The Surgical Environment
The surgical environment is known for its stark appearance and cool temperature. The surgical suite is behind double doors, and access is limited to authorized personnel. External precautions in-clude adhering to principles of surgical asepsis; strict control of the operating room (OR) environment is required, including traffic pattern restrictions. Policies governing this environment address such issues as the health of the staff; the cleanliness of the rooms; the sterility of equipment and surfaces; processes for scrubbing, gowning, and gloving; and OR attire.
To provide the best possible conditions for surgery, the OR is situated in a location that is central to all supporting services (eg, pathology, radiology, laboratory). The OR has special air fil-tration devices to screen out contaminating particles, dust, and pollutants. The temperature, humidity, and airflow patterns are controlled (Meeker et al., 1999).
Electrical hazards, emergency exit clearances, and storage of equipment and anesthetic gases are monitored periodically by of-ficial entities, such as state agencies and JCAHO. To help de-crease microbes, the surgical area is divided into three zones: the unrestricted zone, where street clothes are allowed; the semi-restricted zone, where attire consists of scrub clothes and caps;and the restricted zone, where scrub clothes, shoe covers, caps, and masks are worn. The surgeons and other surgical team mem-bers wear additional sterile clothing and protective devices during the operation.
The Association of PeriOperative Registered Nurses, formerly known as the Association of Operating Room Nurses (and still abbreviated as AORN), recommends specific practices for those wearing surgical attire to promote a high level of cleanliness in a particular practice setting (AORN, 2002). OR attire includes close-fitting cotton dresses, pantsuits, jumpsuits, and gowns. Knitted cuffs on sleeves and pant legs prevent organisms shed from the perineum, legs, and arms from being released into the immediate surroundings. Shirts and waist drawstrings should be tucked inside the pants to prevent accidental contact with sterile areas and to contain skin shedding. Wet or soiled garments should be changed.
Masks are worn at all times in the restricted zone of the OR. High-filtration masks decrease the risk for postoperative wound infection by containing and filtering microorganisms from the oropharynx and nasopharynx. Masks should fit tightly, should cover the nose and mouth completely, and should not interfere with breathing, speech, or vision. Masks must be adjusted to prevent venting from the sides. Disposable masks have a filtration efficiency exceeding 95%. Masks are changed between patients and should not be worn outside the surgical department. The mask must be either on or off; it must not be allowed to hang around the neck.
Headgear should completely cover the hair (head and neckline, including beard) so that single strands of hair, bobby pins, clips, and particles of dandruff or dust do not fall on the sterile field.
Shoes should be comfortable and supportive. Shoes worn in from the outside must be covered with disposable shoe covers for protection from soiling. Shoe covers are worn one time only and are removed upon leaving the restricted area.
Barriers such as scrub attire and masks do not entirely protect the patient from microorganisms. Upper respiratory tract infec-tions, sore throats, and skin infections in staff and patients are sources of pathogens and must be reported.
Because artificial fingernails harbor microorganisms and may cause nosocomial infections (Winslow & Jacobson, 2000), a ban on artificial nails by OR personnel is supported by the Centers for Disease Control and Prevention (CDC), AORN, and the Association of Professionals in Infection Control. Short, natural fingernails are encouraged (Winslow & Jacobson, 2000).