• Halaman

  • Arsipku

  • Kategori

  • Statistik

    • 61,645 Jumlah Pengunjung
  • RSS Trauma

    • Sebuah galat telah terjadi; umpan tersebut kemungkinan sedang anjlok. Coba lagi nanti.
  • Flickr Ku

    More Photos
  • IT

  • Meta

  • Komentar Anda

Kamar Operasi 2

HISTORICAL BACKGROUND

Surgical procedures were not always performed within the confines of a formal hospital setting. The surgeon made house calls when summoned to see a patient. In the early 1900s, the surgical nurse was sent to prepare a suitable room with little traffic and ambient noise for the surgical procedure-usually the dining room, but occasionally the kitchen. Everything was removed from the room, especially carpets, drapes, pictures, and unnecessary furniture. The room was fumigated with sulfur dioxide for 12 hours if time allowed. This was accomplished by burning 3 pounds of sulfur in an iron pot for each 1000 cubic feet of air space. The windows and doors were sealed shut as much as possible. When the fumigation was complete, the walls and surfaces were scrubbed with 5% carbolic acid or hot soda solution. Von Esmarch described cleansing of wallpaper by a process that involved rubbing the surface with soft bread. He based this activity on personal experiments. If time did not permit the fumigation/scrubbing process, the room was to be penetrated with steam from a kettle.

Linen napkins and towels were boiled for 5 minutes in soda solution for use as sponges. The stove and oven were useful as sterilizers. Bricks were kept in the oven for use as warming devices for chilly patients. The kitchen or dining room table was padded for use as the operating bed and placed under the chandelier, with the head toward a north window. For privacy, fine white tissue paper was secured to the window using flour paste. Many surgeons had portable lamps for use in homes equipped with electricity. This was useful at night. White bed sheets were nailed to all of the walls as protective coverings.

The physical environment was of keen importance to the surgeon. The temperature of the room was to be main­tained at 75 to 80° F and additional warming measures, such as heated blankets, hot water bottles, and heated bricks wrapped in flannel were used. In addition to preparing the environment, the nurse was required to have 10 gallons of hot sterile water and 10 gallons of cold sterile water ready for use. Her role included preparing sterile saline by boiling a large container of water and adding 2 teaspoons of table salt. The mixture was boiled for 30 minutes then filtered through cotton that has been baked to a brownish color into a sterile bottle. A cork was used to seal the opening. If the solution was to be kept for future use, the sealed bottle was boiled for 20 minutes for 3 consecutive days. This was believed to prevent spore generation.

 

At the conclusion of the surgical procedure the nurse was required to disassemble, boil, dry, and pack the surgeon’s private instrumentation into his black bag. The room was returned to its original condition by removing the sheets from the walls and sending them out for laundering and restoring carpets and furniture to their usual position. The aim of the nurse was to leave the place as she found it.

 

PHYSICAL LAYOUT OF THE SURGICAL SUITE   

Efficient use of the physical facilities is important. The design of the surgical suite offers a challenge to the planning team to optimize efficiency by creating realistic traffic and workflow patterns for patients, visitors, personnel, and supplies. The design also should allow for flexibility and future expansion and should control for environmental atmospheric regulation (Table 10-1). Architects consult surgeons, perioperative nurses, and surgical services administrative personnel before allocating space.

Construction or Renovation Planning and Design Team

The planning and design of the perioperative environment require a multidisciplinary team, which may include the following:

              Department director

              Nurse manager

              Physicians (surgeon, anesthesia provider)

              Senior perioperative nursing personnel

              Project manager (may be in-house personnel or aconsultant)

       Information technologist Communications (e.g., telephone, intercom, emergency call) personnel

              Support services (e.g., laboratory, radiology) personnel

              Infection control personnel

              Architect

              Interior decorator

No one particular construction or renovation plan suits all hospitals; each is individually designed to meet projected specific future needs. The number of operating rooms, storage areas, and immediate perioperative patient care areas required depends on the following:

* Number, type, and length of the surgical procedures to be performed

              Type and distribution by specialties of the surgical staff and equipment for each

 

Environmental Controls

OR

Postanesthesia Care Unit

Storage Areas

Temperature

68°-73° F (20°-22° C)

70°-75° F (21--24- C)

68°-73° F (20°-22° C)

Humidity

30%-60%

30%-60%

30%-60%

Air exchanges per hour

15

6

4 (minimum)

Recirculated by room unit

Pressure related to adjacent areas

Exchanges with outdoor air per hour

No

Positive

3

No

N/A

2

No

N/A

N/A

 

• Proportion of elective inpatient and emergency surgical procedures to ambulatory patient and minimally invasive procedures

              Scheduling policies related to the number of hours per day and days per week the suite will be in use and staffing needs

              Systems and procedures established for the efficient flow of patients, personnel, and supplies

              Consideration of volume changes and need for future expansion capabilities

              Technology to be implemented and plans for potential technology to be developed

              Safety of staff, patients, and other personnel during construction or renovation

 

Principles in Construction or Renovation Planning

The universal problem of environmental control to prevent wound infection exerts a great influence on the design of the surgical suite and the plans for construction or renovation. Buildings with surgical suites older than 30 years do not have the capability of supporting newer technology with renovation for space and technologic and electrical canabilities. Architects, administrators, and surgical suite : Designers follow several concepts in planning the physical layout and construction of a surgical suite:

1. Strategic planning

a. Avoid as much inconvenience to facility personnel as possible.

b. Include facility personnel in the planning phase as much as possible.

c. Expedite completion as fast as possible without compromising safety of patients, staff, and con-struction personnel.

d. Keep costs down by planning ahead. Do not substitute cheap materials for durable materials. They will only cost more to replace later. Always follow manufacturer’s and blueprint specifications.

e. Plan the project in steps, completing each area before starting the next.

f. Minimize the ordering of supplies for patient use to only those items needed for immediate procedures. Inventory storage will be an issue as the project unfolds.

Resolve replacement issues for current equipment in use. Sometimes it is financially better to buy units in a lot than to replace one at a time. Deals can be made regarding pricing when planning equipment for the new rooms. Better to install equipment from scratch than to add later at an added construction/installation cost.

h. Plan for the closing of rooms without too much disruption if they are to be updated.

i. Determine the balance of fixed equipment versus

mobile equipment for use in several rooms. Determine the need for dedicated rooms such as for endoscopy, cystoscopy, minimally invasive procedures, interventional radiology, trauma, and cardiac procedures.

 

2. Plans for emergencies

a. Power, communications, medical gases, vacuum system, waste gas scavenger, air-handlers, water, and sewage cannot be interrupted. A plan should be in place to counter any accidental cutting of lines by construction personnel. Legionella has grown in standing water lines during phases of construction.

b. Protect monitoring equipment from interference from radiofrequencies caused by construction machines or devices.

c. Plan for capability of construction work stoppage at a moment’s notice if requested by a surgeon during a critical phase of surgery.

3. Exclusion of contamination from outside the suite with sensible traffic patterns to and from the suite

a. Barrier must be in place between working operating rooms (ORs) and the portion of the suite under construction. Wood or drywall panels as temporary walls sealed over all edges with duct tape can keep dust from entering the suite. Plastic sheeting is not sturdy and can easily be punctured.

b. Negative pressure must be maintained in halls with exhaust filtered to the outside of the building.

c. Traffic patterns must be unobstructed for debris removal. Aspergillosis has been isolated in construc-tion debris of older buildings. Toileting and hand-cleansing areas must be available to construction workers.

d. Traffic patterns must be unobstructed for bringing in construction supplies and materials.

4. Separation of clean areas from contaminated areas within the suite during the building phase

a. Patient traffic should be separated from construction traffic.

b. Clean supplies are transferred in an area separate from construction supplies.

c. Biologic decontamination and processing areas remain functional at all times.

5. Noise control

a. Noise pollution should be kept at a minimum when surgical procedures are in process or the general patient population in the hospital is sleeping.

b. Vibrations from powered equipment and jackhammers can disrupt microscopic or other procedures.

Physical plant design and construction/renovation planning of a surgical suite should include detailed consideration for the activities of patients, caregivers, and environmental maintenance.

 

Type of Physical Plant Design

Most surgical suites are constructed according to a variation of one or more of four basic designs:

1. Central corridor, or hotel plan (Fig. 10-1)

2. Central core, or clean core plan with peripheral corridor (Fig. 10-2)

3. Combination central core and peripheral corridor, or racetrack plan (Fig. 10-3)

4. Grouping, or cluster plan with periph Each design has its advantages and disadvantages. Efficiency is affected if corridor distances are too long in proportion to other space, if illogical relationships exist between space and function, or if inadequate considera-tion was given to storage space, material handling, and personnel areas.

 

Location

The surgical suite is usually located in an area accessible to the critical care surgical patient areas and the supporting service departments, the central service or sterile processing department, the pathology department, and the radiology department. The size of the hospital is a determining factor because it is impossible to locate every desirable unit or department immediately adjacent to the surgical suite. A terminal location is necessary to prevent unrelated trafficral and central corridor (Fig. 10-4)

 

from passing through the suite. A location on a top floor is not necessary for microbial control because all air is specially filtered to control dust. Traffic noises may be less evident above the ground floor. Artificial lighting is controllable, so the need for daylight is not a factor; in fact, it may be a distraction during the use of video equipment and other procedures requiring a darkened environment. Most surgical suites have solid walls without windows.

 

Space Allocation and Traffic Patterns

Space is allocated within the surgical suite to provide for the work to be done, with consideration given to the efficiency with which it can be accomplished. The surgical suite should be large enough to allow for correct technique yet small enough to minimize the movement of patients, personnel, and supplies. Provision must be made for traffic control. The type of design will predetermine traffic patterns. Everyone-staff, patients, and visitors-should follow the delineated patterns in appropriate attire. Signs should be posted that clearly indicate the attire and environmental controls required. The surgical suite is divided into three areas that are designated by the physical activities performed in each area.

 

Unrestricted Area. Street clothes are permitted. A corridor on the periphery accommodates traffic from outside, including patients. This area is isolated by doors from the main hospital corridor or elevators and from other areas of the surgical suite. It serves as an outside-to-inside access area (i.e., a transition zone). Traffic, although not limited, is monitored at a central location.

 

Semirestricted Area. Traffic is limited to properly attired, authorized personnel. Scrub suits and head coverings are required attire. This area includes peripheral support areas and access corridors to the ORs. The patient’s hair is also covered.

 

Restricted Area. Masks are required to supplement OR attire where open sterile supplies or scrubbed personnel are located. Sterile procedures are carried out in the OR. The area also includes scrub sink areas and substerile rooms or clean core area(s) where unwrapped supplies are sterilized. Personnel entering this area for short periods, such as labo-ratory technicians, may wear clean surgical coveralls or jumpsuits to cover street clothes. Hair covering is worn and masks are donned as appropriate.

 

TBA

Both patients and personnel enter the semirestricted and restricted areas of the surgical suite through a transition zone. This transition zone, inside the entrance to the surgical suite, separates the OR corridors from the rest of the facility.

 

Preoperative Check-in Unit

If a remote same-day procedure unit is not available for admission of patients who arrive shortly before a surgical procedure, facilities must be provided within the unrestricted area of the surgical suite for patients to change from street clothes into a gown. The area must ensure privacy. It may be compartmentalized with individual cubicles or be an open area with curtains. The decor should create a feeling of warmth and security. Lockers should be provided for safeguarding patients’ clothes. Lavatory facilities must be available.

 

Preoperative Holding Area

A designated room or area should be available for patients to wait in the surgical suite; that area should shield them from potentially distressing sights and sounds. The corridor outside the OR is the least desirable area. The area should provide privacy. Individual cubicles are preferable to curtains. Hair removal and insertion of intravenous (IV) lines, indwelling urinary catheters, and gastric tubes may be done here. The anesthesia provider may insert invasive moni¬toring lines and give regional blocks. These procedures require good lighting. Each patient area is equipped with oxygen, suction, and devices for monitoring and cardiopul¬monary resuscitation.

A nurses’ station within the area provides for medication storage and preparation and for interdepartmental and intradepartmental communication. Computer access to patient information, such as laboratory reports, and to patient care documentation facilitates completion of patients’ records, if necessary. Coordination with people managing the surgical schedule is essential to prevent delays.

 

Induction Room

Some hospitals have an induction room adjacent to each OR, where the patient waits and is prepared preoperatively before administration of anesthesia. Invasive IV lines are placed and/or regional anesthesia may be induced in this area. These are more common in larger facilities, where procedures such as open heart surgery or transplantation is performed.

 

Postanesthesia Care Unit

The postanesthesia care unit (PACU) may be outside the surgical suite, or it may be adjacent to the suite so that it may be incorporated into the unrestricted area with access from both the semirestricted area and an outside corridor. In the latter design, the PACU becomes a transition zone for the departure of patients.

Hospitals and ambulatory care facilities accommodate patients and their families. A designated waiting area must be provided for families. This is most conveniently located outside the surgical suite adjacent to the recovery area.

 

Dressing Rooms and Lounges

Dressing rooms must be provided for both men and women to change from street clothes into OR attire before entering the semirestricted area, and vice versa. Lockers are usually provided. Doors separate this area from lavatory facilities and adjacent lounges. Walls in the lounge areas should have an aesthetically pleasing color or combination of colors to foster a restful atmosphere. A window view of the outdoors is psychologically desirable. Dictating equipment and telephones should be available for surgeons in lounges or in an adjacent semirestricted area.

 

PERIPHERAL SUPPORT AREAS  

Adequate space must be allocated to accommodate the needs of OR personnel and support services. The need for

equipment, supply, and utility rooms and housekeeping determines support space requirements. Equipment and supply rooms should be decentralized, placing them near the appropriate ORs.

 

Central Control Desk

From a central control point, traffic in and out of the surgical suite may be observed. This area usually is within the unrestricted area. The clerk-receptionist is located at the control desk to coordinate communications. A pass-through window may be used to stop unauthorized people, to schedule surgical procedures with surgeons, or to receive drugs, blood, and various small supplies. A computerized pneumatic tube system within the hospital can speed the delivery of small items and paperwork, thus eliminating some courier services, such as from the pharmacy to the control desk. Tissue specimens or blood samples also can be sent to the laboratory through some tube systems.

Computers may be located in the control area. Automated information systems and computers assist in financial management, statistical recording and analysis, scheduling of patients and personnel, materials management, and other functions that evaluate the use of facilities. An integrated system interfaces with other hospital departments. It may have a modem or wireless Internet that allows surgeons to schedule surgical procedures directly from their offices.

Retrieval for review of patient records gives the peri-operative nurse manager the opportunity to evaluate the patient care given and documented by nurses. Personnel records can be maintained. Other essential records can be stored in and retrieved from computer databases. The central processing unit for the OR computer system usually is located in or near the central administrative control area. A fax machine may be available for the electronic transfer of documents, records, and patient care orders between the OR and surgeons’ offices.

Security systems usually can be monitored from the central administrative control area. Alarms are incorporated into electrical and piped-in systems to alert personnel to the location of a system failure. A centralized emergency call system facilitates summoning help. Narcotics are kept locked up and can be signed out only by appropriate personnel. Access to exchange areas, offices, and storage areas may be limited during evening and night hours and on weekends. Doors may be locked. Some hospitals use alarm systems, television surveillance, and/or electronic metal detection devices to control intruders and to prevent vandalism. Computers and records must be secured to protect patients’ confidentiality.

 

Offices

Offices for the administrative patient care personnel and the anesthesia department should be located with access to both unrestricted and semirestricted areas. The staff members frequently need to confer with outside people and to be kept informed of activities within all areas of the suite.

Conference Room/Classroom

Ideally, a conference room or a classroom is located within the semirestricted area. This is used for patient care staff inservice educational programs and is used by the surgical staff for teaching. Closed-circuit television and/or video-cassettes may also be available for self-study. The depart-mental reference library may be housed here.

 

Support Services

The size of the health care facility and the types of services provided determine whether laboratory and radiology equipment is needed within the surgical suite.

 

Laboratory. A small laboratory where the pathologist can examine tissue specimens and perform frozen sections expedites the decisions that the surgeon must make during a surgical procedure when a diagnosis is questionable. A designated refrigerator for storing blood for transfusions also may be located in this room. Tissue specimens may be tested here by frozen section before they are delivered to the pathology department for permanent section.

 

Radiology Services. Special procedure rooms may be outfitted with radiologic and other imaging equipment for diagnostic and invasive radiologic procedures or insertion of catheters, pacemakers, and other devices. The walls of these rooms contain lead shields to confine radiation. A dark¬room for processing radiographic films usually is available within the surgical suite for immediate processing of scout films or contrast dye studies of organ systems.

Work and Storage Areas

Clean and sterile supplies and equipment are separated from soiled items and trash. If the surgical suite has a clean core area, only clean or sterile items are stored there. Soiled items are taken to the decontamination area for processing before being stored, or they are taken to the disposal area. Work and storage areas are provided for handling all types of supplies and equipment, whether clean or contaminated.

 

Anesthesia Work and Storage Areas. Space must be provided for storing anesthesia equipment and supplies. Gas tanks are stored in a well-ventilated area separated from other supplies. Care is taken not to allow tanks or cylinders to be knocked over or damaged. They should stand upright in a secure, stable base for safety. Nondisposable items must be thoroughly decontaminated and cleaned after use in an area separate from sterile supplies. A separate workroom usually is provided for care and processing of anesthesia equipment. Dirty and clean supplies must be kept separated.

The storage area includes a secured space for drugs and anesthetic agents. Some facilities have drug-dispensing machines that require positive identification to obtain medications for . patient use. Larger facilities have pharmaceutical station where a pharmacist dispenses drugs on a per-case basis. Signatures are required for controlled substances. Unused drugs are returned to the pharmacist for accountability.

 

Housekeeping Storage Areas. Cleaning supplies and equipment need to be stored; the equipment used within the restricted area is kept separate from that used to clean the other areas. Therefore, more than one storage area may be provided for housekeeping purposes, depending on the design and size of the surgical suite. Sinks are provided, as well as shelves for supplies. Trash and soiled laundry recep-tacles should not be allowed to accumulate in the same room where clean supplies are kept; separate areas should be provided for these. Conveyors or designated elevators may be provided for prompt removal of bags of soiled laundry and trash from the suite.

 

Central Processing Area. Conveyors, dumbwaiters, or elevators connect the surgical suite with a central processing area on another floor of the hospital. If efficient material flow can be accomplished, support functions can be removed from the surgical suite. Effective communications and a reliable transportation system must be established. Some ORs send all of their instruments and supplies to the sterile processing department for cleaning, packaging, sterilizing, and storing. This system eliminates the need for some work and storage areas within the surgical suite, but exchange areas must be provided for carts. The movement of clean and sterile supplies must be kept separate from that of contaminated items and waste by means of space and traffic patterns.

Utility Room. Some hospitals use a closed-cart system and take contaminated instruments to a central area outside the surgical suite for cleanup. Some perform cleanup procedures in the substerile room. Many, by virtue of the limitations of the physical facilities, bring the instruments to a utility room. This room contains a washer-sterilizer, sinks, cabinets, and all necessary aids for cleaning. If the washer-sterilizer is a pass-through unit, it opens also into the general workroom, which eliminates the task of physically moving instruments from one room to another.

 

General Workroom. The general work area should be as centrally located in the surgical suite as possible to keep contamination to a minimum. The work area may be divided into a cleaning area and a preparation area. If instruments and equipment from the utility room are received from the pass-through washer-sterilizer into this room, an ultrasonic cleaner should be available here for cleaning instruments that the washer-sterilizer has not adequately cleaned. Otherwise, the ultrasonic cleaner may be in the utility room.

Instrument sets, basin sets, trays, and other supplies are wrapped for sterilization here. The preparation and sterilization of instrument trays and sets in a central room ensure control. This room also contains the stock supply of other items that are packaged for sterilization. The sterilizers that are used in this room may open also into the next room, the sterile supply room. This arrangement helps to eliminate the possibility of mixing sterile and nonsterile items.

 

Storage

Technology nearly tripled the need for storage space in the 1980s. Many older surgical suites have inadequate facilities for storage of sterile supplies, instruments, and bulky equipment. Storage space should fit logically into the design of the suite. Those responsible for calculating adequate storage space for instruments, sterile and unsterile supplies, and mobile equipment, such as special OR beds, specialty carts, and equipment, should consider the size of the entire surgical suite. The size of the entire suite is calculated into square feet, and SO°r6 of the total number of square footage of the department is added to serve as storage. This floor space does not include additional storage space needed for postanesthesia equipment. Using a case cart system may slightly decrease the amount of instrument space needed. Plans should include accommodation for the size of each type of case cart used and the numbers that will be in the suite at a given point in the daily surgical schedule.

 

Sterile Supply Room. Most hospitals keep a supply of sterile drapes, sponges, gloves, gowns, and other sterile items ready for use in a sterile supply room within the surgical suite. As many shelves as possible should be freestanding from the walls, which permits supplies to be put into one side and removed from the other; thus older packages are always used first. However, small items must be contained in boxes or bins to prevent them from falling to the floor. Inventory levels should be large enough to prevent running out of supplies, yet overstocking of sterile supplies should be avoided. Storage should be arranged to facilitate stock rotation.

The sterile storage area should be adjacent to or as close as possible to the sterilizing area if sterilizing is done in the surgical suite. Access to the sterile storage area should be limited; it should be separated from high-traffic areas. Humidity should be controlled at 30% to 60%, and temperature should be 68° to 75° F(20° to 24° C). Humidity in excess of 70% would cause concern for condensation within sterile packages and may permit microorganism transfer by capillary action. There should be positive pressure with a minimum of four fresh air exchanges per hour in the sterile storage area.’

 

Instrument Room. Most hospitals have a separate room or a section of the general workroom designated for storing nonsterile instruments. The instrument room contains cup-boards in which all clean and decontaminated instruments are stored when not in use. Instruments usually are segre¬gated on shelves according to surgical specialty services.

Sets of basic instruments are usually cleaned, assembled, and sterilized after each use. Special instruments such as intestinal clamps, kidney forceps, and bone instruments may be stored after cleaning and decontamination. Sets are then made up according to each specialty as needed.

 

Storage Room. Some large, portable equipment must also be stored in the surgical suite, readily accessible for use. A storage room for this equipment, such as the orthopedic table that may not be used daily, keeps equipment out of corridors when not in use. Lasers and video equipment can be damaged if inadvertently bumped by a passing stretcher in a corridor.

 

Scrub Room

An enclosed area for preoperative cleansing of hands and arms should be provided adjacent to each OR. Water spills on the floor are particularly hazardous if the scrub area is in a traffic corridor. An enclosed scrub room is a restricted area within the surgical suite. Paper towel dispensers and mirrors should be located in this area. Trash receptacles, limited to only those items used within this room, should be emptied several times per day. Some facilities have boxes of additional caps, masks, shoe covers, and eye protection in the event of biologic contamination requiring a change of these items during a procedure. The contaminated item should be discarded in the biohazardous trash bin in the OR after changing.

 

QPERATING ROOM         

Each OR is a restricted area because of the need to maintain a controlled environment for sterile and aseptic techniques (Fig. 10-5).

 

Size

The size of individual ORs varies. In the interest of economy and flexibility, it is desirable to have all ORs the same size so that they can be used interchangeably to accommodate elective and emergency surgical procedures. Adequate size for a multipurpose procedure room for ambulatory surgery or endoscopy is at least 20 x 20 x 10 feet (6 x 6 x 3 m), or 400 square feet (approximately 37 mz) of clear floor space. Approximately 20 square feet of space should be planned between fixed cabinets and shelves on two opposing walls. Larger rooms for cardiac or other large procedures are 20 x 30 x 10 feet (600 square feet [approximately 60 m2]). Renovated rooms may be 360 square feet with 18 feet between the fixed shelving units.

A room may be designed for a specialty service if use by that service will be high. The room must accommodate equipment, such as lasers, microscopes, or video equipment, either fixed (permanently installed) or portable (movable). Portable equipment may require more floor space-a minimum of 22 x 22 x 10 feet (484 square feet [approximately 45 m2)). A specialized room, such as one equipped for cardiopulmonary bypass or trauma, may require as much as 600 square feet (approximately 60 m2) of useful space.

 

Some rooms are designated for special procedures, such as gastrointestinal endoscopy, interventional radiologic studies, or the application of casts. Other rooms have adjacent areas used for specific purposes, such as visitor viewing galleries, or for installing special equipment, such as monitors.

 

Substerile Room

A group of two, three, or four ORs may be clustered around a central scrub area, work area, and a small substerile room. Only if the last-mentioned room is immediately adjacent to the OR and separated from the scrub area will it be considered the substerile room throughout this text. A substerile room adjacent to the OR contains enclosed

storage cupboards, a sink, steam sterilizer, a STERIS unit, and a warming cabinet. Although cleaning and sterilizing facilities are centralized, either inside or outside of the surgical suite, a substerile room with this equipment offers thefollowing advantages:

              It saves time and steps. The circulating nurse can do emergency cleaning and sterilization of items here. This reduces waiting time for the surgeon, reduces anesthesia time for the patient, and saves steps for the circulating nurse. The circulating nurse, or scrub person if necessary, can lift sterile articles directly from the sterilizer onto the sterile instrument table without transporting them through a corridor or another area.

              It reduces the need for other personnel to obtain sterile instruments and allows the circulating nurse to stay within the room.

              It allows for better care of instruments and equipment that require special handling. Certain delicate or sensi¬tive instruments or perhaps a surgeon's personally owned set usually are not sent out of the surgical suite. Only the personnel directly responsible for their use and care handle them; the circulating nurse and scrub person can clean them within the confines of the OR and this adjacent room.

              Rooms adjacent to orthopedic or cast rooms should have a sink with a plaster trap for disposal of casting solutions.

              The substerile room also usually contains a combination blanket and solution warmer, cabinets for storage, and perhaps a refrigerator for blood and medications. Empty sterile specimen containers and labels may be conveniently stored in this room. Slips for charges or other records may be kept here. Individual hospitals may find it convenient to keep other items in this room to allow the circulating nurse to remain in or immediately adjacent to the OR during the surgical procedure.      

 

Doors

Doors should be 4 feet wide for ease in moving patients on carts and in beds. Ideally, sliding doors should be used exclusively in the OR. They eliminate the air currents caused by swinging doors. Microorganisms that have previously settled in the room are disturbed with each swing of the door. The microbial count is usually at its peak at the time of the skin incision, because this follows disturbance of air by gowning, draping, movement of personnel, and opening and dosing of doors. During the surgical procedure, the microbial count rises every time doors swing open from either direction. Also, swinging doors may touch a sterile table or person. The risk of catching hands, equipment cords, or other supplies is increased. Doors should not swing out into the hallway.

Sliding doors should not recede into the wall like pocket styles, but should be of the surface-sliding type. Fire regu-lations mandate that sliding doors for ORs be of the type that can be swung open if necessary. Doors do not remain open either during or between surgical procedures. The room air circulation is higher pressure than in the halls to minimize the amount of dust and debris pulled in toward the sterile field. Closed doors decrease the mixing of air within the OR with that in the corridors, which may contain higher microbial counts. Air pressure in the room also is disrupted if the doors remain open.

When construction or renovation is in process, it is important to always keep the doors closed when not trans-porting patients. The air-handling systems are under a strain because of the disrupted processes and are further compromised when the airflow is allowed to equalize. This causes unstable temperature and humidity control. The desired temperature should be between 68° and 73° F(20° and 23° C), with a relative humidity of 30% to 60%. The risk for airborne contaminants is significantly increased.

 

Ventilation

The OR ventilation system must ensure a controlled supply of filtered air. Air changes and circulation provide fresh air and prevent accumulation of anesthetic gases in the room. Concentration of gases depends solely on the proportion of pure air entering the air system to the air being recirculated through the system. Fifteen air exchanges per hour with three exchanges of fresh air are recommended for operating rooms with recirculated air.' Some state building codes require 100% fresh air; others permit up to 80% recirculation of air. If air is recirculated, a gas scavenger system is mandatory to prevent the buildup of waste anes¬thetic gases. Various types of scavengers and evacuators are used to minimize air pollutants that are health risks for perioperative team members.

Ultraclean laminar airflow is installed in some ORs to provide up to 600 air exchanges per hour. This high-flow, unidirectional air-blowing system is housed in a wall or ceiling enclosure. The airflow can be vertical or horizontal. Staff should not pass between the airflow and the sterile field or the purpose for using ultraclean air is defeated.

Laminar airflow was first trialed during hip replacement surgery by Sir John Charnley in Great Britain in the 1950s. Charnley believed that if particulate could be removed from the air, the 7% infection rate could drop. His studies showed that the infection rate did fall to less than 2%. The value of this system in reducing airborne contamination is inconclusive because the rate continued to fall to less than 1% with changes in surgical dressing practices. Although

the laminar system contributes to removing particulates, the improvements in sterile technique overall may have a larger effect on infection rate.

Other types of filtered air-delivery systems that have a high rate of airflow are as effective in controlling airborne contamination. Filtration through high-efficiency particulate air (HEPA) filters can be 99.7% efficient in removing particles that are larger than 0.3 mm. These microbial filters in ducts filter the air, practically eliminating all dust particles. The ventilating system in the surgical suite is separate from the hospital's general system and is to be cleaned, inspected, and maintained on a preventive main¬tenance (PM) schedule.

Positive air pressures (0.005 inch [0.013 cm] of water pressure) of 10% in each OR are greater than that in corridors, scrub areas, and substerile rooms. Positive pressure forces air from the room. The inlet is at the ceiling. Air leaves through the outlets at floor level. If the reverse is true, air is drawn into the room around the doors and through open doors. Microorganisms in the air can enter the room unless positive pressure is maintained. Closed doors maintain this environment and prevent equalization of air pressure. The recommended parameters include a dual filtration system with two filters in succession. The first filter should be at least 30% efficient, and the second filter should be at least 90%.

An air-conditioning system controls humidity. High relative humidity (weight of water vapor present) should be maintained between 30% and 60%. A relative humidity of not less than 50% to 55% is ideal. Moisture provides a relatively conductive medium, allowing static charge to leak to earth as fast as it is generated; sparks form more readily in atmospheres of low humidity.

Operating room temperature is maintained within a range of 68° to 73° F(20° to 23° C). A thermostat to control room temperature can be advantageous to meet patient needs; for example, the temperature can be increased to prevent hypothermia in pediatric, geriatric, or burn patients. Overmanipulation of controls can result in calibration problems. Controls should not be adjusted solely for the comfort of team members; patient normothermia is a strong consideration. Only the maintenance department can regulate temperature in some surgical suites.

Even with controls of humidity and temperature, air-conditioning units may be a source of microorganisms that come through the filters. The filters are changed at regular intervals. Ducts are cleaned by maintenance personnel on a regular schedule.

 

Floors

In the past, floors were conductive enough to dissipate static from equipment and personnel but not enough to endanger personnel from shock or cause explosions from flammable anesthetic gases. Conductivity is not a prime concern in OR design because explosive anesthetic gases are no longer used. The most common flooring used today is seamless polyvinyl chloride that is continued up the sides of the wall for 5 or 6 inches and welded into place. These materials should not degrade or stain with age and cleaning. Metal oxides can be incorporated to decrease the slipperiness of the surface when wet.

 

A variety of hard plastic, seamless materials are used for minor procedure room floors. The surface of all floors should not be porous but suitably hard for cleaning by the flooding, wet-vacuuming technique. Personnel fatigue may be related to the type of flooring, which can be too hard or too soft. Cushioned flooring is available. The floor should be slipproof when wet because surgical hand cleansing causes splashes and spills around the scrub sink and into the OR, where the hands are dried.

Most of the glues and adhesives used in the installation of the flooring are malodorous and potentially toxic. During construction or renovation, care is taken to vent these fumes from the area. A minimum of 2 weeks may be needed to fully rid the area of the smell before it can be safely used for patient care.

 

Walls and Ceiling

Finishes of all surface materials should be hard, nonporous, fire-resistant, waterproof, stain-proof, seamless, nonreflective, and easy to clean. The ceiling should be a minimum of 10 feet (3 m) high and have seamless construction. The height of the ceiling will depend on the amount and types of ceiling-mounted equipment. The ceiling color should be white to reflect at least 90% of the light in even dispersion.

Walls should be a pastel color, with paneling made of hard vinyl materials that is easy to clean and maintain. Seams should be sealed by a silicone sealant. Laminated polyester or smooth, painted plaster provides a seamless wall; epoxy paint has a tendency to flake or chip. Dust and microorga¬nisms can collect between tiles, because the mortar between them is not smooth. Most grout lines, including those made of latex, are porous enough to harbor microorganisms even after cleaning. Tiles can also crack and break. A material that is able to withstand considerable impact also may have some value in noise control. Stainless steel cuffs at collision corners help prevent damage.

Walls and ceilings often are used to mount devices, utilities, and equipment in an effort to reduce clutter on the floor. The ceilings should be reinforced with steel beams to support the load. In addition to the overhead operating light, the ceiling may be used for mounting an anesthesia service column, operating microscope, cryosurgery device, x-ray tube and image intensifier, electronic monitor, closed circuit television monitor and camera, and a variety of hooks, poles, and tubes. Demands for ceiling-mounted equipment are diversified.

Suspended track mounts are not recommended because they engender fallout of dust-carrying microorganisms each time they are moved. If movable or track ceiling devices are installed, they should not be mounted directly over the operating bed but away from the center of the room and preferably recessed into the ceiling to minimize the possibility of dust accumulation and fallout.

 

Piped-In Gases, Computer Lines, and Electrical Systems

Vacuum for suction, anesthetic gas evacuation, compressed air, oxygen, and/or nitrous oxide may be piped into the OR. The outlets may be located on the wall or suspended from the ceiling in either a fixed, rotating orbiter or in a retractable column. The anesthesia provider needs at least two outlets for oxygen and suction and one for nitrous oxide. To protect other rooms, the supply of oxygen and nitrous oxide to any room can be shut off at control panels in the corridor should trouble occur in a particular line. A panel light comes on, and a buzzer sounds in the room and in the maintenance department. The buzzer can be turned off, but the panel light stays on until the problem is corrected. The buzzer should be tested on a routine schedule.

Computer lines for monitors or personal computers (PCs) are commonly located adjacent to the anesthesia machine and the circulating nurse’s writing desk. Additional lines may be attached to computers used in specialties such as neurosurgery, which uses immediate computed tomography (CT) scanning images during the intraoperative care period. Care is taken not to use the keyboard with soiled hands or soiled examination gloves. The keyboard should be of a design that permits adequate cleaning between patients.

Electrical outlets must meet the requirements of the equipment that will be used. Some machines require 220 volt power lines; others operate on 110 volts. Permanently mounted fixtures, such as a clock and radiograph view-boxes, can be recessed into walls and wired rather than plugged into outlets. Outlets suspended from the ceiling should have locking Hubble plugs to prevent accidental disconnection. Grounded wall outlets are used. Electrical cords that extend down the wall and/or across the floor are hazardous. Straight or curved ceiling-mounted tracks are satisfactory for bringing piped-in gases, vacuums, and electrical outlets close to the operating bed. They eliminate the hazard of tripping over cords, but insulation materials around electrical power sources from mobile ceiling-mounted tracks must be protected from repeated flexing to prevent cracks and damage to wires. Rigid or retractable ceiling service columns eliminate these hazards.

Multiple electrical outlets should be available from separate circuits. This minimizes the possibility of a blown fuse or a faulty circuit shutting off all electricity at a critical moment.

All personnel must be aware that the use of electricity introduces the hazards of electric shock, power failure, and fire. Faulty electrical equipment may cause a short circuit or the electrocution of patients or personnel. These hazards can be prevented by taking the following precautions:

1. Use only electrical equipment designed and approved for use in the OR. Equipment must have cords of adequate length and adequate current-carrying capacity to avoid overloading.

2. Test portable equipment immediately before use.

3. Discontinue use immediately if any malfunction takes place, and report any faulty electrical equipment.

4. If a ground fault buzzer sounds, unplug the last device engaged and remove it from service.

Fire safety systems are installed throughout the hospital. All personnel must know the fire rules. They must be familiar with the location of the alarm box and the use of fire extinguishers.

 

Lighting

General illumination is furnished by ceiling lights. Most room lights are white fluorescent but may be incandescent. Recessed lights do not collect dust. Lighting should be evenly distributed throughout the room without harsh shadows. The anesthesia provider must have sufficient light, at least 200 foot-candles, to adequately evaluate the patient’s color. Intraoperatively, the lighting should not cause the organs to appear discolored.

To minimize eye fatigue, the ratio of intensity of general room lighting to that at the surgical site should not exceed 1:5, preferably 1:3. This contrast should be maintained in corridors and scrub areas, as well as in the room itself, so that  the surgeon becomes accustomed to the light before entering the sterile field. Color and hue of the lights also should be consistent.

Illumination of the surgical site depends on the quality 4 light from an overhead spotlight source and the reflection from the drapes and tissues. Drapes should be blue, green, or gray to avoid eye fatigue. White, glistening tissues need  light than dull, dark tissues. Light must be of such quality that the pathologic conditions are recognizable. The overhead operating light must:

              Make an intense light, within a range of 2500 to 12,500 foot-candles (27,000 to 127,000 lux), into the incision without glare on the surface. It must give contrast to the depth and relationship of all anatomic structures. The light may be equipped with an intensity control. The surgeon will ask for more light when needed. A reserve light should be available.

              Provide a light pattern that has a diameter and focus appropriate for the size of the incision. An optical prism system has a fixed diameter and focus. Other types have adjustable controls mounted on the fixture. Most fixtures provide focused depth by refracting light to illuminate both the body cavity and the general operating field. The focal point is where illumination is greatest. It should not create a dark center at the surgical site. A 10- to 12-inch (25 to 30 cm) depth of -:us allows the intensity to be relatively equal at both the surface and depth of the incision. To avoid glare, a circular field of 20 inches (50 cm) in diameter provides a 2-inch (5-cm) zone of maximum intensity in the center of the field with 20% intensity at the periphery.

              Be shadowless. Multiple light sources and/or reflectors decrease shadows. In some units the relationship is fixed; others have separately maneuverable sources to direct light beams from converging angles.

              Produce the blue-white color of daylight. Color quality d normal or diseased tissues is maintained within a spectral energy range of 3500° to 6700° Kelvin (K). Most surgeons prefer a color temperature of about 5000° K, which approximates the white light of a cloudless sky at noon.

              be freely adjustable to any position or angle by either a vertical or horizontal range of motion. Most overhead operating lights are ceiling-mounted on mobile fixtures. Some have dual lights or dual tracks with sources on each track. These are designed for both lights to be used simultaneously to provide adequate intensity and  minimize shadows in a single incision. Many fixtures are adapted so that the surgeon can direct the beam by manipulating sterile handles attached to the lamp or  by remote control at the sterile field. Automatic positioning facilitates adjustment, and braking mechanisms prevent drift (i.e., a movement away from the desired position). Fixtures should be manipulated as little as possible to minimize dispersion of dust over the sterile field. To obtain the best illumination in the shortest time, the first spotlight should be positioned at the surgical site, followed by the second. Ideally, the light can be maneuvered in a 360-degree rotation as needed, quickly and without effort. Smaller lights commonly are restricted because of wiring bundles.

              Produce a minimum of heat to prevent injuring and drying exposed tissues. Most overhead lights dissipate heat into the room, where it is cooled by the air-conditioning system. Halogen bulbs generate less heat than do other types. Lamps should produce less than 25,000 mW/cm2 of radiant energy. If multiple light sources are used, collectively they must not exceed this limit at a single site. Beyond this range, the radiant energy produced by infrared rays changes to heat at or near the surface of exposed tissues. A filter globe absorbs some infrared and heat waves over the lightbulb or by an infrared cylindric absorption filter of a prism optical system.

              Be easily cleaned and maintained. Tracks recessed within the ceiling virtually eliminate dust accumulation. Suspension-mounted tracks or a centrally mounted fixture must have smooth surfaces that are easily acces-sible for cleaning. Lightbulbs should have a reasonably long life. Changing the bulb should not require addi¬tional tools because time may be an issue in a critical part of a surgical procedure. The bulb is usually too hot to touch with the bare hand. Many styles are available that contain several bulbs that provide backup light when one bulb burns out.

A supplemental surgical task light may be needed for a secondary surgical site, such as for the legs or arms during

conduit procurement for cardiovascular procedures. Somehospitals have portable explosion-proof lights. These lights should have a wide base and should be tip-proof. Others have satellite units that are part of the overhead lighting fixture. These should be used only for secondary sites unless the manufacturer states that the additional intensity is within safe radiant energy levels when used in conjunction with the main light source. The use of multiple teams in complex multidisciplinary procedures requires adequate lighting for each operating surgeon.

A source of light from a circuit separate from the usual supply must be available for use in case of power failure.

This may require a separate emergency spotlight. It is best if the operating light is equipped so that an automatic switch can be made to the emergency source of lighting when the usual power fails. Flashlights with fresh batteries should always be immediately available. Some surgeons prefer to work in a darkened room with only stark illumination off the surgical site. This is particularly true of surgeons working with endoscopic instruments and the operating microscope. If the room has windows, light-proof shades may be drawn to darken the room when

this equipment is in use. Because of the hazard of dust fallout from shades, the windows may have blinds contained

between two panes of glass with a handle to open or close the louvers in rooms where this equipment is routinely used. Although the surgeon may prefer the room darkened, the circulating nurse or anesthesia provider must be able to see adequately to observe the patient’s color and to monitor his or her condition. One spotlight can be aimed away from the field in the direction of the anesthesia provider. In some circumstances, the radiograph view-box can be turned on for additional illumination.

Some surgeons wear an adjustable headlight designed to focus a light beam on a specific area, usually in a recessed body cavity such as the nasopharynx. Fiberoptic headlights produce a cool light and reduce shadows. Both the surgeon and first assistant may wear a headlight. Alternatively, a light source that is an integral part of a sterile instrument, such as a lighted retractor or fiberoptic cable, may be used to illuminate deep cavities or tissues difficult to see with only the overhead operating light. Fiberoptic cables should not be permitted to become detached from the instrument and shine directly on the drape for a prolonged period, because a fire may ignite.

 

Radiograph View-Boxes

Radiograph view-boxes can be recessed into the wall. The viewing surface should accommodate a minimum of four standard-size films. The best location is in the line of vision of the surgeon standing at the operating bed. An additional view-box should be located near the anesthesia provider for review of chest films. It can also provide indirect illumination of the anesthesia machine or instrument table during procedures requiring a darkened room. Lights for view-boxes should be of high intensity. A film-holding basket should be planned within reach of each view-box station.

Many facilities have changed from plain film viewing to digital computer monitors. In this circumstance it is still useful to have lighted view-boxes available in the event old films are brought from the archives for comparison with the patient’s new digital images.

 

Clocks

Two clocks should be in each OR. A standard clock for basic time observation should be visible from the field. A time-elapsed clock, which incorporates a warning signal, is useful for indicating that one or more predetermined periods of time have passed. This may be used during surgical procedures for total arterial occlusion, when using perfusion techniques or a pneumatic tourniquet, or during cardiac arrest. Start, stop, and reset buttons should be within reach of the anesthesia provider and the circulating nurse.

 

Cabinets or Carts

Each OR may be supplied with stationary cabinetry unless a cart system or pass-through entry is used. Supplies for the types of surgical procedures done in that room are stocked, or every OR may be stocked with a standard number and type of supplies. Having these basic supplies saves steps for the circulating nurse and helps eliminate traffic in and out of the OR. Glass shelves and sliding doors provide ease in finding and removing items. Many cabinets are made of stainless steel or hard plastic. Wire shelving minimizes dust accumulation. Cabinets should be easy to clean. One cabinet in the room may have a pegboard at the back to hang items, such as table appliances. Gloves used in patient care should be removed when opening the cabinet and removing supplies.

Pass-through cabinets that circulate clean air through them while maintaining positive air room pressure allow transfer of supplies from outside the OR to inside it. They help ensure the rotation of supplies in storage or can be used only for passing supplies as needed from a clean center core. Some pass-through cabinets between the OR and a corridor accommodate supply carts directly from the sterile core, which are easily removable for restocking.

In lieu of or as an adjunct to cabinets, some hospitals stock carts with special sutures, instruments, drugs, and other items for some or all of the surgical specialties. The appropriate cart is brought to the room for a specific surgical procedure.

 

Furniture and Other Equipment

Stainless steel furniture is plain, durable, and easily cleaned.

Each OR is equipped with the following:

              Operating bed with a mattress covered with an imper-vious surface, attachments for positioning the patient, and armboards.

              Instrument tables. These are commonly called “back tables,” although they are actually at the side of the scrub person during the surgical procedure.

              Mayo stand. The Mayo stand is a frame with a removable rectangular stainless steel tray. The frame slides under the operating bed and over the sterile field. The tray serves to bring near the surgical field a supply of instruments that are used frequently during the surgical procedure.

              Small tables for gowns and gloves and/or the patient’s skin preparation equipment and catheterization supplies.

              Ring stand for basin(s). This is optional because most ORs do not use splash basins.

              Anesthesia machine and table for anesthesia provider’s equipment.

              Sitting stools and standing platforms.

              IV poles for IV solution bags.

              Suction canisters, preferably portable on a wheeled base.

              Laundry hamper frame.

              Kick buckets in wheeled “sponge buckets.”

              Wastebasket.

              Writing surface. This may be a wall-mounted stainless steel desk or an area built into a cabinet for the circu-lating nurse to document in the records.

              Computer terminal station. This may be permanently affixed to a hardwired station or mobile wireless. The keyboard should be positioned so the circulating nurse can observe the sterile field. A scanning device may be incorporated for bar-coded drugs and supplies.

 

Communication Systems

A communication system is a vital link to summon routine or emergency assistance or to relay information to and from the OR team. Many surgical suites are equipped with telephones, intercoms, call-lights, video equipment, and computers. These communication systems may connect the OR with the clerk-receptionist’s desk, the nurse manager’s office, the holding area, the family waiting room, the PACU, the pathology and radiology departments, the blood bank, and the sterile processing department. These systems make instantaneous consultation possible through direct communication.

 

Voice Intercommunication System. Either monodirec-tional or bidirectional voice systems, via telephone or an intercommunication (intercom) system, are useful devices for the OR team but are potentially hazardous for the patient. Sounds are distorted to the patient in early stages of general anesthesia. Incoming calls over an intercom should not be permitted to disturb the patient at this time. Also, an awake patient should not receive traumatic information about a pathologic diagnosis (e.g., from a strange voice coming through an intercom speaker box after a biopsy has been performed). Installing any type of intercom equipment either in the adjacent substerile room or scrub area rather than in the OR helps eliminate sounds that could disturb both the patient and the surgeon.

 

Call-light System. In addition to or instead of a voice system, a call-light system can summon assistance from the anesthesia staff, pathologist, patient care staff, and housekeeping personnel. Activated in the OR by a foot- or hand-operated switch, a light alerts personnel at a central point in the suite or displays at several receiving points simultaneously.

 

Closed-Circuit Television. Television surveillance is an easy way for the nurse manager to keep abreast of activities in each OR. By means of a black-and-white or color video camera with a wide-angle lens mounted high in the corner of each OR, the manager may make rounds simply by switching from one room to another by pushing buttons at his or her desk and viewing a monitor in the office. Signs should be posted to indicate that video surveillance is in process.

More commonly, television monitors serve a number of useful purposes for the surgeon within the OR. They are widely used for teaching surgical techniques. This minimizes the number of visitors in the OR, which, in the interest of sterile technique, is advantageous. In addition, monitors provide a better view for more people to see the surgical procedure from a remote area or through a microscope or endoscope. They can also be used for record keeping and documentation for legal purposes for the surgeon. Video recording is possible for this purpose. If video recording is done while patients are in the rooms, each patient should have the opportunity to sign a permission form.

As an aid to diagnosis, an audiovisual hookup between the OR and the radiology department permits radiographs to be viewed on the television screen in the OR without having to be transported into the OR and mounted on view-boxes. With such a hookup, the surgeon gains the advantage of remote interpretive consultation when it is desired.

A two-way audiovisual system between the frozen section laboratory and the OR enables the surgeon to examine the microscopic slide by video in consultation with the pathologist without leaving the operating bed. The pathologist can view the site of the pathologic lesion without entering the OR.

For these purposes the color television camera may be mounted over the operating bed in a number of ways. Usually it is attached to the stem of the operating light and outfitted with detachable sterilizable handles. An operating light with a television camera mounted in the center is available.

Video screens usually are adapted television sets and may be wall mounted or placed on floor stands that can be moved readily. All pieces of television equipment must be labeled to indicate that they comply with applicable electrical safety regulations for use in the OR. They also must be encased in nonporous materials that can be easily cleaned.

 

Computers. A computer terminal or PC in each OR affords access to information and allows data input by the circulating nurse. The type of hardware and software programs available dictates the capabilities of the auto¬mated information system. A keyboard, light pen, and/or bar-code scanner may be used for input. The computer processes and stores information for retrieval on the viewing monitor and by printout from a central processing unit. The system should be wireless for fast transmission of data and should require a password of each user in the system for security. The computer database helps the circulating nurse obtain and enter information that may include

following:

Schedule, including the patient’s name, surgeon, procedure, special or unusual equipment requirements, wound classification, whether procedure is elective or emergency

              Preoperative patient assessment data, nursing diagnoses,

expected outcomes, and plan of care

              Results of laboratory and diagnostic tests

              Surgeon’s preference card with capability to update

              Inventory of supplies and equipment provided and used

              Charges for direct patient billing

              Intraoperative nursing interventions

              Timing parameters, including anesthesia, procedure,

and room turnover

              Incident reports

              Postoperative care in the PACU

The computer terminal may be mounted on the wall or placed on a shelf or a portable table or cart. The computer keyboard should be wireless so it can be moved so that the circulating nurse can see the patient and the activities of the OR team while electronically documenting intraoperative information into the record. The computerized patient information that is generated in the OR may interface with the hospital-wide computer system.

Monitoring Equipment

Monitors and computers are designed to keep the OR team aware of the physiologic functions of the patient throughout the surgical procedure and to record patient data. The anes-thesia provider or a perioperative nurse uses monitoring devices as an added means to ensure safety for the patient during the surgical procedure.

 

SPECIAL PROCEDURE ROOMS

Certain procedures or outpatient treatments may indicate the need for rooms designed for a specific purpose, such as interventional radiology, endoscopy, or cystoscopy. These rooms are designed with equipment for performing the specific interventional procedures, including specialized radiologic and monitoring devices. A radiologist and several endoscopists should be consulted when planning these types of facilities.

Interventional Radiography Room

Endovascular stenting, balloon angioplasty, and other interventions requiring fluoroscopy can be performed in a room with fixed radiographic equipment and specialized radiographic beds (Fig. 10-6). The proximity to the OR is important in case of an emergency that necessitates an open procedure.

Cardiac catheterization may be performed within the surgical suite in a room equipped for fluoroscopy. Imaging screens are located near the head of the operating bed to allow the surgeon and the team to visualize the coronary arteries during the procedure. Monitors, suction, oxygen, and cardiopulmonary resuscitation equipment are available in this room for each cardiac catheterization procedure. The team must be alert for emergency situations, such as a perforated coronary artery, and be prepared for an emergency thoracotomy or transfer to an OR for an open procedure.         

 

MIS Room (Minimally Invasive Surgery)

Some rooms are equipped for laparoscopic procedures. A dedicated MIS room has all the equipment for puncture endoscopy located on a large cart or a ceiling-mounted boom. The use of a boom in these rooms helps minimize the amount of equipment spread around the room by providing a central vertically organized placement of the machinery used for the procedure. Several TV monitors are located around the room for ergonomic viewing of the surgical field by the surgical team. The monitors can be attached to articulated arms on the main boom.

 

These rooms should have the capability of immediately converting to an open procedure in the event of an untoward event such as excessive bleeding.

 

Endoscopy Room. Many surgical suites have a designated room in which nonpuncture flexible or rigid endoscopic procedures, such as bronchoscopy, gastroscopy, sigmoidoscopy, or colonoscopy, are performed. Most are equipped for the use of lasers and electrosurgery. Some endoscopy rooms have radiographic and video capabilities. Some specialized equipment such as light sources can be permanently mounted from ceiling booms or orbiters and is not portable between rooms.

 

Cystoscopy Room. A cystoscopy room (cysto room) may be available for a urologic endoscopic examination or procedure. Ideally, the room should be 350 square feet with a minimum of 15 feet of clear space between fixed cabinets. Waste fluids are collected in special canisters and are disposed of like other biologically contaminated fluids. Older cystoscopy rooms may be equipped with special floor drains for the disposal of fluids during the procedure. Modern styles have eliminated this drain for infection control reasons.

A cysto room is also equipped with radiographic and fluoroscopy machines because many procedures require the use of radiopaque contrast media to visualize the kidneys, ureters, and bladder. Radiograph view-boxes should accom-modate a minimum of four films simultaneously and may be situated near digital monitors. Imaging screens are located in the room to allow the urologist to visualize the urologic structures during fluoroscopy. Some urologists use ultra-sonic equipment, lasers, and electrosurgery to perform minimally invasive procedures.

 

Cesarean Delivery Room. Most facilities that have obstetric departments will have a self contained operating room within the delivery suite (Fig. 10-7). This room is a restricted room with an attached substerile room and scrub sink area. The purpose of this room is to provide equip¬ment and supplies in support of a surgical birth of the baby through the mother’s abdomen (cesarean section) instead of a vaginal birth.

A few differences of the cesarean delivery room include resuscitation supplies and equipment for the newborn and a specialized warming bed that can be used to transport the baby to the special care nursery.

 

CONCLUSION   

The surgical suite is a highly specialized area with distinct environmental controls for safety, cleanliness, and mini-mization of contamination. Personnel who work in the perioperative environment are required to know and understand the “hows and whys” of appropriate attire, what activi¬ties are safe, what environmental controls are in effect, and how to determine if the controls are effective. Environmental sanitation is described in Chapter 12 and environmental hazards are discussed in Chapter 13.

 

23 Tanggapan

  1. This blog’s great!! Thanks :).

  2. kang petugas kamar operasi harus ikutan pelatihan apa aja?

  3. Sebagai perawat kamar bedah/kamar operasi paling tidak punya sertifikat pelatihan dasar bedah umum.

  4. Bang, saya numpang copy, buat referensi..
    Trims banyak.

  5. Ya monggo silahkan………asal bermanfaat aja…….

  6. maaf saya mau tanya.ini sumber referensinya dari buku atau jurnal apa ya? terima kasih sebelumnya..

  7. good, bagus

  8. Teruma kasih atas pertanyaannya, untuk referensinya sebagian besar saya ambil dari buku Berry & Kohn terbitan tahun 2009 OPERATING ROOM TECHNIQUE karangan Nancy Marie, penerbit Elsevier, USA. Itu jawaban dari saya.

  9. I’ve been browsing on-line more than 3 hours nowadays, yet I by no means discovered any interesting article like yours. It’s pretty worth sufficient for me. In my opinion, if all web owners and bloggers made excellent content as you probably did, the internet will be much more helpful than ever before.

  10. Okey, thanks for visiting my bloq. I hope my blog is useful and have benefit for others. Seng my special great for you.

  11. If some one wants to be updated with newest technologies after
    that he must be visit this site and be up to date all the time.

  12. pengetahuan yang sangat berharga buatku
    terimakasih pak
    mohon ijin untuk dishare di blog saya yaaa

  13. Ya terima kasih atas kunjungannya di Blog saya ini yg lama gak diupdate. Ya sy masih Di IBS RS Sardjito Mbak. Silahkan share kalo itu memang bermanfaat. Untuk tahun 2012 sedang berlangsung pelatihan kamar operasi dan hampir selesai. Untuk tahun 2013 belum ada informasi. Kalo ingin informasi langsung ke bagian diklat RS Sardjito no telp langsung 0274-553573. Salam dari Abror……

  14. Genuinely amazed with your type of authoring actually, some
    thing informs me you might be a master. . !

  15. Thank you for your appreciation.

  16. “Kamar Operasi 2 Abrorshodiqs Blog” was in fact a superb posting,
    can’t help but wait to look over more of your blog posts.

    Time to spend a lot of time on the web haha. I appreciate it -Cara

  17. Hi there! I just would like to offer you a huge thumbs up for
    your excellent information you’ve got right here on this post. I’ll
    be returning to your blog for more soon.

  18. This is my first time pay a quick visit at here and i am genuinely pleassant to read all at alone place.

  19. I think everything said was actually very logical.
    But, consider this, what if you were to write a killer post title?
    I mean, I don’t wish to tell you how to run your website, but suppose you added a title that grabbed people’s attention?
    I mean Kamar Operasi 2 | Abrorshodiq’s Blog is kinda vanilla. You should peek at Yahoo’s home page and watch how they create news headlines to grab viewers interested.

    You might try adding a video or a picture or two to get people excited about what you’ve got to say. In my opinion, it would bring your blog a little bit more interesting.

  20. The nicotine liquid sold by reputable manufacturers is available in measured levels of nicotine content, chosen by
    the consumer to match their former tobacco use.
    What are the benefits of electronic cigarettes (e Cigs.
    Colorado Springs – Friday morning, November 20, 2009, and a terrible noise from
    Bront’s room gets me out of bed at 5:30 a.

  21. Whats up are using WordPress for your site platform?
    I’m new to the blog world but I’m trying to get started and create my own.
    Do you need any html coding knowledge to make your own blog?

    Any help would be greatly appreciated!

  22. Hello, i think that i saw you visited my blog so i came to
    “return the favor”.I’m attempting to find things to enhance my site!I suppose its ok to use a few of your ideas!!

  23. bang, hubungannya ruang operasi denga infeksi apa bang?

Tinggalkan Balasan

Isikan data di bawah atau klik salah satu ikon untuk log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Logout / Ubah )

Twitter picture

You are commenting using your Twitter account. Logout / Ubah )

Facebook photo

You are commenting using your Facebook account. Logout / Ubah )

Google+ photo

You are commenting using your Google+ account. Logout / Ubah )

Connecting to %s

Ikuti

Get every new post delivered to your Inbox.

%d bloggers like this: