Hospital operating theatres are high-pressure life-and-death environments, so it is critical that they run efficiently and are fit for purpose.
This not only affects the design of these facilities, but also has an impact on every single fixture, fitting and process that goes into, or happens within, them.
A key consideration in every hospital environment is infection control, particularly during and after surgery when patients are at their most vulnerable and are especially susceptible to potentially-serious infections.
Will Evans, sales director at operating theatre equipment specialist, Starkstrom, explains: “Like in most clinical departments within a hospital, infection control is a critical driver in operating theatre environments. Germs such as fungi, bacteria and viruses vary in size from 100 microns to as low as 0.01 microns. One micron is 1/1000th of a millimetre, so infection control needs to be looked from a number of angles, namely air filtration, instrument sterilisation, building fabric disinfection and, finally, operational discipline and cleaning procedures.
“An operating theatre is not a clean room as such; the very nature of the tasks undertaken means it is ‘dirty’ work, with the presence of body fluids, blood and sweat, plus the ever-present germs previously mentioned. A large part of our role is to design theatre equipment that helps to reduce the chance of pre-operative through to post-operative infections.
“Looking at air quality, for example, it is a little like when you are at the cinema and you can see tiny particles floating around in the light beam that you wouldn't normally notice in daylight. Any piece of dust or other debris larger than 0.5 micron is large enough for certain bacteria to hitch a ride and can become a carrier for infection. These are commonly known as bacteria carrying particles (BCP) or colony forming units (CFU).”
New features
This has led to manufacturers developing a number of new features and often research and development is targeted solely on improving infection control.
In operating theatres, for example, particular focus is given to building fabric and furniture, making sure materials are used that are easy to clean and/or contain a long-life antimicrobial coating to help to reduce touch-acquired bacteria transfer.
All equipment needs to be quick and effectively cleaned, with minimal crevices, grooves or visible screwheads where dust and other debris can hide.
Secondly, there must be a good cleaning regime in place, with widespread support for minimum standards and qualifications for hospital cleaning staff.
“Infection control is only as effective as the cleaning regime that is in place” Evans says.
“This is why you increasingly see more ceiling-mounted architectural equipment, flush wall-mounted membrane-covered PACS displays, and eTCP control panels in theatres, as this means the floors and walls are far easier to clean effectively.”
The next battleground is air quality within the operating theatre suite, which is largely controlled via a differential pressure regime between theatre, anaesthetic and preparation rooms reliant on both filtration and dilution or air changes.
Evans says: “Conventionally ventilated theatre supply air filtration is reliant on a primary and secondary filtration from the air handling unit and the number of air changes per hour.”
In conventional systems the air change rate in the theatre room is approximately 25 times per hour, but in increasingly popular Ultra Clean Ventilation systems this dilution is increased exponentially up to 500 times per hour with the additional protection of local ceiling-mounted HEPA filtration designed to remove 99.97% of particles above 0.3 micron in size.
Evans explains: “Research indicates that CFU or BCP levels vary depending on whether the theatre is empty or occupied, as you would expect, and whether it is conventionally or ultra clean ventilated. This can vary from 180 CFU/m3 in an occupied conventional theatre to the agreed international definition of ‘ultra clean’ of air containing less than 10 CFU/m3 at the wound site.
“But we understand there is still more that industry can do to improve air quality and Ultra Violet Germicidal Irradiation – UVGI products - will be part of the next step forward.”
A balancing act
While infection control is one of the main considerations when running modern operating theatres, there are other drivers.
When planning the construction or refurbishment of theatre departments, adjacencies are important. For example when creating new facilities, design project teams need to consider the location of theatre sterile services units (TSSUs) where surgical instruments are sterilised and packaged between procedures. The closer these are located to the theatre department, the quicker surgical instruments can be put back into use and the greater the patient throughput, which a major consideration for hospitals competing for business.
Patient flow is also important, with designers needing to consider how patients will enter and exit surgical spaces, and the distances patients need to be transported to recovery, critical care or interventional imaging suites such as CT, MRI and X-ray.
In recent years there has been a sea change in operating theatre design, with an increase in the standard minimum room size and the increasing popularity of integrated and hybrid operating theatres. The primary driver for integrated and hybrid theatres is the ability for the theatre to multi-task. A positive result of this approach is increased patient throughput, but also minimising patient transportation to imaging departments.
Evans explains: “How surgical procedures are carried out does dictate to a large degree how operating spaces are designed today. It is becoming more about making theatres run longer and smarter than ever before.”
Ease of maintenance is crucial, too. A lot of new theatre equipment is being designed to enable quick repairs on a more infrequent basis. This includes regularly updating equipment software and building control systems so that theatres do not have to be taken out of action for something as minor as changing the bulb in a warning light.
Commenting on the impact this is having on suppliers, Evans says: “Manufacturing specialist medical equipment is a balancing act of performance, infection control features and price that we have to deliver. We are continually striving to improve our products and find new solutions to help with infection control, which is why we are soon to launch a range of UVGI products.”