to the kick buckets.
• These counts should be verified by the scrub nurse.

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THANK YOU!

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