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THEATRE DESIGN AND

VENTILATION

DR.LOKESH SHAROFF
Orthopaedic surgeon,
Mumbai, India
CONCEPT
It was first introduced by SIR JOHN
CHARNLEY
ZONES IN THEATRE
OUTER ZONE rest of the hospital
outside the theatre complex
CLEAN ZONE theatre complex
outside the operating area
ASEPTIC ZONE Operating area
DISPOSAL ZONE Separate exit for
contaminated / used linen and
instruments
REQUIREMENTS
AIR DELIVERY SYSTEM

AIR FILTERATION SYSTEM

TEMPERATURE CONTROL

HUMIDITY CONTROL
TEMPERATURE CONTROL
- Ideal working temperature is 19-20 *
C to minimize perspiration

- But causes pt. hypothermia

- PT. body temp. should be 24-26 * C


TO AVOID HYPOTHERMIA
HUMIDITY CONTROL
- Should be around 40-60%

- Fastest death of organisms occur at


50% humidity
AIRBORNE PARTICLES
- Measured as BCP/MM3 Bacteria
carrying particles OR
CFU/MM3 Colony forming units

- Each person emits 10k cfu/min at rest


and 50k cfu/min with activity

- This is reduced in SCRUBS to 140-


830 cfu/min with fask mask and caps.
AIRBORNE PARTICLES
- CONVENTIONAL AC (well maintained)- gives
50-500 cfu/mm3

- All particles are not viable viable : non


viable ratio is 1:1000

- Smallest particle in theatre seen in bright


light is 12 microns

- Smallest particle that can carry bacteria is 4-5


microns
AIR FILTERS- 4 LEVELS
- ROUGHING FILTERS
removes Large particles and also protects
sensitive final filters
- PREFILTERS
should be 95% efficient
- FINAL FILTERS
should be 95% efficient with a particle size of 3
microns
- HEPA FILTERS
should be 99.97% efficient with a particle size of
0.3 microns
HEPA FILTERS
- Each hepa filter has a manometer
attached to it to measure the amount
of resistance to filteration for clogging
purposes.
TYPES OF VENTILATION
High velocity air flow
- high speed jets towards operating
table
- high speed air at periphery

Laminar air flow


- horizontal
- vertical
CONVENTIONAL WALL
DIFFUSER
- Produces plenum
- No control of air over operating area
- Upto 500 bcp/mm3 not acceptable
for operation theatres
HIGH VELOCITY AIR JET
- Jets increase air turbulence
- Flow at 0.6 m/s
- Jets may not point at right place and
may dessicate the wound
Vertical laminar flow
- Room within a room principle
- Air is passed through hepa filters
from ceiling downwards
- Flow at 0.3 m/s
- entrainment can happen by moving
personnel
Horizontal laminar flow
- Forms part of a wall
- Easy to install
- Movement across it will cause
uncontrollable turbulence
- adequate clean zone is not possible
PERIPHERAL LAMINAR
CONVENTIONAL LAMINAR
Vertical laminar with canopy and
side panels
- Canopy to overcome peripheral
entrainment
- side panels extend down to floor to
within 20cms from floor
- very successful 10 bcp/m3
Without side panels
- Peripheral entrainment air 0.6 m/s
- Higher energy consumption
- movement causes deflection of
contaminants
EXPONENTIAL AIR FLOW
- Trumpet shaped air flow
- Downward and radially outward flow
of air
- fliteration down to 1 micron
- Trays can be positioned even upto
m outside the actual canopy
STANDARDS IN AIR FLOW
- Direction of air flow shall be under
positive control
- max. viable organisms should be not
more than 1 cfu/mm3
- ULTRA CLEAN ZONE is less than 10
cfu/mm3
AIR CHANGES
- ATLEAST 20-40 AIR CHANGES PER
HOUR

- Pressure gradient should be 1.3-


2.5mm h2O
(more pressure causes rapid drying
of the wound)
AIR QUALITY CONTROL
- Done by CASTELLA SLIT SAMPLER
WATER SUPPLY IN OT
- Tanks and pipes regular inspection
for leakages
- Bore well water should be avoided as
far as possible
- tanks and containers should have
covers/lids to protect from dust
- water sterilised by ultraviolet
radiation
ANTIBIOTIC PROPHYLAXIS
- CHOICE OF AGENT
Active against comon pathogens
Take into account drug allergy and
sensitivity
cefazolin/cefotaxim preferred-long
duration
clinda/vanco in penicillin allergy pts.
Modification for pre-existing cultures
if already on abx then continue
same
ANTIBIOTIC PROPHYLAXIS
- TIMING
Within 15-60 mins prior to incision
Vanco should be given 2 hrs before

- Infusion should complete before


incision
ANTIBIOTIC PROPHYLAXIS
- DURATION
Further dose efficacy is doubtful
Max 24 hrs if only prophylatic
intra-op repeat if length of sx more
than half life of drug
repeat dose if blood loss >1500ml
not to continue abx till drain removal
ANTIBIOTIC PROPHYLAXIS
- RISKS
- PENICILLIN ALLERGY
- ANAPHYLAXIS
- ABX ASSOCIATED DIARRHOEA
- CLOSTRIDIUM DIFFICLE INFECTION
- ABX RESISTANCE
- MULTI-RESISTANCE CARRIAGE
SCREENING SHOULD BE DONE IN HIGH
RISK CASES
THANK YOU

*Pictures taken from journal of orthopedics today

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