POPE 4023 TRANSITION ZONES & PERIPHERAL SUPPORT AREAS

TRANSITION ZONES &
PERIPHERAL SUPPORT
AREAS

SITI ZAIRINI AHMAD
ILKKM KUBANG KERIAN

LEARNING AT THE END OF THIS LEARNING
OBJECTIVES SESSION, THE STUDENT WILL BE ABLE
TO

01 DESCRIIBE PHYSICAL LAYOUT AND
FACILITIES OF THE TRANSITION
ZONES

02 DESCRIIBE PHYSICAL LAYOUT AND
FACILITIES OF THE PERIPHERAL
SUPPORT AREAS

CONTENTS TRANSITION ZONES

01 02 03 04

PERIOPERATIVE HOLDING AREA INDUCTION ROOM POST ANAESTHESIA
ADMISSION CARE UNIT

PERIPHERAL SUPPORT AREAS

05 06 07 08

CENTRAL OFFICES LOCKER ROOMS CONFERENCE / CLASS
CONTROL DESK AND LOUNGES ROOM

09 10 11 12

SUPPORT SERVICE WORK AND STORAGE AREAS SCRUB ROOM
STORAGE AREAS

TRANSITION "Inside the entrance to the surgical suite,
ZONES separates the semirestricted OR corridors
from the rest of the facility"

• Both patients and personnel enter the
semirestricted and restricted areas of the
surgical suite through a transition zone.

• Masks, caps, shoe covers, and cover
gowns (or jumpsuits) may be located on a
cart near transition zones adjacent to
restricted areas.

• Nonsurgical personnel who need to enter
the restricted zone can don a covergown
or jumpsuit, cap, shoe covers, and mask
before proceeding to the designated OR.

01 PERIOPERATIVE ADMISSION
• Unrestricted zone
• Preoperative patients to change from street clothes into a gown
• Waiting area before surgical procedure
• Lockers should be provided for safeguarding patient clothing
• Lavatory facilities and handwashing or alcohol-based hand-rub
dispenser stations must be available
• Alcohol-based hand-rub dispensers should be conveniently located
in each patient care cubicle
• The area must ensure privacy and should shield the patient and
family from potentially distressing sights and sounds
• Should offer 80 ft2 per patient of space to accommodate a
transport cart.

• Insertion of intravenous (IV) lines and, 02 HOLDING AREA
nerve blockades for pain management
may be done in the holding area

• Must have good lighting
• Each cubicle is equipped with oxygen,

suction, and devices for monitoring
blood pressure.
• A crash cart should be easily accessible
for emergencies.
• A nurses’ station within the area
provides close patient observation and
dispensers for medication storage.
• Computer access to patient electronic
medical records
• Care is taken not to have loud
conversations at the nurses’ station.
Private information may be overheard
by patients and families.

03 INDUCTION ROOM

• Are located within the restricted area
adjacent to a group of ORs

• Where the patient is prepared for
anesthesia administration, before
actual induction of GA and airway
management.

• Families of patients are not permitted
• Appropriate surgical attire is required, including a mask.
• Procedures like peripheral IV lines, central lines, invasive

arterial monitoring lines, regional anesthesia are perform
here to saves actual OR time.
• Patients are premedicated and stabilized on the same
OR bed that will be used for the procedure.

04 POST ANAESTHESIA CARE UNIT (PACU)

• PACU may be located outside the surgical suite, or it may be
adjacent to the suite so that it may be incorporated into the
unrestricted area with access from both the semirestricted area and
an unrestricted corridor.

• PACU becomes a transition zone for the departure of patients.
• Space allotted should equal a minimum of 1.5 beds per OR.

• May have waiting area and/or small
private conference rooms where the
surgeon can meet with families
postoperatively

• Some facilities permit certain family
members to sit with recovering
patients when they are stable, but not
ready for release.

PERIPHERAL "Inside the entrance to the surgical
SUPPORT AREAS suite, separates the semirestricted
OR corridors from the rest of the
facility"

• Both patients and personnel enter the
semirestricted and restricted areas of the
surgical suite through a transition zone.

• Masks, caps, shoe covers, and cover
gowns (or jumpsuits) may be located on a
cart near transition zones adjacent to
restricted areas.

• Nonsurgical personnel who need to enter
the restricted zone can don a covergown
or jumpsuit, cap, shoe covers, and mask
before proceeding to the designated OR.

05 CONTROL DESK

• Team Leader - to coordinate communications and control
• Observe and control traffic in and out of the surgical suite
• This area usually is within the unrestricted area but adjacent to the semirestricted corridor.
• A computerized pneumatic tube system within the hospital can speed the delivery of

small items and paperwork
• Computers and printers may be located in the control area. Information systems and

computers assist in financial management, statistical recording and analysis, scheduling of
patients and personnel, materials management, and other functions that evaluate the use
of facilities. An integrated computer system interfaces with other hospital departments,
such as the laboratory, pathology, or patient care division. It may have an intranet
connection that allows surgeons to schedule surgical procedures directly from their offices
• Security systems is monitored from control desk.
• DDA
• Access to exchange areas, offices, and storage areas may be limited during evening and
night hours and on weekends.

06 OFFICE

• Offices for the administrative patient
care personnel and the anesthesia
department should be located with
access to both unrestricted and
semirestricted areas.

• Most administrative offices are
located near the control desk.

• The administration staff frequently
needs to confer with outside people
(sale representatives) and needs to
be kept informed of activities within
all areas of the surgical suite

07 LOCKER ROOMS AND LOUNGES

• Changing rooms with secure lockers, allow OT personnel to change from
street clothes into OR attire before entering the semirestricted area, and
vice versa.

• The area should be secure from unauthorized personnel.
• Doors separate this area from lavatory facilities and adjacent lounges.
• Walls in the lounge areas should have an aesthetically pleasing color and

window view of the outdoors is psychologically desirable
• Refrigerator only for food should be located in this room.
• Antiseptic hand-rub dispensers should be conveniently located at the

entrance and near all food storage areas.
• Dictating equipment, computers, and telephones should be available for

surgeons in the physicians’ lounge or in an adjacent semirestricted area.

• Located within the semirestricted 08 CONFERENCE
area with entrance/exit doors to ROOM
unrestricted areas.

• Used for staff inservice educational
programs and is used by the
surgical staff for teaching.

• Tables and chairs for staff should
be sturdy and easily cleanable.

• Shoe covers and masks should not
be worn in this room.

• Antiseptic hand-rub dispensers
should be conveniently located at
the entrance.

• Departmental holiday parties or
special event celebrations may be
set up in here.

09 SUPPORT SERVICES RADIOLOGY SERVICES

LABORATORY

• Small laboratory for tissue • Special procedure rooms may be
examination and Fresh Frozen outfitted with x-ray and other
Sections procedures imaging equipment for
diagnostic and invasive radiologic
• A designated refrigator for procedures
storing blood for transfusion • The walls of these rooms contain
and Fresh Frozen Section lead shields to confine radiation.
tissue • A darkroom for processing x-ray

films

10 WORK AND STORAGE AREA

ANAESTHESIA WORK AND HOUSEKEEPING STORAGE
STORAGE AREAS AREA

• Storing anesthesia equipment and • Cleaning supplies and equipment
supplies need to be stored; the equipment
used within the restricted area is kept
• Gas tanks a stored in a well-ventilated separate from that used to clean the
(a minimum of 8 air exchanges per other areas.
hour)
• The ventilation is set to negative
• Clean and dirty, sterile and non-sterile pressure with 10 air exchanges per
supplies must be separated hour.

• DDA cupboard and key

10 WORK AND STORAGE AREA

CENTRAL PROCESSING UTILITY ROOM
AREA

• Conveyors, dumbwaiters, or elevators • Some hospitals use a closed-cart
• The movement of clean and sterile system and take contaminated
instruments to a central area outside
supplies must be kept separate from the surgical suite for cleanup.
that of contaminated items and
waste • This room contains a washer-
• The ventilation is set to positive sterilizer, sinks, cabinets, and all
pressure with 4 air exchanges per necessary aids for cleaning.
hour with two fresh.
• Small window

10 WORK AND STORAGE AREA

GENERAL WORKROOM • Should be as centrally located in the
surgical suite as possible to keep
contamination to a minimum.

• May be divided into a cleaning area and a
preparation area.

• An ultrasonic cleaner should be available
here for cleaning instruments that the
washer-sterilizer has not adequately
cleaned.

• Instrument sets, basin sets, trays, and
other supplies are wrapped for
sterilization here.

• Internal biologic and external chemical
indicators are used.

• This room also contains the stock supply
of other items that are packaged for
sterilization.

• The sterilizers that are used in this room
may open also into the next room, the
sterile supply room.

11 STORAGE INSTRUMENT ROOM

STERILE SUPPLY ROOM • Contain cupboard to store all
clean and decontaminated
• Should close as possible to the instruments
sterile processing area
• Segregated according surgical
• Under positive pressure with 4 specialty
total air exchange per hour
with 2 exchange s of fresh air • Some surgeon have their own
specialty set / tray - label their
• Access is limited; should be name
separated from high-traffic
area

• Doors should be closed all time
• Humidity (20% to 60%)
• Temperature (22° C to 26° C)

12 SCRUB ROOM

• An enclosed area for preoperative
cleansing of hands and arms

• Skid-proof mats should be in place in
front of each scrub sink.

• Paper towel dispensers and mirrors
should be located in this area.

• Trash receptacles, limited to only those items used within
this room, should be emptied several times per day.

• Some facilities have boxes of additional caps, masks, shoe
covers, and eye protection in the event of biologic
contamination requiring a change of these items during a
procedure.

• The contaminated item should be discarded in the
biohazard trash bin in the OR after changing.

THANK
YOU