Pre-Construction Setup

The operating theatre project execution sequence starts before any structural work — with dimensional control and drawing coordination that determine whether every later phase closes cleanly.

Floor marking and setting out establish the module grid that every subsequent trade builds against. Errors introduced at this stage compound through framing, wall panel alignment, and final door swing clearances — they are the most expensive to correct once concealed.

• Establish a fixed reference datum for level and grid
• Mark wall centerlines, door openings, pendant coordinates, and M&E riser positions
• Confirm tolerances against the structural slab survey before any fixing begins

Accurate setting-out prevents cumulative drift that otherwise shows up as misaligned panels and pendant conflicts later.

Structural & First-Fix M&E

Substructure framing and first-fix mechanical, electrical, and gas rough-in happen before any wall closure — reversing this order is the single most common cause of rework in OR fit-out.

Substructure installation (steel or aluminum stud framing) defines the cavity into which first-fix services are routed. Medical gas pipework, HVAC ductwork, and power/data containment are installed and pressure-tested inside this open cavity, while access for inspection is still possible.

• Install the substructure framework — steel or aluminum stud, per design
• Run first-fix M&E: medical gas pipes, HVAC ductwork, electrical conduits, data routes
• Coordinate routing so services clear the wall cavity and ceiling plenum without clashes

Radiation Protection & Openings

Lead lining and primary door/window frames are installed once the structural cavity is open but before insulation and panel closure, so shielding continuity can still be inspected.

Lead lining is fixed to the framed cavity walls per the radiation protection design, with particular attention to overlap at joints, penetrations, and frame interfaces — gaps at these points are the typical source of shielding failure. Door and window frames are set into the structure at this stage, aligned to the setout grid from Section 1.

• Install lead lining to walls and designated surfaces per the radiation shielding plan
• Fix door and window frames into the structure — not into the panels — so loads transfer correctly
• Verify frame plumb and shielding continuity at every joint

Frames set into the structure at this stage receive their finished leaves in Section 7, avoiding frame distortion from panel loads.

Envelope & Partition System

With services and shielding in place, rockwool insulation and hygienic wall panels close the envelope and establish the room's airtightness.

Rockwool is fitted between studs for acoustic and thermal performance, followed by wall panel installation — typically a steel-faced or HPL-faced hygienic panel system fixed to the substructure.

• Place rockwool or specified insulation within the cavity for acoustic and thermal performance
• Install modular wall panels, sealing joints to maintain the airtight barrier
• Check panel alignment against the original setting-out lines from Section 1

Panel fixing tolerances at this stage also determine how cleanly doors, control panels, and pendant brackets fit in later phases — misaligned panels are a recurring source of punch-list items at handover.

A continuous, sealed envelope is what makes the room pressure-controlled and cleanable.

Wall Cladding (Sub-Structure) vs. Self-Supporting Clip-In Panels

The sequence above describes a wall cladding panel system built on a sub-structure — rockwool and panel fixed to a framed cavity, as covered in Sections 2–4. This is not the same system as a self-supporting clip-in wall panel, which locks panel-to-panel without a separate framed sub-structure underneath. The two follow different installation logic and are not interchangeable mid-project.

Ceiling Infrastructure

Ceiling grid framing and pendant support installation must be structurally verified before the ceiling is closed — this is the last point of open access to load-bearing points above the room.

Pendant supports for surgical lights, anesthesia booms, and equipment pendants are fixed to the primary structure, not the ceiling grid itself. Ceiling grid framing then infills around these support points, ready to receive LAF frames and finish panels in the next phase.

• Install independent pendant support structures anchored to the building slab, not to the ceiling panels
• Build the ceiling grid framework to the verified layout
• Load-test supports before any equipment is hung

Pendant and light loads must never rely on the decorative ceiling — structural independence is non-negotiable.

Laminar Airflow & Ceiling Finish

The laminar airflow (LAF) frame and ceiling panels are installed once structural load points are confirmed, integrating directly with the HVAC and filtration system above.

The LAF frame is fixed within the verified ceiling grid, with sealing at the frame-to-ceiling interface controlling both air leakage and particulate ingress.

• Fix the LAF diffuser frame to the ceiling grid
• Install ceiling panels around it, maintaining a flush, sealed surface
• Integrate the terminal with the HVAC supply and HEPA filtration train

Because the LAF unit ties directly into the HVAC supply, this phase should be coordinated closely with the mechanical contractor — duct connections and filter housing access need to be confirmed before panels close the void above.

Correct LAF geometry is what delivers unidirectional airflow over the operating field.

Final Openings & Second-Fix M&E

Doors and windows receive their final fix, and all second-fix M&E — power, data, gas outlets, and control panels — is installed and tested before the room moves into finishing trades.

Hermetic doors are hung and adjusted for seal compression at this stage, along with any observation windows. Second-fix M&E covers outlet plates, surgical control panels, and terminal gas points, all of which require functional testing before flooring begins — testing after flooring installation risks damage to the finished surface.

• Hang finished doors and fit glazing into the frames set in Section 3
• Carry out M&E second fix: outlets, controls, medical gas terminals, data points, lighting
• Test circuits, gas lines, and controls individually before system integration

This stage turns a constructed shell into a functional, serviced room.

Flooring & Hygiene Stations

With second-fix M&E tested and confirmed, vinyl flooring and scrub stations are installed as one of the final structural trades before fit-out.

Seamless vinyl flooring is welded at joints and coved up the wall base to eliminate collection points for contamination — a standard requirement for OR-grade hygienic flooring.

• Lay seamless vinyl flooring with welded seams and coved skirting to eliminate dirt traps
• Verify slip resistance and chemical compatibility for theatre use
• Install scrub stations and associated plumbing to specification

A properly welded floor is as critical to hygiene as the ceiling above it.

Fit-Out & Equipment

Built-in cabinetry and medical equipment positioning close out the physical fit-out, ahead of final commissioning.

Built-in storage cabinets, supply units, and fixed casework are installed against the finished walls and flooring. Medical equipment — booms, tables, and imaging where applicable — is positioned and secured to the load points confirmed back in Section 5, closing the loop between structural planning and final equipment placement.

• Fit built-in cabinets, booms, and storage to the panel system
• Position and connect medical equipment per the equipment schedule

Commissioning, not construction completion, is the real finish line — covered next in Section 10.

Commissioning & Handover

The final phase confirms every system installed across Sections 2–9 performs to design, before the room is signed over to the client. Sequence discipline through all 10 phases is what protects this step — a room built out of order rarely commissions cleanly on the first pass.

• 1
  Pre-handover inspection

  Walkthrough against the approved design, checking finishes, seals, and fixed equipment positions.

• 2
  Test & balance documentation

  HVAC air changes, room pressure cascade, and filtration performance recorded and filed for client and regulator review.

• 3
  Client sign-off & warranty activation

  Formal handover documentation issued, with warranty terms activated from the sign-off date.

Frequently Asked Questions