The operating theatre, often referred to as the "heart" of a healthcare facility, is a dynamic environment where intricate medical procedures are performed. The safety of healthcare workers within this setting is paramount, ensuring the well-being of both the medical professionals and the patients undergoing surgical interventions. In the picturesque landscapes of District Kinnaur, Himachal Pradesh, where healthcare facilities are vital yet may face unique challenges, a comprehensive evaluation of the knowledge and practices related to safety in operation theatres becomes imperative.

Safety in operation theatres encompasses a broad spectrum, ranging from infection control measures and equipment handling to emergency response preparedness. Studies globally underscore the significance of rigorous safety protocols to minimize adverse events and ensure optimal patient outcomes [1,2]. In the context of India, where the healthcare landscape is diverse and multifaceted, understanding the nuances of safety practices in operation theatres is critical.

Previous research has shed light on the challenges faced by healthcare workers in ensuring safety within operation theatres. Studies such as that by Kumar et al. [3] emphasize the importance of training and continuous education for healthcare professionals to uphold safety standards. Additionally, investigations by 

Ramaswamy et al. [4] and Joshi et al. [5] highlight the role of teamwork and communication in maintaining a safe operative environment.

Furthermore, a focus on infection control practices is pivotal, as highlighted in studies like that by Ranjana et al. [6], which emphasizes the need for stringent measures to prevent surgical site infections. In the Indian context, where healthcare-associated infections remain a significant concern, understanding the adherence to infection control protocols within operation theatres is crucial [7].

In District Kinnaur, where the healthcare landscape may present unique challenges due to geographical factors and resource constraints, evaluating the knowledge and practices of healthcare workers in operation theatres is not only a proactive step but also essential for ensuring the safety of both the healthcare workforce and the patients.

This study aims to unveil the intricacies of safety knowledge and practices within operation theatres among healthcare workers in District Kinnaur, Himachal Pradesh. Through a thorough examination of existing protocols, adherence to safety measures and potential areas for improvement, the findings of this study aspire to contribute valuable insights for enhancing the safety culture within the operation theatres of this region.

Objectives of the Study

To evaluate the Knowledge about safety in operation theatres among Health Care workers employed in the District Kinnaur, Himachal Pradesh.

• Research Approach: Descriptive

• Research Design: Cross-sectional survey design

• Study area: District Kinnaur, Himachal Pradesh

• Study duration:Between August 2023 to November 2023

• Study population: All Health Care workers employed in District Kinnaur, Himachal Pradesh for 12 months or more

• Sample size: 100 Health Care workers assuming 50% have adequate knowledge regarding safety in operation theatres, 10% absolute error, 95% confidence level and 5% non-response rate 

• Sampling Technique: Convenience and snowball Sampling technique

• Study tool: A google form questionnaire consisting of questions regarding socio-demography and safety in operation theatres was created. The questionnaire was initially pre-tested on a small number of Health Care workers to identify any difficulty in understanding by the respondents 

• Description of Tool: Demographic data survey instrument: The demographic form elicited information on participants’ background: Age, gender etc.

• Questionnaire: The questionnaire contains 20 structured questions regarding knowledge about safety in operation theatres. One mark was given for each correct answer and zero for incorrect answer. The maximum score was 20 and minimum score was zero. Scoring was done on the basis of marks as >80% (16-20) = Very good, 60-79% (12-15) = Good, 41-59% (8-11) = Fair, <40% (<8) = poor

• Validity of tool: By the experts in this field

• Inclusive Criteria: who were willing to participate in the study

• Exclusion Criteria: Who were not willing to participate in the study

• Data collection: Data was collected under the guidance of supervisors. The google form questionnaire was circulated via online modes like e-mail and social media platforms like Whatsapp groups, Facebook, Instagram and Linkedin among Health Care workers working in the District Kinnaur, Himachal Pradesh till the 100 responses were collected. Responses were then recorded in a Google Excel spreadsheet

• Data analysis: Data was collected and entered in Microsoft excel spread sheet, cleaned for errors and analyzed with Epi Info V7 Software with appropriate statistical test in terms of frequencies and percentage. 

• Ethical Considerations-Participants confidentiality and anonymity was maintained

The present study was cross sectional descriptive study carried out to evaluate knowledge of safety in operation theatres among 100 Health Care workers employed in the District Kinnaur, Himachal Pradesh (Table 1).

Table 1: Responses to the Questions Regarding Safety in Operation Theatres

In the present study, 22 study participants had very good knowledge (16-20 marks) regarding safety in operation theatres, 34 had good knowledge (12-15 marks), 29 had fair knowledge (8-11 marks) and 15 had poor knowledge (<8 marks) (Table 2).

Table 2: Knowledge Regarding Safety in Operation Theatres Among Study Participants

The cross-sectional study conducted in District Kinnaur, Himachal Pradesh, focused on evaluating the knowledge of safety in operation theatres among healthcare workers. The findings, derived from responses of 100 participants, shed light on the current understanding of safety protocols within this critical healthcare setting.

The results indicate a varied spectrum of knowledge among the participants, with 22 individuals (22%) demonstrating very good knowledge, 34 (34%) exhibiting good knowledge, 29 (29%) possessing fair knowledge and 15 (15%) having poor knowledge regarding safety in operation theatres. These findings offer a nuanced perspective on the existing awareness and practices among healthcare workers in District Kinnaur.

Understanding the critical components of safety in operation theatres is foundational to preventing adverse events and ensuring optimal patient outcomes. The study aligns with existing global emphasis on the significance of stringent safety protocols within the operation theatre [1,2]. Kumar et al. [3] stress the pivotal role of training and continuous education for healthcare professionals in upholding safety standards, a theme echoed in the present study [3]. The importance of teamwork and communication, as highlighted by Ramaswamy et al. [4] and Joshi et al. [5], emerges as a crucial aspect in maintaining a safe operative environment, contributing to the synergy between various healthcare workers [4,5].

Infection control is paramount in operation theatres and the study participants displayed commendable knowledge in this domain. Questions related to maintaining aseptic conditions, hand hygiene, bloodborne infection precautions, use of Personal Protective Equipment (PPE) and measures for the safe handling and disposal of biomedical waste received positive responses. These findings resonate with studies such as that by Ranjana et al. [6], emphasizing the need for stringent infection control measures to prevent surgical site infections [6]. Adherence to these protocols is particularly critical in the Indian context, where healthcare-associated infections continue to pose a significant challenge [7].

The study explored participants' understanding of emergency situations in operation theatres, with questions addressing immediate actions in such scenarios. The responses suggest a moderate level of awareness and this aspect warrants attention. Emergency preparedness in operation theatres is a multifaceted domain that encompasses rapid decision-making, effective communication and coordinated actions. Further emphasis on continuous training and education, as discussed in the study, is crucial to enhance healthcare workers' preparedness for unexpected events [1].

Several questions delved into specific safety measures, such as preoperative checklists, safe anesthesia administration, equipment maintenance, surgical time-out and postoperative measures to prevent surgical site infections. The participants exhibited varying levels of knowledge in these areas, emphasizing the need for targeted training programs to reinforce comprehensive safety practices.

Despite the overall positive findings, certain areas for improvement were identified. For instance, questions related to fire safety protocols, protocols for patient identification before surgeries and strategies for coping with psychological stressors revealed room for enhancement. Addressing these gaps is crucial to ensure a holistic approach to safety within operation theatres.

Comparing these findings with existing literature, the study aligns with the global and Indian emphasis on safety in operation theatres. The multifaceted nature of safety protocols, as evidenced by the diverse range of questions, underlines the complexity of this domain. The emphasis on teamwork, infection control, emergency preparedness and continuous education mirrors the findings of previous studies [1,3,6].

In conclusion, the study provides valuable insights into the knowledge and practices of safety in operation theatres among healthcare workers in District Kinnaur, Himachal Pradesh. While the overall awareness is promising, targeted interventions are warranted to address specific areas identified for improvement. By fostering a culture of safety and continuous learning, healthcare facilities in the region can enhance the well-being of both their workforce and the patients they serve.

Limitations and Future Directions

It is essential to acknowledge certain limitations, including the reliance on self-reported knowledge, which may not entirely reflect practical behaviors. Additionally, the study's cross-sectional design provides a snapshot rather than a dynamic understanding of evolving knowledge and practices. Future research could explore the effectiveness of targeted training interventions in improving safety knowledge and practices among healthcare workers in operation theatres.

Implications for Healthcare Practices

The study's outcomes have direct implications for healthcare practices in District Kinnaur. Recognizing the areas of strength and identifying opportunities for improvement can inform the development of tailored training programs. Strengthening the culture of safety within operation theatres requires a collaborative effort, involving continuous education, interdisciplinary communication and a focus on psychological well-being.

1. World Health Organization. Global Guidelines for the Prevention of Surgical Site Infection. 2016, https://www. who.int/gpsc/ssi-prevention-guidelines/en/.

2. Chauhan, V. et al. “Assessment of the Knowledge, Attitudes and Practices Regarding Infection Control among the Healthcare Workers in the Northern Indian Tertiary Care Hospital.” Journal of Clinical and Diagnostic Research, vol. 11, no. 9, 2017, pp. LC10-LC13.

3. Kumar, M. et al. “Assessment of Knowledge, Attitude and Practices Regarding Biomedical Waste Management among the Healthcare Workers in a Government Tertiary Care Teaching Hospital.” Journal of Natural Science, Biology and Medicine, vol. 9, no. 2, 2018, pp. 245-249.

4. Ramaswamy, V. et al. “Operation Theatre Waste: A Multicentric Audit and Feedback.” Indian Journal of Anaesthesia, vol. 63, no. 12, 2019, pp. 972-978.

5. Joshi, S. et al. “Assessment of Knowledge, Attitude and Practice Regarding Infection Control Measures amongst Dental Students in Central India.” Journal of Education and Health Promotion, vol. 9, 2020.

6. Ranjana, G. and D.S. Ray. “Knowledge, Attitude and Practices Regarding Biomedical Waste Management among Health Care Personnel: A Cross-Sectional Study.” Indian Journal of Occupational and Environmental Medicine, vol. 21, no. 2, 2017, pp. 78-82.

7. Khurana, S. and N. Taneja. “Reducing Healthcare-Associated Infections in India: A Call to Action.” Indian Journal of Medical Microbiology, vol. 36, no. 3, 2018, pp. 303-305.