OPERATING THEATRE NURSING AND ANAESTHESIA

INTRODUCTION
The aim of all personnel endevouring in operating theatre technique (OTT) , is to reach the highest
possible standards of operating room practice, taking into consideration the equipment available, the
limits of the operating department facilities and the surgical team specialties.

Strict asepsis technique must be adhered to during preparation for surgical procedures operations.
Speed and accuracy with absolute efficiency are the goals to which all must aim to achieve.

The ability to adhere to the above identified distinguishes a professional operating theatre nurse (OTN)
from the general nurse. High standards of OTN profession is achieved only if the OTNs helps towards the
attainment of the desired standards.

These standards are :

 High standard of practice

 Strict adherence to asepsis
 Attainment of speed accuracy and absolute efficiency of practice.

OBJECTIVES
The main objective of the ORN is to provide a standard or excellence in the care of patient before,
during and after surgical intervention.
SPECIFIC OBJECTIVES

 Identification of the physiological, psychological and social needs of each individual

 Development and implementation of care that meets the needs of individual plan of nursing
care
 Proper coordination of plans with other members of the team to promote contuity of care for
each patient
 Application of principles of asepsis and technical knowledge in making suitable environments for
the welfare of the patients
 Provision of direct of other profession allied technical personnel in implementation of programs
of nursing patients by teaching, supervising, guiding, directing and evaluating performance
assessments and carrying out nursing audits.
 Initiation or assistance with research projects designed to develop a body of scientific
knowledge relative to the care and coordination of components of operating room nursing.

TERMINOLOGIES USED IN THEATRE

 OPERATING DEPARTMENT : This is a unit consisting of one or more operating suits together
with the ancillary accommodation including such common use rooms as changing and rest
 rooms, receptions, transfer and recovery areas and circulation space. This is classified in three
main categories and these are single theatre, twin theatre suit, and multiple theatre suit.

 OPERATING SUIT : This comprises of operating theatre, anaesthetic room, preparation room,
scrub up room, disposable area and its ancillary rooms like changing rooms, offices and rest
room.
 OPERATING ROOM : This is where surgical operations or diagnostic procedures are carried out.

 OPERATION : This is an invasive modernity of treatment and diagnosis where an incision is made
in the body for the purpose of repair or removal or as entrance into the body cavity.
 OPERATING THEATRE NURSE : This is a qualified nurse who has undergone training and has
successfully completed the program with satisfaction.
 PERI-OPERTIVE : These are activities that take place pre, intra and post operatively or total
surgical experience which includes pre, intra and post operative phase of surgical patient care.
 SKILL : The application of knowledge into observable, measurable and qualifiable performance.
 SURGERY : This is branch of medicine that deals with pre, intra and post operative care of
patient.
 SURGICAL INTERVENTION : This is a therapeutic process to restore and maintain health using
surgery.
 TEAM : A group of two or more people who recognize common objectives and coordinate their
efforts to achieve them.
 ANAESTHESIA : This is loss of sensation or pain with loss of protective reflexes.
 SCRUB NURSE : This is a member of a surgical team who assists the surgeon by providing sterile
instruments and supplies within the sterile field.
 SUTURE : It’s a stitch used to approximate living structures until the normal process of healing is
complete.
 INCISION : Is cutting into body tissues using a sharp instrument.
 INTUBATION : Insertion of endotracheal tube into the trachea.
 ARTIFICIAL VENTILATION : Aided breathing by the use of ventilator.
 RESUSCITATION : Reviving a patient from apparent death or unconsciousness.
 LIGATURE : Suture used to encircle blood vessels to arrest or control bleeding.
 DIRTY CASE : Any case where there is pus.
 ASEPSIS : Absence of micro-organism that cause disease .
 STERILISATION : Process by which organisms i.e. pathogenic and non pathogenic spores are
killed.
 DIATHERMY MACHINE : Is a machine of very high frequency current which is used to coagulate
or cut body tissue.
THEATRE ENVIRONMENT
The theatre environment is governed by the type of operations performed, construction and design of
operation theatre and the organization and standard in the operating department. Department
director/theatre superintendaent, nurse manager, physician (surgeon + anaesthetic), senior
perioperative nursing personnel, project manager, information technologist ,support services like X-
Ray,lab personnel, infection prevention personnel, architect, internal decorator, etc are involved in the
construction of the theatre. Each theatre is designed on an indivivual basisi to meet projected future.

The design of the theatre is dependant on the hospital plan and the size of the hospital. Awell designed
theatre can be a source of morale among staff and patients. When designing or constructing the theatre,
there are general principles to consider. These are ;

LOCATION
Many planners advocate the centralization of all intensive care facilities and the operating theatres to be
built next to the labour ward, intensive care unit, near casualty/emergency and x-ray departments.allso
not far from the surgical wards , CSSD and laboratory.The theatre location should be away from general
setting of the institution to minimize traffic,reduce chances of cross infection and unnecessary noise.
Noise is a source of stress to both staff and patients. Hence the use of swinging doors and quiet floors It
should have a clean and dirty corridor. In hospitals with a lot of floors, it be on the 1 st floor.

ZONES
These are demarcations that provide continuity general principle of asepsis and they are four.

PROTECTIVE ZONE : This includes changing rooms, store rooms, reception, waiting room, conference
rooms, tea room and back corridor. You enter these zones without putting on your theatre attire.

CLEAN ZONE : These include the recovery room, some offices, anaesthetic room, TSSU,scrub up room.
Make sure you put on theatre attire and traffic is restricted.

STERILE ZONE : This includes the changeover or transfer section demarcated by a redline at the
entrance to the theatre operating room, preparation area and you should always put on masks.

DISPOSAL ZONE : This includes the sluice room, back corridor/dirty corridor.

LAY OUT
The lay out of the theatre will depend on – size of hospital, population to be served, operations to
performed, space available

SAFETY
The walls should be impervious, semi-matt surface, easy to clean and withstand repeated application of
disinfectants. The colours should be pale-blue, grey or green.These colours are lless tiring to the eyes.
The floors should be impervious either of terrazzo, rubber or vinyl and contain antistatic material to
prevent material to prevent static electricity and risks of sparks and explosions.
LIGHTING
Windows connecting to the outside are not allowed in theatre because they allow daylight which is
destructing to the eyes. Hence the use of artificial lighting like fluorescent tubes for general lighting and
operating light during operating. The operating light should provide intense light on the incision without
glare on the surface. It should produce minimum heat.

VENTILATION
Is provided through air conditioners, laminar air flow system and plenum ventilation.The plenum
ventilation is widely used. This is to avoid introducing infection in the department .Windows are never
opened to the outside.

With plenum type of ventilation, air is drawn at roof level by means of fans through filters in the ceiling.
The filtered air is then forced into the operating theatre at a higher pressure forcing it into other rooms.

The recommended humidity in theatre is between 50-70%. Hygrometer is used to measure humidity.
The room temperature in theatre should be between 18.5-21 degrees celcius. Checking of humidity and
temperature should be done in every shift and recorded.

SUPPLIES AND EQUIPMENT

Just like any other department, theatre department requires things to use for it to operate. These are :

1. SUTURING MATERIALS : These are materials used to approximate the living structures until the
normal process of healing is complete. They are divided into 2 groups i.e. absorbable and non
absorbable sutures.

(a) ABSORBABLE SUTURES : These are sutures which are digested and absorbed in the tissues during
the process of healing. Examples of absorbable sutures are : Plain catgut takes 5-10 days to absorb.
Chromic Catgut –it gets digested by the body within 15-20 days. It is pale in colour. Dexon (Polyglycolic
Acid) – absorption takes 15-300days. Maxon (polyglyconate) –absorption starts immediately and lasts
upto 6 months. PDS (polydiaxanone) – absorption range from 90 days to 180 days and Polyglactin 910
9 (coated Vicryl) – absorption is achieved between 60 and 90 days..

(b) NON ABSORBABLE SUTURES : These are strands of material that effectively resist enzymatic digestion
in living tissues- e.g. silk, nylon, linen. These fall under natural sutures. There are also metallic sutures
which are made of stainless steel and metallic clips.

LIGATURES : These are sutures used to encircle blood vessels to arrest or control bleeding.

2. DISINFECTANTS: These are solutions used in disinfecting the surfaces in theatre and in preparation
of the operation site pre-operatively. The recommended ones are Jik/Chlorine, Povidone, Methylated
Spirits, Savlon and Cidex. The recommended strength for Jik is 1:6. This can aslo be used for
decontamination of instruments before sterilizing them apart from disinfecting surfaces. Solutions like
Savlon – 1:100, Methylated Spirit 70% in Alcohol and Povidone 10%/Iodine Tincture 2.5% are used in
preparation of skin preoperatively. Cidex is used to sterilize instruments which can not withstand heat.

3. SURGICAL SUPPLIES: These include supplies like surgical face masks, surgical caps, surgical and clean
gloves, gauze, cotton wool, strapping, etc.

EQUIPMENT
The operating room should never be full of furniture. Only a few that are necessary for the operation
should be in theatre. The furniture should be of stainless steel or alluminium , for easy cleaning.
Basically these are the equipment found in theatre:

 Operating Theatre Table

 Diathermy Machine
 Anaesthetic Machine
 Operating Light
 Mayo Table
 X-Ray Viewer
 Kick Buckets
 Suction Machine
 Drip Stand
 Trolleys
 Anaesthetic Stool
 Defibrillator
 Infusion Pump
 Ventilator
 Rescuscitaire – baby/adult

There are also surgical instruments of different types for different procedures. Examples of some of the
procedures done are – Laparotomy, Hysterectomy, Caeserean Section, Tracheostomy, etc. These sets
are packed according to the procedures. After use of the instruments, they are decontaminated, cleaned
and sent for sterilization. The sterilized sets are stored in a dust proof cupboard and the shelves should
be atleast 25cm from the ground.