An operation theatre is the “heart” of any major hospital. An operating theatre, operating room, surgery suite or a surgery centre is a room within a hospital within which surgical and other operations are carried out.
OT are designed and built to carry out investigative, diagnostic, therapeutic and palliative procedures of varying degrees of invasiveness. Many such setups are customized to the requirements based on size of hospital, patient turnover and may be specialty specific..
The aim is to provide the maximum benefit for maximum number of patients arriving to the operation theatre. Both the present as well as future needs should be kept in mind while planning OT.
•Several basic design types are used in surgical services departments, depending on the age of the facility and the physical design of the areas outside the department.
All surgery departments are designed with the idea of controlling traffic patterns and quickly providing each operating room (OR) with the necessary supplies during and after each case, while keeping clean and contaminated traffic patterns separate.
Most surgical suites are constructed according to a variation of one or more basic designs. The basic designs are:
Central corridor plan
a)Racetrack plan –
In this design, the front entrance to each OR is from the outer corridor, and supplies are retrieved through a rear entrance to the room leading to the central-core storage and work areas.
b) Hotel plan
In this design, the ORs are situated along a central corridor, with separate clean core and soiled work areas. The primary difference in this plan is that all traffic enters and exits the surgery department through a single entrance or a primary entrance and holding area entrance situated along the same corridor.
c) PERIPHERAL CORRIDOR
In this design, the front entrance to each OR is from the peripheral corridor, and supplies are retrieved through a rear entrance from the OR leading to the central-core storage and work areas.
SPECIALITY GROUPING PLAN
The “specialty grouping” plan is simply a variation on the hotel or race track plan, in which ORs are grouped by specialty (e.g., neurosurgery, general surgery), each with its own closely associated clean storage areas and, in some cases, each with its own soiled instrument work area.
The design of any surgery department revolves around environmental control, traffic control, and the desire to prevent surgical site infection (SSI).
Such factors as the separation of clean and soiled work areas and areas of the department specified as restricted and unrestricted assist in the promotion of this idea.
Regardless of the design chosen by the facility, certain principles apply universally. Traffic control follows predetermined traffic patterns that all persons entering the department are expected to follow.
The OR department is divided into four zones based on varying degrees of cleanliness, in which the bacteriological count progressively diminishes from the outer to the inner zones (operating area) and is maintained by a differential decreasing positive pressure ventilation gradient from the inner zone to the outer zone.
- Unrestricted zone or clean area.
- Semi restricted zone or sub sterile area
- Restricted zone or sterile area
- Disposal zone or area
a) UNRESTRICTED ZONE
•This is the area where hospital personnel, OT personnel, patient’s & their attendants can move about in street clothes.
•Connects protective zone to aseptic zone and has other areas also like –Stores & cleaner room –Equipment store room
- Maintenance workshop
- Kitchenette (pantry)
- Firefighting device room
- Emergency exits
- Service room for staff
- Close circuit TV control area
b) SEMI RESTRICTED AREA
After changing from street clothes, with clean gown, cap & OT slipper, the OT team or personnel are, enter in this area. (Operating room attire is required)
• It includes –
- Change rooms for all medical and paramedical staff
- Transfer way for patient, material & equipment’s
- Rooms for administrative staff
- Stores & records
- Pre & post-operative rooms
- I.C.U. and P.A.C.U.
- Sterile stores
c) Restricted/Aseptic zone or sterile area
•This zone has operation theatres & operation room where operations are done.
•This is a place where staff & patients in street clothes & shoes are not allowed to enter. Scrubbed personnel wear sterile gowns & gloves & get ready for operation procedure. (Operating room attire is required)
Disposal zone or area
•Dirty utility area
OT attire mandatory in this area
ADVANTAGES OF ZONNING
Minimizes risk of hospital infection.
Minimizes unproductive movement of staff, supplies & patient.
Increases efficacy of operative team members.
Ensures smooth workflow.
Deceases hazards in operating room. Ensures proper positioning of equipment’s.
Nurses station or counter
Nurses station is an area where nurses and other health care staff sit behind when not working directly with patients and can perform some of their duties.
The station has a counter that can be approached by visitors and patients who wish to receive attention from the nurses. It should be spacious enough to allow two or more personnel to work together.
Pre-operative check area (reception) –
It is the area where OT nursing personnel receive patients. Here patients and his records are checked.
Holding area –
This area is planned for IV line insertion, preparation, catheter / gastric tube insertion, connection of monitors, & shall have O2 and suction lines. Facility for CPR should be available in this area.
Induction/Anaesthetic room – It should have all facilities as in OT.
It should provide space for anaesthetic trolleys and equipment and should be located with direct access to circulation corridors and ready access to the operating room.
It will also allow cleaning, testing and storing of anaesthesia equipment.
It should have sufficient power outlets and medical gas panels for testing of equipment.
Post anaesthetic care units (PACU)/Post–operative or recovery room-
Room where patients are kept & cared until they are out of anaesthesia & until their vital signs become stable.
These should contain a medication station, hand washing station, nurse station, storage space for stretchers, supplies and monitors / equipment and gas, suction outlets and ventilator.
•Staff room – Men and women change dress from street cloth to OT attire; lockers and lavatory are essential; rest room etc. are desirable.
•Sanitary facility for staff- One washbasin and one western closet (WC) should be provided for 8-10 persons. Showers and their number is a matter of local decision.
Inclusion of toilet facilities in changing rooms is not acceptable; they should be located in an adjacent space.
•Offices – for staff nurse and anaesthesia staff- The office should allow access to both unrestricted and semi-restricted areas as frequent communication with public is needed.
•Rest rooms- Pleasant and quiet rest for staff should be arranged either as one large room for all grades of staff or as separate rooms; both have merits. Comfortable chairs, one writing table, a book case etc., may be arranged.
•Laboratory – Small laboratory with refrigerator for pathologist to be arranged.
•Seminar room- Since staff cannot leave an OT easily, it is better to have a seminar room within the OT. Intra-departmental discussions, teaching and training sessions for staff (with audio-visual aids) may be conducted here.
–These rooms should have steel cabinets & separate for specific items.
–These cabinets should be spacious enough to accommodate various items such as sterile linens, sterile trays, sterile drums with sponges, dressings, cotton swabs, bandages, sterile rubber sheets, catheters, sutures, syringes, infusion & transfusion sets.
–A separate store room is needed for unsterile, clean articles such as linen, OT dress items, stainless steel equipment’s.
–The cabinets of store rooms should be made up of such materials which can be cleaned & washed without being damaged.
–There should be bigger store room for equipment’s such as monitoring devices, suction apparatus, O2 cylinder, trolleys, wheel chairs, stretchers, defibrillator, pace makers, bed urinals, OT slippers etc.
This is planned to be built within the restricted area. This should be spacious. Sometime s two or three operation theatres can share one scrub facility.
Scrub area should have deep & wide shink to avoid splash of water on the surrounding area. There should be facilities for running water.
The taps should be such that they could be opened or closed by foot pedals or they have long handles that can be operate by elbows.
•Waiting room – Patient’s attendants or family member’s waiting room with attached toilet & drinking water facility.
•Visitor’s gallery – Gallery from where the visitors can see the operative procedures being performed.
•Utility Room – This is also called clean up room where instruments, articles, gloves are received following surgical procedures. Here all these are cleaned, washed & wiped dry & then wrapped, stored & sent for sterilization.
•Disposal or sluice room –
This room receives all soiled linen & dressing. Here all disposable items are separated according to biochemical waste management code & then packed in leak proof containers.
The soiled linens are sent to the laundry. The OT set up should be such that it should be possible to dispose off soiled items without taking them through sub-sterile or sterile areas.
NUMBER & SIZE
•The number & size can be as per the requirement.
•The standard OT should be rectangular or square in shape and similar in design.
•It should be 20×20×10 feet in size so it provides a floor space of 400 Sq. feet approx.
•It should be spacious enough to allow free movement of personnel, trolleys, stretchers, wheel chairs, monitoring devices, portable x-ray machines etc.
•Cardiac or neurosurgery OT should be bigger in size of 20x30x10 feet with 600 sq. feet floor space.
•OT for endoscopy or minor surgery can be of small size of 18x18x10 feet with a floor space of 324 sq. feet.
•The OT management committee should consider installing an alarm system in case of a life-threatening emergency.
•The activation of this alarm will save valuable time to mobilize the emergency designate staff and direct them to the site of the emergency.
•Electric generator – OT department should have electric generator to ensure uninterrupted electricity supply in case of electricity failure.
•O2 supply & suction system – OT should have piped in O2 supply through central O2 supply system from a central source. There should also be central suctioning through piped in suction arrangement.
•Music system – Operation theatre can also have a soft music system. Music creates a pleasant environment for patients & staff. Music also provide diversion of the patient’s mind. Music can provide relaxation to pts who undergo surgery under local, regional or spinal anaesthesia. It also provide a soothing atmosphere & decreases tension & fatigue of the OT staff.
•Computer terminal – The modern OT construction also provide a surface area for the computer terminal in each OT. These computers are being used to record & maintain patient information.