Operation Theater Operation Theater Design & Management.Design & Management.

Dr.S.N.Kumthekar.Dr.S.N.Kumthekar.Surgeon Oncologist.Surgeon Oncologist.

Kumthekar General Hospital & Kumthekar General Hospital & Cancer Research Center Jule Cancer Research Center Jule

Solapur.Solapur.

What is an Operation What is an Operation theater?theater?

Originally this term was used for a Originally this term was used for a place which was like a tiered place which was like a tiered Amphitheater in which students & Amphitheater in which students & spectators used to watch surgeries spectators used to watch surgeries being performed by a surgeon……. being performed by a surgeon……. As of today….Its a place in a Hospital As of today….Its a place in a Hospital where Surgical Operations are where Surgical Operations are carried out in a controlled carried out in a controlled environment..environment..

Operating theaters have Operating theaters have always…..always…..

Generated a feeling of……..Generated a feeling of……..Awe, Wonder & dramatic expectations,Awe, Wonder & dramatic expectations,Reminiscent of Real drama Reminiscent of Real drama

Theaters…..Theaters…..With the only difference being …..With the only difference being …..

Here there are no Rehearsals! Here there are no Rehearsals!

Fergusson: A 19Fergusson: A 19thth century century Surgeon Stated that ……….Surgeon Stated that ……….

A Surgeon is supposed to have,A Surgeon is supposed to have,1.The Eye of an eagle.1.The Eye of an eagle.2.The heart of a Lion.2.The heart of a Lion.3.The Hands of A Lady.3.The Hands of A Lady.4. & the flair of an accomplished actor .4. & the flair of an accomplished actor .The personality of a surgeon has always The personality of a surgeon has always

reflected his desire to perform the art reflected his desire to perform the art of surgery in front of an appreciative of surgery in front of an appreciative audience!audience!

The Oldest Operation Theater to The Oldest Operation Theater to datedate

A.D.1822. A.D.1822. London.London.St. Thomas Hospital.St. Thomas Hospital.Is now a Museum Of Surgical History.Is now a Museum Of Surgical History.

Another Famous Operating Theater Another Famous Operating Theater from History……….from History……….

• The Ether Dome in Boston A.D. 1824.• John Collins Warren Performing First

Surgery using Ether Anesthesia….

Operation Theater Design:Operation Theater Design:HistoryHistory

In good olden days Operations were In good olden days Operations were performed on as is where as basis. performed on as is where as basis. Surgeons would go to the patient with Surgeons would go to the patient with their tool box & perform the surgery.their tool box & perform the surgery.

Then came the concept of “ Theater”.Then came the concept of “ Theater”.The procedures were limited to Emergency The procedures were limited to Emergency

& life threatening situations Like Abscess & life threatening situations Like Abscess drainage, Amputations, Stricture drainage, Amputations, Stricture dilatation, Superficial lump Excision & war dilatation, Superficial lump Excision & war wounds.wounds.

Operation theater design: Operation theater design: HistoryHistory

Tennon 1788 Proposed separate Rooms to Tennon 1788 Proposed separate Rooms to conduct Operations.conduct Operations.

Dupuytren was performing operations in Dupuytren was performing operations in Wards as late as 1815.Wards as late as 1815.

In the entire 17In the entire 17thth & 18 & 18thth Century Surgeons Century Surgeons performed in Amphitheaters.performed in Amphitheaters.

A New York Surgeon Stephen Smith in 1878 A New York Surgeon Stephen Smith in 1878 advised the abolishing of this system.advised the abolishing of this system.

By 1898 Amphitheaters were abolished.By 1898 Amphitheaters were abolished.

O.R.Design historyO.R.Design historyAdvances in Asepsis & Microbiology Advances in Asepsis & Microbiology

Shook the foundation of Surgeons Shook the foundation of Surgeons Role. The major Advances were the Role. The major Advances were the Four A’S:Four A’S:

1.Anesthesia : 1846.1.Anesthesia : 1846.2.Antisepsis : 1867.2.Antisepsis : 1867.3.Asepsis : 1886.3.Asepsis : 1886.4.Antibiotics :1929.4.Antibiotics :1929.

Operation Theater Operation Theater DesignDesign After these major developments & After these major developments &

from 1935 onwards proper from 1935 onwards proper Operating Rooms as we use Operating Rooms as we use today came in to existence & today came in to existence & went on rapidly went on rapidly modernizing ,keeping pace with modernizing ,keeping pace with the ever evolving advanced the ever evolving advanced technologies.technologies.

Basics of Operation Theater Basics of Operation Theater Design:Design:

• The Present day Operation Theater complex should ideally include the following areas,

• 1.O.R. Office.• Changing & Rest Area With a Toilet.• Scrub Area.• Sterilization area.• Storage area.• Operating Room Proper.• Washing & disposal area.• Post.Op. Recovery room.

Where to Locate the Where to Locate the theater?theater?

As a General rule ,In a Hospital Building As a General rule ,In a Hospital Building the O.R. should be located in such a way the O.R. should be located in such a way so as to permit convenient & so as to permit convenient & uncomplicated traffic of Staff & Patient.uncomplicated traffic of Staff & Patient.

Preferably Ancillary Depts. e.g. Path. lab., Preferably Ancillary Depts. e.g. Path. lab., Radilogy,Post-Op.ICU, Delivery Room Radilogy,Post-Op.ICU, Delivery Room should be located Adjacent to the O.R. & should be located Adjacent to the O.R. & on the same floor.on the same floor.

How many O.R.s A How many O.R.s A Hospital should have ?Hospital should have ?

It depends upon the size & requirements of It depends upon the size & requirements of the Hospital…Usually for a General the Hospital…Usually for a General hospital offering Basic Primary & hospital offering Basic Primary & secondary care services & a bed strength secondary care services & a bed strength of up to 50 beds, One Major O.R. & one of up to 50 beds, One Major O.R. & one septic/minor O.R. is sufficient… In a septic/minor O.R. is sufficient… In a Super/Multispeciality set up specialty Super/Multispeciality set up specialty wise major & minor O.R.’s are requiredwise major & minor O.R.’s are required

What should be the size What should be the size of an O.R. ?of an O.R. ?

A Major O.R. Should have a Dimension of A Major O.R. Should have a Dimension of 20 ft in Length x 18 ft in Breadth….min.20 ft in Length x 18 ft in Breadth….min.

A Minor O.R. Should be ,A Minor O.R. Should be , 16ft in Length x 14 ft in Breadth .16ft in Length x 14 ft in Breadth .In Specialty /Super-specialty set up ,In Specialty /Super-specialty set up ,Bigger space is mandatory.Bigger space is mandatory.

Things to remember Things to remember during construction!during construction!

Flooring …Hard with smooth surface, with minimum Flooring …Hard with smooth surface, with minimum joints, seams & crevices…avoid marble ..use joints, seams & crevices…avoid marble ..use polished Green Kota, or High quality ceramic tiles.polished Green Kota, or High quality ceramic tiles.

The Walls Should have Sealed windows, & should The Walls Should have Sealed windows, & should have Ceramic lining for at least 8ft. Heighthave Ceramic lining for at least 8ft. Height

A Provision for Window / split A.C.A Provision for Window / split A.C. Provision for Low level Self closing Exhaust Fan.Provision for Low level Self closing Exhaust Fan. Washable matt finish Oil paint with soothing shade.Washable matt finish Oil paint with soothing shade.

Things to remember during Things to remember during construction…….construction…….

The ceiling should have smooth white paint,& The ceiling should have smooth white paint,& provision for Lamp & Light fixture supports.provision for Lamp & Light fixture supports.

There should be no Toilet ,on the floor imm. Above There should be no Toilet ,on the floor imm. Above O.R.O.R.

Scrub area should be imm. Adjoining.Scrub area should be imm. Adjoining. A two way self closing door bet. O.R. & Scrub area.A two way self closing door bet. O.R. & Scrub area. Prep./Sterilization room to have direct access to O.R.Prep./Sterilization room to have direct access to O.R. If area permits a Pre Anesthesia & Post Op. If area permits a Pre Anesthesia & Post Op.

Recovery room adjoining…..Recovery room adjoining…..

Most Imp. Thing to Most Imp. Thing to remember:………remember:………

While the O.R. is being constructed & or While the O.R. is being constructed & or renovated….. A clear Dialogue between renovated….. A clear Dialogue between the Architect & the Surgeon Concerned is the Architect & the Surgeon Concerned is a must!a must!

The Concept in Mind, on paper & in The Concept in Mind, on paper & in reality must match…….reality must match…….

Requirements of the Changing Requirements of the Changing RoomRoom. App. Area :12ft. x 13ft.. App. Area :12ft. x 13ft.

1.Two Doors 1.Entry in .2. Entry in Scrub area1.Two Doors 1.Entry in .2. Entry in Scrub area2.Storage for Changing clothes, Cap/ Masks,2.Storage for Changing clothes, Cap/ Masks, Shoe racks etc.Shoe racks etc.3.Sitting & Resting arrangement.3.Sitting & Resting arrangement.3.Changing areas for Male/Female.3.Changing areas for Male/Female.4.Intercom Telephone.4.Intercom Telephone.5.A Library.5.A Library.6.Stationary Rack with Registers.6.Stationary Rack with Registers.

Requirements of Scrub / Requirements of Scrub / Sterilization area.Sterilization area.

1.1. Ideally these two areas should be Ideally these two areas should be separate ,but should have access to separate ,but should have access to O.R.O.R.

2.2. Scrub area to have two large sinks with Scrub area to have two large sinks with levered water cocks .levered water cocks .

3.3. Sterilization area will include Autoclaves, Sterilization area will include Autoclaves, Boilers,& Drum storage platform.Boilers,& Drum storage platform.

4.4. Cabinets for Instruments ,Linens & Cabinets for Instruments ,Linens & Disposables storage.Disposables storage.

Requirements of O.R. Proper 1.Requirements of O.R. Proper 1.1.1. Fittings & fixtures : concealed wiring, sufficient Fittings & fixtures : concealed wiring, sufficient

points on all four walls.points on all four walls.2.2. Lighting in O.R. :Adequate wall mounted Lights Lighting in O.R. :Adequate wall mounted Lights

for Proper General Illumination.for Proper General Illumination. Ceiling Mounted Single/ Double Dome O.R. Ceiling Mounted Single/ Double Dome O.R.

(Cold Light), A stand by Floor Lamp.(Cold Light), A stand by Floor Lamp.3.O.R. Furniture : An Operation Table with all 3.O.R. Furniture : An Operation Table with all

attachments , All necessary trolleys & stands, attachments , All necessary trolleys & stands, Revolving Stools, Saline stands ,Waste Revolving Stools, Saline stands ,Waste collection Buckets etc.collection Buckets etc.

Requirements of O.R. ….2.Requirements of O.R. ….2.

4.Anesthesia Equipments & Medical gases.4.Anesthesia Equipments & Medical gases.5. Anesthesia Drug Trolley.5. Anesthesia Drug Trolley.6. Oxygen/ Nitrous/ Carbon dioxide 6. Oxygen/ Nitrous/ Carbon dioxide

Cylinders or Central Gas Supply.Cylinders or Central Gas Supply.7. B.P. App. on Stand.7. B.P. App. on Stand.8. Multi para Monitors.8. Multi para Monitors.9.Defifibrillator.9.Defifibrillator.10. Ventilator.10. Ventilator.

Requirements O.R. …3.Requirements O.R. …3.

11. Suction machines.11. Suction machines.12. Electro Cautery.12. Electro Cautery.13. X- Ray Imaging ( C-Arm).13. X- Ray Imaging ( C-Arm).14. View Boxes. 14. View Boxes. 15.etc……T.V. monitor, Video Recorders, 15.etc……T.V. monitor, Video Recorders,

Endoscopes, Laparoscopes, Op. Endoscopes, Laparoscopes, Op. Microscopes, Specialty dedicated Microscopes, Specialty dedicated EquipmentsEquipments

Special Considerations in O.R. Special Considerations in O.R. Design:…Design:…

Depending upon the Surgical Specialty need Depending upon the Surgical Specialty need some special designs are necessary e.g. some special designs are necessary e.g. Lamellar air flow curtains, air filters & Lamellar air flow curtains, air filters & purifies, Hyperbaric chambers, etc.purifies, Hyperbaric chambers, etc.

Super specialty surgery needs special Super specialty surgery needs special designs & specific equipment levels.designs & specific equipment levels.

O.R. management.O.R. management.There are several areas in O.R. There are several areas in O.R. management which need strict management which need strict discipline & quality control……discipline & quality control……

1.1. Patient management.Patient management.2.2. Personnel Management.Personnel Management.3.3. Equipment/ Instrument Equipment/ Instrument

managementmanagement4.4. Inventory management.Inventory management.5.5. Disinfection /Fumigation Schedules.Disinfection /Fumigation Schedules.

O.R. Management ….O.R. Management ….6. Linen Management.6. Linen Management.7. Bio- Waste management.7. Bio- Waste management.8. General Civil maintenance & 8. General Civil maintenance &

management…………..management…………..To sum up O.R. management is a To sum up O.R. management is a

complex multitasking operation complex multitasking operation which calls for seamless teamwork , which calls for seamless teamwork , disciplined & consistent efforts.!disciplined & consistent efforts.!

What is the Future of O.R.What is the Future of O.R.Significant advances are on the anvil like Significant advances are on the anvil like what we read in Science fiction….what we read in Science fiction….Robotic Surgery will soon replace the Robotic Surgery will soon replace the Surgeon from O.R. … the surgeon will Surgeon from O.R. … the surgeon will instead sit in front of a console & perform instead sit in front of a console & perform virtual surgery.virtual surgery.Electro Medical & Optical Instruments will Electro Medical & Optical Instruments will witness a dramatic change.witness a dramatic change.Intelligent Surgical instruments are on the Intelligent Surgical instruments are on the horizon!horizon!

A surgeon with his knowledge & A surgeon with his knowledge & skills happens to be the main hero skills happens to be the main hero in this real life situational drama in this real life situational drama

that goes on in an that goes on in an Operation Theater.Operation Theater.

He happens to be the captain of a He happens to be the captain of a Ship……Ship……

A ship that has to sail safely with A ship that has to sail safely with minimum turbulence.!minimum turbulence.!