Comprehensive OR Safety Standards & Emergency Protocols

Ground prong importance

The third prong on a plug is the ground, which prevents electrical shock by redirecting stray electricity.

Monitored electrical systems

These systems detect electrical faults and interruptions, ensuring that any leakage current is identified before it can harm patients or staff.

Patient return electrode

This pad safely returns the electrical current from the patient back to the ESU, completing the circuit.

Burn prevention

Always ensure the return electrode is placed on a well-vascularized, muscular area and is fully adhered to the skin to prevent thermal injury.

Fire triangle

Fires require three elements—fuel (e.g., drapes), oxygen (often enriched in the OR), and an ignition source (like lasers or ESUs).

Class C extinguishers

These are designed for electrical fires and should be readily accessible in all ORs.

RACE protocol

A standardized response to fire—Rescue anyone in danger, Activate the alarm, Contain the fire by closing doors, and Extinguish if safe to do so.

Eye protection

Use goggles with the correct optical density for the specific laser wavelength.

ETT precautions

Fill endotracheal tube cuffs with sterile water instead of air to prevent combustion if the laser hits the cuff.

Instrument safety

Use matte-finished, non-reflective instruments to reduce the risk of laser beam reflection and unintended tissue damage or fire.

Posture

Standing with feet shoulder-width apart provides a stable base and reduces strain on the spine.

Lifting technique

Always bend at the knees, not the waist, and keep the object close to your body to reduce back strain.

Pushing vs. pulling

Pushing uses stronger leg muscles and reduces the risk of injury compared to pulling, which can strain the back and shoulders.

PMMA (Bone Cement)

Releases toxic vapors during mixing. Use in a well-ventilated area with a vapor evacuation system to prevent respiratory irritation and systemic toxicity.

Formalin

A tissue preservative that is a known carcinogen. Always use in a fume hood or well-ventilated area with gloves and a mask.

Ethylene Oxide (EtO)

Used for sterilizing heat-sensitive equipment. It is highly toxic, mutagenic, and carcinogenic—strict handling protocols are essential.

Glutaraldehyde (Cidex®)

A high-level disinfectant. Use in a closed system or ventilated area to avoid respiratory exposure.

Red biohazard bags

Used for items contaminated with blood or body fluids. These bags are clearly marked to prevent accidental exposure.

Sharps disposal

Use puncture-resistant, labeled containers. Never recap needles or overfill containers to avoid needlestick injuries.

Standard precautions

Always wear gloves, masks, and eye protection when exposure to blood or body fluids is possible.

Plume exposure

Surgical smoke contains toxic chemicals and viruses. Use smoke evacuators with HEPA or ULPA filters and wear high-filtration masks.

Sharps safety

Use a neutral zone for passing instruments, magnetic pads to secure sharps, and the one-handed scoop technique for recapping needles.

Temperature

Maintained between 68°F and 73°F to ensure patient comfort and reduce microbial growth.

Humidity

Kept between 20% and 60% to prevent static electricity (which can ignite fires) and maintain equipment function.

Air exchanges

At least 15 per hour, with 20% being fresh air, to reduce airborne contaminants.

Door policy

OR doors must remain closed during procedures to maintain positive pressure and prevent contamination.

Airway first

Always ensure a patent airway before addressing circulation.

Compression depth

At least 2 inches (5 cm) for adults to ensure effective perfusion.

Compression rate

100-120 per minute. Switch rescuers every 2 minutes to maintain quality.

AED use

Automated External Defibrillators should be applied as soon as available for early defibrillation.

START system

Categorizes patients based on urgency—Green (minor), Yellow (delayed), Red (immediate), Black (expectant).

Scene safety

Always ensure the area is safe before providing care to avoid becoming a victim yourself.

LOCKDOWN!

Locks, lights, out of sight—used during active shooter or intruder events.

NIMS

Provides a standardized approach to incident management across agencies.

EOP

Outlines the chain of command and procedures during emergencies.

ICS/EOC

Coordinate on-site and regional responses to disasters.

Natural disasters

Earthquakes, floods, hurricanes—often unpredictable and widespread.

Human-caused disasters

Chemical spills, terrorism—may require specialized response.

Combination disasters

E.g., a hurricane causing a chemical plant leak.

Category A biological threats

High-priority agents like anthrax, smallpox—easily spread, high mortality.

Category B biological threats

Moderate spread, diagnostic challenges—e.g., ricin, salmonella.

Category C biological threats

Emerging threats—engineered or newly discovered pathogens.

Radiological decontamination

Remove clothing, bathe, and irrigate wounds to reduce contamination.

Chemical decontamination

Use 0.5% bleach solution for skin and wound decontamination.

Mustard gas

Causes severe blistering—requires immediate decontamination and supportive care.