New, updated ORs and how to get them (right) Helen Hill, RN, MS

Whether planning a new or renovating an old operating room suite, the advice of the operating room supervisor should be sought. Influencing her advice will be concern for the patients’ comfort and well-being, and the knowledge that fa- cilities must be adaptable to everchang- ing surgical technics.

The operating room supervisor must know the health needs of the communi- ty, and weigh them against other exist- ing or planned facilities. This will help her to make decisions such as whether or not there should be more than one hospital equipped for transplant sur- gery and care of neurosurgical patients; and how extensive should be the total pediatric facilities and the total com- puter services.

She must know both the stated and __

Helen Hill, RN, MS, i s associate director of nursing education at the Hospital for Sick Children, Toronto, Ontario. She received her education at the Toronto General Hospital School of Nursing, the University of Western Ontario, London, Ont, and Boston Uni- versity. She has previously been employed as operating room nurse in neurosurgery; nursing serv- ice supervisor at Toronto General; assistant super- visor in cardiac OR and assistant director of OR nursing at the hospital far Sick Children.

the practiced philosophy and objectives of the hospital. They may differ,

For instance, is the objective truly to give the best patient care or is it to accomplish the greatest possible num- ber of operative procedures in a day?

Does the administration permit oper- ations on patients not formerly admitted to the hospital? Should obstetrical serv- ices and surgical services be combined?

Should potentially explosive anesthet- ic gases be used? Should disposable sup- plies be used? Is the traffic of person- nel arid supplies through the operating room suite adequately controlled?

By her understanding of the orga- nization of the hospital, the operating room supervisor knows whom to con- sult for answers.

A committee composed of members of each and every hospital department should be responsible for planning. It is important to include sociologists whose knowledge of the relationship between environment and psychological reactions will contribute greatly to the comforts of patients. It is time also that we included a representative of our con-

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sumer population - the patient - in our planning committees.

Plans must be flexible. They are al- ways limited by the imagination of the planner who cannot foresee the changes which will occur in the future. Today the rate of change is rapid and increas- ing. If it requires ten years from plan to occupation of a building, to prevent obsolescence we must plan for walls and floors which may be changed easily.

Specific information is necessary for intelligent planning. The operating room supervisor should know such things as the infection rate in her own hospital and the number, type and duration of the operative procedures currently un- dertaken. She should also seek this same information from other centers and learn what other authorities recommend. By inviting her staff‘s ideas, the super- visor can separate the essential and ef- ficient from the unnecessary, indcient and costly.

A three-dimensional model of the area to be built or rebuilt including fur- niture, should be constructed. A small scale model can demonstrate the space allotted but it cannot replace the expe- rience of working in an area to dis- cover its limitations. It can, however, help an amateur architect to see and “feel” the plans more vividly than a flat drawing.

Since a hospital exists primarily for the patient, his needs should be con- sidered first in any planning. The psy- chologist and sociologist can contribute to his welfare, especially if the patient himself is invited to express opinions.

It is imperative that there be a hold- ing area in the operating suite where the patient under sedation can await his operation in undisturbed comfort and safety rather than on a narrow stretcher in the corridor.

An induction room requires costly ex- tra space. But for the patient it offers a quiet soothing secluded atmosphere, sparing him the disquieting activities of operating room personnel, the awesome array of instruments and the resultant psychological tension. Induction of anes- thesia, catheterization and intravenous infusion are more easily performed out- side the operating rooms. These advan- tages must be weighed against the cost.

Because of the high cost of hospitali- zation and because many people can be safely operated on without being admit- ted to the hospital, plans must include out-patient surgical facilities. To elimi- nate duplication of expensive equip- ment, to use staff more efficiently and thus to decrease costs these facilities should be located within the main op- erating room suite. Space must be pro- vided in or nearby the suite where pa- tients can change clothing, or where their relatives may wait.

In thinking about patients’ needs and continuity of care we must decide whe- ther operating room nurses should visit patients before and after surgery. Should the ward nurse stay in the operating room with the patient either while he awaits or during his operation? What added facilities are required if she does either or both?

Will relatives one day expect to go with the patient to the operating room? Will a husband who asks to be present in the delivery room with his wife also wish to be present in the operating room? Again the policies of the hos- pital administration, medical and nurs- ing staff must be known early in the planning stage.

Whether patients should be brought to the operating room on stretchers or beds will depend on the patients’ com- fort. Which is safer and which method

50 AORN Journal

best controls infection must be an- swered by research and controlled studies. The answers will affect the plan and the size of the holding area, the mrridor arrangement and provision of space where empty beds can be stored.

Music can be relaxing for the patient awaiting surgery or undergoing surgery under local anesthetic. It can be piped into the operating room suite but should be easily turned aif at the request of either the patient or the surgeon.

What facilities do staff members need in the operating room suite? Medical, nursing and auxiliary staff require ade- quate lockers, shower and washrooms and lounges. A coffee room within the suite, where staff members may meet, facilitates communication.

Doctors require office space to dictate operative notes and nurses, to prepare procedure books and order supplies. A conference room is necessary for teaching and for staff meetings. Con- duits should be laid during construction for installation of closed circuit televi- sion for teaching purposes.

One of the most important areas of concern in an operating room is infec- tion control. However comfortable the patient may be, you fail him if his wound becomes infected. Since the greatest source for infection is the hu- man being, policies for preventing in- fection must be clearly stated, under- stood and adhered to by everyone who enters the area.

There are physical facilities which can make these policies more effective. Traffic direction for both people and equipment is important. An electronic conveyor belt to bring clean supplies to the suite, and another one to remove soiled supplies, will eliminate some of the personnel traffic.

Among the many designs for suites,

a double corridor type is popular. It reduces travel distance and provides a clean and soiled corridor. Surgical sup- ply salesmen allowed to come to the operating room suite should be met in an adjacent room.

If the intensive care unit is to be included in the restricted area, there must be a room where relatives can wait and don suitable clothing before visiting the patient. Teaching by tele- vision decreases traffic into the operating room itself. Eventually it will be easier to see a surgical procedure on television than by peering over a surgeon's shoul- der from atop a teetering stool.

Air conditioning is of particular im- portance in an operating room to pro- vide clean moist air at a desirable tem- perature, 68-72 F for the safety of the patient. There should be at least 10-12 air changes per hour, with an ideal num- ber of 20. The relative humidity should be 50%-55%.1*3 In the future it may be safe to use recirculated air but this is not advisable yet. The entire operating room suite should be under positive pressure in relation to the rest of the hospital, and each operating room should be under positive pressure in re- lation to its soiled utility room.

To aid in infection control every op- erating room should have a clean utility room and a separate soiled utility room adjacent to it. Though instruments should be sterilized in the operating room suite, linens and supplies may be sterilized elsewhere in the hospital, prob- ably in central supply department. The department should include a room where furniture can be washed and cleaning closets where wet-vacuum pickup ma- chines can be stored.

Where in the hospital should the op- ating room suite'be located? It is im- portant to remember that primary re-

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lationships should be established hori- zontally. To reduce the excess demand on elevators, a problem in most hos- pitals, the operating room suite should be near, and if possible, on the same floor as the central supply room, blood bank, laboratories, and radiology, pa- thology and emergency departments. The location should lend itself readily to expansion.

The total size of the suite will vary with the number and size of the rooms and their associated facilities. The num- ber of operating rooms required is de- termined by the number, type and dura- tion of the procedures to be done there. Planning should allow for lo00 proce- dures per year per operating room2 - an average of approximately four each op- erating day.

Does the incidence of infection rise with the number of procedures done during a single day in an operating room? Is the number significant? Spe- cific data are needed from many hos- pitals before definite statements can be made. When planning the number of operating rooms needed, not only the patients’ welfare but the working hours of staff members must be considered. Ideally, the patient should be spared hours of anxious waiting and missed meals.

The number of hospital beds will also affect the number of operating rooms required. Increasing the number of operations performed by extending the work day has little advantage if the rest of the hospital lacks facilities for continuing care.

The size of the operating room varies with the type of operation to be per- formed there. Although it is not prac- tical to maintain a room for only one type of operation, it is beneficial to plan as much as possible to do certain opera-

tions in certain rooms. A standard op- erating room should have 20 x 20 feet of floor space and operating rooms for cardiovascular and neurosurgery should have 20 x 30 feet. Storage in each room for sutures and other supplies should be recessed.

Other facilities will also affect the size of the suite. Corridors should be 10-15 feet wide. There should be 1.8 to 2.0 spaces in the recovery room for each operating r00m.~ One scrub area sepa- rate from the utility room for every two operating rooms would be appro- priate.

Of course there must be ample stor- age space for supplies, instruments and equipment. Disposable supplies require more storage space than standard sup- plies. Instruments, because they are costly, should be kept in the operating room suite where they are readily avail- able and can be properly cared for.

Anesthetists need working space and storage space for their equipment. De- pending on the size of the department and the amount of equipment, this stor- age space might or might not be in- cluded in the same room with general storage. Space needs to be provided for storage of empty stretchers or beds and as equipment for vital functions is used, more and more space for it must be planned. There should be a reception area where patients and personnel can be greeted.

In planning an operating room suite, lighting, anesthetic gas supply, com- munication systems, x-ray and finish of walls and floors should also be con- sidered.

Recessed lighting with remote con- trol at the operating room table would be ideal. Overhead stalactites are sat- isfactory for bringing compressed air, nitrous oxide, oxygen and electrical out-

52 AORN Journal

lets close to the operating table, They eliminate the hazard of tripping over cords but produce another hazard for tall people.

Two overhead lights in a room are suggested-one at each end of the operating table, so that with a change in site of operation or with two opera- tive sites at one time or with a change of position of the operating room table, adequate light will still be provided.

Communication between personnel within the operating room itself and between those in the operating room and at the reception desk is essential. In the operating room there should be a bulletin board on which the operations scheduled for the day can be listed and special messages posted.

A plastic board for recording blood loss and fluid intake is of particular help when the patient is a small child or is having cardiovascular surgery. A small counter space is beneficial for the nurse to write her necessary reports. An in- tercom located in an adjoining utility room connecting the operating room with the reception desk is suggested.

There should also be an emergency switch that requires only foot decom- pression to alert the desk clerk and others in the corridor that immediate help is required.

The finish of the walls is important both for psychological and safety rea- sons. It should be attractive, easy to

clean and maintain, fire resistant and continuous from the floor to the ceil- ing. The walls should be smooth, of painted plaster or teflon without cracks where dust may lodge.

Floors may be of ceramic tile, ter- razzo or linoleum. Whether they are conductive or not will depend on the type of anesthetic gases used in the area. If the floors are conductive, ground detectors will be necessary to spot faulty electrical equipment.

All planning includes cost. With health care increasingly directed by government, plans must be wise and economical. We must carefully deter- mine priorities, and be convinced that what we plan is truly worth the cost.

The ideal operating room suite has yet to be designed.

The operating room of the future may be mobile - to be taken to the patient’s home, to outer space or even under water. By planning for the future, we will more nearly reach our aim-an operating room that serves the patient and the staff with comfort and 133- ciency.

REFERENCES 1. le Riche, W . H., Balcam, C. E., and van Belle,

G.: The control of infections in hospital, Toronto: University of Toronto Press, 1966, p 77.

2. Peckham, A. H., Jr.: Planning the surgical suite, Hosp Admin in Canada, 8:73-74 (May) 1966.

3. Agnew, G. Harvery: Designing the operative suite, Canad Med Assn J , 93:1071-1079 (Nov) 1965. 1965.

Student loans may be “pardoned” Federal aid in the form of nursing student loans may be partially or fully cancelled through employment in a specified public or other nonprofit hospital, according to the Washington News- letter for Women, a publication of Barrer 6 Associates, Inc.

Available to help nursing schools determine which of their students obtain full forgiveness is the Handbook for loan Cancellation Benefit - List of Hospitals. The publication is produced by division of nursing, Bureau of Health Professions Educafion and Manpower Training, National lnsfifutes of Health.

Hospitals which did not porficipate in the survey may be evaluated in terms of loan cancella- tion by writing to fhe Division of Nursing, 900 Rockville Pike, Bethesda, Md 20014.

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