An Introduction to Operating Room Design

Building a new operating room is a complex process that involves balancing needs of facility staff with construction costs, while also looking forward to future healthcare trends. To make planning and construction go smoothly, it helps to consider every possible variable at the outset of the growth process. Often, this includes an evaluation of current practices.

Evaluate the Current Operating Room

Before officially embarking on the facility planning process, it’s necessary to take stock of how existing operating room space is utilized. Are there any navigation or bottlenecking issues in the current operating room? During this process, identify and consult with staff members to collect their feedback. This not only includes the surgery team, but also those in radiology, administration, laboratory, and beyond.

Set Goals for the New Project

What will be the focus of the new operating room? Does the facility plan to integrate or expand its imaging capabilities? Will the new space require more room for specialized procedures, which can require a larger surgical staff? To begin the planning and design phases of an operating room, several factors must be taken into account. These can easily be broken down into the room’s size, orientation and layout, and supporting systems. Further designs for accompanying spaces are also key.

Room Size

In its 2014 Operating Room Requirements Guidelines, the Facility Guidelines Institute recommends that the minimum inpatient operating room size be no less than 400 square feet. Operating spaces designed for specialized procedures generally require more staff, and are recommended to be at least 600 square feet.

Estimated Industry-Standard Operating Room Sizes

• Small OR - 400 sq ft
• Standard OR - 500 sq ft
• Orthopedic OR - 600 sq ft
• Cardiac OR - 600 sq ft
• Neurological OR - 600 sq ft
• Hybrid OR - 650 sq ft (Plus 120 sq ft separate control room)
• Transplant OR - 800 sq ft

  Determining the size of any operating room requires factoring in the above estimates, while also accommodating for future changes. The room will need to be optimized for the various equipment, supplies, staff, and general work flow.  

Common Operating Room Equipment

• Anesthesia Machine
• Anesthesia Monitor
• Video Monitors and Cameras
• Anesthesia cart
• C-arm
• ESU
• Surgical Microscope
• EKG Machine
• Operating Table
• Operating Lights
• Auto-transfusion
• Laser
• Forced Air Warmer
• SCD
• Pneumatic Tourniquet
• Blood Warmer
• Defibrillator
• Case Cart / Crash Cart
• Prep Tables
• Back Tables
• Specialty Cart
• IV poles
• Mayo stands
• Ring stands
• Kick buckets
• Hazardous waste bins
• Trash bins
• Storage Cabinets
• Desk / Computer
• Linen hamper

See a full list of potential OR equipment >>

Room for expansion

Whether facility expansion is necessitated by regulatory changes, or as the side effect of a rapidly growing practice, the expertly-planned OR can adapt and grow if needed. One contingency plan for growth, outlined in the American Society of Anesthesiologists’ Operating Room Design Manual, is to plan for “soft space” around an OR. If increasing the size of an existing OR space is unavoidable, a facility can use the adjacent space to expand without eliminating critical systems. A less drastic option from the ASA would be to rely on modular furnishings and partitions that can easily be changed. This would allow more flexibility than using more traditional millwork or other permanent structures.

Operating Room Orientation and Layout

Current space expectations in today’s operating room

A crucial part of planning the layout of any operating room is arranging all of the necessary equipment while accounting for all of the daily tasks performed there. A few of these tasks, including patient transfer, sterile equipment setup, and using a mobile C-arm during procedures, take up a sizeable amount of space. A modern OR needs to be able to accommodate all of these, while still maintaining space for all surgical staff to move efficiently through each procedure.

Estimated Equipment Space Requirements

• Nitrous Oxide Machine - 4ft x 4ft - right side head of table
• Anesthesia Machine - 3.5ft x 3.5ft
• Anesthesia Cart - 2ft x 5ft (single) 2ft x 7ft (double)
• Transesophageal Echocardiograph (TEE) 4ft x 2ft
• Rapid Infusion Machines - 2ft x 2ft
• Airway Cart - 3ft x 2ft
• Robotic Surgery - 5ft x 5ft at foot of table
• Robotic Surgery Control Console - 6ft x 6ft behind or at the side of the anesthesia machine.

Space Saving Solutions

An easy way to make sure there is enough maneuvering space in a smaller operating room is to center the design around the surgical table. Larger rooms offer more flexibility for positioning the operating room table, because there will always be enough space to move around the perimeter. In modern operating room design, ceiling mounted booms have allowed operating room designers to negotiate around limited floor space. It isn’t uncommon to see wide range of equipment and system ports located on booms that can be positioned easily for a variety of procedures. While ceiling mounted surgical lights and video screens are the most natural fit for surgical booms, facilities may choose to mount endoscopy towers, anesthesia systems, medical gas systems, data jacks, suction ports, and more.  

Systems Development

Successful placement of operating room furnishings and equipment is dependent on the supporting utility and architectural systems that are installed during the construction process. Without careful planning and installation of these essential systems, the operating room cannot function efficiently. When planning the construction of an operating room, it’s important to think of medical gas, lighting superstructures, utility lines, heating and ventilation systems, and data and communication interfaces as base layers that must be established before work commences.

Ancillary Spaces

Sterile Processing Room

Recent surgical guidelines are favoring the use of sterile processing rooms over substerile rooms located within the surgery suite. These sterile processing rooms are designed to be separate from the operating suite, but may be shared between two or more operating rooms. Sterile processing rooms are designed to provide a one-way traffic pattern of contaminated materials, instruments for cleaning, and the sterilization of various instruments and equipment.

Changing Room

The 2014 FGI Guidelines no longer require staff locker rooms to open directly into the surgical suite. Moving forward, facilities must provide a changing room with lockers, but it may be unisex and can be shared with other departments in the facility.

Current OT Design Trends

As minimally invasive procedures become the new standard, hybrid operating rooms are projected to become the most dominant type of operating suite. To build an operating room with longevity, it’s necessary to consider the eventual integration of new technology including endovascular, MRI, and imaging equipment. Preparation for new technology could include increasing the operating room size, and maintaining flexible, modular designs. Other current trends are increased operating room storage space, and a greater design emphasis on patient privacy during pre- and post-op.