What reason is there for operating room design and standards?
Infection control is a complex, multidisciplinary process that requires acknowledgement by every staff member of the healthcare facility. The physical design of an operating room is based on two principles. The first is that the surgical environment should be completely separated from all sources of contamination such as people, equipment, objects, and food. The second is that potential sources of infection should be contained.
Environmental safety is extremely important, especially fire safety. Fire poses a real threat in the operating room, therefore oxygen, fuel, and sources of ignition should always be separated. Drapes and gowns should be flame resistant to reduce the risk of accidental ignition. When lasers are used in surgery appropriate laser resistant materials should be used, for example, aluminum coated endotracheal tubes. All potential sources of ignition should be free of wear and tear, this means no frayed wires and fully functional safety mechanisms. Compressed gas cylinders should be stored and transported by OSHA standards. According to the Joint Commission, ECRI, and AORN fire risk reduction strategies should include:
- Staff participation in fire drills
- Staff can demonstrate the use of firefighting equipment
- Rescue operation plans for staff
- Gas shut off procedures reviewed by staff
- Location of ventilation and electrical systems by staff
- Review of fire alert policies by staff
- Review of fire department procedures by staff
- A safety based culture in the healthcare facility
Efficient use of healthcare workers, time, space, and material resources minimizes strain and helps to make the best use of people's skills and abilities. Surgery is very time sensitive, so physical design is important in reducing stress caused by too much movement and poor workflow habits. Personnel should be exceptionally knowledgeable of their operative environment, and display a high level of competence in their practice.
Accreditation is a voluntary process, but it implies a high standard of care to public safety. The Joint Commission is the primary accrediting organization for all health care establishments, and they base their standards on both professional and government agencies. Members who make up the board of commissioners are members of the American College of Physicians, the American Society of Internal Medicine, the American College of Surgeons, the American Dental Association, the American Hospital Association,m the American Medical Association, and other selected professionals.
Agencies for Standards and Regulations
The physical ways healthcare workers, patients, and equipment move throughout the healthcare facility are called traffic patterns. Traffic patterns define boundaries between the cleanest and dirtiest areas of the hospital. Design of the facility may affect the observation of traffic patterns, but there are six important guidelines recommended by the Joint Commission that all facilities should follow:
1. The movement of people and equipment into perioperative should be completely controlled. Personnel may only enter the perioperative department through monitored doors, and fire exits are set with alarms to prevent people from un-officially entering the area.
2. The surgical department is divided into three distinguished areas: unrestricted, semi-restricted, and restricted; all of these areas should be separated by transitional rooms or corridors to meet the requirements of asepsis, or cleanliness.
3. People entering the department from outside of the surgical department should always be properly attired when passing into semi-restricted and restricted areas.
4. Area signs should posted within the direct line of vision for visitors.
5. Following the traffic pattern rules should be enforced by everybody, including visitors and non-medical staff.
6. Transition door should be secured and monitored, so that people do not accidentally end up in off limited areas.
How Laminar Airflow Works
The Operating Room Environment
The environmental air pressure in the operating room can increase or reduce the chances of infection. Airflow may not be allowed to pass from unrestricted areas to restricted areas, to do this the surgical suite maintains an air pressure at a level 10% higher than adjacent semi-restricted areas. High-efficiency particular air (HEPA) filters should be installed in the operating room ventilation system, and a laminar airflow (LAF) system should be available to move large volumes of air at a continuous velocity.
Humidity and Temperature should be controlled. The standard for humidity in the operating room is 30% to 60%, and the temperature of the operating room should be maintained at 68* F to 73*F.
Lighting should be provided using either bright LEDs or Halogen base.
Team Based Patient Care
To ensure that operations run smoothly and efficiently, a clear management structure needs to be defined through a chain of command. The chain of command outlines the relationship between management and staff members so that responsibilities are allocated correctly, and rules are followed.
Top 5 Questions You Should Ask Your Surgical Center- and the Answers You Should Receive
- What kind of airflow does your facility have?
- Laminar Airflow
- HEPA filtration
- Negative air pressure in the room to prevent cross contamination
2. What is the temperature and humidity level of your operating rooms?
- 30% to 60% humidity
- 68* F to 73*F
3. What is the traffic flow through your facility?
- The division of of restricted, semi restricted, and unrestricted areas
- Signs are posted
- Proper attire should be donned
- transition rooms or corridors should be available between sections of the department
4. What steps do your personnel take to ensure there is no patient confusion?
- The hospital performs a thorough last minute TIMEOUT to verify the correct patient, surgical procedure, operative site, allergies, and known medications
- Medications are always labeled as soon as they are received
- Specimen are always labeled as soon as they are received
5. Is your facility accredited?
- Yes! If not, find out why.
Nuclear Medicine and Interventional Radiology
Work Areas Within the Facility
Patient Pre-Operative Holding Area
Sterile Instrument Room
Utility Workroom and Decontamination Area
Clean Processing Area
Postanesthesia Care Unit (PACU)
Surgery Waiting Area
Integrated Operating Room Systems
1. Fuller, Joanne Kotcher. 2013. "Surgical Technology Principles and Practices sixth edition." St. Louis, Missouri: Elsevier.
Ashley Vailu'u (author) from Central Texas on March 18, 2015:
Oh yes, air pressure and air quality play an extremely important role in infection control. Asking about the airflow system would definitely be in my top five questions for choosing a facility. Thank you for taking the time to read my hub!
Linda Crampton from British Columbia, Canada on March 18, 2015:
Thank you for sharing this useful information, AVailuu. I found the fact that the air pressure in an operating room is kept higher than the pressure in the surrounding areas especially interesting.