Standard Operating Procedure: Operating Theatre (OT) Management

This Standard Operating Procedure (SOP) outlines the mandatory protocols for the management, safety, and operational efficiency of the Operating Theatre. Adherence to these guidelines is critical to maintaining a sterile environment, ensuring patient safety, and optimizing surgical throughput. This document serves as a standardized reference for all surgical staff, anesthesia providers, and nursing personnel to minimize intraoperative risks and streamline clinical workflows.

1. Pre-Operative Preparation Checklist

• Sterilization Verification: Confirm that all surgical instruments have passed the autoclave cycle and that indicators show correct sterilization.
• Equipment Functionality: Perform a "pre-flight" check on the anesthesia machine, monitors, suction devices, and surgical lights.
• Environmental Controls: Verify that the OT temperature is maintained between 18°C–22°C and humidity levels are between 30%–60%.
• Patient Verification: Execute the WHO Surgical Safety Checklist; confirm patient identity, surgical site, and consent forms.
• Supply Readiness: Ensure all necessary consumables, sutures, and implants are staged based on the surgeon’s preference card.

2. Intra-Operative Management Checklist

• Scrubbing Protocol: Verify that all team members have completed the required 3–5 minute surgical scrub using approved antimicrobial agents.
• Time-Out Procedure: Lead a formal pause before the first incision to confirm the procedure, patient identity, and prophylactic antibiotic administration.
• Sterile Field Maintenance: Constantly monitor the integrity of the sterile field; report any breach immediately to the lead surgeon.
• Specimen Labeling: Ensure every tissue specimen removed is immediately labeled with the patient’s name, ID, and site of origin in the presence of the surgical team.
• Sharps/Sponge Count: Perform a formal count of all instruments, sharps, and sponges at the start, during, and at the end of the procedure.

3. Post-Operative & Turnover Checklist

• Handover: Conduct a structured transfer of patient care to the PACU (Post-Anesthesia Care Unit) nurse, detailing intra-operative complications and medication administered.
• Decontamination: Remove all biohazardous waste and soiled linens according to clinical waste disposal regulations.
• Instrument Processing: Pre-clean instruments to prevent blood drying and transport them to the Central Sterile Supply Department (CSSD) for decontamination.
• Terminal Cleaning: Wipe down all surfaces, monitors, and the operating table with hospital-grade disinfectant to prepare for the next patient.
• Documentation: Complete all electronic health records (EHR) and update the OT logbook with surgical start/end times and staff attendance.

Pro Tips & Pitfalls

• Pro Tip: Use digital "Preference Cards" that are updated quarterly to ensure surgeons have the exact tools they need, reducing unnecessary opening of sterile packs.
• Pro Tip: Implement a "No-Traffic" policy during critical phases of the operation (e.g., induction and closing) to reduce the risk of microbial contamination.
• Pitfall: Never rely on memory for the instrument count. If there is a discrepancy in the count, do not close the patient until a radiological scan or manual re-count resolves the issue.
• Pitfall: Avoid "complacency drift"—the tendency to skip steps in the safety checklist during emergency cases. Emergencies require the most rigorous adherence to protocol.

Frequently Asked Questions

Q: What is the mandatory action if a sterile field is breached? A: Immediately alert the scrub nurse and surgeon. The contaminated item must be removed, and the area must be re-sterilized or covered with new sterile drapes before proceeding.

Q: How often should the OT environment be cleaned? A: "In-between" cleaning occurs after every case. Terminal cleaning must be performed at the end of the daily schedule or after high-risk procedures (e.g., orthopedic implants).

Q: Who is responsible for the surgical site marking? A: The operating surgeon must mark the site while the patient is awake and conscious, ideally before the patient enters the operating room, to avoid "wrong-site" surgery.