Chapter 1. Infection Control

1.6 The Operating Room Environment

The operating room (OR) is a sterile, organized environment. As a health care provider, you may be required to enter the OR during a surgical procedure or to set up before a surgical procedure. It is important to understand how to enter an OR area and how the OR area functions to maintain an sterile environment.

Members of the surgical team work hard to coordinate their efforts to ensure the safety and care of their patients. The surgical team is in charge of the OR and makes decisions regarding patient care procedures. The OR environment has sterile and non-sterile areas, as well as sterile and non-sterile personnel. It is important to know who is sterile and who not, and which areas in the OR are sterile or non-sterile.

Sterile OR Personnel

  • Surgeon
  • Surgical assistant
  • Scrub nurse

Non-sterile OR Personnel

  • Anesthesiologist
  • Circulating nurse
  • Technologist, student, or observer

There are specific requirements for all health care professionals entering the OR to minimize the spread of microorganisms and maintain sterility of the OR environment. Prior to entering the OR, show your hospital-issued ID and inform the person in charge of the purpose of your visit. Refer to Checklist 10 for the specific steps to take before entering an OR.

Checklist 10: Entering the OR
Disclaimer: Always review and follow your hospital policy regarding this specific skill.


 Additional Information

1. Bring all required supplies to the OR. Sterilize or disinfect them as required. This step prevents the need to unnecessarily leave the restricted area.

Movement in the OR should be kept to a minimum to avoid contamination of sterile items or persons.

2. State the purpose of your visit to OR personnel and show your ID. This step allows for clear communication with the health care team.
3. Artificial nails should not be worn, and nail polish should be fresh (not more than four days old) and not chipped. Artificial nails, extenders, and chipped nail polish harbour more microorganisms than hands and can potentially contaminate the sterile area.
4. Remove all jewellery. Wedding bands may be permitted under agency policy. Jewellery harbours additional microorganisms and must be removed prior to a surgical hand scrub.
5. Don surgical attire (top and bottom). Surgical attire must be worn only in the surgical area. Tuck top into pants. Surgical attire must be worn only in the surgical area to avoid contamination outside the surgical area.
6. Cover shoes according to agency policy. Shoe covers will protect work shoes from accidental blood or body fluid spills in the OR. Shoe covers must not be worn outside the OR area.
7. Perform a surgical hand scrub according to agency policy. Surgical hand scrubs reduce the bacterial count on hands prior to applying sterile gloves. Hands are kept above waist at all times.
8. Prior to entering the restricted or semi-restricted area:

  1. Apply mask.
  2. Apply head covering to cover earrings, beard, and sideburns.
  3. Once in the OR, introduce yourself to the surgical staff and inquire about the sterile area and non-sterile areas.
Mask must cover nose, mouth, and chin for a proper seal. Mask should be changed if it becomes wet or soiled.

A surgical mask or N95 mask may be required, depending on whether the patient is on additional precautions.

Knowing what area is sterile/non-sterile will prevent accidental contamination of sterile fields and delays in surgery.

Sterile persons/area

The sterile field should be created as close as possible to the time of use. Covering sterile fields is not recommended.

Sterile areas should be continuously kept in view. An unguarded sterile field is considered contaminated.

Sterile persons should keep well within the sterile area. Sterile persons should pass each other back to back or front to front. A sterile person should face a sterile area to pass it and stay within the sterile field.

Non-sterile person/area

A non-sterile person should stay at least one foot away from the sterile field, and face the sterile field when passing it.

A non-sterile person should not walk between two sterile fields or reach over the sterile field.

Data source: Kennedy, 2013; ORNAC, 2011; Perry et al., 2014; Rothrock, 2014

Critical Thinking Exercises

  1. Why should the sterile field always be kept in sight by the scrub nurse or circulating nurse?
  2. Name three health care providers who are considered sterile in the OR area.


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Clinical Procedures for Safer Patient Care Copyright © 2015 by Glynda Rees Doyle and Jodie Anita McCutcheon is licensed under a Creative Commons Attribution 4.0 International License, except where otherwise noted.

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