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
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
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