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SAFE ENVIRONMENTSAFE ENVIRONMENT

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THEATRE DESIGNTHEATRE DESIGN

Theatre Design Consideration:Theatre Design Consideration:

The prevention of wound infection.The prevention of wound infection. The safety of patients and staff.The safety of patients and staff.

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Design FeaturesDesign Features

Designing a safe environment incorporates Designing a safe environment incorporates features that prevent or control the risk of features that prevent or control the risk of infection, fire, explosion, and chemical and infection, fire, explosion, and chemical and electrical hazards. electrical hazards.

Well-devised traffic patterns, material-Well-devised traffic patterns, material-handling systems, disposal systems, handling systems, disposal systems, positive-pressure and well-dispersed clean positive-pressure and well-dispersed clean ventilation, and high-flow, unidirectional ventilation, and high-flow, unidirectional ventilation systems for special applications ventilation systems for special applications all contribute to a safe surgical all contribute to a safe surgical environment. environment.

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Traffic FlowTraffic Flow

Traffic Patterns in the Surgical Suite, Traffic Patterns in the Surgical Suite, a a three-zone three-zone designation of areas designation of areas within the surgical suite facilitates within the surgical suite facilitates appropriate movement of patients appropriate movement of patients

and personnel.and personnel.

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Traffic FlowTraffic Flow

1.1. Unrestricted areasUnrestricted areas are those in which are those in which personnel may wear street clothes, and traffic personnel may wear street clothes, and traffic is not limited. is not limited.

2.2. In semi-restricted areasIn semi-restricted areas, , such as such as processing and storage areas for instruments processing and storage areas for instruments and supplies, as well as corridors leading to and supplies, as well as corridors leading to the restricted areas of the surgical suite, the restricted areas of the surgical suite, personnel must wear surgical attire and personnel must wear surgical attire and patients must wear gowns and hair coverings.patients must wear gowns and hair coverings.

3.3. Restricted areasRestricted areas include operating rooms include operating rooms and clean core and scrub sink areas. Surgical and clean core and scrub sink areas. Surgical attire and masks are required in these areas attire and masks are required in these areas when there are open sterile supplies or when there are open sterile supplies or scrubbed persons in the area.scrubbed persons in the area.

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Traffic FlowTraffic Flow

The flow of supplies should be from the The flow of supplies should be from the clean core area through the operating clean core area through the operating rooms to the peripheral corridor. rooms to the peripheral corridor.

Soiled materials should not re-enter the Soiled materials should not re-enter the clean core area. Soiled linen and trash clean core area. Soiled linen and trash collection areas should be separated collection areas should be separated from personnel and patient traffic areas from personnel and patient traffic areas for infection control purposes. for infection control purposes.

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VentilationVentilation

Appropriate ventilation systems aid in Appropriate ventilation systems aid in the the

control of infection by minimizing control of infection by minimizing microbial contamination. microbial contamination.

Temperatures in an operating room Temperatures in an operating room should be maintained between 68° and should be maintained between 68° and 73° F (20° to 23° C), with relative 73° F (20° to 23° C), with relative humidity of 30% to 60% to reduce humidity of 30% to 60% to reduce bacterial growth and suppress static bacterial growth and suppress static electricity.electricity.

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Cont…Cont…

Temperatures in that range allow for Temperatures in that range allow for comfort of the surgical team and are comfort of the surgical team and are tolerated by most patients. tolerated by most patients.

Each operating room should have Each operating room should have individual temperature controls to individual temperature controls to accommodate patient safety, as when accommodate patient safety, as when increased warmth is required for patients increased warmth is required for patients at high risk for inadvertent hypothermia at high risk for inadvertent hypothermia during operative procedures. during operative procedures.

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Emergency SignalsEmergency Signals Every surgical suite should have an emergency Every surgical suite should have an emergency

signal system that can be activated inside each signal system that can be activated inside each operating room. operating room.

A light should appear outside the door of the A light should appear outside the door of the room involved, and a buzzer or bell should room involved, and a buzzer or bell should sound in a central nursing or anaesthesia area. sound in a central nursing or anaesthesia area.

The signals should remain on until the alarm is The signals should remain on until the alarm is turned off at the source. All personnel should turned off at the source. All personnel should be familiar with the system and should know be familiar with the system and should know both how to send a signal and how to respond both how to send a signal and how to respond to it. Such a system, restricted to use in life-to it. Such a system, restricted to use in life-threatening emergencies, saves invaluable time threatening emergencies, saves invaluable time in bringing additional personnel and resources in bringing additional personnel and resources for assistance.for assistance.

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Operating Department Operating Department comprisescomprises::

Rest roomsRest rooms Changing roomsChanging rooms Teaching roomsTeaching rooms StorageStorage Reception areasReception areas An operating suiteAn operating suite

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An Operating SuiteAn Operating Suite

Is one functioning unit of a Is one functioning unit of a department: department:

An anesthetic room An anesthetic room Clean preparation room Clean preparation room Scrub-up area Scrub-up area Operating theatre Operating theatre Sluice room Sluice room Exit bayExit bay

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““Clean and Dirty”Clean and Dirty”

All journeys within the All journeys within the department are made from department are made from clean to dirty areas, never clean to dirty areas, never

the other way roundthe other way round

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PatientsPatients Will enter the department from the hospital corridor Will enter the department from the hospital corridor

via a transfer bay. Here they are usually lifted on to via a transfer bay. Here they are usually lifted on to a theatre trolley, leaving the ward bed outside.a theatre trolley, leaving the ward bed outside.

Next they enter either a holding bay area or else Next they enter either a holding bay area or else move directly to the anesthetic room.move directly to the anesthetic room.

Finally they enter the theatre itself where surgery is Finally they enter the theatre itself where surgery is to be performedto be performed

The journey has been one through progressively The journey has been one through progressively cleanercleaner areas, arriving finally at the areas, arriving finally at the cleanest cleanest of all.of all.

Once the wound has been closed and covered with Once the wound has been closed and covered with dressing, it is safe for the patient to return to the dressing, it is safe for the patient to return to the ward via progressively more dirty areas: through ward via progressively more dirty areas: through the exit bay, recovery and the hospital corridor.the exit bay, recovery and the hospital corridor.

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Instrument and EquipmentInstrument and Equipment Are brought from outside the department into Are brought from outside the department into

clean store rooms. Instruments are often supplied clean store rooms. Instruments are often supplied in pre-packed sterilized trays by the Theatre in pre-packed sterilized trays by the Theatre Sterile Supplies Unit (TSSU). Finally, they enter Sterile Supplies Unit (TSSU). Finally, they enter the theatre ready for use on the scrub nurse’s the theatre ready for use on the scrub nurse’s trolley.trolley.

At the end of an operation, dirty instruments, At the end of an operation, dirty instruments, linen and rubbish are removed to the sluice room, linen and rubbish are removed to the sluice room, and when correctly packaged for disposal, to and when correctly packaged for disposal, to agreed collection points. Porters then take them agreed collection points. Porters then take them via a dirty corridor to their several destinations: via a dirty corridor to their several destinations: the TSSU, laundry or hospital incinerator.the TSSU, laundry or hospital incinerator.

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Theatre PersonnelTheatre Personnel

Enter the department via a changing Enter the department via a changing room where outdoor clothing is left. room where outdoor clothing is left.

Once attired in correct theatre dress Once attired in correct theatre dress they can proceed to a suite along a they can proceed to a suite along a clean corridor. clean corridor.

Here they enter via the clean Here they enter via the clean preparation room or the scrub-area, and preparation room or the scrub-area, and like the patient, leave through the exit like the patient, leave through the exit bay.bay.

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The Anesthetic RoomThe Anesthetic Room The anesthetic machineThe anesthetic machine

Suction apparatus Suction apparatus The drug cupboardThe drug cupboard

The Operating TheatreThe Operating Theatre The operating tableThe operating table – centre piece – centre piece

of the room, a very versatile piece of of the room, a very versatile piece of equipment. It has to be in order to equipment. It has to be in order to accommodate the great variety of accommodate the great variety of different operating positions.different operating positions.

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The Operating LightsThe Operating Lights

There are usually two operating lights in There are usually two operating lights in a theatre attached to the ceiling.a theatre attached to the ceiling.

The lights are easily maneuvered, The lights are easily maneuvered, necessary to accommodate the needs of necessary to accommodate the needs of surgery.surgery.

Good lighting is needed to carry out an Good lighting is needed to carry out an operation, and lighting a wound from operation, and lighting a wound from two converging angles is designed to two converging angles is designed to eliminate shadows.eliminate shadows.

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Anesthetic ScavengingAnesthetic Scavenging

A long length of corrugated plastic tubing A long length of corrugated plastic tubing connected to the anesthetic circuit at one connected to the anesthetic circuit at one end, while the other connects to a vent in end, while the other connects to a vent in the ceiling or wall.the ceiling or wall.

The system draws out of the theatre any The system draws out of the theatre any anesthetic gases or agents leaking from anesthetic gases or agents leaking from the circuit and which pollute the the circuit and which pollute the atmosphere.atmosphere.

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The Swab RackThe Swab Rack

This is a metal piece of furniture used for This is a metal piece of furniture used for hanging up swabs during an operation for hanging up swabs during an operation for ease counting.ease counting.

It comprises of several tiers have either It comprises of several tiers have either hooks to hang the swabs, or else holes to hooks to hang the swabs, or else holes to poke them through.poke them through.

The hooks and holes are grouped in The hooks and holes are grouped in numbers off fives, and each tiers can numbers off fives, and each tiers can usually accommodate ten swabs.usually accommodate ten swabs.

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The Swab BoardThe Swab Board

This is for recording the amount of blood loss This is for recording the amount of blood loss during the operation especially major during the operation especially major operation.operation.

The nurses record this information for The nurses record this information for anesthetist's benefit, who will instigate anesthetist's benefit, who will instigate replacement therapy.replacement therapy.

The board is usually marked in two columns; The board is usually marked in two columns; one for blood loss from the swabs and one for one for blood loss from the swabs and one for loss from the suction.loss from the suction.

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Weighing Scale: estimating Weighing Scale: estimating blood lossblood loss

You should find a list of known dry weights of each You should find a list of known dry weights of each different type of swab.different type of swab.

To estimate blood loss, you weigh the blood-soaked To estimate blood loss, you weigh the blood-soaked swab, and from that weight subtract the known dry swab, and from that weight subtract the known dry weight.weight.

This leaves you with the weight of blood lost, This leaves you with the weight of blood lost, which is the amount you record, adding it to the which is the amount you record, adding it to the running total.running total.

e.g.; Dry Large swab = 20g, Soaked in blood = 90ge.g.; Dry Large swab = 20g, Soaked in blood = 90g : 90g – 20g =70g is the weight of the blood loss : 90g – 20g =70g is the weight of the blood loss

(1g = 1ml)(1g = 1ml)

X-ray ScreensX-ray Screens

This is vital as some operations are This is vital as some operations are conducted with close reference to a conducted with close reference to a patient’s x-rays throughout.patient’s x-rays throughout.

e.g. orthopaedic surgery, tumour e.g. orthopaedic surgery, tumour surgery and operations such as surgery and operations such as cholecystectomycholecystectomy

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Rubbish bins, Swab bins and Rubbish bins, Swab bins and Linen binsLinen bins

Every theatre has separate disposal Every theatre has separate disposal containers for rubbish, swabs and linen.containers for rubbish, swabs and linen.

During the operation the swabs must During the operation the swabs must remain separate, to facilitate the swab remain separate, to facilitate the swab counting procedure. counting procedure.

Leave the disposal bags in the theatre until Leave the disposal bags in the theatre until the end of the operation, until the scrub the end of the operation, until the scrub nurse is entirely happy with the final count.nurse is entirely happy with the final count.

Fresh disposal bags are always brought in Fresh disposal bags are always brought in for every operation.for every operation.

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Recovery AreaRecovery Area

Carried out in the corridor outside the Carried out in the corridor outside the operating theatre.operating theatre.

Normally made up of several bed Normally made up of several bed spaces, each with necessary equipment spaces, each with necessary equipment to facilitate recovery e.g. oxygen, to facilitate recovery e.g. oxygen, suction apparatus, pulse oximetry, suction apparatus, pulse oximetry, emergency trolley necessary to deal emergency trolley necessary to deal with cardiac arrests or anesthetic with cardiac arrests or anesthetic emergencies etc.emergencies etc.

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Changing to Theatre ClothingChanging to Theatre Clothing

To cut down on any bacteria brought To cut down on any bacteria brought from outsidefrom outside

Cotton uniform less static electricityCotton uniform less static electricity Pride for nurses working in theatrePride for nurses working in theatre Laundry purposesLaundry purposes Reduce anxiety for patientReduce anxiety for patient

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The EndThe End