Theatre intro design principles - sep 2013

Operating Theatre Design A basic introduction to the design features of modern operating theatres and working principles

Martin Smith2013

Origins of the Word TheatreWhere did the term come from?What does it mean?What does it mean to you?We discuss this

Definitions of theatre on the Web:

theater: a building where theatrical performances or motion-picture shows can be presented;

Theatre: a region in which active military operations are in progress; "the army was in the field awaiting action"; "he served in the Vietnam theater for three years"

Theatre: the place that is the setting for dramatic performances.

Theatre (or theater) is the branch of the performing arts defined by Bernard Beckerman as what "occurs when one or more persons, isolated in time and/or space, present themselves to another or others.Theatre is that branch of the performing arts concerned with acting out stories in front of an audience using combinations of speech, gesture, music, dance, sound and spectacle indeed any one or more elements of the other performing arts. In addition to the standard narrative dialogue style, theatre takes such forms as opera, ballet, mime, kabuki, classical Indian dance, Chinese opera, mummers' plays, and pantomime. In warfare, a theater or theatre is normally used to define a specific geographic area within which armed conflict occurs. A war would have to occur over a large portion of the globe in order to be considered to be large enough to have separate theaters, and the term is not used in the singular. Typically, each theater would be distinct and separate from other theaters. Very often, the delineation occurs along continental boundaries or in separate oceans. ... Theater in military terms, is a geographic location used for military operations. A theater or theatre is a structure where theatrical works or plays are performed or other performances such as musical concerts may be given. While a theater is not required for performance (see Environmental theatre or Street theatre), a theater serves to define the acting and audience spaces and organize the theater space as well as provide facilities for the actors and the tech crew as well as for the audience. http://en.wikipedia.org/wiki/Theatre_(structure)

Lecture Theatre: A lecture hall, a large room used for instruction, typically at a college or University (trad.)

There are lots more see for yourself.

Origins of Theatre

Historical Operating Theatre

Early Surgery!!!https://www.youtube.com/watch?v=ctKKpBTWwwo

Development of the theatre

Surgical team operating on a patient, c.1950s

Environmental requirementsBased on your experience or concepts of the Operating Theatre Environment, what is the difference between the classroom environment and that of the Operating Room?

Theatre Design IssuesBuilding construction (wall and floor material)Heat, light, power, water & drain requirementsAccess staff, patients & equipmentVentilationSupport facilities (ancillary rooms and supplies)

The Operating Theatre (room)

The Built Environment

a Air intake1 Coarse filters2 Fan3 Heaters4 Condensers5 Filters6 Heaters7 Humidifiers8 Attenuatorsb Filtered, humidified (conditioned) airTheatre Air Conditioning

Theatre Air ConditioningRemember - maintain pressure gradientsIdeal conditions *-Temperature-18 to 23 OCHumidity-50 to 60%Air Changes-20 per hour* Note -Conditions may be varied due to patient requirements.Air changes shown are minimum standard.Target Humidity in normal temperature ranges is 55%

Theatre Air ConditioningThe Plenum SystemAirflow is downward from ceiling, exiting at floor vents (or through open doors)

Theatre Air ConditioningLaminar flow systemsAdditional airflow - up to 200 changes per hour.

Laminar flow systems (cont.)

Ceiling Vents of Laminar Flow System

Traffic Patterns

TheatreA.R.ScrubPrep.DirtyExitTraffic PatternsPatients

TheatreA.R.ScrubPrep.DirtyExitTraffic PatternsEquipment

TheatreA.R.ScrubPrep.DirtyExitTraffic PatternsEquipment/instrumentsPatientsStaff

Pressure GradientsHighest LowestKeep doors closed as much as possible to maintain thesePressure dampersIntention = Air flow is from clean to dirty

Charnley-Howarth EXFLOW System

Other Laminar Flow Systems

Quick summaryOperating Department (Theatres)Ideally located near to surgical wards, CSSD, ITUDesign should allow for one way traffic and prevent return flow of contaminants into clean areas

Scrub roomFor hand washing (surgical scrub) gowning & gloving of surgical team

Prep / instrument roomSometimes situated off the Operating room.Storage of instruments & supplies

The Operating Room (Theatre)Focal point of surgical process

Anaesthetic RoomReception & preparation of patientInduction of anaesthesia

Rest/coffee roomDoes exactly what it says on the tin!A place to relax.Beware of careless conversations!Patient confidentiality still applies

Operating theatre design - conclusionBuilding /construction Heat, light, power, water & drainageAccess staff, patients & equipmentVentilationSupport facilities (ancillary rooms and supplies)Policies & proceduresHealth & Safety

Now we consider what goes into the rooms

Stock Control & ManagementAfter considering the built environment we need to examine the materials utilised within it.Question What materials (consumables) are commonly used within the Operating Theatre Environment?

Materials include - EquipmentFurnitureSurgical InstrumentsAnaesthetic instrumentsDisposablesPharmaceuticalsClothing

IssuesStorage conditionsShelf-lifeExpiry datesStock rotationStock controlHazard noticesDamaged goods

Storage must be appropriate & adequate

Type of wine Wine appellation Additional denomination Vintage year Name of the wine Color of the wine Product Labelling Essential issuesQuantity in millilitres Alcohol content by volume Nation of origin (in our case, obviously Italy) Bottling company data Importer (this information is obviously missing from labels of wine purchased in Italy)

For those who dont like wine

For those who dont drink alcohol

Fundamental issue It is vital you check items are in date and note batch numbers before use(Also in event of product failure or recall)Expiry dates & batch numbers

Note

Exp: means for use up to and until the last day of the specified month.

Use by: means for use up to and until the last day of the specified month.

Use before: means for use until the first day of the specified month.

Product Labelling Essential information

Example of products in use Sutures** Pre-prepared needle & thread, used for sewing tissue together. Different sizes & materials used for various tasks

Suture box labelling

Suture box labelling

Individual suture packaging

Drug Labelling

Drug ampoule labels

Intravenous Fluid Labelling

Circulated by Drug and safety Agencies To alert us (the practitioners) to problems or concerns with drugs and equipment.Watch for them and act accordinglyAlert notices

Questions? the end

Some further readingYour Local Department policies.

HBN 26 Facilities for surgical procedures Vol.1 (2004) A guide.

http://www.michaelbone.plus.com/alexis/hospital/hbn26.pdf

Healthcare Infection Society

http://www.his.org.uk/

The Old Operating Theatre Museum St Thomass hospital

http://www.thegarret.org.uk/oot.htm

AAGBI publicationshttp://www.aagbi.org/publications/publications-guidelines/A/F

Department of Healthhttps://www.gov.uk/government/organisations/department-of-health

National Patient Safety Agency (NPSA)http://www.npsa.nhs.uk/

NPSA Guide to labeling & packaginghttp://www.nrls.npsa.nhs.uk/resources/collections/design-for-patient-safety/?entryid45=59831

Medicines & Healthcare products Regulatory Agency (MHRA) Safety informationhttp://www.mhra.gov.uk/Safetyinformation/index.htm

The Productive Operating Theatre - the well organised theatre

http://www.institute.nhs.uk/quality_and_value/productive_operating_theatre/well_organised_theatre.html

And others just try searching the web!

******First picture we see the beginnings of asepsis (note some staff are dressed in Theatre clothing) but the viewing galleries still remainSecond picture here we see the abolition of the viewing gallery, more emphasis on a clean environment and the advent of specialised equipment such as the focussed theatre light & easily cleaned furnitureThird picture even more development sterilisation drums, a viewing window and early anaesthetic apparatus.Fourth picture here we see the surgical team adopting hats and facemasks as part of the rituals.Fifth picture military expediency once again advances in medical & surgical techniques (including the operating theatre) is made during times of conflict.*Here we see the Operating theatre in the mid 19590sThe clothing and equipment are very similar to modern day equivalents.Materials are mainly re-usable (linin based clothing & drapes) unlike the disposables of today.****This plan is a typical set up for a single operating room.The Theatre or Operating Room is supported by several ancillary rooms A.R = Anaesthetic RoomScrub = the room where surgical staff wash their hands & gown & glove prior to entering the sterile fieldPrep. = the room where sterile supplies (instrument trays & disposables) are stored prior to use sometimes this is where the surgical instrument trollies are opened & prepared.Dirty = used to be called the sluice this may be an actual room or a hatch to the dirty corridor through which used instruments, equipment & waste materials are disposed of after use (either for disposal or re-processing)*Principles of air-conditioningAir enters at aCourse filters remove particulate materialFans propel air through the systemHeating coils to heat the air then Cooling coils rapidly chill the air to condense out waterThe dry cold air (a known quantity) is then filtered to remove all particulate matter (dust, skin scales etc.)Once filtered the air is now heated and humidified to provide a safe, comfortable environment for the Operating room.************************************