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Operating Theatre Design | Knowledge Center

The Importance of Healthcare Design

Modular Operating Theatre

From hospitals to ambulatory surgery centers (ASCs), the setting of a healthcare environment is important to the healing and wellbeing of patients, patient’s family and friends, and staff. From the waiting room to the Operating Room, visual appeal, efficiency, and cleanability all play a role in healthcare design decisions hospital planning and design teams must make.

The time patients spend in the waiting room may even contribute to their overall satisfaction: 63% of patients say the most stressful aspect of their appointment is waiting. Modern healthcare facilities understand an inviting – and efficient – facility design ultimately promotes a healing environment for patients and staff alike.

Many modern healthcare facilities take an evidence-based approach to the design of a building’s interior: They use credible research to influence an environment’s design to improve patient and staff outcomes.

Healthcare Design Elements

Color in Healthcare Environments

Over the years, numerous theories and studies have delved into the psychophysiological effects of color. In 2003, a comprehensive review of that work was published by the Coalition for Health Environments.

  • Color for Calming or Arousal – Based on studies, the intensity of a color seems to make more of a difference than the color itself. Nevertheless, cool colors (green, blue, purple) are somewhat more relaxing while warm colors (red, orange, yellow) offer a level of increased stimulation.
  • Color and Spaciousness – Lighting in a space contributes directly to the feeling of spaciousness. Cool, white, fluorescent light contributes more than other lighting types. The level of color saturation (chroma) makes more of a difference than the actual hue. Based on studies, color has the capacity to alter room size with cool colors receding and warm colors advancing.
  • Color and Thermal Comfort – Color has the ability to affect people’s sense of temperature and perceived comfort. A specific study experimented with employees of an air-conditioned factory and discovered when the walls of the cafeteria in the factory were painted in light blue, employees felt cold at 75° F. When the same walls were painted orange, employees felt too hot at 75° F. Subsequent studies have confirmed this finding.
  • The Operating Room Red/Green Phenomena – The theory states that after looking at red (i.e., the color of blood) for a prolonged period of time, the human eye “red” receptors become fatigued. The result is diminishing sensitivity to red causing an afterimage of green floaters in front of the fatigued eye since green is the opposite of red. When a surgical team member looks away from the red wound to a green or blue wall it may cause less strain to the eye and prevent the green afterimage. For these reasons, it is often recommended surgical walls be blue or green in color.

Lighting in Healthcare Environments

The impact light has on outcomes in healthcare settings has also been the topic of extensive scientific studies. Lighting in healthcare environments can have an impact in five main areas:

Performance of Visual Tasks

The most obvious requirement for lighting in healthcare is the need for the surgical staff to see clearly during a procedure. The light allows for visual discrimination which is vital for surgeons during a procedure. For minimally invasive (MIS) procedures, it’s important the ambient light is conducive to the visualization of the surgical monitor. When it comes to lighting color, green has proven to cause the least eye fatigue.

Lighting and Risk for Error

The quality of lighting in a healthcare environment also impacts the risk of errors. Higher lighting conditions are correlated with fewer errors. Dark MIS rooms have been shown to increase the risk for errors by OR staff including medication errors and errors in counts. Ideally, room lights during MIS procedures could use high levels of complimentary light to achieve both surgeon comfort and visual acuity as well as high levels of light for visual task performance.

Lighting and Human Circadian Rhythms

Circadian rhythms are biological events that repeat themselves at regular intervals. They are responsible for synchronizing the body’s internal clock to 24 hours and are comprised of three components – internal oscillator, external oscillators, and the melatonin hormone. The internal oscillator is located in the hypothalamus of the brain. External oscillators respond to external stimuli such as the light and dark cycles of the day. Finally, melatonin carries “time” information to all parts of the body through the bloodstream.

Lighting, Mood, and Perception

There is strong evidence exposure to bright light in the morning is effective in improving mood and maintaining proper internal timekeeping. Providing cycled lighting in the healthcare environment can improve staff sleep quality and alertness.

Staff Stress and Satisfaction

Some studies have examined the impact of light – both artificial and natural – on mood and task performance in healthcare settings. One such study indicates nurses exposed to three hours of daylight conditions daily experienced less stress and were more satisfied. Furthermore, surveys of surgical nurses reported having increased natural light had a positive impact on their work life.

The Staff and Patient Experience in the Operating Room

The physical environment can have a significant impact on safety and human performance, and this is exceedingly relevant in the healthcare environment. Many clinicians, architects, and hospital administrators believe the hospital environment can benefit the satisfaction of healthcare providers as well as patient satisfaction and outcomes.

The Patient Experience: Color, Design & Motifs

Today’s caregivers acknowledge patient satisfaction and convenience as contributors to healing which has led to an understanding design is a means to change the perception of patient care and enhance the overall patient experience. Studies suggest the physical attributes of the hospital have had an impact on patient perception of quality of care. For example, lighter colors are often associated with cleaner environments.

Imagery and motifs may also play a role in patient satisfaction within the healthcare setting. Evidence shows even brief periods of exposure to a nature scene in a healthcare environment makes a difference for patient satisfaction. Consistent with other studies, the use of positive distractions (both visual and auditory) can affect patient outcomes. The design of the environment may have an effect on perceived care, even when patients are under some form of sedation.

Types of Operating Room Wall Panel Materials

The type of wall material in the healthcare setting plays a role in the overall facility design, cleanability, and sustainability.

Stainless Steel

Stainless Steel is a non-porous, flat panel typically made of AISI 304 stainless steel. Panels attach to a steel substructure utilizing clips or screws. The surface requires an anti-corrosive finish to prevent oxidation/rust. Cut-outs for monitors, electric outlets, accessories, etc. may be completed in a factory or at the jobsite.

HPL (Laminate)

High Pressure Laminate (HPL) panels are composed of a resin impregnated kraft paper, a decorative paper, and a clear melamine overlay. These sheets are bonded at high pressures and temperatures to substrates such as medium density fiberboard (MDF) or particleboard. Cut-outs for monitors, electric outlets, accessories, etc. are completed at the job site.

Drywall

Drywall is a porous, flat panel made of gypsum plaster sandwiched in between two sheets of thick paper. Panels attach to metal or wood studs using nails or screws. Cut-outs for monitors, electric outlets, accessories, etc. are finished at the jobsite. Exposed surfaces must be finished with paint, epoxy, or other materials after installation to protect the visible paper layer.

Glass

Glass is a non-porous, flat panel composed of natural and abundant raw materials (sand, soda ash, and limestone) that are melted at very high temperatures. Panels attach to a steel substructure utilizing clips or screws. The surface does not require any additional coatings or finishes. Cut-outs for monitors, electric outlets, accessories, etc. are prefabricated in a factory setting.

  • Environmental Protection – Glass is sustainable from its origin to its demise. From abundant natural raw materials such as sand, creating glass does not require disturbing the natural environment. Because of its fully recyclable quality, glass is a sustainable choice that can close the consumption loop.
  • Electromagnetic Shielding – Glass inherently provides electromagnetic shielding. Additional shielding can be achieved via added insulation as needed.
  • Noise Protection – Up to 33 dB without additional insulation. Higher sound insulation can be achieved by additional insulation in the substructure.
  • X-Ray & Laser Protection – A special coating on the back of the glass scatters light to reduce reflection. The reflection of the laser light is less than 6% depending on the color of the coating.  
  • Hygienic Protection – Glass is nonporous, does not have joints, and provides for a smooth surface. This makes it highly cleanable. These properties also make the glass easier to clean.
  • Fire Protection – Glass and substructure are inherently non-flammable. Insulation can be added for additional protection. 

Made of specially tempered security glass, MEDglas™ Prefabricated OR Walls combine beauty, strength, ultra-durability, and cleanability. With a virtually limitless range of Operating Room wall finishes including colors, patterns, and images as well as lighting options, these modular glass walls for the OR provide a long-lasting and aesthetically pleasing combination of a hospital healing environment and functional workspace to support the wellbeing of both patients and clinicians.

Learn more about MEDglas

Benefits to Prefabricated Modular Operating Room Walls

  • Speed of Installation – Prefabricated OR walls are delivered ready to install.
  • Customizable and Future-Ready – A customizable design means your Operating Room can grow with you as your needs evolve.
  • Infection Prevention in Hospitals – OR walls should be nonporous and eliminate any open areas for mold and mildew to grow. Similarly, wall material should protect from surface moisture penetration. Modular walls can be completely sealed, eliminating the nooks and crannies that can be hard to clean and disinfect.

Modular Ceiling with Laminar Flow System

The ceiling is another element of the healthcare environment that plays a role in infection prevention and future-ready design. Modular Operating Room ceiling systems such as CLEANSUITE® OR Ceiling System use a prefabricated structural frame that installs faster and cheaper than traditional on-site laminar-flow ceiling systems.

CLEANSUITE offers:

  • A single large-diffuser system that delivers gapless laminar flow to minimize turbulence and gently guide particles away from the surgical site
  • Simplified connections that eliminate the need for on-site welding, and also minimize labor for heating, ventilation, air conditioning (HVAC), medical gases, and utilities
  • Internal and external truss systems to allow for seamless mounting of surgical lights, booms, monitors, and C-arms

Learn more about CLEANSUITE

Hermetically sealed doors

The hermetically sealed door has been specifically designed for use in areas where hygiene and the control of air leakage are critical. The door has a unique patented track system which enables it to seal perfectly when closed helping to reduce air handling costs, cross-contamination and wound infections.

  • Types used: sliding or hinged

Contributors to This Article

Lena Elias-Fogle, BSN RN, CNOR
Director, Global Clinical Solutions

Lena is a seasoned healthcare leader with extensive experience leading complex perioperative environments as well as new program development, continuous process improvement, clinical outcomes, operational excellence, and stakeholder experience.

References

Color in Health Care Environments, Using color to enhance aesthetics, wayfinding, and safety, October 2015, Sponsored by American Biltrite, Peter J. Arsenault, FAIA, NCARB, LEED AP Continuing Education.

Designing A Safer OR, By Anjali Joseph and David Allison | November 16, 2018, Anjali Joseph, PhD, EDAC, is the Spartanburg Regional Health System Endowed Chair in Architecture + Health Design and Director of the Center for Health Facilities Design and Testing at Clemson University (Clemson, S.C.).

Spagnolo, A. M., Ottria, G., Amicizia, D., Perdelli, F., & Cristina, M. L. (2013). Operating theatre quality and prevention of surgical site infections. Journal of preventive medicine and hygiene, 54 (3), 131–137.

HERD Volume 5, Number 2, pp 80-98 Copyright ©2012 Vendome Group, LLC WALL FINISH SELECTION IN HOSPITAL DESIGN 80 WWW.HERDJOURNAL.COM ISSN: 1937-5867 HERD Vol. 5, No. 2 WINTER 2012 • HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 81.

A Survey of Facility Managers, Sarel Lavy, PhD, and Manish K. Dixit, PhD Candidate.

Reiling J, Hughes RG, Murphy MR. The Impact of Facility Design on Patient Safety. In: Hughes RG, editor. Patient Safety and Quality: An Evidence-Based Handbook for Nurses. Rockville (MD): Agency for Healthcare Research and Quality (US); 2008 Apr. Chapter 28. Available from: https://www.ncbi.nlm.nih.gov/books/NBK2633/.

Dahle, J., & Patterson, P. (2018). Operating Room Design and Construction: Technical Considerations. In A. Kaye, R. Urman, & C. Fox, III (Eds.), Operating Room Leadership and Perioperative Practice Management (pp. 107-121). Cambridge: Cambridge University Press. doi:10.1017/9781108178402.014.

How LEDs are eliminating mistakes in the operating room (MAGAZINE), Light, liver, and the pursuit of happiness: Surgeons in Scandinavia swear that Chromaviso's tunable color system helps them see better, improves results, and sends everyone home in a better frame of mind, as Mark Halper discovers, Mark Halper, June 2nd, 2017.

Ambulatory Facility Design and Patients' Perceptions of Healthcare Quality Franklin Becker, PhD, Bridget Sweeney, MS, Kelley Parsons, PhD First Published July 1, 2008, Research Article https://doi.org/10.1177/193758670800100405.

Devlin, Ann Sloan. "Judging a book by its cover: Medical building facades and judgments of care." Environment and behavior 40.3 (2008): 307-329.

Iwata, N., Ichii, S., & Egashira, K. (1997). Effects of bright artificial light on subjective mood of shift work nurses. Industrial Health, 35, 41–47.

Effects of sacred space environment on surgical patient outcomes, Schmock, B. N., Breckenridge, D. M., Benedict, K.  2009 | International Journal for Human Caring Volume 13, Issue 1, Pages 49-59.

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