Vietnam Conf_OR Design

7/30/2019 Vietnam Conf_OR Design

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By: John C. Hoelscher, AIA, ACHA Jim Lazzeri, PEPrincipal Principal/Mechanical Engineer

RTA Architects Cator Ruma & Associates

Colorado Springs, Colorado USA Lakewood, Colorado USA

Lecture Series Fall 2008Operating Suite

Design

Healthcare Design - Vietnam


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John C. Hoelscher, AIA, ACHA Graduate University of Nebraska 1971

Certified Healthcare Specialist ACHA

Principal RTA Architects

Married 37 Years, 4 Children,

7 Grandchildren

Fourth Trip to Vietnam in Last

2 Years



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Jim Lazzeri, PE Graduate University of Colorado

Professional Engineer - Mechanical

Principal Cator Ruma & Associates

First Trip to Vietnam.



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Why we are here? To help equip Vietnamese Architects

in the design of state-of-the arthealthcare

facilities.

In Vietnam there are unique culturaldifferences that will & should shape

healing environments.

These differences are best understoodby Vietnamese Architects.



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Operating Suite Design

Clean Core Concept Clean/Sterile supplies

Scrub areas

Procedure Rooms access

Patients/Dirty instruments utilize

separate semi-restricted corridor



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Operating SuiteDesign

Layout Prevent nonrelated traffic thruthe

suite

Designed to move the flow of

materials & personnel fromdirty to

sterile w/o compromisinguniversal

precautions (one way flow)

Divided into three designatedareas



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Unrestricted Area Includes central control point to

monitor the entrance of patients,personnel & materials

Street clothes are permitted in

this area

Unrestricted



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Semi-restricted Area Includes the peripheral support areas

of the surgical suite. Corridorsleading to the restricted areas of the

surgical suite.

Limited to authorized personnel

and patients. Personnel are required

to wear surgical attire and cover all

head and facial hair.

Semi-restricted



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Restricted Area Includes operating and procedure

rooms, the clean core, and scrub sinkareas.

Surgical attire and hair coverings are

required. Masks are required where

open sterile supplies or scrubbed

persons may be located.

Restricted



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Overall Organization Areas are defined by the activities

performed in each area.



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Flow Diagram

Clean Core Concept

Patient

Arrival

Check-in

Pre-OP

OR Procedure Room

Phase I Recovery-PACU

Departure



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Flow Diagram

Clean Core Concept

Personnel

Arrival

Changing/Lounge

Scrub

OR Procedure Room

Lounge



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Flow Diagram

Clean Core Concept

Material

Dock

Breakout

Clean Storage

Clean Assembly

Deliver to Procedure Room



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Flow Diagram

Clean Core Concept

Dirty

Transport to Decontamination

Wash/Sterilized

Terminal Sterilization

Clean Assembly

Clean Supply



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The 10 Basic Guidelines in

Operating Room Design


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Guidelines in Operating Room Design1. Ceiling Height

2. Room Size

3. Room Shape

4. Table Orientation

5. Anesthesia

6. Equipment Boom Placement

7. Mounting Locations

8. Sterile Field

9. Documentation Station

10.Common Design



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1. Ceiling Height 10 minimum height for minimum headaches

106 better for combination boom with 3

arms



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1. Ceiling Height


10-6


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1. Ceiling Height


10-0


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1. Ceiling Height


9-6


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2. Room Size Square footage

400 square feet minimum

10 radius clear area (AIA)

600 better accommodates new proceduresand equipment

800+ square foot for Neuro, interventional,or other specialty rooms



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2. Room Size


The smaller the incision

The more equipment in the room.


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3. Room Shape Room proportions and features dictate usablesquare footage

Doors, columns, angled walls, air returns,soffits remove useable space.



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3. Room Shape 27-8 x 19-11 = 551 square feet



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3. Room Shape



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3. Room Shape 21-7 x 19-11 = 431 square feet



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3. Room Shape If the room is rectangular

in shape



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3. Room Shape Consider shifting

equipment set towards

head end of room



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4. Table Orientation Table is typically orientated

with foot facing

away from patiententry



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4. Table Orientation Orientation Typically follows the long axis ofroom



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4. Table Orientation Angle table for small rooms



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4. Table Orientation Will the table be rotated for specialtyprocedures? 90 180 degrees? Can anesthesia

and equipment cover these positions?



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5. Anesthesia


Provide approx. 100 sq ft of space

7-8 ft

table to wall

Use a dead corner toeliminate traffic


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5. Anesthesia


Transfer from patients

right to avoid conflict

with anesthesia

equipment.


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6. Equipment Boom PlacementFoot/Head Mounts

Able to reach either side of table

Able to park in convenient location

Keep away from patient entry area

Side Mounts Patient right, opposite from patient loading

side of the table



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7. Mounting Locations Make sure mount

locations dont create

arminterferences withother booms, lights,

walls, soffits



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8. Sterile Field Should be free fromdoors

and otherequipment

The design shouldminimize traffic in

thearea



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9. Documentation Station Located towards foot

of room

With view of sterile fieldand supply source



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9. Documentation Station



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10. Commonality of Design Use consistent design to keep users life easierand focused on the work at hand.

Avoid mirror image rooms if possible

any case / any room



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Operating RoomDesign

Positive Pressure differential(clean to lessclean)

Monitoring of room pressuredifferential


SupplyMonitor

LowWall

ReturnOR Table

LowWall

Return

Room

Pressurization

0.01-in. WG

Exfiltration

20-25 air exchanges per hour(AIArecommendations)

Air supplied for 90% efficientfilters

Laminar flow supply diffusers


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Laminar Flow in Cooling Mode



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Laminar Flow in Cooling Mode



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Isolation Panels



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Code Authority Issues NFPA 99 OR SmokeEvacuation


Exhaust

Air

100%

Outside

Air

Exhaust Air Ductwork

Operating room

Supply air

ductwork

95% Efficient

filter

30%

Efficient

Pleated

filter

+ -

Positive Pressure

Exfiltration 100% Outside Air

Economizer Operation


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Minimally Invasive Surgery (MIS) Smaller incision

Utilizes

Surgical instruments

Light source

Endoscopic Video

Camera Surgeon manipulates

instruments while viewingvideo monitors



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Image-Guided and Computer-AidedSurgery

Utilizes radiography, fluoroscopy, CT sonography, MRIdevises

Navigational systems

Three-dimensional image-guided systems



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Robotic-AssistedSurgery

Components

Surgeons console Robotic arm abovetable

Endoscopic Camera

Surgeon sits at consoleand manipulates the

robotic arm while viewing


Zimmer Gunsul FrascaPartnership


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Operating Suite DesignPre-Operative

Pre-Operative Holding Area

Under direct visual control ofnursing staff


Handwashing

Isolation Room

Pre Operative Holding

Patient Cubicle

Control

Each stretcherstation shall bea minimum of

80 S.F. (100 S.F.preferred)

Provide Patientprivacy

(cubicle

curtains)

Provide isolation room forinfectious patients (120 S.F.

minimum) Hand washing station 1/4 beds


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Pre-Operative SuiteDesign



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Operating Suite DesignPost Anesthesia Care Unit(PACU)

Patient Bed area 120 S.F.recommended

11-0 Headwall length

Minimum of 5-0 between beds

Provide at least one

isolation room

Handwashing station

1/4 beds

Nursing ration 1/2


Handwashin

g

Isolation Room

Meds

Clean

Patient Bed

Soil

Nourishment

Control

PACU


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PACU Suite Design



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Operating Suite DesignSterile Processing

Decontamination

Trash/soiled linen

Clean assembly

Terminal/

Sterilization

Clean Supply

Case Cart Storage


Sterilizers

Clean Assembly

Washer Sterilizer

Decontam.

Vendor

Cart Wash

TrashClean Equip.

Clean Supply

Case Carts

Storage

Break down room

Sterilization


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Operating Suite DesignSterilization


Washer Sterilizer

Cart wash

Sterilization/Clean assembly

Decontaminate


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Operating Suite DesignSupport Areas

Control Station

Scrub station w/ view window

Substerile

Flash sterilization

Fluid and blanket warmer

Hand washing

Soiled work room

Equipment Storage


Clean

Core

Scrub Substerile

Gurney

StorageMatr. Pass Thru

Equip Storage


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Operating Suite DesignSupport Areas

Control Station

Scrub station w/ view window

Substerile

Flash sterilization

Fluid and blanket warmer

Hand washing

Soiled work room

Equipment Storage


Staff

Lounge

Vendor

Anethesia

Lockers

Lockers

Control Future

Decon.

Elec.

IT

UnrestrictedCo

rridor

Semi-restrictedC

orridor

Endoscopy

Gurney


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Operating Suite DesignTrend Impact Universal Room Design Maintain flexibility amid specialization

Robotics Accommodate size & video anticipatechange

Interventional Procedures Ceiling-mounted imagingmodalities

Miniaturization Plan for changes to currentdevices

Digital Integration Real-time ergonomic display ofimages & information;adaptive infrastructures

Long-term Flexibility/Modularity Ability to adapt equipment &



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Credits BerchtoldCorporation

A Visual Referencefor Evidence-Based Design (2008Jain Malkin)

Next Generationof Operating

Rooms AIAAbstract (2004)

Documents

Vietnam Conf_OR Design