Environmental - Safety - DN - DM

PRPD/DN/DM/PON/09 1
THEATRE DESIGN
Theatre Design Consideration:
• The prevention of wound infection.

• The safety of patients and staff.
PRPD/DN/DM/PON/09 2
DesignFeatures
• 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 3
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 4
Traffic Flow
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 persons in the area.
PRPD/DN/DM/PON/09 5
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 6
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 7
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 8
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 9
Operating Department comprises:
• Rest rooms
• Changing rooms
• Teaching rooms
• Storage
• Reception areas
• An operating suite
PRPD/DN/DM/PON/09 10
“Clean and Dirty”
All journeys within the department

are made from clean to dirty areas,
never the other way round
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.
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 laundry or hospital
incinerator.
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.
• 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.
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.
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.
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.
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.
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)
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
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.
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.
The End

Environmental - Safety - DN - DM

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PRPD/DN/DM/PON/09 1

Theatre Design Consideration:

• The prevention of wound infection.

All journeys within the department

 Are brought from outside the department into clean

• Enter the department via a changing room

The Operating Theatre

 The lights are easily maneuvered, necessary to

 Good lighting is needed to carry out an

 The system draws out of the theatre any anesthetic

 It comprises of several tiers have either hooks to

 The hooks and holes are grouped in numbers off

 The nurses record this information for anesthetist's

 The board is usually marked in two columns; one for

This is vital as some operations are conducted

e.g. orthopaedic surgery, tumour surgery and

• Normally made up of several bed spaces, each

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