By Matt McLaurin
From the September 2014 issue of Today’s Facility Manager
Typically incorporating MRIs, CT scanners, or other cardiac catheterization lab tools, surgical suites that house these intraoperative imaging machines are commonly known as hybrid operating rooms (ORs). Given that the 2014 edition of the Facility Guidelines Institute’s (FGI’s) Guidelines for Design and Construction of Hospitals and Outpatient Facilities requires these imaging equipment tools to be permanently integrated into hybrid ORs, it’s critical to design facilities with these in mind. To meet standards and codes, it is essential to anticipate and address challenges associated with hybrid ORs by planning them for flexible futures.
Facility managers (fms) know when designing a hybrid OR that space planning is critical. A minimum of 650 square feet of clear floor space is required for new construction ORs, and 600 square feet for renovated ones, but depending on the modality of imaging equipment in place these can be up to 2,600 square feet. Along with a recommendation to install ORs in spaces with at least 750 square feet and 10′ ceilings, specifications that help accommodate for future upgrades, control, and equipment rooms must be considered, as they are necessary for housing data and electrical equipment for imaging devices.
Designing for multiple rooms to use a single device is another technique to reduce imaging equipment costs and space requirements. For this approach common control and equipment rooms must be accessible from each OR.
As fms in healthcare settings know, constructing ORs with HVAC requirements in mind is a must. As a top priority is to reduce the potential for airborne particles to cause surgical site infections, unidirectional non-aspirating diffusers must be used in operating and procedure rooms. Requirements for ventilation in operating rooms, as specified by ASHRAE Standard 170-2013, include: a minimum of 20 air changes per hour; a primary diffuser array of unidirectional non-aspirating diffusers that cover the operating table by at least one foot on all sides supplying air to the space between 25 cfm (cubic feet per minute)/square foot and 35 cfm/square foot; and no more than 30% of the diffuser array can be employed for non-diffuser usage.
To maximize future flexibility, designers and fms should consider using an integrated ceiling system rather than a monolithic design, as the former allows for air distribution, lighting, and access panels to be installed in much closer proximity than the latter. Within integrated ceiling systems, fms can choose fully welded or modular setups. Modular systems provide flexibility during initial installations and accommodate future changes and updates without the need to replace some or all sections, while fully welded systems offer simple installation. This increased flexibility also allows more time for final equipment selections.
Meanwhile, wireless communication technology is developing, so it is a matter of when, not if, wireless devices and equipment will be ubiquitous in ORs. This technology will decrease some location and position limitations of imaging equipment. It may eventually enable interchangeable pieces of equipment, allowing multiple modalities to be merged into a single OR as well as accelerated maintenance and repair.
Integrating imaging equipment into ORs offers a range of benefits, from improved patient outcomes and reduced hospitals stays to minimized anesthesia occurrences and enhanced infection prevention. Complex cases can also be treated more easily, since the suite can handle procedures up to open surgery. And as the level and diversity of technology housed in hybrid ORs increases, specialists from several disciplines can work alongside one another and fit procedures to individual patients. With the advancement of hybrid ORs it is increasingly important for fms to ensure a well planned and coordinated strategy while maintaining flexibility for future enhancements and installations.