Current Issues in Operating Theatres

Operating theatre teams around the world face fresh challenges every year. In this post we’ll explore some of the current issues in operating theatres, and examine the ways in which operating theatre teams are rising to meet these challenges.

Infection Control and Ventilation

The pandemic caused severe disruption to all surgical specialties. UK operating theatres cancelled elective surgical procedures while avoiding aerosol generating procedures (AGPs).

A recent paper in the Royal College of Surgeons annals reported on how operating theatres across the world had used negative pressure environments to reduce the spread of infectious airborne particles during AGPs. This paper went on to present an overview on how operating theatre ventilation systems can work to reduce both virus transmissions and surgical site infections (SSIs).

The paper concludes that, while there is not yet enough evidence to recommend that all operating theatres convert to negative pressure environments, all health settings should have negative pressure rooms available for high-risk patients.

Head here to read the latest research on operating theatre ventilation in the Royal College of Surgeons annals.

You can also read our guide to cleaning for infection prevention and control in operating theatres.

Improving Operating Room Efficiency

One of the current issues in operating theatres is how to improve efficiency while reducing turnaround time between procedures. A recent paper in Folio 3 Digital Health explored the possibilities of using Internet of Things (IOT) devices to improve operating room efficiency best practices.

“Smart” medical equipment allows for predictive maintenance, so teams can address any potential issues long before they become problems. IOT devices can also help reduce medical errors during surgical processes through allowing for faster and more powerful data sharing among the operating team.

Head here to read the full paper on the possibilities of IOT devices in operating theatres.

In June 2020, the NHS England Improvement Hub published a resource entitled The Productive Operating Theatre. This is a series of modules designed to help theatre teams work together to improve the quality of the patient experience and the safety of surgical services. The resource outlines ways in which theatres can make best use of available time and expertise.

Head here to access the full suite of Productive Operating Theatre resources.

Consumables and Equipment Management

A key focus area for improving operating theatre efficiency is good management of consumables and equipment. Investing in connected IOT devices might be a good long-term goal. But lower-tech solutions can help operating theatre teams make huge improvements to efficiency in the short-term too.

For example, we stock a range of absorbent floor mats designed to capture fluids during surgical procedures. They can help you to optimise your fluid management, which won’t just improve health and safety – it’ll also optimise your turnaround times between procedures.

Communication and Working Together to Overcome Challenges

The Association for Perioperative Practice recently ran an online survey asking theatre nurses to share their experiences of work, and the challenges they face in the theatre environment.

The charity aimed to highlight issues such as bullying, pressure, and support from senior members. As in an operating theatre environment, these issues don’t just result in unpleasant working environments. The working environment can affect patient safety and outcomes.

The WHO Surgical Safety Checklist, first published in 2010, contains numerous measures to help operating theatres foster a supportive environment based on mutual respect. For example, it outlines that all surgical procedures should start with a briefing, during which senior staff members should actively welcome queries and concerns from junior staff members.

Head here to read our full guide to the WHO Surgical Safety Checklist.

Improving the Running of Your Operating Theatre

At Cairn Technology, we’re here to help you run your operating theatre more efficiently and effectively. We have a number of products and services to help you do that, and a team of experts on hand to give you the advice you need.

For example, our absorbent floor mats can help you to optimise your fluid management to help your health and safety and turnaround times, as well as other surgical supplies for infection control and high-level performance.

Do You Have a Question About Current Issues in Operating Theatres?

Whether you want a consultation on effective infection control, or some advice on improving operational effectiveness in the theatre, our experts are here to help.

Get in touch to talk to one of our experts today.



Introduction to the WHO Surgical Safety Checklist – 5 Steps

The World Health Organisation (WHO) first published their Surgical Safety Checklist in 2010. It’s a series of five critical steps that surgical teams should perform before and after surgical procedures to reduce the risk of certain adverse events.

The WHO claims that the Surgical Safety Checklist has reduced surgical complications and mortality by over 30%. Any surgical team around the world can perform the checklist in under two minutes. It’s designed to be affordable and sustainable, so that even surgical teams in low and middle income countries can adopt it.

What Are The 5 Steps to Safer Surgery?

The 2008 WHO Surgical Safety Checklist is essentially a process for improving communication between surgical teams. It involves five steps:

  1. Briefing
  2. Sign in
  3. Time out
  4. Sign out
  5. Debriefing

Step 1 – Briefing

The aim of the briefing is to confirm the order of the operating list, to delegate tasks and to confirm that everyone knows their role during the procedure.

The whole surgical team should receive a thorough, focused and supportive briefing before any procedure. They should feel free to ask any questions and raise any concerns they might have. Senior staff members should actively welcome queries from junior staff members.

The briefing should take place in a quiet room with a closed door, so as to ensure patient confidentiality. Any member of the team can lead the briefing, and they must encourage an atmosphere of open communication.

The briefing should begin with all members of the team introducing themselves. When discussing the patient, they should be referred to by name. Next should be an overview of the operating list – and all members of the team should have received a copy of this before the briefing. In this way, they can consider any questions or concerns in advance.

Step 2 – Sign In

The aim of the sign in is to ensure that all necessary preparations for surgery have been made, and that it’s safe to introduce anaesthesia. So all other activity must stop before the sign in, to allow the anaesthetist and Operating Department Practitioner (ODP) to give it their full attention.

The sign in process is a series of questions:

  • Has the patent confirmed their identity, site, procedure and consent?
  • Is the site marked?
  • Is the anaesthesia machine and medication check complete?
  • Does the patient have a known drug allergy?
  • Does the patient have a difficult airway, or an aspiration risk?
  • Is there any risk of blood loss?

These questions should be read aloud, and where necessary, the patient should be involved in the discussion. If any item in the list needs clarifying, then it must be done immediately, and the sign in process should be repeated from the beginning.

Anaesthesia should only commence once the sign in is complete, with all discrepancies resolved.

Step 3 – Time Out

The aim of the time out is to ensure that the surgical team is undertaking the correct procedure on the correct patient, and that all the correct measures are in place to prevent harm.

As with the sign in, all activity must stop to allow the team to focus on the time out. It should begin once the patient has been safely positioned with all necessary monitoring attached.

This is another series of questions which, again, should be read aloud – from the list, and not from memory:

  • Confirm that all team members are present, and that all have been introduced by name and role.
  • Confirm the patient’s name, procedure, and incision site.
  • Anticipate critical events for the surgeon, the anaesthetist, and the nursing team.
  • Ensure that all essential imaging is displayed, including X-rays, CT scans, and MRI, to reduce the risk of wrong-site surgical marking.

Surgery should only commence once the time out process has been successfully completed.

Step 4 – Sign Out

The aim of the sign out is to ensure that the surgical procedure has been completed in its entirety and documented accordingly. This step also ensures the patient’s ongoing safety beyond the theatre.

Again, all activity must stop to allow the whole team to focus on the sign out, and the sign out must be completed before any member of the team leaves the operating theatre. The patient should also remain in the theatre until any discrepancies have been resolved.

It’s once again a case of reading a series of questions aloud from a list. A surgical nurse should begin by verbally confirming the name of the procedure, before conducting thorough instrument, sponge and needle counts.

Then comes the specimen labelling process, and the nurse should read all specimen labels aloud, including the patient’s name. They should also confirm whether there are any equipment problems to address.

Finally, the surgeon, anaesthetist and nurse should confirm the key concerns for the patient’s ongoing recovery and management.

Step 5 -Debrief

The aim of the debrief is to allow the surgical team to review their performance, to identify achievements along with any areas that may need improvement.

Like the initial briefing, the debriefing should be attended by everyone. The atmosphere should be professional yet open, welcoming, and supportive.

If any actions are identified, there should be a clearly identified person appointed to deal with it. This way, everyone will know their responsibilities, which will make it much more likely that any problems will be addressed.

More Resources for Safer Surgeries

You can download a copy of the Surgical Safety Checklist from the WHO’s website. The WHO’s site also has a number of instructional videos outlining how to use the checklist, and how not to use it.

We also have a guide to standard infection control precautions in healthcare settings, and a guide to cleaning for infection prevention and control in operating theatres.

Finally, head here to read our guide to selecting the correct surgical instrument for procedures.

Want to talk about how we can help you ensure operational effectiveness in the theatre? Get in touch to talk to one of our experts today.