Planning an Operation Theatre Complex
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Transcript of Planning an Operation Theatre Complex
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Planning an Operation Theatre Complex
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Operation theaters
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Definition
Specialized facility in hospital where invasive treatment is given under strict aseptic controlled environment by trained personnel
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Objectives of planning
• Promote high standards of asepsis
• Ensure safety
• Optimal physical working conditions
• Ensure optimum utilization
• Facilitate coordinated services
• Rigidity and flexibility
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Design considerations
• Location• Workflow• Basic work areas and Division of space• Zoning concept• Air filters• Machinery and equipment• Organization• Policies and procedures• problems
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Zoning
• Why?
• What is it?
• 3 or 4?
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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
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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 ,blue-white color of daylight, heat cntrl
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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
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O.T. Needs Specialized Planning.
YES
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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
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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.
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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.
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S S Harsoor 18
Comfort•Result can be disastrous
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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
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Different zones of OT Complex
4 Zones…
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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
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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
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Different zones of OT Complex…
3) Aseptic zone Operation Rooms
(Sterile)
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4) Disposal zone- Disposal areas from
each OR & Corridor leading to disposal zone
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Basic Principles of Planning an O.T & Recovery room
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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)
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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)
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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 >0.5)
– Temperature 20-240 C (for Pt needs)
– 0.005 H2O Positive air pressure in OR
– Humidity 50-60%
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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
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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
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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
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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 >25000W/Cm2 radiant heat to be produced,
– Halogen lights preferred
– UPS of adequate capacity for OR light, monitors, cautery, Anaesthesia machines
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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
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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.
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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
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Recovery room is an integral part of the OT
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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.
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Administrative policies in OT.
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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.
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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.
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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
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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.
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Measures to check the infection rate
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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.
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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
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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.
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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