OT
OT
OT
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Special Article
Summary
Designing of an operation theatre complex is a major exercise and is mainly intended to benefit the
patient. The need for safety, convenience and economy will guide the planning of a modern operation theatre
complex, whatever the size, number or the speciality. Guidelines based on current and widely accepted recommendations as also ones for possible expansion of the operation theatre complex are dealt with in this article.
Key words
Operating room, Operating theatre complex; Designing , Planning and organisation;
Induction room, Accreditation.
Introduction
An operation theatre complex is the heart of any
major surgical 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. Operating theatres were so-called in the United
Kingdom because they traditionally consisted of semi-circular amphitheatres to allow students to observe the medical procedures .The Old Operating Theatre in London is
one of the oldest, dating back to 1822 (Oxford English Dictionary and Wikipedia.com).
The patient is the centre point of a functioning OT
complex. He / she is in isolation for varying times, away
from his near and dear ones and is physically sick. Efforts
are directed to maintain vital functions, prevent infections /
promote healing with safety, comfort and economy.
The establishment and working of the operation theatre ( O.T.) needs specialised planning and execution and is
not a simple civil engineering work.Acivil-mechanical-electrical-electronic- bio medical combo effort driven and coordinated by the needs, preferences and safety of the medical/ surgical team forms the basis for starting and maintaining an operation theatre. Anaesthesiologists, by virtue of their
knowledge of the intricacies of physiology, physics and biomedical aspects of medicine and constant proximity to the
operation theatre should preferably be involved from the early
stages of planning of operating theatres1.
On an average, operation theatres cater to 50% of
the needs of total healthcare seekers. Anaesthesia-con-
1. M.D., Principal, 2. D.N.B., Assistant Professor, Department of Anaesthesiology and Critical Care, Vijayanagar Institute of Medical Sciences
(VIMS), Bellary 583104 ( Karnataka ) Correspondence to : S S Harsoor, Vijayanagar Institute of Medical Sciences (VIMS), Bellary 583104
(Karnataka ) E mail:harsoorss@hotmail.com
Accepted for publication on 25.4.07
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(1)
Sterile stores
(2)
(4)
(5)
Maintenance workshop
Kitchenette (pantry)
Emergency exits
Service room for staff
(6)
(7)
(3)
(4)
(2)
(3)
(8)
(9)
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within the OT complex. Intra-departmental discussions, teaching and training sessions for staff (with
audio-visual aids) may be conducted here.
(12) Store room- This is designed to store large but less
frequently used equipment in the OT. There should
be storage space for special equipment after cleaning.
(13) Theatre sterile supply unit (TSSU)- Within this
area, following are desirable i. Temperature between 180 -220 C, humidity of 40%50% is the aim.
ii. Air conditioned with 10-12 air exchanges per hour
2.
Zone wise distribution of the area, so as to avoid crisscross movements of men & machines
3.
4.
iv. Option to store in from one side and remove from
5.
other side .
v. Proper inventory to prevent running out of stock.
(14) Scrub room- This is planned to be built within the
restricted area. Elbow operated or infrared sensor
operated taps / water source is ideal. It is essential to
have non slippery flooring in this area.
Types of OT complexes
There are three main categories of operating theatres4 :
1.
The single theatre suite with OT, scrub-up and gowning, anaesthesia room, trolley preparation, utility and
exit bay plus staff change and limited ancillary accommodation.
2.
3.
6.
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8.
Corridors not less than 2.85 m width for easy movement of men, stretcher & machines
9.
10.
11.
12.
13.
14.
Pre-operative area with reception with separate designated area for paediatric patients is desirable.
15.
16.
The safety in working place is essential, and fire extinguishers have to be planned in appropriate zone.
17.
Ventilation
Ventilation should be on the principle that the direction of air flow is from the operation theatre towards the
main entrance4 .There should be no interchange air movement between one OT and another. Efficient ventilation
will control temperature and humidity in OT, dilute the contamination by micro-organisms and anaesthetic agents.
There are two types of air conditioning systems : recirculating and non recirculating3.
Non recirculating systems heat / cool the air as desired and convey it into the operating room with ideally 20
air exchange per hour. Air is then exhausted to outside.
Anaesthetic agents in the OT air are also automatically
removed. These are thus ideal but are expensive.
The circulating system takes some or all of the air,
adjusts the temperature and circulates air back to the room.
The broad recommendations include:
- 20-30 air exchanges / hour for recirculated air
- Only upto 80% recirculation of air to prevent build
up of anaesthetic and other gases
- Ultraclean laminar air flow the filtered air delivery must be 90% efficient in removing particles
more than 0.5m m.
- Positive air pressure system in OT: It should ensure a positive pressure of 5 cm H2 O from ceiling of OT downwards and outwards, to push out
air from OT.
- Relative humidity of 40-60% to be maintained4
- Temperature between 20 0 -240 C. Temperature
should not be adjusted for the comfort of OT personnel but for the requirement of patient, especially in pediatric, geriatric, burns, neonatal cases
etc.
Pendant services
Two ceiling pendants for pipeline services should be
designed; one for surgical team and one for anaesthetist4.
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5.
6.
7.
8.
Electrical load calculation should be based on, equipments likely to be used and appropriate current carrying capacity cords to be used.
9.
1.
2.
3.
damage wires. Wires inside rigid or retractable ceiling service column can help to some extent
Lighting
Scavenging
5.
6.
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Data management
7.
Halogen lights produce less heat and hence preferred. OT light should not produce more than 25000
mw/cm2 of radiant energy. Elimination of heat by dichroic reflectors (cold mirrors) with heat absorbing reflectors or filters should be available along with the
luminaire4.
8.
UPS of adequate capacity to be installed after considering OT light, anaesthesia machine, monitors,
cautery etc until the back up generator takes over
10.
Access to the OT areas and outside should be possible. It should have a laminar flow hood, a refrigerator,
space for drug storage locked containers for controlled
substances computer, desk area for paper work and pharmaceutical literature. Special kits for specific surgeries may
also be arranged. The pharmacy may open for 1 to 24
hours based on need but it is desirable that an after hour
system is planned.
Communications
1)
2)
3)
Catering
4)
Cleaning
The construction materials selected for the OT complex should aim to minimize maintenance and cleaning costs4.
5)
6)
No reception area.
No separate rooms for
Surgeons
Anaesthesiologist
Jr. doctor
OT attendants
7)
8)
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Conclusion
In the present era of evidence based medicine, it becomes imperative to give maximum importance to planning an Operation Theatre Complex. Within the limitations
of finance and space, the best results can be obtained and
anaesthesiologist with multiple roles inside the operation
theatre complex, should be consulted in the process. Efforts should be made to conform to the standards laid down
by local bodies and international agencies, as healthcare
facilities in India are now catering to more and more international clientele. However, new OTs and hospitals that
are being established can not be expected to fulfil all theoretical requirements as new ideas are constantly being
developed. By the time they are incorporated into buildings, fresh ones take their place on the drawing board.
References
1.
Dorsch JA and Dorsch SE. Operating room design and equipment selection. Understanding Anaesthesia Equipment, 4th edition ; Williams and Wilkins 1999 : 1015-16.
3.
Gupta S.K., Kant S, Chandrashekhar R. Operating unit - planning essentials and design Considerations. Journal of Academy
of Hospital Administration 2005;17:01 12.
4.
5.
6.
Miller RD. Operating room information systems. Millers Anesthesia, 6th Edition; Elsevier - Churchill Livingstone 2005; 313132.
7.
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