The operating table, the surgical instrument table, and special equipment to be used in the sterile field is cleaned prior to each case.
X-ray machines, surgical microscopes, and other items that are difficult to clean are draped in sterilized plastic to maintain asepsis.
The anesthesiologist/nurse anesthetist remains outside of the sterile field and is separated from the sterile field by a sterile drape.
Maintaining Asepsis (Sterility)
With regard to asepsis, the three areas of concern (to minimize the number of undesirable organisms present) within the Surgical
1. The "sterile field" itself as described above. Only fully scrubbed staff (known as the "scrub team") is permitted in this area in
the center of each Operating Room.
2. Within the Operating Room, both the scrub team as well as the additional staff that are not in the sterile field must abide by
strict rules established by the Medical Center.
3. Semi-restricted areas, including spaces such as the pre-op and patient holding areas, PACU, instrument workroom, non-
sterile supply storage, staff lockers/lounges/toilets/showers, control desk, and surgery administration offices.
Internal Operating Room Circulation
It is critical to plan an Operating Room in such a way that a high level of sterile technique can be achieved.
The circulator places the packs on the instrument table from the side of the instrument table away from the sterile field. The scrub
nurse unwraps the sterile instruments and places them on the surgical instrument table prior to the procedure. With the exception of
some specialty surgical procedures, the surgical instrument table is positioned toward the foot of the operating table, but always
within the sterile field. A single instrument table may be up to 8.0 feet (2440 mm) in length, or there could be more than one
instrument table. Once the procedure starts, the scrub nurse constantly draws from this source to supply the surgeons during the
operation. The circulator also assists the surgeon with devices used in the sterile field such as lasers.
No one walks between the operating room table and the surgical instrument table, except those in sterile garb who have thoroughly
scrubbed. When portable X-ray equipment is used, space for these items must be considered. Surgical microscopes or video
Design Guide - Surgical Service
Page 3 of 14
Date: August 2005
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