Unikelvin guide to Modular

Operation Theaters

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WHAT IS AN OPERATION THEATRE (OT)?

Operation Theatre (OT), also called as an Operating

Room, is a facility in a Hospital, where surgeries or medical
interventional procedures are carried out in an aseptic or
sterile environment. They are designed and built to
minimize the introduction, generation, and retention of
airborne particles, contaminants, and microbes.

• They are positively pressurized to check the infiltration

of airborne contaminants from outside.
• They are built with materials that do not shed particles
.
• All the clinical personnel, such as doctors and
technicians wear protective masks and gloves while
inside the OT.
• There will be a Laminar Airflow (LAF) or HEPA filters
in
the ceiling, that would supply the OT with clean air.

Modular Operation Theatre (OT): is built with systems

that are seamlessly integrated with each other for
providing superior cleanliness in the OT. A typical modular
OT consists of modular wall and ceiling panels with
integrated medical gas and electrical systems, ceiling
suspended LAF, return air risers, epoxy or vinyl flooring.
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NABH GUIDELINES FOR OT

As per NABH (National Accreditation Board for Hospitals and Healthcare Providers in India), below
are the Air-conditioning requirements for Operation Theatres. NABH doesn’t mandate the OTs to be
modular, as long as they satisfy the following requirements. It is up to the Healthcare Organization to
go with either a modular or a normal OT.

As per NABH, the OTs are classified as , Type A and Type

B.

• Type A is also called as Super-Speciality OT for

carrying out surgical procedures related to
Cardiothoracic surgery, Neurosurgery, Orthopaedic
surgery (Joint & Hip replacements), Vascular Surgery,
Tumour removal, Transplant surgeries (heart, liver,
kidney), etc.

• Type B is also called as General OT, primarily used

for carrying out less critical surgical procedures such
as day-care procedures, IVF, gynaecology,
ophthalmology and other general surgeries.

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AIRCONDITIONING FOR OT
AIR-CONDITIONING REQUIREMENTS

SI Parameter Super-specialty OT General OT

1 Temperature 21+3°C. 18+2°C for joint replacements. 21+3°C
2 Humidity (%) 20-60%. 20-60%
The OT shall always be maintained at least 7.5 Pascals more than the adjacent space
3 Pressurization to check there is no cross-contamination of dirty air from adjacent spaces.

4 Air Changes/Hour > 20 > 20

5 Fresh Air ~20% ~20%

6 Air Velocity Unidirectional airflow on the OT table. The air face velocity of 25 -35 FPM
The air is supplied to OT through terminal HEPA (High-Efficiency Particulate Air) Filters
7 Air Supply mounted on the ceiling. It is unidirectional, downward airflow at a velocity of ~90 FPM.

The AHU shall have G-4 Prefilters (10 μm filtration at 90% efficiency) and F-7 Fine
8 Filtration Filters (5 μm filtration at 99% efficiency). The terminally mounted LAF / H14 HEPA
Filters filter out particles of size more than 0.3 μm with 99.997% Efficiency

AHU shall be recirculatory type, With 40 mm thick double-skin construction with thermal
break profile, with G-4 Prefilters (10 μm) & F-7 Fine filters (5 μm), Shall have DX
9 Air Handling Unit cooling coil or Chilled water coil for cooling, strip heater or hot water coil for RH
regulation, belt-driven or direct driven plug fan with superior efficiency and life, EC-2
Efficiency grade motor, AHU shall come with Variable Frequency Drive (VFD).

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AIRCONDITIONING FOR OT
AIR HANDLING UNIT (AHU)

SI Parameter Description

Minimum AHU capacity shall be the Volume of Example:

AHU the OT multiplied by Air changes & divided by
1 Capacity 60. However the right capacity should be Dimensions: Length: 6 M, Width 7 M, Height 2.5 M
(CFM) maximum of the above CFM and Dehumidified Volume : 6x7x2.5 = 105 M3 = 105 x 35.3 = 3690 Ft3
CFM calculated from heat load estimation. Minimum Capacity: V x ACH/60= 3690*20/60
= 1230 CFM
AHU shall have 20 μm fresh air filter (G3 Grade), 10 μm prefilter (G4 Grade) and 5 μm fine
2 Filters in filter (F7 Grade). The intent of having multiple filtration levels is to filter out bigger particles
AHU and bring down the load on room thermal 0.3 μm HEPA filters in LAF (H13 Grade)

HEPA filters shall have high-pressure drops. Hence the blower-motor shall be designed for
High Static Pressure (1000-1250 Pa). Belt-driven Backward Curved (DIDW BC) fan was
3 Fan-Motor widely used. Nowadays there are energy-efficient Fans such as Direct-Driven Plug Fans or
Electronically Commutated (EC) Fans are available. These fans have a longer life,
consume less power and easy to maintain due to less number of moving parts.
The Cooling coil (part of AHU) will cool the fresh and return air. The coil can be connected to a
4 Cooling chilled water source or a Direct Expansion (DX) outdoor unit. DX ODU is ideal for small
Element
hospitals and chilled water is economical for bigger hospitals with a chiller.
A strip heater can be installed in the AHU that would heat the air to control its RH. This is ideal
Humidity for small applications. In case there’s an availability of hot water, a Hot water coil, can be
5 Control used to control RH of the air. Strip heater should be thyristor controlled for safety and shall be
connected to AHU control panel for energy-efficient operation.

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AIRCONDITIONING FOR OT
AIR HANDLING UNIT (AHU)

SI Parameter Description
6 Ductwork 24 G (0.63 mm) / 22 G (0.80 mm) GI ductwork. Supply air duct will have 13 or
19 mm thermal insulation while return air duct can have 9 or 13 mm.
7 Fumigation For the purpose of Fumigation, a separate AHU can be used or same AHU can be
used with a provision for Fumigation of OT.

Typical AHU Dwg Laminar Air Flow (LAF)

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CONSTRUCTION OF OT

WALL & CEILING

Improper walls pose a risk of generation of airborne particles would lead to infections during surgeries. Wall
materials that generate particles such as plain civil walls & gypsum should be completely avoided. In the case
of PUF or HPL Panels, the OT shall be made airtight with the help of coving and food-grade silicone sealant.
OT Walls can be made of including and not limited to the following.

Sl Option Description
1 PU Paint Anti-microbial, anti-fungal, low VOC (Volatile Organic Compounds) Poly-Urethane
Paint on walls. This is the most widely used OT walls in India. Cost-effective & faster
execution

2 Vinyl PVC / Vinyl wall cladding can also be used to convert civil walls into OT Wall. Simple,
Cladding durable & faster execution

3 PVC Anti-microbial, hygienic PVC cladding such as BIOCLAD ® Can also be used. Simple,
Cladding durable & faster execution

4 HPL Panels High Pressure Laminate panels for wall and ceiling- Sturdy & high impact resistance

5 Modular PUF Panels are the widely used options for modular OTs. PUF Panels can have PCGI
Panels or SS-304 Sheets on outer side & provide Superior sterile / aseptic environment

6 Ceiling Ceiling shall have a suspended vertical LAF. In such cases, it is preferred to go with
PCGI / SS / HPL Panels for ceiling as they don’t shed any particles.

6 Return Air Return air should be drawn from the bottom corners of the OT through return air risers
Risers

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CONSTRUCTION OF OT

PU Painted OT PUF Panel OT

Vinyl OT

SS-304 Panel OT HPL Panel OT

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CONSTRUCTION OF OT
FLOORING
Flooring is a very important part of OT or a cleanroom. Given that the contamination or airborne particles
have a downward flow, the floor can harbor infections if not laid as per the requirements. The flooring shall
be selected to have higher durability. Edges of the room should be sealed airtight with proper corner coving.

Following considerations shall be kept in mind before choosing the flooring

• Electrostatic discharges: Risk of static charge build-up in the floor

can damage the equipment or even cause an ignition. Choosing an
antistatic dissipative floor (ESD) will protect against such problems.
• Durability: high durability and load-bearing capacity, to withstand
heavy traffic in the form of equipment, trolleys and people.
Otherwise, it could crack, spoiling the seamless finish and
becoming a site of microbial growth, eventually become a source of
infections
Vinyl Flooring • Presence of VOC: Epoxy and polyurethane resins are inert and low
in Volatile Organic Compounds (VOCs), releasing no particles into
the surrounding environment.
• Possibility of retrofitting in case of existing flooring
• Resistance to water, chemicals and normal wear & tear
• Ease of laying and maintaining.
• Flexibility to repair within minimum downtime
• Antimicrobial property: flooring can have antimicrobial additive
that actively target bacteria in contact with the floor.

Epoxy Flooring
Vinyl & Epoxy are the most commonly used
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IMPORTANT CONSIDERATIONS

Below are some of the design considerations while building an Operation Theatre

1. Split or Window air conditioners should not be used. They are 100% recirculatory units and
provide inferior air cleanliness. This will result in pockets of microbial growth leading to infection and
affecting clinical outcomes of the patients.

2. Each OT should have a dedicated Air Handling Unit (AHU) and no two OTs can share same AHU as
there would be cross-contamination between the OTs.

3. The AHU and outdoor air intake should be located away from sources of contaminated air such as
Vehicle parking area, Diesel generator exhaust, toilet exhaust, Lab exhaust etc.

4. It is preferred to have a floor-mounted AHU rather than a ceiling suspended AHU, due to ease of
access and maintenance. Ceiling suspended AHUs are known to leak water into OT or adjacent areas.

5. In case of space constraint, ceiling suspended AHU can be installed, provided there is proper access
provided for periodical maintenance.

6. The OT shall be maintained with air cleanliness compliant with ISO-14644 around the clock. The
AHU blower shall be operational 24/7. During the non-functional hours, the AHU can be run with 25%
load with or without cooling. Variable frequency devices (VFD) may be used to conserve energy.

7. The OT shall always be maintained at positive pressure concerning adjacent spaces. This is to ensure
no unclean, contaminated and infected air infiltrates into the OT. A Magnehelic or differential pressure
gauge can be fixed at OT entrance to indicate the pressure differential.

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VALIDATION & TESTING OF OPERATION THEATRES
OT System shall be tested, validated and documented as per ISO-14644 or NABH
guidelines. Below are the list of tests to be carried out while OT is commissioned and the
validation shall be repeated every six months.

SI Testing Parameter Acceptable Range Frequency of

Testing
1 Temperature 18-21°C. 6 Months
2 Humidity (%) ~55%. 6 Months
ISO Class 5 (at rest). a cubic foot of air
3 Airborne Particle Count should not have more than 0.5 μm or larger. 6 Months

4 Air Change Rate Calculation > 20 6 Months

Air velocity at outlet of terminal 25-35 FPM at Working height
5 filtration unit /filters 90-100 FPM at the filter face 6 Months
Pressure Differential levels wrt
6 adjoining areas ~7.5 Pascals 6 Months
Validation of HEPA Filters
7 using PAO/ Integrity Test. > 99.97% down to 0.3μm 6 Months

From the clinical outcome and patient safety perspective, All the above tests should be carried out
every six months, to assess the sterility of the OT. In case of any deviations, the system needs to
be corrected. Otherwise, the system will impact the clinical outcomes of patients.

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References

• Revised Guidelines for Air Conditioning in Operation Theatres –NABH-Air Conditioning OT (2018)
• HVAC Design Manual for Hospitals and Clinics by the American Society of Heating, Refrigerating and Air-
Conditioning Engineers, Inc (ASHRAE).
• International Standard ISO 14644-1:2015(E), Cleanrooms and associated controlled environments Part 1:
Classification of air cleanliness by particle concentration, ©ISO 2015.
• Cleanroom Technology: Fundamentals of Design, Testing and Operation by W. Whyte © 2001, published by
John Wiley & Sons Ltd.

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