THE THEATRE SETTING

Location
• The surgical suite is usually located in an area
accessible to
1. Critical care surgical patient areas
2. Central sterile services department (CSSD)
3. Pathology department, and
4. Radiology and Laboratory department.
• The size of the hospital is a determining factor
because locating every desirable unit or department
immediately adjacent to the surgical suite is complex.
 THEATRE DESIGN
• The operating room is designed and built to prevent
infection

• It normally has only one main entrance with double

swing doors

• There are indicators along the path to the theatre

indicating one is approaching a sterile area
 THEATRE DESIGN
The floors and walls in the operating room (s) should
be:
1. Hard
2. Bright coloured tiles
3. Easy to clean
4. All the walls in the operating room (s) are free of
fissures, or crevices
5. All the ceilings in the operating room (s) are
seamless and easy to clean
Wall and Floors of Operating Room
 THEATRE DESIGN
• The reception is the boundary between the non-
sterile outside environment and the sterile theatre
suit
• Hospital staff and relatives who are not operating
room staff cannot go beyond this point

• Normally there is RED LINE indicating the limit for

those who are not theatre staff
 THEATRE RECEPTION
• If such a person has to go beyond the RED LINE,
Special foot wear, gowns and theatre cap are often
provided for them to cover their dresses

• Patients are received here, transferred unto operating

room trolley

• Check and assessment done during patient transfer

 STAFF CHANGING ROOMS
• Extending from the reception is a corridor that leads
to the changing rooms (Male and Female)
• These rooms have shelves which house fresh theatre
scrubs/attire
• It also have hangers for staff dresses
 STAFF CHANGING ROOMS

• It has wash rooms and sometimes baths where staff

who are heavily splashed with body fluids could wash
down
• Gumboots or enclosed shoes also available

• Staff remove their outside outfits and wear the

scrubs, clogs, theatre caps and enter the theatre
through the inner door
Changing Rooms
Changing Rooms
 OFFICES AND PANTRY
• Offices for the nursing staff
• Documents on staff and others are kept

• Since staff may not be able to go out to buy food,

some theatres have pantry where the hospital supply
food for theatre staff on duty
• Staff who obtained their own food could also eat in
the pantry
 THEATRE DESIGN
• STORE ROOMS
• This is the place where supplies are kept
• Standby Equipment are also kept here

• SCRUB UP AREA
• It has sink with flowing water for surgical hand
scrubbing
SCRUB UP AREA
 THEATRE DESIGN
• The main theatre room

• Sluice END
Sluice Room
THEATRE DESIGN
 DISINFECTION
• Disinfection: it is a method that destroy or prevent
the growth of most microorganisms from an inanimate
surface before reuse
• Antisepsis is a process which eliminates
microorganisms in living tissues.
• Cleaning: is the process that physically removes all
visible dirt, soil, blood or other body fluids from
inanimate objects including the Theatre floor and walls to
reduce risks of disease transmission in the Operating
Room.
 Cleaning
• Cleaning can be done daily:
a. at the beginning of the day’s activity,
b. between the cases, and
c. at the end of the day)
• Special cleaning can be done on weekly basis or
monthly.
 Cleaning
• Areas to be cleaned
1. Walls
2. Floors
3. Storage shelves,
4. Operation bed/table.
5. Trolley
DISINFECTION OF INSTRUMENTS
a. After each surgical case the nurse gathers all of the
instruments (including soiled and not used) and
terminally decontaminate in the washer with 0.5%
Chlorine.
b. All linen is placed in the linen bucket.
c. Disposable items in the trash/bin
d. Large equipment is wiped with a disinfectant and
placed in its usual storage
DISINFECTION OF INSTRUMENTS
d. The floors are cleaned with disinfectant
e. The stationary equipment (operating table,
electrosurgical power unit, etc) are all wiped clean
with disinfectant.
f. Any visible soil is washed with disinfectant
 DISINFECTION OF INSTRUMENTS
• Making surgical instruments safe for patients and staff
begins with a process called Decontamination

• Decontamination
• It is the process physically or chemically removing,
inactivating, or destroying blood borne or other
pathogens on a surface or item, to the point where they
are no longer capable of transmitting infectious particles,
and the surface or item is rendered safe for handling,
use, or disposal
 Decontamination
• Decontamination involves 3 activities
1. Pre-soaking
2. Rinsing
3. Manual Cleaning
4. Drying
 Pre-soaking
• The purpose of presoaking is
1. To prevent blood and debris from drying on
instruments
2. To remove microbial load
• Pre-soaking requires the instruments to be submerged
in the solution

• For a short immersion period (10 mins), instruments

may be presoaked in the following
 Pre-soaking
1. Proteolytic enzymatic detergent:
• Proteolytic enzymes dissolve blood and debris, and
the detergent removes dissolved particulate from the
surfaces of instruments, including otherwise
inaccessible areas such as lumens
2. Chlorine bleach
• It is corrosive; however, it effectively reduces the
microbial load.
• Presoaking is done at the sluice end
• It should not be done at the scrub sinks
 Rinsing
• After the period of immersion the instruments are
removed and rinse under running water.
• The is done to remove the chemical disinfectant from
the instrument
• Utility Gloves are used during this process
 Manual Cleaning
• The instruments are washed by hand in the sluice
room
• The purpose of manual cleaning is to remove residual
blood and debris before terminal sterilization
• Fill the washing sink with clean, warm water
• Add normal detergent
• Use a soft brush to clean the instruments
 Manual Cleaning
• Keep instruments totally submerged while brushing to
minimize aerosolizing microorganisms and chemicals.
• Rinse instruments thoroughly in distilled or deionized
water
• Inadequate rinsing can leave a surface residue that
can stain instruments
• Clean with clean soft towel/gauze
• Air dry it
 Formula for Making a Dilute Chlorine
Solution from Concentrated Solutions
1. Determine the concentration (% concentration) of
the commercial chlorine solution
2. Determine the desired concentration (% dilution)
you intend to use

3. Total Part of Water = [% concentrate] - 1

[ % Dilute ]
• E.g. to prepare 0.5% chlorine from 5%
• Total parts of water = [5% /0.5%]- 1
= 10-1
=9
Take 1 part of the concentrated solution and 9 parts
of water
• To prepare 0.1% chlorine solution from 5%
• Total parts of water = [5% /0.1%]-1
= 50 – 1
= 49
• Take 1 part of concentrated solution and 49 parts of
water
 STERILIZATION
• Sterilization is the process by which all pathogenic and
non pathogenic microorganisms, including spores, are
killed.
• It is the only process that ensures that an item is free
from all microbes.
• There are two main methods of sterilization
1. Physical
a. Dry heat
b. Moist heat
 STERILIZATION
2. Chemical methods.
a. Gaseous Chemical
b. Liquid Chemical

• Physical methods generally rely on moist or dry heat.

• Chemical methods on the other hand, use gaseous or
liquid chemicals.
Chemical Methods of sterilization
A.Gaseous Chemical Methods
1. Ethylene oxide
a. Gas is used to sterilize items that are sensitive to
heat or moisture.
b. When handled properly, EO is reliable and safe for
sterilization
Chemical Methods of sterilization
• Disadvantages
i. Toxic emission and residues of EO present health
hazards to healthcare providers and patients.
ii. It is highly flammable and explosive in air and
therefore, must be used in an explosion-proof
sterilizing chamber
Chemical Methods of sterilization

2. Hydrogen Peroxide Gas Plasma Sterilization

• A hydrogen peroxide gas plasma sterilization system employs 1.8 ml
of 58% hydrogen peroxide that is vaporized in a sterilization chamber
after a vacuum is created
• The vapour is converted into a plasma by means of radio-frequency
energy.
• Plasma State of a substance: When the substance is heated and all
chemical bonds are broken
Chemical Methods of sterilization
• The resulting plasma consists of highly charged
particles and free radicals that sterilize instruments at
low temperature in one hour without producing toxic
emissions or residues.
• Its by-products are simply water vapour and oxygen.
• The plasma particles destroy a wide variety of
microorganisms, including bacteria, fungi, viruses, and
spores.
Chemical Methods of sterilization
• It is used to sterilize metallic and non-metallic
instruments, fibre-optic cables, endoscopes,
microsurgical equipment, glass, ceramic, and electrical
equipment in a low-temperature (50C) and low
moisture environment.
• There are no toxic by-products
• In contrast to ethylene oxide, which is toxic, explosive,
carcinogenic, and takes up to 12 hours for effect, and
packs must be thoroughly aerated prior to use
Chemical Methods of sterilization
• However, the hydrogen peroxide gas plasma system is
not appropriate for sterilization of cellulose products,
towels, paper, cotton, dressings and similar items that
absorb the sterilant, making it incompletely effective.
 Liquid Chemical Method

• Liquid Chemical Sterilization with

2% Glutaraldehyde
• When items cannot tolerate sterilization by
saturated steam under pressure and when the
time required for gas sterilization is impractical,
liquid chemical sterilization is employed.
• A 2% activated aqueous Glutaraldehyde solution
( Cidex) is the agent often employed
 Liquid Chemical Method
• Instruments must be completely immersed in the
solution for 10 hours to achieve sterilization
• Disadvantages
a. Takes longer time to kill microorganisms
b. Coagulates blood and fix tissues to surface

3. Formaldehyde 8% can also be used for 24 hours to

achieve sterilization
 Physical Methods
• Heat is a dependable physical agent for the destruction of
all forms of microbial life, including spores.
• It may be used moist or dry.

A.Moist heat/Steam under

pressure/Autoclave
• This method is the least expensive, most efficient, and
least time-consuming method and is the method of first
choice, whenever possible.
 Moist heat
• For the steam process to achieve sterility, the time,
temperature, pressure, and moisture must be present
in correct proportions.

• The minimum time for the entire cycle in the

autoclave sterilizer is 25-30 minutes at 121-132
degrees Celsius
 Moist heat
• Flash/high-speed pressure sterilization
• This speeds up the process in the autoclave sterilizer
by:
a. Increasing the temperature,
b. Decreasing the time, and
c. Processing the item unwrapped.
 Moist heat
• Flash sterilization should be used only in an
emergency (e.g., a surgical instrument has been
dropped, no alternative exists, and the instrument is
needed immediately).
• Advantages of Steam Sterilization
1. It is the easiest, safest, and surest method of on-site
sterilization
2. Steam is the least expensive and most easily
supplied agent
3. Steam leaves no harmful residue.
 Dry Heat
• The items to be sterilized are subjected to heated air
in an enclosed oven or container.
• This method is usually reserved for sterilizing
powders, oils, sharps, sponges, and bandages.

• Disadvantages
• The major disadvantages of dry heat are that it
penetrates materials slowly and unevenly
 Sterility Indicators and Control
Monitors
• It is necessary to have a reliable, inexpensive method
for checking the effectiveness of a sterilizing process.
Packages wrapped for sterilization are sealed with
indicator tape.
a. Tape used on packs to be steam sterilized has
temperature sensitive areas that change colour when
exposed to high temperatures.
b. Tape used on packs to be gas sterilized has areas that
change colour upon exposure to the used (Ethylene
Oxide).
 Sterility Indicators and Control
Monitors

• These indicators are called process monitors.

• It is important to note that these indicators reveal
only that the pack has undergone a sterilization
process.
• It does not indicate that the item is sterile.
 Shelf Life
• SHELF LIFE: The length of time an item can be
considered sterile.
• Sterility is event related; it is not strictly related to
time
• where the package contains unstable components
such as drugs or chemicals, time becomes an
important factor
• Storage conditions are established to maintain the
integrity of the package.
 Shelf Life
• An item is considered sterile on the basis of the
following events:
i. Integrity, type, and configuration of packaging
material.
ii. Condition of storage.
• Most commercially sterilized products are considered
sterile up to the expiry date on it as long as the
integrity of the package is maintained.
 Shelf Life
• An expiration date put on the label by the
manufacturer indicates the maximum time the
manufacturer can guarantee product stability and
sterility on the basis of test data approved by the FDA.

• Integrity of Packaging Material and Handling

• The method of sterilization establishes the type of
packaging material that may be used.
 Shelf Life
• Shelf life is affected by the:
1. Permeability and density of the material,
2. Type of closure used, and
3. Method by which the package is handled
 Shelf Life
• The following alters the integrity of packaging
materials:
a. An item is no longer considered sterile after an
accidental puncture, tear, or rupture of the package
b. Squeezing or crushing a package may force air out
and draw unsterile air in, thus contaminating the
contents.
c. The accidental wetting of a package contaminates
the contents.
 Shelf Life
• To ensure the integrity of the packing material, avoid
the following:
i. Handling the package with moist or wet hands
ii. Handling the package with soiled gloves
iii. Placing the package on a wet surface
• Dust Cover
• For rarely used items a sealed, airtight plastic bag
protects a sterile package from dust, dirt, lint,
moisture, and pests during storage.
• A dust cover will protect the integrity of the package.
 Storage Conditions
• The maintenance of sterility is related to the event
and is not based on time.
• How sterile packages are handled and stored is as
important as how long they can remain sterile.
 Storage Conditions
• The following guidelines are helpful in maintaining the
sterility of a package during storage:
1. Storage areas are clean and free of dust, lint, dirt,
and vermin.
2. Routine cleaning procedures are followed for all
areas in the perioperative environment.
3. All sterile items should be stored under conditions
that protect them from the extremes of temperature
and humidity.