OBSTETRICS AND GYNAECOLOGY

ASSIGNMENT
ON
SETTING UP OF OPERATION
THEATRE

SUBMITTED TO SUBMITTED BY

MRS. S. BHUVANESHWARI M.Sc (N)

NURSING TUTOR M.Sc(N) II YEAR

GCON, CUDDALORE. GCON, CUDDALORE

SUBMITTED ON :
INTRODUCTION

Operation room or operation theatres (OT) as the name suggests are the units in health care
organization which are concerned with manifestation of human bodies for the purpose of
treatment or diagnosis of health disorders this they can be considered the areas in the hospital
where operation surgeries or operative procedures can be performed either for diagnostic or
treatment purpose. The operation theaters usually have special units attached to them as pre and
post operative recoveries for care of the patients immediately before and after the surgery.
Operating room have large light and easy to clean rooms with typical overhead surgical light
with special wireing. Operating room generally do not have window to create easy air
conditioning and have a controlled temperature.

CLASSIFICATION OF OT
1. Extent of surgery involved
2. Types of service provided
3. Sharing of OT
4. Urgency situation

1. Extent of surgery involved

a.Minor OT
b.Major OT

A. Minor OT :- There are the OT in which simple procedures such as suturing, dressing, healing
minor debridements may be performed most of these are operated under local anesthesia .
B. Major OT :- There are well equipped with all the arrangements for general and spinal on
anesthesia required for surgeries The Extensive surgeries involving deep tissue are performed
here .

2. Type of service provided

a. Out patient OT
b. Inpatient OT
A. Outpatients OT :- May be located in the outpatient department and involves .The surgeries
performed on outpatient basis usually they are minor surgeries performed under local anaesthesia
B. Inpatient OT :- In a hospital are usually used for in patients. They are usually located away
from the outpatient department however some outpatient procedure requiring short stay may be
performed inpatient OT .

3. Sharing of OT

A. Decentralized
B. Centralized
A. Decentralized :- One means there are several operation theaters each dedicated to particular
surgical specially or located near the speciality department for Example :-
 Neurosurgery
 Orthopedic
 ENT OT
 Eye OT
 General surgery
 Gynaec
 Renal
 Plastic OT
 Renal / urology OT
 Transplant OT
 Radiotherapy OT

B . Centralized:- One means There as only one OT complex in the entre hospital in one location
shared by the different surgical specialities .

4. URGENCY SITUATION

A. Emergency OT
B. Elective OT
A. Emergency OT :- This OT are concerned with surgeries to be informed in care of on
Emergency. These OT function like Emergency and have to be ready all the time to handle and
surgery which is to be performed urgently .
B. Elective OT:- These are regular OT of hospital in which the routine planned surgeries are
performed as per the list of patients decided at last one day prior to the surgery .

STAFFING OF OT
The staffing can be measured in many ways,
1. Number of hours worked.
2. Hours associated with direct patient care.
3. Workload calculation.

DESIGN

 Major operating room

 Recovery room
 Sub sterilizing area
 Sterile instruments supply and storage
 Scrub area
  Clean up area
 Male dressing room
 Female dressing room
 Nurse station
 Wheeled stretcher area

BENEFITS OF GOOD STAFFING

1.Improves patient outcome

2. Lowers mortality rate
3. Increase OT efficiency
4. Reduce patient waiting time for surgery
5. Balance workload

ESSENTIALS REQUIRED FOR OT

1. Location with in the hospital
2. Quantity
3. Size
4. Design
5. Equipment required

OT staffing is based on
1. Total number of hours of cases
2. Number of cases operated per day
3. Type of cases
4. Nature of cases
5. Prescribed norms and policies and procedures

POLICIES OF OT
1. Functions of OT .
2. Duties and responsibilities of doctors and nurses and technicians .
3. Checklist for preparing OT for surgeries .
4. Maintenance of records of surgeries .
5. Methods of aseptic techniques should be followed .
6. Maintenance of sterility in different zones .
7. Disposal of Medical waste .

STAFFING PATTERN OF OT
MEMBERS OF OT TEAM
1. OT in charge
2. Operating consultant
3. Collaborating surgeons
4. Scrub nurse .
5. Circuiting nurse
6. Anaesthetists
7. Percussionist
8. OT technicians
9. Pre recovery staffs
10. Post recovery staffs
11. Sterilization staffs
12. Store keeper
13. Helping staffs

GENERAL PRINCIPLES

1. All the OT staff and the patient most into OT attire on entering zone –I

2. OT attire most include the OT pant shirts shoes or slippers, cap mask and gown

3. Any part of the OT attire must be changed when they are visibly soiled

4. No person should move out of the OT area after from the OT stock

5. As for as possible the OT attire stock should have all sizes to suit the needs of different people

6. The discorded OT attire should be moved out of the OT area as early as possible

7. The discorded OT attire should be moved out of the OT area as early as possible

8. The OT room should focus on maintaining asepsis

9. Adequate and suitable and changing facilities should be provided for staff clothing and the
attire

10 . There should be adequate provision for disposal of soiled linen within changing room after
daily use or if contaminated before and end of shift reusable surgical attire should be sent for
laundering

11. Safety spectacles or goggles mast be warm when it is appropriate

PRINICIPLES OF USING GOWN

1. All personnel in the operating suite should wear sterile gowns over the OT suit while
performing as a member of the operating team.

2. Gown should be changed immediately if it is soiled with blood or fluids during surgery

3. The procedure of wearing gown should be followed as per the organization protocol

PRINICIPLES OF USING GLOVES

1. Hair can be a sources of contamination so use of caps in the OT should be mandatory

2. The cap should cover all the hair completely.
3. If the cap has ties it the back they should be lied securely to avoid cap falling during
surgery.
4. Veiled person should remove their veils and put on a sterile cover.

EQUIPMENTS REQUIRED IN OT

Air conditioning unit 1

Anaesthesia macnine 1

C/S set 1

Instrument table 1

Laparotomy set 1

Laryngoscope 1

OR light 1

OR table 1

Oxygen unit 1

Spinal set 1

B P apparatus adult 1

B P apparatus paediatric 1

Stethoscope 1

Suction apparatus 1

Wheeled stretcher 1

OPERATION THEATER ZONES

Zone 1 – Outer zone : rest of the hospital outside the theatre complex. Also called as outer zone
and unsterile zone or non restricted zone or interchange area.

This zone avoids the exposure to contaminated areas after changing to surgical attire.

Zone 2 – Clean zone : theatre complex outside the operating area. Also called as middle
intermediate zone or semi restricted area and should be in – between two

zones. This should be large to receive supplies for surgery

Zone 3 – Aseptic zone : operating area. Also called as inner most or most sterile area or restrict
zone

Zone 4 – Disposal zone : separate exit for contaminated / used linen and instruments

Zones in the OT based on sterility

Sterile /ultra sterile Clean zone Protected zone Disposal zone

zone
OT attire mandatory OT attire mandatory OT attire not OT attire mandatory
in this area in this area mandatory in this area in this area

1.Operating suite 1.Sterilization area 1.Changing rooms 1.Dirty utility area

2.Sterile preparation 2.Store area 2. Reception area 2.Disposal corridor
area 3.Preoperative area / 3.Waiting area
3.Scrub station room 4.Trolley bay
Gowning area 4.Post operative
4.Anaesthesia recovery area/ room
induction area 5.OT staff & Doctor’s
room

SET UP

LAYOUT AND PHYSICAL REQUIREMENTS:

 The operating theater should be accommodating to safe surgery and anesthesia and
should be at least 7x7m with a ceiling height of 3.5m.
 This is to allow adequate space for operating theater equipment, intraoperative imaging
and patient monitoring.
 The typical design and layout of the operating theater involves a patient bed with an
anesthesia machine at the head, surgeons and assistants standing to the right and left of
the patient and a scrub technician near the feet of the patient or to one side with a sterile
table full of surgical equipment.
 There should be adequate room for various patient positions for the various sub-
specialties and types of surgeries as well as space to adequately allow an anesthesia
machine and various instruments to come in and out of the operating theater.
 In order to allow for intraoperative patient positioning, a safety strap shall be placed
above the patient's knees to prevent movement if the bed is tilted or moved.
 Safety straps shall also be placed on patients arms to prevent unintended injury from an
arm falling off the arm table.
 In the supine position, the operating table should be able to tilt and rotate into various
positions including Trendelenburg and reverse Trendelenburg positions.
 These positions will place pressure on various parts of the body, therefore it is important
to provide padding to pressure points along the patient.
 Each operating room fits into a well designed system that meets the various needs of
operative patient care.
 In addition to easy access to the operating rooms themselves, a theater area should
include:
● A waiting room for patients and family with reception
● Patient changing areas
● Examination rooms
● A pharmacy
● Storage areas for surgical and anesthesia equipment
A central supply store for non-reusable items
● A surgical instrument storage area
● Decontamination and sterilization facilities
● A postoperative recovery area
● Dressing rooms for theater staff
● Lounge for theater staff
● Clinicians’ work and documentation area
 Environment Temperature:
 The temperature of the operating theater should be between 18°C and 24°C.
 Keeping the room above 18ºC is important to prevent intraoperative hypothermia.
 Central AC : 20 -22 degree centigrade
 Humidity : 50m- 60%
 Positive pressure ventilation
 Air change : 20 times/hr with recycled air; of which 5 times with fresh air
 HEPA filter of 5’’ class
 Laminar air flow through diffuser
 General lighting : cold light, even distribution, varying intensity
 Operating light: seiling mounted, cold light, shadow less focusable beam
 Medical gas pipeline: anaesthesia gas, air, oxygen & suction
 Power supply : uninterrupted (UPS) and generator back up (safety)
  Earthing : all electrical equipment
 Fire safety : fire / smoke detectors. Fire hydrants &extinguishers
 Power switches : away from operating area.

FLOOR / WALL / CEILING

FLOOR

 Non slippery, antiseptic, non reflective, non porous, water, stain and fire resistant
 Seamless

WALLS

 Same quality as the floor

 Seamless
 Usually stainless steel

CEILING

 Same quality as floor

 Usually stainless steel
 Diffuser for laminar air flow
 Mounting for lights

OT DOORS

 Wide doors
 Sound proof
 Non reflective surface
 Radiation resistant
 Fire resistant
 Sliding type of door
 Glass cut out for visibility

SCRUB STATION

 For sterile hand wash

 Types: stainless / granite/ marble/ cement
 Gradient of basin forward and downwards
 Gradient towards outlet
 Hot water mixing: automatic or manual
 Non splashing taps ; possible to change direction
 Elbow/ foot or infra red operated taps
 Soap dispenser : manual / automatic
STERILE PREPARATION AREA

 Sterile bins storage

 Sterile instrument tray storage
 Preparation of operation sets.

ROLE OF NURSE IN OT

1. Pre-operative check for the availability of the materials for surgery

2. Psychological preparation of the patient
3. Follow correct aseptic techniques.
4. Positioning of the patient
 Proper administration of medications as per policies
 Delivering of high quality patient care
 Nursing care based on EBP.
 Participate in risk assessment and reporting
 Assess, plan, implement and evaluate care
 Maintaining of resources.
 Organize and prioritize the work load
 Support other staffs in maintaining health

CONCLUSION

OT is that specialized facility of the hospital where life saving or life improving procedures are
carried out on human body by invasive methods under strict aseptic conditions in a controlled
environment by specially trained personel to promote healing and cure with maximum safety,
comfort and economy. It is a room in a hospital equipped for the performance of surgical
operations under complete aseptic conditions.

BIBILOGRAPHY

 www.vumc.org
 https://www.slideshare.net
 https://www.scribd.com
 https://hospaccxconsulting.com