Hospital planning and designing

Operating theatre
Session:6.2
Planning of Operating Unit

• At the end of this session, student will be able to:

• Discuss the planning and design considerations for an Operation Theatre
(OT)
• Identify the challenges in planning and designing of the OT services in a
hospital

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 Contents

• Introduction
• Planning of the OT- Criteria
• Location of the OT Complex
• Planning Considerations
• Advantages of Zoning
• OT Suite Circulation Pattern
• Scales of Accommodation
• Design Aspects
• Laminar Air flow in OT
• Grouping of Operation Theatres
• Modular OT
• Hybrid OT 3
What comprise surgical department ?

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Introduction
• Advances in diagnostic facilities, improved aseptic procedures, safer
anaesthetic techniques, sophisticated equipment and skills

• At the present time, about 50% of the hospital beds are surgical beds and
about 50% to 60% of the inpatients requires surgical treatment

• As a general rule, one operating theatre is required for every 50 general in-
patient beds and for every 25 surgical beds

• Surgical facilities therefore represent a central life saving activity

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Introduction Contd..

• Its performance is also dramatic and its successes and failures are highly
visible.

• The activities carried out in this department can make the reputation of
the hospital.

• This makes it imperative that an operation theatre (OT) be designed

scientifically to ensure sterility, easy maintenance and effective utilization

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Definition

An OT is that specialized facility of the hospital where life saving or life

improving procedures are carried out on the human body by invasive
methods under strict aseptic conditions in a controlled environment by
specially trained personnel to promote healing and cure with maximum
safety, comfort and economy.

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Why operation theatre are called so ?

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Objectives of Planning

• Promote high standards of asepsis

• Ensure maximum standard of safety
• Optimise utilisation of OT and staff time
• Optimise working conditions
• Patient and staff comfort in terms of
thermal, acoustic and lighting
requirements

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 Objectives of Planning Contd..

• Allow flexibility
• Facilitate coordinated services
• Minimize maintenance
• Ensure functional separation of spaces
• Provide a soothing environment
• Regulate the flow of traffic

The aim is to provide the maximum benefit for maximum number

of patient arriving to the operating theatre.

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Planning of the OT- Criteria

1. Functional criteria
• Design to follow functional requirements

2. Economic or work flow criteria

• Flow of patients, supplies, staff

3. Environmental criteria
• Safety / comfort for patients / staff

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Types of surgical patients

• In patients
• Outpatients
• Ambulatory surgery patient

Difference between Outpatients and Ambulatory surgery patient ?

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 Location of the OT Complex

• Away from internal traffic

• Convenient, uncomplicated flow
• Patients, staff, supplies
• Access to elevators, ramps
• Close to Lab, Blood bank, X ray, SICU, Labour room, CSSD
• Maximum protection from
• Direct sunlight, heat, dust, noise
• Permit future expansion

Cul-de-sac location ?
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Size

• Restricted to a functionally optimum size

• All operating suites should be of standard size and uniform design
• The design should be flexible for use for general surgery

However, Cardiothoracic and Neurosurgery may require larger operating rooms to

accommodate large surgical team and special equipment

Traditional OT – 6.5m X 6.5m X 3.5m

Floor area - 6.5m X 6.5m = 42.25 m2 or 452.084 sq.ft

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Number of Operating Suites

Considerations:
• Number and type of surgeons
• Type of hospital
• Hospital policy and procedures
• Hospital bed complement
• Number and nature of elective and emergency surgery anticipated
• Number and type of surgical patients
• Number of operations per day
• Expected average length of stay of surgical patients
• Expected turn over interval in operation theatre
• Estimated time for cleaning between operations
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Number of Operating Rooms

• Rao committee in 1968 recommended 1 Operating theatre for every 50 beds

# of Hospital Beds Minor O.T Major O.T
300 2 4
500 2 6

750 2 10

1000 2 15

• Super specialties like Cardio thoracic surgery, Pediatric surgery, Etc. should have
separate operation theatres

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American and European Pattern

• American model- without anesthetic rooms or other ancillary rooms

• European model- with a full complement of ancillary rooms
• American Authorities recommend 1 operating suite for every 25
surgical beds or 1 operating suite for two or three operations per
day.
• European Authorities recommend 1 operating suite for every 50
surgical beds or 1 operating suite for six operations per day.

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Planning Considerations

Zoning:
• Protective Zone/ outer zone
• Clean Zone/ intermediate zone
• Sterile Zone / inner zone
• Disposal Zone

• These zones are bacteriological zones of varying degrees of cleanliness

• The bacteriological count diminishes from the outer to the inner zones
• Maintained by a differential decreasing positive pressure ventilation gradient from
the inner zone to the outer zone
• 100% sterility must be ensured in the sterile zone
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Scales of Accommodation

Protective zone: Sterile zone:

• Reception • Operating Suite
• Waiting area • Scrub room
• Trolley bay • Anaesthesia induction
• Changing room room
Clean zone: • Set up room
• Pre operative room Disposal zone:
• Recovery room • Dirty utility
• Plaster room • Disposal corridor
• Staff room
• Store 20
Advantages of Zoning

The zoning of the operating department has the following advantages:

• Minimizes the risk of hospital infection

• Minimises unproductive movement of the staff, supplies and patients
• Increases efficiency of the staff working in the operation suites
• Ensures smooth work flow
• Reduces hazards in the operating suites
• Ensures proper positioning of the equipment
• Ensures optimum utilisation of the operating suites

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Sub areas
• Pre- operating check –in • Office – for staff nurse
• Holding area • Rest rooms
• Induction area • Laboratory
• Post- anesthetic care unit • Seminar room
• Staff room • Store room
• Sanitary room for staff • Theatre sterile supply unit
• Anesthesia gas/ cylinder (TSSU)
manifold room • Scrub room
DEBATE
• GROUP A - WHY SHOULD WE GROUP B - WHY SHOULD NOT WE
HAVE INDUCTION ROOMS ? HAVE INDUCTION ROOMS ?
Types of OT complexes

• The single theatre suite with OT, scrub-up and gowning, anesthesia
room, trolley preparation, utility and exit bay plus staff change and
limited ancillary accommodation.
• 2. The twin theatre suite with facilities similar to 1, but with
duplicated ancillary accommodation immediate to each OT,
sometimes sharing a small post anesthesia recovery area.
• 3. OT complexes of three or more OTs - with ancillary
accommodation including post anesthesia recovery, reception,
porter’s desk, sterile store and staff change.

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 OT Suite Circulation Pattern PATIENT MOVEMENT

DIRTY CORRIDOR STAFF MOVEMENT

ROUTE FOR DISPOSAL & ACCESS FOR MAINTANENCE WORK
DZ SUPPLIES & DISPOSAL

OR O R O R
AZ TSSU - - -
1 2 3

CZ
CLEAN CORRIDOR

PZ STERILE PATIENT ADMIN STAFF

RECOVERY
GOODS TRANSFER OFFICE CHANGE
D Z = DISPOSAL ZONE
A Z = ASEPTIC ZONE
STORE ZONE ROOMS
C Z = CLEAN ZONE
P Z = PROTECTIVE ZONE

OUTER CORRIDOR
Design Aspects

• Recommended size : 6.5m X 6.5m X 3.5m

• 2 scrub positions should be provided at entrance to OT
• Ceiling should be high enough to accommodate A/C ducts and also permit
location of operating lights and pendants.
• Minimum height required for fixing operating light is about 3 meters.
• Ceiling should contain minimum number of fissures, open joints or crevices to
ensure dust free environment.
• Surface/floor must be slip resistant
• Antistatic effects – recommended conductivity 1m ohm (max 10m ohms )

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 Design Aspects Contd..

• Doors should be wide enough with 2 leaves

• Door should be protected upto a height of 1.5 meters with
Rubber or PVC
• Post operative door should also be wide

5-9 feet

Door type- Spring loaded flap Min 7 feet

type / sliding door?

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Design Aspects Contd..

Should OT have windows ?

Direct sunlight may interfere with artificial and precise light control in
the operating room and also increases load on A/C system

Windows – Should be dust proof, 3-4 feet above floor level

and 15 % of floor area.

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Design Aspects Contd..

• Scrub Area – should be located as close to OR as possible to ensure least

contamination after scrubbing
• Sinks
• Number should be at least 2 per OR or 3 for two adjacent ORs,
• Position and design should ensure minimal splashing
• Working height = 96 cms with water source 10 cms higher
• Taps – Elbow operated/ Leg operated/ Automatic with infra red sensors

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Design Aspects Contd..

• Water for scrubbing used should be treated prior in storage tanks

• Gowning area should be adjacent or within scrub area
• Plumbing and sanitation – Entire shaft of sewage shaft must have
impervious lining to seal contamination
• Avoid drainage outlets within the Operating Room

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Design Aspects Contd..

Walls
• Laminated / smooth paint
• Light color )blue/green)
• Semi- matt surface

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Lighting

General Light – intensity can be 500 – 2000 lux

• O. T light – Roof hanging or mobile units available
• Central field – 2000 – 3000 candles / Sq Mt (15000 lux)
• Floor around table – 200 – 300 candles / Sq. Mt (25000-125000 lux of light)
• Walls – 300 – 500 candles / Sq. Mt
• Intensity at place of incision – 40,000 lux
• Should not produce more than 25000 mw/cm2 of radiant energy

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Lighting

• O.T lights should be directionally flexible yet steady once focused-

should have sterile handle
• Light should be shadow less.
• Movement should not interfere with other suspended equipment
like pendant
• Height of O.T light should not be less than 2 meters above floor level

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Electricity

• Ensure uninterrupted power supply to the O.T especially while a surgery is being
conducted
• Ideal to have electrical supply from two separate grids, a generator back up and a
standby generator for the O.T.
• UPS for all equipment or a central UPS for all the OT equipment
• Electrical Control Unit to be located in Protective Zone
• Stabilizers to ensure no voltage fluctuation
• Adequate electric points/Power outlets on each wall along with heavy duty plug points
– 1.5 m height from floor
• X- RAY Illumination point
• Since anesthetic gases are heavy and settle down, it is safer to have outlets 1 meter
above floor level
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Air Conditioning

• Helps in maintaining the aseptic condition of the operating room by letting only
controlled air to pass inside
• Improves the efficiency of the surgical team by creating a pleasant environment
and helps maintaining the vital functions of the patient by providing the
optimum comfortable environment
• The air temperature should be 65 F to 75 F and humidity should be 50% to 60%
• There should be 100% fresh air
• Air changes - 20 times per hour
• Air filter of 1 to 3 microns should be used
• HEPA filters – High Efficiency Particulate Air Filters are used to ensure clean
environment.
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Air Conditioning and Ventilation

• Proper ventilation system of positive pressure with different gradients

• A/C, Laminar flow and HEPA filters takes up almost 1 metre space above false
roofing and hence a clear area of 4.5 metres is essential
• Laminar Flow of air – Vertical laminar flow is preferred because of maximum
aseptic environment above the operation table
• Return air ducts should be located 30 cms above floor and atleast 2 – 4 must
be located. If two are installed, then they must be opposite to each other

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Laminar Air flow in OT

Source: https://www.youtube.com/watch?v=JcoRO3NSA0c&t=1s
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Plumbing

• Sewerage shaft should not pass through operating room

• Impervious lining to seal contamination
• Toilets to be provided in change room area

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Water Supply

• Adequate and running fresh water supply to be ensured

• 400 litres/bed/day (guideline). Emergency reserve should be
planned
• Taps should be easily handled, 10cm above basins or foot
operated ( post covid)
• Ensure self water flow after de- salination

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Grouping of Operation Theatres

Advantages are:-
• Maximum flexibility in use- Improves utilisation
• Easy expansion at times of future demands
• Simplifies theatre staffing and better training, centralisation and
standardisation of procedures improving efficiency
• Economics in common facilities such as men, material, machines
and minutes
• Easy and economic maintenance
• Improved cleaning and better sterilisation
• Minimizes infection and cross-infection
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Sterilization

• CSSD or TSSU
• Location – either within OT complex or outside
• Areas – receiving area, clean up, processing area, work area for
sorting, testing, inspection, packaging, store, issue counter
• Cleaning methods – manual, ultrasonic cleaning
• Methods of sterilization – steam (autoclave), hot air, cold or ethylene
oxide (gas sterilization), cidex solution for scopes, gamma irradiation
sterilization (for disposables)

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Surgical corridors

Not less than 3.04 to3.65m (10-12 feet) wide

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Modular OT

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Hybrid OT

• It combines a conventional operating

room with an imaging system – MRI, CT
scan or angiography systems.
• A hybrid operating room makes it
possible to simultaneously reach a
diagnosis and provide treatment during
surgical interventions.
• Accommodate 8-20 people
• Height 2.97 to 3.63m

Source: http://hybridoperatingroom.com/hybrid-operating-room-layouts-3d-design-mockups/
Hybrid OT
• Allows less invasive surgery
• Reduces patient recovery time
• Patient safety
• If required, open surgery can be
done.
Size
A hybrid OT is required to be 1.5x as
large, with size of 1000 square feet and
minimum clear floor area of 600 square
feet .
 Summary

• Key planning considerations: Convenient functional relationship and

communication with the surgical ward, ICU, CSSD, blood bank,
medical imaging and laboratory services
• Objectives of OT Planning:
• Promote high standards of asepsis
• Ensure maximum standard of safety
• Optimise utilisation of OT and staff time
• Optimise working conditions
• Patient and staff comfort in terms of thermal, acoustic and lighting
requirements

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Summary

• To have high standard of asepsis, high quality Air

conditioning with proper ventilation system of positive
pressure with different gradients is essential
Type SIZE
1. Minimum 33.44 sq meters / 360 sq.
ft
2. Preferred size for OT 44.60 sq meters / 480 sq.
ft

3. Preferred size for major 55.70 sq meters / 600 sq ft

OT
4. Hybrid OT 1000 sq ft

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Summary

• Zoning in OT:
• Protective Zone
• Clean Zone
• Sterile Zone
• Disposal Zone

• These zones are bacteriological zones of varying degrees of cleanliness and

help in maintaining asepsis and smooth work flow

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 Further Reading

• http://www.ijaweb.org/article.asp?issn=0019-5049;year=2007;volu
me=51;issue=3;spage=193;epage=199;aulast=Harsoor
• http://www.healthcaredesignmagazine.com/architecture/redefining
-operating-room
/
• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3771780/

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Disclaimer

All data and content provided in this presentation are taken

from the reference books, internet – websites and links, for
informational purposes only.

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Thank you

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