ARE YOU READY TO OPERATE? Designing ORs to meet new technological advancements

Transcription

1 ARE YOU READY TO OPERATE? Designing ORs to meet new technological advancements Gary Hamilton PE, SASHE, LEED AP BD+C, CxA, EDAC Ionel Petrus PE, LEED AP BD+C, CEM 2016 SmithGroupJJR 1

2 Objectives The audience will know how to use the ASHRAE 170 Guidelines as the starting point for their OR Design The audience will know what steps in design is necessary to include the use of advance technology and how it will relate to the mechanical system The audience will understand how to ensure that a positive pressurization is designed, implemented and maintained in ORs The audience will understand how to layout of the OR ventilation system for a Hybrid ORs 2016 SmithGroupJJR 2

3 Technological Advancements in ORs Image guided procedures less invasive Robotic Surgery Da Vinci Surgical system Tele-Surgery Tumor Ablation for Cancer Treatment Single Incision Laparoscopic Surgery High-definition 3-dimensional video images 2016 SmithGroupJJR 3

4 Operating Room of the Future 2016 SmithGroupJJR 4

5 Technological Advancements in ORs Robotic Surgery Question: What is da Vinci Surgery? Answer : The da Vinci Surgical System is a sophisticated robotic platform designed to expand the surgeon's capabilities and offer a state-of-the-art minimally invasive option for major surgery. With da Vinci, small incisions are used to insert miniaturized wristed instruments and a high-definition 3D camera SmithGroupJJR 5

6 Da Vinci Surgical System 2016 SmithGroupJJR 6

7 Hybrid OR Room Requirements Ceiling typically 15 to 16 high (floor to floor) Lead-lined walls required for radiation protection Separate controls and equipment rooms Increase ceiling support for equipment booms Positive pressure and laminar airflow for OR-level sterility Adequate space for all support equipment and supplies 2016 SmithGroupJJR 7

8 Hybrid OR Room 2016 SmithGroupJJR 8

9 FGI Guidelines 2014/ ASHRAE Minimum of 400 SF Requirement for Hybrid OR 650 SF Minimum dimension of 24 feet for new construction Minimum of 22 feet for renovation Also depends on the Imaging Equipment to be installed Control room maybe required for the imaging system control equipment (120 SF) Perform full scale mockup for Hybrid ORs 2016 SmithGroupJJR 9

10 MEP Considerations for Hybrid ORs Imaging equipment need separate cooling from OR space Some Imaging equipment requires closed loop cooling Loop will pass into OR, requires protective means to prevent water leakage Consider double-jacketing horizontal or vertical cooling lines Install drip pans below cooling lines in ceiling Consider space requirement for imaging equipment room Electrical transformer and panels Supplemental cooling units Heat exchangers Pumps RF Shield for Ductwork penetrating the Imaging magnetic field 2016 SmithGroupJJR 10

11 FGI Guideline Definitions A procedure room is defined as a room for the performance of procedures that do not require an aseptic field but may require use of sterile instruments or supplies. Procedure rooms are considered unrestricted areas. Local anesthesia and minimal and moderate sedation may be administered in a procedure room, but anesthetic agents used in procedure rooms must not require special ventilation or scavenging equipment. An operating room (OR) is defined as a room in the surgical suite that meets the requirements of a restricted area and is designated and equipped for performing surgical operations or other invasive procedures that require an aseptic field. Any form of anesthesia may be administered in an OR as long as appropriate anesthesia gas administration devices and exhaust systems are provided. A hybrid operating room is an operating room that has permanently installed equipment to enable diagnostic imaging before, during, and after surgical procedures. (Use of portable imaging technology does not make an OR a hybrid operating room.) 2016 SmithGroupJJR 11

12 ASHRAE 170 (2013) Design Parameters 2016 SmithGroupJJR 12

13 ASHRAE 170 (2013) OR Minimum Requirements Minimum ACH = 20 Positive Pressure w.r.t adjacent spaces (+0.01 in w.c. or 2.5 Pa) (typical 20% airflow differential) RH = 20-60% Design Temp = F Unidirectional Diffusers, Average Velocity cfm/ft² Diffuser shall be concentrated to provide airflow over patient and surgical team 2016 SmithGroupJJR 13

14 What is the right ACH? ACH rely on Memarzadeh & Manning research Kenneth Goddard Curve that was done in 1960 s ACH based on bacteria colonies Internal load for Hybrid rooms will dictate the ACH Usually more that 25 ACH Open heart, Orthopedic, bone marrow and organ transplant should have a ACH between SmithGroupJJR 14

15 ASHRAE 170 (2013) Diffuser Minimum Requirements Area of Primary Supply should extent min. 12 inch beyond surgical table No more than 30% of Primary diffuser area shall be used for non diffuser uses (where we can place booms outside diffuser array) Additional diffuser maybe required to achieve environmental requirements 2016 SmithGroupJJR 15

16 ASHRAE 170 (2013) Air Distribution Laminar Diffuser Average Velocity ASHRAE 170 Requirement for OR cfm/ft² A minimum 2 low sidewall exhaust grilles spaces at opposite corners of the room installed 8 inch above the floor Pressure relationships per Table 7-1 of the standard must be maintained in all modes of HVAC operation Pressurized room- require ducted returns Air Change can be reduce for unoccupied periods pressurization have to be maintained 2016 SmithGroupJJR 16

17 ASHRAE 170 (2013) Humidification Humidification is required when outdoor humidity and indoor moisture sources do not meet requirements of ASHRAE 170 Reservoir-type or evaporative pan humidifiers are prohibited A humidity sensor should be located downstream of the injection source. Controls should limit duct humidity to maximum value of 90%RH when operating Hospital steam must not be treated by Amines If so use steam to steam generators for humidifiers 2016 SmithGroupJJR 17

18 Room Pressurization All OR and Procedure room is required to have Positive pressurization w.r.t to the adjacent corridor (0.01 inch in w.c) ASHRAE Rule of thumb is to allow 20% less Return than Supply CFM (TAB contractor determines final value) Room Differential Airflow is directly proportional to the leakage of the OR enclosure (room construction very important) Visual Room pressurization monitor important 2016 SmithGroupJJR 18

19 Laminar Flow Diffuser Design Face Velocity for Laminar Diffuser should not exceed 35 fpm (Why?) Elevated rate of skin particle erosion off surgical team members Overcooling of the patient, resulting in hypothermic complications Uncomfortable drafts Entrainment of contaminated air. Two types of Laminar Flow system used in OR Design Full Laminar diffuser above operating table and 12 inches around Air curtains with laminar flow diffusers in middle 2016 SmithGroupJJR 19

20 Laminar Flow Diffuser For Hybrid ORs Recommended Full Laminar diffuser above operating table Diffuser array should also meet the 12 inch around the table if the table is rotated 90 Not Recommended Air curtains More equipment will create excess turbulent flow in the operating zone 2016 SmithGroupJJR 20

21 Maintaining Positive Pressure - VAVs or Non-Venturi Valves Option 1 Use VAV Box on supply and return w/ terminal reheat Airflow sensors can go bad ( Affected by lint, dirt & dust) Not as accurate as other 2 options Option 2 Non-Venturi Valve (AccuValve type Tracking pairs) on supply & return w/ Electric duct heaters Cheaper that Phoenix No Airflow senor to maintain Low pressure drop Option 3 Phoenix Venturi Valves on supply & return w/ Electric duct heaters No Airflow sensor to maintain Expensive Cannot be use in combination with VAVs High pressure drop 2016 SmithGroupJJR 21

22 OR Controls The Future 2016 SmithGroupJJR 22

23 OR Controls The need Energy efficient control sequences and control devices Safe closed loop control with true variable feedback Space management and room turnover automation Improved user experience with clear intuitive user interfaces Fast, Accurate, quiet and reliable room temperature, humidity and pressure control 2016 SmithGroupJJR 23

24 OR Controls OR of the Future Closed Loop valves Control True airflow measurement Fast acting and failsafe No schedule maintenance Multiview Monitor Display set points and room status Can network for values Room Pressure Monitor Multiple Room Monitor at NS 2016 SmithGroupJJR 24

25 OR Controls Source: h*p://cgproducts.johnsoncontrols.com/jci-kiosk-normal-2.swf 2016 SmithGroupJJR 25

26 Air Handling Units Best Practice for Future ORs Custom AHUs should be chosen because of longevity and the close cooling condition that is need for ORs Longer life More reliable Less Leakage Leakage percentage should specified not to exceed 1% 2016 SmithGroupJJR 26

27 Final items Questions 2016 SmithGroupJJR 27

28 Thank you! Gary: Ionel: 2016 SmithGroupJJR 28