The OR is a sensitive place filled with so many unspoken rules, ranging from blatant to subtle, that you must follow. During this week, my first actually being part of the OR team, I’ve received guidance from surgeons, residents, and scrub techs in the form of helpful suggestions and gentle scoldings. First, the basics:

1. Wear only green scrubs and a bouffant cap when on the OR floor.
   1. but don’t wear green OR scrubs anywhere else!
2. Wear a surgical mask in the OR when sterile packs are open.
   1. but don’t wear them outside or else patients can’t see your face.
3. Don’t wander too much in the OR.
   1. The turf is divided between the anesthesiologist, surgeon, and scrub tech. They can be territorial.

Once they break open the sterile packs and begin the procedure, that’s when it gets real.

1. DON’T TOUCH ANYTHING BLUE.
   1. Seriously. Don’t hand over anything, don’t clean things up, don’t brush up against it, don’t even look at it funny. Everyone is serious about sterility.
2. Don’t pass anything non-sterile near the field.
3. Don’t lean over the field either. Gravity is a pain.
4. Don’t trip over suction, cautery, irrigation, scope optic/illumination lines.
5. Don’t interfere with time-out at the beginning our counting instruments and sharps and gauze at the end.
6. Don’t say anything unless prompted by the surgeon. And when you do, don’t talk too loudly, especially when the patient is present and awake.
7. Do anything scrubbed people ask you to do. Fetch equipment, push stools, adjust glasses, reach into gowns to retrieve beepers, move around ceiling monitors, whatever.

Except when you’re scrubbed in. Then the rules invert.

1. DON’T TOUCH ANYTHING NOT BLUE.
   1. Seriously. Don’t wipe your nose, don’t push up your glasses, don’t pick up dropped equipment, don’t touch anything that’s outside the surgical field or below the surgical table.
2. Don’t raise your hands above your neck or below your waist. That is your sterile box.
3. Don’t lean over the field still. Your face isn’t sterile.
4. Don’t squat or crouch into into your non-sterile zone. If your legs fatigue, lean on the patient. They don’t mind.
5. Dictate everything you do, especially with regards to sharps. You don’t want to leave one in the patient.

Okay, that should be a good start. In the OR, it’s tricky to balance staying out of the way and being helpful as such a new team member, but I’ll get into it soon. The work done in modern ORs is nothing short of remarkable.