OR Etiquette: Customs & Courtesies

First things first plan to be in the operating room before the patient arrives. Introduce yourself to the circulating nurse who should have a desk/workspace in a corner of the operating room. Most operating rooms have a white board where they put all pertinent information for the “time out” prior to the case, where you should write your name and title so the circulator can document who was in the room.

Next if you are allowed to scrub in the case (be sure to ask the surgeon well in advance), obtain your gloves and gown. If you’re not sure what glove size you are, ask someone for help, most women wear between a 6-7 and most men wear between a 7-8. If the case is already “open”, meaning all the surgical instruments are laid out on a sterile table, the expectation is that you open your gloves and gown with sterile technique as to not contaminate the table. If you are unsure about how to open your gloves and gown, wait until someone can show you the correct way.

When the patient arrives in the OR, you can be helpful by assisting with positioning the patient. When the patient moves onto the surgical table, the main priority is anesthesia safely obtaining an airway. During this time try to keep conversations and distractions to a minimum. You can help by securing the safety strap across the patient’s hips/thighs, connecting the sequential compression device (SCDs) to the pump. Once the patient is asleep you can expose the operative site, reposition the patient and help with shaving or prepping the skin that is in the operative field.

Once the patient is positioned, the circulator will prep the skin, most commonly with chlorahexadine or betadine. This is your cue to go scrub ( see attached video for a basic how to). Ideally you should be scrubbed in before your surgeon.

Once your hands are cleaned, enter the OR without touching any surface. Approach the scrub table and dry your hands (see video below)

Then get gowned and gloved.

Now its time to drape the patient. You can assist the surgeon with this.

What follows is getting all cords (suction, Bovie electrocautery, laparoscopy, etc.) plugged in. Once everything is situated its time to the “Time Out” a safety stop to confirm that the patient, surgery, operative site, and all equipment is verified, this is another time to minimize all conversations and distractions.

Once the surgery start, your role is dependent on the surgeon and your experience level. Regardless of your role during the operation, things to keep in mind are:

  • Everything blue is sterile, if you are scrubbed in you may touch these items
  • Do not grab items off the mayo stand or back table, unless you have explicit permission from the scrub tech.
  • Be cognizant of your sharps and hand them back carefully or set on the Mayo Tray and announce that you have set it down to the scrub tech.  Do not set a sharp down on the patient if you are done using it.
  • If you are suturing, make sure you protect the needle (turn the needle so the point is aimed towards your instrument)  before handing the needle driver back to the scrub tech.
  • As a junior level resident or medical student, you should assist in helping clean/dry the operative field at the conclusion of the case and you should be helping to take the drapes down, you should not just assume that the scrub techs will take care of this as they will be busy with final count and breaking down the back table.

When in doubt, just ask! The operating room can be an overwhelming foreign place… it can also be the most magical place. Observe the flow of the different roles in the operating room and pay attention to the nonverbal cues that are communicated in the operating room and you’ll fit in in no time!


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