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Archive Surgical Construction 2020

Building Infection-Free ORs

Consider the impact architecture and design can have on SSI rates.

Joe Paone

Joe Paone


Kenneth Peterson Photography
CLEAN START Avera McKennan Hospital in Sioux Falls, S.D., is renovating 14 ORs to make them larger and less likely to harbor harmful pathogens.

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.

Access control

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."

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