The OR can be a scary place to be if you aren’t familiar with the rules and regulations. I was fortunate to have been allowed to shadow in the OR since I was in high school so I had a basic knowledge of what to expect when it came to my clinical rotations and starting residency, however others aren’t as fortunate to have such a thorough orientation to the operating room. OR staff is very protective of their operating rooms and rightfully so, because if anyone breaks sterility it could jeopardize a case or could expose a patient to a higher risk of a surgical site infection. This series aims to be a general guide for those just getting started in the OR whether you are a curious pre-medial hopeful like I was, a medical student starting their surgical clerkship, a brand new scrub tech, or dream of being an operating room nurse. So without further adieu the first rule to success in the operating room is looking like you fit in! If you are just going to observe in the OR, your first goal should be to blend in, drawing attention to yourself in the operating room especially if you are not part of the surgical team is asking to be kicked out of a case.

Side note: it is important to take note of what counts as a substerile area versus a sterile area. In general the pre-operative/patient holding area is “unsterile” meaning patient families can come and go in their street clothes, and no one is required to adhere to any specific OR dress standards. In every hospital I have ever worked at, the pre-op area is separated from the substerile hallway by a red line on the floor. Do not cross this line unless you adhere to the dress standards I’ll discuss below. Another important distinction is crossing from the substerile hallway into an OR. If you are going to enter an OR, be sure to stop and put on a mask which will be located above the scrub sink which are located outside the operating room.

Scrubs

Most hospitals require hospital issued surgical scrubs which can only be worn inside the hospital. These scrubs are normally kept in a scrub machine or a scrub dispenser within the OR or surgical clinic.

Long Sleeves

Although it is hospital dependent, typically white coats, long sleeve shirts, and jackets are not allowed once you cross into the sub-sterile hallway so be sure to take these items off. You will likely find OR jackets in the same dispenser as OR scrubs which you will be permitted to wear into the sub sterile hallway and into the OR (I strongly recommend getting yourself a jacket or two if you are not going to scrub into a case – the OR is a frigid place to stand for several hours).

Shoes

If you want to wear your street shoes into the OR you must use shoe covers. If you are going into a particularly messy case you may want to consider boot covers instead. Be sure your shoes are comfortable, cover your toes and foot entirely, ideally are water proof and thick enough to protect you from any dropped objects.  I chose to have my designated OR shoes which are comfortable, waterproof and non-slip and I keep them at the hospital so I’m allowed to wear them into and out of the OR without needing shoe covers. A very popular shoe brand is Dansko, however I found the Grey’s Anatomy brand is more comfortable as they aren’t as narrow and tight across the top of the foot. (This is the pair I wear and highly recommend!) Although there are no restrictions on what type of socks, I highly recommend compression socks as they make a big difference in fatigue over the course of the day.

Scrub caps

Every hospital I have rotated during my residency allows personal scrub caps as long as they are laundered frequently and cover all of my hair (for the military ladies check out  my favorite etsy store which has scrub caps with bun covers), In medical school the hospitals I rotated through required a blue bouffant cap to be worn over any personal scrub caps, and other hospitals only permitted disposable scrub caps to be worn into the OR. Regardless of hospital policy be sure all hair is secured underneath a scrub cap before crossing into a substerile/sterile area.

Jewelry

I have my ears pierced and am allowed to wear my small stud earrings into the OR, but just because I am paranoid I actually wear locking back earrings so I can be confident my earrings wont fall out. Be reasonable with your earring choices, don’t wear anything too flashy or dangling. Keep in mind if you are going to scrub in on a case you are not allowed to wear bracelets or rings. I keep my watch in my scrub pocket and I tie my rings into my scrub pants (just don’t forget they are there!), but many people I know like putting their ring on a necklace change or if they are really fancy they have a ring holder like this one.

Glasses

Be sure to have your glasses (prescription or safety googles) fitted to decrease the chance they may slide down your nose. Although you may not have a problem with your glasses slipping during your every day activities, keep in mind in the OR you will be wearing a mask which can allow condensation to form on the bridge of your nose and you will likely be looking down onto the operative field. Before having my glasses adjusted for a better fit, I relied on eyeglass ear grips like these to ensure my glasses wouldn’t fall into the surgical field.

Masks

You may walk through a substerile hallway without a mask, but before entering any OR be sure to put a mask on. Masks are required inside the operating room whenever a case is “open” i.e. the surgical tools are laid out in preparation for a patient or if a patient is on the operating table. The only time a mask is not require inside the operating room is at the conclusion of a case when the sterile table can be broken down while anesthesia waits to wake up the patient. When in doubt, put a mask on you will never be wrong for wearing  a mask when entering the operating room.