An operating theater (also known as an Operating Room (OR), operating

suite, operation suite, or Operation Theatre (OT)) is a facility within a

hospital where surgical operations are carried out in an aseptic
environment.

History
Early operating theaters in an educational setting had raised tables or
chairs at the center for performing operations surrounded by steep tiers of
standing stalls for students and other spectators to observe the case in
progress. The surgeons wore street clothes with an apron to protect them
from blood stains, and they operated bare-handed with unsterilized
instruments and supplies.

The oldest surviving operating theater is thought to be the 1804 operating

theater of the Pennsylvania Hospital in Philadelphia.[12] The 1821 Ether
Dome of the Massachusetts General Hospital is still in use as a lecture hall.
Another surviving operating theater is the Old Operating Theatre in
London.[13] Built in 1822, it is now a museum of surgical history. The
Anatomical Theater at the University of Padua, in Italy, inside Palazzo Bo
was constructed and used as a lecture hall for medical students who
observed the dissection of corpses, not surgical operations. It was
commissioned by the anatomist Girolamo Fabrizio d'Acquapendente in
1595

Structure
Operating rooms are spacious, in a cleanroom, and well-lit, typically with overhead
surgical lights, and may have viewing screens and monitors. Operating rooms
are generally windowless, though windows are becoming more prevalent in
newly built theaters to provide clinical teams with natural light, and feature
controlled temperature and humidity. Special air handlers filter the air and
maintain a slightly elevated pressure. Electricity support has backup
systems in case of a black-out. Rooms are supplied with wall suction,
oxygen, and possibly other anesthetic gases. Key equipment consists of
the operating table and the anesthesia cart. In addition, there are tables to
set up instruments. There is storage space for common surgical supplies.
There are containers for disposables. Outside the operating room, or
sometimes integrated within, is a dedicated scrubbing area that is used by
surgeons, anesthetists, ODPs (operating department practitioners), and
nurses prior to surgery. An operating room will have a map to enable the
terminal cleaner to realign the operating table and equipment to the desired
layout during cleaning. Operating rooms are typically supported by an
anaesthetic room, prep room, scrub and a dirty utility room.

Several operating rooms are part of the operating suite that forms a
distinct section within a health-care facility. Besides the operating rooms
and their wash rooms, it contains rooms for personnel to change, wash,
and rest, preparation and recovery rooms, storage and cleaning facilities,
offices, dedicated corridors, and possibly other supportive units. In larger
facilities, the operating suite is climate- and air-controlled, and separated
from other departments so that only authorized personnel have access.

Operating room equipment

The operating table in the center of the room can be raised, lowered, and
tilted in any direction.[2]

The operating room lights are over the table to provide bright light, without
shadows, during surgery.

The anesthesia machine is at the head of the operating table. This machine
has tubes that connect to the patient to assist them in breathing during
surgery, and built-in monitors that help control the mixture of gases in the
breathing circuit.

The anesthesia cart is next to the anesthesia machine. It contains the

medications, equipment, and other supplies that the anesthesiologist may
need.

Sterile instruments to be used during surgery are arranged on a stainless

steel table.[2]

An electronic monitor (which records the heart rate and respiratory rate by
adhesive patches that are placed on the patient's chest).

The pulse oximeter machine attaches to the patient's finger with an elastic
band aid. It measures the amount of oxygen contained in the blood.

Automated blood pressure measuring machine that automatically inflates

the blood pressure cuff on a patient's arm.

An electrocautery machine uses high frequency electrical signals to

cauterize or seal off blood vessels and may also be used to cut through
tissue with a minimal amount of bleeding.
If surgery requires, a heart-lung machine or other specialized equipment
may be brought into the room.

Supplementary portable air decontaminating equipment is sometimes

placed in the OR.[3] [4]

Advances in technology now support hybrid operating rooms, which

integrate diagnostic imaging systems such as MRI and cardiac
catheterization into the operating room to assist surgeons in specialized
neurological and cardiac procedures.

Surgeon and assistants' equipment

People in the operating room wear PPE (personal protective equipment) to

help prevent bacteria from infecting the surgical incision. This PPE includes
the following:

A protective cap covering their hair

Masks over their lower face, covering their mouths and noses with minimal
gaps to prevent inhalation of plume or airborne microbes

Shades or glasses over their eyes, including specialized colored glasses for
use with different lasers. a fiber-optic headlight may be attached for greater
visibility

Sterile gloves; usually latex-free due to latex sensitivity which affects some
health care workers and patients

Long gowns, with the bottom of the gown no closer than six inches to the
ground.

Protective covers on their shoes.

If x-rays are expected to be used, lead aprons/neck covers are used to

prevent overexposure to radiation
The surgeon may also wear special glasses that help him/her to see more
clearly. The circulating nurse and anesthesiologist will not wear a gown in
the OR because they are not a part of the sterile team. They must keep a
distance of 12-16 inches from any sterile object, person, or field.

TYPES OF OPERATING ROOM

Operating rooms (ORs) come in various types, each tailored to different

surgical needs and specialty. Operating rooms are based on their

1. Specialization

2. Functionality

Based on specialization we have ;

1. General Operating Room: Used for a wide range of surgeries and

procedures, from routine to complex. It is equipped with standard surgical
tools and equipment.

2. Cardiac Operating Room: Specialized for heart surgeries, including open-

heart surgery and other procedures involving the cardiovascular system.

3. Neurosurgical Operating Room: Designed for brain, spine, and nervous

system surgeries. It typically includes advanced imaging and navigation
tools.

4. Orthopedic Operating Room: Equipped for bone, joint, and

musculoskeletal surgeries, often featuring specialized tables and
equipment for positioning and alignment.
5. Pediatric Operating Room: Tailored for surgeries on infants and children,
with equipment and protocols suited to pediatric patients.

6. Robotic Surgery Room: Contains robotic surgical systems that allow

surgeons to perform minimally invasive procedures with enhanced
precision.

7. Endoscopy Suite: Equipped for minimally invasive procedures using

endoscopes, including diagnostics and treatments through natural orifices.

8. Ophthalmic Operating Room: Specialized for eye surgeries, with

equipment designed for precision and to handle delicate procedures.

Each type of OR is designed to meet the specific requirements of the

surgeries performed, ensuring both patient safety and optimal outcomes.

Based On Functionality we have ;

1.Modular Theatre

A modular theatre, or modular operating room, refers to a flexible and

adaptable surgical space designed to accommodate various types of
surgeries and procedures. Key features typically include:

1. Modular Design: The room can be reconfigured or adapted based on

specific surgical needs. This includes adjustable lighting , movable
equipment and adaptable wall panels

2. Advanced Technology: Often equipped with state-of-the-art imaging

systems, integrated surgical tools, and advanced communication
technologies to support various surgical specialties.

3. Flexibility: Designed to easily adapt to different surgical procedures by

reconfiguring the space, allowing for quick changes in setup and
equipment.

4. Enhanced Sterility: Features designed to maintain a sterile environment

while allowing for flexibility, including easy-to-clean surfaces and advanced
air filtration systems.

5. Efficiency: Aims to improve workflow and efficiency by integrating

technology and design to streamline surgical processes and reduce
turnaround times between procedures.

Modular theatres offer the advantage of flexibility and adaptability, making

them suitable for hospitals and surgical centers that handle a wide range of
procedures.

2. Casualty Theatre

A casualty theatre, also known as an emergency operating theatre, is

specifically designed for urgent and emergency surgeries. Here are some
characteristics of a casualty theatre:
1. Emergency Focus: Tailored for handling urgent and life-threatening
conditions that require immediate surgical intervention.

2. Rapid Setup: Equipped for quick setup and efficient operation, allowing
surgical teams to act swiftly.

3. Advanced Equipment: Includes essential surgical tools and equipment

for various types of emergency procedures.

4. High Throughput: Designed to manage a high volume of cases, often

operating around the clock.

5. Accessibility: Located in or near emergency departments to provide

immediate access to surgical care.

Casualty theatres play a crucial role in emergency medicine by providing

timely surgical intervention for critical patients.

OPERATING ROOM NURSING OR PRE-OPERATIVE ASEPSIS

Operating room (OR) nursing preoperative asepsis refers to the practices

and procedures used to minimize the risk of surgical site infections (SSIs)
and maintain a sterile environment before surgery.
PRE-OPERATIVE PREPARATION

1. Patient Preparation: Ensure the patient is properly prepared for surgery,

including:

- Showering or bathing with antimicrobial soap

- Removing jewelry, makeup, and nail polish

- Wearing a hospital gown

2. Skin Preparation: Clean and disinfect the skin at the surgical site using:

- Antimicrobial solutions (e.g., chlorhexidine)

- Sterile drapes or towels

3. Hair Removal: Remove hair from the surgical site using:

- Clippers or razors (avoiding razor burn)

- Antimicrobial solutions for hair removal

ASEPTIC TECHNIQUES:

1. Hand Hygiene: Perform proper hand hygiene using:

- Soap and water

- Alcohol-based hand rubs

2. Gowning and Gloving: Wear:

- Sterile gowns

- Sterile gloves

3. Masking: Wear a surgical mask to prevent:

 - Droplet transmission

- Contamination

4. Instrument Sterilization: Ensure instruments are sterilized using:

- Autoclaving

- Ethylene oxide sterilization

- Gamma radiation

ENVIRONMENTAL CONTROL:

1. OR Cleaning: Clean the OR with:

- Antimicrobial solutions

- Ultraviolet (UV) light disinfection

2. Air Quality: Maintain a sterile air environment using:

- Laminar airflow systems

- HEPA filters

3. Temperature Control: Maintain a consistent temperature range (68-

73°F/20-23°C).

PATIENTS POSITIONING AND DRAPING:

1. Positioning: Position the patient to:

- Prevent pressure points

- Facilitate surgical access

2. Draping: Use sterile drapes to:

 - Isolate the surgical site

- Prevent contamination

ADDITIONAL CONSIDERATIONS:

1. Antibiotic Prophylaxis: Administer antibiotics as ordered to prevent SSIs

2. Surgical Site Marking: Verify surgical site marking to prevent wrong-site

surgery

3. Team Briefing: Conduct a team briefing to review the surgical plan and
patient information.

OPERATING ROOM PROTOCOLS

Operating room protocols are essential for maintaining a sterile
environment, ensuring patient safety, and preventing infections. Below are
the key aspects of these protocols:

Key Aspects of Operating Room Protocols

1. Sterility:

- All personnel must perform a surgical scrub before entering the sterile
field.

- Only sterile items can touch other sterile items; non-sterile items should
never come into contact with sterile areas.

2. INFECTION CONTROL
 - Follow strict hand hygiene protocols.

- Use appropriate personal protective equipment (PPE).

3. Safety:

- Confirm patient identity, surgical site, and procedure with a time-out

before starting.

- Use proper body mechanics and ergonomic practices to prevent injury.

The following nurses play a crucial role in maintaining these

protocols;
1. Circulating Nurse:The circulating nurse is a registered nurse
who makes preparations for an operation and continually
monitors the patient and staff during its course, who works in
the operating room outside the sterile field in which the
operation takes place, and who records the progress of the
operation, accounts for the instruments, and handles specimens

. Role and Responsibilities:

- Patient Advocate: Ensures the patient’s safety and comfort before,

during, and after the procedure.

- Preparation: Checks the OR for cleanliness, ensures all equipment is

available and functioning, and sets up the operating room.

- Documentation: Keeps accurate records of the surgery, including

instruments used, time of procedures, and patient vitals.

- Coordination: Works with the surgical team to provide necessary

supplies, equipment, and assistance.

- Monitoring: Observes the surgical field, anticipates needs, and maintains

sterile technique by opening sterile supplies and assisting with gowning
and gloving.

. Key Actions:

- Ensure all consents and paperwork are completed.

- Verify the patient’s identity and surgical site.

- Assist with patient positioning and draping.

- Manage surgical counts (sponges, needles, instruments) to prevent

retained surgical items.

- Communicate with other departments (e.g., pathology, radiology) as

needed.
2. Scrub Nurse/Technician Protocols

. Role and Responsibilities:

- Sterile Field: Maintains the sterility of the surgical field.

- Instrumentation: Sets up surgical instruments and equipment, ensures

they are sterile, and passes them to the surgeon during the procedure.

- Assistance: Provides direct assistance to the surgeon and surgical team.

. Key Actions:

- Perform a surgical scrub and don sterile gown and gloves.

- Arrange instruments in an organized manner for easy access.

- Monitor the sterile field and ensure that all team members adhere to
sterile techniques.

- Count sponges, needles, and instruments before, during, and after

surgery.
 - Handle specimens appropriately, ensuring they are labeled and sent to
the lab as needed.

OTHER ESSENTIAL PROTOCOLS

1. Swabbing Protocols

. Purpose:

- Absorb Fluids: Used to absorb blood, bodily fluids, and irrigation

solutions to keep the surgical field clear.

- Maintain Visibility: Keeps the surgical site visible for the surgeon.

. Key Actions:

- Use sterile swabs or sponges to dab and absorb fluids from the surgical
area.

- Ensure proper technique to avoid contamination of the sterile field.

- Track and count all swabs and sponges used during the procedure to
prevent any from being left

inside the patient.

2. NEEDLE COUNTING PROTOCOL

Needle counting is the process of meticulously accounting for all surgical
needles before, during, and after a surgical procedure to ensure none are
left inside the patient's body.

Purpose: The main objective is to prevent retained surgical items (RSIs),

which can lead to serious complications or infections.
Procedure

- Pre-Procedure Count: A count of all needles and other surgical

instruments is performed before the surgery starts.

- Intra-Procedure Count:This counts are conducted during the surgery

whenever new needles are introduced, at set intervals, or when there is a
shift change among the surgical team.

-Post-Procedure Count: A final count is done before closing the surgical

site to ensure all needles are accounted for.

. Documentation: Every count is carefully documented, including the initial,

any interim counts, and the final count. Any discrepancies must be
immediately addressed and resolved.

Responsibility: The circulating nurse and the scrub nurse or surgical

technologist typically perform and verify the counts.

. Importance: This protocol is essential for patient safety, helping to

prevent RSIs and ensuring the integrity of the surgical process.

3. INSTRUMENTATION

Instrumentation in the operating room involves the preparation, handling,

and management of surgical tools and equipment.

Purpose

- Ensure Sterility: To prevent infections by keeping instruments sterile.

- Facilitate Efficiency: To streamline the surgical procedure with organized
and accessible instruments.

- Maintain Safety: To ensure instruments are functioning correctly and used

appropriately.

Role:

- Preparation: Sterilizing, assembling, and arranging instruments before the

procedure.

- Management: Handling instruments during surgery to maintain sterility

and functionality.

- Post-Procedure: Cleaning, sterilizing, and storing instruments after the

surgery.

Importance:

- Patient Safety: Prevents infections and surgical errors, ensuring patient

safety.

- Operational Efficiency: Contributes to a smoother and more efficient

surgical process.

- Quality of Care: Allows the surgical team to focus on the procedure rather
than dealing with issues related to instruments

Conclusion

Operating room protocols are crucial for ensuring patient safety,

maintaining sterility, and preventing infections. By adhering to protocols for
sterility, infection control, safety checks, needle counting, and
instrumentation, the surgical team effectively manages the operating room
environment. The roles of circulating nurses, scrub nurses, and technicians
are vital in upholding these protocols and ensuring successful surgical
outcomes.