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THEATRE DESIGN AND VENTILATION презентация
Содержание
- 1. THEATRE DESIGN AND VENTILATION
- 2. CONCEPT It was first introduced by SIR JOHN CHARNLEY
- 3. ZONES IN THEATRE OUTER ZONE – rest
- 4. REQUIREMENTS AIR DELIVERY SYSTEM AIR
- 5. TEMPERATURE CONTROL - Ideal working temperature is
- 6. HUMIDITY CONTROL - Should be around 40-60%
- 7. AIRBORNE PARTICLES - Measured as BCP/MM3 –
- 8. AIRBORNE PARTICLES - CONVENTIONAL AC (well maintained)-
- 9. AIR FILTERS- 4 LEVELS ROUGHING FILTERS removes
- 10. HEPA FILTERS - Each hepa filter has
- 11. TYPES OF VENTILATION High velocity air flow
- 12. CONVENTIONAL WALL DIFFUSER
- 13. - Produces plenum - No control
- 14. HIGH VELOCITY AIR JET
- 15. - Jets increase air turbulence -
- 16. Vertical laminar flow - Room within a
- 17. Horizontal laminar flow - Forms part of
- 18. PERIPHERAL LAMINAR
- 19. CONVENTIONAL LAMINAR
- 20. Vertical laminar with canopy and side panels
- 21. Without side panels
- 22. - Peripheral entrainment air 0.6 m/s
- 23. EXPONENTIAL AIR FLOW
- 24. - Trumpet shaped air flow -
- 25. STANDARDS IN AIR FLOW - Direction of
- 26. AIR CHANGES ATLEAST 20-40 AIR CHANGES PER
- 27. AIR QUALITY CONTROL - Done by CASTELLA SLIT SAMPLER
- 28. WATER SUPPLY IN OT - Tanks and
- 29. ANTIBIOTIC PROPHYLAXIS - CHOICE OF AGENT
- 30. ANTIBIOTIC PROPHYLAXIS TIMING Within 15-60
- 31. ANTIBIOTIC PROPHYLAXIS - DURATION Further dose
- 32. ANTIBIOTIC PROPHYLAXIS - RISKS - PENICILLIN ALLERGY
- 33. THANK YOU *Pictures taken from journal of orthopedics today
CONCEPT It was first introduced by SIR JOHN CHARNLEY
Слайд 3ZONES IN THEATRE
OUTER ZONE – rest of the hospital outside the
theatre complex
CLEAN ZONE – theatre complex outside the operating area
ASEPTIC ZONE – Operating area
DISPOSAL ZONE – Separate exit for contaminated / used linen and instruments
Слайд 5TEMPERATURE CONTROL
- Ideal working temperature is 19-20 * C – to
minimize perspiration
- But causes pt. hypothermia - PT. body temp. should be 24-26 * C TO AVOID HYPOTHERMIA
- But causes pt. hypothermia - PT. body temp. should be 24-26 * C TO AVOID HYPOTHERMIA
Слайд 7AIRBORNE PARTICLES
- Measured as BCP/MM3 – Bacteria carrying particles OR
CFU/MM3
– Colony forming units
- Each person emits 10k cfu/min at rest and 50k cfu/min with activity
- This is reduced in SCRUBS to 140-830 cfu/min with fask mask and caps.
Слайд 8AIRBORNE PARTICLES
- CONVENTIONAL AC (well maintained)- gives 50-500 cfu/mm3
- All
particles are not viable – viable : non viable ratio is 1:1000
- Smallest particle in theatre seen in bright light is 12 microns
- Smallest particle that can carry bacteria is 4-5 microns
Слайд 9AIR FILTERS- 4 LEVELS
ROUGHING FILTERS
removes Large particles and also protects sensitive
final filters
PREFILTERS should be 95% efficient
FINAL FILTERS should be 95% efficient with a particle size of 3 microns
HEPA FILTERS should be 99.97% efficient with a particle size of 0.3 microns
PREFILTERS should be 95% efficient
FINAL FILTERS should be 95% efficient with a particle size of 3 microns
HEPA FILTERS should be 99.97% efficient with a particle size of 0.3 microns
Слайд 10HEPA FILTERS
- Each hepa filter has a manometer attached to it
to measure the amount of resistance to filteration for clogging purposes.
Слайд 11TYPES OF VENTILATION
High velocity air flow
- high speed jets towards
operating table
- high speed air at periphery
Laminar air flow
- horizontal
- vertical
Слайд 13
- Produces plenum
- No control of air over operating area
- Upto
500 bcp/mm3 – not acceptable for operation theatres
Слайд 15
- Jets increase air turbulence
- Flow at 0.6 m/s
- Jets may
not point at right place and may dessicate the wound
Слайд 16Vertical laminar flow
- Room within a room principle
- Air is passed
through hepa filters from ceiling downwards
- Flow at 0.3 m/s
- entrainment can happen by moving personnel
Слайд 17Horizontal laminar flow
- Forms part of a wall
- Easy to
install
- Movement across it will cause uncontrollable turbulence
- adequate clean zone is not possible
Слайд 20Vertical laminar with canopy and side panels
- Canopy – to overcome
peripheral entrainment
- side panels – extend down to floor to within 20cms from floor
- very successful – 10 bcp/m3
Слайд 22
- Peripheral entrainment air 0.6 m/s
- Higher energy consumption
- movement causes
deflection of contaminants
Слайд 24
- Trumpet shaped air flow
- Downward and radially outward flow of
air
- fliteration down to 1 micron
- Trays can be positioned even upto ½ m outside the actual canopy
Слайд 25STANDARDS IN AIR FLOW
- Direction of air flow shall be under
positive control
- max. viable organisms should be not more than 1 cfu/mm3
- ULTRA CLEAN ZONE – is less than 10 cfu/mm3
Слайд 26AIR CHANGES
ATLEAST 20-40 AIR CHANGES PER HOUR
Pressure gradient should be 1.3-2.5mm
h2O
(more pressure causes rapid drying of the wound)
Слайд 28WATER SUPPLY IN OT
- Tanks and pipes – regular inspection for
leakages
- Bore well water should be avoided as far as possible
- tanks and containers should have covers/lids to protect from dust
- water sterilised by ultraviolet radiation
Слайд 29ANTIBIOTIC PROPHYLAXIS
- CHOICE OF AGENT
Active against comon pathogens
Take
into account drug allergy and sensitivity
cefazolin/cefotaxim preferred-long duration
clinda/vanco in penicillin allergy pts.
Modification for pre-existing cultures
if already on abx – then continue same
Слайд 30ANTIBIOTIC PROPHYLAXIS
TIMING
Within 15-60 mins prior to incision
Vanco should
be given 2 hrs before
Infusion should complete before incision
Infusion should complete before incision
Слайд 31ANTIBIOTIC PROPHYLAXIS
- DURATION
Further dose efficacy is doubtful
Max 24 hrs
if only prophylatic
intra-op – repeat if length of sx more than half life of drug
repeat dose if blood loss >1500ml
not to continue abx till drain removal
Слайд 32ANTIBIOTIC PROPHYLAXIS
- RISKS
- PENICILLIN ALLERGY
- ANAPHYLAXIS
- ABX ASSOCIATED DIARRHOEA
- CLOSTRIDIUM DIFFICLE
INFECTION
- ABX RESISTANCE
- MULTI-RESISTANCE CARRIAGE – SCREENING SHOULD BE DONE IN HIGH RISK CASES
