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Surgical Attire

Staff changed into scrubs at the hospital

Top is secured at waist, tucked in or close to body

Al hair is covered

No visible jewelry worn by scrubbed and non-scrubbed staff

Mask is worn by (secured with both ties) in the presence of open sterile items and equipment

Cover gowns/jackets are worn and secured to prevent inadvertent contamination while walking past sterile field

Dedicated shoes or shoe covers are worn

Sterile Technique

Sterile field is prepared close to time of surgery <1 hour

Sterile items are transported in covered or enclosed cases/carts

Sterile packages are inspected for punctures, tears, and expiration dates

Sterile field is maintained troughout the procedure with traffic patterns established with a minimum of one foot perimeter respected by the unsterile personnel

Sterile items are presented to scrubbed person or placed securely on field

Liquids are poured only once, without splashing, and the remainder is discarded

Draping is accomplished in a sterile manner:
* Draping is performed by a minimum of two people
* Hands are "cuffed" while presenting drapes to unsterile personnel
* Anesthesia screen is not dropped prior to placement
* Drapes are not lifted or moved after placement

Items are flashed sterilized only in an emergency situation and a closed container is used or transport to the sterile field

Surgical Hand Scrub

Scrub is performed according to manufacturer's directions and aseptic technique

Scrubbed personnel do not contaminate themselves while gowning and gloving

Time Out

Observe Universal Protocol "Time Out"

Site marked prior to entry into OR suite (in pre-op holding area)

Circulator calls "TIME OUT"

Circulator checks patient's ID bracelet- patient identificiation

Circulator states the correct site

Circulator reads aloud the surgical procedure to be done

Outpatient chart review- H&P reviewed and documented

Skin Prep

Hair is removed using clippers

Skin prep is performed according to manufacturer's directions and aspectic technique

Type of Prep used

Sufficient drying time is allowed prior to draping


Traffic in and out of the room is kept to essential personnel/tasks

The traffic pattern during the case avoids the sterile field whenever possible

Environmental Cleaning

Horizontal surfaces are free of dust and organic debris

After procedure, reusable patient items such as straps are cleaned between uses

After procedure, visibly soiled areas of the floor (three to four feet perimeter around the bed) is mopped free of all blood and debris

OR doors are closed between cases

Scrub tech removes excess tissue from instruments

Enzymatic spray prior to delivery to CS

Operating room's environmental temperature and humidity temperature range 68-73 degrees and humidity range 30-60%. Staff takes and documents corrective action if temperature and humidity ranges are not met

Linen, equipment and supplies are properly stored within the operating room and OR department, including appropriate covers and storage practices to minimize the potential for dust and contamination


Medications are labeled appropriately when in use

Refrigerators are specific for medications, staff foods, etc.

Safety devices are used whenever possible

Sharps are removed and disposed of appropriately at the completion of each case

Sharps containers are accessible, secured to wall/counter and emptied when the "full" line is reached

Unused medications/fluids are disposed of at the end of each case

Fluid warmers are checked for approved temperature ranges each day the OR is functioning. If the OR is closed it is documented on the warmer log.

Cleaned / Soiled Areas

Dirty / clean equipment is stored separately

Glass is disposed of in rigid sharps containers

Biohazard waste is labeled and covered

Cleaning supplies are labeled

Approved cleaning supplies

General Infection Prevention

Soiled linens are placed in designated covered hampers

Under sink storage is limited to disinfectants / cleaners

No eating or drinking in patient care area

Clean equipment is labeled clean / clean label removed for used equipment

All sterile supplies are dry with intact packaging, not stored on the floor

Low storage areas must have solid surface shelving

Storage of sterile supplies is 8-10" above the floor and 2" away from exterior walls

Ice scoop is not stored in the ice machine

Staff know where to find and how to access infection prevention policies and procedures

CDC isolation guidelines are available on isolation carts or other designated areas in the department

Staff are aware of when to use Airborne isolation and which rooms are negative pressure

Staff are knowledgable about blood spill protocol

Staff know the kill time for disinfectants used

Staff have access to and are familiar with the MDRO list

Staff have knowledge of hand hygiene requirements and practice these requirements

Please note that this checklist is a hypothetical example and provides basic information only. It is not intended to take the place of, among other things, workplace, health and safety advice; medical advice, diagnosis, or treatment; or other applicable laws. You should also seek your own professional advice to determine if the use of such checklist is permissible in your workplace or jurisdiction.