How Modular Operation Theatre Helps in Reducing Nosocomial Infections?
There have been substantial changes in the design and practice of operating theatres in the last 20 years. It is possible that most of these changes have been incorporated to prevent the infection of patient’s wound at the time of operation.
Nosocomial infections have interfered with successful medical treatment throughout the history in any hospital. However, the nature and type of infection have altered with changing concept of a hospital and its function in the community. Today, we are concerned with a host of hospital associated infections and it is our desire to have our patients benefit from the additions of modern medicine and surgery without the threat of infectious complication. Installation of modular operation theatre equipment has proven to help reduce the nosocomial infections in the operating theatre area during a surgery.
There are basic policy decisions in execution of operation theatre departments and it is imperative that high standard of discipline be maintained to minimize the incidence of infection and cross-infection.
Design and Maintenance of Hospital Ventilation Systems and the Prevention of Airborne Nosocomial Infections
A building ventilation system is expected to supply air at a comfortable temperature and humidity level. In the hospital setting, heating, ventilation, and air conditioning (HVAC) systems must often provide specially conditioned air to protect the health of patients and staff. Certain patients are particularly vulnerable to infection from airborne pathogens. Others, such as tuberculosis patients, are potential sources of airborne infection, which may put those around them at risk. To design a proper hospital ventilation system, one must be familiar with both the physical and biologic characteristics of airborne agents causing nosocomial infections. Knowledge of ventilation strategies and equipment used to reduce the potential for airborne transmission of disease requires understanding of airborne particle management for contamination control.
Protective Environments Operating room Surgery is by nature a process requiring invasive procedures that expose host tissues to the outside environment, creating the potential for exposure to external agents, such as bacteria and fungi. Therefore, in the operating room, the surgical site and instrument table should be considered the cleanest area, and infection control efforts should be directed toward providing protection through appropriate ventilation control.
As the leading healthcare equipment manufacturers, we can believe that a surgical site infection is a well-documented surgical complication. Aseptic technique and prophylactic antibiotics provide the first line of defence, but it has been shown that removing bacteria and fungi from operating room air helps to minimize infection. Microorganisms shed by humans are the most common airborne agents in a correctly designed operating room with appropriate air filtration. Large volumes of air filtered through high efficiency filters should be provided from panels in the operating room ceiling over the surgical site. The downward force of air from the ceiling supply diffuser provides a focused ventilated area around the surgical site that is constantly washed by a high volume flow of clean air. Such airflow moves particles away from the operating table toward the air returns at the margins of the room. It is important that this displacement airflow of filtered air is delivered in such a manner that infectious particles shed by the operating team are swept away toward the return ducts and not trapped and re-circulated within the vicinity of the procedure. The more objects that interrupt the airflow pattern, the greater the turbulence. Special clean room laminar flow ventilation with HEPA filtration has been used in orthopaedic cases to prevent the consequences of surgical site infections. A vertical flow system designed to provide a downward flow of air over the surgical site actually increases the air exchanges in the cleanest zone. Air delivery from a horizontal direction will not prove an extra benefit because personnel and equipment in the way of the directed airflow cause turbulence and potential trajectory of problematic particles toward the surgical site. Vertical flow is preferred over horizontal airflow for space management and infection control considerations.
Pressure management in the protective operating room environment is designed by a positive airflow out of the cleanest area of the operating room suites. This designation does not give guidance for what is necessary to provide that pressurization. Authors have suggested that a differential air volume (supply versus exhaust/return) exceeding 10% to 15% will provide the required airflow. Such suggestions have not been validated. Consistent management of pressure is a problem when windows are operable or doors are left open. Using an anteroom or door closure is an essential component for room pressure management. Operating rooms have multiple doors, and if any of those doors are open, the pressure differential is eliminated until the door is closed. Procedural practice for operating rooms should include closed doors, except for egress, while the surgical site is open.
Investigations have shown value in properly clothing the operating room team for maximum contamination control. The surgical team is a potential reservoir of infection. The average person sheds approximately 107 particles of sloughed skin per day. During an hour-long surgical procedure, each individual in the operating theatre may shed 106 particles. Each one of these particles may be carrying bacteria that can infect a surgical site. However, in the properly ventilated operating room, such shedding should not pose an infectious risk to patients. For operative procedures involving insertion of a prosthetic device and for which ultraclean air may be desired, shedding can be greatly reduced by providing surgical personnel with negatively pressured evacuated gowns.
Opportunistic environmental microbes such as Clostridium perfringens or Aspergillus spores should be minimized in an operating room setting. These soil microorganisms are readily filtered from incoming air if filters are installed and maintained properly. Such microorganisms would be expected in air supply systems that have leaks or tears in the filters. A lack of maintenance also is a problem, because it allows a reservoir of microbial growth in the air-delivery system. Such inadequate maintenance or installation must be avoided in the critical surgical areas.
Shed microbes from human attendants must be controlled with the directed airflow and barrier protection. However, Investigators have raised the issue that masks do not affect the presence of microbes in a surgical setting. The range of microbial recovery from air sampling suggests that the use of barriers will prevent the inadvertent shedding of microbes from exposed areas such as the mouth or hair. Barriers have also been shown to prevent contamination of drapes and the surgical site. With aseptic technique and appropriate ventilation, the exposed skin from both the patient and attendants becomes an important source for microbial exposure in the surgical setting. Unclean floors from track dirt and accumulated debris could become an internal source for C. Perfringens or other soil microorganisms if disturbed.
Human source microbes can be controlled with aseptic technique and barrier protection. A forced air ventilation system will enhance the cleanliness of the critical surgery area. The ventilation system is essential in a Modular OT for protecting the surgical site using particle displacement dynamics of properly directed purified air movement.
Basic principles of designing Operating Departments
Besides the actual number of theatres required, it is also important to have spare operating theatre so that in case one of the operating theatre is down for maintenance, this operating theatre can always be used. This should be the Cardinal principle incorporated for any specialty or multi-specialty hospitals.
- Centralisation of major operating suites
- Provision of convenient access between the operating and other departments
- Comprehensive sterile supply services
- Flexibility in the allocation of theatres to various specialties
- Provision of sufficient fresh air to dilute the bacterial count in vital areas below a critical level and positive pressure ventilation to design flow of air from clean to less clean areas
- Zoning of hospitals
- Individual self-contained operating theatres so that there is minimal amount of movement and door openings when operating equipment is being used
- Careful selection of interior finishes
- Modular industrialized systems are increasing with a number of hospitals coming up and these consists of factory made components for operating suites, complete with integrated mechanical and electrical engineering services including air-conditioning.
- The great advantage of these packaged industrialised modular theatres is that they are pre-designed and engineered with guaranteed performance and shorter erection time.
- The vertical laminar flow system within the operating enclosure of these specially designed operating theatres is designed to reduce the airborne infection to an exceptionally low degree.
This is the same unit, which features a down flow of operating air system, provide a comfortable environment for the surgical team in terms of thermal, acoustic and lighting requirements, and finally the objective of these specially pre-fabricated operating theatre is to provide the highest standards and patient’s safety and the optimum use of manpower and financial resources.
There have been a lot of arguments about the possibility of infection from the air at the time of operation, and it is a field in which decisions have been based on bacteriological findings along, in any case, the provision of a plenum and good positive pressure ventilation has resulted in lowering of the infection rate. Hence, it is essentially to develop a well-proofed modular operation theatre design to prevent the spread of nosocomial infection in the operation theatre.
MGI India Pvt. Ltd. is amongst the leading modular operation theatre manufacturers in India. Apart from offering the best quality material, MGI also boasts of its designing capabilities and beyond. Get in touch today to understand your requirements and make a plan to build your modular operation theatre!
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