CST Certified Surgical Technologist Exam

The operating room cycle encompasses all activities from patient arrival through discharge from the surgical suite. Understanding this cycle is fundamental to surgical technology practice.

The preoperative phase begins when the decision for surgery is made and ends when the patient is transferred to the operating table. During this phase, the surgical technologist reviews the surgical schedule, confirms case carts and supplies, and prepares the operating room environment. Room preparation includes checking suction, ensuring proper lighting function, positioning the operating table, and verifying availability of specialized equipment.

Patient identification is a critical safety step. The surgical technologist participates in verifying patient identity using two identifiers (typically name and date of birth), confirming the scheduled procedure, and checking for signed consent. The patient's chart is reviewed for allergies, lab values, imaging studies, and any special considerations.

The intraoperative phase begins when the patient is transferred to the operating table and ends when the patient is admitted to the post-anesthesia care unit. This phase includes patient positioning, skin preparation, draping, the surgical procedure itself, specimen handling, wound closure, and dressing application.

The surgical technologist functions in either the scrub role or the circulating role during this phase. The scrub role involves maintaining the sterile field, passing instruments, anticipating surgeon needs, and managing surgical specimens. The circulating role involves patient advocacy, documentation, obtaining supplies, and coordinating with other departments.

The postoperative phase begins when the patient is admitted to recovery and continues through discharge and follow-up. Immediate postoperative responsibilities include transferring the patient safely, communicating relevant information to recovery staff, and completing documentation. Room turnover includes proper disposal of sharps and biohazardous waste, cleaning and disinfection, and preparation for the next case.

Efficient case turnover is essential for operating room productivity. The process includes removing all disposable items, wiping down surfaces with appropriate disinfectant, mopping the floor, restocking supplies, and preparing for the next procedure. Turnover time depends on facility protocols and case complexity.

The instrument cycle describes the pathway of surgical instruments from use through processing and return to service. This cycle ensures instruments are safe, sterile, and functional for each procedure.

Instruments must be treated at the point of use to prevent bioburden from drying on surfaces. This involves wiping instruments with sterile water-moistened sponges during the procedure, keeping lumens and box locks open, and placing instruments in designated containers after use. Enzymatic spray may be applied to prevent soil from drying.

Used instruments are transported to the decontamination area in closed, leak-proof containers. Biohazard labels are required. Instruments should not be allowed to dry during transport as dried bioburden is more difficult to remove.

Decontamination is the first step in reprocessing and involves removing organic material and reducing microbial load. Manual cleaning uses enzymatic detergent, brushes, and friction under running water. Automated cleaning uses washer-decontaminators or ultrasonic cleaners.

Ultrasonic cleaning uses high-frequency sound waves to create cavitation, which produces microscopic bubbles that implode and dislodge soil from instrument surfaces. Ultrasonic cleaners are effective for instruments with lumens, serrations, and box locks. Items must be submerged and positioned to allow solution contact with all surfaces.

Washer-decontaminators combine washing, rinsing, and thermal disinfection in automated cycles. Water temperature, detergent concentration, and cycle times are monitored to ensure effectiveness.

After decontamination, instruments are inspected for cleanliness, function, and integrity. Hinged instruments are checked for proper alignment and smooth movement. Scissors are tested for cutting ability. Forceps are examined for proper tooth alignment. Any damaged or malfunctioning instruments are removed from service.

Instrument sets are assembled according to standardized count sheets. Instruments are arranged in order of use or by type. Heavy instruments are placed on the bottom of trays. Instruments with delicate tips are protected. All hinged instruments are opened to allow steam penetration.

Instruments are packaged in materials that allow sterilant penetration while maintaining sterility after processing. Common packaging materials include woven textiles, nonwoven wrappers, paper-plastic pouches, and rigid sterilization containers.

Sequential wrapping uses two layers of material with items wrapped using the envelope fold technique. Each layer provides a barrier, and the double layer ensures sterility maintenance. Pouches are sealed with heat or self-sealing adhesive and should be filled no more than three-quarters full to allow steam circulation.

Steam sterilization is the most common method for heat-stable instruments. Standard cycles include gravity displacement (longer exposure times) and dynamic air removal or prevacuum (shorter exposure times due to efficient air removal).

Gravity displacement sterilizers rely on steam entering the chamber and displacing air downward through a drain. Because air removal is passive, longer exposure times are required. Typical parameters are 250°F (121°C) for 30 minutes or 270°F (132°C) for 15 minutes.

Prevacuum sterilizers use a series of vacuum pulses to remove air before steam injection. This allows faster penetration and shorter cycles. Typical parameters are 270°F (132°C) for 4 minutes. A Bowie-Dick test is performed daily to verify air removal function.

Sterile items are stored in clean, dry, well-ventilated areas away from sinks and high traffic zones. Event-related sterility indicates that items remain sterile unless the package is compromised by moisture, tears, or contamination. Packages are inspected before use for integrity, and chemical indicator results are verified.