Ventilation Systems and Themal Conditions in Operating Rooms

7/29/2019 Ventilation Systems and Themal Conditions in Operating Rooms

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VENTILATION SYSTEMS ANDTHERMAL CONDITIONS IN

OPERATING ROOMSMettere il nome di chi presenta


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Control of the asepsis level

Control of the concentration of any form of pollutants:

chemical (anaesthetic gas and volatile substances)

physical (particulate and aerosol)

micro-biological (pathogenic agents related to thehuman presence, to the surgical interventionsthemselves and to the spores carried on by theairborne particulate).

Rising trends in surgical activities:

The needs: to assure values of the air quality not dangerous for

the health of the operators;

to contain the infection risks.


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Hospital infections in Italy: Over 500.000 cases a year (30.000 deaths) on 9,5

million patients (30-35% related to the operating site); Over 1,5 million /year for medical treatments; An expected loss of 3 million of working days.

The cost of a sepsis of small entity, caught in the operating room,is about 3.500 7.000 at expense of the hospital structure.The cost of a deep sepsis is up to 20.000 25.000.

In some countries the insurance companies don't cover the

deep sepsis as imputed to a bad hospital management.


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The Aim of the Research is to assess :

the genesis of the pollution phenomena in operatingrooms;

the correlations among the boundary conditions(rooms technological state, type of surgical operation,people in the room, clothing, clinical frame of the patient,etc.).

The research is carried out both within four surgical rooms atthe Cento Hospital (Ferrara, Italy) (general surgery,

urology/gynecology, emergency and orthopedics) and withinthe CERTECA (Air Technologies Researches Centre)Laboratory of the Ferrara University.


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Cento Hospital


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OperatingRoomsat Cento Hospital:

HVAC Plants


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CERTECA

(Air Technologies Researches Centre)


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The CERTECA Test Facility reproduces a real operatingroom, with all the equipments, HVAC plant and controlsystems able to reproduce different conditions of ventilation

and pollution.


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CERTECA CENTRE:

HVAC Plants


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1. Containing in-field sensitive data (implemented on a server atthe hospital and not directly accessible to the researchers)

2. Containing all the data of scientific interest (implemented on aserver at the University of Ferrara)

3. Containing the experimental data of contamination,decontamination, efficiency and effectiveness of ventilationtests carried out in the same room under the different conditions

of operation.

Data arecollected onthree databases:

12

3


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The Automatic Data Acquisition Systems performs the

followings functions:

- identification of the patient going into the operating room (RFID)

- identification of the personnel present in the room (RFID)- time schedule of the surgical operation (RFID)

- identification of the surgical irons set (RFID)

- assessment of the successful sterilization of the irons set (RFID)- identification of the of anaesthetic infusion (Palm-PC)

- identification of the surgical intervention (Palm-PC)

- identification of the used prostheses (Palm-PC + bar code)

The final aim is to build a computerized clinical report


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Microbiological pollution(Petri Plates, S.A.S.)

Physical Pollution(Kanomax)

Environmental Comfort(Babuc A)

Air Flow Control(Balometer, Ultrasonic Anemometer)

Microbiological andMicrobiological andEnvironmentalEnvironmental

MonitoringMonitoring

Measuring campaigns have been performed either with theoperating room at restor in operating


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Petri Plates S.A.S

Babuc A

Kanomax

Instrumentation Layout

Orthopaedics Room

Surface: 36 m2

Ventilation Plant: turbulent flow (22 air changes/hour) absolutedouble filtering.


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Microbiological Measurements:

1. Passive instruments

(Petri plates)

2. Active equipment(SAS instrument).

Microbiological Monitoring


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Passive AirPassive AirSamplingSampling

99 DataData collectedcollected inin

OrthopaedicOrthopaedic RoomRoom atatrestrestandand inin operatingoperating

99 PlatesPlates incubatedincubated at 37at 37CCfor 48 hoursfor 48 hours

99

NumberNumber

of CFUof CFU

verifiedverified


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ActiveActive AirAir SamplingSampling

99 SurfaceSurface airair samplersampler (SAS(SAS--PBIPBIInternationalInternational))

99 A known volume (6000 l/h) of airA known volume (6000 l/h) of air isisblownblown ontoonto AgarAgar CleanClean RoomRoomContact FDA (55 mm)Contact FDA (55 mm) plateplate

99 SASSAS waswas positionedpositioned onon toto harmharm--shelfshelf(1m(1m awayaway fromfrom thethe operatingoperatingbedbed))

99 PlatesPlates werewere incubatedincubated at 37at 37CC forfor4848 hourshours

99 DataData collectedcollected inin OrthopaedicOrthopaedic

RoomRoom atatrestrestandand inin operatingoperating


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Physical and Environmental Monitoring

1. Babuc A data acquisitionsystem

2. Kanomax Geo- particulatemeter

o

p

q

n

n BABUC A

o PSYCHROMETRIC PROBE

p GLOBOTHERMOMETRIC PROBE

q ANEMOMETRIC PROBE


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Following the ISO 14644 Rules for the white rooms andother sterile environments, the measurements of theairborne particulate (0.3 m , 0.5 m, 1 m, 3 m e 5 m)

have been performed in correspondence at 6 points.

Physical Pollution

2m

2m

A

C

E F

B

D

Door


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10 min, 20 min, and 30 min tests have been performed forsetting up the optimal sampling time allowing the ventilation

plant to effect a sufficient number of air exchanges withoutintervention by the operators.

- Operating room at rest- Kanomax Geo- with sampling flow

of 2.8 l/min.


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The result of tests show that the minimum sampling time forattaining the asymptotic value is 30 min.

Concentrazione polveri sala ortopedia

12 marzo 2005condizione at rest - punto A

0.0E+00

5.0E+04

1.0E+05

1.5E+05

2.0E+05

2.5E+05

3.0E+05

3.5E+05

4.0E+05

9.05 9.08 9.11 9.14 9.17 9.20 9.23 9.25 9.28 9.31 9.34 9.37 9.40 9.43

ora

particelle/m

3

0.3 micron

0.5 micron

1 micron

3 micron

5 micron

March 12th2005

Point A Room at rest

Hours

ROOM AT REST


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The distribution of the concentration (ten minutes averaged values)depends on the position of the sampling point:

- A = 400.000 part/m3

- B = 50.000 part/m3

- C, D, E, F = near to the asymptotic value since the beginning.

The doors operation influences the concentration level at the nearestpoints (A and B).Door opens from left to right, the left part of the room (A) remains

exposed for more time.

0

500

1000

1500

2000

2500

3000

3500

particelle/m3

A B C D E F

pun to d i r il ievo

Concentrazione media s ala ortopedia

12 marzo 2005 - condizione at rest

0.3 micron

0.5 micron1 micron3 micron5 micron

March12th

2005Room at rest


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The results of the measurements allow us to classify the

orthopaedic room as ISO 5 class (ISO 14644 Rules) at rest .

1.00E+001.00E+003.64E+011.42E+029.91E+02F

3.64E+013.64E+011.07E+022.84E+021.73E+03E

1.00E+001.00E+001.00E+003.64E+012.09E+03D

1.00E+001.00E+001.00E+001.00E+009.55E+02C

3.64E+013.64E+013.64E+011.43E+021.66E+03B

1.07E+022.49E+024.60E+021.13E+033.43E+03A

5m3 m1 m0.5m0.3 m

Concentration (particle/m3)po in t

Mean Values in orthopaedics room at rest 12/03/2005

5.04.13.94.2CLASS

5m1 m0.5m0.3 mdiameterN =log (C

n) - 2,08log (0.1/D)N

Particle diameter considererDnumber of particle / m

3

Cn

ClassificationISO orthopaedicstheatre


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ROOM IN OPERATING

The time course of the concentration is similar for all theparticles, the difference among the values is sensible to thediameter of the particles.

Notable differences arise among the various interventiontypologies or among episodes occurring in the same operation

Misura micropolveri

1 Marzo 2005 - Ortopedia

0,E+00

1,E+06

2,E+06

3,E+06

4,E+06

5,E+06

6,E+06

7,E+06

7.58 8.26 8.55 9.24 9.53 10.22 10.50 11.19 11.48 12.17 12.46 13.14 13.43 14.12

orario

particelle/m3

0,E+00

1,E+07

2,E+07

3,E+07

4,E+07

5,E+07

6,E+07

7,E+07

particelle/m3

(0.3micron)

0.5 micron

1 micron

3 micron

5 micron

0.3 micron

artroscopia spalla

osteosintesi

(raggi+tecnico)

pu lizia OR


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Misura concentrazione polveri sala di or topedia

28 febbraio 2005 - condizione operating

0,0E+00

5,0E+05

1,0E+06

1,5E+06

2,0E+06

2,5E+06

3,0E+06

3,5E+06

4,0E+06

9.50 10.19 10.48 11.16 11.45 12.14 12.43 13.12 13.40

ora

partic

elle/m3

0,0E+00

5,0E+06

1,0E+07

1,5E+07

2,0E+07

2,5E+07

3,0E+07

3,5E+07

4,0E+07

particelle/m3

(0,3micron)

0.5 micron

1 micron3 micron

5 micron

0.3 micron

asportazione ernia disco

ricostruzione apparato

estensore

realizzazione ginocchiera

in gesso

artroscopia con artrite

9 notably higher values during the reconstruction of theextensor apparatus than those referring to the arthroscopy

9 remarkable peak of concentration corresponding to the

realization of a plaster knee-guard.


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ENVIRONMENTAL COMFORT

Thermal comfort conditions in the operating room: a verycomplex problem.

It is necessary to conciliate several requirements:

homothermic conditions of the patient, avoiding the

risk of Hypothermia

comfort conditions of the components of the surgical

team

Incorrect micro-climatic conditions can also affect theairborne microbiological components promoting the

development and the growth of bacterial colonies.


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The aim of the study is to verify the correlation among the twodifferent techniques of investigation:

the first (objective): the acquisition of the most important

parameters related to the environment, the medicaloperators and the patient

the second (subjective): the gathering of the judgmentsexpressed by all the presents towards the environment

The latter objective can be reached by means of a

questionnaire regarding the feelings of comfort or uneasiness,the clothing, the weight, the age, the activity level, etc.


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The microclimatics parameters, the clothing characteristics

and the activity level, allow to elaborate the Fangers indicesof thermal comfort:

Predicted Mean Vote (PMV)

Predicted Percentage of Dissatisfied (PPD).

The measures have been performed placing the equipmentin the center of the room at a height of 1,5 meters, with the

scialytic lamp both turned on and off, with the room both atrestand in operating

The results of this investigation conducted either in field or insimulated environment will allow us to set an investigationmethodology and a measuring protocol aimed to theidentification of new indices of thermal stress specific for the

environment that is the object of our study.


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At rest


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In operating


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Control of ventilation rates

Perodically the flow rates at the air intakes are checkedusing an AIRDATA Shortridge-ADM-850L balometer.


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The air flow distribution isalso verified by using aThies Bi-axial Ultrasonic

Gonioanemometer


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G. Lupo

Dipartimento di Ingegneria Civi le

Universit degli Studi di Messina

Contrada di Dio - S. Agata Messina (Italy)

Tel 090 3977308 - Fax 090 3976474

e-mail: [email protected]

Universit degliStudidiFerraraFACOLTA DIARCHITETTURA

Universit degliStudidiPalermoFACOLTA DIINGEGNERIA

Universit degliStudidiMessinaFACOLTA DIINGEGNERIA

S. Mazzacane

Dipartimento di Architettura

Universit degli Studi di FerraraVia Quartieri 8 44100 Ferrara (Italy)

tel +39-0532-29.36.46

fax +39-0532-29.36.27

email [email protected]

C. Giaconia; S. Costanzo; A. Cusumano

Dipartimento di Ricerche Energetiche ed Ambientali

Universit degli Studi di Palermo

Viale delle Scienze 90128 Palermo (Italy)Tel. +39-091-236213

Fax +39-091-484425

[email protected]

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Ventilation Systems and Themal Conditions in Operating Rooms