PRINCIPLES OF OPERATING THEATRE DESIGN.pptx

A brief overview of operating theatre design for surgical residents and students.

1. PRINCIPLES OF OPERATING THEATRE DESIGN JOS UNIVERSITY TEACHING HOSPITAL DEPARTMENT OF SURGERY PRESENTER DR. ABDULLAHI ISMAILA REGISTRAR JULY 13, 2024 MODERATOR: DR. STANLEY AKUBUKO

2. OUTLINE Introduction History Statement of surgical importance Principles of operating theatre design Factors affecting operating theatre design Operating theatre design team Categories of operating theatre 13/07/2024 2

3. OUTLINE 2 Architecture of the operating theatre Zones of the operating theatre Doors, floor, walls and ceilings, roof and lighting of the operating theatre Air-conditioning and ventilation in the operating theatre Operating room equipment Scrub room Anaesthesia induction room Recovery room Sluice room CSSD 13/07/2024 3

4. OUTLINE 3 Safety measures in the operating theatre Asepsis in the operating theatre Operating theatre management Current trends Local challenges Conclusion References 13/07/2024 4

5. INTRODUCTION The Operating Theatre (OT) is a facility within a hospital where surgical operations are carried out in an aseptic environment The modern operating theatre, safety checks, accepted theatre etiquette and theatre instrument sterilization process have made a significant positive impact on outcomes after surgery Operating room (OR) means one surgical room Surgical suite the entire surgical facility including operating rooms, anaesthetic room, scrub room, and a disposal room 13/07/2024 5

6. HISTORY Historically, operating theatres were designed to encourage large audiences of observers Surgeons often wore their outdoor clothes and no consideration was given to sterility The outcomes of surgery were therefore less than satisfactory In 1884, Gustav Neuber implemented a comprehensive set of restrictions to ensure sterilization, use of gowns, caps and shoe cover Sterilization was initially done adjacent to the operating room In 1890, surgical gloves were introduced by Williams Halstead 13/07/2024 6

7. HISTORY 3 13/07/2024 7

8. HISTORY 4 13/07/2024 8

9. STATEMENT OF SURGICAL IMPORTANCE A basic knowledge of the principles of theatre design, theatre etiquette and sterilization are important for surgeons, aiding them to preserve the sterile field, and hence ensure an improved outcome for the patient. 13/07/2024 9

10. PRINCIPLES OF OPERATING THEATRE DESIGN 2 Asepsis Safety Efficiency Access Should be Cul -De Sac Good lighting 13/07/2024 10

11. PRINCIPLES OF OPERATING THEATRE DESIGN 2 Adequate ventilation system Adequate temperature control The operating suite should include well defined areas or zones 13/07/2024 11

12. FACTORS AFFECTING OPERATING THEATRE DESIGN Type of hospital Type of specialties Available funds Patients turnover No. of Surgical beds No. of Surgeons Number and nature of elective and emergency surgery anticipated Number of operations per day Expected turn over interval in OT Estimated time for cleaning between operations 13/07/2024 12

13. OPERATING THEATRE DESIGN TEAM Architect Surgeon, anesthetists and theatre nurses Civil engineer Electrical engineer Mechanical engineer Information Technologists. Interior Designers. Environmental Specialists 13/07/2024 13

14. CATEGORIES OF OPERATING ROOMS The American college of surgeons (ACS) describe OR facilities based on the types of procedures performed. The criteria include minimal floor space, types of anesthetic used, and space circumferential around the OR bed. Procedure room: 150 square feet floor area with 12 feet minimum clear dimensions at the head, sides, and foot of the OR bed. Minor procedures under LA General OR: 250 to 400 square feet floor area with 15 to 18 feet minimum clear dimensions at the head, sides, and foot of the OR bed. Local, General and regional anesthesia are used here. Other OR: 600 to 650 square feet with a 24 to 25 foot width and accommodate multiple ceiling-mounted booms, monitors and high-technology equipment such as robotics and controlling consoles. 13/07/2024 14

15. CATEGORIES OF OPERATING ROOMS 2 Based on Sterility Ultra sterile (CTVS, Transplant OT) Sterile Septic Based on construction Modular Non-modular (conventional) Based on timing of surgery: Routine Emergency 13/07/2024 15

16. ARCHITECTURE OF THE OPERATING THEATRE Location of the OT All ORs in an OT complex Away from general traffic, at a terminal part of the hospital In close relation and with accessibility to: Emergency, Blood bank, Radiology, Intensive care unit, Central sterile supply department, Laboratory, Casualty Away from incineration area or refuse disposal area Designed to have 4 zones based on level of contamination 13/07/2024 16

17. ARCHITECTURE OF THE OPERATING THEATRE 2 Location of the OT All OTs in an OT complex Away from general traffic, at a terminal part of the hospital In close relation and with accessibility to: Emergency, Blood bank, Radiology, Intensive care unit, Central sterile supply department, Laboratory, Casualty Operating room Scrub room Recovery room Sluice room CSSD Others 13/07/2024 17

18. ZONING IN THE OPERATING THEATRE Minimizes risk of hospital infection in the operating room Minimizes unproductive movement of staff, supplies and patients Ensures smooth work flow Reduces hazards in the operation suites Ensures proper positioning of the equipment Ensures optimum utilization of the operation suites 13/07/2024 18

19. ZONES OF THE OPERATING THEATRE There are four zones in operation theater: Protective Zone – theatre entrance Changing rooms Reception area Holding/Waiting area Trolley bay/Transfer area OT attire not mandatory in this area 13/07/2024 19

20. ZONES OF THE OPERATING THEATRE 2 Clean zone – theater complex outside the operating area Sterilization area Pharmacy/Store area Preoperative area/room Post operative recovery area/room ICU OT Staff & Doctor’s rooms Maintenance workshop OT attire ± facemask 13/07/2024 20

21. ZONES OF THE OPERATING THEATRE 3 Sterile zone – operating area Operating suite Sterile preparation area Scrub station/room Gowning/gloving area Anaethesia induction area Full OT attire mandatory in this area 13/07/2024 21

22. ZONES OF THE OPERATING THEATRE 4 Disposal zone – all exposed instruments (used or unused), pathological specimens,, suction jars, soiled linen are passed from the theatre to disposal corridor & returned for changing, sterilizing or any other necessary procedure. Disposal Corridor Janitor’s Closet Sluice room Separate exit for contaminated/used linen and instruments Full OT attire mandatory in this area 13/07/2024 22

23. ZONES OF THE OPERATING THEATRE 5 13/07/2024 23

24. THE OPERATING THEATRE - DOORS Doors should be wide (4 ft at least) for ease to moving patients on carts and beds Ideally, sliding doors should be used exclusively in the OT for the main corridor They eliminate the air currents caused by swinging doors Microorganism that have previously settled in the room are disturbed with each swing the door. Closed doors decrease the mixing of air within the OR with that in the corridors, which may contain higher microorganism count 13/07/2024 24

25. THE OPERATING THEATRE - FLOORS The most common flooring used is seamless polyvinyl chloride Continued up the sides of the wall for 5 to 6 inches and welded into place Antistatic to minimize danger of static electricity These material should not degrade or stain with age and cleaning Metal oxides can be incorporated to decrease the slipperiness of the surface when wet 13/07/2024 25

26. THE OPERATING THEATRE - WALLS Finishes of all surface materials should be: hard, nonporous, fire-resistant, waterproof, stainproof, seamless, non-reflective, and easy to clean Walls should be pastel color, with paneling made of hard vinyl material that is easy to clean and maintain Seams should be sealed with a silicone sealant Laminated polyester or smooth painted plaster provides a seamless wall 13/07/2024 26

27. THE OPERATING THEATRE – WALLS 2 Medical gas pipelines ( anaethetic gas, oxygen, air, suction) Usually fitted and delivered via these walls Power outlets - for electro-medical equipment needed for life support and for performing surgery are fitted to the walls Sparkless electrical outlets at least 5 ft. from the floor 4 power outlet should be provided on every wall of OT Near Anaesthetist , 6 power outlets should be provided All these outlets should be on UPS Other accessories – wall clock, monitors, board/check list 13/07/2024 27

28. THE OPERATING THEATRE - ROOF The height of ceiling depends on the amount and types of ceiling- mounted equipment Minimum 10 feet high Seamless construction The ceiling color should be white to reflect at least 90% of the light in even dispersion Used to mount device and equipment in an effort to reduce clutter on the floor 13/07/2024 28

29. THE OPERATING THEATRE – GENERAL LIGHTING Generally OR is furnished with static ceiling light and mobile (operating) spotlight Most room lights are white fluorescent, but they may be incandescent Lighting should be evenly distributed throughout the room without harsh shadows The anesthesia provider must have sufficient light, at least 200 foot- candles, to adequately evaluate the patient’s color 13/07/2024 29

30. THE OPERATING THEATRE – OPERATING LIGHT Make an intense light, within a range of 2500 to 12,500 foot- candles (27,000 to 127,000 lux), into the incision without glare on the surface The light should be equipped with an intensity control with a minimum of four brightness levels The ratio of intensity of general room lighting to that at the surgical site should not exceed 1:5 (preferably 1:3), to minimize eye fatigue Should give contrast to the depth and relationship of all anatomic structures Lights should be freely movable both in horizontal and vertical ranges 13/07/2024 30

31. THE OPERATING THEATRE – OPERATING LIGHT 2 Halogen lights produce less heat and hence preferred Heat absorbing reflectors or filters should be available Intraoperatively the lighting should not cause the organs to appear discolored A reverse light should be available Auxiliary light for a second surgical site is often beneficial 13/07/2024 31

32. THE OPERATING THEATRE – OPERATING LIGHT 3 13/07/2024 32

33. OPERATING ROOM 13/07/2024 33

34. OPERATING ROOM 2 13/07/2024 34

35. OPERATING ROOM 3 13/07/2024 35

36. AIR HANDLING UNIT (AHU) IN THE OPERATING THEATRE The AHU is used to achieve heating, air-conditioning and ventilation (HVAC) in the operation theatre It regulates the temperature, humidity, pressure and controls the flow of air in and out of the theatre Components: heater, cooler, humidifier, filters (HEPA - efficiency 99.97% down to 0.3 microns or higher), fans Air is delivered via vertical laminar airflow, in a unidirectional fashion Air change of 10-20/hour should be maintained 13/07/2024 36

37. AHU IN THE OPERATING THEATRE 2 100% fresh filtered air delivered through terminal HEPA filters which flows in 2 directions in high velocity (25 – 35 FPM) Vertically downwards(on the OT table) and then horizontally outwards Positive pressure (minimum 2.5 Pa ) in the OT ensures airflow from clean to contaminated areas to eliminate risk of infection High relative humidity should be maintained between 20% and 60% (55% ideal) Humidity in excess of 70% can permit condensation inside sterile packaging OT temperature is maintained within a range 18 o C – 21 o C 13/07/2024 37

38. AHU SCHEMAMATIC DIAGRAM 13/07/2024 38

39. AHU 13/07/2024 39

40. VERTICAL LAMINAR AIRFLOW SYSTEM 13/07/2024 40

41. VERTICAL LAMINAR AIRFLOW SYSTEM 2 13/07/2024 41

42. OPERATING ROOM EQUIPMENT The operating table in the center of the room can be raised, lowered, and tilted in any direction The anesthesia machine is at the head of the operating table. This machine has tubes that connect to the patient to assist in ventilation during surgery, and built-in monitors that help control the mixture of gases in the breathing circuit. An electronic monitors (which records the heart rate and respiratory rate by adhesive patches that are placed on the patient's chest) Others: Pulse Oximeter, Automated BP Machine 13/07/2024 42

43. OPERATING ROOM EQUIPMENT 2 The anesthesia cart is next to the anesthesia machine. It contains the medications, equipment, and other supplies that the anesthesiologist may need. The sterile instruments tray to be used during surgery are arranged on a stainless steel table An electrocautery machine uses high frequency electrical signals to cauterize or seal off blood vessels and may also be used to cut through tissue with a minimal amount of bleeding Specialized equipment e.g., Heart-Lung Machine 13/07/2024 43

44. OPERATING ROOM EQUIPMENT 3 Sitting stools and standing platforms that safely stack to give additional height to the user IV poles for IV solution bags. The anesthesia provider may clip the upper drapes to the IV poles Others: Suction machine, Endoscopy equipment, C-Arm-fluoroscopy machines, Surgical instruments, Respiratory ventilators Power switches: Away from Operating area 13/07/2024 44

45. OPERATING ROOM EQUIPMENT 4 13/07/2024 45

46. SCRUB ROOM Area for hand/forearm washing before surgery One scrub room per OR should be provided near the entry At least 2.1m wide The working height of scrub station is 96 cm with water source 10 cm higher If possible gowning area should also be provided Photo-electric cell operated wash basin, so that there is no body contact Hot and Cold running water Non-splashing tap with splash limiting basins 13/07/2024 46

47. SCRUB ROOM 2 13/07/2024 47

48. ANAESTHESIA INDUCTION ROOM Located next to the operation room Standard site for induction of anaesthesia before transfer to the OR Suitable for holding patients prior to operative procedures at times when the OR is not available Anaesthesia machine, drugs, equipment, gas etc. should be readily available 13/07/2024 48

49. RECOVERY ROOM Equidistant from all theatre suite and the ICU Trained recovery staff (one-to-one) Vital sign monitors, Oxygen supply, Mechanical suction Immediate access to drugs and equipment Angle poise lamp/trolley Stationary for investigation forms Wash hand basin with hot and cold running water Patient Screen 13/07/2024 49

50. SLUICE ROOM Soiled utility room – set aside for collection, cleaning and disinfection of soiled equipment Requirements in the sluice room Hand washbasin Flusher disinfector Here urine bottles, toilet buckets etc. are placed into the flusher disinfector that will clean and disinfect the receptacles Clean Storage area Disinfected items that are not to be used immediately are stored Cupboards or racks are use 13/07/2024 50

51. CENTRAL STERILE SUPPLY DEPARTMENT (CSSD) An integrated place in hospitals and other health care facilities designated for sterilization Usually situated in close proximity with or within the OT Critical equipment are sterilized as they come in contact with blood stream or sterile regions of the body Mostly steam sterilization using an autoclave at (121°C -132°C) is used 13/07/2024 51

52. OTHER ROOMS IN THE OPERATING THEATRE Pharmacy/store room Holding area Seminar room Laboratory room Administrative room One toilet/seven members of theatre staff Shower cubicle Storage cabinets for personal items 13/07/2024 52

53. SAFETY MEASURES IN THE OPERATING THEATRE Fire safety: Fire/smoke detectors, Fire hydrants & extinguishers, Sprinklers Electricity safety Power supply: Uninterrupted (UPS) and generator back up Anti-static floors Earthing: All electrical equipment (safety) Self limiting circuit and functional fuses Emergency exit doors 13/07/2024 53

54. SAFETY MEASURES IN THE OPERATING THEATRE 2 OR staff safety Non-slippery floor Safety box for sharps Non-permeable theatre clothes and aprons Anti-static boot (above the ankle boot) Face shield should be used All appliances must be secured, not exposing any wire. Good and efficient surgical instruments 13/07/2024 54

55. SAFETY MEASURES IN THE OPERATING THEATRE 3 Patient safety Theatre design in zones is built to reduce the risk of infection Good lighting to reduce risk of injuring adjacent structures Laminar flow of air to reduce contamination Induction room is designed separate from the operating room so as to reduce anxiety in the patients. 13/07/2024 55

56. ASEPSIS IN THE OPERATING THEATRE One day in a week should be given for maintenance of OT Swabs should be taken away from areas of OT Air-conditioning and filters of OT should be checked regularly Adequate pressure should be maintained all the time Operating staff having infection should not be permitted in OT Sterilization of mobile equipment and operation table should be ensured 13/07/2024 56

57. ASEPSIS IN THE OPERATING THEATRE 2 Regular cleaning policy Preparatory Cleaning An hour before the beginning of the first operation every theatre day Operative Cleaning Areas contaminated by organic spillage during the operation are immediately cleaned Intermediate Cleaning General clean up OT room in between procedures Terminal Cleaning After completing list, OT cleaned, used items removed, fumigated 13/07/2024 57

58. OPERATING THEATRE MANAGEMENT This is done by a manager who oversees that: Promote high standard of asepsis Ensure maximum standard of safety for patient and staff Ensure optimum utilization of operation theatre and its staff Ensure optimum conditions of work for surgical and supporting team Ensure comfortable treatment of patients 13/07/2024 58

59. OPERATING THEATRE MANAGEMENT 2 Theatre management team should regularly review utilization, cancellations, late starts & waiting lists. Responsible for clear communication Ensures suitable equipping of all theatres 13/07/2024 59

60. CURRENT TRENDS 13/07/2024 Advances in technology now support hybrid operating rooms which integrate diagnostic imaging systems such as MRI and cardiac catheterization into the operating room Integrated operating rooms feature functionally integrated surgical systems that combine lighting, audio, video, and operating equipment in a single, centrally controlled unit to improve surgical efficiency Overhead lights can be fitted with cameras to enable recording, or clinical imaging for data collection or teaching Mobile operating theatre is a concept of having a fully equipped and fully functional operating theatre, which can be transported from one place to another 60

61. LOCAL CHALLENGES Lacking minimum standard requirements Inadequate operating rooms, equipment and staffing Ill-defined zoning in the theatre Poorly equipped waiting/holding area Lack of UPS Lack of availability of theatre based scrubs/attire Prolonged patient-out to patient in time 13/07/2024 61

62. CONCLUSION The implementation of proper operating theatre design, management and maintenance is paramount in ensuring safe surgery and improving patient outcome. 13/07/2024 62

63. REFERENCES Bailey and Love’s Short Practice of Surgery. CRC Press. 27ed. 2018 Booth C. Operating room principles: environment. In: Porteous M, Bauerle S (eds), Techniques and principles for the operating room. Stuttgart: Thième , 2010: pp 45–56. Boyers SP. Operating room setup and instrumentation. Clin Obstet Gynecol. 1991 Jun;34(2):373-86. doi : 10.1097/00003081-199106000-00021. PMID: 1831075. E. Q. Archampong , S. B. Naaeder , B. Ugwu. Baja’s Principles and Practice of Surgery (Including Pathology in the Tropics. Repro India Ltd. 5 ed. 2015 13/07/2024 63

64. THANK YOU 13/07/2024 64