Operating theater . It is an independent structure in which surgical interventions and anesthesia-resuscitation actions necessary for the proper development of an intervention and its consequences that generally take place outside the operating room are practiced.
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- 1 General characteristics of the operating room
- 1 Surfaces
- 2 Air conditioning
- 3 Lighting
- 2 Basic equipment
- 3 Biosecurity
- 1 Objectives
- 2 Access areas
- 4 Infection control standards
- 5 Design and structure of the operating room
- 6 Operating room equipment
- 1 General
- 2 Additional
- 7 Safety during procedures
- 8 Cleaning, disinfection, decontamination and sterilization
- 9 Sources
General characteristics of the operating room
- All of them will be smooth, continuous, easy to wash and resistant to cleaning and disinfection products.
- The floors will be non-slip.
- There will be between 15 and 20 renovations per hour, with 100% contribution of outside air.
- Temperaturecontrol between 18 and 22 degrees.
- Absolute HEPA filters (EU = 4.).
- Positive pressure.
- Localized extraction of anesthetic gases.
- Of environment: adjustable from 0 to 1000 lux, continuously or not less than four steps.
- From field: shadow – free level of 100,000 lux.
Maintenance . Documentation to be up-to-date in complying with the obligations in terms of discipline and maintenance control will be kept at the disposal of the Health Service.
Operating room gases . There will be fixed pipes, for supplying medical gases , from the storage outside the block, and they will have in each operating room the following minimum quantities of supply points:
- Two oxygenintakes .
- Two vacuum intakes with high and low flow differentiation.
- Two intakes of nitrogen protoxide.
- Medicinal air.
- All shots will be perfectly identified by universal signage.
- Surgical lamp
- Operating table.
- Team anesthesiamachine with gas monitoring and respirator.
- Hemodynamic parameter monitor (ECG and non-invasive blood pressure).
- Vaccum cleaner.
- Adequate furniture (stool, stools, May tables, instrument tables, etc.).
- Defibrillator monitor (its number will be a function of the distribution or physical position of the operating rooms).
- The surgical block that, due to its activity, requires it, will have a medical radiodiagnosis device equipped with an image intensifier. A negatoscope by operating room.
- Protect the healthand personal illness of health professionals and patients. Safe condition, appropriate barriers. Adopt “Universal Precautions”.
- Guarantee Disinfection and Biosecurity forboth patients and health personnel.
Black zone . It is the access area, where the operating conditions and presentation of the patients are reviewed; all related administrative and staff work is done (changing dress for special operating room clothing).
Gray area . All personnel who enter the gray area must wear surgical pajamas. The head is covered with a cloth cap and hides all the hair to prevent hair loss in sterile areas; the nose and mouth are covered with a mask.
White zone . The area of greatest restriction is the sterile area or white area in which the operating room itself is located.
Infection control standards
Circulation . With sufficient amplitude and in the same direction, avoiding the passage of clean materials through dirty areas. The entrance of the operating room personnel is by changing room, placing a room for exclusive use. The patient will be admitted on a special stretcher. The operating room doors will be kept closed for the duration of the surgery . At the end of the surgery, dirty clothes and contaminated waste must leave the operating room in bags in accordance with the regulations.
Surgical clothing . Caps, chinstraps, shoe covers, rubber gloves; washable or disposable. Do not wear jewelry. Short nails. All forms of surgical clothing serve a single purpose: they provide a barrier between sources of contamination and the patient or staff. Asepsis standards should never yield to individual comfort or fashion trends.
Design and structure of the operating room
Size . The ideal size is 35-60 square meters, from here it would be too large, it would be of little use to have the material to be used 5-6 meters away and we would have to move increasing the risk of contamination. Less than 35 square meters would be too small, the operating room personnel could not move comfortably.
Walls and ceilings . The ceilings must be smooth, of unalterable and sound absorbing material. The walls and doors must be non-flammable and covered with waterproof and unalterable, stain-proof, crack-free, easy-to-clean, non-gloss, color-depressing materials. The operating rooms must be devoid of windows to the outside and if they are, they must be hermetically sealed. They should not use the tiles to cover their walls because the joints are favorable places for the development of germs.
Floors . Floors must be antistatic to dissipate electricity from equipment and personnel, and how to prevent the accumulation of electrostatic charges in places where flammable anesthetics are used. Made of flat material, waterproof, unalterable, hard and resistant. At the plinth level, the corners must be rounded to facilitate cleaning. Conductive concrete slab , linoleum and terrazzo floors are available .
Positive pressure . The air must be expelled from the operating rooms to the non-sterile areas, extracting the floating particles . To achieve this goal, the air conditioning installation must be calculated to obtain higher pressure in the operating room. The pressure difference must be at least five millibars between each zone, that is: inside the operating room there will be atmospheric pressure + fifteen millibars, in the pre and post-surgical areas it will be atmospheric pressure +10 millibars, and finally in the patient entry-exit area will be atmospheric pressure + 5 millibars.
Humidity and temperature . The temperature and humidity control of the surgical area are automatic, with ambient sensors that send a signal to the regulators and these, in turn, govern the stages of production of cold or heat. You must maintain a high relative humidity of 55% to help reduce the possibility of an explosion. Sparks form more easily if humidity is low. The temperature must be kept between 18 to 24 ° C (thermostat).
Control of the environment . It is calculated that man emits a certain number of particles from 0.5 to 10 mm in diameter in his immediate environment. These particles are suspended in air, produced by skin scales, sweating, and mainly by Flügge drops from the airways. The improvement of the environment in the operating room is obtained mainly with well-trained personnel, who wear the surgical pajamas correctly, who only pass through what is essential in the operating room, who speaks as little as possible during the interventions and who abides by the rules of asepsis and antisepsis
General lighting . General lighting should be uniformly distributed throughout the operating room, sufficient to detect changes in the color of the patient’s skin, proportionate to that of the operative field, to reduce eye fatigue. Both in the operative area and the general one in the operating room it must be flexible, adjustable and controllable. The ratio between the brightness at the surgical site, the periphery of the surgical site and the perimeter of the operating room must be 5: 3: 1.
Surgical lighting . Surgical lighting should be: Intense, without reflections and adjustable in intensity. Illuminate in the incision area to a range of 2,500 to 12,500 foot plugs (27,000 to 127,000 lux). A depth of focus of 25 to 30 cm. it allows an intensity that is similar in the surface and deep part. It does not produce shadows. Color blue white (daylight). Do not produce heat Easy to clean Easy to adjust in positions
Air conditioning . The operating room must be isolated from the outside and equipped with an air conditioning system equipped with special filters (they retain 99% of particles larger than 3 microns). With filter control and humidity degree (revision c / 6 months) This air conditioning system must be laminar flow and must have humidity control.
Operating room equipment
- Surgery table.
- Instrumentation table.
- Side tables.
- Buckets and containers.
- Garment and waste bag holders.
- Anesthesia machine.
- Scialitic lamp.
- Platforms or stairs.
Operating table . They provide a raised surface that supports the patient’s body during surgical procedures, stabilizing the patient’s position and providing optimal exposure of the operative field. Today there is a wide range of technological sophistication, from manual or electrically controlled tables to those with remote control.
May table . Variable height accessory with a support bar resting on a base. It has a frame for a rectangular stainless steel tray. It is used to place the instruments that will be of continuous use during the intervention: Scalpel , scissors , hemostatic forceps and others of specialty.
Surgical lamp . It must be explosion proof. Auxiliary radiant energy for the operative field. It is advisable that the operating room lamps have an automatic switch in case of failure or atmospheric electric shock .
Safety during procedures
Antisepsis . Contamination prevention. Instrumentation. Packaging and lettering. Sterilization. Sterile field. Field clothing. Clothing. Cleaning agents. Patient’s skin. Asepsis techniques.
Field clothing . Moisture resistant. Abrasion resistant. Free of strands and lint. Porous. Not flammable.
Cleaning, disinfection, decontamination and sterilization
Cleaning . Physical, chemical and mechanical process that involves removing, separating and eliminating organic and inorganic dirt or debris from the surfaces of medical surgical material / equipment.
Disinfection . Process by which most, but not all, of the pathogenic microorganisms present in objects are destroyed by the action of chemical agents.
Decontamination . The process of releasing an object from a polluting substance such as dirt, infectious material.
Sterilization . Physical-chemical process that destroys all forms of life ( bacteria , viruses , fungi ), both pathogenic and non-pathogenic, including their highly resistant sporulated forms