An Evidence-Based Framework for Designing Operating Rooms: Integrating Indoor Environmental Quality, Clinical Outcomes, and Energy Performance

ObjectiveThis study proposes an evidence-based design (EBD) framework for operating rooms (ORs) that integrates indoor environmental quality (IEQ), clinical outcomes, and energy performance into a unified, digitally enabled approach.BackgroundHospitals are among the most energy-intensive building types, requiring strict environmental control to support infection prevention, patient safety, and clinical performance. However, in practice, IEQ and energy efficiency are often addressed separately, resulting in suboptimal environmental conditions and increased health risks, including healthcare-associated infections (HAIs). ORs are complex environments where aligning environmental, technical, and clinical requirements is critical.MethodsThe methodology is grounded in EBD principles and integrates architectural, engineering, epidemiological, and clinical perspectives within a lifecycle-oriented decision-making framework. It follows the engineering design model proposed by Morris Asimow, structuring the process across the building lifecycle and focusing on the early design phases (Phases 1-3), when decisions have the greatest impact on performance, safety, and long-term operational efficiency.ResultsA smart OR model was developed that integrates a cyber-physical IEQ control system with a multisensor network for real-time monitoring and adaptive regulation. The closed-loop system dynamically adjusts environmental conditions to user needs, enabling simultaneous control of different microclimatic zones. Simulation results indicate that individualized control can improve patient thermoregulation by reducing heat loss while maintaining acceptable conditions for surgical staff and supporting energy efficiency.ConclusionsThe findings indicate that integrating user-centered IEQ control with cyber-physical systems can support adaptive, high-performance ORs that better align patient needs, staff comfort, and energy efficiency, while promoting safer and effective care delivery.