DESIGN CONSIDERATIONS FOR MEDICAL GAS PIPELINE SYSTEM

Designing, building and operating a medical gas distribution system can be complicated. It can involve hundreds of regulatory and safety considerations. An oversight could have serious implications for the schedule and budget of the installation, in addition to the dangers it could present to patients.

The things that should be kept in mind before designing a medical gas pipeline system are given by the HTMs. Health Technical Memoranda (HTMs) give comprehensive advice and guidance on the design, installation and operation of specialised building and engineering technology used in the delivery of healthcare. The 2022 volume HTM looks at issues of design, installation, verification and validation for MGPS. It covers the user requirements for flow, pressure and diversity and gives technical guidance on the design, installation and accommodation of plant and medical pipeline distribution systems.

Other standards are the British Standards EN 737 (BS EN 737), Compressed Gas Association, Canadian Standards Association, and the International Standards Organization. Cylinders should follow American Society for Testing and Materials standards, and pipes should have Lloyd’s certification as per BS 2871.

Apart from abiding by the standards mentioned above, here are some other design considerations-

  • The gases are supplies from the manifold room that consists of the gas reserves and control panels, which should always be situated on the ground floor having easy access to delivery vehicles.
  • This room should be well ventilated and lit and no grease, oil or naked flame should be used near the vicinity of the area.
  • A sperate room for compressors and vacuum pumps, called the plant room must be in close proximity of the manifold room.
  • For ensuring uninterrupted supply, two separate banks must be used and the switch from the Bank in use to reserve bank must be without fluctuation in the line pressure.
  • There should be a regulator for each cylinder band to initially reduce the cylinder pressure to the pressure in the two-line regulators that control the final pressure.
  • Before the system is finally handed over, tests like Pressure drop test, Valve tightness, Correct valve zoning, Anti-confusion test for checking cross connection, Flow rate and pressure test, etc is carried out.

Thus, before designing an installment as big and complex as a Medical Gas Pipeline System, there are innumerable things to keep in mind.

FACTORS FOR SELECTING WASHER DISINFECTOR FOR CSSD

Cleaning is the process of removing foreign bodies from objects and is normally accomplished using water with detergents or enzymatic products. In the healthcare industry, automatic cleaning process is accomplished by washer disinfectors. Washer disinfectors are designed to wash and disinfect specific medical utensils, surgical instruments and other healthcare equipment.

Washer Disinfector for CSSD

Washer disinfectors are used in healthcare industry to either prepare goods for future sterilization, to remove residues from surgical products, or to disinfect goods for later use. Surgical instruments should be presoaked or rinsed with water, to prevent drying of blood and to remove blood from the instruments. After a complete washer disinfection cycle, the instruments can be inspected, placed in sealed sterilization pouches or wraps for autoclaving process. In-depth cleaning of instruments is required before disinfection and sterilization because dried materials, organic or inorganic, that remain on the surfaces of instruments hamper the effectiveness of these processes.

 The four major factors to consider while selecting the apt washer disinfector for your facility are as follows:

  1. Number of beds in the hospital (i.e. capacity)

The rack decides the chamber capacity of the washer disinfector and can have a significant impact of the cleaning ability of the machine itself. Within every rack is a retained internal volume of up to 5L depending on the design of the machine. An optimum number of racks will help to further reduce the volume of water required per phase and hence also reduce the energy and detergent consumed. Having a greater capacity per rack enables more trays to be process per load. This in turn can reduce the number of times a washer needs to run during the day thereby improving efficiencies and lowering costs across the board.

Racks of the Washer Disinfector

2. Water consumption per sterilization cycle

The three reasons a washer disinfector consumes water – rinse with water, wash with detergent and water and disinfect with water. With depleting resources and increasing reliability on them. It is important to leave our resources for the future generations. That our sterilizer does not utilize the greatest volume of water per cycle consumed during sterilization process.

3. Energy consumption per sterilization cycle

The washer-disinfectors may be equipped with two heating systems, steam and electrical, for optimal reliability, manual or automatic switching between both systems may be performed at any time. This provides backup to minimize any bottlenecks when the steam supply goes down. The machine should have minimum energy consumption. When the machine is idle, the washer-disinfector can be programmed to switch off and only come back on when needed, to further save energy.

4. Time per sterilization cycle

Washer disinfectors are required to frequently heat water to near boiling point in order to achieve thermal disinfection within the stipulated time period. The time is a critical factor because all the microorganisms do not die off at the same time, thus increasing the cycle time. This minimum exposure time is the least required time for a complete washing cycle. At the end of the cycle, time is required to heat the air used to dry the load and contributing to the time cycle of the washer disinfector. In today’s fast-moving world, it is necessary to have short sterilization cycles as this will improve the turnaround time for the medical equipment which will result in less hospital inventory thus decreasing the space requirement in the hospital.

With a washer disinfector, the instruments are washed and disinfected properly with every cycle. Over an average hour-long cycle (although with advanced technology, machines can perform an entire cycle in about 35 minutes), the machine automatically changes phases from flushing and washing to rinsing, disinfecting and drying. Automatic washer disinfectors ensure minimal human contact with contaminated instruments means staff is protected from the risk of sharps injuries and eye splash incidents due to manual cleaning and rinsing. At the end of each cycle, all the instruments have been flushed of resistant contaminants such as blood, tissues and bone fragments. Medical instruments are also washed with detergents that preserve instruments against degradation and disinfected thermally in water at temperatures of approximately 80-90 degrees Celsius. All of this, with negligible time or labor from your staff – so they are better able to focus on offering the highest level of care to your patients.

The effectiveness of high-level disinfection and sterilization mandates effective cleaning, patient safety and minimizes hospital acquired infection.

Understanding CSSD in a Hospital Environment

What is a CSSD?

Central Sterile Supply Department (CSSD) is a service unit in a hospital that processes, controls the sterile stores supply to all departments of the hospital. The essentials of this department are correct design, appropriate equipments, skillful operators and a unidirectional work  flow.

CSSD should have these three zones  namely:

  1. Soiled zone
  2. Clean Zone
  3. Sterile Zone

 What are the functions of a CSSD?

To monitor and enforce controls necessary to prevent cross infection according to infection control policies. To establish and maintain sterile processing and distribution standards. To operate efficiently to reduce overhead expense

Activities of the CSSD:

  • Cleaning
  • Disinfection of semi/non critical items
  • Sterilization of critical items
  • Supply of sterile materials

Objectives and Functions:

  • To provide sterilized material
  • Contributing to reduction in the incidence of hospital infection
  • To avoid duplication of costly equipments
  • To maintain record of effectiveness of cleaning, disinfection and sterilization process

What are common Sterilization Techniques?

  • Dry Heat
  • High Pressure Autoclave
  • Ethylene Oxide Sterilization
  • Chemical Sterilization
  • Radiation Sterilization

Some of the salient features of a CSSD module are:

  • Enables admin and operational staff to track and manage the inventory information of items that need to be sterilized in the form of packs/sets or individual quantity to be delivered to OT, pathology labs, ICU, emergency and wards in a hospital
  • Detailed records of cleaning, disinfection and sterilization
  • Implement infection control policy using CSSD module across all departments in a hospital that improves patient safety by enforcing and checking the controls necessary from time to time, to prevent cross infection

Planning a Department: 

The interior design of a CSSD within a hospital is one important task when it comes to infection control matters. To get the best performance, most suitable equipment and best working conditions is a vital task

  1. Physical planning
  2. Functional planning
  3. Personal planning
  4. Equipment planning
  5. Financial planning
  6. Quality control
  7. Preventive maintenance
Central Sterilization and Supply Department

Organization:

Personnel in CSSD  comprises of a Supervisor who may be a nurse followed by other staff like chief, assistant, technicians, aides, orderlies and messengers that get trained on the job.

Facilities  required for the CSSD:

  • Reception control and disinfection area.
  • Washing and sanitizing carts.
  • Staff changing  room , lockers, toilets.
  • Supervisor’s office .
  • Clean work area required to for preparing special instruments, testing instruments,  equipments, linens, assembling treatment trays and linen packs, and for preparing materials for sterilization.
  • Assembly area required for medical- surgical treatment  packs, sets and trays. Work bench with multiple drawers for instruments and suppliers are necessary.
  • Double door, pass- through autoclaves.
  • Sterile store and adequate space for loaded sterilizer carts.
  • Issue counter .
  • Clean cart storage area.
  • Provision for supply of steam, hot  and  cold water and other utilities and services.

FACTORS IN SELECTING OT LIGHTS

An insight into OT lights


OT lights are the most prominent aid parallel with the surgical equipments for medical practitioners. They are used by clinicians, surgeons and proceduralists in emergency rooms, labor and delivery, examination room, etc. OT light is a medical device intended to illuminate a local area or cavity of the patient to assist medical practitioners during a surgical procedure. It is very essential to provide an excellent source of light during various medical procedures like dental treatment, surgery, examination rooms etc. Hence, they must be designed in a favorable manner as it is extremely critical for staff comfort and patient’s safety.

Types Of OT Lights


OT lights can be categorized by lamp type or mounting configuration. Two lamp types are conventional (halogen) and LED (light emitting diode).
OT lighting configurations may include ceiling-mounted, wall-mounted, or on floor stand

  • Shadow-Less OT Lights
  • OT Light without Camera
  • OT Light with Camera

Problems Associated with OT lights

  • Surgeons experience eyestrain and light load on operating continuously for long hours
  • Heating of LED
  • Blocking of lights
  • Breakage of wire inside the equipment
  • Failure of slip ring, fuse, lamp or insulation
  • Failure of electronic devices
  • Power supply cable detachment

Because surgical lighting is complex, sophisticated and often customized for an operating room an efficient illumination needs adequate balance of luminance, temperature, weight and shadow management. Considering these factors will effectively reduce errors and minimize eye fatigue, a main factor in performing successful and safe procedures.

Factors in selecting OT Lights

  • Lux: Unit for the amount of visible light measured by a luxmeter at a certain point.
  • Central illuminance (Ec): Illuminance (measured in lux) at 1m distance from the light emitting surface in the light field center.
  • Light field center : Point in the light field (lighted area) where illuminance reaches maximum lux intensity. It is the reference point for most measurements.
  • Depth of illumination: The distance between the points of 20% illumination intensity above and below the center point. Successful illumination requires a special balance of luminance, shadow management, volume, and temperature. This maximizes visibility at the surgical site while minimizing eye fatigue
  • Shadow dilution: The light’s ability to minimize the effect of obstructions.
  • Light field diameter
  • (D10): Diameter of light field around the light field center, ending where the illuminance reaches 10% of Ec. The value reported is the average of four different cross sections through the light field center.
  • D50: Diameter of light field around the light field center, ending where the illuminance reaches 50% of Ec. The value reported is the average of four different cross sections through the light field center.
  • Power : 100-240 VAC, 50/60 Hz
  • Heat Management: Light will be always energy so in order to prevent from tissue desiccation, a safe heat management is mandatory. Heat can be measured in two places: at the light patch, and at the light head. Heat can cause discomfort for the surgeon, and can dry exposed patient tissue. A quality surgical light will minimize heat to improve comfort and patient outcomes.

CRITICAL FACTORS IN SELECTING MODULAR OT

Operating Theaters are changing as technological advances expand the possibilities of what can be achieved within the sterile environment. The working environment for medical staff such as doctors and nurses must be considered from the viewpoint of human engineering. Modular operation theater is a designing approach using standardized units for easy construction and flexible arrangement.

The pre-engineered Modular OT not only solves the problem of infections but also facilitates speedy construction, high quality finish in prevention of contamination build up, long durability, robust, flexible designs for future expansion and ease of maintenance. The other advantages of applying concepts of Modular Operation Theatre during construction are:

  • Improved Health and Safety
  • Minimal Site Disruption- Lesser disruption and noise is produced in comparison with traditional methods of Operation Theater construction
  • No Compromise on quality- None of the compromise associated with bouncy floors, cavities, sharp edges and others
  • Highly customizable- no restrictions regarding layout, internal appearance and external treatments
  • Sustainability- These are more energy efficient, environmentally friendly and delivers a rust and maintenance free system with longer service life
  • Designing and development based on International Health care / Medical Solutions- It is fabricated using material sourced from across the globe helping to reduce project costs, carbon footprint and helping the economy
A typical Modular OT

This modular operating room adapts to fit whatever space might be available; it is equally suited for new construction and for rebuilding and expansion projects. The system is cost effective in the long run, and that has a significant economic impact for hospitals over the long run. Examples of this sustainability include flexibility, time saving and confidence for investments

Although the installation and maintenance of a Modular OT is easy and simple there are however a few critical factors to be considered before selecting a Modular OT:

  • The possibility of future expansion should be kept in mind while designing the Modular OT
  • It should be isolated from traffic, noisy areas and away from contamination and cross infection
  • The AHU of each OT should be a dedicated one and should not be linked to an air conditioning of any other area
  • Laminar flow of conditioned air should be within 19-21℃ with 0.3 micron HEPA filter
  • Window and split AC should not be used in any type of OT because they are pure re circulating units and have convenient pockets for microbial growth which cannot be sealed
  • The materials that can be used for the wall and ceiling panel of Modular Operation Theater are:
  1. 1.6mm thick EGP steel panels backed by 12mm thick Gypsum
  2. Stainless steel SS202 or SS304 panels
  3. High-pressure Laminate panels as per EN standard
  4. PUF sandwiched panel
    The above materials can be used as per the client’s requirements

What does the future of Modular OT hold?
With new technology coming in so fast, advancement of Modular OT is already on its way. The new concept preferred by healthcare professionals, architects and designers is Glass Modular OT.


There is no material that is older and has a brighter future than glass

The material glass is known for already 9,000 years but especially today belongs to the most modern solutions for customers who emphasize hygiene, safety and design. There are nearly no limits neither in processing nor in design.

In Healthcare, architects, designers and planners of OTs as well as surgeons and other medical staff need a material to rely on completely. Glass is such a material

Why Glass?

  • Extremely tough, steady and functional
  • Does not age
  • Easy to clean
  • Absolutely hygienic  
  • Environmentally friendly
  • Scratch and shock proof
  • Translucent

Design considerations for an Operation Theater

An Operating Theater is a facility within a hospital where surgical operations are carried out in an aseptic environment. Being one of the biggest and busiest departments within a hospital, it thus makes it one of the most critical departments as well.

Inside a modern operating room

Critical factors to be considered while designing an OT:

  • Location
    • The best location for the surgical department is one which permits a convenient and uncomplicated flow of patients, staff and clean supplies traffic.
    • The OT should be located that there will be no traffic through it and no interference from the activities of other departments.
    •  Regarding services, ideal adjacencies would be emergency, radiology, clinical laboratories, intensive care units and central sterile and supply department.
  • Design
    • Just as important as the determination of the number and types of operating rooms is the planning of the three basic zones with the OT
    • Three types of activities and circulation take place in these zones and the degree of sterility maintained in each zone is different:
      • Outer zone is the clean area
      • Intermediate zone is the sub-sterile area
      • Outer zone is the administrative area
  • Most Efficient and Cost-Effective OT
    • That doesn’t have a separate anesthetic room
    • That has shared scrub facilities between operating rooms
    • That has a common disposal bay
    • That has central supplies room to service several operating rooms
    • That has a supply distribution system in which case carts are made available to each operating room
    • Where disposal traffic line is segregated from the patient, staff and clean supply traffic line

Design Features for OT

While planning and equipping each operating room, a series of questions need to be answered. They relate to size, usage, lighting, intercommunication and signal systems, electronic equipment and monitoring system, medical gas system and other service lines, fixtures, safety precautions such as grounding for X-Ray, TV camera and against static electricity, storage, supply cabinets, environmental control, etc.

Some of the critical factors that should be considered while designing an Operation Theatre are:

  • Total room size
  • Best placement of lights, cameras, monitors, and the AV equipment
  • Ceiling structures
  • Articulating display arms
  • Equipment booms should be designed to allow for added capabilities in the future

Additional space is required for the infrastructure and electronics to support the components outside the OT.

Hybrid OT

Future of OTs:

Future Operating Theaters will include the latest in operating room design, imaging capability, equipment integration and patient monitoring, including technologies such as:

  • Intelligent lighting system operated through the surgeon’s wand
  • Diagnostic imaging equipment that provides real-time information during surgery
  • Computer-controlled, motorized combination operating room table and ICU bed
  • Robotic cross-cleaning systems with biocidal misting
  • Flat panel monitors outside the surgical zone to check patient vital statistics and diagnostic images

Conclusion:

In the current scenario of evidence based medicine, it is imperative to give maximum importance to planning an Operation Theatre. Within the limitations of finance and space, the best results can be obtained by consulting healthcare professionals. Efforts should be made to conform to the standards laid down by local bodies and international agencies, as healthcare facilities in India are now catering to more international patients.

AI in Cold Chain Supply: What future beholds…

The latest of AI technology replicates human intelligence in machines. The ability to adapt to changing social discourse, is the new boom in this field of innovation.

“Hey Siri, what time is my lunch with the client?”
“Hey Siri, is the amazon package xyz coming today or tomorrow?”
“Hey Siri, can you please email the client regarding the delay of the shipment?”

Siri is a form of AI entering our daily life. If not already, Artificial Intelligence will soon enter the biotech industry. Cold-chain supply shipments require careful measuring and monitoring of its content’s temperature, pressure, tilt level, tamper detection, and much more. Even the slightest change in the variables can lead to the vain output of the product.

From the warehouse to the delivery station, AI can be integrated to enhance each stage’s productivity and cost-effectiveness.

In the warehouse, AI can perform visual inspection process, where it scans images of the shipment, to ensure no damage has been done to the packages that are going to be transported.

To minimize such damage and ensure quick delivery of products from first mile to last mile, cloud-based platforms can be set up allowing access to all stakeholders (consumers, manufactures, delivery heads) for sensor data of the shipment. The AI will be performing comprehensive analysis and provides info to the end user about the product (basic manufacturing information, safety compliances). Manufactures will be able to take instant measures form smart devices/ control panel. Furthermore, AI can analyze the cost-data sheets to create a magical bridge for suppliers to enhance their supply chain management productivity. (‘Morgan’).

AI technology will further provide instantaneous route changes to the destination for the quickest route available and for the time/ day the shipment should be moved according to different requirements for each drug/ food product and weather conditions. AI is a novel technology in today’s world that can save billions of dollars; however, if this gold coin is not shined regularly, it can lose its value.


By-Anoushka Kabra, Intern at Lifeplan Technical Solutions.
Citations:
Morgan, Blake. “5 Examples Of How AI Can Be Used Across The Supply Chain.” Forbes, Forbes Magazine, 19 Sept. 2018, www.forbes.com/sites/blakemorgan/2018/09/17/5-examples-of-how-ai-can-be-used-across-the-supply-chain/.