OP E R ATING THEATR E S
be a fibre optic light cable connected to a light source, or cordless and battery operated with rechargeable devices, which provide greater flexibility and movement. Day surgery operating theatres should also meet the same space requirements as in-patient operating theatres to accommodate minimal invasive surgery (HBN 10-02, 2007) and must meet statutory requirements in relation to all facilities, services and lighting as identified in HBN 26 (2004).In minimally invasive surgery, the main lighting is often reduced to facilitate the viewing of the visual display screens. However, it is important to remember that fully operational ceiling mounted surgical lights are still required.
Operating microscopes are used in several specialties to provide versatility and new dimensions of treatment to microsurgical techniques in specialties such as neurosurgery and ENT – significantly enhancing technical performance and patient outcomes. They can be ceiling mounted, such as in ophthalmic theatres, or free standing – depending on the departmental needs. Portable microscopes provide greater flexibility within theatre suites when maintenance is required. The light omitted from a microscope assists the surgeon to focus on the operating field, by magnifying structures such as nerves and blood vessels not normally seen. They can also video record the procedure for teaching and legal issues. It is important to remember that microscopes – due to the varying intensities, spot size and working distances – can irradiate heat that has been known to cause significant burns and damage to tissue. Light related interruptions and adjustments in the operating theatre have been shown to cause a significant distraction during surgical procedures, having quantifiable outcomes on surgical performance and patient safety. In a study identified by Curlin & Herman (2020),
on average, a light adjustment occurred every 7.5 minutes causing the surgeon in 97% of cases to pause and stop what they were doing. This highlights the risks and identifies an opportunity to significantly minimise equipment related distractions, thereby enhancing patient safety and quality outcomes.
Conclusion
Surgical light technology has advanced, producing several forms of LED lighting, containing multiple lamps that can either be white or a combination of white and multi- coloured lamps. These can be adjusted by the surgeon to produce the desired outcome. These should always be supplied as a ‘main’ and ‘satellite’ pair, as it is the combination of the two which reduces shadow from the surgical site.
When using a combination of light sources, this offers greater flexibility across all specialties when taking into consideration the features of the light and function required. Heat production from all forms of surgical lighting needs to be analysed. However, LED lights do not produce heat – creating a more comfortable working environment, potentially improving surgical team performance, efficiency and patient outcomes.
References 1 Barach,
P.Rostenberg,B 2015 Design of Cardiac Surgery Operating Rooms and the Impact of the Built Environment
https://www.researchgate.net/ publication/271377065 [Accessed August 2020]
2 Jahnavi Curlin, AB. Charles K. Herman, MD, MBA.2015 Current State of Surgical
Lighting.Thieme Medical Publishers, Inc., 333 Seventh Avenue. [Accessed August 2020]
3 HBN 26: Facilities for surgical procedures in acute general hospitals. Department of Health 2004.
https://www.gov.uk/government/publications/ facilities-guidance-for-surgical-procedures-in-
acute-general-hospitals [Accessed August 2020].
4 HBN 10-02: Facilities for day surgery units. Department of Health 2007.
https://www.gov.uk/ government/publications/day-surgery-facilities- buildings-guidance [Accessed August 2020]
5 HBN 01-01: Cardiac facilities. Department of Health 2013.
https://www.gov.uk/government/publications/ guidance-for-design-and-planning-of-cardiac- facilities [Accessed August 2020]
6 Health Building Note 26 – Facilities for surgical procedures. HBN NHS Estates 26 Vol 1 ISBN: 0113224958 (October 2004). NB The DH discontinued this resource in 2012
7 Takeshi Ide, MD, PhD.Yoshitaka Kinugawa, BS. Yuichi Nobae, BA. Toshihiro Suzuki.Yoshiyuki Tanaka, BS. Ikuko Toda, MD, PhD.Kazuo Tsubota, MD, PhD. 2015 LED Light Characteristics for Surgical Shadowless Lamps and Surgical Loupes
www.PRSGlobalOpen. com [Accessed August 2020]
8 WHO 2012
http://www.who.int/medical_devices [Accessed August 2020]
CSJ
Lindsay Keeley
Lindsay Keeley, RGN, BSc (Hons) has a degree in professional nursing studies, and is currently the patient safety and quality lead for the Association of Perioperative Practice (AfPP). Lindsay is part of the AfPP HQ team, supporting members with guidance on best practice and professional advice, particularly around patient safety and quality. As part of her role, she holds an honorary contract working in practice at Harrogate District Hospital. Previous AfPP roles include Northern & Yorkshire team leader, ophthalmic sig lead, link member and member of the governance committee. Lindsay was also RCN learning representative and chair of the RCN West Yorkshire Branch. Lindsay’s previous job was team leader/surgical first assistant with extended skills and practice educator for theatres at Spire Hospital, Leeds. A registered nurse with over 30 years’ experience, she has spent most of her career in perioperative practice, across both the NHS and independent sector working in several specialties, including ENT and Ophthalmics.
OCTOBER 2020
WWW.CLINICALSERVICESJOURNAL.COM l 21
©Brandon Medical
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24 |
Page 25 |
Page 26 |
Page 27 |
Page 28 |
Page 29 |
Page 30 |
Page 31 |
Page 32 |
Page 33 |
Page 34 |
Page 35 |
Page 36 |
Page 37 |
Page 38 |
Page 39 |
Page 40 |
Page 41 |
Page 42 |
Page 43 |
Page 44 |
Page 45 |
Page 46 |
Page 47 |
Page 48 |
Page 49 |
Page 50 |
Page 51 |
Page 52 |
Page 53 |
Page 54 |
Page 55 |
Page 56 |
Page 57 |
Page 58 |
Page 59 |
Page 60 |
Page 61 |
Page 62 |
Page 63 |
Page 64 |
Page 65 |
Page 66 |
Page 67 |
Page 68 |
Page 69 |
Page 70 |
Page 71 |
Page 72 |
Page 73 |
Page 74 |
Page 75 |
Page 76 |
Page 77 |
Page 78 |
Page 79 |
Page 80 |
Page 81 |
Page 82 |
Page 83 |
Page 84 |
Page 85 |
Page 86 |
Page 87 |
Page 88 |
Page 89 |
Page 90 |
Page 91 |
Page 92
