What are the key considerations before starting a new modular operating theater (OT)?

Key Considerations Before Starting a New Modular Operating Theater (OT)

When designing or refurbishing a new modular operating theater, prioritize safety features that minimize fire risks, optimize ventilation, and ensure efficient emergency evacuation to reduce patient morbidity and mortality. 1

Fire Safety and Emergency Evacuation

• Install well-marked fire manual call points, fire extinguishers, and oxygen shut-off valves (Area Valve Service Units - AVSUs) that are easily accessible and visible 1
• Position AVSUs strategically to allow isolation of individual zones affected by fire without shutting off oxygen supply to the entire theater suite 1
• Design multiple exit routes - ideally three separate exits per department, with at least two allowing for horizontal evacuation 1
• Implement modern sprinkler and misting systems to contain fires quickly 1
• Arrange operating theaters in zones so that >50% remain unaffected if a fire occurs (e.g., divide 8 theaters into two blocks of four, separated by fire-rated sub-compartments) 1
• Install override controls for smoke control and ventilation systems 1

Structural Design and Layout

• Consider ground floor location for easier evacuation, or if not possible, install vertical evacuation lifts with dual electrical supply 1
• Create easy interconnecting routes between operating theaters and ICUs to facilitate evacuation if needed 1
• Ensure door widths on bays and rooms are large enough to accommodate bariatric beds without adjustment 1
• Separate clinical and non-clinical areas to reduce contamination risks 1
• Design ceiling structures carefully - if ceiling voids with removable tiles and electrical cabling are necessary, ensure they meet fire safety standards 1

Ventilation and Air Quality

• Install ventilation systems that provide appropriate air changes per hour: 25 for operating theaters, 15 for anesthetic rooms, and 10 for recovery areas 1
• Implement HEPA filters and laminar airflow systems to reduce infection risks 2
• Ensure proper temperature control (20-23°C) and humidity (50-60%) to reduce perioperative hypothermia risk 1

Infection Control Measures

• Design traffic flow patterns that minimize unnecessary movement in and out of the operating theater 1
• Keep doors closed during procedures to maintain ventilation efficiency 1
• Install proper scrub stations and clean/dirty utility areas 3
• Use bacteriostatic floors with corner covings to prevent pathogen accumulation 3
• Position operating tables to maximize laminar airflow effectiveness 3

Equipment and Technology Integration

• Install medical gas pipeline systems (MGPS) with appropriate redundancy 3
• Provide flexible arm light pendants and comprehensive utility pendants 3
• Include surgeon control panels with precise indications 3
• Consider integration of technical assistance systems into a holistic clinical infrastructure 4
• Install ICU pendants which improve electrical safety and reduce fire risk 1

Operational Protocols

• Develop clear protocols for patient scheduling, with "dirty cases" placed last on operating lists to minimize infection risk 1
• Establish protocols for cleaning between cases, with special attention to visible contamination 1
• Create policies for safe handling and disposal of sharps 1
• Implement protocols for safe drug handling to prevent contamination 1
• Develop specific protocols for using lasers or other potential fire hazards in the operating theater 1

Emergency Preparedness

• Create bespoke emergency evacuation action cards and plans specific to the operating theater layout 1
• Provide evacuation aids suitable for different patient scenarios, including evacuation sheets, chairs, and mats 1
• Consider smoke hoods for staff to extend evacuation time in case of fire 1
• Conduct regular fire and evacuation training for all staff, including simulation exercises 1

Staff Training and Culture

• Establish a culture of safety through regular training and simulation exercises 5
• Train staff on proper use of evacuation equipment and fire extinguishers 1
• Develop protocols for operating theater discipline to minimize unnecessary traffic and reduce infection risks 6
• Implement regular maintenance checks and testing of all safety equipment 1

Common Pitfalls to Avoid

• Neglecting to zone operating theaters properly, which could lead to complete shutdown during emergencies 1
• Installing inadequate ventilation systems that fail to prevent oxygen enrichment of ambient air 1
• Designing narrow doorways that impede rapid evacuation of patients on beds 1
• Failing to provide adequate training on emergency protocols and equipment use 1
• Overlooking the need for multiple exit routes and evacuation plans 1