Aseptic and SepticOperation Theatre Orientation

Introduction• Heart of an hospital-OT

• Team• Skilled Surgeons

• Nurses

• MLOP

• Anaesthetist

Separate theatres for septic and aseptic surgeriesAseptic Theatre:-

• Cataract• PKP• Squint– Retina– Glaucoma

Septic (Minor Theatre):--Enucleation- Evisceration- DCR- DCT - Infected Cases

Planning of OT

• An should have• High standard of asepsis

• Maximum standard of safety for patients and staffs

• Optimum utilization of space and staff time

Location of Aseptic Theatre

• The Location Should be• Free from general traffic Eg: Away from road side

• Free from noise and other disturbance

• Free from contamination and possible sources of infection

• Closure to ward

Operation Theatre Zones

• Four Types of Zones• Sterile Zone

• Clean Zone

• Protective Zone

• Disposable Zone

• Sterile Zone• Operation Room

• Scrub room

• Anaesthesia room(Block room)

• Instruments sterilization

• Clean Zone:-• Pre operative block room• Nurses work room• Recovery room• Anaesthesia /Medication store

• Protective Zone:-• Reception room in OT

• Waiting room for relative of patient

• Dress changing room

• Pre Anaesthesia room

• General store room

• Main Autoclave room

• Trolley lay,Wheel chair,Stretcher

• Control area of electricity

• Disposal Zone:-• Dirty /Blood stained linen

• Used head caps,mask,socks

• Solid materials both disposable and non disposable should move with out crossing sterile & clean zones.

Operation Room

• Contains:-• Airconditioning –maintains asepsis • Operating table

• Adjustable chair for surgeons

• Instruments trolley

• Microscope & other necessary equipments,Phaco machine etc

• A working space of around 1. 2 m around operation table

• IV stand tray and fluids

• One Bowlstand for rinsing hand with sterile water.

Instruments

• Surgical instruments sets and different ocular surgeries

• Bipolar diathermy with points

• Vitrectomy machine with vitrectomy probes

• Boyle apparatus for GA

Sub sterilizing Area

• Instaclave with cheatle forceps and container

• Stainless steel basin for cleaning the instruments

• Electric water drums for boiling water or drum with clean sterile water.

• Soft brush for cleaning the Instrument & instrument cover

• Adequate water supply

Scrub Area

• Sink with running water facility• Hands should not touch surface of sink

• Scrubbing Solution (Chlorhexidine, Iodine 7.5%)• With Soap and brush• 6 minutes for scrubbing• First one minute for two times using soap then 2

minutes used for solution first time scrubbing with brush and full fore arm

• Second 2 minutes with scrubbing solution for proximal half of fore arm

Location of Septic OT

• Located at a place which has limited access to patients

• Closure to ward

• Away from aseptic OT

• Should have separate dressing room,scrub room,sterilization section

• Should have good ventilation

• Good lighting system

• Instruments and eye towels should be sterilized separately from other than linen like coats.

• Flash autoclave or sterliser-in between cases

Staffing Pattern

• OT Manager is usually OT Nursing officer

• OT Manger has to ensure

• Availability of equipments ,instruments and nursing staffs

• Proper care and maintenance of equipments

• Theatre cleaning and sterility

• Adherence to work discipline

• Maintenance of OT records

• Relationship with other departments

Staff Allocation

• Operation area

• Scrub nurse- 2 for 1Surgeon

• Circulating nurse-1for 1 Surgeon

• Block room-Local –1-3 persons,GA-2 persons

INFORMATION BOARD

• Notice board for display of daily operation

• Schedule with details at entrance of OT

• Helps to begin the preparations without delay

Roles of MLOP in OT

• Circulating MLOP:-• To give nursing care to patients during preparation for

the surgery

• Checks the case sheet

• Helps doctors in giving local anaesthesia and counseling to the patient .

• She makes available the sterile things and medicines supplied needed for surgery

Scrub MLOP

• Scrub MLOP is a well trained person,who will be familiar with procedure of surgery

• She assists the surgeon through out the surgery

• Helps to wear sterile gown

• Arranges instrument trolley

Dress code

• Should wear only special theatre dress to minimize cross infection.

• Should not leave outside OT with theatre linen

• Caps must be worn to cover the hair completely

• Face masks must be worn.

• Dress colour-preferably light blue,green

Slippers and Overshoes

• Should remove personal slippers outside OT

• Feet must be washed

• Theatre slippers should be worn

• Slippers should be scrubbed after use daily

• Theatre slippers should not be used outside the theatre

A dedicated OT MLOP

• Should have a same of sincerity ,honesty and punctuality and compassion to all the patients.

• Should have sufficient knowledge of medical terms

OT Discipline

• MLOP should come early before the start of surgery

• Take all responsibility to arrange the theatre,ready to the patient and allocate the surgeon

• Eating or drinking tea or coffee should be strictly prohibited in OT area

Personal Hygiene

• Hairs and Nails must be kept clean and short

• No Nail polishing or jewellary

• Cuts and abrasion should be corrected and reported to incharge person

• Infectious diseases like common cold should get prompt and complete medical treatment

Patient Hygiene

• Should have their bath and wear clean dress

• Diabetic ulcer patient Hansen or other infected diseases should be operated at the end

• Disposable cap and shoes to every patient

Key Point to Remember• OT should be located away from pollution (Noise & Air)• The attender /visitors should not be allowed to stand in

front of OT• MLOP should check the working conditions of equipments

, electrification etc prior to surgery• MLOP should take responsibilities to inform/make

arrangements for repair and replacement of equipment.• An extra supply of instruments should be available at

request.• An extra supply of all OT dresses must be available for

visitors and staffs• The medical personal should strictly follow the theatre

discipline