During a power outage in an ongoing surgical case, which sequence best describes the immediate actions?

• A. Continue with the case, replace lights, notify the surgeon.
• B. Initiate downtime procedures, preserve the sterile field, switch to backup power, continue with essential equipment.
• C. Preserve the sterile field, immediately discontinue the case, evacuate the room.
• D. Switch to backup power, continue with nonessential equipment, pause the case.

Answer: (B)

When an outage occurs in the middle of a case, the priority is to restore control and protect the patient by following a downtime protocol that keeps the sterile field intact and ensures essential functions remain powered. The best sequence starts with initiating downtime procedures so the team has a clear plan, assigns roles, and verifies the status of instruments, counts, and critical equipment. This creates a controlled environment rather than a chaotic scramble.

Preserving the sterile field is the next crucial step. The sterile field is the patient’s protection against infection, and interruptions can compromise sterility quickly. By safeguarding the field first, you prevent contamination even as the room is adapting to the outage. Then switching to backup power supports safety-critical needs—lighting, suction, and essential equipment that keeps the procedure viable. Without reliable power to these core devices, proceeding safely becomes impossible.

Finally, continuing with only the essential equipment ensures the patient remains under safe, monitorable conditions while the team works through the outage. Nonessential devices should remain offline to avoid unnecessary clutter, overload, or distraction, and to preserve power for what truly matters.

Other options miss a key piece of logic: simply continuing the case or only replacing lights before a formal downtime plan risks contamination and confusion; immediately discontinuing the case and evacuating is overly drastic for a standard outage and isn’t the general first response; switching to backup power and then running nonessential equipment ignores the need to protect the sterile field and to follow a structured downtime process.