NABH

NABH-Air Conditioning_OT
REVISED GUIDELINES FOR

AIR CONDITIONING
IN OPERATION THEATRES
Issue No. 2 Issue Date: 06/ 14 Page 1 of 8

Revised Guidelines for Air Conditioning in Operation Theatres –
Air Conditioning In OT
A. The air conditioning requirements for Operation Theater in a HCO have been
deliberated at length with manufacturers, engineers, technical committee
members and other stake holders and the following guidelines have been
finalized.
B. For this purpose operation theaters have been divided into groups:
1. Super specialty OT: Super specialty OT means operation theatres for

Neurosciences, Orthopedics (Joint Replacement), Cardiothoracic and
Transplant Surgery (Renal, Liver etc).
2. General OT: This includes operation theatres for Ophthalmology, District

hospital OTs, FRU OT and all other basic surgical disciplines.
Daycare centre: Day surgery is the admission of selected patients to

hospital for a planned surgical procedure, returning home on the same
day, would fall under the category of general OT.
C. The following basic assumptions have been kept in view:
 Occupancy: Standard occupancy of 5-8 persons at any given point of time

inside the OT is considered.
 Equipment Load: Standard equipment load of 5-7 kW considered per OT
 Ambient temperature & humidity at each location to be considered while
designing the system.

OT Construction:
a) Paint- antibacterial, anti-fungal

b) OT door – automatic/ Hermitically Sealed/Touch free (preferable)
c) General Lights – Clean room lights
d) Provision of safety against static charge.
e) Separate power circuit for equipment like C-arm
f) Flooring – seamless, incl skirting, should not be of porous stone as it absorbs
moisture and could be a source of bio-burden.

REQUIREMENTS – Super Specialty OT
1. Air Changes Per Hour:
 Minimum total air changes should be 25 based on international guidelines

although the same will vary with biological load and the location.
 The fresh air component of the air change is required to be minimum 4 air
changes (ie 16%) out of total minimum 25 air changes.
 If HCO chooses to have 100% fresh air system than appropriate energy
saving devices like heat recovery wheel, run around pipes etc should be
installed.
2. Air Velocity: The vertical down flow of air coming out of the diffusers should be
able to carry bacteria carrying particle load away from the operating table. The
airflow needs to be unidirectional and downwards on the OT table. The air
velocity recommended as per the international and national guidelines is 90-
120 FPM at the Grille/ Diffuser level.
3. Positive Pressure: There is a requirement to maintain positive pressure

differential between OT and adjoining areas to prevent outside air entry into
OT. The minimum positive pressure recommended is 15 Pascal (0.05 inches of
water) as per ISO 14644 Clean Room Standard.
4. Air handling in the OT including air Quality: Air is supplied through Terminal
HEPA filters in the ceiling. The minimum size of the filtration area should be 8’ x
6’ to cover the entire OT table and surgical team. The minimum supply air
volume to the OT (in CFM) should be compliant with the desired minimum air
change. Air quality at the supply i.e. at grille level should be Class 100/ ISO
Class 5 (at rest condition).
Note: Class 100 means a cubic foot of air should not have more than 100
particles measuring more than 0.5 microns or larger.

5. Air Filtration: The AHU must be an air purification unit and air filtration unit.
There must be two sets of washable flange type pre filters of capacity 10
microns and 5 microns with aluminum/ SS 304 frame within the AHU. The
necessary service panels to be provided for servicing the filters, motors &
blowers. HEPA filters of efficiency 99.97% down to 0.3 microns or higher
efficiency are to be provided in the OT and not in the AHU.
6. Temp & RH for Super-specialty OT: it should be maintained 21 C +/- 3 C

(except for Ortho for Joints replacement as 18 C +0 & -2 C) with corresponding
relative humidity between 40 to 60% though the ideal RH is considered to be
55%. Appropriate devices to monitor and display these conditions inside the OT
may be installed.

REQUIREMENTS – General OT
1. Air Change Per Hour:

 Minimum total air changes should be 20 based on international guidelines
although the same will vary with biological load and the location.
 The fresh air component of the air change is required to be minimum 4 air
changes (ie 16%) out of total minimum 20 air changes.
2. Air Velocity: should be same as per previous guide.
3. Positive Pressure: There is a requirement to maintain positive pressure

differential between OT and adjoining areas to prevent outside air entry into
OT. The minimum positive pressure recommended is 15 Pascal (0.05 inches of
water).
4. Air handling/Filtration: should be same as previous. When not possible, the

OTs should be well ventilated with 2 filtrations (pre and microvee filters should
be in position at the AHU).
5. Temperature and Humidity: The temperature should be maintained at 21C +/- 3

Deg C inside the OT all the time with corresponding relative humidity between
40 to 60%. Appropriate devices to monitor and display these conditions inside
the OT may be installed.

Design considerations for Planning New Operation Theatres
 The AHU of each OT should be dedicated one and should not be linked to air
conditioning of any other area for all OT constructed.
 During the non functional hours AHU blower will be operational round the clock
(may be without temperature control). Variable frequency devices (VFD) may
be used to conserve energy.
 Window & split A/c should not be used in any type of OT because they are
pure re circulating units and have convenient pockets for microbial growth
which cannot be sealed.
 The flooring, walls and ceiling should be non porous, smooth, seamless without
corners (coving) and should be easily cleanable repeatedly. The material
should be chosen accordingly. Hermetic sealing of the doors is recommended.
 Validation of system to be done as per ISO 14664 standards and should

include:
 Temperature and Humidity check
 Air particulate count
 Air Change Rate Calculation
 Air velocity at outlet of terminal filtration unit /filters
 Pressure Differential levels of the OT wrt ambient / adjoining areas
 Validation of HEPA Filters by appropriate tests like DOP etc; repeat after
6month in case HEPA found healthy.
 Maintenance of the system: It is recommended that periodic preventive

maintenance be carried out in terms of cleaning of pre filters at the interval of
15 days. Preventive maintenance of all the parts is carried out as per
manufacturer recommendations.

References
1. Heating and Ventilation System. Health Technical Memorandum 03-01:

Specialized ventilation for healthcare premises. Part A – Design and
installation. Department of Health/ Estates and Facilities Division. November
2007.
2. Designing an Ideal Operating Room Complex. Indian Journal of Anaesthesia

2007; 51 (3): 193-199.
3. Melhado MA, Hensen JLM, Loomans M, Forejt L. Review of Operating room

ventilation standards. STP – Society of Environment Engineering. 2006.
4. Day Surgery Unit Guide – Standards and Recommendations. Reports, Studies

and Research. Ministry of Health and Consumer Affairs, Madrid. 2008.
5. Guidelines for Quality Cataract Management in Secondary level eye centers.

Sightsaver International. Oct 2008.
6. American Society of Heating, Refrigerating and Air Conditioning Engineers

(ASHRAE) Standards. Ventilation for Indoor Air Quality. 24 January 2010.
Retrieved 2010-11-29.

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NABH-Air Conditioning_OT

REVISED GUIDELINES FOR

Issue No. 2 Issue Date: 06/ 14 Page 1 of 8

1. Super specialty OT: Super specialty OT means operation theatres for

2. General OT: This includes operation theatres for Ophthalmology, District

Daycare centre: Day surgery is the admission of selected patients to

C. The following basic assumptions have been kept in view:

 Occupancy: Standard occupancy of 5-8 persons at any given point of time

Issue No. 2 Issue Date: 06/ 14 Page 2 of 8

a) Paint- antibacterial, anti-fungal

Issue No. 2 Issue Date: 06/ 14 Page 3 of 8

REQUIREMENTS – Super Specialty OT

1. Air Changes Per Hour:

 Minimum total air changes should be 25 based on international guidelines

3. Positive Pressure: There is a requirement to maintain positive pressure

Issue No. 2 Issue Date: 06/ 14 Page 4 of 8

6. Temp & RH for Super-specialty OT: it should be maintained 21 C +/- 3 C

Issue No. 2 Issue Date: 06/ 14 Page 5 of 8

1. Air Change Per Hour:

2. Air Velocity: should be same as per previous guide.

3. Positive Pressure: There is a requirement to maintain positive pressure

4. Air handling/Filtration: should be same as previous. When not possible, the

5. Temperature and Humidity: The temperature should be maintained at 21C +/- 3

Issue No. 2 Issue Date: 06/ 14 Page 6 of 8

Design considerations for Planning New Operation Theatres

 Validation of system to be done as per ISO 14664 standards and should

 Maintenance of the system: It is recommended that periodic preventive

Issue No. 2 Issue Date: 06/ 14 Page 7 of 8

1. Heating and Ventilation System. Health Technical Memorandum 03-01:

2. Designing an Ideal Operating Room Complex. Indian Journal of Anaesthesia

3. Melhado MA, Hensen JLM, Loomans M, Forejt L. Review of Operating room

4. Day Surgery Unit Guide – Standards and Recommendations. Reports, Studies

5. Guidelines for Quality Cataract Management in Secondary level eye centers.

6. American Society of Heating, Refrigerating and Air Conditioning Engineers

Issue No. 2 Issue Date: 06/ 14 Page 8 of 8

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