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25 February 1967 S.A.

MEDICAL JOURNAL 181


THE MODERN CONCEPTION OF AN OPERATING THEATRE SUITE
M. TOWERS. M.B., CH.B., D.A., Port Elizabeth
We have, of recent years, heard a great deal about the
'winds of change', and nowhere can this be more aptly
applied than in the great changes in thought and practice
that have developed in regard to the construction, and
organization, of the modern operating theatre suite.
There have been so many commissions and investigat-
ing bodies, appointed in different parts of the world. to
probe into the many aspects of this fascinating subject,
that the reports and literature that have accumulated, have
assumed formidable proportions.
Since extensive new hospital building and reconstruc-
tion is contemplated all over South Africa. it is essential
that these new ideas of what should constitute the ideal
operating theatre suite, should be widely disseminated,
and more fully understood.
We are on the brink of an era of what I shall describe
as 'spare part' surgery. I refer to organ transplants. So it
seems that surgery is going to become more complicated,
more exacting and time-consuming, and will require the
combination of more teams. Yes, the 'winds of change',
are blowing lustily here, too. Gone are the days of the
urgical virtuoso-to be replaced by surgical teams or
units. Gone too, are the days when the operating theatre
taff would accept, without protest, adverse, unhealthy,
and trying working conditions. Gone also, are the days
when all the anaesthetist was expected to do, was to
keep the patient asleep and immobile, when he was de-
fined as 'a man half asleep, looking after another man
half awake'.
Today his job is not only to keep the patient asleep,
but he plays the major role in keeping the patient alive.
This, inter alia, involves a host of monitoring equipment,
laboratory facilities and others, for special investigations,
plus the immediate availability of everything required for
any resuscitative measures.
All the skills of modern surgical units and all the new
scientific developments will be of little value unless the
operating theatre suite is properly planned and works
efficiently.
The operating theatre suite must be so well designed
and so attractively set out, that not only will the work
done there be of the highest order, but the personnel en-
gaged therein, will find it a real pleasure to work in such
ideal surroundings. Fatigue will be minimal, boredom non-
existent, efficiency at its highest peak, and pride of achieve-
ment the driving force.
Yet, despite all this turmoil, we as a profession, cling
tenaciously to our conservative concepts. We are just natur-
ally opposed to any radical changes, and in fact, seem to
be allergic to them. Simply the mention of them will always
evoke a reaction.
Most of the operating theatres in this country are com-
pletely outdated-they open directly from a main corridor,
in such a way as to be constantly exposed to gross con-
tamination; a steam sterilizing room, with its high humi-
dity, steam and heat, often leads directly off the theatre;
and often there is no provision for ventilation, except by
opening windows, and doors; the windows are facing
directly into the sun, and even the direction of the pre-
vailing winds have not been taken into consideration.
In many of our hospitals, where air-conditioning, and
plenum ventilation, have been installed, these have proved
unsatisfactory. The reason for this is either because the
initial specifications have been inadequate, or the com-
pleted job has been accepted without proper tests having
been carried out to ascertain whether everything is work-
ing efficiently, and conforms to certain minimal standards.
Too often the services of a competent bacteriologist are
not consulted.
In many instances it is obvious that the basic principles
of plenum ventilation are not fully understood. The idea
is to introduce filtered air-conditioned air at a temperature
of 70F and a humidity of 50%, through apertures near
the ceiling in the theatre. This air must be under pressure,
and there must be _ 20 changes of air in the theatre per
hour. This air is forced down to the floor taking any
organisms with it, and gets out of the theatre suite under
the doors.
In many instances, particularly. where ventilation and
air-conditioning have been installed into previously built
theatres, we see rather a conflicting et-up. The air is cor-
rectly introduced into the theatre, which unfortunately has
a sterilizing room, directly communicating with it. In this
room, there is invariably a canopy over the sterilizer,
with an extraction fan high up. So the air from the theatre,
plus any contaminated elements, gets into the sterilizing
room, where the extraction fan high up sucks up the air
from the floor leveL and in the process, ucceeds in dis-
seminating. very effectively, any organisms which might
be present.
Gordon, in his article on the post-anaesthetic recovery
room. describes the initial opposition encountered from the
medical and nursing staff to the establishment of a re-
covery room. TOW that it has been in existence for 10
years, they wonder how they ever managed without one.
Yet now that, as a natural outcome to the existence of
a recovery ward, an intensive therapy unit is about to be
established. opposition is being encountered from the same
sources. This unit should be near, but not part of the
operating theatre suite.
Before embarking on a description of the modem
operating theatre suite, I should like to enumerate some
basic aphorisms, which have evolved from the massive
assault on this subject, by the various investigating bodies.
I. Do not consider economy when planning an operat-
ing theatre suite and certainly not at the expense of effi-
ciency. Remember that good operating conditions can
never be cheap, or acquired at bargain rates.
2. Plan for the future-and plan on a very liberal scale.
The extra expense now will pay handsome dividends later.
3. Don't consider an operating theatre as a factory, and
try to get the maximum return for the initial investment.
Always ask, not how many operations can be done, but
rather, how many should be done. Ideally, each theatre
182 S.A. TYDSKRIF VIR GE 'EESKU 'DE 25 Februarie 1967
should be given a completely free day. in the mid-week
-besides the weekends-pIu a two-hour break between
'slates'. The greater the number of operations done in a
theatre, the higher the possible incidence of sepsis.
4. It is not good economics to try and convert old
theatres. They are never completely satisfactory, and
eventually new theatres must be built.
5. The modern idea is veering towards progressive pa-
tient care, and building a surgical block completely
separate from the rest of the hospital.
Progressive patient care is the systematic grouping of
patients, according to their degree of illness, and depend-
ency on the nurse. rather than by classification of disease
and sex. It is a method of planning the hospital facilities,
both staff and equipment, to meet the individual require-
ments of the patient, and in practice, does not infer the
construction of new hospitals, but a reorganization of the
existing one. Thus there would be (a) intensive care units
for critically ill patients, regardless of diagnosis or sex,
who need highly specialized and constant nursing care; (b)
self-care units for convalescent patients, or those requiring
investigation; (c) intermediate care units-not in either
of the above categories and which would constitute
of all patients in hospital; and (d) beds attached to
outpatient departments-for I-day patients like those hav-
ing minor operations, electroconvulsive therapy, etc.
6. Much faulty planning in the past was due to an
approach which concentrated on the operating theatre,
without taking into account the equally important ancillary
services and rooms. This conception of a recovery ward
attached to the theatre suite is not only accepted every-
where as a must, but many overseas hospitals have had
this unit for 10 years or longer and could not envisage
working without one.
BASIC PRINCIPLES IN PLANNING AN OPERATING THEATRE
SUITE (OTS)
The sire. Ideally. it should be a separate building wi'h
its own corridor of approach to ensure that it is literally
a cul-de-sac, its lay-out should not be influenced by the
ward block plan, it should have maximum protection from
the prevailing winds, solar irradiation, or sources of heat,
and it should not be exposed to any source of direct con-
tamination.
It should be on the first floor, with the central sterile
supply depot (CSSD) situated immediately below it. In the
rare case where the free availability of land permits the
OTS to be sited on the ground floor, it is advisable to
protect it, by building on an extra floor above it.
Today, with the modern idea of a large reception room
and a recovery ward forming part of the OTS, the question
of the distance this unit is away from the wards is not an
important one. The rooms of the suite should be so
arranged that there is a continuous progression from the
entrance to the suite. through zones that increasingly
approach sterility, to the operating and sterilizing rooms.
People working within the suite should be able to move
from one clean zone to another, without having to pas
through unprotected traffic areas. Thus. the surgeon, after
he has changed into his operating clothes. should be able
to move to the scrub room, without having to pass through
the entrance lobby. Tt should be possible to remove dirty
materials from the suite, without passing through the clean
area. The direerion of the air flow within the operating
suite should be from clean to less clean zones. The heating
and ventilating systems should ensure, safe, comfortable
climatic conditions for the patients, surgeons and staff.
The ratio of surgical beds and number of operating
theatres required is difficult to assess with any fixed rules.
Much depends on the type of work done. the number and
nature of the industries in the area, and the number of
surgeons, urgical firms, and operations done. Too many
operations in a theatre encourages sepsis. Each theatre
should be used only 4 days a week, long 'slates' should be
avoided, there should be adequate time allowed between
'slates' for theatre to be properly cleaned, and finally,
there should be separate theatres for septic cases, plaster
removals, neurosurgery; Stewart and Douglas recommend
one operating theatre for every 30 beds. It is better to
keep the lay-out of each theatre more or less the same.
Building theatres as mirror images of each other is not
good policy.
The size of the operating theatre should be 22 x 22 ft.-
a little larger than that usually recommended. The increase
in recent years of operations in which 2 teams operate
synchronously-abdomina-perineal resection. open hearts.
etc., calls for a large theatre, 25 x 25 ft. in every large
general hospital, and not less than 2 operation rooms of
this size in a teaching hospital.
The height of many of the older theatres was deter-
mined by the supposed need for large windows and for
providing a large volume of air. Today, with efficient
mechanized ventilation, and adequate lighting facitities,
windows are not absolutely necessary, and the height of
the ceiling need not be over 10 feet. However, the height
is also often determined by the type of lighting used.
Proper anti-static measures must be taken; all theatre
walls must be screened with wire mesh to minimize outside
electrical interference, and even the colour of the wall
and ceilings must be carefully planned.
There are five basic probems involved when planning
an operating theatre suite (OTS) which directly influences
its design, and general lay-out.
I. The Method of Sterilization
The present-favoured method is bv high-pressure steam. plus
a pre-vacuum, in an autoclave. .
There is, however, a great deal of research going on in this
field, and it is quite possible, that in the neat future, a more
efficient method like ? gamma irradiation may supersede the
present one.
Only a small 'flash' autoclave is needed in the preparation
room adjacent to the theatre. This is for instruments that have
become contaminated during the operation or for those re-
qUired and not initially supplied. Sterilizing time for these is
4 - 5 minutes.
The currently accepted idea is the establishment of a central
sterile supply depot (CSSD). This should be sited on the
ground floor, below the operating suite, and
should commUnIcate With the sterile zone via an exclusive lift
or hoist.
The CSSD will provide sterile packs, and the bulk of the
materials such as gowns, caps, masks. gloves. towels,
tubing, catheters, syringes, sterile water and saline. etc.
H was thought that the CSSD should not supplv the sets of
instruments for each operation, as there was too much indivi-
dual variation and this would necessitate much laroer stocks
of instruments. This has. however, not been the ex-
25 February 1967
S.A. M-E-f).ICA-L lOUR 'Al 183
perience. In the centres where the CSSD performs this func-
tion, the concensus of opinion is that it works very well, and
that even allowing for the individual idiosyncrasies of sur-
geons, most can manage with the packs provided. There are
decided ad"antages in having one CSSD only, for, b e s i d e ~ the
economy in staff and equipment, the teaching programme is
more comprehensive. since nurses doing their theatre training
can be taught about every branch of surgery. It is generally
accepted today that sterile packs have almost completely
superseded drums.
In addition. because it has been found satisfactory to store
sterile packs for relatively long periods of time, provision for
the storage of these has had to be made in the OTS. The
CSSD situated as it is on the ground floor, can be so planned
that it proyides sterile materials for outlying small hospitals,
clinics, maternity services, etc.
In many of the larger hospitals, additional sterilization faci-
lities ha"e been provided. A theatre sterile supply unit (TSS )
has been established within the theatre suite to serve all the
theatres. Here, packs of instruments are made up according to
the requirements of individual surgeons, and then sent to
where they are needed together with the sterile packages
ordered from the CSSD. After each operation, the instruments
should be washed in the sink room, and returned in a con-
tainer to the TSSU or CSSD, to be autoclaved and stored, be-
fore being assembled for use again.
In many hospitals, particularly in the SA, ethylene oxide
is being used to sterilize the large equipment, like heart-lung
machines. anaesthetic equipment, etc. This method is not en-
tirely satisfactory. It is expensive, usually needs a separate
room, and is potentially toxic and dangerous to the personnel.
2. The A \'oidance of Cross-Infection
This is one of the main considerations influencing theatre de-
sign. This is why the OTS should be an entirely self-contained
area; why proper provision must be made to control and moni-
tor the air currents coming into the suite from outside; why
the theatre areas can only be entered via the change rooms;
why only proper theatre clothes can be worn; why nothing
likely to contaminate the theatre area, like the patients' folders,
X-ray films. ward clothes and blankets and even wrist-watches,
should be permitted into the sterile zone; and why any excess
movements, and talking in the theatre is to be discouraged.
3. The Provision of Suitable Climatic Conditions
Admission into the sterile zones, of filtered, air-conditioned
air, with a humidity of 50 - 60% and a temperature of be-
tween 65
0
- 75F. Plenum ventilation under pressure and
change of air every 3 minutes. To achieve a satisfactory condi-
tion, one must make rigid specifications; the plant must be
meticulously tested before acceptance and thereafter, regularly
and thoroughly maintained, and there must be provision made
for a humidifier, and a refrigeration plant.
There is really no necessity for windows, except that there
are many people with claustrophobia. Tindal, in his very radi-
cal article on this subject, envisages the theatres of the future
as large steel air-conditioned cylinders, under about two at-
mospheres of pressure. The theatre clothes he recommends are
skin-tight and gloves are replaced by thorough washing, plus
the application of resin to the hands.
The deyelopment of lighting facilities has lagged behind
that of theatre design. The present overhead lighting seen in
most of our theatres, is very unsatisfactory, and a source of
constant annoyance to the surgeon. They have to be moved
and refocused by someone in the theatre at frequent interv::.ls
during the average operation, the results are seldom quite
right. and all this unnecessary movement over the theatre table
encourages wound infection.
Blin. of Paris, has devised an ingenious lighting system,
which has. i/ller alia, been installed in the Port of Spain Hos-
pital, Trinidad, and seems to be working satisfactorily. His
source of light is from outside the theatre which has, as its
ceiling, a transparent dome. By a system of reflectors, which
are moved by electric motors, the surgeon can focus the light
onto 2 separate operating fields at the same time. The control
lever has been conveniently placed within easy reach of the
surgeon and is covered with a sterile towel or cover for each
operation.
It i possible that the electrical engineers might in the near
future devise something even better than this. It is enough that
we realize the shortcomings of our present lighting sY3tem.
and campaign for something better.
4. The Imporlance of MonilOring Syslems and Provision of
Teaching Facililies
Since surgery is becoming progressively more complex, it has
become necessary to use more sensitive, and more efficient
monitoring equipment. If these were all housed in the theatre.
they would occupy enough space to interfere with its efficiency.
and also constitute an additional hazard towards wound sepsis.
Fortunately. internal television, though expensive to instal.
has solved a host of problems, and is, without any doubt.
accepted as an essential part of the equipment in any teaching
hospital today.
Television allows a monitoring room to be outside the
theatre, often in a room above. It permits the theatre super-
visor to see what is going on in theatres, via a television
screen, and obviates the necessity of having to build viewing
domes, or galleries for the students or nurses, who can now.
in the lecture theatre, obtain a perfect view of operative pro-
cedures, on the television screen.
5. Adequate Provision for Ancillary Services
A large reception room with amenities for staff, patients.
and their relatives: a recovery ward, an anaesthetic suite.
which includes study and research facilities, a laboratory. a
blood transfusion unit. X-ray units, separate theatres for sep-
tic cases, an endoscopy theatre, a separate neurosurgical theatre
unit, a separate theatre for removal of plaster-of-paris casts.
and generous facilities in the staff change rooms for both sexes,
including rest rooms, bathrooms, a library, a common-room.
a tea room, etc., should all be provided within the OTS.
DESIGN OF THE OPERATING THEATRE SUITE
Although the design of the modern OTS which I am about
to describe, is one which has gained considerable popu-
larity in numerous hospitals all over the world, it has not
been accepted as the ultimate in theatre design. There is,
for example, the modular SySlem in which the operating
zone, is one large, unimpeded floor space, on which are
erected prefabricated transparent theatre units. The ad-
vantages claimed for this system is that the whole lay-out
can, in a matter of hours, be dismantled, and any future
changes in design can thus be economically incorporated
into the reassembled units.
It is precisely because there is, to date, no universally
accepted design for an OTS that I have concentrated on
basic principles. A simple plan setting out this OTS design
is shown below.
The modern OTS besides complying, wherever possible.
with the principle of isolationism, is divided into four
zones: (I) an outer protective zone-leading into (2) a
clean zone; (3) a sterile zone; and (4) a disposal zone.
1. DUler Protective Zone
This zone will occupy the major portion of the floor area
of the OTS because it is here where provision mu t be
made for housing the many ancillary services. It is in this
zone that the architect must be given a free hand to plan
for every conceivable contingency. and provide all the
comforts_ and safeguard the health of everyone connected
with the operating theatre suite.
I shall enumerate, briefly, the many components of this
zone, with short explanations where necessary.
(a) A reception room should be generous in size, as it
must fulfil a number of functions, and the decor should
184 S.A. TVDSKRIF VIR GENEESKUNDE 25 Februarie 1967
PLAN OF OPERATING THEATRE SUITE DESIGN
OlR1Y CORRIDOR - DISPOSAL
f---r--------,rl
-l
lfl
lfl
C
O.T.
1
J
oPE.Rf\1lNG
THEATRE
CLEAN ZONE
OUTER
PROTECTIVE ZONE
O.T OT
OPE RATING
be bright and pleasant. It aelS as an auembly site; the pa-
tients for the day's operating list are wheeled in on special
trolley beds, during the course of the morning. The pre-
sence of this room helps to reduce the amount of infection
brought into the clean and sterile zones of the OTS. As
the prospective operating cases are wheeled in they are
a sembled in one section of this room. Before their opera-
tion. everything on the patient, and on the trolley belong-
SUITE CORRJDOR
ing to the ward is stripped, and clean sterile sheets, operat-
ing clothes, pillows. etc.. are donned. and the trolley pushed
on to the clean side of the reception room.
When the patient is ready to be wheeled into theatre,
the trolley top. plus the patient, is transferred onto a clean
trolley base, that operates only in the clean zone, and
from this zone is wheeled into the anaesthetic room, which
leads directly into the theatre.
5
S.A. MEDICAL JOURNAL 25 February 1967
In the reception room the patients can be given their pre-
medication, drips can be put up, and the anaesthetist can
once more assess their suitability for operation. Patients'
relatives can be interviewed, and facilities should exist
where the relatives can be with the patient before opera-
tion. At night, patients from casualty can be admitted for
observation, without disturbing patients in the wards.
Office accommodation should be provided for a recep-
tionist or secretary-typist, a theatre supervisor, the duty
sister and staff, and medical staff. There should be a place
for the patient's relatives, and one where these people can
be interviewed, when necessary, by members of the medi-
cal staff. At the entrance there should be a cloak-room,
where overcoats. hats, umbrellas, etc., can be deposited.
A scrub-up room, a small preparation room, a small steri-
lizer, a cupboard for keeping dangerous drugs, and a store-
room for sterile packs and equipment, must all be provi-
ded. Lastly, adequate wash-up and toilet facilities for
staff and visitors of both sexes, plus amenities like a tea
room, and even music and television, must be incorporated
into the scheme.
(b) A recovery ward. The necessity for this ward as an
integral part of the OTS has been universally conceded.
In every hospital where this has been installed it has
proved so successful and worth while that they wonder
how they ever managed without it.
Every patient is taken from the theatre to this recovery
ward on specially constructed trolley beds which are used
in this ward. These trolley beds have large castors. and a
quick and efficient tipping mechanism, operable from either
end. The head end is under separate control, so that the
patient can be sat up. The width is 2 ft. 6 in., they have
a 4 in. rubber mattress, and the ends and sides are quickly
removable in case of emergency. Intravenous transfusion
stands are incorporated, plus a bracket for an oxygen
cylinder. To be on the safe side, plan to have 2 beds for
every theatre, even though one could probably do with
less. Tn many hospitals, this ward has been used as a com-
bined unit, for constant care of patients with respiratory
deficiencies. Another use to which this ward has been put,
is the reception of night admissions. This keeps the other
wards quiet, and groups together patients requiring more
urgent attention during the night.
The length of stay of patients in the recovery ward
varies from 30 minutes to 2 days. The average time is 2
hours. 0 patient is permitted to leave this ward until
cardiovascular function and respiration are stable, the re-
flexes all recovered, and full consciousness present.
A full-time member of the medical staff, preferably an
anaesthetist, is usually appointed to supervise the running
of this ward, but the patient's own surgeon and physician
still manage the care of the patient.
The nursing staff is usually chosen for its higher stan-
dard of intelligence, and for its greater interest and apti-
tude for this type of work. The nurses undergo an inten-
sive and highly specialized training in respiratory physi-
ology, surgical shock. and the various aspects of all the
monitoring equipment.
There should be adequate bed space, and there should be
2 points for suction, 2 for piped oxygen, 1 for compressed
air, a sterile container with a catheter, and 2 angled-spot-
lights for each bed.
l85
Adequate equipment for monitoring, plus whatever may
be required for dealing with any postoperative emergency,
will include laryngoscopes, intratracheal tubes and connec-
tions, bronchoscopes, ventilators, ECG and EEG machine,
various drugs, intravenous fluids, blood, etc.
Since this ward is in continuous use, all amenities must
be provided. This will include a kitchenette, a nursing
station and sister's office, a doctors' room, plus lavatorie
and ablution facilities and rest rooms for both sexes, with
similar facilities for the nursing staff. An efficient call
system with a link at each bed, so that the nurse can sum-
mon help without any delay, is essential.
A preparation room, a sterilizing room, storage rooms
for dressing packs and equipment, drug cupboards. sluice
room, scrub-up room, washing facilities, etc., are all part
of this recovery ward.
(c) Change roonU". It is important to remember that in
the approved theatre de ign, the theatre zone can only be
entered via the change rooms. These too should be on the
generous scale, and cater not only for both sexes of the
medical and nursing staff, but for different people like the
cleaners, electricians, engineers, maintenance staff, techni-
cians, etc.
Besides showers, baths, change rooms, and locker rooms,
there could be rest rooms, a library, and a tea room. It is
a good idea to instal a glass partition looking into the
theatre corridor, so that there could be communication be-
tween, say, a chief, and his registrar. without having to
enter the theatre area.
(d) AnaestheTic deparrmenT. This would consist of an
office suite for the head of the department, a duty room, a
common room, a reading room, a technical work room, a
research laboratory, a lecture room, a sterilizing room and
a secretary's office.
(e) A laborarory for doing emergency work like frozen
sections, Astrup readings, blood chemistry, electrolytes,
etc.
(/) A blood transfusion unit with all the facilities it
needs.
(g) An X-ray deparrmenT for coping with all theatre X-
ray services.
(h) Special neurosurgical Thearres, with their own X-ray
units for doing all their investigatory work.
(i) A plaster room in which all plaster-of-paris casts are
removed. a procedure which is notorious for spreading
organisms.
(j) A septic thearre for doing all cases known to be
septic.
(k) An emergency TheaTre, for those cases like ruptured
appendices, which come in as emergencies, and are known
to be potentially septic.
(I) An endoscopy Theatre, in which only bronchoscopies,
sigmoidoscopies, cystostomies, and oesophagoscopies are
done.
(m) Adequate store rooms for storing monitoring and
other equipment, intravenous transfusions, and a host of
surgical equipment and linens, etc., associated with a
theatre suite.
(n) A special room for doing the ethylene oxide steriliza-
tion.
(0) Spare rooms for which plenty of uses can always be
found.
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186 S.A. TYDSKRIF VIR GENEESKUNDE 2S Februarie 1967
2. A Clean Zone
This is really in the nature of a barrier zone, and consists
mainly of a clean corridor, plus certain storage facilities.
It is in this zone that clean trolley bases are housed. and
where facilities exist for keeping them clean.
3. A Sterile Zone
It is here that the theatres, anaesthetic rooms, sterilizing
rooms, sterile store rooms, scrub rooms, and perhaps a
TSSU is housed.
Mention has already been made of the different patterns
advocated for theatre designs, varying from Tindal's revo-
lutionary idea of stainless steel theatres under 2 atmos-
pheres pressure, the modular system, and the one I am
about to describe very briefly, based on the operatmg
theatre lay-out at the Royal Infirmary, Dundee. However
the same basic principles already described apply, particu-
larly as regards the ventilation, air-conditioning. suitable
barriers to avoid infection, and the advisability of building
each theatre unit alike, and not as a mirror image of each
other.
Each theatre unit consists of:
(a) An anaesthetic room which should not be smaller
than 190 sq.ft. and bigger if used for teaching purposes.
The lighting in this room must be adequate, and it is essen-
tial to have a special light, easily focused and adjustable
for venepuncture work, epidurals, etc. In this room too,
there must be piped oxygen and nitrous oxide, plus a spare
pipe-line ready for any future anaesthetic gas. A sink,
wash-basin, and work table are essential, and there should
be at least 3 electrical points. In addition there should be
a dangerous drug cupboard, and one for linen removed
from the patient. It is wise to have conduits for monitoring
cables from the central monitoring room, let into the anaes-
thetic room.
The general decor should be soothing, the walls should
be covered with plastic to give a panelling effect and the
ceilings should have a delicate, attractive pictorial design.
In this room, anaesthetic induction will be done, moni-
toring equipment adjusted, diathermy plates and tourni-
quets applied, etc. This room should open directly into
the theatre, and should have a separate entrance from the
clean zone.
(b) A scrub room, with the usual scrub-up facilities and
leading directly into theatre.
(c) An exit room, leading out directly from the theatre,
and communicating with the anaesthetic room and having
a separate exit into the aseptic corridor. It is in this room
where the clean trolley bed is waiting to receive the patient
who is then wheeled into the recovery ward.
(d) The operating theatre which besides conforming to
the already mentioned specifications with regards to size,
ventilation, and lighting must have provision for piped
oxygen and nitrous oxide, plus a spare line for a future
gas, at least 2 suction points, conduits for monitoring
cables, and for television and perhaps a built in X-ray unit.
There must be the usual antistatic measures with spark-
proof electric points and switches, and the X-ray screens
should permit the films to be put in from outside the
theatre.
All excess equipment should be housed outside the
theatre, which should contain the absolute minimum com-
patible with efficiency.
All unnecessary movements, talking, and walking about
in theatre is discouraged, and articles like wrist-watches,
patient's folders, etc., are not allowed to be brought into
theatre.
(e) A sterilizing room containing a small 'flash' sterilizer,
for sterilizing any instrument which has fallen on the floor,
or become contaminated, and instruments required for the
operation and not already set out. It is also used for setting
out the sterile packs, etc.
(f) A STOre room for storing the sterile packs, instru-
ments, etc., that might be required in the theatre.
Besides the theatres, this zone houses offices for the
theatre staff and surgeons, store rooms, and in many hos-
pitals, a TSSU. If the latter is installed, it must be divisible
into 2 self-contained parts to allow for maintenance and
repair work. without the necessity of a complete shut-
down. A dark room for processing X-ray films must also
be incorporated in this suite.
4. A Disposal Zone
Completely separate with no direct access into any of
the other zones. The only communication with the theatre
zone is via a 2-sided autoclave, and special hatches, which
convey dirty linen and dressings put into containers down
the special chutes, into the disposal zone. It is desirable t?
have only one disposal zone to serve the whole OTS. ThIS
not only enables better supervision of the cleansing and
of the equipment, but the teaching of this part of the
theatre work is thus centralized and non-nursing personnel
can be used.
No instrument trolley is allowed into the disposal zone.
The instruments after they have been washed are passed
via an autoclave, into the disposal zone, into the CSSD
or autoclaved and passed into the TSSU.
Thus the disposal of soiled and infected material is direct
to the disposal zone, over barriers that prevent the passage
of any personnel. There is no fear of an airborne spread
of infection from the disposal zone to other zones, since
the direction of the OTS ventilation is in the
direction and under pressure.
The disposal zone opens directly on to a 'dirty' corridor,
completely separate from the OTS.
There are also chutes leading from the disposal zone, to
the non-sterile area of the CSSD and to the incinerator re-
ceiving-room.
co CLUSION
It must be realized that an article such as this can only touch
on the fringes of the detailed planning required when an
OTS is actually built.
If however I succeed in evoking a 'state of awareness' to
the and imperfections of our existing theatres,
and initiate a desire to 'do something about it', 1 shall be
highly satisfied.
BIBUOGRAPHY
Douglas, D. M. (1962): Lancet, 2, 163.
Gordon, R. A. (1963): Canad. Anaesth. Soc. J., 10, 140.
Hospital Brief (1960): Architect Journal, 132, 7 July.
Lidwell, O. M. and Blowers, R. (1962): Lancet, 2, 945.
Lowenthal, l. (1962): Brit. Med. J., I, 1437.
Ministry of Health (1957): Hospital Building BuUetin, No. 1. London:
Her Majesty's Stationery Office. ...
Nutlield Provincial Hospital Trust and the Umverstty of Bnstol (1955):
Studies in the Functions and Design 0/ Hospitals, chapt. 3. London:
Oxford University Press.
Raven, R. W. (1962): Brit. Med. l., 1, 43.
Smith, W. (1960): Planning the Surgical Suite. New York: Dodge.
Tindal, A. (1962): Lancet, 2, 240.