NICU Standard 9: Operating Rooms Intended for Use by Newborn ICU Patients

Operating rooms in health-care facilities where infant procedures may be performed shall be constructed to operating room specifications except for the following modifications:

Assuming infant’s eyes are shielded (eye patches) while in the operating room, no changes to the IES guidelines for operating rooms5 are required. However, light sources meeting the values identified in Standard 23 are recommended.

Laminar flow diffusers over the surgical bed shall be set at the low end of the air velocity range (approximately 25 ft/min) and balanced with the surrounding slot diffuser air curtain to minimize convective and evaporative heat and water loss from higher air flow onto the infant. In addition, ambient temperature and humidity shall be adjustable into the range of 72-78° F (22 to 26° C) with a relative humidity of at least 30%.

The acoustic environment set forth in Standard 28 shall be one of the bases for all design choices.

Procedure Rooms Within the Newborn ICU

Where provided, Specialized procedure spaces or rooms within the NICU shall be constructed to achieve all of the above, as well as all of the requirements for an infant bed space elsewhere in these Recommended Standards, except for the following modifications:

Each procedure room must be in a semi-restricted area, physically separated from other areas so that during surgery or procedures patient and staff flow may be strictly controlled. Air flow must be designed so as to not disrupt the air curtain around the surgical field, and shall be adjustable so as to be able to increase to 15 changes/hr during procedures, then return to baseline values set forth in this Standard. Where anesthetic gas will be used in this room, a waste anesthetic gas disposal (WAGD) scavenging system to vent waste inhalation anesthesia and analgesia gases is required. HVAC equipment shall be of a type that minimizes the need for maintenance within the room.

Procedure rooms shall have a minimum clear floor area of 180 square feet (16.7 square meters) exclusive of built-in shelves or cabinets, hand washing stations, and columns. Rooms where procedures will require more personnel and large equipment shall be sized to accommodate these needs including additional space for equipment and staff needed for resuscitation and other emergencies. When laser procedures occur in these rooms, the rooms shall be designed to comply with The Association of Surgical Technologists’ Standards of Practice for Laser Safety6.

Where infants having surgery in the NICU recover in their own beds no separate recovery or post-anesthesia areas are required.

Separate sterile corridors and work areas for storage and processing of surgical instruments leading to the procedure room are not required. However, support areas for storage of clean and sterile surgical supplies shall be provided, and a handwashing station shall be provided near the entrance to each procedure room or in the procedure room.

Ambient lighting recommendations set forth in Standard 23 shall be followed except where higher illuminances are required as set forth in IES recommendations for operating rooms5. Increased ambient lighting must still be adjustable and indirect.

Interpretation: Standard operating room environments may be temporarily modified to better accommodate term infants requiring surgery, but cannot be made optimal for some term and preterm infants, nor can the problems associated with transporting less stable infants away from the intensive resources of the NICU be avoided. There is sufficient experience to conclude that certain procedures can be performed in the NICU without compromising patient safety or outcomes.

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