WHY THE NEED FOR AN OPERATION THEATRE?
The foremost role of any surgical procedure is:
- To relieve the patient of his/her suffering not amenable to conservative management
- Achieved by the expertise of the surgeon and adequate instrumentation
To perform an operation, infrastructure is required. This infrastructure is provided by an operation theatre.
LOCATION
The location of operating room ideally should be away from a main corridor where is there is less “people” traffic. It should be in the upper stories of the building to meet the asepsis and modern air conditioning requirements. It should also have a separate wing for future expansion. Proximity to a blood 2bank, imaging, histopathology lab and intensive care unit are added advantages.
Asepsis is achieved and maintained by “zoning”. The importance of zoning cannot be over emphasized. It's role is to provide and maintain asepsis and to stop unproductive movement of staff, supplies and patients for proper positioning of equipment in OT.
The traditional zones in the operation theatre are:
- Protective Zone
- Clean Zone
- Sterile zone: The sterile zone is an area of one hundred percent sterility. It should roughly occupy about ¼ of the area of total operation theatre complex (OTC). In this area, positive pressure ventilation is maintained even when OT is not in use.
- Disposal Zone
An Operation theatre complex (OTC) may consist of 3–5 theatres. Let us see what the design of a basic operation theatre complex should be like.
The theatre complex should consist of a non-sterile area, a semi sterile area and a sterile area.
The entrance is as indicated by E. Once inside the complex there is a 6ft wide corridor for patient entry into the pre- holding area. This entry is for patients with non-infective conditions only.
Entry into the change room is via a 4ft wide corridor. This entry is done after removing footwear just outside the change room.
Referring to Figure 1.1, there are three change rooms. The dimensions of one room is about 15 × 9 sq feet and the other two about 11 × 10 sq feet. Male, female surgeons and the technicians could use these rooms.
After changing from street clothes into OT dress, the OT personnel could either enter into the 5ft corridor directly into the clean OT or through another door into minor OT for operating on infected cases. This 5 foot corridor is a semi- sterile area. Personnel wearing OT clothes, cap and mask only are allowed inside this area.
The entry into the operation theatre is through a 7 ft wide sterile corridor. The patients from the pre-holding area are brought inside the OT through this corridor.
The dimensions of the operation theatre are about 20 × 13 sq feet, which is the minimum requirement for vitreo- retinal surgery. If the Operation theatre is exclusively used for cataract or anterior segment surgeries an area of 14–15 × 13 sq feet should be more than adequate.
OT stores located within the OT complex is a sterile area. It is described later in the chapter on Central sterile supplies department.
At the far end of the OTC is the scrub area for the surgeons and the operation theatre assistants.
(The shape of the OT in the figure illustrated is for aesthetic appearance. It could even be a straight wall).
PACKING AND STERILISATION AREA
The sterilisation room is an area of 20 × 10 sq. feet. It serves as an area for decontamination and washing of instruments and for packing and sterilisation. Autoclaves, packing material, storage area, can all be housed in this location. This sterilisation area serves the purpose for all the three operation theatres.
DOORS OF THE OPERATING THEATRES
The doors of OT should be double leaf, swing doors wherever patient entry is required. The width of the doors should be a minimum of 5 feet at least. It should be washable. It is ideal if covered in the lower half by up to 1.25 metres with material made of rubber or poly vinyl chloride. The most desirable location of the main access door would be on patient's left and on the head side of the patient.1
The door panel should be manufactured from a non-organic core faced with hard plastic laminate framed with flush aluminum profile.5
The combination of a neoprene gasket and unique rail system ensures excellent sealing when closed, which helps to maintain accurate air flows reducing air handling costs, the possibility of cross contamination and the incidence of wound infections.
The doors should be easy to clean and can also be automated.
WALLS, FLOOR AND CEILING OF THE OPERATING THEATRES
The walls should be joint- less, hard, robust and impervious to dust, amenable to easy cleaning and be washable.
The floor should be non-staining, easily washable and should have copper strips or linoleum PVC (conductive flooring) in the floor. There should not be any wall mounts/shelves inside the OT-operating area, to prevent accumulation of dust and moisture. All wall mounts, if any for gas pipe lines etc., should be within reach for consistent cleaning/mopping.
Electrically conductive flooring is needed in environments where static electricity could affect the electronic equipments in the operating theatres. Static electricity is generated by various types of friction, and is everywhere in our surroundings. When the electricity is transferred between people or to objects, there is a discharge that can cause discomfort or in the worst case, damage to sensitive equipment. The electronic equipments sensitive to static electricity, which could cause both immediate and latent faults, would be manifested several years after the equipment has been put into service.6
In workplaces with sensitive equipment, measures must be taken to protect the equipment. The main protective measure to prevent the charging of people and objects is to connect them to earth, which acts as a massive uncharged receiver. It is easy to see why the flooring is an important part of this function, and why it should be constantly antistatic and electrically conductive.
The ceiling should be moisture- proof painted with washable paint with minimum fissures and open joints and curved corners
SEPTIC OPERATION THEATRES
The septic OT is about 15 × 13 sq feet and is used for infected cases. It has a separate entry for patients and also has a separate scrub. All soiled linen should be disposed into the dirty utility room via a hatch system from where it is taken outside the OT. This OT has its own linen which is colour coded to avoid mixing with linen used for non-infected cases.
PRE-HOLDING AREA
The pre- holding area is an area where the patient waits before he is wheeled into the operation theatre. In an ophthalmic set up, the same area can be made available for postoperative patients.
This area can also serve as a fully equipped ICU with a multi parameter monitor, suction apparatus, provision of an oxygen outlet, emergency equipment, endotracheal tubes and adjustable beds. Staffing in this area can include a trained nurse and a consultant/internist on call.
WARDS, ATTENDEE's ROOM, TOILETS
On the same floor as the OT complex is the space for pre and postoperative patients similar to a general ward. Provisions for semi-private, private or deluxe rooms could also be made. A floor space of about 73 × 31 sq feet can be made available for this purpose.
A space of about 10 × 20 sq.ft for dining for patients and their attendees can be made available.
There is also a nursing station, nursing superintendent's room, duty doctor's room with toilet facilities for hospital personnel and patients and their attendees separately. Provision is made for windows for adequate ventilation and lighting.