operation theater
TRANSCRIPT
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