Operating theater

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Inside a modern operating room Operating theatre.jpg
Inside a modern operating room

An operating theater (also known as an operating room (OR), operating suite, or operation suite) is a facility within a hospital where surgical operations are carried out in an aseptic environment.

Contents

Historically, the term "operating theatre" referred to a non-sterile, tiered theater or amphitheater in which students and other spectators could watch surgeons perform surgery. Contemporary operating rooms are devoid of a theatre setting, making the term "operating theater" a misnomer.

Operating rooms

Operating rooms are spacious, easy to clean 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 theatres 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. [1]

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(s), 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.

Temperature and surgical site infections (SSI). The current operating room design temperature is between 65 and 75 °F (18 and 24 °C). [2] [3] Operating rooms are typically kept below 73.4 °F (23 °C) & room temperature is the most critical factor in influencing heat loss. [4] Surgeons wear multiple layers (surgical gowns, lead aprons) and may perspire into an incision if not kept cool and may decrease concentration and increase errors. [4] Higher temperatures increased subjective physical demand and frustration of the surgical staff. [2] One option is to heat the patient to prevent surgical site infections (SSI) and keep the surgical team cool. There is a 3 fold increase in infection for every 1.9 degree Celsius body temperature decrease [5] and radiation is the major cause of heat loss in patients, and convection (through air) is the second cause of heat loss. [6] In the first hour it is common for healthy patient’s temp decrease 0.5-1.5 °C as anesthesia causes rapid decrease in core temperature. [6] One study found that the most efficient method of maintaining normothermia included using warm wraps and a heating blanket (commercially known as a Bair Hugger) [6]. Additionally, pre-warming for thirty minutes may prevent hypothermia. [4]

Operating room equipment

Sala de Cirurgia Hospital de Estancia.jpg
Hybrid operating room for cardiovascular surgery at Gemelli Hospital in Rome Hybrid operating theatre gemelli rome.jpg
Hybrid operating room for cardiovascular surgery at Gemelli Hospital in Rome

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:

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.

History

The Agnew Clinic, 1889, by Thomas Eakins, showing the tiered arrangement of observers watching the operation. The Agnew Clinic - Thomas Eakins.jpg
The Agnew Clinic , 1889, by Thomas Eakins, showing the tiered arrangement of observers watching the operation.
An operating room in the United States, c. 1960. Heart-Lung Machine with rotating disc oxygenator Hospital Operating Room (FDA 042) (8250274128).jpg
An operating room in the United States, c. 1960. Heart-Lung Machine with rotating disc oxygenator

Early operating theatres 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.[ citation needed ]

The University of Padua houses the oldest surviving permanent anatomical theatre in Europe, dating from 1595, it was used as an anatomical lecture hall where professors operated only on corpses. Theatre-anatomique-Padoue.JPG
The University of Padua houses the oldest surviving permanent anatomical theatre in Europe, dating from 1595, it was used as an anatomical lecture hall where professors operated only on corpses.

The University of Padua began teaching medicine in 1222. It played a leading role in the identification and treatment of diseases and ailments, specializing in autopsies and the inner workings of the body. [7] In 1884 German surgeon Gustav Neuber implemented a comprehensive set of restrictions to ensure sterilization and aseptic operating conditions through the use of gowns, caps, and shoe covers, all of which were cleansed in his newly invented autoclave. [8] In 1885 he designed and built a private hospital in the woods where the walls, floors and hands, arms and faces of staff were washed with mercuric chloride, instruments were made with flat surfaces and the shelving was easy-to-clean glass. Neuber also introduced separate operating theaters for infected and uninfected patients and the use of heated and filtered air in the theater to eliminate germs. [9] In 1890 surgical gloves were introduced to the practice of medicine by William Halsted. [10] Aseptic surgery was pioneered in the United States by Charles McBurney. [11]

Surviving operating theaters

Old Operating Theatre in London Old Operating Theatre.jpg
Old Operating Theatre in London

The oldest surviving operating theater is thought to be the 1804 operating theatre 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. Built in 1822, it is now a museum of surgical history. The 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 1594.

See also

Related Research Articles

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Ether Dome United States historic place

The Ether Dome is a surgical operating amphitheater in the Bulfinch Building at Massachusetts General Hospital in Boston. It served as the hospital's operating room from its opening in 1821 until 1867. It was the site of the first public demonstration of the use of inhaled ether as a surgical anesthetic on October 16, 1846, otherwise known as Ether Day. Crawford Long, a surgeon in Georgia, had previously administered sulfuric ether in 1842, but this went unpublished until 1849. The Ether Dome event occurred when William Thomas Green Morton, a local dentist, used ether to anesthetize Edward Gilbert Abbott. John Collins Warren, the first dean of Harvard Medical School, then painlessly removed part of a tumor from Abbott's neck. After Warren had finished, and Abbott regained consciousness, Warren asked the patient how he felt. Reportedly, Abbott said, "Feels as if my neck's been scratched". Warren then turned to his medical audience and uttered "Gentlemen, this is no Humbug". This was presumably a reference to the unsuccessful demonstration of nitrous oxide anesthesia by Horace Wells in the same theater the previous year, which was ended by cries of "Humbug!" after the patient groaned with pain.

Perioperative mortality has been defined as any death, regardless of cause, occurring within 30 days after surgery in or out of the hospital. Globally, 4.2 million people are estimated to die within 30 days of surgery each year. An important consideration in the decision to perform any surgical procedure is to weigh the benefits against the risks. Anesthesiologists and surgeons employ various methods in assessing whether a patient is in optimal condition from a medical standpoint prior to undertaking surgery, and various statistical tools are available. ASA score is the most well known of these.

Surgical technologist Profession

A surgical technologist, also called a scrub, scrub tech, surgical technician, or operating room technician, is an allied health professional working as a part of the team delivering surgical care. Surgical technologists are members of the surgical team. The members of the team include the surgeon, surgeon's assistant, circulator nurse and anesthesia provider. They possess knowledge and skills in sterile and aseptic techniques. There are few mandatory professional requirements for surgical technologists, and the scope of practice varies widely across countries and jurisdictions. Surgical technologists attend junior colleges and technical schools, and many are trained in military schools. In the military they perform the duties of both the circulator and the scrub. The goal is for surgical technologists to be able to anticipate the next move the surgeon is going to make in order to make the procedure as smooth and efficient as possible. They do this by having knowledge of hundreds of surgical procedures and the steps the surgeon needs to take in order to complete the procedure, including the very wide range of surgical instruments they may need. Specialties can include, but are not limited to, the following: genitourinary, obstetrics and gynaecology, urology, ENT, plastics, general, orthopedics, neurology, and cardiovascular. They only work in surgical or perioperative areas and are highly specialized.

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Asepsis

Asepsis is the state of being free from disease-causing micro-organisms. There are two categories of asepsis: medical and surgical. The modern day notion of asepsis is derived from the older antiseptic techniques, a shift initiated by different individuals in the 19th century who introduced practices such as the sterilizing of surgical tools and the wearing of surgical gloves during operations. The goal of asepsis is to eliminate infection, not to achieve sterility. Ideally, a surgical field is sterile, meaning it is free of all biological contaminants, not just those that can cause disease, putrefaction, or fermentation. Even in an aseptic state, a condition of sterile inflammation may develop. The term often refers to those practices used to promote or induce asepsis in an operative field of surgery or medicine to prevent infection.

A post-anesthesia care unit, often abbreviated PACU and sometimes referred to as post-anesthesia recovery or PAR, or simply Recovery is a vital part of hospitals, ambulatory care centers, and other medical facilities. It is an area, normally attached to operating room suites, designed to provide care for patients recovering from general anesthesia, regional anesthesia, or local anesthesia.

The perioperative period is the time period of a patient's surgical procedure. It commonly includes ward admission, anesthesia, surgery, and recovery. Perioperative may refer to the three phases of surgery: preoperative, intraoperative, and postoperative, though it is a term most often used for the first and third of these only - a term which is often specifically utilized to imply 'around' the time of the surgery. The primary concern of perioperative care is to provide better conditions for patients before operation and after operation.

Deep hypothermic circulatory arrest (DHCA) is a surgical technique that induces deep medical hypothermia. It involves cooling the body to temperatures between 20 °C (68 °F) to 25 °C (77 °F), and stopping blood circulation and brain function for up to one hour. It is used when blood circulation to the brain must be stopped because of delicate surgery within the brain, or because of surgery on large blood vessels that lead to or from the brain. DHCA is used to provide a better visual field during surgery due to the cessation of blood flow. DHCA is a form of carefully managed clinical death in which heartbeat and all brain activity cease.

A surgical nurse, also referred to as a theatre nurse or scrub nurse, specializes in perioperative care, providing care to patients before, during and after surgery. To become a theatre nurse, Registered Nurses or Enrolled Nurses must complete extra training. There are different speciality areas that theatre nurses can focus in depending on which areas they are interested in.

Operating room management

Operating room management is the science of how to run an operating room suite. Operational operating room management focuses on maximizing operational efficiency at the facility, i.e. to maximize the number of surgical cases that can be done on a given day while minimizing the required resources and related costs. For example, what is the number of required anaesthetists or the scrub nurses that are needed next week to accommodate the expected workload or how can we minimize the cost of drugs used in the Operating Room? Strategic operating room management deals with long-term decision-making. For example, is it profitable to add two additional rooms to the existing facility? Typically, operating room management in profit-oriented health-care systems emphasizes strategic thinking whereas in countries with publicly funded health care, the focus is on operational decisions.

Scrubs (clothing)

Scrubs are the sanitary clothing worn by surgeons, nurses, physicians and other workers involved in patient care in hospitals. Originally designed for use by surgeons and other operating room personnel, who would put them on when sterilizing themselves, or "scrubbing in", before surgery, they are now worn by many hospital personnel. Their use has been extended outside hospitals as well, to work environments where clothing may come into contact with infectious agents. Scrubs are designed to be simple, easy to launder, and cheap to replace if damaged or stained irreparably. In the United Kingdom, scrubs are sometimes known as theatre blues.

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Perioperative nursing is a nursing specialty that works with patients who are having operative or other invasive procedures. Perioperative nurses work closely with surgeons, anaesthesiologists, nurse anaesthetists, surgical technologists, and nurse practitioners. They perform preoperative, intraoperative, and postoperative care primarily in the operating theatre.

Hybrid operating room

A hybrid operating room is a surgical theatre that is equipped with advanced medical imaging devices such as fixed C-Arms, X-ray computed tomography (CT) scanners or magnetic resonance imaging (MRI) scanners. These imaging devices enable minimally-invasive surgery. Minimally-invasive surgery is intended to be less traumatic for the patient and minimize incisions on the patient and perform surgery procedure through one or several small cuts.

Central sterile services department

The central sterile services department (CSSD), also called sterile processing department (SPD), sterile processing, central supply department (CSD), or central supply, is an integrated place in hospitals and other health care facilities that performs sterilization and other actions on medical devices, equipment and consumables; for subsequent use by health workers in the operating theatre of the hospital and also for other aseptic procedures, e.g. catheterization, wound stitching and bandaging in a medical, surgical, maternity or paediatric ward.

Surgical humidification is the conditioning of insufflation gas with water vapour (humidity) and heat during surgery. Surgical humidification is used to reduce the risk of tissue drying and evaporative cooling.

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References

  1. "Operating Theatres | ModuleCo | Manufactured for Life". ModuleCo. Retrieved 2021-06-10.
  2. 1 2 Hakim, Mumin; Walia, Hina; Dellinger, Heather L.; Balaban, Onur; Saadat, Haleh; Kirschner, Richard E.; Tobias, Joseph D.; Raman, Vidya T. (2018-04-06). "The Effect of Operating Room Temperature on the Performance of Clinical and Cognitive Tasks". Pediatric Quality & Safety. 3 (2): e069. doi:10.1097/pq9.0000000000000069. ISSN   2472-0054. PMC   6132757 . PMID   30280125.
  3. ANSI/ASHRAE/ASHE Addendum h to Standard 170-2008. (2011). Ventilation of Health Care Facilities. Retrieved from https://www.fgiguidelines.org/wp-content/uploads/2015/07/ASHRAE170ad_h.pdf
  4. 1 2 3 Hart, Stuart R.; Bordes, Brianne; Hart, Jennifer; Corsino, Daniel; Harmon, Donald (2011). "Unintended Perioperative Hypothermia". The Ochsner Journal. 11 (3): 259–270. ISSN   1524-5012. PMC   3179201 . PMID   21960760.
  5. Reynolds, Luke; Beckmann, James; Kurz, Andrea (December 2008). "Perioperative complications of hypothermia". Best Practice & Research. Clinical Anaesthesiology. 22 (4): 645–657. doi:10.1016/j.bpa.2008.07.005. ISSN   1521-6896. PMID   19137808.
  6. 1 2 Rosenberger, Laura H.; Politano, Amani D.; Sawyer, Robert G. (June 2011). "The Surgical Care Improvement Project and Prevention of Post-Operative Infection, Including Surgical Site Infection". Surgical Infections. 12 (3): 163–168. doi:10.1089/sur.2010.083. ISSN   1096-2964. PMC   4702424 . PMID   21767148.
  7. Jerome J. Bylebyl, "The School of Padua: humanistic medicine in the 16th century," in Charles Webster, ed., Health, Medicine and Mortality in the Sixteenth Century (1979) ch10
  8. Deysine, M (2003). Hernia infections: pathophysiology, diagnosis, treatment, prevention. Informa Health Care. pp.  13. ISBN   0-8247-4612-0.
  9. Bishop, WJ (1995). The Early history of surgery. Barnes & Noble. pp.  169. ISBN   1-56619-798-8.
  10. Porter, R (2001). The Cambridge illustrated history of medicine. Cambridge University Press. pp.  376. ISBN   0-521-00252-4.
  11. Gross, E (1990). This day in American history. Verlag für die Deutsche Wirtschaft. pp.  61. ISBN   1-55570-046-2.
  12. "Pennsylvania Hospital History: Virtual Tour - Surgical Amphitheatre". www.uphs.upenn.edu.