1. Job descriptions:
Each OR staff member must understand his/her own function and responsibilities and must be written by each hospital to plan and coordinate the work.

2. Physical layout of OR department:
Each department (suite) is designed on an individual basis to meet projected, specific future needs.
The number of rooms required depends on:
Number of operations and length to be performed.
Type and distribution by specialties of surgical staff.
Proportion of elective inpatient and ambulatory pt. to emergency operation.
Number of hrs./day and days/wk. the dept. will be use.

3. Location of OR suite:
The OR suite is usually located in an area near to critical care surgical pt. areas and the supporting service department e.g. the central sterilization department, pathology and radiology.

5. Principles in design:
Exclusion of contamination from outside the suite with traffic patterns within the suite (How to get the pt. in and out).
Separation of clean (restricted) from contaminated areas within the suite.
Types of design.
Central corridor.
Double corridor.
Peripheral corridor.
Grouping, cluster plan.

6. The OR suite should be large enough to allow for correct techniques, and easy movement of pts., personal and supplies.
The OR suite is divided into three areas:
Unrestricted area: street clothes are permitted.
Semi restricted area: OR uniform is required, the pt. may transferred to clean stretcher.
Restricted: masks, caps are required, sterile procedures are carried out in these rooms.

13. Processing of supplies:
Utility room:
It's the room where the clean up of the surgical instrument take place after each operation (kitchen for cleaning instrument).
General work room (packing room) :
Where the instrument sets, trays, basin set and other supplies are wrapped for sterilization in this room.
Sterile supply room:
keeping supplies of sterile linen, sponges, gloves and other sterile items ready for use in OR. (N.B: Older packages are always used first.)

14. It contains all clean instruments which are not used.
Instrument room:
It contains all clean instruments which are not used.
Storage room:
For keeping some large, portable equipment in OR to be ready for use if needed.

15. Scrub room:
It's an enclosed area for surgical scrubbing of hands and arms to each operating room.

26. Operating Room Itself:
Size:
It's a desirable to have all room the same size so that they can be used in any elective and emergency operations.
The normal size 37 square meters but a specialized room such as cardiopulmonary bypass may require as much as 60m.

27. Sub sterile room:
It contains sink, steam sterilizer or washer sterilizer (it's within the operating room).
Advantages:
It save time and steps, emergency cleaning and sterilization of item can be done here by circulating nurse.
It reduce the need of messenger service.
It gives better care of instrument and equipment that require special handling.

28. Doors:
Sliding doors should be used in the OR they eliminate the air currents caused by swinging door.
N.B. "Doors don't remain open either during or between operation."
Ventilation:
Each room must have ventilation system to provide fresh air and prevent accumulation of anesthetic gases, that may produce dizziness to OR team members.

29. Room temperature:
Is maintained within range of c and may increase in cases of pediatric, geriatric and burn pt. to prevent hypothermia.

30. Floor:
Should be conductive enough to dissipate static from equipment and personal, but not conductive enough to produce electrical shock.
Walls and ceiling:
Should be hard nonporous fire resistant, waterproof, stain proof and easy to clean. Have electrical system, vacuum, compressed air, O2 nitrous oxide

36. N.B: Electrical outlets must meet the requirement of the equipment that will be used.
Furniture and other equipment
Each room should has:
Operating table with rubber mattress connect to a remote to position pt. in different types of position required.
Instrument tables.
Mayo stand
Ring stand for basin.
Sitting stools.
IV stands.
Suction bottle and tubing with a portable machine.
Anesthesia machine.
Light (focus).

43. Principles of A Septic and Sterile Technique Definitions
Infection:
"Invasion of the body by pathogenic microorganism and the reaction of tissues to their presence and their toxins."

45. Antibiotic:
"Substances, natural or synthetic that inhibit growth or destroy microorganism. Used as therapeutic agents against infectious disease.
Asepsis:
"Absence of microorganism that cause disease."
Sepsis:
"Severe toxic state resulting from infection"

48. Antiseptic:
"Organic or non-organic chemical compounds that inhibit the growth of organism without necessary killing them."
Bactericidal:
"Agent that destroys bacteria."
Disinfectants:
"Agents that kill growing forms of microorganism except spores. "
Sterilization:
"The complete destruction of all microorganism ( pathogenic and non-pathogenic ) in both vegetative (active) and sporing state".
Sterile:
"Free of microorganism including all spores".

55. Sterile Technique:
"Methods by which contamination with organism is prevented to maintain sterility throughout the operation procedure."  
Stages of Infection:
Invasion.
Localization.
Resolution leading to recovery.

57. Classification of Infection:
Surgical infections may be classified in various ways:
By source
By etiology.
Classification by Source:
Home or Community Infection: These are natural disease process that develop or were including before patients admission to hospital.
Nosocomial Infection: Infections that patients acquire during hospitalization as a complication of operation (UTI - Cellulitis - Phlebitis- Bacteremia - Abscess).

61. Classification by Etiology:
Includes the causative agents
Bacterial infection: could be aerobic or anaerobic, gram (+)
Non – Bacterial: as fungi and virus.
Predisposing Factors to infection:
Incidence and types of infections that occur in surgical patient are affected by the following factors:
Malnutrition
Age
Obesity
Impaired defense mechanism.
Length of pre-operational hospitalization (incidence of Nosocomial infection).
Duration of operation.
presence of chronic disease (Cardiovascular of Respiratory).

67. Sources of Contamination in OR:
Skin staphylococcus
Hair
Nasopharynx
Fomites (contaminated particles are present on objects such as operating room surfaces (walls, floor cabinet.
Air
Human Error

68. Infection Control and Prevention
The Centers for Disease Control and Prevention (CDC) mandates that one should consider body secretions and excretions of all individuals as contaminated, therefore,standard precautions must be observed at all times during patient care.
AIDS, hepatitis (several strains), pyogenic infections, and numerous other blood-borne infections can be transmitted via puncture wounds.
Sharps must be handled responsibly in all situations.

74. The scrub person must always pass the handle of the knife to the surgeon while holding the knife by the shaft. It is safest if suture is mounted just before use, again, passing the handle to the surgeon.
All personnel should wear gloves when performing patient-care tasks, i.e., when catheterizing a patient, when starting intravenous fluids,and when handling potentially contaminated articles, such as soiled sponges,instruments, intravenous lines, blood transfusion sets and blood pouches ,and any other items soiled by body secretions or excretions that might provide the source of infection through a break in the skin. Some authorities advocate double gloving when virulent infections are present or suspect.

75. Ways to prevent Infection:
On the ward before surgery:
A complete bath early morning before surgery.
Shaving of appropriate area and be sure not to break the skin and all loose hair are removed.
A clean OR gown (open gown) for the patient.
A complete check of body for pustule, abscess, cold.

76. During Operation:
Patient's Hair should be cover with OR cap.
Cleaning the OR site well with antiseptic solution (betadine).
No person is allowed to work in OR with cold or sore throat or conjunctivitis.
Passage of personnel in the OR is limited only the staff who works in this operation.

77. After the Operation:
In the Recovery Room:
Take care and be sure that dressing on place.
Don't let dirty sheets contact with the wound.
In the ward:
Don't put clean operation (case) in a bed next to dirty case in the same room.
If the dressing become wet or soiled, change it, using strict sterile technique.
Keep the patient clothes and his bed clean.
Encourage the patient to move, eat proper food and maintain good personal hygiene.
Teach the patient about the disease before he goes home.