Clean room - clean operating room | clean operating room layout based on pollution control ideas

2019-02-16 11:39:00   Editor: jushong shares    0

 

There are various layout modes for clean operating rooms. The recommended or customary modes are different in different countries. There is no uniform format. As long as the internal plane and channel form of the clean operating room conform to the principle of short function and cleanliness, It works. This article is only an attempt to evaluate the layout of various clean operating rooms from the perspective of pollution control in the surgical department. The proposal should be reasonably determined according to China's national conditions and the actual conditions of the specific project, and it is not necessary to blindly apply a certain layout mode.


Key words clean technology clean operating room architecture and layout


1 Introduction


The evolution of modern hospital buildings indicates that the progress of pollution control ideas has played a significant role in promoting the development of hospital surgical departments. The clean operating room is a relatively independent clean medical area consisting of different levels of clean operating rooms and auxiliary rooms for the operating room. It is one of the most risky cross-infections in hospitals. For the construction of clean operating rooms, engineering and hygiene control measures should be effectively combined to form a multidisciplinary comprehensive measure to effectively control bacterial concentration, achieving better surgery with fewer investments. Zone control effect. Practice has proved that advanced control ideas and reasonable human and material flow arrangements can simplify the layout of buildings and the layout of air-conditioning systems, reduce the cost of construction and operation, and make various management measures easier to implement, while effectively controlling the risk of cross-infection. .


Nowadays, the control concept of the clean operating room as a comprehensive control system has been accepted. As the architectural plan should be in the layout of the internal plane and channel of the clean operating room,


It conforms to the principle that the functional process is short and clean. Specifically, according to this control idea, clear clean and pollution zones should be carried out in the surgical department according to functional requirements. Reasonably plan the flow of people and things, cleanliness and pollution. Avoid cleanliness and dirty flow lines during operation. This is a very important part of the comprehensive control system of the surgical department.


The composition of the surgical department varies slightly depending on the different building layouts and management systems of each hospital. But the basic composition is as follows:


(l) Health pass area: The part of the doctor, nurse or visitor who enters the operating room to change shoes, dressing, and toilets.


(2) Surgical core area: Includes various grades of operating room and auxiliary rooms for direct service to it. Such as the operating room front room, brush room, pre-room, recovery room, sterile dressing storage room, equipment storage room, preparation room, nurse station and so on.


(3) Equipment supply area: Equipment (apparatus, dressing, etc.) in the operating room. Processing location and supply route. The equipment can be supplied by the central material supply room, and the equipment and dressing used can be cleaned and disinfected in the surgical department.


(4) Other medical districts: medical office, duty room, conference room, anesthesia office, plaster room, family waiting area, endoscopy room, frozen section room, dark room, dirt storage place, change place or cart storage At the same time, there are also air-conditioning equipment, medical gases and power distribution rooms.


(5) Teaching room area: Teaching observation room or classroom, for medical students teaching or doctor training.


The level of cleanliness in the operating room depends on the type of surgery or the type of surgical incision. There are usually three types of surgery:


(l) Sterile surgery: The entire procedure is required to be performed under aseptic conditions, also known as a type of incision.


(2) Contamination surgery: Surgery in the stomach, intestines, appendix, etc., at some stage during the operation, there is the possibility of contamination, also called the second type of incision surgery.


(3) Infection surgery: The infection has been formed in the surgical site, also called surgery.


The operating room cleanliness level is divided into four levels. Sterile surgery should be performed in Class I and II, intraoperative, contaminated surgery is best placed in Class III and IV operating rooms, and T to IV operating rooms are concentrated in the clean area. Infection in the operating room is set separately according to medical needs. If necessary, it should be designed as a negative pressure isolation chamber.


The number, size and air cleanliness of the operating room can be determined according to the nature, scale, grade and financial resources of the hospital. Due to the high cost and high operating cost of the Class I clean operating room, it should be strictly controlled and used with caution. For general hospitals, when a Class I clean operating room is indeed required, the number of Class I clean operating rooms should not exceed 15% of the total number of clean operating rooms. For specialist hospitals, Class I clean operating rooms should also control the number of construction. With the development of medical devices, the area of clean operating rooms has expanded. According to the scale of hospitals in China, the minimum net area recommended for clean operating rooms is shown in Table 1:


2 Basic requirements for the layout of clean operating rooms


According to the general requirements of the hospital, the clean operating room should be self-contained, and it should be close to the surgical nursing unit with which it is closely related, and the related radiology, pathology, disinfection supply room, blood bank and other paths are short. The surgical department should be divided into clean areas and non-clean areas. The operating room and functional rooms that directly serve the operating room are placed in the clean area. The level of special auxiliary rooms should be determined as needed. The level of the corridor should not be higher than the clean room connected to it. Starting from the idea of pollution control in the surgical department, the clean operating room should first have the following basic building countermeasures:


2.1 Building countermeasures to maintain positive pressure in clean operating rooms have the following two main aspects:


2.1.1 Keep the airtightness of the clean operating room, the surrounding structure is tight and less sewed, and the structure of the operating room must be able to maintain a positive pressure in the surrounding area such as the peripheral corridor. The surgical department should not pass through anti-seismic joints, expansion joints, etc.


2.1.2 The installation of the building facilities enables the person and the logistics to maintain the gradient positive pressure distribution in the surgical department when the clean room is cleaned indoors or outdoors or in different cleanliness areas. The air flow direction must be maintained from the higher cleanliness area to the lower area. The usual facility is to have an air lock, buffer chamber or transfer window between the clean and non-clean areas. The buffer chamber should have a cleanliness level and be on the same level as the clean side, but not higher than 1000. The buffer chamber volume should not be less than 10m3.


For this reason, patients, medical staff, equipment, etc., entering the surgical department from other medical areas should:


1 In the path of the patient's exit, make sure that there is no air shower in the patient's passage through the buffer zone at the change of the car.


2 The medical staff will go out and ensure the buffer zone through the locker room.


3 people, goods elevators should not be located in the clean area. If it can only be located in the clean area, a buffer room must be provided at the exit. Since the air in the well flows under the pressure during the operation of the elevator, it is desirable to provide an exhaust device in the buffer chamber.


4 Set the bypass room or transfer window when the equipment is in different areas with different cleanliness.


5 Foreign countries often set up the front room in the outpatient population of the Class I clean operating room as a buffer zone.


2.2 Building countermeasures for clean operating room maintenance


Maintenance lines for air conditioners and other equipment rooms in the surgical department should be designed to ensure maintenance from outside the clean area. The air-conditioned room is usually placed outside the surgical department, or directly above or below the surgical department.


If the original self-cleaning machine is to be installed indoors during the renovation of the original facilities, the building structure must be able to maintain cleanliness during maintenance, not pollute the room, or consider other installation methods. The access door of the operating room facilities is opened to the corridor or other areas, and should not be placed indoors during maintenance.


3 Clean operating room layout and evaluation


The layout of the clean operating room is a reflection of the pollution control idea. Due to different control ideas, the emphasis on the control is different, which makes the layout of people, logistics lines and cleanliness and dirty flow lines different. There are various layout modes for clean operating rooms, and the recommended or customary modes vary from country to country. Some literatures simply sum up a large number of layout patterns from the perspective of architecture, making it difficult to understand the true meaning of various layouts. This article is only an attempt to divide the layout of the following four surgical departments with the “control focus”, and evaluate it from the perspective of pollution control in the surgical department:


3.1 Single corridor type (see Figure 1) - Emphasis is on the simplicity and shortness of people and logistics lines


Because of the simplicity and convenience of this layout, medical staff are willing to accept and easy to follow. This kind of pollution control idea considers these to be the most important guarantee factors for control effectiveness.


                      

3.1.1 Old-style single corridor: It originated in the United Kingdom. The old surgical department in our country is basically this layout. In the middle is a clean corridor with operating rooms and auxiliary rooms on both sides.


Sterile items (surgical instruments, dressings, etc.), medical personnel and patients pass through this corridor. Similarly, post-operative dirt passes through this corridor and exits from the dirt. The biggest problem with this type is that there is no clear distinction between cleanliness and pollution flow lines. Clean and dirty people flow and logistics in the same channel, it is difficult to divide the cleansing streamline in space, and can only be distinguished by time difference. This raises the demands on the quality and skills of employees, and strict management must be used to control cross-contamination. If this type of packaging equipment is used for packaging (such as foreign-made sewage after loading containers or closed trolleys, domestic packaging is often used), pollution control is still feasible. The single corridor system, which is unable to effectively reduce the risk of cross-infection, has been gradually phased out, and this layout is no longer used in newly designed hospital buildings abroad.


3.1.2 New single corridor: The advantage of a single corridor is that it can effectively use the area. The route of people flow and logistics is the shortest, which is the most suitable for people to walk. It is very popular among medical staff. In order to solve the problem of cleansing and diversion, Europe has developed a new single corridor design concept with an operating unit with an anterior chamber (see Figure 2). The idea is to divide a large control area into several small control areas, which weakens the function of clean and dirty separation of single corridors, and is more convenient for pollution control. Each operating room typically has three front chambers that form a unit. The three anterior chambers are the restroom, the anesthesia guide, and the supply preparation room (or the dirt disposal room, depending on the layout). The units are connected by a large cleaning corridor, and the medical staff, patients, sterilized products, and after-use equipment are all taken out from a corridor. However, with the surgical unit, in the past, surgeons used to wear sterile clothes in the operating room, and a large amount of dust and fibers were emitted during the opening and wearing of the sterile clothes. It is now possible to change clothes after washing hands in a clean bathroom. Post-soil can be treated in situ in the dirt treatment room. The patient is able to perform anesthesia guidance in a quiet anesthesia-guided room rather than in the operating room, free from irritation from the surgical environment. This not only fully utilizes the function of the surgical unit, but also simplifies the problem of clean and dirty flow.


               

3.1.1 Old-style single corridor: It originated in the United Kingdom. The old surgical department in our country is basically this layout. In the middle is a clean corridor with operating rooms and auxiliary rooms on both sides.


Sterile items (surgical instruments, dressings, etc.), medical personnel and patients pass through this corridor. Similarly, post-operative dirt passes through this corridor and exits from the dirt. The biggest problem with this type is that there is no clear distinction between cleanliness and pollution flow lines. Clean and dirty people flow and logistics in the same channel, it is difficult to divide the cleansing streamline in space, and can only be distinguished by time difference. This raises the demands on the quality and skills of employees, and strict management must be used to control cross-contamination. If this type of packaging equipment is used for packaging (such as foreign-made sewage after loading containers or closed trolleys, domestic packaging is often used), pollution control is still feasible. The single corridor system, which is unable to effectively reduce the risk of cross-infection, has been gradually phased out, and this layout is no longer used in newly designed hospital buildings abroad.


3.1.2 New single corridor: The advantage of a single corridor is that it can effectively use the area. The route of people flow and logistics is the shortest, which is the most suitable for people to walk. It is very popular among medical staff. In order to solve the problem of cleansing and diversion, Europe has developed a new single corridor design concept with an operating unit with an anterior chamber (see Figure 2). The idea is to divide a large control area into several small control areas, which weakens the function of clean and dirty separation of single corridors, and is more convenient for pollution control. Each operating room typically has three front chambers that form a unit. The three anterior chambers are the restroom, the anesthesia guide, and the supply preparation room (or the dirt disposal room, depending on the layout). The units are connected by a large cleaning corridor, and the medical staff, patients, sterile items, and after-use equipment are taken from a corridor. However, with the surgical unit, in the past, surgeons used to wear sterile clothes in the operating room, and a large amount of dust and fibers were emitted during the opening and wearing of the sterile clothes. It is now possible to change clothes after washing hands in a clean bathroom. Post-soil can be treated in situ in the dirt treatment room. The patient is able to perform anesthesia guidance in a quiet anesthesia-guided room rather than in the operating room, free from irritation from the surgical environment. This not only fully utilizes the function of the surgical unit, but also simplifies the problem of clean and dirty flow.


                           

3.2 Aseptic supply gallery (see Figure 3) - Emphasis on preoperative sterile item flow lines

            

Preoperative sterile items (devices and dressings) are the cleanest, and the key to pollution control is to prevent any possibility of any interference or contamination of the sterile items during the flow. Domestically, it is considered that the aseptic package from the material supply center is safe and can pass anywhere. This view is lacking from the perspective of pollution control.


3.2.1 Central Supply Type: The most typical is the “central island” type layout idea created and developed by the United States since the 1970s (Figure 3). It is a model that separates a single streamline of sterile items independently. This key protected area called the “Central Island” is a sterile supply corridor (hall). Sterile items (such as post-sterilization dressings and instruments) in direct contact with the surgical incision are supplied directly from the central material supply station via a dedicated clean elevator, which is the cleanest streamline, and the “central island” is surrounded by all clean operating rooms. . Sterile items are distributed by specialized nurses and stored in the wall-mounted storage cabinets in each operating room. One side of the storage cabinet is connected to the operating room, and the other side is connected to the sterile supply area. It is considered that the streamline thus supplied is the shortest, and it is also the route with the least risk of contamination. Outside the clean operating area is the ring corridor. Use a ring corridor to separate the clean area from the quasi-clean area. The medical staff and patients before and after the operation, as well as the postoperative sewage logistics line, are placed in the corridor, without entering the aisle (hall). The sterilized wash basin used by the operator is placed on the side of the outer ring. Outside the ring corridor is the quasi-clean area.


Such a layout makes it easy to separate sterile items from other human streams and streams, without the possibility of interfering with the cleanliness of the cleanest sterile items. Some large-scale general hospitals in China have adopted such a layout. But the concept of “central island” is based on the rich resources of the United States and the expensive manpower. Its clear logistics facilitates the use of disposable items and minimizes the reprocessing of reusable items. It packs all the items as dirt after surgery and no longer categorizes them. Greatly reducing the skill and labor costs for employees is important to the United States. However, the scale of the operation department is large, the area is large, and there are many wastes. The area of the sterile walkway in the center is not economical, and it may not be suitable for China's national conditions.


3.2.2 porch supply type: The flow of this layout is opposite to the above, and can also be seen as the variation of the above layout, which is an improved type of clean streamline independent. The peripheral corridor serves as a single supply area dedicated to clean items. The veranda has the highest cleanliness and positive pressure. Whether or not to adopt such a layout mainly depends on the layout of the building and the arrangement of the dirty elevator. Otherwise, the corridor for supplying the sterile articles is too long, and the outer protective structure is difficult to handle, and it is difficult to maintain the sterile clean state of the supply corridor for a long time.


3.3 Sewage recovery type (see Figures 4 and 5) - Emphasis is placed on post-sewage logistics lines


Since dirt is the most likely to cause cross-infection, the flow line of dirt is the most important from the perspective of pollution control. This line of thinking emphasizes the separation of post-operative instruments, dirt, and other streamlines that are most contaminated.


3.3.1 Gallery recycling: It is a way to separate the sewage logistics lines independently. Sterile items, preoperative and postoperative caregivers and patients pass through the clean central corridor. Set the used item recycling route to the corridor in the outer perimeter. Form the core area of surgery. Set disinfection and brushing space in the central corridor (note local exhaust). After the sewage is treated in situ (non-proliferation), it is transported out of the special dirt ladder through the outer corridor in the shortest route (to minimize the pollution range), and it is impossible to interfere with any other streamlines. It is also in line with people's walking habits and is easily accepted by medical staff. Some outer corridors form a ring shape (see Figure 4), and some outer corridors form a squat type (see Figure 5). However, post-operative flow of people and sterile supply lines can only be resolved by time difference. At present, most of the newly built surgical departments in China use this similar layout, which is in line with domestic conditions. If there are too many operating rooms, a peripheral dirt ring corridor will take up a lot of space and it is not reasonable.


               


                         

3.3.2 Cleaning the veranda type: This layout differs from the above process in that the patient's flow line is also set to the outer gallery. To avoid misunderstanding, the dirt gallery is called a cleaning gallery. Has been popular in foreign times. As the patient walks the veranda, the veranda must be widened and the outer gallery door replaced by an automatic surgical door, which increases the cost. In addition, when the doctor escorted the patient to the recovery room, if the patient had a doctor directly returned to the operating room, the pollution control failed. If the doctor passes through the health passage, it will cause layout difficulties. It is not used often.


3.4 One-way pass type (see Figure 6) – emphasizes preoperative and postoperative streamline separation


This kind of pollution control thought is that preoperative sterile items, medical staff and patients are clean, and people and things after surgery are polluted. The so-called cleansing and diversion is the separation of people and logistics lines before and after surgery. Preoperative flow and logistics enter the clean central corridor and are diverted to the operating rooms. Post-operative flow and logistics must go through the outer gallery and be irreversible. Various people and logistics lines are unidirectional. This layout has the clearest streamlines, avoiding any possibility of crossover of the cleansing streamlines. However, it is difficult to arrange in the layout and flow direction. Sometimes, in order to ensure that these people and the logistics flow have a single flow direction, two layers have to be arranged, and the area is wasted. In addition, the streamlines will be lengthened accordingly. Because the flow of people is one-way, it does not meet people's usual walking habits, must be trained, and medical staff are not very welcome. Domestic hospitals are rarely used.


                      

In short, before the design of the surgical department, we must pay attention to the layout of the layout and the planning of the streamline. Regardless of the layout, preoperative sterile device dressings should be the primary guaranteed route, and post-operative dirt routes must be taken seriously. Judging from the current management level of hospitals in China, it is often emphasized before surgery. Conditional double-corridor layout can be used to better control pollution, maintain reasonable gradient pressure distribution within the department, and direct flow of airflow. It is in line with the current situation in China and also meets the working habits of medical staff.


4 Conclusion


The layout of the clean operating room is the embodiment of pollution control ideas, and has a close relationship with people, logistics lines, airflow organization, positive pressure control and building structure. There are various layout modes for clean operating rooms. The recommended or customary modes are different in different countries. There is no uniform format. As long as the internal plane and channel form of the clean operating room meet the short-term and clear-cut principles of functional procedures, It works. To study the characteristics of different types of operating rooms and auxiliary rooms, analyze various sources of pollution and their pollution pathways, as well as the possibility of cross-infection. The idea of a safeguard system requires that hygiene and engineering measures must be coordinated with each other to achieve optimal pollution effects in order to achieve pollution control objectives.


Under this principle, according to the actual situation of the hospital, an appropriate layout can be selected in the form of end-to-end arrangement, center arrangement, lateral arrangement or ring arrangement on a specific plane. The channel form can be selected according to the following principles:


1 When the soil has local disinfection and packaging measures, it can be arranged in a single channel;


2 When the above conditions are not met, a clean and dirty double channel arrangement can be used;


3 When there are population diversion conditions, multi-channel arrangements can be used;


4 The general middle walkway is designated as a clean corridor, and the outer gallery is a dirt (clean) corridor.


In short, it is necessary to fully study the relationship between the method of adoption and the relevant practitioners. This article is only trying to explore the connotation of the layout of various clean operating rooms from the perspective of pollution control in the surgical department. It is suggested that a reasonable clean operating room layout should be determined according to China's national conditions and the actual conditions of specific projects. There is no need to apply some layout mode.


references


1. Shen Jinming. Design of hospital standards and operating room in the Federal Republic of Germany (one of the research reports on the construction standards of hospital clean operating rooms).


2. Shen Jinming. Japanese hospital standards and operating room design ("Hospital clean operating room construction standards" research report 2).


3. Shen Jinming. Hospital standards and operating room design in the United States ("Hospital clean operating room construction standards" research report three).


4. Shen Jinming. British hospital standards and operating room design ("Hospital Clean Operating Room Construction Standards" research report 4).


5. Zhu Ying, Shen Jinming, Models and comparisons of operating room purification air conditioning systems (5 (Research report on hospital clean operating room construction standards).