IDEAL OBS GYN OT SET UP

OPERATION THEATRES ARE THE HEART OF A HOSPITAL
these must be well planned and well maintained
THIS PRESENTATION IS AN ATTEMPT TO COMPILE ALL THE DATA AVAILABLE ON INTERNET VARIOUS PRESENTATIONS INTO ONE AND SUMMARISE THE SALIENT FEATURES

1. Ideal C section OT/OR set up Narendra Malhotra OBSTETRICIAN AGRA www.rainbowhospitals.org

2. PROF.NARENDRA MALHOTRA M.D., F.I.C.O.G., F.I.C.M.C.H, F.R.C.O.G.,F.I.C.S .,A.F.I.A.P. Prof. Dubrovnick International University V.P. WAPM(world association of prenatal medicinne ) President ISAR Presiddent Elect ISPAT Sec Gen SAFOG Member FIGO guidelines committee President FOGSI (2008-2009) Dean I.C.M.U. (2008) Director Ian Donald School of Ultrasound National Tech. Advisor for FOGSI-G.O.I.—Mc Arthur Foundation EOC Course Managing Director GLOBAL RAINBOW HEALTH CARE Director ART-RAINBOW –IVF Practicing Obstetrician Gynecologist at Agra. Special Interest in High Risk Obs., Ultrasound, Laparoscopy and Infertility, ART & Genetics Member and Fellow of many Indian and international organisations Awarded best paper and best poster at FOGSI : 5 times, Ethicon fellowship, AOFOG young gyn. award, Corion award, Man of the year award, Best Citizens of India award Over 50 published and 200 presented papers Over 100 guest lectures given in India & Abroad and 24 ORATIONS Organised many workshops, training programmes , travel seminars and conferences Editor 18 books, many chapters, on editorial board of many journals Editor of series of STEP by STEP books Revising editor for Jeatcoate’s Textbook of Gynaecology 7 th and 8 th edition (2015) Very active Sports man, Rotarian and Social worker MALHOTRA NURSING & MATERNITY HOME PVT. LTD. GLOBAL RAINBOW HEALTH CARE,AGRA 84, M.G. Road, Agra-282 010 Phone : (O) 0562-2260275/2260276/2260277, (R) 0562-2260279, (M) 98370-33335; Fax : [phone] www.malhotrahospitals.com,www.rainbow hospitals.org

3. Location of the Operating Theatre Suites Separated from the main flow of hospital traffic Should be easily accessible from surgical wards and emergency rooms. Floor should be covered with antistatic material, The walls should be painted with impervious, antistatic paint. (reduces the dust levels and allows frequent cleaning) The surfaces must withstand frequent cleaning and decontamination with disinfectant.

4. Layout of the Operating Theatre clean corridor scrub-up area Recovery area Anesthetic room sterile supplies store

5. Operating theatre : macros processes

6. Wards Operating theatre OR1 OR2 ORn Recovery ICU Operating theatre : trajectory

7. Operating theatre : Components Operating theatres (mono disciplinary or shared) ED operating theatres Recovery rooms Induction rooms Endoscopia operating rooms Obstetric operating theatre Stretchers Obstetric labor rooms Interventional radiology ORs ED Sterilisations Wards Two scopes:

8. Operating theatre : some observations Turn dedicated operating rooms (OR) into shared polyvalent ones improves the economic efficiency. Induction outside the OR (in an induction room) improves the OR usage Keep the right balance between the surgery volume target and all human and material resources. SFAR recommendation: 1.5-2 recovery beds per OR

9. Operating theatre : performance indicators Three types of patients concerning the surgery programming : E lective patients programmed at D-8 : elective surgery patients of week W are known the week W-1 (in general , before Thursday noon ) to allow the validation of the surgery program of the operating rooms and the personal planning, Semi-urgent patients programmed at D-1 : patients known the day before their intervention Patients not yet known at the beginning of D . A good surgery program depends directly on the capacity to anticipate the demands of different operators . This anticipation requires the knowledge of the patients to be operated at least one week before . Health professionals agree that a ratio of 80 to 85% of patients known at D-8 is signal of efficient surgery programming . Of course, one has to take into account emergency surgeries and the catchment area and target market of the hospital .

10. Operating Room time usage: Hospital OR time provision - « temps de mise à disposition » (TMD), a decision of hospital management based on the opening times of each room – OR sessions, OR timed used - « temps réel d'occupation des salles » (TROS) , part of the TMD actualy used for an intervention, i.e. interval from patient arrival in the room to end of cleaning of the room Conventional OR time « temps conventionnel MeaH », base OR times defined by Agency MeaH to benchmark different hospitals . For each OR : Conventional Day OR time of 10 hours (08h30 -18h30) Conventional « continuity of care duty » of 14 hours (18h30 - 08h30) Operating theatre : performance indicators

11. Ratio 1 (allocation) : Hospital OR time provision / MeaH convention 68 - 90% with one at 111%. Ratio 2 (programing & regulation) : Time used / Time programmed 45% - 77%, mean 62%. National objective (CTN) : 75 - 80%. Ratio 3 (productivity) : Timed used / MeaH convention 31% - 63%. Operating theatre : performance indicators

12. Surgery occupation time - TROS : T1 patient preparation time : patient arrival to induction, T2 induction time: induction to incision, T3 surgery intervention time, T4 duration of bandage, T5 : cleaning . TUC = time needing a medical specialist ( operator and anaesthestist ). Operating theatre : performance indicators

13. OR time provision (TMD) and overtime Ratio of overtime is a significant capacity regulation issue. General agreement (CTN), 2% overtime seems unavoidable Most hospitals visited by MeaH found ways to improve their overtime ratio and hence reducing overtime cost. Operating theatre : performance indicators

14. A typical Operating room .

15. OPERATION THEATRE - 1 Dr patil OT all in one …………advantage and disadvantages both

16. OPERTAION THEATRE FOR C SECTION GLOBAL RAINBOW HEALTH CARE AGRA

17. THEATRE DESIGN GLOBAL RAINBOW HEALTH CARE AGRA Theatre Design Consideration: The prevention of wound infection. The safety of patients and staff. AEROCIDE LAMINAR HEPA FILTER

18. Designing a safe environment incorporates features that prevent or control the risk of infection, fire, explosion, and chemical and electrical hazards. Well-devised traffic patterns, material-handling systems, disposal systems, positive-pressure and well-dispersed clean ventilation, and high-flow, unidirectional ventilation systems for special applications all contribute to a safe surgical environment. Design Features

19. FIXTURES

20. 20 PRPD/DN/DM/PON/09 Design specifications have been identified and followed in the WEST since many yrs

21. 21 PRPD/DN/DM/PON/09 And have improved with newer specifications and guidelines

22. Traffic Patterns in the Surgical Suite, A three-zone designation of areas within the surgical suite facilitates appropriate movement of patients and personnel. Traffic Flow

23. Traffic Flow Unrestricted areas are those in which personnel may wear street clothes, and traffic is not limited. In semi-restricted areas , such as processing and storage areas for instruments and supplies, as well as corridors leading to the restricted areas of the surgical suite, personnel must wear surgical attire and patients must wear gowns and hair coverings. Restricted areas include operating rooms and clean core and scrub sink areas. Surgical attire and masks are required in these areas when there are open sterile supplies or scrubbed persons in the area.

24. 24 PRPD/DN/DM/PON/09 Traffic Flow The flow of supplies should be from the clean core area through the operating rooms to the peripheral corridor. Soiled materials should not re-enter the clean core area. Soiled linen and trash collection areas should be separated from personnel and patient traffic areas for infection control purposes.

25. Ventilation Appropriate ventilation systems aid in the control of infection by minimizing microbial contamination. Temperatures in an operating room should be maintained between 68° and 73° F (20° to 23° C), with relative humidity of 30% to 60% to reduce bacterial growth and suppress static electricity.

26. TEMP HUMIDITY The temperature and the humidity (not less than 55%) play a important role in maintaining staff and patient comfort. They must be carefully regulated and monitored . (In low humidity there is a danger of the production of electrostatic sparks.) Ideally, the operating room should be 1ºC cooler than the outer area. (This aids in the outward movement of air: the warmer air in the outer area rises and the cooler air from within the operating theatre moves to replace it.)

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28. Laminar flow & ultraclean air Laminar airflow is designed to move particle free air over the aseptic operating field in one direction. It can be designed to flow vertically or horizontally and is usually combined with high efficiency particulate air (HEPA) filters. HEPA filters remove particles > 0.3 micron in diameter with an efficiency of 99.97%.

29. 29 PRPD/DN/DM/PON/09 Emergency Signals Every surgical suite should have an emergency signal system that can be activated inside each operating room. A light should appear outside the door of the room involved, and a buzzer or bell should sound in a central nursing or anaesthesia area. The signals should remain on until the alarm is turned off at the source. All personnel should be familiar with the system and should know both how to send a signal and how to respond to it. Such a system, restricted to use in life-threatening emergencies, saves invaluable time in bringing additional personnel and resources for assistance.

30. Operating Department comprises : Rest rooms Changing rooms Teaching rooms Storage Reception areas An operating suite

31. 31 PRPD/DN/DM/PON/09 An Operating Suite Is one functioning unit of a department: An anesthetic room Clean preparation room Scrub-up area Operating theatre Sluice room Exit bay

32. “Clean and Dirty” All journeys within the department are made from clean to dirty areas, never the other way round

33. PRPD/DN/DM/PON/09 Patients Will enter the department from the hospital corridor via a transfer bay. Here they are usually lifted on to a theatre trolley, leaving the ward bed outside. Next they enter either a holding bay area or else move directly to the anesthetic room. Finally they enter the theatre itself where surgery is to be performed The journey has been one through progressively cleaner areas, arriving finally at the cleanest of all. Once the wound has been closed and covered with dressing, it is safe for the patient to return to the ward via progressively more dirty areas: through the exit bay, recovery and the hospital corridor.

34. Instrument and Equipment Are brought from outside the department into clean store rooms. Instruments are often supplied in pre-packed sterilized trays by the Theatre Sterile Supplies Unit (TSSU). Finally, they enter the theatre ready for use on the scrub nurse’s trolley. At the end of an operation, dirty instruments, linen and rubbish are removed to the sluice room, and when correctly packaged for disposal, to agreed collection points. Porters then take them via a dirty corridor to their several destinations: the TSSU, laundry or hospital incinerator.

35. Theatre Personnel Enter the department via a changing room where outdoor clothing is left. Once attired in correct theatre dress they can proceed to a suite along a clean corridor. Here they enter via the clean preparation room or the scrub-area, and like the patient, leave through the exit bay.

36. The Anesthetic Room The anesthetic machine Suction apparatus The drug cupboard The Operating Theatre The operating table – centre piece of the room, a very versatile piece of equipment. It has to be in order to accommodate the great variety of different operating positions.

37. The Operating Lights There are usually two operating lights in a theatre attached to the ceiling. The lights are easily maneuvered, necessary to accommodate the needs of surgery. Good lighting is needed to carry out an operation, and lighting a wound from two converging angles is designed to eliminate shadows.

38. 9 Anesthetic Scavenging A long length of corrugated plastic tubing connected to the anesthetic circuit at one end, while the other connects to a vent in the ceiling or wall. The system draws out of the theatre any anesthetic gases or agents leaking from the circuit and which pollute the atmosphere.

39. The Swab Rack This is a metal piece of furniture used for hanging up swabs during an operation for ease counting. It comprises of several tiers have either hooks to hang the swabs, or else holes to poke them through. The hooks and holes are grouped in numbers off fives, and each tiers can usually accommodate ten swabs.

40. 40 PRPD/DN/DM/PON/09 The Swab Board This is for recording the amount of blood loss during the operation especially major operation. The nurses record this information for anesthetist's benefit, who will instigate replacement therapy. The board is usually marked in two columns; one for blood loss from the swabs and one for loss from the suction.

41. 41 PRPD/DN/DM/PON/09 Weighing Scale: estimating blood loss You should find a list of known dry weights of each different type of swab. To estimate blood loss, you weigh the blood-soaked swab, and from that weight subtract the known dry weight. This leaves you with the weight of blood lost, which is the amount you record, adding it to the running total. e.g.; Dry Large swab = 20g, Soaked in blood = 90g : 90g – 20g =70g is the weight of the blood loss (1g = 1ml)

42. This is vital as some operations are conducted with close reference to a patient’s x-rays throughout. e.g. orthopaedic surgery, tumour surgery and operations such as cholecystectomy X-ray Screens

43. Rubbish bins, Swab bins and Linen bins Every theatre has separate disposal containers for rubbish, swabs and linen. During the operation the swabs must remain separate, to facilitate the swab counting procedure. Leave the disposal bags in the theatre until the end of the operation, until the scrub nurse is entirely happy with the final count. Fresh disposal bags are always brought in for every operation.

44. NEONATAL RESUSCITATION STATION

45. 45 PRPD/DN/DM/PON/09 Recovery Area Carried out in the corridor outside the operating theatre. Normally made up of several bed spaces, each with necessary equipment to facilitate recovery e.g. oxygen, suction apparatus, pulse oximetry , emergency trolley necessary to deal with cardiac arrests or anesthetic emergencies etc.

46. 46 PRPD/DN/DM/PON/09 Changing to Theatre Clothing To cut down on any bacteria brought from outside Cotton uniform less static electricity Pride for nurses working in theatre Laundry purposes Reduce anxiety for patient

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56. SUMMARY HOW TO MAKE AN IDEAL OBSTETRIC O.T .

57. HAPPY C SECTION TO ALL OF U