The document discusses the operation theatre (OT) facility in a hospital. It describes the OT as a specialized facility where life-saving procedures are performed under aseptic conditions. It outlines the different types of surgeries performed in OTs and discusses important considerations like OT layout, zoning, equipment, cleaning and sterilization protocols, and staffing to maintain aseptic standards and safety. It emphasizes the role of proper construction, maintenance, and organization of OTs for efficient functioning and infection control.

2. I .
PRESENTED BY :- MR JASWINDER SINGH (HEAD OT)
AND
MR RAKESH BAKSHI (SR. PHARMACIST)

4. • OT is that specialized facility of the hospital where
life saving or life improving procedures are carried
out on human body by invasive methods under
strict aseptic conditions in a controlled environment
by specially trained personnel to promote healing
and cure with maximum safety, comfort and
economy.
• It is a room in a hospital equipped for the
performance of surgical operations under
complete aseptic conditions.

5.  Emergency Surgeries
 Elective Surgeries
 Major Surgeries
 Minor Surgeries
 Intermediate Surgeries
 Ambulatory/ Daycare Surgeries

6. EMERGENCY OPERATION:
It must be carried out as soon as possible after the
diagnosis has been made and the patient is prepared for
operation in proper way.
ELECTIVE OPERATION:
It is carried out sometime after the diagnosis has been
made and when they suit best for the patient and the
hospital

7. • Microsurgery: Surgery performed under magnification.
• Used most commonly for anastomosis.
• Cryosurgery: Surgery which is based on use of liquid
nitrogen at a very low temperature (based on cryoablation)
• Laproscopic Surgery: Its use requires minimal incision and
minimal post operative care and stay in the hospital.
• Advantages: faster recovery, lesser pain and less scarring.
• Bio-medical Laser : In this, there is absence of physical
contact and the cutting is without mechanical pressure
(scalpel) which makes the operation non-traumatic. (Light
amplification by simulated emission of radiation)
ADVANCE SURGRIES

8. • •
OBJECTIVES
• Promote high standard of asepsis.
• Ensure maximum standard of safety for patient and
staff from environmental, anaesthetic, radiological
equipment and post operative hazards
• Ensure optimum utilization of operation theatre
and its staff.
• Ensure optimum conditions of work for
surgical and supporting team
• Ensure comfortable treatment of patients.

9. • Operation Theatre: where surgical operations and
certain diagnostic procedures are carried out.
• Operating
ancillary
suite and theatre
areas, anaesthesia
suite-
room,
O.T with
room for
instrument trolleys, a disposal room, a scrubbing &
gowni•
ng area.
• Operation Theatre Complex. : An unit consisting of
one or more operating
accommodation for the
suites
common
with ancillary
use such as
changing room, rest room, receptions, transfer, pre
operative area, post-operative area and circulating
space.

10. • Accessibility to ICU, Post surgical wards, CSSD,
Emergency and Blood Bank
• Access to Iifts
• Away from internal & external traffic flow
• Future expansion
• Ideally located on Top Floor, dust free environment &
reduced bacterial load in area
• Quiet environment: No Noise, Dust, Wind, Heat and
Direct Sun light Problem
• Least scope of cross infection

11. S
Depends upon -
• No. of Surgical beds
• No. of surgeons
• Scheduling of operations
• Quantum of emergency cases
• Out patient surgery
• Type of hospital
• Type of specialities
• Number and nature of elective and emergency surgery antIcipated
• Number of operations per day
• Expected ALOS of surgical patients
• Expected turn over interval in OT
• Estimated time for cleaning between operations
• Time allowed for staff breaks
• Amount of time reserved for emergency use

12. THE RECOMMENDATION
a) 50 Beds: 1 Major and no Minor operating room
b) 50 to 100 Beds: 1 Major and 1 Minor operating rooms.
c) 300 Beds: 3 Major and 1 Minor operating rooms.
d) 500 Beds: 5 Major and 2 Minor operating rooms
e) 750 Beds: 8 Major and 2 Minor operating rooms.
f) 1000 Beds: 10 Major and 2 Minor operating rooms.
Americans: 1 OT for 25 beds.
Europeans: 1 OT for 50 beds.

14. • Basic activities involved in the Act of Surgery
• Supporting Procedures
• Administrative Procedure
• Clerical Procedures
• Housekeeping Procedures

15. • Basic activities involved in the Act of Surgery
• Reception and identification
• Pre-operating supervision of
• Depilation of patient
• Transfer of patient to OT
• Administration of Anaesthesia
• Intubation
• Extubation
operation table to trolley or bed to recovery room
• Post operative supervision of

16. • Staff changing to operating room garments and
shoes
• Putting on cap, gloves and apron
• Aseptic washing of hands
• Gowning
• Laying out, checking and re-checking the no. of
instruments

17. • Preparation of operation lists, duty schedules
• Requisition of patient
• Notification to wards of time for patient transport to and
fro the surgical department
• Distribution of messages
• Requisition of records, equipment and material
• Contacts with other departments, lab, workshops and supplies
• Ascertain availability of doctors and supporting staff

18. ■
• Preparation of operation records
• Preparation of operation room records
• Filing
• Statistical interpretation of operation room
records
• Collection of used instruments
• Collection of used materials and soiled surgical
instruments, dressings and underlays
• Cleaning of operation rooms and other areas in the
surgical department
• Disposal or incineration of refuse

19. • Minimises risk of hospital infection in the operating
room
• Minimises 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
• There should be movement from one clean area to
another without having to pass through dirty areas.
• Soiled linen & wastes should be removed without
passing through clean area .

20. TYPES OF OT ZONES
• Protective Zone
• Clean Zone
• Sterile Zone
• Disposal Zone

21. PROTECTIVE ZONE
This includes entrance for patients, staff & supplies where
normal hospital standards of cleanliness applies & where
normal everyday clothes are worn.
• Reception
• Waiting room
• Changing room
• Store room
• Autoclave/TSSU
• Trolley Bay
• Control area of electricity

22. CLEAN ZONE
This is the main area of the OT where all patients, staff should
undergo complete changing of clothes before entering.
• Pre-operating room
• Recovery room
• Theatre work room
• Plaster room
• X-ray unit with dark room
• Sisters work room
• Staff work room
• Anaesthesia Store

23. STERILE / ASEPTIC ZONE
This is the inner zone, where conditions are as near sterile
as possible. It applies to 2 rooms in a suite, the theatre &
theatre supply room. All staffs who might handle the
exposed instruments, must be scrubbed & gowned.
• Operating Room
• Scrub Room
• Anaesthesia Room
• Instant instrument sterilization
• Instrument trolley area

24. DISPOSAL ZONE
This is where all exposed instruments used or unused,
pathological specimens, lotions, suction jars, soiled linen are
passed from the theatre to disposal corridor & returned for
changing, sterilizing or any other necessary procedure.
• Dirty wash up room
• Disposal Corridor
• Janitor's Closet

26. • One day in a week should be given for maintenance of OT
• Swabs should be taken away from areas of OT
• Air-conditioning of OT should be checked regularly
• Filters should be properly maintained
• Spare bulbs should be kept in stock in OT department
• Adequate pressure should be maintained all the time
• Operating staff having infection should not be
permitted in OT
• Sterilisation of mobile equipment and operation table
should be ensured
MANTINANCE OF OT AND ASEPTIC STANDARD

27. POLICY ON CLEANINING TECHNIQUE
• Preparatory Cleaning
• Operative Cleaning
• Intermediate Cleaning
• Terminal Cleaning

28. • An hour before the beginning of the first
detergent or
operation, a damp dusting with
disinfectant.
• Every morning OT is to be cleaned and
carbolized before starting of first case.
• All equipment OT tables, walls and floors have to
be cleaned and carbolized using 1°/o hypochlorite
solution. Check the concentration of available
hypochlorite, dilute accordingly.
• Example: Hypochlorite solution available 4o/o
solution of sodium hypochlorite: dilute 1 in 4, to
250ml of 4o/o sodium hypochlorite add 750ml of Water
PREPARATORY CLEANING

29. • Areas contaminated by organic debris such as
blood & sputum, during the operation should
receive immediate cleaning. An in use dilution
of phenolic detergent germicide or other broad
operation germicide.
OPERATIVE CLEANING

30. • General clean up OT room for the next patient's
instruments should be placed directly into perforated trays
for processing in a washer sterilizer, or may be covered for
transportation to the CSSD for terminal sterilization.
• Furniture - cleaned with germicide
• Floor - wet vacuuming is the method of choice. If wet mop is
used, then a fresh one must be used each time & no buckets at
all.
• Collect waste materials, sharps, sponges and soiled linen
separately in colour coded bags according to hospital waste
disposal protocol.
• After removing the blood from the floor and other spillage
areas as per hospital protocol disinfect and wash the area
thoroughly
INTERMIDATE CLEANING

31. • At the end of day's schedule a vigorous cleaning of the OT table etc.
• Clean the O.T. area, after removin all the used material & other items
to be discarded.
• Mop with 1°/o sodium hypochloride solution , dilute as
mentioned earlier.
• After mopping the floor
tabletops and equipments
marked ''X'': in red .
carbolize the OT walls, floor,
except where contraindicated
• Bacilocid spray
• Fumigation: Fumigation in gas proof enclosure with Hydrogen
Peroxide & Silver Solution or any other Fogger Solution.
TERMINAL CLEANING

32. FUMIGATION
AREA THAT REQUIRES FUMIGATION:
•Operation Theatre complex and Intensive Care areas
•Cardiac Cath Lab, Endoscopy Lab, Bronchoscopy Lab
•Special cases as advised by Infection Control Committee
Method Of Fumigation
By OT care machine
1 Remove all articles likely to be damaged by fumigation
2 Remove any containers with Hypo-chlorite solutions
3 Wash OT properly
4 Fumigate
•

33. METHOD
•Check OT fogger machine put 15 ml of fogger machine
solution(Alkyl Dimethyl Benzyl Ammonium Chloride )in 1 lit of
water
•Put the machine inside the OT wire and switch outside the
OT
•Seal the OT properly
•Put on the machine for ½ hour.
•Turn the Ale on and exhaust the fumes
•Cleaning, carbolization & bacilloacid spray should be carried

34. CLEANING OF ENTIRE OT ON WEEKENDS
Saturday Evening
•Remove all equipment, OT tables, anesthesia machine, and
heart lung machine, Ventilator etc.
•Wash each OT thoroughly with detergent and water
paying special attention to the corner of OTs.
•Dry the OT and walls with dry duster and carbolize
properly with 1°/o hypochloride
•Carbolize all the equipment and place them properly in
the OT.
•Close the OT and to not allow anybody to enter unless
there is a surgical case.

36. • OT unit needs specialised services, such as piped
suction and medical gases, electric supply, heating, air-
conditioning, ventilation and efficient lift services. OT
requires more height above 4.2 meters
Dedicated AHU Air Handling Unit for 1OO% fresh
air for each OT.
• Minimum area for general operating room is 40 sq
m
• Cardio-vascular, Neuro-surgery, Orthopeadic and
other procedures which require additional
equipment needs minimum area of 60 sq m.

37. GROUPING OF OPERATION THEATERS
1. Maximum flexibility in use
2. Easy expansion
3. Simplifies theatre staffing
4. Easy & economical maintenance
5. Improved cleaning and better sterilization
6. Minimises infection & cross-infection
7. Minimizes cancellation of operating schedule
8. Improves utilisation of operating suites
9. Flexibility in allocation of operating suites

38. OT CONSTRUCTION
• Floor
Flooring - Vinyl floors, Antistatic to minimize danger of
static electricity
Earthing for electrical installation - laying flat copper strips 6ft
deep in the floor.
Minimum conductivity-1ohm, maximum-10 ohm.
Floor corners and edges rounded to facilitate cleaning .
• Walls - plain, free of glare, easily cleaned & impervious
• Doors: sliding doors, wide for passage of pt trolleys &
equipments .
• Ceiling: False roofing not preferred.
• Paint colour: Light & non reflecting

39. LIGHT
• Most important component of OT
• Central field of operation should be 2000-3000 candela per
sqm.
• The floor around surgical table should be 200-300 candela
per sqm and walls 300-500 candela perm sq.
• The colour composition should be such that anaesthestist
will be able to see the colour changes of the patient skin.
• General light luminance may vary from 500 lux to 2000 lux
• Operating Light:
• Easy maintainability repair and maintenance
• Fitting be directly flexible
• Control accurate and quick
• Shadowless
• Heat radiation small

40. POWER OUTLET
• OT require electro-medical equipment for life support
and for performing surgery. For using these
equipments power outlets at convenient location are
needed.
• 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
• Power outlet should also be located at one meter
above the floor level.

41. AIR-CONDITIONING AND VENTILATION
• Construction of OT should be made in a way that it could be fitted
with modern air-conditioning system.
• Height of 4.2 m is needed in OT, coz air-conditioning duct, laminar
flow and high efficiency filter takes 1 m space above false ceiling.
• Grill for return air-duct should be located 30 cm above floor level.
Minimum of 2 return ducts should be provided in the OT
• Vertical laminar flow is preferred in OT, which is the most
advanced A/c technology today, which is a unidirectional air flow
through high efficiency particulate filters.
• The laminar flow system maintains an air change of 10- 20/hour in
the OT & supplies 100°/o fresh filtered air through HEPA filers which
flows in 2 directions in high velocity, vertically down wards or
horizontally.
• Positive pressure in the OT room should be maintained to
eliminate risk of infection.

42. SCRUB STATION
• It is provided near the entry room of the OT
• One scrub room per Operation room should be
provided.
• The working height of scrub station is 96 cm with
water source 10 cm higher
• If possible gowning area should also be provided
• It is better to have photo electric cell operated wash
basin, so that there is no body contact

43. PERSONAL MANAGEMENT IN OT
• By convention, OTs all over the world are under the overall
charge of the anaesthesiologist.
• OT is a area which needs certain qualities from its personnel such
as, stamina for long standing hours, emotional stability to cope
with the stressful environment, good team spirit, stable health
and respect the patient's right for privacy.
• Surgeon
• Anaesthetist
• Assistant
• Scrub nurse
• Circulating nurse
• Anaesthetist nurse
Further there are assistants to help: Radiographer, Technicians,
Disposal staff

44. Mobile Equipments
• Anaesthetic apparatus
• Anaesthetic table
• X-ray equipment
• Diathermy equipment
• Electrical suction
apparatus
• Pulse monitor
• Ventilator
• Monitor-cum
defribrilator
• Heart lung machine
Fixed Equipments
• Operating Table
• Wall intercom station, nurse
call system, wall clock
• Tele. at circulation nurse work
area
• Film illuminator at foot end of
operating table
• Sx light, ceiling mounted over
the centre of the operating
table.
• Video cameras for observation
on ceiling tracks.
• I■
EQUIPMENTS

45. INSTRUMENT STERILIZING POLICY
• CSSD - can be located anywhere in the hospital to facilitate
utilization by other areas , preferably close to OT as they are
the main user.
• TSSU -This system is seldom used.
Located within the operating deptt. to facilitate maximum
utilization, flow of instruments, supervision of sterilization by
nursing staff. However, on economic & efficiency grounds 2
sterilizing units in one hosp is difficult.
• Sterilization unit between 2 OTs -This is practiced in small
setup, where the autoclave is kept between 2 OT suites.

46. COMPUTERIZATION IN OT
- MODERN OT IS INCOMPLETE WITHOUT COMPLETE
COMPUTERIZATION.
- HIS OT MODULE
- COMPUTERIZATION FOLLOWING
- MAINTAINING RECORD KEEPING HAS BECOME A NECESSITY FOR
THE FOLLOWING:
- PTS RECORDS SO AS TO AVOID STACKS OF
- FOR TELECOMMUNICATION WITH THE VARIOUS WARDS &
SUPPORT AREAS SO AS TO FASTEN THE SUPPORTING WORKS IN
OT FOR TEACHING PURPOSES THE FUNCTIONS IN THE OT CAN BE
DIRECTLY TELECASTED IN TO THE STUDENTS ROOM OR DOCTORS
ROOM SO THAT DOCTOR CAN VISUALIZE THE PROCEDURE
SITTING OUTSIDE THE OT ROOM.

49. • Close communication and coordination between pre-op area
and theatre using agreed procedures is essential
• A nominated person should liaise with wards and transport
staff from theatres
• A suitable holding area staffed and equipped will assist with
smooth flow
• Agreement should be made for preparation and transport of
patients to and from theatres
• Policies on fasting, anticoagulation, shaving, dentures,
jewellery, appropriate underwear and removal of make-up
should be developed
• Units should agree the level of training needed to escort
patients to and from theatres
• A documented system of handover and identification of
patient should be in place
OPERATING LIST MANAGMENT

50. EFFECTIVE USE OF THEATRE TIME
• It is important that all theatre lists start and finish at the
agreed time.
• Realistic scheduling of theatres will prevent cancellations.
• All day theatre lists have proven efficient, within the
synchronising of surgical and anaesthetic time and staffing
• Good time keeping principles should be adopted and
monitored by the theatre management team.
• Pro-active re-allocation of cancelled theatre lists.

51. DURING THE THEATRE ALLOCATED TIME, A THEATRE
MAY BE IN ONE OF THE FOLLOWING STATES:
• A patient undergoing an operating procedure
• A patient may be administered anaesthesia
• The theatre being cleaned or set up
• The theatre may be unused
The theatre could be unused due to one of the
following reasons:
• Delay in starting the first case
• Delay between cases
....

52. • The efficiency of an operating theatre is commonly
expressed in terms of theatre utilisation, and is a
frequently quoted performance indicator.
• There is no universally accepted or consistent descriptor of
theatre utilisation. Therefore benchmarking and
improving theatre utilisation and resource allocation
within the health system is extremely difficult.
• Theatre utilisation = Theatre used time
Theatre allocated time
The theatre allocated time is a period for which the
theatre is adequately staffed and scheduled for given
service or clinician.
OPERATION THEATRE UTILISATION

53. Improving theatre utilization is a key performance
target for hospital in terms of ensuring :
• Timely surgical intervention for patients.
• Reduce length of stay.
• Increase activity and income.
• Improved productivity and value for money from
the services provided.

54. • OTs generate 42°/o of a hospital's revenue.
• The average OR runs at only 68o/o capacity.
• The average OR starts on time only 27°/o of time.
• The average patient out to patient in time is 31.5
minutes standard- 15 minutes
• O.Ts are choked by paperwork.
nurses fill in average of 15 pieces of paper per
patient.
FACTS

55. KEY PERFORMANE INDICATORS
• O.T. Utilization: depends upon
• No. of cases canceled or delayed
• Doctor or Anesthetist availability
• Patient canceling the process
• Lab /radiology reports not available on time
• Bills /advances not paid
• Consent not taken
• CSSD not functioning or not making instruments available on time
• O.T. equipments non functioning
• First procedure prolonged
• Attendants not properly communicated about the procedure
• Clean-up & set-up time
• Performance data of surgeon
• Number of Minor and Major cases

56. • Time motion
study low /on
time starts
• Process flow
charts
• Root cause
analysis
PREOPERATIVE PHASE
STUDIES ON OT
UTILISATION
• Delay in assembling of OT team in the OT
complex sequencing
- Due to different OPD hours
- Due to heavy OPD.
- Tight scheduling of doctors.
• Delay in supplies.
Operative phase
• Sequencing of equipment
• Standardization of procedures.
• Specific surgeons for specific
procedures.
• Trained staff.
Post operative phase
• OT preparation
• Availability of beds in ICU and
■ ■ ■ ■

57. HISTORY SHEET
1. Name of equipment
2: Date of purchase 3:
Cost of equipment
4:
5:
6:
7:
8:
9:
Name and address of supplier
Date of purchase
Date of installation
Department where installed
Environmental control* Spare
parts inventory
10: Technical manual/circuit diagrams/literature 11:
After sales service arrangement
12: Guarantee period
13: Warranty period
14: Life of equipment
15: Depreciation per year
16: Charges of tests**
17: Use coefficient*** 18:
Down time up time
19: Cost of maintenance
20: Date of condemnation
21: Date of replacement
(*) Proper environment control in terms of temperature, lighting and ventilation should be
ensured and recorded, whenever applicable.
(**)whenever applicable.
(***) should be applied to assess the utilization of equipment.
RESOURCE
UTILISATION
(MACHINE)

58. •
STORE AUDIT AND ANALYSIS
STORES AND SUPPLY CHAIN MANAGEMENT
• Standard products selection /usage
• Proper forecasting and need assessment bulk purchases
• Limited no of vendors purchases discounts, Quality assured
• Reorder levels estimation
• Proper usage analysis
• Just in time