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Hybrid Operating Theatres

It feels great to be back onboard www.HospitalDesignTips.com after a while as we have been extremely busy with our assignments on greenfield healthcare projects and despite our best endeavours we had to keep all our energies focussed on our current clients and best protecting their interests.

A big Welcome back to all our regular visitors and readers of www.HospitalDesignTips.com, we hope to keep you abreast of the latest developments in the healthcare industry through informative new articles regularly. I have been meaning to expand my article on Operating Theatres to include Hybrid Theatres and this article will focus on that subject.

As more and more Cardio-Thoracic and Trauma hospitals and specialist clinics are considering, and many more are actually opting to go down the Hybrid Theatres route, it pays to have an understanding of how the process works.

Hybrid Theatres in hospitals combine an Operating Theatre with imaging equipment to allow the surgeons to view live, high definition medical images in real-time. This benefits both – the patient in terms of reduced risks and fewer procedures and inter-department transfers and faster recovery, and the surgeons in terms of reduced operating times, reduced risk to patients, improved success rate due to accurate and high definition real time imaging information.

Hybrid Operating Theatres require more space than conventional theatres for the ceiling or floor mounted imaging equipment in the case of single plane angiography equipment. Optimum Hybrid Theatre area is approximately between 65 and 75 square meters. There are 90 and 120 sq meter Hybrid Theatres around too but rare. Make sure not to forget adjacent space of about 10 square meters for all the technical cabinetry for the Imaging equipment and operating table, the need for uninterruptible power supply (UPS) for the angio table to return to horizontal position if in tilt mode and UPS for the control console to ensure no images are lost in case of mains failure. Also  remember to have ample space for cooling equipment for the heat generated by the technical cabinetry and for cooling the imaging gantry etc.

In addition to the Scrub, Prep and Dirty Utility rooms, a Control Room is required to operate the imaging equipment and to assist the surgical team. This will be similar to any Cath Lab control room in terms of layout, area and equipment. Remember the angio C-arm can be ceiling or floor mounted if single plane or if bi-plane it will be both ceiling and floor mounted.

From flexibility viewpoint Hybrid Theatres also need to perform both as a standalone Cath Lab and a Theatre when required. For this reason the imaging C-Arm needs to be able to move out of the way when operating. During the last few years this was achieved by using the ceiling mounted C-arm that could slide out of the way. Recently however, floor mounted multi-axis movement capable C-arms on a robotic arm are starting to appear on the market that can sit a few meters away but are fully synchronised with the tilting operating tables to acquire real-time images. When not required they can be parked out of the way with the arm contracted.

Hybrid Operating Theatres need a very co-ordinated design given all the equipment that is ceiling mounted including the theatre lights, surgical and anaesthetic pendants, high definition 6-8 monitors on a sliding gantry, the C-arm and radiation shielding screen, to avoid any clashes and giving all possible combinations of this equipment by the surgeons while not blocking view of the Control room staff.

Before embarking on the Hybrid Operating Theatres transition another very important step to remember is to have your premises checked for sufficiency of access route for the largest pieces of the imaging equipment for doors and corridor dimensions, and ceiling height. In addition to this the floors and ceiling structures also need to be probed for their ability to support very heavy equipment, as well as provision of floor trunking to facilitate any services to be connected between the Table, technical cabinets and the control room.

I sincerely hope that this short article gives you some basic idea and understanding that is necessary at the design and/or concept stage to consider transition to Hybrid Operating Theatres for hospitals and healthcare setups. Should you need more assistance or require our professional services please do contact us here.

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About the Author:
Harry McQue is a hospital Design & Equipment Manager with Post Graduate degrees in business management and information technology. Harry has 20+ years of international experience ranging from working on hospital projects in Dubai (Middle East) to over £1 Billion hospital projects in the UK & Europe. You can benefit from his experience at: www.hospitaldesigntips.com. If you have current or upcoming projects big or small or  topics that you would like his advice on, you can get in touch via the Contact page.

Copyright 2008-2017, http://www.hospitaldesigntips.com Hospital Design Tips. Reproduction by permission only. Please Contact for any permissions for use and advice.

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Easy Guide to Pathology Lab Design

Planning Pathology labs including microbiology, biochemistry and haematology should be fairly simple and straight forward. But we know from experience that if careful thought is not given at the design and planning stage, the simplest of things can and most probably will go wrong.

So what do we really need to watch out for? Although designing a hospital is a painstaking procedure best left to the professionals, still the following three basic aspects pertaining to hospital lab design need to be remembered:

Lab Benching
The material and surface are your first consideration. For labs that deal with strong chemicals, Trespa (a brand name and material by Trespa) is the best choice in the market in terms of performance & affordability. Though its extremely important how they are joined as there should be no room for any crevices where organisms can grow. Within Trespa, there are two types – Trespa Athlon and Trespa TopLab (both registered trademarks of Trespa) .

Athlon is more impact and scratch resistant while TopLab is more chemical resistant.

DuPont’s Corian is the top choice when price is not the main concern, as its virtually seamless, scratch & stain resistant, non-porous material that can be moulded into limitless shapes for customised design, such as worktop and lab sink as one piece with no cuts, crevices or joins hence ideal for lab benching and joinery requirements.

The other important aspect is the height & depth of the lab benching. Generally recommended height is 920mm for standing and depths are 600mm or 750mm but you will come across situations where an 800mm deep benching is required. This maybe needed to accommodate a deep equipment above or below the lab benching.

You need to remember that with a 750mm deep benching the space below is less than that due to the back panel which hides the services running behind such as electrical cables and water and drain pipes. Make sure you know the height and depth of your under bench fridges and cupboards as well as how big and heavy your worktop mounted analysers and centrifuges are.

Services
The second important consideration is the quantity and type of services required for each piece of equipment dotted around the labs and the need for power, data, potable or special water (distilled, de-ionised, RO), lab gasses, sinks and drainage. Some of these are normally placed at regular measurements around the labs depending on the activities being carried out.

Environment
Depending on chemicals and equipment used, fumes and heat dissipation (such as -70 degree freezers and blood fridges) issues can be significant. This has to be dealt with ventilation and convection cooling/air-conditioning.

While on ventilation, attention needs to be given to the fume cabinets and safety cabinets that require very careful and purpose built exhausts. These can be re-circulating (requiring specific filtration) or exhaust type that take the extract out to a certain level outside the building.

As experts in the field for a long while we strongly encourage hospital design students and newbies to get in touch with us. We are happy to assist upcoming and budding designers of the future!

 

About the Author:
Harry McQue is a hospital Design & Equipment Manager with Post Graduate degrees in business management and information technology. Harry has 20+ years of international experience ranging from working on hospital projects in Dubai (Middle East) to over £1 Billion hospital projects in the UK & Europe. You can benefit from his experience at: www.hospitaldesigntips.com. If you have current or upcoming projects big or small or  topics that you would like his advice on, you can get in touch via the Contact page.

Copyright 2008-2017, http://www.hospitaldesigntips.com Hospital Design Tips. Reproduction by permission only. Please Contact for any permissions for use and advice.

Any broken link? Please let us know via Contact form.

 

Have You Considered These Medical Equipment Planning Basics?

Medical equipment planning and layout design are one of the trickiest parts within the hospital design process and as such demand a thorough consideration of all aspects.

Each clinical space is woven around how clinicians interact with the equipment and the patients. It takes into account the universal principles of infection control, general hygiene and ease of maintenance and cleaning. This is the common sense stuff with things like locating wash hand basins near the entrance to remind medical staff to wash hands before and after interacting with the patients.

Medical equipment, fittings and fixtures layout follows the work flow and must separate the “dirty” and “clean” zones.

Height of hospital equipment, shelving and layout should allow easy access to hospital staff of an average height. The same goes for all diagnostic units, which should be suitably adjustable to cater to all heights/sizes of patients.

While a great majority of medical equipment is easy to relocate through attached wheels, this is not the same for larger medical equipment units such as MRI’s, and CT scanners parts of which are bolted to the floor or wall. Access and egress are both important. So thought needs to be given not just to facilitate the initial arrival and installation of these large/oversize medical units before the last wall is built, but also how to remove the equipment when it needs servicing or decommissioning and replacement. It pays to consider if these big units can be dismantled into smaller modules and whether the equipment can pass through the corridor corners? Are any trolley options available? Is the door large enough to accommodate easy passage of these units? Does it need to go in a lift? If yes, are the service lifts large enough to cater to the size and weight?

Over and above the size/movement aspects of large hospital equipment, building structure is another aspect to consider well before the construction starts. The hospital X-ray unit, for example needs steel in the ceilings to provide the ceiling tracks on which the X-Ray head is mounted. Slab deflection and vibration requirements should be established with the equipment providers.

Continuing with the example of the X-Ray, the X-Ray table, the head on the gantry, the wall mounted bucky, the control console and the generator all need services and floor trunking dimensions and locations should be provided to the structural engineers to plan that before the concrete is poured. Otherwise cutting out the trunking will be an expensive and time consuming job. Worse still the steel mesh may not allow you to cut the floor as it will compromise the slab stability.

Special hospital equipment also gets installed in stages, such as the theatre pendant and lights; the suppliers normally issue the steel plate at the construction stage which should be bolted to the concrete ceiling. The rest of the services and pendant is built just before the false ceiling goes up. For security reasons, the doors and locks should be installed to the rooms but decoration outstanding otherwise the builder may have to go back in to touch up and fix any scratches and broken items.

Likewise most advanced lasers and radiation equipment require interlocking doors as a safety measure, which is automatically turned on before switching on the said units, in addition to the warning lights outside the room.

The above discussion caters to the basic requirements only, should you desire to protect your huge investment in an upcoming hospital project it is a must that you have an experienced design manager on board while appointing the lead architects.

This is where we come in. We have worked with clinical, architectural, civil, structural, MEP, landscape, interior and other designers, engineers, medical professionals, authorities, medical equipment manufacturers and many many other entities over the years and can save you a lot of time, money and hassle but guiding you through our advice, reviewing your designs, pointing you in the right direction or whenever you have a question or at a crossroad and need pointing in the right direction. So come talk to us!

 

About the Author:
Harry McQue is a hospital Design & Equipment Manager with Post Graduate degrees in business management and information technology. Harry has 20+ years of international experience ranging from working on hospital projects in Dubai (Middle East) to over £1 Billion hospital projects in the UK & Europe. You can benefit from his experience at: www.hospitaldesigntips.com. If you have current or upcoming projects big or small or  topics that you would like his advice on, you can get in touch via the Contact page.

Copyright 2008-2017, http://www.hospitaldesigntips.com Hospital Design Tips. Reproduction by permission only. Please Contact for any permissions for use and advice.

Any broken link? Please let us know via Contact form.

 

General Operating Theatre Design

Designing an operating theatre outlines the intricacies of the hospital design process. An operating theatre suite consists of the Theatre, the Anaesthetic room, Scrub room and the Dirty Utility (or just Utility) room. We will look at planning just the Operating Theatre itself in this hospital design guide article. A number of facilities do not have a separate Anaesthetic room, anaesthesia is carried out in the operating theatre.

The size and room dimensions vary but as an indication it should be about 7 meters wide by 8 meters long (56 square meters).

We can help you develop your own or review your designs for a small fee and give you our feedback. Please get in touch through the comment section at the bottom if you require this service.

Over-riding principles while designing an operating theatre are:

  • Flexible use of the space;
  • Ease of clinically cleaning the theatre – including the floor, walls, surgeons panel and any equipment such as pendants and theatre lights;
  • Ease of use of surgeons panels, theatre lights and pendants.

There are different arguments for either having all equipment and instruments on mobile trolleys to allow 100% flexibility on use of the theatre and ease of cleaning the theatre versus mounting a great majority of equipment on ceiling mounted theatre pendants. The ceiling slab must be able to hold the weight of the theatre lights, pendants and the equipment if mounted on the pendants. It is highly recommended that you check with your structural engineer.

Ceiling Mounted Equipment:

1.  Pendants

Expect a Surgical and an Anaesthetic Pendant in any theatre which have power, data and various gas outlets. There are several major suppliers on the market with numerous different types. Pendants can be rigid, rigid-retractable or fully articulated. Theatres require fully articulated pendants for maximum flexibility. A lot of co-ordination is required between medical gas, electrical, and pendant trade contractors together with electrical, mechanical and structural engineers/consultants while installing pendants to ensure all structural steel support is in place, gas pipes are properly connected and power and data cables run at the correct programmed dates.

Various life saving equipment must be powered off Isolated Power Supply (IPS) which is also backed up by Un-interruptible Power Supply (UPS), in case of power failure during surgery.

2. Theatre Lights

There used to be the Gas Discharge lights or Halogen lights. Aspects to consider were bulb life, costs associated and Theatre down time while bulbs were changed.

There is a new kid on the block in the last few years – LED technology. About 30% more expensive compared to the existing technology but very long life bulbs (over 20,000 hours), ease of maintenance (couple of minutes to replace an LED), cheap cost of replacement (fraction of older technology) and ability to vary light temperature hence helping to diagnose cancerous cells etc.

Theatre Lights must be backed up by a battery back up in case of power failure during surgery. Suggested time can be 3 hours back up. Note that general lighting and emergency escape lighting should also be on similar battery/UPS back up time. The battery backup unit can be a large wall mounted cabinet about 1m x 1m and about 300-400mm deep. It will need to be mounted not far from the Theatre Lights but not inside the clinical space.

3. Camera

In a teaching facility, a camera (now a days High Definition Camera) and microphone is also required for one way video (from Operating Theatre to Lecture Theatre and/or Seminar Rooms) and two-way audio for surgeons and students to communicate. The camera can either be installed in the handle of the main Theatre Light of installed on a separate ceiling mounted arm. Consider all implications for power and data transfer (HD requires much higher bit rate transfer). Consider a wireless Reality TV / Big Brother style microphone on the surgeon to allow freedom of movement.

In Orthopaedic Theatres you would need to consider the largest ceiling mounted item – The Laminar Flow or the Ultra Clean Ventilation (UCV) Canopy. This item will need a separate article as we are planning a general Theatre in this article.

Wall Mounted Equipment:

1. Surgeons Panel

The panels can the older style steel type or the more current Membrane Type panels which allow ease of cleaning/disinfection. The membrane can be made anti-microbial by inclusion of silver nitrate. A newer version of panels can be touch screen which is now proving very popular taking over the mechanical switch panels and allows a lot of functionality simply by programming as the Theatre changes over time and new items are added and old removed.

For ease of cleaning and aesthetics, the panels should be flush mounted.

Note that all the pendants, theatre lights, general lights, gas alarm panel, IPS/UPS, and warning signs for X-Ray in-use / Laser in-use signs outside Theatre, air sampling ducts, clocks etc need considered and carefully co-ordinated among the trade contractors and design consultants for services and wiring.

Floor Mounted Equipment:

1. Theatre Table

Generally these are rechargeable and don’t necessarily require power socket close by.

2. Trolleys

Trolleys are used for instruments and equipment such as video endoscopes and anaesthetic equipment.

We mentioned ease of cleaning at the start. To enable this the walls should have special plastic enamel paint to allow chemical cleaning if required in case of disinfection. The ceiling is generally constructed of plaster board or special metal to ensure it is air-tight and easily cleaned.

Airflow regime is an important part of moving the air from clean areas towards dirty and out of the Operating Theatre suite to ensure the Theatre is the most clean environment for operating on the patients.

I trust the above has given you some basics to consider when planning your next operating theatre.

About the Author:
Harry McQue is a hospital Design & Equipment Manager with Post Graduate degrees in business management and information technology. Harry has 20+ years of international experience ranging from working on hospital projects in Dubai (Middle East) to over £1 Billion hospital projects in the UK & Europe. You can benefit from his experience at: www.hospitaldesigntips.com. If you have current or upcoming projects big or small or  topics that you would like his advice on, you can get in touch via the Contact page.

Copyright 2008-2017, http://www.hospitaldesigntips.com Hospital Design Tips. Reproduction by permission only. Please Contact for any permissions for use and advice.

Any broken link? Please let us know via Contact form.

 

What do we do at HDT

Clinical design and medical equipment planning are one of the trickiest parts of the hospital design process and as such demand a thorough consideration of all aspects.

Clinical space planning is woven around how clinicians interact with their space, equipment and patients. It takes into account the universal principles of infection control, general hygiene and ease of maintenance and cleaning. It ranges from the common sense stuff like locating wash hand basins near the entrance to remind medical staff to wash hands before and after interacting with the patients to the more complex items like Compliance.

Departmental adjacencies, patient, visitors, staff flow, patient experience, compliance, sustainability, form and function, safety, future flexibility are just a few things that need considered during design, build, maintain and replace process.

Simple items like standard mounting height of hospital equipment, shelving and layout should allow easy access to hospital staff of an average height. The same goes for all diagnostic units, which should be easily adjustable to cater to the varying patient heights/sizes.

This is where we come in. We have extensive experience of working with architectural, MEP, structural and other consultants, medical professionals, authorities, medical equipment manufacturers and many other entities over the years across several small to large healthcare projects. We can save you a lot of time, money and hassle by guiding you through advice, reviewing your designs, answering your questions or pointing you in the right direction when you are at crossroads. So come talk to us!

We at Hospital DesignTips.com offer following services as a “second opinion” to clients, who maybe investors, a private developers, builders and construction companies, firm of architects, health planners or members of general public. For small or deserving projects, we will offer our services free of charge as well but will be dependent on available time & resources.

 

We can,

  • help clients to develop a brief for their hospital project
  • act as consultants to review and advise on the clinical design throughout the design development stage
  • review an already existing design with a view to improve or amend
  • provide specialist advice on medical equipment procurement, planning services and pre-installation requirements
  • advise on specialist drawing tools and databases to plan clinical design and help produce various reports and schedules for commercial, M&E and construction teams
  • help create and maintain detailed project programmes
  • help you find specialist advisors including Programme Optimisers, Radiation Protection and Laser Protection Advisors
  • help locate equipment that meets specific spatial and services requirements

 

About the Author:
Harry McQue is a hospital Design & Equipment Manager with Post Graduate degrees in business management and information technology. Harry has 20+ years of international experience ranging from working on hospital projects in Dubai (Middle East) to over £1 Billion hospital projects in the UK & Europe. You can benefit from his experience at: www.hospitaldesigntips.com. If you have current or upcoming projects big or small or  topics that you would like his advice on, you can get in touch via the Contact page.

Copyright 2008-2017, http://www.hospitaldesigntips.com Hospital Design Tips. Reproduction by permission only. Please Contact for any permissions for use and advice.

Any broken link? Please let us know via Contact form.