AGORA CLIMATE CONTROL SYSTEMS

Corporate

The interiors of operating theatres must withstand from heat and moisture in a hospital environment.
 The requirements for wall finishes in an operating room are described below :

    • The ability to withstand damage by mobile equipment
    • To be impervious to moisture and unaffected by heat and steam
    • To have a smooth matt finish, without crevices
    • The colour should be of light rainbow hues
    • To be totally unaffected by colour change, staining or mildew
    • To be capable of modification for minor alterations
    • Should not cause the build-up of a static electrical charge
    • Should be joint less or have joints capable of being sealed
    • An anticipated life of not less than ten years

ESD-Control tile flooring helps to control involuntary personnel movement caused by electrostatic discharge, prevent hazardous static discharge directly to patient’s body and prevent fire or explosion when flammable anesthetics are used. ESD results in a danger of explosion caused by gases used for anesthesia in operation rooms. 

In countries with modern medical technology, the explosive gases are no longer used. However, ESD protection is more challenging because some diagnostically/ therapeutically fields use more high-tech electronic medical equipment like electronic sensors, measuring instruments, actuators, microprocessor-controlled devices, etc. which requires ESD protection.

    • Electrical and electrostatic characteristics
    • Physical/ Mechanical properties
    • Chemical resistance
    • Clean room consideration - low carbon content / low out gassing
    • Installation consideration
    • Maintenance consideration
    • Ease of performance for access floors
    • Fire resistance
    • Appearance
    • Cost consideration

Electronically operated hermetically sealing sliding doors are provided to maintain sterility and accurate air pressure in the department.

    • Contamination risks in the rooms are under control 
    • Disinfecting is quicker and safer
    • Control the overpressure in the room
    • Acoustic and noise control
    • Creating a quite environment inside and outside the operating theater/clean room

of a failure of the air handling unit, the overpressure is under control Some of the other equipments used in operating theatre, which the company installs, are as below.

   • Medical gas supplies
    • Power supply
    • Flow balancer up to height of door
    • No connection of clean air area to the surroundings
    • Visual separation

 • Remote control panels individual control of:
          ¤ Air conditioning system
          ¤ Surrounding lighting system
          ¤ Operating theatre lamps
          ¤ Operating table

    • Monitoring of the medical gas supply and the IT network

For Surgeons:
          ¤ Absolutely sterile environment
          ¤ Increase in success rate of surgeries
          ¤ Post-Operative infection rate can be reduced by 65%
          ¤ Less Post-Operative recovery time
          ¤ Due to Laminar flow, surgeon do not inhale the anesthetic gasses
          ¤ Temperature and Humidity can be adjusted to suit specialized              surgeries (eg. Bronchology)
          ¤ Safety for medical staff from electrical equipment failure due to              conductive flooring
          ¤ Touch free entry/exit after scrubbing
          ¤ Hands free telephone for mid-surgery consultation

    • For Hospital Administration:
          ¤ Preference for surgeons to work in a better environment; laminar flow,              sterile, better illumination
          ¤ Easy to clean and easy to maintain Operation Theatres
          ¤ Electrical faults can be rectified from outside, so entry of technicians               can be restricted to some extent

    • For Patients:
          ¤ Less Post-Operative recovery time
          ¤ Safety for medical staff from Electrical equipment failure due to              conductive flooring

Floor plan and design should be based on:

    • Patient admission pattern
    • Staff & visitor traffic patterns
    • Need for support facilities such a nursing station, storage, clerical space, administrative & educational        requirements.
    • Eight to twelve beds per unit is considered best from a functional perspective.
    • Each healthcare facility should consider the need for positive and negative pressure isolation rooms within        the ICU.
    • This need will depend mainly upon patient population and State Department of Public Health requirements.
    • Each intensive care unit should be a geographically distinct area within the hospital, with controlled        access.
    • Location should be chosen so that the unit is adjacent to, or within direct elevator travel to and from, the        emergency department, operating room, intermediate care units, and radiology department
    • The preferred design is to allow a direct line of vision between the patient and the central nursing station.
    • In ICUs with a modular design, patients should be visible from their respective nursing substations.
    • Sliding glass doors and partitions facilitate this arrangement, and increase access to the room in        emergency situations.
    • Signals from patient call systems, alarms from monitoring equipment, and telephones add to the sensory        overload in critical care units.

• A central nursing station should provide a comfortable area of sufficient size to accommodate all        necessary staff functions.
    • When an ICU is of a modular design, each nursing substation should be capable of providing most, if not       all functions of a central station.
    • There must be adequate overhead and task lighting, and a wall mounted clock should be present.
    • Adequate space for computer terminals and printers is essential when automated systems are in use.     •       Patient records should be readily accessible.
    • Adequate surface space and seating for medical record charting by both physicians and nurses should be       provided.
    • Shelving, file cabinets and other storage for medical record forms must be located so that they are readily       accessible by all personnel requiring their use.

    • A separate room or distinct area near each ICU or ICU cluster should be designated for the viewing and       storage of patient radiographs.
    • An illuminated viewing box or carousel of appropriate size should be present to allow for the simultaneous       viewing of serial radiographs.
 

  • Work areas and storage for critical supplies should be located within or immediately adjacent to each ICU.
    • There should be a separate medication area of at least 50 square feet containing a refrigerator for       pharmaceuticals, a double locking safe for controlled substances, and a sink with hot and cold running       water.
    • Countertops must be provided for medication preparation, and cabinets should be available for the       storage of medications and supplies.

    • Each ICU or ICU cluster should have a receptionist area to control visitor access.
    • Ideally, it should be located so that all visitors must pass by this area before entering.
    • The receptionist should be linked with the ICU(s) by telephone and/or other intercommunication system.
    • It is desirable to have a visitors' entrance separate from that used by healthcare professionals. This       entrance should be securable if the need arises.

 • If a special procedures room is desired, it should be located within, or immediately adjacent to, the ICU.
    • One special procedures room may serve several ICUs in close proximity.
    • Consideration should be given to ease of access for patients transported from areas outside the ICU.
    • Room size should be sufficient to accommodate necessary equipment and personnel.
    • Monitoring capabilities, equipment, support services, and safety considerations must be consistent with       those provided in the ICU proper.
    • Work surfaces and storage areas must be adequate enough to maintain all necessary supplies and permit       the performance of all desired procedures without the need for healthcare personnel to leave the room

    • Clean and dirty utility rooms must be separate rooms that lack interconnection.
    • They must be adequately temperature controlled, and the air supply from the dirty utility room must be        exhausted.
    • Floors should be covered with materials without seams to facilitate cleaning.
    • The clean utility room should be used for the storage of all clean and sterile supplies, and may also be        used for the storage of clean linen.
    • Shelving and cabinets for storage must be located high enough off the floor to allow easy access to the        floor underneath for cleaning.
    • The dirty utility room must contain a clinical sink and a hopper both with hot and cold mixing faucets.
    • Separate covered containers must be provided for soiled linen and waste materials.
    • There should be designated mechanisms for the disposal of items contaminated by body substances and        fluids.
    • Special containers should be provided for the disposal of needles and other sharp objects.

   • An area must be provided for the storage and securing of large patient care equipment items not in active       use.
    • Space should be adequate enough to provide easy access, easy location of desired equipment, and easy       retrieval.
    • Grounded electrical outlets should be provided within the storage area in sufficient numbers to permit       recharging of battery operated items.
 

    • A patient nourishment preparation area should be identified and equipped with food preparation surfaces,       an ice-making machine, a sink with hot and cold running water, a countertop stove and/or microwave oven,       and a refrigerator.
    • The refrigerator should not be used for the storage of laboratory specimens.
    • A hand washing facility should be located in or near the area.

    • A staff lounge must be available near each ICU or ICU cluster to provide a private, comfortable, and        relaxing environment.
    • Secured locker facilities, showers and toilets should be present.
    • The area should include comfortable seating and adequate nourishment storage and preparation facilities,        including a refrigerator, microwave oven, etc.
    • The lounge must be linked to the ICU by telephone or intercommunication system, and emergency cardiac        arrest alarms should be audible within.

• A visitors' lounge or waiting area should be provided near each ICU or ICU cluster.
    • Visitor access should be controlled from the receptionist area. One and one-half to two seats per critical       care bed are recommended.
    • Public telephones (preferably with privacy enclosures) and dining facilities must be available to visitors.
    • Television and/or music should be provided.
    • Public toilet facilities and a drinking fountain should be located within the lounge area or immediately       adjacent.
    • Warm colors, carpeting, indirect soft lighting, and windows are desirable.
    • A variety of seating, including upright, lounge, and reclining chairs, is also desirable.
    • Educational materials and lists of hospital and community-based support and resource services should be       displayed.
    • A separate family consultation room is strongly recommended.

    • Patients transported to and from an ICU should be transported through corridors separate from those        used by the visiting public.
    • Patient privacy should be preserved and patient transportation should be rapid and unobstructed.
    • When elevator transport is required, an oversized keyed elevator, separate from public access, should be       provided.
 

    • A perimeter corridor with easy entrance and exit should be provided for supplying and servicing each ICU.
    • Removal of soiled items and waste should also be accomplished through this corridor.
    • This helps to minimize any disruption of patient care activities and minimizes unnecessary noise.
    • The corridor should be at least eight feet in width.
    • Doorways, openings, and passages into each ICU must be a minimum of 36 inches in width to allow easy       and unobstructed movement of equipment and supplies.
    • Floor coverings should be chosen to withstand heavy use and allow heavy wheeled equipment to be       moved without difficulty.

  • Ward-type ICUs should allow at least 225 square feet of clear floor area per bed.
    • ICUs with individual patient modules should allow at least 250 square feet per room (assuming one patient       per room),
    • Provide a minimum width of 15 feet, excluding ancillary spaces (anteroom, toilet, storage).
    • Isolation rooms should each contain at least 250 square feet of floor space plus an anteroom.
    • Each anteroom should contain at least 20 square feet to accommodate hand-washing, gowning, and       storage.
    • If a toilet is provided, it must be private.
    • A cardiac arrest/emergency alarm button must be present at every bedside within the ICU. The alarm       should automatically sound in the hospital telecommunications center, central nursing station, ICU       conference room, staff lounge, and any on-call rooms. The origin of these alarms must be discernable.
    • Space and surfaces for computer terminals and patient charting should be incorporated into the design of        each patient module as indicated.
    • Storage must be provided for each patient's personal belongings, patient care supplies, linen and        toiletries. Locking drawers and cabinets must be used if syringes and pharmaceuticals are stored at the        bedside.
    • Personal valuables should not be kept in the ICU. Rather, these should be held by Hospital Security until       patient discharge.

Additional approaches to improving sensory orientation for patients may include:

    • The provision of a clock, calendar, bulletin board, pillow speaker connected to radio and television.
    • Televisions must be out of reach of patients and operated by remote control.
    • If possible, telephone service should be provided in each room.
    • Comfort considerations should include methods for establishing privacy for the patient. Shades, blinds,        curtains, and doors should control the patient's contact with his/her surroundings.
    • A supply of portable or folding chairs should be available to allow for family visits at the bedside. An       additional comfort consideration is the choice of color scheme for the room, which should promote rest and       have a calming effect.

Each intensive care unit must have:

    • Electrical power,
    • Water, oxygen,
    • Compressed air,
    • Vacuum, lighting,
    • And environmental control systems that support the needs of the patients and critical care team under       normal and emergency situations, and these must meet or exceed regulatory and accreditation agency       codes and standards.

• Grounded 110 volt electrical outlets with 30 amp circuit breakers should be located within a few feet of        each patient's bed.
    • Sixteen outlets per bed are desirable.
    • Outlets at the head of the bed should be placed approximately 36 inches above the floor to facilitate        connection,
    • To discourage disconnection by pulling the power cord rather than the plug.
    • Outlets at the sides and foot of the bed should be placed close to the floor to avoid tripping over electrical        cords.

 • The water supply must be from a certified source, especially if hemodialysis is to be performed.
    • Zone stop valves must be installed on pipes entering each ICU to allow service to be turned off should line       breaks occur.
    • Hand-washing sinks deep and wide enough to prevent splashing, preferably equipped with elbow, knee,       foot, or sonar-operated faucets, must be available near the entrances to patient modules, or between       every two patients in ward-type units.
 

    • Total luminance should not exceed 30 foot-candles.
    • It is preferable to place lighting controls on variable-control dimmers located just outside of the room.
    • Night lighting should not exceed 6.5 fc for continuous use or 19 fc for short periods.
    • Separate lighting for emergencies and procedures should be located in the ceiling directly above the       patient and should fully illuminate the patient with at least 150 fc shadow-free
    • A patient reading light is desirable, and should be mounted

    • A minimum of six total air changes per room per hour are required, with two air changes per hour       composed of outside air.
    • For rooms having toilets, the required toilet exhaust of 75 cubic feet per minute should be composed of       outside air.
    • Central air-conditioning systems and re-circulated air must pass through appropriate filters.
    • Air-conditioning and heating should be provided with an emphasis on patient comfort.
    • For critical care units having enclosed patient modules, the temperature should be adjustable within each       module.

    • These systems provide for "paperless" data management, order entry, and nurse and physician charting.        If and when a decision is made to utilize this technology, it is important to integrate such a system fully with        all ICU activities.
    • Bedside terminals facilitate patient management by permitting nurses and physicians to remain at the        bedside during the charting process.

    • Voice Intercommunication Systems
    • Satellite Laboratory
    • Physician On-Call Rooms
    • Administrative Offices

The embryology laboratory should have adequate space to follow good laboratory practice.

    • The construction of the laboratory should ensure aseptic and optimal handling of gametes and
       pre-embryos during all phases of the treatment.
    • The location of storage areas and equipment such as incubators, centrifuges and cryo equipment should        be logically planned for efficiency and safety within each working area.
    • Separate office space should be provided for administrative work, such as record keeping and data entry.
    • A general wet area in which washing of equipment, sterilization, etc., is performed, should be separate        from the embryo laboratory. Moreover, if fixatives are applied, these analyses should be performed in a        separate room in a fume-hood.
    • When commissioning the laboratory, thought should be given to the most recent developments in       equipment and facilities. Bench height, adjustable chairs, microscope eye height, efficient use of space       and surfaces, sufficient air-condition and the amount of daylight, all contribute to a working environment       that minimizes distraction and fatigue. Consideration should also be given to local health and safety       requirements.

    • The laboratory equipment used should be adequate for laboratory work and easy to clean and disinfect.
    • Critical items of equipment, including incubators and frozen embryo storage facilities, should be       appropriately alarmed and monitored.
    • All embryo laboratories should have an automatic emergency generator backup in the event of power        failure.
    • A minimum number of two incubators is recommended. Gas cylinders should be placed outside or in a       separate room with an automatic backup system.
    • Incubators should be frequently cleaned and sterilized. Nitrogen tanks should be cleaned and sanitized at       least every year.

All assisted reproductive technologies involve handling biological material, and pose a potential hazard of transmitting diseases to personnel. Sources of infection in this system are compounds and follicle fluid of animal origin. Therefore,

• Vaccination of the personnel against hepatitis B or other available viral disease is recommended.
• Screening patients and gamete donors for HIV, hepatitis B/C and other sexually transmitted diseases before treatment or gamete cryopreservation should be routinely adopted.
• Although patients' admittance to IVF treatment cycles is regulated by physicians, the laboratory staff must be informed about the risks of handling potentially infected biological material. The following recommendations should be considered.
• If one or both partners are HIV-positive, IVF and embryo transfer should not be attempted, unless local rules give authorization after extensive examination. Donor semen is advised for a seronegative woman if her partner is seropositive, as HIV-1 viral particles may be present in the cytoplasmic compartment of motile spermatozoa. Therefore, the possibility exists that viral particles enter the oocyte during fertilization either with conventional IVF or intracytoplasmic sperm injection (ICSI). The fate of these particles in the resulting embryo is unknown.
• If the male partner is infected by the virus of hepatitis B, the seronegative woman must be vaccinated before IVF.

The purpose of the protective measures is also to ensure aseptic conditions for gamete and embryos.
The procedures should deal with, but not be limited to, the following:

    • Use of laboratory clothing.
    • Use of non-toxic (non-powdered) gloves and masks.
    • Use of eye and face protection if cryogenic materials are handled.
    • Use of vertical laminar-flow benches.
    • Use of mechanical pipetting devices.
    • Use of mechanical pipetting devices.
    • Disinfection and sterilization of potentially infected equipment.
    • Use of disposable material; after usage, it must be discarded immediately in the proper waste containers.       Potential infectious materials must be disposed of in a manner that protects laboratory workers and       maintenance, service, and housekeeping staff from exposure to infectious materials in the course of their       work.
    • Needles and other sharps should be handled with extreme caution and discarded in special containers.

Cross-contamination with infectious material from one patient to another could still occur during the cryopreservation procedure when straws with semen or embryos are filled by dipping the straw in patient medium with semen or embryos, sealing it and passing it into liquid nitrogen without external disinfection. 

A. The air conditioning requirements for Operation Theater in an HCO have been deliberated at length with manufacturers, engineers, technical cornmittee members and other stake holders and the following guidelines have been finalised.

B. For this purpose operation theaters have been divided into two distinct groups:

       i. Superspeciality OT: Superspeciality OT means operations of Neurosciences, Orthopedics (Joint             Replacement), Cardiothoracic and Transplant Surgery (Renal, Liver etc).

       ii. General OT: This includes Ophthalmology and all other basic surgical disciplines. District hospital             OTs and FRU OT would fall under this category.

C. The following basic assumptions have been kept in view:

       • OT Size: Standard OT size of 20' x 20' x 10' (Ht. below the false ceiling level is considered).
       • Occupancy: Standard occupancy of 5-8 persons at any given point of time inside the OT is          considered.
       • Equipment Load: Standard equipment load of 5-7 kW considered per OT.
       • Ambient temperature & humidity at each location to be considered while designing the system.