POPE 4023 OPERATING ROOM

POPE 4023
THE PERIOPERATIVE ENVIRONMENT

OPERATION ROOM

SITI ZAIRINI AHMAD
ILKKM KUBANG KERIAN

LEARNING OBJECTIVES

AT THE END OF THIS SESSION, STUDENTS WILL
BE ABLE TO

• EXPLAIN CATEGORIES OF OPERATING
ROOM

• EXPLAIN VENTILATION SYSTEM IN
OPERATING ROOM

• DESCRIBE CHARACTERISTIC AND
STRUCTURE OF OPERATING ROOM

OPERATION THEATRE (OT)

Operating room means a room used
for the performance of surgical
procedures requiring one or more
incisions and that is required to
comply with all applicable licensure
codes and standards for an operating
room.

150 SQUARE
FEET MINIMUM
CLEAR FLOOR
AREA

PROCEDURE 12 FOOT 3' -6" CLEARANCE AT
ROOM MINIMUM CLEAR BOTH SIDES, THE FOOT
DIMENSION AND THE HEAD OF THE
CLASS A OPERATIO-NG TABLE

SURGICAL PROCEDURE
PERFORMED UNDER TOPICAL
AND LOCAL INFILTRATION
BLOCKS WITH OR WITHOUT
ORAL OR INTRAMUSCULAR
PREOPERATIVE SEDATION

250 - 400 SQUARE
FEET MINIMUM
CLEAR FLOOR
AREA

GENERAL 15 - 18 FOOT 3' -6" CLEARANCE AT
OR MINIMUM CLEAR BOTH SIDES, THE FOOT
DIMENSION AND THE HEAD OF THE
CLASS B OPERATIO-NG TABLE

MINOR OR MAJOR SURGICAL
PROCEDURE PERFORMED IN
CONJUNCTION WITH ORAL,
PARENTERAL OR INTRAVENOUS
SEDATION OR UNDER ANALGESIC
OR DISSOCIATIVE DRUGS

600 - 650 SQUARE
FEET MINIMUM
CLEAR FLOOR
AREA

OTHER ORs 24 - 25 FOOT 4' -0" CLEARANCE AT
MINIMUM CLEAR BOTH SIDES, THE FOOT
CLASS C DIMENSION AND THE HEAD OF THE
OPERATION TABLE

PROVIDES FOR MAJOR
SURGICAL PROCEDURES THAT
REQUIRE GENERAL OR
REGIONAL BLOCK ANESTHESIA
AND SUPPORT OF VITAL BODILY
FUNCTIONS

VENTILATION SYSTEM IN OPERATION ROOM

Must ensure a controlled The primary concerns for ACH are important
supply of filtered air under flow of ventilation include concerns based on
how the air is distributed,
positive pressure filtered, and exhausted. the size of the
individual OR.

Fifteen ACH with three General ORs and cesarean .†A gas scavenger
exchanges of outside air delivery suites require 20 system is used to
ACH with four OA exchanges prevent the buildup
(OA; 15:3) are of waste anesthetic
recommended for (20:4) gases where general
procedure rooms.
inhalation
Various types of scavengers, vacuum systems, and smoke anesthesia is used.
evacuators are used throughout the OR to minimize air pollutants

that are health risks for patients and perioperative team
members.

VENTILATION SYSTEM IN
OPERATION ROOM

PLENUM
AIRFLOW
SYSTEM

LAMINAR
AIRFLOW

PLENUM AIRFLOW SYSTEM

Plenum is a section of an • Often used in large commercial
HVAC systems buildings and factories to help
improve air quality and reduce
Through a plenum, the air is energy costs
• Pushed into the
ductwork • Has 2 types of plenums in an HVAC
• Distributed throughout system
the system ⚬ Supply Plenum
• When necessary, the air ⚬ Return Plenum
is removed

SUPPLY PLENUM RETURN PLENUM

• Is a box that located at a low • The return plenum box is the air’s
point in your building, can be second stop, and it is connected to
either inside or outside and is the return outlet of heat pump,
typically made of cast iron, furnace, or AC.
steel, or aluminum with louvers.
• It receives air from your system’s
• Used to distribute fresh air into return vents, heats or cools it, then
a building or exhaust the returns it for redistribution through
unclean air same ductwork and continues on
its way through the house to be
• Allow exchange of fresh air and reheated by another segment of
exhaust air in an efficient, your HVAC system.
controlled manner
• Is fitted with an air filter to ensure
that the air that gets sucked back
into the system is clean and safe.

• This can happen as frequently as
once per day.

BENEFITS OF USING A PLENUM IN HVAC

Reducing Noise
Levels

Improve Airflow
Cooling Purpose
Protecting the
System Against Dirt

LAMINAR AIRFLOW SYSTEM

• Ultraclean laminar airflow is • It is designed to flow
installed in some ORs to uninterrupted from the
combat airborne particulate cleanest area to the less clean
contamination by providing area into air return grilles in
70 to 160 ACH. the lower sidewalls.

• Laminar airflow is a high- • Cool air from the laminar
pressure, unidirectional air- diffuser travels more quickly
moving diffuser housed in a than isothermic air -
cluster in a wall or ceiling hypothermic effect.
enclosure.

HORIZONTAL AIRFLOW VERTICAL AIRFLOW

• Passes from the wall diffuser to • Vertical downward airflow is
an opposite lower return grille. designed to flow from the top of the
room, over the patient, lights, and
• Objects in the air pathway shed equipment, and continue downward
particulate into the clean forming a canopy toward the lower
airstream. corners of the room where the air
return grilles are located.

TYPES OF VERTICAL LAMINAR FLOW

STANDARD VERTICAL AIR CURTAINED PHYSICAL CURTAINED
LAMINAR FLOW VERTICAL FLOW VERTICAL FLOW

Provides a narrow Uses a peripheral secondary Uses air foils hanging from
boundary of operating airflow at a higher velocity to the ceiling on four sides to
space that begins at the widen and frame the primary
ceiling and interfaces with laminar flow from the ceiling maintain the downward
the field, personnel, and direction of airflow. The air
ambient room air before it to the lower pressure air
is exhausted through air return grilles in the base of funnels down toward the
field, flowing around and
return grilles. the walls.
behind the team.

OBSTACLES TO LAMINAR AIRFLOW
EFFECTIVENESS

Objects that pass between the flow of clean air and the sterile field around
the patient shed particles that can contaminate the surgical site. Heat
emanating and rising from the team members, the patient, and
equipment—referred to as thermal plume— changes the course of the
laminar flow. Several physical barriers and events that interrupt airflow and
return include the following:

• Spotlights over the field
• Ceiling booms with surgical machinery and equipment
• Mayo stands over the patient
• Microscopes, articulated laser arm, and C-arm
• Personnel and patient thermal plume
• Opening and closing the OR door (sliding and swinging doors;

proportionately higher with swinging doors)

OPERATING ROOM TEMPERATURE

Should be
maintained between
20° C to 24° C

Can be adjusted -
pediatric, geriatric &
burn patients

Should not be adjusted
solely - team member
comfort

Only maintenance
can adjust - call early

OPERATING ROOM HUMIDITY

Should be
maintained between
20% to 60%

Humidity = weight of
water vapor present

Moisture provides
conductive medium and
allow a static charge

70% can permit
condensation inside
sterile packaging

CHARACTERISTIC AND STRUCTURE OF
OPERATING ROOM

SUBSTERILE PIPED-IN MONITORING
ROOM GASES SCREENS
DOORS COMPUTER
RADIOGRAPH
FLOORS LINES SCREENS
WALLS AND ELECTRICAL CLOCKS

CEILING SYSTEMS CABINETS OR
LIGHTING CARTS

CHARACTERISTIC AND STRUCTURE OF
OPERATING ROOM

FURNITURE AND CLOSED-
OTHER EQUIPMENT CIRCUIT TV
COMPUTER
COMMUNICATION
SYSTEM
VOICE

INTERCOM
CALL-LIGHT

SYSTEM

THANK YOU...