Ongoing regulation and guideline updates mean that health care facilities have to be flexible, and highly sensitive areas, such as surgical suites, are certainly no exception. Surgical suites that integrate imaging equipment into their layouts, often called hybrid operating rooms (ORs), require an increasingly detailed design plan to accommodate their many features, such as computerized temography (CT) scanners, MRIs, and other cardiac catherization laboratory tools.

Floor space, HVAC equipment, and wireless communication technologies — along with incorporating imaging equipment that typically only have five-year lifespans, are just a few of the myriad of factors that must be considered when planning a hybrid OR. With that in mind, it’s critical to design these spaces with both current and future needs in mind. Here, we’ll talk about the benefits of hybrid ORs as well as the challenges that arise when planning and designing them.


Hybrid ORs are experiencing rapid changes. Not only are they enabling the advancement of procedures and treatment for patients, but they are also encouraging new and innovative methods of using imaging equipment. As a result, vendors are developing devices with greater functionality and higher resolution in mind. These changes mean planning hybrid suites with future flexibility in mind is no longer only a best practice. It’s now a necessity.

Integrated ceiling systems present one of the best ways to allow for upcoming changes and design modifications. Rooms with monolithic ceilings don’t offer flexibility for future renovations and are more likely to have air distribution devices installed in less-than-ideal spaces. Integrated ceilings, by comparison, enable air distribution, lighting, and access panels to be installed much closer to one another. This setup provides doctors, nurses, and surgeons with improved lighting and airflow during procedures and also provides maximum protection for patients.

Modular and fully welded are the two most common types of integrated ceilings. The former offers configurability during installation and allows for future adjustments and updates without completely replacing some or all of its sections. The latter is welded off-site and delivered in sections that are bolted together during the installation process, making for a simple install. Regardless which system is chosen, integrated ceilings make hybrid ORs more versatile and grant owners more time to select equipment.


The major changes hybrid ORs are undergoing means coordination is key to a successful project. Continuous communication between the design team, stakeholders, and vendors will help the spaces function properly and be delivered successfully. One way to provide surgical staff with a view of what the final space will look like is through a 3-D model, which gives staff a clear vision of the room and should be utilized early in the design phase. An approved 3-D design can then serve as the baseline for a full-scale mock-up, which allows the design team to address any complications before finalizing the design and beginning construction.

One of the most critical aspects of designing a hybrid OR is space planning. The 2014 Facility Guidelines Institute (FGI) guidelines have the following recommendations:

• A minimum clear floor space of 650 square feet for new construction and 600 square feet for renovations of operating rooms. Depending on the size of imaging modality and imaging equipment, these rooms can be as large as 2,600 square feet;

• Hybrid OR installation in spaces with at least 750 square feet and 10 foot ceilings. These dimensions allow for future equipment upgrades; and

• Account for control rooms and equipment rooms, which are necessary for housing data and electrical equipment for the imaging device.

Additionally, some facilities design multiple rooms to share a single piece of equipment, maximizing the investment and minimizing cost and space requirements. In order to make this approach feasible, facilities must have common control and equipment rooms adjacent to the common operating rooms.

A top function for any HVAC equipment, especially in health care facilities, is to reduce airborne particles’ potential to cause illnesses. In operating and procedure rooms specifically, where surgical-site infections can occur, unidirectional non-aspirating diffusers are used to address this. There are specific ASHRAE 170-2013 requirements for health care facilities, which include:

• No more than 30 percent of the primary diffuser array area can be utilized for non-diffuser usage;

• Unidirectional non-aspirating diffusers that extend beyond the operating table by at least 1 foot on all sides; and

• Twenty air changes per hour (ACH) for operating rooms and supply of 25-35 cfm per square foot.

HVAC requirements are just one aspect of hybrid ORs the design team has to consider. Diagnostic and monitoring equipment, medical gas connections, monitors to exhibit information from the imaging equipment, and surgical lighting all frequently hang from booms and mounts fixed to the ceiling, so they must be accounted for, as well. With that, communication between vendors, surgical staff, and the engineering team is especially crucial, since there are many components fighting for ceiling space. The earlier this coordination happens, the better, as that helps avoid complications and redesigns during construction.


Wireless communication is the new reality in health care facilities. With this technology, location(s) and position(s) limitations of imaging equipment are reduced along with maintenance and repair downtimes. Multiple modalities consolidated into a single operating room is on the horizon, since wireless technology allows for interchangeable pieces of equipment.

A number of additional factors will help spearhead innovation in health care. Continuous efforts to improve patient outcomes, growing standards for quality metrics, and health care reform are just a few of these elements. We can expect hybrid ORs to make additional improvements, as well. These suites make the most of current technology to help develop new ways for patients to receive diagnoses and procedural care while also incorporating advanced imaging equipment that enables the highest level of patient care.

So, why should health care facilities integrate imaging equipment into operating rooms?

Reduced hospital stays and recovery times, improved patient outcomes and infection prevention, decreased possibility of complications, and minimized anesthesia encounters are just a few of the many benefits of this practice. Patients also receive a higher degree of individualized care since the sheer variety of the technology requires specialists from multiple disciplines to work together.

With a high level of planning, coordination, and communication, health care facilities can reap the rewards of designing hybrid ORs for future flexibility.

Publication date: 4/18/2016

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