Basic Instructions Guide In the operations department

Geographical Location:

• The operating suite must be located in a suitable position relative to all hospital departments to ensure easy access.
• It should be situated away from sources of contamination.
• It must be positioned away from direct sunlight and strong winds.
• Centralization of Equipment and Devices: It is essential to have the necessary equipment and devices available in each operating room to avoid duplication.
• Hospital Size: The larger the hospital in terms of bed capacity, the greater the need for operating rooms—i.e., (2 operating rooms for every 50 beds).
• Number of Staff in the Operating Suite.
• Operating rooms should be spacious enough to facilitate staff movement.
• Operating staff must be highly skilled and efficient, with continuous training provided.

2) Low-Risk Area Includes:

• Changing room for doctors and nurses, equipped with a restroom (for both males and females).
• Waste storage area.
• Doctors' accommodation rooms.
• Linen storage.

3) Medium-Risk Area Includes:

• Patient preparation room.
• Recovery room.
• Operating supervision office.
• Doctors' office.
• Storage room for surgical supplies.
• Staff lounge.
• Equipment and endoscopy room.
• Pharmacy.
• Sterile instrument storage rooms.
• Sterile pack storage rooms.
• Dedicated area for receiving used instruments and tools, with a separate entrance.
• Main control rooms (Electricity – Gases – IT).
• Firefighting and fire safety equipment.

4) High-Risk Area Includes:

• Operating rooms of all types.
• Operating rooms must have a dedicated exit for contaminated and used instruments.
• A designated pathway must be in place for isolated cases to and from the operating rooms.

Operating Room Contents:

• Electric surgical light (2 units if possible) – A special type (shadowless) with a sterile, easily movable arm.
• Operating table (surgical bed): Moves in all directions depending on the type of surgery.
• Accessory stand: Includes leg and arm supports, a leather strap for patient stabilization, a small headrest, a special headrest for brain surgeries, and shoulder supports.
• Anesthesia machine.
• Large instrument table (Back Table).
• Mayo table (movable instrument table).
• Small anesthesia table.
• Monitor (digital observation device).
• Movable electric suction device.
• Movable electrocautery device (Diathermy).
• Round, wheeled chairs (with and without backrests).
• Scale, whiteboard, and an electronic panel with a regular clock and a surgery timer.
• Small metal step stool.
• Three IV stands.
• Infusion pump (syringe pump – infusion pump).
• Fluid warmer.

Specialized Equipment:

Ophthalmic Surgery Room:

• Vitrectomy machine.
• Surgical microscope.
• Electrically operated microscope chair.
• Cooling device for cataract surgeries.
• Electric autoclave.

Orthopedic Surgery Room:

• Special orthopedic surgery table (attached to the main table).
• High-intensity X-ray machine (C-Arm).
• Electric or pneumatic tourniquet.
• Surgical microscope.
• Dedicated microscope chair.
• Walls and doors should be lead-lined.

Neurosurgery Room:

• Operating table that supports all necessary positions for different surgical cases.
• Surgical microscope.
• Dedicated microscope chair.

ENT Surgery Room:

• Surgical microscope for ear surgeries.
• Dedicated microscope chair.
• Laryngoscope with a light source.

Urology Surgery Room:

• Complete endoscopic system with a light source, cables, and fluid pump.
• Operating table compatible with resection procedures and leg removal for endoscopic surgeries.
• Electrocautery device compatible with endoscopes.
• Lithotripsy (stone fragmentation) device.
• Mobile X-ray machine (C-Arm).

Obstetrics and Gynecology Surgery Room:

• Infant bed equipped with suction and oxygen.
• Surgical endoscope.

Open-Heart Surgery Room:

• Heart-lung machine with an integrated water system.
• Defibrillator (DC shock and internal paddles).
• Cell saver (blood conservation device).
• Patient warming system (Bair Hugger).
• Activated Clotting Time (ACT) measurement device.
• Cardiac ultrasound machine with transesophageal probe (TEE).
• Arterial blood gas (ABG) analyzer.

Equipment for Organ Transplant Operating Rooms:

Operating Room Requirements:

The operating room must meet the following conditions:

A. Compliance with Standards:

• It must adhere to the standards and specifications for operating rooms as outlined by the Minister of Health.
• It must meet the quality standards set by the Supreme Committee for Human Organ Transplantation.

B. Minimum Required Medical Equipment:

• Efficient anesthesia machine equipped with a suitable ventilator.
• Backup Ambu bag and sufficient oxygen cylinders, along with multiple oxygen supply sources.
• Electrocardiogram (ECG) monitor.
• Pulse oximeter to measure blood oxygen saturation.
• Capnograph to monitor carbon dioxide levels in exhaled air.
• Non-invasive blood pressure monitor for regular readings every five minutes.
• Defibrillator integrated with a monitor, along with necessary medications for cardiopulmonary resuscitation (CPR).
• Suction device.

Additional Requirements for Major Surgeries or Critical Cases:

In addition to the previously mentioned equipment, the following must be available:

• Invasive blood pressure monitor.
• Ventilator integrated with the anesthesia machine must have multiple alarms for any malfunctions and provide various ventilation modes.

Recovery Room Equipment:

The recovery room must be equipped with:

• Monitors for ECG, blood oxygen saturation, and blood pressure.
• Defibrillator readily available.
• Ambu bag.
• Suction device.
• Electric shock device (defibrillator).
• An anesthesiologist must supervise the room.

Laboratory:

The facility's internal laboratory must be capable of performing all necessary tests for organ transplantation, including:

• Complete blood count (CBC).
• Blood chemistry analysis.
• Monitoring of immunosuppressive drug levels in the blood based on the type used, with ongoing adjustments.
• Tissue compatibility testing before transplantation.
• Comprehensive infection diagnostics, including various viruses, bacteria, fungi, and parasites.
• Aerobic and anaerobic cultures, including blood cultures, body fluid cultures, etc.

Blood Bank:

The medical facility must have at least a storage blood bank with the following:

• Blood refrigerator with sufficient capacity.
• Plasma and cryoprecipitate freezer.
• Automated platelet agitator.
• System for blood type compatibility testing.
• Records for blood and its derivatives' intake and usage.
• A team including a physician with the Egyptian Fellowship in Blood Transfusion (or an equivalent qualification), supported by technicians and administrative staff.

Diagnostic Imaging Unit:

The medical facility must have an advanced diagnostic imaging unit equipped with:

• Standard X-ray machine for chest and full-body imaging as needed.
• Ultrasound machine with Doppler and echocardiography capabilities, along with standard imaging features. The unit must allow use in operating rooms, ICUs, and patient rooms, with various probe frequencies as required.
• Advanced mobile X-ray machine (C-Arm), with a digital screen for use in interventional radiology procedures during surgeries.
• Angiography imaging devices (traditional or digital).
• Spiral CT scanner with 3D imaging capabilities, biopsy guidance, and other functions.
• An advanced MRI scanner can be used as an alternative to the CT scanner.

Digital Records & Medical Data Management:

• The facility must have an advanced digital system for storing, processing, and retrieving medical data for all organ transplant patients, including test results, imaging, and reports.
• This system must allow secure data sharing between medical facilities while maintaining patient confidentiality.
• Electronic integration of the organ transplant program with the Supreme Committee for Human Organ Transplantation website for efficient operations and maximum benefit.