2 facilities for surgery - hfs 10... · 53 hbn 04-01: supplement 1 – isolation facilities for...

Consultation draft not for publication

HBN 10-01 January 2020 1

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Health Building Note 10-01 2

Facilities for surgery 3

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Version 1.1 5

February 2020 6

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9

Version

history/revisions

Version

Date Author Changes

Version 1.0 24/02/20 Archus project team Consultation draft for technical engagement – wider reference group.

Version 1.1 25/02/20 Archus project team Updated in response to NHS England and Improvement comments

(deletions and clarifications / policy-related) prior to release for

technical engagement.

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Introduction to the Technical Standards 12

The Technical Standards provide best practice guidance for all those involved in 13

strategic planning and design of new healthcare buildings and on the adaptation or 14 extension of existing facilities; also on the design, installation and operation of 15 specialised building and engineering technologies used in the delivery of health care. 16 They provide tools to assist with the calculations required to produce schedules of 17 accommodation, exemplar data sheets and case studies of recent schemes. 18

Developed by multi-disciplinary teams, they reflect latest best practice and current 19 policy. They are peer-reviewed and assessed for equality impact prior to dissemination 20

via www.gov.uk2. 21

What is best practice guidance? 22

The Technical Standards provide best practice guidance inasmuch as they describe 23 methods, techniques and exemplar technical solutions that are generally accepted as 24 superior to any alternatives – because: 25

they produce results that are superior to those achieved by other means; 26

they have become standard ways of successfully doing things (e.g., a 27

standard way of complying with legal or ethical requirements). 28

The Technical Standards are published in two formats: 29

Health Building Notes (HBNs) 30

HBNs provide technical information in the form of best practice guidance to support 31

the briefing and design processes for individual projects in the NHS building 32 programme. They are based on the patient’s experience across the spectrum of care 33

from home to healthcare setting and back. 34

Most of the content will be familiar to healthcare planners, architects and others with 35 formal design education. However, it will also be useful for the informed client, 36 commissioners and regulators – those who do not have detailed knowledge of capital 37

investment projects but who want more involvement and information on the issues that 38 are encountered in these types of project. 39

HBNs are published as a suite of 17 core subjects: 40

1 See https://www.gov.uk/government/collections/health-building-notes-core-elements and https://www.gov.uk/government/collections/health-technical-memorandum-disinfection-and-sterilization and https://www.gov.uk/government/publications/complete-list-of-nhs-estates-related-guidance 2 See https://www.gov.uk/government/collections/health-building-notes-core-elements and https://www.gov.uk/government/collections/health-technical-memorandum-disinfection-and-sterilization and https://www.gov.uk/government/publications/complete-list-of-nhs-estates-related-guidance

http://www.gov.uk/

https://www.gov.uk/government/collections/health-building-notes-core-elements

https://www.gov.uk/government/collections/health-technical-memorandum-disinfection-and-sterilization

https://www.gov.uk/government/publications/complete-list-of-nhs-estates-related-guidance


https://www.gov.uk/government/collections/health-technical-memorandum-disinfection-and-sterilization

https://www.gov.uk/government/publications/complete-list-of-nhs-estates-related-guidance



41

Care-group-based HBNs provide information about a specific care group or pathway 42

and cross-refer to HBNs on generic (clinical) activities or support systems as 43 appropriate. 44

Core subjects are sub-divided into specific topics and classified by a two-digit suffix (-45 01, -02 etc), and may be further subdivided into Supplements A, B etc. 46

All HBNs are supported by the overarching HBN 00-01, which deals with the key areas 47

of building and design. 48

Example 49

The HBN on accommodation for adult in-patients is represented as follows: 50

HBN 04-01: Adult in-patient facilities 51

The supplement to HBN 04-01 on isolation facilities is represented as follows: 52

HBN 04-01: Supplement 1 – Isolation facilities for infectious patients in acute 53

settings 54

All HBNs should be read in conjunction with the relevant parts of the Health Technical 55 Memorandum series. 56

Health Technical Memoranda (HTMs) 57

HTMs focus on healthcare-specific elements of standards, policies and up-to-date 58 established best practice. They are applicable to new and existing sites, and are for 59

use at various stages during the whole building lifecycle. 60



Healthcare providers have a duty of care to ensure that appropriate governance 61 arrangements are in place and are managed effectively: HTMs provide best practice 62 engineering standards and policy to enable management of this duty of care. 63

It is not the intention within this suite of 64 documents to unnecessarily repeat 65

international or European standards, 66 industry standards or UK Government 67 legislation. Where appropriate, these will 68 be referenced. 69

Healthcare-specific technical engineering 70 guidance is a vital tool in the safe and 71 efficient operation of healthcare facilities. 72

HTM guidance is the main source of 73

specific healthcare-related guidance for estates and facilities professionals. 74

The core suite of nine subject areas provides access to guidance which: 75

is more streamlined and 76

accessible; 77

encapsulates the latest 78

standards and best practice 79

in healthcare engineering, 80

technology and sustainability; 81

provides a structured 82

reference for healthcare 83

engineering. 84

All Health Technical Memoranda are 85 supported by the initial document HTM 86

00, which embraces the management 87 and operational policies from previous 88

documents and explores risk 89 management issues. 90

Compliance matters 91

There are numerous statutes, legal requirements and industry standards with which 92 healthcare organisations, supporting professionals, contractors and suppliers must 93 comply. Guidance on how to comply with these is given in the respective Technical 94 Standards and the NHS Premises Assurance Model (PAM).3 95

[DN: any other sources to be added here? Suggest also add see www.gov.uk/??? for 96 up-to-date information IF a home page is established in addition to those existing for 97

downloads of current HBNs and HTMs.] 98

3 See https://www.gov.uk/government/publications/nhs-premises-assurance-model-launch

http://www.gov.uk/

https://www.gov.uk/government/publications/nhs-premises-assurance-model-launch



In England, compliance with HTM 05-01 Firecode4 Managing Healthcare Fire Safety 99 is mandatory. It sets out the Department of Health and Social Care’s (DHSC’s) policy 100 on fire safety in the NHS. It includes best practice guidance on management 101 arrangements for fire safety. 102

Compliance with the Technical Standards is not statutory but it may be used as 103

evidence in legal proceedings. 104

[DN: text to be reviewed by legal advisors.] 105

Evidencing that Technical Standards have been followed – or being able to explain 106

why not – will be relevant in demonstrating compliance with the above legal 107 requirements and standards. 108


Assurance of healthcare infrastructure 110

The foundations for the assurance of estates and facilities are laid in a set of legal 111 requirements and standards, primarily: 112

Regulations 12 and 15 of the Health and Social Care Act 2008 (Regulated 113

Activities) 2014 on the safety and suitability of premises. 114

o Both of these regulations also form part of the Care Quality 115

Commission’s (CQC) fundamental standards. 116

o Health Building Notes (HBNs) and Health Technical Memoranda 117

(HTMs), among others, are specifically referenced in the CQC’s 118

Guidance for providers on meeting the regulations5 as a means of 119

complying with these Regulations. 120

The Health Act 2009 includes provisions that place a statutory duty on 121

healthcare organisations, providers of primary care services, and voluntary 122

organisations providing NHS care in England to have regard to the NHS 123

Constitution, which stipulates that patients have a right “to be cared for in a 124

clean, safe, secure and suitable environment”. 125

Language usage in Technical Standards 126

In HTMs and HBNs, modal verbs such as “must”, “should” and “may” are used to 127 convey notions of obligation, recommendation or permission. The choice of modal 128 verb will reflect the level of obligation needed to be compliant. 129


4 See https://www.gov.uk/government/publications/managing-healthcare-fire-safety 5 See https://www.cqc.org.uk/file/182052

https://www.gov.uk/government/publications/managing-healthcare-fire-safety

https://www.cqc.org.uk/file/182052



The following describes the implications and use of these modal verbs in HTMs/HBNs 131 (readers should note that these meanings may differ from those of industry standards 132 and legal documents): 133

“Must” is used when indicating compliance with the law. 134

“Should” is used to indicate a recommendation (not 135

mandatory/obligatory), i.e. among several possibilities or methods, one is 136

recommended as being particularly suitable – without excluding other 137

possibilities or methods. 138

“May” is used for permission, i.e. to indicate a course of action permissible 139

within the limits of the HTM or HBN. 140


142

Typical usage examples: 143

“All publicly-funded organisations must ensure that all contracts 144

established to collect and treat waste conform to the Public Contracts 145

Regulations.” [obligation] 146

“All low voltage (LV) distributions should be configured as TN systems.” 147

[recommendation] 148

“Alcohol hand gels that do not contain siloxanes may be rinsed out and 149

the packaging recycled or placed into the municipal waste stream.” 150

[permission] 151

“Shall”, in the obligatory sense of the word, is never used in current 152

HTMs/HBNs. 153

Project derogations from the Technical Standards 154

Healthcare facilities built for the NHS are expected to support the provision of high-155

quality healthcare and ensure the NHS Constitution right to a clean, safe and secure 156 environment. It is therefore critical that they are designed and constructed to the 157 highest and most appropriate technical standards and guidance[1]. This applies when 158

organisations, providers or commissioners invest in healthcare accommodation 159

(irrespective of status, e.g. Foundation and non-Foundation trusts). 160

The need to demonstrate a robust process for agreeing any derogation from Technical 161 Standards and guidance is a core component of the business case assurance 162

process. 163

The starting point for all NHS healthcare projects at Project Initiation Document (PID) 164 and/or Strategic Outline Case (SOC) stage is one of full compliance. 165

[1] Statutory standards plus technical standards and guidance specific to NHS facilities : https://www.gov.uk/government/collections/health-building-notes-core-elements https://www.gov.uk/government/collections/health-technical-memorandum-disinfection-and-sterilization https://www.gov.uk/government/publications/complete-list-of-nhs-estates-related-guidance

https://eur01.safelinks.protection.outlook.com/?url=https%3A%2F%2Fwww.gov.uk%2Fgovernment%2Fcollections%2Fhealth-building-notes-core-elements&data=02%7C01%7Cs.holding%40archus.uk.com%7Ccaa85c978d994873b5cf08d7b948e8cb%7C64da2db92a7e4a63882965a27f3c0e5e%7C0%7C0%7C637181595103495580&sdata=2osK7ULyrjoNOiDEJ2BenHmlZ1Z8or6ZDWkSvV0ckEs%3D&reserved=0

https://eur01.safelinks.protection.outlook.com/?url=https%3A%2F%2Fwww.gov.uk%2Fgovernment%2Fcollections%2Fhealth-technical-memorandum-disinfection-and-sterilization&data=02%7C01%7Cs.holding%40archus.uk.com%7Ccaa85c978d994873b5cf08d7b948e8cb%7C64da2db92a7e4a63882965a27f3c0e5e%7C0%7C0%7C637181595103495580&sdata=%2FV9wzdHQ%2FQPHmcmruAe2uzE5h%2Bh2twEkdywGljKnkic%3D&reserved=0

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A schedule of derogations will be required for any project requiring external business 166 case approval and may be requested for those that have gone through an internal 167 approvals process. 168

While it is recognised that derogation is required in some cases, this must be risk-169 assessed and documented in order that it may be considered within the appraisal and 170

approval process. 171

Derogations must be properly authorised by the project’s senior responsible owner 172 and informed and supported by appropriate technical advice (irrespective of a project’s 173 internal or external approval processes). 174

[DN: NHS England and NHS Improvement is piloting a standardised approach to the 175 derogations process: this will be referred to here, once agreed.] 176

Overview of the healthcare planning 177

process 178

At the heart of the healthcare planning process is the design of the model of care, 179 which is the overarching philosophy identifying how the health economy, and 180

organisations within it, will deliver care in the future. This should reflect the health care 181

philosophy and particular circumstances of the whole health economy / organisation, 182

national and local. 183

Models of care should assess the opportunities for future provision, with particular 184

emphasis on modernising: 185

The care process and integrated patient pathways; 186

Use of technology; 187

Use of design; 188

Workforce considerations. 189

190

Healthcare planning allows healthcare providers to reflect on current ways of working 191

and provides a framework to refine / alter / improve service delivery. Robust healthcare 192 planning has much to offer as a discipline: from understanding the health needs of a 193 population through to planning and mapping best practice in the delivery of services 194

and informing the design and configuration of buildings. 195



Evidence suggests that the earlier the planning 196 process starts, the more detailed the brief and the 197 smoother the procurement process. 198

The design brief needs to be comprehensive to 199 enable private sector bidders to correctly interpret 200

requirements and develop robust and innovative 201 design solutions. 202

Healthcare planning is an essential part of the work 203 leading up to and including the development of the 204

business case of a healthcare service development 205 – for infrastructure, this may involve a new-build or 206 refurbishment capital scheme. 207

The benefits of a robust healthcare planning process include: 208

the opportunity for healthcare providers to embrace new ways of working 209

a vehicle by which space and environmental requirements can be 210

reconfigured to optimise efficiency 211

support for the production of an informed design brief that balances the 212

relationships between the care process, development and use of medical 213

technologies and the design of the physical environment 214

enabling healthcare providers to develop new models of care and then: 215

o translate them into detailed service specifications 216

o suggest ways in which the services and departments could be 217

configured for optimal performance and efficiency. 218

In summary, the process is about translating opportunities presented in new models 219 of healthcare delivery and new technologies into the requirements for physical space 220

and design. 221

Purpose of the design brief 222

Good briefing and design improves the efficiency of operational relationships. Each 223

HBN identifies unique design quality requirements and aspirations. Every new 224 department will be unique as the demands will be different depending on location, 225 whether a new-build or refurbishment, local staffing issues and demographics. 226

The initial briefing document is vitally important and the make-up of the client project 227 team should encompass all sections of the workforce. The design brief details client 228

requirements and informs the development of the design as it progresses and: 229

provides a clear set of instructions setting out the overarching goals 230

can be used to assess proposals as they are refined. It enables all 231

stakeholders to be aware of the project scope and intended functionality. 232

When finalised, it ensures that there is no scope creep or shortfall. 233



can be used to inform a feasibility study and can be used to develop cost 234

and time estimates (etc). 235

The project team should familiarise itself with the intentions of design guides. The 236

generic activity spaces described in this HBN are as described in the full suite of HBNs, 237 including the standard sizes described in HBNs 00-01, 00-02, 00-02 and 00-04 (and 238 also in the ProCure22 Repeatable Room documentation). 239

The design brief will start with a definition of the services or functions to be 240 accommodated, decomposing these functions into specific sub-functions and then to 241

activities. 242

A schedule of accommodation (in effect, a functional brief) is compiled. This sets out 243 the accommodation specifics for preparation of design options and includes: 244

the number and size of activity spaces / rooms 245

relationships between rooms and groups of rooms 246

equipment, furniture, finishes required that will fit the activity space / room 247

for its functional purpose 248

the environmental conditions required for each activity space / room 249

(temperature range, humidity, air movement, acoustics, etc) 250

functional specifications of the department / unit including considerations 251

such as: how it will interact with the whole hospital / healthcare facility; 252

inter-dependencies; fit with policies and organisational goals; intended 253

outputs and benefits; intended further phases of development. 254

Design and quality considerations 255

The healthcare planning and design process needs to be broad enough to include not 256 only the issues surrounding the treatment of disease, but also the promotion of health 257 and prevention of disease – essentially the creation of a safe and therapeutic care 258

environment. 259

Whole hospital policies will generally cover: 260

safety and security including lock-down; 261

privacy and dignity; 262

interior design; 263

wayfinding and access; 264

infection prevention and control; 265

supply and distribution; 266

fire safety strategy; 267

equality; 268

[DN: QUESTION FOR REVIEWERS: what other policies should be included 269

here?]. 270

The following sections cover recognised best practice in the healthcare planning and 271 design processes. 272



Involvement of patients and carers in planning and 273

design 274

It is strongly recommended that patients are involved in the co-production of planning 275 and design at a local level. 276

Patients and their carers are experts about themselves and as such are clearly 277 important members of the healthcare team. In the US, a 2017 scientific advisory panel 278 analysed research evidence and compiled a “Framework for Patient and Family 279

Engaged Care”6 (see Appendix X for a discussion document). 280

[DN: QUESTION FOR REVIEWERS: would it be useful to include this as an 281

appendix?] 282

The framework defines steps that healthcare organisations can take to make sure that 283 they are partnering with patients and families in their care: “Patient and family engaged 284 care (PFEC) is care planned, delivered, managed, and continuously improved in active 285 partnership with patients and their families (or care partners as defined by the patient) 286

to ensure integration of their health and health care goals, preferences, and values. It 287

includes explicit and partnered determination of goals and care options, and it requires 288 ongoing assessment of the care match with patient goals.” 289

Successful PFEC requires conversations with healthcare providers about what health 290

means to patient groups and to individual patients and what they need from them in 291 order to live their healthiest lives. Research shows that PFEC leads to: 292

better relationships between patients, carers and healthcare providers; 293

improved patient safety; 294

reduced healthcare costs; 295

reduced unnecessary readmissions to hospital; 296

healthcare staff feeling ‘more connected’ to their work. 297

The Planetree organisation7 based in the US is involved in developing the PFEC 298

framework. It describes person-centred care as “… more than hospitality. It is more 299

than amenities and inviting surroundings. [It] care creates positive impressions and 300 satisfying experiences, but beyond that, it improves lives. [It] creates workplaces that 301 energise and inspire joy at work. It improves health outcomes and unites communities 302

around health and wellness. It can be defined and is attainable and measurable.” 303

Similarly, the Point of Care Foundation (POCF)8 in the UK and Ireland is working to 304 “radically improve the way people are cared for and to support the staff who deliver 305 care”. It uses methodologies such as “Experience-Based Co-Design and Patient and 306 Family-Centred Care” to deliver improvements in care quality. It has programmes 307

6 See https://nam.edu/wp-content/uploads/2017/01/Harnessing-Evidence-and-Experience-to-Change-Culture-A-Guiding-Framework-for-Patient-and-Family-Engaged-Care.pdf?__hssc=139852332.3.1582387943634&__hstc=139852332.f66068011fefdb5e1797d312a2bbb842.1582387943634.1582387943634.1582387943634.1&__hsfp=3419937260&hsCtaTracking=3e06a622-355d-441e-aed6-a06f9a4609a7%7C22d6c8f5-69b5-4e23-ad25-c9762eac5855 7 See https://www.planetree.org/ for details 8 See https://www.pointofcarefoundation.org.uk/ for details

https://www.planetree.org/

https://www.pointofcarefoundation.org.uk/



running in over 200 hospitals, hospices and other organisations. For an example of 308 the POCF’s work see videos (February 2020) by Our Dorset showing training in patient 309 and engagement – and its impact: 310

https://www.pointofcarefoundation.org.uk/news/new-films-show-impact-of-311 engagement-for-an-integrated-care-system/. 312

Eliminating mixed-sex accommodation 313

Compliance with prevailing standards and guidance in respect of elimination of mixed-314 sex accommodation is required. The DHSC requires all providers of NHS-funded care 315

to confirm that they are compliant with the national definition “to eliminate mixed sex 316 accommodation except where it is in the overall best interests of the patient or reflects 317 the patient's choice”. 318

Care Quality Commission (CQC9) inspections regularly assess compliance of 319 essential standards of quality and safety by those providing NHS services, including 320

NHS-funded care and hospices.10 NHS services should eliminate mixed sex 321 accommodation where it is in the best interests of the individual or reflects personal 322

choice. However, the CQC advises its inspectors that there are some exceptions, 323 including: 324

in the event of a life-threatening emergency; 325

where critically ill patients need one-to-one nursing care in ITU; 326

where a nurse must be physically present in the room/bay at all times e.g. 327

in level 2 (high dependency care); 328

where a short period of close patient observation is needed e.g. post 329

anaesthetic recovery; 330

on the joint admission of couples or family groups. 331

The CQC advises that there is no justification for placing a person in mixed sex 332

accommodation for the following reasons (or similar): 333

more convenient for staff; 334

a shortage of staff or poor skill mix; 335

a shortage of beds; 336

predictable fluctuations in activity or seasonal pressures; 337

predictable non-clinical incidents e.g. ward closures; 338

while waiting for assessment, treatment or a clinical decision; 339

because of restrictions imposed by old estate (i.e. old buildings and 340

facilities are not considered an excuse for non-compliance); 341

9 The CQC is an independent regulator of health and adult social care services in England and protects the interests of those whose rights are restricted under the Mental Health Act 10 See https://services.cqc.org.uk/sites/default/files/gac_-_dec_2011_update.pdf Essential standards of quality and safety

https://www.pointofcarefoundation.org.uk/news/new-films-show-impact-of-engagement-for-an-integrated-care-system/

https://www.pointofcarefoundation.org.uk/news/new-films-show-impact-of-engagement-for-an-integrated-care-system/

https://services.cqc.org.uk/sites/default/files/gac_-_dec_2011_update.pdf



based on a clinical specialism (i.e. caring for people within the same 342

clinical specialty e.g. respiratory or orthopdaedics is not an excuse for 343

noncompliance); 344

a ‘take it or leave it’ approach (i.e. if the patient had to choose between 345

accepting mixed sex accommodation and going elsewhere); 346

custom and practice. 347

Mixed sex accommodation refers not only to sleeping arrangements, but also to 348 bathrooms or WCs and the need for patients to pass through areas for the opposite 349 sex to reach their own facilities. 350

There is an additional requirement for mental health and learning disability inpatient 351 units in relation to the availability of same-sex day space, particularly for women who 352

use services. In mental health, promoting physical and sexual safety through 353 eliminating mixed sex accommodation is one of the key things that is cited in terms of 354 promoting sexual safety. 355

Children, and in particular adolescents, need special consideration. 356

The national guidance on eliminating mixed-sex accommodation is only relevant in 357 areas where patients are admitted. Therefore, mixed-sex units are not in breach of the 358

guidance if patients treated will go home the same day their care is provided. 359

NHS organisations should have a policy on mixed sex accommodation. The policy 360

should state what exceptions are permissible and what action staff should take if there 361 is a potential or actual breach. All staff should be aware of the policy. There should be 362 clear monitoring procedures to record where and why a breach has occurred and 363

actions taken to avoid a repeat. (See Appendix 2, Policies Checklist.) 364

Providing privacy and dignity 365

Privacy and dignity are very important to people receiving care. There may be 366

evidence linked to Outcome 1 (of 28) of the CQC’s 16 essential standards: ‘Staff must 367 be aware of the importance of maintaining dignity and privacy at all times and take 368

action’. These outcomes outline what the CQC expects people using a service to 369 experience when the provider is meeting the essential standards. 370

The focus should be on people’s experiences of care, and the quality of the treatment 371

and support that they receive. (This is what matters most to people who use services, 372 rather than the underpinning systems, policies and processes needed to deliver their 373

care.) 374

Creating a therapeutic environment 375

“Environments are considered therapeutic (with healing qualities) when 376 there is direct evidence that a design intervention contributes to 377

improved patient outcomes.” 378

(Chapter 12 of ‘Investing in hospitals of the future’ (WHO, 2009)). 379



Healthcare facilities should provide a therapeutic environment in which the overall 380 design of the building contributes to the process of healing and reduces the risk of 381 healthcare-associated infections rather than simply being a place where treatment 382 takes place. 383

Ideally, the following should be provided, but will depend on the location of the unit 384

and whether on a community or acute site: 385

attractive external views; 386

access to nature and outdoors; 387

acoustic benefits; 388

ability to control the environment, where practicable; 389

legibility of place11, including wayfinding aids12. 390

Patients will also spend some time waiting and consideration should be given to the 391 environment and appropriate entertainment/refreshments. Emphasise importance of 392 visual and physical access to nature & outdoors for orientation, stress relief, reduce 393

aggression etc. 394

There needs to be inclusion of the suitability of the unit space to enable some patients 395 to be accompanied by carers/relatives. 396

To be mindful of older people, some of whom will have dementia, refer to design 397 features in Health Building Note 08-02 – ‘General design guidance for dementia-398 friendly health and social care healthcare buildings environments13’ and The King’s 399

Fund Enhancing the Healing Environment Programme’s14 Environmental Assessment 400 Tool15. 401

Ensuring equality 402

Healthcare providers must meet all regulatory requirements with regard to equality. In 403 England, the Disability Discrimination Act (DDA)16 was repealed and replaced by the 404

11 See HBN 00-01 General design guidance for healthcare buildings (2014) especially Chapter 6, ‘Evidence-based design ideas for a therapeutic environment’ https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/316247/HBN_00-01-2.pdf 12 See the 2005 HBN on effective wayfinding and signing systems https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/148500/Wayfinding.pdf 13 See https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/416780/HBN_08-02.pdf 14 The King’s Fund’s Enhancing the Healing Environment Programme encouraged and enabled nurse-led teams to work in partnership with patients to improve the environment in which they deliver care. The EHE programme has now been completed and the work on dementia friendly-design is being taken forward by the Association for Dementia Studies, University of Worcester, see https://www.worcester.ac.uk/about/academic-schools/school-of-allied-health-and-community/allied-health-research/association-for-dementia-studies/home.aspx 15 See https://www.kingsfund.org.uk/sites/default/files/EHE-dementia-assessment-tool.pdf for this PDF tool 16 See http://www.legislation.gov.uk/ukpga/1995/50/contents and https://www.gov.uk/definition-of-disability-under-equality-act-2010

https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/316247/HBN_00-01-2.pdf

https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/316247/HBN_00-01-2.pdf

https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/148500/Wayfinding.pdf

https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/148500/Wayfinding.pdf

https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/416780/HBN_08-02.pdf

https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/416780/HBN_08-02.pdf

http://www.worcester.ac.uk/dementia

https://www.worcester.ac.uk/about/academic-schools/school-of-allied-health-and-community/allied-health-research/association-for-dementia-studies/home.aspx

https://www.worcester.ac.uk/about/academic-schools/school-of-allied-health-and-community/allied-health-research/association-for-dementia-studies/home.aspx

https://www.kingsfund.org.uk/sites/default/files/EHE-dementia-assessment-tool.pdf

http://www.legislation.gov.uk/ukpga/1995/50/contents

https://www.gov.uk/definition-of-disability-under-equality-act-2010

https://www.gov.uk/definition-of-disability-under-equality-act-2010



Equality Act (2010)17. The Equality Act covers the same groups that 405 were protected by existing equality legislation – age, disability, gender reassignment, 406 race, religion or belief, sex, sexual orientation, marriage and civil partnership and 407 pregnancy and maternity. 408

Equality Act protected characteristics 409

The following are protected characteristics: 410

age; 411

disability; 412

gender reassignment; 413

marriage and civil partnership; 414

pregnancy and maternity; 415

race; 416

religion or belief; 417

sex; 418

sexual orientation. 419

420

The NHS Long Term Plan Section 218 makes the commitment that the service will take 421

appropriate action on prevention of ill-health and health inequalities. 422

Considering adaptability / future-proofing 423

For the majority of services, there is a likelihood that there will be changes in service 424 provision and growth in demand over time, due to advances in treatment and changes 425

in local demographics (and so on). Therefore, it is essential that local project teams 426 develop robust future-proofing / activity modelling as part of the business case process 427 for any new-build or refurbishment scheme. 428

Building in flexibility 429

Healthcare planners should ensure that the unit is designed such that it can be as 430

flexible as possible. 431

Design/decoration considerations will be dependent on infection prevention and 432 control protocols and FM cleaning regimes. See HBN 00-09 on infection control in the 433

built environment. 434

When project-specific, this will be covered within Whole Hospital Policies. 435

17 See http://www.legislation.gov.uk/ukpga/2010/15/contents and https://www.england.nhs.uk/wp-content/uploads/2016/02/nhse-specific-duties-equality-act.pdf for the NHS England response to the specific duties of the Equality Act Equality information relating to public facing functions (2016) 18 See https://www.longtermplan.nhs.uk/online-version/chapter-2-more-nhs-action-on-prevention-and-health-inequalities/

http://www.legislation.gov.uk/ukpga/2010/15/contents

https://www.england.nhs.uk/wp-content/uploads/2016/02/nhse-specific-duties-equality-act.pdf

https://www.england.nhs.uk/wp-content/uploads/2016/02/nhse-specific-duties-equality-act.pdf

https://www.longtermplan.nhs.uk/online-version/chapter-2-more-nhs-action-on-prevention-and-health-inequalities/

https://www.longtermplan.nhs.uk/online-version/chapter-2-more-nhs-action-on-prevention-and-health-inequalities/



[DN: QUESTION FOR REVIEWERS: would it be helpful to include a checklist of 436 policies as an appendix for all HBNs?] 437

Sustainability and ‘Net Zero Carbon’ targets 438

Healthcare provision is a significant contributor to the UK’s carbon footprint. (In 2019, 439 this was estimated to be around 5.4% of our greenhouse gases.) Accordingly, all NHS 440 organisations have their part to play in meeting Net Zero Carbon targets alongside 441

other sustainability measures19. 442

In January 2020, Health chief Sir Simon Stevens announced three steps the NHS will 443

take during 2020 to tackle this problem: 444

1. NHS England has established an expert panel to chart a practical route map to 445 enable the NHS to get to ‘net zero’. The panel will submit an interim report to 446 NHS England in summer 2020 and a final report ahead of the November 2020 447

UN Climate Change Conference (COP26) in Glasgow20. The panel will 448

consider changes the NHS can make in its own activities; in its supply chain; 449 and through wider partnerships; 450

2. the NHS Long Term Plan21 commits to better use of technologies22 to make up 451

to 30 million outpatient appointments redundant, sparing patients thousands of 452

unnecessary trips to and from hospital. It is estimated that 6.7 billion road miles 453 each year are from patients and their visitors travelling to the NHS; 454

3. the panel will consider changes that can be made in the NHS’s medical devices, 455

consumables and pharmaceutical supply, and areas the NHS can influence 456 such as the energy sector as the health service moves to using more renewable 457

energy. 458

Providing a safe and secure environment 459

Design solutions can assist in making healthcare facilities safer and more secure. 460 Security is always an important aspect to consider, involving: 461

the security of the unit; 462

security and safety of the people who use the unit including staff, patients 463

and visitors; 464

potential for lockdown as required (which will be covered by the 465

organisation’s Lockdown Policy). Process of controlling the movement and 466

access – both entry and exit – of people (NHS staff, patients and visitors) 467

around a Trust site or other specific Trust buildings or area in response to 468

an identified risk, threat or hazard that might impact upon the security 469

19 See https://www.england.nhs.uk/2020/01/greener-nhs-campaign-to-tackle-climate-health-emergency/ 20 See https://sdg.iisd.org/events/2020-un-climate-change-conference-unfccc-cop-26/ 21 See https://www.longtermplan.nhs.uk/ 22 See https://www.longtermplan.nhs.uk/online-version/chapter-5-digitally-enabled-care-will-go-mainstream-across-the-nhs/

https://www.england.nhs.uk/2020/01/greener-nhs-campaign-to-tackle-climate-health-emergency/

https://sdg.iisd.org/events/2020-un-climate-change-conference-unfccc-cop-26/

https://www.longtermplan.nhs.uk/

https://www.longtermplan.nhs.uk/online-version/chapter-5-digitally-enabled-care-will-go-mainstream-across-the-nhs/

https://www.longtermplan.nhs.uk/online-version/chapter-5-digitally-enabled-care-will-go-mainstream-across-the-nhs/



and/or safety of patients, staff and assets or, indeed, the capacity of that 470

facility/service to continue to operate. 471

See HBN 00-07, Resilience planning for NHS facilities23, which provides guidance on 472 designing and planning for a resilient healthcare estate. (This Technical Standard aims 473 to help NHS-funded providers to determine appropriate levels of resilience for sites, 474 buildings and installations against a wide range of emergencies, hazards and threats 475

and their impacts and consequences including resilience to the impacts of climate 476 change.) 477

478

479

480

23 See https://www.gov.uk/government/publications/resilience-planning-for-nhs-facilities

https://www.gov.uk/government/publications/resilience-planning-for-nhs-facilities



Contents 481

482

Introduction to the Technical Standards ................................................................................................ 3 483

What is best practice guidance? ......................................................................................................... 3 484

Health Building Notes (HBNs) ......................................................................................................... 3 485

Health Technical Memoranda (HTMs) ............................................................................................ 4 486

Compliance matters ............................................................................................................................ 5 487

Assurance of healthcare infrastructure .............................................................................................. 6 488

Language usage in Technical Standards.............................................................................................. 6 489

Project derogations from the Technical Standards ............................................................................ 7 490

Overview of the healthcare planning process ........................................................................................ 8 491

Purpose of the design brief ................................................................................................................. 9 492

Design and quality considerations ........................................................................................................ 10 493

Involvement of patients and carers in planning and design ............................................................. 11 494

Eliminating mixed-sex accommodation ............................................................................................ 12 495

Providing privacy and dignity ............................................................................................................ 13 496

Creating a therapeutic environment ................................................................................................ 13 497

Ensuring equality............................................................................................................................... 14 498

Equality Act protected characteristics .......................................................................................... 15 499

Considering adaptability / future-proofing ....................................................................................... 15 500

Building in flexibility .......................................................................................................................... 15 501

Sustainability and ‘Net Zero Carbon’ targets .................................................................................... 16 502

Providing a safe and secure environment ........................................................................................ 16 503

1.0 Introduction to Health Building Note 10-01 ................................................................................... 23 504

Policy context .................................................................................................................................... 23 505

Adaptability / flexibility and future-proofing .................................................................................... 24 506

2.0 Access .............................................................................................................................................. 24 507

Patient journey / patient pathway .................................................................................................... 24 508

In-patient surgery ............................................................................................................................. 25 509

Day surgery ....................................................................................................................................... 25 510

‘Loop’ pathway .............................................................................................................................. 25 511

‘Shuffle’ pathway .......................................................................................................................... 25 512

3.0 Activity spaces ................................................................................................................................. 26 513

Functional Content & Space Standards ............................................................................................ 26 514



Space standards: HBN 10-01 ......................................................................................................... 26 515

Space standards: HBN 00 series .................................................................................................... 26 516

Space standards: ProCure 22 Framework ‘Repeatable Rooms’ ................................................... 27 517

Developing the schedule of accommodation ................................................................................... 27 518

Front of House / Entrance Facilities .................................................................................................. 29 519

Reception & Staff Base:................................................................................................................. 29 520

Waiting Room: .............................................................................................................................. 29 521

Admissions Lounge: ...................................................................................................................... 29 522

Interview / Counselling Room: ...................................................................................................... 30 523

Operating Theatre Suite .................................................................................................................... 30 524

Traditional UK General Arrangement: .......................................................................................... 30 525

Patient & Staff Flows: .................................................................................................................... 31 526

Air Pressure Regime: ..................................................................................................................... 31 527

General Operating Theatre ............................................................................................................... 31 528

The space will be used by: ............................................................................................................ 32 529

The area will accommodate: ......................................................................................................... 32 530

Activities: ....................................................................................................................................... 32 531

Adjacencies: .................................................................................................................................. 33 532

Suggested Room Layout:............................................................................................................... 34 533

Minor Operating Theatre .................................................................................................................. 35 534



Activities: ....................................................................................................................................... 35 537


Enhanced Treatment ........................................................................................................................ 38 539



Activities: ....................................................................................................................................... 38 542

Adjacencies: .................................................................................................................................. 39 543


Anaesthetic Room ............................................................................................................................. 41 545


Activities: ....................................................................................................................................... 41 547

Adjacencies: .................................................................................................................................. 42 548




Preparation Room ............................................................................................................................. 43 550


Activities: ....................................................................................................................................... 44 552

Adjacencies: .................................................................................................................................. 44 553


Scrub up & Gowning ......................................................................................................................... 45 555


Activities: ....................................................................................................................................... 45 557

Adjacencies: .................................................................................................................................. 46 558


Theatre Dirty Utility .......................................................................................................................... 47 560


Activities: ....................................................................................................................................... 47 562

Adjacencies: .................................................................................................................................. 48 563


Exit Bay .............................................................................................................................................. 48 565

Alternative Theatre Suite Model ...................................................................................................... 49 566

General Department Arrangement:.............................................................................................. 49 567

Sedation within the theatre: ......................................................................................................... 49 568

Scrub on entry to the department: ............................................................................................... 49 569

Dirty items bagged and taken to disposal hold: ........................................................................... 49 570

Disposal Hold .................................................................................................................................... 50 571


Storage .............................................................................................................................................. 51 573

Bulk Store: ..................................................................................................................................... 51 574

Clinical Equipment Store: .............................................................................................................. 51 575

Linen Store: ................................................................................................................................... 51 576

Ready-use Store: ........................................................................................................................... 52 577

Blood Storage: ............................................................................................................................... 52 578

Storage Requirement Calculator: .................................................................................................. 52 579

Recovery Unit .................................................................................................................................... 52 580

Suggested General Arrangement: ................................................................................................. 52 581

Recovery Room / Bays: ................................................................................................................. 53 582

Recovery Staff Base ....................................................................................................................... 53 583

Recovery Clean Utility ................................................................................................................... 54 584



Recovery Dirty Utility .................................................................................................................... 54 585

Staff Accommodation ....................................................................................................................... 54 586

Rest Facilities:................................................................................................................................ 54 587

Beverage Bay:................................................................................................................................ 54 588

Changing Facilities: ........................................................................................................................ 54 589

Offices: .......................................................................................................................................... 54 590

Hybrid Operating Theatres ............................................................................................................... 54 591


Adjacencies: .................................................................................................................................. 56 593


Support/utility ............................................................................................................................... 57 595

4.0 Engineering requirements .............................................................................................................. 58 596

Introduction ...................................................................................................................................... 58 597

Environmental requirements ............................................................................................................ 58 598

Energy ............................................................................................................................................... 58 599

Maximum demands .......................................................................................................................... 59 600

Services distribution .......................................................................................................................... 59 601

Isolation ............................................................................................................................................ 59 602

Commissioning .................................................................................................................................. 59 603

The operating theatre ....................................................................................................................... 60 604

Mechanical services ...................................................................................................................... 60 605

Electrical services .......................................................................................................................... 61 606

Public health services .................................................................................................................... 63 607

First stage and second stage recovery .............................................................................................. 63 608

Mechanical services ...................................................................................................................... 63 609

Electrical services .......................................................................................................................... 65 610

Public health services .................................................................................................................... 67 611

References ............................................................................................................................................ 68 612

HBNs .............................................................................................................................................. 68 613

HTMs ............................................................................................................................................. 68 614

Acts and Regulations ..................................................................................................................... 68 615

Standards ...................................................................................................................................... 68 616

NHS national policies .................................................................................................................... 68 617

Other ............................................................................................................................................. 68 618

Wider sources of healthcare planning information, tools and support ........................................... 69 619



NHS England & NHS Improvement’s Model Hospital Portal......................................................... 69 620

The ProCure22 Framework ........................................................................................................... 69 621

Miscellaneous sources including professional membership organisations .................................. 69 622

Appendices ............................................................................................................................................ 72 623

Room data sheets ............................................................................................................................. 72 624

Useful reading ..................................................................................................................................... 116 625

626

627



1.0 Introduction to Health Building Note 628

10-01 629

1.1 HBN 10-01 ‘Facilities for surgery’ is a new Technical Standard that replaces 630 HBN 26 ‘Facilities for surgical procedures’ (2004) and HBN 10-02 ‘Facilities for 631

day surgery units’ (2007). It provides guidance on the planning and design of 632 infrastructure for inpatient and day patient surgical services in the UK. Since 633 HBNs 26 and 10-02 were published, research shows that common problems in 634 operating theatre suites include: 635

Design-related factors: 636

o ventilation 637

o temperature and humidity 638

o acoustical environment 639

o lighting 640

o materials 641

Environmental threats to patient safety include: 642

o frequent door swings 643

o clutter 644

o poor air quality 645

o surface contamination 646

o excessive noise 647

Staff performance and satisfaction are impacted by factors such as: 648

o general layout 649

o equipment and furniture 650

o ergonomics 651

1.2 HBN 10-01 addresses these issues, providing new standards – activity space 652

layouts, adjacencies, functional content and exemplar schedules of 653 accommodation. Checklists for stakeholder needs and quality of patient/staff 654 experience are included. [DN: these to follow.] Engineering considerations have 655 been updated and reference the latest guidance, standards, regulations and 656

legislation. 657

Policy context 658

1.3 The design of operating suites requires a complete understanding of not only 659 built environment factors but also roles of different team members, the tasks 660 they perform, the processes involved during a procedure, and the myriad 661

equipment and technology that is integrated into the department / unit zones. 662

1.4 This HBN is a response to latest thinking. The strongest body of research deals 663

with environmental factors impacting bacterial contamination and SSIs: 664



Laminar flow ventilation systems have been shown to help reduce SSIs in 665

some studies while other studies showed no difference between laminar 666

flow systems and traditional ventilation systems. 667

Frequent door swings are also a major problem that affect airflow and 668

cause disruptions. 669

1.5 Persistent problems posed by the built environment to patient and staff safety 670 are generally in the form of contaminated surfaces, inadequate workspaces, 671 trip hazards, loud noises, poor furniture and equipment ergonomics, and 672 uncomfortable working environments (temperature, humidity, and air quality). 673 Appropriately-sized activity spaces are critical, given the increasing amount of 674

equipment and numbers of people in the modern theatre suite. Storage needs 675 are such that essential items must be immediately available at hand. 676

Adaptability / flexibility and future-proofing 677

1.6 Surgical practices evolve more rapidly than one can modify a corresponding 678 built environment. The complex interaction of these system components and 679 spaces will have an impact patient and staff safety, efficiency, and satisfaction. 680

1.7 Built environments will evolve over the coming years, as technology advances 681

rapidly, and as many different types of procedures can be done safely as day 682

cases. Innovation in design should keep pace with innovation in clinical 683 services. It must be based on a strong understanding of the evidence base and 684 be informed by a multidisciplinary systems approach to developing and testing 685

concepts and ideas. 686

687

2.0 Access 688

Patient journey / patient pathway 689

2.1 The design of the facility should facilitate uninterrupted patient flow. On their 690 operation day, patients make the following journey through: 691

main reception area; 692

admission suite; 693

sub-waiting area; 694

anaesthetic room; 695

operating theatre; 696

post-anaesthesia care unit (PACU); 697

second-stage recovery; 698

discharge lounge. 699

2.2 The operating theatres should be on the same floor as the admission suite and 700 recovery areas. 701



2.3 As an increasing number of patients undergo surgery without a general 702 anaesthetic, remaining conscious throughout the entire procedure, and hence 703 remain aware of their surroundings even in the operating theatre. 704

2.4 Designers should aim to create an environment that is conducive to making 705 patients feel at ease and giving them confidence, thus aiding the healing 706

process. At the same time, it should facilitate efficient working, and contribute 707 to staff morale. 708

In-patient surgery 709

710

711

[DN: QUESTION FOR REVIEWERS: is this diagram useful? Is it correct? Should 712 critical care be added as an alternative to recovery?] 713

Day surgery 714

‘Loop’ pathway 715

2.5 After Recovery Stage 1, patients go to post-op prior to discharge. 716

717

[DN: QUESTION FOR REVIEWERS: is this diagram useful? Is it correct?] 718

‘Shuffle’ pathway 719

2.6 Patients go to recovery prior to discharge. 720



721

[DN: QUESTION FOR REVIEWERS: is this diagram useful? Is it correct?] 722

723

724

725

3.0 Activity spaces 726

Functional Content & Space Standards 727

3.1 Case mix and demand will affect capacity and how this will have an impact on 728 the design of the unit. Professional healthcare planners will model activity data 729 in order to convert demand into space requirements. There are many factors to 730

be taken into account: it is likely that different models will be used. 731

Space standards: HBN 10-01 732

3.2 Highly-specialist activity spaces described by this HBN include: 733

Theatre 734

Minor theatre 735

Enhanced treatment 736

Hybrid catheter 737

Hybrid CT 738

Anaesthetic 739

Prep 740

Scrub 741

Frozen section 742

Control room 743

Space standards: HBN 00 series 744

3.3 Many of the rooms that are found in the operating department are standard and 745 repeatable rooms that are described in HBN 00 or within the documentation for 746

P22 Framework schemes (see below). The HBN 00 series provides guidance 747 on space standards for the following in healthcare settings: 748

HBN 00-01: general design principles. 749

HBN 00-02: bathrooms, shower rooms, changing areas and toilets. 750

HBN 00-03: generic clinical and clinical support spaces including 751

bedrooms, consulting rooms and offices. 752




HBN 00-04: circulation and communication spaces including corridors and 753

stairs. 754

HBN 00-10: flooring, walls, ceilings, sanitary assemblies and windows. 755

3.4 Spaces around regular activities are shown as coloured blocks. For details 756 about the make-up of these zones, refer to HBN 00-03. 757

3.5 HBN-compliant room data sheets (RDS) should be used. (See Appendix X for 758 RDS exemplars relevant to this HBN.) 759

Space standards: ProCure 22 Framework ‘Repeatable Rooms’ 760

3.6 For capital schemes using the framework, ProCure 22 provides guidance 761 on project management and a set of bespoke Repeatable Rooms via the 762 ProCure22 Club24. 763

[DN: update Framework reference if it is renewed before publication of this HBN.] 764

Developing the schedule of accommodation 765

3.7 Before early design-team user-group meetings, but following discussion with 766

the client during the briefing process, the healthcare planner will ideally have 767 assembled a preliminary schedule of accommodation using standard/ 768

repeatable rooms with specialist rooms as required. 769

3.8 The schedule of accommodation will list all rooms, following the patient through 770

the department, and giving the floor areas of each. No schedule of 771 accommodation will be the same for different units in different scenarios as the 772

model of care, local demographics, staffing levels, and other local provision will 773 impact on the final brief. 774

The design team will use the HBN notional schedule of accommodation 775

as a baseline in order to develop a project specific schedule based on the 776

clinical demand of individual healthcare providers. 777

The healthcare organisation’s user group meetings will refine and 778

delineate requirements. 779

24

The ProCure22 Club is a community of professionals who have been involved with one or more ProCure21+ or ProCure22 schemes. The Club

gives access to many resources, including:

the ProjectShare repository of scheme information, including the Standardisation initiative’s repeatable rooms;

the StandardShare repository of scheme information, including the Standardisation initiative’s standardised components;

details of current schemes;

all guidance and documentation on ProCure22. Potential ProCure22 clients should complete and submit their details below, potential or existing Principal Supply Chain Managers should contact their PSCP to authorise access. Other requests should be discussed directly with Zamir Bi, ProCure22 Administrator, on 0113 254 6133 or email [email protected].

https://procure22.nhs.uk/procure22-club/

mailto:[email protected]



3.9 The client and design team should be aware that the choice of procurement 780 route may have an impact on the choice of activity spaces and thus the 781 schedule of accommodation. 782

783

784

785

786

787

788

Figure X: Design team response to procurement route 789

790

3.10 The process is as follows: 791

792

Design team develops

activity spaces compliant with procurement

route

Client chooses procurement route

Client directs design team to follow appropriate guidance

Design team responds to user requirements including model of care, local demographics, staffing levels and other local provisions

User group meetings delineate requirements

and refine the schedule of accommodation

Design team creates a project-specific schedule of accommodation based on local clinical demand

Design team uses the HBN exemplar schedule of accommodation as a

baseline

Project-specific

schedule of

accommodation



793

Front of House / Entrance Facilities 794

Reception & Staff Base: 795

3.11 On entering the department, the patient should be greeted by a reception desk. 796 Guidance for provision of reception desks can be found in HBN 00-03 Section 797 7. 798

3.12 Depending on the layout of the department, additional staff bases may be 799

required. 800

Waiting Room: 801

3.13 The area of the central waiting space area will be calculated to accommodate 802 the maximum number of predicted patients and will also allow for escorts, 803

carers and wheelchair users. A metric will be used to determine the numbers 804 which will depend on location and demographics. The patient may be ambulant 805 or in a wheelchair. The waiting area should be overseen by the staff base. 806 Beverage facilities and sanitary facilities should be close by. Information 807

systems should be provided and the ambience of the room should be calming 808 and relaxing. Refer to HBN 00-03, chapter 7 for guidance on waiting-area 809

provision. 810

Admissions Lounge: 811

3.14 If patients arrive in the operating department for surgery straight from their 812 homes, the waiting room should be utilised as part of the admissions lounge. 813

The size of the room should be increased to accommodate up to ten people at 814 one time. 815

3.15 Patients arriving in the lounge will have had their pre-operative assessment and 816 examination previously and should only require minimal physical assessment 817

on the day of surgery. A small number of consulting/ changing rooms with an 818

examination couch will be required, with entry from the waiting area and a 819

separate exit to the operating suite. 820

3.16 Under this system, patients will be formally identified and admitted once they 821 have entered a consulting room, in order to maintain their privacy. They will 822 change in this room and not return to the waiting area. All doors will require 823 secure access and should be wheelchair-accessible. The patients’ clothing will 824

be securely labelled and transferred to their in-patient accommodation via the 825 recovery unit. 826

3.17 Refer to HBN 00-03 for guidance on the provision of consulting rooms. 827



Interview / Counselling Room: 828

3.18 An Interview / counselling room should be provided for quiet conversations and 829 for breaking bad news to patients and their families. Examples of standard 830

counselling rooms are described within HBN 00-03. 831

3.19 This room can be used flexibly as required. 832

Operating Theatre Suite 833

3.20 Whilst each room will be described individually, it is important to first consider 834

the suite as a whole, for the purpose of patient and staff flows, clean and dirty 835 areas, and air pressure regimes. 836

Traditional UK General Arrangement: 837

3.21 The majority of UK operating theatre suites consist of the following rooms: 838

Operating Theatre 839

Anaesthetic Room 840

Preparation 841

Scrub 842

Dirty Utility 843

Exit Bay. 844

3.22 This suite can then be multiplied to provide the requisite number of operating 845 theatres to meet demand. 846



3.23 Some space efficiencies can be achieved through the sharing of either the 847 anaesthetic room, scrub, or dirty utility between two or more theatres. For this 848 reason, theatre suites are often paired and therefore it is recommended in any 849 new-build facilities that there are an even number of theatres. 850

Patient & Staff Flows: 851

852

3.24 The patient will enter the theatre through the anaesthetic room and will exit via 853

the exit bay. 854

3.25 Anaesthetic staff will enter via the anaesthetic room, whilst the surgeons and 855

scrub nurses will enter via the scrub room. 856

3.26 Clean supplies are delivered to the preparation room, where they are prepared 857 and laid out on trolleys for transfer to the theatre. Dirty waste is stored in the 858

dirty utility until it is transferred to the disposal hold. It is important that the dirty 859 flow is kept away from patient and staff movement as much as is practicable. 860

Air Pressure Regime: 861

3.27 [DN: QUESTION FOR REVIEWERS: Should we include a diagram and 862

supporting text describing the air pressure regime here (or in the engineering 863 section)? 864

Cross-reference HTM 03-01.] 865

General Operating Theatre 866

3.28 The general operating theatre will be used for the majority of complex 867

interventions. 868

3.29 The recommended size for a general operating theatre is 55m2. 869



The space will be used by: 870

The patient; 871

Up to 10 staff, including: 872

o Surgical team & assisting staff; 873

o Anaesthetist & assisting staff; 874

o Circulating support staff 875

The area will accommodate: 876

A surgical zone containing the patient table, surgical team and equipment, 877

pendants, operating lights, anaesthetist and anaesthesia equipment; 878

879 A circulation zone around the outside of the surgical zone to allow for free 880

movement of staff and equipment without disturbing the surgical zone; 881

A storage zone for trolleys and equipment that are not in use to be kept 882

out of the way of the surgical team and circulation zones. 883

Activities: 884

Patient may be connected 885

to anaesthetic machine. 886

Maintenance of general 887

anaesthesia 888

Monitoring/diagnostic or 889

therapeutic equipment may 890

be used. 891



Assembling and connecting 892

mobile equipment. 893

Surgical instruments on 894

instrument trolley may be 895

used. 896

Surgical procedures may be 897

performed under local or 898

general anaesthetic. 899

Mobile image intensifier 900

may be used. 901

Computer generated 902

images are viewed using 903

ceiling or wall mounted 904

screens. 905

Used swabs may be 906

checked, weighed and 907

recorded. 908

Operating lists may be 909

displayed. 910

Recording patient 911

data/notes. 912

Electronic patient records 913

(EPRs) may be accessed 914

and updated. 915

Patient is transferred from 916

operating table to 917

bed/trolley. 918

Storage of small items of 919

equipment or consumables 920

as required 921

Theatre control panel 922

should be flush mounted. 923

"IN USE" sign sited outside 924

the doorway of the room. 925

anaesthetic machine may 926

be located on a dedicated 927

medical supply unit - project 928

team option929

Adjacencies: 930

931

3.30 The operating theatre forms part of a suite, including anaesthetic, scrub, 932 preparation, dirty utility & exit bay. In twin theatre arrangements, some of the 933 ancillary spaces may be shared. Where ancillary rooms are shared, the 934

mechanical engineer should be consulted as it will have an impact on the air 935 pressure regime and have potential for cross infection. 936



Suggested Room Layout: 937

938

939



Minor Operating Theatre 940

3.31 Where less complex interventions are undertaken, a smaller minor operating 941 theatre may be used. The operations that can be accommodated include: 942

XYZ 943

[DN: QUESTION FOR REVIEWERS: please advise which procedures should 944

be included in this list.] 945

3.32 The recommended size for a minor operating theatre is 42m2. 946

3.33 The general arrangement of the minor operating theatre is similar to that of the 947 general operating theatre, but with smaller circulation and storage zones. 948


The patient; 950

Up to six staff, including: 951



o Circulating support staff 954




A circulation zone around the outside of the surgical zone to allow for free 958

movement of staff and equipment without disturbing the surgical zone; 959

A storage zone for trolleys and equipment that are not in use to be kept 960

out of the way of the surgical team and circulation zones. 961

Activities: 962




anaesthesia 966



be used. 969





used. 974




Mobile image intensifier 978

may be used. 979






screens. 983



recorded. 986


displayed. 988


data/notes. 990



and updated. 993



bed/trolley. 996



as required 999

Theatre control panel 1000

should be flush mounted. 1001



anaesthetic machine may 1004

be located on a dedicated 1005

medical supply unit - project 1006

team option 1007

1008

1009




1011

1012



Enhanced Treatment 1013

3.34 Where minor interventions are required, an enhanced treatment room may be 1014 used. The operations that can be accommodated include: 1015

XYZ 1016

[DN: QUESTION FOR REVIEWERS: please advise which procedures should 1017

be included in this list.] 1018

3.35 The recommended size for an Enhanced Treatment Room is 24m2. 1019

3.36 Patients in an enhanced treatment room will not be placed under general 1020 anaesthetic. 1021


The patient; 1023

Up to three staff, including: 1024

o Surgeon; 1025

o Scrub and support team. 1026




A circulation zone for entry from ancillary rooms and movement; 1030

A storage zone. 1031

Activities: 1032



be used. 1035





used. 1040



anaesthetic or nerve block 1043




screens 1047



recorded. 1050


displayed. 1052


data/notes. 1054



and updated. 1057





bed/trolley. 1060



as required 1063


the doorway of the room.1065

Adjacencies: 1066

3.37 The enhanced treatment room will not require a full theatre suite of rooms but 1067

may use an en-suite scrub and preparation room. 1068

1069




1071



Anaesthetic Room 1072

3.38 Dedicated anaesthetic rooms are often provided in the UK, however elsewhere 1073 in the world the patient is often anaesthetised within the operating theatre. The 1074 requirement for dedicated anaesthetic rooms will be a project decision. 1075

3.39 Initial clinical procedures, for example monitoring and the insertion of 1076 intravenous infusions, will commence in the anaesthetic room. 1077

3.40 In most circumstances a patient will be transferred to the anaesthetic room from 1078 either the in-patient ward or the admissions lounge accompanied by a nurse 1079

escort, parent or carer. 1080

3.41 It is essential to be able to access the patient from all sides. 1081

3.42 Privacy, and the maintenance of an undisturbed environment, is of great 1082 importance. 1083

3.43 The recommended size for an anaesthetic room is 19m2. 1084


The patient; 1086

Up to two staff, including: 1087

o Anaesthetist & assistant; 1088

1 other (i.e. Patient escort). 1089

Activities: 1090

Anaesthetic accessories 1091

and equipment are stored. 1092

Controlled and scheduled 1093

drugs are stored securely. 1094

Holding/storing sterile 1095

equipment. 1096

Holding/storing stock of 1097

infusion fluids. 1098

Refrigerated storage of 1099

drugs/medicines. 1100


displayed. 1102


data/notes. 1104

Collecting used anaesthetic 1105

accessories for 1106

reprocessing. 1107

Collecting waste materials 1108

for disposal. 1109

Clinical wash-hand basin 1110

will be used. 1111

Administration of 1112

intravenous analgesia 1113

Administration of general 1114

anaesthesia 1115


anaesthesia. 1117




therapeutic equipment will 1119

be used 1120

Consideration should be 1121

given to the patient transfer 1122

methodology (i.e. within 1123

anaesthetic room or theatre 1124

and where and how hoists 1125

are used). 1126

The call repeat lamp and 1127

controlled drugs cupboard 1128

indicator are situated over 1129

the door outside the room. 1130

Room in use switch and 1131

indicator (optional) 1132

A music system may be 1133

provided to reduce patient 1134

anxiety; 1135

Specialist table attachments 1136

may be stored here; 1137

Ceiling mounted hoist 1138

subject to local evaluation of 1139

space and fittings. 1140

Adjacencies: 1141

1142

3.44 The anaesthetic room will be en-suite to the theatre and will need to be 1143

accessed from outside the theatre. 1144

1145




1147

1148

Preparation Room 1149

3,45 Instrument packs and other sterile supplies for the day’s operating list are 1150 delivered to the preparation room of each theatre from the sterile store. 1151

3.46 The preparation room should provide storage and suitable work surfaces for 1152

the laying-up of instrument trolleys. 1153

3.47 The recommended size for a preparation room is 12m2. A larger room may be 1154 required for organ transplant procedures. 1155

3.48 If the operating theatre has ultra-clean ventilation, there is an option to omit a 1156 preparation room, as instruments can be laid up in the operating theatre 1157 beneath the ventilation canopy. However, there are design implications to which 1158 robust solutions should be found: 1159

a suitable alternative location for the storage of immediate back-up sterile 1160

supplies, instrument packs and other items such as lotions, suturing 1161

material and sterile fluids and the heated lotion cabinet should be 1162

provided. 1163

Where a preparation room is omitted, an anaesthetic room must be 1164

provided, as the laying-up of instrument trolleys is not acceptable at the 1165

same time that the patient is being induced in the operating theatre. 1166




A minimum of two members of staff. 1168

Activities: 1169

Instrument trollies and 1170

equipment are stored. 1171

Temporarily holding/storing 1172

sterile equipment and 1173

consumables sufficient for 1174

the operating list planned 1175

A small supply of common 1176

consumables to be stored 1177

(e.g. sutures and dressing 1178

materials). 1179

A heated lotion cabinet is 1180

sited in this room. 1181

Holding/storing stock of 1182

warmed irrigation fluids. 1183


displayed. 1185

Sterile instrument trolleys 1186

for the operation procedure 1187

at hand will be prepared by 1188

a scrubbed instrument 1189

technician/nurse with the 1190

assistance of at least one 1191

circulating nurse. 1192

Prepared instrument trolleys 1193

will be transferred into 1194

theatre at the appropriate 1195

time without contaminating 1196

the instruments or drapes. 1197

Collecting waste materials 1198

for disposal. 1199

Separate data and voice 1200

outlets may be used where 1201

structured cabling solutions 1202

are not available1203

1204

Adjacencies: 1205

1206

3.49 The preparation room will be en-suite to the theatre and will need to be 1207

accessed from outside the theatre to allow for the delivery of clean supplies. 1208




1210

Scrub up & Gowning 1211

3.50 The scrub up and gowning area is used by surgical staff to scrub their hands 1212

and arms before surgery, and to put on their surgical gown (assisted by a 1213 circulating nurse). In some instances, the scrub nurse will gown and glove the 1214

surgeon and surgical assistants). 1215

3.51 The recommended size for a scrub room is 9.5m2 to allow for 3 people to use 1216 the scrub sink. A project option is to instead provide a recessed scrub bay within 1217 the theatre. 1218

3.52 One scrub and gowning room can be shared between two operating theatres, 1219 both of which should be directly accessible with sufficient space for six people, 1220

with three people scrubbing back to back. In this situation, the mechanical 1221 engineer should be consulted, as it will have an impact on the air pressure 1222 regime. 1223


Up to three surgical staff (six in a shared room); 1225

Scrub/circulating nurse. 1226

Activities: 1227



Staff will scrub for the 1228

appropriate period at a 1229

suitable trough 1230

Staff will be able to view a 1231

clock to time their scrub 1232

Provision of medicated 1233

scrub solution and medical 1234

hand sanitizer is made to 1235

suit the number of people 1236

scrubbing 1237

Provision of sterile 1238

scrubbing brushes 1239

Provision of paper towels 1240

Sterile Gown Packs are 1241

stored away from the area 1242

of possible splash-back 1243

A selection of different sizes 1244

of Sterile Gloves is stored 1245

away from the possible area 1246

of splash-back (potentially 1247

in a purpose built glove 1248

dispenser container. 1249

A gowning trolley for 1250

opening sterile packs is 1251

located at a safe distance 1252

from the trough 1253

Used paper towels and 1254

opened gown packaging is 1255

discarded into appropriately 1256

sized waste bins. 1257

A circulating nurse is 1258

available to tie gowns for 1259

the scrubbed personnel 1260

Project option to configure 1261

this as a six-person room 1262

serving two theatres 1263

Adjacencies: 1264

3.53 The scrub room will be en-suite to the theatre and will need to be accessed 1265 from outside the theatre. 1266

1267




1269

1270

Theatre Dirty Utility 1271

3.54 The theatre dirty utility room should be large enough to enable cleaning of 1272

theatre equipment, and disposal of rinse bowls, suction bottles and other 1273 surgical waste. A disposal unit consisting of sink and hopper with concealed 1274 cistern should be provided. Mops and buckets for immediate use in theatre are 1275

stored here, and a bucket sink is required. 1276

3.55 After use, re-usable instruments are stored on a distribution trolley (either in 1277 sealed containers or the trolley itself is able to be closed/sealed) in the dirty 1278 utility. When the trolley is full it is taken to the disposal hold to await the return 1279

of instruments to the sterile services department. 1280

3.56 Space is not required for holding materials for disposal or reprocessing since 1281 sacks and bags, once full, should be closed and taken to the disposal hold to 1282 await collection. The whole-hospital policy for disposal will determine the 1283

frequency of collection. It should, however, be acknowledged that volumes of 1284 waste from a single procedure may be considerable. 1285


Up to two staff. 1287

Activities: 1288

Disposal of liquid waste 1289 Holding sharps in a 1290

container 1291



Clinical waste will be 1292

disposed of 1293

Disposal of used protective 1294

clothing 1295

Disposal of non-clinical 1296

waste 1297

Items requiring disposal 1298

may be held here 1299

Items for immediate 1300

cleaning of floors and 1301

furniture within theatres will 1302

be stored here 1303

Instruments requiring 1304

reprocessing may be stored 1305

here temporarily 1306

Clinical handwashing may 1307

take place 1308

Adjacencies: 1309

3.57 The dirty utility room will be en suite to the theatre and will need to be accessed 1310 from outside the theatre. As a project option, the dirty utility may be shared 1311 between two or more theatres. 1312

1313


3.58 Refer to HBN 00-03, Section 8 for dirty utility design guidance. 1315

Exit Bay 1316

3.59 An exit bay should be provided on exit from the theatre to allow for holding of 1317 the patient’s bed prior to transfer from theatre to recovery. 1318

3.60 An exit bay may be shared between two theatres; however, single exit bays 1319 may be more efficient because they will be less likely to get blocked with storage 1320 equipment. The area should be sufficient for the parking of two beds with 1321 additional circulating space. Walls should be protected against heavy traffic in 1322 this area. 1323

3.61 The bay may contain a local equipment store. 1324



Alternative Theatre Suite Model 1325

3.62 For large operating departments, the amount of space required for en-suite 1326 ancillary rooms can be significant, with large cost implications. 1327

3.63 An alternative model is one that eliminates the need for individual rooms by 1328 treating the department as a whole. This has been employed to great success 1329 at Erasmus Medical Centre in Rotterdam. Each theatre still has an en-suite 1330

preparation room and exit bay, but that is the extent of the en-suite provision. 1331

3.64 [DN: Erasmus layout to follow] 1332

3.65 This model provides a significant saving in floor area requirements and, 1333 therefore, capital costs. 1334

General Department Arrangement: 1335

3.66 [DN: diagrams to follow] 1336

Sedation within the theatre: 1337

3.67 The use of separate anaesthetic rooms is used widely in the UK but is less 1338

common elsewhere in the World. It is common practice in the US and some 1339 European countries to exclude the traditional anaesthetic room from the 1340

operating department layout. 1341

3.68 Patients are prepared for their operation in the operating theatre, avoiding the 1342 need for dedicated anaesthetic rooms, and the duplication of anaesthetic 1343

equipment. 1344

3.69 The omission of dedicated anaesthetic rooms should be treated as a radical 1345

departure from common UK practice, and should only be considered with the 1346 full support and participation of the clinical team. 1347

3.70 Dedicated anaesthetic rooms should always be provided to operating theatres 1348 that are used for children, as it provides a much calmer environment than the 1349

theatre itself and allows for parents to accompany their children prior to 1350 sedation. 1351

Scrub on entry to the department: 1352

3.71 In this model, scrub facilities are provided at the point of entry to the department 1353

for staff, ideally close to staff welfare facilities. Staff scrub at the start of their 1354 shift, with the whole department past the scrub point being treated as clean. 1355

Dirty items bagged and taken to disposal hold: 1356

3.72 To omit the need for a dedicated dirty utility, items must be bagged and taken 1357

to the disposal hold immediately after surgery. Capacity and management of 1358 the disposal hold will need to be considered. 1359



Disposal Hold 1360

3.73 In an operating department a considerable quantity of material for disposal is 1361 generated, and a central disposal hold is required. Bagged refuse, clinical 1362 waste, soiled linen and materials for recycling are held here safely and securely 1363 while awaiting collection. This lockable room should be accessible from the 1364 hospital street. Collections may then be made without the need to enter into the 1365

main circulation space. 1366

3.74 Full “sharps” containers from the anaesthetic rooms, operating theatres and 1367 recovery unit will also be stored in the disposal hold. 1368

3.75 Project teams should also refer to the DHSC current decontamination policy to 1369 ensure that medical devices are stored and reprocessed or disposed of in a 1370 safe manner. 1371

3.76 Instruments that have been used on a possible CJD or vCJD patient should not 1372

be re-used but may be quarantined by securely storing in a rigid sealed 1373 container after use, until the diagnosis is confirmed. For further guidance see 1374

‘Advisory Committee on Dangerous Pathogens Spongiform Encephalopathy: 1375 Transmissible spongiform encephalopathy agents: safe working and the 1376

prevention of infection’ (DH, 2003). 1377

3.77 Other distribution trolleys will be stored in the hold while awaiting collection by 1378

the SSD. These trolleys can be extremely large (1500 mm x 750 mm). When 1379 planning the size of the hold, the approximate number of trolleys to be stored 1380

following an operating session and frequency of collection should be taken into 1381 consideration. 1382

1383


3.78 Refer to HBN 00-03, Section 9 for disposal hold design guidance. 1385

1386



Storage 1387

3.80 It cannot be overstated how important it is to ensure that theatre departments 1388 have the correct allowance for storage. Theatres need ready access to a large 1389 amount of equipment and consumables. 1390

3.81 The type of storage to be considered includes: 1391

Bulk Store: 1392

3.82 Packaged instrument trays and supplies are delivered from the SSD on a daily 1393

basis. Additional sterile instruments and equipment are also kept in this room. 1394 Bench-top sterilizers should not be installed, as the protocols are difficult and 1395 time-consuming to complete. Adequate instruments and an agreed turnaround 1396 time for these will obviate the need for benchtop sterilizers and reprocessing of 1397

instruments in clinical areas. 1398

3.83 Non-sterile items are also stored here. 1399

3.84 See HFN 29 – ‘Materials management (supply, storage and distribution) in 1400 healthcare facilities’ and HTM 71 – ‘Materials management modular storage’ 1401

for further details. 1402

Clinical Equipment Store: 1403

3.85 Floor space within this store is needed for a variety of equipment including drip 1404 stands, monitoring equipment, ultrasound machines and haemodialysis 1405

equipment. Where possible, clinical equipment should be stored off the floor to 1406 help maintain a dust-free environment. Shelf space is needed for smaller items 1407

such as infusion pumps, ventilator accessories, monitoring equipment and 1408 suction apparatus. Electrical socket-outlets are required for charging 1409 equipment. Under-provision of storage for equipment may lead to unused 1410 equipment being kept in patient areas. This store should be located within easy 1411

access of the recovery unit and adjacent to the equipment service room. 1412

8.86 There is also a need for storage of operating table accessories such as arm 1413

boards (for the anaesthetist or surgeon), lithotomy poles (where required) head 1414 rests (for ENT. Ophthalmology and neurosurgery) and in some instances for a 1415 specialist operating table (for orthopaedics or neurosurgery) Many table 1416 accessories are stored on a purpose provided mobile frame, some hospitals 1417 incorporate a small storage room at the main doors to theatres off the exit bay 1418

specifically for this purpose. 1419

Linen Store: 1420

3.87 Storage is required for clean linen supplies, either in a linen store or on a linen 1421 exchange trolley. The amount of linen storage required depends on the linen 1422

supplies policy, the number of deliveries per day and the number of patients. 1423



Ready-use Store: 1424

3.88 A dedicated, easily accessible store for gas cylinders is required for the 1425 operating theatre. It should conform with the requirements of HTM 2022 – 1426

‘Medical gas pipeline systems’. 1427

Blood Storage: 1428

3.89 At least one blood storage refrigerator is required in the operating department. 1429 This should be located within easy access from operating theatres and the 1430 recovery unit. Personnel from the transfusion laboratories require easy access 1431 for supply and top-up purposes. 1432

3.90 Larger departments may prefer to have two blood refrigerators, one of which 1433 could be located in the recovery unit. 1434

3.91 The refrigerator should be wired in with central alarms and, possibly, barcode 1435

locks. 1436

3.92 Use of these refrigerators is governed by national and local blood transfusion 1437

service regulations. 1438

Storage Requirement Calculator: 1439

3.93 [DN: QUESTON FOR REVIEWERS: if we can devise a metric to help project 1440 teams decide how much storage is required, would this be useful?] 1441

1442

Recovery Unit 1443

3.94 A dedicated recovery unit is required. This should be located centrally in the 1444

operating theatre department. For a department with eight operating theatres, 1445 it is recommended that a minimum of 16 recovery beds are provided. However, 1446

the final number will depend on local knowledge of the clinical specialties and 1447

the number of patients/procedures undertaken. 1448

Suggested General Arrangement: 1449

3.95 [DN: Diagrams to follow.] 1450

3.96 The recovery suite consists of the following rooms: 1451

Recovery Room / Bays 1452

Staff Base 1453

Clean Utility 1454

Dirty Utility 1455



Recovery Room / Bays: 1456

3.97 Most patients are admitted to the unit for postoperative care. Understandably, 1457 many patients are disoriented when they are waking from sedation. It is 1458

therefore essential that the environment reflect a therapeutic atmosphere whilst 1459 continuing to meet the clinical requirements. Natural daylight enhances the 1460 feeling of well-being and is desirable. 1461

3.98 Hospital protocols will determine how long the patient is to remain in recovery 1462 before being discharged back to their post-operative ward or in the case of a 1463

day case patient, to the second stage recovery area. 1464

3.99 Staff will need 360º access to a patient, therefore an island solution is required 1465

in each bed space. The main overhead lighting should be dimmable. A wall 1466 mounted clock with a sweep seconds hand is required, visible from all bed 1467 spaces. 1468

3.100 For best practice and to ensure the patient’s privacy and dignity, every bed 1469

space should be separated by radiation protected partitions or curtains, with a 1470 curtain at the foot end of each bed space. 1471

3.101 25% of the recovery spaces should be single cubicles, each of which can be 1472 utilised as a normal recovery bed but is suitably equipped for caring for Critical 1473

Care patients. Further guidance on requirements for critical care bed spaces 1474 can be found in HBN 04-02. 1475

3.102 Consideration should be given to the use of hoists in the recovery unit. A 1476 number of options are available. For maximum flexibility, a hoist in every bed 1477 space is the ideal solution for new facilities or a major refurbishment. 1478

3.103 Clinical hand-wash basins are required are required at the foot of the bed 1479 spaces. A minimum of one basin between two beds is required. 1480

3.104 Refer to HBN 00-03, Section 5 for typical recovery space design guidance. 1481

Recovery Staff Base 1482

3.105 The recovery unit requires a dedicated communications base serving as a focal 1483 point and observation post within the clinical area. It should be enclosed in a 1484 glazed partition to reduce noise levels. The base will require a minimum of three 1485 telephone lines plus data access, computer facilities and white message board, 1486 and direct access to the clean and dirty utility rooms. A number of designs have 1487

been reviewed. Some units have a large, raised central station, enclosed by 1488 partition walls of wired fireproof double-glazed glass, from which all bed spaces 1489 are visible. Advantages of this arrangement are that people can have 1490 conversations on the telephone or face-to face, while limiting the noise levels 1491 in the clinical area. All incoming information from the operating theatres, via 1492

computer links, arrives at this central point. 1493

3.106 Refer to HBN 00-03, Section 12 for general staff base design guidance. 1494



Recovery Clean Utility 1495

3.107 The clean utility provides storage for clean disposable items and equipment. It 1496 may also accommodate: 1497

lockable controlled drugs cupboard; 1498

drugs refrigerator; 1499

warm blanket storage facility. 1500

3.108 Shelf space is needed for items of equipment such as infusion pumps, ventilator 1501

accessories, monitoring equipment and suction apparatus. Electrical socket-1502 outlets are required for charging equipment. 1503

3.109 One anaesthetic machine and a cardiac arrest trolley with defibrillator should 1504 also be located here. 1505

3.110 Refer to HBN 00-03, Section 8 for clean utility design guidance. 1506

Recovery Dirty Utility 1507

3.111 The equipment in this dirty utility room will be identical to that described in the 1508

theatre dirty utility room (described in section X of this document) with the 1509

exception that if disposable bedpans, vomit bowls etc are used, a macerator is 1510

required. If re-usable bedpans etc are used, a steam washer/sterilizer is 1511 necessary. 1512

3.112 Refer to HBN 00-03, Section 8 for dirty utility design guidance. 1513

Staff Accommodation 1514

3.113 [DN: QUESTION FOR REVIEWERS: are there any HBN 10-01-specific 1515 requirements for staff accommodation that should be included here?] 1516

[DN: See HBNs XX] 1517

Rest Facilities: 1518

Beverage Bay: 1519

Changing Facilities: 1520

Offices: 1521

1522

Hybrid Operating Theatres 1523

3.114 Dedicated medical imaging rooms can be located within the Operating 1524 department as part of the theatre suite. 1525



3.115 Two models for the use of these imaging rooms are available. Either the theatre 1526 itself is equipped with imaging equipment that is moved via tracks to the patient 1527 within the operating room, or the patient is moved to an adjacent imaging room. 1528 In both cases the option of accessing the imaging room at other times, e.g. for 1529 use by intensive care patients is desirable so the location within the complex 1530

may need to consider this requirement. In either case, there will be a 1531 requirement for a control room. 1532


The Patient; 1534

Up to 8 staff, including: 1535


o Radiology team; 1537


o Circulating support staff. 1539

Activities: 1540




anaesthesia 1544



be used. 1547





used. 1552




Patient undergoes 1556

interventional diagnostic 1557

procedures 1558




screens. 1562



recorded. 1565


displayed. 1567


data/notes. 1569



and updated. 1572



bed/trolley. 1575



as required 1578



Contrast media may be 1581

administered. 1582

Disposal of waste. 1583

1584


HBN 10-01 Facilities for surgery Consultation draft February 2020 Version 1.0 56

Adjacencies: 1585

1586

Option 1 – Adjacent OR & Imaging Option 2 – Combined Hybrid Theatre 1587


1589



1590

Support/utility 1591

Storage 1592

3.116 [DN: Consider provision and storage of ultrasound machine - an ultrasound 1593 machine is a good diagnostic tool; it can be used at the patient’s side (therefore 1594

not having to move the patient). It depends on demand and sharing with ED. 1595 Which option is more efficient and less costly?] 1596

3.117 [DN: Would need a small storage room for bulk stores (e.g. IV fluids/oxygen 1597 tubing/masks etc.) Medium size? 1598

3.118 This will depend on supply and delivery and FM frequency of delivery. With 1599 clever design, these could be stored within Gratnell-type trolleys. It will vary with 1600

demand. Site visits will possibly show how they solve the supply issues.] 1601

3.119 [DN: mention medicines storage – cross-reference the new HBN 14-02.] 1602

3.120 [DN: Other storage requirements? May need to use carts as much as possible, 1603 and have a top-up system. FM-dependent, e.g linen.] 1604

Dirty utility 1605

3.121 [DN: Provision of small dirty utility with bedpan washer/macerator.] 1606



4.0 Engineering requirements 1607

Introduction 1608

4.1 This section sets out the engineering services recommendations for the 1609

specialist day surgery rooms contained within the department. 1610

4.2 It does not cover any areas outside of the rooms or infrastructure. Reference 1611 should be made to the associated HTM’s to which the designer must be familiar 1612 with. 1613

4.3 This guidance will inform the designers with the criteria and materials 1614 specification needed to meet the functional requirements. Specific 1615 requirements should be formulated in discussion with both end-users, such as 1616

clinicians as well as electrical and water safety groups and manufacturers of 1617 specialist equipment. Some issues particularly those related to the use of lasers 1618 will require specific and detailed discussion with other professional consultants. 1619

4.4 Where lasers are to be used, safety precautions in accordance with the relevant 1620

standards should be employed, including the provision of warning lights, door 1621 interlocks and pressure stabiliser shielding. 1622

Environmental requirements 1623

4.5 An increasing number of patients undergo surgery without a general 1624 anaesthetic and hence remain aware of their surroundings, even in theatres. 1625

4.6 Designers should aim to create an environment that is conducive to making 1626 patients feel at ease and giving them confidence, thus aiding the healing 1627 process. At the same time, it should facilitate efficient working and contribute to 1628 positive staff morale. 1629

4.7 Detailed environmental requirements for specialist equipment should be 1630

obtained from the manufacturers for the specific equipment to be installed. The 1631

comfort of patients and staff are an essential consideration in respect of 1632 temperature stability. Humidity and temperature control will frequently be a key 1633 feature of successful design. 1634

4.8 Centralised cooling and air conditioning units should be considered in 1635 preference to local stand-alone units. 1636

4.9 Recommended minimum environmental criteria is identified under each specific 1637 room type that follow. 1638

Energy 1639

4.10 Metering of all major plant and equipment serving the rooms should be in 1640 accordance with CIBSE recommendations and reflect Building Regulations 1641



Part L2, plus the requirements of any environmental assessment criteria, such 1642 as BREEAM. 1643

4.11 All meters should be linked to a Building Management System. 1644

Maximum demands 1645

4.12 Details of consumption and load patterns of significant individual items of 1646 equipment must be sought from manufacturers or suppliers. Most commonly 1647

the finding of this information will take place as part of the equipment tendering 1648 process which usually happens after the engineering services base design has 1649

been completed. 1650

4.13 Designers should implement a strategy whereby they utilise technical details 1651 from a minimum of three manufacturers and take worst case scenarios for 1652 inclusion in the design and in agreement with the Trust. 1653

4.14 This strategy will allow the Trust time to select the latest equipment that best 1654

suits their requirements in line with their procurement strategy. 1655

Services distribution 1656

4.15 The distribution of services to final points of use should be concealed in walls, 1657

floors and above ceilings. 1658

Isolation 1659

4.16 Devices for the control and safe isolation of engineering services should be: 1660

Located in circulation rather than working areas 1661

Protected against unauthorised operation 1662

Clearly visible and accessible, where intended for operation by the 1663

department clinical staff. 1664

4.17 Consideration should be given to the comfort as well as the safety of patients 1665 and others. 1666

Commissioning 1667

4.18 The engineering services should be commissioned in accordance with the 1668 validation and verification methods identified in the latest HTMs. Engineering 1669 services for which a specific HTM is not currently available should be 1670 commissioned in accordance with `Engineering commissioning’ published by 1671

the Institute of Healthcare Engineering and Estate Management. Flow 1672 measurement and proportional balancing of air and water systems require 1673 adequate test facilities to be incorporated at the design stage. Guidance is also 1674

contained in commissioning codes published by the Chartered Institute of 1675 Building Services Engineers. 1676



4.19 The services for some diagnostic imaging equipment may need to be 1677 commissioned before the final completion of the engineering contract 1678 programme, to allow the imaging equipment commissioning to be completed 1679 prior to the first patient. Parts of this commissioning are concerned with 1680 radiation safety and the approval of the RPA must be obtained for the imaging 1681

processes and schedules proposed. 1682

The operating theatre 1683

4.20 A control panel to accommodate environmental controls, alarms and 1684 instrumentation, clocks, medical viewing screens, door locks and lighting 1685

controls should be provided. 1686

4.21 The control panel should be fully recessed and ideally accessed for 1687 maintenance outside of the theatre itself. 1688

Mechanical services 1689

Environmental criteria 1690

4.22 The environmental criteria should be in accordance with HTM 03-01. 1691

Ventilation 1692

4.23 The ventilation central system should be designed in accordance with HTM 03-1693

01 including design of air-movement control schemes for operating theatres. 1694

Heating 1695

4.24 The heating distribution system should be designed in accordance with HTM 1696 03-01. 1697

4.25 The heating provision in the operating suite should be achieved via the 1698 ventilation system. 1699

4.26 A low temperature all air system is to be provided with duct mounted heater 1700 batteries. The batteries should be located in the ceiling void, ideally in corridors 1701 or ancillary rooms, to ensure they are fully accessible. 1702

Cooling 1703

4.27 The cooling distribution system should be designed in accordance with HTM 1704 03-01. 1705

4.28 The cooling provision in the operating suite should be achieved via the 1706

ventilation system. 1707

4.29 As a low temperature all air system is provided, the main cooling coils on the 1708 air handling units should be utilised. The heater batteries should be utilised to 1709 adjust the room temperatures to meet individual user requirements. 1710



Medical gas 1711

4.30 Medical gas services should be designed in accordance with HTM 02-01. Outlet 1712 quantities identified should form the starting point for discussions with the users 1713 and inclusion in project room data sheets. 1714

Domestic water services 1715

4.31 Domestic water services should be designed in accordance with HTM 04-01 1716 and agreed with the Water Safety Group. 1717

Humidification 1718

4.32 Humidification is not a general requirement of HTM 03-01. 1719

Building Management System 1720

4.33 The operating suite should be connected to the central BMS network. 1721

4.34 Each room should be provided with wall mounted temperature controllers to 1722 enable user control within the temperature parameters set out 2.1.1 above 1723

Electrical services 1724

Electrical power distribution 1725

4.35 The primary objective is to deliver designs that are both safe for staff, patient 1726

and visitors and available when they need to use it. HTM 06-01 provides 1727

excellent guidance on electrical distribution within a healthcare estate, 1728

addressing both of these issues and forms the basis upon which design 1729 proposals should be assessed. 1730

4.36 As required by HTM 06-01, these recommendations need to be considered, 1731 reviewed and expanded upon in conjunction with the Trust Electrical Safety 1732 Group (ESG), to finalise the brief and include but not limited to the following: 1733

Normal electrical supplies (dual path) 1734

Emergency electrical supplies 1735

Electrical interference 1736

Uninterruptable supply units (UPS) 1737

Isolated power supplies (IPS) 1738

4.37 Risk is addressed from two different viewpoints, the effect on the patient 1739 (clinical risk, life safety) and continuity of service (business continuity), i.e. whilst 1740

a patient may be safe the loss of a facility such as IT servers over a prolonged 1741 period will prevent the functioning of the hospital. 1742

4.38 The designer should lead this process in terms of clinical risk, obtaining 1743 guidance from the Trust in terms of business continuity. 1744

4.39 For operating theatres, a minimum of clinical risk A should be adopted for all 1745

patient zones and clinical risk B to all other areas. 1746

4.40 Electrical supply connections to all medical electrical equipment should comply 1747

with BS 7671 and associated guidance notes. 1748



4.41 Designers must ensure that the electrical loads are balanced across the infra 1749 structure network and that there is sufficient capacity to meet current and 1750 potential future demands. 1751

4.42 Where laminar flow hoods are provided, dual supplies to each controller should 1752 be considered. 1753

Lighting 1754

4.43 Natural light is of particular importance to the well-being of patients and staff. 1755 All surgical facilities, where possible, should have natural daylight directly from 1756 windows, or by means of borrowed light. Where natural light is not available 1757

through conventional means, consideration should be given to technologies 1758 such as artificial skylights etc. 1759

4.44 Artificial lighting should be provided to supplement as required, and achieve the 1760 desired light levels and environment conditions whilst considering energy 1761

consumption. Its positioning should be carefully considered. 1762

4.45 Where this is the case, proposals should reflect the guidance set out in CIBSE 1763 Lighting guides with particular reference to LG2 ‘Hospitals and Healthcare 1764

Buildings’. 1765

4.46 At each entrance of the theatre, a safety sign and warning lamp must be 1766

provided in order to warn people that they are entering a controlled area and to 1767 comply with the statutory requirements. 1768

4.47 The warning lamp must provide clear indication in red when it is energised and 1769 may incorporate the legend ‘Do Not Enter’, visible only when illuminated. ‘Laser 1770 in Use’ signs should also be provided where equipment is present. 1771

4.48 Signs should be switched by the surgeon’s panel or appropriate devices 1772 interlocked with the operation of the equipment and operating suite doors. 1773

Call systems 1774

4.49 Addressable call systems should be designed in accordance with HTM 08-01. 1775

Outlet quantities identified should form the starting point for discussions with 1776

the users and should be included in project room data sheets. 1777

Security 1778

4.50 Local security policies should determine at the planning stage the level of 1779

security to be provided. 1780

4.51 Closed circuit television (CCTV) should be provided, where required, in 1781 consultation with the users, to monitor patients undergoing treatment in 1782 restricted areas and where left unattended. The interference to which such 1783 equipment may be subjected should be considered when specified to ensure 1784

acceptable electromagnetic compatibility. Care should be taken in the 1785

positioning of monitors in order to preserve patient privacy. 1786



Fire detection 1787

4.52 Addressable fire detection systems should be designed in accordance with 1788 HTM 05-02 and the wider fire strategy for the department in agreement with the 1789 Fire Officer and Local Fire Brigade. 1790

Information technology and communications 1791

4.53 Synchronised clocks within theatres connected to lighting circuits forming an 1792 integral part of the theatre control panel should be provided. 1793

4.54 The surgeon’s panel should be connected to the Trust’s IT network and be able 1794 to monitor the UPS/IPS supplies within the area. 1795

4.55 Cabling should be installed on dedicated containment and take cognisance of 1796 the EMC Directive. 1797

4.56 Containment should be provided to maintain the cable performance and 1798 bending radius. Designers should consult with the Trust IT team to identify 1799

specific Trust specifications and requirements such as interleaving of supplies. 1800

4.57 Cable runs for CAT6a/7 cables should be limited to 90m. 1801

Entertainment 1802

4.58 Background music facilities should be provided on the surgeon’s panel, in 1803

consultation with the Users and added to the project data sheets. 1804

Public health services 1805

Above ground drainage 1806

4.59 Provision for inspection, rodding and maintenance should ensure “full bore” 1807 access and be located to minimise disruption or possible contamination. 1808 Manholes should not be located within the department. 1809

First stage and second stage recovery 1810

Mechanical services 1811

Environmental criteria 1812

4.60 The environmental criteria should be in accordance with HTM 03-01. 1813

Application Ventilation AC/hr Pressure

(Pascals)

Supply

filter

Noise

(NR)

Temp

(°C)

Comments

First stage recovery

Supply and Extract

15 Bal EU7 35 21-25°C

Secondary stage recovery

Supply and Extract

6 Bal EU7 35 21-25°C

Lower air change rate on the basis no exhaled anaesthetic gases present

1814



1815

Ventilation 1816

4.61 The ventilation central system should be designed in accordance with HTM 03-1817

01. 1818

Heating 1819

4.62 The heating distribution system should be designed in accordance with HTM 1820 03-01. 1821

4.63 The heating provision in the recovery room should be achieved via the 1822


4.64 A low temperature all air system is to be provided with duct mounted heater 1824

batteries. The batteries should be located in the ceiling void, ideally in corridors 1825 or ancillary rooms, to ensure they are fully accessible. 1826

Cooling 1827

4.65 The cooling distribution system should be designed in accordance with HTM 1828

03-01. 1829

4.66 The cooling provision in the recovery room should be achieved via the 1830


4.67 As a low temperature all air system is provided, the main cooling coils on the 1832

air handling units should be utilised. The heater batteries should be utilised to 1833 adjust the room temperatures to meet individual user requirements. 1834

Medical gas 1835

4.68 Medical gas services should be designed in accordance with HTM 02-01. Outlet 1836 quantities identified should form the starting point for discussions with the users 1837

and inclusion in project room data sheets. 1838

Domestic water services 1839

4.69 Domestic water services should be designed in accordance with HTM 04-01 1840

and agreed with the Water Safety Group. 1841

Humidification 1842

4.70 Humidification is not a general requirement of HTM 03-01. 1843

Building Management System 1844

4.71 All recovery rooms should be connected to the central BMS network. 1845

4.72 Each room should be provided with wall mounted temperature controllers to 1846 enable user control within the temperature parameters set out 3.1.1 above 1847



Electrical services 1848

Electrical power distribution 1849

4.73 The primary objective is to deliver designs that are both safe for staff, patient 1850

and visitors and available when they need to use it. HTM 06-01 provides 1851 excellent guidance on electrical distribution within a healthcare estate, 1852 addressing both of these issues and forms the basis upon which design 1853 proposals should be assessed. 1854

4.74 As required by HTM 06-01, these recommendations need to be considered, 1855

reviewed and expanded upon in conjunction with the Trust Electrical Safety 1856

Group (ESG), to finalise the brief and include but not limited to the following: 1857

Normal electrical supplies (dual path) 1858

Emergency electrical supplies 1859

Electrical interference 1860

Uninterruptable supply units (UPS) 1861

Isolated power supplies (IPS) 1862

4.75 Risk is addressed from two different viewpoints, the effect on the patient 1863 (clinical risk, life safety) and continuity of service (business continuity), i.e. whilst 1864 a patient may be safe the loss of a facility such as IT servers over a prolonged 1865

period will prevent the functioning of the hospital. 1866

4.76 The designer should lead this process in terms of clinical risk, obtaining 1867 guidance from the Trust in terms of business continuity. 1868

4.77 For 1st stage recovery areas a minimum of clinical risk A should be adopted, 1869

with category B for 2nd stage recovery. 1870

4.78 Electrical supply connections to all medical electrical equipment should comply 1871

with BS 7671 and associated guidance notes. 1872

4.79 Designers must ensure that the electrical loads are balanced across the infra 1873

structure network and that there is sufficient capacity to meet current and 1874

potential future demands. 1875

Lighting 1876

4.80 Natural light is of particular importance to the well-being of patients and staff. 1877

All surgical facilities, where possible, should have natural daylight directly from 1878 windows, or by means of borrowed light. Where natural light is not available 1879 through conventional means, consideration should be given to technologies 1880 such as artificial skylights etc. 1881

4.81 Artificial lighting should be provided to supplement as required, and achieve the 1882

desired light levels and environment conditions whilst considering energy 1883

consumption. Its positioning should be carefully considered. 1884



4.82 Where this is the case, proposals should reflect the guidance set out in CIBSE 1885 Lighting guides with particular reference to LG2 ‘Hospitals and Healthcare 1886 Buildings’. 1887

4.83 Clinical task lighting at each bed space is essential for the continuous clinical 1888 assessment of a patients colour and general physical status. 1889

Call systems 1890

4.84 Addressable call systems should be designed in accordance with HTM 08-01. 1891 Outlet quantities identified should form the starting point for discussions with 1892 the users and should be included in project room data sheets. 1893

Security 1894

4.85 Local security policies should determine at the planning stage the level of 1895 security to be provided. 1896

4.86 Closed circuit television (CCTV) should be provided, where required, in 1897

consultation with the users, to monitor patients undergoing treatment in 1898 restricted areas and where left unattended. The interference to which such 1899 equipment may be subjected should be considered when specified to ensure 1900

acceptable electromagnetic compatibility. Care should be taken in the 1901 positioning of monitors in order to preserve patient privacy. 1902

Fire detection 1903

4.87 Addressable fire detection systems should be designed in accordance with 1904

HTM 05-02 and the wider fire strategy for the department in agreement with the 1905 Fire Officer and Local Fire Brigade. 1906

Information technology and communications 1907

4.88 Cabling should be installed on dedicated containment and take cognisance of 1908 the EMC Directive. 1909

4.89 Containment should be provided to maintain the cable performance and 1910 bending radius. Designers should consult with the Trust IT team to identify 1911 specific Trust specifications and requirements such as interleaving of supplies. 1912

4.90 Cable runs for CAT6a/7 cables should be limited to 90m. 1913

Entertainment 1914

4.91 HTM 08-03 recommends that entertainment facilities will enhance patient well-1915

being and experience, and identifies various systems to be considered. These 1916 being: 1917

Television 1918

Internet services (Wi-Fi) 1919

Music 1920

IT and Communications (also see section above) 1921

Healthcare information 1922



4.92 It is important that designers consider the inclusion of entertainment systems 1923 from the outset within 2nd stage recovery areas in conjunction with the user’s, 1924 as integral systems are the preferred option. 1925

Public health services 1926

Above ground drainage 1927

4.93 Provision for inspection, rodding and maintenance should ensure “full bore” 1928 access and be located to minimise disruption or possible contamination. 1929 Manholes should not be located within the department. 1930

4.94 [DN: Links to the relevant HTMs will be provided.] 1931

1932



References 1933

HBNs 1934

[DN: List will be inserted (see list in introduction which will be updated for new titles to 1935 be published this year)] 1936

HTMs 1937

[DN: List will be inserted (see list in introduction which will be updated for new titles to 1938 be published this year)] 1939

Acts and Regulations 1940

[DN: list will be inserted] 1941

Standards 1942

[DN: List will be inserted] 1943

NHS national policies 1944

NHS Improvement (2017). National priorities for acute hospitals 2017 – good 1945

practice guide: focus on improving patient flow. 1946

https://improvement.nhs.uk/resources/good-practice-guide-focus-on-improving-1947 patient-flow/ 1948

NHS Improvement (2017). National priorities for acute hospitals 2017 – case studies: 1949

focus on improving patient flow. 1950

https://improvement.nhs.uk/resources/case-studies-focus-improving-patient-flow/ 1951

[DN: Additional references will be inserted] 1952

1953

Other 1954

Royal College of Physicians (2013). Future hospital: Caring for Medical Patients – a 1955 Report from the Future Hospital Commission to the Royal College of Physicians. 1956 RCP, London. 1957

[DN: Additional references will be inserted] 1958

https://improvement.nhs.uk/resources/case-studies-focus-improving-patient-flow/



Wider sources of healthcare planning information, 1959

tools and support 1960

NHS England & NHS Improvement’s Model Hospital Portal 1961

The Model Hospital25 is a digital information service designed to help NHS providers 1962

improve their productivity and efficiency. The Model Hospital is a web tool that can be 1963 used by anyone in the NHS from board to ward to explore and compare productivity, 1964 quality and responsiveness data to identify opportunities to improve. Model 1965 Ambulance, Model Mental Health and Model Community Health Services have also 1966

recently been developed for trusts which provide these services. Trusts can use the 1967 tools to dive deeper into their data and compare with peers to understand “what good 1968 looks like” and thus identify areas for improvement. 1969

The ProCure22 Framework 1970

The ProCure22 Framework is the recommended procurement method for publicly-1971

funded capital projects over £1 million. 1972

The Principal Supply Chain Partners (PSCPs) have developed a number of repeatable 1973

room arrangements26 for use in NHS Acute and Mental Health facilities, all of which 1974 are fully compliant with HBNs and HTMs. 1975

The P22 Training Academy has created a suite of e-modules which are freely available 1976 for use.27 1977

A number of P22 toolkits are also available (including the Clinical Design 1978 Requirements Toolkit [DN: this may be included as an appendix]. The P22 Framework 1979 encourages users to test its toolkits and provide feedback to inform continuous 1980

improvement. 1981

Miscellaneous sources including professional membership 1982

organisations 1983

DN: QUESTION FOR REVIEWERS: What organisations should we include here? The 1984

criteria for inclusion need to be defined. 1985

IHEEM

Institute of Healthcare Engineering and Estates Management

An International Professional Engineering Institute specialising in the Healthcare Estates Sector.

https://www.iheem.org.uk/

Knowledge Portal and Technical Advisory Platforms: https://www.iheem.org.uk/Knowledge-Portal

Health Estate Journal:

https://www.iheem.org.uk/Health-Estate-Journal

HefmA https://www.hefma.co.uk

Hefma Pulse magazine:

25 See https://improvement.nhs.uk/resources/model-hospital/ 26 See http://www.procure21plus.nhs.uk/repeatable_rooms/ 27 See INSERT LINK

http://www.procure21plus.nhs.uk/repeatable_rooms/


https://www.iheem.org.uk/

https://www.iheem.org.uk/Knowledge-Portal



https://www.hefma.co.uk/

https://improvement.nhs.uk/resources/model-hospital/




Health Estates and Facilities Management Association

A branch-based network of Estates and Facilities Professionals working in the NHS.

https://www.hefma.co.uk/our-magazine

AfH

Architects for Health

A network of like-minded people who share ideas, experiences and best practices in healthcare design.

https://www.architectsforhealth.com/

ABHI

Association of British Healthcare Industries

The UK’s leading industry association for health technology.

https://www.abhi.org.uk/

Resource Hub:

https://www.abhi.org.uk/resource-hub/

DiMHN

Design in Mental Health Network

A not-for-profit, social enterprise company with charitable aims and is open to anyone with an interest in the design of mental health facilities.

https://www.dimhn.org/

The Network magazine:

https://www.dimhn.org/the-network/

IPS

Infection Prevention Society

Infection prevention best practice.

https://www.ips.uk.net/

Journal of Infection Prevention:

https://www.ips.uk.net/professional-practice/journal-infection-prevention-jip/#.XlMhiGj7Q2w

EuHPN

European Health Property Network

A membership of professionals from a wide range of disciplines that meets annually for a workshop.

https://euhpn.eu/

Salus

An online knowledge community dedicated to designing a healthier society.

https://www.salus.global/

EFPC

European Forum for Primary Care

The aim of the forum is to improve the health of the population by promoting strong Primary Care. This is done by advocating for Primary Care, by generating data and evidence on Primary Care and by exchanging information between its members.

http://euprimarycare.org/

The King’s Fund

Strategic priorities are to work with people in the health and care system to:

drive improvements in health and wellbeing across places and communities

https://www.kingsfund.org.uk/

Integrated care topic:

https://www.kingsfund.org.uk/topics/integrated-care

https://www.hefma.co.uk/our-magazine

https://www.architectsforhealth.com/

https://www.abhi.org.uk/

https://www.abhi.org.uk/resource-hub/

https://www.dimhn.org/

https://www.dimhn.org/the-network/

https://www.ips.uk.net/




https://euhpn.eu/

https://www.salus.global/

http://euprimarycare.org/

https://www.kingsfund.org.uk/





improve health and care for people with the worst health outcomes

support people and leaders working in health and care.

SCIE

Social Care Institute for Excellence

Resources, consultancy and training on integrating health, care and related services.

https://www.scie.org.uk/integrated-care

LGA

Local Government Association

Health and care systems across the country are joining up services to improve the health, wellbeing and experiences of individuals, through both national and local transformation programmes.

Integration and the Better Care Fund:

https://www.local.gov.uk/our-support/our-improvement-offer/care-and-health-improvement/integration-and-better-care-fund

BIM4Health

Building Information Modelling for Health

A community of practice to help raise awareness of BIM and build capacity and capability.

http://www.bim4health.org/bim4health/index.html

1986

1987

https://www.scie.org.uk/integrated-care




http://www.bim4health.org/bim4health/index.html



Appendices 1988

1989

Room data sheets 1990

1991

Room Data Sheet 10-11-01 General Theatre 1992

1993 Project: HBN10-02

Hospital department: Operating Theatres and Day Surgery

Room: 10-11-01 General Theatre

Revision date: 04/11/19

Review date: 04/11/21

1994 Inclusions Considerations

Activities and requirements Patient may be connected to anaesthetic machine.

Maintenance of general anaesthesia

Monitoring/diagnostic or therapeutic equipment may be used.

Assembling and connecting mobile equipment.

Surgical instruments on instrument trolley may be used.

Surgical procedures may be performed under local or general anaesthetic.

Mobile image intensifier may be used.

Computer generated images are viewed using ceiling or wall mounted screens.

Used swabs may be checked, weighed and recorded.

Operating lists may be displayed.

Recording patient data/notes.

Electronic patient records (EPRs) may be accessed and updated.

Patient is transferred from operating table to bed/trolley.

Storage of small items of equipment or consumables as required

Theatre control panel should be flush mounted and

ideally should be accessible for maintenance from

outside the theatre.

"IN USE" sign sited outside the doorway of the room.

anaesthetic machine may be located on a dedicated medical supply unit - project team option

Outlets defined as voice or data will be the same for structured cabling solutions.

Personnel 1 x Patient

Up to 6 x Staff Planning relationships Direct access to corridor/exit bay

Direct access from preparation room

Direct access from Anaesthetic Room

Direct access to dirty utility room

Direct access from scrub room/area



Space data Area:

Ceiling Height: 3m (is a nominal height - actual height will be subject to

design, local equipment and environmental considerations.)

1995

1996

10-11-01 General Theatre Schedule of components 1997

1998

Quantity Description Group Comments

1 LUMINAIRE

operating theatre table

with satellite

shadowless

lux 140000

and lux 110000

1

6 SOCKET outlet

Switched

13 amp

Twin

Wall/trunking mounted

1

Located around the theatre

1 CLEANER'S SOCKET outlet

Switched

13 amp

Single

Wall mounted

1

Low level mounting approx..

150 – 200mm height above

floor

9 SOCKET outlet

double data/voice

wall/trunking mounted

1

Located around the theatre




2 PENDANT

electrical services including

o single socket outlet 13

amp x 12

medical gases including

o oxygen, medical x1

o nitrous oxide, medical

x 1

o 4kPa compressed air,

medical x1

o Gas scavenging (AGS)

x1

o 7 kPa compressed air

surgical x1

2 articulated arms

with docking system

ceiling mounted.

1

1 SWITCH

light 1

At door

1 TRUNKING, power and data

Length as drawn 1

1 WORKTOP

700mm deep

with 50mm upstand

fixed@ 900mm to top

length as drawn

Support legs SUP1001/1003 as

required

1

At ‘foot’ of operating table

1999



1 CONTROL STATION

Integrated workstation/control

panel for surgical procedure

room

900H x 1200W: comprises:

1

Is this the approximate size of

the CoPAX station

Room Control Panel

o With Touch screen

operation

PACS Viewing screen

o Kiosk style

o Fanless

o With USB port

o Heavy duty, industrial

grade

o Capable of 24/7

operation

Would this be able to double

as the in room computer

documentation station for OR

records, swab counts etc.?

Keyboard

o Fixed

o Wipeable membrane

cover

o Trackpad mouse

1x Operating lamp ON/OFF

switch;

1x Emergency battery lighting

"ON"; indicating;

3x General lighting ON/OFF

including dimmer switch lamp

1x Standby generator electric

mains "ON" indicating lamp;

1x Air temperature indicating

gauge

1x Air temperature control

1x Humidity indicating gauge

1x Humidity control and

indicating lamp;

1x Ventilation plant "ON";

(NORMAL) indicating lamp

1x Indicating lamp "FILTER

REPLACE"



1x Indicating lamp "LOW AIR

FLOW';

1x Indicating lamp "MEDICAL

GAS FAILURE"

1 x Clock time elapsed

1x Clock synchronous (time of

day)

1x Room "IN USE"; light,

ON/OFF switch

2 SCREEN, COMPUTER

ceiling/wall mounted 2

For ease of viewing from

surgeon’s operating position

2 BRACKET

Computer monitor

Ceiling/wall mounted

2

1 BOARD

Marker

Whiteboard

dry-wipe

with pen holder

wall mounted

600H 900W

2

Above worktop

1 ANAESTHETIC MACHINE/WORKSTATION

with ventilator

with accessories

mobile

1580H 565W 695D

3

2 SUCTION UNIT

Pipeline

high pressure

theatre

3

1 CHAIR

Anaesthetist

Wipeable

height adjustable

3



1 COMPUTER

complete with keyboard

screen

and telephone

wall mounted

3

At worktop

1 DIATHERMY APPARATUS

Surgical

monopolar and bipolar

operation

portable

190H 400W 330D

3

2 HOLDER

Sack

with lid

foot operated

large

capacity 120 litres

mobile

3

At ‘foot’ of table

2 KICKABOUT

bowl stand

stainless steel

360mm dia.

3

1 PLATFORM

step-stand

stackable

portable

130H 480W 330D

3

1 SCALE

Swab

includes Mains adaptor

3

At worktop



2 STAND

lotion bowl

single

stainless steel

(Bowls not included)

3

2 STAND

lotion bowl

double

stainless steel


3

2 STAND

Infusion

twin hook

breaks

mobile

3

1 STOOL

surgeon/anaesthetist

height adjustable

includes anti-static seat pads

3

1 TABLE

surgical procedures

radiotranslucent

o/a 1005H 2100W 835D

3

May be on a fixed pedestal

subject to project decision

1 TROLLEY

dressing/instrument

stainless steel

buffered

870H 450W 450D

3

1 TROLLEY

dressing/instrument

stainless steel

buffered

870H 750W 450D

3



1 TROLLEY

Instruments

stainless steel

buffered

870H 920W 620D

3

1 TROLLEY

instrument tray

MAYO

Height adjustable

650W 450D

3

2000

2001



Room Data Sheet 10-11-03 Enhanced Treatment Room 2002



Room: 10-11-03 Enhanced Treatment Room










Mobile image intensifier may be used.

Computer generated images are viewed using ceiling or wall mounted screens



Recording patient data/notes..











Up to 3 x Staff

Planning relationships Direct access to corridor/exit bay




Space data Area:



2005

2006

2007

2008

2009

2010



10-11-03 Enhanced Treatment Room Schedule of components 2011

2012


1 LUMINAIRE


with satellite

shadowless

lux 140000

and lux 110000

1

5 SOCKET outlet

Switched

13 amp

Twin


1


Switched

13 amp

Single

Wall mounted

1



floor

9 SOCKET outlet

double data/voice


1




1 PENDANT



amp x 12




x 1


medical x1


x1


surgical x1

2 articulated arms

with docking system

ceiling mounted.

1

1 SWITCH

light 1

At door


Length as drawn 1

1 WORKTOP

700mm deep

with 50mm upstand

fixed@ 900mm to top

length as drawn


required

1


2013



1 CONTROL STATION



room


1


the CoPAX station

1 Room Control Panel

o With Touch screen

operation

1

PACS Viewing screen

o Kiosk style

o Fanless

o With USB port


grade

o Capable of 24/7

operation





Keyboard

o Fixed

o Wipeable membrane

cover

o Trackpad mouse


switch;


"ON"; indicating;






gauge




indicating lamp;




REPLACE"




FLOW';


GAS FAILURE"



day)


ON/OFF switch

1 BOARD

Marker

Whiteboard

dry-wipe

with pen holder

wall mounted

600H 900W

2

Above worktop


with ventilator

with accessories

mobile

1580H 565W 695D

3

2 SUCTION UNIT

Pipeline

high pressure

theatre

3

1 CHAIR

Anaesthetist

Wipeable

height adjustable

3

1 COMPUTER


screen

and telephone

wall mounted

3

At worktop




Surgical


operation

portable

190H 400W 330D

3

2 HOLDER

Sack

with lid

foot operated

large

capacity 120 litres

mobile

3


2 KICKABOUT

bowl stand

stainless steel

360mm dia.

3

1 PLATFORM

step-stand

stackable

portable

130H 480W 330D

3

1 SCALE

Swab


3

At worktop

2 STAND

lotion bowl

single

stainless steel


3



2 STAND

lotion bowl

double

stainless steel


3

2 STAND

Infusion

twin hook

breaks

mobile

3

1 STOOL


height adjustable


3

1 TABLE

surgical procedures

radiotranslucent

o/a 1005H 2100W 835D

3

May be on a fixed pedestal

subject to project decision

1 TROLLEY

dressing/instrument

stainless steel

buffered

870H 450W 450D

3

1 TROLLEY

dressing/instrument

stainless steel

buffered

870H 750W 450D

3

1 TROLLEY

Instruments

stainless steel

buffered

870H 920W 620D

3



1 TROLLEY

instrument tray

MAYO

Height adjustable

650W 450D

3

2014

2015



Room Data Sheet: 10-11-04 Hybrid Operating Theatre (CT) 2016



Room: 10-11-04 Hybrid Operating Theatre (CT)










Patient undergoes interventional procedures under CT scan














Contrast media may be administered.

Disposal of waste.


Up to 8 x Staff






Direct access of CT scanner from ‘parked’ position.

Direct line of sight from control room to surgeon

Space data Area:



2019

2020



10-11-04:Hybrid Operating Theatre (CT) Schedule of components 2021


1 LUMINAIRE


with satellite

shadowless

lux 140000

and lux 110000

1

5 SOCKET outlet

Switched

13 amp

Twin


1


Switched

13 amp

Single

Wall mounted

1



floor

9 SOCKET outlet

double data/voice


1

1 SWITCH

light 1

At door


Length as drawn 1

1 WORKTOP

700mm deep

with 50mm upstand

fixed@ 900mm to top

length as drawn


required

1

2 PENDANT

electrical services including 1





amp x 12




x 1


medical x1


x1


surgical x1

2 articulated arms

with docking system

ceiling mounted.

2022

2023

2024

1 CONTROL STATION



room


1


the CoPAX station

Room Control Panel

o With Touch screen

operation

1

PACS Viewing screen

o Kiosk style

o Fanless

o With USB port


grade

o Capable of 24/7

operation





Keyboard

o Fixed



o Wipeable membrane

cover

o Trackpad mouse


switch;


"ON"; indicating;






gauge




indicating lamp;




REPLACE"


FLOW';


GAS FAILURE"



day)


ON/OFF switch

2025



1 IMAGER, COMPUTER TOMOGRAPHY (CT)

128 slice unit 2


heat exchanger

1800H 900W 750D

2


imaging cabinet

1800H 900W 750D

2

1 RACK, x-ray lead apron

3 hangers

hinged

wall mounted

2

2 SCREEN, COMPUTER


2 BRACKET

Computer monitor


2

1 BOARD

Marker

Whiteboard

dry-wipe

with pen holder

wall mounted

600H 900W

2

Above worktop


with ventilator

with accessories

mobile

1580H 565W 695D

3

2 SUCTION UNIT

Pipeline

high pressure

theatre

3

1 CHAIR 3



Anaesthetist

Wipeable

height adjustable

1 COMPUTER


screen

and telephone

wall mounted

3

at worktop


Surgical


operation

portable

190H 400W 330D

3

2 HOLDER

Sack

with lid

foot operated

large

capacity 120 litres

mobile

3

by worktop

2 KICKABOUT

bowl stand

stainless steel

360mm dia.

3

1 PLATFORM

step-stand

stackable

portable

130H 480W 330D

3

1 SCALE

Swab


3

at worktop



2 STAND

lotion bowl

single

stainless steel


3

2 STAND

lotion bowl

double

stainless steel


3

2 STAND

Infusion

twin hook

breaks

mobile

3

1 STOOL


height adjustable


3

1 TABLE

surgical procedures

radiotranslucent

o/a 1005H 2100W 835D

3

Will be on a fixed pedestal,

commensurate with type and

make of CT Scanner

1 TROLLEY

dressing/instrument

stainless steel

buffered

870H 450W 450D

3

1 TROLLEY

dressing/instrument

stainless steel

buffered

870H 750W 450D

3



1 TROLLEY

Instruments

stainless steel

buffered

870H 920W 620D

3

1 TROLLEY

instrument tray

MAYO

Height adjustable

650W 450D

3

2026

2027



Room Data Sheet: 10-11-05 Hybrid Operating Theatre (MRI) 2028



Room: 10-11-05 Hybrid Operating Theatre (MRI)










Patient undergoes interventional procedures under MRI scan














Contrast media may be administered.

Disposal of waste.


Up to 8 x Staff






Direct access of MRI scanner from ‘parked’ position.

Direct line of sight from control room to surgeon

Space data Area:



2031

2032



10-11-05: Hybrid Operating Theatre (MRI) Schedule of components 2033

2034


1 LUMINAIRE


with satellite

shadowless

lux 140000

and lux 110000

1

5 SOCKET outlet

Switched

13 amp

Twin


1


Switched

13 amp

Single

Wall mounted

1



floor

9 SOCKET outlet

double data/voice


1

1 SWITCH

light 1

At door


Length as drawn 1




2 PENDANT



amp x 12




x 1


medical x1


x1


surgical x1

2 articulated arms

with docking system

ceiling mounted.

1

1 WORKTOP

700mm deep

with 50mm upstand

fixed@ 900mm to top

length as drawn

Support legs SUP1001/1003 as required

1

2035

2036

2037

1 CONTROL STATION



room


1


the CoPAX station

Room Control Panel

o With Touch screen

operation

PACS Viewing screen Would this be able to double




o Kiosk style

o Fanless

o With USB port


grade

o Capable of 24/7

operation



Keyboard

o Fixed

o Wipeable membrane

cover

o Trackpad mouse


switch;


"ON"; indicating;






gauge




indicating lamp;




REPLACE"


FLOW';


GAS FAILURE"



day)


ON/OFF switch

2038



2 SCREEN, COMPUTER


2 BRACKET

Computer monitor


2

1 IMAGER, MAGNETIC RESONANCE IMAGING

(MRI), closed bore. 2

1 TABLE PATIENT

Surgical procedure

MRI imager

floating top

2

Will be on a fixed pedestal,

commensurate with type and

make of MRI Scanner

1 BOARD

Marker

Whiteboard

dry-wipe

with pen holder

wall mounted

600H 900W

2

Above worktop


with ventilator

with accessories

mobile

1580H 565W 695D

3

2 SUCTION UNIT

Pipeline

high pressure

theatre

3

1 CHAIR

Anaesthetist

Wipeable

height adjustable

3



1 COMPUTER


screen

and telephone

wall mounted

3

at worktop


Surgical


operation

portable

190H 400W 330D

3

2 HOLDER

Sack

with lid

foot operated

large

capacity 120 litres

mobile

3

by worktop

2 KICKABOUT

bowl stand

stainless steel

360mm dia.

3

1 PLATFORM

step-stand

stackable

portable

130H 480W 330D

3

1 SCALE

Swab


3

at worktop



2 STAND

lotion bowl

single

stainless steel


3

2 STAND

lotion bowl

double

stainless steel


3

2 STAND

Infusion

twin hook

breaks

mobile

3

1 STOOL


height adjustable


3

1 TROLLEY

dressing/instrument

stainless steel

buffered

870H 450W 450D

3

1 TROLLEY

dressing/instrument

stainless steel

buffered

870H 750W 450D

3



1 TROLLEY

Instruments

stainless steel

buffered

870H 920W 620D

3

1 TROLLEY

instrument tray

MAYO

Height adjustable

650W 450D

3

2039

2040



Room Data Sheet: 10-11-07 Anaesthetic Room 2041

2042

Project: HBN10-02


Room: 10-11-07 Anaesthetic Room




Activities and requirements Anaesthetic accessories and equipment are stored.

Controlled and scheduled drugs are stored securely.

Holding/storing sterile equipment.

Holding/storing stock of infusion fluids.

Refrigerated storage of drugs/medicines.



Collecting used anaesthetic accessories for reprocessing.

Collecting waste materials for disposal.

Clinical wash-hand basin will be used.

Administration of intravenous analgesia

Administration of general anaesthesia

Maintenance of general anaesthesia.

Monitoring/diagnostic or therapeutic equipment will be used

Consideration should be given to the patient transfer

methodology (i.e. within anaesthetic room or theatre and where

and how hoists are used).

The call repeat lamp and controlled drugs cupboard indicator

are situated over the door outside the room.

Room in use switch and indicator (optional)

A music system may be provided to reduce patient anxiety;

Specialist table attachments may be stored here;

Ceiling mounted hoist subject to local evaluation of space and fittings.

Separate data and voice outlets may be used where structured

cabling solutions are not available


1 - 2 x Staff

1 other

Planning relationships Direct access from corridor

Direct access to Operating theatre

Space data Area:

Ceiling Height: 3m to match adjacent theatre

2044

2045

2046

2047



10-11-07: Anaesthetic Room Schedule of components 2048


1 PULL/PUSH BUTTON

staff emergency call, reset

integral/adjacent indicator lamp

wall mounted

1

Above worktop

1 LAMP

repeat call, patient / staff or staff

emergency

or cardiac call

1

At door

1 LUMINAIRE

Examination

Ceiling mounted

Adjustable

1000 lux

1

At head of patient

1 ILLUMINATED SIGN

'Room in use' 1

Outside door

1 LUMINAIRE

indicating controlled drugs

cupboard repeat

1

6 SOCKET outlet

switched

13 amp

twin


1

1 CONNECTION UNIT

switched

13 amp

flex outlet

indicator light

wall mounted

1

Adjacent to controlled drugs

cupboard

1 CLEANERS’ SOCKET outlet

switched

13 amp

1

Low level mounting approx.


floor




single

wall mounted

2 SOCKET outlet

double data / voice


1

1 CUPBOARD

base unit

LH door

with formed plastic liners

850h 450d 655w

1

1 CUPBOARD

base unit

RH door

with 2 shelves

850h 450d 655w

1

1 OUTLET cable

fused

13 amp

ceiling mounted

1

For exam lamp

1 CONNECTION UNIT

unswitched

13 amp

flex outlet

1

For clock

1 OUTLET

controlled drugs cupboard 1

1 CONNECTION UNIT

Switched

13 amp

1

For drugs fridge

1 OUTLET

oxygen medical

trunking-mounted

1

1 OUTLET 1




vacuum medical

trunking mounted

1 OUTLET

4 kPa compressed air, medical

trunking mounted

1

1 OUTLET

nitrous oxide medical

trunking mounted

1

1 OUTLET

gas scavenging (AGS), medical

trunking mounted

1

1 SWITCH

light 1

At door

1 SWITCH

'Room in use' illuminated sign. 1

At door

1 WORKTOP, Clinical

700mm deep,

with 50mm upstand

fixed@ 900mm to top

length as drawn


required

1

1 WASH BASIN

Clinical

with non touch panel mounted

tap/s.

1

1 TRUNKING for power and data

length as drawn 1

1 TRUNKING for medical services

length as drawn 1

1 CLOCK

synchronous

with second sweep hand

2

Above door to theatre

(out of patient’s line of sight)




wall mounted

1 BOARD MARKER

Whiteboard

dry wipe

with pen holder

wall mounted

600H 900W

2

1 BRACKET,

holder, suction unit

trunking mounted

2

1 SUCTION UNIT

Pipeline

high/low pressure

rail/wall mounted

use with BRACKET, holder

3

1 CABINET

Metal

controlled drugs

1 door

lockable

with warning light

wall mounted

550H 600W 3000

3

1 DISPENSER

barrier cream

disposable single cartridge

wall mounted

2

1 DISPENSER

paper towel

wall mounted

2

1 DISPENSER

Medical hand sanitizer 2




lever action

wall mounted

1 DISPENSER

Soap

disposable single cartridge

lever action

wall mounted

2

1 DISPENSER

disposable gloves set of 3

and disposable apron

wall mounted

2


electrically powered piston

ventilator

mobile

1350H 750W 650D

3

1 COMPUTER


and screen

3

1 HOLDER

Sack

with lid

foot operated

medium

freestanding

875H 430W 385D

3

1 HOLDER

sharps box

up to 7 litre capacity

rail/trolley hang or wall

mounted

170H 125W 100D

3

1 MONITOR 3




vital signs

multi-parameter

with accessories

280H 360W 215D

1 REFRIGERATOR

medical (drug/vaccine)

capacity 160 litre

external temperature gauge

automatic defrost

lockable

underbench

850H 550W 620D

3

1 STAND

Infusion

twin hook

breaks

mobile

3

1 STOOL


height adjustable


3

1 SYRINGE pump

anaesthetic use

with diprifusor

115H 400W 180D

3

1 TROLLEY

dressing/instrument

stainless steel

buffered

870H 450W 450D

3

2049

2050



Room Data Sheet: 10-11-08 Prep Room 2051 2052

Project: HBN10-02


Room: 10-11-07 Prep Room




Activities and requirements Instrument trollies and equipment are stored.

Temporarily holding/storing sterile equipment and consumables

sufficient for the operating list planned

A small supply of common consumables are stored (e.g. sutures and

dressing materials).

A heated lotion cabinet is sited in this room.

Holding/storing stock of warmed irrigation fluids.


Sterile instrument trolleys for the operation procedure at hand will be

prepared by a scrubbed instrument technician/nurse with the assistance

of at least one circulating nurse.

Prepared instrument trolleys will be transferred into theatre at the

appropriate time without contaminating the instruments or drapes.

Collecting waste materials for disposal.

Separate data and voice outlets may be used where structured cabling

solutions are not available

Personnel 2 x Staff

Planning relationships Direct access from corridor

Easy access from scrub room

Direct access to Operating theatre

Space data Area:

Ceiling Height: 2700mm

2054

2055

2056

2057

2058

2059

2060



10-11-08: Prep Room Schedule of components 2061


3 SOCKET outlet

switched

13 amp

twin


1

1 CLEANERS’ SOCKET outlet

switched

13 amp

single

wall mounted

1

Low level mounting approx.


floor

1 SOCKET outlet

double data / voice


1

1 CONNECTION UNIT

switched

13amp

1

For warming cabinet

1 CONNECTION UNIT

unswitched

13 amp

flex outlet

1

For clock

1 SWITCH

light 1

At door

1 CUPBOARD

base unit

LH door

with formed plastic liners

850h 450d 655w

1

1 CUPBOARD

base unit

RH door

with 2 shelves

1




850h 450d 655w

1 WORKTOP, Clinical

700mm deep,

with 50mm upstand

fixed@ 900mm to top

length as drawn


required

1

1 TRUNKING for power and data

length as drawn 1

Above worktop

1 CLOCK

synchronous

with second sweep hand

wall mounted

2

1 BOARD MARKER

Whiteboard

dry wipe

with pen holder

wall mounted

600H 900W

2

1 CABINET warming,

contrast media and solutions,

stainless steel,

wall mounted

2

1 COMPUTER


and screen

3

On worktop

1 READER

Bar Code 3

Connected to PC




2 HOLDER

Sack

with lid

foot operated

medium

freestanding

875H 430W 385D

3

1 HOLDER

sharps box

up to 7 litre capacity

rail/trolley hang or wall

mounted

170H 125W 100D

3

2 TROLLEY

dressing/instrument

stainless steel

buffered

870H 450W 450D

3

3 TROLLEY

dressing/instrument

stainless steel

buffered

870H 750W 450D

3

1 TROLLEY

instrument tray

MAYO

Height adjustable

650W 450D

3

2 STAND,

lotion bowl,

single,

stainless steel,


3




2 STAND

Lotion bowl

Double

Stainless steel

(bowls not included)

3

2062

2063



Useful reading 2064

Ahmad, N., Hussein, A.A., Cavuoto, L., Sharif, M., Allers, J.C., Hinata, N., Ahmad, B., Koslowski, J.D., 2065 Hashmi, Z., Bisantz, A. and Guru, K.A. (2016). “Ambulatory movements, team dynamics and 2066 interactions during robot-assisted surgery”. BJU International, Vol. 118, pp. 132–139. Retrieved from 2067 http://onlinelibrary.wiley.com/doi/10.1111/bju.13426/full 2068

Ambulatory Surgery Center Association. (2016). Retrieved from http://www.ascassociation.org 2069

Andersson, A.E., Bergh, I., Karlsson, J., Eriksson, B.I. and Nilsson, K. (2012). “Traffic flow in the 2070 operating room: an explorative and descriptive study on air quality during orthopedic trauma 2071 implant surgery”. American Journal of Infection Control, Vol. 40, pp. 750–755. Retrieved from 2072 https://tinyurl.com/yb7wbuzq 2073

Andersson, A.E., Petzold, M., Bergh, I., Karlsson, J., Eriksson, B.I. and Nilsson, K. (2014). “Comparison 2074 between mixed and laminar airflow systems in operating rooms and the influence of human factors: 2075 experiences from a Swedish orthopedic center”. American journal of infection control, Vol. 42 No. 6, 2076 pp. 665–669. 2077 https://tinyurl.com/yd3az3jv 2078

Assem, M., Ouda, B. K. and Wahed, M.A. (2012). “Improving operating theatre design using facilities 2079 layout planning”. In Biomedical Engineering Conference (CIBEC), 2012 Cairo International, IEEE, pp. 2080 109–113. 2081

Association of periOperative Registered Nurses. (2015). Guideline for a Safe Environment of Care, 2082 Part 2. Guidelines for Perioperative Practice. AORN, Denver, CO. 2083

Australasian Health Facility Guidelines (2017). Operating Room - General, 42m2. Accessed 22 January 2084 2018. 2085 https://healthfacilityguidelines.com.au/component/operating-room-general-42m2-1 2086

Baillie, J. (2010). “Smoothing the path to the theatre”. Health Estates Journal, Vol. 64 No. 22, pp. 33-2087 37. 2088

Baillie, J. (2012). “Premier performers for the theatre”. Health Estates Journal. August, pp. 55–66. 2089

Bayramzadeh, S., Joseph, A., San, D., Khoshkenar, A., Taaffe, K., Jafarifiroozabadi, R. and Neyens, 2090 D.M. (2018). “The impact of operating room layout on circulating nurse’s work patterns and flow 2091 disruptions: a behavioral mapping study”. HERD: Health Environments Research & Design Journal, 2092 https://doi.org/10.1177/1937586717751124. 22 January 2018. 2093

Berg, R.J., Inaba, K., Sullivan, M., Okoye, O., Siboni, S., Minneti, M. and Demetriades, D. (2015). “The 2094 impact of heat stress on operative performance and cognitive function during simulated 2095 laparoscopic operative tasks”. Surgery, Vol. 157, pp. 87–95. Retrieved from 2096 https://tinyurl.com/y8l6lx69 2097

Birnbach, D.J., Rosen, L.F., Fitzpatrick, M., Carling, P. and Munoz-Price, L.S. (2015). “The use of a 2098 novel technology to study dynamics of pathogen transmission in the operating room”. Anesthesia & 2099 Analgesia, Vol. 120, pp. 844–847. 2100

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https://tinyurl.com/yb7wbuzq

https://healthfacilityguidelines.com.au/component/operating-room-general-42m2-1

https://doi.org/10.1177%2F1937586717751124

https://tinyurl.com/y8l6lx69



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Brandt, C., Hott, U., Sohr, D., Daschner, F., Gastmeier, P. and Rüden, H. (2008). “Operating room 2104 ventilation with laminar airflow shows no protective effect on the surgical site infection rate in 2105 orthopedic and abdominal surgery”. Annals of Surgery, Vol. 248, pp. 695–700. Retrieved from 2106 https://tinyurl.com/ycaeqhj5 2107

Breier, A., Brandt, C., Sohr, D., Geffers, C. and Gastmeier, P. (2011). “Laminar airflow ceiling size: No 2108 impact on infection rates following hip and knee prosthesis”. Infection Control, Vol. 32, pp. 1097–2109 1102. 2110

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Burlingame, B. (2015). “FGI Guidelines Update # 3: operating room requirements for 2014 and 2116 beyond”. FGI Guidelines Updates. Retrieved from https://www.fgiguidelines.org/wp-2117 content/uploads/2015/07/FGI_Update_ORs_140915.pdf 2118

Cadenhead, C.D., Waggener, L.T. and Goswami, B. (2017). “The role of architecture and physical 2119 environment in hospital safety design”. In Sanchez, J.A., Barach, P., Johnson, J. and Jacobs, J.P. 2120 (Eds.) Surgical Patient Care, Springer International Publishing, London, pp. 159–183. 2121

Chauveaux, D. (2015). “Preventing surgical-site infections: measures other than antibiotics”. 2122 Orthopaedics & Traumatology: Surgery & Research, Vol. 101, S77–S83. Retrieved from 2123 https://www.sciencedirect.com/science/article/pii/S1877056814003272 2124

Conrad, C., Konuk, Y., Werner, P.D., Cao, C.G., Warshaw, A.L., Rattner, D.W. and Miller, D.L. 2125 (2012). “A quality improvement study on avoidable stressors and countermeasures affecting surgical 2126 motor performance and learning”. Annals of Surgery, Vol. 255, p. 1190. Retrieved 2127 from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3354736/ 2128

Dascalaki, E.G., Gaglia, A.G., Balaras, C.A. and Lagoudi, A. (2009). “Indoor environmental quality in 2129 Hellenic hospital operating rooms”. Energy and Buildings, Vol. 41, pp. 551–560. Retrieved from 2130 https://tinyurl.com/yb636b2w 2131

Engelmann, C., Neis, J., Kirschbaum, C., Grote, G. and Benno, M. (2014). “A noise-reduction program 2132 in a pediatric operation theatre is associated with surgeon’s benefits and a reduced rate of 2133 complications: a prospective controlled clinical trial”. Annals of Surgery, Vol. 259, pp. 1025–1033. 2134

Evans, R.P. (2011). “Current concepts for clean air and total joint arthroplasty: laminar airflow and 2135 ultraviolet radiation: a systematic review”. Clinical Orthopedics and Related Research, 469, pp. 945–2136 953. doi:10.1007/s11999-010-1688-7. Retrieved 2137 from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3048268/ 2138

https://tinyurl.com/ycaeqhj5

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https://www.fgiguidelines.org/wp-content/uploads/2015/07/FGI_Update_ORs_140915.pdf

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https://www.sciencedirect.com/science/article/pii/S1877056814003272

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Frabetti, A., Vandini, A., Balboni, P., Triolo, F. and Mazzacane, S. (2009). “Experimental evaluation of 2144 the efficacy of sanitation procedures in operating rooms”. American Journal of Infection Control, Vol. 2145 37, 658–664. Retrieved from https://tinyurl.com/ycwnc6wz 2146

Friedrich, M.G., Boos, M., Pagel, M., Thormann, T., Berakdar, A., Russo, S. and Tirilomis, T. (2017). 2147 “New technical solution to minimise noise exposure for surgical staff: the ‘silent operating theatre 2148 optimisation system’”. BMJ Innovations, Vol. 3 No. 4, pp. 196–205. LOOK ON CHC WEBSITE 2149

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Hasfeldt, D., Laerkner, E. and Birkelund, R. (2010). “Noise in the operating room – what do we know? 2157 A review of the literature”. Journal of PeriAnesthesia Nursing, Vol. 25, pp. 380–386. 2158 doi:10.1016/j.jopan.2010.10.001. 2159

Hemphälä, H., Johansson, G., Odenrick, P., Åkerman, K. and Larsson, P.A. (2009). “Lighting 2160 recommendations in operating theatres”. In Proceedings of the 17th World Congress on Ergonomics, 2161 International Ergonomics Association, Zurich. 2162

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Hooper, G.J., Rothwell, A.G., Frampton, C. and Wyatt, M.C. (2011). “Does the use of laminar flow and 2166 space suits reduce early deep infection after total hip and knee replacement?” Bone & Joint Journal, 2167 Vol. 93, pp. 85–90. Retrieved from http://www.boneandjoint.org.uk/content/jbjsbr/93-2168 B/1/85.full.pdf 2169

Hughes, N.L., Nelson, A., Matz, M.W. and Lloyd, J. (2011). “Solutions for prolonged standing in 2170 perioperative settings”. AORN Journal, 93(6), pp. 767–774. 2171

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