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Design of an Operating Theatre

HVAC system design for an operating theatre starts with a
reminder of the following key objectives:
To control the concentration of harmful bacteria;
To prevent infiltration of less clean air into the operating theatre;
To create an air flow pattern that carries contaminated air away
from the operating table;
To provide a comfortable environment for the patient and
operating team;
To ensure uninterrupted operations;
To save energy.
The operating theatres are categorized as 'general' and
'ultraclean'. Ultra-clean OTs, used for procedures, such as, organ
transplant, orthopedic surgery, neurosurgery, etc., where bacterial
contamination is relatively more critical.

Critical parameters for OT


air through 2 layer beds in series

(efficiency of the 1st filter bed being >30% & that of

the 2nd filter bed being >90%)

HEPA filters (to remove > 0.3 m with an efficiency of


Positive pressure
Requirement of 15-20 air changes /hour with a minimum of

3 air changes of fresh air (20%

Fresh Air).
Air should flow from the ceiling & be exhausted near the floor

Temperature of 20- 220C, is comfortable & inhibits

bacterial growth.

Relative humidity 30-60% to slow down bacterial


(ultra clean air) & UV radiation have been suggested

as additional measures in certain situations (orthopedic

Design parameters for operating theatres

Design parameters



1. Temperature

201 C

201 C

2. Relative Humidity



3. Bacterial count

<35 cfu/m3

<10 cfu/m3

4. Supply air velocity at the

operating table
5. Fresh air (no recirculation)

0.38 m/s

0.38 m/s

20 air changes/hour

20 air changes/hour

6. Total number of air changes 20 air changes/hour

>30 air changes/hour

7. Pressurisation

+25 Pa

+25 Pa

8. Filtration efficiency

99.997% at terminal

99.997% at terminal

9. Supply air discharge area

2.4m x 1.8m

2.8m x 2.8m

The fans, both on the supply and exhaust side are provided with Variable Speed Drive (VSD).
The VSD basically helps to maintain the flows against varying static (filter congestion, etc.) and also for setback for
unoccupied hours.
The supply air passes through an energy wheel before treatment by a dedicated set of AHUs.
The treated air is supplied through terminal HEPA (99.997% efficient) filters.

In some cases the return air was collected through return air openings provided near the floor level at the four corners of the
OT. The shown designs, however, are allowing the return air to be collected from the adjacent rooms.
OTs are provided with relief dampers for maintaining positive pressure.
The humidity is maintained by using heaters

Laminar airflow or unidirectional airflow distribution.

Laminar flow is a specialized airflow characterized by higher volumes, stable directions, and
low turbulence (or low mixing).
Laminar airflow ventilation systems are designed to move air in a parallel streamlines, usually
through a bank of HEPA filters either along a wall or in the ceiling.
Laminar flow systems use perforated ventilation grills across the entire ceiling or side wall at
air flow rates significantly greater than normal to force a steady constant stream of air across
the entire room, similar to a smooth steady flow out of an open water faucet versus one that
splashes as the water comes out of the faucet.

distribution systems that
deliver air from the
ceiling, with a downward
movement to several
exhaust inlets located on
effective air movement

Temp. Contours in surgical ward

Air flow in surgical wards

Atmospheric air suction through 5 micron filter and
pass through HEPA filter on controlled velocity and
provide sterile air.
The pre-filtered units are placed in suction point on
two opposite walls of O.T. The pre-filters have
adjustable speed blowers with over temperature
protection. The O.T. air suck from bottom side via
pre-filters and sent back through vertical chamber
(with HEPA Filters) placed exactly over operation
The velocity of air at outlet is 0.45 m/s, which
provides Bio-Clean Air as per Federal Standard 209
The Control Box contains Normal, Start, Stop &
Speed control for blowers. Supervision panel with
individual LED indicator for each blower showing
their status and an alarm circuit for emergency.


The air flow is vertical from the filter

ceiling over the operating table to the
suction units placed at the bottom of two
opposite walls of the Operating Theatre.
The Vertical flow from ceiling units
divided over the operation area of both
the side depending on the customer's
Effective working areas can be adjusted
through ceiling unit design. This
Laminar air flow is ultra cleaned over the
entire operating area and instantly the
theatre is bacteria free.


Design Factors

Total supply air quantity (CFM)- this is determined by considering both the
required air change rate and space cooling loads. The air change rate is often
the determinant.
CFM = ( V x ACH ) / 60
V = room volume, ft3
ACH = air changes per hour

Critical Work Envelope (CWE)- the

location within the room identified as
a zone of significant influence on a
process or procedure taking place,
as compared to other envelopes
within the same room. In surgical
suites, this includes the patient and
surrounding team.

Projection Distance the required distance, resulting in a velocity at that

distance to effectively remove particulate away from the CWE. In surgical suites,
this is the distance from the laminar flow panels in the ceiling down to about 6
above the operating table.
Distance = 10 feet (30+6) = 7 feet [3 m - (0.76m+0.15)=2.09m]

Laminar Panel Active Area the size of

an array of laminar panels required to
cover the critical work envelope with an air
piston of sufficient velocity to effectively
carry away particulates. For applications
with laminar flow panels only, the array
should extend at least 6 beyond the edge
of the critical work envelope.
3.4 M

Supply Air Temperature Differential

(T) the difference between the actual
space temperature and the supply air
temperature. With space heating and
cooling loads, the supply air must be
warmer or colder than the design set point
of the space.

2.4 M

Obstructions laminar flow air streams are disrupted from their paths
by obstructions such as lights, poles, and other ancillary equipment.
Priority should be given to maintaining unobstructed flow during
design. Obstructions are expected and the preferred arrangement is to
include the obstruction entirely within the perimeter of the CWE to
keep turbulent eddies totally within the clean air column.
Particulate that strikes an object will typically move around and be
carried away from it within the air stream.

Heat Sources equipment and surgical teams create thermal plumes

that oppose the direction of the laminar air stream to flush away
particles. These sources should be located sufficiently within the CWE,
or completely outside the CWE.

Air Curtains

Air curtaining movement