Physical Environment and Safety Standards
By Javier Espinales, CST
Physical Environment and Safety Standards
• Objectives:
• 1. Identify and describe hazards to the patient in the operative department.
• 2. Identify support services that work with the OR team in the care of the patient.
• 3. Discuss the type of air-handling system required in the OR and the temperature and humidity required to maintain a sterile field.
• 4. Identify cleaning procedures, traffic patterns, and routines in the operative environment.
Physical Environment and Safety Standards
• 5. Identify the design types of the OR.
• 6. Identify hospital departments that relate to surgical services.
• 7. Discuss the working environment of the OR.
• 8. Identify the physical components of the OR.
Physical Design of the OR Suites
• Location – Usually in an area near critical care and supporting departments.
• Principles in design.
– Exclusion of contamination from outside the suite.
– Separation from clean and contaminated areas.
Areas of the Operating Room
• Central Core Race Track Plan
• Central Core Peripheral Corridor
• Central Core Hotel Plan
• Central Core Cluster Combination
Physical Design of the OR Suites
• Ventilation System
– Should provide clean air and remove airborne contamination
– Air exchange should be 20 air changes per hour
– HEPA filters capable of removing bacteria
Physical Design of the OR Suites
• Vestibular/Exchange Area
– Unrestricted Area
– Semirestricted Area
– Restricted Area
Peripheral Support Areas
• Preoperative Check-in Unit
• Preoperative Holding Area
• Induction Room
• Post Anesthesia Care Unit (PACU)
• Dressing Rooms and Lounges
• Control Desk
Peripheral Support Areas
• Anesthesia Work Room
• Housekeeping
• General workroom
• Storage
• Sterile Supply Room
• Instrument Room
Peripheral Support Areas
• Laboratory Dept
• Radiology Dept
• Pathology Dept
• Environmental Services
• Central Sterile Supply and Processing
Operating Room
• Usually 20’ x 20’ x 10’
• Larger rooms 20’ x 30’ x 10
– Larger pieces of equipment; Microscopes, C-arms,
Video equipment.
Operating Room
• Substerile Room
– Saves time and steps
– It allows better care of equipment
– Usually contains a warmer, Flash/washer sterilizer
Operating Room
• Inside the room
– Temperature and Humidity
• Temp between 65 F and 75 F
• Humidity between 50% and 55%
– Floors - most common seamless vinyl
– Walls and Ceilings
Physical Components of the OR
• Equipment
• Electrical outlets
• Suction outlets
• Gas outlets
• Lights
• Viewing box
Standard OR Furniture
• O.R. Table
Standard OR Furniture

• Mayo Stand
Standard OR Furniture
• Back table
Standard OR Furniture
• Ring stand
Standard OR Furniture
• Kick buckets
• Linen hamper
Hazards in the OR
• Safe environment
– Equipment must be properly handled and operated properly.
– ST’s must be educated and trained on safety measures.
– Surgical team must have knowledge of the possible hazards and how to keep everyone safe.
Hazards in the OR
• Physical: noise, ionizing radiation, electricity, injury to body, fire, explosion
• Biologic: laser/electrosurgical plume, pathogens , latex sensitivity, sharps injury
• Chemical: disinfecting agents, waste anesthetic gas, vapors and fumes
Physical Hazards
• Surgical Lights – non glare
• Noise in the OR
• Proper posture and body mechanics
• Electrical hazards
• Radiation
Fire Hazards
• Fire/explosion can result from:
– Source of ignition
• Spark from metal hitting metal
– Oxygen
– Flammable materials
• Gas, vapor, liquid (ethyl alcohol)
Biological Hazards
• Universal precautions – defined in 1985
• Standard precautions – defined in 1996
• Causes
– Needles in needle holders
– Suturing
– Manual tissue retraction
– Needle on the field
Biological Hazards
– Dropping needle/blade on a foot
– Reaching for falling items
– Placing sharps into sharps containers
Biological Hazards
• Preventions for possible sticks
– Have a sharps management plan
– Neutral zone
– Appropriately place sharps containers
– Never recapped needles
– Sharps on the mayo stand should be kept in a central area.
– Load needles prior to use
Biological Hazards
• Hazardous waste disposal
– Infectious waste disposed in a red bags
• Follow local policy
• Management for exposure
– Needle stick squeeze wound, then clean
– Exposure to oral or nasal flushed with water
– Eyes flushed with water or saline
Biological Hazards
• Laser plume
– Use a smoke evacuator or use the suction tip to the regular suction canister.
• Latex allergy
– To patient and staff
– Two types
• External and systemic
Chemical Hazards
• Waste Anesthetic Gases
• Methyl Methacrylate – Bone cement, liquid and power components.
• Formalin
• EtO
• Glutaraldehyde