operation theater

Operation theater

PRESENTED BY

Dr. Aniruddha LahiriDr. Soumi Aditya

Dipayan royKrittika Lahiri

Amit SinhaMoumita Roy

Saumyasree Pradhan

IMPORTANCE

For Hospital Administrator-Most profitable area

For patient- confidence & good outcome, less chance of post op complications

For surgeon- practice with full potential of expertise, more confidence, convenience

CHALLENGEVery costly affairNeed meticulous planningDifficult to change once made

Asepsis

Change in conception

Older concept – Different OT for different specialties

Newer concept- Groping and flexibility

Conflict of interest- between surgeon & administrator

Advantage of groupingEfficient use of stuff & facilitiesEffective supervision & controlFlexibility in schedulingBetter disciplineRound the clock serviceImproved asepsis Better training facilitiesEconomy in engineering maintenanceEasy material supplyReduction in ancillary accommodation by

50%

Location

Guiding principals-

◦Accessibility to- surgical words, CSSD, SICU, emergency, blood bank, lift

◦Free from external disturbance

◦Provision for future expansion

Required Numbers of OT rooms

Total no of beds

No of OT Major

No of OT Minor

OPD OT Major

OPD OT Minor

50 1 -- -- 1

75 1 1 -- 1

100 1 1 -- 1

300 3 1 -- 1

500 5 2 1 1

750 8 2 1 1

Calculation

N=T/C (N= no of rooms, T= no of operations per year, C= capacity of the room per year)

T=B × 365 × P/L ( B=no of surgical beds, P= occupancy, L = avg length of stay)

C= D × H/A ( D=working day in a year, H=avg working hour / day, A= operating time in hour)

OPERATION TIME

Average OPERATION time 2 hoursAbout 4 Operation in a day in a ORAbout 8 hour working time / day‘knife to closure” – 54%Supportive activity – 31%Making OT ready for operation- 15%

HOW TO IMPROVE EFFICIENCY?

Timely attendance↓ 31% + 15%Separate anesthesia and lay up

roomsProper training & motivation of

personnelProper scheduling of operation

( appropriate mix)

OT room sizeFor general operation – 18’× 18’ (324 sq.ft) or 18’ × 20’ (360 sq.ft)

For specialized Operation – 25’ × 25’ (625 sq.ft) –to accommodate extra specialized machine like heart-lung machine etc.

O.T lighting

Powerful, cool, shadow less light Should penetrate deeper cavities in

operative field Mandatory independent UPS back up

Electrical outletsSpark less fittings 5 feet high from the floorSufficient number of sockets (at

least 6) with adequate 15 m.amp sockets (at least 2)

Flooring

Moderately conductive to dessipate accumulated electro static charges

Conductivity between 1 mili.ohm – 10 mili. ohm

Previously copper strips laid in the flooring

Now-a-days newer materials are used

AIR- CONDITIONING

Temperature- 19 ⁰ - 24⁰ CHumidity- 50% - 60%Air exchange- 20 – 30 per hour with 80%

recirculationHEPA filter- eliminate particle up to 3 micro

meter size.Periodic maintenance of HEPA filter.Positive air pressure- air flow from clean to less

cleaner area .Laminar air flow system.

WALLSEasy to wash and wipe Joint less or minimal jointsMarble or mosaic wall preferred over

tiles Rounded internal corners

Colors of wall Light, Soothing to eyesrefreshing

DOORSWith 90 cms (to pass a person in

sterile gown and the patient trolley)

Opens towards the movement Sliding door is preferred

Instrument planning

This is determined, to a great extent, by..

The level of the hospital. The nature and extent of surgical

procedures. The extent or constraints of the

financial, physical & human resources in their acquisition, installation & use.

Therefore, while planning for the equipment of an O.T. it is necessary to,

Match their characteristics & specification with the professional & technological requirements & other considerations of logistics & resources.

THE STANDARD INVENTORY OF EQUIPMENTS ARE….

Operating light system

Operating Table & transfer trolley system

Anesthesia equipment

CONTINUED……..

•Surgical diathermy machine

•Ventilator

•Suction apparatus

•Channel monitor

•Defibrillator

CONTD………

C- arm fluoroscopy machine

Pulse oxymeter

Instrument trolley

Flash sterilizer

Operating microscope

Cont…..

LaparoscopeBronchoscopeLithoclastLaryngoscopeBag Valve MaskUltraschall UltrasoundPatient heating and cooling

equipment

Cont…….

Electrical communication system Close circuit tv Fixed services system medical gases vacuum cold light

Patient heating and cooling equipment X- ray machine (portable or wall-mounted)

Special Instruments:

Cardiac O.T. Heart – Lung Machine Make: TERUMO & Sons. Model: 8000

Monitor for heart- lung machine. Blender in Heart- lung Machine. External Pacemaker ACT II (Activated Clotting Time) Intra- Aortic Balloon Pump [ IABP ] Machine Make: Data Scope Model: CS 100

Sternal Saw Octopus.

Ortho O.T.Special O.T. TableMan Man Saw.Electronic torniquet.N20 Drill

Neuro O.T.o Harmonic- Ultracision Scalpelo Operating microscope Make : NC4 Zeisso Medas Drill

zoningOperation theatre should be

designed with the aim of minimizing the risk of hospital acquired infection or surgical site infection

Therefore the whole OT is segregated into 4 zones depending on the type of activities level or degree of sterility and pattern of circulation

Principles of ZoningThe aim is to minimize infection

with staff and equipment movements

General principles:-Clean and dirty traffic flow in OT

should as best as possible.Spaces in the suites should be

designed such that there is continuous progression of cleanliness

Cont…..The staff working in the OT

should move from clean area to other without passing trough unprotected zones

Wastes should be removed from OT should be from clean area to less

Also air movement should be separated from rest of the hospital

Sterile zonesIt’s the innermost zone of the

suite with highest level of cleanliness and asepsis

This zone includes :-Scrub areaPreparation roomOperative theatreArea of instrument packing and

steriliasation

Clean zoneThe clean zone is around the sterile

zone and has air pressure positive in comparison to protective zone

It includes the following:-◦Changing room◦Stores room◦Anesthetists room◦Recovery room◦Patient transfer room◦Nursing staff room

Protective zone

Outside the clean zone is the protective zone

It acts as a barrier between the clean zone and the rest of the hospital

Access to this area is entirely separate as people enter and leave in their street clothes and shouldn’t penetrate until after changing OT shoes and clothing

Disposal zoneThis is a corridor from where

used instruments, linen and operating room debris is removed and taken out

Interlock hatch system

Circulation within the OTEquipment and supplies

Clean area:-◦ TSSU(total sterile supply unit)>Theatre preparation

room>Point of use

Sterile:-◦ CSSD or TSSU>Theatre preparation room>Point of

use

Dirty:-◦ Theatre>Disposal

area>TSSU>Laundry>Destruction unit

FUNCTIONAL RELATIONSHIPS OF DIFFERENT ROOMS

Scrub up room

1. Proximate to the operating room

2. Elbow operated tabs

3. Taps should be 3ft apart

Anesthesia room

Room for induction of anesthesia

Space should be 160 sqft

Sub sterilizing room

Washing instruments and sterilization

Distinction between dirty and sterile procedures

Flash sterilization

Anesthesia equipment room

Storage of anesthetic gases and equipments

Outside ventilation

Dark roomDevelopment of filmsIt includes film

storage box, developing tank,sink

Fracture room

Fixed equipments in the fracture room includes stainless steel work counter, plaster sink, viewing box

Locker and changing room

Lockers for clothes and other belongings

Locker room includes wash basin, toilet, racks for foot wear, hooks for apron, shelves etc

Separate changing room for doctors, nurses and technicians.

Instrument store

Trolley parking Cleaner closet

Recovery room

No of beds should be equal to the average number of patients operated

Open ward or single room Accommodation for utility

room

Circulation within the OT

Patient:Wards/ICU Reception Transfer area Anesthetic room Theatre Exit Lobby Transfer area Recovery area ICU/ward

Staff: Entrance changing rooms working areas rest room exit

Functions of the operating department.

Duties and responsibilities of personnel

Staffing patterns, work hours, including emergency duties.

Methods of scheduling of operations.

Safety precautions for dispatch of patients to operation theatre and return to nursing units.

POLICIES AND PROCEDURES

Methods of checking operating room readiness to receive patients, including

Essential personnel

Scrub room facilities

All appliances and equipment

Drugs, medicines, fluids

Sterile supplies, i.e. basins, catheters, drains, dressings, sponges, packs, gloves, drapes, sheets, towels, gowns, aspirating syringes, sutures, water, saline, instruments, etc.

Records and forms, including report of physical examinations and consent of operation

Technique for scrubbing hands.

Mask, cap and gowning techniques.

Instructions as to who may enter operating room.

Duties of circulating nurses and attendants.

Technique for assistants and unsterile personnel.

Procedure for shock, massive hemorrhage, transfusion reaction or death of patient.

Instructions on deposition of patients’ valuables including rings, jewellery, dentures.

Methods of sponge selection, accounting and disposition.

Record of operative procedures, anaesthesia.

Care and disposition of tissue removed.

Use of recovery room including staff, techniques, procedures and records.

Methods of enforcement of aseptic techniques before, during and following operation.

Clearing of operating rooms following operations, with particular emphasis on septic cases.

Care, cleaning, repair and maintenance of instruments and equipment.

Frequency of sterilization, carbolisation and fumigation checks.

SAFETY HAZARDS

Methods of checking wiring and electrical equipment by engineers.

Methods of checking correct climatic conditions.

Checking air filters in AC system.

Checking for anaesthetic and oxygen gas leakages.

Control of fire hazards :

Provision of fire extinguishers and their locations

Directions for correct operation of each type of extinguisher

Familiarisation of all personnel with handling and use of fire extinguishers.

PROTECTION OF PATIENTS

Methods of patient identification.

Restraining of patients during movement on trolleys or stretchers.

Protection of patients on operating table.

Method of checks of positioning regarding respiratory obstruction, pressure on nerves, and impairment of circulation.

Procedure for sponge count and instrument count.

Selection and use of sponges.

BACTERIOLOGICAL PRACTICES

Proper wearing of masks.

Masks changing between operations.

Removal of masks on leaving operating room.

Changing caps daily.

Restrictions on visitors to OT suite.

Handling and disposal of disposable syringes and needles, other disposables.

Daily cleaning procedures of operating rooms.

Weekly disinfection procedure of operating rooms.

Weekly cleaning of ceiling of operating rooms.

Procedure for use of mops.

Frequency of changing of mops.

Cont….

THANK YOU