Operating room

In recent days in Kazakhstan huge attention is paid to the quality of treatment in medical and treatment institutions. It goes without saying that an important role in it is played by correct arrangement of work of medical personnel, correct selection of necessary diagnostic operational equipment, implementation of construction and designing Works in a traditional units with strict observation of adequate regulatory documents, observation of route and maintaining all of the set classes of cleanliness of rooms excluding development of internal hospital infections.

LLP Surgicare Kazakhstan leaning on advanced experience of foreign partners and its own experience in implementation of such projects is glad to offer you it's services in equipment and reconstruction of operational units and renovation wards.

Set for equipment of operational room is clean room for direct implementation of operational intervention of various specialization. Requirements to the parameters of air inside premises of the operation room depends on type of the specialization. The major parameters defining the cleanliness of the air inside these premises is number of viable microorganisms and number of mechanical particles of certain size in the unit of the air volume.

The number of units forming colony per one cubic meter of air is a defining factor of risk of infectious contamination of operational wound and, as a consequence, post operational complications after implementation of abdominal surgery.

The number of mechanical particles inside the unit of air volume is a defining factor in successful implementation of operations connected with introduction of different kinds of objects into a human organism - artificial organs, joints, implants of heart.

At the designing recreational rooms, thus, the following factors are taken into consideration:

• Specialization of operational room (defines class of cleanliness of the premise, exchange rate, temperature regime, created pressure - excessive for aseptic and negative for septic operational rooms);
• Area of the Zone covered by laminar flow (it takes into account location of surgery table, instrumental table, surgical light, life-saving apparatus);
• Location of the room in the general planning of premises of the operational unit (it defines the scheme of direction of movement of air flow from cleaner premises into a less clean ones).

At that modern designing of operational units of supply console of medical gases for anesthesiologists- resuscitators are located directly in the operational room and, thus, need for separate room of anesthesiology disappears. This is important to divide the waste of receipt into operational rooms of the patient, surgery team, instrument and auxiliary equipment.

Based on the factors listed above and also the structure of operational unit the necessary configuration of the set of technical equipment for creation of the system of clean rooms of the operational unit is determined. The modern operating room is a clean room of a certain class of cleanliness. Inside operating room the local zone of high cleanliness for creation of effect of air capsulating by sterile conditioning of air in the area of location of surgical table is created. It is achieved by inflow of cleaned air through air dispenser of a large area (up to 9 square meters), built-in ceiling enclosing structure above the operating table.

Inside the clean room of the operating room the whole set of measures on excluding occurrence, accumulation and keeping of pollution in the form of microorganisms or mechanical particles is carried out.

• Air Exchange in 400-600 1/hour inside the zone of operating table guarantees removal of aerosol emissions beyond the zone of location of surgery table;
• Absence of turbulence of the flow provides fencing of the patient from the operating team and hinders penetration of microorganisms into wound surface which creates minimal danger of contamination of the operating wound;
• High pressure in aseptic operating room (or low pressure in the room of septic operating room) in relation to adjacent premises, rational arrangement of air flows from cleaner rooms into less clean ones exclude hit of pollution into critical zone of aseptic operating room (or removal of pollution from septic operating room).

Use of these measures guaranteed to provide significant reduction of the level of internal hospital infection and, as a consequence, reduction of the level of post-operational complications.

Conditioned air supply to the premises of the medical and treatment institutions equipped with the above-mentioned sets creates comfortable environment for medical personnel which positively affect the quality of the medical process.

Construction norms and rules of the Republic of Kazakhstan at designing the operating units:

1. The structure of the premises of both general profile and special operating blocks includes septic and aseptic departments (operating rooms with auxiliary and service rooms). At that the auxiliary premises of the operating unit are planned separately for aseptic operating room and separately for septic operating room.
2. At the creation of specialized operating units the cases when there are only aseptic departments (neurosurgery, cardio surgery etc.) in the operating unit may occur. By the sign of availability of one department (aseptic) or two departments (aseptic and septic) operating units are divided into aseptic and combined.
3. The number of operating rooms in the operational unit depends on the structure, size and profile of surgery departments, surgery activity, complexity and duration of surgeries, time of the patient's treatment at the hospital, number of operating days etc. Number of the operating rooms in central district and inter-district hospitals, in rural areas and in the municipal district hospitals should be considered: one operating room for every 30 beds of surgery profile and 25 beds in hospitals of emergency help. In specialized department of surgery profile at consideration of the number of operating rooms it is important to take into account profile of departments. Number of operating rooms in regional and clinical hospitals is defined in each certain case task for design.
4. Operating rooms, as a rule, are designed for one operating table.
5. The number of operating tables and the type of operating rooms in specialized operating unit depend on the type and potential of the structural sub-departments of hospitals and are determined by the task for designing.
6. The number of operating rooms in septic department of the operating unit is taken depending on the local conditions (number of beds with purulent pathology). In the operating units of the general profile hospitals the approximate proportion of septic and aseptic operating rooms must be 1: 3, but not less than one septic operating room for operating unit.
7. At number of operating rooms more than 6 it is recommended to provide control post.
8. Architectural and planning solution of the operating block must provide division of it into non-passing aseptic and septic departments and rational zoning of its premises according to functional division into the following zones: sterile, strict, limited and general hospital regimes.

Sterile zone includes the premises of the operating units.

The area of strict regime includes the premises:

• Training of the personnel to operations consisting of preliminary operating and wardrobe personnel for special and working clothes;
• Preparation of the patient to operation consisting of premises of preparation of the patient to the operation or anesthetic room;
• For placing the machines and equipment designed for life support of patients consisting of premises for machines of extracorporeal circulation and the hypothermia machine;
• Post-operating wards consisting of wards and premises (posts) of nurse on duty;
• Auxiliary purpose including gateway at the entry to the operating room (at absence of the anesthetic room).

Area of limited regime includes the premises:

• For Preparation to the operation of the instruments and equipment - sterilizing and centralized preliminary sterilizing room of the operating unit, instrumental and material, for disassembly and washing of the instruments, disinfection of anesthetic and breathing machine;
• The personnel - a room of surgeons, protocol, room of the anesthesiologist, a room of medical nurses-anesthesiologists and the room of the junior personnel;
• Auxiliary purpose including gateways at the entrance to septic and aseptic department, room of central remote control of monitor system for observation of patients condition, gypsum, for service of post operational wards (washing and disinfecting bedpans, washing and drying of oilclothes and other);
• Warehouse purpose - for keeping blood, movable x-ray apparatus, anesthesia storeroom, for preparation of disinfecting solution and keeping disinfectants, for temporary storage of gurneys.

Area of General hospital regime includes premises:

• For personnel - room of the head of the department, room of a senior medical nurse, room of personal hygiene of the personnel with the shower;
• Warehouse purpose - cleaning tools storeroom, gypsum storage store room.

9. The number of beds in post operational wards should be provided according to the norm - two beds for one operation room. At availability of departments of anesthesiology and resuscitation, resuscitation and intensive therapy post operating wards are not provided, and their number is considered in the number of beds of the department of anesthesiology and reanimation.
10. The number of auxiliary premises, rooms of relaxation of medical personnel, sanitary passing and hand washers must be in accordance with the requirements of the sanitary and epidemiological requirements to the object of healthcare.
11. In the department, as a rule, it is important to provide rooms for local conditioners, area of which is defined by the equipment setting.
12. For elimination of the possibility of receipt of air masses from the ward departments, staircase and elevator halls and other premises into operating unit it is important to arrange gateways with air overpressure between the said premises and the operating unit.
13. The most rational is the room of operating unit within the separate medical and diagnostic block directly adjacent to the ward block or connected with it by warmed passing. Placement of the operating unit on the upper floor of the ward block is allowed. The operating room for emergency surgeries at the registry department must be planned in all hospitals on the first floor. All operating rooms must be equipped with machines of pneumatic delivery to sub-units of clinical and diagnostic laboratories and vice versa. For implementation of surgeries on emergency help in multi-profile hospitals it is important to provide additional operating rooms on duty.
14. Post operating wards are recommended to be placed in the separate isolated block at the operating unit or within the department of anesthesiology and resuscitation, or isolated within the ward surgery d
15. The structure and the potential of the rooms of operating units depend on the type and number of beds of the hospital, potential and structure of its subunits.
16. The areas of the premises of the operating unit must be provided taking into account the requirements of the sanitary rules of sanitary and epidemiological requirements to the object of healthcare.