What are the steps to assist the surgical team during an operation, including maintaining a sterile field, preparing instruments, patient positioning, monitoring, communication, and emergency response?

How to Assist During Surgery

All surgical team members must maintain strict sterile technique, prepare equipment before the procedure begins, minimize OR traffic, and actively participate in the surgical safety checklist to reduce mortality and morbidity. 1, 2

Pre-Operative Preparation

Operating Room Setup

• Prepare all necessary instruments and equipment before the patient enters the OR to eliminate the need for staff to leave during the procedure 3
• Minimize equipment to only what is strictly necessary for the specific case, replacing standard trolleys with dedicated pre-prepared ones containing minimal but adequate stock 3
• Ensure alcoholic hand hygiene solution is readily available at multiple locations 3
• Prefer disposable materials including surgical drapes, gowns, and instruments when possible to reduce contamination risk 3
• Prepare all surgical materials (sutures, scalpel blades) in advance in sterilizable containers 3

Personal Protective Equipment

• Don appropriate PPE before any patient contact: surgical gown, head cover, shoe covers, surgical goggles, and double gloves 3
• For high-risk procedures involving aerosolization (intubation, airway management), wear FFP2/FFP3 respiratory masks 3, 4
• Ensure proper fit of all protective equipment, with special attention to mask seal for bearded operators 3

Establishing and Maintaining the Sterile Field

Sterile Technique Principles

• Sterile items must only contact other sterile items; any breach requires immediate correction unless patient safety would be compromised 5, 6
• The sterile field extends from the surgical site to table height; anything below table level or out of direct vision is considered non-sterile 6, 2
• Never reach across a sterile field; pass instruments around the field or use sterile transfer forceps 6, 2
• Keep sterile gowns and gloves within the sterile zone (front of body from chest to table level, sleeves from 2 inches above elbow to fingertips) 6, 2

During the Procedure

• Change gloves immediately after contact with contaminated material or if any damage occurs 3, 7
• Anticipate the surgeon's needs to minimize requests and movement; the scout nurse and operating surgeon should coordinate material needs before incision 3
• Keep OR doors closed at all times with clear signage discouraging unnecessary entry 3, 4
• Personnel should not leave the OR once the procedure begins; if exit is unavoidable, full re-gowning and gloving is required upon return 3

Patient Positioning and Monitoring

Positioning Safety

• Limit disconnection of anesthetic circuits when positioning to prevent contamination 3
• Ensure adequate padding of pressure points and proper body alignment to prevent nerve injury and pressure ulcers 1
• Apply mechanical VTE prophylaxis (compression devices) before induction for procedures longer than 30 minutes 1

Intraoperative Monitoring

• Implement active warming for all procedures exceeding 30 minutes to prevent hypothermia-related infection and bleeding complications 1
• Monitor temperature continuously through transport and recovery, not just during the surgical case 1
• Ensure prophylactic antibiotics (typically first-generation cephalosporins) are administered within 1 hour before incision 1

Communication and Team Coordination

Surgical Safety Checklist

• Actively participate in all three pause points (sign-in, time-out, sign-out) to reduce perioperative mortality and complications 1
• During time-out, verify patient identity, surgical site marking, procedure description, antibiotic timing, and equipment readiness 1
• Speak up immediately if any checklist element is missing or incorrect; hierarchy must not impede safety 1

Intraoperative Communication

• Maintain clear communication about instrument counts, specimen handling, and any observed breaches in sterile technique 5, 2
• All team members must voice concerns about safety issues including medication errors, equipment malfunctions, or contamination events 1
• Establish traceability of all healthcare workers present during the procedure for infection control purposes 3

Medication Safety

High-Risk Drug Handling

• Label every syringe immediately after drawing medication with drug name, concentration, and preparation date 1
• Perform two-person verification for all high-risk drugs (insulin, heparin, concentrated electrolytes, vasoactive agents) 1
• Discard any unlabeled syringe without use; never assume contents are known 1
• Read each medication label three times: during preparation, before administration, and after administration 1

Emergency Response Preparedness

Fire Safety

• Complete OR-specific fire safety education before entering the operating room, as fire prevention directly reduces patient mortality 1
• Know the location of fire extinguishers, saline buckets, and fire blankets 1
• Recognize high-risk situations: head/neck/upper-chest cases with open oxygen delivery near electrocautery create the "fire triad" (oxidizer, ignition source, fuel) 1
• Participate in scheduled fire-drill simulations to reinforce rapid response skills 1

Emergency Protocols

• Know your assigned role in emergency protocols (fire, cardiac arrest, malignant hyperthermia) and be prepared to act immediately 1
• Keep emergency drug doses and protocol steps readily accessible, ideally on a pocket reference card 1

Post-Procedure Responsibilities

Instrument and Waste Management

• Use dedicated containers for sharp instruments placed immediately outside the OR 3, 7
• Dispose of all contaminated materials in designated hazardous waste containers 4, 7
• Handle all sharps with extreme caution to prevent percutaneous exposure 7

PPE Removal

• Remove PPE in dedicated doffing areas following proper sequence: remove the first (most contaminated) pair of gloves first, then gown, then second pair of gloves, then face protection 4, 7
• Perform hand disinfection with hydro-alcoholic solution immediately after removing all PPE 4, 7

Environmental Cleaning

• Clean and disinfect all surfaces and electromedical devices after each procedure 3, 7
• Sanitize the OR and surrounding areas as soon as possible after completion 4, 7
• Allow adequate time between cases for proper terminal cleaning 7

Critical Pitfalls to Avoid

• Never assume sterility; if there is any doubt about contamination, treat the item as non-sterile 5, 6, 2
• Do not enter or exit the OR unnecessarily once the procedure begins, as each transit increases contamination risk 3
• Avoid reaching over sterile fields or turning your back to sterile areas, as this creates unobserved contamination opportunities 6, 2
• Do not delay correction of sterile technique breaches unless immediate correction would endanger the patient; address violations as soon as safely possible 5
• Never use unlabeled medications or assume syringe contents without verification 1