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The operating room must be a clean room? Wrong!
Release time:
2024-03-26
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In 1964, Baden Memorial Hospital in New Mexico built the world's first vertical laminar flow clean operating room, which adopted the advanced one-way flow air supply system in the electronics industry at that time. Subsequently, countries around the world followed suit, and vertical laminar flow (one-way flow) clean operating rooms were almost popular all over the world. With the progress of medical technology, the improvement of medical management level and the rationality of cognition, the efficacy of one-way flow clean operating room has been questioned and the rationality of its application has been examined in the past decade. A new technical concept is gradually taking shape, that is, the operating room is not a clean room, although the operating room air conditioning system has a pressure difference, an air filter, and a number of air changes.
In 1964, Baden Memorial Hospital in New Mexico built the world's first vertical laminar flow clean operating room, which adopted the advanced one-way flow air supply system in the electronics industry at that time. Subsequently, countries around the world followed suit, and vertical laminar flow (one-way flow) clean operating rooms were almost popular all over the world. With the progress of medical technology, the improvement of medical management level and the rationality of cognition, the efficacy of one-way flow clean operating room has been questioned and the rationality of its application has been examined in the past decade. A new technical concept is gradually taking shape, that is, the operating room is not a clean room, although the operating room air conditioning system has a pressure difference, an air filter, and a number of air changes.
Laminar flow (unidirectional flow) ventilated operating rooms tend to have a higher risk of infection. The German National Hospital Monitoring System KISS, under the leadership of Dr. Christian Brandt (KISS), conducted a study of the influence of vertical laminar flow on surgical site infection rates in a total of 99230 operations in 63 surgical departments in 55 years in German hospitals. Results of multivariate analysis: laminar ventilated operating rooms were identified as tending to a higher risk of post-operative infection.
Ordinary high efficiency filter can only filter microorganisms and can not be sterilized. In practical applications, the filter itself has become a hotbed for microbial growth and a source of pollution. Bacteria, fungi and other microorganisms multiply on the filter, grow and penetrate the filter to cause serious secondary pollution.
Computer simulation shows that 150 times/h ventilation is higher than 20 times/h the number of particles falling into the surgical incision. In 1998, ASHRAE in the United States used computers to simulate 160 operating room configurations and collected 12.9 million experimental data, which showed that the number of air supply smallpox with 150 air exchange times/h (air volume 20376 m3/h) was almost twice as high as the number of particles falling into the surgical incision with 20 air exchange times/h. The whole chamber laminar flow and the cross-sectional wind speed of 0.15 m/s still cannot eliminate the upper part of the surgical incision. The United States does not agree with the role of clean technology in reducing postoperative infections, and does not believe in the excessive role of clean air technology in reducing postoperative infection rates. After 6 years of debate, the United States unified the different views and measures of environmental control in medical institutions. At the same time, contractors and medical institutions reached a consensus, and finally issued the ANSI/ASHRAE/ASHE 170-2008 standard "ventilation of medical facilities", avoiding the concept of clean technology and cleanliness.
The basic elements of clean room: pressure difference (pressure gradient), air filtration system, sufficient purification air volume, air flow organization. The high-level clean room usually adopts the air flow organization form of one-way flow. The higher the cleanliness and the higher the quality of the controlled environment, the better the product quality. The above description is not difficult to see: one-way flow air treatment system has a tendency to higher risk of infection rate, that is to say, the higher the cleanliness, the greater the risk of infection rate, which is the opposite of the technical concept of clean room, can not be explained.
Reducing the risk of postoperative infection is an important indicator for evaluating surgery. It is well known in the medical community that the body's own flora is the main source of infection for patients. Domestic clinical practice has already proved that as long as the strict implementation of surgical disinfection and sterilization procedures, the incision infection rate of ordinary aseptic operating rooms can be controlled within 1%. The use of a one-way flow air treatment system with large investment and high energy consumption in the operating room is actually a "technical misunderstanding".
Medically controlled environment-Comfortable, sterile, odor-controlled, minimizing the risk of nosocomial infection.
For many years, there has been no conclusive evidence that cleansing techniques reduce the overall risk of surgical site infection. On the contrary, the one-way flow air treatment system is not suitable for the operating room, which has been confirmed by the new medical practice and has become a fact that does not need to be refuted or answered. The United States, the birthplace of the one-way flow clean operating room, abandoned the concept of "clean" 50 years later and implemented the "ventilation" of medical facilities ".
This can not but cause the attention of clean industry science and technology workers. The one-way flow air treatment system with high cost, high energy consumption and poor effect will eventually be eliminated by the medical application field.
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