Hospitals

Surgical Suite grated with the surgical suite, is an intermediate or outer zone activity.

/nner zone; The actual operating rooms, the scrub areas, the patient holding or induction areas, All alien traffic should be eliminated. Mere we want to maintain the highest level of cleanliness and aseptic conditions.

Outer zone administrative areas have Increased in importance, Offices are needed for the surgical supervisor, the clerks who manage scheduling and paper work, the clinical instructor (particularly if there is a school of nursing), possibly the chief of staff, There must be provision for surgeons to díctete medical records.

And don't forget the patient. After all, he is the primary concern. Who is responsible lor his transportation to the surgical suite, and on whose bed or stretcher? How is he checked in and where does he wait if the room for which he is scheduled is not ready? Who hae not seen surgical corridors lined with occupied stretchers for want of adequate holding, preparation or induction areas? Another factor is added it any ambulant outpatient work ie to be done. There must be provision for receiving, controlled wailing, dressing rooms and toilets, A variety of persons must be provided with lounge, locker and toilet space—surgeons (male and female), nurses, technicians, aides, orderlies. Coffee and cole seem to lubricate the entire department; some systematic provision for their supply is warranted,

A conference or classroom for departmental meetings end in-service treining programs ia easily justified.

The access to ell these erees should be removed from strictly surgical areas, as people are entering and leaving in street clothes and should not penetrate into other zonas until after changing shoes and clothing.

The planning and equipping of the intermediate zone are based on the method of processing and storing of the thousands of items involved. It is fairly common practice for the central sterile supply department, elsewhere in the hospital, to be responsible for the prep aration and autoclaving of all surgical linen packs, gloves, syringes, needles, end external fluids. The storage of these items to be used in surgery becomes the responsibility of the surgical department end adequate space must be provided for a predetermined level of inventory, (See Fig. 1J

The method of processing surgical instruments has been the subject of various research projects, notably at the University of Pittsburgh (see The Modern Hospital. November t955). The new ultrasonic cleaning equipment is eliminating a time-consuming, laborious process. The cost of the equipment discourages duplication and encourages the consolidation of work areas where lay personnel can be trained under close supervision to carry out approved processing techniques.

The method of packing and sterilizing instruments and utensils will determine the site, type, and location of autoclaves needed- Consideration must be given to inclusion of an ethylene oxide sterilizer for cystoscopes, bronchoscopes and delicate surgical instruments which cannot be sterilized by steam or high temperatures, How and where instruments will be stored is another decision to be made.

Suitable storage space must be provided for: (e) clean surgicel supplies such as extra linen, tape, bandage materials, etc.; {b) parenteral solutions, external fluids or sterile water, <c) essential drugs and narcotics; (d) blood supplies, bone bank, tissue bank, eye bank, etc.; (e) radium and isotopes used in surgery,

It seems impossible to provide adequate centralized garage-type spaces for bulky equipment not in constant use. Dr Carl Walter has estimated that an average of 80 sq ft per operating room is needed.

The intermediate zone also houses the focili-ties for handling waste, soiled linen, etc., and janitorial equipment for routine housekeeping.

The anesthesia service cannot be shortchanged. It may spread over all zones of the surgical suite. Office space is required, work and storage space tor equipment. And most im

Fig. 1 Flow chart

From Design and Construction of General Hospitals by U.S. Public Health Servicet US. Department of Health, Education and Welfare (195$),

DOCTOCS APEAS

Fig. 1 Flow chart

From Design and Construction of General Hospitals by U.S. Public Health Servicet US. Department of Health, Education and Welfare (195$), portant is the decision on where induction of the patient is to take place: centrally to all rooms, locally in induction areas (aometimes referred to as preparation or holding rooms) or in the operating room proper. There are acknowledged hazards in moving anesthetized patients and equipment. Induction areas should permit quicker turnover in operating room usage, but they also require more anesthetists and nurses to administer.*

The posl-anesthesia recovery room has become an integral part of the surgical suite in most coses. The sice will vary from one-and-a-half to two beds per operating room. There is a close relationship between the anesthesia department and the recovery room.

Any frozen section laboratory should be located near the entrance of the surgical suite so thai laboratory personnel need not penetrate the inner zono,

Any dark room facilities should be located to serve those rooms generating greatest load of film, normally ihe cystoscopic, urological and orthopedic services. It should be accessible from a corridor to prevent alien traffic through any operating room.

Inner zone planning includes the operating rooms and I heir essential supportive elements. Decisions must be made on the type of scrub-up sinks or troughs and their location providing minimum travel to the operating room to eliminate chance of contamination after scrub procedure.

The need tor local "substerilizing" rooms is being questioned by many authorities. The trend toward centralization of work areas and sterilizing equipment, end the changing techniques ot instrument packaging are reducing the importance of the substerilizing area. Circulation travel distance and work patterns are factors determining the need for decentralized work areas. When such areas are provided there should be staff access for servicing and stocking them without going through an operating room.

The program of need dictates the gross area required lor the surgical suite. Recent developments indicate that more efficient departments with minimum travel distances can be planned In bulky squarish areas. This tendency has affecied the location ot the surgical suite in relationship to the hospital as a whole, The suite has come downstairs to a lower floor where it is more possible to spread out and achieve the desired shape, divorced from the usually narrow structural pattern of a nursing unit. Planning within the squarish areas has been made possible with the parallel development of air conditioning and artificial lighting. Dependence upon windows tor ventilation and light is a thing of the past. The optimum conditions of temperature, humidity, and light level can be controlled by mechanical means far better than by nature. (See Fig. 2.)

The surgical suite location must mesh with the total circulation pattern so that patients con be moved to and from surgery with a minimum of travel through other hospital services. Its location is also affected by its close relationship to three other major hospital services the x-ray department, the clinical laboratories, and the central sterile supply-

One other important factor in the location of the surgical suite is future expansion. Anticipate ways and means to permit growth in an orderly fashion without upsetting the basic relationship of internal organization —or without extending lines of travel to unacceptable or uneconomical lengths.

•Experience with various suites indicóles that what was planned for induction frequently is converted to other causes

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