Intra- Operative Management and Nursing Care Using The Nursing Process

2. ZONING OF THE THEATRE COMPLEX

The surgical suite is a controlled environment designed to minimize the spread of pathogens and allow a smooth flow of patients, staff, and equipment needed to provide safe patient care. The suite is divided into three distinct areas: unrestricted, semi restricted, and restricted areas.

The OR is divided into 3 zones:

  • unrestricted area
  • semirestricted area
  • restricted area
UNRESTRICTED AREA

The unrestricted area is where people in street clothes can interact with those in surgical attire. These areas typically include the points of entry for patients (e.g., holding area), staff (e.g., locker rooms), and information (e.g., nursing station or control desk).
UNRESTRICTED ZONE: Area outside the OR Complex.
Personnel is not in theatre attire (clean pants/top; footwear; cap; mask) Non OR staff / visitors can be in this area

SEMIRESTRICTED AREA

The semirestricted area includes the surrounding support areas and corridors. Only authorized staff are allowed access to the semirestricted areas. All staff in the semirestricted area must wear surgical attire and cover all head and facial hair.
SEMIRESTRICTED ZONE: The OR staff in theatre attire but no need for mask; but Outside personnel must change footwear before entering this zone. Pre-op patient waiting area (Reception)


RESTRICTED AREA

In the restricted area masks are required to supplement surgical attire. The restricted area can include the OR, scrub sink area, and clean core.
RESTRICTED ZONE: This area personnel full theatre attire there is positive pressure ventilation. Surgical procedure takes place here.


Traffic flow in the OR follows the Zoning concept:

                  UNRESTRICTED ZONE

                          ^                             V

                 SEMIRESTRICTED ZONE

                        ^                               V

                        RESTRICTED ZONE


STRUCTURAL COMPLIANCE
  • TEMPERATURE: Keep bacterial count in 180C - 220C environment low
  • AIR EXCHANGE:20 – 25 Air Exchanges per clean air in an hour; to maintain circulation
  • AIR FLOW: From the top corner through a corner opposite in the lower end
    Around the OR Table – Vertical Laminar flow, flowing from the top downwards and outwards.
POSITIVE PRESSURE

Highest pressure in the RESTRICTED ZONE VENTILATION
Lower pressure in the Semi restricted Zone but this pressure is higher than the Unrestricted Zone
FLOW OF AIR IS FROM RESTRICTED ZONE TO UNRESTRICTED ZONE

OTHER CONTROLS TO KEEP ENVIRONMENT SURGICALLY CLEAN:
  1. Personnel change to OR Attire
  2. Personnel with URTI / other infections not allowed to circulate/scrub for cases
  3. Cleaning Routine for OR Complex
    • Beginning of the day
    • Between Cases
    • Terminal Cleaning at the end of the day; between cases, after biohazard cases
    • Yearly Cleaning (Close theatre; High Dusting, Painting, Major Repairs, Equipment Check/Replacement)
  4. Controlled Movements by Personnel
  5. Sliding Doors
  6. Keeping Biohazard Cases last in the list
  7. Keep Orthopedic Implant Room Specific
  8. Spillage protocol
DESIGNATED AREAS IN THE OR
  1. Airlock
  2. Reception Area
  3. Scrub Room
  4. Operating Room where the intervention is done
  5. Instrument Preparation Room
  6. Sterile Pack Room
  7. Storage Room for Sterile Surgical Supplies
  8. Storage Room Non-Sterile Supplies