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Chapter Two
Operating Theater Design

Revision
POWER SYSTEM IN HOSPITAL
 The electrical demands of a hospital far outweigh those for most
other building types since they have unique equipment with very
large power requirements

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Power Supply Criteria Factors

Reliability

Economy Durability
Power supply
design should
implement:

Maintaina
Efficiency
bility

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Emergency and Standby Power Systems

To provide an alternate source of power if the normal source of power fails

Emergency: automatically provides reliable electric power within a specified

time to critical devices

Standby: provides electric power of acceptable quality

• Legally Required Standby Systems: legally required standby by government/state

• Optional Standby Systems: supply power to facilities where life safety does not depend on the
performance of the system

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Switching devices

To switch/alter the critical loads from the normal utility source

Three types:
• Automatic transfer switch: capable of sensing the normal supply voltage and
self-acting equipment
• Bypass/isolation switches: bypass an automatic transfer/other switch and
connect the source directly to the load, allow maintenance
• Static Transfer Switches: used when high-speed (~4ms) operation is required

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OR…

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Outline
Introduction
History
OR
Design objective
Design team
Design considerations
 Zones of OT
Some special considerations
OR ventilation system
Some equipment and instruments used in OR

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Chapter objective
To analyze and design:
 Well-devised traffic patterns, material-handling systems, well-
dispersed clean ventilation and disposal systems for a safe surgical
environment.

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Introduction
An operating theatre, operating room, surgery suite or a surgery
center is a room within a hospital in which surgical and other
operations are carried out in a sterile environment by trained
personnel.
the term "operating theatre" referred to a tiered theater or
amphitheater in which students and other spectators could watch
surgeons perform surgery

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Introduction…
 OR form the backbone of all surgical intervention in the hospital
 An operation theatre complex is the “heart” of any major surgical
hospital.
Hospital operating rooms are among the most infection-sensitive
environments in health care facilities.
A safe environment incorporates features that prevent or control the
risk of infection, fire, explosion, and chemical and electrical hazards

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Historical Perspective

Early surgeries were done in convenient rooms

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History…

In 18thcentury, theatres were built in the form of amphitheaters

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History…

Late 19thcentury, rooms were designated as operating theatres with large windows
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History…

20thcentury marked the beginning of the modern operation theatre complex

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Objective of Planning
Promote high standards of asepsis Minimizing the total operating cost
Ensure safety of patients and staffs and overtime use
working in OT Maximizing the optimum utilization
Ensuring maximum comfort to the of OT
surgical team Providing complete environmental
control
Optimal physical working
conditions Flexibility of uses of operating suites
Facilitate coordinated services

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Design Team

Health care
professionals
Interior
(surgeons, Engineers
designers
anesthetists,
nurses)

Information
Environmental
Architects technology
specialists
specialists

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Design Considerations
Location
Workflow
Basic work areas and division of space
Zoning concept
Air filters
Machinery and equipment
Policies and procedures

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Zones of OT
 Four zones

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Zones…
OT block of outer zone

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Zones…
ZONE 1– Protective zone– (General access area): at the entrance of OT
 Reception room
 Waiting room/area
Conference room
 Change rooms
Pre anesthesia room
Store room
Lifts, stairs, Trolley bay

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Zones…
ZONE 2– Clean zone –(limited access oStaff resting room
area):connects protective zone to aseptic
zone oEquipment store room
Zone only accessible to staffs having oEmergency exits
changed their outer clothing oFire fighting device room
Client holding and preparation area oStores & cleaner room
Includes: oMaintenance workshop
oPre-operating room oKitchenette (pantry)
oRecovery room (post-anesthesia care
unit, PACU)
oPlaster room

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Zones…
OT outer zones

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Zones…
OT Inner zones

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Zones…
ZONE 3– Sterile/Aseptic Zone –Restricted access area: includes
rooms which are kept sterile
oOperating suite
oScrub room
oAnesthesia room
oInstruments trolley area

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Zones…

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Zones…
ZONE 4– Disposal Zone – dirty utility and disposal corridor
Backside and most outer area

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Operating Theater Traffic Flow

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Types of OT complexes

The twin theatre suite: Three or more OTs:

The single theatre with facilities similar to 1, with ancillary
suite: with OT, scrub-up but with duplicated accommodation
and anesthesia room, ancillary accommodation
including post anesthesia
trolley preparation and immediate to each OT,
sometimes sharing a small
recovery, reception,
limited ancillary
post anesthesia recovery porter’s desk, sterile
accommodation.
area. store and staff change.

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Special considerations
Location
• The OT should be separate from general ‘traffic’ and air movement
of rest of the hospital
• Should permit a convenient and uncomplicated flow of patients and
staffs
• Close to surgical ward and ICU
• Adequate electric lift is planned for vertical movement from
casualty on the ground floor

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Considerations…
• Adequate & appropriate space allocation
• Provision for ventilation & temperature control
• Provision for emergency exit
• Consideration for future expansion

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Ventilation
oAppropriate ventilation systems aid in the dramatic control of infection by
minimizing microbial contamination.
oSupply heated/cooled humidified ultraclean air to the OR & adjacent
clean areas.
oComfort of the staff & patients.
oRemoval of the anesthetic pollutants.
oRemoval of contaminated air system.
oEach operating room should have individual temperature controls to
accommodate patient safety.

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Ventilation…
 Maintaining sterile environment is the priority task in OR
To minimize Surgical site infection
 Minimizing traffic in to and out of the OR

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Ventilation…
Surgical instrument contamination increase with
The length of procedure and
The number of peoples present in the operating room
Protective ventilation
Reducing post operation preliminary complications
Reduce the risk of infection

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Ventilation…
Laminar flow: linear air flow (never collides)

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Ventilation…

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Types…
Vertical parallel laminar flow Horizontal parallel laminar flow

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Ventilation System…
Op box ventilation system

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Ventilation…
HIPPA filter: removes 99.99% of microorganism by ensuring ultra
clean air flow

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Ventilation…
 Positive pressure (~ 4 different p0 levels )
Corridor~ normal
OR~ High p0 (pushes all bacteria
and contaminated air out)

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Ventilation…

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Ventilation…
Aero Laminar Air Flow Animation.mp4

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Equipment
Trolleys: should be cleaned and have safety rails with well fitting tube and
mask
Oxygen cylinder: all of which are regularly checked and empty cylinders
replaced
Suction apparatus: should be well cleaned and checked with spare
suction tubes and catheters available.
Anesthetic machine: should in good working order.
Fire policy: regular fire drills and weekly testing fire doors are essential
safety precautions.

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Instruments
 Are brought from outside the department into clean store rooms and
supplied in pre-packed sterilized trays
At the end of an operation, dirty instruments, linen and rubbish are
removed to the sluice room, and correctly packaged for disposal, to
agreed collection points.
Inclues…

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…
 Swab: It is an absorbent pad used in surgery and medicine for
cleaning wounds or applying medication
 The Swab Rack: This is a metal piece of furniture used for
hanging up swabs during an operation
 The Swab Board: This is for recording the amount of blood loss
during the operation especially major operation
 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
Weigh the blood-soaked swab, and from that weight subtract
the known dry weight. i.e. 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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…
 Rubbish bins, Swab bins and Linen bins
Every theatre has separate disposal containers for rubbish,
swabs and linen
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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Hybrid OR

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OR…
 The hybrid OR will save precious moments when a life is on the
line
Minute matters!

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OR…

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OR…
Sample OT Room

World class modular operation theatres at MIOT International

Hospitals.mp4

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END

Thank you!

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