The surgical service space shall be divided into two designated areas: 1) semi-restricted areas (e.g. storage areas for clean and sterile supplies, sterile processing rooms, scrub stations, and corridors leading to restricted areas of the surgical suite, etc.); and 2) restricted areas (e.g. operating rooms, hybrid operating rooms, sterile procedure rooms, cardiac catheterization labs, etc.) that can be reached only through a semi-restricted area. The surgical service space shall be located and arranged to provide direct support from the anesthesia/recovery service space with a common door to prevent nonrelated traffic through the surgical service space.
An operating room suite design with a sterile core shall provide for no cross traffic of staff and supplies from the decontaminated/soiled areas to the sterile/clean areas. The use of facilities outside the operating room for soiled/decontaminated processing and clean assembly and sterile processing shall be designed to move the flow of goods and personnel from dirty to clean/sterile without compromising universal precautions or aseptic techniques in either department.The number of operating rooms and recovery beds, and the sizes of the support areas, shall be based on the expected surgical workload. Hospitals shall maintain at least the number of operating rooms in ratio to licensed bed capacity as follows:
|Licensed Bed Capacity||Number of Operating Rooms|
|Less than 25||One|
|25 to 99||Two|
|100 or more||Three|
For each additional 100 beds, and for each major fraction thereof, at least one additional operating room shall be maintained, unless approved to the contrary by the Department of Public Health. Required operating rooms are in addition to special operating rooms, cystoscopy rooms and fracture rooms which are provided by the hospital. Beds in a distinct-part skilled nursing service, intermediate care service or psychiatric unit shall be excluded from calculating the number of operating rooms required
Exception: Surgical service space is not required in a rural general acute care hospital, if the hospital maintains written transfer agreements with one or more general acute care hospitals that provide surgical and anesthesia services. Written transfer agreements shall be approved by the Department of Public Health, Licensing and Certification.
Each room shall have a minimum clear floor area of 400 square feet (37.16 m2) with a minimum of 20 feet (6096 mm) clear dimension between fixed cabinets and built-in shelves; and a system for emergency communication with the surgical service space control station. X-ray or imaging viewing capabilities shall be provided.
Exception: Where renovation of existing operating rooms is undertaken in facilities built under the 2001 or prior California Building Code, each operating room shall have a minimum clear floor area of 324 square feet (30.10 m2) with a minimum of 18 feet (5486 mm) clear dimension between fixed cabinets and built-in shelves.
Each room shall have a minimum clear floor area of 250 square feet (23.23 m2) with a minimum of 15 feet (4572 mm) clear dimension between fixed cabinets and built-in shelves. X-ray viewing and/or other imaging modality capabilities shall be provided
Exception: Where renovation of operating rooms is undertaken in facilities built under the 2001 or prior California Building Code rooms for surgical cystos-copy shall have a minimum clear floor area of 180 square feet (16.72 m2). Cast rooms for open reductions, if provided, shall have a minimum clear floor area of 180 square feet (16.72 m2), no dimension of which shall be less than 11 feet (3353 mm).
Services, except for the enclosed soiled workroom referenced in Section 118.104.22.168 and the housekeeping room referenced in Section 122.214.171.124, may be shared with the obstetrical facilities. Service areas, when shared with delivery rooms, shall be designed to avoid the passing of patients or staff between the operating room and the delivery room areas. The following shall be provided in support of the surgical service space:
If provided within the surgery suite, a sub-sterile area(s) shall be equipped with a flash sterilizer, warming cabinet, countertop, and handwashing station. If a sterilizing facility(ies) with high-speed sterilizer(s) or other sterilizing equipment for immediate or emergency use are provided, they shall be directly accessible from the operating room(s) it serves or shall be located inside the clean core if the clean core is directly accessible from the operating room(s). This room shall be accessible without traveling through any operating room. Other facilities for processing and sterilizing reusable instruments, etc., may be located in another hospital department such as central sterile supply.
A medication station shall be provided in accordance with Section 1126.96.36.199.
Scrub sinks shall be located outside of sterile areas. A minimum of two scrub sinks shall be provided in a surgical unit containing one operating room. Four scrub sinks shall be provided in surgical units containing two operating rooms. One additional scrub sink shall be provided for each additional operating room. Scrub sinks shall have water supply controls not requiring direct contact of the hands for operation.
A direct-wired or battery-operated clock or other equivalent timing device shall be visible from the scrub-up sinks.
An enclosed soiled workroom (or soiled holding room that is part of a system for the collection and disposal of soiled material) for the exclusive use of the surgical service space shall be provided. The soiled workroom shall contain a flushing-rim clinical sink or equivalent flushing-rim fixture, a handwashing fixture, a work counter, and space for waste receptacles and soiled linen receptacles. Rooms used only for temporary holding of soiled material may omit the flushing-rim clinical sink and work counters. However, if the flushing-rim clinical sink is omitted, other provisions for disposal of liquid waste shall be provided. The room shall not have direct connection with operating rooms. Soiled and clean utility room or holding rooms shall be separated. The soiled workroom shall provide 24 square feet (2.23 m2) per operating room up to eight operating rooms and shall have a minimum area of 48 square feet (4.46 m2), with no dimension less than 6 feet (1829 mm).
This room shall not be used for food preparation.
A clean utility room is required when clean materials are assembled within the surgical service space prior to use or following the decontamination cycle. It shall contain a work counter, a handwashing fixture, storage facilities for clean supplies, and a space to package reusable items. The storage for sterile supplies must be separated from this space. If the room is used only for storage and holding as part of a system for distribution of clean supply materials, the work counter and hand-washing fixture may be omitted. Soiled and clean utility rooms or holding rooms shall be separated.
Provide an anesthesia workroom for cleaning, testing and storing anesthesia equipment. This room shall contain work counter(s) and sink(s) and racks for cylinders.
for equipment and supplies used in surgical service space. Each surgical service space shall provide sufficient storage area to keep its required corridor width free of equipment and supplies, but not less than 150 square feet (13.94 m2) or 50 square feet (4.65 m2) per operating room, whichever is greater.
Appropriate areas shall be provided for male and female personnel (orderlies, technicians, nurses and doctors) working within the surgical service space. The areas shall contain lockers, showers, toilets, lavatories equipped for handwashing, and space for donning surgical attire. These areas shall be arranged to encourage a one-way traffic pattern so that personnel entering from outside the surgical service space can change and move directly into the surgical service space.