operation theater

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Operation theater PRESENTED BY Dr. Aniruddha Lahiri Dr. Soumi Aditya Dipayan roy Krittika Lahiri Amit Sinha Moumita Roy Saumyasree Pradhan

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Page 1: Operation Theater

Operation theater

PRESENTED BY

Dr. Aniruddha LahiriDr. Soumi Aditya

Dipayan royKrittika Lahiri

Amit SinhaMoumita Roy

Saumyasree Pradhan

Page 2: Operation Theater

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

Page 3: Operation Theater

CHALLENGEVery costly affairNeed meticulous planningDifficult to change once made

Asepsis

Page 4: Operation Theater

Change in conception

Older concept – Different OT for different specialties

Newer concept- Groping and flexibility

Conflict of interest- between surgeon & administrator

Page 5: Operation Theater

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%

Page 6: Operation Theater

Location

Guiding principals-

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

◦Free from external disturbance

◦Provision for future expansion

Page 7: Operation Theater

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

Page 8: Operation Theater

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)

Page 9: Operation Theater

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%

Page 10: Operation Theater

HOW TO IMPROVE EFFICIENCY?

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

roomsProper training & motivation of

personnelProper scheduling of operation

( appropriate mix)

Page 11: Operation Theater

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.

Page 12: Operation Theater

O.T lighting

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

operative field Mandatory independent UPS back up

Page 13: Operation Theater

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)

Page 14: Operation Theater

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

Page 15: Operation Theater

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.

Page 16: Operation Theater

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

Page 17: Operation Theater

DOORSWith 90 cms (to pass a person in

sterile gown and the patient trolley)

Opens towards the movement Sliding door is preferred

Page 18: Operation Theater

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.

Page 19: Operation Theater

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.

Page 20: Operation Theater

THE STANDARD INVENTORY OF EQUIPMENTS ARE….

Operating light system

Operating Table & transfer trolley system

Anesthesia equipment

Page 21: Operation Theater

CONTINUED……..

•Surgical diathermy machine

•Ventilator

•Suction apparatus

•Channel monitor

•Defibrillator

Page 22: Operation Theater

CONTD………

C- arm fluoroscopy machine

Pulse oxymeter

Instrument trolley

Flash sterilizer

Operating microscope

Page 23: Operation Theater

Cont…..

LaparoscopeBronchoscopeLithoclastLaryngoscopeBag Valve MaskUltraschall UltrasoundPatient heating and cooling

equipment

Page 24: Operation Theater

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)

Page 25: Operation Theater

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.

Page 26: Operation Theater

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

Page 27: Operation Theater

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

Page 28: Operation Theater

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

Page 29: Operation Theater

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

Page 30: Operation Theater

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

Page 31: Operation Theater

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

Page 32: Operation Theater

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

Page 33: Operation Theater

Disposal zoneThis is a corridor from where

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

Interlock hatch system

Page 34: Operation Theater

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

Page 35: Operation Theater

FUNCTIONAL RELATIONSHIPS OF DIFFERENT ROOMS

Scrub up room

1. Proximate to the operating room

2. Elbow operated tabs

3. Taps should be 3ft apart

Page 36: Operation Theater

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

Page 37: Operation Theater

Anesthesia equipment room

Storage of anesthetic gases and equipments

Outside ventilation

Dark roomDevelopment of filmsIt includes film

storage box, developing tank,sink

Page 38: Operation Theater

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.

Page 39: Operation Theater

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

Page 40: Operation Theater

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

Page 41: Operation Theater

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

Page 42: Operation Theater

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

Page 43: Operation Theater

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.

Page 44: Operation Theater

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.

Page 45: Operation Theater

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.

Page 46: Operation Theater

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

Frequency of sterilization, carbolisation and fumigation checks.

Page 47: Operation Theater

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.

Page 48: Operation Theater

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.

Page 49: Operation Theater

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.

Page 50: Operation Theater

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.

Page 51: Operation Theater

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….

Page 52: Operation Theater

THANK YOU