A Treatise on Modular Operation Theatre
and
How It Helps in Reducing Nosocomial Infections
There have been substantial changes in
the design and practice of operating
theatres in the last twenty 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.
In looking at the result of trials of
various methods to prevent infection it
is important to remember that the only
certain criterion is the effect on sepsis
in patients.
There has 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.
Nosocomial
infections
have
been
interfered with successful medical
treatment through out 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 (the modern hospital has
lost the gloom of its precursor, where
every feature reminded one of the
proximity of the death).
Today the
hospital remains a place of suffering and
disease, but the accent is on life.
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.
Knowledge about causes of nosocomial
infection has rapidly accumulated
through out the world and meeting and
forums for exchange of information
have emerged between specialists from
various countries.
The
use
of
Epidemiology
and
accompanying statistical methods grew
out of attempts to understand, predict,
and control the great epidemics of our
past. The study and interventions of
the infection control practices grew out
of the need to understand and control
institutional epidemics.
Basic design principles selected
for modular planning for a standard
operating department.
Hospitals are of various types, but in all,
understand and simplify that we are
looking at general hospitals ranging
from 600 to 1000 beds -- it follows that
the initial range of sizes should cover 6,
8, 10, 12 and 20 theatres.
It is assumed that all the theatres need
not be built at one time i.e. single phase,
and the subsequent theatres can be built
in a planned phasing manner, but it is
Page 1 of 11
A Treatise on Modular Operation Theatre
and
How It Helps in Reducing Nosocomial Infections
necessary with expansion of population,
there should be possibility of expanding
operation theatre department.
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. In order
to
determine
this,
the
hospital
department has been divided into
‘zones’ as given below :1.
Protective zone : The protective
zone is the entrance area for
patients, staff and supplies where
normal hospital standards of
cleanliness apply and where
normal everyday clothes can be
worn.
2.
Clean zone :
In order to pass
between the protective zone and
the clean zone everything must
undergo a system of transfer.
This is the main area of the
department and all patients, staff
and supplies must be clean. A
strict cleaning routine applies and
everybody
must
undergo
a
complete changing routine to
enter.
3.
Aseptic zone : The aseptic zone
is the inner area where conditions
are as near sterile as possible. It
applies to two rooms in each suite
: the theatre and the theatre
supply room. All staff who might
handle exposed instruments must
be scrubbed and gowned.
4.
Disposable zone :
In the
disposable zone all exposed
instruments (used or unused),
pathological specimens, lotions,
suction jars and soiled linen are
passed from the theatre to a
disposal corridor and returned for
cleaning, sterilizing or any other
necessary process.
Any hospital which has been a large
operating department also has a great
deal of traffic, to preserve the
departmental character, a control
system must be imposed over all people
entering or leaving the hospital.
Page 2 of 11
Zoning principles applied
A Treatise on Modular Operation Theatre
and
How It Helps in Reducing Nosocomial Infections
Organization
and
Staffing
Operating Departments
a.
An
operating
department
consisting of one or more
operating suites together with
ancillary accommodation provided
for common use of these suites,
such as changing room, rest
rooms, reception, transfer and
recovery areas and circulation
space.
b.
An operating suite comprises the
operating theatre together with
its own ancillary areas, namely :
anaesthetic room, preparation
rooms, aseptic store and a room
for instrument trolleys, disposal
room, scrub-up and gowning
area.
c.
maintenance,
this
operating
theatre can always be used. This
should be the Cardinal principle
incorporated for any specialty or
multi-specialty hospitals.
of

Centralisation of major operating
suites.

Provision of convenient access
between the operating and other
departments.

Comprehensive
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.
An operating theatre is a room
where surgical operations
and
diagnostic procedures carried out.
sterile
supply

Basic principles of
Operating Departments

designing
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
Page 3 of 11
Individual
self-contained
operating theatres so that there is
minimal amount of movement
and door openings when operating
equipment is being used.

Careful selection
finishes.
of
interior
A Treatise on Modular Operation Theatre
and
How It Helps in Reducing Nosocomial Infections
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.
There are various points for achieving
the best results.
The requirements for wall finishes in an
operating room are described under the
following headings :1.
The great advantage of these packaged
industralised modular theatres is that
they are pre-designed and engineered
with guaranteed performance and
shorter erection time.
2.
3.
The vertical laminar flow system within
the operating enclosure of these
specially designed operating theatres
are designed to reduce the airborne
infection to an exceptionally low
degree.
4.
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 safety and the optimum use of
manpower and financial resources.
7.
Wall Finishes in Operating Rooms
The interiors of operating theatres must
withstand assault and battery from heat
and moisture in a hospital environment.
5.
6.
8.
9.
An anticipated life of not less
than ten years.
The
ability
to
withstand
damage by mobile equipment.
To be impervious to moisture
and unaffected by heat and
steam.
To have a smooth matt finish,
without crevices.
The colour should be of light
rainbow hues.
To be totally unaffected by
colour change, staining or
mildew.
To be capable of modification
for minor alterations.
Should not cause the build-up
of a static electrical charge.
Should be jointless or have
joints capable of being sealed.
The wall finishes that we use has a
number of advantages as has been
described above.
It can adhere to
almost any form without joints, it will
bridge cracks cracks caused by limited
movement or joints in the structure, and
the thickness of the finish can be
increased to reduce the possibility of
damage by mobile equipment.
Page 4 of 11
A Treatise on Modular Operation Theatre
and
How It Helps in Reducing Nosocomial Infections
A most important thing is, the finish
interior
should
look
aesthetically
pleasing and should not darken with age
and cleaning.
of control, improving the personnel
mobility in the work environment. It
typically
requires
less
frequent
monitoring and help control static on
carts
or
other
similar
movable
equipment as well as on personnel.
CONDUCTIVE TILE FLOORING
Specific
Features
required
when
evaluating and selecting the right ESDcontrol tile.
ESD-CONTROL TILE flooring helps
control involuntary personnel movement
caused by electrostatic discharge,
prevent hazardous static discharge
directly into patients and prevent fire or
explosion where flammable anesthetics
are used.
ESD results in a danger of explosion
caused by gases used for anaesthesia in
operation rooms.
In those countries
with modern medical technology, the
explosive gases are no more used.
However, ESD protection is much more
demanding because surgery and some
diagnostical/ therapeutical fields use
more and more high-tech electronic
medical equipment like electronic
sensors,
measuring
instruments,
actuators,
microprocessor-controlled
devices and etc. which requires ESD
protection.
The ESD control tile system performs
by creating a ground path of moderate
electrical conductivity from human body
or equipment to flow to ground. ESDcontrol tile system provides a broad are
ITEM
Electrical
and
electrostatic
characteristics
Physical/ Mechanical properties
Chemical resistance
Cleanroom consideration - low
carbon content / low outgassing
Installation consideration
Maintenance consideration
Ease of performance for access
floors
Fire resistance
Appearance
Cost consideration
CONDUCTIVE
TILE
Class 34 + 43
CEN
CLASSIFICATION
en685
THICKNESS - EN 2.0mm, 3.0mm
428
SIZE - EN427
610mm x 610,
900x900 mm
micro-squared
WEIGHT/M2
3.2 Kg(2.0mm)
EN430
5.4Kg (3.0mm)
ELECTRICAL
2.5 x 10-4 to 10-6
RESISTANCE
ohm
DIN 51953 ASTM
F-150 or NFPA99
Page 5 of 11
STATICDISIIPATIVE TILE
Class 34 + 43
2.0mm, 3.0mm
610mm x 610,
900x900 mm microsquared
3.2 Kg(2.0mm)
5.4Kg (3.0mm)
10-4 TO 10-6 ohm
A Treatise on Modular Operation Theatre
and
How It Helps in Reducing Nosocomial Infections
STATIC
GENERATION
AATC - 134
Less than 100 volts
with conductive
footwear per
AATC-134 at 20%
relative humidity
Less than 300 volts
with conductive
footwear per AATCC134 at 20% relative
humidity
STATIC DECAY
Federal Test
Mehthod 101
Method 4046
5,000 volts to zero
in less than 0.01
seconds per
Federal Test
Mehtod 101,
Method 4046 at
15% relative
humidity
0.00618 W/m.K
(2.0mm)
5,000 volts to zero in
less than 0.2 seconds
per Federal Test
Mehtod 101, Method
4046 at 15% relative
humidity
B1
B1 Q1
B1
B1 Q1
>1.08 W/cm2
(class 1 interior
floor finish, NFPA
Life Safety Code
101)
<75
>1.08 W/cm2 (class 1
interior floor finish,
NFPA Life Safety
Code 101)
HEAT
RESISTANCE
DIN51612
THERMAL
CONDUCTIVITY
DIN 51612
FIRE
RESISTANCE
DIN4102 ONORM
B3810
Critical Radiant
Flux ASTM E-648
or NFPA 225
0.00618 W/m.K
(2.0mm)
1.31%
RESISTANCE TO Offers excellent
Offers excellent
CHEMICALS
resistance, ask for resistance, ask for
DIN423/DIN51958 special sheet
special sheet
REPAIRABLE
Yes
Yes
STANDARD FOR Confirms to the requirement of NFPA 99
HEALTH CARE
in effect at the time of installation
FACULTIES
NFPA 99
Fulfils product
Yes
Yes
requirements
EN649
<75
Hermetic Sealing Sliding Doors
Smoke Density
ASTM E-662
<450
<450
ABBRASION
RESISTANCE
ASTM D-1044,
CS-10-F Wheel,
500 Gm Weight
Cycles
%
Gauge Loss
2500
.40
5000
.80
7500
1.20
10000
1.60
Cycles
Loss
2500
5000
7500
10000
RESISTANCE TO M
WEAR EN 6601/DIN51963
% Gauge
.40
.80
1.20
1.60
M
RESIDUAL
0.03mm (2.0mm) 0.03mm (2.0mm)
IDENTATION
0.04mm (3.00mm) 0.04mm (3.00mm)
EN433/DIN51955
DIMENSIONAL
STABILITY
EN434
EFFECT OF
CASTOR CHAIR
EN425
COLOR
FASTNESS ISO
105 B02
IMPACT SOUND
ABSORPTION Vli,
ISO140, 1SO717
CVCM ASTM E
1.31%
595NASA SP-R022A PSS 01-702
Z 0.10%
Z 0.10%
No damage
No damage
At least 6
At least 6
approx 2dB
approx 2dB
Electronically
operated
Hermetically
sealing sliding doors have been provided to
maintain sterility and correct air pressure in
the department. The doors are constructed
with high-density particleboard cores and
high pressure laminate faced on both sides.
The cores are set firmly in an aluminium
frame, suitably sealed with a non-porous
non-shedding gasket.
The door track is constructed from an
aluminium extrusion, fixed firmly to the
walls and the door running within the track
is by nylon wheels.
The track and
wheel design is such that during the last 50
mm at travel on the closing cycle, the door
moves in 3 directions to form a seal against
the floor, at the bottom and against the
frame on both sides and at the top. Nylon
runner guides are fixed to the floor in such
a way that they do not obstruct trolley
movement through the door. They will
Page 6 of 11
A Treatise on Modular Operation Theatre
and
How It Helps in Reducing Nosocomial Infections
provide stability during the opening and
closing cycles and assist in creating the
necessary pressure at the bottom of the
door to maintain the seal.
There have been a number of sales
arguments regarding the hermetic sealing
sliding door, type
MF-5 Medicare for
Operation Theatres and the answers are as
under:
WHY A SLIDING DOOR?
* user friendly
* large openings are no problem for the
designer
* creating a room without obstacles
* saving expensive space in the room
* preventing air turbulence : bacteriological
balance
: guarantee sterile
environment
* easier for a wheelchair user
* smaller air outlet
* loadings on the wall are better distributed
* reduced risk of damage to the door
* safer operation less risk of hitting people
WHY A HERMETIC SEALING SLIDING
DOOR?
* contamination risks in the rooms are
under control
* disinfecting is quicker and safer
* control the overpressure in the room
* acoustic and noise control
* creating a quite environment in and
outside the operating theater/clean room
* in case of a failure of the air handling unit,
the overpressure is under control
* in case of fire = smoke, prevents smoke
from spreading saving lives!
* climate control: constant temperature of
18°C - 24 °C and a humidity of 40 - 60% is
quickly under control
* the number of air changes and amount of
clean air required is reduced when using
hermetic doors. This saves money.
* less clean air is necessary with hermetic
doors
MECHANICAL CONCEPT FROM THE
HERMETIC SEALING SLIDING DOOR,
TYPE MF-5 MEDICARE
* unique track system:
guiding under a
45° angle with 6 mm. deep indentations at
the closed position by means of the own
weight of the doorblade and the 45° angle,
the door closes to the wall and floor and is
hermetically sealed.
* canopy over the full length of track with a
sloping top for the perfect hygiene
* lever handle: a special inside and outside
lever handle lifts out the door of its
hermetic closing position and allows even
heavy doors to be opened easily
* toprollers:special nylon top rollers with
double roller bearings are designed for a
smooth and silent running.
* door stability:
the door has a 5 mm.
thick aluminum surrounding which stabilizes
the doorblade and prevents damage
* doorblade finish: large range of hard
plastic laminate finishings are possible
* operating:
manually
automatic
manually with self
closing system
* options:
X-ray protection
Laser protection
flush finished vision
panels.
Page 7 of 11
A Treatise on Modular Operation Theatre
and
How It Helps in Reducing Nosocomial Infections
* maintenance:
very limited because of
the amount of wear and tear parts.
We advise each year to check your doors
on damaged gaskets and correct hermetic
sealing, we offer a custom made door
according to the demands of the customer
* Sealing
The door is designed and
tested on hermetically sealing at an
overpressure of 100Pa, the air tightness is
99,9986% airtight. The door is designed in
consultation with doctors/architects and
technical bureaus who design operating
theatres and clean rooms
MANUAL OPERATING POSSIBILITIES
* manually: by means of the lever handle
opening and closing
* manually with selfclosing system:
*by means of the lever handle opening and
closing by a spring
* with an extra magnet connected to
- emergency network
- push button
- timer relay
- radar
- card or digital entrance
control
* safety
photocells in the
- one or two
opening
- deceleration measuring
system always alert
- over pressure safety
- safety edge on the blade
edge.
* possibilities
for
- adjustable timer closer
auto reverse
- RS232 connection for
communication with
building
control system
- connection for interlock
function
- half opening / full opening
possible for person and
bed
passage
ELECTRIC OPERATOR, TYPE SDA-03
INVESTMENT
* own design, software and manufacturing
* plug and play system
* opening speed of 800 mm. per second
* low power consumption
* silent and smoothly operating
* large amount of possibilities
* one automation for all types of sliding
doors
* low maintenance costs
* easy to install on existing sliding doors
* operating - pushbutton, footswitch, pull
cord
- touch less radar
In the healthcare and cleanroom sector, the
investments are calculated for a period of ±
20 - 30 years.
Nevertheless people require high demands
of the doors and we can offer the client
this!
The sliding doors answer to these
fundamental questions by:
* reliability in operating
* simple
* users friendly
Page 8 of 11
A Treatise on Modular Operation Theatre
and
How It Helps in Reducing Nosocomial Infections
* many possibilities
* custom made
* large range of finishing colours
* professional advice, co-corporation,
experience and participation
* We have 25 years of experience in
operating theatres and delivers doors
all over the world.
requires understanding of airborne
particle management for contamination
control.
Protective Environments
* We can offer a solution for the air control
rooms and help prevent contamination from
patients in the operating theatre.
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
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.
Surgical site infection is a welldocumented
surgical
complication.
Aseptic technique and prophylactic
antibiotics provide the first line of
defense, 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
Page 9 of 11
A Treatise on Modular Operation Theatre
and
How It Helps in Reducing Nosocomial Infections
downward force of air from the ceiling
supply diffuser provides a focused
ventilated area around the surgical site
that is constantly washed by a highvolume 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 orthopedic
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
Page 10 of 11
A Treatise on Modular Operation Theatre
and
How It Helps in Reducing Nosocomial Infections
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.
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 for
protecting the surgical site using
particle displacement dynamics of
properly directed purified air movement.
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
Page 11 of 11
For MGI (INDIA) PVT. LTD.
ASHOK CHANDRA
DIRECTOR