Chapter 3: Operating Theater Design

INTRODUCTION
• Safe environment incorporates features that prevent
or control the risk of infection, fire, explosion, and
chemical and electrical hazards.
• An operation theatre complex is the “heart” of any
major surgical hospital.
• An operating theatre, operating room, surgery suite
or a surgery centre is a room within a hospital within
which surgical and other operations are carried out.
• Hospital operating rooms are among the most
infection-sensitive environments in health care
facilities.
 Historical Perspective
• Early surgeries were done in convenient rooms.
• In 18thcentury, theatres were built in the form of
amphitheaters.
• Late 19thcentury, rooms were designated as
operating theatres with large windows.
• 20thcentury marked the beginning of the modern
operation theatre complex.
 Operating Theater
• It is specialized facility in hospital where invasive
treatment is given under strict aseptic controlled
environment by trained personnel.
 Objective of Planning
• Promote high standards of asepsis
• Ensure safety
• Optimal physical working conditions
• Ensure optimum utilization
• Facilitate coordinated services
 THEATER DESIGN TEAM
• Health care professionals
• Surgeons, anesthetists, nurses
• Architects
• Engineers
• Information technology specialists
• Interior designers
• Environmental specialists
 Design Considerations
• Location
• Workflow
• Basic work areas and Division of space
• Zoning concept
• Air filters
• Machinery and equipment
• Organization
• Policies and procedures
• Four zones can be described in an OT complex
based on varying degrees of cleanliness,
ZONE 1– PROTECTIVE – (General access area)
• Reception room
• waiting room
• trolley bay
• Conference room
• Change rooms
ZONE 2– CLEAN AREA –(limited access area):
•Recovery room
•Emergency autoclave area
•Staff resting room
•Emergency exits
•Equipment store room
•Fire fighting device room
•Stores & cleaner room
•Maintenance workshop
•Kitchenette (pantry)
•Close circuit TV control area
ZONE 3– STERILE AREA –Restricted access
zone:
•Operating room
•Scrub room
•Anesthesia room
•Setup room
ZONE 4– DISPOSAL AREA – dirty utility
disposal corridor 
Operating Theater Traffic Flow
 Types of OT complexes
1.The single theatre suite: with OT, scrub-up
and anesthesia room, trolley preparation, utility and
exit bay plus staff change and limited ancillary
accommodation.
2.The twin theatre suite: with facilities similar
to 1, but with duplicated ancillary accommodation
immediate to each OT, sometimes sharing a small
post anesthesia recovery area.
3.Three or more OTs: with ancillary
accommodation including post anesthesia recovery,
reception, porter’s desk, sterile store and staff
change.
 Special considerations
1. Location
•The OT should be separate from general ‘traffic’ and air
movement of rest of the hospital.
•planned on the first floor, connecting to surgical and other wards
on the same floor.
•Adequate electric lift is planned for vertical movement from
casualty on the ground floor.
• Adequate & appropriate space allocation.
•Provision for ventilation &temperature control.
•Provision for emergency exit.
•Consideration for future expansion.
 Surgical
wards

ICU
A&E
Operat
ing
Theatr
e
SSS
D Day
Case
Ward
Radiol
ogy
 2.OPERATION SUITE
• The number & size can be as per the
requirement but recommended size is 6.5 m x
6.5m x 3.5 m.
• Glass windows can be planned on one side only.
2.1 Shape:
Rectan Oval Rounded
gle Rectangle
 6.2 DOORS :
Main door = 1.2 - 1.5m wide
•Room doors:
– Single or double
– Spring loaded
– Manual (hand operated) or 
– Automatic (foot or sensor operated)
6.3 Windows:
•Small size
•Made of glass
•Preferable on one side of the theatre room
6.4 Height:
•3m (10ft)
•Addition of 1- 2ft
6.5 Walls
•Made of impervious material.
•Laminated surface with plastic sheath or vinyl sheet.
•Smooth surface without interstices.
•Collusion corners to be covered with steel or aluminum
plates,
•Light color ( light blue or green ) washable paint will
be ideal.
6.6 Floor
•Impervious
•continuous smooth surface covering without
interstices.
•Ant slippery
•Antistatic
6.7 COLOUR
•Recommended color is pale blue, green or grey
•Allow reflection of light and yet soothing to eyes
6.8 OP. table
•Heavy & stable
•Adjustable
6.9 Lightening
General rooms & corridors:
• Surface ceiling mounted florescent lamps
• Even illumination of 500lux
Operating rooms:
•Shadow less overhead ceiling mounted halogen lamps
•25,000-125,000lux
• Produce blue white color of day light
•Generate less heat( <250,000mW/cm sq of radiant
energy)
•Installation of dimming device
 Cont.
• Ratio of intensity of general rooms lighting that of
op. room lighting = 1 : 3
• Minimally invasive surgical procedures require much
lower lighting, however: at the site of the surgery,
the lighting level must be lower able to 50 lux
 Cont.
• Corridors not less than 2.85 m width for easy
movement of men, stretcher & machine.
• Separate corridors for uses other than going into OT.
• Rooms for different persons working in OT & for
different purpose (it should be as per zone & size ).
• Gas & suction (control, supply & emergency stock)
for all OTs & areas.
• Provision for adequate & continuous water supply.
• Proper drainage system.
 Cont.
• The safety in working place is essential, and fire
extinguishers have to be planned in appropriate
zone.
• Provision for expansion of the OT complex should be
borne in mind during planning stages itself
 Cont.
6.10 Ventilation
• Appropriate ventilation systems aid in the control of infection by
minimizing microbial contamination.
•Supply heated/cooled humidified ultraclean air to the op.room &
adjacent clean areas.
•Comfort of the staff & patients.
•Removal of the anaesthetic pollutants.
•Removal of contaminated air system.
•Each operating room should have individual temperature controls
to accommodate patient safety.
•Exit root: 
•Wall mounted air duct outlets.
 Types Of Ventilation System

Ceiling mounted air condition supply filtered air Patterns.

Vertical parallel laminar flow.
Horizontal parallel laminar flow
Op box ventilation system
6.11 Humidity
•50-60%
•Generated by passing air through steam injection or 
•Fresh soft water from a spinning disc.
6.12 TEMPERATURE
•Range = 18-25 degree cent.
6.13 Theatre Electricity
•Power line of 220volts.
•Use of circuit breakers.
•Locking plugs for suspended ceiling outlets
•Explosive proof plugs.
•Resilient & flexible insulation around ceiling electrical
power sources.
•Wall outlets installed 1.5m above the floor. 
•Emergency power source ( Generator, UPS)
Communication Network
•Intercoms –one phone/suite
•Code warning signals(emergency state)
Closed Circuit Tv:
•Indirect visualization
•Communication
•Help to keep to the people in op. room
 EQUIPMENTS
• Trolleys: should be cleaned and have safety rails with
well fitting tube and mask,
• Oxygen cylinder: all of which are regularly checked
and empty cylinders replaced.
• Suction apparatus: should be well cleaned and
checked with spare suction tubes and catheters
available. 
• Anesthetic machine: should in good working order. 
• All electric equipment should regularly checked.
• Fire policy, regular fire drills and weekly testing fire
doors are essential safety precautions.
 Instruments
• Are brought from outside the department into clean
store rooms and supplied in pre-packed sterilized
trays by the Theatre Sterile Supplies Unit (TSSU).
• Finally, they enter the theatre ready for use on the
scrub nurse’s trolley.
• At the end of an operation, dirty instruments, linen
and rubbish are removed to the sluice room, and
when correctly packaged for disposal, to agreed
collection points.
• Porters then take them via a dirty corridor to their
several destinations: the TSSU, laundry or hospital
incinerator.
 Anesthetic Scavenging
• A long length of corrugated plastic tubing connected
to the anesthetic circuit at one end, while the other
connects to a vent in the ceiling or wall.
• The system draws out of the theatre any anesthetic
gases or agents leaking from the circuit and which
pollute the atmosphere.
 Workflow of OT
DIRTY CORIDOR
OT

OR-1 OR-2 OR-3

CLEAN CORIDOR

RECOVERY
ROOM
STORE TRANSFER
ZONE STAFF
CHANGING
ROOM
PATIENT STAFF
OUTER CORIDOR
EARLY OPERATING ROOM
IDEAL OP.THEATER WALL & FLOOR
Hospital laboratory design
 Laboratory facilities are designated as :-
i. basic Biosafety Level 1
ii. basic – Biosafety Level 2
iii.containment – Biosafety Level 3
iv.maximum containment – Biosafety Level 4
• The international biohazard warning symbol and sign
must be displayed on the doors of the rooms where
microorganisms of Risk Group 2 or higher risk
groups are handled.
• Biosafety level designations are based on
• a composite of the design features, construction,
containment facilities, equipment, practices and operational
procedures required for working with agents from the
various risk groups.
• Classification of infective microorganisms by risk
group
• Risk Group 1 (no or low individual and community risk) A
microorganism that is unlikely to cause human or animal
disease.
• Risk Group 2 (moderate individual risk, low community
risk) A pathogen that can cause human or animal disease
but is unlikely to be a serious hazard to laboratory workers,
the community, livestock or the environment.
• Risk Group 3 (high individual risk, low community
risk) A pathogen that usually causes serious human or
animal disease but does not ordinarily spread from
one infected individual to another.
• Risk Group 4 (high individual and community risk) A
pathogen that usually causes serious human or animal
disease and that can be readily transmitted from one
individual to another, directly or indirectly.
• Diagnostic and health-care laboratories (public health,
clinical or hospital-based) must all be designed for
Biosafety Level 2 or above
 Laboratory design and facilities
 In designing a laboratory special attention should be
paid to conditions that are known to pose safety
problems.
1. Formation of aerosols
2. Work with large volumes and/or high concentrations
of microorganisms
3. Overcrowding and too much equipment
4. Infestation with rodents and arthropods
5. Unauthorized entrance
6. Workflow: use of specific samples and reagents.
 Design features
1. Ample space must be provided for the safe conduct of laboratory
work
2. Walls, ceilings and floors should be smooth, easy to clean,
impermeable to liquids and resistant to the chemicals and
disinfectants normally used in the laboratory. Floors should be slip-
resistant.
3. Bench tops should be impervious to water and resistant to
disinfectants, acids, alkalis, organic solvents and moderate heat.
4. Illumination should be adequate for all activities. Undesirable
reflections and glare should be avoided.
5. Laboratory furniture should be sturdy. Open spaces between and
under benches, cabinets and equipment should be accessible for
cleaning.
6. Storage space must be adequate to hold supplies for
immediate use and thus prevent clutter on bench tops
and in aisles.
7. Space and facilities should be provided for the safe
handling and storage of solvents, radioactive materials,
and compressed and liquefied gases.
8. Facilities for storing outer garments and personal
items should be provided outside the laboratory working
areas.
9. Hand-washing basins, with running water if possible,
should be provided in each laboratory room, preferably
near the exit door.
10. Doors should have vision panels, appropriate fire
ratings, and preferably be self closing.
11. Facilities for eating and drinking and for rest should
be provided outside the laboratory working areas.
12. At Biosafety Level 2, an autoclave or other means
of decontamination should be available in appropriate
proximity to the laboratory.
13. Safety systems should cover fire, electrical
emergencies, emergency shower and eyewash facilities.
14. First-aid areas or rooms suitably equipped and
readily accessible should be available.
15.If there is no mechanical ventilation, windows
should be able to be opened and should be fitted with
arthropod-proof screens.
16.A dependable supply of good quality water is
essential. An antiback flow device should be fitted to
protect the public water system.
17. There should be a reliable and adequate electricity
supply and emergency lighting to permit safe exit and A
stand-by generator is desirable for the support of
essential equipment.
18. There should be a reliable and adequate supply of
gas.
19.Physical and fire security must be considered. Strong
doors, screened windows and restricted issue of keys
are compulsory.
 Laboratory equipment
• Together with good procedures and practices, the use
of safety equipment will help to reduce risks when
dealing with biosafety hazards.
• Lab Equipment should be selected to take account of
certain general principles, i.e. it should be:
1. Designed to prevent or limit contact between the
operator and the infectious material
2. Constructed of materials that are impermeable to
liquids, resistant to corrosion and meet structural
requirements
3. Fabricated to be free of burrs, sharp edges and
unguarded moving parts
4. Designed, constructed and installed to facilitate
simple operation and provide for ease of
maintenance, cleaning, and decontamination.
5.glassware and other breakable materials should be
avoided, whenever possible.
 Essential biosafety equipment
1. Pipetting aids – to avoid mouth pipetting.
2. Biological safety cabinets, to be used whenever:
 Infectious materials are handled
there is an increased risk of airborne infection
procedures with a high potential for producing aerosols are used
3. Plastic disposable transfer loops. Alternatively, electric transfer
loop incinerators may be used inside the biological safety cabinet to
reduce aerosol production.
4. Screw-capped tubes and bottles.
5. Autoclaves or other appropriate means to decontaminate
infectious materials.
• 6. Plastic disposable Pasteur pipettes, whenever
available, to avoid glass.
• 7. Equipment such as autoclaves and biological
safety cabinets must be validated with
appropriate methods before being taken into use.
Recertification should take place at regular
intervals, according to the manufacturer’s
instructions
 Laundry and kitchen apparatuses in hospital
 All washable fabrics can easily be disinfected:
 either by hot water, if the correct temperature is used for
the correct time or
 by cold water, if the correct disinfectant is used at the
correct concentration, for the correct time.
 The word ‘linen’ is used to cover all items to be
laundered. And
in health facilities, linen is divided into two categories
 Soiled linen which has been used and is no longer fresh,
but is uncontaminated by infectious agents.
• Fouled and infected linen which is obviously fouled (with
urine, faeces, blood,vomit, pus, etc) this is contaminated
linen.
• It is necessary to have appropriate linen handling procedures in
place in order to avoid cross-contamination, and to avoid the
transmission of infectious diseases to the linen handlers.
 Other equipment-related safety issues in the laundry are
• Do not overload the washing, spinning, or drying machines as this
strains the bearings
• Do not under-load washing machines as this wastes cleaning
chemicals
• Avoid accidents laundry floors must be well drained to avoid
slippage
• Do not spread linen on the ground or over bushes to dry but hang
it from washing lines if spin- and tumble-driers are not available
• Refer to the manufacturer’s manual, national
guidelines, and expert advice in order to ensure that
sufficient stocks of the correct industrial cleaning
agents and chemicals are purchased for the laundry.
 Laundry staff must understand
• The proper use of appropriate chemicals to kill
bacteria, and
• the correct amount of cleaning agent which is
effective, not wasteful, and does not cause foaming
• correct temperatures for washing
 if you cannot be certain of the type of contamination
involved it is safer just to use detergent
• 65oC for 10 minutes for soiled linen.
• 93oC for 10 minutes for fouled and infected linen
 For transporting linen there must be sufficient
physical separation between:
• the routes used by dirty laundry and clean linen
trolleys
• the trolleys designated and labelled for use with
dirty or clean linen
• the storage locations for clean linen and piles of dirty
or condemned linen.
 Hygiene Practices in the Kitchen
Separate equipment (such as knives, chopping
boards and slicing machines) that are used for
handling raw food from those used for cooked
food so that microbes are not transferred to the
cooked food, causing food poisoning.
Hand-washing facilities with soap for kitchen staff
so that they can wash their hands between
handling different types of food, between
different activities, and after going to the toilet.
Adequate refrigeration through properly
working refrigerators and cold store rooms.
Extraction hoods over cookers which are clean
and working effectively.
 Essential biosafety
equipment
1. Pipetting aids – to avoid mouth pipetting.
2. Biological safety cabinets, to be used whenever:
 Infectious materials are handled
 there is an increased risk of airborne infection
procedures with a high potential for producing aerosols are used
3. Plastic disposable transfer loops. Alternatively, electric
transfer loop incinerators may be used inside the biological
safety cabinet to reduce aerosol production.
4. Screw-capped tubes and bottles.
5. Autoclaves or other appropriate means to decontaminate
infectious materials.
 Cont’d
• 6. Plastic disposable Pasteur pipettes, whenever
available, to avoid glass.
• 7. Equipment such as autoclaves and biological
safety cabinets must be validated with
appropriate methods before being taken into
use.
• Recertification should take place at regular
intervals, according to the manufacturer’s
instructions
 Laundry and kitchen apparatuses in
hospital
 All washable fabrics can easily be disinfected:
 either by hot water, if the correct temperature is used for
the correct time or
 by cold water, if the correct disinfectant is used at the
correct concentration, for the correct time.
 The word ‘linen’ is used to cover all items to be laundered.
• In health facilities, linen is divided into two categories
1.Soiled linen which has been used and is no longer fresh,
but is uncontaminated by infectious agents.
2.Fouled and infected linen which is obviously fouled (with
urine, faeces, blood, vomit, pus, etc) this is contaminated
linen.
 Cont’d
 It is necessary to have appropriate linen handling procedures in
place in order to avoid cross-contamination, and to avoid the
transmission of infectious diseases to the linen handlers.
 Other equipment-related safety issues in the laundry are
– Do not overload the washing, spinning, or drying machines
as this strains the bearings
– Do not under-load washing machines as this wastes cleaning
chemicals
– Avoid accidents laundry floors; must be well drained to avoid
slippage
– Do not spread linen on the ground or over bushes to dry but
hang it from washing lines if spin- and tumble-driers are not
available
 Cont’d
• Refer to the manufacturer’s manual, national guidelines,
and expert advice in order to ensure that sufficient stocks
of the correct industrial cleaning agents and chemicals are
purchased for the laundry.
 Laundry staff must understand
– The proper use of appropriate chemicals to kill bacteria,
and
– the correct amount of cleaning agent which is
effective, not wasteful, and does not cause foaming
– correct temperatures for washing
 Cont’d
 If you cannot be certain of the type of contamination
involved it is safer just to use detergent
– 65 oC for 10 minutes for soiled linen.
– 93 oC for 10 minutes for fouled and infected linen
 For transporting linen there must be sufficient physical
separation between:
– the routes used by dirty laundry and clean linen trolleys
– the trolleys designated and labelled for use with dirty or
clean linen
– the storage locations for clean linen and piles of dirty or
condemned linen.
 Hygiene Practices in the Kitchen
Separate equipment (such as knives, chopping boards
and slicing machines) that are used for handling raw
food from those used for cooked food so that microbes
are not transferred to the cooked food, causing food
poisoning.
Hand-washing facilities with soap for kitchen staff so
that they can wash their hands between handling
different types of food, between different activities,
and after going to the toilet.
 Space Requirements in kitchen
 Dimensions
 Kitchen layouts are determined by two main sets of
dimensions:
sizes of equipments & fittings
 spaces which must be left clear for access &
movements 
 Grouping of equipment
wall grouping
island grouping
 Standardization
Standardization in kitchen is very important. For this, the dimensional
conformity of equipment is required.
There is no universal standards for sizes & dimensions of equipments.

But the European Catering Equipment Manufacturers Association favours

the use of Swiss Gastro-Norm system which is widely used in Europe.

The Gastro- Norm is a series of dimensions for pans & trays, but can be
used for all kind of equipment.
The design of modular units gives:
good appearance
flexibility
changebility of units