INTEGRATED THEATRES
rest of the hospital. In the 1950s, what became known as the ‘matchbox on a muffin’ hospital; the first of these was the Hospital Memorial France-Etats- Unis Saint-Lo in 1956. These hospitals featured a podium of several storeys’ height which housed the critical hospitals services: operating theatres, diagnostics, sterilisation departments and domestic services. Stacked on top of these in a tall ‘matchbox’ tower were the wards, which were all served from a central, high-tech core.
This vertical hospital design meant that theatres stepped away from the older twin suite design, and operating rooms became a much more focussed surgical environment.
Centralised sterilisation was adopted, birthing the CSSD model that is still widely followed today; an article in the British Medical Journal published in 1962 stated: “A strong case could be made in favour of removing sterilising- rooms and sink rooms from the vicinity of the theatres,”2
citing rising concerns
about cross-infection within the older ‘twin suite’ theatre design as evidence of the need for change. This design increased the adaptability of service configuration; changes could be made to the lower structure, including to operating theatres, without impacting the wards above.
This focus on flexibility led to
widespread discussion of operating theatre layout and materials. The Nuffield Trust report states: “If a 20-foot square is drawn round the core of activity surrounding the table, it is apparent that sufficient peripheral space will be enclosed to allow free movement and the placing of equipment.”3 It is interesting to note that this
report also included a section on the use of colour in the operating theatre, an area of healthcare practice that is coming increasingly into wider focus today. This exploration of the theatre environment also led to a move away from the traditional method of natural illumination, with operating theatres now becoming a much more mechanised environment. Surgeons’ preference for control over their operating environment grew apace with developments in lighting, ventilation and temperature; environmental variables gradually came under machine control as the technology boom spawned
58 l JULY 2018 l OPERATING THEATRE
The nucleus hospital concept was developed in the early ‘80s in an attempt to build replicable, low- energy hospitals.
improvements such as commercially viable air conditioning systems. The work of Gordon Friesen, a hospital administrator in Canada whose life’s work became based around healthcare planning, introduced the concept of strict separation of clean and dirty workflows during this time, based on theories of microbiological cross-contamination and staff practice.
1970s
Late in the preceding decade, design began on the Greenwich Hospital, which broke away from the widely popularised ‘matchbox on a muffin’ typology. The Greenwich design followed the ‘horizontal hospital’ concept, with low rise buildings spread out across a broader length rather than the widely-accepted towers of the previous generation of hospitals. This idea aimed to make hospitals more flexible by enabling additional service areas to be added to the outer extremities of the building without disrupting activity in adjacent areas. The previous high-tech circulation methods that had seen mobilised transport taking patients to and from theatre was replaced with low tech methodologies, with theatres and functionally related departments now being sited close to one another; in this capital- and energy-starved decade, innovations in theatre design slowed
considerably and the healthcare market stagnated.
1980s and 1990s Throughout these decades, the basic precepts of healthcare in the UK began to shift towards ‘patient centric’ care. The nucleus hospital concept was developed in the early ‘80s in an attempt to build replicable, low-energy hospitals, with operating theatres located at the central hub of the building and wards spread across the projecting wings.
The focus on operating theatre
environment, previously maintained from the surgeon’s perspective, expanded to include patient experience as a deciding factor in hospital design. Natural light, often previously discarded in favour of controlled, artificial lighting, made a return to the operating theatre, with daylight-excluding blinds fitted between two panes of glass to prevent dust build-up and retain the flexibility to suit different surgical requirements and preferences.
As minimally-invasive and day
surgical techniques developed through the late ‘80s and into the ‘90s alongside new technology, operating theatres for day cases began to be widely housed in separate day surgery units, with independent workflows and pathways for both staff and patients. Inpatient theatre suites began to follow a new design, with the traditional separation of clean and dirty flows discarded in favour of a single corridor system as “the simplest and often the most economic.”4 The recommended size of operating theatres in the UK increased5
to 40m2 in
an effort to accommodate the growing amount of equipment present in theatre, such as surgical stack systems or medical lasers. The height of new operating theatres designed during this period increased as part of a future-proofing activity, driven in part by the difficulties experienced in the late ‘80s and early ‘90s when refurbishing theatres to include laminar flow canopies. By the end of the ‘90s, these specialist ventilation systems were fitted to theatres across the UK where high- risk operations were conducted, in an effort to minimise surgical site infections. The reconfiguration of lighting and electricals was required in order for retrofitted canopies not to
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