Architectural principles and isolation
The location of the operating theatre suite must ensure maximum isolation. As a rule, it is placed on a separate floor of a multi-story surgical building or occupies an independent wing of the building connected to the rest of the hospital by a corridor. A key element of isolation is a special airlock (a gateway in the corridor) that separates the hospital and operating suite regimes.
Inside the suite itself, patient flows are also segregated: separate operating rooms for "clean" and "purulent" surgeries are always provided. The most appropriate solution is considered to be the creation of a completely autonomous operating theatre suite attached to purulent surgery departments.
Four zones of sterility
To minimize the risk of infections, the space is divided into four zones with a strict gradation of regimes.
- Sterile regime zone (1st zone). The strictest area. It directly includes the operating room (for performing interventions), the scrub room (for washing and preparing the hands of the surgical team), and the sterilization room (for processing instruments).
- Strict regime zone (2nd zone). Entry here is carried out exclusively through the sanitary filter-station, where personnel sequentially pass through the changing room, showers, and booths for donning sterile clothing (from where they exit into the corridor or scrub room). This is where the anesthetic room, washroom, blood transfusion rooms, equipment and medication storage rooms, and on-call team rooms are located.
- Limited regime zone (3rd zone, technical). Combines production facilities. This is where the urgent analysis laboratory, photo laboratory, plaster room, clean linen storage and blood preparation rooms are located. Personnel rooms (for anesthesiologists, surgeons, nurses) and technical units are also situated in this zone: air conditioners, vacuum stations, oxygen and anesthetic gas supply installations.
- General hospital regime zone (4th zone). Administrative and utility section, entry to which is through a sanitary airlock. It includes the offices of the head of the department, the head nurse, and rooms for waste and soiled linen collection.
Access rules and asepsis maintenance
Only participants of the current operation (surgeons, assistants, scrub nurses, anesthetic team), as well as orderlies performing routine cleaning, and visiting physicians or students have the right to be in the first (sterile) zone only. All staff clothing must be special (scrub suits or gowns) and differ in color from the uniforms of employees in other departments.
Sterility is achieved by preventing the introduction of microorganisms. Since bacteria are most commonly fixed on dust particles, the main rule of asepsis is continuous dust removal. This is facilitated by:
- Special design of airlocks.
- Patient preparation (washing, shaving the operative field, changing linen).
- Staff preparation (thorough hand hygiene, sterile clothing, masks, caps, shoe covers).
Operating room cleaning regimens
Five types of cleaning are strictly regulated in the operating suite:
- Preliminary. Carried out in the morning before work begins. Consists of damp wiping of all horizontal surfaces (equipment, windowsills) from dust settled overnight.
- Routine. Performed by an orderly directly during the operation (removing balls, wipes, instruments that have fallen to the floor).
- Postoperative. Takes place in the pauses between operations, once the patient has been wheeled out. Includes removing soiled linen, taking away used instruments, wiping surfaces with an antiseptic, and washing the floor.
- Terminal. Performed at the end of the working day. This is a thorough damp cleaning of the floor, walls, ceiling, and equipment using disinfectant solutions (e.g., 1–3% hydrogen peroxide with a detergent or benzalkonium chloride) followed by turning on bactericidal lamps.
- General. Scheduled weekly. An unscheduled general cleaning is mandatory if the operating room was contaminated with intestinal contents, pus, or after surgeries on patients with anaerobic infection (gas gangrene).
Briefly: answers to topical questions
What disinfectant solutions are used for terminal and general cleaning of the operating room?
Solutions of hydrogen peroxide, benzalkonium chloride, as well as soap-soda mixtures are used for terminal and general cleaning of the operating room.
- Terminal cleaning — disinfectant solutions are used, including 1–3% hydrogen peroxide ($H_2O_2$) solution with the addition of a detergent, as well as benzalkonium chloride and other preparations.
- General cleaning — detergent soap-soda solutions and disinfectants are used. The procedure includes spraying surfaces with a disinfectant solution followed by its removal by mechanical wiping.
What microclimate and ventilation parameters must be maintained in the operating room?
In the operating room, it is necessary to maintain an optimal temperature and humidity regime, ensure the predominance of air supply over exhaust, and prevent drafts.
- Ventilation — a supply-and-exhaust system is used, supplying clean, preheated, and, if necessary, humidified air.
- Laminar flow — in specialized operating rooms, a directed flow of sterile air from top to bottom is formed. It is injected under a pressure of 0.2–0.3 atm and provides a 500-fold air exchange per hour.
How is the operative field treated with antiseptics directly on the operating table?
Treatment of the operative field on the operating table is carried out by repeated smearing of the skin with antiseptics according to established surgical methods.
- Grossich-Filonchikov method — fourfold treatment with a 5% alcoholic solution of iodine; iodonate and betadine are also used. The skin is smeared before draping the operative field with sterile linen, after draping, before suturing, and after suturing.
- Bakkal method — application of a 1% alcoholic solution of brilliant green in case of iodine intolerance in adults and children.
- Chlorhexidine treatment — use of a 0.5% alcoholic solution of chlorhexidine.
The order of general cleaning is easy to remember by the rule "From top to bottom, from liquid to light": first, the solution is sprayed onto the ceiling → walls → objects → floor. Then everything is mechanically wiped, and at the very end, bactericidal UV lamps are turned on.
Class and exam questions
What is the difference between current cleaning and post-operative cleaning?
Current cleaning is performed directly during the surgical intervention (picking up dropped sponges and instruments), while post-operative cleaning is performed between surgeries after the patient has left the room.
What is the sanitary filter-station for and where is it located?
The sanitary filter-station serves as the sole entrance to the second zone (strict regime). It ensures proper preparation of personnel: removing street clothes, showering, and donning a sterile surgical suit.
When is unscheduled general cleaning prescribed?
It is performed immediately after operations accompanied by massive contamination with pus, intestinal contents, as well as after interventions for anaerobic infection (e.g., gas gangrene).
What else to study on this topic
- Organization of the sanitary filter-station workflow: rules of personnel movement
- Specifics of operating theatre suites for treating purulent surgical infection
- Properties and mechanisms of action of disinfectants (hydrogen peroxide, benzalkonium chloride)
- Preventive measures against infection in anaerobic conditions
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Other topics in the section "CHAPTER 2. ASEPSIS AND ANTISEPSIS"
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