Many hospitals have operating departments built decades ago that need renewing without interrupting surgery. Refurbishing while the hospital stays open is possible, but it requires a precise method: phased works, dust containment, separate routes and construction solutions that keep the time on site to a minimum.

Why is it difficult to refurbish a working operating department?

A working operating department holds patients, staff and sterile materials a few metres from the site. There are four main difficulties.

  • Dust: construction dust can carry fungal spores, a known risk for immunocompromised patients.
  • Noise and vibration: they disturb surgery and the wards nearby.
  • Continuity of service: theatres cannot stay closed for long without reducing planned operations.
  • Shared services: ventilation, medical gases and power also serve the theatres still in use, and must be altered with interruptions kept minimal and planned.

How are the works organised in phases?

Phased refurbishment divides the operating department into sections that are renewed one at a time. While one section is under works, surgery continues in the theatres still in use.

  1. Survey of the existing building: condition of the structure, service routes, constraints.
  2. Phasing plan: which theatres close, in what order and for how long, in line with the surgical schedule.
  3. Preparation: separation of the site area and set-up of routes.
  4. Works in the closed section: demolition, services, installation of the new envelope.
  5. Checks and reopening: testing, final cleaning, validation of the theatre following the hospital's procedures.
  6. Next phase: the cycle repeats on the following section.

Which containment measures are needed?

Containment measures are defined before the works with the hospital management and the infection prevention and control team. The most common are:

  • sealed barriers between the site and active areas, often with the site kept at negative pressure relative to the wards, so that air does not escape towards clean areas;
  • separate routes for workers, materials and waste, which avoid clinical areas wherever possible;
  • frequent cleaning and protection at access points;
  • noisy work grouped into agreed hours;
  • checks during the works, to confirm that the measures are working.

Why do modular systems reduce time and risk?

A pre-finished modular system moves much of the work from the site to the factory. Walls arrive already finished and are assembled dry: no plastering, filling or sanding in the work area, so less fine dust and less noise. Manufacturing takes place at the plant while the spaces are prepared on site, so each phase is shorter.

After the refurbishment, too, removable panels make a difference: services maintenance is done by opening a panel, without demolition or wet trades. The differences from walls built in place are covered in the guide to modular walls or plasterboard in hospitals.

What should be ready before refurbishing an operating department?

Refurbishment in a working hospital succeeds when decisions are taken before the site opens. It is worth having ready:

  • an accurate survey of the existing building, because every surprise during the works extends the current phase;
  • a complete detailed design, with the position of every outlet, monitor, cabinet and door;
  • a phased programme shared with the hospital management;
  • an approved containment plan;
  • coordination between the envelope manufacturer, the services contractors and the main contractor.

What does ADAM offer for operating department refurbishments?

ADAM S.r.l. has developed the SALUS system since 2006: pre-finished panels with continuous, cleanable surfaces that can be opened for services maintenance, suitable for operating theatres and controlled-contamination environments. Through its ADAM Health division, ADAM also supplies medical doors, including hermetic automatic sliding doors, technical ceilings, recessed cabinets and pass-through boxes.

SALUS walls are designed and manufactured at the plant in Bernate Ticino, near Milan, and arrive on site already finished. ADAM follows the project through four phases — consulting, budgeting, design and building ventures — with a single point of contact, as described on the Services page.

Operating theatres with ADAM systems are on the Projects page, and the guide to modular operating theatres describes their components and delivery stages. To discuss refurbishing an operating department, contact the ADAM team.