Safety, Guidelines, and Design of

the Surgery Suite

Ramona Conner, MSN, RN, CNOR
Manager, Standards and Recommended Practices
Association of periOperative Registered Nurses (AORN)
rconner@aorn.org

Frank Zilm, D.Arch, FAIA, FACHA

President, Frank Zilm & Associates, Inc.
Chester Dean Lecturer on Healthcare Design
The University of Kansas

Frank@zilm.com
Presentation
 Overview of 2014 FGI Guidelines for Surgical
Services
 The Planning of Surgery Suite – what our
members say
 What do you think?
2014 FGI Guidelines – Surgery
Section 2.2-3.3
The Big Idea
  A2.2-3.3.1.1 (4) Surgical suite areas
Semi-restricted area: Peripheral support areas of the surgical
suite, including storage areas for clean and sterile supplies,
sterile processing rooms, scrub sink areas, and corridors
leading to restricted areas of the surgical suite.

Restricted area: A designated space in the semi-restricted

area of the surgical suite that can be reached only through a
semi-restricted area. The restricted areaincludes operating
rooms and other rooms in which invasive procedures are
performed.
 New Definitions
Operating Room Procedure Room

•  restricted area •  unrestricted area

•  for invasive •  for procedures that
procedures that do not require an
require an aseptic aseptic field but may
surgical environment require use of sterile
•  any form of instruments or
anesthesia may be supplies
administered •  no general
anesthesia
Sterile Processing
  General
(a) The sterile processing room shall consist of a decontamination area
and a clean work area.
*(b) Sharing of the sterile processing room between two or more operating
rooms shall be permitted.

The sterile processing room shall be designed to provide a one-way traffic

pattern of contaminated materials/instruments to clean materials/
instruments to the sterilizer equipment.
A2.2-3.3.6.13 (1)(c) One-way traffic in sterile processing. The one-way
flow of contaminated materials/instruments to clean materials/instruments
is similar to the cleaning/sterilization flow/process in central services (see
Section 2.1-5.1).This flow helps decrease the potential for cross-
contamination of sterile
instruments.
Time for change! If we don’t do it
this way, why still build it this way?
Substerile rooms: Sacred Cow?
• Perpetuate outdated practice
• Facilitate poor practices
• Costly & unnecessary expense
– Equipment: $40K - $100K
– Mechanical and Electrical: $60K
– Floor space (50 square feet) - $1200/sq. ft. x 50 = $60K
– Total: $160K per rm. minimum
Plus long term:
– Maintenance
– Process monitoring supplies &
– Personnel time
New: Sterile Processing
Sterile processing flow
 The bottom line

The building design should

provide functionally equivalent
space for decontamination and
sterilization of surgical
instruments in all locations
where sterilization processes
are performed
Changing Changing Rooms
2010 2014

A one way traffic pattern- A locker area shall be

persons entering from provided
outside the suite change
and move directly into the Unisex room is permitted
surgical suite
 Clinical Practice Guidelines
Change Too

  Clean surgical attire should be worn in the semi-restricted

and restricted areas
  Scrub attire should be donned in a designated dressing area
before entry from the outdoors into the semi-restricted and
restricted areas
  Health care personnel should change into street clothes
whenever they go outside of the building
  Cover apparel does not prevent contamination of scrub attire
Operating Rooms
(1) Operating room
(a) Each operating room shall have a minimum clear floor area
of 400 square feet (37.20 square meters) with a minimum clear
dimension of 20 feet (6.10 meters).
*(b) Where renovation work is undertaken and it is not possible
to meet the above minimum standards, each room shall have a
minimum clear floor area of 360 square feet (33.48 square
meters) with a minimum clear dimension of 18 feet (5.49
meters).
Benchmark of 20 new surgery
suites
Documenting equipment
Cut out of Room Configurations
 What is a Sterile Field?
 Area around the site of the incision or the
site of introduction of an instrument into a
body orifice.
 All furniture covered with sterile drapes and
all personnel who are in sterile attire.
3-D Models illustrating ideal positioning
Testing room size, entry strategies
LPCH Mock-Up Neuro Hybrid
LPCH Mock-Up Neuro OR1
Image-Guided Rooms
A2.2-3.3.2.1 (2) Operating rooms for image-guided surgery or
procedures requiring more space for personnel or
equipment. Image-guided surgery occurs in rooms equipped with
advanced audiovisual technology. Surgical procedures that may
require additional personnel and/or large equipment include some
cardiovascular, orthopedic, and neurological procedures.

(a) Operating rooms of this type shall have a minimum clear floor
area of 600 square feet (55.74 square meters) with a minimum
clear dimension of 20 feet (6.10 meters).
(b) Where renovation work is undertaken and it is not possible to
meet the above minimum standards, these rooms shall have a
minimum clear floor area of 500 square feet (46.50 square
meters) with a minimum clear dimension of 20 feet (6.10 meters).
Hybrid Operating Rooms
A minimum clear floor area of 650 square feet (60.39 square meters) is
recommended for a hybrid operating room. However, the size of a hybrid
operating room is highly dependent on the functional requirements of the
room as
an operating environment as well as the requirements of the imaging
equipment it contains, which generally increase the room area
requirements.
Control room. If required, a control room shall be provided that
accommodates the imaging system control equipment.
(a) The control room shall have a minimum area of 120 square feet (11.15
square meters), which shall be permitted to include fixed work surfaces.
(b) The room shall be physically separated from the hybrid operating room
with walls and a door.
Pre Operative Care
(a) Area
(i) Where patient bays are used, a minimum clear floor area of
60 square feet (5.58 square meters) shall be provided for each
patient in a lounge chair or stretcher.
(ii) Where cubicles are used, each station shall have a
minimum clear floor area of 80 square feet (7.43 square
meters).
(iii) Where single-bed rooms are used, a minimum clear floor
area of 100 square feet (9.29 square meters) shall be provided
in each room.
PACU
PACU size. A minimum of 1.5 post-anesthesia patient care
stations per operating room shall be provided.

If pediatric surgery is part of the functional program, the

following requirements shall be met:
Pediatric recovery stations shall be separate from adult
stations.

(a) Area. A minimum clear floor area of 80 square feet (7.43

square meters) shall be provided for each bay or cubicle.
PACU Demand 16

14

12

5-Jan
6-Jan
Census - Beds in Use

10 7-Jan
8-Jan
9-Jan
8 Max
12-Jan

Time of Day
What our members say
AORN Work Settings
AORN Job Description
AORN Years as a nurse
Role in Process
Architects Role in Process
ACHA Respondents
Current Issues
Existing Problems
(1=Least important, 5= most important
Top Shortcomings of existing
space
1.  Storage
2.  Ability to maintain a sterile field
3.  Size of OR
4.  Technical characteristics (electrical power, air circulation)
5.  Staff support spaces
6.  Prep/Phase II area
7.  Flow/circulation of personnel, patients, equipment/supplies
8.  Number of ORs
9.  Control of traffic
10.  Size of PACU
11.  Location of elements within the OR
12.  Finishes and fixtures
Current Issues
Future Needs
Future Needs - AORN
(1=Least important, 5= most important)
Future Planning Issues -ACHA
Effectiveness of tools
Satisfaction with project - AORN
Effectiveness of tools - AORN
(1= Not useful, 5=very useful)
Effectiveness of Methods - ACHA
Do we understand each other?
Satisfaction with architect
600 sf O.R. Net or Gross sq.ft.?
O.R. Size Net or Gross Square Foot
ACHA Respondents
Scale of Drawing? AORN
Scale of Drawing - ACHA
What do you think?