State of Kuwait Ministry of Health Infection Control Directorate Task Foree Group for Designs and Constructions of health care facilities Guidelines for Design of Operating Theaters ~ 2009CONTENTS Introduction a Classes of operating suite ......ssssuseee Layout of the operating theater Size Outer zone Main Access corridor, Transfer area, control station, Documentation area & Preoperative patient holding area(s). .......- a Staff clothing change areas. . Patient clothing change area. Soiled workroom or holding room (Dirty utility room) House keeping room The clean zone The sterile supplies store Equipment and supply storage ......... Medication station .....e00+6 Anesthesia room. ......-- Sub-sterile service area(s) Recovery areas .......+ Post-anesthetic care units (PACUS).. Phase II recovery... A clean corridor area. ‘Clean —p, room... Rest area, lounge for staff, report preparation ‘area, and toilet Facilities A supervisor's offices or stations and teaching areas. Other Service Areas ...sssees ceeeseeeeesserenee The sterile Core .........seeessesee General operating room(s) Procedure rooms. Additional requirements for orthopedic surgery... : Room) for surgical eystoscopie and other endourologic procedures. Scrubbing area : ; Scrub sinks sss Standards for Details and Finishes General requirements Specific requirements Walls... Floors .. Ceiling Doors... Corridor width General illumination ....... | Operating room lights Recommended illumination levels jn each room Airsupply Rooms) for cardiovascular, onthopedie, neurological, and other special procedures : uReRe wc ww ee IIIIIARAMReferences Types of air supply Plenum Ventilation .... ; Laminar flow ventilation .......04 Design features . Ait changes Filtration Flow... Pressure cece Maintenance ...... Temperature and humidity F Recommended specifications of air supply in different areas of the OT. Scavenging system... ‘i eeseeeees Gas and suction system Water supply tees Drainage system. ‘Communication Electricity ..eessssseseoe Safety requirements Fire Alarm Portable Fire Extinguishers Emergency lighting Exit signs. Emergency exit doorsIntroduction In the past few years there has been an effort to renovate and build new specialty centers throughout Kuwait. Many of them involving the renovation and expansion of many operating theaters with the addition of new specialties which has created the necessity of national guidelines to build and renovate such facilities. ‘The size, location, and configuration of the surgical suit and support service departments shall be designed according to the functional program of the facility. This may be achieved by designing either an outpatient and/or inpatient surgery facility, or a combined inpatient-outpatient surgical su Classes of operating suite The size and locetion of the surgical procedure rooms shall be determined by the level of care to be provided. The levels of care as defined by the American College of Surgeons are as follows: Class A: Provides for minor surgical procedures performed under topical, local, or regional anesthesia without pre-operative sedation. Excluding intravenous, spinal, and epidural routes; these methods are appropriate for Class B and Class C facilities. Class B: Provides for minor or major surgical procedures performed in conjunction with oral, parenteral, of intravenous sedation or under analgesic or dissociative drugs. Class C: Provides for major surgieal procedures thet require general or regional block anesthesia and support of vital bodily functions. : Layout _& size of the operating theater Important design considerations include the mix of inpatient and ouspatient operations, patient Hows inte and out of the operating room (OR) area, and flexibility to allow the incorporation of new technologies. ‘An operating suit design with theses areas must restrict acvess and provide no cross traffic of staf and supplies from the soiled areas to the clean or sterile areas to maintain unidirectional inovemens Layout oye surgical suite shall be located and arranged to prevent non related traffic through the suite { The clinical practice setting shall be designed to fuilitate movement of patients and personne! jpto, through, and out of defined areas within the surgical suite a5 well the transportation of supplies and waste materials to and from the OR. = Signs shall clearly indicate the surgical attire required, Size: * the number of operating rooms and recovery beds and the sizes of the support areas shall be based on the expected surgical workload. _ ‘The number of offices, stations, and teaching areas in the surgical suite shall depend upon the functional program.1. Outer zone _: is should contain: ~ Main Access corridor = Transfer area = Supervisor office or contro! station - Documentation area = Preoperative patient holding area(s), = The changing facilities. = Soiled workroom or holding room (Dirty utility room) = house keeping room Main Access corridor: The patient entrance to the access corridor shall be electronically controlled (code operated or magnetic card). ‘The transfer area: shall be a minimum of 22 square meters. Provisions shall be made for the isolation of patients with infectious diseases. Supervigor office or control station: should be located to permit visual observation by the nursing staff for all traffic in and out the suit. Documentation area: The dictation and report preparation area may be accessible from the lounge ara, Preoperative patient holding area(s: In ‘facilites with two or more operating rooms, areas shall be provided to acvommodate stretcher patients as well as sitting space for ambulatory patients, This area includes the checking of preoperative patients and a holding area. Each trolley space shall be serviced with oxygen and suctioning, preferably in wall panels. (1) Size : The number of bed or trolley spaces provided shall be 1.5 bed spaces per theater room. {@) Location: These areas shall be under the direct visual control of the nursing staff and may be part of the recovery suite to achieve maximum flexibility in managing surgical case loads (3) Space requirement: Each stretcher station shall be a minimum of 7.43 square meters exclusive Gf general circulation spaee through the ward and shall have @ minimum clearance of 1.22 meters on the sides of the stretchers and the foot of the stretchers. (4)Patient privacy: Provisions such as cubicle curtains shall be made for patient privacy. ‘Cultural issues should be taken into consideration such as separation of the male and female patient in reception areas. (5) Provisions shall be made for the isolation precautions of infeetious patients {6) An airborne infection isolation room is not required in a preoperative holding aree, Provisions forthe recovery of a potentially infectious patient with an airborne infection shall be determined by an ICRA.Staff clothing change area: = The operating theatre should be designed with a separate entrance for the staff. This entrance should leads to their changing rooms, These areas shall be arranged to encourage a one way traffic pattern so that personnel entering from outside the surgical suit can change and move directly into the surgical suit. = Appropriate areas shall be provided for male and female personnel (cleaners, technicians, nurses, and doctors) working within the surgical suit. _ The areas shall contain lockers, showers, toilets, lavatories equipped for hand washing, ‘and space for donning surgical attire. _ Showers are not recommended prio: to start of the duty, however they are allowed after duty hours. Patient clothing change areas If the functional program defines outpatient surgery as vart ofthe surgical, a separate area shall be provided where outpatients and same-day admission patients may change from street clothing into hospital gowns and be prepared for surgery. wet shall include a waiting room, locker(S), toilet(s), and clothing change’er gowning area. 1 Where private holding room(s) or cubicle(s) are provided, a separate change area |S not required. Soiled workroom or holding room (Dirty utility room): _ All operating suites should easily access a sluice or dirty utility room = Soiled and clean workrooms or holding rooms shall be separated. | eo closed soiled workroom (or soiled holding room that is part of system forthe aullcetion and disposal of soiled material) shall be provided for the exclusive use of the surgical suite. ~The room shall be located in the semi restricted area. The Selled workroom shall contain a flushing-rim clinical sink or equivalent fushing-tim fixture, a hand-washing station, a work counter, and space for waste receptacles and soiled linen receptacles. = Rooms used only for temporary holding of soiled material may omit the flushing-tim ae oiral sink and work counters. However, ifthe fushing-rim clinical sink is omitted, other provisions for disposal of liquid waste shall be provided. —eemsom shall not have direct connection with operating rooms or other sterile activity rooms,House keeping room: _ House Keeping failities shall be provided for the exclusive use of the surgical suit 1 “ie shall be ditectly aecessible for the suit, shall conti hand washing station, and provision for storage of supplies and house keeping equipment = This room shall be separate from the clean workroom, ‘The clean zone: This should contain: ~The sterile supply store. Equipment and supply store = Medication station. - Anesthesia room. - Sub-sterile service area(s) ~ Recovery areas ~ A cclean corridor area - Clean utility room. | Reatarea, lounge for steff, report preparation area, and toilet facilities 7A supervisor's offices or stations and teaching areas = Other Service Areas ‘The sterile supply store: storage space for sterile and clean supplies should be adequass for the functional plan. The space should be moisture and temperature controlled and free from cross traffic, Equipment and supply store Storage room(s) shall be provided for equipment and supplies used in the surgical suite. Pane gjeal suite shall provide sufficient storage area 10 keep its required corridor width Fas of equipment and supplies, but not less than 13.94 square meters oF 4,65 square meters per operating room, whichever is greater. Brora areas shall be provided for portable x-ray equipments stretchers, fracture tables, warming —ertas auxiliary lamps, ete. These areas shall be out of corsidors and traffic, | Jfeaicnl gas storage: Main storage of medical gases may be outside or inside the facility. pevision shall be made for additional separate storage oF reserve Gas cylinders necessary 10 complete at least one day’s procedures. Medication station: _ Provisions shall be made for storage and distribution of the drugs and routine medications eed in the theater. This may be done from 2 medicine preparation room or unit, fused, a medicine preparation room or unit shall be lunder visual control of the nursing staff. =e shall contain a Work counter, sink, refrigerator and double locked storage for controlled substances. Hand washing station shall be provided.Anesthe: Anesthesia room: The anesthesia work room for cleaning, testing, ant d storing anesthesia equipment shall ontain work counters, sinks, and racks for cylinders _ Phew onstruction, depending on the functional progtarh» the anesthesia work room should provide space for anesthesia case carts, and other anesthesia equipments. ‘The room shall be a minimum of 12 - 16 square meter ‘There shall be built-in cupboards and work benches, ‘with fitted stainless steel sink and drain, cree that are enclosed in cupboards with glass pane!s shall Pe provided for anesthetic tubing and storage for equipment. Safety drug cupboards shal be installed and service panels fitted to the wall. erile service area: provided if required by the functional program Recovery Areas ic care Ww (PACUS other set directly into the intensive care unit. before entering the operating theater - Patient privac i - Facil Guetchers, supplies, and equipment. aan 8 «a faces shall be hard wearing and washable. Wood must be used. ~ Fike standing equipment shal include anesthetic machine ‘monitor, and defibrillator. prcisions shall be made for separate storage of clean and soiled items. This area acts as a service area between two oF more operating OF procedure rooms. Other qutites for processing and sterilizing reuseble instruments, le» 2 typically located in ‘another hospital department, such as central servi tesa! be equipped with a flash sterilizer (for em: Supply storage arca, hand washing station with hands-free controls and work space shall be ces. erpeney use), warming cabinet, sterile = Space requirements: The design shall provide a minimum of 7.43 square meters {0° each patient bed, exclusive of general ceulation Spore ‘within the PACU, with a space for Pgitional equipment described in the functional progrme ‘and for clearance of atleast 1.52 acttars bexween patient beds and 1.22 meters belwern patient bedsides and adjacent walls. "Layout: In nevs construction, at least ome door to the recovery room shall provide access digeoly from the surgical suite without erossing public hospital corridors hore shall be two sets of exit doors, one set leaving 6° the main hospital wards, and the Tet Snnecting door 10 the intensive care unit should be through the clean corridor, passing theough a changing room where personnel are required to change info clean surgical aie revisions for patient privacy such as cubicle curtehe shall be made. ty requirements: Each PACU shail contain a medication station; nurse station with dascing facies clinical sink; provisions for bedpan cleaning; and storage space for _ Seavices shall include suction, oxygen, air and electricity points. = ennitor shall be available for each bed and acoPss 9 ‘defibrillators and respirators. A mrhall be an examination light over each bed space‘ation with hands-free or wrist blade- uniformly distributed to provide - Hand-washing station(s): At least one hand-washing st operable controls shall be available for every four beds, equal access from cach bed. ~ Staff toilet: A staff toilet shall availability to patients. _Srovisions shall be made for the isolation of infectious patients. = Fret pome infection isolation room (AIIR) is not required in a PACU. Provisions for the an svery of potentially infectious patient with an airborne infection ‘shall be determined by an [CRA Phase TI recovery. Where outpatient surgeries are to be part of the surgical suite, and where outpatients receive Class B or Class C sedation, a separate Phase Il or step-down recovery room shall be 1 be located within the working area to maintain staff a new construction, at least one door shall access the PACU without crossing unrestricted corridors of the hospital. = Space requirements {@) The design shall provide a minimum of 465 square mais fo Space for additional equipment described inthe functions) PrP era part des ofthe lounge chairs and the foot of the lounge chairs. Separate and additional recovery space may be necessary (9 actors SA recovery space should be provided for pediatric patients and the layout facilitate the presence of parents in the PACU. (5) A minimum clear floor area of 9.29 squate meters shall be provided in single-bed rooms. sn as cubicle curtains shall be made. Patient privaey: Provisions for patient privacy sue ty requirements: The oom shall contain hand-washing stations, a nurse station with Charting facilities, clinical sink, provision for bedpan cleaning, and storage space for supplies and equipment. (a) Hand-washing stations: - a pond-washing station shal be provided in each room 7 Ese one hand-washing station with hands-free operable controls shall be provided for every four lounge chairs, uniformly distributed to provide ‘equal access from each lounge chair. (b) Toilet rooms: yo" Staif toilet: A staff toilet shall be provided with direct access tothe staff availability to patients. _ Patient toilet: A patient totlet shall be provided with direct for the exclusive use of patients. _ provisions shall be made for the isolation of infectious patients. ‘An airborne infection isolation room is not required in @ Phase Il recovery area. Provisions A tha recovery of a potentially infectious patient with an airborne infection shall be determined by an ICRA. + each patient in a lounge chair, with ‘m and for clearance of 1.22 meters on date patients. If children receive {of the surgical suite should .e working area to maintain access to the Phase Il recovery unit Clean corridor Area: Zoridors leading to the restricted areas of the surgical suiteClean work room (Clean utili = Clean workroom: A clean workroom shall be provided when clean materials are assembled within the surgical suite prior to use or following the decontamination cycle, = Soiled and clean workrooms or holding rooms shall be separated. ~The clean workroom or supply room shall not be used for food preparation. = Storage space for sterile and clean supplies shail be sized to mect the functional program. The space shall be moisture and temperature controlled and free from cross-traffic. = If shall contain a work counter, a hand-washing station, storage facilities for clean supplies, and a space to package reusable items. = The storage for sterile supplies must be separated from this space. = Clean supply room: If the room is used only for storage and holding as part of a system for distribution of clean and sterile supply materials, the work counter and hand-washing station may be omitted. Rest area, lounge for staff, report preparation area, and toilet facilities: = Separate or combined lounge for male and female staff shall be provided. Lounge shall be designed to minimize the need to leave the suit and to provide conyenient access to the recovery room. = These lounges may contain furniture for rest , area for food and drinks preparation, TV, computer, fridge and toilet with hand washing facilities. _ The furniture should be easily washable and non dust forming or collecting. Wooden furniture is not allowed inside the theater suit. = Report preparation area shall be provided and shail be accessible from the lounge area. the number of these offices ‘A supervisor’s offices or stations _and teaching area: depends on the functional program of the operative suit Other Service Areas: Provisions for refrigerated blood bank storage that meets the standards of the American Blood Banking Association shall be provided. - Storage for harvested organs: Where applicable, reftigeration facilities for harvested organs shall be provided. Storage for pathological specimens: Provisions for storage of pathological specimens prior to transfer to pathology section shall be provided. _ Area for preparation and examination of frozen sections: This area may be part of the general laboratory if immediate results are obtainable without unnecessary delay in the completion of surgery. _ Tee machine: should be provided from self dispensing ice makers to provide ice for treatment and patient use. [examination provisions: Provisions shall be made for patient examination, interviews, preparation, testing, and obtaining vital signs of patients for outpatient surgery.“The serie core is restricted area of the operating suit, includes operating, procedure rooms and serub sink areas. Ti this area surgical attire and hair coverings are required. = Nluskes are required where open sterile supplies or subbed persons may be located {Signs shall clearly indicate the surgical attire required in each area. General operating room(s) New construction Space requirements: Each room shal have a minima clear area of 37.16 square aoe omclusive of fixed of wallemounted cabinets and builti9 shelves, with a minimum rae meters clear dimension between fixed cabinets and builtin shelves. _ Couamunieation system: Bach room shall have a system for emerBency communication with the surgical suite.control station. _ Xeray viewers: X-ray film viewers for handling atleast four films simultaneously of igital image viewers shall be provided. _ Geielrustion requirements: Operating room perimeter walls, ceiling, and floors, including penetrations, shall be sealed. eaasvations Where renovation work is undertaken, every ¢for shall be made to meet the above vremtmum standards. It i not possible to meet the above standards, cach room shall have a rium elear area of 33-45 square meters, exclusive ‘of fixed or wall-mounted cabinets and built- nos with a minimum of 5.49 meters clear dimension ‘between fixed cabinets and built-in shelves. procedure room! { vascular, orthopedic neurological, and. other special procedures that require ‘additional personnel ‘and/or large equipment ___ space requirements: When included, these room(3) shall have, in addition to the above Fajuirements for general operating rooms, & minimen ‘clear area of 95.74 square meters, ea inimum of 6.10 meters clear dimension exclusive of fixed or wall-mounted cabinets and built-in shelves. = Puimp room: Where open-heart surgery is performed, an additional room in the ouirlted area of the surgical suite, preferably adjoining this operating room, shall be designated as a pump room where extra corporeal ‘pump(s), supplies, and accessories are stored and serviced. _ Equipment storage rooms: Where complex: ohopedic and neurosurgical surgery is performed, additional rooms shall be in the restricted area of the surgical suite, Preferably adjoining the specialty operating roorts, ‘which shall be designated as Rauipment storage rooms forthe large equipment "ised to support these procedures. _ Plumbing and electrical connections: Appropriate ‘plumbing and electrical connections Shall be provided in the cardiovascular, othopedie, ‘geurosurgical, pump, and storage rooms.Scrubbing are: Scrub sin) Renovation: Where renovation work is undertaken, every effort shall be made to meet the above minimum standards, If itis not possible to meet the above measurement standards, the following standards shall be met: (a) Orthopedic surgical rooms shall have a minimum clear area of 33.45 square meters, with a minimum dimension of 5.49 meters. (6) Rooms for cardiovascular, neurological, and other special procedures shall have a minimum clear area of 37.16 square meters. Additional requirements for orthopedic surgery “Equipment storage: Where included, this room shall, in addition to the above requirements, have enclosed storage space for splints and traction equipment. Storage nay be outside the operating room but must be conveniently located. Plaster trap: Ifa sink is used forthe disposal of plaster of pars, a plaster trap shall be provided. Room(s) for surgical eystoscopic and other endourologic procedures Space requirements: (this room shall have a minimum cleat area of 32.52 square meters exchustye of fixed or wall~ Os obinets and builtin shelves, with a minimum of 4.57 meters clear dimension between fixed cabinets and built-in shelves. (6) In renovation projects, rooms for surgical eystoscopy shall be permitted to have a minimum clear area of 23,23 square meters. Scray viewer: X-ray viewing capability to accommodate at least four lms simultaneously shall be provided. —Serub room shall be approximately 9.25 square meters. Facilities must include @ serub aie farat least 3 people, with hands free operable controls. There shall be @ glove and gown bench or trolley separated from the sink, ___Senub position shall be provided ness the entrance to each operating ‘90%. = Sere Pocilities should be arranged to minimize incidental splatter on near by personnel, medical equipment or supply carts. cece lane at sorub stations peraitting observation of room interiors should be provided. _ Serub sink used for surgical scrubbing must be of cleanable and disinfectable material such as stainless steel. The sink should have rounded comers to allow easy cleaning and prevent ‘accumulation of water and bacteria. Hands free operation is a must, for example elbow operated or clectronie sensors = High side panels to control splash are preferred. epee ereraource should be at high enough level not to come in eontact with the evubbing persou’s arm duting the procedure of serubbing and not far from the edge so 12 x SEthat the scrubbing person does not lean on the edge of the sink and contaminate his clothing. | Knee operated sinks ate not preferred because ofthe contact with the surgeon's clothing «Surgical scrub solution shall be dispensed with hands free dispenser. = eeresping up room shall have a clearly identified timer or clock for timing of the serubbing procedure. This may also be an electronic timer. = Course filters shall be installed to filter the water used in sorubbing room Standards for Details and Finishes a, General requirements: Glass fronted cupboards for storing various small items required during surgery for example, wes and dressing tapes, shal be built into the walls. This prevents dust collection 0” 6, aeeupboards which are wall mounted. Non glare, see through glass doors of cupboards shall ce cateamed! with stainless steel , which make the door lie flash with the wall wen closed. aml be a minimum of joints in the frame and the cupboard shall be designed fo ensure adequate cleaning. _ “The use of wooden material in finishing should be avoided. | Ail storage shall be at a height which is easily accessible, : | Stay soreens and service pendants shall be Bult nto the wall so that they sv flush, to sacar oasy and efficient cleaning and minimize the risk of dust collection and infection. __ "There shall be provision for two X-ray electrical sockets and 6 twin electrical outlets in addition to service pendants and service wall panels Windows must not be built in the sterile area but only in the dirty zone and should contain 4 filter for not allowing insect inside the theatre TANG visnble to consider future medical advances when designing 37 operating theater although itis considered less cumbersome to have equipment ‘built into the walls, to lessen the problem of dust collection and infection items such as ‘monitors should be free standing, are Prelopinent in thet efficiency may make them smaller and more compact. pecific requirements Wall finishes in areas such as elean corsidors, central sterile supply spaces specialized raiographie rooms, and minor surgical procedure rooms shall Be ‘washable, smooth, and able to withstand chemical cleaning, ee rishes in areas such as operating rooms, delivery rooms, and trauma oO shall se atalbbable, able to withstand chemical cleaning, bacteriostatic and monolithic. _ alls can be painted with seamless coating material such as Apoxy. Walls in operative rooms (instead of painting) could be covered with full height of 1.5 vn thick flexible vinyl sheeting welded to antistatic floor with round skirting level coer peathesia, serubbing and recovery rooms (instead of painting) may bbe coated swith flexible vinyl up to the level of 1.2 meters. Recent practic started to use stancless steel panels to cover the walls of entire operating room. 13= Walls must be smooth without cracks, seams, open joints, crevices or dividers which harbor dust, insects or bacteria and all cut edges should be tapered to the wall to prevent collection of dust = Walls must be scratch resistant , withstanding wear and tear with fixed smooth trolley height wall protectors along corridors and exit areas = Wall surfaces should be hard end resist janpact, impermeable and stain proof = Around sinks and washbasins there sould be anti splash back of staneless steel or ceramic tile. If ceramic tile is used it should be adequately bonded with smooth water proof type of grout - Walls penetrated by pipes ducts and conduits should be tightly sealed to minimize entry of insects and rodents Floors: - Floor finishes shall be cleanable. - Floor finishes in areas such as clean corridors, central sterile supply spaces, specialized radiographic rooms, and Class A operating rooms shall be washable, smooth, and able to withstand chemical cleaning. - Floor finishes in areas such as operating rooms, delivery rooms, and trauma rooms shall be serubbable, able to withstand chemical cleaning, and monolithic, with af integral base. ~All floor surfaces in clinical areas shall be constructed of materials that allow the easy movement of all required wheeled equipment. = {vinyl used throughout the operating theater suite (the theater, anesthesia room, scrubbing- up room and recovery room), the flooring should be 2-5 mm thick flexible, antistatic vinyl sheet, welded at the seems to provide a safe continuous water proof surface. = The antistatic vinyl sheeting should be coved up the wall, to form a 100-150 mm skirting, = All corners shall be rounded slightly to prevent the harboring of dust and bacteria, and there shall be no cracks or cervices at the seams, which may allow pests into these clean areas. Ceiling: = Ceiling finishes shall be appropriate for the areas in which they are located and shall be as. follows: (@) Clean areas I. Ceiling finishes in these areas such as clean corridors, central sterile supply spaces, specialized radiographic rooms, and Class A operating rooms shall be smooth, scrubbable, non absorptive, rion perforated, capable of withstanding cleaning with chemicals, and without crevices that can harbor mold and bacteria growth. 2. Ifa lay-in ceiling is used, it shall be gasketed or clipped down to prevent the passage of particles from the cavity above the ceiling plane into the semi-restricted environment, 3. Perforated, teguler, serrated, or highly textured tiles shall not be used. (b) Sterile areas, Ceilings in restricted areas such as operating rooms shall be monolithic, serubbable, and capable of withstanding chemicals. Cracks or perforations in these ceilings are not allowed. (©) Mechanical and electrical rooms. Suspended ceilings may be omitted in mechanical and electrical rooms/ spaces unless required for fire safety purposes. = The minimum ceiling height shall be 2.4 meters, with the following exceptions: 41. Ceiling in opersting, delivery rooms and other rooms containing ceiling mounted surgicsl Tight fixtures shall be of sufficient height to accommodate the equipments or fixtures and their normal movement 2. Ceiling in corridors, storage rooms and toilet rooms shall be not less than 2.35 meters, - Equipment rooms and similar spaces where impact noise may be generated shall not be located directly over delivery and operating suit. ‘There shall be double door from the anesthetic room into the theater, and from the theater through the exit lobby, at least 1.5 meter in width ‘Other doors to and from the dirty utility rooms and the scrub up room shall be a minimum of | meter in width. ‘All doors shall have a small, high window and shall be electronically operated. Doors should be made of washable material which can tolerate washing with detergents and disinfectants. Doors should NOT be manufactures of wooden material Corridor width se Minimum corridors in the operating suite, where patients are transported on stretchers or beds, shall be 2.44 meters wide. __Possages and corridors used exclusively for staff aocess shall be a minimum of 1.12 meters in clear widthGeneral illumination: = Operating and delivery rooms shall have general lighting in addition to special lighting units provided at surgical and obstetrical tables. General lighting and special lighting shall be on separate cireuits. Lighting should be bright with even light spaces. Lamps should render colors natural Lamp surfaces should be easy to clean and should not collect dust. Fixtures should limit glare or any other undesirable reflections and direct view of lamps. Operating room light: = Optimal illumination in the surgical field is essential, especially during precise surgical procedures, A wide range of surgical lights are available and should be closely matched to the needs of the procedures performed. Specific considerations include the intensity of the light, the size of the illuminated field, the production of heat and shadows, and the maneuverability of the lamps . - A common model consists ofa single lamp placed in the center of a concave reflective shell, cach aligned at a slightly different angle to widen the illuminated area and minimize shadows. The diameter, shape, and composition of the concave reflective surface determine the focus depth, as well as the shadows and glare produced. Models equipped with focus adjustment to help sharpen the intensity of the illumination are available. - In addition to field size and illumination, ‘naneuvezability is a vital consideration. Ceiling-mounted tract lighting provides the greatest range of motion, with as much as 360degtees flexibility , and it fully illuminates the head and feet. Ceiling-mounted fixed units are most commonly used. They should be situated over the table to illuminate the largest field possible. All lights should be equipped with handles to allow the staff to position them duting the procedure, These handles should be capable of being sterilized. Disposable sterile handle covers are available from most manufacturers. ~The range of moveinent over the operating table shall consist of a diameter of 3.5 meters, with the center of the table as the center of the circle. The normal height from the ground shall be 2.06 meters, but shall also be capable of a height not less than 1.5 meters. The light shall be capable of a 360 degree rotation .It shall be completely stable when positioned, ~The light shall have focus and dimming control, but it is preferable for the dimmer not to be positioned on the light. = It shall be possible fora failsafe mechanism to be incorporated into the theater light, so that if one lamp fails then there is a second lamp which gives sufficient light to continue work. This second lamp shall give a minimum of 50% intensity of the first lamp. = Atungsten lamp of at least 24 volts is usual -The light shall not cause shadows and shall be sufficient to see clearly into a deep wound. The intensity of the light shall be between 1000 and 3000 lumens/sq foot, according to the personal preference of the surgeon, ~The external surfaces of surgical luminaries shall be entistatic, and not attract dust particles, The theater light and the fittings shall be capable of easy cleaning and maintenance. Pere ~The luminaries shall not be capable of transmitting heat in a down ward direction ,which may dry the tissues in the wound and over heat the surgical team. Provision shall be 16made for the heat generated by the lamps to be expelled over from the center of the operating field. Table (1): Recommended illumination levels in each room Surgical suite Tiuminance (Foot-candles) ‘Operating room , general 130-200 ‘Operating table “Task lighting as required ‘Scrub general 75. ‘Clean up room, instruments 50, ‘Anesthesia storage 30 ‘Sub-sterile room, 30 Toilets! bathing, General(inchides water closets shower/tub) 30 Night lightin 3 Utility room (clean and soiled ) General 30 ‘Work counter 50 Stairways: 20 | Storage rooms 20, Obstetric delivery suite Scrub, general 5. (Operating room 150-200 Delivery table Task lighting as required Post-delivery recovery area 5. Sub-sterilizing room 30. Janitor closet 20 [Locker rooms 20 Corridors | Day 20, Night 10‘The air supply to each operating theater suit should be independent, so thet it can be switched off and maintained without affecting the entire theater complex. If this is not feasible, cach unit should supply no more than two separate suits. rypes of air supply: Air is supplied to the operating theater by: 1- Plenum Ventilation (conventional): This is the most frequently used system in general purpose operating rooms. Airborne organisms or colony forming units (cfu) are typically of the order of between 150 - 300 cfu/m3 in conventional operating theattes The bacterial counts at the wound site should be no more than 50 -500 colony forming units (efu) per cubic meter. 2- Laminar flow ventilation: : ‘The laminar flow is usually used in specialized orthopedic units and cardiothoracic units, often in conjunction with sophisticated closed. This system is unidirectional and delivers air flows over the operating table of 300 air changes per hour and a bacterial count of 10 (BCP) or less per cubic meter at wound site. Laminar flow may be delivered vertically or horizontally; the former is preferable, (1) Air supply (2) In new construction and major renovation work, air supply for operating and delivery rooms shall be from non-aspirating ceiling diffusers with a face velocity in the range of 25 to 35 fm (0.13 to 0.18 m’s}, located at the ceiling above the ceater of the work area. Retum air shall be near the floor level, at a minimum, Return air shall be permitted high on the walls, in addition to the low returns, 'A face velocity of around 25 to 35 fom (0.13 to 0.18 ms) is sufficient from the non-aspirating diffuser acray provided the array size itself is set correctly. The non-aspirating diffuser array size should be set appropriately such that it covers at least the afea footprint of the table plus a reasonable margin around it, In the cited study, this margin is 53.34 centimeters on the short side and 25.40 centimeters on the long side, If additional diffusers are required, they may be located outside this central diffuser array. Up to 30 percent of the central diffuser array may be allocated to non-dififuser items (medical gas columns, lights, ete.). The operating and delivery room ventilation systems should operate at all times to maintain the air movement relationship to adjacent areas, ‘The cleanliness of the spaces is compromised when the ventilation system is shut down. For example, airflow from a less clean space such as the corti ‘occur, and standing water can accumulate in the ventilation system (near humidifiers or cooling coils). (©) Bach operating and delivery room shall have at least two return-air inlets located as far from each other as practical (©) Turbulence and other factors of air movement shall be considered to minimize the fall of particulates onto sterile surfaces. (@) Standards for special procedures. Where extraordinary procedures, such as organ transplants, justify special designs, installation shall properly'meet performance needs as determined by applicable standards, These special designs should be reviewed on a case-by-case basis, \ 18Design features = Air changes se vlaintenance of 20 -24 changes per hour, of which atleast 5 should be fresh ait from outside, Approximately 80% of the air in the room is recycled through a canopy over the operating table and passes through a Sum filter. The recommended air change rate in an operating room is 20 to 25 air changes pet hour (ACH) for ceiling heights between 2.74 meters and 3.66 meters. (@) Operating and delivery room ventilation systems shall operate at al times, exept during vvaintenance and conditions requiring shutdown by the building’s fire alarm system. (6) During unoccupied hours, operating and delivery room air change rates msY be reduced, provided the positive room pressure is maintained as required in Table 2 Filtration Om ster all air with peefilter followed by final filter (two ~ stage filtering ). Airis drawn in from the atmosphere and passes through a Sym filter to 95 pereent Gtreiency coerse filler to remove dust and debris is installed after the atmosphere air has been drawn into the air handling unit (AHU). __RRlowe the air is delivered tothe operating site it passes through a high efficiency particulate air (HEPA) filter with 2 0:3pm fier end 2 99.97% efficiency which removes bacterial contamination. ~The air is introduced at the ceiling and exhausted near the floor. ~ Bahaust system in the corridors and the sluice room then removes the ait © the unosphore outside. Regular service and mamtenance of the ventilation plant is ‘essential, the filter should be changed at least twice per year oF ‘more as determined by the atmospheric conditions e.g high dust or pollution Flow _ The system should provide a single directional flow regime, with both high and low exhaust locations. _ There should not be reversal of eir flows when exits are opened oF anny leakage through the seals around the doors and windows when they are closed. Pressure Differential! pressure shall be a minimum of 2.5 Pa between different areas in the OT to ensure air flow as recommended in Table 3. Maintenance Meaanrerunce exit of operating suit should be accessed from outside the these. If any maintenance aaa javolving the air supply system in the operating theater, the infection control department seed be informed and any work in the theater area should only resumed with the permission of Soo oe ol aepartment after the collection of the appropriate environmental ‘samples. ‘Temperature and humidity Temperature and humidity control is essential with an ait conditioning unit attached caperitocing system to carefully regulate both temperature and humidity ibis preferred to have a systom with the facility to print out and record the parameters in the sterile core. 19 eS‘Table (2): The recommended specifications of Air Supply in Special air conditioning and voltage regulation shall be provided. ‘Temperature shall be maintained between 20-23°C in the operating room with relative humidity should have a minimum 50% - 65% with 55% being the average recommended. ‘The higher the humidity the higher the chance of lectronie sparks developing. Humidifiers shall not permit the growth and multiplication of microorganisms. ‘The operating room should 1°C cooler then the outer area ‘Temperature shall be individually controlled for each operating. areas of the OT. = 1 aie | Minimum) | Re | air Minimum | All air ‘ if movement ; circulated | Relative Bie ‘Area ; change of | total air | exhausted tive} Design | Area) relationship by means | humidity | designation | “te outdoor ) change | to nity | emperature toadjacent | °Y ofroom | % airper | pechour | outdoors | °C ‘area units hour Operating rooms/ - 20-23 tener out 5 20.25 - No’ | soss | Zar room Recovery a Z 2i-24C | room = 7 12 No | 5085 | 70-758 Critical rae and - : : 50-65 a intensive ‘ 2 ne 70-15F care “Anesthesia o Gas In 7 7 Yes No : 7 storage | i dalle In - 10 Yes No 7 Sete room, + Bathroom 7 10 ‘ 7 : 24C in u BF Clean linen : storage Out a 2 Upinty’ | corridor! In - 10 Yes No - - dirty room. 20Fach space routinely used for administering inhalation anesthesia and inhalation analgesia shall be served by a scavenging system to vent waste gases. ‘Kn scavenging system should be designed to remove as much of the gas as possible from the room environment ‘A scavenging system captures and exhausts waste gases to minimize the exposure of the operating room staff to harmful anesthetic agents. qpevenging systems remove ges by a vacuum or a passive exhaust system ot both Vacuum seavengers use the suction from an operaling room vacuum wall outlet or 8 dedicated vacuum system, To prevent positive or negative pressure in the vacuum System from affecting the pressure inthe patient circuits, manifolé-type vacuum srevengers use one oF more positive or negative pressure teief valves in an interface ‘with the anesthesia system. In contrast, open ~type vacuum scavengers have vacuum ports that are open to the atmosphere through some type of reservoir; such units do not Feaqire valves for pressure relief. Passive exhaust scavengers can vent into & hospital Vontilation system (if the system is the non-re-cireulating type) or, preferably, into a vetizated exhaust system. The slight pressure ofthe waste gas discharge from the anesthesia machine forces gas through large-bore tubing and into the disposal system or directly into the atmosphere. Soe ee esta scavenging systems are required, ar supply shall Bé at or near the ceiling, Retum or exhaust air inlets shall be near the floot level eee vam system is used, the ges-collecting system shall be arranged so i does not disturb patients’ respiratory systems. dn om the scavenging system shall be exhausted directly tothe outsc ‘The cassthesia evacuation system may.be combined with the room exhaust sysier% provided the part used for anesthesia ges scavenging exhausts directly to the outside and is not pact of the recirculation system. The part used for anesthesia gas scavenging exhausts directly to the outside and is not part of the recirculation system. Pa stmned that anesthetizing equipment will be selected and maintained to minimize leakage and contamination of room ait ‘The NIOSH (National Institute of Occupational Safety and Health) recommended exposure limit (REL) for N2O is 25 ppm as « time-weighted average (TWA) during the period of anesthetic administration ,This REL is intended to prevent deoreases in mental performance, audiovisual ability, and manuel dexterity during expose toN20. Pes should be monitored when the anesthetic equipment is installed and every 3 months thereafter Connection ports with different-diameter hoses for N2O and 02 should be used to reduce the possibility of incorrectly connecting the gas delivery and seavenei™t hoses. see ber hoses, connections, tubing, and breathing bags should be checked daily and replaced when damaged or when recommended by the manufactntet ‘The scavenging system exhaust rates (low rates) shall be approximately 50 liters per minute (L/min) to minimize leakage of N20. 21= Gas and suction outlets should be self sealed when not in use ~ Outlets from different gases should have non interchangeable connections , for fear of giving wrong gas during anesthesia ~ Filters on air and gas supplies should be capable of removing all partictes larger than 5 microns _ Standardizing the position of gas outlets throughout the lhospital to ensure that accidents cannot occur so outlets should supply oxygen, air, suction and nitrous oxide provided in that order from left to right = Portable anesthesia machine should provide 1 oxygen, | air, Isuction and one nitrous oxide gas outlet in the anesthetic room = There must be 3 suction outlets per room for operative rooms and 3 outlet per bed in recovery room Water supply: - Hot and cold water supply at sufficient pressure should be piped to most areas of thester to operate all fixtures and equipments during maximum demand = Hot water should be at maximum temp 65 degree centigrade Supply capacity for hot and cold water piping should be determined on the basis of fixture units using recognized engineering standards Each water service main , branch main , riser and branch to a group of fixtures should have valves and stop valves should provide for each fixture and appropriate panel for access should be provided at all valves where required ~ Filtered water may be provided for drinking Drainage system for water sinks should be adequate and efficient | General piping requirements: frdm inert material, clean joining, no erosions, not enhancing microorganism growth, smooth with no cracks or crevices , non porous, and have no dead legs (should have continues flow) - Common piping materials: 1+ stainless steo! 2- aluminum, 3 PVC or CPVC Drainage system: - Drainage piping shall not be installed within the ceiling or exposed in operating, delivery rooms, central services , and electronic data processing area. _ Floor drains are not to be installed in operating and delivery rooms. Alternative methods include (a) an aspiratoritrap installed in a wall connected to the collecting trough of the ‘operating table by a closed, disposable tube system, or (b) a closed system using portable collecting vessels. eanmunication: _ Telephones ean be positioned in anesthesia or laying uP room and telephone should be silent and have light indicator for urgent messages = Ringing phones or telecom are permitted in offices rest aed, reception area, nurse station at recovery bay Tae can be installed for communication between operating theater and laboratory, reception and other rooms Electricity: Service pendants for electricity may be used for plagging in the anesthetic machine, monitoring equipment oto provide power forthe diathermy, _Tragmuct safer for wiring to be plugged in at a height, to prevent personnel tripping ‘over the wires and disconnecting vital equipment. Orr lectcl points shall be capable of giving sufficient power for many varieties of machinery. ___ RACHID. «shall be provided to protect the delieate machinery from sudden surges of power. i _ ‘All electrical points in the operating theatre suite shall be serviced by the emergency power system. There shall be ao more than 10 second transfer of power supply: Safety requirements 7 Fire Alarm: A single state fire alarm system shal! be provided throughout the building. = Bene alarm system shall be designed and installed in ‘accordance with the requirements of National Fire Standard _ Heat detectors shall be installed in the following areas: 1. Storage rooms, IL. Mechanical equipment and service rooms, I. Janitor closets. smoke detectors shall be installed in corridors, at top of ‘each exit stair shaft, in every holding room _ Smoke alarms shall be installed with permanent connections to an electricai circuit and orett nave no disconnect switches between the over-CoHEnt device and the smoke alarm, ___ Shall etvgvornmended to bave water sprinklers in the theatre suite itself. Automatic heat sensing devices may be used, but in low occupancy areas such as stores, smoke detectors should be installed. _ $AeSlanm signals shall be audible only atthe reception desks and offices. Fire panels in the other ateas shall have flashing fights ané the location of the fire on the panel. _ Pejeewomagnetic doots are used in te theatre suite, then there must be an automatic release for manual door opening.Portable Fire Extinguishers: _ Multipurpose fire extinguishers 5 Kg or equivalent capacity shall be provided and so located that the travel distance to an extinguisher does not exceed 15 m. _ Fire extinguishers shall be located so that they are not unduly exposed to fire hazards and where possible, ator near the exits from the building or room, and shall be mounted by means of wall attachments, _ Fire extinguishers shall be installed in accordance with the requirements of the National Fire Standards. Emergency ligh _ Power for emergency lighting systems shall be provided from either : L.A generator, “Emergency Electrical Power Supply for Buildings or Ii, Batteries “Unit Equipment for Emergency Lighting.” = The emergency lighting shall be provided to average levels of at least 10 lx at floor level in exits , corridors, principal routes providing access to exits, generator rooms holding rooms, and traditional healing rooms. : _ The emergency lighting system shall be provided to continuously supply power in the event that the regular power supply is interrupted and be so designed and installed that upon failure of the regular power it will assume the electrical load ‘automatically for a period of not less than one hour. _ Must have an illuminated sign with “EXIT” above the door. Tite exite are located at the end of the main corridor Jeading to the outside. «A continuous illuminated exit sign shall be provided in means of way out, over evEY a erent nd over every Way out from rooms with an occupant load greater than 30 Emergency exit doors: _Asany other facility emergency exit doors should be available inthe operation theater for any possible emergency evacuation. However, during non. emergency sineiion those deors must romain closed at all times . These doors are directly connected 19 he outside so they are in the dirty or outer zone, _ No emergency doors should be situated near the sterile operating theaters, ~All exit doors shall open in the dicection of exit travel. Bait doors shall be clearly identifiable and no hangings or draperies shall be placed ever ‘emergency exit doors to conceal or obsoure any exit.References: _ Guidelines for design and construction of hospitals &chealth care facilities AIA (American Institute of academy of Architects),the facility guidelines institate, with ‘psistance from US department of health and human services, 3" edition Aug, 2002 _ Standard specification for design of operating theaters and Intensive Care Unit Directorate of Infection Control, Ministry of Health, Kuwait 2001. _ Fire safety requirements for health stations, health centers and nursing stations. Technical Committee of Health Care Facilities, Government of Canada Sep.1999 (last modified Sep. 2003). Available from www. hrsdc.ge.ca/asp/gateway. asp _. "Bilective encray-efficient lighting for healthcare, Small commercial lighting program in New York State, Available from http:/selp.lightingresearch,or/healthcareresources.as> = Controlling exposures to nitrous oxide during anesthesia administration, Avesthetic goses guidelines for work place exposures. NIOSH ( National Institute of Safety ard Occupational Health, USA) May, 2000. _ Plumbing design for health care facilities American Society of Plumbing Engineers 'ASPE Plumbing engineering Design Hand book, volume 3. Available from www.ASPE.org/ASPE_publications _ Anesthesia gas scavenging system, Article by Carl Lawes , Available from www.ebme.co.k. . _Tntroduction to scavenging, Anesthesia UK ( An educational site with training resources for Anesthetic professionals) www.frea.co.uke Hospital Infection Control seting up with minimal resources, Shaheen Mehtar, Oxford University Press, 1992. _ General Principles of OR Design and Construction, ACS Surgery: Principles and Practice. Available from wwyw.medseape.com\viewarticle\503005-2 National Institutes of Health: Farhad Memarzadeh and Andrew P. Manning, “Comparison of Operating Room Ventilation Systems in the Protection of the Surgical Site” (ASHRAE Transactions 2002, Vol. 108, pt. 2) _ Fachad Memarzadeh and Zheng Jiang, “Effect of Operation Room Geometry and Ventilation System Parameter Variations on the Protection of the Surgical Site” (AQ 2004). _ National Institutes of Health: Farhad Memarzadeh and Andrew P, Manning, “Comparison of Operating Room Ventilation Systems inthe Protection ofthe Surgical ite” (ASHRAE Transactions 2002, Vol. 108, pt.2) and Fathad Memarzadeh and Zheng, Siang, “Effect of Operation Room Geometry and Ventilation System Parameter Variations on the Protection of the Surgical Site” (IAQ 2004).) my Building Note for SD Renovation Project Buildings should include: The adequacy of engineering services, ease of access and facility for installation oF new wiring, pipe work and ventilation ducts/plant, eto; ‘The height of ceilings, the change of floor levels and fire precautions. Physical constraints to adaptation such as load-bearing walls and columns. Upgrading must conform to current fire safety and other statutory regulations. Ventilat The whole CSSD areas will require special ventilation. Washer disinfectors and sterilizers emit considerable heat and humidity. Electronic controls essentials for the correct operating of equipment can be affected. Working conditions can become intolerable unless fully insulated machines are selected, all pipe work is insulated and extract ventilation is provided specific to these machines. Canopies for extraction may be required over machines. ‘Adequate ventilation of the CSSD plant roum can be achieved economically since ihe room has an external wall. And can be summarized as follows * Decontamination area: 20 ACH/ Air Changes per Hour Temperature: 16-20°C Humidity: 30-60% Negative air pressure * Packing & sterile store: 20 ACH Temperature: 16-19°C Humidity: not more than 40% Positive air pressure Page 1 of ‘Atachnent |