Design and management of Operation theaters in a Hospital.

1. Operation TheaterOperation Theater
Design & Management.Design & Management.
Dr.S.N.Kumthekar.Dr.S.N.Kumthekar.
Surgeon Oncologist.Surgeon Oncologist.
Kumthekar General Hospital & CancerKumthekar General Hospital & Cancer
Research Center Jule Solapur.Research Center Jule Solapur.

3. What is an Operation theater?What is an Operation theater?
Originally this term was used for a placeOriginally this term was used for a place
which was like a tiered Amphitheater inwhich was like a tiered Amphitheater in
which students & spectators used to watchwhich students & spectators used to watch
surgeries being performed by asurgeries being performed by a
surgeon……. As of today….Its a place in asurgeon……. As of today….Its a place in a
Hospital where Surgical Operations areHospital where Surgical Operations are
carried out in a controlled environment..carried out in a controlled environment..

4. Operating theaters have always…..Operating theaters have always…..
Generated a feeling of……..Generated a feeling of……..
Awe, Wonder & dramatic expectations,Awe, Wonder & dramatic expectations,
Reminiscent of Real drama Theaters…..Reminiscent of Real drama Theaters…..
With the only difference being …..With the only difference being …..
Here there are no Rehearsals!Here there are no Rehearsals!

5. Fergusson: A 19Fergusson: A 19thth
century Surgeoncentury Surgeon
Stated that ……….Stated that ……….
A Surgeon is supposed to have,A Surgeon is supposed to have,
1.The Eye of an eagle.1.The Eye of an eagle.
2.The heart of a Lion.2.The heart of a Lion.
3.The Hands of A Lady.3.The Hands of A Lady.
4. & the flair of an accomplished actor .4. & the flair of an accomplished actor .
The personality of a surgeon has alwaysThe personality of a surgeon has always
reflected his desire to perform the art ofreflected his desire to perform the art of
surgery in front of an appreciativesurgery in front of an appreciative
audience!audience!

6. The Oldest Operation Theater to dateThe Oldest Operation Theater to date
A.D.1822.A.D.1822.
London.London.
St. Thomas Hospital.St. Thomas Hospital.
Is now a Museum Of Surgical History.Is now a Museum Of Surgical History.

7. Another Famous Operating TheaterAnother Famous Operating Theater
from History……….from History……….
• The Ether Dome in Boston A.D. 1824.
• John Collins Warren Performing First
Surgery using Ether Anesthesia….

8. Operation Theater Design:Operation Theater Design:
HistoryHistory
In good olden days Operations were performed onIn good olden days Operations were performed on
as is where as basis. Surgeons would go to theas is where as basis. Surgeons would go to the
patient with their tool box & perform the surgery.patient with their tool box & perform the surgery.
Then came the concept of “ Theater”.Then came the concept of “ Theater”.
The procedures were limited to Emergency & lifeThe procedures were limited to Emergency & life
threatening situations Like Abscess drainage,threatening situations Like Abscess drainage,
Amputations, Stricture dilatation, SuperficialAmputations, Stricture dilatation, Superficial
lump Excision & war wounds.lump Excision & war wounds.

9. Operation theater design: HistoryOperation theater design: History
 Tennon 1788 Proposed separate Rooms toTennon 1788 Proposed separate Rooms to
conduct Operations.conduct Operations.
 Dupuytren was performing operations in WardsDupuytren was performing operations in Wards
as late as 1815.as late as 1815.
 In the entire 17In the entire 17thth
& 18& 18thth
Century SurgeonsCentury Surgeons
performed in Amphitheaters.performed in Amphitheaters.
 A New York Surgeon Stephen Smith in 1878A New York Surgeon Stephen Smith in 1878
advised the abolishing of this system.advised the abolishing of this system.
 By 1898 Amphitheaters were abolished.By 1898 Amphitheaters were abolished.

10. O.R.Design historyO.R.Design history
Advances in Asepsis & MicrobiologyAdvances in Asepsis & Microbiology
Shook the foundation of Surgeons Role.Shook the foundation of Surgeons Role.
The major Advances were the Four A’S:The major Advances were the Four A’S:
1.Anesthesia : 1846.1.Anesthesia : 1846.
2.Antisepsis : 1867.2.Antisepsis : 1867.
3.Asepsis : 1886.3.Asepsis : 1886.
4.Antibiotics :1929.4.Antibiotics :1929.

11. Operation TheaterOperation Theater
DesignDesign
 After these major developments &After these major developments &
from 1935 onwards proper Operatingfrom 1935 onwards proper Operating
Rooms as we use today came in toRooms as we use today came in to
existence & went on rapidlyexistence & went on rapidly
modernizing ,keeping pace with themodernizing ,keeping pace with the
ever evolving advanced technologies.ever evolving advanced technologies.

12. Basics of Operation TheaterBasics of Operation Theater
Design:Design:
• The Present day Operation Theater complex
should ideally include the following areas,
• 1.O.R. Office.
• Changing & Rest Area With a Toilet.
• Scrub Area.
• Sterilization area.
• Storage area.
• Operating Room Proper.
• Washing & disposal area.
• Post.Op. Recovery room.

13. Where to Locate theWhere to Locate the
theater?theater?
As a General rule ,In a Hospital BuildingAs a General rule ,In a Hospital Building
the O.R. should be located in such a waythe O.R. should be located in such a way
so as to permit convenient &so as to permit convenient &
uncomplicated traffic of Staff & Patient.uncomplicated traffic of Staff & Patient.
Preferably Ancillary Depts. e.g. Path. lab.,Preferably Ancillary Depts. e.g. Path. lab.,
Radilogy,Post-Op.ICU, Delivery RoomRadilogy,Post-Op.ICU, Delivery Room
should be located Adjacent to the O.R. &should be located Adjacent to the O.R. &
on the same floor.on the same floor.

14. How many O.R.s AHow many O.R.s A
Hospital should have ?Hospital should have ?
It depends upon the size & requirements ofIt depends upon the size & requirements of
the Hospital…Usually for a Generalthe Hospital…Usually for a General
hospital offering Basic Primary &hospital offering Basic Primary &
secondary care services & a bedsecondary care services & a bed
strength of up to 50 beds, One Majorstrength of up to 50 beds, One Major
O.R. & one septic/minor O.R. isO.R. & one septic/minor O.R. is
sufficient… In a Super/Multispeciality setsufficient… In a Super/Multispeciality set
up specialty wise major & minor O.R.’sup specialty wise major & minor O.R.’s
are requiredare required

15. What should be theWhat should be the
size of an O.R. ?size of an O.R. ?
A Major O.R. Should have a Dimension ofA Major O.R. Should have a Dimension of
20 ft in Length x 18 ft in Breadth….min.20 ft in Length x 18 ft in Breadth….min.
A Minor O.R. Should be ,A Minor O.R. Should be ,
16ft in Length x 14 ft in Breadth .16ft in Length x 14 ft in Breadth .
In Specialty /Super-specialty set up ,In Specialty /Super-specialty set up ,
Bigger space is mandatory.Bigger space is mandatory.

16. Things to rememberThings to remember
during construction!during construction!
 Flooring …Hard with smooth surface, withFlooring …Hard with smooth surface, with
minimum joints, seams & crevices…avoidminimum joints, seams & crevices…avoid
marble ..use polished Green Kota, or Highmarble ..use polished Green Kota, or High
quality ceramic tiles.quality ceramic tiles.
 The Walls Should have Sealed windows, &The Walls Should have Sealed windows, &
should have Ceramic lining for at least 8ft.should have Ceramic lining for at least 8ft.
HeightHeight
 A Provision for Window / split A.C.A Provision for Window / split A.C.
 Provision for Low level Self closing ExhaustProvision for Low level Self closing Exhaust
Fan.Fan.
 Washable matt finish Oil paint with soothingWashable matt finish Oil paint with soothing
shade.shade.

17. Things to remember duringThings to remember during
construction…….construction…….
 The ceiling should have smooth white paint,&The ceiling should have smooth white paint,&
provision for Lamp & Light fixture supports.provision for Lamp & Light fixture supports.
 There should be no Toilet ,on the floor imm. AboveThere should be no Toilet ,on the floor imm. Above
O.R.O.R.
 Scrub area should be imm. Adjoining.Scrub area should be imm. Adjoining.
 A two way self closing door bet. O.R. & ScrubA two way self closing door bet. O.R. & Scrub
area.area.
 Prep./Sterilization room to have direct access toPrep./Sterilization room to have direct access to
O.R.O.R.
 If area permits a Pre Anesthesia & Post Op.If area permits a Pre Anesthesia & Post Op.
Recovery room adjoining…..Recovery room adjoining…..

18. Most Imp. Thing toMost Imp. Thing to
remember:………remember:………
 While the O.R. is being constructed & orWhile the O.R. is being constructed & or
renovated….. A clear Dialogue betweenrenovated….. A clear Dialogue between
the Architect & the Surgeon Concerned isthe Architect & the Surgeon Concerned is
a must!a must!
 The Concept in Mind, on paper & inThe Concept in Mind, on paper & in
reality must match…….reality must match…….

19. Requirements of the ChangingRequirements of the Changing
RoomRoom. App. Area :12ft. x 13ft.. App. Area :12ft. x 13ft.
1.Two Doors 1.Entry in .2. Entry in Scrub area1.Two Doors 1.Entry in .2. Entry in Scrub area
2.Storage for Changing clothes, Cap/ Masks,2.Storage for Changing clothes, Cap/ Masks,
Shoe racks etc.Shoe racks etc.
3.Sitting & Resting arrangement.3.Sitting & Resting arrangement.
3.Changing areas for Male/Female.3.Changing areas for Male/Female.
4.Intercom Telephone.4.Intercom Telephone.
5.A Library.5.A Library.
6.Stationary Rack with Registers.6.Stationary Rack with Registers.

20. Requirements of Scrub /Requirements of Scrub /
Sterilization area.Sterilization area.
1.1. Ideally these two areas should beIdeally these two areas should be
separate ,but should have access toseparate ,but should have access to
O.R.O.R.
2.2. Scrub area to have two large sinks withScrub area to have two large sinks with
levered water cocks .levered water cocks .
3.3. Sterilization area will include Autoclaves,Sterilization area will include Autoclaves,
Boilers,& Drum storage platform.Boilers,& Drum storage platform.
4.4. Cabinets for Instruments ,Linens &Cabinets for Instruments ,Linens &
Disposables storage.Disposables storage.

21. Requirements of O.R. Proper 1.Requirements of O.R. Proper 1.
1.1. Fittings & fixtures : concealed wiring, sufficientFittings & fixtures : concealed wiring, sufficient
points on all four walls.points on all four walls.
2.2. Lighting in O.R. :Adequate wall mounted LightsLighting in O.R. :Adequate wall mounted Lights
for Proper General Illumination.for Proper General Illumination.
Ceiling Mounted Single/ Double Dome O.R.Ceiling Mounted Single/ Double Dome O.R.
(Cold Light), A stand by Floor Lamp.(Cold Light), A stand by Floor Lamp.
3.O.R. Furniture : An Operation Table with all3.O.R. Furniture : An Operation Table with all
attachments , All necessary trolleys & stands,attachments , All necessary trolleys & stands,
Revolving Stools, Saline stands ,WasteRevolving Stools, Saline stands ,Waste
collection Buckets etc.collection Buckets etc.

22. Requirements of O.R. ….2.Requirements of O.R. ….2.
4.Anesthesia Equipments & Medical gases.4.Anesthesia Equipments & Medical gases.
5. Anesthesia Drug Trolley.5. Anesthesia Drug Trolley.
6. Oxygen/ Nitrous/ Carbon dioxide6. Oxygen/ Nitrous/ Carbon dioxide
Cylinders or Central Gas Supply.Cylinders or Central Gas Supply.
7. B.P. App. on Stand.7. B.P. App. on Stand.
8. Multi para Monitors.8. Multi para Monitors.
9.Defifibrillator.9.Defifibrillator.
10. Ventilator.10. Ventilator.

23. Requirements O.R. …3.Requirements O.R. …3.
11. Suction machines.11. Suction machines.
12. Electro Cautery.12. Electro Cautery.
13. X- Ray Imaging ( C-Arm).13. X- Ray Imaging ( C-Arm).
14. View Boxes.14. View Boxes.
15.etc……T.V. monitor, Video Recorders,15.etc……T.V. monitor, Video Recorders,
Endoscopes, Laparoscopes, Op.Endoscopes, Laparoscopes, Op.
Microscopes, Specialty dedicatedMicroscopes, Specialty dedicated
EquipmentsEquipments

24. Special Considerations in O.R.Special Considerations in O.R.
Design:…Design:…
Depending upon the Surgical Specialty needDepending upon the Surgical Specialty need
some special designs are necessary e.g.some special designs are necessary e.g.
Lamellar air flow curtains, air filters &Lamellar air flow curtains, air filters &
purifies, Hyperbaric chambers, etc.purifies, Hyperbaric chambers, etc.
Super specialty surgery needs specialSuper specialty surgery needs special
designs & specific equipment levels.designs & specific equipment levels.

25. O.R. management.O.R. management.
There are several areas in O.R.There are several areas in O.R.
management which need strictmanagement which need strict
discipline & quality control……discipline & quality control……
1.1. Patient management.Patient management.
2.2. Personnel Management.Personnel Management.
3.3. Equipment/ InstrumentEquipment/ Instrument
managementmanagement
4.4. Inventory management.Inventory management.
5.5. Disinfection /Fumigation Schedules.Disinfection /Fumigation Schedules.

26. O.R. Management ….O.R. Management ….
6. Linen Management.6. Linen Management.
7. Bio- Waste management.7. Bio- Waste management.
8. General Civil maintenance &8. General Civil maintenance &
management…………..management…………..
To sum up O.R. management is aTo sum up O.R. management is a
complex multitasking operationcomplex multitasking operation
which calls for seamless teamwork ,which calls for seamless teamwork ,
disciplined & consistent efforts.!disciplined & consistent efforts.!

27. What is the Future of O.R.What is the Future of O.R.
Significant advances are on the anvil likeSignificant advances are on the anvil like
what we read in Science fiction….what we read in Science fiction….
Robotic Surgery will soon replace theRobotic Surgery will soon replace the
Surgeon from O.R. … the surgeon willSurgeon from O.R. … the surgeon will
instead sit in front of a console & performinstead sit in front of a console & perform
virtual surgery.virtual surgery.
Electro Medical & Optical Instruments willElectro Medical & Optical Instruments will
witness a dramatic change.witness a dramatic change.
Intelligent Surgical instruments are on theIntelligent Surgical instruments are on the
horizon!horizon!

28. A surgeon with his knowledge &A surgeon with his knowledge &
skills happens to be the main heroskills happens to be the main hero
in this real life situational dramain this real life situational drama
that goes on in anthat goes on in an
Operation Theater.Operation Theater.
He happens to be the captain of aHe happens to be the captain of a
Ship……Ship……
A ship that has to sail safely withA ship that has to sail safely with
minimum turbulence.!minimum turbulence.!