Designing Surgical Operating Rooms: Hospital and Healthcare Management Consultants

Designing Operating Room September 2014
DESIGNING SURGICAL OPERATING ROOMS

1
NOUS HOSPITAL CONSULTANTS (P) Ltd.

HOSPITAL AND HEALTHCARE
MANAGEMENT CONSULTANTS
PLANNING AND DESIGNING OF 22
HOSPITAL OPERATING ROOMS & SURGICAL SUITES
A PRESENTATION BY DR. K B SOOD

LEADING HOSPITAL & HEALTHCARE MANAGEMENT CONSULTANTS OF INDIA

INTRODUCTION 3
Hospitals are considered to be most complex of the building forms and

In fact, the have equally complex Management Systems.
rich and
famous in the Of all the areas in the Hospitals, the Operating Rooms, earlier called
society used Operating Theatres, are the most complex design problems.
to invite the
Surgeons to Well planned Operating Room makes Surgeons more capable, and assists
their houses them to make their work more effective.
for
performance Historically, the term "Operating Theatre" referred to a non-sterile, large
of the surgery room or Amphitheatre, which had a raised table or chair in the centre for
on them. the patient and where students and other spectators could watch Surgeons
perform surgery, standing on the tiered stands.
This was Most patients were firmly held down or strapped down with the help of
done in the assistants.
hope of
The Surgeons wore street clothes and an apron to protect them from blood
having a
better stains. They operated with zeal but bare-handed, with unsterilized
outcome of instruments and supplies.
the They had to work fast, lest the patient dies during the operation due to pain
Operation.
rather than due to the surgery.

HISTORY 4
Sometimes, in the early 18th century, the first Operating Room was
created and Surgery became a specialization and Surgeons became
known as specialised Physicians.
From that time onwards, Surgeons have been pushing for their own space,
The first nurses and equipment.
Operating Sometimes, in 1840, Anaesthesia, the science of pain control, came into
Room has being. It helped Surgeons to slow down, become methodical, purposeful
been used as and to explore deeper into the Human body.
a paradigm Around that time itself, Lister’s “Carbolic Spray” antisepsis came into being
and it helped to improve the outcome of surgery.
for the
Modern Then, gradually, local anaesthetic agents, muscle relaxants and
barbiturates were introduced.
Operating
Soon, wearing of gowns, gloves and masks, washing of hands, etc.
Rooms
became standard practice with Surgeons.
Anaesthesia coupled with control of the airways, by using tubes placed in
the wind pipes, completed this process and Operating Rooms became
special places in the Hospitals.

EARLY OPERATION THEATRE 5

EARLY OPERATION THEATRE 6

EARLY OPERATION THEATRE - 1863 7

EARLY OPERATION THEATRE - 1908 8

MODERN OPERATING ROOMS 9
It is generally agreed that the basic principles for planning Operating

Rooms, as adopted in 1920, when first special area was allocated in a
Hospital for its Surgical Operating Room, have not much changed.
The heavy
workload The prime concern is to be able to perform a surgical procedure (operate)
that in a Safe, Comfortable and Undisturbed Environment.
two world
The process of surgery is generally determined by the skills of the
wars brought
for surgeons
Surgeon.
helped a lot Everything that can be, is sterilised, and what cannot be sterilised, is either
to sanitised or wrapped up in sterilised clothing.
standardise
Today, one may add to this the various technological marvels like
not only the Endoscope, Bio-reactors, Robots and now the on-screen computer utilities
surgical which augment the surgical skills.
technique
but also the
Most of the new equipment cannot be sterilised by traditional methods.
surgical The high cost of some of the Equipment requires that the said Equipment
work place move from one Operating Room to another.
So a variety of protocols have been adapted in various surgical facilities to
achieve the same result.

EARLY OPERATION ROOM - 1916 10

DEFINITIONS 11
Operating Rooms in a Hospital provide the physical facility where surgery

Surgical
or some procedure is performed under sedation, on the patients coming
Team from Out Patient Department (OPD) and In-patient Department, by a team
comprises of of Healthcare Providers.
Surgeons,
Anaesthetist, The team is always headed by the Medical Staff and has been granted the
Nurses,
privilege to perform the said procedure under sedation, (To operate) by a
Technicians
Hospital Order.
& sometimes
Obstetricians The Operating Room is a specially constructed room, which has regulated
Dentists environment and controlled access and is categorised as Bio-clean Room.
as also other It utilises special equipment and instrumentation.

Operating
Room One or more Operating Rooms are supported by additional areas and
personnel rooms which provide various support functions.
involved in
surgery Collectively, Operating Rooms and their supporting areas are known as the
“Surgical Suite”.

DEFINITIONS 12
Traditionally, the Operating Rooms where a surgical procedure is

performed is known as Operating Room (technically these are Surgical
Operating Rooms).
When these Over time, certain invasive procedures performed under sedation, like
procedure endoscopy, Cystoscopy, etc. also were being performed in the Operating
rooms are
Rooms to exploit the benefit of the controlled environment available there.
Soon the Operating Rooms became assigned for such procedures and
few in
became known by the name of the procedure; like Endoscopy Room,
number, they
Delivery Room, etc.
may be
When the number of procedure rooms increased in the Hospital, they
located moved out of the Surgical Suites and were organised as their respective
within the suites like Endoscopy Suite, Obstetric Suite, etc. with their specific pre-
Surgical procedure and post-procedure supporting areas.
Suite
Their planning and designing is also governed by Operating Room
Planning & Designing Guidelines but is modified to accommodate
specific requirements attributable to the procedure being performed.

DEFINITIONS - SURGICAL OPERATING ROOMS 13
The basic function of Operating Room is to perform invasive procedures

on patients, who have been given some form of sedation, using surgical
Minimal
instruments.
Incision
Technique is During this process, the patient is exposed to pathogenic agents, from the
air or the instruments or from surgeon’s hands, etc. The patient’s body is
a form of
another source for pathogenic agents which may infect the next patient in
Open the Operating Room.
Surgery,
Members of the Surgical Team and support staff, when moving around and
where
when talking, are another source of pathogenic agents.
incision
length is In order to reduce, preferably eliminate this iatrogenic process of
transmission of pathogenic agents during the performance of the surgical
kept minimal
procedure, the design of Operating Room started following the principles of
to reduce design of Clean Rooms as provided for the Pharmaceutical Industry.
scarring.
The first clean room of Hospital was the Hospital Pharmacy where
solutions, for injection, were manufactured.

Here the access to Human Body is achieved by one or more surgical

incision(s) and the procedure is called Open Surgery, performed for the
purpose of structurally altering the human body by the incision or
destruction of tissues.
These
SURGICAL These may be further categorised as
OPERATING Operating Room for Minor Surgery
ROOMS or Operating Room for Major Surgery
are depending upon the depth of invasion achieved.
deliberated
Their planning followed the well known standard for Clean Rooms, which
on in rest of
are followed in the Pharmaceutical Industry.
this
 Federal Standard 209
presentation
 British Standard 5295
 ISO Standard 14644 - Clean Rooms
 Pharmaceutical Clean Room Classification & Good Manufacturing
Practices

DEFINITIONS - SURGICAL PROCEDURE ROOMS 15
They were created as modified Surgical Operating Rooms within standard

Surgical Suite; but over time, the working protocols in Surgical Procedure
Rooms came in conflict with the protocols of Surgical Operating Rooms
and gradually these were pushed out of the Surgical Suite, first to semi-
restricted areas and later to other areas in the Hospital; and thus they
became independent identities.
These
The following is the list of various Surgical Procedure Rooms found in
Surgical Hospitals.
Procedure
 Cardiac Cathertisation Room
Rooms shall
 Cystoscopy Room
be discussed  Delivery Rooms or Labour Rooms
separately  Dental Treatment Rooms
 Endoscopy Procedure Room
 Laser Rooms for Ophthalmology
 Oral Surgery Rooms
This deliberation may not apply in totality for these rooms, especially when
they are provided as independent suites.

This discussion is limited to Surgical Operating Rooms,

henceforth to be called Operating Rooms
and Surgical Suite and the Surgical Team.
Further, there can be free standing Surgery Centres

which may or may not have beds, support areas
but such centres are always based on Classical Surgical Suites.
So this discussion will always refer to a Hospital based Surgical Suite.

The areas within a Surgical Suite are categorised into Zones

Each Zone has its well defined regulated environments and access restrictions.
The traffic is regulated between Zones.
Donning of special dress, shoes, mask, cap, etc. is also mandated
when a person moves from one zone to another.
Thus, the Surgical Suite is a composite unit in a Hospital or a Healthcare Facility,

which provides all needed areas and services to the Surgical Team.
A typical Surgical Suite will have a number of Operating Rooms

with different capabilities
but supported with common support rooms and services.
It is important to remember that though the Surgeon is the leader of the team
but all others involved in performance of Surgery or in supporting Surgical Suite
activities, including Hospital Engineers, Housekeeping Staff, etc.,
play important role in success of the surgery being performed.

PRINCIPLES FOR DESIGNING CLEAN ROOMS 18
1. Define the space

2. Define the level of cleanliness that will be achieved
3. Build Tight – the space should be so constructed that there are no or minimal
penetrations
4. Minimise the particle generation by using proper civil finishes and regulating
personnel number and their activities
5. Provide adequate Airflow to dilute the particles concentration within the space.
It requires
o Supply adequate air to achieve required dilution of particles
o Appropriate Filtration of makeup air (outside air) as well as re-circulated air
o Condition the supply air to meet design parameters for temperature,
humidity, air changes and air flow
o Control air velocity so that it can wash the settled particles
o When required, achieve Pressurisation to prevent entry of outside air by
infiltration
o Control airflow pattern to wash all areas, where stagnation may take place,
leading to particle accumulation

6. Control Noise: Clean rooms, due to large volumes of airflow, are inherently
noisy and require adequate noise control measures.
7. Control of Static Electricity
o Static Electricity leads to clumping of small size particles and which affects
their removal in standard air flow conditions. So the equipment, instruments,
etc. are made of anti-static material.
o Till early part of this centaury, control of Static Electricity was also required
to prevent fire accidents where flammable anaesthetic agents were used for
anaesthesia. This required use of anti-static or conductive flooring
Currently, anti-static or conductive flooring is used in Hospital Information
Technology Rooms (Server Rooms or Health data Exchange Rooms) only.
8. Optimise Energy Consumption: Clean rooms operations are highly energy
intensive so the design must adopt strategy(ies) for conserving energy.

9. Carry out Third Party Validation & Certification

o All clean rooms need to be periodically tested for their performance as a
Clean Room of a particular Class,
o All its related processes validated, all equipment calibrated, tested and
validated conforming to various Standards.
o They are required to maintain this certification at all times.
o The time interval for re-certification will usually be 12 months or less.
10. The technicians and other staff are also required to be trained, tested and
certified in using the Clean rooms.
These principles are followed for setting the standards for cleanliness in relation
to the Operating Rooms and the Surgical Suite but they are not followed verbatim.
In Surgical Operating Rooms, the objective is to control contamination rather than

to control the quantity of particles present as required in Pharma Industry.

HEALING ENVIRONMENTS IN OPERATING ROOMS
21
Healing environment, describes a combination of physical setting and social culture that
aids in healing and assists the patients and their families to manage the stress imposed
by the illness.
It is very important in the Surgical Suite where the patient’s experience will last almost a
life time.
Here, it requires provision of simple, clean, hygienic, sober, soft (not loud) interiors (not
visual stimulations through lighting, loud colours, architectural features, etc.), provision
of windows in pre-operative and post operative holding rooms, adequate lighting,
provision of soft music, quiet & comfortable seating, adequately sized doors for un-
hindered movement.
It also requires minimisation of ambient noise, mechanical noise and reduction of glare
as well as provision of adequate privacy and provision of good indoor air quality.
It mandates interaction with family in pre-operative and post operative holding rooms,
especially when the holding times are longer than an hour.
It must be a interaction which sooths the patient’s nerves.


OPERATION THEATRE – 1980 onwards 22

STANDARD TYPES OF OPERATING ROOMS 23
The American College of Surgeons in its Guidelines published in May 2000

has classified Operating Rooms into following classes “A – C”, based on
the combination of surgical procedure that can be performed and the depth
of sedation, as per American Society of Anaesthesiologist, that can be
achieved.
The same classification is used in other American standards for
(FGI 2010 provisioning of MEP Services like ASHRAE, NFPA, etc.
has adopted
There have been a number of other classifications based on different
the same
parameters, which were followed but over the years, this classification has
Classification become the standard all over the world.
for its
Operating Rooms are generally so designed so as to enable their use for
deliberations)
changed speciality on short notice to accommodate varying patient load.
NOUS has further categorised the Class “C” Operating Rooms based on
their Clean Room status, for type of surgeries to be performed. We shall
discuss that little later.

Class “A” Operating Room

These can It provides for minor surgical procedures performed under topical and local
be located in infiltration blocks with or without oral or intramuscular preoperative
sedation. It includes Special Dressing Rooms.
OPD or any
department These procedures can also be appropriately performed in Class “B” and
of the “C” facilities.
Hospital. (Excluded are procedures that make use of spinal, epidural, axillary and
stellate ganglion blocks; regional blocks, etc. (e.g., interscalene and supra-
These are clavicular, infra-clavicular, and intravenous regional anaesthesia.)
also located Specifications

in Surgical
Clear Floor Area 150 SFT minimum
Suites for
carrying out Minimum Clear Dimension 12 Foot
minor
Minimum clearance at both sides, the foot and
procedures 3 Foot & 6 Inches
the head of the operating table from the wall

MINOR OPERATING ROOM 25

Class “B” Operating Room

It provides for minor or major surgical procedures performed in conjunction
with oral, parenteral, or intravenous sedation or under analgesic or
These are dissociative drugs.
always
located in These procedures are also appropriately performed in Class “C” facilities
Surgical Suite but cannot be performed in Class “A” facilities.
Or
Departmental
These are the bulk of Operating Rooms, which are available in smaller
Surgical Hospitals. They are provided with special finishes and standard HVAC
suites systems, with local Secondary Filters.
These get Specifications

converted to
Procedure Clear Floor Area 250 SFT minimum
Rooms during
evolution of Minimum Clear Dimension 15 Foot
the hospitals
3 Foot & 6 Inches

CLASS “B” OPERATING ROOM 27

These are Class “C” Operating Room

It provides for major surgical procedures that require general or regional
always
block anaesthesia and support of vital bodily functions.
located in
Main Surgical These Operating Rooms are generally so designed so as to enable their
use for changed speciality on short notice to accommodate varying patient
Suite
load. The clear Floor Area may also be increased for accommodating
These get additional equipment or staff, or for creating a controlled environment, as
converted to may be required for the surgery proposed to be performed in a particular
Operating Room. For example, additional Clear Floor Area of 200 SFT
Specialised
minimum needs to be added for Heart Lung Machine in a CTVS OR
or Organ
Specific Specifications
Operating Clear Floor Area 400 SFT minimum
Rooms
Minimum Clear Dimension 18 Foot
during
evolution of Minimum clearance at both sides, the foot and
4 Foot
the hospitals the head of the operating table from the wall

MAJOR OPERATING ROOM 29

UPGRADED OPERATING ROOMS 30
Hybrid Operating Room

It is an upgraded Class “C” Operating Room which has an imaging devices
These are integrated within the surgical Operating Room and it provides for major
always surgical procedures that require general or regional block anaesthesia and
support of vital bodily functions.
located in
Main Surgical These Operating Rooms have a CT scanner, MRI scanner or a Cath Lab is
Suite integrated within the Operating Room to provide synchronised imaging
services for evaluation of surgical procedure and/or mid surgery correction
of the procedure. Appropriate Engineering services, RF shielding, control
These
room interface, etc. may need to be provided, whenever required.
become
organ specific Specifications
due to the Clear Floor Area 900 SFT minimum
imaging
Minimum Clear Dimension 18 Foot
modality
provided Minimum clearance at both sides, the foot and
4 Foot 6 inches

HYBRID OPERATING ROOM 31
Brainsuite®, developed by Brainlab AG of Munich, Germany, is a workflow-optimized

neurosurgical Operating Room that integrates image-guided surgery, ...

HYBRID OPERATING ROOM 32

Intelligent Operating Room

The minimally invasive surgery, when combined with robotic surgery and
These telemedicine, especially for Neuro-surgery or Urology requires information
Intelligent that allows coordinated and collaborative care between the surgeon,
Operating surgical team, consulting physicians, pathologists and other specialists in
Rooms have different locations.
multiple flat
panel high
This requires instant communication and visualization of various facets of
definition
monitors, surgical field and relate it to its pathology.
mounted to
the walls and These Operating Rooms are known as “Intelligent Operating Room.”
ceiling for
displaying the Specifications
information
which has Clear Floor Area 1200 SFT minimum
been
processed Minimum Clear Dimension 18 Foot
outside the
Surgical Suite
4 Foot 6 inches

INTELLEGENT OPERATING ROOM 34

Operating Room and Lasers

The term Use of a laser scalpel in otherwise conventional surgery is becoming more
laser includes common. The laser beam is also used to vaporize soft tissue with high
all medical water contents.
lasers and
optical When an Operating Room is designated to be used exclusively for use of
radiation Laser in Surgery, design must meet safety precautions in accordance with
devices,
BS EN 60825 and cater for permanent non-reflective surfaces including
including light
emitting
floors, walls & ceilings and provision of laser absorbing coverings on all
diodes openings. It will have interlocked doors with access control and need
(LEDs) and higher allocation of electrical load for operating the lasers.
intense
light/heat Specifications
sources,
referred to as Clear Floor Area 600 SFT minimum
intense
pulsed light Minimum Clear Dimension 18 Foot
(IPL)
(sources) Minimum clearance at both sides, the foot and
systems. 4 Foot

OPERATING ROOM & LASERS 36
Jefferson University Hospital, USA


OPERATING ROOMS & CLEAN ROOM STATUS 37
NEAR ZERO BACTERIA OPERATING ROOMS

These Class “C” Operating Rooms provide Clean Room status where CFU
For near Zero count is minimal. The HVAC system provides HEPA Filters (Class H13-
H14), pressurisation, Laminar Airflow and air conditioning.
Bacteria
environment, These have been developed on basis of Charnlay’s Chamber designed for
the air Hip Implantation.
delivery
These provide for Cardiac Surgery, Neuro Surgery, Implant Surgery,
plenum size Transplant Surgery, Burns & Plastic Surgery and Tissue Implant Surgery
is minimal and accommodate all needed special equipment.
8 x 8 Feet
(optimal is 10 Specifications
x 10 feet)
Clear Floor Area 600 SFT minimum
Therefore
extra floor Minimum Clear Dimension 20 Foot
area is
required Minimum clearance at both sides, the foot and
6 Foot

CTVS OPERATING ROOMS 38

MODULAR OPERATING ROOMS OR SURGICAL SUITES 39
Functionally, there is no difference between conventionally-built Operating

Rooms or Surgical Suites or the ones which are built using Modules and
Modular are known as Modular Operating Rooms.
Operating
Rooms
provide Both are subject to the same standards (e.g. NHS-HBN 26 in UK) and
flexibility to regulations. Project specifications and acceptance tests need be defined to
change the ensure that quality standards are met at handover for both types.
size as well
as class of However, planners and designers need to take into account the differences
the in the processes for building the two types.
Operating
Room,
Modular Operating Rooms is pre-manufactured, brought to site and
especially
when it has erected whereas the other type is built like any other civil structure on site.
been
anticipated Being pre-manufactured, very detailed and precise specifications need to
that such a be generated for Modular Operating Rooms. Being a room in a room
change shall concept, they need higher slab to slab height and more floor area but they
be required are easy to de-contaminate, provide better control over maintenance
in future. activities and do not require entry of maintenance staff as most of services
are accessible on outer surface of the shell..

MODULAR OPERATING ROOMS 40

PROVISIONING OF OPERATING ROOMS 41
For 24x7
Always provide at least 2 Operating Rooms in any facility which has a
availability,
department of Surgery of any speciality. The second Operating Room
a set of 2 should be of same or higher class as compared to first Operating Room.
independent
Surgical In case of provisioning of Class “C” Operating Room, at least 2 Operating
Rooms of same class must be provided. Then it can back up the single
Suites should Operating Room of Class “A” & “B”, as may have been provided.
be provided
with In the Emergency Department, if Operating Rooms are provided, it must
be minimum 2 number of Class “C” Operating Rooms.
independent
HVAC Wherever possible, Operating Room(s) should be as 2 banks with
systems, independent HVAC services.
so that each
Surgical Suite When the number of Operating Rooms is more than 8 in a Hospital, these
can be should preferably be organised as two or more Surgical Suites and not
cleaned one.
independently

Where the For urgent or emergency surgery, depending upon their specific utilisation,
need for at least one or two Operating Rooms should always be available in the
Surgical Suite schedule.
urgent or
emergency Multi-functionality of Operating Rooms must be maximized. It is strongly
surgery is recommended that, wherever possible, Operating Rooms should not be
speciality-classified, but should be used according to scheduling criteria of
high, the Hospital.
provision for
two separate In case of Class “C” Operating Room, provisioning is determined by the
equipment required to be placed within the Operating Room, level of
Surgical Environment Control required and its overall utilisation in terms of surgical
Suites with time (Intra-operative Time) over a time window of one week or 5 working
at least 2 days. Thus, in a Surgical Suite, there can be General Operating Rooms
which are not assigned or Operating Room assigned for CTVS Surgery,
Operating Neuro Surgery, Orthopaedics, Implant Surgery, Ophthalmology, ENT, etc.
Rooms shall Even the pre-operative and post-operative support areas can be
be made segregated and assigned as per Hospital policy.

All Operating Room schedules must provide for at least 12 Hours

utilisation of the Surgical Suite, which in turn must provide for at least 10
Hours utilisation of each of the Operating Rooms therein.
The weekly schedule must provide for at least 50 Hours utilisation of each
of the Operating Rooms and at least 60 Hours utilisation of the Surgical
Suite.
The weekly schedule must provide for at least 30 Hours for weekly
cleaning & maintenance of all Operating Rooms and at least 36 Hours for
weekly cleaning & maintenance of the Surgical Suite.
There should be specified time windows for maintenance of all Medical &
Allied Equipment, stocking of supplies, maintenance of all engineering
equipment and services and for sterility checks.
After every weekly cleaning & maintenance, the Surgical Suite

controller must check the results and certify that the Surgical Suite in
general and all Operating Rooms, individually, are fit for performing
surgeries as will be scheduled.

SUPPORTING AREAS FOR OPERATING ROOMS 44
Operating Rooms are the heart of any Surgical Suite but these must be
supported by additional rooms and areas so that Operating Rooms
remains sterile and are able to provide the desired environment,
equipment support and decontamination services.
Each Provisioning of supporting areas in the Surgical Suite will be determined by

a number of variable factors and is established by the process of
Surgical
Functional Analysis and type of surgeries to be performed.
Suite
becomes The size of each room and the number of rooms to be provided is
subjective and it must conform to Hospital Policy.
unique by
virtue of its The principle for allocation of supporting areas in the Surgical Suite
supporting is, “what can be avoided is better not provided”.
areas
Whatever is relevant to surgical activity being performed should be there
and rest should move out. The offices, class rooms, mechanical areas,
maintenance areas, etc., should be placed in vicinity of the Surgical Suite.
CSSD and GMP facility for recycling of Single use devices will never be
part of the Surgical Suite Complex.

At least one room each of the following categories must be provided to

provide functionality in a Surgical Suite with Class “C” Operating Rooms.
Supporting Areas for Patient Care

Details for Patient Receiving Area
supporting Pre-operative Patient Station(s)
areas Pre-operative Induction Room(s)
should be Post-operative Recovery Room(s) (Post Anaesthetic Care Unit,
worked out PACU)
Post-operative Patient Station(s)
in
Neonatal Care Room (Optional)
association
Nursing Station(s)
with the
Medication Station(s)
Surgical Special Dressing Room(s)
Team
Sub-sterile Room(s) (Sterilisation sub units) (Optional – may not be
provided if Central Sterile Service Department (CSSD) or Theatre Sterile
Service Unit (TSSU) is available)


Since similar Scrub Facilities
supporting Clean Change Room(s)
areas are Scrub Station(s) suitable for 4 persons, one Scrub Station for two
there in the Operating Rooms
Hospital in Clean Storage Facilities
other For Sterile and Clean Supplies
Clean Workroom(s) including Anaesthesia Workrooms, Pump Rooms
departments,
(for priming the Heart Lung Machine)
the
Clean Supply Room(s) for dispensing sterile and clean supplies
specifications
For Surgical & Medical Stores
as applied For Anaesthesia Equipment, Gas Cylinders, reserve Gas Cylinders
there also and Medical Stores as required for Anaesthesia
apply here For common Equipment, Linen and common Instruments


Clean Storage Facilities for Special Equipment

Plan &
Design
Orthopaedic Equipment Storage
proper Plaster Cast Storage
Corridors Pump Room for Heart Lung Machine
Equipment Room for Neurosurgery
Clean Cystoscopy Instrument Preparation and Storage Room
Corridor C-Arm Radiology Machine Storage
Cart Storage
Sterile
Staff Rooms
Corridor
Staff Clothing Change Rooms, separate for Men & Women including
Dirty Lockers Room, Shower Rooms, etc.
Corridor Surgical Suite Toilets separate for Men & Women
Staff Lounges, separate for Medical Staff & Other Staff
Multi-purpose Meeting Room


Support Room(s) for Patients
Patient Clothing Change Room(s) including Lockers Room
Patient Toilets, separate for Men & Women
Patient Attendant’s Waiting Room & Toilets
The Vending Area
nomenclature Multi-purpose Meeting Room
of supporting Surgical Suite Control Station
areas is self Fire & Life Safety Control Room for the Surgical Suite
Surgical Suite Supervisor’s Office
descriptive
Surgical Suite Information Technology Server, Documentation Area
& Control Room
Pantry
Night Duty Room
Multi-purpose Meeting Room
Cart Storage


Surgical Suite Technical Area

CSSD and Radiographic Film Processing Room
GMP facility Stat Lab & Frozen Section Room
for recycling Contrast Media Preparation Room
of Single use Storage Facilities for Blood, Organs, Tissues & Samples
devices will Cryo-preservation Room
Storage Facilities for Housekeeping Equipment and Supplies
never be
Theatre Sterile Supply Unit (TSSU)
part of the
Instrument Steriliser(s) Room
Surgical
Large Equipment Steriliser(s) Room
Suite Decontamination Facilities
Complex. Soiled Receiving for used and contaminated goods and supplies
Decontamination Workroom(s)
Disposal Holding Room(s)


Teaching Areas
The offices, Conference Room
class rooms, Resident Room(s)
Viewing Room(s)
mechanical
Surgical Suite Mechanical & Electrical Services Area for housing the
areas,
following Equipment
maintenance
Isolated Power Supply System
areas, etc., Uninterrupted Power Supply System
should be Air Handling Units
placed in In Line Water Filtration System
vicinity of the Surgical Suite Information Technology Hardware
Surgical Medical Gases Cylinder Store & Manifold Room
Suite In addition following may be needed in large Suites
Engineering & Bio-medical Engineering Work Room
Surgical Suite Information Technology Control Room

NEO NATAL ROOM
POST OPERATIVE WARD
TSSU
SCRUB STATION FROZEN SECTION UNIT

PLANNING PARAMETERS 52
The planning and design parameters are intended to bring better

understanding of the functionality of the Surgical Suite to all stakeholders –
Planning
Healthcare Providers, Regulators, Promoters, Architects, Engineers and
Parameters Healthcare Equipment Industry so that planning and designing process is
relate to standardised.
functional
This will standardise the Surgical Suite operations to the extent that the
requirements variable will be the Operating Rooms only.
1. A Surgical Suite shall provide for eight (8) or less number of Operating
While
Rooms.
Design 2. When the number of Operating Rooms exceeds eight (8), these should
preferably be planned as two Surgical Suites with independent
Parameters
engineering services. This helps to reduce the traffic within the Surgical
relate to Suite and thereby helps in reducing Nosocomial infections.
facility
(The microbial load in the Surgical Suite air is directly
design
proportionate to the number of persons, who move around in the
restricted area of the Surgical Suite.)

3. All Operating Rooms will be provided with an Emergency Call

Communication System.
This Emergency Call Communication System can be a call bell with call
generating switch in each Operating Room; and the call registry with audio &
video response and a panel showing the Operating Room Number, from where
the call has originated, located in the Surgical Suite control room. This
Emergency Call Communication System can be more sophisticated
Computerised Systems with display units, repeater panels, etc., and with
multiple displays in Surgical Suite control room, Security Supervisor’s Room,
Medical Superintendent’s Office or Medical Director’s Office.
4. All Operating Rooms will be provided with an “In Use Illuminated

Display System”.
This System, controlled from within the Operating Room will light up a red sign
or a lamp at following locations to display that the particular Operating Room is
in use. Where multiple lamps indicating multiple Operating Rooms are to be
displayed, the display will provide the identity of the Operating Rooms being
used.
o On all doors opening into the Operating Room
o In the Surgical Suite control room
o In the Surgical Suite Lounge where members of the surgical team can see
it.

5. Protecting the privacy and dignity of the patients, especially when they
are sedated, or recovering from an anaesthetic, is essential.
Some surgical operations necessitate exposing patients in ways that can be
distressing and embarrassing.
Planning and designing must provide for curtained cubicles, and control over
CCTV recordings wherever so required.
Hospital policies must ensure that staff is trained and respects the privacy and
dignity of the patients.
6. Use of flash sterilizers in the Surgical Suite and use of the bench-top
sterilizers in Operating Room is being phased out in favour of central
processing in the CSSD. All hospitals should ensure that the Surgical
Suite has adequate stocks of surgical instruments to overcome issues
associated with dropped instruments.
7. When background music is provided in the Operating Rooms, it will be

individualised for each Operating Room and the player unit shall be
located in the technical area of the Surgical Suite. The wired-in
Speakers within the Operating Room should be ceiling mounted and
moisture-resistant.

8. Surgical Suites generate considerable quantity of material for disposal

and this must be held safely and securely prior to its disposal.
Therefore all Surgical Suites will have a proper Disposal Zone with minimum 3
Rooms.
o Soiled Receiving Room which shall receive the used and contaminated
goods and supplies for temporary storage.
o Decontamination Workroom, with a steriliser of appropriate size, for

decontaminating the goods and supplies including bagged refuse, clinical
waste, soiled linen and materials for recycling.
o Disposal Holding Room, which will hold the decontaminated goods and
supplies while awaiting collection by Hospital Waste Collector, CSSD,
Laundry or other agencies.
o Full “sharps” containers from the other area of Surgical Suite like pre-
operative units, induction rooms, post operative units, etc., will also be
stored in this room.
o All trolleys including instrument trolleys, after use, shall be covered

adequately and then stored in this room

9. Ideally no offices should be provided in the Surgical Suite other than

the one for Surgical Suite Supervisor. All offices should be outside the
Surgical Suite but if any offices are to be provided; these shall be in the
unrestricted Zone. Only lounges shall be provided in the semi restricted
Zone.
10. Provision of Conference cum meeting Room in the semi restricted Zone
should only be made in Hospitals which are associated with Medical
Schools for purpose of real time review of surgery being performed.
This helps to reduce the number of persons present in the Operating
Room, so vital to control spread of infection.
11. Surgical Suites are part of the Hospitals and do not need any Bulk
Storage Spaces. The Hospital policy should manage the daily supply to
the Surgical Suite.
12. Within the Surgical Suite, separate storage is required for

o Equipment and non-sterile Supplies
o Linen and Operating Room Garments
o Sterile Supplies & Trolleys
o Instrument Systems

13. Interaction with Hospital Services

The Surgical Suite needs to interface with all Hospital administrative & utility
Services. The following are listed to highlight their importance.
o Pharmacy Services
o Stores and Materials Management Services
o Housekeeping, Cleaning and Sanitizing Services
o Waste Management Services
o Life and Fire Safety Services
o All types of Emergency Care Services
o Engineering and Maintenance Services
14. Video Recording and Projection

 Evaluate if the images have to be projected into the Operating Room during
surgery. If yes, will it be on a large format display on the wall or on a screen
near the surgeon. Accordingly provide suitable Screens. As of now, this is
especially important in Operating Room for Orthopaedic Surgery, Neuro-
surgery and re-constructive surgery.
 Evaluate if the images have to be captured and will it be only the incision
site or also the overall room activity in the Operating Room for multi point
interaction. If yes, determine the camera locations, light levels and provide
the needed hardware and connectivity.

15. Interaction with Hospital Services

The Surgical Suite needs to interface with all Hospital administrative & utility
Services. The following are listed to highlight their importance.
o Pharmacy Services
o Stores and Materials Management Services
o Housekeeping, Cleaning and Sanitizing Services
o Waste Management Services
o Life and Fire Safety Services
o All types of Emergency Care Services
o Engineering and Maintenance Services
16. Video Recording and Projection

 Evaluate if the images have to be projected into the Operating Room during
surgery. If yes, will it be on a large format display on the wall or on a screen
near the surgeon. Accordingly provide suitable Screens. As of now, this is
especially important in Operating Room for Orthopaedic Surgery, Neuro-
surgery and re-constructive surgery.
 Evaluate if the images have to be captured and will it be only the incision
site or also the overall room activity in the Operating Room for multi point
interaction. If yes, determine the camera locations, light levels and provide
the needed hardware and connectivity.

ZONING IN THE SURGICAL SUITE 59
The Surgical Suite has the following three (3) designated Areas (zones), as
specified by FGI based on the type of physical activities to be performed in
these areas.
This division also mandates change of street clothes and provision of

display signs, that shall clearly indicate the surgical attire required.
This zoning is defined to provide for control over the environment.

1. Un-restricted area
2. Semi-restricted area
3. Restricted area
This zoning corresponds to classical 4 Zones, as under.

1. Un-restricted area Protective Zone
2. Semi-restricted area Clean Zone
3. Restricted area Aseptic Zone
There is an additional zone called Disposal Zone

CHARACTERISTICS OF UN-RESTRICTED AREA

1. It is where controlled environment of Surgical Suite inter-faces with
outside.
2. It provides for entrance of patients, personnel, and materials.
3. It acts as the first barrier and all staff changes the shoes and street
clothes in this Zone.
4. The patient trolleys are also changed here if so required.
5. The traffic is not restricted but it includes a central control point to
monitor this traffic.
6. The Street clothes are permitted in this area.
7. It does not provide any waiting areas.

CHARACTERISTICS OF SEMI-RESTRICTED AREA

1. It is main environment in Surgical Suite & is fully controlled in
terms of the comfort factors and particulate count.
2. It provides the peripheral support areas of the Surgical Suite.
3. The environment control must provide for dilution of any
accumulated vapours from any source.
4. It houses the patient holding areas, recovery rooms, lounges, etc.,
and has storage areas for clean and sterile supplies, work areas
for storage and processing of instruments, and corridors leading to
the restricted areas of the Surgical Suite.
5. The Traffic in this area is limited to authorized personnel & patients
6. Personnel are required to wear surgical attire and cover all head
and facial hair.

CHARACTERISTICS OF RESTRICTED AREA

1. The restricted area includes operating and procedure rooms, the
clean core, and scrub sink areas.
2. All of these are provided with a pre-determined fully controlled
environment in terms of the comfort factors and particulate count.
3. The quality of air in this zone will determine if the Operating Room
is a Zero Bacteria or Ultra Clean, etc.
4. The Traffic in this area is limited to authorized personnel and
patients.
5. In addition to wearing surgical attire, masks are required where
open sterile supplies or scrubbed persons may be located.

CHARACTERISTICS OF DISPOSAL ZONE

1. This is where all used, soiled material is disposed off to Hospital
utility service.
2. The environmental parameters are controlled here too, to make
them not only comfortable but safe.
3. The Street clothes are not permitted in this area.
4. In addition to wearing hospital or surgical attire, masks are
required to prevent personnel contamination.
5. The Traffic in this area is limited to authorised personnel only.

LAYOUT OF THE SURGICAL SUITE 64
HOSPITAL ENGINEERING
SERVICES
HOSPITAL
 PATIENT CORRIDOR RESTRICTED
UNRESTRICTED SEMI RESTRICTED
ATTENDANT’S
WAITING AREA AREA AREA
AREA
 TOILETS
CLEAN CORRIDOR STERILE CORRIDOR
 VENDING
MACHINES
DIRTY CORRIDOR
DISPOSAL
ZONE
GRAPHIC LAYOUT TO SHOW RELATIONSHIPS OF ZONES IN SURGICAL SUITE


GRAPHIC LAYOUT
TO SHOW
NUMBERS REFER
RELATIONSHIPS OF
TO TABLE
UNRESTRICTED BELOW
AREA
1 Patient Receiving Area 9 Night Duty Room 17 Contrast Media Preparation Room 25 Surgical Suite Mechanical & Electrical
Services Area
2 Staff Change Rooms, separate for Men 10 Multi-purpose Meeting Room 18 Storage Facilities for Blood, Organs, 26 Isolated Power Supply System
& Women including Lockers Room, Tissues & Samples
Shower Rooms, etc.
3 Surgical Suite Toilets separate for Men 11 Fire & Life Safety Control Room for the 19 Cryo-preservation Room 27 Uninterrupted Power Supply System
& Women Surgical Suite
4 Patient Clothing Change Rooms 12 Cart Storage 20 Storage Facilities for Housekeeping 28 AHU Rooms
including Lockers Room Equipment and Supplies
5 Patient Toilets, separate for Men & 13 Surgical Suite Technical Area 21 Teaching Areas 29 In Line Water Filtration
Women
6 Surgical Suite Control Station 14 Stat Lab 22 Conference Room 30 Engineering & Bio-medical Engineering
Work Room
7 Surgical Suite Supervisor’s Office 15 Frozen Section Room 23 Resident Rooms 31 Surgical Suite Information Technology
Control Room
8 Surgical Suite Information Technology 16 Radiographic Film Processing Room 24 Viewing Room 32 Medical Gases Cylinder Store &
Server & Control Room Manifold Room
33 Pantry

NUMBERS
GRAPHIC LAYOUT REFER TO
TO SHOW TABLE
RELATIONSHIPS BELOW
OF
SEMI-
RESTRICTED
AREA
1 Storage Facilities for Orthopaedic 8 15 22

Staff Rooms Pre-operative Patient Holding Rooms Storage for Sterile and Clean Supplies
Equipment
2 9 Staff Lounges, separate for Medical 16 23
Storage Facilities for Plaster Cast Post-operative Recovery Rooms Clean Workrooms
Staff & Other Staff
3 Pump Room for Heart Lung Machine 10 Multi-purpose meeting room 17 Neonatal Care Room 24 Clean Supply Room
4 Storage Facilities for Neurosurgery 11 18 25 Storage Facilities for Surgical &
Theatre Sterile Supply Unit (TSSU) Nursing Stations
Equipment Medical Stores
5 Cystoscopy Instrument Preparation 12 19 26
Instrument Sterilisers Medication Stations Storage Facilities for Anaesthesia
and Storage Room
6 13 20 27 Storage Facilities for common
Storage Facilities for C-Arm Machine Large Equipment Sterilisers Special Dressing Rooms
Equipment
7 Cart Storage 14 Supporting Areas for Patient Care 21 Clean Storage Facilities 28 Storage Facilities for Linen
29 Storage Facilities for common
Instruments

GRAPHIC LAYOUT TO SHOW RELATIONSHIPS OF RESTRICTED AREA IN A GENERAL HOSPITAL


GRAPHIC LAYOUT TO SHOW RELATIONSHIPS OF RESTRICTED AREA IN SUPER SPECIALITY HOSPITAL


Entry To Restricted Zone
Class “A” Operating Rooms
Class “B” Operating Rooms
Class “A”
Class “C” Standard Operating Rooms
Operating
Class “C” Ultraclean Operating Rooms
Rooms can
also be Class “C” Near Zero Bacteria Operating Rooms
located in Class “C” Hybrid Operating Room
the semi-
Class “C” Intelligent Operating Room
restricted
Zone.
In a classical layout, the Operating Rooms shall be laid out, in the order, as
above.
The maximum number of Operating Rooms of any type in a standard
Surgical Suite should be 8.

EXPANSION OF SURGICAL SUITE
For expansion, in every Surgical Suite, put at least two Class “C”
Operating Rooms side by side so that when merged,
they provide 400 x 2 = 800 SFT. Operating Room
For expansion to create Hybrid or Intelligent Operating Rooms, in every

Surgical Suite, the last 3 or 4 Operating Rooms can be merged.
LOCATION OF THE SURGICAL SUITE
Access to the Surgical Suite should be restricted and it must interface a

waiting area for the patient attendants as well interface to Surgical Suite
Control Station.
Rest of the Surgical Suite needs to be isolated from all other Hospital
traffic.


At the same time, the Surgical Suite should be easily accessible from the
Hospital’s Emergency Department, Intensive Care Units, Critical Care
Units, Imaging Service units and Diagnostic Laboratories.
Therefore, location of the Surgical Suite is central to design of the Hospital.

In high rise buildings, it is preferred to locate the Surgical Suite on the
podium block rather than in the towers.
In Low rise buildings, it is preferred to locate the Surgical Suite on the top
most floor, which naturally provides control on traffic as well as a terrace to
provide space for mechanical services.
When Surgical Suites are stacked, the Surgical Suites with Intelligent
Operating Room or Hybrid Rooms are placed on lower floors and others
are placed on higher floors.
Since the Surgical Suite requires a large number of Air handling Units
(AHUs), UPS Systems; it is preferred that a terrace to accommodate the
mechanical equipment is available for the Surgical Suite.

If that is not possible, a service floor above the Surgical Suite may be
provided.
In any case, there should not be any wet areas, especially the toilets,
located on floor above any part of the restricted area zone of the Surgical
Suite.
Ideally, no traffic cores, lift wells, staircase wells, ramp or ramp wells,
service shafts or chutes should pass through the extent of the Surgical
Suite especially through the extent of its restricted area zone.
These should preferably be located immediately outside or across the

corridor to the Surgical Suite.
When located, by design, in the restricted area zone of the Surgical Suite,
these shall not be used but completely sealed off so that air contained
within them will not be able to cause any bio-contamination.

DESIGN PARAMETER FOR THE SURGICAL SUITE73
The design should provide for control over traffic, lighting and thermal
The old comforts within the Surgical Suite.
wise saying The controlled environment should provide minimal Bio-contamination.
“A place for The Engineering Services should be 100% safe with adequate backups,
everything
in case of failure of any primary service.
and
The Communication system should provide high volume, high speed
everything
connectivity.
in its
place,” And the Surgical Suite should be able to upgrade to adopt any new
applies the Healthcare Technologies while remaining operational.

most, to the
design of The built environment in the Surgical Suite must provide for privacy,
the Surgical dignity and confidentiality of the patient. It must be as quiet as possible,
Suite
especially the post operative recovery area.

The Surgical Suite building block will always be provided with a fixed wire
One basic mesh on all openings including windows, ventilators, doors and all other
apertures. It will be provided to envelop the building on all surfaces
design
opening to outside air.
principle is
The window shutters will be opening within the confines of the wire mesh.
that
All apertures in building walls shall be provided with rain protection with
“Everybody sloping external sun shade slabs or canopies.
should
All doors opening to outside of the building shall be so designed as to
spend the enclose adequate vestibular area between the wire mesh-holding shutter
placed outside and the glazed shutter placed inside.
least
possible When the Surgical Suite is provided with centralised HVAC systems, all
windows shall be fixed, non-open able type.
time in the
Surgical The centralised HVAC systems will be provided with adequate fresh air
intake.
Suite.”

Following design parameters are listed for design guidance.
1. The Net to Gross conversion factor considered for the Surgical Suite
should be 170 - 200% as compared to 135 – 145% for overall Hospital.
2. The clear height required in Operating Rooms as measured from
Finished Floor Level to bottom of false ceiling is minimum 3 M.
3. Depending upon the structural design, design of HVAC supply air
plenum, the preferred slab to slab height is 4 M or more.
4. The Operating Room area has to be column free.
5. If so required in a building, the floor housing the Surgical Suite can
have higher slab to slab height or a different structural grid than rest of
the Hospital.
6. A flat slab is preferred for Surgical Suite top slab.
7. Wherever possible, fixed, non-openable Windows should be provided
in the Operating Room.

8. Operating Rooms in the Surgical Suite shall never be designed by
using the Mirror Image Handing for multiple rooms but will always be
individually designed (Single Handing) with same activity flow and
relate to the layout. This is required for standardising the availability of
services at the same place in all Operating Rooms which in turn
reduces operational errors.
9. Minimal Electrical Load (kVA) for Equipment, to be considered for
planning shall be as under. The Electrical Load for HVAC will be extra.
o Class “A” Operating Rooms 4
o Class “B” Operating Rooms 5
o Class “C” Standard Operating Rooms 6
o Class “C” Ultraclean Operating Rooms 7.5
o Class “C” Near Zero Bacteria Operating Rooms 7.5
o Class “C” Hybrid Operating Room 10 +
o Class “C” Intelligent Operating Room 12.5 +
(+ will be determined by the additional imaging & monitoring equipment
provided)

10.Clear Corridor Width
o The primary corridor should be at least 2.4 Meter wide in the Surgical
Suite.
o The secondary corridor should be at least 1.8 Meter wide in the Surgical
Suite. This includes all corridors where trolley traffic is envisaged.
o The tertiary corridor should be at least 1.2 Meter wide in the Surgical Suite.
This includes all corridors where no trolley traffic is envisaged.
11. Operating Rooms, should be provided with clear door opening of
minimum 1400 mm. Preferably, all doors should be sliding type and
with motorised control for non push operation.
12. All doors in the pressurised Operating Rooms, shall be hermetically
sealed and provided with controls for dual openings; full opening and
limited opening. The limited opening width should be 600 mm or 750
mm, just enough to admit one person.

13.The Surgical Suite should be provided with Automatic, double panel,
sliding doors in the primary corridor to facilitate bed or patient stretcher
movement except where fire doors are required.
14.All the doors should be provided with clear door opening of minimum
1400 mm.
15. The automatic sliding doors shall be provided with controls for dual
openings; full opening and limited opening. The limited opening width
should be 600 mm or 750 mm, just enough to admit one person.
16. All doors in the Surgical Suite other than as above shall be standard
single panel swing doors provided with clear door opening of minimum
1200 mm.
17.All doors in the Surgical Suite shall be provided with standard “Vision
Panel”. Standard vision Panel is a 700 mm x 200 mm double glass
glazed panel which is provided in the door at a height of 1150 mm from
Finished Floor Level.

18.The design should make maximum use of natural light. It shall try to
achieve a minimum daylight factor of 2 percent (excluding all direct
sunlight penetration) in 75 percent of all space occupied for critical
visual tasks.
19.It must provide for either automatic dimming controls or accessible
manual lighting controls, and appropriate glare control.
Explanation:
Daylight Factor vide BS 8206-2:2008 which broadly bands average daylight factors into
the following categories for for Hospitals & Healthcare buildings and which is generally
followed.
Under 2 – Not adequately lit – artificial lighting will be required.
Between 2 and 5 – Adequately lit but artificial lighting may be in use for part of the time.
Over 5 – Well lit – artificial lighting generally not required except at dawn and dusk – but
glare and solar gain may cause problems.

20.LIFTS
o At least 2 Lifts, placed side by side, shall be provided to serve a
Surgical Suite located at any floor other than the Ground Floor.
o Lift Car will be protected by a bump rail or a combined handrail and
bump rail on three sides of the lift car.
o The selection of an appropriate Lift speed is dependent on building
height. However, speed has very little effect on the handling capacity
of lifts in Surgical Suite floors, due to the prolonged loading and
unloading times.
o Ideally, a Lift serving the Surgical Suite shall be capable of carrying
patients on a standard extended bed together with the necessary staff
and equipment. This lift should have a rated load of 2500 kg with clear
car floor area of 1800 mm wide by 2700 mm deep and clear door
opening width of 1400 mm. The door height of the Lift car shall be
2100 mm or more.
o (Reference-Health Technical Memorandum 08-02 of United Kingdom & BS EN 81-70)

20.LIFTS
o Lift Car will be illuminated to, at least, 100 Lux at floor level
o An electrically-driven exhaust fan (for scavenging) must be
provided in the car ceiling.
o An Emergency Bed Service (EBS) facility should be available in
any lift that is not a dedicated Surgical Suite Lift.
o The Lift Lobby at all floors shall provide turning of patient trolley
through 900. This requires a clear space without column or wall or
partition, in front of lift doors which is at least 2500 mm, preferably
3000 mm long and as wide as the civil openings for the Lifts.
21.The design should make maximum use of natural Ventilation and
achieve an outdoor air supply rate of 10 litres per second per person.
The final design is derived by integration of the functional parameters
with the architectural layout and by applying the interpretation of the
statues that govern not only the activities within the Surgical Suite
and Operating Room but also the provision of MEP services.

INFECTION CONTROL IN THE SURGICAL SUITE 82
The Operating Rooms specifically and the Surgical Suite in general

Proof of the functions to provide a controlled environment for the performance of
effects of surgical procedures.
operating-
Surgical wound infections are the second most common nosocomial
room infection and may involve either the incision site or adjacent structures.
architecture
Most surgical wound infections result from microbial contamination
on
(endogenous or exogenous source) of the wound during surgery.
Surgical
infection is Operating Room procedures are designed to provide the maximum
reduction of exogenous microorganisms that could contaminate the
almost
surgical wound.
impossible to
obtain; Medical Treatment will take care of the endogenous infections.
but it
In addition to facility design, compliance of Surgical Team members with
contributes surgically aseptic procedures is a critical component in the prevention of
equally surgical wound infections.

Infection Control Practices

o Employee Health
o Surgical Attire
o Surgical Drapes
o Traffic Control
o Education Facilities within Surgical Suite & ORs
o Surgical Environments
 Floors, Walls and Ceilings
 Temperature and Humidity
 Airborne Contamination and Ventilation Systems
o Handling of Infectious Waste, Linen and Sharps
o Intra-operative Infection Control
o Housekeeping Requirements



PRINCIPLE OF DESIGN
A well-proportioned vestibular space or "gray area" with inside-outside
access to the Hospital corridor and surgical suite, appropriately isolated by
doors, serves a number of purposes in the control of contamination.
The area itself is a sort of airlock between the common corridor and
surgical suite proper and demarcates a well-designed transfer area,
including storage space for clean carts.
Opening on this vestibular space would be the control office, scheduling
desk, various offices, surgeons' lockers, and other areas requiring outside-
inside access.
By such an arrangement these spaces need not open directly onto a
common hospital corridor.

PRINCIPLE OF DESIGN
Conventional closed cabinets in operating rooms have to be stocked and
used from the inside and they readily accumulate dust on shelves.
Because the nature of these cabinets requires that they be opened during
both septic and clean surgical operations, a contradiction exists between
requirements and performance.
To overcome these difficulties, the pass-through cabinet which has been
provided with delivery of clean air into the cabinet is recommended. The
pass-through cabinet is stocked from the outside and used from the inside.
Alternatively, a cabinet on wheels with a bank of wire shelves, which is
stocked outside and is used inside. This cabinet has a clean-air plenum
derived from the nearest clean-air duct, and clean air is emitted through a
multivent panel in the ceiling of the cabinet.


PRINCIPLE OF DESIGN
Surgical Instrument Processing including Sterilisation should ideally be as
close to the surgical suite as possible.
If sterilisation is not possible, at least the instrument cleaning and packing
for sterilisation should be in control of the Surgical Suite In-charge.
The loss of or damage to expensive and delicate instruments,
maldistribution of instruments, errors in makeup of surgical instrument
trays, pilferage, and delays in obtaining emergency instruments have
caused many errors as well as increased operating times leading to higher
infection rates.

PRINCIPLE OF DESIGN
Cart-wash installations are provided in some surgical suites but these are
no way superior to conscientious wipe-down of metal parts of the cart with
70% ethyl alcohol and phenolic detergent wipe of the plastic mattress
covers of the patient cart.
Cleaning of the casters provides nearly 100% protection.
For advanced Class C Operating rooms, a internal set of carts in the
surgical suite which are cleaned daily in the evening should be provided.

PRINCIPLE OF DESIGN : AIR-HANDLING SYSTEMS

Most conventional operating rooms should be ventilated by efficient, well-
maintained systems with or without high efficiency particulate air (HEPA)
filtering depending upon their class and type of surgery.
A proper stream of clean air, blowing at as a gentle stream should wash
down the surgical team, instruments and patient.
The environment of such operating rooms suffers by abuse, but otherwise
has been found to be effectively clean
Defective air systems and poorly maintained Air-handling systems are
responsible airborne contamination in surgery.
When an otherwise effective air-handling system is abused, by leaving a

corridor door open during operative procedures; permitting unrestricted
opening and closing of operating room doors as people come and go;
allowing technical, nursing, and anesthesia personnel to circulate in and
out of operating rooms wearing short-sleeved shirts; too much talking;
excessive flapping of drapes, towels, and gowns and other maneuvers that
unsettle previously shed particles from horizontal surfaces are responsible
for such infections.

ARCHITECTS AND ENGINEERS
CANNOT DESIGN AWAY SURGICAL INFECTION
BUT SOUND ARCHITECTURE AND ENGINEERING
CONTRIBUTES TO CONTROL OF CONTAMINATION
BY APPROPRIATE CONTROL OF TRAFFIC & AIR BORNE
INFECTION HAZARDS
THANK YOU
Creating value for healthcare providers, hospital owners and investors

by devising comprehensive healthcare systems
A PRESENTATION BY
Dr. K. B. SOOD
E mail : nousdoc@gmail.com, Tel : (+011) 2685 8017

Designing Surgical Operating Rooms: Hospital and Healthcare Management Consultants

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Designing Operating Room September 2014

DESIGNING SURGICAL OPERATING ROOMS

NOUS HOSPITAL CONSULTANTS (P) Ltd.

DESIGNING SURGICAL OPERATING ROOMS

PLANNING AND DESIGNING OF 22

HOSPITAL OPERATING ROOMS & SURGICAL SUITES

A PRESENTATION BY DR. K B SOOD

NOUS HOSPITAL CONSULTANTS (P) Ltd.

DESIGNING SURGICAL OPERATING ROOMS

Hospitals are considered to be most complex of the building forms and

DESIGNING SURGICAL OPERATING ROOMS

DESIGNING SURGICAL OPERATING ROOMS

DESIGNING SURGICAL OPERATING ROOMS

DESIGNING SURGICAL OPERATING ROOMS

DESIGNING SURGICAL OPERATING ROOMS

DESIGNING SURGICAL OPERATING ROOMS

It is generally agreed that the basic principles for planning Operating

DESIGNING SURGICAL OPERATING ROOMS

DESIGNING SURGICAL OPERATING ROOMS

Operating Rooms in a Hospital provide the physical facility where surgery

as also other It utilises special equipment and instrumentation.

DESIGNING SURGICAL OPERATING ROOMS

Traditionally, the Operating Rooms where a surgical procedure is

DESIGNING SURGICAL OPERATING ROOMS

The basic function of Operating Room is to perform invasive procedures

DESIGNING SURGICAL OPERATING ROOMS

Here the access to Human Body is achieved by one or more surgical

DESIGNING SURGICAL OPERATING ROOMS

They were created as modified Surgical Operating Rooms within standard

DESIGNING SURGICAL OPERATING ROOMS

This discussion is limited to Surgical Operating Rooms,

Further, there can be free standing Surgery Centres

DESIGNING SURGICAL OPERATING ROOMS

The areas within a Surgical Suite are categorised into Zones

Thus, the Surgical Suite is a composite unit in a Hospital or a Healthcare Facility,

A typical Surgical Suite will have a number of Operating Rooms

DESIGNING SURGICAL OPERATING ROOMS

1. Define the space

DESIGNING SURGICAL OPERATING ROOMS

DESIGNING SURGICAL OPERATING ROOMS

9. Carry out Third Party Validation & Certification

In Surgical Operating Rooms, the objective is to control contamination rather than

DESIGNING SURGICAL OPERATING ROOMS

It must be a interaction which sooths the patient’s nerves.

DESIGNING SURGICAL OPERATING ROOMS

DESIGNING SURGICAL OPERATING ROOMS

The American College of Surgeons in its Guidelines published in May 2000

DESIGNING SURGICAL OPERATING ROOMS

Class “A” Operating Room

also located Specifications

DESIGNING SURGICAL OPERATING ROOMS

DESIGNING SURGICAL OPERATING ROOMS

Class “B” Operating Room

These get Specifications

DESIGNING SURGICAL OPERATING ROOMS

DESIGNING SURGICAL OPERATING ROOMS

These are Class “C” Operating Room

DESIGNING SURGICAL OPERATING ROOMS

DESIGNING SURGICAL OPERATING ROOMS

Hybrid Operating Room

DESIGNING SURGICAL OPERATING ROOMS

Brainsuite®, developed by Brainlab AG of Munich, Germany, is a workflow-optimized

DESIGNING SURGICAL OPERATING ROOMS