1. © 2015 HDR, Inc., all rights reserved.

2. OPERATING ROOM DESIGN & OPERATION Andy Yosten September 15, 2015

3. INTRODUCTION CODES & STANDARDS OPERATION ROOM (OR) DESIGN PRACTICES NEW TECHNOLOGY & STRATEGIES

4. 1. Understand latest changes to codes and standards for operating rooms 2. Discuss current operating room design practices 3. Identify new technologies and how they affect operation strategies LEARNING OBJECTIVES

5.  Facilities Guidelines Institute (FGI) o Guidelines for Design and Construction of Health Care Facilities (2010) o Incorporated ASHRAE 170 -2008 for all HVAC requirements  ASHRAE/ASHE Standard 170 – 2008 o Ventilation of Health Care Facilities CODES & STANDARDS

6. Recent Changes  Facilities Guidelines Institute (FGI) o Guidelines for Design and Construction of Health Care Facilities ( 2014 ) o Incorporated ASHRAE 170 - 2013 for all HVAC requirements  ASHRAE/ASHE Standard 170 – 2013 o Ventilation of Health Care Facilities o Incorporates all addenda thru November 2013 CODES & STANDARDS

7. Recent Changes  Humidity levels  Return/exhaust grille location  Operating room classification o OR vs procedure room  Space requirements CODES & STANDARDS

8. EVOLUTION OF THE OPERATING ROOM

9. 1900 – Roosevelt Hospital NYC Library of Congress Prints

10. 1950 – Northfield, Minnesota

11. 2000 – Bethesda, Maryland

12. 2015 – Parkland Hospital

13.  User requirements  Specialized procedures  Room size and layout  Lighting  Equipment layout  Booms  Imaging equipment DESIGN CONSIDERATIONS

14.  Room size and layout  Lighting  Equipment layout  Booms  Imaging equipment HVAC DESIGN PROCESS

15.  Primary diffuser array shall extend a min. of 12 in. beyond footprint of table  No more than 30% of diffuser array shall be used for non-diffusers such as lights, gas columns, ect. HVAC DESIGN PROCESS

16. Air Curtain vs Laminar Flow DESIGN PROCESS  Laminar Flow o Large volume of sterile air o Minimize entry of bacteria into sterile field o Constant volume can help with patient comfort  Air Curtain o Dome-like sterile procedure area by increasing air velocity at the perimeter o Sterile field is washed with a slow moving column of air o Slot diffusers used to direct away down and away from the patient creating a boundary

17. OPERATING ROOM Design Practices

18.  Primary diffuser array coordination  Placement of lighting  Locate columns and booms  Imaging equipment supports  Return air locations HVAC/ROOM LAYOUT

19.  Pressure: + 0.01 in. wc  Maintain positive pressure to all adjoining spaces at all times PRESSURE RELATIONSHIPS

20.  Patient comfort  Surgeon and personnel comfort  Control of pollutants  Ability to quickly raise and lower temperature  Humidity control TEMPERATURE REQUIREMENTS ASHRAE 170 -2013

21.  Best practices  Surgeon preference  Setback control  HVAC design strategy AIR CHANGES REQUIREMENT ASHRAE 170 -2013

22. FILTRATION ASHRAE 170 -2013

23.  FGI Guidelines (2010) o 30% - 60% RH  FGI Guidelines (2014) o 20% - 60% RH  CMS o Must document change o Monitor humidity  Equipment Considerations HUMIDITY CONTROL

24.  Primary diffuser array to provide concentrated airflow over patient and surgical team  Airflow: Unidirectional, downward with average velocity of 25 to 35 cfm/ft 2  At least two low sidewall grilles at opposite corners installed approximately 8 in. Above floor PARTICULATE CONTROL

25.  NFPA 99 Health Care Facilities Code (2012) – Smoke purge systems are not required  Most recently language existed in NFPA 56A (2005) and previous editions of NFPA 99  CMS requirements SMOKE EVACUATION Code excerpt: ASHRAE 170 -2013

26.  Integrated operating room “Smart OR”  Hybrid operating room  Integrated ceiling solutions  Ultra-clean operating room NEW TECHNOLOGIES & OR STRATEGIES

27.  Combine patient-specific data will intelligent devices to support real time decisions  Support trends in robotic surgery technology  More space required  Control room NEW TECHNOLOGIES & OR STRATEGIES Integrated Operating Room “Smart OR”

28. Hybrid Operating Room  CT scanners, MRI scanners, fixed C-Arms  Larger surgery team of 8 to 20 people  More space required  Control room  Vibration considerations NEW TECHNOLOGIES & OR STRATEGIES

29. FULLY INTEGRATED CEILING SYSTEM

30. ULTRA CLEAN SURGICAL SUITES

31. Best Practices  Dedicated AHU  Coils in series  Humidifier location  Energy efficiency – DOAS  Boom location – laminar flow sterile field HVAC DESIGN

32.  Scheduled modes – “unoccupied setback”  Integrated optimization  Factors o Staff usage o Existing conditions o Cost SETBACK STRATEGIES

33. © 2015 HDR, Inc., all rights reserved. OPERATING ROOM DESIGN & OPERATION Andy Yosten September 15, 2015

34. © 2015 HDR, Inc., all rights reserved.