Theatre design, one of the most critical steps in hospital construction. When wrongly designed and situated, poses a significant health hazard to both the patient and the environment.

1. SURGICAL
THEATRE DESIGN
DR. EMMANUEL ALI ADAMU
COLLEGE OF MEDICAL
SCIENCES, UNIVERSITY OF
MAIDUGURI

2. OUTLINE
• Introduction
– Definition of terms
– Brief history
• Siting of a theatre complex
• Purpose
• Architectural planning
• Types of Operating Theatre
• Components
• Zones of Operating Theatre
• OT Suite requirements
• Surveillance in OT
• Conclusion

3. DEFINITION
• An operating theatre(also known operating room,
operating suite, or operation suite) is a facility
within a hospital where surgical operations are
carried out in an aseptic environment.
• Asepsis is a condition or state in which
contamination by a living microorganisms is
reduced to the barest minimum
• Antisepsis is the process or procedure whereby
transient pathogenic organisms are destroyed
• Anaesthesia is a state characterized by loss of
feeling and sensation induced to perform surgery
and other painfull conditions. It may be local or
generalized

4. INTRODUCTION-brief history
• Early dedicated rooms for surgical procedures
were called operating theatres because they were
literally theatres, built in a gallery style for public
observation.
• Early British examples such as St. Thomas
Hospital in London were probably based on the
16th century anatomy theatres at Padua and
Bologna in which teaching and demonstrations
were principal considerations.
• In 19th century, operations used to be advertized
in newspapers and surgeons might get a round of
applause at the end of the procedure from the
paying public.

5. Brief history contd
• It was found that operations had been cancelled
because public demand of a larger theater had to be
found
• At one time operations were undertaken on hospital
wards, in patients’ homes, and in doctors consulting
rooms.
• In 18th century, the demonstration and teaching of
surgery became so important, so dedicated rooms for
surgical operations were built.
• The design of operating theatres have continued to
evolve through the years in response to surgical needs
and practice

6. ONE OF THE OLDEST SURVIVING THEATRES
AT UNIVERSITY OF PADUA 1804

7. OLD THEATRE DESIGN TO ACCOMMODATE
THE WATCHING PUBLIC

8. TIERED ARRANGEMENT OF
OBSERVERS IN THE OLDEN THEATRES

9. Brief history contd
• Following the great stride of conquest of sepsis
and pain, theatre design inclined toward
promotion of asepsis.
• The contents of the theatres were made with
easily washable materials, round-angled objects
were used, window frames were flush with the
inner surface of the walls, surgeons replaced
frock coats with theatre gowns, washed their
hands before operating and wore gloves and
masks

10. Siting of a theatre
• The design of a theatre in contrast to the siting is of
major importance from a bacteriological point of view.
• A theatre should however be;
• Sited in a cul-de-sac portion of the hospital preferably in a storey
• Not close to an incinerator or refuse dump
• Away from a heavily trafficked part of the hospital
• Easy and swift access to the intensive care unit(ICU)/high
dependency unit(HDU) accident and emergency(A&E) and wards
• Adequate & appropriate space allotted as per utility of the area
• Provision for ventilation & temperature control, keeping in mind
the need for laminar flow
• Provision for expansion of the OT complex should be borne in
mind during planning stages itself.
• Provision of emergency exit

11. Purpose of a surgical theatre
• OT complexes are designed and built to carry out
investigative, diagnostic, therapeutic and
palliative procedures of varying degrees of
invasiveness.
• Many of such set ups are customized to the
requirements based on size of hospital, patient
turnover and may be speciality specific.
• The aim is to provide the maximum benefit for
maximum number of patients arriving to the
operation theatre.
• Both the present as well as future needs should be
kept in mind while planning.

12. Architectural Planning

13. TYPES OF OPERATING THEATRES
• Based On Sterility
• Ultra Sterile E.G Transplant OT
• Sterile
• Septic
• Based On Timing
• Routine
• Emergency
• Based On Construction
– Traditional
– Conventional
– Modular
OR
– Hybrid OT
– Integrated OT
– Digital OT

14. COMPONENTS
• Operating room
• Anaesthetic room
• Scrub room
• Utility room

15. SCRUB ROOM
• 2 doors: leading to the corridors and into
the theatre.
• Sinks with taps that can be manipulated
with the elbow or automated via infra-red
body detector sensors.
• Soap holders that can be manipulated by
foot pedal or elbows.

16. SCRUB ROOM …
• Good drainage and suitable panels
incorporated into the sink to prevent
splashing of clothes.
• Anti-slip and anti-static floor
• Easily cleaned shelves for gown packs and
gloves
• Adequate facilities for separate disposal of
linen and paper

17. OPERATING ROOM
• A double door entrance from the
anaesthesia room; A double door exit into
the clean corrido.
• 2 small door entrances from the clean store
room.
• An opening from the scrub room.
• A single exit door to the dirty corridor for
the removal of drapes, instruments, and
waste products.

18. OPERATING ROOM
• All doors should be well sealed in order to
comply with the air-ventilation system.
• The operating table should be adjustable with
all working parts sealed. The cushions should
be easy to clean and in good repair.
• The operating light should be adjustable, sealed
and easily cleansed with facilities for
attachment of light handles for adjustment by
the operating team.

19. OPERATIG ROOM…
• The walls and floors should be plastered or
covered with morale works which should lie
well sealed and any defect repaired as a matter
of urgency as the soaking through of loathing
water will cause an increase in bacterial content
in the theatre environment.
• The floor should have smooth finish and slope
gently towards a gully so dial they can be easily
swilled down.

20. OPERATING ROOM…
 Fixed surfaces should be avoided and reliance
placed on steel trolleys. X-ray viewers should be
inset into the wall and kept in good repairs as
should electric sockets.
 It should not be over equipped. All non-
functioning machines removed as they serve as
reservoirs for dust and microorganisms.

21. OPERATING ROOM…
CONTROL OF AIR CIRCULATION
 Controlled positive pressure (plenum) ventilation
with the use of filters is the normal trend in
modern operating theatre.
 Positive pressure because, it prevents
contaminated air infiltrating into the theatre. The
incoming air can be distributed by:
 Turbulent Ventilation
◦ It rapidly mixes with the air already present in
the theatre
 Displacement Ventilation
◦ Air is introduced gently a merely displaces the
theatre air by quiet downward movement.

22.  The air is introduced at ceiling levels in both types and
extracted by exhaust situated near the floor.
 Filters: Should have pores of about 5mm. Bacteria
occurs as aggregate of particles of dust hence will not
enter pores. Those made of disposable fabrics and
oiled mesh are very effective. Adequate maintenance
important otherwise there would be;
1.Heavy contamination of air entering the theatre
2.Pore blockade so that air does not enter the theatre.
Unventilated Theatre- bacterial count= 3000cfu/m3
Well Ventilated Theatre- bacterial count= 200cfu/m3
Ultra Clean Air Ventilation - bacterial count= 10cfu/m3

23. ANAESTHESIA ROOM
• Has one door to the dirty corridor and one to
the operating room
• Contains materials and equipments for the
induction of anaesthesia
• Anaesthesia is induced here, though been
done in the operating room at this
environment

24. STORE ROOM
• Has two doors opening into the operating
room
• Surgical equipments are stored here
• The perioperative nurse counts the
equipments before and after surgery before
returning them to the store

25. ZONES IN THE OT
• Sterile zone
• Clean zone
• Protective zone
• Disposal zone

26. STERILE ZONE
• Operating suite
• Sterile preparation area
• Scrub station
• Gowning area
• Anesthesia induction area
• OT ATTIRE IS MANDATORY IN THIS AREA

27. STERILE ZONE

29. CLEAN ZONE
• Sterilization area
• Store area
• Pre-operative area/room
• Postoperative recovery area/room
• OT Staff & Doctor's room
• OT ATTIRE MANDATORY IN THIS AREA

30. PROTECTIVE ZONE
• Changing rooms
• Reception area
• Waiting area
• Trolley bay
• OT ATTIRE NOT MANDATORY IN THIS AREA

31. DISPOSAL ZONE
• Dirty utility area
• Disposal Corridor
• OT ATTIRE MANDATORY IN THIS AREA

32. REQUIREMENTS IN AN OT
• Central AC; 20-22 degree Centigrade
• Humidity ; 50-60%
• Positive pressure ventilation
• General lightening; cold light & even distribution
• Laminer air flow through diffuser
• Operating light; Ceiling mounted, shadow less
focusable beam
• Medical gas pipeline for Oxygen supply
• Power supply should be uninterrupted
• Fire safety; fire or smoke detectors, fire
extinguishers
• Power switches should also be away from operating
area.

33. OTHER REQUIREMENTS
• Wide door; Sound proof, non- reflective
surface,radiation resistant & fire resistant.
• Sliding type of door
• Glass cut out for visibility.

34. Surveillance in the OT
• Surgical Site Infections(SSI's) are 2nd to 3rd
most common health care associated
infections.
• Complications of surgical procedures cause
considerable morbidity & mortality.
• If these occur intraoperatively, it carries
mortality as high as 77%.

35. CONCLUSION
• Theatre design has evolved over centuries in response to
the change in pattern of healthcare delivery and the
expanding knowledge of diseases and its treatment.
• In the present era of evidence based medicine, it
becomes imperative to give maximum importance to
planning an Operation Theatre Complex.
• Within the limitations of finance and space, the best
results can be obtained when the anaesthesiologist with
multiple roles inside the operation theatre complex is
consulted in the process.

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