Using a treatment room as a class B or class C OR

QUESTION: On very busy days, the surgery center where I work has been using a small treatment room to accommodate our increased caseload. Is it okay to use a treatment room for surgical procedures Like arthroscopies and hernia repairs?

ANSWER: A treatment room is not an acceptable place to perform invasive procedures unless it meets the qualifications of an OR. Building codes for health care facilities follow the guidelines established by the American Institute of Architects (AIA) Academy of Architecture for Health. The building codes for treatment rooms and ORs are different. The 2006 edition of AIA's Guidelines for Design and Construction of Health Care Facilities specifies building and design parameters that help to ensure patient and workplace safety. (1)

The AIA categorizes ORs as class A, class B, or class C. Treatment rooms are in the class A category. Class B ORs are intended for intermediate surgical procedures. Class C ORs are intended for major surgical procedures. The following guidelines pertain to construction and design features of ORs in outpatient surgical facilities.

* Size--According to the AIA, in an outpatient surgical facility, a class A OR for minor surgical procedures should have a mini mum of 150 sq ft of floor area. In addition to the floor space, there should be a minimum clearance of 3 ft 6 inches at the head, foot, and both sides of the OR bed. Class B ORs for intermediate surgical procedures should have a minimum of 250 square feet of floor space and also should have a minimum clearance of 3 ft 6 inches at the head, foot, and sides of the OR bed. Class C ORs for major surgical procedures should have a minimum of 400 sq ft of floor space with a minimum clearance of 4 ft at the head, foot, and sides of the OR bed. (1)

* Air exchange and ventilation--The AIA recommends an air exchange rate of 20 to 25 changes per hour in rooms with ceiling heights between 9 ft and 12 ft, with a minimum of 15 total air exchanges per hour. Air should move out from the OR to adjacent areas (ie, positive airflow). Treatment rooms are required to have an air exchange rate of six total exchanges per hour. (1)

* Temperature and humidity--The temperature range in an OR should be between 68[degrees] F to 73[degrees] F (20[degrees] C to 22.8[degrees] C) with a humidity range of 30% to 60%. (1) The temperature for a treatment room is 75[degrees] F (24[degrees] C). There are no relative humidity requirements for treatment rooms.

* Medical gas and vacuum--Class B and class C ORs are required to have two oxygen outlets and two vacuum outlets. A treatment room is only required to have one oxygen outlet and one vacuum outlet. (1)

* Lighting--The OR should have special overhead light fixtures in addition to general room lighting. Furthermore, the general and special lighting should be on separate circuits. (1) Treatment rooms are required to have either a fixed or portable light.

* Electrical receptacles--Class B and C ORs should have eight duplex receptacles or 16 single receptacles with six electrical receptacles accessible to the head of the OR bed. (1) The treatment room bed should be accessible to two duplex receptacles.

* Scavenger system--A scavenger system is required whenever inhalation anesthetics are used to ventilate waste anesthetic gases. The waste gases should be exhausted directly to the outside. (1) If anesthetic gases are being used in the treatment room, then it must have a scavenger system.

If your health care facility planned for future expansion and has the proper engineering and architectural controls in place for space requirements, air exchanges and ventilations, medical gas and vacuum systems, lighting, and electrical outlets, it is acceptable to use a room labeled as a treatment room as an OR. If the above conditions are not met, then it is unacceptable to use a treatment room as an OR.

Editor's note: At various times throughout the year, the Recommended Practices Committee seeks review and comment on proposed recommended practices from members and other interested individuals. When available, these proposed recommended practices appear on AORN Online at http://www .aorn.org. Proposed recommended practice documents are available for review and comment for a 30-day period after they are posted. Interested individuals who do not have access to the Internet may obtain copies of the proposed documents by calling the Center for Nursing Practice at (800) 755-2676 x 334. A deadline for comments is indicated with each document. Please check these sources frequently to locate proposed recommended practices. All comments received are considered as the document is finalized. Thank you for your participation.

REFERENCES

(1.) American Institute of Architects Academy of Architecture for Health. Guidelines for Design and Construction of Health Care Facilities. Washington, DC: American Institute of Architects; 2006:120, 127, 130, 189-207, 221-225.

MARY OGG

RN, MSN, CNOR

PERIOPERATIVE NURSING SPECIALIST

AORN CENTER FOR NURSING PRACTICE

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