Module #1 James E. Carpenter, MD Peter M. Murray, MD Sterile Technique & Ortho. Surgery Room Setup Developed by the Surgical Skills Task Force of the American Board of Orthopaedic Surgery (ABOS) in collaboration with the American Academy of Orthopaedic Surgeons (AAOS), and the American Orthopaedic Association (AOA)/Council of Orthopaedic Residency Directors (CORD) Presentation #1: Sterile Technique and Ortho. Surgery Room Setup

Sterile Technique and Orthopaedic Surgery Room Setup: Hand and Microsurgery Surgery ABOS/AAOS Surgical Skills Task Force 2013

Introduction Patient transfer Hand table positioning Tourniquet application Draping Appropriate cautery care Maintenance of sterile field Taking down drapes

Patient Transfer Lock bed and position as close as possible to the OR bed at the same height Patient transfer – Under own power – Draw sheet Wear gloves and eye protection!!!

Hand Table Positioning Most designs lock to side of OR table. Important to secure Legs deployed and flat on floor, no rocking

Tourniquet Application Choose appropriate size: – 18 in for upper arm – 12 in for forearm Cast padding applied beneath tourniquet – Ensure that padding extends beyond edges Protective barrier to avoid scrub solution leaking under tourniquet causing burns Hook up pneumatic hose and set alarm and time – 100mm Hg above systolic pressure – 110 minutes

Draping Place down sheet on hand table first – Avoid gown contamination Take arm from scurb nurse using stockinette – Impervious stockinette if hand is not prepped Tourniquet towel 2 layers of drapes Apply custom hand table drape with aperature – Follow directions on drape Consider underneath side of drape unsterile at all times….cant go back!!

Cautery care < 40 for most hand surgery procedures Always have a holder for the bovie or bipolar – This is a dangerous insturment!!

Maintenance of the Sterile Field Do not violate sterile pathway once created