Standard Operating Procedure: Operating Theatre (OT) Management

This Standard Operating Procedure (SOP) outlines the rigorous protocols required for the management of the Operating Theatre (OT) to ensure patient safety, minimize infection risks, and maximize operational efficiency. Adherence to these guidelines is mandatory for all surgical, nursing, and support staff to maintain a sterile environment, optimize throughput, and ensure high standards of perioperative care.

1. Pre-Operative Preparation & Safety

• Patient Verification: Confirm identity, surgical site, and procedure against the consent form and medical records using the WHO Surgical Safety Checklist.
• Surgical Site Marking: Verify the site is marked by the operating surgeon before induction of anesthesia.
• Environment Check: Ensure the OT is cleaned according to sterile standards, with all required instruments and equipment pre-staged and tested for functionality.
• Temperature Control: Adjust room temperature (typically 18°C–22°C) and humidity levels to minimize patient hypothermia and microbial growth.

2. Intra-Operative Protocol

• Scrubbing and Gowning: All personnel must perform a surgical scrub for 3–5 minutes and don sterile gowns and gloves using aseptic technique.
• Patient Positioning: Secure the patient safely to prevent pressure sores or nerve injury, using appropriate padding for all pressure points.
• Timeout Execution: Conduct a mandatory "Time Out" immediately before skin incision. Confirm patient, site, procedure, and antibiotic prophylaxis status with the entire team.
• Count Management: Execute formal counts of sponges, needles, and instruments at the start, during changes in staff/shift, and before wound closure.
• Specimen Handling: Label all specimens immediately at the field, ensuring correct identification and documentation.

3. Post-Operative & Terminal Cleaning

• Patient Transfer: Ensure stable vital signs before transferring the patient to the Recovery Room or ICU with a formal handoff briefing.
• Waste Disposal: Segregate medical waste according to biohazardous protocols. Dispose of sharps in puncture-proof, labeled containers.
• Instrument Processing: Conduct a preliminary rinse/soak for surgical instruments to prevent blood drying before they are sent to Central Sterile Services (CSSD).
• Terminal Cleaning: Perform a deep-clean of the theater using hospital-approved disinfectants, including floors, walls, and equipment surfaces, prior to the next procedure.

Pro Tips & Pitfalls

• Pro Tip: Implement a "Color-Coded Cart" system for different types of surgeries (e.g., Orthopedic, General, Laparoscopic) to reduce setup time and error.
• Pro Tip: Establish a "Sterile Field Traffic Light" system where movement in and out of the OT is restricted during critical phases of the procedure.
• Pitfall: Never rely on memory for counts; if a discrepancy occurs during the instrument/sponge count, the surgeon must be notified immediately before proceeding with closure.
• Pitfall: Failure to perform routine equipment calibration leads to mid-surgery failures. Log all equipment maintenance schedules rigorously.

Frequently Asked Questions (FAQ)

Q: What is the primary purpose of the "Time Out"? A: The "Time Out" is the final safety barrier designed to prevent wrong-site, wrong-procedure, or wrong-patient surgeries by ensuring the entire team agrees on the details before the first incision.

Q: How long should an OT remain empty after an aerosol-generating procedure? A: This depends on the OT’s Air Exchange Rate (ACH). Generally, a waiting period (often 20-30 minutes) is required to allow the HVAC system to clear airborne contaminants before terminal cleaning begins.

Q: Who is authorized to initiate a count discrepancy procedure? A: Any staff member—nursing, surgical, or anesthesia—is authorized and encouraged to call a count discrepancy. The scrub nurse and circulating nurse are responsible for initiating the formal search protocol immediately upon noticing a mismatch.