Personal Protective Equipment and Standard Precautions in the OR
Objective. The student will select and correctly don and doff required PPE for OR use and explain each element of Standard Precautions as it applies to surgical technology practice.
This lesson, its worked examples and its practice questions has not yet been verified by a licensed clinician in the field or by a certification or approval body. It is a study draft and may contain errors. Do not use it to make decisions about any patient or medication. Always follow your instructor, your supervising professional, and current official references and regulations.
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Personal Protective Equipment and Standard Precautions in the OR
Every surgical technologist works in an environment where contact with blood, body fluids, and sharp instruments is routine. Protecting yourself, your team, and your patient depends on two interlocking frameworks: Standard Precautions and the correct use of personal protective equipment (PPE). Mastery of both is a core competency tested on the NBSTSA CST examination and enforced in every accredited surgical suite.
What Are Standard Precautions?
Standard Precautions are a set of infection-control practices developed by the Centers for Disease Control and Prevention (CDC) and required by OSHA's Bloodborne Pathogens Standard. They treat the blood and certain body fluids of every patient as potentially infectious, regardless of known diagnosis. In the OR, this means you apply the same protective measures for every case—routine appendectomy or high-risk trauma.
Standard Precautions cover:
- Hand hygiene before and after patient contact and after removing gloves
- PPE use whenever exposure to blood or body fluids is anticipated
- Safe handling of sharps to prevent needlestick and scalpel injuries
- Environmental controls such as proper disposal of contaminated items and cleaning of surfaces
- Respiratory hygiene and cough etiquette
In the surgical setting, Standard Precautions are reinforced by engineering controls—physical devices that reduce risk—and work-practice controls—procedural changes that alter how a task is performed.
Engineering Controls in the OR
Engineering controls remove or isolate the hazard before it reaches the worker. Key examples include:
- Sharps containers: puncture-resistant, leak-proof containers placed within arm's reach at the sterile field for immediate disposal of needles, blades, and other sharps.
- Neutral zone (hands-free) technique: a designated area—usually a small basin or magnetic pad on the sterile field—where sharps are placed by one team member and retrieved by another, so that no two people handle the same sharp simultaneously. This is the single most effective work-practice control for preventing scalpel and needle injuries in the OR.
- Blunt-tip suture needles: used whenever tissue permits to reduce needlestick risk.
- Retractable or safety-engineered devices: self-sheathing syringes and scalpels that activate a protective cover after use.
Required PPE for the OR
Selecting the right PPE requires matching protection to anticipated exposure. Standard surgical PPE includes:
Surgical gown: provides a sterile barrier between the scrubbed team member and the sterile field. The gown is considered sterile only from the chest to the level of the sterile field (table height) and from the sleeves to approximately two inches above the elbow. Back panels and areas below table level are not considered sterile.
Surgical gloves: double-gloving is strongly recommended by the AST and AORN for most procedures because it significantly reduces the risk of inner-glove perforation reaching skin. Gloves must be inspected for integrity during the procedure.
Surgical mask: filters respiratory droplets from the wearer and from the sterile field. Masks must fit snugly over nose and mouth and must be changed between cases or when visibly wet. In cases with known or suspected airborne pathogens (e.g., active tuberculosis), an N95 respirator replaces the standard surgical mask.
Eye protection / face shield: required whenever splatter or aerosol of blood or body fluids is anticipated—this includes virtually all open surgical cases. Glasses alone are insufficient; protective eyewear must provide side-barrier coverage.
Shoe covers: protect footwear from blood and fluid spills common in the OR environment.
Head covering: a bouffant cap or hood covers all hair to reduce particulate and microbial shedding onto the sterile field.
Donning PPE: Order Matters
PPE is donned before entering the sterile field in this general sequence: surgical attire (scrubs, head cover, shoe covers) → surgical hand antisepsis → sterile gown (assisted by circulator) → sterile gloves. Masks and eye protection are applied before hand antisepsis so the face is not touched afterward.
Doffing PPE: Where Contamination Risk Is Highest
Doffing is the moment most likely to result in self-contamination. The outer surfaces of the gown and gloves are considered contaminated after any case. The correct doffing sequence for the OR removes the most contaminated items first while keeping unprotected skin away from contaminated surfaces:
1. Break the gown ties (circulator may assist).
2. Remove gown and outer gloves together: grasp the gown at the shoulders, peel it away from the body rolling it inward (contaminated surface inward), and pull it off inside-out, removing the outer gloves with it in a single motion.
3. Hand hygiene with inner gloves still on.
4. Remove inner gloves by the peel method—avoid touching outer surfaces.
5. Hand hygiene again with bare hands.
6. Remove eye protection by handles or ear-pieces only; avoid touching the front lens.
7. Remove mask by ties or ear loops only; avoid touching the front.
8. Hand hygiene once more.
Any deviation from this sequence risks transferring pathogens from contaminated PPE to skin, eyes, or mucous membranes.
Patient Safety Connection
Standard Precautions protect not only the surgical team but also the patient. An ST who is careless during doffing and self-contaminates can carry pathogens out of one case and into the next. Strict adherence to hand hygiene and PPE protocols is therefore both a personal safety measure and a patient safety obligation—directly linked to surgical site infection (SSI) prevention.
Key Takeaways
- Treat every patient's blood and body fluids as infectious.
- Match PPE to the specific exposure risk of each case.
- Use the neutral zone for all sharps; never pass sharps hand to hand.
- Doffing sequence is as important as donning—remove the most contaminated items first, rolling contaminated surfaces inward.
- Hand hygiene is performed multiple times during the doffing process.
Key terms9
Materials: Surgical gowns, gloves, masks, eye protection, shoe covers, UV fluorescent lotion kit, UV lamp, OSHA bloodborne pathogens reference handout, PPE scenario cards, AST Core Curriculum
Check: Doffing observed by instructor with UV lamp review; zero self-contamination events required; PPE selection exercise scored at 80% or higher to pass.
Practice check8
Answer each question, then check it. Nothing is recorded; this is your own practice.
