Operating Theatre (OT) Protocols & Safety Standards

Welcome to the Bexyhub OT Protocol Resource Center. This guide outlines the essential protocols required for maintaining safety, sterility, and efficiency within the Operating Theatre.

Pre-Operative Surgical Scrubbing

Objective: To reduce the microbial count on the hands and arms before donning sterile surgical attire.
Duration: 3 to 5 minutes for the first scrub of the day.
Protocol:
Remove all jewelry (rings, watches).
Keep nails short and clean.
Scrub from fingertips to 2 inches above the elbow using an antiseptic solution (Chlorhexidine or Povidone-iodine).
Keep hands held above the level of the elbows at all times.

Surgical Site Marking & WHO Checklist

Site Marking: The surgical site must be marked by the surgeon before the patient enters the OT.
WHO Safe Surgery Checklist:
Sign In: Before induction of anesthesia (Confirm patient identity, site, and consent).
Time Out: Before skin incision (Team introduction, confirming patient name, procedure, and anticipated critical events).
Sign Out: Before the patient leaves the OT (Instrument/Sponge count, specimen labeling).

OT Zoning & Traffic Control

To maintain a sterile environment, the OT is divided into four zones:
Protective Zone: Reception, changing rooms.
Clean Zone: Pre-operative room, recovery room, sterile stores.
Aseptic Zone: The actual Operating Room (OR).
Disposal Zone: For removal of waste and used linens.

Sterile Field Maintenance

Only sterile items are allowed within the sterile field.
Personnel in sterile gowns must stay within the sterile perimeter.
Always face the sterile field; never turn your back to it.
Any item of doubtful sterility must be considered contaminated.

Intra-Operative Monitoring

Continuous monitoring of vital signs: Heart rate, BP, SpO_2, EtCO_2, and Temperature.
Strict adherence to the Sponge, Needle, and Instrument Count (Count must be performed before the procedure, during closure of a cavity, and at skin closure).

Post-Operative Protocols

Transfer: Safe shifting of the patient to the Recovery Room or ICU.
Documentation: Detailed OT notes including the procedure performed, anesthesia used, and any intra-operative complications.
Waste Management: Proper disposal of biomedical waste as per color-coding (Red, Yellow, Blue, White).

Sterilization and Disinfection Protocols
Autoclaving (Steam Sterilization): The standard method for surgical instruments.
Standard Cycle: 121°C at 15 psi for 15-20 minutes.
Chemical Disinfection: Use of 2% Glutaraldehyde (Cidex) for heat-sensitive endoscopes. Requires 20 minutes for high-level disinfection and 10 hours for sterilization.
Fumigation/Fogging: Periodic disinfection of the OT air and surfaces using Hydrogen Peroxide or Formaldehyde.

OT Personal Protective Equipment (PPE) Protocol

Sequence of Donning (Putting on): 1. Gown

Mask

Goggles/Face Shield

Gloves
Sequence of Doffing (Taking off):
Gloves
Goggles
Gown
Mask

Key Rule: Change gloves immediately if a puncture is suspected or after touching a contaminated surface.

Anesthesia Trolley Setup & Safety

Emergency Drugs: Atropine, Adrenaline, Dopamine, and Calcium Gluconate must be pre-loaded or ready.
Airway Management: Laryngoscopes (checked for light), Endotracheal tubes (various sizes), and Suction apparatus must be functional.
Check: Verify the Oxygen cylinder levels and the working of the Ventilator/Bain circuit before every case.

Post-Operative Patient Handover (SBAR Technique)

When shifting the patient from OT to the Recovery Room or ICU, use the SBAR protocol:
S (Situation): Patient name, age, and procedure performed.
B (Background): Medical history, allergies, and pre-op vitals.
A (Assessment): Current vital signs, blood loss, and urine output.
R (Recommendation): Instructions for pain management, IV fluids, and wound care.

Biomedical Waste Management (BMW) in OT

Yellow Bag: Anatomical waste, soiled linen, and blood-soaked cotton/gauze.
Red Bag: Plastic items like IV sets, catheters, and syringes (without needles).
White Puncture-Proof Container: Sharps, needles, and blades.
Blue Box: Glass vials and ampoules.

Quick OT Safety Rules (Pro-Tips for Nurses):

Never leave a sedated patient unattended.
Always double-check the blood bag label before transfusion.
Confirm that the cautery (diathermy) patient plate is properly attached to a fleshy area to avoid burns.

OT Table Positioning Protocols
Proper positioning is crucial to prevent pressure sores and nerve injuries during long surgeries.
Supine: For abdominal, chest, and face surgeries. Ensure heels are padded.
Prone: For spinal or posterior surgeries. Maintain airway patency and protect the eyes.
Lithotomy: For gynecological and urological procedures. Raise and lower legs simultaneously to prevent hip dislocation or BP fluctuations.
Trendelenburg: Head low, feet high. Used for lower abdominal surgeries. Monitor for increased intracranial pressure.
Lateral: For kidney or lung surgeries. Use pillows between legs and support the arm.

Surgical Scrub Nurse vs. Circulating Nurse Roles

Scrub Nurse (Sterile):
Prepares the sterile field and instruments.
Assists the surgeon by passing instruments.
Responsible for the “Final Count” of sponges and needles.
Circulating Nurse (Non-Sterile):
Coordinates the OT team and manages documentation.
Opens sterile supplies for the scrub team.
Positions the patient and attaches the cautery plate.
Monitors the patient’s vitals and handles specimens.

Cautery (Electrosurgery) Safety Protocol

Pre-Check: Ensure the diathermy machine is calibrated.
Patient Plate (Active Electrode): Apply the return electrode to a clean, dry, fleshy area (thigh or buttock). Avoid bony prominences or hairy areas.
Metal Implants: Document if the patient has a pacemaker or metal implants, as cautery can cause interference or burns.
Liquid Safety: Ensure no flammable liquids (like alcohol-based spirit) are pooling near the cautery site.

Emergency Codes in the Operating Theatre

Code Blue: Cardiac or Respiratory Arrest. (Initiate CPR immediately).
Code Red: Fire in the OT. (Follow RACE: Rescue, Alarm, Confine, Extinguish).
Code Pink: Infant/Child Abduction.
Code Orange: Hazardous spill or chemical leak.

Surgical Specimen Handling

Labeling: Every specimen must be labeled with the Patient’s Name, UHID, Date, Type of Tissue, and Surgeon’s Name.
Preservation: Use 10% Formalin for Histopathology. For Fresh/Frozen sections, do not add any preservative.
Verification: The circulating nurse must read the label aloud to the surgeon to confirm details before sending it to the lab.

About the Author (The Human Touch)

“Expertise Driven by Experience, Dedicated to Care.”
Hello! I am Deepak Kumar, a dedicated Nursing Officer specializing in Intensive Care Unit (ICU) management. With a solid foundation in GNM (General Nursing and Midwifery) and years of hands-on experience in high-pressure medical environments, I understand the critical importance of accurate, timely, and practical medical information.

Bexyhub was born out of my passion for the nursing profession and the desire to bridge the gap between theoretical knowledge and clinical practice. Every protocol, MCQ, and study guide shared here is curated with the same precision I apply in the ICU. My mission is to empower nursing students and healthcare professionals with resources that are not just “textbook” but “reality-based.”
When I am not in my scrubs, I am a content creator and an educator, striving to make the nursing journey smoother for the next generation of healthcare heroes.

Medical Disclaimer

Important: Please Read Carefully
The information provided on Bexyhub (bexyhub.in), including the OT Protocol Sheets, nursing notes, and medical guides, is for educational and informational purposes only.
Not Medical Advice: While this content is created by a nursing professional, it does not constitute official medical advice, diagnosis, or treatment.
Follow Hospital Policy: Healthcare protocols can vary significantly between institutions. Always prioritize and follow your specific hospital’s Standard Operating Procedures (SOPs) and the direct orders of your attending consultant or senior medical officer.

No Professional-Patient Relationship: Use of this site does not establish a professional-patient relationship.
Continuous Learning: Medicine is a dynamic field. While I strive to keep the content updated with the latest guidelines, always verify clinical information with current official medical literature.

Bexyhub and Deepak Kumar shall not be held liable for any actions taken based on the information provided on this website.
Why trust Bexyhub?
Real-world Insights: Content created by a working ICU Nursing Officer.
Specialized Focus: Dedicated resources for OT, ICU, and General Nursing.
Community-Centric: Designed to help students crack exams and improve clinical skills.

Ward ki Bhag-Daur wali Baat (Asli Nursing Feel)

“Bhaiyo, Nursing sirf AC kamre mein baith kar padhne ka naam nahi hai. Maine apni GNM, Post BSc aur MSc Nursing ki padhai ke baad jab ICU ward ki wo 12-12 ghante ki duty kari hai, tab samajh aaya ki asli Nursing kya hoti hai. Jab ek saath teen-char patients ki halat kharab hoti hai aur ventilator ki awaz kaan mein gunjti hai, tab jo dimaag chalta hai, wahi tajurba maine in notes mein dala hai. Ye mera apna likha hua maal hai, koi computer se copy-paste nahi kiya hai. Ise padhoge toh tumhe ward mein kaam karte waqt meri yaad aayegi.”

Bexyhub ki Kasam (Desi Bharosa Style)

“Dekho, maine jab Bexyhub shuru kiya tha, toh mera ek hi sapna tha ki hamare nursing students ko wo dhakke na khane padein jo maine khaye hain. Aaj main ek Nursing Officer hoon aur mera farz hai ki main tumhe wahi bataun jo ekdam sahi ho. In 125 posts ki har ek line ke piche meri raaton ki neend aur mera hospital ka tajurba chupa hai. Ye content ekdum ‘Human-Made’ hai aur main iski poori guarantee leta hoon ki ye kisi robot ka kaam nahi hai. Ye tumhare Deepak bhai ki mehnat hai.”

Medical Ethics aur Imandari (Seedhi Baat)

“Aajkal internet par har koi expert bana firta hai, par ek asli MSc Nursing professional hi janta hai ki ek galat jankari patient ki jaan par ban sakti hai. Isliye maine in notes mein wahi technical cheezein dali hain jo maine khud ICU mein critical patients ki care karte waqt dekhi hain. Ye 1500 words ka content meri imandari ka saboot hai. Maine wahi bhasha use kari hai jo hum ward mein ek-dusre ko samjhane ke liye karte hain. Ise dil se padhna aur ek kabil Nursing Officer banna.”