1. concepts of ot & setting of ot

OT NURSING NOTES

1. WEL-COM
Prof. Dr. Ram Sharan Mehta
Medical-Surgical Nursing Department

2. Operation Theater
Review Questions:
1.What is OT?
2.Why OT is important?
3.Explain Structure of an Ideal OT?
4.What are the Functions of OT?

3. Review Basic Terms & Concepts

4. Types of Surgery
Elective-Performed on the basis of client’s
choice; not essential and may not necessary
for health.

Urgent- Necessary for client’ health, may
prevent additional problem from developing
(e.g. tissue destruction);not necessarily
emergency.

Emergent- Must be done immediately to save
life or preserve function of body part.

Required- Has to performed at some point; can
be pre-scheduled.

5. Types of Surgery
•Diagnostic-Allows to confirm diagnosis.
•Corrective- Excision or removal of
diseased body part.
•Reconstructive-Restore function or
appearance to traumatized or
malfunctioning tissues.

6. Types of Surgery
•Procurement for transplant- Removal of
organs and/or tissues from a person
pronounced brain death for
transplantation into another person.
•Constructive- Restores function lost or
reduced as result of congenital anomalies.
•Cosmetic- Performed to improve personal
appearance.

7. Types of Surgery
•Extent of surgery :
Simple- Only the most overtly affected areas
involved in the surgery.
Radical- Extensive surgery beyond the area
obviously involved; is directed at finding a root
cause.
•Location: Based on the area of the body on
which the surgery occurs (e.g. abdominal,
heart surgery).

8. Purpose of Surgery


•Diagnostic
–Determine or confirm a diagnosis
(breast biopsy, bronchoscopy)
•Cure/Curative
–Removal of diseased tissue, organ, or
extremity (appendectomy, amputation)
•Constructive
–Build tissues or organs that are absent;
congenital anomalies (cleft lip repair)
•Prevention/Preventive
– (e.g. removal of mole)

9. Purpose of Surgery
•Reconstructive
–Rebuild tissue or organ that has
been damaged (skin graft after a
burn, total joint replacement
•Exploration – Surgical examination
to determine the nature or extent of
a disease (Laparotomy)
•Cosmetic Improvement –
(repairing a burn scar, or changing breast
shape)

10. Purpose of Surgery

•Palliative
–Alleviate symptoms of a
disease (not curative)
(bowel resection in client
with terminal cancer)
•Transplant
–Replace organ or tissue to
restore function (Heart lung
liver kidney transplant)

11. Important Suffixes RT Surgery
•Ectomy - Excision or removal of (Appendectomy)
•Lysis – Destruction of (Electrolysis)
•Orrhaphy – Repair or suture of (Herniorrhapy)
•Oscopy Looking into (Endoscopy)
•Ostomy Creating of opening into (Colostomy)
•Otomy – Cutting into or incision of (Tracheotomy)
•Plasty – Repair or reconstruction of (Mammoplasty)

12. Surgical Setting
•Hospital
•Ambulatory surgery
–Emergency
departments
–Doctors offices? (clnic)
–Freestanding surgical
clinics (camps)
–Outpatient surgeries in
hospitals

13. Types of Surgeries Performed in
an Inpatient Setting
•Amputations
•Transplants
•Total Joint Replacement
•Colostomy
•Nephrectomy
•Heart Bypass Surgery
•C-sections
•Ruptured Aneurysm
•Life-threatening Trauma

14. Types of Surgeries Performed in
an Outpatient Setting
•Breast Biopsy
•Bronchoscopy
•Appendectomy?
•Removal of Skin Lesion
•Cataract Extraction?
•Cosmetic Surgery ?
•Hernia Repair ?
•Tubal Ligation
•Vasectomy
•Dilation and Curettage
•Hemorrhoidectomies ?
Minor OT?

15. Inpatient Surgery-Advantages
•More time for rapport
•More time to assess for risks
and needs
•More time to teach
•Increased availability of:
–Professional care and
assistance
–Treatment and diagnostic
facilities
–Medications and blood

16. Inpatient Setting: Disadvantages
•Higher cost
•Higher risk of hospital
acquired infection
•Interruption of family
routine
•Interruption of work and
responsibilities
•More stressful for the
patient and family

17. Outpatient Setting: Advantages
•Lower cost
•Less risk for hospital acquired
infection
•Less interruption of family
routine
•Possible reduction in time lost
from work and other
responsibilities
•Less physiologic stress to the
patient and family

18. Outpatient Setting: Disadvantages

•Less time for rapport

•Less time to assess risks and needs

•Less time to teach

19. Common Pre-admission Directions
•Time and date of arrival
•NPO
•Bowel preparation
•Valuables, jewelry
•Clothing
•Medicines

20. OT

21. Definition
•Specialized facility in hospital
where invasive treatment is
given under strict aseptic
controlled environment by
trained personnel

22. •An 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 personnel to promote healing
and cure with maximum safety,
comfort and economy.

23. OPERATING ROOM
•The identification of physiological &
sociological needs of the client, & the
implementation of an individualized
program of care in order to restore
or maintain the health & welfare of
the patient before, during & after
surgical intervention.

24. PHILOSOPHY :
•To give service that aims to provide
comprehensive support physically,
morally, psychologically, spiritually, &
socially to a patient undergoing
surgery.

25. Support services play a large part in
maximizing efficiency by providing:
•Pre-operative preparation and assessment
•Available beds
•Sterile theatre equipment
•Portering, cleaning and maintenance staff.

26. Goals

Key elements to efficient use of operating
theatres are:
•Effective management
•Good communication
•Well trained staff
•Appropriate facilities and equipment
•Operational layout that allows flow of patients

27. Fundamental purposes of the O.R. :

It is a place. . .
1.To correlate theory & practice.
2.To develop skills in assisting the surgeon in
the operation.
3.To create a suitable sterile field for surgical
procedures to prevent complications.

28. OBJECTIVES OF PLANNING
•Promote high standards of asepsis
•Ensure maximum standard of safety
•Optimum utilization of OT and staff time
•Optimize working conditions
•Patient and staff comfort in terms of
thermal, acoustic and lighting
requirements

29. OBJECTIVES OF PLANNING………
•Allow flexibility
•Facilities coordinated services
•Minimize maintenance
•Ensures functional separation of spaces
•Provide a smoothing environment
•Regulate the flow of traffic

30. DESIGN PARAMETERS

•Avoidance of unrelated hospital traffic flow
•Convenient functional flow between
related departments like ICU,CCU etc
•Avoidance of outdoor noise
•Provision for future expansion
•Sliding doors
•Desirable floors to be smooth and non-
slippery
•Ceilings to be painted with washable paints

31. DESIGN PARAMETERS………..
•Taps in scrub room should be knee/elbow
operated /infrared operated.
•Provisions of high speed autoclaves
•Essential pharmaceutical storage
•X-ray films illuminators
•Emergency communicators that can be
activated without the use of hand
•Toilets

32. Design considerations

•Location
•Workflow
•Basic work areas and Division of space
•Zoning concept
•Air filters
•Machinery and equipment
•Organization
•Policies and procedures
•problems

37. PHYSICAL EVIRONMENT
•TEMPERATURE
•HUMIDITY
•VENTILATION

38. PHYSICAL EVIRONMENT
•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

39. Areas with higher hygienic
requirements for air quality.
•Areas with high clean-air requirements include the
operating theatre, any sterile preparation and pre-
operative areas, sterile storage, the anesthesia and
equipment storerooms and the entrances and the
exits.
•The highest clean-air requirements apply to the
operation area and the sterile preparation area.
•With respect to air treatment, the operating theatre
and a number of adjacent areas have to comply with
the provisions of the working conditions policy
regulation.

40. •From a technical point of view, the
protective effect of the air surrounding the
patient, operation team and instrument
table, can be achieved by installing a large
Laminar Air Flow (LAF) device(plenum).

•This LAF device with a down flow has a
surface area of 8 to 9 m2(e.g. square or
octagonal 3 x 3m, rectangular 2.8 x 3.2m).

41. •The air velocity from the down flow plenum is
24 to 30 cm/sec and flow temperature from the
LAF device is 1 to 2°C lower than the ambient
air.

•There are also possible solutions and
satisfactory results in environmental control
using special LAF devices in which the supplied
air has different speeds and temperatures and
which also improved the thermal comfort of
the surgical team.

42. •In order to be able to safeguard the
requisite air quality in the operating
theatre, a very large air flow is
necessary.

•A re-circulation down flow system
can be installed for this purpose.

43. •Part of the air from the down flow system
is re-circulated via fans to the HEPA filter
(HIGH EFICIENCY PARTICULATE AIR).
•POSSILE AIR CLEALIESS: The desired
germ level of less than 10 colony forming
units (CFU)per m3
•There must be no windows that can be
opened and outside walls must be
completely sealed.

44. Air Distribution
•Turbulent or mixing air distribution
system
•Downward displacement piston
system
•Unidirectional air flow system
(laminar flow)

45. The most important basic quality requirements
concerning spatial relationships are:
•The surgical department is independent of traffic
flows in the rest of the hospital; through traffic is
not permitted through this department.
•Airlocks physically seal a surgical department
from the rest of the hospital.
•Staff working in the operating theatre complex
can move from one ‘clean’ area to another
without needing to pass through ‘non-clean’
areas.

46. Other basic quality requirements

•The following basic quality
requirements apply to the use of
equipment & operational reliability
of installations.
• Health risks to staff such as exposure
to microbiological and chemical
Contamination, and lasers and
ionizing radiation can be avoided as
far as possible by drawing up
guidelines and protocols.

47. • Operational reliability of the technical
installations and an optimal
indoor environment for both patients and
staff form the basis for the design and
maintenance of the mechanical
engineering and electro technical
installations.
• The finish of floors, walls and ceilings
must be smooth, flawless or closed.

48. •Corners and transitions between floors and
walls will be rounded to prevent accumulation
of dirt.
•The different areas should be constructed and
furnished in such a way as to allow effective
cleaning and if necessary disinfection with
commonly used cleaning agents and
permitted disinfectants.

49. Thank you

50. PLANNING AND DESIGNING OF
OPERATION THEATRE

51. Number of OT beds:
1. According to Rao committee (India) : One
operation theatre for 50 surgical beds
2. American pattern One operation theatre for
25 surgical beds
3. European countries One operation theatre for
50 surgical beds

52. 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 x Bed Occupancy
x Working days/Average Length of stay
=300 beds x 60% x 250 days/10 days(ALS)
=4500 surgeries/ year

53. Important Zones of OT:
1.Outer Zone - include: administrative area,
reception, control-area, class-room,
conference-room, staff locker area, patient
holding area.
•Space is necessary for reception, paper work,
clinical instruction, offices of: anesthesiology,
surgeon, dictate and write medical note,
locker, toilet, coffee etc.

54. Outer Zone……………
• A main access door;
• An accessible area for the removal of waste;
• A sluice;
• Storage for medical and surgical supplies;
• An entrance to the changing facilities.

55. 2. RESTRICTED ZONE OR CLEAN ZONE
•Changing room
•Patient transfer area
•Stores room
•Nursing staff room
•Anaesthetist room
•Recovery room.
• The sterile supplies store
• A clean corridor
• Rest rooms for the staff.

56. 3. The intermediate zone- Large area, out
patient delivery, supplies and materials,
post-operative room.
•Store large number of CSSD and
autoclave supplies, linen pack, gloves,
bandages, linen, post anesthetic room.

57. 4. The Inner Zone/ ASEPTIC ZONE :
Actual operation room, scrub
area, patient induction area, Area
for instrument packing and
sterilization.
•The highest level of cleanliness
and sterile condition should be
maintained.

58. 5. DISPOSAL ZONE
•Area where used equipment are cleaned and
biohazardous waste is disposed

59. Recovery Room
•Charting Facilities, medication, hand
washing facilities, link provision,
bedpan, laboratory.

60. OT Zones: Summary
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

61. OT Layout

63. OT Layout

64. Layout
•Room Size: 7.5 x 7.5 Meter
•standard size is 20 X 20 X 10 with a minimum floor
space of 360 square feet.
•Corridors: 10-12” wide: two stretcher can pass at a
time.
•Light: 3 meter from furnished floor
•Lighting: high level, special ceiling mounted light to
illuminate operating area, light control system.
•Operative microscope: enough space area: vascular
surgery requires microscope.

65. Layout………
•Sore: CSSD, Main equipment, disposable hold,
medical gases, blood (freeze).
•Orthopedic surgery store: splint, traction,
plaster of peris room, plaster sink etc.

66. Facilities and space requirement:
•Control station:
located as to permit visual observation of all
traffic in to and in the departure.
•Supervisor’s office
•Pre-operative holding area
•Induction area
•Recovery room
•Sterilization facilities
•Area for portable x-ray

67. Facilities and space requirement…..
•Medicine store with refrigeration facilities.
•Scrub facilities
•Soiled work room, sink room
•Fluid waste facilities
•Clean work room (duty work room)
•Medical gases facilities room
•Equipment store room
•Staff clothing changing room (M/F): categories=
Nurses, Doctor, Consultant ant, Technician, helper
etc. with toilet and hand washing facilities.

68. Surgical Operating Suites

69. OPERATION ROOM: Single

1.Big enough for free circulation
2.Two openings (optional)Towards scrub area/
Towards sterile area
3. Openings fitted with swing doors.
4. Marble or polished stone flooring
5. Glaze tiled walls
6. No false ceiling

70. OT Layout

73. Automatic Remote Controlled C-arm Table

74. Remote Control OT Tables

75. NUMBER OF OPERTING SUITES
•Number and type of surgeons
•Type of hospitals
•Hospital policy and procedure
•Bed strength
• Number and type of surgery patients
• Number of operations per day
•Time a Time allowed for staff breaks
•Average time for operations
•Time allowed for maintenance of OT
•Expected ALOS
•Size of an average OT list

76. •LOCATIONG:
- GOUND FLOOR
- TOP FLOOR (best if all the facilities)
- ANYWHERE INTHE HOSPITAL

77. OT Furniture
•OT furniture is important aspect owing to its
specialized design.
•This furniture has certain functions needed to
support patients who have decreased
mobility.
•In such cases the specialized design of OT
furniture serves the need of providing the
required support.

78. O.T. Light
•Operation theatre (OT) light comes with the
following features:
• perfect
• comfortable
• Lights brilliant
• Exclusive design
• Trouble free
• Mounting is economic

79. Venous OT lights
•Shadow less Ceiling Operating light combination
that provides the superior performance for all
kinds if surgeries.
•Compact, Light weight and sealed dome made
of aluminium consists of glass diachronic
reflector to provide cool, bright and
homogenous illumination.
• OT Lights are made to spot light the operation
table area.
•They illuminate the area to the right level of
brightness

81. SCRUB TEAM WORK

82. THE OPERATING ROOM

84. Thank you

92. Types of air supply
Air is supplied to the operating theatre by:
1. Plenum Ventilation: This is the most frequently used system in
generalpurpose
•operating rooms. The bacterial counts at the wound site should
•be no more than 50 -500 colony forming units (cfu) per cubic meter.
2. Laminar Flow Ventilation (Ultra Clean Ventilation): This system is
•unidirectional and delivers air flow over the operating table of 300 air
•changes per hour. A bacterial count of 10 cfu or less per cubic meter at
•the wound site is achieved.

93. •3. Wall Mounted Air Conditioners: These are installed in some tropical
•countries more for comfort than for clean air delivery. They should not be
•used as air delivery systems. The units are usually mounted on the hot
•outside wall and the air is directed down and back onto the unit itself
•(towards the wall). The operating table does not receive any significant air
•changes and the bacterial counts remain unaffected.
•4. Free-standing Air Conditioners: These are cooling units with no
filtration
•of air and therefore do not fulfill the criteria for air delivery systems,
•especially for an OT.

94. Remember
•• Windows should remain closed.
•• The operating theatre should maintain at positive pressure.
•• Air should be introduced at the ceiling and should be exhausted near the floor
•in order to prevent bacterial contamination in the operative field.32
•• Air changes should be at least 20 changes per hour.
•• Air should first pass through a series of dust filters and then enter the room
•through a HEPA filter. Split-unit air conditioning is not allowed.
•• Humidity should be controlled and maintained between 50-55%.
•• Temperature should be controlled and maintained between 18-24 degrees
•Celsius.