How big should our ORs be? What space do we need for preoperative and postoperative care?

These and other questions are addressed in the 2001 edition of the Guidelines for Design and Construction of Hospital and Health Care Facilities by the Health Guidelines Revision Committee of the Facilities Guidelines Institute and published by the American Institute of Architects.

Excerpts from the guidelines:

The size of ORs depends on levels of care as defined by the American College of Surgeons:

*Class A: Minor procedures under topical, local, or regional anesthesia without preoperative sedation

*Class B: Minor or major procedures with oral, parenteral, or IV sedation or under analgesic or dissociative drugs

*Class C: Major surgery that requires general or regional block anesthesia and supports vital bodily functions.

Inpatient and outpatient surgical suites shall be divided into three designated areas:

*Unrestricted: Includes central control point; street clothes permitted

*Semirestricted: Peripheral support areas, work areas, and corridors; surgical attire and hair covering required

*Restricted: OR and procedure rooms, clean core, and scrub sink areas. Surgical attire, hair coverings required; masks required where open sterile supplies and scrubbed staff are located.

Size of ORs in hospital-based surgical suites:

*General ORs: 400 sq ft; authorities may grant a deviation of 360 sq ft in renovations of existing facilities if it is not possible to meet the new facility standards.

*ORs for cardiovascular, orthopedic, neurological, and other specialties: 600 sq ft; in renovation projects, authorities may grant a deviation of 400 sq ft for cardiovascular, neuro, and other special procedures, and 360 sq ft for orthopedics if it is not possible to achieve the standards for new facilities.

For ambulatory surgery, OR sizes are geared to the level of care:

*Class A OR: 120 sq ft, 10 ft minimum dimension, 3 ft clearance around operating table

*Class B: 250 sq ft, 15 ft minimum dimension, 3 ft clearance around operating table

*Class C: 400 sq ft, 18 ft minimum dimension, 4 ft clearance around operating table.

For the first time, the guidelines have a recommendation for storage space. The suite should have enough storage area to keep the corridor free of equipment and supplies but not less than 150 sq ft or 50 sq ft per OR, whichever is greater.

Other new recommendations address areas for preoperative and postoperative care:

*In the preop holding area, each stretcher station will be 80 sq ft with 4 ft clearance at sides and foot. Provisions will be made for infectious patients and patient privacy.

*Phase 2 recovery should have 50 sq ft for each recliner with 4 ft clearance at sides and foot. Also needed are a handwashing station for each four chairs, a nurses’ station, sink, bedpan waters, and storage.