SURGICAL SUITE

The planning and equipping of each operating room are based on a series of questions, such as : (a) size,
(b) usage, (c) environmental control`, (d) lighting-surgical and general illumination`, (e)
intercommunications and signal systems-, (f) electronic equipment and monitoring system', (g) service
lines, such as suction, oxygen, nitrous oxide, compressed air, (h) provision for x-ray, not only x-ray tube
stand but control, transformer, and necessary lead protection, (i) provision for TV camera, movie
cameras, other recording equipment, (j) safety precaution in hazardous areas, (k) cabinet work, supply
cabinets and storage for operating table appliances, (I) need for clocks, film illuminators.

The operating rooms themselves will account for only about one-fourth of the total area required for
the suite with its supportive functions such as

Offices and administration areas, scrub areas, work and supply rooms, laboratory, dark room, post-
anaesthesia recovery, holding or induction areas, lounge, locker and toilet rooms for various personnel
groups, conference or teaching rooms, and circulation within the department.

Within the surgical suite we have three basic zones predicated on three types of activity and circulation
involved, and the degree of sterility to be maintained. The preplanning analysis of these areas is just as
important as the determination of the number and type of operating rooms.

Outer zone : Administrative elements and basic control where personnel enter the department, patients
are received and held or sent to proper holding areas of inner zone ; conference, classroom areas, locker
spaces, any outpatient reception, etc .

Intermediate zone : Predominantly work and storage areas ; outside personnel will deliver to this area
but should not penetrate the inner zone . The recovery suite, if completely integrated with the surgical
suite, is an intermediate or outer zone activity .

Inner zone : The actual operating rooms, the scrub areas, the patient holding or induction areas. All alien
traffic should be eliminated . Here we want to maintain the highest level of cleanliness and aseptic
conditions .

Outer zone administrative areas have increased in importance. Offices are needed for the surgical
supervisor, the clerks who manage scheduling and paper work, the clinical instructor (particularly if
there is a school of nursing), possibly the chief of staff. There must be provision for surgeons to dictate
medical records .

And don't forget the patient . After all, he is the primary concern . Who is responsible for his
transportation to the surgical suite, and on whose bed or stretcher? How is he checked in and where
does he wait if the room for which he is scheduled is not ready? Who has not seen surgical corridors
lined with occupied stretchers for want of adequate holding, preparation or induction areas? Another
factor is added if any ambulant outpatient work is to be done .There must be provision for receiving,
controlled waiting, dressing rooms and toilets .
A variety of persons must be provided with lounge, locker and toilet space-surgeons (male and female),
nurses, technicians, aides, orderlies . Coffee and cola seem to lubricate the entire department ; some
systematic provision for their supply is warranted .

A conference or classroom for departmental meetings and in-service training programs is easily justified.

The access to all these areas should be removed from strictly surgical areas, as people are entering and
leaving in street clothes and should not penetrate into other zones until after changing shoes and
clothing .

The planning and equipping of the intermediate zone are based on the method of processing and storing
of the thousands of items involved . It is fairly common practice for the central sterile supply
department, elsewhere in the hospital, to be responsible for the preparation and autoclaving of all
surgical linen packs, gloves, syringes, needles, and external fluids . The storage of these items to be used
in surgery becomes the responsibility of the surgical department and adequate space must be provided
for a predetermined level of inventory

The surgical suite location must mesh with the total circulation pattern so that patients can be moved to
and from surgery with a minimum of travel through other hospital services . Its location is also affected
by its close relationship to three other major hospital services the x-ray department, the clinical
laboratories, and the central sterile supply . One other important factor in the location of the surgical
suite is future expansion . Anticipate ways and means to permit growth in an orderly fashion without
upsetting the basic relationship of internal organization-or without extending lines of travel to
unacceptable or uneconomical lengths

NURSERY'

As one of the areas in the hospital where patients are most vulnerable to infection, the nursery should
be planned to provide the best means for the care, safety, and welfare of the infants . Although the
plans and diagrams, shown here, have been developed for hospitals of specified sizes, the principles set
forth apply to all hospitals, large or small, new or old.

Basic recommendations for planning nurseries that have been developed, based on clinical experience
and study, include : limiting the number of infants in each nursery ; wide spacing of bassinets within
each nursery ; separation of bassinets by cubicle partitions ; promoting the use of aseptic techniques
and
DIAGNOSTIC X-RAY SUITE

Location

The diagnostic x-ray department should be located on the first floor, conveniently accessible both to
outpatients and inpatients . It is also desirable to locate the department close to the elevators and
adjoining the outpatient department and near other diagnostic and treatment facilities . The functional
requirements of the department are usually best satisfied by locating the x-ray rooms at the end of a
wing . In this location, the activity within the department will not be disturbed by through traffic to
other parts of the hospital, and less shielding will be required because of the exterior walls.

Administration Spaces

Every radiologist has specific ideas on the most suitable ways for arranging and operating the
administrative functions of the x-ray department . Some of the variables involved are assignment of
personnel and functions, reception of patients, sequence of patient exarninetions, film distribution, end
staff viewing facilities . This plan provides for flexibility of space arrangements by allowing for variation
of several of the operations within the administrative unit .

Waiting Room

General waiting space for about ten patients is located at the entrance to the department . From here
the patient is directed to an assigned dressing room . A separate area, to the left of the entrance and in
sight of the secretary-receptionist, is provided for wheelchair and stretcher patients . This section is
partitioned off by a curtain which may be partially drawn to provide privacy, yet afford the necessary
surveillance of unattended patients from the secretary-receptionist's desk . Additional chairs in this area
can be used to accommodate the attendants of these patients or for an overflow of waiting patients
when needed

Radiologists Office

This office is conveniently situated near the x-ray rooms, the secretaryreceptionist's desk and the filing
distribution area, and is not too easily accessible to the public ; it is also provided with a door which
opens directly to the technicians' corridor . The fire exit which is located off the technicians' corridor
provides a second exit from the department for the radiologist .

Film Files

The film files are located in the collection and distribution area and convenient to the radiologist's
office . Since it is desirable to keep active films for at least five years, approximately 125 linear feet of
filing space is provided . After that time, additional storage space elsewhere will be needed for the less
active files . Closed front metal x-ray files are recommended (see Fire Safety) . Teaching files may not be
needed in a hospital of this size, but if desired, a section of the active files, may be allotted for this use.

General Facilities
Dressing Rooms

Three dressing rooms for each x-ray machine should be provided so that the equipment and staff can
function without delay. Each dressing room should be equipped with a straight-back chair, clothes hook,
mirror, and a shelf below the mirror . For the protection of patients' valuables, the doors may be
equipped with locks, or centrally located lockers may be provided . Where doors are installed, they
should swing outward to avoid the possibility of being blocked by a patient and should be at least 12
inches from the floor . For the convenience of patients in wheelchairs, an outsized dressing room is
provided . Instead of a door, it is equipped with a curtain so that the patient can maneuver easily .

Patients' Toilet ROOMS

Toilets should be immediately available for patients undergoing fluoroscopy, and similar facilities should
be conveniently available for waiting patients . A minimum of two toilets should be provided for each x-
ray room . All toilets should be located near the x-ray rooms