Operation theater management

1. OT- MANAGEMENTOT- MANAGEMENT
BHANU DIXIT
POORMINA UNIVERSITY

3. Operation Theatre
• The operation theatre suit of a hospital is a complex workshop and the
most important facility of the surgical department.
• Operating theatres are expensive to build and equip.
• In smaller hospitals (50-100 beds), a single operating room may have
been sufficient to meet the need. For a larger hospital, departments of
eye, ENT, Obstetrics and Gynaecology, and the super speciality
disciplines will also need the services of operation theatres.
• The standard of air hygiene established for operating rooms demands
a complicated and expensive ventilation system, which would be
difficult to provide at a number of different points around the hospital.

4. OT suite circulation pattern

5. LOCATION
• Location of the suite must ensure that
patients can be moved to and from
surgery with a minimum of travel
through other hospital areas.
• The location of OT suite should not
only be considered in relation to
surgical ward but also to the outpatient
department.

6. LOCATION
The main points to be considered in the location of the
OT suite on a hospital are:-
Accessibility to
Surgical wards
CSSD
Emergency
Blood bank
ii. Access to bed lift
iii. Internal hospital traffic flow
iv. External traffic and disturbances.

7. NUMBER OF OPERATING
ROOMS
• The number of operating rooms
depends upon the predicted number of
operations per day, which in turn is
related to the number of surgical beds,
other surgical specialities like
neurology, urology, thoracic surgery,
etc. and the average length of stay
(ALS) of surgical cases.

8. NUMBER OF OPERATING
ROOMS
• In a large general hospital, approximately 25
to 30 per cent of admitted patients are
surgical, and approximately 50 per cent of all
admitted cases undergo some sort of
operation. If there are 100 surgical beds (all
types including eye, ENT, gynaecology,
orthopaedics, etc.) and the ALS is 10 days,
there are likely to be 10 operations per day
on an average.

9. Time Utilisation Study
• No. of surgical beds × Occupancy rate
×No. of working days in a year (usually
260)
ALS
ALS = average length of stay

10. Number of OT
Total no.
of beds
Major OT Minor OT OPD Major OT Minor OT
50 1 0 0 1
75 1 1 0 1
100 1 1 0 1
300 3 1 0 1
500 5 2 1 1
750 8 2 1 1

11. OPERATING ROOM
ACCOMMODATION
OT suite Area in sq. ft.
Theatre superintendent office 120
General and linen store 120
6-bed recovery room 480 (6 × 80)
2-bed recovery bay 160 (2 × 80
Mobile X-ray unit and darkroom 120
Trolley bay 80
Safaiman’s alcove 80
Relations waiting, with toilet Day surgery 160
Reception/Scheduling 100
Men’s change/locker 120
Women’s change/locker 120
Patient preparation 120
Gowned — waiting booth2 80

12. Major Equipment and Appliances
 Channel monitor
 Heart lung machine
 Anaesthesia machines
 Defibrillator
 Flash steriliser
 Deep freezer (for frozen
section)
 Instrument trolleys
 C–arm fluoroscopy machine
 Operating tables
 Suction apparatus
 Shadow less ceiling lamp
 Shadow less pedestal
lamps
 Close-circuit TV camera
 Electrical communication
system
 Operating microscope
 Surgical diathermy machine
 Pulse oxy meter
 Ventilator

13. ZONING
The aim of zoning is that when staff
members, patients or supplies enter the
OT suite, the risk factors of carrying the
chances of infection with them get lesser
and lesser, as they pass from the
protective through clean to aseptic zone.

14. General Principles
• 1. Clean from dirty traffic-flow within the OT suite should be
segregated as best as possible. Spaces in the suite should be
arranged in such a way that while moving from one space to
another, there is continuous progression of cleanliness from
entrance of OT suite to the operating room.
• 2. Staff working in the OT department should be able to move
from one clean area to the other without having to pass
through unprotected areas.
• 3. Soiled materials and waste should be removed from the
operating rooms without passing through clean areas.
• 4. OT ventilation should be independent of the air movement of
the rest of the hospital. Therefore, the direction of airflow
within the OT suite should be from cleaner to less clean areas.

15. Sterile Zone
• The OT suite organisation revolves
around the central aseptic work area,
i.e. the actual operating rooms.
Activities take place in this zone that
require full aseptic conditions, such as
exposure of living tissues and handling
sterile instruments
• Here, the highest level of cleanliness
and aseptic conditions are maintained.

16. Clean Zone
• The clean zone is designed around the aseptic zone. This zone
is only accessible to staff having changed their outer clothing
in the protective zone and prepared patients transferred from
the ward trolley to OT stretcher, and clean supplies. ‘Patient
holding and preparation area’ is marked in the clean zone.
• This zone contains storage space for clean surgical supplies,
medical stores including parental solutions, and instruments.
Anaesthesia induction rooms, anaesthesia stores and
anaesthetists room are located in this zone. A frozen section
laboratory, if provided, and any darkroom facility should be
located in the clean zone.

17. Protective Zone
• Outside the clean zone is the protective zone forming a barrier
between the clean area of the suite and the less clean rest of
the hospital area. This zone contains the administrative
elements including theatre nurse supervisors office, where
stores are received, personnel enter the department, where
locker and change rooms are located, patients are received and
held. Patients wait here on trolleys if the operating room for
which he or she scheduled is not ready.
• We all know of surgical corridors of large hospitals lined with
occupied trolleys for want of adequate holding, preparation or
induction area. Access to this area is entirely separate, as
people enter and leave in their street clothes and should not
penetrate into inner zones until after changing into OT shoes
and clothing. Recovery room is located in this zone.

18. Disposal Zone
• Disposal zone is the corridor from where
used instruments and used linen and
operating room debris is taken out. This zone
must have an independent access to the
outside corridor. Disposal zone has only one-
way traffic, viz. from inside the operating
room to the outside and never vice versa.
This is achieved by a door or a hatch from
operating room opening into the disposal
corridor.

20. FUNCTIONAL
INTERRELATIONSHIP OF ROOMS
• Scrub-up
• Anaesthesia Room
• Anaesthesia Equipment Room
• Sub sterilising Room
• Darkroom
• Fracture Room
• Locker and Changing Room
• Instrument Stores
• Trolley Parking
• Recovery Room

21. LIGHTING, ELECTRICAL AND
AIR-CONDITIONING
Lighting
The surgeon’s requirement for light is that it should
be powerful, cool, shadow less, and capable of
penetrating to the bottom of deep cavities. An
emergency lighting system which comes into
operation automatically is also necessary in
operation theatres to enable work to continue
without a break if the mains supply fails.

22. Cont………
Electrical Outlets
•All electrical outlets should be “spark less” fittings
and be placed 5 feet from the floor, to be above the
level of a possible concentration of inflammable
anaesthetic gases. This is necessary even though a
good ventilation system can reduce the concentration
of explosive gases and adequate humidity reduces
static. Sufficient number of plug points, at least two of
which should be for power equipment of 15 Amp rating

23. Cont…….
Air-Conditioning in OT Suite
Full air-conditioning with filtered air supply is a necessity in
operation theatres which tends to generate a need for greater
floor to ceiling height than in other hospital departments. While
perceptible air movement may be desirable in operating rooms for
the surgical team, draughts, particularly at the level of the
operating table, must be avoided. The air speed at which air
movement becomes perceptible rises with temperature, and air-
conditioning systems enable the rate of input of air to be related
to its temperature in order to provide comfortable conditions.

24. Cont………
Air Intake
Studies on positioning of the air intake
show that samples of air taken at street
level, at roof level and in the wards show
that much advantage is to be derived
from placing the intake at or above roof
level.

25. Cont………
Airflow
Positive air pressure has to be provided at the aseptic core which
is ideally met with 16-18 air changes per hour, and gradually
tapering off to 12 changes per hour at the non sterile areas. In the
modern operating room, laminar airflow system with side vents
and exhaust system is the ideal. In the laminar airflow system, air
velocity varies at 50 feet per minute at the foot level to 75 feet per
minute at table height to 150 feet per minute at the ceiling level.
High efficiency particulate air (HEPA) filters used in the system
provide the highest level of air sterility by filtering out participate
matter of up to 0.3 micron which excludes almost all known sizes
of micro-organism.

26. Safety Hazards
1. Methods of checking wiring and electrical equipment by
engineers
2. Methods of checking correct climatic conditions, especially
humidity
3. Checking air filters in AC system
4. Checking for anaesthetic and oxygen gas leakages
5. Control of fire hazards
• Provision of fire extinguishers and their location
• Directions for correct operation of each type of extinguisher
• Familiarisation of all personnel with handling and use of fire
extinguishers

27. Emergency Equipment
1. Cardiac trolley readily available
2. Do all personnel know its location
3. Specific duties of each person in case of
need

28. Protection of Patients
1. Methods of patient identification
2. Restraining of patients during movement on trolleys/
stretchers
3. Protection of patient on operating table. Method of
checks for positioning regarding respiratory
obstruction, pressure on nerves, and impairment of
circulation
4. Procedure for sponge count and instrument count
5. Selection and use of sponges.

29. Bacteriological Practices
1. Proper wearing of masks
2. Masks changing between operations
3. Removal of mask on leaving operating room
4. Changing caps daily
5. Restrictions on visitors to OT suite
6. Handling and disposal of disposable syringes and needles, other disposables.
7. Daily cleaning procedure of operating rooms
8. Weekly disinfection procedure of operating rooms (modern aerosol formalin
disinfectors achieve satisfactory disinfection in a short time and the operating
room is available for use after six hours)
9. Weekly cleaning of ceiling of operating rooms
10. Procedure for use of mops
11. Frequency of changing of mops.