For the better development of the operation theatre

1. Practices and better
development in OT & ICU
Ranganathan D
JPNATC
AIIMS

2. Development goals
• To assist anesthesiologist and surgeon.
• Maintenance of equipment & instruments.
• Promote and contribution to lead quality care.
• Patient care and safety.
• Maintain a good environment inside the OT &
ICU
• Follow up of protocols and SOP .

3. WHO safety checklist
WHO checklist comprises of three steps
Sign In-followed before the intubation
Time out- done after the intubation
Sign Out- followed after the surgery over

4. WHO safety checklist in OT

5. Surgical attire
•Surgical attire is followed as per
protocol in AIIMS.
•Avoid Wearingsurgical suite out
side the OT & ICU
•Follow the sterile zone and unsterile
zone .
•Wearing of facemask and not covering
Of hair is seeing in our daily life.

6. Good practices inside the OT
• Exhaled anesthesia gas treated by suction or
use AGSS
• Running inside the OT is prohibited
• Avoid using loose talk inside the OT
• Using of smart mobiles is not good to the
surgical team

7. Better Practices
• Label the oxygen humidifier ,that must be
used only 72 hours duration
• Use only the sterile water for the
humidification.
• Label the NS/ sterile water bottle with date
and time of opened.
• Avoid needles kept
intact with the vial .

8. DVT and Accessories
• Apply the DVT cuffs as per the recommendation.
• Don’t use on Contraindicated patients.
• Read more about Deep vein thrombosis intermittent
pneumatic compression
• No need to apply for the short procedure’s and
active young patients.
• Monitor the cuffed area 24 hours once .

9. Patient with 24yrs/male had a RTA had
patients came with facial injury. DVT cuffs ??

10. Ultrasound
• It’s works on the principals on PZT effect
• It has some basic modes echo m mode,
doppler ,normal B mode) and 3D mode.
• Ultrasound probe is made of PZT crystals.
• Use Enzymatic solution for cleaning.
• Better visualization - saline or sterile jelly
• Avoid alcohol based solution (chlorhexidine
gluconate)
• Try to learn more about USG .

11. Arterial and CVP Monitoring
• Use pressure bag with heparin saline.
• connected with blood set for better results.
• Instead of using iv catheter in arterial line (radial) use
haemocath with floswitch.
• Transducer set with PM line must kept ready .
• Connect it without any air in the PM line
• Heparin saline must be prepared with

13. Basic Parameters to check
• Technologist role is check this following
parameter daily morning
i. Temperature 21-24
ii. Humidity
iii. Pressure
iv. Laminar air flow conditions
v. Floor mopping/wall has done or not
vi. Equipment carbolizations
vii. Dicard the used and unused drugs in previuos
shift.

14. Laminar air flow and A/C
Good OT environment.
Sterility with humidity maintenance.
Positive pressure .
Pressure relief damper .
Low particulate counts .
Low noise .
Cfu is 5-8 in the petrifilm.

16. Equipments
• Always keep on charging the medical equipments
• Avoid using solvent ether and surgical spirit near
the high voltage equipments like Diathermy.
• Use only the bacillol 25 solution for carbolization.
• Check the power cord and circuit damages.
• Check Earthing and UPS backup .
• Use only type C & D power cord.
• Use of euro power cord is not recommended.

17. Power cord D& M type

18. Ventilator
• Ventilators are checked before connecting to
the patients(Full test) in ICU
• Connect the humidifier and sterile water with
drip set for humidification.
• Use single use breathing circuits for patient
• Set all values & modes and confirm with the
doctor .
• Check the bed mattress is working or not to
avoid bed sore

19. Patient in ICU

20. Ventilator handling - Best practices
• Prepare ventilator before shifting the patient
• Use sterile ventilator circuit
• ETO sterilized humidifier chamber with sterile
water connect to the chamber .
• Use the HME filter
• Discard the circuit after use.

21. Patient with Continuous use of NIBP
cuffs at the forearm

22. Monitoring –Best practices
• Apply SPO2 probe to the site freely
• Don’t apply the Pulse oximeter probe tightly.
• Use soft cotton roll for applying BP cuffs
• Inspect the power cord and cables.
• Regular inspection of sites
(arterial,venous,epidural )
• Follow up the aseptic precaution for Epidural
catheter removal.

23. Mobility of the patient
• Check the patient mobility .
• Talk free to the patients.
• Check for the patient conscious level
• Delirium
• Guide the patients in ROM (Range of Motion)
exercise
• Help the patient in power grip & Spirometry
practice for Chronic Obstructive Pulmonary
Disease (COPD)
• Help during the Physiotherpy .

24. Sterilization of trays & consumables
• Sterilization tray (spinal tray)is sent is labeled with
thick pla-card
• In the store check for the any fungal growth
and other (eg.rat,cockroach,snakes)

25. Radiation Safety
• Surgical team members are advised to wear
radiation safety garments.
• Calculation of radiation exposure by TLD batch
• Don’t allow any health workers without wearing
safety attires
• Red light or radiation symbols with pla-cards should
be there out the room doors for the radiation
indication.

26. Apply with radiation safety batches
• Regular dosimetric calculation
• Protective safety garments-Lead apron and
thyroid shield
• Do not fold the lead apron and keep only the
respective places.

27. Better Practices
• TLD batches for all staffs working in OT and ICU
• Surgical suit outside the OT- solution ?
• Pressure bag & blood set for arterial monitoring
• Labels for humidifier & HME filter in ICU
• Soft roll for BP cuffs.
• Use recommended disinfectant solution for
cleaning & sterilization.
• Alcohol based solution equipment
(eg.Ether,spirit).
• AGSS – suction.
• Power cord type C &D.

28. Be a Professional