Discussion on the design of operating room for positive and negative pressure switching
In order to improve the utilization rate of the operating room, the hospitals designed the negative pressure operating room to switch between the positive and negative pressure operating rooms. The positive and negative pressure switching operating room is generally designed to be Class III. Non-contaminating Class III surgery is performed during positive pressure, and contaminated surgery is performed during negative pressure. Positive and negative pressure switching is achieved by controlling the amount of exhaust air in the operating room.
Suggestions for switching the operating room between positive and negative pressure:
In the construction of the clean surgical department, the operation of infectious diseases or surgery for patients with infectious diseases should follow the management of infectious diseases. To this end, each hospital is equipped with a vacuum cleaning operating room. Through years of experience in designing clean surgical departments and on-site use effects, we have studied the following problems in the design of positive and negative pressure switching operating rooms and made recommendations.
(1) Positive and negative pressure switching operating room flow layout
To prevent infection, it is necessary to start from the overall design of the hospital. From the plane layout stage, it is necessary to consider the clean items, dirt and personnel flow. To avoid the pollution corridor, the positive and negative pressure operating room can be placed close to the workshop. A special channel is opened for the patient to do the pollution surgery, or the positive and negative pressure switching operating room is located close to the dirt elevator, and the patient doing the pollution surgery enters the operating room from the sewage ladder through the cleaning corridor. When the positive and negative pressure switching operating room is used as a negative pressure operating room, in order to prevent the spread of infectious virus to its adjacent area, the air pressure direction is adjusted to control the airflow direction as the main means, and the operating room should maintain the adjacent adjacent rooms. A static pressure difference of at least -8 Pa, thereby achieving isolation of patients with infectious diseases and prevention of air infection in patients susceptible to infection. In order to better protect other areas of the clean surgical department, a buffer chamber must be provided between the negative pressure operating room and its adjacent area. In some hospitals, the positive and negative pressure switching operating room is only equipped with a buffer front chamber, and some only have a rear chamber. This design scheme has a great risk of infection, that is, when a person walks out of the operating room, it will bring out some Infectious air, its adjacent areas will be contaminated. The positive and negative pressure switching operating room plane flow should be cleaned and shunted, and the operating room is provided with a buffer front and back chamber. Before the buffering, the indoor sensor pool is set up so that the doctor can brush in and out of the operating room. Washing hands frequently is the most important means to prevent infection transmission. The back chamber is provided with a dirty wash tank for dirt cleaning treatment to keep the infected items within a minimum range. This kind of scheme has been applied in many cases and has played a very good role in preventing infection, and it has been increasingly recognized by users.
(2) Positive and negative pressure switching operating room and its front and rear room air conditioning system configuration
The air conditioning system in hospital construction equipment is an important measure to prevent the spread of germs through the air, so its design and management is very important. There are different levels of air cleanliness in the operating department. The air conditioning and ventilation system is used to achieve different cleanliness of each area. By controlling indoor air pressure and airflow, it prevents air intrusion in the contaminated area and prevents cross-infection. In general, the pressure difference between the negative pressure operating room and the front chamber is the corridor > front chamber > negative pressure operating room to maintain the flow direction from the outside to the inside. The pressure difference between the positive pressure operating room and the front chamber is opposite, and the airflow direction is from the inside to the outside. From the perspective of ensuring the overall control of the clean operating department and the flexible use of the clean operating room, the positive and negative pressure switching operating room and the front and rear rooms are combined with an air conditioning system. When the operating room is in non-working state, the system stops running, only the fresh air is kept to maintain the positive pressure operation. At this time, the temperature and humidity requirements in the operating room are low, so only the fresh air needs to be cleaned and sterilized in the operating room. Yes, the small air volume in the front and back rooms can supply air, reducing unnecessary waste of resources.
Some air-conditioning design companies use an air-conditioning system in the front room and the clean corridor, and an air-conditioning system in the back room and the cleaning hall. This design mainly considers the high-efficiency filter and the front and rear rooms in the operating room dedicated air supply ceiling. The resistance of the filter of the air supply unit is different, and there is a problem that the air volume adjustment is difficult. Nowadays, there are many kinds of filters on the market. As long as the designer selects the same resistance as the filter of the air supply ceiling when selecting the filter used in the front and rear rooms, the problem of difficulty in adjusting the air volume will be solved.
(3) Positive and negative pressure switching operating room exhaust system setting
The positive and negative pressure switching operating room properties determine that the operating room should be equipped with two sets of large air volume exhaust systems. In order to exclude a part of lighter anesthetic gas and indoor dirty air, the upper air outlet is located at the top of the patient's head side. This is the air outlet setting when the operating room is used as a positive pressure. When the operating room is under negative pressure, the two exhaust systems are simultaneously opened. The patient is used as a source of infectious diseases. The air passing through the patient should be removed on the leeward side at the shortest distance to avoid the infection of the doctor. From this point of view, The exhaust vent of the large air volume exhaust system should be placed at the lower part, and the wind sent by the wind ceiling will have an upward 20cm~50cm refraction, so the air vent is preferably set at a height of 20cm~50cm, and the operating room is long. Close to the patient's head side position. Some designers have two sets of exhaust systems for the positive and negative pressure switching operating room. The two sets of exhaust systems share an upper exhaust vent, and the position of the vent is on the patient's head. The disadvantage of this solution is that the patient is infected. The source will infect some of the air in the room. If the high air volume is set as the upper air outlet, the patient's infected air will pass through the doctor's head, which will bring great health hazards to the doctor.
(4) Start and stop sequence of circulating air conditioning unit and exhaust fan
In order to ensure an orderly pressure gradient in the surgical department and prevent cross-infection, the sequence of starting and stopping the circulating air conditioning unit and the exhaust fan in the positive pressure operating room and the negative pressure operating room are different. When the positive and negative pressure operating room is in a positive pressure state for surgery, first turn on the circulation unit and then turn on the small air volume exhaust fan, stop the exhaust fan first, then stop the circulation unit, and the positive pressure state in the operating room will not be interrupted. When the positive and negative pressure operating room is under negative pressure for operation, first open the exhaust fan (the two exhaust systems are simultaneously opened), then turn on the circulating unit, first stop the circulating unit, and after a certain time delay (to remove the polluted air in the operating room) Then, the exhaust fan is stopped, the new fan unit is in the running state, and the operating room is restored to the positive pressure state. Some designers have not neglected the conversion of the start and stop sequence of the recirculating air conditioning unit and the exhaust fan during the control design of the positive and negative pressure switching operating room, and found the problem when debugging. If the problem is discovered after being put into use, the polluted air in the operating room will leak out and infect other areas of the surgical department, which will have serious consequences.
The original intention of establishing a positive and negative pressure switching operating room is to control the spread of infectious sources, reduce the infection rate of surgery, protect the health of personnel, and improve the utilization rate of operating rooms. From the perspective of controlling airborne infection, the layout process of positive and negative pressure switching operating rooms also plays a leading role. The advanced design concept of clean air conditioning system is the key to building a clean operating room. The positive and negative pressure operating room should be designed as an independent purification air conditioning system, and the air conditioning system should be properly configured to avoid energy waste. We should continue to explore in the actual construction experience, advocate the advanced ideas of energy-saving construction, constantly improve the design of the positive and negative pressure switching operating room, and further improve the use of positive and negative pressure switching operating room.
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