A day in the life of a surgical technologist

For a Surgical Technologist, most days can run on either an 8 hour shift or a 12

hour shift. Eight hour professionals can work on first shift (6:30 – 3:00), second shift

(2:30 – 11:00) or third shift (11:00 – 7:00). The operating room, or OR, is where an ST

spends most of his or her day. The OR is a brightly lit, relatively cool and quiet work

environment in which concentration is a must.

The surgical technologist is responsible for the three phases of surgical patient

care with minimal direction or supervision from other surgical team members. The three

phases of case management are the preoperative, intra-operative, and post operative

phases. In most normal instances you will find the surgical technologist to function in a

sterile capacity during the surgical procedure.

The preoperative phase occurs before the incision is in or is made at the operative

site. Most of the duties of a surgical technologist occur during this preoperative case

management phase. The surgical technologist reports to the facility wearing street clothes

at the designated work time or in a called in manner for emergency situations. The

surgical technologist enters the department in a nonrestricted area and enters into a locker

room where they must change into appropriate OR attire. This particular type of attire can

only be worn in a semi-restricted or restricted area of the operating room for protection of

keeping microbial counts to a minimum and limiting the spread of bacteria. This OR

attire consists of a scrub suit, hair cover, and shoe covers. When personnel enter into a

restricted area a mask must also be worn. Most facilities have policies that limit the

amount of makeup, fragrances, artificial nails, and nail polish along with wearing
jewelry. The hair cover, shoe covers, and mask must be disposed of after each use or

after each case. The scrub suit should be changed if it becomes wet or soiled, otherwise it

is to be removed at the facility and placed in the soiled linen container to be cleaned

within the facility. Taking scrub suits that are soiled with blood borne pathogens into the

home raises the potential for spreading pathogens in the home and to other members of

the household. Hair has shown to be a heavy source of contamination; therefore, no hair

should be left exposed on the surgical environment. Masks are worn in restricted areas

where sterile supplies are open and while surgery is in progress. The purpose of wearing

a mask is to contain and filter the moisture droplets that are expelled from the mouth and

nose during talking in normal breathing. This is especially important if a surgical team

member is sneezing or coughing. The mask also serves a different purpose where it filters

the inhaled air from surgical plume and protects the user from fluid splashes to mucous

membranes. The main purpose of shoe covers is to protect the shoe from gross

contamination. Shoes that are worn in the operating room are only to be worn in the

operating room. To prevent cross contamination shoes worn in the operating room cannot

be worn outside that environment.

Once the surgical technologist is ready to enter the semi-restricted or restricted

areas of the operating room, they can begin with case preparation. One of the very first

things that must be done is a basic hand wash. The surgical technologist will then go to

the front desk of the operating room to receive the assignments for the day. Once the

assignment is made, it is time to begin preparing the OR for the case. The surgical

technologist is responsible to verify that all necessary furniture and equipment is present

in the operating room and it is arranged for easy use, efficiency, and the best possible
sterile technique. The surgeon will have a preference card that will list all of the basic

equipment, supplies, instrumentation, suture, prep, and medications that will be needed

for the procedure. Once the surgical technologist secures the list, supplies are gathered

and brought into the operating room. There is a back table pack that is positioned and

placed on the back table. All of the instrument sets are placed on a flat surface near the

back table for setup efficiency. At this time the back table pack is opened in the

appropriate manner then all other sterile supplies are opened onto the back table creating

a sterile field. Before opening any sterile item onto the sterile field, the surgical

technologist must verify that the item has been exposed to sterilization according to

indicator and packaging while also examining the integrity of the packaging.

Once all needed items are opened onto the sterile field, the surgical technologist

will begin a surgical scrub. The surgical scrub is performed on the technologist’s hands

and arms to 2 inches above the elbow with an antimicrobial scrub solution prior to each

surgical procedure. The surgical scrub is intended to remove as many microorganisms as

possible from the hands and arms and render them surgically clean. There are various

methods today to perform a surgical scrub. Two of the basic methods include the count

method or the counted brushstroke method. The timed method requires the hands and

arms to be scrubbed for a certain length of time such as five minutes. A counted

brushstroke method requires that a certain number of strokes be performed on each plane

of the hands and arms. As medicine is becoming evidence-based, research has shown that

the mechanical action and abrasive brushes that are used for these methods render the

skin broken and frail. Most facilities are going to an alcohol based scrub that will save

the surgical technologist time and are shown to be more effective than the use of soap,
water, and brushes. Once the surgical scrub is complete, the surgical technologist can

proceed to the OR, keeping hands above the waist, and proceed to the sterile gown and

gloves that have already been opened. The surgical technologist must dry the hands and

arms in the appropriate fashion as to avoid contamination. After drying, the surgical

technologist will approach the sterile field grasping at the center near the neck without

touching the gloves that are on top. The surgical technologist will hold the inside of the

gown and allow the gown to unfold toward the floor. The surgical technologist then

places the hands and arms into the sleeves and slides the gown over the arms using a

swimming motion. Once the gown is on, the surgical technologist secures the sterile

gloves using the closed glove method. It is also recommended the surgical technologist

double glove for added protection. Once the surgical technologist has secured the

appropriate sterile attire, preparation of the sterile field can begin.

The most logical and efficient pattern consists of draping the mayo stand,

organizing the back table, and organizing the mayo stand. Once all areas are organized, it

is mandatory for the surgical technologist to perform a surgical count. To protect the

patient from injury, all items that could be retained in the surgical wound are counted in a

prescribed manner. Policies directing sponge, sharps, and instrument counts have been

established by the Joint Commission for the Accreditation of Healthcare Organizations,

the Association of perioperative Registered Nurses, and the Association of Surgical

Technologist. In preparation of the surgical procedure, the surgical technologist must

assist all team members with sterile attire, prepping and draping of the surgical patient,

while also positioning all the sterile team members and furniture. Once the members and

equipment are set up, the surgical technologist can began to sort out the remaining
supplies and instruments that are needed on the surgical field such as suction, bovie, and

sponges.

The intraoperative phase occurs while the surgical procedure is being performed.

One of the main responsibilities of the surgical technologist is to maintain the sterile

field. The surgical technologist is responsible for handling and maintaining sponges,

passing and handling instruments, handling and caring for specimens and caring and

handling of tissues. The surgical technologist also has a primary role in assisting with

dissection of tissues, retraction of tissue, hemostasis, and wound dressings. It is vital that

the surgical technologist has a complete understanding of the procedure being performed

and anticipates the needs of the surgeon. The surgical technologist must have the

knowledge and ability to ensure quality patient care during the intraoperative phase.

The postoperative phase occurs after dressing application. The surgical

technologist must ensure that all sharps and nondisposable items are removed from the

drapes while the sterile back table, mayo stand, and basins set are moved away from the

operating table. This portion of the sterile field is maintained until the patient is

transported to the Post anesthesia care unit. As soon as the items that must remain sterile

are moved away from the operating table, the surgical technologist removes dirty gloves

and returns to the operating table to assist with drape removal and patient clean up. All

operating room team members assist with patient transfer and transportation once the

procedure is finished. Once the patient has been transported from the OR, the surgical

technologist may begin breakdown of the setup. Specimens are cared for as needed.

Sharps are placed in sharp containers. Instruments are removed from the Mayo stand and

back table and assembled back into their container to be transported to the
decontamination room. All disposable items are placed in the waste receptacle and

removed from the room while all linens items are placed in the appropriate hampers and

removed from the room also. Suction canisters and tubing are discarded in the biohazard

containers and removed from the room. All furniture and equipment is cleaned and a

basic hand wash is performed. This cycle is performed for every operating room case of

the day.