Operation theatre design

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1. -Dr Nisar Ahmed Arain Assistant professor Anesthesia/Critical care/ER OPERATION THEATRE DESIGN

2. OPERATION THEATRE -The design of operation theatre should provide with “optimum facilities” and minimum inconvenience in the management of different areas. The prime requirements in the design of theatre are the “control of infections and safe environment for the patient”

3. THE STRUCTURE OF OPERATION THEATRE -1-The walls should be hard and easily washable material e.g MARBLE -2-Pipes and central Oxygen, Nitrous Oxide, suction should be fitted to the walls. -3-Adequate Air-conditioning should be provided -4-In the absence of window adequate light should be provided. -5-Fire extinguisher should be adequate

4. ANESTHESIA ROOM Preparation of an anesthetic room -1-Attach an anesthetic breathing system with a proper size face mask -2-Confirm proper functioning of Mechanical Ventilators -3-Confirm availability and proper functioning of central suction (or wall mounted suction) -4-Confirm availability of a-Intravenous solutions b-Connecting tubes c-Suction catheter

5. -1-Local Anesthesia (Lidocaine) -2-Benzodiazapine (Diazepam) -3-Catacholamines to treat allergic reactions -4-Opiod (Fentanyl, Sufentanyl) PREPARING DRUGS FOR INDUCTION AND TO USE THEM IN EMERGENCY CASES

6. STERILIZATION ROOM A sterilization room should be built adjacent to the operation theatre with a functional glass window. Through this window instruments and equipment can be passed freely between the operation room and ST room without repeatedly opening the main doors RECOVERY ROOM --The main purpose of recovery room is to give post -operative care and nursing care to the patient --The resuscitation equipment must be available and facilities for oxygen and suction should also be there --Essential articles such as I /v infusion, fluids, I/V stand, stethoscope, BP apparatus etc. Should be there

7. --Cylinders of oxygen and Nitrous oxide, additional equipment infusion fluid bags, syringes, needles, drugs, and operation related equipment are kept in this room STOREROOM CHANGING ROOM -A room is provided for theatre personal to change into OT cloths, footwear, sterile caps and mask also kept in this room SCRUB ROOM -The Surgeons, Nurses, and students scrub in this room and this room opens into the OT OPERATION TABLE -A modern operation table has adjustments to enable surgeon to give proper and safe position to the patient -Some tables are designed for specific type of operation but most are made as an all purposes

8. THEATRE TECHNIQUE -1-Surgical scrub technique -2-Gowning and Gloving POSITION OF PATIENT USED FOR SURGERY -Supine, Dorsal, Recumbent position – used for operation of Eye ear, Face, chest, abdomen, Breast, legs, feet and hands -Lateral position – is used for operations on Kidney, liver, & Hip Lithotomy position is used for operations on external Genitalia Vagina, and in anal infection -Prone position – is used for posterior cerebellar and spine operations PREPARATION OF THEATRE EQUIPMENT AND SUPPLIES Theatre Cleaning Cleaning is a process which physically removes organic matter but does not necessarily destroy micro-organism

9. DAILY ROUTINE CLEANING -Operation heater is closed at least one hr before operations are started. -The floor is cleaned when ever it gets dirty. -It is also cleaned at the end of the days work. -Ideally the floor is cleaned with machine with scrub and suction dries CLEANING BETWEEN CASES -Area which is contaminated or dirty have to be cleaned -If blood spills on the floor it is covered by 1% Hypochloride solution for 10 minutes, then it is moped away DAILY CLEANING AT THE END OF THE DAY Routine cleaning is the same, but attention should be paid to the wall

10. WEEKLY CLEANING -The floor is washed & cleaned after removing all the equipment and furniture from the theatre CLEANING OR AFTER FINISHING INFECTED CASES -Routine cleaning is carried out -Fumigation should be done either with the Formalin vapour or Hypochloride spray. -In case the patient had an infection that can be transmitted through the blood, then all linin and instruments are soaked in 1% Hypochloride solution before washing DEEP CLEANING -This is a six-monthly programmed cleaning of the clinical area of the theatre departments which will be undertaken by a dedicated “Deep clean team” -This cleaning includes all the patient's areas, preparation room, ceilings, and walls etc. -Nonclinical areas such as storerooms and offices will receive a yearly clean -The deep clean Programme will be drawn up in the consultation with “cleaning managers”, Facilities staff, Infection control team and theatre manager

11. PREPARATION OF EQUIPMENTS FOR STERILIZATION -Instruments are prepared on a metal tray which is covered by a large drape which is secured to the rim of the tray CLEANING AND CARE OF INSTRUMENTS -Instruments must be thoroughly washed either by hand or by using a “sonic washer "This is paid (applied) to joint and grooves of instruments INSTRUMENTS AND DIFFERENT TYPE OF DISINFECTION -The precise type of disinfection depends on the type of instruments. medical devices, equipment and surgical materials are divided into three general categories depending on the potential risk of infection CRITICAL ITEM -These are instruments or objects that are introduced directly into the blood stream or into other normally sterile areas of the body e.g cardiac catheter

12. SEMI CRITICAL ITEMS -These instruments are introduced into body cavities and therefore come into contact with intact mucous membranes, but do not ordinarily penetrate body surfaces e.g endotracheal tube NON-CRITICAL ITEMS -These are items that do not ordinarily penetrate, but touch only intact skin, such items includes crutches, bed board, blood pressure cuff INSTRUMENT PREPARATION -Clean all the instruments and material prior to sterilization -Dirt, Blood and all contamination should be completely removed as they comprise sterilization -Always soak instrument in water and detergent immediately is done to remove blood and human body fluids -Rinse instruments thoroughly after washing to remove any residue from the cleaning agents -Dry instruments should be packed in towels loosely

13. METHODS OF STERILIZATION HEAT STERILIZATION MOIST HEAT METHOD -An autoclave provides moist heat under pressure which achieves temperature higher than that of the Boiling point of Water -Autoclave is used to sterile most of the equipment in common use like dressings, metal wire, and instruments -Dressings should be wrapped in a paper or cloth Glassware should be packed individually -Rubber gloves wrapped in glove covers or paper -Rubber catheter, suture, and treatment trays should be wrapped in paper or muslin cloth -Here the sterilization is done in Hot air oven at 1600-degree centigrade for one hour. It is usually fitted with internal Fan to provide an even distribution of heat DRY HEAT

14. -REQUIREMENT OF HEAT STERILIZATION Item , time , and minute -Glassware 60 minutes -Instruments 60 minutes -Wooden articles 60 minutes -Suture Needles 60 minutes -Syringes 75 minutes -Needles 120 minutes STEAM AND FORMALDEHYDE -Low temperature steam with formaldehyde autoclave can be used to sterilize heat labile material such as Plastic and anesthetics SATURATED STEAM UNDER PRESSURE -The Flash sterilizer is frequently used in the operation theatre for urgently needed unwrapped instrument. -The Temperature used is 270 degree for a period of 3 – 10 mi cycle

15. COLD STERILIZATION METHODS OF STERILIZATION GAMMA IRRADIATION -Gamma rays ionizing radiation can be used commercially for sterilization of a wide range of articles such as SUTURE SYRINGES, SYRIGES NEEDLES, CATHETERS , and dressing material ETHYLENE OXIDE -This is a colorless liquid with boiling point with a 10.70 degree centigrade and it is highly inflammable and explosive. It is specially used for sterilizing anesthetic machine, sutures, and dental equipment etc. PASTEURIZATION -It is a method of low temperature disinfection particularly used for “endoscopic instruments”. -The cleaned instrument is totally immersed in an electrically heated water tank at 75-degree foe at least 10 minutes

16. BOILING -Each instrument should be totally immersed in a container of distilled water and boil for 5 minutes, at a temperature of 90 to 100-degree Celsius SUTURE -A stitch or row of stitches holding together the edges of a wound or surgical wound PURPOSE OF SUTURE -To hold a wound edges together in a good apposition until such time that the natural healing process is sufficiently well established to make the support from the suture CHOICE OF SUTURE MATERIAL Choice depends on -Properties of suture material -Absorption rate -Size of suture -Type of needle -Handling characteristics of knotting properties

17. NATURAL SUTURE MATERIAL -It is Non-Absorbable -Silk -Linin Stainless steel wire SYNTHETIC SUTURE MATERIAL ABSORBABLE -Polyglycolic acid -Polyglactin -Polydiosone NON-ABSORBABLE -Polyamide (Nylon) -Polyester (Dacron)

18. -NEEDLE POINT FIVE POINTS OF NEEDLE POINTS ARE IN COMMON USE -Conventional cutting needle -Reverse cutting needle -Blunt point needle -Straight -1/4 circle -3/8 circle -1/2 circle -5/8 circle -Half curve -Half curve at both end THERE ARE SEVERAL SHAPES OF SURGICAL NEEDLES, THESE INCLUDE