Therapeutic environment can be defined as the total of all external conditions and influences affecting an individual in the illness situation.Infection prevention in the operating room is achieved through prudent use of aseptic techniques in order to prevent contamination of the open wound. Isolate the operating site from the surrounding unsterile physical environment. Create and maintain a sterile field in which surgery can be performed safely.

1. MAINTANENCE OF
THERAPEUTIC
ENVIRONMENT IN
OPERATION THEATRE
PRESENTED BY:
Adarsh S A
2nd year BSc Nursing
Assisi College Of
Nursing

2. THERAPEUTIC ENVIRONMENT
THERAPEUTIC ENVIRONMENT CAN BE DEFINED AS
THE TOTAL OF ALL EXTERNAL CONDITIONS AND
INFLUENCES AFFECTING AN INDIVIDUAL IN THE
ILLNESS SITUATION.

3. RULES TO MAINTAIN THERAPEUTIC
ENVIRONMENT
1. INFECTION PREVENTION IN THE OPERATING ROOM IS ACHIEVED
THROUGH PRUDENT USE OF ASEPTIC TECHNIQUES IN ORDER TO
PREVENT CONTAMINATION OF THE OPEN WOUND.
2. ISOLATE THE OPERATING SITE FROM THE SURROUNDING
UNSTERILE PHYSICAL ENVIRONMENT.
3. CREATE AND MAINTAIN A STERILE FIELD IN WHICH SURGERY CAN
BE PERFORMED SAFELY.

4. ACHIEVING A THERAPEUTIC ENVIRONMENT
1. ADEQUATE COMFORT, FOOD, CLEANLINESS, AND REST
2. FREEDOM FROM INJURY
3. INDIVIDUALIZED PATIENT CARE
4. FRIENDLY, COURTEOUS, ACCEPTING ATMOSPHERE
5. FEELING OF SECURITY AND SELF WORTH
6. DIVERSIONAL ACTIVITIES FOR THE PATIENT

5. APPLICATION OF PRINCIPLES OF
THERAPEUTIC ENVIRONMENT
• METHOD OF VACCUMING AND DUSTING AND OTHER GENERAL
CLEANING SHOULD BE DONE.
• ALL ORGANIC MATERIAL SHOULD BE REMOVED FROM EQUIPMENT
OR SURFACES BEFORE DISINFECTION PROCESS.
• CLEANING AND DISINFECTION BY CHEMICALS THAT WILL NOT
HARM SURFACES, MATERIALS SHOULD BE SELECTED.
• CLEANING AND DISINFECTION SOLUTION SHOULD BE USED IN
REQUIRED CONCENTRATIONS FOR ADEQUATE TIME AND
ACCORDING TO DIRECTIONS.
• USE DISPOSABLE EQUIPMENTS AS MUCH AS POSSIBLE.

6. FACTORS AFFECTING AN OPTIMUM
ENVIRONMENT
• TEMPERATURE
• HUMIDITY
• AIR MOVEMENT / VENTILATION
• PURITY OF AIR
• LIGHTING
• LOW NOISE
• PSYCHO-SOCIAL ENVIRONMENT

7. STEPS TO MAINTAIN THERAPEUTIC
ENVIRONMENT
• PROPER PREPARATION OF CLIENT
• HAND WASHING
• SURGICAL HAND SCRUB
• USING BARRIERS SUCH AS GLOVES AND SURGICAL ATTIRES
• MAINTAINING A STERILE FIELD
• USING STANDARD SURGICAL TECHNIQUE
• MAINTAINING SAFE ENVIRONMENT IN OPERATING ROOM

8. MAINTAINING A STERILE FIELD
• A STERILE FIELD MUST BE ESTABLISHED AND MAINTAINED IN
ORDER TO REDUCE THE RISK OF CONTAMINATING
SURGICAL/PROCEDURE AREA.
• PLACING ONLY STERILE ITEMS WITHIN THE STERILE FIELD.
• OPENING, DISPENSING, OR TRANSFERRING STERILE ITEMS WITHOUT
CONTAMINATING THEM.
• CONSIDERING ITEMS BELOW THE LEVEL OF DRAPED CLIENT TO BE
UNSTERILE.
• NOT ALLOWING STERILE PERSONNEL TO REACH ACROSS UNSTERILE
AREAS OR VICE VERSA OR TO TOUCH UNSTERILE ITEMS.

9. • THE NECKLINE, SHOULDER, AND BACK ARE CONSIDERED TO BE UNSTERILE
AREAS OF THE GOWN.
• RECOGNIZING THAT THE EDGES OF A PACKAGE CONTAINING A STERILE ITEM
ARE CONSIDERED UNSTERILE.
• RECOGNIZING THAT A STERILE BARRIER HAS BEEN PENETRATED IS CONSIDERED
CONTAMINATED.
• NOT PLACING STERILE ITEMS NEAR OPEN WINDOWS OR DOORS.
• STERILE DRAPES SHOULD BE USED TO ESTABLISH A STERILE FIELD.
• ITEMS USED WITHIN A STERILE FIELD SHOULD BE STERILE.
• A STERILE FIELD SHOULD BE CONSTANTLY MONITORED AND MAINTAINED.
• MOISTURE IN STERILE FIELD SHOULD BE AVOIDED. IF A SOLUTION SOAKS
THROUGH A DRAPE THEN IT SHOULD BE COVERED WITH ANOTHER STERILE
DRAPE.
• POLICIES AND PROCEDURES FOR BASIC ASEPTIC TECHNIQUE SHOULD BE
WRITTEN, REVIEWED ANNUALLY AND READILY AVAILABLE.

10. PRINCIPLES IN OPERATION THEATRE
• DOORS AND WINDOWS MUST BE KEPT CLOSE AS MUCH AS
POSSIBLE.
• WARD NURSE MUST HANDOVER PATIENT TO THEATRE NURSE WITH
ALL DETAILS LIKE PRE-MEDICATION DETAILS, IV LINE.
• PATIENT SHOULD BE SHIFTED TO OT ALWAYS IN TRLOLLEY.
PATIENT SHOULD REMOVE ALL JEWELRIES AND IN OT GOWN AND
CAP.
• INITIALLY PATIENT IS KEPT IN PREOPERATIVE ROOM AND LATER
SHIFTED TO THEATRE. IDEALLY ANESTHETIST, SURGEON, AND
THEATRE NURSE ACCOMPANY PATIENT.
• OT NURSE SHOULD CONFIRM CONSENT FORM, CASE SHEET, SITE
AND SIDE OF SURGERY.

11. • SEPARATE THEATRE SHOES SHOULD BE WORN BY SURGEON,
ANESTHETIST, OT NURSE, AND ASSISTANTS
• UNNECESSARY MOVEMENTS, TALKING LOUDLY, COMMENTING,
LAUGHING SHOULD BE AVOIDED
• ALL PERSON ENTERING THEATRE SHOULD WEAR OT DRESS, CAP,
MASK, FOOTWEAR
• CLOTHES, DRESS SHOULD BE WASHED, IRONED, AND CLEAN AND
KEPT READY FOR EVERYDAY USE
• MOBILE PHONES SHOULD BE SWITCHED OFF
• ANY PUBLIC PERSON OR RELATIVES SHOULD NOT BE ALLOWED
INSIDE OPERATION THEATRE

12. • ONE SENIOR NURSE IS MADE IN CHARGE OF THEATRE IN ALL
ACTIVITIES
• OT NURSE AND ASSISTANT SHOULD ACCOMPANY PATIENT TO
POSTOPERATIVE NURSE
• PATIENT SHOULD BE SHIFTED OUTSIDE OT ONCE ANESTHETIST
CONFIRM THE FITNESS FOR SHIFT

14. CONCLUSION
THE OPERATION ROOM ENVIRONMENT IS A HIGH RISK
ENVIRONMENT, THE RISK CAN BE MINIMIZED BY ADHERING
TO STRICT RULES AND REGULATION FRAMED BY TIME TO
TIME BASED ON EVALUATION OF RISK ENCOUNTERED BY
THE HEALTH CARE PROVIDERS, CLIENTS AND FAMILY AND
HOSPITAL ADMINISTRATION