operating room
An operating room (abbreviation: OP ) is a special room in a hospital or doctor's office in which surgical interventions, the operations , are carried out. Personnel and equipment resources are bundled in one room in which high hygiene standards can be met through structural and technical building measures. Operating departments in hospitals combine several operating theaters and the necessary functional and ancillary rooms into one structural unit. Parts of the training for the professional groups working there also take place in the operating room. As a hybrid operating room is called modern operating rooms, which also imaging large appliances such as computer or magnetic resonance imaging included or by the presence of angiography devices as cardiac catheterization laboratory can be used.
Hygienic aspects
The focus is on avoiding infection of the operated patient through the penetration of pathogens into the surgical wound . Conversely, handling blood and other body fluids can also pose a risk of infection for people working there. Therefore, special hygiene regulations according to the Infection Protection Act apply to the operating theater . As a rule, it is separated from the other facilities by personnel sluices and may only be entered with surgical clothing, protective hoods and mouth-nose protection , in order to keep contamination by pathogens as low as possible.
Only authorized persons are allowed to stay in the operating room during an operation in order to protect the patient's hygiene and privacy and to enable trouble-free work. The patient covered with sterile (aseptic) cloths , the instrument table and the surroundings of the sterile-clad surgeons and assistants are considered as sterile zones which non-sterile staff may not enter. It is surrounded by the jumper zone , named after the so-called jumper , an operating room nurse who is on standby and whose job it is to assist people in sterile clothing. At the head end of the patient, the non-sterile anesthesia zone is usually separated with additional cloths , where the anesthesiologist and the anesthesia nursing staff work. The doors should work automatically and should remain closed during the operation for hygienic reasons.
Structural properties
Air conditioning
In Germany, operating theaters must be air-conditioned using ventilation and air conditioning systems . In addition to a constant temperature (22–26 ° C in the operating field), humidity (30–65% RH ) and a maximum noise level of 48 dB (A), the air should be as low as possible and the concentration of anesthetic gases must be kept below the MAK values become. The surgeons often want a lower room temperature, which reduces the multiplication of germs and makes it easier to work in protective clothing. However, this would lead to increased cooling of the patient, which occurs anyway under prolonged anesthesia . The problem is avoided through increased component cooling and intraoperative heating of the patient.
With a low- turbulence displacement of the supply air from the ceiling, the supply air is low in germs through several filter stages. Operating lights can have a disruptive effect on the planned air flow due to their shape and heat emission. Overpressure in the operating room prevents air from entering from the outside unplanned. For the so-called septic operating theaters - for operations in purulent or infected tissue - the air flows are appropriately planned and exhaust air filters are used.
inventory
Operating theaters are fully air-conditioned and windows are not used, especially in new buildings, because of the uneven lighting conditions and possible disruptions to hygiene. Solutions with incidence of daylight are still possible. The floor, walls and ceiling are designed to be washable and smooth transitions between them help prevent dust accumulation. Since wristwatches may not be used in areas at risk of infection, wall clocks are permanently installed.
The hospital's emergency power system ensures independence from the public power grid . The connections for electricity, water, gas and network are often ceiling-mounted in order to avoid tripping hazards and to have freedom when redesigning the room. Standardized gas sockets guarantee the supply of compressed air , oxygen , nitrous oxide , vacuum and the extraction of anesthetic gases. Communication is ensured through telephones and access to the hospital's IT network.
Anesthesia workstations , the operating tables in the center and other built-in components can be modularly expanded or replaced. Operating lights for illuminating the operating area are available in addition to the room lighting and are often mounted on the ceiling. They have to meet special requirements in terms of light intensity, angle of incidence in the operating field, focus point and light color.
If necessary, the surgeon uses a special surgical microscope . Permanently installed X-ray viewers, increasingly being replaced by flat screens for digital display, enable operation planning, while mobile X-ray devices enable the results of the operation to be checked in the room. Newer operating theaters are occasionally equipped with computed tomography devices for this purpose.
Adjoining rooms and logistics
Personnel enter and exit the operations department via a lock room where clothes are changed. In order to avoid glare effects under intensive artificial lighting and to enable visual control of compliance with hygiene guidelines, clothing in operating areas is dark green or blue. Material can be delivered and disposed of via an entrance with a bell and intercom.
A patient lock enables the immobile patient to be transferred from the bed to the operating table and vice versa. Being close to the intensive care unit and the emergency room helps to reduce and shorten time-consuming patient transports to the necessary extent.
In order to be able to prepare and initiate the anesthesia undisturbed, the anesthetist has a small, closed anteroom available ( initiation room ), or there are centralized initiation rooms for several operating theaters. A central holding area at the lock is also possible . After the operation, the patient is brought to a recovery room until stabilization , which is equipped with monitoring devices and is usually still within the operating wing.
In addition, there are rooms for surgical hand washing and hand disinfection , for sterilization and reprocessing of surgical instruments and instruments, storage rooms, offices, staff lounge, toilets, etc.
Workplace operating theater
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As a workplace, the operating theater is inevitably de-individualized, functional and characterized by the shielding of external influences. Perceptible day-night differences are largely absent, and if there are no windows, they are even completely absent.
The demands of the patients and those of the staff can collide with each other and with economic necessities and structural conditions. There is a certain risk of accidents for patients and staff. Ergonomics and the design of the products used in the OR therefore play an important role. Operating units are among the most expensive work units in a hospital. In 2010, the cost of one minute of surgery in Germany was estimated at 10 to 120 euros, depending on the calculation basis and interests.
The design and management of operations departments must be implemented across professional groups , taking into account aspects of occupational safety and health economics . Approaches to this are the software-supported OR simulation and the new concept of an experimental OR , in which a practical simulation of patient treatment (see medical simulation ) and other work processes is possible.
Historical pictures
England's oldest operating theater (1822) in the Museum of St Thomas' Hospital , London
New Orleans Surgical Washroom 1906
Operating theater in Bandung , Indonesia around 1910
Operation in a French church in 1917 during the First World War
Mobile operating theater for surgery at Heidelberg University Hospital (1957)
Mobile operating theater for surgery at Heidelberg University Hospital (1957)
Operating theater of the Dresden Medical Academy , 1956
See also
literature
- Walter Steuer and 11 co-authors: Hygiene and Technology in Hospitals (Contact & Study Volume 207), Expert-Verlag, Stuttgart, 1996, ISBN 3-8169-1370-9 .
- BP Müller-Stich, MW Büchler: Operating theater of the future . Der Chirurg 87 (2016), pp. 999-1001.
Web links
- Robert Koch Institute: Recommendations of the Commission for Hospital Hygiene and Infection Prevention
- S1 guideline requirements for air conditioning systems (RLTA) in medical facilities in AWMF -online
- OP.inside portal for OR organization
Individual evidence
- ↑ Duden online: OP, the
- ↑ K.-H. Tscheliessnigg: The hybrid operating room as the multifunctional therapy room of the future - interdisciplinarity, image-guided therapy, integration of medical technology such as CT, angiography, navigation and robotics in: Journal für Kardiologie - Austrian Journal of Cardiology 2010; 17 (7-8), 285-292, online: PDF
- ↑ DIN 1946-Part 4 Ventilation systems in hospitals , VDI 6022 Hygiene requirements for ventilation systems and devices
- ↑ Problem that has been known for a long time. B. Krönig spoke as early as 1904 about the need to heat operating theaters and the unfavorable effects of high room temperatures on the surgeon. He comes to the conclusion that heating the operating table rather than the room. B. Krönig: About electrically heated operating tables. in: Archives of Gynecology and Obstetrics, Springer Berlin / Heidelberg 1904, online: doi: 10.1007 / BF02058542
- ↑ a b c Axel Kramer: Krankenhaus- und Praxishygiene, S. 162 ff. Elsevier, Urban & FischerVerlag, Munich 2001, ISBN 978-3-437-22310-5 .
- ↑ Center for Spinal Surgery and Neurotraumatology at the BGU Clinic Frankfurt. Retrieved October 26, 2010 .
- ↑ Thomas Busse: OR Management: Basics . medhochzwei Verlag, Heidelberg 2010, ISBN 978-3-86216-001-3 , p. 170 ( limited preview in Google Book search).
- ↑ Ulrich Matern u. a .: Working conditions and safety at the workplace OP in: Dtsch Arztebl 2006; 103 (47): A 3187-92, online: PDF
- ↑ Hartwig Bauer: Workplace OP: Reality and Demands in: Deutsches Ärzteblatt Vol. 103 Issue 47, November 24, 2006, online: PDF
- ↑ Frankfurter Rundschau, May 4, 2010: On the way to the digital clinic. Innovative simulation technology calculates optimal processes in the operating room ( Memento from August 2, 2012 in the web archive archive.today )
- ^ Note at Deutsches Ärzteblatt, August 31, 2006. (No longer available online.) Archived from the original on September 3, 2007 ; Retrieved October 24, 2010 . Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice.
