Total OR Congress: Monitoring quality requires continuous attention

In the special conference location Supernova of the Jaarbeurs Utrecht, after two corona years it was finally time again for a new live edition of Totaal OK, targeting stakeholders in OR construction, operation and use. The 2022 program focused on choices and experiences of users; design/furnishing, practical and medical use, guidelines and management of new, integral OR concepts received attention from multiple angles on September 15. Safety was the key word of the conference day.

Much has changed in the design of ORs in recent decades. Innovations such as hybrid ORs with imaging techniques, new air handling systems and tighter regulations have led to a continuous stream of OR renovations in hospital country. In particular, it has led to more spacious OR centers, in part because the amount of equipment is increasing.

The pre-Corona editions of Total OK focused extensively on these developments. The 2022 edition focused primarily on safety, infection prevention, sustainability and comfort - the essential outputs of investment in OR quality. About eight speakers from different backgrounds, from consultants and surgeons to scientists - sometimes even in multiple roles, passed in review. The day kicked off with two lectures on (air) quality, first from Stefan van Heumen of TNO Delft. His main observation was that there are seven different guidelines for the construction, design and use of the OR. The topic was broadened to particle measurement in practice at the Eindhoven Catharina Hospital. Air quality expert Johan Laurensse tested the hospital's ORs in view of the new guideline RL8. In most ORs, there are two types of air quality: in the plenum area and in the periphery. Increasingly, systems are in circulation that generate equal air quality, such as the Opragon system. For example, how do you prevent air particles from the periphery from reaching the wound area? An important conclusion of Laurensse is that much can be gained with simple solutions such as moving quietly through the OR.

A broader piece of safety was highlighted by trauma surgeon and professor Maarten van der Elst. He first mentioned 1,500 deaths per year in hospitals due to "preventable behavior. The Reinier de Graaf Gasthuis and TU Delft, respectively, are working hard on patient safety, with the introduction and testing of innovative systems. For example, some of the instruments in the Delft ORs are being tracked using sensors so that their loss can be prevented. More far-reaching is the DORA project in cooperation with TU Delft. DORA (Digital Operating Room Assistant) is special software based on a checklist. If checkmarks are red, surgery cannot be performed; the acute problem must be solved first. This can vary from an open door to a missing instrument.

Another concern is thermal comfort in the OR. Marcel Loomans of TU/e studied the temperature experience of the OR staff, with the main findings being that a cold sensation on arms and head is the most significant negative experience. The anesthesiologist experiences the most complaints; the surgeon the least. There are no major research differences between the individual types of air handling systems.

As an anesthesiologist at UMC Amsterdam/AMC, Niek Sperna Weiland calls attention to the CO2 footprint of ORs. It is too high. Sperna Weiland identifies three areas of concern: medical gases, energy consumption and materials. Major gains can be made in all areas. "Anesthesia gases are strong greenhouse gases that are not broken down by the body and exhaled. With the same effect as Desflurane, dozens of times lower CO2 emissions can be achieved with Propofol." As for energy consumption, "Air treatment accounts for 90%, so night or off mode can save a lot of energy and money." A lot of gains can also be made with reductions in material use, especially when it comes to using up spent packaging.

Back to practice. Koen Defoort of the Sint Maartenskliniek in Nijmegen experienced a major OR renovation as a direct participant. It gave the orthopedic surgeon at the specialized clinic the opportunity to optimize OR quality in construction, equipment and operating processes. "Infection prevention is a top priority in orthopedics, as there is a worldwide boom in infections after surgeries - especially when it comes to prosthetics. Revision and post-treatment puts enormous pressure on production." As part of infection prevention, the use of no-touch switches for opening doors and turning on equipment is an important step. The surgeon's practice summed up the day well: people-centered action can make a lot of difference in the quality of treatment, such as keeping checklists simple to avoid silly ticking off. Experiencing the working space as pleasant can also make a difference (spacious, ergonomic ORs with daylight). Defoort also advocates a focus on unambiguous registration, for example by including the surgery report in the patient's EPR.

Lectures on partial aspects such as the use of the electric surgical knife and the robotization of the OR closed the day. Prof. Dr. Maarten Steinbuch (TU/e and co-founder Eindhoven Medical Robotics) is not only working on surgical robots, he is interpreting a vision that is much broader. It is already the case that remote surgery can be performed by a treating physician using the Da Vinci surgical robot (minimal invasion). The labor aspects of treatment are only in the early stages, says Steinbuch.In the near future, it will be possible to have a surgeon retire later, as operations become less and less intensive and time-consuming. To be continued, no doubt, during a future edition of Total OK.   

Cleanroom Combination Group was present at this edition of Total OK with a new booth. This showed the new Hybrid OR 1 of OLVG-Oost Amsterdam, a fantastic project of which CCG is enormously proud. 

During the conference, many interesting conversations were held, inspiring lectures attended and a pleasant program and a dynamic day were enjoyed. 

Michiel van Kooten (COO) told that Cleanroom Combination Group is currently building and/or will build the MRI-OK of the Wilhelmina Kinderziekenhuis Utrecht and the OR-complexes of the Wilhelmina Ziekenhuis Assen, OLVG-Oost Amsterdam and UMC Groningen, as well as 4 endo-OKs of Amsterdam UMC (location VUmc). Great assignments for CCG as an OR specialist.  

The Medicare EI1 is the first hermetically sealing sliding door system to achieve the highest EI1 rating in accordance with EN 1634-1, the European standard for fire resistance on doors. To meet this standard, it is tested whether the door can stop flames (E), does not rise too much in temperature (I) and whether the door does not emit too much heat radiation (W).

In addition to fire resistance, smoke resistance is also very important. In addition to fire resistance, Metaflex Medicare EI1 doors have also been successfully tested for smoke resistance and certified in accordance with EN 1634-3, the European standard for smoke resistance on doors. Smoke permeability is classified according to the Sa and S200 value.

Virtually no air movement occurs when opening and closing the Medicare EI1 sliding door. This door system has also achieved the highest airtightness classification D (4) according to EN 1026/12207. The unique locking system ensures that the door remains airtight even at high under- or overpressure within the specified tolerances.

This door is well suited for areas where fire safety is important, such as operating rooms, intensive care units, x-ray rooms, pharmacies and emergency rooms.

During the OK Totaal congress, the focus was on "hygiene. How can we (better) manage, control and register? To this end, CaTeC's new pressure monitoring interface - the CPS 6000 system - is equipped with a glass display, for pressure monitoring in operating rooms and patient rooms. The new glass-fronted display is much easier to clean due to its new design.

Many will recognize the display because the product is already used in their hospital. The updated version and user-friendly menu structure have been optimized even further! Also important are the management, control and recording of current climate parameters. For control and validation, CaTeC has presented the updated hand-held meters TSI96xx. Features include a color display, an improved menu structure and a robust and reliable system through the use of ceramic flow elements. An ergonomic handle guarantees optimal use.

The products are designed for application in hospitals and operating rooms, focusing on improved hygiene, validation, accuracy, reliability and simplicity of use.