OPERATING THEATRES


with a design based around the rate of airflow being greater in the centre of the operating field – directly above the patient – and reduced around the perimeters. The system subsequently patented by Howorth made it less likely that patients would be exposed to infection, or that people moving into the operating area would disrupt the airflow.


Exflow and the screenless variant The Howorth Exflow UCV became a big seller for Howorth, and in 2013 it launched a new variant, the screenless Exflow Evolution UCV canopy. The screenless design addressed the need for more space in theatres, which, in becoming increasingly ‘hi-tech’, were beginning to incorporate not only ‘traditional’ equipment such as lighting, pendants, monitors, and surgeon’s control panels, but also a range of digital technology – for example to enable ‘live’ audio/video streaming of surgery to other locations. This growing trend called for greater equipment siting flexibility, and it was to address this that Howorth developed the Exflow Evolution. The ‘new’ UCV canopy utilised the basic construction of the existing two Exflow variants, Exflow 28 and 32, but ‘innovative engineering at the air discharge’ not only improved the canopy’s performance, but also eliminated the need for partial walls or additional low-level air recirculation ducts, remote fans, or cooling units.


Coanda design


Said to be ideal for both new-build and retrofit installations, and with its design meaning shorter installation times, the Evolution is based around patented Coanda active and passive systems – ‘unassisted or assisted air displacement devices designed to replicate the controlled airflow of a solid side screen’. Both the Evolution models, Exflow 28-12 and Exflow 32-12, reportedly ‘exceed the performance requirements of HTM 03-01 in many areas, particularly with regard to the non-entrainment test’. Given its early work with Professor Sir John Charnley, Howorth will perhaps always be best known as a pioneer of UCV theatre canopy design. Its current- day product portfolio, however, is much broader – ranging from UCV canopies, theatre lighting, pendants, and touchscreen theatre control panels, to vendor-neutral digital hardware and software supply and integration. The latter, increasingly important activity for it, enables, say, a surgical team, to integrate equipment from multiple suppliers in a theatre cost-effectively and easily, allowing surgeons to ‘cherry-pick’ the most suitable theatre ‘scopes’, and, for example, to select instruments from a range of suppliers confident that they will all operate seamlessly.


54 Health Estate Journal June 2018


The screenless design of the Exflow Evolution addressed the increasing need for more space in operating theatres.


Turnkey specialism


Howorth’s Group Sales director, Tom Ford, also highlighted how, over the past 20 years, the Bolton firm had established a reputation for its turnkey projects. These see it not only supply a full range of theatre equipment for both new-build operating theatre and ITU schemes, but also co-ordinate and manage all the construction and installation, fitting out, and commissioning elements, to deliver a fully functioning medical facility ready for clinical use.


In the Group Sales director role Tom Ford is responsible for sales management and co-developing and implementing sales strategy across all three Howorth Air Technology divisions – Healthcare, Life Sciences and Pharmaceutical Manufacturing, and Service/Aftermarket. It was predominantly to discuss the activities of the first – Healthcare – that we had arranged to talk. Beginning with a look back at how Howorth’s first ultraclean ventilation canopies emerged, he said: “In the 1950s and 1960s, while still supplying the textile industry, Howorth also provided ventilation and temperature / humidity control equipment to the brewing industry. “Indeed right from its inception the business has been all about controlled environments – controlling temperature, humidity, and airborne contaminants. In the early 1960s, aware of the work that Hugh Howorth had undertaken for the brewing industry,” Tom Ford continued, “Professor Sir John Charnley contacted him to see if he could help him address the problem he was having with surgical


site infections following some of his orthopaedic operations. Suspecting that the SSIs were due to airborne contamination in the theatre, the Professor asked Hugh Howorth to develop a solution, which he readily agreed to work with the surgeon to do.


Working in ‘a greenhouse’ “The first Exflow system, launched in 1962,” he continued, “was very much like a greenhouse, spanning from floor to ceiling, but was HEPA-filtered. Although effective at containing airborne contaminants, the air was recirculated within a very enclosed space, which meant the system provided little control over the temperature inside; consequently the surgeons tended to get very hot. The system’s development saw it evolve into a ceiling-mounted unit with recirculation fans and HEPA filters built in, with the design remaining quite similar through various upgrades until about 2005. The step-change then came in 2013, with the launch of the Exflow Evolution; we removed the side screens, but to generate the side protection introduced a Coanda air diffusion system. We discovered on testing and commissioning the Exflow Evolution that in fact it offered higher performance than the old screen canopies in respect of the very narrow air field generated above the patient.” He continued: “UCV canopies are measured on a number of key parameters – including airflows at 2 m and 1 m from the floor, and air entrainment to stop contaminated air coming back into the clean zone – using positive pressure.


©King’s College Hospital NHS Foundation Trust


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