ot & protocols

1. Moderator: Dr.K.S.Dhillon
HOD, Dept. of Gen. Surgery
Max super speciality Hospital,
Mohali, Punjab
Presenter : Dr. Asif Mian Ansari
DNB resident
Dept. of General Surgery
Max hospital, Mohali

2. OperationTheater
Room used by surgical and anesthesia team to carry out
surgeries

3.  Should have unidirectional flow movement
 Should have One entry and One exit
 No criss-cross of the movement inside the OT complex
 Double door airlock should be at the entry and exit of the OT
Complex
 OT should be linked to the Dirty corridor through Pass
Box/Hatch Box
 Pre-OP and Post-OP Rooms should be placed as such that
there will not be any criss-cross of the Pre and Post OP patient

4.  ZONE 1– PROTECTIVE:
 Reception,Waiting,Trolley Bay, Change Rooms, Rooms for
administrative staff, Stores & Record and Conference Room
 ZONE 2– CLEAN AREA:
 Pre Operative, Post Operative, Plaster Room, Staff lounges, Stores
 ZONE 3– STERILE AREA:
 OperatingTheatre, Scrub Room, Anesthesia Room, Setup Room
 ZONE 4– DISPOSAL AREA:
 Dirty Utility, Disposal areas from each OT & Corridor leading to
disposal zone

5.  Most integrated function is required
 Cleanliness
 Sterile environment
 Safety of facilities, equipments and devices
 Working environment with safety of patient & staff
 Standard walls, ceiling, doors and floor parameters
 Standard airflow, temperature, pressure, humidity, electricity,
medical gas and lighting systems
 high availability of extension

6.  Scrub Room should preferably in betweenOT or at the nearby
 Should not have any toilet inside the clean area
 No toilet should be placed in the upper floor of the OT
 OT complex should have auto sliding door & with vision panel

7.  6 x 6 x 4 m (8 x 8 x 4 m for CTVS/robotic Surgery)
 Floor: 2 mm thick antistatic PVC Roll/Tile/Epoxy coating
 No sewage/drain pipe should be inside the OT
 No fire pipe and sprinkler should be inside the OT
 Anything to be fixed on wall should be flushed on the wall
 Should have preferably one hermetically sealed window &
preferably be opened towards outside the building
 Internal ducting inside OT should be of prefabricated
Aluminium insulated with Nitrile Rubber/Polyethylene

8.  Exhaust cabinet should be equipped
 Door preferably shall be Automatic Hermetically sealed
sliding door
 OT wall should be coated with antibacterial or epoxy painting
by 300 micron thickness
 Sealed Peripheral light with dimmable facility
 Laminar flow system with two mono filament polyester sheet
and terminal HEPA filter of 0.3 micron

9.  Anaesthetic Pendant
 Surgeon Pendant
 LED OT Light
 X-Ray viewer  flushed on the OT wall
 Writing Board  flushed on the OT wall
 Built in storage cabinet  flushed on the OT wall
 Pressure relief dumper  placed to the clean corridor
 Scrubber adjacent to OT/steal/hands free control (infra-
red)/manual foot

11.  Air:
 Air changes : 20 ( 4 fresh air changes )
 Velocity of 25-35 feet per minute
 Air is supplied throughTerminal HEPA (High-efficiency particulate
arrestance ) filters in the ceiling: >1 feet each side of OT table
 Unidirectional laminar flow
 Majority air return should be picked up 75-150 mm above floor level
 Every OT should have dedicated nearby AHU (air holding unit) of
more than 4500 CFM (cubic feet per minute) capacity

13.  Pressure:
 Minimum positive pressure recommended is 2.5 Pascal
 Even during non operating hours
 Temperature:
 21 +/- 3 degree C (18 +/- 2 degrees for ortho & joints replacement)
 Humidity:
 May vary 20 to 60% (ideal 55%)
 Electricity:
 5-7 kW power load per OT(7-9 kW for super speciality OT)

14. ASEPSIS
SCRUB,
GOWNING,
GLOVING
HAZARDS
ROLES OF
PERSONS
UNTRAINED
MEDICAL
PERSON

15.  Sterile team: Surgeon, assistant surgeon,
Surgical technologist
 Unsterile team: Anesthesiologist,
Circulator, Environmental services
 Three areas of operating room:
 Unrestricted : street cloths / traffic is not limited
 Semi-restricted :not allowed to everyone / wear
scrub and cap
 Restricted :proper OT room/scrub area / scrub,
cap and mask

16.  OT clothing:
 Operating room scrubs (shirt and pants) , Comfortable shoes and
shoe covers, eye protection, Hair covers , Personnel protective
equipment, mask
 Hazards in operating room:
 Chemical: anesthetics, formaldehyde, bone cement
 Biological: radiation, needle sticks, infections, surgical smoke
 Control of transmission of infection in OT room:
 Hand washing & scrubbing, personal protection, maintenance of
sterile barrier

17.  Before:
 Cut nails, remove visible soil, remove jewellery, wash hands with non
medicated soap & dry them
 Surgical scrub, cap & mask
 Chlorehexidine > iodophors > triclosan > plain soap

22.  Sterile persons  only sterile items
 Non-sterile persons  only non-sterile items
 Gloved hands should be above waist line, in front of
chest/abdomen of the self
 Fingers should be crossed preferably, to prevent reflex touch
of unsterile objects
 Unsterile person must stay 3 feet from the sterile field
 Unsterile person should not walk between two sterile areas
 An un-scrubbed person should face the sterile field when
passing by it

23.  OT is a potential source of infection
 Cleaning  as needed every day & after every operation
 Itemes are classified acc. to Spaulding classification & sent for
disinfection/sterilization
 OT sterilization methods:
 Formaldehyde fumigation
 Hydrogen peroxide + Silver nitrate solution (ecoshield)
 Aldekol
 Bacillocid rasant
 Ultraviolet radiation

24.  Formaldehyde fumigation:
▪ Stop AC, close all doors
 150 g of KMnO4 + 280mL of formalin  formaldehyde gas for every
1000 cubic feet
 Takes overnight. next day  300mL of 10% ammonia for 2-3 hours
 remaining neutralize formalin vapours
 It is toxic
 Hydrogen peroxide-11% + Silver nitrate-0.01% (ecoshield)
 Environmental friendly & non toxic
 10 % & 20 % solutions  10% cleaning & 20% to clean mop by which
cleaning is being done

25.  Aldekol:
 Formaldehyde 6%, Glutaraldehyde 6% and Benzalkonium chloride
5%.
 For 4000 cft 325 aldekol in 350 ml of water is sprayed for 30 minutes
 OT Closed for 2 hrs
 Bacillocid rasant:
 Glutaral 100 mg/g, benzyl-alkyl-dimethyl-ammonium-chloride 60
mg/ g, di-decyl-di-methyl-ammonium chloride 60 mg/g
 Fast, formaldehyde free and good cost/benefit ratio

26.  Ultraviolet radiation:
 Daily U.V. Irradiation for 12 -16 hours is recommended and is to be
switched off for 2 hrs before entering OT

27.  Swabs are collected every week  cultured on blood agar
collection areas are:
 Operation table at the head end
 Over lamp
 FourWalls
 Floor below the head end of the table
 Instrument trolley
 AC duct

28.  Modular OTs are developing continuously
 Fixed standards for OTs
 OT protocols
 Mechanical cleaning is always necessary before sterilization of
OT
 Sterilization of OT & its monitoring