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How To Design A Safer Operating Room

Infection in the OR can be deadly. A new design concept by NBBJ aims to reduce the risk.

Getting an infection during surgery is a serious problem. Surgical site infections, which occur in the part of the body operated on, in the skin, tissue, organs, or an implant, can prolong hospital stays by more than a week, and increase the patient’s risk of dying as much as 11-fold (one study estimated surgical infections cause 8,000 deaths a year). They also double the hospital’s cost of treatment. To prevent dangerous infections, the global architecture firm NBBJ (along with American Shared Hospital Services) designed a new operating room concept that reduces the opportunity for germs to enter the surgical wound by combining a hands-free lighting system with clean air ventilation.

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Architecture is a major factor in preventing surgical site infections. The physical environment and ventilation of the operating room impacts how pathogens travel through the air. Many surgeries are designed for laminar air flow, a ventilation system that pushes clean air down from the ceiling toward the floor, directing contaminated air away from the surgical site.

Rather than pushing clean air down from a high ceiling and over infection-prone lighting equipment, NBBJ’s new design–which looks kind of like a circular space ship attached to the ceiling–combines a laminar air flow ventilation system with an array of lights within the same unit. Patented in December, it eliminates the risk of dust from large standing lights passing near the surgery site, and allows surgeons to manipulate the brightness and focus of the lighting remotely, giving them more control and better visibility while they work. “This is really addressing the root cause of infection by looking at design in a whole new way,” says Joan Saba, a partner in NBBJ’s health care practice.

How It Works
Called OR 21, the system is a modular unit that can be tailored to the specifications of whatever surgeries take place in that room–if the space is used for only minor procedures, an operating room might only need four light fixtures, while an OR that hosts intense procedures like heart surgery might have 24 fixtures.

Currently, most operating rooms feature lighting attached to booms, suspending moveable lights directly above the operating table. However, this bulky equipment can attract dust and other particles, which can enter the surgical site either by traveling through the air or from the surgical team’s hands as they reach up to adjust the lighting mid-surgery.


Unlike a light attached to a boom, a surgeon can’t manually reach up and adjust the lights in OR 21, reducing the chance that he or she will pick up some bit of infectious material from the boom. The lights can be manipulated using voice commands and gestures (sort of like a surgical Microsoft Kinect). This hands-free method allows operating room staff to change the brightness levels of specific light fixtures and focus light on particular areas, giving them more control over lighting in the space without the risk of germs, and without the surgeon needing to turn away from her work.

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“You’ve error-proofed one portion of the OR, because there’s nothing to clean,” says Rich Dallam, another partner who works in health care at NBBJ. “There’s nothing to harbor particulates that could potentially cause infections.”

Next Steps
NBBJ has been designing its new health care projects to be able to accommodate OR 21, though the system is still being being tested. Because the system allows operating rooms to have controlled lighting without the use of booms, it does not require the high ceilings of current state-of-the-art operating rooms. This could reduce the cost of building new surgeries, but more importantly, it would allow older health facilities with low ceilings to be remodeled with the latest in lighting technology.

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About the author

Shaunacy Ferro is a Brooklyn-based writer covering architecture, urban design and the sciences. She's on a lifelong quest for the perfect donut.

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