operation theatre discipline

Theatre discipline

adil ghauri

Operation theatre should be sited near Surgical wardsMain liftsEmergency and accident departmentRadiology departmentIntensive care office

SITE

Clean and Dirty areas

Clean and dirty areas should be well demarcated with staff traffic to remain minimum at clean area.

Infection control

Important factors for controlling the infection are

Appropriate designControlled air qualityQuality cleaningImpermeable clothingHand scrubbingPatient preparation

Principles in design

Outer reception areaClean zone

Outer reception areaReception officeReception area where patients wait for

checking inArea for storage of trolleysArea for hanging clean gowns and

overshoes for parents to wear when accompanying children to anesthetic rooms

Clean zone: It includesWide and clean corridor that allows

access to and from Anesthetic room

Recovery area Clean storage room

Emergency autoclaveStaff relaxation and changing rooms

Operting theatre

Scrub room

It is designated as Two doors; one to corridor and one to operating theatreSink with taps that can be manipulated with elbows and soap holders that can be manipulated with foot pedals or elbowsGood drainage and suitable panels incorporated in sink to prevent splashing of clothesAntiseptic floorsEasily cleaned shelves for gown packs and glovesAdequate facilities for disposal of linen and paperBrushes for cleaning finger nails

OPERATING ROOM

Should have double door entrance from anesthetic room and double door exit from clean corridor

Should have small entrances from clean store room and opening from scrubbing room

A single exit door to dirty corridor

All doors should be well cleaned in order to comply with air ventilation system

Operating theatres, recovery rooms and anesthetic rooms must be designed to have adequate power points and emergency electricity, piped gases, anesthetic scavenging system, lightening and wall suction

Cardiac resuscitation equipment must be readily available

Temperature range between 19 degree Celsius and 22 degree Celsius with humidity of 45-50%

Operating table should be adjustable with all working parts sealed, regularly cleaned to ensure checked to ensure that it can be raised and lowered smoothly within appropriate gears for trendelenburg tilt and lateral tiltand an adequate breaking system

Lights should be adjustable, sealed and cleaned with facilities of light handles so surgeon and scrub team can adjust it

Plaster work and floor should be well sealed any defect should be repaired as matter of emergency

Fixed surfaces should be avoided and reliance placed on steel trolleysRadiographic viewers should be inserted into wall and kept in good repair

EQUIPMENTS

Trolleys should be cleaned and have safety rails with well fitting tube and mask, all of which are regularly checked and empty cylinders replaced

Suction apparatus should be well cleaned and checked with spare suction tubes and catheters available

Anesthetic machine should in good working order

All electric equipments should be regularly checkedFire policy, regular fire drills and weekly testing fire doors are essential safety precautions

Control of Air Quality

An OT should be fitted with controlled ventilation and filters because non-visceral bacteriological contamination of wound is predominantly from air

For general surgical theatres the maximum benefits are obtained from 20 air changes per hour using 5mm size filter

In orthopedic OT there should be ultra clean air in which bacterial count is kept below 10 CFUs per cubic mm

Additional measures includeMinimizing number of individuals in OTAvoiding excess movement of individuals in OTEnsuring that air vents are not obstructed and that the doors are closed