The operating room requires stringent management protocols to maintain its cleanliness and ensure a controlled environment. Relevant systems include disinfectant and hygiene protocols, storage and monitoring of sterilized items, and handling procedures for instruments and materials used on patients with infectious diseases. The key guidelines and regulations are summarized as follows:
The architectural layout of the operating room should align with principles of hospital infection prevention and control. It should feature a logical design, clearly defined zones, and distinct markings. The layout should adhere to the basic principles of functional workflow optimization and the separation of clean and contaminated areas.
Staff entering the operating room must comply with all its protocols, such as those concerning attire and footwear changes, visitation rules, patient safety management, verification procedures, and regulations concerning the use of instruments and equipment.
Modern laminar flow operating rooms employ air-cleaning technologies to manage microbial contamination to varying extents. These technologies not only provide clean air but also control airflow direction, creating a positive-pressure environment. This setup ensures that airflow moves from high cleanliness areas (such as the surgical zone) to lower cleanliness areas, establishing a sealed and clean internal environment. Opening doors reduces the positive pressure in the room, allowing a small amount of external air to enter, which can compromise the air's cleanliness. During surgery, door openings are minimized, and operating with open doors is strictly prohibited.
When scheduling multiple surgeries in the same operating room on the same day, procedures must follow the principle of performing sterile surgeries before contaminated surgeries. Surgeries for patients with infectious diseases such as hepatitis B, syphilis, or HIV are scheduled after those involving non-infectious patients.
Work areas within the operating room undergo cleaning and disinfection every 24 hours. Between consecutive surgeries on the same day, and after all surgeries are completed for the day, operating rooms must be cleaned and disinfected promptly. A thorough cleaning of the operating room is conducted weekly, including floors, walls, ceilings, and the surfaces of instruments and equipment. Monthly checks include bacterial cultures from the hands of surgical participants after handwashing, bacterial cultures of the operating room air, and bacterial cultures for sterilized materials.
Disinfection protocols for instruments and materials used on patients with special infections are defined as follows:
- Postoperatively, instruments used for patients with gas gangrene or Pseudomonas aeruginosa infections require fumigation with 40% formaldehyde and potassium permanganate (200 ml of 40% formaldehyde and 100 g of potassium permanganate per 100 m3).
- Instruments used for patients with hepatitis B, Pseudomonas aeruginosa infections, or open tuberculosis are initially immersed in a solution containing 2,000 mg/L of active chlorine for 60 minutes, then subsequently cleaned and sterilized using an autoclave under high-pressure steam.
- Drainage materials and bottles are immersed in a solution containing 2,000 mg/L of active chlorine for 60 minutes before being disposed of in designated containers, which are then handled by hospital staff according to unified waste disposal protocols. Used surgical dressings are packed and sent to the laundry for specialized processing in dedicated washers.