Operation Thea

1. Hospital Administration Made Easy PLANNING AND ORGANIZATIONOF OPERATION DEPARTMENT DR.N.C.DAS

2. PLANNING AND ORGANIZATION OFOPERATION DEPARTMENT With recent technological development in medical science and increase public demand the modern surgical practices is becoming more complex and expensive affairs. About 50% of all hospital beds are allocated to surgical departments. Surgical facilities, therefore represents a central life saving activity. Therefore its success or failure highly influence the hospital reputation. (v) This has led to a detailed scientific planning of the operation theater complex.

3. 1. To promote highest standard of asepsis. To ensure maximum safety for patients and staff from installation hazards. Optimum utilization of OT and staff time. Smooth and effective functioning of OT. Good working environment for doctors and staff. Allow flexibility by use of multiple operation suits. OBJECTIVE OF PLANNING

4. PLANNING CRITERIA To meet the objectives and functions of the OTs, the planning consideration must meet the following criteria's. ERGOMETRIC OR WORK FLOW FUNCTIONS Location Size No of OTs Grouping of OTs Zoning Equipment Installation Space for free movement of Staff, patients, supplies PLANNING CRITERIA ENVIRONMENTAL TECHNICAL Lighting Air Conditioning Ventilation Water Supply Fire Safety Plumbing Clothing OT Staff Functional Areas Preparation of patient Sterilization Units Scrub Station Designing & Finishing

5. FUNCTIONAL CONSIDERATION LOCATION: Maximum six suits in one OT complex, preferably ground floor. Easy access to CSSD, sterilization unit, emergency and surgical wards. Maximum protection from sun, sounds, heat and wind. Independent of general traffic flow. Easy access to other areas of OT. SIZE: General OT unit 18’ x 18’ or 40 Sqmeter. Super specialist OT unit 60 Sqmeter. Additional room for heart lung machine, c-arm etc. Paired OTs help in proper utilization of instruments and equipments.

6. NUMBER OF OTs 1.No. of OTs = One OT unit for 50 surgical beds. 2. No. of operations/ day = No. of Surgical beds Average length of stay surgical patient 3. No. of operations/ day = No. of Surgical beds x % of Bed occupancy x 365 ALS x 100 x No. of working OT days The number of operations per suit should not exceed 06 per day or 8 to 10 hr. per day.

7. FACTORS INFLUENCING NO. OF OTs TYPE OF HOSPITAL TYPE OF SURGERY NO. OF HOSPITAL BEDS HOSPITAL POLICY FACTORS STAFF & STRENGTH & CAPACITY OF STERILE SUPPLY AVERAGE NO. OF OPERATIONS TIME FOR OT MAINTENANCE TURN OVER RATE IN OT AVERAGE LENGTH OF STAY PROJECTED EMERGENCY SURGICAL CASES

8. NO. OF OTs AS PER HOSPITAL BEDS (COMMITTEE ON PLAN PROJECT) In addition of this additional OT suits for CTVS, Renal & Paediatric Surgery.

9. ADVANTAGE OF GROUPING OF OTs FLEXIBILITY IN USE EASY EXPANSION IN FUTURE BETTER TRAINING & STAFF UTILIZATION OT GROUPING BETTER UTILIZATION OF EQUIPMENTS & INSTRUMENTS BETTER MAINTENANCE MINIMIZE INFECTION BETTER CLEANING & ASEPSIS FLEXIBILITY IN OT ALLOCATION

10. ZONING OF OTs Based on the bacterial consideration and to provide maximum asepsis the entire OT complex can be divided into various zones. CLEAN ZONE PROTECTIVE ZONE ZONNING DISPOSAL ZONE ASEPTIC ZONE

11. Reception, Patient identification and Case sheet check Waiting area for relatives Changing room for OT staff and surgeons Pre- anesthesia room Store room, trolley boy Autoclaves Record and controller room OT in charge, Electric Control Seminar and meeting room Entrance to observation gallery PROTECTIVEZONE

12. CLEAN ZONE Patient preparation Room Recovery Room Plaster Room, Blood Storage, Frozen Section Work Room for doctors, sisters Nurses Duty Room Anaesthesia Room Equipment Room, drugs, lines, X-ray board Clean closet, telephone and fire fighting equipments

13. STERILE OR ASEPTIC ZONE Main Operating Suits Scrub Station Anaesthesia Station Instrument Sterilization and trolley lying DISPOSAL ZONE Dirty Wash up Room Disposal Corridor; connected to clean zone Janitor Closet SCRUB STATION 96 cm height with water taps with sensors 10 cm high. Both hot water and cold water, soap liquid and scrubber.

14. ENVIRONMENTAL FACTORS ELECTRICITY: Ensure round the clock electric supply Stand by generator system UPS for all equipments and gazettes Central field illumination 2000-3000 candles/ sqmt Floor around table 200-300 candles/ sqmt Minimum Glares, four power outlets on each wall at height of 1.5 meter Structured cabling system, Isolation Circuit for appliances Separate copper earthing, avoid extension cords OPERATING LIGHT: Shadow less, mobile, hanging pendent easily maintainable OT light. Intensity should be 4000 lux at incision and 8000 lux at 9 cm deep.

16. Maintenance of temperature 220C for comfort.

17. Humidity 55 % + 5 percent.

18. 100% fresh air with 20 changes per hour.

19. Filter of 1 to 3 micron size to be used.

20. Central air-conditioning system.

22. All anaesthetic gases to be vented out to exhaust.

23. Flow of air 2 to 3 cu meter/ minute.

25. Impervious lining to seal contamination.

26. Toilets to be provided in change room area.

27. All fire safety measures to be taken.

29. Taps should be easily handled or foot operated.

31. Each unit must have from 4-7 O.T staffs. Chief Surgeon O.T Assistant Chief Anaesthetist Anaesthesia Assistant Scrub Nurse Anaesthetic Nurse Circulating Nurse O.T Nurse for assisting Attendants, Safaiwala, OT technicians

32. PHYSICAL ACTIVITIES ADMINISTRATIVE AREA SUPPORTIVE SERVICES RECEPTION OF PATIENT PHYSICAL FACILITIES HOUSE KEEPING STORE KEEPING REPAIR & MAINTENANCE CLERICAL ACTIVITY

34. Identification of patient and part to be operated.

35. Shifting patient to OT table.

36. Administration of anaesthesia, intubation positioning.

37. Preparation of surgical area and draping.

38. Intubation after operation, recovery from anaesthesia.

40. Scrubbing and hand washing

41. Gowning, putting gloves

43. Preparation of OT list

44. Requisition of patient

45. Identification of patient, part and records

46. Shifting patient to OT

48. Transfusion Record

49. Consent to patient for operation

51. Counting and collection of soiled instruments, disposables

52. Counting of abdominal sponges

53. Cleaning of OT table and area

55. Indent and stocking of essential drugs and injections.

57. Height should be 3-3 ½ meter.

58. Pale color to be used.

59. Resistant to minor damage or impact.

60. Free of cravices and flaking.

61. All corners to be smoothly carved.

64. Adequate free area around the table for free movement.

65. Tables connected to Gas Pipe Lines .