2. SPECIFIC OBJECTIVES
•Define common terms used in operati
theatre nursing
•Outline the principles of theatre design
•Describe the potential hazards in
theatre and how they can be prevented
3. DEFINITION OF TERMS
Operating Suite
•Comprises the operating room with its
immediate axillary areas such as the
anesthetic room, sterile prep room,
disposal room, scrub up room, gowning
room and an exit room.
4. Definition of terms cont….
•Operation – this is an invasive modality of
treatment, where an incision is made into
the body tissue for the purpose of repair or
removal or entrance into the body cavity.
5. Definition of terms cont….
•Peri-operative – this is the total surgical
experience which include pre, intra, &
post operative phases of patient care.
•Surgery- this is a branch of medicine
that deals with pre, intra and post
operative care of the patient.
6. Definition of terms cont….
Antisepsis
•Prevention of sepsis by exclusion,
destruction or inhibition of growth or
multiplication of microbes from body
tissues/fluids
Asepsis
•Absence of microbes that cause disease
7. Definition of terms cont….
Antiseptic
•Is an inorganic compound that combats
sepsis by inhibiting growth of microbes,
not necessarily killing them.
Aseptic Technique
•Methods by which contamination by
microbes is prevented.
8. Definition of terms cont….
Contamination
•Soiled/infected by microbes
Formite
•Inanimate object that may be
contaminated with infectious microbes
and serves to transmit disease
9. Definition of terms cont….
Decontamination
•Refers to cleaning and disinfecting/
sterilizing processes carried out to make
contaminated items safe to handle
10. Definition of terms cont….
Standard Precaution
•Procedures followed to protect
personnel from contact with blood and
body fluids of all patients
Sterile
•State of being free from living microbes,
including all spores
11. Definition of terms cont….
Sterile Field
•The area around site of incision or site
of introduction of instruments that has
been prepared for use of sterile supplies
and equipment
Sterile Technique
•Method by which contamination with
microbes is prevented to maintain
sterility thru out surgical procedure
12. THEATRE DESIGN
•General lay out depends on hospital
plan
•Preferably built on first floor near
casualty, Labour room and ICU.
•May be Single theatre with sterilizing
room, Twin theatre with combined
sterilizing room or Multiple theatre (3 or
more Ors)
13. THEATRE DESIGN- GENERAL
PRINCIPLES
•Sufficient number of ORs to allow cleaning
and preparation for operation under
calm/unhurried
•Heating and air conditioning should be
comfortable for patients and staff
•Operating suite should be free from general
traffic and air movement
14. Theatre design- general
principles cont….
•Rooms of the suite should be arranged
to facilitate continuous progression thru
zones that increasingly approach
sterility
•Direction of air flow should be from
cleaner to less clean areas
15. Theatre design- general principles
cont….
•Walls and floors should be impervious,
easily washable and withstand repeated
application of disinfectants
•Colors should be less tiring to the eyes
(pale-blue, grey, green)
16. AXILLARY ROOMS
RECEPTION & TRANSFER AREAS
•For reception and checking of patients’
particulars
•For transfer of patient from ward onto
theatre trolley/disinfecting ward trolley
wheels before entering the clean zone
17. Clean corridor
•Divides general traffic and clean area of
theatre (demarcates dirty and clean zones)
•Floor hump is used to divide
•Location of the Exchange bay –
inside/outside trolleys, disinfectants,
overboots/gowns
18. Theatre sterilizing & supply
unit (tssu)
•For equipment/instrument preparation
and sterilization
•May be located in the clean zone with
space for storage of pre-sterilized
packages
19. Anaesthetic room
•Should have similar hygienic conditions as
TSSU
•Should be reasonably sound-proof to avoid
interference of general preparations
•Located adjacent to the OR
20. Operating room
•Where surgical procedures take place
•Should be the cleanest with minimal
equipment and personnel
•Should have anaesthetic machine, diathermy,
suction, good lighting/heating/cooling
systems, cardiac monitors etc.
21. Scrub-up room
•Located adjacent to the OR and should be
large enough to allow for gowning and
gloving as well
•Should have deep sinks with elbow or
foot-operated taps (cold and hot water)
22. Soiled utility /sluice room
•To handle soiled instruments/linen after
surgery
•Should preferably be away from the OR
and TSSU
23. Recovery/post-anaesthetic
•For patients recovery from anaesthesia
before going to the ward
•Should be equipped with individual suction
apparatus, oxygen supply, monitors for
accurate observation and nursing
25. Lighting
•Windows are discouraged in theatre
because day light is distracting to the eyes
•Theatres require efficient system of artificial
lighting
•A full automatic emergence lighting system
should be available for stand-by
26. Lighting cont….
•Emergency lighting should be tested
regularly to ensure absolute reliability
•Apart from having an in-built emergency
lighting system, mobile emergency lighting
fittings are necessary as alternatives when
the in-built system fails
27. Types of Operating Theatre
Lighting
1. Multi Reflector Luminaire
•Scialytic – This type of lighting has an optical
lens with a single lamp of 100 - 150watts
•Metallic reflector light fitting has metal
reflectors which are heavily polished and
radiates light rays.
28. 2. Multi Lamp Luminaire:
This type of lighting has 6 – 9
separate lamps each lamp is
40watts and are placed in single
housing unit
They provide shadowless lighting
29. Ventilation
•Artificial ventilation is recommended in
theatres
•Air conditioning plant should be installed in
the operating suite to help maintain room
temps between 18.5-22oC and humidity
between 50-55%
30. Types of ventilation systems
1. Plenum ventilation system
•This system is fitted on roof of the building
•Sucks air from the environment purifies,
humidifies, heats or cools the air and pushes the
air at high pressure through its diffusers
•Highest pressure is in the operating room and
lowest is in the dirty corridor
31. 2. Ultra cleaning ventilation
system
•This is an advanced system used in vascular
and transplant surgery reduces post
operative infection by 0.6%
•Pushes air through its diffusers at higher
velocity
•It is 90% efficient
32. POTENTIAL HAZARDS IN
THEATRE AND PREVENTION
•Theatres have been full of hazards for both
patients and care-givers
•Primary dangers include fires, exposure to
anaesthetic agents and direct exposure to
biological materials
•Potential for physical injury from electric shock,
explosions and inhalation of toxic substances
33. HAZARDS IN THEATRE
•Faulty equipment or improper usage
increases the risk
•Staff should have knowledge of hazards
associated with equipt use, causes of
accidental injuries and sources of health
risks
34. Hazards in theatre cont….
•All individuals working in theatre have
personal responsibility to ensure safe
working environment for themselves and
others
35. Classification of hazards
•Physical hazards: Injuries, falls, noise,
electricity, radiation and fire
•Chemical hazards: Anaesthetic gases,
toxic fumes from gases & liquids,
disinfectants & cytotoxic drugs
36. Classification of hazards cont….
Biological hazards:
•Patients as hosts of pathogens,
infectious/clinical waste, cuts and needle
stick injuries and latex sensitivity
37. Prevention of physical hazards
•Staff must use all electro-medical equipment
according to manufacturer’s instructions e.g.
do not operate them with wet hands, do not
put liquids on top of equipment to avoid
spillage and short circuit
38. Prevention of physical hazards
cont….
•Staff must use proper body mechanics to
avoid back pain, as they stand for long hours
in awkward positions
•Proper shoes should be worn for comfort
and safety
•Operating table heights should be adjusted
appropriately
39. Prevention of physical hazards
cont….
•Staff and patients must be protected from
radiation during exposure to minimize
development of cancer, genetic mutations,
spontaneous abortions and congenital
abnormalities
40. Prevention of physical hazards
cont….
•Keep anaesthetic machines, gas cylinders
and flammable liquid containers away from
sources of heat and should not touch each
other
•Do not grease or oil vials for gas cylinders or
anaesthetic machines
41. Prevention of physical hazards
cont….
•All operating suites should have fire warning
and safety systems
•All staff should be familiar with location and
operation of fire alarms and fire
extinguishers
42. Prevention of chemical hazards
•Theatres should have closed absorption
technique (scavenging system) to absorb
anaesthetic gases and restrict their
circulation into the air
•All items sterilized with Ethelyn Oxide should
be aerated for 24hrs to prevent dizziness,
N/V, cancer
43. Prevention of chemical hazards
cont….
•Gloves, masks and goggles should be worn
when using disinfectants such as
Glutaraldehyde (Cidex) and should be diluted
in proper concentrations to prevent irritating
the eyes and skin
•Safety precautions should be observed when
administering cytotoxic drugs
44. Prevention of biological hazards
•Treat all body fluids as infectious
•Supervisors should ensure that appropriate
protective materials are available and staff should
be encouraged to use them
•Clinical waste should be handled and disposed
appropriately and separate from domestic waste
45. Prevention of chemical hazards
•Standard precautions should be adequately
communicated and reinforced to ensure
compliance and protect staff from
occupational injuries such as needle stick
pricks
