Standards

General¹

1. Medical Directors must ensure that the requirements in Public Health Ontario’s Infection Prevention and Control for Clinical Office Practice document regarding physical spaces, including the surgical space and reprocessing space, are met.
2. Medical Directors must ensure:
   1. The OHP complies with all applicable building codes including fire and safety requirements;
   2. All electrical devices are certified by the Canadian Standards Association (CSA) or are licensed for use in Canada;
   3. Any anesthetic or ancillary equipment and any medical compressed gases and pipelines comply with the CSA or be licensed for use in Canada;
   4. There is an emergency power supply that allows for safely completing a procedure that is underway and for recovering the patient (e.g., generator, uninterrupted power supply, etc.);
   5. Accessfor persons with disabilities complies with provincial legislation² and   municipal bylaws;
   6. Necessary spaces can be accessed by and accommodate stretchers and wheelchairs;
   7. The size of the OHP is adequate for all the procedures that will be performed within it;
   8. The OHP layout facilitates safe patient care and patient flow; and
   9. At minimum, the following areas of the OHP are functionally separate:
      1. administration and patient-waiting area
      2. procedure room and/or operating room
      3. recovery area (where applicable)
      4. clean utility area
      5. dirty utility room
      6. reprocessing room (where applicable)
      7. endoscope cabinet (where applicable)
      8. staff change room and staff room.
3. Medical Directors must ensure the physical space allows for appropriate movement of patients in an emergency, including:
   1. safely evacuating patients and staff if necessary (e.g., stretchers, wheelchairs, or other adequate methods of transport are available), and
   2. appropriate access to the patient for an ambulance to transfer the patient to a hospital.

Procedure Room/Operating Room Physical Standards

Physical Requirements

4. Medical Directors must ensure the OHP has:
   1. lighting as required for the specific procedure being performed;
   2. floors, walls, and ceilings that can be cleaned to meet infection control requirements;
   3. immediate access to hand-washing facilities and proper towel disposal;
   4. openings to the outside effectively protected against the entrance of insects or animals; and
   5. space sufficient to accommodate equipment and staff required for the procedure, and to move around while sterile, without contamination.

Ventilation

5. Medical Directors must ensure
   1. there is ventilation sufficient to ensure patient and staff comfort, and fulfill occupational health and safety requirements;
   2. there is ventilation and air circulation augmented to meet manufacturer’s standards and address procedure-related air-quality issues (e.g., cautery smoke, endoscopy, disinfecting agents, anesthesia gases), where applicable;
   3. air exchanges meet infection control standards³ for the type of procedure being performed; and
   4. if using gas sterilization for reprocessing, a positive pressure outbound system is used and vented directly to the

Equipment Maintenance and Inspection

6. Medical Directors must ensure:
   1. Medical equipment is maintained and inspected at least yearly and as necessary by a qualified biomedical technician and has an active service contract;
   2. Equipment necessary for emergency situations (i.e., defibrillators, oxygen supply, suction) is inspected on a weekly basis and documented;
   3. Related documentation for all equipment is available, including:
      1. record of certification of medical equipment by a qualified biomedical technician,
      2. equipment operating manuals,
      3. equipment maintenance contracts with an independent and certified biomedical technician, and
      4. log for maintenance of all medical devices.

Recovery Area Physical Standards

7. Medical Directors must ensure a sink is available for hand washing.
8. For Level 2 and 3 facilities, Medical Directors must ensure:
   1. The size of the recovery area can accommodate the number of patients for two hours of operating room time (i.e., 1 hour procedure = 2 patients, 0.5 hour procedure = 4 patients); and
   2. The recovery area allows for transfer of patients to/from a stretcher and performance of emergency

Endnotes

^1. The Canadian Standards Association (CSA) and other standards development organizations have published standards and guidance documents for the design, construction, and renovation of healthcare facilities. Please see CSA Standard Z8000 for more information. The Canadian Anesthesiologist’s Society also identifies a list of CSA Standards that describe the standards for medical devices and equipment.

^2. Accessibility for Ontarians with Disabilities Act, 2005, S.O. 2005, c. 11.

^3. For more information see the Surgical Space requirements set out in Public Health Ontario’s Infection Prevention and Control for Clinical Office Practice.