Planning an Operation Theatre Complex

Planning an Operation Theatre Complex

Operation theaters

Definition Specialized facility in hospital where invasive treatment is given under strict aseptic controlled environment by trained personnel

Objectives of planning • • • • • •

Promote high standards of asepsis Ensure safety Optimal physical working conditions Ensure optimum utilization Facilitate coordinated services Rigidity and flexibility

Design considerations • • • • • • • • •

Location Workflow Basic work areas and Division of space Zoning concept Air filters Machinery and equipment Organization Policies and procedures problems

Zoning • Why? • What is it? • 3 or 4?

Zoning • ZONE 1 – PROTECTIVE - reception, waiting,trolley bay, change rooms • ZONE 2 – CLEAN AREA – preoperative,recovery,plaster room,staff lounges,stores • ZONE 3 – STERILE AREA – operating room, scrub room, anesthesia room,setup room • ZONE 4 – DISPOSAL AREA – dirty utility, disposal corridor

Special considerations • Air – supply, direction of flow, pressure changes in areas,air changes, monitoring of quality • Temperature and humidity – 21-24 centi, 45-60% humidity • Lighting – at incision area 50 to 125K lux with intensity cntrl, non-shadow ,bluewhite color of daylight, heat cntrl

Planning for an Operation Theatre • 1. O.T. Needs Specialized Planning. • 2. Different zones of OT Complex • 3. Basic Principles of Planning an O.T & Recovery room • 4. Administrative policies & Work schedules in OT functioning • 5. Measures to check the infection rate

O.T. Needs Specialized Planning. YES

O.T. Needs Specialized Planning. • O.T. Work is complex and concentrated and requires intense coordinated team work within the unit & with other agencies providing them the essential supporting services like – Transport of Men and Machine – Cleaning & Sterilization – Disposal – Record Keeping and Monitoring

O.T. Needs Specialized Planning… • Special features of O.T. working - Caters to 50% of the total Healthcare seekers. - Wide range & level of skilled persons working as team. - Equipments vary from pin to most sophisticated machines.

O.T. Needs Specialized Planning. • Both the Team members & health care seekers are at the peak of their sympathetic activity at some or the other time of the operative procedure.

Comfort

•Result can be disastrous

S S Harsoor

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O.T. Needs Specialized Planning. • These special features regarding the O.T. work makes the place very special &hence needs special structural & functionability planning to render better services safely, comfortably and with economy

Deficiencies in OTs (existing OTs)

Deficiencies in OTs (existing) 1) Waiting Area & Recovery-

• Either Not earmarked • if existing - Not well equipped - Lack of basic amenities

2) No reception area 3) No separate rooms for – Surgeons / Anesthesiologists Jr. Doctors / OT Attendants

Deficiencies in OTs(existing)… 4. No separate CSSD 5. Inappropriate size & type of O T 6. Lack of appropriate working conditions • laminar flow & mandatory air exchange • Temperature controls

7. Scarcity of Staff – at all levels

Deficiencies in OTs(existing)… 8. No OT assistants & OT Technicians available 9. Training programmes (lack of). 10. No OT audits conducted regularly & /or scientifically 11. Lack of Standard OT protocol

Different zones of OT Complex 4 Zones…

Different zones of OT Complex (1) Protective Zone Includes • Change rooms for all staff with conveniences • Transfer bay for patient, material & equipments • Rooms for administrative staff • Stores & records • Pre & Post operative rooms • I.C.U., Sterile Stores

Different zones of OT Complex (2) Clean Zone • Connects protective zone to aseptic zone (O.R.) • Has areas – Equipment Store room – Maintenance Workshop – Kitchenette (Pantry) – Firefighting device room – Service room for staff – Close circuit TV Control area – Emergency exit

Different zones of OT Complex… 3)

Aseptic zone Operation Rooms (Sterile)

4) Disposal zone Disposal areas from each OR & Corridor leading to disposal zone

Basic Principles of Planning an O.T & Recovery room

Basic Principles of Planning an O.T & Recovery room 1. Location: 1st floor & above very near to Surgical wards & SICU 2. Corridors : 3 - 3.5 m width for easy movements of men & machines 3. Zone wise distribution of the area so as to avoid criss cross movements of men & machine 4. Provision for emergency exit ( Many people & Machine)

Basic Principles of Planning an O.T & Recovery room 5. Operation rooms: – No. & size as per the requirement (50% of the surgical beds) • Size 20’X20’X10’ • Glass windows one side only – Sliding door, (2 Flap door,1.5 mts)

Basic Principles of Planning an O.T & Recovery room 6. Ventilation & temperature control – 20-30 air exchanges / Hr – Up to max 80% recirculation of air – Ultraclean Laminar airflow (90% removal of particles >0.5µ )

– Temperature 20-240 C (for Pt needs) – 0.005 H2O Positive air pressure in OR – Humidity 50-60%

Basic Principles of Planning an O.T & Recovery room 7. Strong & impermeable flooring with minimum no. of joints • Conductive flooring to dissipate static electricity (Min 1 Ohm - Max 10 Ohm Recommended)

8. Washable Wall• Laminated Polyester or smooth Paint • Collusion corners to be covered with steel • Colour should allow reflection of light yet give soothing to eyes

Basic Principles of Planning an O.T & Recovery room 9. Electric points on wall/ Pendants • More than 1.5 m height • Explosion-proof plugs • Multiple outlets from different sources of Power • Load calculation based on equipments • Proper capacity Current carrying Power Cords

Basic Principles of Planning an O.T & Recovery room 10. Lighting – Room to Surgery area lighting to be 1:3 ratio – Shadowless light with 25000-125000 Lux of light – 10-12” depth of focus of light will illuminate both surface & deeper tissues – Minimum 2000 Lux light to asses colour of patient

Basic Principles of Planning an O.T & Recovery room 10.Lighting … – Blue-white daylight with spectral energy range of 50000K ( 3500-67000 Kelvin acceptable) – Not >25000µ W/Cm2 radiant heat to be produced, – Halogen lights preferred – UPS of adequate capacity for OR light, monitors, cautery, Anaesthesia machines

Basic Principles of Planning an O.T & Recovery room 11. Piped Gases • Automatic/ SemiAutomatic fail safe manifold system • 2 each Gas & suction outlets (Central supply & Emerg stock) for all Pre-Op holding, OR( One N2O), PACU, Recovery

Basic Principles of Planning an O.T & Recovery room 12. Scrub room – Elbow/ Infrared sensor operated Taps – Non-Slippery flooring essential

13. Good pre operative area with reception. Separate area for Paediatric patients Provision for future expansion. Adequate Illumination.

Basic Principles of Planning an O.T & Recovery room 14. O.R. Panels - recessed into walls - contains X ray view, temperature, Humidity control, hands free phone, clock, time elapsed indicator, music etc - Foot operated call light system

Functional requirements & facilities for O.T.

Functional requirements & facilities for O.T... • Teaching & training the staff to minimize the risk of infection & cross infection • Administration – Co-ordination of services – Maintaining steady supply – Prompt disposal of materials, bills & correspondence. – Providing incentive for better working

Recovery room is an integral part of the OT

Recovery room is an integral part of the OT • Pts retained for observation till the vitals are stable • All the protective reflexes return to normal • Before sending the pts. home in case of day care surgery.

Staffing pattern of an OT

Staffing pattern of an OT • • • • • • • •

I/C of O.T.- Anesthesiologist (HOD/Prof) Nursing superintendent Deputy OR Nurse incharge (each OR) – 5-6 (d. N.R.) 6 trained nurses (each OR) 30 — 36 (d, N.R,) Theatre technician (each OR) - 6 (d, N.R) Asst. (4 each OT) -24 (d, N.R) Orderlies - a pool of 6-10

Staffing pattern of an OT… • • • • • •

Store & sterilization 2 Receptionist 3 (d, N.R) Security Staff 2 Record keeper 2 Electric Engineer 1 Electrician 3 (d, N.R.) .

• D- day duty ,N-Night, R Reliever for off

Administrative policies in OT.

Administrative policies in OT. • OT is the place where strict discipline has to be followed. • Slightest negligence on part of any level of person can prove disastrous. • Delegation of work & decentralization should be the main aspect of OT. administration.

Administrative policies in OT.. – Good communication at all levels (in staff, with pt’s, with pts relatives & other units etc.) – Accountability of every person to his /her superior. – Complete data keeping regarding every procedure.

Administrative policies in OT.. •

Necessary SOP( standard operating practices) is to be prepared for the following – – – – – –

Acceptance of cases for OT Basic procedures For preparing OT schedule OT personnel House keeping staff Clerical staff

Work & time schedules in OT functioning

Work & time schedules in OT functioning • OT work is complex & concentrated, and requires an intense coordinated team work, within the unit carrying out the procedure and other agencies, in providing essential supporting work like – Cleaning & sterilization – Transport of equipments – Disposal

Work & time schedules in OT functioning… – Maintenance, monitoring & keeping records of working

• For these reasons, work schedule & time schedule has to be planned very carefully. • Work schedule of OTs is as follows: – Receipt of OT list at least 24 hrs in advance – Receipt of sterile linen & instruments from CSSD 12-24 hrs in advance.

Work & time schedules in OT functioning… – Daily / Weekly / monthly indent of inventory – OT attendent & orderly has to reach in OT ½Hr before others, – staff nurses, Incharge Nurse, Deputy/ N.Supdt., Consultants

• Patients reach waiting area 1Hr before operation. • All staff members have to change their dress, put on mask, cap, & OT shoes

Work & time schedules in OT functioning… – Cleaning & dusting of the premises (2 Hrs before) – Checking & replenishing the drugs & other material OT wise (By OT sisters) – Checking of gas supply & anesthesia machines- OT Technicians – Preparing instruments trolly as per operation list (OR wise) 15-30 min before. & special request (after getting scrubbed)

Work & time schedules in OT functioning… • Check all machine & electric gadgets (OR wise by OT technician) • Starting time of operations & order of operations followed strictly • After checking the identity of patients site & type of surgery & consent, the pt is taken into respective OT.

Work & time schedules in OT functioning… Anaes. Assistant should be ready to help Anaesthetist & surgeons. • After the patient is shifted from OT table, OR is cleaned & soiled material is sent to disposal room through service hatch (Nearly 15-20 minutes time needed) • Same sequence of events continues till the OT list is over or 8 Hrs of work

Work & time schedules in OT functioning… – There-after one emergency OT works similarly – In between the operations Tea / Coffee is served to team members (without interrupting the work continuity) – Every job done is documented after finishing the operative work (data keeping- daily/monthly/Annual)

Work & time schedules in OT functioning… – Every person leaves the OT premises after changing his/her dress again & taking off the mask, cap & OT shoes. – One team of surgeon, Anaesthetist, Nurse & O.T attendent & Technician is available all 24 hrs (on call) for any emergency operation

Work & time schedules in OT functioning… – One of ORs kept ready for emergency operation at any hour of the day. – Patients & operation details are to furnished in advance to OT sister & Anaesthetist (by surgeon) so as to start the work on time ( to cut short preparation time)

• Daily/weekly/monthly cleaning of various parts of OT complex.

Measures to check the infection rate

Measures to check the infection rate • O.T discipline, if followed sincerely & strictly by all staff directly or indirectly related to OT, can bring down the infection rate to minimum. • Staff should be educated & trained in O.T.discipline & monitored periodically.

Measures to check the infection rate… • Good CSSD & TSSU., & maintaining sterility of all items used for surgery. • Proper & periodic cleaning & disinfection of premises & other things used in O.T. • Taking care of personal factor by all staff members - Scientifically changing dress, cap mask, shoes, scrubbing & gowning

Measures to check the infection rate… • Taking due precautions while taking infected case & thereafter. • Proper time spacing between two surgeries. • Timely & proper disposal of soiled material.

Number of OTs required for 600 bedded hospital. • For 600 bedded hospital (300 Surg. Beds) • Out of Surgical Beds, 50% of Pts are expected to undergo the surgery as such • For 8 Hrs working for 6 days a week – No of surgeries= Surg Beds*Bed Occupancy*Working days/Average Length of stay • =300 beds* 60% *250 days/10 days(ALS) • =4500 surgeries/ year