Building Infection-Free ORs

Planning to renovate your old ORs or build brand new ones? There's a lot you can do from architectural and design perspectives to enhance your infection prevention efforts. Here are some things to keep in mind.

The impact of OR door openings on infection control is in question. "There's a belief that opening and closing doors frequently might increase SSI risks, but the literature now doesn't support that because our airflows are so well designed," says Arthur Brito, AIA, CAU, EDAC, LEED AP BD+C, WELL AP, an associate principal and senior vice president and healthcare practice leader at architecture and design firm HKS in Miami, Fla.

"We conducted a simulation study and found contamination in the OR was less related to the number of door openings and more to the number of people in the OR," says Anjali Joseph, PhD, EDAC, endowed chair in architecture + health design and research at Clemson (S.C.) University's College of Architecture, Arts and Humanities. Ultimately, the more crowded your OR typically is, the more space you should build.

Still, keeping the OR doors closed during surgery is good practice. One way to reduce door openings is to increase visibility into the rooms. "The reason you want to look in is to understand what stage the case is in," says Bryan Langlands, AIA, FACHA, EDAC, LEED GA, principal and medical planner with architecture, planning and design firm NBBJ in Seattle, Wash.

The obvious way to avoid "pop-ins" is to include windows in OR designs, so staff can easily check the status of a case. Avera McKennan Hospital in Sioux Falls, S.D, is in the process of renovating 14 ORs originally built in the early 1980s. "One thing that's been very helpful is we put large windows in the doors," says Mary Leedom, RN, MS, NEC, an assistant vice president for perioperative services. "I believe that's minimized traffic in our rooms."

You don't want people constantly leaving the room during surgery to get supplies, but you also don't want clutter. Should you have more storage in the OR to prevent door openings? It's a difficult choice.

Dr. Joseph recommends any OR storage be seamless and integrated into the wall system to avoid taking up floor space and collecting dirt. "Place storage close to whoever needs to access it — where the circulating nurse is, within the anesthesia work area," she says. Remember, though, that OR storage creates more horizontal surfaces, which infection preventionists consider a danger point.

Then there's the equipment itself, including the lights and monitors. If they're positioned on the floor, you create more places for dust to collect, and wires to trip over. Mounting equipment on booms frees up floor space, but also creates places for contaminants to collect that the surgeon could kick up when, for example, he manually adjusts the surgical light.

Booms also can affect laminar flow. "You're blowing the air into the OR lights, and the air gets turbulent and goes through the surgical site," says Mr. Brito.

Avera McKennan installed a system that combines the surgical lights with laminar flow. The lights can only be manipulated using voice commands and hand gestures. The LED white light also provides continual disinfection, but isn't harmful to people like UV light is. "We run it all day on a lower level, and when the rooms are cleaned and emptied for the night, they go into a high-disinfection mode," says Ms. Leedom.