Fig. 7.1
Example of theatre layout
Between each of these rooms, a set of doors will be present and it is important that these remain closed during surgery. This ensures patient privacy and is also important for maintaining a sterile environment. Theatres have a laminar airflow system, with air flowing into the main theatre to maintain a positive pressure within them, minimising dirty air entry from the corridors into the rooms. By keeping the doors open, particularly to the main corridors, you are unbalancing this pressure system, thereby increasing the chance of infection to the patient. This is one of the reasons surgeons will often get angry with students who constantly walk in and out of the theatres or those who keep the doors open for long periods of time. In procedures with a high risk of surgical site infection, such as orthopaedic joint replacement procedures, theatres are often designed with an additional ventilation system above the operating table. This pumps a laminar flow of air specifically around the operating table, thereby further reducing the risk of infection. Again, this is important to be aware of as a student, as you should not stand inside this flow of air when observing procedures unless scrubbed up.
The Surgical Team
In theatres, a whole range of team members are present and it is useful to have an idea of what to expect prior to your first visit. Whilst there is large variation on the exact people present you can expect to see the following in the majority of procedures:
Consultant Surgeon
Trainee Surgeon
Anaesthetist
Scrub Nurse
Operating Department Practitioner/Assistant (ODP/ODA)
Circulating Nurse
Each of these individuals has an important role to play within the surgical team and it is imperative they work together to ensure the best outcomes for the patient. The surgeons will generally be in charge of the technical aspects of the procedure and are therefore usually scrubbed next to the patient. They rely heavily on the scrub nurse, a fully scrubbed nurse, for assistance with the instruments during a procedure. Next the circulating nurse has a very broad role within the team. Not only will they help with getting extra equipment required for the operation from the preparation room, but they will additionally be available to help out with a wide array of tasks the sterile team cannot perform such as adjusting various equipment settings. The anaesthetist role is vital for the patient in theatres. They will be responsible for the induction of anaesthesia and maintaining the patient stable throughout the procedure and are assisted by the ODP/ODA. Additionally, should the patient become haemodynamically compromised; the anaesthetist will take a central role in the management process.
Whilst the personnel mentioned above will usually be present it is not uncommon for a large array of additional members to be present. A collection of people may be present intermittently as additional tasks are required or may be there for the entire duration of the procedure to assist with additional equipment and parts of an operation. In general, the more complex a procedure or equipment utilised during the procedure the more staff will be required. Some of the staff that you may expect to find includes:
Technician/trained nurse – e.g. robotic procedures
Radiographers – where x-ray imaging is required intraoperatively
Runner – to take samples to the lab
Porters
More nurses
Nurse in Charge/Team Manager
Theatre Etiquette
Many people are nervous about their first experience in theatres, but in truth by following a few simple steps there really is nothing to worry about. It is important to realise that in theatres there is one primary priority; the patient. As a student you must ensure that you are not hindering patient safety and hence your teaching will always come second to this. However, despite this, theatres are a great place to learn anatomy and get some good hands on experience whilst still at medical school.
The day before going to theatres ask the consultant whether he or she is happy for you to be in theatres with them and ask when you should arrive. Many surgeons will expect you to clerk the patients and present the cases to them prior to the operations, so you may have to come earlier or go to the ward the night before. Make sure you know what operation is planned and have a read about it prior to the case if possible. In the morning don’t miss breakfast, as this is a common cause of students fainting in theatres. Once you arrive ensure that you:
Change into scrubs – hospitals will differ in the colour of the surgical scrubs worn.
Wear appropriate footwear – either change into clogs or put blue shoe covers on.
Long hair is tied back.
Cover your hair with a surgical hat.
Ensure you are not wearing any jewellery or wrist watches.
Keep your medical student ID visible at all times.
Do not leave valuables in the changing rooms, as you will often not have a locker.
Once ready to get into theatre make sure you go into theatres through the correct door. The main door directly into theatres from the corridors is best avoided if the patient is on the table, so go in through the anaesthetic room or the scrub room. When inside make sure that you introduce yourself to the surgical team and theatre sister, ensuring everyone knows who you are. A few simple rules to follow once in theatre include:
Don’t touch anything covered in blue/green as this is sterile, especially on tables and trolleys.
Don’t touch the surgeons after they have gowned up.
Some surgeons will want you to wear masks whenever instruments are open.
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