Operating rooms in health-care facilities where infant procedures may be performed shall be constructed to operating room specifications except for the following modifications:

Assuming infant's eyes are shielded (eye patches) while in the operating room, no changes to the IES guidelines for operating rooms5 are required. However, light sources meeting the CRI and GA values identified in Standard 22 are recommended.

Laminar flow diffusers over the surgical bed shall be set at the low end of the air velocity range (approximately 25 ft/min) and balanced with the surrounding slot diffuser air curtain to minimize convective and evaporative heat and water loss from higher air flow onto the infant. In addition, ambient temperature and humidity shall be adjustable into the range of 72-78° F (22 to 26° C) with a relative humidity of at least 30%.

The acoustic environment set forth in Standard 27 shall be the basis for all design choices except for the necessary hard (cleanable) room surfaces. No effort need be made to achieve this standard in adjacent spaces if doors are expected to remain closed during most of the procedures.

Specialized Procedure Spaces or Rooms Within the Newborn ICU

Specialized procedure spaces or rooms within the NICU shall be constructed to achieve all of the above, as well as all of the requirements for an infant bed space elsewhere in these Recommended Standards, except for the following additional modifications:

Each procedure area must be physically separated from other areas so that during surgery or procedures patient and staff flow may be strictly controlled. Air flow must be designed so as to not disrupt the air curtain around the surgical field, and shall be adjustable so as to be able to increase to 15 changes/hr during procedures, then return to baseline values set forth in Standard 10. A scavenging system to vent waste inhalation anesthesia and analgesia gases is required. HVAC equipment shall be of a type that minimizes the need for maintenance within the room.

Procedure rooms designed for surgery or ECMO shall have a minimum clear floor area of 360 square feet (33.5 square meters) with a minimum dimension of 16 feet (4.9 square meters) exclusive of built-in shelves or cabinets, hand washing stations, and columns. These rooms shall be designed to comply with safety requirements for performance of laser surgical procedures. The space requirements for these functions in multi-bed rooms shall have a minimum clear floor area of 225 square feet (21 square meters) exclusive of built-in shelves or cabinets, hand washing stations, columns and aisles.

It is assumed that infants having surgery in the NICU will be operated on and recover in their own beds and that surgical personnel will bring needed sterile surgical equipment and supplies to the NICU. Therefore, no additional recovery or post-anesthesia areas are required nor are work areas for storage and processing of surgical instruments and separate corridors leading to the operative area. However, support areas for storage of clean and sterile surgical supplies shall be provided, and a scrub station shall be provided near the entrance to each procedure room in a corridor limited to authorized personnel and patients.

Ambient lighting recommendations set forth in Standard 22 shall be followed except where higher illuminances are required as set forth in IES recommendations for operating rooms⁵. Increased ambient lighting must still be adjustable and indirect.

Interpretation: Standard operating room environments may be temporarily modified to better accommodate term infants requiring surgery, but cannot be made optimal for some term and preterm infants, nor can the problems associated with transporting less stable infants away from the intensive resources of the NICU be avoided. There is now sufficient experience to conclude that certain procedures can be performed in the NICU without compromising patient safety or outcomes.

It is now also evident that the environment currently recommended for NICU design may have a positive impact on infant outcomes. This Standard now makes provision for infants requiring surgical procedures to be similarly benefited.