2. Objectives
• What is operation room/ theater?
• Theatre design consideration
• Safe environment
• Traffic Flow
• The three-zone of traffic flow
• Room ventilation
• Emergency Signals
• OR attire
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3. Definition of Operation Theatre
• An operating theater (also known as an operating room, operating suite, theatre
operation suite or OR) is a facility within a hospital where surgical operations are
carried out in an aseptic environment.
• Historically, the term "operating theatre" referred to a non-sterile, tiered theater or
amphitheater in which students and other spectators could watch surgeons perform
surgery.
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4. Theatre Design
Theatre design consideration:
• The prevention of wound
infection.
• The safety of patients and
staff.
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5. Design Features
Designing a safe environment incorporates features that prevent or control the risk of,
• Infection,
• Fire,
• Explosion, and
• Chemical hazards
• Electrical hazards.
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6. Design Features-cont…
• 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.
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7. Traffic Flow
• Traffic patterns in the surgical suite, a three-zone designation of areas within the
• surgical suite facilitates appropriate movement of patients and personnel.
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8. Traffic Flow-cont…
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.
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10. 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.
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11. 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.
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13. An Operation Suite
Is one functioning unit of a department:
• An anesthetic room
• Clean preparation room
• Scrub-up area
• Operating theatre
• Sluice room
• Exit bay
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14. Surgical Attire
Purpose:
• The primary purpose of operating theatre attire is to in still a sense of discipline in
those working in the operating theatre, and to identify the operating theatre as a
separate clean area.
• It is also to ensure that clean clothes are worn when operating on the patient to
prevent harmful bacteria.
• Upon arrival in the operating theatre suite, all personnel working in the OT will
change out of their street clothes and into theatre attire and closed toed shoes
(clogs or boots).
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15. Surgical Attire-cont…
Those that work in the OT but are not part of the scrub team do not need to wear
anything more than head cover.
Those working in the OT and are part of the scrub team including working in the layup
area will wear:
• Head cover
• Plastic apron
• Surgical mask
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16. Surgical Attire-cont…
• Additionally, those involved directly in the operation procedure will also wear eye
protection to avoid splashing.
• Sterile gown and gloves are added for scrubbed team members.
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17. Components of Attire
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Each item of OT attire is a specific means of
protecting the patient from the sources of
contamination and risk of infection.
• Body Cover
• Surgical Mask
• Head Cover
• Gown
• Gloves
• Eye Protection
• Shoes and Shoe Covers
18. 1. Goggles & Face-shield -Protection of the mucous membranes of the eyes/nose/mouth
by using face shields/ goggles
2. Mask-To protect the airway (upper and lower respiratory tracts) from the particulate
matter generated by droplets / aerosols prevents human infection.
The types of mask required:
• Triple layer medical mask
• N-95 Respirator mask
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19. • Gloves-Nitrile gloves are chemical resistant and are preferred over latex gloves. if
nitrile gloves are not available, latex gloves can be used. Non powdered gloves are
preferred to powdered gloves.
• Coverall/gowns (with or without aprons)-Coveralls typically provide 360-degree
protection because they are designed to cover the whole body, including back and
lower legs and sometimes head and feet as well.
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20. • Head cover-Head cover should cover the head and neck while providing clinical care
for patients. Hair and hair extensions should fit inside the head cover.
• Shoe cover-Shoe covers should be made up of impermeable fabric to be used over
shoes to facilitate personal protection and decontamination.
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21. Hand Washing
Definition:
Hand washing is also known as hand hygiene, is the act of cleaning
one's hands with soap and water to remove viruses/bacteria/microorganisms, dirt,
grease, or other harmful and unwanted substances stuck to the hands. Drying of the
washed hands is part of the process as wet and moist hands are more easily re-
contaminated
Types of Hand washing:
a. Medical
b. Surgical
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22. Medical Hand Washing
The World Health Organization (WHO) recommends washing hands for at least 20
seconds
The nurses when to do hand washing:
• Before and after touching/caring for any sick person
• Before and after doing any therapeutic procedures
• After touching ward or patient’s surroundings.
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23. Steps of Medical Hand Washing
Wet Hands. Wet your hands and apply enough liquid soap to create a good lather. ...
• Step 1: Rub Palms Together. ...
• Step 2: Rub the Back of Hands. ...
• Step 3: Interlink Your Fingers. ...
• Step 4: Cup Your Fingers. ...
• Step 5: Clean the Thumbs. ...
• Step 6: Rub Palms with Your Fingers.
• Step 7: Rub both the wrists in a rotatory manner
Rinse and dry the hands thoroughly
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25. Surgical Hand Washing
• Hand wash with soap and water on arrival to OR, after having donned theatre
clothing (cap/hat/bonnet and mask).
• Use an alcohol-based handrub (ABHR) product for surgical hand preparation, by
carefully following the technique before every surgical procedure.
• If any residual talc or biological fluids are present when gloves are removed following
the operation, handwash with soap and water
• A timed scrub should last for one to three minutes. The best water temperature is
very hot; this tends to kill bacteria more quickly.
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26. Steps of Surgical Hand Washing
• Allow the water to run and cover the nail pick and brush with soap, using your
elbows on the soap dispenser; clean your nails and remove any gross debris from
your hands
• Start by scrubbing your hands and forearms, down to your elbows, using the
WHO hand washing procedure for the hands and a rotational action for your
forearms ; this should last for at least one minute
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27. • Wash the soap from your hands and forearms by holding up your arms with your
hands elevated under the tap, such that the water runs off into the sink from your
elbows.
• Repeat this procedure a further three times, initially down to the mid-forearm, then
down to the wrists , then just for the hands, each time lasting for at least one minute
• Keeping your arms elevated , dry your hands and forearms with the sterile towels in
the gowning pack, using a dabbing motion instead of a wiping motion ; use one
towel for each hand, before throwing them away
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29. Steps for Donning of PPE
• Step 1:Remove jewelry and other accessories. Tie hair properly
• Step 2:Perform hand hygiene as per WHO protocols
• Step 3: Wear Cap
• Step 4: Wear Shoe Cover
• Step 5: Perform hand hygiene as per WHO protocols
• Step 6: Wear the inner gloves
• Step 7: Put on the Gown
• Step 8: Place the medical mask
• Step 9: Wear goggles
• Step 10: Wear face shield
• Step 11: Place the hood
• Step 12: Wear the outer gloves
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30. Steps for Doffing of PPE
• Step 1: remove the outer gloves
• Step 2: Remove Coverall/Gown
• Step 3: Remove Shoe cover
• Step 4:Perform hand hygiene as per WHO guidelines
• Step 5: Remove the goggles and Face Shield
• Step 6:Remove the mask
• Step 7:Remove the cap
• Step 8: Remove the inner glove
• Step 9: Perform hand hygiene as per WHO guidelines
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31. REFERENCES
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2.Surgical Attire (2011). Perioperative Standards and Recommended Practices for Inpatient and Ambulatory Settings.
Denver, CO. 57-71.
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detergent treatment. Microbiology Immunology; 44(8), 653-656.
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streptococcus carried on the scalp. New England Journal of Medicine; 323(14), 968-972.
6.Dineen, P. & Drusin, L. (1973). Epidemics of postoperative wound infections associated with hair carriers. The Lancet;
1157-1159.
7.Summers, M. M., Lynch, P. F. & Black, T. (1965). Hair as a reservoir of staphylococci. Journal of Clinical Pathology;
18(13), 13-15.
8.Noble, W. C. (1975). Dispersal of skin microorganisms. British Journal of Dermatology; 93(4), 477-485.
9.Tammelin, A., Domicel, P., Hambraeus, A. & Stahle, E. (2000). Dispersal of methicillin-resistant staphylococcus
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