IDEAL OBS GYN OT SET UP

Ideal C section OT/OR set up
Narendra Malhotra
OBSTETRICIAN
AGRA
www.rainbowhospitals.org

PROF.NARENDRA MALHOTRA
M.D., F.I.C.O.G., F.I.C.M.C.H, F.R.C.O.G.,F.I.C.S.,A.F.I.A.P.
• Prof. Dubrovnick International University
• V.P. WAPM(world association of prenatal medicinne)
• President ISAR
• Presiddent Elect ISPAT
• Sec Gen SAFOG
• Member FIGO guidelines committee
• President FOGSI (2008-2009)
• Dean I.C.M.U. (2008)
• Director Ian Donald School of Ultrasound
• National Tech. Advisor for FOGSI-G.O.I.—Mc Arthur Foundation EOC Course
• Managing Director GLOBAL RAINBOW HEALTH CARE
• Director ART-RAINBOW –IVF
• Practicing Obstetrician Gynecologist at Agra. Special Interest in High Risk Obs., Ultrasound, Laparoscopy
and Infertility, ART & Genetics
• Member and Fellow of many Indian and international organisations
• Awarded best paper and best poster at FOGSI : 5 times, Ethicon fellowship, AOFOG young gyn. award,
Corion award, Man of the year award, Best Citizens of India award
• Over 50 published and 200 presented papers
• Over 100 guest lectures given in India & Abroad and 24 ORATIONS
• Organised many workshops, training programmes, travel seminars and conferences
• Editor 18 books, many chapters, on editorial board of many journals
• Editor of series of STEP by STEP books
• Revising editor for Jeatcoate’s Textbook of Gynaecology 7th and 8th edition (2015)
• Very active Sports man, Rotarian and Social worker
MALHOTRA NURSING & MATERNITY HOME PVT. LTD.
GLOBAL RAINBOW HEALTH CARE,AGRA
84, M.G. Road, Agra-282 010
Phone : (O) 0562-2260275/2260276/2260277, (R) 0562-2260279, (M) 98370-33335; Fax : 0562-2265194

Location of the
Operating Theatre Suites
• Separated from the main flow of hospital traffic
• Should be easily accessible from surgical wards and emergency
rooms.
• Floor should be covered with antistatic material,
• The walls should be painted
with impervious, antistatic paint.
(reduces the dust levels and
allows frequent cleaning)
• The surfaces must
withstand frequent cleaning and
decontamination with disinfectant.

Layout of the Operating Theatre
clean corridor
scrub-up
area
Recovery
area
Anesthetic
room
sterile supplies store

Allocation programming supervision
D-7 / D-1Year N
Semestre S
D
registration
D
Feedback loop
Year N+1
Semestre S+1
Monthly
Mission : superviser les différentes catégories intervenants
pour optimiser et sécuriser la prise en charge
Fréquence : quotidienne
Mission : adaptation des processus et rappels formalisés
pour le respect des processus validés
Fréquence : Mensuelle
Weekly
« operating
theatre
board »
« Commission
des utilisateurs
du bloc »
Mission : adaptation des vacations
Fréquence : Annuelle (voire semestriel)
« Supervision
cell »
« Coordonnateur »
Missions : arbitrer les priorités
médicale relatives à la prise en
charge immédiate (= du jour)
« Chef du
bloc »
Missions : veiller à l’application des règles,
contribuer à l’évolution des règles pour améliorer
l’efficience, la sécurité et les conditions de travail.
Operating theatre : macros processes

Wards
Operating theatre
OR1
OR2
ORn
Recovery
ICU
Operating theatre: trajectory

Operating theatre: Components
Operating theatres (mono
disciplinary or shared)
ED operating theatres
Recovery rooms
Induction rooms
Endoscopia operating rooms
Obstetric operating theatre
Stretchers
Obstetric labor rooms
Interventional radiology ORs
ED
Sterilisations
Wards
Two scopes:

Operating theatre: some observations
Turn dedicated operating rooms (OR) into shared
polyvalent ones improves the economic efficiency.
Induction outside the OR (in an induction room) improves
the OR usage
Keep the right balance between the surgery volume target
and all human and material resources.
SFAR recommendation: 1.5-2 recovery beds per OR

Operating theatre: performance indicators
Three types of patients concerning the surgery programming:
• Elective patients programmed at D-8 : elective surgery patients of
week W are known the week W-1 (in general, before Thursday noon)
to allow the validation of the surgery program of the operating rooms
and the personal planning,
• Semi-urgent patients programmed at D-1: patients known the day
before their intervention
• Patients not yet known at the beginning of D.
A good surgery program depends directly on the capacity to anticipate the
demands of different operators. This anticipation requires the knowledge
of the patients to be operated at least one week before.
Health professionals agree that a ratio of 80 to 85% of patients known at
D-8 is signal of efficient surgery programming.
Of course, one has to take into account emergency surgeries and the
catchment area and target market of the hospital.

Operating Room time usage:
• Hospital OR time provision - « temps de mise à disposition »
(TMD), a decision of hospital management based on the opening
times of each room – OR sessions,
• OR timed used - « temps réel d'occupation des salles » (TROS),
part of the TMD actualy used for an intervention, i.e. interval from
patient arrival in the room to end of cleaning of the room
• Conventional OR time « temps conventionnel MeaH », base OR
times defined by Agency MeaH to benchmark different hospitals. For
each OR :
• Conventional Day OR time of 10 hours (08h30 -18h30)
• Conventional «continuity of care duty » of 14 hours (18h30 - 08h30)

Ratio 1 (allocation) : Hospital OR time provision / MeaH convention
68 - 90% with one at 111%.
Ratio 2 (programing & regulation) : Time used / Time programmed
45% - 77%, mean 62%. National objective (CTN) : 75 - 80%.
Ratio 3 (productivity) : Timed used / MeaH convention
31% - 63%.

Surgery occupation time - TROS :
• T1 patient preparation time : patient arrival to induction,
• T2 induction time: induction to incision,
• T3 surgery intervention time,
• T4 duration of bandage,
• T5 : cleaning.
TUC = time needing a medical specialist (operator and anaesthestist).

OR time provision (TMD) and overtime
Ratio of overtime is a significant capacity regulation issue.
General agreement (CTN), 2% overtime seems unavoidable
Most hospitals visited by MeaH found ways to improve their overtime
ratio and hence reducing overtime cost.

OPERATION THEATRE - 1
Dr patil OT all in one …………advantage and disadvantages both

OPERTAION THEATRE FOR C SECTION
GLOBAL RAINBOW HEALTH CARE AGRA

THEATRE DESIGN
GLOBAL RAINBOW HEALTH CARE AGRA
Theatre Design Consideration:
• The prevention of wound infection.
• The safety of patients and staff.
AEROCIDE
LAMINAR HEPA FILTER

• Designing a safe environment
incorporates features that
prevent or control the risk of
infection, fire, explosion, and
chemical and electrical
hazards.
• Well-devised traffic patterns,
material-handling systems,
disposal systems, positive-
pressure and well-dispersed
clean ventilation, and high-
flow, unidirectional
ventilation systems for special
applications all contribute to
a safe surgical environment.
Design Features

20 PRPD/DN/DM/PON/09
Design specifications have been identified and followed in the WEST since many yrs

And have improved with newer specifications and guidelines

Traffic Patterns in the Surgical Suite,
A
three-zone
designation of areas within the surgical suite
facilitates appropriate movement of patients and
personnel.
Traffic Flow

Traffic Flow
1. Unrestricted areas are those in which
personnel may wear street clothes, and
traffic is not limited.
2. In semi-restricted areas, such as
processing and storage areas for
instruments and supplies, as well as
corridors leading to the restricted areas
of the surgical suite, personnel must
wear surgical attire and patients must
wear gowns and hair coverings.
3. Restricted areas include operating rooms
and clean core and scrub sink areas.
Surgical attire and masks are required in
these areas when there are open sterile
supplies or scrubbed persons in the area.

Traffic Flow
• The flow of supplies should
be from the clean core area
through the operating
rooms to the peripheral
corridor.
• Soiled materials should not
re-enter the clean core
area. Soiled linen and trash
collection areas should be
separated from personnel
and patient traffic areas for
infection control purposes.

Ventilation
• Appropriate ventilation systems aid in the
control of infection by minimizing microbial
contamination.
• Temperatures in an operating room should
be maintained between 68° and 73° F (20°
to 23° C), with relative humidity of 30% to
60% to reduce bacterial growth and
suppress static electricity.

TEMP HUMIDITY
The temperature and the
humidity (not less than 55%) play
a important role in maintaining
staff and patient comfort.
They must be carefully regulated
and monitored.
(In low humidity there is a danger of the
production of electrostatic sparks.)
Ideally, the operating room
should be 1ºC cooler than the
outer area.
(This aids in the outward movement of air:
the warmer air in the outer area rises and
the cooler air from within the operating
theatre moves to replace it.)

Laminar flow & ultraclean air
Laminar airflow is designed to move particle free air over the
aseptic operating field in one direction.
It can be designed to flow vertically
or horizontally and is usually
combined with high efficiency
particulate air (HEPA) filters.
HEPA filters remove
particles > 0.3 micron in
diameter with an
efficiency of 99.97%.

Emergency Signals
• Every surgical suite should have an
emergency signal system that can be
activated inside each operating room.
• A light should appear outside the
door of the room involved, and a
buzzer or bell should sound in a
central nursing or anaesthesia area.
• The signals should remain on until
the alarm is turned off at the source.
All personnel should be familiar with
the system and should know both
how to send a signal and how to
respond to it. Such a system,
restricted to use in life-threatening
emergencies, saves invaluable time in
bringing additional personnel and
resources for assistance.

Operating
Department
comprises:
• Rest rooms
• Changing rooms
• Teaching rooms
• Storage
• Reception areas
• An operating suite

An Operating Suite
Is one functioning unit of a department:
• An anesthetic room
• Clean preparation room
• Scrub-up area
• Operating theatre
• Sluice room
• Exit bay

“Clean and Dirty”
All journeys
within the
department
are made
from clean to
dirty areas,
never the
other way
round

PRPD/DN/DM/PON/09
Patients
• Will enter the department from
the hospital corridor via a transfer
bay. Here they are usually lifted on
to a theatre trolley, leaving the
ward bed outside.
• Next they enter either a holding
bay area or else move directly to
the anesthetic room.
• Finally they enter the theatre itself
where surgery is to be performed
• The journey has been one through
progressively cleaner areas,
arriving finally at the cleanest of
all.
• Once the wound has been closed
and covered with dressing, it is safe
for the patient to return to the
ward via progressively more dirty
areas: through the exit bay,
recovery and the hospital corridor.

Instrument and Equipment
• Are brought from outside the
department into clean store rooms.
Instruments are often supplied in pre-
packed sterilized trays by the Theatre
Sterile Supplies Unit (TSSU). Finally,
they enter the theatre ready for use
on the scrub nurse’s trolley.
• At the end of an operation, dirty
instruments, linen and rubbish are
removed to the sluice room, and
when correctly packaged for disposal,
to agreed collection points. Porters
then take them via a dirty corridor to
their several destinations: the TSSU,
laundry or hospital incinerator.

Theatre Personnel
• Enter the department via a
changing room where outdoor
clothing is left.
• Once attired in correct theatre
dress they can proceed to a
suite along a clean corridor.
• Here they enter via the clean
preparation room or the scrub-
area, and like the patient, leave
through the exit bay.

The Anesthetic Room
• The anesthetic machine
• Suction apparatus
• The drug cupboard
The Operating Theatre
• The operating table – centre
piece of the room, a very
versatile piece of equipment. It
has to be in order to
accommodate the great variety
of different operating positions.

The Operating Lights
 There are usually two
operating lights in a
theatre attached to the
ceiling.
 The lights are easily
maneuvered, necessary to
accommodate the needs
of surgery.
 Good lighting is needed to
carry out an operation,
and lighting a wound from
two converging angles is
designed to eliminate
shadows.

9
Anesthetic Scavenging
 A long length of corrugated
plastic tubing connected to
the anesthetic circuit at
one end, while the other
connects to a vent in the
ceiling or wall.
 The system draws out of
the theatre any anesthetic
gases or agents leaking
from the circuit and which
pollute the atmosphere.

The Swab Rack
 This is a metal piece of
furniture used for hanging
up swabs during an
operation for ease
counting.
 It comprises of several tiers
have either hooks to hang
the swabs, or else holes to
poke them through.
 The hooks and holes are
grouped in numbers off
fives, and each tiers can
usually accommodate ten
swabs.

The Swab Board
 This is for recording the
amount of blood loss during
the operation especially
major operation.
 The nurses record this
information for anesthetist's
benefit, who will instigate
replacement therapy.
 The board is usually marked
in two columns; one for
blood loss from the swabs
and one for loss from the
suction.

Weighing Scale: estimating blood loss
 You should find a list of known dry
weights of each different type of
swab.
 To estimate blood loss, you weigh
the blood-soaked swab, and from
that weight subtract the known dry
weight.
 This leaves you with the weight of
blood lost, which is the amount you
record, adding it to the running total.
e.g.; Dry Large swab = 20g, Soaked in
blood = 90g
: 90g – 20g =70g is the weight of
the blood loss
(1g = 1ml)

This is vital as some
operations are
conducted with close
reference to a patient’s
x-rays throughout.
e.g. orthopaedic surgery,
tumour surgery and
operations such as
cholecystectomy
X-ray Screens

Rubbish bins, Swab bins and Linen bins
 Every theatre has separate
disposal containers for rubbish,
swabs and linen.
 During the operation the swabs
must remain separate, to
facilitate the swab counting
procedure.
 Leave the disposal bags in the
theatre until the end of the
operation, until the scrub nurse
is entirely happy with the final
count.
 Fresh disposal bags are always
brought in for every operation.

NEONATAL RESUSCITATION STATION

Recovery Area
• Carried out in the corridor outside the operating theatre.
• Normally made up of several bed spaces, each with
necessary equipment to facilitate recovery e.g. oxygen,
suction apparatus, pulse oximetry, emergency trolley
necessary to deal with cardiac arrests or anesthetic
emergencies etc.

Changing to Theatre Clothing
• To cut down on any bacteria brought from
outside
• Cotton uniform less static electricity
• Pride for nurses working in theatre
• Laundry purposes
• Reduce anxiety for patient

SUMMARY
HOW TO MAKE AN IDEAL OBSTETRIC O.T.

IDEAL OBS GYN OT SET UP

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