It seems wherever you go in Nashville, construction cranes dot the skyline for new structures, and roads are closed left and right for improvements and renovations. Though you won’t see the remodeling and construction happening within operating rooms, these renovations are crucial to providing the best possible care for patients. Messer Construction Co. has been tasked with the overhaul and modernization of operating rooms (OR) for a Nashville-based medical complex, all requiring very specific processes and considerations throughout the process for the hospital to continue running business as close to normal as possible.

Since March of 2018, Messer has painstakingly renovated 12 ORs to date, with each room taking 45 days to complete within a very specific timeline. Throughout this process, Metro and Department of Health inspections take place every step of the way to ensure the health and safety for patients.

The process always starts on a Friday evening after the last surgery of the week to fully utilize the weekend, a time when surgeries are not typically scheduled. Before any demo work begins, air quality tests are performed, and the control barriers and devices are installed. During the weekend, heavy demolition takes place all before the 7 a.m. deadline that comes with Monday mornings.

When demolition is complete, the existing concrete structure is scanned for utilities including mechanical, electrical and plumbing, and the full plan for the renovation is drafted depending on the room’s conditions. Engineers and crew must work swiftly to develop and plan, as each room varies with equipment needs, utilities required and concealed conditions. When a plan is set, in-wall and above-ceiling utilities are installed and the ceiling is then framed. Once drywall is hung and painting is done, the waterproof epoxy flooring is installed, taking 10 days to complete without any other work taking place. Wrapping up the project, everything must be installed from doors and lights, to technology and medical equipment. A final inspection takes place, and the rooms have their final disinfection and sanitation before going back in circulation, ready for patients.

Besides the actual steps in the construction of renovating an OR, much planning and coordination is required based on the schedule of surgeries. Many rooms are specifically equipped to perform specialized procedures, and the strict timeline and schedule of the renovation must be followed. With no more than three rooms able to be taken off line and renovated at once, timing is of utmost importance, especially during the high-volume season that comes with the end of the year. With hospitals never truly closing and floors above and below fully functioning, loud noises that might typically be at a construction site must be kept to a minimum. With this, hammer drilling and powder actuated nail guns are prohibited at the site. Aside from planning and working a construction site amid a hospital setting, other functions of the process must be highly controlled to meet safety standards.

Because surgeries are taking place as nearby as the wall opposite of rooms being renovated, full infection control must be implemented to keep the surrounding areas free of any potential contaminants and debris. To remain sterile, barriers are installed the full height of the wall to contain the work and any material entering or exiting the space is completely encapsulated. A full-time crew is also employed to disinfect and clean throughout the job, including the full wipe-down of all carts entering and exiting the site. Additional cleanliness measures include mandated suits and hairnets for the crew going between sterile areas and construction sites. Other precautions to minimize contaminants from escaping into sterile spaces include air scrubbers with HEPA level filters to capture any airborne contaminants, sticky mats at exits to ensure particles are not tracked out of the construction space, carbon air filters to contain odors, and negative pressurization of the construction space to ensure that even the air within the construction space does not escape into sterile areas. By adhering to these necessary standards, the hospital can continue working and performing surgeries in a safe environment.

With meticulous planning and adherence to specific timelines with detailed infection control measures, Messer continues to successfully renovate the ORs behind closed doors and with little notice, thereby bringing improved efficiency and technology to better serve the community without disrupting ongoing care delivery.

Howard BrianBrian Howard is a senior project executive at Messer Construction Co. and has been with the company since 2000. Besides working with the ORs, Howard is on an advisory board with the Academies of Nashville Public School and is a member of Associated General Contractors of Middle Tennessee. For more information, go online to