IL BLOCCO OPERATORIO. Guida ragionata alla progettazione. Capitolo 8: Modelli di layout e flussi

This Guide is addressed to the Commissioner of the Surgical Block (SB) [“Blocco operatorio (BO)”], to the Medical Director of the Hospital Unit, to the Architect and to the Project Manager of the process of planning, designing and delivering an SB. It raises necessary questions to be asked in the various phases of planning, design and construction of an SB, examining possible solutions, highlighting strengths and weaknesses, and reporting some examples of implementation. Chapter 8, Layout models and flows, aims to exemplify the translation of the planning and organizational management recommendations discussed in the previous chapters into “layout models”. The “layout models”, or “distribution schemes” of the spaces, synthetically represent the rules of spatial configuration (modelpattern) that determine the structure of the system and which define optimal arrangements (layout) of the elements of the system: the spatial units, areas and zones. In order to define the layout of the SB and the spatial models of the surgical intervention area (M-AIC), a checklist of 10 questions is presented, which planners and designers of the SB should ask themselves. Consequently, a diagram and an example of the different M-AIC solutions that can be adopted, as well as the identification of their strengths and weaknesses, are presented: A. double corridor for cleanliness and dirt; B. mixed corridor and clean-sterile core; C. single mixed corridor, with possible variants. A flows diagram follows: 1. patient; 2. surgical team and socio-health operator; 3. clean and sterile material; 4. dirty material and waste. These flows are then transferred to paths of layout models of an 8-theaters SB (one of the scenarios hypothesized in chapter 7) according to diversified distribution hypotheses, based on these fundamental characteristics: • Double-corridor layout or racetrack square, linear distribution of the rooms with separate dirty path, shared recovery. • Racetrack square, cluster room distribution, separate dirty path, shared recovery. • Double-corridor layout or racetrack square, distribution of the opposing rooms facing a sterile-clean core, shared recovery. • Double-corridor layout with rooms facing outwards, distribution of the rooms opposite each other and a mixed corridor, shared recovery. • Racetrack square with outward facing rooms, linear distribution of the rooms on a mixed corridor, support spaces in front, shared recovery. • Racetrack square with outward facing rooms, linear distribution of the rooms on a mixed corridor, adjacent support spaces, shared recovery. For each type of SB layout listed above, the strengths and weaknesses are indicated and examples of projects are reported: new SB of the specialist surgeries of AOU Careggi Firenze (2015-2018); SB of the new hospital building of the Misericordia di Grosseto (2011-2017); SB of the S. Stefano Hospital in Prato (2010-2013); SB of the New Felettino Hospital of La Spezia, 2010 project; SB on floor 1 of the multifunctional plate of the A. Gemelli University Hospital, Rome (2004); new SB of the Policlinico San Martino Genova, operating room plan (2017-2020); SB of Delta Hospital, CHIREC Hospital Group, Auderghem region of Brussels (2017); SB of New Children’s Hospital of Helsinki (2018). The last paragraph is dedicated to the logistics of materials within the SB; an overview of the handling technologies and an evaluation of the storage spaces are offered in the examples cited above.