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 ,bluewhite 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.

Comfort

Result can be disastrous

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

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 20X20X10
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 >0.5)
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 >25000W/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

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.

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 pts, 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
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.

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