Operating Room is planned within a complex which has a pre operative area where the patient is prepared for the intervention, the area where the intervention takes place (Operating Room) and a post operative area (Recovery). This recovery is then connected to a surgical Intensive Care Unit (SICU), before the patient is shifted back to a general room from where he is finally discharged. It is also recommended to have a dirty corridor on the other side of the sterile corridor to prevent the mixing of dirty and sterile supplies inside the OR.
Any Operating Room has the following features and products:
Seamless walls, ceilings and floor. This is a basic feature requirement to prevent growth of microbes inside OR. Apart from this the other features include
Heating Venting & Air Conditioning – Laminar Air Flow
Each OR should have an individual Air Handling Unit, which will have a provision for taking in return air duct from the OR, fresh air intake, mixing chamber, cooling coil section, fan and motor section, fine filter section and supply duct. HEPA filters will be placed at the terminal end inside the Plenum which will be made of either SS 304 or extruded Aluminium. All ductings, supply and return ducts should be constructed from Aluminium only. While the supply will be through a plenum installed in the centre ceiling of the OR, the return ducts would be taken from the bottom four corners of the OR. Some of the AHU’s also have UV box at the supply end of the unit.
It is recommended to have 30 air exchanges with 5 fresh air exchanges for super specialty ORs and 25 air exchanges with 4 fresh air exchanges for General ORs. Fresh air intake is done by installing a backward curve blower inside the AHU. It is always recommended to have 100% fresh air exchanges for Septic OR (these AHUs will not have provision to take return air back from the OR).
Surgeons Control Panel: Which will record all the critical parameters during the surgery including time, humidity, temperature inside the room, HEPA filter status (optional), differential pressure inside and outside the room, medical gas status, hands free telephone, control of peripheral lights etc.
Pendants: Single arm or double arm pendants with provision for medical gases and electrical
outlets including data outlets. Pendants also have racks which can house equipment like cautery machines, monitors etc. Pendants can be either Anaesthesia or Surgeon Pendants. X Ray View Box: For viewing radiographic films. These days modern ORs also install PACS (Picture Archiving & Communication System)viewer inside OR to get all the patient related details like images, lab reports, patient case history etc directly from the Hospital Information System.
Writing Board: To jot down details regarding the case in process if any. Pass Box: For removal of dirty materials from the OR into a dirty corridor for proper disposal View Window: These days Surgeons do demand for having access to natural light inside the OR. These can be done through a double glazed glass window with motorized blinds which is flushed into the modular panel
OR Storage: Every OR has a huge demand for storage area within it. In olden days these storages were in the form of mobile units, but since there is a shortage of space inside the OR, it is always preferable to have flushed storage cupboard inside the OR.
OR Scrub: An OR complex needs to have scrubs located in the sterile corridor just outside the OR. As a thumb rule it is desirable for every OR should have its own individual scrub, a minimum of two ORs can be catered through one scrub. Scrub can be either single bay, double bay or triple bay manual or automated scrub with facility for both hot and cold water with a mixer.
Hermetically Sealing Sliding Door: An OR is regarded as a clean room of Class 100, hence it is essential to ensure absolutely no ingress of microorganisms into the OR from outside. The environment inside the OR is totally controlled and hence sealing of the door is essential. Sliding door is recommended because a swing door cuts into the Laminar Air Flow in the OR.
While the ceiling height is always a cause for debate inside an OR a 3.0mtr ceiling is always desirable.
During the construction phase, it is always recommended to have a true slab height of a minimum 4.2mtr with Post Tension Slab (PT Slab) for the OR Floor, so that about 1.2mtr can be used for running various services like HVAC duct, MGPS copper lines, Electrical conduits etc. The ideal dimension of an OR for a Multispecialty Hospital should be 20’ x 20’ for general surgeries, about 25’ x 25’ for Specialty Surgeries, 25’ x 30’ for Robotic Surgeries and 30’ x 30’ for a Hybrid Theatre.
Need for going Modular
- With a growing demand for sterile aseptic procedures, the demand for Modular OR has in creased manifold. Some of the advantages of Modular OR are as follows: · Proper insulation of the OR from outside atmosphere. This will result in minimal temperature leaks from the OR to the outside.
- Ease of installation and ease of maintenance of sterility. The modular concept can also help hospitals to make any changes or shift the OR itself to a new location in future. · India being a tropical country, the temperatures are generally very high during summers. This can result in high temperature difference inside the OR (about 16-180 C) and outside (about 40-450 C). This huge difference can result in humidification of the walls resulting in fungal growth inside the OR.
- Similarly during rains any water ingress due to seepage can hamper the working of the OR.
- Modular OR is easy to be cleaned and disinfected, hence lesser chances of infection and better patient turn around.
- Cost is definitely a major criteria in selection of type of OR. The price difference between a modular and non-modular will only be Rs.3.00 – 4.00 lacs per OR. However the cost savings are tremendous and the hospital can expect an ROI within a couple of years of installation.
Materials used for Wall and Floor of a Modular OR
Various materials can be used for Modular OR’s like EGP, PPGI, SS 304, Aluminium, Corian, HPL, Glass, PVC, Thermoplastic etc. The flooring should be either Epoxy or Vinyl. Vinyl is normally laid on a 3mm Self Leveling epoxy compound. It is always desirable to have an antimicrobial coating on top of OR surfaces like walls, ceilings and floors.
OR Integration: With a growing demand for technology, a lot of hospitals and most of the teaching institutions opt for OR integration wherein a surgical procedure can be beamed live to an audience elsewhere either inside the hospital or in an outside location. This feature is also used frequently by Doctors to have a second opinion during the course of any procedure. This is done through multiple cameras which are integrated into a system and then beamed live. For this the OR needs to have proper Optical Fibre Network which provides them with the requisite bandwidth.
In case of a transplant OR (for organ transplant surgeries), one needs to have two adjacent located ORs which are interconnected using a pass-box.
In addition to these, care needs to be taken to ensure that every OR has its own individual electrical distribution board and MGPS valve box. It is essential to ensure that these DBs and valve boxes are installed just outside the respective ORs inside the sterile corridor itself. Each OR will also have a Pressure Relief Damper (PRD) to relieve any excessive air pressure build up inside the OR into the adjacent sterile corridor.
As far as firefighting system is concerned, ORs will only have fire detection system only. Installation of fire fighting sprinkler systems are prohibited inside the OR complex.
It is mandatory for hospitals to get their HVAC systems and Medical Gas systems validated every six months through a third party validating company.
About the author:
Santosh Menon – Hospital Consultant, toshmani@hotmail.com
