O PERATING R OOM T ECHNIQUE

1. OPERATING ROOM TECHNIQUE ::: PREPARED BY ::: Ibrahim H. Shamia, RN, MSN, PhD Fellow Ibrahim Shamia O. R. Technique

2. Environmental SafetyOperation Theater Requirement • Objectives: • After completion this presentation the participant will be able to: • Identify specific areas within the OR suit where in attire and behaviors affect the manner of care delivery. • Discuss how environmental layout contribute to aseptic technique. • Describes methods of environmental controls that contribute to an aseptic environment. Ibrahim Shamia O. R. Technique

3. Operation Team Concept: • The team's common goal is the prevention of infection, the efficient and effective delivery of care to the individual patient for the relief of suffering and restoration of bodily. • Structure and function one a favorable post operative out-come contributing to the patients in the operation room completely dependent on the health team, so the O.R. team should work like a symphony and in harmony with each other for total accomplishment of successful out come Ibrahim Shamia O. R. Technique

4. Physical Layout of the O.R • Effectiveness utilization of the physical facilities is important. • The design of the O.R. offers a challenge to the planning team to optimize efficiency by creating realistic traffic and workflow patterns for patients, personnel, supplies. • The design should also allow for flexibility and future expansion. • Architects consult the surgeons, O.R. nurses, and administrative before allocating space. Ibrahim Shamia O. R. Technique

5. Design of O.R • The planning and design of O.R. need multidisciplinary team, which may include the following: • Department director. • Nurse manger. • Physicians (surgeons, Anesthetist). • Information technologist. • Communications personnel (e.g., telephone, intercom, emergency call). • Support service personnel ( e.g., laboratory, x-ray). • Infection control personnel. • Architect. Ibrahim Shamia O. R. Technique

6. Design of O.R Cont., • No one plan suites all hospitals, each is designed on the individual basis to meet projected specific future needs. • The number of rooms required is a function of: • The number and length of operation to be performed. • The type and distribution by specialties of surgical staff. • The proportion of elective inpatients and ambulatory patients to emergency operation. • The scheduling policies related to the number of hours per day and days per week the suite will be in use. • The systems and procedures established for the flow of patient, personal and supplies. Ibrahim Shamia O. R. Technique

7. Design of O.R Cont., Ibrahim Shamia O. R. Technique

8. Location of O.R. • The O.R. is usually located in an area accessible to the critical care (I.C.U.) surgical patient areas and supporting service department i.e. central service department and radiology. • A terminal location is necessary for microbial control since all air is filtered to control dust. • Traffic noises may be less evident a above the ground floor. Ibrahim Shamia O. R. Technique

9. Principles of Design • The universal problem of environmental control to prevent wound infection exerts a great influence upon the design of O.R. department. • Clean and contaminated area should be well differentiated • Principles in planning the physical layout of an operation department: • Exclusion of contamination area with in the department with sensible traffic pattern within the O.R. department . • Separations planning of an O.R. department which separate clean from contaminated area make it easier to carry out aseptic technique. • The clean area is often referred to as the restricted area. Ibrahim Shamia O. R. Technique

10. Types of Designs • Most of O.R. are constructed according to a variation of one or more of four basic designs: • Central corridor, or hotel plan. • Central core, or clean core plan with peripheral corridor. • Grouping or cluster plan with peripheral and central corridor. Ibrahim Shamia O. R. Technique

11. Types of Designs Cont., • Each design has its advantages and disadvantages. • Efficiency is affected if corridor distance are too long in proportion to other space: • If illogical relationships exist between space and function. • If inadequate consideration was given to storage spaces, material handling, and personal areas. Ibrahim Shamia O. R. Technique

12. Division of O.R 1- Unrestricted Area: • It is the outer most part of O.R. department. • Here street clothes are allowed. • It is separated from semi-restricted area by Red Line. • The exchange areas: patients and personal enter the semi-restricted area of operation department through this area. Ibrahim Shamia O. R. Technique

13. Division of O.R Cont., • It includes: 1. Doctors, nurses changing room: • Found in this room the scrub suit & all what you need to trans to the semi restricted area like shoes cover & head cap, each one of the staff have locker in changing room. 2. Receiving area for supplies. 3. O.R. administrative clerk. Ibrahim Shamia O. R. Technique

14. Division of O.R Cont., 2- Semirestricted Area: • It is the area between unrestricted area and restricted area (operation theater), before entering this area wear scrub suit, shoes cover and head cover. • It has peripherals support areas, access corridors to O.R. theater. Ibrahim Shamia O. R. Technique

15. Division of O.R Cont., • It includes: 1. Pre Operative Holding Area: • Is the place where patients wait before surgery. • It is also used for pre operative check up, inserting of I.V. lines for local anesthesia administration. 2. Post anesthesia (surgery) care unit (Recovery Room): • Usually located near the operation room. • Supplied by equipments and monitors to manage a patient during recovery from anesthesia. Ibrahim Shamia O. R. Technique

16. Division of O.R Cont., 3- Restricted Area: A- Operation Room: • The mask must be wearing. • It is designed according to the specialty that is going to use it. • It is should be large enough to allow operation to be done safely. • Doors should be sliding so as to keep air flow from outside minimal. Swing doors are also acceptable. • ْRoom temperature is maintained with arrange of 20 – 26 C Ibrahim Shamia O. R. Technique

17. Division of O.R Cont., • Ventilation the flow of air is laminar and a positive pressure. The air is changed 20 times/hr. • Floors should be conductive enough to disperse any static electricity to pass in to ground. • Wall and ceiling swath the material used for surfacing should be hard , non-porous, fire resistance , water proof and easy to clean Ibrahim Shamia O. R. Technique

18. Division of O.R Cont., B- Storage Room: • These arms in the semi-restricted area are used for storing clean equipments and supplies. • Dirty and soiled items are not thought here e.g. anesthesia room and orthopedic room. C- Sterile Supply Room: • Here sterile items are stored for ready use in O.R. like sets of instruments, bandage, gauze and basins. Ibrahim Shamia O. R. Technique

19. Division of O.R Cont., D. Utility Room: • Here the instruments are washed, cleaned before they are sent to general work room or C.S.S.D. E. Sub Sterile Room: • It is a room adjacent to an O.R. where emergency cleaning and sterilization is done. It can be used for string some items like specimen containers and medication. F. Scrub Room: • The O.R. room is usually next to the scrub room. Ibrahim Shamia O. R. Technique

20. O.R. Instruments • Power- Driven Instrument: • E.g.,: Saws- Drills- Dermatomes. • Powered instrument increase speed of procedures. • Reduce operating time. • Decrease fatigue. • Sources of Power: • Electricity from direct current or battery. • Compressed air or nitrogen by cylinder or pipes system. Ibrahim Shamia O. R. Technique

21. Rules for Use Electrical Instrument: • Should be explosion proof motor. • Must have spark proof connection. • Power switches should be off when plugging electrical cord into outlets. • Alert the anesthesiologist if electrical equipment will be use. • Do not immerse motor in liquid. • Follows the manufactures recommendation in cleaning & lubricating, sterilizing the equipment. • Check power cords and plugs for cracks or break. • Test for working condition before handling to the surgeon. Ibrahim Shamia O. R. Technique

22. O.R. Instruments Cont., • Air-Powered Instrument: • The gases in use might be either O2 or Nitrogen. • It's either piped into the O.R or supplied from a cylinder. • The pressure must be monitored by regulator. Ibrahim Shamia O. R. Technique

23. O.R. Instruments Cont., • - These Instruments Used in Orthopedic for: • Drilling. • Clotting. • Shaping. • Beveling bone. • Blood loss from bone is reduced. Ibrahim Shamia O. R. Technique

24. Furniture and Other Equipment • Stainless steel furniture is plain, durable, and easily cleaned. • Each O.R. is equipped with the following: • Operating bed with a mattress covered with an impervious surface, attachments for positioning the patient, and arm board. • Instrument tables. • Mayo stand. • Small table for gowns and gloves and patient preparation equipment. Ibrahim Shamia O. R. Technique

25. Furniture and Other Equipment • Ring stand for basin. • Anesthesia machine. • Sitting stools and standing platform. • I.V. poles for I.V. bags. • Suction containers. • Laundry hamper. • Kick buckets on wheeled bases. • Wastebaskets. • Written surface. Ibrahim Shamia O. R. Technique

26. Furniture and Other Equipment Cont., • Communication System • Voice intercommunication system. • Call-Light System. • Closed-Circuit Television. • Computers. • Monitoring Equipment Ibrahim Shamia O. R. Technique

27. Special Procedure Rooms • Certain procedures may indicate the need for rooms designed for a specific procedures such as: • Cardiac catheterization Room. • Endoscopy Room. • Cystoscopy Room Ibrahim Shamia O. R. Technique

28. Thank You Ibrahim Shamia O. R. Technique