In the traditional surgery suite design, operating rooms are grouped around a “sterile core” — from which case carts and sterile supplies are retrieved by the circulating nurse and taken into the operating rooms in preparation for surgery. A “substerile” room was typically placed between two operating rooms to provide “flash” or emergent sterilization of unwrapped items to be used immediately in the operating room. The sterile core often housed a sterilizer as well. Because the items were sterilized in open baskets that could be contaminated by improper handling and exposure during transport, the substerile rooms were placed as close as possible to the operating rooms and the sterile core was considered a restricted area.
CURRENT TREND
Sterilization practices have changed in recent years. Use of flash sterilization was originally intended for only one or two instruments — such as a pair of surgical scissors or forceps. These simple instruments were easy to clean and sterilize quickly. The complexity of today’s instruments require careful and thorough cleaning by skilled personnel familiar with the intricacies of many “non-standard” sterilization processes. Moreover, the time required to retrieve an instrument from a central sterile processing department is now usually quicker than performing the flash sterilization process within the surgery suite. The term “flash sterilization” has now been replaced with what is called “immediate-use steam sterilization.” With immediate-use steam sterilization (IUSS), sterile items emerge from the sterilization process in rigid, enclosed containers that protect the items from being contaminated during transport from the sterilization chamber to the point of use.
FACILITY IMPACT
Using the IUSS process eliminates the need for multiple spaces within the surgical suite for sterile processing. Constructing substerile rooms in a hospital-based surgery suite or an ambulatory surgery center is no longer advised (FGI 2014) — thus saving significant dollars in equipment and construction costs. Instead, a single “sterile processing room” may serve an entire surgery suite or groups of operating rooms depending on the size of the surgery suite.
The sterile processing room typically requires a 12’ by 20’ space — or about 240 net square feet — and should be designed to facilitate a one-way soiled-to-clean traffic pattern with separately designated decontamination and clean work areas. The entrance should be via the contaminated side of the sterile processing room from the semi-restricted area of the surgical suite. The exit should be via the clean side of the sterile processing room directly into the clean core or a semi-restricted corridor, or into an operating room. If sterile processing is not performed within the surgery suite, a sterile processing room is not required. In any case, the sterile core is now typically referred to as a “clean core” and considered a semi-restricted area when there are no open sterile items.
As noninvasive and minimally-invasive surgeries have spread rapidly throughout all specialties during the past several decades, the need for additional instruments and new equipment has proliferated. Longer instruments and larger equipment further increases the need for planning. In addition to specialty operating room tables and positioning devices, imaging equipment, video towers, navigation systems, microscopes, lasers and cautery machines, a plethora of disposable accessories for the new equipment must also be accommodated within the surgery suite.
SIGNIFICANT COST SAVINGS
According to the 2014 Facility Guidelines Institute Update Series (Conner 2014), the potential cost savings are enormous. The cost of providing a single substerile room could be $100,000 to $160,000 for the equipment and infrastructure and another $60,000 for the floor space, excluding long-term operational costs for maintenance, regulatory compliance, and personnel. This compares to about $80,000 more for a sterile processing room that could support the entire surgery suite. These costs could be eliminated entirely if no sterilization is performed in the surgery suite at all — thus relying upon a central sterile processing department.
Source: “Update Series: Sterile Processing in the Surgical Suite,” Guidelines for Design and Construction of Hospitals and Outpatient Facilities, Facility Guidelines Institute, 2014.