Tags: Cath Lab, Top 10 List




In any clinical setting, from a dental office to a surgical suite, the single most important aspect of healthcare design is maintaining a sterile environment. This is because the greatest risk factor for a patient is infection. Nosocomial infections are infection as a result of treatment in the healthcare setting, but secondary to the patient’s original condition.

It is estimated that 88,000 people died of complications surrounding nosocomial infections in the US each year. By comparison, about 7,000 die each year in the US from medication errors. (2005 data)

There are numerous opportunities to spread infection in the healthcare environment. This topic alone can fill volumes. This post will focus on what an architect should know about the flow of sterile instruments in the surgical setting.

Know your flow.

Understand the route a surgical instrument will take in your department. It is different than that of the patient or staff. Start in the operating room.

1. Sterile instruments are placed into the room by staff for use in the next procedure.

2. After a procedure is completed, instruments are taken out of the room for cleaning. This room may be called clean-up, decontam, soiled utility, or simply “dirty”.

3. The instruments are cleaned of visible debris, deemed “clean” and moved to an assembly area.

4. In the assembly area, they are placed into a tray (also called a cassette) and typically enclosed in a sterile wrap. (It looks like a gift wrapped package in a blue paper towel. But, no bow.)

5. The wrapped instruments are then placed into a sterilizer where they are exposed to a process that will kill any microscopic organisms still alive. Steam, hydrogen peroxide and Ethylene Oxide are the most common.

6. The wrapped tray containing the sterile instruments is stored for use in the next procedure.

It is critical to understand the flow of patients, staff and instruments within the surgical setting. The progression from dirty to clean to sterile should be easily identifiable as you review the space. There are plenty of books dedicated to this topic. Take a weekend to become familiar and a month or so to become an expert.

Remember that almost 90,000 people die each year from infections introduced to them in the healthcare environment. Don’t expect this 5 minute read to place you in a position to solve the problem. Do your research and learn how you can make patients safer as a result of better design.

Start by becoming familiar with the tools of the trade:

Tags: Eto, Hydrogen Peroxide, Plasma, Steam Sterilization, Sterilzation, Temperature Sterilization, Ultrasonic cleaner




Well, that may be a bit of a stretch. Imaging areas are still some of the most complex to plan and design. The MRI needs floor support and RF shielding, the ultrasound tech wants lights on dimmers,  the new digital Mammo unit is so fast you need to add extra changing rooms to keep up and the trend in general X-ray now eliminates the need for unistrut in the ceiling… Huh? Wait, that sounds easier.

Yes.  For once there is a trend in the imaging area that is making the room easier and cheaper to build. Finally! After 20 years of more and more sophisticated requirements, the newest general rad systems are a relative breeze to install. No ceiling infrastructure and no floor trenches.

Let’s compare:

(Click on an image to view details and then click your browsers back button to return.)

The newer units in the bottom row are all floor standing with a wall attachment for support. Electrical and cables are fed from the wall to the control area. The table is a simple gurney, with no electrical requirements at all. (Except the last image, which is attached to the arm.) The x-ray tube and detector are integral to the system, so no wall bucky either. Sounds simple doesn’t it?

Don’t forget about the basics. You still need a physicist report and room shielding. You still want an X-ray in-use sign for the entry door that is interfaced to the x-ray control. Last, there is a sort of “docking device” to lift the arm that holds the tube and detector. You will need a room to store this when it is time to service it. But you can stash it in the basement with the bio-med folks.

The change is driven by a number of factors. Financial, technological and market-driven. But, it seems safe to assume that the trend will not reverse itself. So before you get too far along in your design, set an appointment with the Imaging Director and have a discussion about the future. It just might save your project tens of thousands of dollars in design and infrastructure costs.

Tags: Digital Imaging, Future Trend, General Rad, Unistrut