guidelines for ideal layout for an operating theater...
TRANSCRIPT
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Guidelines for Ideal Layout
for an Operating Theater
Complex
Dr.R.D.Ravindran
Aravind Eye Hospital
Madurai
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Patient Flow
1. WARD
2. BLOCK ROOM
3. THEATRE
4. RECOVERY ROOM
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Transfer area
This is an area, usually a corridor, where the patient is transferred from an outside trolley to an inside trolley.
A red line on the floor can demarcate the limit upto which the out side trolley could come from where the patient is shifted to the inside one.
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General Considerations in
OT Complex Planning
• OT Location
• Understand OT layout / Zoning
• Ventilation system
• Water purification systems
• Central sterile supplies process
• Biomedical waste disposal
• Laundry
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Location
• The OR complex be segregated from high traffic areas
• Ideally it should be situated so that the patients & staff only pass through the passage, thus minimising the chances of infective organisms being carried inside.
–In a separate wing
–Top floor or ONE FROM TOP (WATER PROOFING CONCERNS)
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OT Layout
• Common usage areas
• Semi Sterile corridor / Areas
• Sterile corridor
• Operating Rooms
• CSSD / Sterile storage
• Surgical stores
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OT Layout
• Common usage areas
– Pre & Post op patent areas
– Dress change room
– Lounge for staff
• Street dress allowed
• No need to cover the hair
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Common usage areas
STERILE CORRIDOR
SEMI-STERILE CORRIDOR
OPERATING ROOMS
OPERATING ROOMS
OT Layout
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Ideal OT Layout
• Separate Sterile From Non Sterile
Traffic
–Central corridor plan
–Peripheral corridor or race track plan
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Ideal Layout Separate Sterile From Non Sterile Traffic
Central corridor plan • The central core of the complex is the most
clean portion. • The sterilized items access the ORs from here • Peripheral corridor for unsterile traffic
Peripheral corridor plan • An encircling peripheral area is the cleanest
area that connects the ORs. • The dirty traffic accesses the OR from other
(inner) side.
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Ideal OT Layout
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NABH Guidelines
• OT Size: Standard OT size of 20’ x 20’ x
10’ (Ht. below the false ceiling level is
considered).
• Occupancy: Standard occupancy of 5-8
persons at any given point of time inside
the OT is considered.
• Equipment Load: Standard equipment
load of 5-7 kW considered per OT.
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• Two doors
Front door
• Personnel entry
• Dirty instruments
& Linen
Rear Door
• Sterile supply
OT Room Design
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Location of Scrub Area
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OT Layout
• No need for a “substerile”
room between every two
operating rooms
• No need for the door of
the staff dress change
room to open directly into
the semi-restricted area
of the surgical suite
•
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Flooring & Walls
• The flooring, walls and ceiling should be
non porous, smooth, seamless without
corners and should be easily cleanable
repeatedly.
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Central air-conditioning of
the operating room is ideal.
Positively Pressurized
HEPA Filter (0.3 µM) - to
minimize air borne
contamination
Ventilation System
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Ventillation
• Air Change Per Hour:
– Minimum total air changes should be 25
– Fresh air component of the air change to be minimum 4 air changes
• Air Velocity:
– The vertical down flow of air coming out of the diffusers should be able to carry bacteria carrying particle load away from the operating table.
– The airflow needs to be unidirectional and downwards on the OT table.
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Ventillation
• Positive Pressure
– Minimum positive pressure recommended is
15 Pascal (0.05 inches of water)
• Air is supplied through HEPA filters
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• Minimum size of the air
supply area should be 6’
x 4’ to cover the entire
OT table & surgical team
• Return air should be
taken out through the
exhaust grille located
near the floor level
(approx 6 inches above
the floor level).
Ventillation
Design process
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Temperature and Humidity
• The temperature should be maintained at
21 +/- 3 Deg C
• Relative humidity between 40 to 60%
though the ideal Rh is considered to be
55%.
• Appropriate devices to monitor and display
these conditions inside the OT
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Air Filtration
• AHU must be an air purification unit & air filtration unit.
• Two sets of washable flange type pre filters of capacity 10 microns & 5 microns with aluminum/ SS 304 frame within the AHU.
• HEPA filters of efficiency 99.97% down to 0.3 microns or higher efficiency may be provided in the AHU.
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Ventillation
• The AHU of each OT should be dedicated
one and should not be linked to air
conditioning of any other area.
• During the non functional hours AHU
blower will be operational round the clock
(may be without temperature control).
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Window & Split Airconditioner
• Window & split A/c should not be ideally
used in any type of OT because they are
pure re circulating units and have
convenient pockets for microbial growth
which cannot be sealed.
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Periodical Validation
• Temperature and Humidity check
• Air particulate count
• Air Change Rate Calculation
• Air velocity at outlet of terminal filtration unit / filters
• Pressure Differential levels of the OT with ambient / adjoining areas
• Validation of HEPA Filters
• Preventive maintenance every 15 days
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Water Purification System
• Water is an important reservoir of microorganisms
like Pseudomonas & other gram –ve organisms.
• Dedicated water tank for OT
• Reverse Osmosis Water
• Effectively removes all types
– Pyrogens
– Microorganisms
– Colloids & dissolved inorganics
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RO water Plant
• Germicidal
• Multi grade Micron filter
– To remove suspended
solids
• Reverse osmosis
– To remove total dissolved
solids
• Ultra filtration (< 0.02 µm)
– To remove microbes/
Endotoxin etc.,
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Common usage areas
STERILE CORRIDOR
SEMI-STERILE CORRIDOR
OPERATING ROOMS
OPERATING ROOMS
CSSD Layout
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Autoclave Loading Area (Unsterile)
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Loading of Bins
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View of Unloading Sterile bins and Storage
Area
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Storage of Sterile bins in a rack
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Common usage areas
STERILE CORRIDOR
SEMI-STERILE CORRIDOR
OPERATING ROOMS
OPERATING ROOMS
CSSD Layout
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Surgical Supplies Store
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Biomedical waste
• Dedicated area for collection and
storage
• Covered area
• Easily accessible
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THANK YOU