INTEGRATED THEATRES
70 years of innovation in operating theatre design
Sincethebirthof theNationalHealthService in1948, the healthcare landscapeintheUKhas undergone incredible transformation. Steve Peak, Vanguard delivery and development director, discusses how hospitaldesignhaschangedand, inparticular,how thedesignof operating theatres continues toevolveat arapidpace to this day.
The frequency of change in healthcare means that the lifespan of the operating theatre is relatively short compared to the lifespan of the hospital building as a whole. On average, operating theatres can be expected to undergo significant refurbishment every 10 to 12 years. Although it is difficult to pin down specific changes in design theory and architectural practice to particular decades – the complexity of healthcare buildings means that the design process often spans years, as does the construction phase – it is clear the operating theatres have undergone a dramatic transformation over the past 70 years.
1950s
The NHS was in its infancy during the post-war period, when many aspects of UK industry were still recovering. As a result, much of the NHS estate remained as it had been prior to the implementation of state-funded healthcare.
Operating theatres were often part of a ‘twin suite’ design – two operating rooms designed as part of a self- contained department, sharing ancillary facilities and often staff between the two theatres. While this adhered to the functionalist principles of ease of access to necessary facilities, with instrument sterilisation for example often taking
place either within the theatre or in an immediately adjacent room, it meant that patients had to be transported long distances in order to reach wards. Often mechanised transport was required to move patients the necessary distance to recovery, so corridors were designed with adequate width to allow this kind of movement. Towards the end of the decade,
however, as the country began to regain momentum following the war, theatre technology began to change. The first studies in operating theatre ventilation were published in the USA, noting that when the flow of contaminated air into the theatre from outside was reversed by positive
In the 1960s, healthcare architects widely adopted a new style of hospital building which changed the way operating theatres interacted with the rest of the hospital.
pressure, there was: “an immediate reduction in the bacteria in the air and… a striking fall in the incidence of wound infections from 37 out of 427 clean operations to 5 out of 532.”1 This new knowledge led to further investigations and evidence-based development of positive-pressure air flow, the precursor to the ultra-clean ventilation systems in use today. The goal of asepsis, rather than antisepsis, led to developments in operating theatre practice and attire. Crucially, in 1955 the Nuffield Trust published its research report Studies in the Function and Design of Hospitals, which was to change and inform hospital and operating theatre design for the next 30 years.
1960s
In the 1960s, healthcare architects widely adopted a new style of hospital building which changed the way operating theatres interacted with the
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