The Operation

Theater

THEATER (O) d. Functional criteria: Design follows function is the

NE OPERATION
theater, operatin room or surgery golden rule.
operating
An
guteis aroom within a hospital, within which surgical pHYSICAL FACILITIES
operations are carried out. Operating theater was so

the United Kingdom because they tradi- Location

led in
mons onally consisted ot semiciraular amphitheater to
students to observe the medical procedures.
The best location for the OTis the one which permits
a convenient and uncomplicated flow of patients, staff
ellow
The old operating theatre in London is one of the and clean supply traffic. It should be close to surgical
shig eldest, dating back to 1822. It is similar in age to the wards and ICU, OT receives patients from the floor
pherdome in Baston built in1824. The surgical suite through non public corridor, elevators and ramps.
agenat entire surgical facility including operating room In most cases they are returned through the same
al, ways, workrooms, storage and front desk. route. Convenient access to elevators is, therefore,
essential.
aTa ofa Aims of Planning
Ja7,Na2 Orientatlon
To promote high degree of asepsis
b. Ensure maximum safety to patients and staff Northern orientation of operation theater is
stablish considered to be most suitable to ensure adequate
AVals working in OT.
Ensure maximum utilization of the OT. day light within the theater and to avoid glare.
al wald Ensure maximum comfort to the surgical team,
Number of Operatlon Theaters
July 19%
HA, Va
considering long hours of work in difficult The factors responsible for determining the total
posture. number of operating theaters in a hospital are as under
contro
ning o provide conmplete environmental
Flexibility of uses of operating suites. a. Type of hospital
b. Hospital bed compliments
Crtleria for Planning
n e n i a i

Jan,196
C. Number and type of surgical patients
Environmental crieria: Provide complete environ- d. Number and type of surgical specialties
Number and
type of surgeons
nental control for safety of patient as well as the f. Number of operation
e.

staff working in OT. per day

Ecomomic criteria: Optimization of the inter 8. Average length of stay of surgical patient

Telationship between various financial areas and h. Hospital Policy

i. Expected tum over interval in OT.
operating departments. and Average size of an OT list
wOrk florw criteria: The flow of patients,to staff
be well k. Estimated cleaning time for OT between
sur

uPplies in operating department geries

planned.
 250 hhrkah osttieuit2-ttot
. Allowance for emergency surgeries
m. Allowance for septic cases
flexibility, high standard of asepsis,
ia. bet
better hygjene
and better supervision and managemenet hy
n. Allowance for staff breaks.
Apart from the above points, there are some Advantage of Grouping of OT
standard methods for calculation of number of There are certain distinct
operating theatres for a hospital. This can be of the OT as: advantages
tages ofof #.the
determined from the number of beds for surgical i. Easy expansion in future groupin
patients and expected length of stay of these patients, ii. Maximum flexibility of use
e.g. if there are 20 beds for surgical patients (all type ii. Better staffing,
of surgeries) and the average length of
stay is 10 days, iv.
organizing and
Greater efficiency in resource control
then there will be on an average 20 utiliza
operations per
day. From this value, the number of operating rooms
v. Easy to maintain ation
vi. Minimize cross infection
can be determined, once it is known how vii. Increases utilization of OT.
many
operations per day each room can be expected to vii. Minimizes cancellation of OT ist.
provide for.2
Number of operation per day can be calculated by: Declslon Criterla
No. of operation per day =
eighed while
Following criteria must be weighed
decision for OT:
while making
No. of surgical beds x % of bed i. The size of OT.
ii. Usage.
ocupancy rate 365 ii. Lighting (surgical and general
Average length of stay x 10 x No. of
iv. Inter communication.
illumination
working days v. Signal system.
Number of Operating Suites and Hospital Beds vi. Electronic equipment and monitoring system
As per American Standard, one OT is required for
vii.Medical Gas System ( Suction, Oxygen, Nitroue
every 25 surgical beds (Fig. 32.3). European Standards
Oxide, Compressed air) and other service line
vii. Safety precaution such as grounding for
say one O.T for every 50 surgical beds. Rao Committee X-tavs
TV Camera against electricity.
(1968) is also in conformity with European Standards. Protectic

The Committee on planned Project (COPP- 1964) has

ix. Storage, supply cabinets, clocks, film iluni
theater
nation.
given the following standard: are:
x. Environmental control AC, etc.
fatie
i. Zoning of O.T
No. of OT Required b. Troll
Lifts
No. of hospital Indoor OPD+ Size of the Operating Room
Emergency Stair
beds The size will depend upon the surgical facilities: Swit
Minor Major i. General Operating Room - 40 sq. meter. . Pre
Minor Major
300 3 ii. CVTS, Neurology, Orthopedics 60 sq, meler
Additional adjoining room is required for Heare
room
Clean zo
500 5
750 8 1 Lung Machine. Preo
1000 10 ii. Endoscopy suite will require Procedure Room b Keco
20 sq. meter Thea
d. Xera
In addition to the above, super specialties like iv. For OT of 200-300 bed district hospital the
CTVS, Pediatric surgery should have additional optimum size is 18'x 18' to 18' x 20 butn e.Siste
operating facilities more than 400 sq. feet. store
Slerile z
Grouping of OT oning of oT epsis
The be
operating rooms should grouped together to This is designed to achieve a high degree of ase Anes
form a single surgical theatre complex. This gives The OT is divided into 4 zones (Fig, 32.1}
d.Instr
 R ARO 251

Chm zon

Preopermting room
Recovery room
Theater work room
X-ay pleste
room
Sister's room,staf
nurse room and
Sterlle ton
P r o t e c t i v e zone
anesthesle ttore room

Patient's walting
area and reception
Trolley bay Operating sute
Scrub room
Stairs
Zonlng Anesthesla room
of O.T.
Switch room Instruments trolley
Preanesthesle erea
room,change room,
store room

I t willindlude-
dirty room,
disposel comdor
and Janitors
comidor

Disposal zone

Flg. 32.1: Zoning of OT

ofoperating(isposa zone: It will include dirty room, disposal

the entrance
Prokectioezomc:Thisis at which lie in this area corridor and Janitors corridor.
facilities
theater. The main OT
are ENGINEERING SPECIFICATIONS OF
area and reoeption
fatient's waiting Design of Operating Sultes
with Circulation
b.Trolley bay Area (Figs 32.2 to 32.6)
Lifts these
desirable but if
YStairs i. Windows: Windows are not
benelits of having
Switch room are required for psychological
it should be:
Pre anesthesia room, changing room, store aglass panel,
a. Double walled
room.
b. 15 % of total floor area
Can 2ome: Next zone is the dean zone. It provides the floor level
c. 3 feet to 4 feet above
Preoperating roam leaves and 5 feet wide.
i. Doors: Door with two
Kecovery room resistant. It should be
c Theater work room ii. Floor: It should be fire
electroconductive by way of providing copper
d.e. X-ray room, plaster room PVC tiles
Sister's room, staff nurse room and anesthesia chips in the floor about 6 inches apart.
and marble floors are ideal.
store room. with
iv. Walls: No crevices, no joints, painted
perile zone: This zone will indude: emulsion paint.
a. Operating Suite in particular with washable
v. Ciling: It should be cement plaster
b. Scrub room. for easy
Corners should be rounded off
paints.
C. Anesthesia room
d. Instruments trolley area. cleaning
 ESIAiandbnp
Circulation In operating aute

To warde
Intenslve etc.
care
Theater

Tragsfer

Post
operatlive
recovery

Anesthetic
,0-14a Chauy From wards
etc.

SO.unh Flg. 32.2: Design of operating suttes with crculation area

sub
Plaster sterilizing
stóre

Cystoscopy
Store Fracture
room Splint Dark Scrub
store Minor treatment
room up

Instuments

Central stenle Surgeons

supply dept lockers
Nurses
WC WcLockers

Flg. 32.3 Operating sute -Amerlican patten (Source 5)

vi Coloring of OT: ight Blue or Egyptian yellow is a. OT. General 400 LUX
preferable. It should be soothing to eyes. b. Operating Room 1000 LUX
vii. Air Conditioning:
Desirable c. OT. Cavity 50000 LUX Fire
a.
Temperature is 22°C red
b. Minimum of 0-14 air changes per hour with d. Recovery Room 300-400 LU
e. Other Area LWater
humidity.
. 1.5 Ton
150-300 LUX
require
capacity of AC per 18 Sq. Meter is ix. Fire Protection, fire detection and
fire fighting
adequate. Overhe
vii. Illuminations The recommended illuminations
a.
Alarm system for fire detection. Electrie
b. Fire extinguisher and fire hydrants should
are given as follows be provided. day.7
Standb
should
 253

8ter

O.T. O.T.
Nurse Recovery Anest
hesla

Disp.
Corridoor room

Equlp-
ment
O.T. O.T.
Ster

Fig. 32.4 Layout of operation theatre for 200-300 bed hospital (Source 6)

pDisposal Dirty corrldor Disoosa

Bay Bay
Preparationn Preparation Theatre
Operation room Operation Operation room Operation sterile
room room room room Supply
Scrub Scrub unit

Clean corridor
Seriizer

Change Sterle
Post-operative P Pe-operative room store
recovery holding nurses

OR Transfer Clean
trolleyroey
reception MMstore wash

Fig. 32.5: (Source 4)

c Fire exit routes to be clearly earmarked with Following physical facilities must be provided in
red paint and well illuminated. operating theater complex:
is the normal a. Reception and office 140-160 sq. feet
.Water Suply: Liters/bed/day
500
b. Transfer
requirement and in addition to that, separate area

ting overhead tanks for O.T complex. C. Entrance

is 3kV/bed/ d. Cloak room 80-100 sq. feet
Electricity: Normal requirement
Shaul

day. There should be provisions of inverters and e. Pre-operative room 70-80 sq. feet / bed
80-100 sq. feet each
standby generator facility. All electric wiring f. Staff changing room
should be concealed. 8. Notice board
254 Prabtaego
existing hospital. The operating suites are
h. Holding bay 160 sq. fecet remote area state-of-the-art-technolog finand
with ished n
i. Anesthesia room
80-100 sq. feet
these suites are transported and installed ther
k. Scrub
j. Operating
room Room: The operating room should be hospital in desired place. This hospitals,
is areinwhere the

arranged in pairs with

scrub room and concept in
the planning I of
can be installedn
utionary
normally hospital components
interfering with the functioning the hosnho
sub-sterilization room.
of
REQUIREMENTS OF internal suites are high standahe
finished to a

ESSENTIAL PHYSICAL sterile area having a vinyl floor finish with with
SURGICAL OPERATING ROOM wall and
more, a
small utility
ceiling being a steri-sheen spray fini finish. Sterile
suits offour or fitted with clean standard polvestea
room
1. Sub-clean up: In waste of are

room is required
for disposal of liquid The theatres are fitted with main and door
size 80-100 sq. feet.
attached operating lamps, medical pa6telite
retractable s
2. Theater Sub-sterilization

to OT, area 80-100 sq.

ft.
unit (TSSu): It is
surgeon's panel and a surgical microscope ndants,
external appearance of the suitei is designed
The
be provided
This area should
3. Dirty utility room: into the existing hospital and give an attractive n
and work bench. neutral
with a sink of large size aggregate surface. The new suits are ready fo
for reception of use n
4Recovery ward:
A special ward delivery on site,
13 weeks time from
after surgery. Patients remain
patient immediately
lengths of time
in recovery ward for varying and the Staffing of OT
condition of patients
depending upon the
70-80 sq. feet/bed. The operating theaters are under the department.
poicy. The size is
hospital surgical facilities. The work cannot be assigned
single entity, as it is team work. The operating theatetoa
Space Requlrement
has recommended are the perfect examples of the team work under
Committee on Plan Project (COPP) of the head. of the
at a scale of the dedicated team leadership
a space requirement for 300-bed hospital department of surgery and a fully devoted sister 07
25-40 sq. Feet/bed. and technicians of the theatre, who are responsik
Modular Operating Theater for the functioning of the theatre. It is organized
what is known around five groups of staff:
There is emergence of new concept,
The operating suites i. The Surgeons
as the Modular Suite (Fig. 32.6).
outside the hospital ii. The Anesthesiologists
are built somewhere else, i.e.
suite ii. Nurses
building. In some of the cases, the modular
included theatre, anesthetic, scrub, dirtyutility, 4-bed iv. Technicians
v. Attendants of OT.
recovery, reception area, staff changing rest room suite to the
and link corridor attaching the new

Staffing of 0T In a District Hospital

(201-300 beds)
S. No. Staf District headauarters hospita
201-300 bedded

Emergency OPTHI A&E Electioe

Or ENT
2 3
Staff nurse
2
2 OT Assistant
3 Sweeper 1
Total 11 4

Fig. 32.6: Modular operating theater

 Sinished
and th
ed in the Bowl steriliser big
255
Sutheretoinnant
17
E u l p m e n t so f O 7 18 Bowl steriliser medium
tensive. The 19 machine (Electric cautery)
a without highly
equipment Diathermy
ern O T is
will depend upon the OT 20 Suction apparatus-electrical
T
quipments o f OT Suction apparatus - foot operated
pitals. wiTt
dard
hemodern

eof euiar in moderm OT a r e being enumerated

specialty,
however some of the 21
22
23
Dehumidifer
Ultraviolet lamp philips
model 4 feet
articd
wal
kerle ara
T u i p m e n t su

(Table
s e

32.1
24
25
Ethylene oxide sterilizer

Microwave sterilizer
eser do
a satlli s
follows
1.

A
O Tt a b l e s

n e s t h

A n e s t h e s i a
e s i a m a c h i n

v e n t i l a t o r s
e s

POLICIES AND PROCEDURESS

pendantThh
cope.
toblend
i Defibrillator

tal multi
parameter
Monitor
Administration of the OT
The OT management is an example of perfect
team

variety of personnel ranging

Neonatal
management, where
6 C a u t e r y m a c h i n e

a
OT
skilled
veneut
for ueeinr
7 .

8 . C-Arms
C e n t r a l s u c t i o n

ification machine
from highly skilled surgeons to
attendarnts, work under
minimal
tremendous stress and strain

duration of work in uncomfortable posture,

long
9. P h a k oe m u l s i f i c

drilling
system
without much verbal communication. It requires a
dedicated OT
10. AO
11. A r t h r o s c o p e of surgery team,
disciplined head
who a r e self
system
surgery
nurse, devoted anesthesiologist,
artnent o
Endoscopic

12
Lithoclast & Lithotripter
of asepsis and quality
Surgery OT. motivated for high degree
signed to a
ng theaten The
e q u i p m e n t s

machine
in Cardiac
assurance.

Heart lung
ork, unde a.
b. Octopus OT Scheduling
ead of the Defibrillator
the OT
perfect planning of
sister 01 Fibrillator
There should be
PAC, pre-
scheduling, timely preparation, complete to theater.
responsibe e. Multiparameter

operative treatment and shifting of patient

organized f. Hemotherm

g. ACT machine.
No wastage of time between two operations.

for district hospital® Punctuality

List of OT equipments
Table 32.1:
District If an operation is scheduled at 0900 hrs, it means

Name of the equipment that time, and 0900

SNa headquarters everything should be ready by
hospital (201 hrs means start of the operation right on time, right
300 bedded)
every time.
Horizontal
Autoclave HP
1 Training of Staff
2 Autodave HP Vertical (2 bin)
trained in the maintenance
All staff member should be
Pediatric
3 Operation table ordinary
Nobody is
hospite 4Operation table hydraulic Major of asepsis and universal precaution.
Minor is unconscious, the
5 Operation table hydraulic watching the OT staff, the patientthe patient's life is
&E Elci 6 table non-hydraulic field typee
Operating 2 relatives a r e waiting outside,
7 Operating table orthopedic OT team. No body, in fact is
8 Autoclave with buners 2 bin
totally in the hands of who
the OT team, it is the team,
9 Autoclave vertical single bin required to observe well trained in "NO
to be
10 Shadowless lamp oeiling type major knows it. The team has
pe minor TOUCH TECHNIQUE".
11 Shadowless lamp ceiling
12 Shadowless lamp stand model
Operating List
13 Focus lamp ordinary
3 well in advance with perfect
Sterilizer big (Instrument) The list must be planned
Sterilizer medium (Instrument)
5 The postponement of a n operation
time management.
16 Steriliser small (Instruments)
256 p ARÁVISMR 99Y9A13trN
not desirable; it is
highly
dissatisfying to a patient
id causes lot of inconvenience to the
Fogging
surgical team,
e patients and relatives. It may mar the reputation AC should be put on for 10 min then put o
the hospital. put on 1 hour after fogging.
mounted 2 feet from the floor. The machinineCh Fogging
rty Cases with help fogging machines
of is fogging done
(Fig. 32.7)
ese kinds of cases should be handled at last of the a. Quantity required for fogging of OT:
T and O.T must be cleaned and disinfected after Space in Dilution in water
procedure. C.Ft. Duration of fpagimg
1000 200 ml. in 800 m. water
JNITORING OF OT ASEPSIS 20 mimutes
2000 400 ml. in 1600 ml. water
ereshould be strict policy guidelines for the asepsis 40 minutes
3000 600 ml. in 2400 ml. water
the OT: 60 mimutes
There should be time schedule for maintenance b. Chemicals used for fogging of OT:
of OT. One day in a week should be fixed for
Formu- Product Labor Total
maintenance. lation cost Rs. cost Rs. co6t KS.
Time OT Opportu-
Swabs should be collected and sent for Temins nity cost
checking closed The
inter

of the microbial growth

especially in AC duct. (No.of needcon

ACof OT should be checked

thoroughly including procedures
effectiveness of its filters. 1. Formal- 124
Lost) equpme

150 274 24 aantrolt

Wherever 46
possible HEPA filter should be used. dehyde e eit
Environmental control of the OT in respect of KMnO+ Wards on
Am.
temperature, humidity and ventilation, air
2. Ecoshield 90 107 1 hour
hanges. 0 NTENS

Adequate pressure maintenance. :9. Staff with infection should not be

isinfection of the equipment, OT table and other allowed to enter
the OT.
urticdes of OT, should be ensured.
umigation for effective disinfection of the OT at REFERENCES
egular interval with standard equipment and
tandard procedure. 1. www.wikipedia.org/wiki/operating_theatre
2. Hospital Planning and Administration-WHO-1995p14.
3. IGNOU modules, PGDHHM, Clinical,
Diagnostic&
Therapeutic Services -2001:p31
4.
Hospitals-Planning, Design &Management-GD Kundars
et al: p. 176.
5. World Health
Organization Monograph Series- Hospital
Planning and Administration-1.
6. Ref- JAHA Vol. 7, No.1,
Jan. 1995.
7. http://www.osha.gov/SLTC/ etools/hospital/surgial!
surgical.htm.
8. Planning and Designing of Operation Theatre complex
for District
Hospitals (200-300 beds -Shakti Gupta, et a
JAHA, Vol.7,No.1,1995,p-4
9.
Flg. 32.7: Fogging machine for sterlization of OT PHSData-DGHS, Ministry of Health &E.W.Govtofindia
New Delhi.