Aseptic and Septic Operation Theatre Orientation

1. Aseptic and SepticOperation Theatre Orientation Introduction • Heart of an hospital-OT • Team • Skilled Surgeons • Nurses • MLOP • Anaesthetist

2. Separate theatres for septic and aseptic surgeries Aseptic Theatre:- • Cataract • PKP • Squint • Retina • Glaucoma Septic (Minor Theatre):- -Enucleation • Evisceration • DCR • DCT • Infected Cases

3. Planning of OT • An should have • High standard of asepsis • Maximum standard of safety for patients and staffs • Optimum utilization of space and staff time

4. Location of Aseptic Theatre • The Location Should be • Free from general traffic Eg: Away from road side • Free from noise and other disturbance • Free from contamination and possible sources of infection • Closure to ward

5. Operation Theatre Zones • Four Types of Zones • Sterile Zone • Clean Zone • Protective Zone • Disposable Zone

6. Sterile Zone • Operation Room • Scrub room • Anaesthesia room(Block room) • Instruments sterilization

7. Clean Zone:- • Pre operative block room • Nurses work room • Recovery room • Anaesthesia /Medication store

8. Protective Zone:- • Reception room in OT • Waiting room for relative of patient • Dress changing room • Pre Anaesthesia room • General store room • Main Autoclave room • Trolley lay,Wheel chair,Stretcher • Control area of electricity

9. Disposal Zone:- • Dirty /Blood stained linen • Used head caps,mask,socks • Solid materials both disposable and non disposable should move with outcrossing sterile & clean zones.

10. Operation Room • Contains:- • Airconditioning –maintains asepsis • Operating table • Adjustable chair for surgeons • Instruments trolley • Microscope & other necessary equipments,Phaco machine etc • A working space of around 1. 2 m around operation table • IV stand tray and fluids • One Bowlstand for rinsing hand with sterile water.

11. Instruments • Surgical instruments sets and different ocular surgeries • Bipolar diathermy with points • Vitrectomy machine with vitrectomy probes • Boyle apparatus for GA

12. Sub sterilizing Area • Instaclave with cheatle forceps and container • Stainless steel basin for cleaning the instruments • Electric water drums for boiling water or drum with clean sterile water. • Soft brush for cleaning the Instrument & instrument cover • Adequate water supply

13. Scrub Area • Sink with running water facility • Hands should not touch surface of sink • Scrubbing Solution (Chlorhexidine, Iodine 7.5%) • With Soap and brush • 6 minutes for scrubbing • First one minute for two times using soap then 2 minutes used for solution first time scrubbing with brush and full fore arm • Second 2 minutes with scrubbing solution for proximal half of fore arm

14. Location of Septic OT • Located at a place which has limited access to patients • Closure to ward • Away from aseptic OT • Should have separate dressing room,scrub room,sterilization section • Should have good ventilation • Good lighting system • Instruments and eye towels should be sterilized separately from other than linen like coats. • Flash autoclave or sterliser-in between cases

15. Staffing Pattern • OT Manager is usually OT Nursing officer • OT Manger has to ensure • Availability of equipments ,instruments and nursing staffs • Proper care and maintenance of equipments • Theatre cleaning and sterility • Adherence to work discipline • Maintenance of OT records • Relationship with other departments

16. Staff Allocation • Operation area • Scrub nurse- 2 for 1Surgeon • Circulating nurse-1for 1 Surgeon • Block room-Local –1-3 persons,GA-2 persons

17. INFORMATION BOARD • Notice board for display of daily operation • Schedule with details at entrance of OT • Helps to begin the preparations without delay

18. Roles of MLOP in OT • Circulating MLOP:- • To give nursing care to patients during preparation for the surgery • Checks the case sheet • Helps doctors in giving local anaesthesia and counseling to the patient . • She makes available the sterile things and medicines supplied needed for surgery

19. Scrub MLOP • Scrub MLOP is a well trained person,who will be familiar with procedure of surgery • She assists the surgeon through out the surgery • Helps to wear sterile gown • Arranges instrument trolley

20. Dress code • Should wear only special theatre dress to minimize cross infection. • Should not leave outside OT with theatre linen • Caps must be worn to cover the hair completely • Face masks must be worn. • Dress colour-preferably light blue,green

21. Slippers and Overshoes • Should remove personal slippers outside OT • Feet must be washed • Theatre slippers should be worn • Slippers should be scrubbed after use daily • Theatre slippers should not be used outside the theatre

22. A dedicated OT MLOP • Should have a same of sincerity ,honesty and punctuality and compassion to all the patients. • Should have sufficient knowledge of medical terms

23. OT Discipline • MLOP should come early before the start of surgery • Take all responsibility to arrange the theatre,ready to the patient and allocate the surgeon • Eating or drinking tea or coffee should be strictly prohibited in OT area

24. Personal Hygiene • Hairs and Nails must be kept clean and short • No Nail polishing or jewellary • Cuts and abrasion should be corrected and reported to incharge person • Infectious diseases like common cold should getprompt and complete medical treatment

25. Patient Hygiene • Should have their bath and wear clean dress • Diabetic ulcer patient Hansen or other infected diseases should be operated at the end • Disposable cap and shoes to every patient

26. Key Point to Remember • OT should be located away from pollution (Noise & Air) • The attender /visitors should not be allowed to stand in front of OT • MLOP should check the working conditions of equipments , electrification etc prior to surgery • MLOP should take responsibilities to inform/make arrangements for repair and replacement of equipment. • An extra supply of instruments should be available at request. • An extra supply of all OT dresses must be available for visitors and staffs • The medical personal should strictly follow the theatre discipline

27. Thank You