Planning an

Operation Theatre Complex

Operation theaters
 Definition
Specialized facility in hospital where
invasive treatment is given under strict
aseptic controlled environment by trained
personnel
 Objectives of planning
• Promote high standards of asepsis
• Ensure safety
• Optimal physical working conditions
• Ensure optimum utilization
• Facilitate coordinated services
• Rigidity and flexibility
 Design considerations
• Location
• Workflow
• Basic work areas and Division of space
• Zoning concept
• Air filters
• Machinery and equipment
• Organization
• Policies and procedures
• problems
 Zoning
• Why?
• What is it?
• 3 or 4?
 Zoning
• ZONE 1 – PROTECTIVE - reception,
waiting,trolley bay, change rooms
• ZONE 2 – CLEAN AREA –
preoperative,recovery,plaster room,staff
lounges,stores
• ZONE 3 – STERILE AREA – operating room,
scrub room, anesthesia room,setup room
• ZONE 4 – DISPOSAL AREA – dirty utility,
disposal corridor
 Special considerations
• Air – supply, direction of flow, pressure
changes in areas,air changes, monitoring
of quality
• Temperature and humidity – 21-24 centi,
45-60% humidity
• Lighting – at incision area 50 to 125K lux
with intensity cntrl, non-shadow ,blue-
white color of daylight, heat cntrl
Planning for an Operation Theatre
• 1. O.T. Needs Specialized Planning.
• 2. Different zones of OT Complex
• 3. Basic Principles of Planning an O.T
& Recovery room
• 4. Administrative policies & Work
schedules in OT functioning
• 5. Measures to check the infection rate
O.T. Needs Specialized
Planning.

YES
O.T. Needs Specialized Planning.
• O.T. Work is complex and concentrated
and requires intense coordinated team
work within the unit & with other agencies
providing them the essential supporting
services like
– Transport of Men and Machine
– Cleaning & Sterilization
– Disposal
– Record Keeping and Monitoring
O.T. Needs Specialized Planning…
• Special features of O.T. working
- Caters to 50% of the total
Healthcare seekers.
- Wide range & level of skilled
persons working as team.
- Equipments vary from pin to
most sophisticated machines.
O.T. Needs Specialized Planning.
• Both the Team members & health
care seekers are at the peak of
their sympathetic activity at some or
the other time of the operative
procedure.
 •Result can be disastrous
Comfort

S S Harsoor 18
O.T. Needs Specialized Planning.
• These special features regarding the
O.T. work makes the place very
special &hence needs special
structural & functionability planning to
render better services safely,
comfortably and with economy
Deficiencies in OTs
(existing OTs)
Deficiencies in OTs (existing)
1) Waiting Area & Recovery-
• Either Not earmarked
• if existing - Not well equipped
- Lack of basic amenities
2) No reception area
3) No separate rooms for –
Surgeons / Anesthesiologists
Jr. Doctors / OT Attendants
Deficiencies in OTs(existing)…
4. No separate CSSD
5. Inappropriate size & type of O T
6. Lack of appropriate working
conditions
• laminar flow & mandatory air exchange
• Temperature controls
7. Scarcity of Staff – at all levels
Deficiencies in OTs(existing)…

8. No OT assistants & OT
Technicians available
9. Training programmes (lack of).
10. No OT audits conducted
regularly & /or scientifically
11. Lack of Standard OT protocol
Different zones of
OT Complex

4 Zones…
Different zones of OT Complex
(1) Protective Zone Includes
• Change rooms for all staff with conveniences
• Transfer bay for patient, material &
equipments
• Rooms for administrative staff
• Stores & records
• Pre & Post operative rooms
• I.C.U., Sterile Stores
Different zones of OT Complex

(2) Clean Zone

• Connects protective zone to aseptic zone (O.R.)
• Has areas
– Equipment Store room
– Maintenance Workshop
– Kitchenette (Pantry)
– Firefighting device room
– Service room for staff
– Close circuit TV Control area
– Emergency exit
Different zones of OT Complex…
3) Aseptic zone
Operation Rooms
(Sterile)
4) Disposal zone -
Disposal areas from each
OR & Corridor leading to
disposal zone
Basic Principles of Planning
an O.T & Recovery room
 Basic Principles of Planning an
O.T & Recovery room
1. Location: 1st floor & above very near to
Surgical wards & SICU
2. Corridors : 3 - 3.5 m width for easy
movements of men & machines
3. Zone wise distribution of the area so as to
avoid criss cross movements of men &
machine
4. Provision for emergency exit
( Many people & Machine)
 Basic Principles of Planning an
O.T & Recovery room
5. Operation rooms:
– No. & size as per the requirement
(50% of the surgical beds)
• Size 20’X20’X10’
• Glass windows one side only
– Sliding door, (2 Flap door,1.5 mts)
 Basic Principles of Planning an
O.T & Recovery room
6. Ventilation & temperature control
– 20-30 air exchanges / Hr
– Up to max 80% recirculation of air
– Ultraclean Laminar airflow (90% removal of particles
>0.5µ )

– Temperature 20-240 C (for Pt needs)

– 0.005 H2O Positive air pressure in OR
– Humidity 50-60%
Basic Principles of Planning an
O.T & Recovery room
7. Strong & impermeable flooring with
minimum no. of joints
• Conductive flooring to dissipate static electricity
(Min 1 Ohm - Max 10 Ohm Recommended)
8. Washable Wall-
• Laminated Polyester or smooth Paint
• Collusion corners to be covered with steel
• Colour should allow reflection of light yet
give soothing to eyes
Basic Principles of Planning an
O.T & Recovery room
9. Electric points on wall/ Pendants
• More than 1.5 m height
• Explosion-proof plugs
• Multiple outlets from different
sources of Power
• Load calculation based on
equipments
• Proper capacity Current carrying
Power Cords
 Basic Principles of Planning an
O.T & Recovery room
10. Lighting
– Room to Surgery area lighting to be 1:3
ratio
– Shadowless light with 25000-125000
Lux of light
– 10-12” depth of focus of light will
illuminate both surface & deeper tissues
– Minimum 2000 Lux light to asses colour
of patient
 Basic Principles of Planning an
O.T & Recovery room
10.Lighting …
– Blue-white daylight with spectral energy
range of 50000K ( 3500-67000 Kelvin acceptable)
– Not >25000µ W/Cm2 radiant heat to be
produced,
– Halogen lights preferred
– UPS of adequate capacity for OR light,
monitors, cautery, Anaesthesia machines
 Basic Principles of Planning an
O.T & Recovery room
11. Piped Gases
• Automatic/ SemiAutomatic fail safe
manifold system
• 2 each Gas & suction outlets
(Central supply & Emerg stock) for
all Pre-Op holding, OR( One N2O),
PACU, Recovery
 Basic Principles of Planning an
O.T & Recovery room
12. Scrub room
– Elbow/ Infrared sensor operated Taps
– Non-Slippery flooring essential

13. Good pre operative area with

reception.
Separate area for Paediatric patients
Provision for future expansion.
Adequate Illumination.
 Basic Principles of Planning an
O.T & Recovery room
14. O.R. Panels
- recessed into walls
- contains X ray view,
temperature, Humidity control,
hands free phone, clock, time
elapsed indicator, music etc
- Foot operated call light system
Functional requirements
& facilities for O.T.
Functional requirements &
facilities for O.T...
• Teaching & training the staff to minimize
the risk of infection & cross infection
• Administration
– Co-ordination of services
– Maintaining steady supply
– Prompt disposal of materials, bills &
correspondence.
– Providing incentive for better working
 Recovery room is an
integral part of the OT
Recovery room is an integral
part of the OT
• Pts retained for observation till
the vitals are stable
• All the protective reflexes
return to normal
• Before sending the pts. home
in case of day care surgery.
Staffing pattern of an OT
Staffing pattern of an OT
• I/C of O.T.- Anesthesiologist (HOD/Prof)
• Nursing superintendent
• Deputy
• OR Nurse incharge (each OR) – 5-6 (d. N.R.)
• 6 trained nurses (each OR) 30 — 36 (d, N.R,)
• Theatre technician (each OR) - 6 (d, N.R)
• Asst. (4 each OT) -24 (d, N.R)
• Orderlies - a pool of 6-10
Staffing pattern of an OT…

• Store & sterilization 2

• Receptionist 3 (d, N.R)
• Security Staff 2
• Record keeper 2
• Electric Engineer 1
• Electrician 3 (d, N.R.)
.
• D- day duty ,N-Night, R Reliever for off
Administrative policies
in OT.
 Administrative policies in OT.
• OT is the place where strict discipline has to
be followed.

• Slightest negligence on part of any level of

person can prove disastrous.

• Delegation of work & decentralization should

be the main aspect of OT. administration.
Administrative policies in OT..
– Good communication at all
levels (in staff, with pt’s, with pts
relatives & other units etc.)
– Accountability of every person
to his /her superior.
– Complete data keeping
regarding every procedure.
Administrative policies in OT..
• Necessary SOP( standard operating
practices) is to be prepared for the
following
– Acceptance of cases for OT
– Basic procedures
– For preparing OT schedule
– OT personnel
– House keeping staff
– Clerical staff
Work & time schedules in
OT functioning
Work & time schedules in
OT functioning
• OT work is complex & concentrated, and
requires an intense coordinated team
work, within the unit carrying out the
procedure and other agencies, in
providing essential supporting work like
– Cleaning & sterilization
– Transport of equipments
– Disposal
Work & time schedules
in OT functioning…
– Maintenance, monitoring & keeping records of
working
• For these reasons, work schedule & time
schedule has to be planned very carefully.
• Work schedule of OTs is as follows:
– Receipt of OT list at least 24 hrs in advance
– Receipt of sterile linen & instruments from
CSSD 12-24 hrs in advance.
Work & time schedules in
OT functioning…
– Daily / Weekly / monthly indent of inventory
– OT attendent & orderly has to reach in OT
½Hr before others,
– staff nurses, Incharge Nurse, Deputy/
N.Supdt., Consultants
• Patients reach waiting area 1Hr before
operation.
• All staff members have to change their
dress, put on mask, cap, & OT shoes
Work & time schedules in
OT functioning…
– Cleaning & dusting of the premises (2 Hrs
before)
– Checking & replenishing the drugs & other
material OT wise (By OT sisters)
– Checking of gas supply & anesthesia
machines- OT Technicians
– Preparing instruments trolly as per operation
list (OR wise) 15-30 min before. & special
request (after getting scrubbed)
Work & time schedules
in OT functioning…
• Check all machine & electric gadgets
(OR wise by OT technician)
• Starting time of operations & order of
operations followed strictly
• After checking the identity of patients
site & type of surgery & consent, the
pt is taken into respective OT.
Work & time schedules
in OT functioning…
Anaes. Assistant should be ready to help
Anaesthetist & surgeons.

• After the patient is shifted from OT table,

OR is cleaned & soiled material is sent to
disposal room through service hatch
(Nearly 15-20 minutes time needed)
• Same sequence of events continues till
the OT list is over or 8 Hrs of work
Work & time schedules
in OT functioning…
– There-after one emergency OT works
similarly
– In between the operations Tea / Coffee
is served to team members (without
interrupting the work continuity)
– Every job done is documented after
finishing the operative work (data
keeping- daily/monthly/Annual)
Work & time schedules in OT
functioning…
– Every person leaves the OT premises
after changing his/her dress again &
taking off the mask, cap & OT shoes.

– One team of surgeon, Anaesthetist,

Nurse & O.T attendent & Technician
is available all 24 hrs (on call) for any
emergency operation
Work & time schedules
in OT functioning…
– One of ORs kept ready for emergency
operation at any hour of the day.
– Patients & operation details are to furnished in
advance to OT sister & Anaesthetist (by
surgeon) so as to start the work on time ( to
cut short preparation time)
• Daily/weekly/monthly cleaning of various
parts of OT complex.
Measures to check the
infection rate
Measures to check the
infection rate
• O.T discipline, if followed sincerely &
strictly by all staff directly or
indirectly related to OT, can bring
down the infection rate to minimum.

• Staff should be educated & trained

in O.T.discipline & monitored
periodically.
 Measures to check the
infection rate…
• Good CSSD & TSSU., & maintaining
sterility of all items used for surgery.

• Proper & periodic cleaning & disinfection

of premises & other things used in O.T.

• Taking care of personal factor by all staff

members - Scientifically changing dress,
cap mask, shoes, scrubbing & gowning
Measures to check the
infection rate…
• Taking due precautions while
taking infected case & thereafter.
• Proper time spacing between two
surgeries.
• Timely & proper disposal of soiled
material.
Number of OTs required for
600 bedded hospital.
• For 600 bedded hospital (300 Surg. Beds)
• Out of Surgical Beds, 50% of Pts are
expected to undergo the surgery as such
• For 8 Hrs working for 6 days a week
– No of surgeries= Surg Beds*Bed Occupancy*Working
days/Average Length of stay
• =300 beds* 60% *250 days/10 days(ALS)
• =4500 surgeries/ year