Understanding the Importance of Properly Setting Up a Sterile Tray in the Operating Room

Setting up surgical trays properly in accordance for the type of surgery being performed is an important step in any surgery. The correct arrangement of the surgical tray allows the surgeon to perform the surgery more efficiently which leads to decreased costs and better patient outcomes.

Every surgeon and procedure have a specific instrument preparation so the team assembling the trays need to understand each specific surgeon's requirements to ensure proper arrangement. These specific requirements are typically outlined on a preference card. Each preference card is unique to the surgeon and procedure being performed. These should be updated regularly to reflect the surgeon’s current preferences. Selecting the appropriate instrumentation will decrease any delays during the procedure and provide the best outcome for the patient.

To begin setting up a surgical tray, sterile gloves should be worn, and the stand and tray should be placed near the team assisting the surgeon with the procedure. A sterile drape should be placed over the stand and the tray where the instruments will be placed. The sterile instruments should be opened carefully.

Once the package is opened, the technician should re-glove in order to place the individual instruments on the tray. It is recommended to re-glove as often as necessary to avoid cross-contamination. They should inspect expiration dates to ensure each instrument is current and not expired. Sterilization indicators should be checked to ensure the items are sterile. If the instruments are no longer sterile, new instruments should be obtained to prevent the risk of infection to the patient. The packaging should also be inspected for an breaks or tears that may have occurred during transport. Any problems with the packaging should be addressed. All instruments should be open and set-up as close to the surgery start time as possible to help maintain sterility.

The instruments should be placed carefully on the tray using proper sterile technique. It is critical at this point to make sure that nothing contaminates the sterile field or the sterile instruments. If at any point, the sterile field is contaminated, a new instrument set will need to be pulled and assembled. The instruments should also be arranged according to the surgery being performed. Any surgeon preferences should also be taken into consideration. The instruments should not overlap or be too crowded on the tray. Any additional surgical equipment necessary to perform the procedure should be added next. All duplicate or additional unopened sterile instruments should be kept in the room should the need arise for additional instrumentation.

Surgery delays due to incorrect instrumentation or poorly assembled trays directly relate to increased costs. Whenever additional trays or instrument sets need to be pulled for a procedure, the previous instruments need to be recleaned and repackaged before they can be used again. In addition, instruments from the preference cards should be the only items opened and placed on the tray. Additional instrumentation that is not needed is wasteful and leads to higher costs. Ensuring the team is properly trained to pull according to preference cards and handle the sets carefully can greatly decrease a hospital’s operating cost.

While waiting for a replacement set of instruments can increase costs, it can also impact a patient’s quality of care. Any delays can cause the patient to be under anesthesia longer and have greater risk for exposure to infection. These incidences can influence the success of the surgery and the patient’s post-operative recovery.

Ensuring proper surgical tray set-up is critical to providing the best service to the patient and can reduce costs for the hospital. Both should be kept in mind by the surgical team when setting up a surgical tray to optimize the outcome for the patient and the hospital.

Independent Healthcare Consultant and Clinical Educator at Surgical Solutions.