5.1.1 Surgical Environment

The clean operating department should block interference from all pollution pathways in an all-round, whole-process manner; therefore, the environmental quality that can affect the air quality of the operating department also constitutes a potential hazard. Hence, the site of the clean operating department should preferably be chosen in an area with relatively good natural environmental quality, low atmospheric dust and bacterial concentrations, and no harmful gases; this is the ideal way to ensure air cleanliness while saving the most energy and reducing investment and operating costs.

The clean operating department should avoid areas with heavy traffic, high noise levels, and severe air pollution, and keep away from polluting places such as boiler rooms, kitchens, garages (parking lots), animal houses, mortuaries, refuse rooms, and incinerators. When such areas cannot be avoided or kept at a distance, the site should be located on the upwind side of the most frequent wind direction of the city or region; when there are approximately two prevailing wind directions, it should be located opposite to the direction with the minimum wind frequency.

5.1.2 Man-made Environment

It is very necessary to artificially design and modify the existing environmental space so as to reduce interference and pollution and to create conditions favorable to the air cleanliness requirements.

For example, main roads, parking lots, and areas with frequent transportation are among the sources of noise and dust; therefore, quiet signs should be posted in these areas. The road surface should preferably be made of wear-resistant materials that do not easily generate dust, and exposed soil should be reduced or eliminated as much as possible.

Greening serves to beautify the environment, purify the air, and prevent dust from rising. However, the greening around the operating department should mainly consist of turf and evergreen vegetation; ornamental flowers and trees should not be planted, so as to avoid dust being stirred up by the frequent need for digging, sowing, transplanting, and sweeping fallen leaves, which would affect the environment of the operating department. Moreover, the trees planted should preferably be species with relatively high dust absorption and dust retention rates, a certain bactericidal capability, and no flying flowers or catkins.

[Reference] The dust content in the air above an area planted with turf can be reduced by 2/3 to 5/6, and the amount of $CO_2$ absorbed from the air is $1.50,mathrm{m^3/(m^2 cdot h)}$.

[Reference] When the traffic flow on a main arterial road exceeds 800 vehicles/h, the distance between the clean operating department and the arterial road should preferably be greater than 50m.

5.1.3 Architectural Requirements for Negative-Pressure Operating Rooms

(1) Negative-pressure operating rooms should form a zone of their own, with independent entrances and exits, and establish quick connections with the building passages outside the operating department.

(2) The layout of negative-pressure operating rooms should provide separation of clean and dirty flows, and be equipped with dedicated sterile storage rooms, flushing and disinfection rooms, and clean corridors.

(3) Partition doors and buffer rooms should be provided between the negative-pressure operating rooms and the clean corridors within the clean operating department, so as to facilitate the isolation and sealing-off of the negative-pressure operating rooms.

5.1.4 Relevant Requirements for the Clean Operating Department in Hospital Buildings

The clean operating department may be located in the ward building or the medical technology building, but the following relationships must be properly handled.

(1) General conditions.

1) The shorter the distance for transporting patients to the operating department, the better.

2) The building column grid, story height, and main circulation routes should be favorable to the plan layout and pipeline requirements of the clean operating department.

3) Properly handle the adjacency relationships between the central supply department, ICU, blood bank, laboratory department, etc., and the operating department.

(2) The clean operating department should form a zone of its own or occupy one or two dedicated floors, which is conducive to organizing the flow of people and materials within the operating department, reducing external interference, and ensuring the environmental quality of the clean operating department.

(3) The conventional operating department should be placed in the surgical ward building, which can shorten the patient transport distance, facilitate the work of doctors, and improve medical efficiency.

1) Located on the middle floors of the ward building, it can better shorten the distance patients travel for surgery and improve efficiency.

2) Located on the top floor of the ward building, the dimensions of the local building column grid can be appropriately adjusted to make the layout flexible, and the influence of equipment pipelines is also correspondingly

  • (a) Located on the top floor of the ward building　connected to the outpatient department
  • (b) Located on an intermediate floor of the ward building　connected to the outpatient department
  • (c)
  • (d) Ward　Outpatient　Located on the ground floor of the ward building
  • (e) Ward
  • (f) Ward
  • (g) Ward　Outpatient
  • (h) Ward　Outpatient
  • (i) Ward　Outpatient　Located in the connecting block of the I-shaped complex
  • (j) Ward　Outpatient　Located in the bifurcation of the I-shaped bifurcated complex
  • (k) Ward　Auxiliary medical　Outpatient　Located in other areas between the outpatient department and the ward

Figure 5.1　Location of the surgical department in the hospital building should be reduced. However, the top floor is unfavorable for energy conservation and leak prevention, so thermal insulation and leak prevention must be done well; equipment with strong vibration and noise should not be placed there, so as to avoid affecting or disturbing the surgical department [Figure 5.1(a–g)].

3) Located within the medical technology building, it is convenient to liaise with related departments, with short and direct routes. In addition, the column grid of the medical technology department should be conducive to the flexible arrangement of operating rooms, making the functions of the surgical department more reasonable [Figure 5.1(h–k)].

(4) Departments closely related to surgery and the clean surgical department should be conveniently linked with short and direct routes, which is conducive to improving medical quality and medical efficiency.

1) ICU (surgical intensive care unit): It should preferably be located on the same floor as the surgical department and directly connected to the exit of the surgical department, which helps shorten the transport distance for postoperative patients and facilitates the handover arrangements for postoperative monitoring between the surgeons and anesthesiologists and the ICU nursing staff, thereby improving medical quality.

2) Supply room: The surgical department requires a large quantity of disinfection and sterilization supplies and disposable items, and its exchanges with the supply room are very frequent; dedicated horizontal or vertical circulation should be provided for rapid delivery and retrieval. Generally, large surgical departments with more than ten or so operating rooms, due to the large volume of disinfection/sterilization and material supply, should establish a dedicated surgical department supply room to serve them.

3) Clinical laboratory: It mainly performs physiological or pathological analysis and testing of blood, body fluids, and tissue specimens, providing a scientific basis for the diagnosis of surgeons; therefore, the closer and more convenient it is to the surgical department, the better.

4) Blood bank: The surgical department has a large and urgent demand for blood in the hospital; the blood bank should be located near the surgical department to facilitate blood delivery.

5) Blood gas room: A blood gas room should be provided in large surgical departments, with a floor area of $18 sim 24text{m}^2$, divided into 2 rooms for duty and testing and arranged as a suite. The staff entrance is in the non-clean area, and a specimen pass-through window is designed on the wall at the junction with the clean corridor to facilitate specimen transfer; a logistics transmission system may also be used to transfer specimens.

6) Rapid pathology section room. Large surgical departments should have a rapid pathology section room with an area of about $18text{m}^2$; the entrance should preferably be in the non-clean area, and the specimen pass-through window should be located on the wall at the junction between this room and the clean corridor to facilitate specimen transfer.