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Ot techniques
1. OPERATION THEATRE TECHNIQUES
CONTENTS
1) The surgical team
2) Preventionof infectionsinOT
3) Hazards inOT
4) Equipmentsof OT
5) Drugs usedinOT
6) Instrumentsof OT
7) Sterilisationof OT
8) Designinganideal OTroomcomplex
9) Responsibilityof anesthetist
10) Admissionof patienttotheatre
11) Positioningof patient
12) Care of specimens
13) Surgical terminology
2. THE SURGICALTEAM
A teamof surgical medical staff helpthe surgeonduringoperation.Personnels of teamdependontype
of surgery.Mostteamsinclude the followingpersonnels.
1) Surgeon:- A surgeonisas physicianwhoperformssurgical operations.Specialitiesinclude:-
Cardiac surgery,Colonandrectal,dental,transplantsurgery.
2) Anesthesiologist:- Ananesthesiologistisaphysicianqualifiedinanesthesia&perioperative
medicine.
3) Certifiedregisterednurse anesthetist:- (CRNA) A nurse anesthetistisaregisterednurse with
advancededucational credentials&significantclinicaltraining.A certifiedregisterednurse
anesthetistprovide care topatientsthatrequire anesthesiaorpainmanagementbefore
surgeriesorspecifictypesof medical procedures.
4) Operatingroomnurse:- isa registerednurse specializedinperioperativenursingpractice.
5) Circulatingnurse:- Dutiesof circulatingnurse are carriedoutside the sterile area.Circulating
nurse managesall necessarycare inside surgeryroom, assistingthe teaminmaintaining&
creatingcomfortable &safe environmentforthe patient&observingthe teamfromawide
perspective.
6) Physicianassistant:- A physicianassistantisahealthcare professional whopracticesmedicineas
a part of healthcare team withcollaboratingphysicians&otherhealthcare providers.
7) Surgical technician:- isanalliedhealth professional workingasapart of teamdelievering
surgical care.They possessknowledge insterile &aseptictechniques.
8) Residents:-A residentdoctororhouse officerisaphysicianwhopractice medicineunderthe
director indirectsupervisionof attendingphysician.
9) Medical representative:- A medical representative providesinformationaboutmedicines&
drugsavailable tothose whoprescribe medicines.
4. INFECTIONPREVENTION & CONTROL IN OT
STANDARD PRECAUTIONS:-
1) Hand hygiene
2) Personal protectiveequipments(PPE)
3) Aseptictechniques:-Preventionof needle stickinjury
4) Environmental cleaning
5) Instrumentsreprocessing.
6) Waste management
Bloodspillage management/bloodorbodyfluidpostexposuremanagement.
CDC recommendationfor preventionofSSI:-(SSI- SURGICALSITE INFECTION)
1) CategoryIA:- Stronglyrecommendedforimplementation&supportedbywell designed
experimental,clinical orepidemiological studies.
2) CategoryIB:- Stronglyrecommendedforimplementation&supportedbysome experimental,
clinical orepidemiological studies&strongtheoretical rationale.
5. 3) CategoryII:- Suggestedforimplementation&supportedbysuggestive clinical or
epidemiological studiesortheoretical rationale.
4) No recxommendation:- Unresolvedissue.Practice forwhichinsufficientevidence orno
consensusregardingefficacyexists.
CDC Recommendationfor Surgical site infection:-
1) Preoperative
2) Intraoperative
3) Postoperative
4) Surveillance
Preoperative:-
1) Preparationof patient
2) Hand antisepsisforsurgical teammembers
3) Managementof infectedorcolonizedsurgical personnel.
4) Antimicrobialprophylaxis.
Preparation of patient:-
1) Identify&treatall infectionsremotetosurgical site before electiveoperationIA.
2) Do not remove hairpreoperativerlyunlessitinterfere withoperationIA.
6. 3) If needed,remove hairimmediatelybefore operationpreferablywithelectricclippersIA.
4) Require patientstoshowerorbathe withanantisepticagentatleastthe nightbefore the
operatingdayIB.
5) Thoroughlywash& cleanat & around the incisionsite toremove grosscontaminationbefore
performingskinpreparationIB.
Hand/Forearm asepsisfor surgical team:-
1) Keepnailsshort& donot wearartificial nailsIB.
2) Performpreoperative surgical scrubforatleast2-5 minusingan appropriate antisepticIB.
3) Dry handswithsterile towels&dona sterile gowns&glovesIB.
Antimicrobial prophylaxis:-
1) Administeraprophylacticantimicrobial agentwhenindicatedIA.
2) Administerbythe IV route the initial dose notmore 1 hour before incisionIA.
Intraoperative:-
1) Ventilationsystem
2) Cleaning&disinfectionof environmentalsurfaces
3) Microbiological sampling.
Ventilation:-
1) Maintainpositive pressure ventilationinthe operatingroomIB.
2) Maintaina minimumof 15 air changesperhourwithat least3 freshairIB.
3) Do not use UV radiationinthe operatingroomto preventSSIIB.
4) Keepoperatingroomdoorsclosedexceptasneededforpassage of equipmentpersonnel &the
patientIB.
Cleaning& disinfectionofenvironmental surfaces:-
1) Whenvisible soilingorcontaminationwithbloodorotherbodyfluidsorsurfacesorequipments
occurs, use an approveddisinfectanttocleanthe affectedareabeforethe nextoperationIB.
2) Do not performspecial closingthe operationroomaftercontaminatedordirtyoperation.
Sterilizationofsurgical instruments:-
Sterilize all surgicalinstrumentsaccordingtoguidelinesIB.
Surgical attire & drapes:-
1) Wear full PPEIB
2) Surgical maskthat fullycoversthe mouth& nose
3) Cap or hoodto fullycoverhairon head& face.
4) Sterile gloves.
7. 5) Impermeablesterile gowns.
Change scrub suitswhenvisibly soiledorcontaminatedwithbloodorbodyfluidsIB.
Asepsis& surgical technique:-
1) Adhere toprinciplesof asepsiswhenplacingintravasculardevicesIA.
2) If drainage isused,use a closedsuctiondrain,insertitthrougha separate incisiondistant
fromthe operative incision&remove itassoonas possible IB.
Cleaningspillsofblood & body fluids:-
Proceduresfordealingwithsmall spillagese.g- splashes&droplets.
- Gloves& plasticapronmustbe worn.
- The area shouldbe wipedthoroughlyusingdisposablepaperroll/towels
- The area shouldbe cleanedusinganeutral detergent&warmwater.
- Recommendedconcentrationof Presept1tab in2.5 waterliterstodecontaminate surfaces.
- Usedgloves,apron/towelsshouldbe disposedinyellow wastebag.
- Wash hands.
Large blood spillsindry areas (such as clinical areas):-
- Where possible,isolatespill area.
- The area must be vacatedfor at least30 minutes.
- Wear protective equipmentlike disposable gloves,eyewear,mask&plasticapron.
- Coverthe spill withpapertowels.
- Place all contaminateditemsintoyellow plasticbagorsharpcontainerfordisposal.
- Pour(35 tab Preseptin1 waterliter) sdolution&allow 10minutesToreact thenwipe up.
- Decontaminatedareasshouldthenbe cleanedthoroughlywithwarmwater& neutral
detergent.
- Followthisdecontaminationprocesswithaterminal disinfection.
- Discard contaminatedmaterials(absorbenttoweling,cleaningcloths,disposable gloves&
plasticapron).
- Wash hands.
8. HAZARDS IN OT:-
Varietyof different equipmentsare usedbypersonnel workinginoperatingroom.Thisentailsworking
insemi-closedenvironment,comingintocontactwithdangerousmedical tools&substances.Itinclude
sharp objectse.g.- scalpels&syringes,anestheticgases,drugs&sterilizingchemicals.Thisincludesrisk
& hazards managementinoperatingroom.
Classificationof hazards:-
A surgical teammembercouldaccidentallyinjurehimself orherself duringsurgical equipment,slipsor
fallsif a wetfloor,fall fromOTtable,injury due toimproperpositioning,wrongsurgeryonpatient,
havingidentical names&paindue tolonghours of standingor handlingof patients.
Causesof hazards & safety measures:-
1) Falls/slipscauses:-
- Wet floor
- Wrong theatre shoes
- Oil spillages
- Emptypaper foils&suture wraps
- Trailingcables
- Unstable theatre shoes
Safety measuresinclude:-
- Propercleaning
- Avoidance of trailingelectrical cables
- Use of identical theatre shoes
- Careful arrangementof operatingroomequipment&furniture
- Dutiful use of kickabout& waste buckets.
- Faultyshoes& platformsshouldbe removedfromcirculation&be broughtbackonlyafter
theyhave beenrepaired.
2) Trauma causes:-
- Carelesshandlingof sharps
- Uncoordinatedspeed
- Falls
- Inexperienceof careprovider
Safetymeasures include:-
- Provision&use of disposable bagsfordisposable sharps.
9. - Careful handlingof sharps.
- Extreme care whenspeedisrequired.
3) Electrocaution causes:-
- Faultyelectrical equipment
- Poormaintenance culture.
- Wrong handlingtechniques
- Unfimiliarity
Safetymeasures:-
- Prompt& propermaintenance of equipments.
- Careful attentiontoelectrical contactswhenusedonpatients.
4) Radiation safetymeasures:- Lead shouldbe testedroutinelybyradiologydepartmentevery6
months.
- Radiationexposure: - Thisshouldbe monitoredwithfilmbadgesorpocketdosimeters,
these mustbe checkedmonthlybyradiationprotectionofficers.
5) Burns safety measures:-
- Ensure that all equipmentincludingcables,surgical instrumentation&patientplates are
fullyinsulated&that any faultyequipmentisremovedimmediately&reported asper
hospital policy.
- Alwaysensure thatelectro-surgical equipmentsare keptwithinaninsulatedcontainer
throughoutthe procedure.
6) Heat stroke causes:-
- Faultyventilationdevices.
- Overcrowding
- Presence of heatgeneratingequipmentwithinthe operativeroom.
Safetymeasuresinclude:-
- Repair& maintenance of faultyventilationdevices.
- Avoidqvercrowdingof operatingroom(OR).
- Maintainnormal operatingroomtemperature of 16-20 deg C.
7) Infectioncauses:-
- Contractingof HIV & AIDSvirus throughneedle stick,splashingof bloodcontacttothe eyes.
- HepatitisA & B & otherorganism.
- Failure tomaintainaseptictechnique.
- Poorventilation.
- Unreliable cleaning&decontamination.
- Dirtyoperationroomattire.
- Use of non-theatre equipment.
8) Infectionsafetymeasures:-
- Propermaintenance of aseptictechnique.
- Careful handlingof infected&contaminatedcauses.
10. - Standardprecautions.
- Reliable routine cleaningprogramme.
- Properventilation.
- Adequate decontamination&sterilizationof appropriate equipments/objects.
- Personal &patienthygiene.
- Identification/separationof highriskpatients.
- Utilize safe zone duringeachsurgical procedure.
- Dispose of sharpsinsharps containerimmediatelyafteruse.
- Use of PPE.
- For eye/face exposures: - Use an eye wash& rinse forabout 15 minutes.
- For a needle stick: - Washwithsoap/waterorbetadine if available.
- Reportexposuresimmediatelytohospital PEPcommitteesforproperevaluation&
recommendation.
- Employersmustensure thatthe appropriate protective equipmentsisavailable &that
employeesare trainedtowear& use it.
Air pollutioncauses:-
- Leakingof ambientgases(gaseousmixture mainlynitrogen&oxygen)
- Septiccases.
Safetymeasuresinclude:
- Gas cylindersshouldbe checkedforleakageseverymorning.
- Closedcircuitanestheticadministrationshouldbe encouragedtoreduce the theaterlevel
of composedgases.
- Checkcorrugatedtubesforleakages&recentgas leakage fromothersourcesto reduce the
theaterlevel of ambientgases.
- Avoidsparksor active fire outbreak.
- Avoidovercrowdinginoperatingroom.
- Emptywaste bucketpromptly.
- Provide adifferenttheaterforsepticcases.
- Execute anefficientcleaningtopreventrodent infestation.
- Noise shouldbe reducedtominimum.
Fire outbreaks/sparks causes:-
- Lack of trainingforthe fire precaution&fighting.
- Nakedflamesinthe theatre.
- Excessive heat.
- Lack of fire preventioninbuiltinoperatingroom.
Safetymeasures:-
11. 3 basicelementsof surgical fire constitutefire triangleswhichare:-
1) Ignitionsource:- Electrosurgical equipment,surgical laser,electrocautery,fiberopticslight
source & defibrillators.
2) Oxidisersinclude- Oxygenenrichedatmosphere nitrousoxide,medical air.
Fuelsinclude operatingtheatre materialslike mattresses,sheets,gowns,drapes&
dressings.
Oxygen Heat
Fuel(Oil)
Ways of minimizingignitionrisks:-
Duringelectrosurgerythe pencil shouldbe placedinquiverorholsterwhenitisnotinactive use & the
active electrodesshouldbe activatedonlywhenthe tipisunderthe surgeon’sdirectvision.
Eliminationof fuels:-
- Avoidthe use of flammable gasese.g.- Etherorcyclopropane gases.
- Provisionof agood ventilationsystemtodiffusethe concentrationof flammablegas,vapor
or liquid.
- Safe keepingof flammable items.
Ways of eliminatingsparks:-
- Ensuringthat the theatre floormostespecially,aroundthe operation&anestheticroomsis
spark resistant.
- Theatre flooringshouldbe of terrazzo/marble laiduponametal meshtoconductcurrents
away.
- Patientsonwhomdiathermymachine isusedmustbe adequatelyguarded.
- Avoidcreatingfrictionsontwometallicsurfaces.
- Stools,buckets,trolleys,equipmentstandsetcshouldhave antistaticproperties.
- Shoe coversor shoeswornmusthave soles& heelsimpregnatedwithnonconducive
properties.
- All electrical cordsmustbe rubbercoated.
- Avoidnakedflamesasthisliterallysetupanignition,veryhotobjectslikelights&sourcesof
heatetc shouldbe leastone meterawayfromanestheticmachine oranyflammable agent
or item.
12. - There mustbe nosmoking.
- The positionof extinguishersinthe theatresshouldbe well marked&the fire routes&
assemblypointsshouldbe knownbyall personnel.
- Regularfire drillsshouldbe done toimprove onawareness.
Ways of minimizingoxidizingrisks:-
- Duringoropharyngeal surgery,suctioningof potential breathinggasleakshouldbe done as
a meansof scavenginggasesfromoropharynx of anintubatedpatient.
- Wet gauze shouldbe usedwithuncuffedtracheal tubestominimise leakagesof gasesinto
the oropharynx of all guaze,sponges&pledgets&theirstringsshouldbe keptmoist
throughoutthe procedure torenderthemignitionresistant.
Ways of minimizingfuel risks:-
Duringskinpreparation,the surgeonshouldavoidpoolingorwickingof flammableliquidpreps(spirit
containing).The flammable liquidpreparationsshouldbe allowedtodryfullybefore draping.
Classesof fire extinguishers:-
1) ClassA fire:- Thiscomprisesof solidssuchascarbonaceousmaterialslike paperwood7their
derivatives.Itshouldbe extinguished withwater.
2) ClassB fire:- Thisinvolvesliquids&liquefiable solidse.g.oil,fat,petroleumproducts,paradingwax
etc.theyshouldbe extinguishedwithsodiumbicarbonate powder,carbondioxide,incombustible
sheetorfoam materials.
3) ClassC fire:- Thisinvolvespropane,butane,methane i.e.liquefiedgases,theyare extinguishedwith
wateror theircontainers.
4) ClassD fire:- Thisinvolvesmetals.Watermustnotbe usedinsteadCO2,dry sandshouldbe utilized.
Respondingto surgical fire during surgery:-
- If fire occur in operatingroomduringa surgical procedure,the firstconcernisthe safety of
the patient& personnel.
- To preventexplosion,the burningarticle isremovedimmediatelyfromthe proximityof
oxygensource &the anestheticmachine oroutletof pipedingases.
- The fire on the fieldissmotheredwithwettowels&burningdrapesare removedfromthe
patient.
- The shut off valvesforpipedingasesare turnedoff & electrical powercordsare unplugged.
Injury during surgery:-
A penetratinginjury(e.g.needle stick) orasplash(e.g.intothe eye mucusmembrane) withfluids,
contaminatedwithbloodobodyfluidsmustnotbe ignoredif exposure tobloodorbodyfluidsoccurs.
The followingproceduresshouldbe performed:-
13. - Stopactivityimmediately,&stepbackfrom the pointof contamination.
- Cleanse the puncture site orflushthe eye withcool water.
- Flushoutthe puncture site withalcohol oriodine preparation.
- Reportthe incidentaccordingtosecuritypolicy&procedure seekmedical attention
promptly.
- Followthe particularprotocol establishedbythe facilityforfollow up.
Safety measuresinpreventingchemical hazards:-
Improperhandlingof chemicalscanresultininjurytohealthcare workers&patients:-
- All chemical containersmusthave properlabelingindicatingcontents,safe use &associated
hazards.Thisalso appliestosecondarycontainers.
- Potential hazardsassociatedwiththe use of chemicals,inthe practice settingshouldbe
identified&the safe practicesshouldbe established.
- Injuriesmayresultfromexposuretoanyportionof the body,includingthe integumentary
or respiratorysystem.
- Perioperative staff canprotectthemselvesbyhelpingcontainers&basinstightlycovered.
Causesof deaths on OT table:-
- Preoperativepatient’scondition.
- Inexperiencedpersonnel.
- Lack of monitoringdevices.
- Cardiac arrest.
- Respiratoryarrest.
- Imbalancedanesthesia
- Severe hemorrhage.
- Prolongedanesthesia.
- Lack or resuscitativeequipments.
- Lack of resuscitative drugs.
- Discourage operationonpatientsatriskof moridity
Safety measures:-
- Good inductiontechnique
- Provisionof goodmonitoringdevices/resuscitativedrugs&equipments.
- Identifyhighriskpatients.
- Supervisionof lesscompetenthands.
- Preventionof undue bloodloss&provision forfluidlevel maintenance.
- Avoidance of undulyprolongedanesthesia&surgerytime.
Risk management:-
It consistof 4 relatedelements:-
14. 1) Administration
2) Prevention
3) Correction
4) Documentation
Administration:-
- Regulation,recommendations,guidelines&laws shouldbe enforcedtopreventdisastrous
consequencesof occupationalhazards.
- Policies&proceduresshouldbe written,reviewedperiodically&updatedasappropriate.
- Protective attires&safetyequipmentsshouldbe made availabletoemployeesas
appropriate.
- Monitoringdevicesshouldbe usedinall hazardouslocationasrecommendedbyregulatory
agencies.
- Employeeshealthservicesshouldbe providedforimmunization&inthe eventof injury.
Prevention:-
- Regularin-service trainingprogramsshouldbe conductedtokeepemployeesinformed
abouthazards & safeguardmeasures.
- Employeesshouldbe taughthow to use & care fornew equipmentsbefore it’sbeenputto
use.
- Employee mustknowthe location&use of emergencyequipmentssuchasfire
extinguishers&shutoff valves.
- Employee mustwearPPEas appropriate.
- Routine preventivemaintenance shouldbe providedforall potentiallyhazardous
equipments.
Correction:-
- Faultyor malfunctioningequipmentsshouldbe takingoutof serviceswithimmediate effect
to preventharmto the patients&users.
- Anyform of injuryshouldbe reported,withmedical attentionsoughtfor,assoonas
possible.
- Unsafe conditionsshouldbe reported.
Documentation:-
- Recordall informationaboutequipmentinthe theatre.
- A well planned orientationprogramfornewlyemployedstaff orstudentsinthe operating
room shouldbe organized.
- Incidentreportregardinginjuriestohealthcaregiver&patientsshouldbe filledinline with
the facilityprocedures.
15. EQUIPMENTS IN OPERATION THEATRE
1) Operatingtable:- Multi-purposedside controlledtable.
2) Monitors:- Monitordisplaysdifferentoutputparametersof the patientwhichhelpthe patientin
diagnosing.
ECG monitor:- An electrocardiogram records the electrical signals in heart. It's a common test
used to detect heart problems and monitor the heart's status in many situations.
Electrocardiograms — also called ECGs or EKGs — are often done in a doctor's office, a clinic
or a hospital room. And they've become standard equipment in operating rooms and ambulances.
An ECG is a noninvasive, painless test with quick results. During an ECG, sensors (electrodes)
that can detect the electrical activity of heart are attached to chest and sometimes limbs. These
sensors are usually left on for just a few minutes.
-
16. Other monitors:-
- Pulse oximetry:- an oximeter that measures the proportion of oxygenated
haemoglobin in the blood in pulsating vessels, especially the capillaries of the finger
or ear.
-
17. - Bloodglucose monitor:- A blood glucose meter is a small, portable machine that's used to
measure how much glucose (a type of sugar) is in the blood (also known as the blood
glucose level). People with diabetes often use a blood glucose meter to help them manage
their condition.
3) Anestheticmachine:- Assisstspatientsbreathingduringsurgery.
18. 4) Heart lungmachine:- A machine thattemporarilytakesoverthe functionof heartandlungs,
especiallyduringheartsurgery.
19. 5) Surgical ceilinglight:- Surgical lightisamedical device intendedtoassisstmedical personnel
duringa surgical procedure byilluminatingalocal area or cavityof the patient.
27. Formaldehydekills the microbesbyalkylatingthe aminoacids& sulfydral groupof protiens
& prine bases.
Inspite of the gas beinghazardouscontinuestobe usedinseveral developingcountries.
Fumigationusuallyinvolvesthe followingphases- Firstthe areatobe fumigatedisusually
coveredtocreate a sealedenvironment,nextthe fumigantisreleasedintothe space tobe fumigated,
thenthe space is heldfora set periodwhilethe fumigantgaspercolatesthroughthe space & acts on&
killsanyinfestationinthe product,nextthe space isventilatedsothatthe poisonousgasesare allowed
to escape fromthe space & renderitsafe forhumansto enter.
Procedure of fumigation:-
1) Thoroughlycleanwindows,doors,floor,walls&all washable equipmentswithsoap&water.
2) Close windows&ventilatorstightly.If anyopeningsfound,seal itwithcellophane tape orother
material.
3) Switchof all light, A/C& otherelectronicitems.
Personal care during fumigation:-
1) Adequate care mustbe takenby wearingcap,mask,footcover,spectacle.
2) Formaldehydeisirritanttoeye & nose & ithas beenrecognisedasapotential carcinogen.So
the fulmigatingemployeemustbe providedwiththe personal protectiveequipments.
Creatingthe formaldehyde gas:-
28. Electricboilerfumigationmethod:- Foreach1000 Cu.feetof the volume of operationtheatre 500
ml of formaldehyde (40%solution) addedin1000 ml of water inan electricboiler,leave the room&
seal the door.After45 minutes(variabledependingtovolume presentsinthe boilsapparatus)
switchoff the boilerwithoputenteringintothe room.
Methodsof fumigation:-
1) In principle,we have togenerate formaldehyde gas.
2) Can be done by mosteasierwayto mix the neededquantityof formalintowater&heatingat
lowertemperaturesat80 degC to 90 degC.
Can be done alsowithadditionof formalintopotassiumpermangnate.
Addingpotassium permangnate to formaldehyde:-
- Potassiumpermangnate method:-Forevery1000 cu. feetadd450 gm of potassium
permangnate (KmnO4) to500 ml of formaldehyde (40% solution).Take about5-8bowels(
heatresistant: place itin variouslocations)withequallydividedpartsof formaldehyde&
add equally dividedKmnO4toeachbowel.Thiswill cause autoboiling&generate fume.
- Afterthe initiationof formaldehydevapor,immidiatelyleavethe room& seal itatleast48
hours.
Fumigationto be neutralized:-
- Neutralize residualformalingaswithammoniabyexposing250 ml of ammoniaperliterof
formaldehydeused.
- Place the ammoniasolutioninthe centerof the room& leave itfor3 hours to neutralize the
formalinvapor.
An example :-
- Operationtheatre Volume =LXBXH= 20X15X10=3000 cu feet.
- Formaldehyderequiredforfumigation=500 ml for1000 cu feet.
- =So 1500 ml of formaldehyderequired.
- Ammoniarequiredforneutralization=150 ml of 10% ammoniafor500 ml of formaldehyde.
- = So450 ml of 10% ammoniarequired.
Needfor newerchemical agents in hospital use:-
1) A needfornonaldehyde basedchemicalsisgrowingconcern.
2) Needforqickersterilizationmethodswitheverincreasingworkloads.
3) Needfornontoxicsafe agents.
Care of self& surroundings:-
29. - Theatre dress(includesheadcap,mask,apron,chapel shouldbe made available forall
personswhoare enteringintothe operationtheatre (surgeons,anasthetist,microbiologist
team, theatre assisstants&helper)
- Surroundingsshouldbe clean&free fromgarbage,opendrainage,bushes,shrubs,wastes.
Do not keepanymaterial whichare notnecessaryforoperationtheatre procedures.
- Operationtheatre shouldbe cleaned&fumigatedasthe prevailingconditionsof workload.
- Dependsonsepticcaseshandledinthe theatre.
Safety ofair conditioning& water coolingsystems:-
- Legionairesdisease isassociatedwithairconditioningsystem.
- Chlorination/Heatingof watermayprove betteralternatives.
Betweenproceduresinthe operationtheatres:-
- Cleanoperationtables,theatre equipmentwithdisinfectantsolutionwithdetergent.
- In case of spoilage of blood/bodyfluidsdecontaminate withbleachingpowder/chlorine
solution(10%available chlorine).
- Alwaysdiscardwastesinprescribedplasticbags- don’taccumulate biohazardwasteinthe
operationtheatres.
- Don’tdiscard soiledgownsinoperationtheatre.
At the endof the day in operationtheatre:-
- Cleanall the table topsinks,doorhandleswithdetergent/lowlevel of disinfectant.
- Cleanthe floorswithdetergentsmixedwithwarmwater.
- Finallymopwithdisinfectantlike Phenolinthe concentrationof 1:10.
- Low concentrationof Phenol serveasperfume ¬as disinfectant.
INFECTIONCONTROL PROGRAMS:-
1) Monitoringof hospital associatedinfections.
2) Trainingof healthcare workers.
3) Investigationsof outbreaks.
4) Anytechnical lapses.
5) Monitoringof staff health.
6) Educationof universal precautions.
7) Advise onisolationof infectiouspatients.
8) Waste disposal
9) Safetyuse of anticbiotics/antibioticpolicy.
ROLE OF MICROBIOLOGYDEPARTMENT:-
- Identifiesthe pathogens.
- Monitoringof antibiotictherapy.
30. - Educationof specimencollection&transportation.
- Informationonantibiogrampattern.
- Data on hospital infection.
- Surveillance of the hospital environment.
- Counsellingof the hospital staff.
SLIT SAMPLER:-
- Very effective/highlysensitive.
- Fixedvolume of airissucked&bacterial countsare made.
SURVEILLANCE OF OPERATION THEATRE
EXAMINATION OFAIR:-
- Estimationsare done fordetectionof bacteriacarryingparticlesinair.
- Factors influence numberof personspresent,bodymovements,disturbancesof clothing.
METHODS OF AIR SURVEILLANCE:-
- Settle plate method.
- Slitsamplermethod(fromgivenvolume)
- Countsvary frommanysettle plate method.
- Recordposition- Time- Duration
Plateswithmediaasbloodagar exposed forspecifiedperiod&incubatedinthe
incubatorfor24 hoursat 37 deg C.
HOW MANYBACTERIA ARE PATHOGENIC:-
- Countsvary onnumberof personal presentinthe givenarea.
- Behaviourof persons.
- Dependonnature of procedures,type of operations.
- Varyingranges.
- But only1% are pathogenic.
- Presence of S.aureusmakesdifference.
SURVEILLANCE FOR ANAEROBIC SPORES:-
- The age oldtraditionof detectionof anaerobicsporesof Cl.tetani &othergas gangrene
producingsporesinthe operationtheatre &closingthe theatresislosingrelevancewith
changingunderstanding&newerconcepts.
- Routine ®ulartestingforanaerobicsporesisnotessential exceptwhentherewas
suspected case of tetnusor gas gangrene attributedtooperatinginparticularoperation
theatre.
IDEAL TO SURVEY FOR ANAEROBES:-
31. - It isideal tosurveythe operationtheatresforanaerobeswhenoperatinginnewly
constructedor afterremodelling&structural alterationsare done.
- In these circumstancessurveillancewillincreasesafetyof the theatres.
DO WE NEED SURVEILLANCE REGULARLY:-
- Bactteriological surveillance testingatregularintervalsisnotwarranted.
- But warrantedwhenmodificationof operationtheatresisdone.
- In anyunforeseenincrease of incidence of infectionfromanyparticularoperationtheatre.
FACTORS WHICH INFLUENCESAFETY IN HOSPITAL ENVIRONMENT:-
- Operationtheatre- Discipline:-
1) Onlypeople absolutelyneeded foranassignedworkshouldbe present.
2) People presentintheatre shouldmake minimalmovementsin&out of theatres,whichwill
greatlyreduce bacterial count.
3) Airborne contaminationisusuallyaffectedbytype of surgery,qualityof airwhichinfact
dependsonrate of air exchange.
Every body partners in infectioncontrol:-
- All personsincludingthe leastcadre of employersare partnersininfectioncontrol
regulations.4promptdisposal of theatre waste outof theatre isof top priority.Anyspillage
of bodyfluidsincludingbloodonthe floorsishighlyhazardous&prompts the rapid
multiplicationof nosocomial pathogensinparticularPseudomonasspp.
The Followingprecautionshave greatly reducedthe rates of infection:-
- Everyhospital mustconstitute infectioncontrol committee tomonitorthe eventsinthe
hospital,onall mattersrelatedtocontrol of infections.
- The entryof unnecessarypersonnel tobe restrictedtooperationtheatreaseveryone
contributestoinfection.
- A thoroughwashingwithwarmwater& gooddetergent&carbonizationcanbringoverall
improvementthanmere fumigation.
STERILIZATION & DISINFECTION POLICIES:-
- Create yourown infectioncontrol teamwhichsuitsyourhospital.
- Infectioncontrol teamdecidesthe policies.
- Educate the staff onmethods& policiesinhospital safety&hygiene.
- Educate the staff onfewuseful options,manytheoretical ideasconfuse.
32. DESIGNING ANIDEAL OT ROOM COMPLEX:-
An operationtheatre complex isthe ‘heart’of majorsurgical hospital.Anopeartingtheatre,operating
room,surgerysuite or a surgerycentre isa room within ahospital withinwhichsurgical &other
operationsare carriedout.
PURPOSE OF OPERATION THEATRE COMPLEX:-
OT complexesare designed&builttocarry out investigative,diagnostic,therapeutic& palliative
proceduresof varyingdegreesof invasiveness.Manysuchsetupsare customizedtothe requirements
basedon size of hospital,patientturnover&maybe specialityspecific.The aimisto provide the
maximumbenefitformaximumnumberof arrivingtothe operationtheatre.Boththe presentaswell as
future needsshouldbe keptinmindwhile planning.
DIFFERENT ZONES OF OT COMPLEX:-
The location& flowof patients,the staff &materialsformthe three broadgroupsto be considered
duringall stagesof design.
Four zonescanbe describedinOT complex,basedonvaryingdegreesof cleanliness,inwhich
the bacteriological countprogressivelydimnishesfromthe outertoinnerzones(operatingarea) &is
maintainedbyadifferential decreasingpositivepressureventilationgradientfromthe innerzone tothe
outerzone.
33. 1) Protective zone:- It includes:-
- Change roomsfor all medical ¶medical staff withconviniences.
- Transferbay forpatient,material &equipments.
- Roomsfor administrative staff.
- Stores& records.
- Pre & postoperative rooms.
- ICU & PACU(Postanesthesiacare unit)
- Sterile stores.
2) Cleanzone:- Connectsprotective zone toasepticzone &hasother areasalsolike:-
- Stores& cleanerroom.
- Equipmentstore room.
- Maintenance wokshop.
- Kitchenette (Pantry)
- Firefightingdevice room
- Emergencyexists
- Service roomforstaf
- Close circuitTV control area
3) Asepticzone:- Includesoperationrooms(sterile)
- Includesoperationrooms(sterile)
4) Disposal zone:- Disposal areasfromeach operatingroom& corridorleadsto disposal zone.
Subareas (excludingOTplace)
1) Pre-operative checkin area (reception):- Thisisimportantwithrespecttomaintainingprivacy,
for changingfromstreetclothestogown& to provide lockers&lavatoriesforstaff.
2) Holdingarea:- This areais plannedforIV insertion,preparation,catheter/gastrictube insertion,
preparation,connectionof monitors&shall have oxygen&suctionlines.FacilityforCPRshould
be available inthisarea.
3) Inductionroom (Anestheticroom):- Itshouldhave all facilitiesasinOT,but there iscontroversy
as to itsneed.One foreach OT isrequired,ideallyeachisduplicateof the otherineachfloor.
The anesthetic roomwill provide amore tranquil atmosphere tothe patientthanthe OT.It
shouldprovide space foranesthetictrolleys&equipment&shouldbe locatedwithdirectaccess
to circulationcorridors& readyaccessto the operatingroom.It will alsoallow cleaning,testing
& storingof anesthesiaequipment.Itshouldcontainworkbenches,sink.Itshouldhave
sufficientpoweroutlets&medical gaspanelsfortestingof equipment.
4) Post anesthesiacare unit (PACU):- Preferablyadjacenttorecoveryroom.These shouldcontain
a medicationstation,handwashingstation,nurse station,storage space forstretchers,supplies
& monitors/equipment&gas,suctionoutlets&ventilator.Additionally80sq.feet (7.43 sq.m)
for eachpatientbed, clearence of 5 ft(1.5 m) betweenpatientbedsides&adjacentwalls
shouldbe planned.
5) Staff room:- Men & womenchange dressfromstreetclothtoOT attire,lockers&lavatoryare
essential,restroomTV etc. are desible.
34. 6) Sanitory facilityfor staff:- One washbasin& one westerncloset(WC) shouldbe providedfor8-
10 persons.Showers&theirnumberisa matterof local decision.Inclusionof toiletfacilitiesin
changingroomis not acceptable,theyshouldbe locatedinanadjacentspace.
7) The anesthesiagas /cylindermanifoldroom/storage area:- A definite areatobe designated.It
shouldbe ina cool,cleanroom that isconductedforfire resistantmaterials.Conduciveflooring
mustbe presentbutisnot requiredif noninflammable gasesare stored.Adequate ventilation
to allowleakinggasesto escape,safetylabels&separate placesforempty& full cylinderstobe
allocated.
8) Offices- Forstaff nurse & anesthesiastaff:- The office shouldallow accesstobotunrestricted&
semi-restrictedareasasfrequentcommunicationwithpublicisneeded.
9) Rest rooms:- Pleasant&quietrestforstaff shouldbe arrangedeitherasone large room for all
gradesof staff or as separate rooms,bothhave merits.Comfortablechairs,one writingtable,a
bookcase mayetc be arranged.
10) Laboratory:- Small labwithrefrigeratorforpathologisttobe arranged.
11) Seminar room:- Since staff cannot leave anOT complex easily,itisbettertohave a seminar
room withinthe OTcomplex.Interdepartmentaldiscussions,teaching&trainingsessionforstaff
(withaudio-visualaids) maybe conductedhere.
12) Store room:- Thisisdesignedtostore large butlessfrequentlyusedequipmentinOT.There
shouldbe storage space for special equipmentaftercleaning.
13) Theatre sterile supplyunit:- (TSSU) Withinthisarea,followinhgare desirable
- Temperature between18-22deg C,humidityof 40-50% is the aim.
- Airconditioningwith10-12,air exchangesperhour.
- Storage of sterile drapes,sponges,gloves,gowns&otheritemsreadytouse.
- Optiontostore infromone side & remove fromotherside.
- Properinventorytopreventrunningoutof stock.
14) Scrub room:- Thisis plannedtobe builtwithinthe restictedarea.Elbow operatedorinfrared
sensoroperatedtaps/watersource isideal.Itisessential tohave nonslipperyfloodinginthis
area.
TYPES OF OT COMPLEXES:-
There are 3 main categoriesof operatingtheatres:-
1) The single theatre suitwithOT,scrub-up& gowning,anesthesiaroom, trolleypreperation,
utility&exitbaypMlusstaff change & limitedancillaryaccomodation.
2) The twintheatre suits withfacilitiessimilarto1, but withduplicatedancillaryaccomodation
immidiate toeachOT,sometimessharingasmall postanesthesiarecoveryarea.
3) OT complexesof three ormore Otswithancillaryaccomodationinludingpostanesthesia
recovery,reception,porter’sdesk,sterile store &staff change.
PRINCIPLES TO BE TAKEN INTO CONSIDERATION WHILE PLANNING AN OT (PHYSICAL/
ARCHITECTURE):-
35. 1) Location:- Low rise buildingslimitedtotwoor three storey’shighare prefferedbecause of
maximumadvantage of natural light&ventilationasappropraite canbe delievered.The OT
shouldbe separate fromgeneral’traffic’&airmovementof restof the hospital,OTsurgical
wards, intensive care units(ICU),accident&emergencydepartment(A&E),radiological
department(X-ray)shouldbe closelyrelated&accessisalsorequiredtosterilizing&disinfecting
unit(SDU) & laboratoryfacilities.The locationof the operationcomplex inamulti storey
buildingisplannedforthe firstfloor,connectingtosurgical &other wardson the same floor.
Adequate electricliftisplannedforvertical movementfromcasualtyonthe groundfllor& ENT,
orthopaedics,ophthalmology&otherwadsonthe floorabove.
2) Zone wise distributionof the area,soas to avoidcrisscross movements of men&machines.
3) Adequate &appropriate spaceallottedasperutilityof the area.
4) Provisionforemergencyexit.
5) Provisionforventilation&temperature control,keepinginmindthe needforlaminarflow,
HEPA filterairconditioneretc.
6) Operationrooms:- The number&size can be as perrequirementbutrecommendedsize is6.5
mX6.5 mX3.5m. Glasswindowscanbe plannedonone side only.
Doors:- Main door to the OT complex hastobe of adequate width(1.2to 1.5 m).The doorsof
each OT shouldbe springloadedflaptype,butslidingdoorsare prefferedasnoair currentsare
generated.All fittingsinOTshouldbe flushtype &made of steel.
The surface/flooringmustbe slipresistant,strong&imperviouswithminimumjoints
(e.g.- mosaicwithcopperplatesforantistaticeffect) orjointlessconducive tiles/terazzo,
linoleumetc.The recommendedminimumconductivityis1m ohm & maximum10 m ohms.
Presentlythe needforantistaticflooringhasdimnishedasflammab;le anestheticagents
are no longerinuse.
Walls:- Laminatedpolyesterorsmoothpaintprovidesseamlesswall,tilescanbreak& epoxy
paintcan chip out.Collusioncornerstobe coveredwithsteeloralluminiumplates,colourof
paintshouldallowreflectionof light&yetsoothingtoeyes. Lightcolor(lightblue orgreen)
washable paintwill be ideal.A semi mattwall surface reflectslesslightthanahighlyglossfinish
& is lesstiringtothe eyesof OT team.
Operationtable:- One operationtable perOT
Electric point:- Adequate electricpointsonthe wall (at1.5 m heightfromthe floor)
X-ray illuminators:- There shouldbe X- ray filmilluminatorspreferablyrecessed.
Scrub area:- To be plannedperatleastfor2-3 personsineachOT.
7) There has to be preperationroomincleanzone.
8) Corridors notlessthan 2.85 m widthforeasymovementof men,stretcher&machines.
9) Separate corridorsforusesotherthan goingintoOT.
10) Roomsfor differentpersonsworkinginOT& for differentpurpose (Itshouldbe asperzone &
size)
11) Gas & suction(control,supply&emergencystock) forall Ots& areas where patientsare
retained.Oxygen,gas&suctionpipe tobe connectedwithcentral facility&standby local
facilityshouldalsobe availabble.
36. 12) Provisionforadequate &continuouswatersupply.Besidesnormal supplyof available waterat
the rate of 400 litersperbedperday,a separate reserve emergencyoverheadtankshouldbe
providedforoperationtheatre.Elbow tapshave tobe 10 cm. above washbasins.
13) Properdrainage sytem.
14) Pre-operative areawithreceptionwithseparatedesignatedareaforpediatricpatientsis
desirable.
15) Adequate illuminationwithshadow lesslampsof 70,000-12,000 lumensintensity,forassessing
patientcolour& tissue visibility(discussedunder“lighting”)
16) The safetyinworkingplace isessential,&fire extinguishershave tobe plannedinappropriate
zone.
17) Provisionforexpansionof the OTcomplex shouldbe borne inmindduringplanningstagesitself.
Recommendedonthe numberof OTs required:-
It isobservedthatoutof all surgical beds,of the hospital,50% of patientsare expectedto
undergosurgery.Thusfor100 beds,withaverage lengthof stayof 10 daysfor each patient,10
operationsperdaycan be performed.
In general,multiuse Ots,insteadof multipleOtsofferadvantages of efficientmanpower
untilization,economical maintainence&bettertrainingof supportingstaff.
Thus ina 300 beddedhospital (with150 surgical beds),one OTcomplex with3Otsfor general
surgery,gynaecology,orthopaedics/ENT,one forendoscopy& one forseptic. OTwill be requiredwith8
hoursa dayworkingduration.
Ventilation:- Ventilationshouldbe onthe principle thatthe directionof airflow isfromoperation
theatre towardsthe mainenterance.There shouldbe nointerchange airmovement betweenone OT&
another.Efficientventilationwill control temperature &humidityinOT,dilute the contaminationby
micro-organisms&anestheticagents.
There are twotypesof air-conditioningsystems:- re-circulating&no re-circulating.Nonre-
circulatingsystemsheat/coolthe airasdesired&conveyit intothe operatingroomwithideally20 air
exchange perhour.Airisthenexhaustedtooutside.Anestheticagentsinthe OT airare also
automaticallyremoved.Theseare thusideal butnotexpensive.
The circulatingsystemtakessome orall of the air,adjuststhe temperature &circulatesairback
to the room. The broad recommendationsinclude:-
- 20-30 airexchanges/hourforre-circulatedair.
- Onlyupto80% recirculationof airto preventbuildupof anesthetic&othergases.
- Ultracleanlaminarairflow:- The filteredairdelieverymustbe 90% efficientinremoving
particlesmore than0.5 mm.
- Positive air pressure systemin OT:- It shouldensure apositive pressure of 5cm of H2O
fromceilingof OT downwards&outwards,topush outair fromOT.
37. - Relative humidity of 40-60%to be maintained.
- Temperature between20-24deg C.Temperature shouldnotbe adjustedforthe comfortof
OT personnel butforthe requirementof patient,especiallyinpediatrics,geriatric,burns,
neonatal casesetc.
PENDANT SERVICES:-
Two ceilingpendantsforpipelineservicesshouldbe designed,one forsurgical team&one for
anesthetist.Anestheticpendantshouldbe retractable &have linitedlateral movement&provide ashelf
for monitoringequipment.Itshouldhave oxygen,nitrousoxide,forbarpressure,medical compressed
air,medical vaccum,scavengingterminal outlets&atleastfourelectricsockets.
PIPED GASES IN THE OT:-
1) Automatic/semi-automaticfall safe manifoldroomtobe designed.
2) Two outletsforoxyge,suction&one forN2O are a manimumineachOT.
3) Pipeline supplysystemshouldbe able tocutoff frommainline if the problemoccursanywhere
alongthe delieveryhosing/tubing.
SCAVENGING:- The methodof scavengingshould be decidedduringplanningstage of OT.US &
International standardsare available forscavengingbutitisideal toplanthe type of system.
(active/passive) &no.& locationof scavengingbeforehand.
ELECTRICAL:-
All electrical equipmentsinthe OTneed propergrounding:-
In the past,isolatedpowersystemswere prefferedwhenexplosiveagentsare beingused.They
have the advantage of a transformerusinggroundedelectricity&there isnoriskto the patientor
machinesif a machine getsfaulty.
The groundedsystems asusedat homesofferprotectionfrommacroshockbutdevicesmay
lose powerwithoutwarning.Lifesupportsystems,if inuse couldbe disturbed.
Followingcriteriaare ideal with respectto electicityinOT complex:-
1) Use of circuit breakers/interruptersisdesirable if there isanoverlaodorgroundfault.
2) Powerline of 220 volts.
3) Suspendedceilingoutletsshouldhave lokingplugstoavoidaccidental disconnection.
4) Insulationaroundceilingelectrical powersourcesshouldwithstandfrequentbendings&
flexings.Theyshouldnotdevelopcracks& shouldnotdamage wires.Wiresinsiderigidor
retractable ceilingservice columncanhelptosome extent.
5) Wall outletstobe installed1.5m above ground.
6) Use of explosionproof plugs.
38. 7) Multiple outletsfromdifferentelectrical linesourcesshouldbe available.
8) Electrical loadcalculationshouldbe basedon,equipmentslikelytobe used&appropriate
currentcarrying capacitycords to be used.
9) Emergencypower:- OTelectrical networksneedtobe connectedtothe emergencygenerators
withautomatictwoway changeoverfacility.
LIGHTING:- Some natural daylightisprefferedbystaff.Where possible,highlevel windowswhichgive a
visual appreciationof the outsideworldcanbe consideredinthe OT.
1) General lighting:- Colorcorrectedflourescentlamps(recessedorsurface ceilingmounted) to
produce evenilluminationof atleast500 lux at workingheight,withminimal glare are preffered.
Means of dimnishedmaybe neededduringendoscopies.Tominimizeeye fatigue,the ratioof
intensityof genearl roomlightingtothatat the surgical site shouldnotexceed1:5,preferably
1:3. Thiscontrast shouldbe maintainedincorridors&scrubareas,as well asinthe room itself,
so that the surgeonbecomesaccustomedtothe lightbefore enteringthe sterilefield.Color&
hue of the lightsalsoshopuldbe consistent.
2) About2000 lux lightisneededtoassess the aptientscolor.
3) White & glistening/shinybodytissuesneedlesslightthandark& dull tissues.
4) Operatingarea:- Overheadlightgivesadequate illuminationbothatdepthaswell assurface of
body.
5) About10-12 inch of focusof lightgivesadequate illuminationbothatdepthaswell assurface of
body.
6) Lightsshouldbe freelymovable bothinhorizontal &vertical ranges.Pendantsystemsare
preffered.OTlightshouldproduceblue white colorof daylighratspectral energyrange of
50,000 K(35000-67000 kelvinacceptable)produce lessheat&hence preffered.OTlightshould
not produce more than25000 mw/sq.cm.of radiantenergy.Eliminationof heatbydichroic
reflectors(coldmirrors) withheatabsorbingreflectorsorfiltersshouldbe available alongwith
luminaire.
7) An auxillarylightforasecond
8) Halogenlights produce lessheat&hence preffered.OTlightshouldnotproduce more than
25000 mw/sq.cmof radiantenergy.Eliminationof heatbydichroicreflectors(coldmirrors)
withheatabsorbingreflectorsorfiltersshouldbe avaliable alongwiththe luminaire.
9) An auxillarylightforasecondsurgical site isalsobeneficial.
10) UPS of adequate capacitytobe installedafterconsideringOTlight,anesthesianmachine,
monitors,cauteryetcuntil the backupgeneratortakesover.
11) In endoscopicOts,areducedlightingissometimesrecommended.A grazinglightoverthe floor
can be helpful.
Anesthesiaequipment& monitoringneeds:-
At leastone anesthesiologistshouldbe inthe teaminvolvedinplanninganOT.It isimperative that
certainmandatoryconsiderationswithrespecttothe anestheticequipmentU&monitorsbe
39. plannedduringthe planning&designstage itself.Personal,practice &cost preferencesmay
influencethe plans.
Communications:- Telephones,intercom&code warningsignalsare desirable insidethe OT.One
phone perOT & one exclusivelyforuse of anesthesiapersonnelisdesirable. Intercomtoconnectto
control desk,pathology&otherOts as well asuse of pagingrecievers(bleeps) isalsoideal.A code
signal,whenactivated,signalsanemergencystate suchascardiac arrest or needforimmidiate
assistance.
Catering:- Basic servicessuchaspreparationof beverages&some snacks,use of vendingmachines
may be planned,augmentedbyprovisionof hot& coldmealsfrommainhospital kitchen.
Cleaning:- The constructionmaterialsselectedforthe OTcomplex shouldaimtominimize
maintainence &cleaningcosts.
Data management:- Customize networkconnectionsshouldbe putinplace ona conduitshouldbe
planned.A well designedsystemcanprovide automatedrecords,materialsmanagement,laboratory
trackingetc. The software of OT managementare costrly& hospitalsare generallyslow toadoptto
changes.CustomizedOTsoftware canneeds.
Operatingtheatre satellite pharmacy:- Accessto the OT areas & outside shouldbe possible.It
shouldhave a laminarflowhood,arefrigerator,space fordrugstorage lockedcontainersfor
contolledsubstancescomputer,deskareaforpaperwork& pharmaceutical literature.Special kits
foe specificsurgeriesmayalsobe arranged.The pharmacymay openfor1 to 24 hoursbasedon
needbutit isdesirable thatanafterhour systemisplanned.
Statutory regulations:- The design&planningof anOT complex willneedcompliance with
mandatoryregulationsrelatedto local administrationsuchasMunicipal corporation,government,
pollutioncontrol boards,fire safetydepartment,watersupply&drainage etc.
USUAL AREAS OF DEFICIENCIES INOTs(EXISTING OTs):-
1) No receptionarea
2) No separate roomsfor
- Surgeons
- Anesthesiologist
- Jr. Doctor
- OT attendents
3) Notenoughnumberof change for differentclassof people.
4) Inappropriate size &type of doorsetc .
5) Lack of laminarflow&mandatoryair exchange systemsinOT.
6) Lack of standardOT protocol.
7) No separate central sterilesupplydepartment(CSSD).
8) Waitingarea- Recovery
40. - Notwell equipped
- Lack of amenities
THE AUTHORITY FOR STANDARDIZATION:-
Reccomendationsare available invarioussurgical,anesthesia&nursingmanualswithregardtothe
planning&establishmentof operationtheatres/complexes.The hospital cangetaccreditedbythe Joint
Commissionof accreditationof healthcare organizations(JCAHO),aprofessionallysponsoredprogram
that stimulatesahighqualityof patientcare inhealthcare facilities.There isalsoanaccreditation
optionthatis available forambulatorysurgerycenters(Accreditationassociationforambulatoryhealth
care- AAAH).The departmentof health&social security(DHSS) inUK haspublicationscontaining
informationonplanningfornewhealthbuildings&forupgradingexistingbuildings.
CONCLUSION:- Inthe presenteraof evidencebasedmedicine,itbecomesimperativetogive maximum
importance toplanninganoperationtheatre complex.Withinthe limitationsof finance &space,the
bestresultscanbe obtained&anesthesiologistwithmultiplerolesinsidethe operationtheatre
complex,shouldbe consultedinthe process.Effortsshouldbe made toconformto standardslaiddown
by local bodies&internationalagencies,ashealthcare facilitiesinIndiaare now cateringtomore &
more international clientele.Howevernew OTs& hospitalsthatare beingestablishedthatcannotbe
expectedtofulfill all theoretical requirementsasnew ideasare constantlybeingdeveloped.Bythe time
theyare incorporatedintobuildings,freshonestake theirplace onthe drawingboard.
THE DUTIES OF ANESTHESIOLOGIST DURING SURGERY:-
An anesthesiologistisaphysicianwho,aftercompletingmedical school,servedafouryearresidencyto
specialize inanesthesiology.Some anesthesiologistschooseasubspecialitysuchaspediatricanesthesia
& spendanotheryearcompletingafellowship.One dutyof ananesthesiologistduringsurgeryisto
sedate the patient,butthatisonlypart of herresponsibility.
1) Administeranesthetics:- Before surgery,anesthesiologistsreview the patient’smedical history
to determine anyissuesthatmightbe encounteredduringthe procedure.Basedonthe
patient’s history&the procedure tobe performed,anesthesiologistsdecide onthe bestmethod
to sedate the patient.Whenpatientarrivesinthe operatingroom, the anesthesiologist
administyersthe anestheticinone of three forms- aregional anesthetic,whichnumbsaspecific
portionof the body,a local,whichblockssensationsinasmallerarea,ora general anesthetic,
whichrendersthe patientunconscious.Asproceduresprogress,anesthesiologistsmayneedto
make adjustmentstoensure thatpatientsremaincomfortable.
2) Monitors patient:- Anesthesiologistshave the primary responsibilityformonitoringthe
patient’svital signsduringsurgery.Inadditiontobasicmeasurementssuchaspulse,blood
pressure &temperature,anesthesiologistsalsomeasure the patient’srespiration.If the patient
isundergeneral anesthetic,the anesthesiologistmeasuresthe volume the patientinhales&
carbon dioxide level exhaled.Duringsome procedures,the anesthesiologistmustalsomonitor
the volume of bloodbeingpumpedbythe heart,nerve functionsorthe bloodpressure inside
the patient’slungs.If the procedure requiresthe use of special monitors,suchasarterial
41. catheters,the anesthesiologististypicallyresponsibleforplacingthem.Anesthesiologistsalso
ensure thatpatientsremaininthe properposition,suchaskeepingthe patient’sheadalligned
duringnecksurgery.
3) Controlsintravenous fluids:- Duringsurgery,patientstypicallyreceiveintavenousfluidstohelp
control dehydration&to allowthe administrationof medicationsthroughthe drip.
Anesthesiologistsare inthe control of IV.Shouldthe patientrequire bloodtransfusion,whether
as a resultof an unexpectedoccurrence duringsurgeryorthroughpriorplanning,the
anesthesiologistisalsoincharge of transfusion.
4) Handlesmedical emergencies:- Asphysicians,aneshesiologistsare trainedtotreatthe whole
patient,notjustthe patient’spainissues.Wheneverapatientexperiencesaconditionsuchas
heartarrythmia,lowbloodpressure,hemorrhagingorbreathingdifficulties,the anesthesiologist
reacts to the problem&take the corrective stepsnecessary.Thismayinvolveadjustingthe
anesthetic,administeringadditional drugsortakingotheractionstosafeguardthe patient’s
health.
ADMISSION OF PATIENT TO THE OPERATION THEATRE:-
All patientsarrivingtotheatremusthave completedachecklistbefore admittedtothe OT department.
1) Patient’sweight,temperature,respirationrate,bloodpressure,pulse rate,bloodsugar,fasting
status& fluidintake mustbe recordedasrequired.
2) Allergiesmustbe recorded.
3) Medicationchart& IV prescriptionsheetmustaccompanythe patient.
4) Cannulasite mustbe documented.
5) Bladder/catheteremptied.
6) Loose teeth,caps,crowns& braces mustbe recorded.
7) Jewellerymustnotbe worn.
8) Patientmustbe cleanfortheatre to reduce riskof intraoperative infection.Hairmustbe clean&
free fromlice.
9) Nail varnishmustbe removed.
10) Theatre gownmustbe worn.
11) X-raysmustbe present.
12) Bloodresults mustbe presentinthe chart if it isrequiredforsurgery.
13) Recentor currentinfectionse.g.- Rotavirus,chestinfectionsetc.
14) Parentspresent,contactnumber,patient’sproperty&patientcomfortermustbe recorded.
15) The consentformmust be signed& validationof correctsite &side of surgerymade withthe
patientorpatient’sguardianpriortoadmissiontoOT suite bythe competentmedical person.
16) The surgical site for surgerymustbe markedon the patient& verificationof markedsite tobe
made verballywiththe nurse/patient&parents& guardian.
POSITIONING PATIENT DURING SURGERY:-
42. Surgical positioningisthe practice a patientinparticularphysical positionduringsurgery.The goal in
selecting&adjustingaparticularsurgical positionistomaintainthe aptient’ssafetywhileallowing
access to the surgical site.
Positioningnormallyoccursafteradministrationof anesthesia.Inadditiontoconsiderations
relatedtothe locationof surgical site,the selectionof asurgical positionismade afterconsidering
relevantphysical &psychological factors,suchas-
- Bodyalignment
- Circulation
- Respiratoryconstraints
- Musculatorysystemtopreventstressonthe patient.
Physical traitsof patientmust alsobe consideredincluding
- Size
- Age
- Weight
- Physical condition
- Allergies
- Type of anesthesiaused
Changingpositions:- If the patienthasbeenimmobilized,itamybe importanttochange the patient’s
positionperiodicallytopreventbloodpooling,tostimulatecirculation&to relievepressueonthe
tissues.The patientshouldnotbe placedinunnatural positionsforanextendedperiodof time.After
anesthesia,thevpatient’sinabilitytoreachtomovementsmaydamage these muscle gropusby,for
example,movingbothlegssimultaneously.
Risk to extremities:-
1) The most commonnerve injuriesduringsurgeryoccurinthe upper& lowerextremities.
2) Injuriestothe nervesinthe arm or shouldercanresultinnumbness,tingling&decreased
sensoryormuscularuse of the arm, wristor hand.
3) Many operatingroom injuriescouldbe solvedbysimplyrestrainingthe arms& legs.
4) Othercausesof nerve ormusculardamage to the extremitiesiscausedbypressure onthe body
by surgical teamleaningonpatient’sarms&legs.The patient’sarmscan be protectedfrom
thesesrisksbyusinganarm sled.
5) Seperationof sternumduringheartprocedure canalsocause the firstribto put pressure onthe
nervesinthe shoulder.
6) The lithotomypositionisalsoknowntocause stresson the lowerextremities.
Positions:-
1) Supine position:- The mostcommonsurgical position.The patientlieswithbackflaton
operatingroombed.
43. 2)
3) Trehelenburgposition:- Same assupine positionbutthe uppertorsoislowered.
4) Reverse trehelenburgposition:- Same assupine butthe uppertorsoisraised& legsare
lowered.
