There are four zones in an operating theater: the outer zone outside the theater complex, the clean zone within the complex but outside operating areas, the sterile zone within operating areas, and the disposal zone for contaminated items. Within the sterile zone are the operating suite, preparation areas, and stations for scrubbing, gowning, and gloving. Operating rooms must maintain sterile conditions and precise temperatures and humidity. Proper equipment, furniture, lighting, and monitoring allow surgeons to perform operations safely and effectively. Strict protocols are followed for attire, scrubbing, gowning, and gloving to prevent infections.

2. Zones in Operation Theater
There are four zones in operation theater:
1. Outer zone – rest of the hospital outside the
theater complex.
2. Clean zone- theater complex outside the
operating area.
3. Sterile zone- operating area .
4. Disposal zone- separate exit for contaminated /
used linen and instruments.

3. Sterile zone
• Operating suite
• Sterile preparation area
• Scrub station
• Gowning area
• Gloving area
OT attire mandatory in this area

4. Operating suite (Operating Room)
It is a facility within a hospital where
surgical operations are carried out in an
aseptic environment.

5. Categories of operating rooms
The American college of surgeons (ACS) describe OR
facilities based on the types of procedures performed .
The criteria include minimal floor space, types of
anesthetic used, and circumferential around the OR
bed .
The types of OR with minimal floor space are as
follows:
• Procedure room: 150 square feet floor area with 12
feet minimum clear dimensions at the head ,sides,
and foot of the OR bed . Local anesthesia are used
here.

6. • General OR: 250 to 400 square feet floor
area with 15 to 18 feet minimum clear
dimensions at the head ,sides, and foot of
the OR bed . Local, General and regional
anesthesia are used here.
• Other OR: 600 to 650 square feet with a
24 to 25 foot width and accommodate
multiple ceiling-mounted booms ,monitors
and high-technology equipment such as
robotics and controlling consoles.

7. Operating room humidity
An air conditioning system controls humidity.
High relative humidity (weight of water vapor
present) should be between maintained 20%
and 60%. Humidity in excess of 70% can
permit condensation inside sterile packaging.

8. Operating room temperature
OR temperature is maintained within a range
68˚F to 75˚ F (20˚C to 24˚C). A thermostat to
control room temperature can be advantageous
to meet patients need; for example,
The temperature can be increase to prevent
hypothermia .

9. Doors of OR
• Door should be 4 feet wide for ease to moving
patients on carts and beds. Ideally, sliding should
be used exclusively in the OR for the main
corridor. They eliminate the air currents caused
by swinging doors. Microorganism that have
previously settled in the room are disturbed with
each swing the door.
• Close doors decrease the mixing of air within the
OR with that in the corridors, which may contain
higher microorganism count

10. Floor
In the past, floors were conductive enough to
dissipate static from equipment and personnel but
not enough to endanger personnel from shock or
cause explosions for flammable anesthetic gases.
The most common flooring used is seamless
polyvinyl chloride that is continued up the sides of
the wall for 5 to 6 inches and welded into place.
These material should not degrade or stain with age
and cleaning . Metal oxides can be incorporated to
decrease the slipperiness of the surface when wet.

11. Walls and ceiling
Finishes of all surface materials should be hard ,
nonporous, fire- resistant, waterproof, stain-
proof, seamless, nonreflective, and easy to
clean. The ceiling should be a minimum 10 feet
high and have seamless construction . the height
of ceiling depends on the amount and types of
ceiling- mounted equipment.
The ceiling color should be white to reflect at
least 90% of the light in even dispersion.

12. Walls should be pastel color , with paneling
made of hard vinyl material that is easy to clean
and maintain. Seams should be sealed with a
silicone sealant. Laminated polyester or smooth
painted plaster provides a seamless wall; normal
paint has a tendency to flake or chip.
Walls and ceiling often are used to mount device
And equipment in an effort to reduce clutter on
the floor.

13. Lighting
Generally OR is furnished with static ceiling light
and mobile spotlight. Most room lights are white
fluorescent , but they may be incandescent.
Lighting should be evenly distributed throughout
the room without harsh shadows, especially in the
working area of the sterile field.
The anesthesia provider must have sufficient light ,
at least 200 foot- candles, to adequately evaluate
the patient’s color.
Intraoperatively the lighting should not cause the
organs to appear discolored.

14. The overhead operating light must:
Make an intense light , within a range of 2500 to
12,500 foot- candles (27,000 to 127,000 lux),into
the incision without glare on the surface. It must
give contrast to the depth and relationship of all
anatomic structures.
The light should be equipped with an intensity
control with a minimum of four brightness
levels. The surgeon asks for more light when
needed. A reverse light should be available.

15. Monitoring screens
Monitors and computers are designed to keep
the OR team aware to physiological functions of
the patient throughout the surgical procedure
and to record the patient data.
The anesthesia provider or a perioperative staff
uses monitoring device as an added means to
ensure safety for the patient during the surgical
procedure.

16. The screen may be built into portable carts or
attached to articulate arm or ceiling booms.
They may be plasma or liquid crystal display (LCD)
and measure 20 to 22 inches, and in some
facilities up to 42 inches, in size.
Plasma screen are heavier and do not last as long
as LCD versions.
Most commonly, video monitors serve a number
of useful purposes for the surgeon with in the OR.

17. Furniture and other equipment
Stainless steel furniture is plain, durable and easily
cleaned . Each OR is equipped with these basic items:
• OR bed with a Mattress covered, attachment for
position the patient, and arm boards.
• Instrument table. They are actually side of the scrub
person during the surgical procedure.
• Small table for gowns and gloves and the patient’s skin
preparation equipment and catheterization supplies.
• Anesthesia machine and table for anesthesia provider’s
equipment

18. • Sitting stools and standing platforms that
safely stack to give additional height to the
user .
• IV poles for IV solution bags. The
anesthesia provider may clip the upper
drapes to the IV poles.
• Suction canisters, preferably portable on a
wheeled base.
• Laundry hamper frame.

19. Operating room equipment
• The operating table in the center of the room can
be raised, lowered, and tilted in any direction.
• The operating room lights are over the table to
provide bright light, without shadows, during
surgery.
• The anesthesia machine is at the head of the
operating table. This machine has tubes that
connect to the patient to assist them in breathing
during surgery, and built-in monitors that help
control the mixture of gases in the breathing
circuit.

20. • The anesthesia cart is next to the anesthesia
machine. It contains the medications, equipment,
and other supplies that the anesthesiologist may
need.
• Sterile instruments to be used during surgery are
arranged on a stainless steel table.
• An electronic monitor (which records the heart rate
and respiratory rate by adhesive patches that are
placed on the patient's chest).
• The pulse oximeter machine attaches to the
patient's finger with an elastic band aid. It
measures the amount of oxygen contained in the
blood.

21. • Automated blood pressure measuring machine that
automatically inflates the blood pressure cuff on
patient's arm.
• An electrocautery machine uses high frequency
electrical signals to cauterize or seal off blood vessels
and may also be used to cut through tissue with a
minimal amount of bleeding.
• If surgery requires, a heart-lung machine or other
specialized equipment may be brought into the room.
• Advances in technology now support hybrid operating
rooms, which integrate diagnostic imaging systems
such as MRI and cardiac catheterization into the
operating room to assist surgeons in specialized
neurological and cardiac procedures.

22. Scrub station

23. Scrub in: To wash the hands and forearms very
thoroughly, as for surgery. To scrub in implies the
use of a brush (and often an implement to clean
under the nails).
When performing a procedure that requires sterile
technique, it is important to perform hand hygiene
with an antimicrobial agent that will remove debris
and transient micro-organisms from the nails,
hands, and arms. This reduces the resident
microbial count to a minimum and inhibits the
rapid regrowth of micro-organisms.

24. Traditionally, the surgical hand scrub was
performed by using an antimicrobial
agent and a sterile sponge and brush to
clean the nails, hands, and forearms. In
recent years, a brushless technique
using an agent with 50% to 90% alcohol
combined with chlorhexidine gluconate
has been introduced as an alternative to
the traditional surgical hand scrub.

25. This brushless technique is as
effective for preventing surgical-site
infections as the traditional surgical
hand scrub The surgical
scrub involves first decontaminating
the hands, then donning a
sterile surgical gown and pair of
sterile gloves.

26. Before performing the pre-scrub wash
and rinse, don surgical attire and
remove all jewelry. Fingernails must be
well groomed and nails must be no
longer than ¼ inch. Avoid artificial nails,
and if you wear nail polish, it must not
be chipped or worn longer than 4 days.
Wearing nail polish longer than 4 days
fosters bacterial growth.

27. Steps of scrubing

28. Gowning area

29. Step of gowning
• Dry one hand and arm, starting with the hand
and ending at the elbow, with one end of the
towel. Dry the other hand and arm with the
opposite end of the towel. Drop the towel.
• Pick up the gown in such a manner that hands
touch only the inside surface at the neck and
shoulder seams.
• Allow the gown to unfold downward in front
of you.
• Locate the arm holes.

30. • Place both hands in the sleeves.
• Hold your arms out and slightly up as you
slip your arms into the sleeves.
• The theatre assistant then prepares
to secure the gown at the neck and upper back.
Gowns differ in how they are secured, but most
with have either ties, buttons.

32. Gloving

33. Step of Gloving

34. Types of gloving
There are two types of gloving:
Open gloving method
Close gloving method

35. Open gloving method
The open gloving techniques is used with
changing a glove during a surgical procedure or
when donning gloves for procedure not
requiring gowns.
The assisted- open gloving technique is used by
the scrub person to help other sterile team
members don gowns and gloves before entering
the sterile field.

36. Steps of Open Gloving Technique
1.) Open the sterile pack of gloves and drop
them into the sterile field.
2.) Lift right glove by grasping the inside of the
cuff with left hand.
3.) Slide right hand into glove without touching
the gown (if wearing a gown) or the outside of
the glove. Do not adjust glove or cuff until both
gloves are on.

38. Close gloving method
The close gloving method affords
assurance against contamination when
donning gloves ; no bare skin is exposed in
the process because the bare hands do not
extend through the cuffs of the gown.