Operating Room Management: Types and Procedure

Introduction

The operating room is the room in which the operation or surgical procedures are performed. Therefore, maintaining the operating room is essential for hygiene purposes, better convenience and efficiency of the working staff. In addition, good management and maintenance of the operating room can maximize the number of operations in the operating room with positive outcomes.

What Is an Operating Room?

The operating room is a particular room in the hospital where life-saving and other surgical procedures are performed on patients under aseptic (free from infection) conditions and under close supervision of medical staff. It is a place where important decisions concerning the surgery and the patient are being carried between the surgeon, anesthetist, nurse, and the technicians. It has a controlled environment to promote the patient's healing with safety and comfort.

What Is Operating Room Management?

Operating room management deals with how the operating room is being managed to maximize the efficiency of the facility and the number of cases on a particular day. The operating room is a profitable room in the hospital that is popular because surgeries are performed there; thus, the operating room management plays a keen role in developing hospital and surgical outcomes. So, operating room management is a crucial step to accomplishing the goals of the operating room. The goals of the operating room are:

• Ensuring patient safety and outcomes.

• Better access to the patient and the surgical sites.

• Increases the efficiency of the operating room materials with better utilization.

• Reduce patient surgery delays.

• Ensure satisfaction in patients and staff.

What Is the Necessity of Operating Room Management?

Operating room management is necessary because it protects the staff and the patient from any infections caused by previously done surgeries in the operating room.

What Are the Zones of the Operating Room?

There are four zones in the operating room. They are:

• Protective Zone - It includes the entrance of the patient and staff. It involves the reception, waiting room, changing room, store room, autoclave (a device used to sterilize the instruments), and control panels for electricity.

• Clean Zone - This is the main area where patients and staff change their clothes before entering. It includes the pre-operating room, recovery room, plaster room, X-ray room, anesthesia room, and staff room.

• Sterile or Aseptic Zone - It is the inner zone where the environment or the surrounding area is almost sterile (free of infectious organisms). All staff who are exposed to surgical environments go for a scrub (washing the hands and forearm to reduce the risk of infections) It involves the operating room, scrub room, anesthesia room, instrument sterilization, and instrument trolley area.

• Disposal Zone - It is where all the instruments, specimens, and lotions are passed from the theater to the disposal area and where a few items are sterilized. It includes the dirty washup room and the disposal corridor.

How Is the Operating Room Managed?

Operating room management involves the steps to clean the operating room and sterilize the instruments before the next surgery. Operating room management includes the following.

• Once-in-a-week or weekend maintenance.

• Swabs (surgical dressings made of cotton) are taken away from the areas of the operating room.

• Air-conditioners in the operating room are usually checked.

• Adequate pressure is always maintained in the room.

• The staff who are infected are not allowed to enter the operating room.

• Sterilization of the equipment is done routinely.

What Are the Different Types of Operating Room Cleaning?

There are four types of cleaning. It includes

• Preparatory Cleaning - Before the first surgery, dusting with disinfectant is done. The everyday operating room is cleaned and carbolized (sterilizing with phenols) before starting the first surgery. All the equipment and the floors are cleaned with one percent hypochlorite solution after diluting it.

• Operative Cleaning - Areas contaminated with blood and sputum after the surgery require immediate cleaning with antiseptic phenol detergents.

• Intermediate Cleaning - Generally, the operating room is cleaned up for the next patient, and instruments are kept in the trays for sterilization. Furniture and floor are also sterilized with germicide and wet vacuuming, respectively. Blood stains on the floor and waste materials are separately disposed of into color-coded bags.

• Terminal Cleaning - After all the operations in the operating room are completed, a vigorous cleaning of the operating room is done. Cleaning the operating room after disposing of the waste materials and removing the used materials are carried out. A clean mopping with one percent hypochlorite solution is done after diluting it. Mopping the floor with carbolized operating room walls, floors, tabletops, and the equipment present in it is also done. Bacillocid spray (sprays used to disinfect) and fumigation is performed.

What Is Fumigation?

It is a cleaning process that is used to disinfect and remove harmful microorganisms with the help of a chemical formula containing 40 percent gas (sulfuryl fluoride) for eight hours and is then neutralized to further proceed with the surgery in a room. The operating rooms, intensive care units, cardiac catheterization laboratory (laboratory used to perform tests and procedures related to the heart like angioplasty and angiogram), endoscopy laboratory (an area where the procedure for endoscopy or tests to look into the body done), and bronchoscopy laboratory (an area where the procedure for bronchoscopy or tests to look into lungs are performed) are where fumigations are performed. The method used to fumigate is a formaldehyde solution. The solution contains 40 percent formalin and 500 milliliters of clean water.

The fumigation process is as follows:

• Remove all the materials that can get damaged after fumigation.

• Remove the containers containing hypochlorite solutions.

• Wash the operating room thoroughly.

• Then fumigate.

• Before starting it, turn off the air conditioners.

• Check the operating room care machines.

• Add the formalin 40 percent in 500 millimeters of clean water in the operating room care machines.

• Put the machine inside the operation room.

• Close and seal the operation room completely.

• Place the machine for half an hour.

• Keep the operating room closed for 10 hours.

• Turn on the air conditioner after half an hour to exhaust the fumes; if fumes are left, they can neutralize by using ammonia.

• Cleaning, carbonization, and bacillocid sprays are done before fumigation.

What Is Meant by Once-In-A-Week Cleaning of the Operating Room?

Once-in-a-week or weekend cleaning means cleaning the operating room entirely one day in a week or on a weekend. It involves the following:

• Remove all the equipment, anesthesia machines, operating room tables, ventilators, and other machines.

• Washing the operation room with detergents.

• Drying the walls with a dry duster and carbolizing them with 1 percent hypochlorite.

• Carbolizing all the equipment and placing it well.

• Closing the operating room till the next surgical case is scheduled.

Conclusion

The operating room is the room present in hospitals where surgeries are done. These rooms require special care and maintenance to protect the patients and the staff from infection or disease. These operating rooms are maintained by providing: a protective zone, clean zone, sterile zone, and disposal zone. These rooms are managed differently on weekends to disinfect and close them. A method called fumigation is used to disinfect the operating room with the help of formaldehyde. Thus by following these management procedures the sterilization of the operating room is maintained and managed well for better outcomes.