MODULAR OT SPECIAL
​
Modular Operating Theatre – Things to Ponder
Monojit Mitra  - Facility Director, FV Hospital, Ho Chi Minh City, Vietnam

​Date: 16 April 2022
“Modular” in the Oxford Dictionary is defined as an adjective “to employing or involving a module or modules as the basis of design or construction” – the design aspect is well captured by all Modular OT manufacturers, wherein the individual sections or “modules” are pre-fabricated independently, transported to site and “fit-in” together for any Modular OT.
Modular Operation Theatre comes with its unique sets of advantages – both in offsite fabrication, usage and maintenance, some of which are highlighted here -
 
  • Speed (of Execution) – off site fabrication allows parallel work to commence irrespective of weather influence
  • Flexibility (to adopt, change) as per need
  • Cost (direct and indirect) – shorter lead time
  • Ease of Maintenance (inspections, testing and check) with reduced downtime
  • Better Hygienic Characteristics – anti-microbial and easy clean wall, jointless and seamless smooth surface
 
Any successful MOT starts with a solid base. The modular elements must be mounted to strong structure – including floor rails, ceiling rails, vertical mounts and all types of panels (in a combination of stainless steel, HPL, glass or solid surface); medical gas outlets, sanitary and electrical, medical equipment, HVAC components, OR integration requirements are met here along with fire and lead protection (for radiation safety)

Key components of a MOT are included in the make to order solution and be grouped as -  
 
  1. Structural Fabrication – the frame, wallboards, floor, gas and electrical panels
  2. HVAC Components – laminar flow, HEPA filters, inlet and return air path
  3. Medical Equipment – OT Lights, Table, Anaesthesia Machines, Monitors,
  4. Access, Accessories and Finish – floor, paint, cabinets, doors, pendants, OR Integrated Control System
Protecting environment of Modular OT -
 
  1. First filter bank – incoming air is mixed with recirculated air and reconditioned for temperature and humidity
Method
Operation
Efficiency
Interception
Particles enter into the filter and become entrapped and attached to the filter fibers.
MEDIUM
Diffusion
Small particles, moving in erratic motion, collide with filter fibers and remain attached
​HIGH
Electrostatic
Particles bearing negative electrostatic charge are attracted to the filter with positively charged fibers
HIGH
 
1.High- efficiency filters – HEPA[1] filter bank – at least 99.97% efficient for removing particles less than 0.3 micron in diameter. Effectiveness of the HEPA will depend on – configuration of the room, furniture and person in the room, placements of the units relative to the contents and layout of the room and the location of supply and exhaust registers or grills.
 
  1. Ultraviolet Germicidal Irradiation (UVGI) [2]– Two types – duct irradiation (UV lamps are placed inside ducts that remove air from room to disinfect the air before it is recirculated; have little or no exposure of persons in the room) and Upper Air UGVI (a fixture with a series of parallel plates to columnize the irradiation outward while preventing the light from getting to the eyes of the room’s occupants)


[1] HEPA - type of pleated mechanical air filter. Acronym for "high efficiency particulate air [filter]”
 

[2] UVGI – effective in reducing the transmission of airborne bacterial and viral infections
​
 
  1. Laminar Air Flow for Ventilation – Designed to move air in a single pass, usually through a bank of HEPA filters – the unidirectional system optimizes airflow and minimizes air turbulence.
 
  1. Positive Pressurization – Pressure difference between two adjacent air spaces – OR and the corridor outside; Air flows away from positive pressure rooms – so that outside air cannot enter the OR. Some key engineering specifications to follow are –
 
  1. Pressure Differentials - > 2.5 Pascal (0.01” water gauge)
  2. Air Exchange per hour - 15
  3. Filtration Efficiency – Supply at 99.97% @ 0.3-micron DOP (dioctylpthalate particles); Return air – HEPA filtered
  4. Room Airflow direction – out to the adjacent area
  5. Clean to Dirty airflow in room – Away from the patient
  
Factors while choosing the Correct Medical Equipment -
 
A model of engagement of stakeholders, worth emulating consists of the following eight interconnected steps
 
  1. User Requirements – who will use them, application based with right accessories
  2. Innovation from Manufacturers – in product design
  3. Commitment to Quality – in all aspects – manufacturing, logistics, installation, service
  4. Feedback from Existing Users – performance, spare support, compliance
  5. Cybersecurity and Connectivity (other equipment, HIS) – threats and stability
  6. After Sales Support Commitment – Warranty, Contract, Uptime Guarantee
  7. Total Value of Ownership Approach – to the hospital
  8. Financial Stability – of manufacturer in executing multiple projects together
 
Careful analysis and understanding are required before any MOT project covering all above. Existing issues like sound proofing and acoustics (specially with material having high RT[1] time); project planning involving designer, fabricator, complex user requirements among other things need to be pondered as well.


[1] RT or Reverberation time - time required for the sound to “fade away” or decay in closed space.
About the Authorr :
Monojit Mitra, Facility Director, FV Hospital, Ho Chi Minh City, Vietnam

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