1) The document provides an overview of operating theatre design, discussing the origins of the term "theatre" and how operating room environments have developed over time. 2) It describes key design considerations for operating theatres including construction materials, ventilation, traffic flow, and support facilities. Maintaining appropriate temperature, humidity, and air pressure differentials between rooms is important for infection control. 3) The document outlines various equipment, supplies, and pharmaceuticals used within operating theatres and issues relating to their storage, labelling, stock control and expiration dates to ensure safety. Appropriate product labelling and alerting staff to recalls are also discussed.

1. Operating Theatre DesignOperating Theatre Design
A basic introduction to the design
features of modern operating
theatres and working principles
Martin Smith
2013

2. Origins of the Word “Theatre”
• Where did the term come from?
• What does it mean?
• What does it mean to you?
We discuss thisWe discuss this

3. • Definitions of theatre on the Web:
• theater: a building where theatrical performances or motion-picture shows can be presented;
• Theatre: a region in which active military operations are in progress; "the army was in the field awaiting
action"; "he served in the Vietnam theater for three years"
• Theatre: the place that is the setting for dramatic performances.
• Theatre (or theater) is the branch of the performing arts defined by Bernard Beckerman as what "occurs
when one or more persons, isolated in time and/or space, present themselves to another or others.“
• Theatre is that branch of the performing arts concerned with acting out stories in front of an audience using
combinations of speech, gesture, music, dance, sound and spectacle — indeed any one or more elements of
the other performing arts. In addition to the standard narrative dialogue style, theatre takes such forms as
opera, ballet, mime, kabuki, classical Indian dance, Chinese opera, mummers' plays, and pantomime.
• In warfare, a theater or theatre is normally used to define a specific geographic area within which armed
conflict occurs. A war would have to occur over a large portion of the globe in order to be considered to be
large enough to have separate theaters, and the term is not used in the singular. Typically, each theater
would be distinct and separate from other theaters. Very often, the delineation occurs along continental
boundaries or in separate oceans. ...
• Theater in military terms, is a geographic location used for military operations.
• A theater or theatre is a structure where theatrical works or plays are performed or other performances such
as musical concerts may be given. While a theater is not required for performance (see Environmental theatre
or Street theatre), a theater serves to define the acting and audience spaces and organize the theater space
as well as provide facilities for the actors and the tech crew as well as for the audience.
http://en.wikipedia.org/wiki/Theatre_(structure)
• Lecture Theatre: A lecture hall, a large room used for instruction, typically at a college or University (trad.)
There are lots more – see for yourself.

4. Origins of Theatre

6. Historical Operating Theatre

7. Early Surgery!!!
https://www.youtube.com/watch?v=ctKKpBTWwwo

8. Development of the theatre

9. Surgical team operating on a
patient, c.1950s

10. Environmental requirements
Based on your experience or concepts of
the Operating Theatre Environment, what
is the difference between the classroom
environment and that of the Operating
Room?

11. Theatre Design Issues
• Building construction (wall and floor
material)
• Heat, light, power, water & drain
requirements
• Access – staff, patients & equipment
• Ventilation
• Support facilities (ancillary rooms and
supplies)

12. The Operating Theatre (room)

13. The Built Environment
TheatreTheatre
OrOr
Operating RoomOperating Room
A.RA.R.
ScrubScrub
PrepPrep.“DirtyDirty”
Patient Exit
DisposalDisposal

14. 1 2 3 54 76 8a b
a Air intake
1 Coarse filters
2 Fan
3 Heaters
4 Condensers
5 Filters
6 Heaters
7 Humidifiers
8 Attenuators
b Filtered, humidified (conditioned) air
Theatre Air Conditioning

15. Theatre Air Conditioning
Remember - maintain pressure gradientsRemember - maintain pressure gradients
“Ideal” conditions *-
Temperature- 18 to 23 O
C
Humidity - 50 to 60%
Air Changes- 20 per hour
* Note -
Conditions may be varied due to patient requirements.
Air changes shown are minimum standard.
Target Humidity in normal temperature ranges is 55%

16. Theatre Air Conditioning
The Plenum System
Airflow is downward from ceiling, exiting at floor
vents (or through open doors)

17. Theatre Air Conditioning
Laminar flow systems
Additional airflow - up to 200 changes per hour.

18. Laminar flow systems (cont.)

19. Ceiling Vents of Laminar Flow System

20. Theatre
A.R.
Scrub
Prep.“Dirty”
Exit
“Traffic Patterns”

21. Theatre
A.R.
Scrub
Prep.“Dirty”
Exit
“Traffic Patterns”
Patients

22. Theatre
A.R.
Scrub
Prep.“Dirty”
Exit
“Traffic Patterns”
Equipment

23. Theatre
A.R.
Scrub
Prep.“Dirty”
Exit
“Traffic Patterns”
Equipment/instruments
Patients
Staff

24. Pressure Gradients
“Dirty”
A.R.
Scrub
Theatre
(“clean”)
Prep.
Highest Lowest
Keep doors closed as much as
possible to maintain these
Pressure
dampers
Intention = Air flow is from “clean” to “dirty”

25. Charnley-Howarth EXFLOW System

26. Other Laminar Flow Systems

28. Quick summary
• Operating Department (Theatres)
• Ideally located near to surgical wards,
CSSD, ITU
• Design should allow for one way traffic
and prevent return flow of contaminants
into clean areas

29. Scrub room
For hand
washing
(surgical scrub)
gowning &
gloving of
surgical team

30. Prep / instrument room
Sometimes
situated off
the
Operating
room.
Storage of
instruments
& supplies

31. The Operating Room (Theatre)
Focal point
of surgical
process

32. Anaesthetic Room
• Reception &
preparation
of patient
• Induction of
anaesthesia

33. Rest/coffee room
• Does exactly what it
says on the tin!
• A place to relax.
• Beware of careless
conversations!
• Patient
confidentiality still
applies

34. Operating theatre designOperating theatre design --
conclusionconclusion
• Building /construction
• Heat, light, power, water & drainage
• Access – staff, patients & equipment
• Ventilation
• Support facilities (ancillary rooms and supplies)
• Policies & procedures
• Health & Safety
• Now we consider what goes into the rooms

35. Stock Control & Management
After considering the built environment we
need to examine the materials utilised
within it.
Question –
What materials (consumables) are
commonly used within the Operating
Theatre Environment?

36. Materials include -
• Equipment
• Furniture
• Surgical Instruments
• Anaesthetic instruments
• Disposables
• Pharmaceuticals
• Clothing

37. Issues
• Storage conditions
• Shelf-life
• Expiry dates
• Stock rotation
• Stock control
• Hazard notices
• Damaged goods

38. Storage must be appropriate & adequate

39. 1. Type of wine
2. Wine appellation
3. Additional denomination
4. Vintage year
5. Name of the wine
6. Color of the wine
Product Labelling – Essential issues
7. Quantity in millilitres
8. Alcohol content by volume
9. Nation of origin (in our case, obviously Italy)
10. Bottling company data
11. Importer (this information is obviously missing
from labels of wine purchased in Italy)

40. For those who don’t like wine

41. For those who don’t drink alcohol

42. Fundamental issue –
It is vital you check items are “in date”
and note batch numbers before use
(Also in event of product failure or recall)
Expiry dates & batch numbers

43. Note
‘Exp’: means for use up to
and until the last day of the
specified month.
‘Use by’: means for use up
to and until the last day of
the specified month.
‘Use before’: means for
use until the first day of the
specified month.

44. Product Labelling – Essential information

45. Example of products in use – Sutures*
* Pre-prepared needle & thread, used for sewing tissue
together. Different sizes & materials used for various tasks

46. Suture box labelling

47. Suture box labelling

48. Individual suture packaging

49. Drug Labelling

50. Drug ampoule labels

51. Intravenous Fluid Labelling

53. Circulated by Drug and safety Agencies –
To alert us (the practitioners) to problems or
concerns with drugs and equipment.
Watch for them and act accordingly
Alert notices –

54. Questions?
the end

55. Some further reading
Your Local Department policies.
HBN 26 – Facilities for surgical procedures Vol.1 (2004) A guide.
http://www.michaelbone.plus.com/alexis/hospital/hbn26.pdf
Healthcare Infection Society
http://www.his.org.uk/
The Old Operating Theatre Museum – St Thomas’s hospital
http://www.thegarret.org.uk/oot.htm
AAGBI publications
http://www.aagbi.org/publications/publications-guidelines/A/F
Department of Health
https://www.gov.uk/government/organisations/department-of-health
National Patient Safety Agency (NPSA)
http://www.npsa.nhs.uk/
NPSA Guide to labeling & packaging
http://www.nrls.npsa.nhs.uk/resources/collections/design-for-patient-safety/?entryid45=59831
Medicines & Healthcare products Regulatory Agency (MHRA) Safety information
http://www.mhra.gov.uk/Safetyinformation/index.htm
The Productive Operating Theatre - the well organised theatre
http://www.institute.nhs.uk/quality_and_value/productive_operating_theatre/well_organised_theatre.html
And others – just try searching the web!