Color also has an effect – even in operating rooms

Working in operating rooms presents challenging working conditions. The workplace-specific factors, in addition to the high technical demands, also cause physiological problems for the staff. Proper and meaningful use of color not only improves the working climate but also reduces error risks and increases employees' concentration.

The increasing cost and performance pressures, especially in operating rooms, pose new challenges for hospitals. It is also essential to increase productivity through design and redesign of relevant spaces. There is also a necessity to achieve comprehensive optimized medical care within the available resources and the resulting budget constraints. Architectural design has a strong influence on the performance capacity of the clinic. Ergonomics of the workplace, where color also plays an important role, is crucial here.

Ten years ago, the design of new operating rooms was largely in the hands of engineers. Technical innovations were the main focus. Additionally, medical knowledge is currently doubling approximately every five years. Design was a secondary consideration. With medical technological progress, design must also keep pace: ergonomics and functionality are about the well-being and safety of patients and, above all, about relieving staff.

Workplace Operating Room

The operating room as a workplace is necessarily de-individualized, functional, and characterized by shielding from external influences. Perceptible differences between day and night are largely absent, and in rooms without windows, they are completely missing. The demands of patients and staff can sometimes conflict with each other, as well as with economic necessities and architectural conditions. There is a certain risk of accidents for both patients and staff. Ergonomics and the design of the products used in the OR therefore play an important role. Operating units are among the most expensive units in hospitals. The operating minute in Germany was valued at seven euros in 2009. The design and management of surgical departments must therefore be addressed as broadly as possible, incorporating aspects of occupational safety and health economics (from Wikipedia). Color is part of occupational safety.

Analysis of Structural Designs and Their Impact on the Performance of OR Processes

The design of OR areas requires consideration of process- and workplace-specific factors that influence the economic performance and quality of both staff and patient care. Structural measures should be systematically included in evaluations during planning through evidence-based analyses. Where experimental scientific studies are lacking for evaluation, the strength of recommendations should be based on Good Clinical Practice (GCP).

Supporting Psychological Functions to Keep the Workflow Smooth

Consistently high concentration working conditions require strong physical and mental conditioning. This also includes turning off and avoiding colored afterimages.

Color Perception: The Successive Color Contrast

Color perception through the eye can produce astonishing effects. If we look at an intense hue for a while and then look at another surface, the complementary color is projected onto the surface in a subdued form by the eye. The eye provides us with a color that is not actually visible.

How does this phenomenon occur? When viewing a red hue for an extended period, for example, the red receptor's pigment is depleted. If I then look at a white wall, only the blue and green receptors remain: the mixture results in the sum of all remaining colors, creating the successive color contrast.

A well-known example is clothing and surgical drapes in operating rooms. They are usually green or blue. This helps suppress the afterimage effect. If the clothing were white, the surgeon would see a bluish-green afterimage when looking up. The eye needs to readapt, which takes time and reduces concentration.

However, colorfulness does not stop at clothing: floors, ceilings, and especially walls are also involved.

Simultaneous Contrast

The effect is based on the complementary law, which states that each pure color physiologically demands its complementary color, its complement. If this is not present, the eye simultaneously produces the complementary color. A strong green makes a neighboring neutral gray appear reddish-gray, while a strong red makes the same gray appear greenish-gray. (The combination of two non-complementary, pure colors causes the eye to generate the respective complementary color, so each color pushes the other into its complement, causing both colors to glow with new effects.)

Treatment and Operating Rooms

Here, the concerns of doctors and nurses and the fears of patients must be considered simultaneously. The sterility of the room must be supported by colors (bright, warm tones as a hue between cool shades). The washrooms preceding the operating rooms should be visually distinct from the OR, for example, showing a yellowish hue, since they are used to prepare for surgery and can be monitored from there.

The operating rooms themselves are of particular importance. It is crucial to balance the high luminance differences on the surgical field. The luminance gradient in the OR must be adjusted for the strenuous visual work of the surgeon. This can be achieved by using dark (blue or greenish), approximately 10% reflective drapes and medium-toned wall colors. These drapes achieve roughly the same luminance as the surgical field (blood and tissue). The very bright surgical lamp would cause enormous glare with white drapes and make the actual surgical field appear too dark. Colored drapes are mainly blue when working with screens or when a television broadcast is used in training, and matte dark green where very good visual conditions are required.

The wall colors should also be coordinated with the brightness. Recipes cannot be distributed because each operating room should be reassessed based on architecture, multiple surgical fields, and the surgical process. The starting points are the surgical drapes, clothing, surgical fields, and workflow. The more focused the surgery, the more precisely color and light can be tailored to the needs of staff and patients.

For the Patient:

It is also important where the patient's head is positioned. It would be advisable if the anesthetist does not see an even more distressed patient due to green or blue reflections from the drapes. If the patient is conscious, the visual field should be kept in a bright, sunny tone.

One should not only consider the operating room but also the patient’s entrance and recovery room. Patients are often prepared in an anteroom. They are usually pushed into this room in bed and nervously await the start of treatment. The ceiling acts as a visual wall for the patient. For the patient in bed, the room's visual and experiential sequence differs from that of a healthy person. For them, the ceiling becomes a visual wall, and the side wall influences mood. The visual wall can also serve as an expectation function. Therefore, it needs to be somewhat relaxing to help reduce anxiety. Despite trust in the routine of doctors and the technical and chemical strength of medicine, the situation is not routine for the patient. Here, color and colored light should help the patient relax. For example, a small projection lamp shining on the ceiling with the word "relax" could be used. Harmoniously graduated light colors in the bright range would be suitable for this anteroom.

Objective Criteria for a Sensible Design of Operating Rooms

A well-coordinated ergonomics should enable a smooth workflow to meet the increased demands of frequent use. Ergonomics also includes color and light. Therefore, detailed investigations are necessary during planning. Here are some questions that are part of solving the task:

· Which surgical fields are involved?
· What is the physiology of the operation, what needs to be considered?
· Which color fabrics are used (green - blue)?
· What is the luminance of the field relative to the environment?
· How are the colored afterimages caused by the surgical view and environment neutralized?
· Where must color correction be applied to avoid constant adaptation of the eye?
· What is the noise exposure?
· What is the spatial workflow of surgeries?
· Which functional zones are present?
· Which cleanroom materials are used?
· How is the lighting? Where can it be optimized?
· Which colors are already fixed?

These and other project-specific topics are addressed and form the basis for objective criteria.

Conclusion

We perceive colors as light or heavy, passive or active, cold or warm, bright or dark. Color affects our sensations and senses, but also our subconscious. Skillful and meaningful use of color contributes to a more livable environment and a more humane working environment.

Coloring should not only be a matter of personal "taste" of the entrepreneur but should be guided by objective criteria and the identity of the company to serve people and their needs. Additionally, the color design helps hospitals send a specific message outward to patients and inward to staff.

Anyone not suffering from chromophobia should embrace color. Color in homeopathic doses is the appropriate means to physiologically and psychologically support highly intelligent people in their work to perform their highly concentrated tasks error-free. After all, neither surgeons nor their teams use doping or stimulants to do their jobs. For this to remain the case and for patients to benefit, color—used meaningfully—makes an important contribution. Naturally, light belongs to this, as it makes color visible.

Sources:

Wikipedia → Operating Room
Dr. Heinrich Frieling: Law of Color
Dr. Heinrich Frieling: Color in the Room
Dr. Heinrich Frieling: Light and Color at the Workplace
Alexander Wunsch: Artificial Light and Vision