Q-1 Modular OT or only Laminar air flow is enough for NABH Accreditation  plz narrate details if anyone has experience ?

Dr Sandeep Hassan

For entry level Nabh. Modular OT or laminar airflow is not required. But when doing a OT it's better to go for atleast a simple modular format OT for enhanced safety and better patient experience.

Dr Senthil

q-2 What are the NABH Standards for Ophthalmology Operation Theatres?

NABH  standards related to OT. 

Reference : REVISED GUIDELINES FOR AIR CONDITIONING IN OPERATION THEATRES 

Clause B states that : 

B. Though these guidelines are desirable under all programs, they are NOT MANDATORY for the SHCOs( Small Healthcare Organisations- Eye Hospitals are SHCOs)  and HCOs implementing pre-entry certification standards.

C. Modular Operation Theatre is NOT A MANDATORY REQUIREMENT under any program.

It is totally left to HCO whether they want to install it. What is important is standards and its objective elements are implemented, integrated in the day to day working of the hospital/OT without compromising patient and HCO team safety

Dr Nirmal Frederick

Q-3- What should be the floor to ceiling Height when we plan a OT?

The Floor to celing height should be a minmum of 12 Feet- and the walls and roof of the OT should not have any beams or coloumns, so that there is enough space for LAF ducts etc.

Dr Senthil

Q 4-What exactly is a modular OT? What is its Definition

I think a properly customized and well planned OT  is anyway better

Dr Arup chakraborthy

MODULAR OPERATION THEATRE

Dr.Eng. Walid Tarawneh

Medical Equipment Consultant & Senior Medical Equipment Planner at KEO International Consultants.

By; Dr.Eng. Walid Tarawneh  

Description

In an operating department for which the most integrated function is required, cleanliness must be kept and the safety of facilities, equipment and devices must be maintained any times. Furthermore, the working environment for medical staff such as doctors and nurses must be considered from the view point of human engineering. 

The modular operating theatre satisfying those conditions consists of wall, ceiling and slanted panels, and is capable of incorporating not only electrical equipment, medical gas system and lighting gears but all the necessary functions and equipment at need.

Modular theater has a high availability of extension providing for the introduction of new facility in the future, establishing as well an operating environment with high work ability and enough function.

Features

• A continuous flow of highly filtered ‘bacteria-free’ air is reticulated under positive pressure into the operating field and air contaminants generated during surgery are removed from the site.
• With anti-bacterial paint - has minimum durability of 15 years. 
• Seamless. 
• Easy to clean steam cleaned, electro metric (ideal for high humidity areas) ·
• Vapor permeability (allows substrate moisture to escape) protects against growth of bacteria, mould and yeasts
• Moisture resistance, freeze / thaw resistance. ·
• The most complex and challenging area of hospital construction is the operating department. The modular Operating Theatre integrated approach to the construction and  co-ordination of operating Theatre. The modular operating theatre offer the advantage of speedy construction combined with design, future expansion and development in surgical technique whilst simultaneously providing a structure of the highest quality and standards.

Main Systems / Equipment

• Plenum Unit (Laminar Air Flow)  
• The wall & Ceiling 
• Air & Light 
• Pendants 
• Hermetically door  
• O.T. Control Panel
• X-ray / PAC viewer 
• Pressure relief damper
• Scrub sink 
• O.T. Table 
• Anti-Static Flooring 
• Writing board 
• View window 
• Hatch Box /Bass through cabinet 
• Equipment storage unit 
• Pressure Stabilizer

PLENUM UNIT (LAMINAR AIR FLOW) 

Bacteria cause infection within operating Theatre. The selection of ceilings should suits all surgical applications. Ceiling should be provided with optional air-conditioning and control systems, or as part of an existing mechanical services systems, the range of specialist ceilings reduce the risk of post-operative infection, whilst providing optimum comfort through the use of conditioned, filtered clean air. The system should be designed to allow the client to select from a variety of lighting and diffuser arrangements to suit the specific requirements of the operating team. The ceilings to be consist of a plenum box supplied with conditioned air from the central system via "S" class HEPA filters mounted on the inlet to the supply ceiling. All HEPA filters and housings to be factory tested and certified in accordance with DIN: 1946 and DIN:4799. All ceilings should incorporate supports to secure them to the main structural frame of the modular operating theater, or structural slab.

THE WALL & CEILING

The modular operation room will be a free standing structure. Constructed room composite free standing. These panels are produced of EGP sheet, S.S.-304 , S.S.-316 sheet or glass panels . All the four corners have return air duct outlets and grill for the same made of steel duly powder coated with the color choice to suit the hospital. Distance between the walls and panels to be around 100 mm, it have full support to provide straight by using clamps near the columns. Additional space can be utilized for making storage area/ hatch box (pass box/cabinet). Anti bacterial paint does not leach out so that its anti microbial system remains active through out the life of the product. The tolerate harsh cleaning and chemical agents dry film thickness of finished surface to be 200 microns. Filling of all joints and cavities with metallic epoxy filler and sanded flush to provide a joint-less finish and them sprayed with water based liquid plastic aseptic and self-sterilizing wall coating system to a d.f.t. of 200 micron with primer.

Air & Light

The air /light diffusers to consist of two layers of mono filament precision woven polyester of uniform porosity, with an open area of sufficient resistance to create laminar air flow from the diffuser face. Diffusing the air into the theaters, uniformly over the total area. The range of ventilated ceilings to provide the sterility and cleanliness required in today's operating theatre environment. Integral lighting provides an illumination level in excess of 1300-lux at the wound sit and electronic steeples dimming down to 3% without flicker.

Pendants

In an Operating Theatre, the two most important personnel are the anesthetists and the surgeon. With their handy uses next to them, they form a group of specialized people who strive to heal and save lives. A  well  designed  working  environment  is  much appreciated by them. This includes proper ventilation, advance surgical tools and also positioning of the supply system. The anesthetist is always positioned behind the patient’s head and the surgeon towards the patient's leg. 

Pendants provide:

• Medical gases supply to equipment
  
• Electrical power supply 
• Data points 
• Shelves for some equipment 
• Drawers for accessories
• Support arms for mounting monitors, pumps… etc.
• Mounting of Medical Devices and others 

Hermetically Sliding Door

The use of hermetically sealed sliding doors is to maintain satirically and the correct air pressure in the room, which requires less valuable space than hinged doors. The door to be operated manually and/or automatically with microprocessor based electronic automation system. The door frame to be made out of high quality anodized aluminum extrusion and the door panel to be made out of compact laminated board that can withstand high abrasions. The door should run on rubber rollers and guided with nylon runner guides which are to be fixed to the door in such a way that they do not obstruct trolley movement through the door. The controller to be capable of either being operated by elbow switches/ foot Switches, radar switch (touch less sensor). All doors should be able to be operated manually easily in the event of failure power supply or the automation unit.

Writing Board

A Size of 965mmx655mm one operating list board to be provided in each operating theatre. The board to be made of ceramic having magnetic properties and flushed to the wall of the operating room. 

View Window

The view window of specified size to be provide consisting of double insulated fixed glazing with not less than 5mm thick toughened glass. Window frame to be powder coated aluminum of approved shade flush mounted with wall paneling.

O.T. Control Panel

All the controls for the modular operation theatre are to be provided on a membrane type, micro controller based electronic control panel mounted in the theatre wall. Control panel to meet the electrical safety codes for high and low voltage systems. The control panel to be user friendly and case of operating and maintenance purpose. The fascia to be made with superior quality UV resistance membrane with sterilization feature. The control panel may consist of 6 tiles or 9 tiles.  These tiles as below.

1 Time of Days Clock 

1 Elapsed Time Clock 

1 Temperature Display/Control 

1 Humidity Display/Control Lighting Control/ Dimming

1 Medical Gas Alarm Systems 

1 Hands Free Telephone 

1 HEPA Filter Status Indicator 

1 OT Pressure Indicator 

1 Music Control

High Voltage Equipment and Remote Cabinet

All high voltage equipment should be installed in a separate enclosure can be positioned away, allowing maintenance to be carried out with minimum disturbance. The remote cabinet should consists of operating lamp transformers, remote relay card, electrical distribution equipment and circuit protection equipment for all circuits within the operating theatre.

Pressure Relief Damper

Pressure relief dampers to be provided in each room to prevent cross contamination of air from clean and dirty areas. Suitable sized air pressure relief damper to be strategically placed, enabling differential  room pressure to be maintained and ensure that when doors are opened between clean and dirty area. Counter-weight balancing system to be providing in the PRD to maintain positive pressure inside the operation room. The body to be epoxy coated as per standard BS colors first class electrolyzed steel plate to be used for body and with high grade SS-304 stainless steel for blade

----to be continued- Please come back