safe environment n.
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  2. PRPD/DN/DM/PON/09

  3. PRPD/DN/DM/PON/09

  4. THEATRE DESIGN Theatre Design Consideration: • The prevention of wound infection. • The safety of patients and staff. PRPD/DN/DM/PON/09

  5. Design Features • 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. PRPD/DN/DM/PON/09

  6. 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. PRPD/DN/DM/PON/09

  7. Traffic Flow • Unrestricted areasare those in which personnel may wear street clothes, and traffic is not limited. • 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. • Restricted areasinclude 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. PRPD/DN/DM/PON/09

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  9. 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. PRPD/DN/DM/PON/09

  10. PRPD/DN/DM/PON/09

  11. 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. PRPD/DN/DM/PON/09

  12. Cont… • Temperatures in that range allow for comfort of the surgical team and are tolerated by most patients. • Each operating room should have individual temperature controls to accommodate patient safety, as when increased warmth is required for patients at high risk for inadvertent hypothermia during operative procedures. PRPD/DN/DM/PON/09

  13. PRPD/DN/DM/PON/09

  14. 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. PRPD/DN/DM/PON/09

  15. Operating Department comprises: • Rest rooms • Changing rooms • Teaching rooms • Storage • Reception areas • An operating suite PRPD/DN/DM/PON/09

  16. 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 PRPD/DN/DM/PON/09

  17. “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

  18. 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. PRPD/DN/DM/PON/09

  19. 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. PRPD/DN/DM/PON/09

  20. 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. PRPD/DN/DM/PON/09

  21. 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. PRPD/DN/DM/PON/09

  22. 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. PRPD/DN/DM/PON/09

  23. 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. PRPD/DN/DM/PON/09

  24. 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. PRPD/DN/DM/PON/09

  25. 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. PRPD/DN/DM/PON/09

  26. 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) PRPD/DN/DM/PON/09

  27. X-ray Screens 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

  28. 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. PRPD/DN/DM/PON/09

  29. 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. PRPD/DN/DM/PON/09

  30. 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 PRPD/DN/DM/PON/09

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  40. The End PRPD/DN/DM/PON/09