PLANNING AND DESIGNING OF OPERATION THEATER

BY PAUL PRIYARAJ.J

OPERATION THEATER(OT)
Operation theater so called in the United Kingdom because they traditionally consisted of semicircular amphitheater to allow students to observe the medical procedures. It is also called as operating room or surgical suite(which includes entire surgical facilities like operating rooms, hall, ways, workrooms, storage and front desk etc). The oldest operating theater is in London, which was built in the year 1822 and the other one is in Boston, dating back to 1824.

DEFINITION
OT is that specialized facility of the hospital where life saving or life improving procedures are carried out on the 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.

AN INSIDE VIEW OF OPERATION TEATER

AIMS OF PLANNING
To promote high degree of asepsis Ensure maximum safety to patients and staff Ensure maximum standard of safety. Optimize utilization of OT and staff time. Optimize working conditions. Patient & staff comfort in terms of thermal, acoustic and lighting requirements. Allow flexibility.

Facilitate coordinated services. Minimizes maintenance. Ensure functional separation of spaces. Provide soothing environment. Regulates flow of traffic.

CRITERIA FOR PLANNING

Environmental Criteria Economic Criteria

Work flow Criteria

Functional Criteria

PHYSICAL FACILITIES
LOCATION
The best location for the OT is which permits a convenient and uncomplicated flow of patients, staff and clean supply traffic. It should be close to surgical wards and ICU and should receives patients from the floor through non public corridor, elevators and ramps. Convenient access to elevators is also essential.

ORIENTATION
Northern orientation of operation theater is considered to be most suitable to ensure adequate day light within the theater and to avoid glare.

Physical layout of operating room should be excluded of contamination from outside area with proper traffic patterns within the suite and separation of clean areas from contaminated areas within the surgical suite.

LAY OUT OF OT

FACTORS DETERMINING THE NUMBER OF OT

Type of Hospital Hospital bed compliments Number and type of surgical patients Number and type of surgical specialties Number and type of surgeons Number of operation per day Average length of stay of surgical patient Hospital Policy

Estimated cleaning time for OT between surgeries Allowance for emergency surgeries Allowance for septic cases Allowance for staff breaks

NUMBER OF OT(COPP-1964)
No of OT Required
No of hospital beds Indoor OPD + Emergency

Minor

Major

Minor

Major

300 500 750 1000

2 2 2 2

3 5 8 10

1 1 1 1

X 1 1 1

SIZE OF THE OPERATING ROOM

General Operating Room 40 sq.meter. CVTS, NEUROLOGY, ORTHOPEDICS 60 sq.meter and additional adjoining room is required for Heart Lung Machine.

Endoscopy suite will require Procedure Room 20 sq. meter.

For OT of 200-300 bed hospital the optimum size is 18 x 18 to 18 x 20 but not more than 400 sq. feet.

ZONING OF OT
1. 2. 3. 4. The OT is divided into 4 zones; PROTECTIVE ZONE CLEAN ZONE STERILE ZONE DISPOSAL ZONE

1.PROTECTIVE ZONE This is at the entrance of operating theater. The main facilities which lie in this area are:

a. b. c. d. e. f.

Patients waiting area and reception Trolley bay Lifts Stairs Switch room Pre anesthesia room, changing room, store room.

 2. CLEAN ZONE It provides a. Pre-operating room b. Recovery room c. Theater work room d. X-ray room, plaster room e. staff nurse room and anesthesia store room

3. STERILE ZONE

a. b. c. d.

This zone will include: Operating Suite in particular Scrub room Anesthesia room Instruments trolley area

4. DISPOSAL ZONE: It will include dirty room, disposal corridor and janitors corridor.

DESIGN PARAMETERS
OT should be planned so as to ensure: Avoidance of unrelated hospital traffic flow in the area. Convenient functional relationship and communication with surgical ward, ICU, CSSD, blood bank, medical imaging and laboratory services. Avoidance of outdoor source of noise. Provision for future expansion/alterations. The walls should be galvanised iron/ Stainless steel panels, joints filled with epoxy and the surface is treated with anti bacterial paint.

 DOORS
Door with two leaves and 5 feet wide using high grade stainless steel to ensure durability and sterility.

Hermetically Sealed Automatic Sliding Door

Hermetically Sealed Automatic Sliding Doors are preferred in the laminar flow operating theatres.

FLOORS
It should be fire resistant and should have only high quality antibacterial rubber floorings.

WALLS
Walls and ceiling should be aesthetically pleasing nonporous, fire resistant, water and stain proof, seamless, non-reflective and easy to clean.

CEILING
It should be cement plaster with washable paints. Corners should be rounded off for easy cleaning.

COLORING OF OT
Light Blue or Egyptian yellow is preferable.

AIR CONDITIONING
a. Desirable Temperature is 22 C. b. Minimum of 10-14 air changes per hour with 50% humidity. c. 1.5 Ton capacity of AC per 18 Sq. Meter is adequate.

 ILLUMINATIONS
a. b. c. d. e. OT.General 400 LUX Operating Room 1000 LUX OT.Cavity 5000 LUX Recovery Room 300 400 LUX Other Area 150 300 LUX

 FIRE PROTECTION, FIRE DETECTION AND FIRE FIGHTING;

a. Alarm system for fire detection. b. Fire extinguisher and fire hydrants should be provided. c. Fire exit routes to be clearly earmarked with red paint and well illuminated.

WATER SUPPLY;
500 Liters/bed/day is the normal requirement.

 ELECTRICITY:
Normal requirement is 3kV/bed/day. There should be provisions for inverters and standby generator facility. All electric wiring should be concealed.

Following physical facilities must be provided in operating theater complex:

Reception and office - 140-160 Sq. feet Transfer area Entrance Cloak room - 80 100 sq. feet

Staff changing room - 80-100 sq. feet each Notice board Holding bay Anesthesia room Scrub room Operating Room : The operating room should be normally arranged in pairs with scrub room and sub-sterilization room. Sub clean up: In suits of four or more, a small utility room is required for disposal of liquid waste of size 80-100 sq. feet Dirty utility room : This area should be provided with a sink of large size and work bench.

Surgical Scrub Sink

Taps in the scrub room should be knee/elbow operated.

X-Ray Viewers

There should be Xray film illuminators preferably recessed into the wall.

Pressure Differential Meter

This device provides convenience to monitor air pressure inside the modular operating theatres

Pass Through Boxes

Pass through boxes with interlocking systems are used where clean zone needs to be isolated from unclean area.

Recovery Room: A special ward for reception of patient immediately after surgery. The require size is 70-80 sq. feet/bed.

OT should have facilities for high speed autoclaves/ sterilizers for immediate/emergency requirements of sterilizing equipment.

Control Panels

Surgeon Control Panels are individually designed and customized for each hospital project.

Stainless Steel Storage Cabinets for Operating Theatres

Storage cabinets should be embedded in wall panels to enhance the usability and also maintain the hygiene of operating theatres.

Direct Digital Control System

High tech innovative direct digital control systems (DDC) provides the complete information as well as freedom of controlling temperature, humidity etc from touch screen surgeons control panels.

EQUIPMENTS OF OT
1. 2. 3. 4. 5. 6. 7. 8. OT tables Anesthesia machines Anesthesia ventilators Defibrillator Neonatal multi parameter monitor Cautery machine Central suction C-arms

9. 10. 11. 12. 13. 14.

Phako emulsification machine AO drilling system Arthroscope Endoscopic surgery system Lithoclast & Lithotripter The equipments in cardiac surgery OT Heart lung machine Octopus Defibrillator Fibrillator Multiparameter

 Hemotherm ACT machine.

THANK YOU