SAFE ENVIRONMENT

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SAFE ENVIRONMENT

• PRPD/DN/DM/PON/09

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THEATRE DESIGN

• Theatre Design Consideration
• The prevention of wound infection.
• The safety of patients and staff.

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• 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.

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• 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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• Traffic Flow
• Unrestricted areas are 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 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.

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• 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.

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• 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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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.

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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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Operating Department comprises

• Rest rooms
• Changing rooms
• Teaching rooms
• Storage
• Reception areas
• An operating suite

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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

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Clean and Dirty

• All journeys within the department are made from
  clean to dirty areas, never the other way round

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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.

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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 nurses
  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.

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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.

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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.

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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.

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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.

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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.

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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.

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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)

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• X-ray Screens
• This is vital as some operations are conducted
  with close reference to a patients x-rays
  throughout.
• e.g. orthopaedic surgery, tumour surgery and
  operations such as cholecystectomy

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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.

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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.

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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

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The End