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PAPER-402
Ms. SUSMITA BHAUMIK
An OT is that specialised 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
Function
Operating theaters had a raised table or chair of some sort at the center
for performing operations, and were surrounded by several rows of seats
(operating theaters could be cramped or spacious) so students and other
spectators could observe the case in progress.
The surgeon wore his street clothes with an apron to protect them from
blood stains, and he operated bare-handed with unsterile instruments and
supplies. (Gut and silk sutures were sold as open strands with reusable,
hand-threaded needles; packing gauze was made of sweepings from the
floors of cotton mills.)
Goals
Key elements to efficient use of operating theatres are:
• Effective management
• Good communication
• Well trained staff
• Appropriate facilities and equipment
• Operational layout that allows flow of patients.
•Effective planning and scheduling systems will enable smooth patient flow thus
increasing capacity, improving patient and carer experience, improved employee
satisfaction and morale
The operation theatre complex consists of four main systems,
•Surgical support system (the environment)
•Traffic and commerce (the activities)
•Communication and information (the records)
•Administration ( the management)
ADMINISTRATION
Overview and strategy
Staffing
Postponements
Operating list
management
Trauma and
emergencies Effective use
of theatre time
Theatre design
Theatre management structure
Experienced surgical staff should prepare patients who have multiple and
complex medical problems, this can prevent cancellation at anaesthetic
assessment.
Pre-operative assessment for patients who are elderly, have multiple and
complex medical problems can benefit from a team approach between
anaesthetist, surgeon and physician.
Cancellations of surgery
• Pre-operative assessment
• Increased communication
Regular review of cancellation can assist with target areas for redesign and
innovation.
Receive patient to
Admission
ward following operation
Home Home
Scheduling
Average time per operation can be agreed and used to assist building
theatre templates.
9.00 am 1 2.30pm
Case 1
Case 2
Case 3
Processes
Process steps examples
102
1 MINUTE
MINUTES
DATA
Core data set
Suggested Measures
Late Starts (e.g. >15mins) / Early Finishes (e.g. >60mins) / Overruns (e.g. >30mins)
• Example – For ten Orthopaedic sessions with a scheduled start time of 8:30am the
sample showed four (or 40%) started >15mins late.
• Delays
• Monitor theatre delays for one week to agree on the top 10 reasons for delays. When
this is agreed, 4 weeks data will be collected against the top 10 delays. Once 4
weeks of 10 delays have been gathered, charts will need to be produced. Time needs
to be collected against each reason(s) per day, as the top ten offenders may not
amount to the longest waste in time.
Resources
Aim: To increase the utilisation and quality of care within operating theatres.
Change Concepts
PAPER-402
MS.SUSMITA BHAUMIK
OBJECTIVES OF PLANNING
Promote high standards of asepis
Ensure maximum standard of safety
Optimum utilisation of OT and staff time
Optimize working conditions
Patient and staff comfort in terms of thermal, acoustic and lighting
requirements
Allow flexibility
Facilities coordinated services
Minimize maintenance
Ensures functional separation of spaces
Provide a smoothing environment
Regulate the flow of traffic
DESIGN PARAMETERS (OPTIMAL RELATIONSHIP BETWEEN
VARIOUS FUNCTIONAL ZONES)
CIRCULATION SPACE
STAFF CHANGING
PATIENT RECEPTION
AND RESTING AND RECOVERY
CIRCULATION SPACE
THEATRE
STERILE
OPERATING SUITES
SUPPLY
CIRCULATION SPACE
DESIGN PARAMETERS
Avoidance of unrelated hospital traffic flow
Convenient functional flow between related departments like
ICU,ITU ETC
Avoidance of outdoor noise
Provision for future expansion
Sliding doors
Desirable floors to be smooth and non-slippery
Ceilings to be painted with washable paints
Taps in scrub room should be knee/elbow operated /infrared operated.
Provisions of high speed autoclaves
Essential pharmaceutical storage
X-ray films illuminators
Emergency communicators that can be activated without the use of
hand
Toilets
PHYSICAL EVIRONMENT
TEMPERATURE
HUMIDITY
VENTILATION
Areas with higher hygienic requirements for air quality.
Areas with high clean-air requirements include the operating theatre, any
sterile preparation and pre-operative areas,
sterile storage, the anesthesia and equipment storerooms and the
entrances and the exits. The highest clean-air requirements apply to the
operation area and the sterile preparation area.
In order to be able to evaluate whether the air system, the air flow
profiles are correctly functioning, a CFD calculation is
recommended at the design stage. This also makes it possible to
ascertain whether, at a specific internal heat load, the selected
diffused air temperature and the selected air velocity will not lead to
an excessively high level of cooling in the operating theatre. This
will also reveal at an early stage any short-circuiting between air
supplied from the plenum and the site of the intake openings for air
recirculation
Assuming that the air from the HEPA filter is sterile, the only
possible emission source will be the operation team, the OT staff,
the patient, the material used and the equipment.
preoperative area 15
TEMPERATURE AND HUMIDITY
Normal person at rest (unclothed) – 240-270c with relative
humidity of 50%
Body looses heat during anesthesia.
So,
R.H – 45-60% recommended (adults 40% , children and infants
55%-60%)
In UK, 200 – 220 c with R.H. 50% to 60%
In US, 210 -24.50 c with R.H 50-60%
Other basic quality requirements
The following basic quality requirements apply to the use of equipment, operational
reliability of installations and finish in a surgical department:
Health risks to staff such as exposure to microbiological and chemical
Contamination, and lasers and ionizing radiation can be avoided as far as
possible by drawing up guidelines and protocols.
The finish of floors, walls and ceilings must be smooth, flawless or closed.
Corners and transitions between floors and walls will be rounded to prevent
accumulation of dirt. The different areas should be constructed and furnished in such
a way as to allow effective cleaning and if necessary disinfection with commonly
used cleaning agents and permitted disinfectants.
ZONING IN OT
CONSISTS of 4 zones
- Changing room
- Patient transfer area
- Stores room
- Nursing staff room
-Anaesthetist room
- Recovery room
C. ASEPTIC ZONE –
•Scrub area
•Preparation room,
•Operation theatre,
•Area for instrument packing and
sterilization.
D. DISPOSAL ZONE
STERALIZING
DEPT
STERILE
SCRUB
PEPARATION
OPERATING ROOM
STAFF
PATIENT-OUT CHANGE
PATIENT IN
NUMBER OF OPERTING
SUITES
Number and type of Time allowed
a for staff
surgeons breaks
Type of hospitals Average time for
Hospital policy and operations
procedure Time allowed for
Bed strength maintenance of OT
Number and type of Expected ALOS
surgery patients Size of an average OT
Number of operations list
per day
1. According to Rao committee
2. American pattern
3. European countries
• perfect
• comfortable
• Lights brilliant
• Exclusive design
• Trouble free
• Mounting is economic
Venus O.T. Lights
Shadow less Ceiling Operating light
combination that provides the superior
performance for all kinds if surgeries.
Compact, Light weight and sealed dome
made of aluminium consists of glass
diachronic reflector to provide cool, bright
and homogenous illumination.
• disposal traffic