DIN 1946-4 Folie 2 / 73 Brunner Haustechnik Brunner Haustechnik Brunner Haustechnik AG, CH AG, CH AG, CH - - - 8304 Wallisellen 8304 Wallisellen 8304 Wallisellen - - - Z Z Z ü ü ü rich rich rich TESKON 2009 - TMMOB Makina Mühendisleri Odası Đzmir Current hospital guidelines in Current hospital guidelines in Current hospital guidelines in Current hospital guidelines in Germany and in Switzerland Germany and in Switzerland Germany and in Switzerland Germany and in Switzerland DIN 1946-4: Ventilation and air conditioning; Ventilation in hospitals SWKI 99-3: Heating, ventilation and air-conditioning in hospitals DIN 1946-4 Folie 2 / 81 TESKON 2009 - TMMOB Makina Mühendisleri Odası Đzmir
82
Embed
Current hospital guidelines in Germany and in Switzerland · DIN 1946-4 Folie 3/ 73 Brunner HaustechnikBrunner Haustechnik AG, CHAG, CH--8304 Wallisellen8304 Wallisellen--ZZüürichrich
This document is posted to help you gain knowledge. Please leave a comment to let me know what you think about it! Share it to your friends and learn new things together.
Carl Caspar von Siebold (1769–1807)During Siebolds aegis occurred the reconfiguration of the Theatrumanatomicum (1788) and an extension of the capacity of the Juliusspital (1799) in which 1805 the first modern operating room of the world was setup.
TESKON 2009 - TMMOB Makina Mühendisleri Odası Đzmir
Inspiration Inspiration Inspiration Inspiration throughthroughthroughthrough Sir J. Sir J. Sir J. Sir J. CharnleyCharnleyCharnleyCharnley 1968196819681968
TESKON 2009 - TMMOB Makina Mühendisleri Odası Đzmir
Swiss Guideline for the design, construction, Swiss Guideline for the design, construction, Swiss Guideline for the design, construction, Swiss Guideline for the design, construction, operation and monitoring of ventilation operation and monitoring of ventilation operation and monitoring of ventilation operation and monitoring of ventilation and and and and airconditioningairconditioningairconditioningairconditioning systems in hospitalssystems in hospitalssystems in hospitalssystems in hospitals
TESKON 2009 - TMMOB Makina Mühendisleri Odası Đzmir
Development of the standard OPDevelopment of the standard OPDevelopment of the standard OPDevelopment of the standard OP----Room: Room: Room: Room: "small" ULF with 2000 "small" ULF with 2000 "small" ULF with 2000 "small" ULF with 2000 ---- 3000 m3000 m3000 m3000 m3333/h /h /h /h
TESKON 2009 - TMMOB Makina Mühendisleri Odası Đzmir
Revision of the Swiss Revision of the Swiss Revision of the Swiss Revision of the Swiss hospital hospital hospital hospital guideline guideline guideline guideline
� Start January 22nd, 1997� Target: End in 1998� essential Hospital-organisations participate
� Hospital hygiene� Technical and maintenance service� Building services engineering
� 1st draft with official consultation January 2001� final draft December 2002 (2nd official consultation)
TESKON 2009 - TMMOB Makina Mühendisleri Odası Đzmir
ComparisonComparisonComparisonComparison of of of of costscostscostscosts, , , , findingsfindingsfindingsfindings� By decreasing the outdoor air flow to 1000 m³/h and by
increasing the circulating air flow to 3.000 m³/h (OR-supplyair flow: 4000 m³/h) energy costs are virtually unaltered.
� Electricity costs are even lower at a circulating air flow of 7000 m³/h than in the case of DIN with an outdoor air flow of 2800 m³/h.
� Electricity costs only amount for approx. 5 – 8 % of the annualcosts for the air-conditioning of operating rooms.
� With optimisation of the ULF/circulating air concepts, annual costsmay even be further reduced compared to the DIN cases (seeDGKH-OPT-case).
TESKON 2009 - TMMOB Makina Mühendisleri Odası Đzmir
RKI requirements for surgeryRKI requirements for surgeryRKI requirements for surgeryRKI requirements for surgery
� Unidirectional airflow ventilation is essential for aseptic interventions with high risk of infection.
� The size of the ceiling panel has to conform to the type of surgical intervention. As a rule, the operating table and the instrument tables shall be protected.
� A room class I (DIN1946-4) shall be installed only in the operating room.
TESKON 2009 - TMMOB Makina Mühendisleri Odası Đzmir
Conventions of theConventions of theConventions of theConventions of the German Society German Society German Society German Society forforforforHospital Hygiene (et all.) Hospital Hygiene (et all.) Hospital Hygiene (et all.) Hospital Hygiene (et all.)
� Protection range with a size of 2.8 x 2.8 m required (containing OP and instrument tables)
� unidirectional airflow� Total size: 3.2 x 3.2 m with aprons 5 - 50 cm� Filter class H 14� degree of primary turbulence < 5%� corridors for sterile goods supply shall be
TESKON 2009 - TMMOB Makina Mühendisleri Odası Đzmir
Scope of Scope of Scope of Scope of DIN 1946DIN 1946DIN 1946DIN 1946----4444
- hospitals buildings- day hospitals- physician’s practices with intervention rooms- outpatient surgery centres / facilities / ambulatories- dialysis centres- facilities for internal and external (service) units for
the processing of medical devices / sterilization areas
TESKON 2009 - TMMOB Makina Mühendisleri Odası Đzmir
Guide Guide Guide Guide forforforfor planningplanningplanningplanning, , , , constructionconstructionconstructionconstruction and and and and operationoperationoperationoperation
Operation optimisation of existing operating systems6. Re-qualification
Personnel training, to supplement and complete thesystem documentation, maintenance management, disposal of consumables, short microbiological tests
5. Operation
To apply the performance specifications, systemqualification, documentation, to conclude theimplementation phase
4. Implementation
To implement the performance specifications in theplanning department, to conclude the planning phase
3. Planning
Performance specifications, to conclude the phase of establishing the objectives
2. Project aims
To determine the current situation, establish the basics, and declare the aims
� Prepared by the orderer / customer in cooperation with experts
� The target definition phase will be concluded when the performance specification of the project is approved by all parties involved in target definition.
system, IT equipment etc.)� Maintenance staff (technical service, external maintenance
service, energy suppliers, etc.)� Planner (architects, building services engineering, ...)� Consultant (organizational and financial consultants, ...)� Further parties involved in the project
TESKON 2009 - TMMOB Makina Mühendisleri Odası Đzmir
Air Air Air Air hygienehygienehygienehygiene in oin oin oin operating roomsperating roomsperating roomsperating rooms
Operating rooms are distinguished into:
� Operating rooms with ventilation systems of unilateral flow (ULF) for attaining a protected areain which the operation takes place and where theinstruments tables are positioned (roomroomroomroom classclassclassclass 1A1A1A1A);
� Operating rooms with ventilation systems of mixedor turbulent displacement flow (roomroomroomroom classclassclassclass 1B1B1B1B).
TESKON 2009 - TMMOB Makina Mühendisleri Odası Đzmir
BBBBasic requirements on ventilation and airasic requirements on ventilation and airasic requirements on ventilation and airasic requirements on ventilation and air––––conditioning in operating rooms class conditioning in operating rooms class conditioning in operating rooms class conditioning in operating rooms class 1B1B1B1B
� Sound pressure level at a nominal air flow rate of max. 48 dB(A)
� Supply air temperature 19-26°C (adjustable)� Measurement of comfort (though not defined)� Testing of the recovery time (recovery test)
according to DIN EN ISO 14644-3� Reduction of the particle concentration
TESKON 2009 - TMMOB Makina Mühendisleri Odası Đzmir
BBBBasicasicasicasic requirements onrequirements onrequirements onrequirements on ULF air diffusersULF air diffusersULF air diffusersULF air diffusersin in in in operatingoperatingoperatingoperating roomsroomsroomsrooms classclassclassclass 1A1A1A1A
� supply air velocity = 0,23 to 0,25 m/s� minimum local supply air velocity = 0,15 m/s� sound pressure level at a nominal air flow rate
of max. 48 dB(A)� supply air temperature 19 - 26°C (adjustable)� local deviation from Tmean: 0,3 K� measurement of comfort (though not defined)
TESKON 2009 - TMMOB Makina Mühendisleri Odası Đzmir
Integral OP acceptance tests (qualification) Integral OP acceptance tests (qualification) Integral OP acceptance tests (qualification) Integral OP acceptance tests (qualification)
Two Two Two Two acceptance testsacceptance testsacceptance testsacceptance tests::::
Technical acceptance testTechnical acceptance testTechnical acceptance testTechnical acceptance testperformance parameter of the HVAC system
Hygienic acceptance testHygienic acceptance testHygienic acceptance testHygienic acceptance testsufficient protective effect against load entry from outside
sufficient protective effect against load entry from inside
Two Two Two Two acceptance testsacceptance testsacceptance testsacceptance tests::::
Technical acceptance testTechnical acceptance testTechnical acceptance testTechnical acceptance testperformance parameter of the HVAC system
Two Two Two Two acceptance testsacceptance testsacceptance testsacceptance tests::::
TESKON 2009 - TMMOB Makina Mühendisleri Odası Đzmir
� measured values:measured values:measured values:measured values: particle concentration cx at a hygienically relevant measuring point X in the area to be protected
� definition
� example: cx = 950 P/ft³: SGX = 3,0
Local Local Local Local protection class protection class protection class protection class SGxSGxSGxSGx
TESKON 2009 - TMMOB Makina Mühendisleri Odası Đzmir
Result: Protection effect of the OPResult: Protection effect of the OPResult: Protection effect of the OPResult: Protection effect of the OP----Room Room Room Room
� The smallest numerical value of the local protection classes is used to characterise the actual protective effect of the operating room
� Usual range of values: SG = 1 ... 5
� The result integrates all influences of the clean air diffuser (ULF), medical devices and anaestheticequipment, i.e. heat-load, convection, turbulences,...
TESKON 2009 - TMMOB Makina Mühendisleri Odası Đzmir
Interpretation of the protection classes Interpretation of the protection classes Interpretation of the protection classes Interpretation of the protection classes
poor1’000’0000
insufficient100’0001
sufficient10’0002
Good1’0003
outstanding1004
excellent105
Classificationmean particle concen-tration at measuring point X [P/ft3]
TESKON 2009 - TMMOB Makina Mühendisleri Odası Đzmir
Acceptance test (turbulence intensity) Acceptance test (turbulence intensity) Acceptance test (turbulence intensity) Acceptance test (turbulence intensity)
Figure D.2: 17 test positions in the measuring grid
projected onto the floor below the ULF outlet
These examinations shall be carried out in the form of averaged double determinations above the test positions (n = 17 in accordance with Figure D.2 projected onto the floor below the LTF outlet ) marked by black, orange and white self-adhesive dots.
TESKON 2009 - TMMOB Makina Mühendisleri Odası Đzmir
MicrobiologicalMicrobiologicalMicrobiologicalMicrobiological teststeststeststests in in in in thethethethe operatingoperatingoperatingoperating roomroomroomroom
� The decision on the need for microbiological / hygienic checks during operation is made by the hospital-hygiene expert in charge.
� Requirements (Example sedimentation plates):room class Ia: mean value of the specific colony forming units: ≤ 1 CFU / (50 cm2 • 60 min);
� room class Ib: mean value of the specific colony forming units : ≤ 5 CFU / (50 cm2 • 60 min).
� Airborne-germ counts in the empty operating room are not required in any case.
TESKON 2009 - TMMOB Makina Mühendisleri Odası Đzmir
� The target is a European guideline
� The first steps for the CEN guideline are made: RESOLUTION taken by CEN/TC 156 Ventilation for buildings, agrees to create the following Working Group:CEN/TC 156; WG 13 CEN/TC 156; WG 13 CEN/TC 156; WG 13 CEN/TC 156; WG 13 –––– Ventilation in HospitalsVentilation in HospitalsVentilation in HospitalsVentilation in Hospitals
� Research and development in the laboratory operating room at the HTA School of Engineering + Architecture in Lucerne
Summary and lookSummary and lookSummary and lookSummary and look----out IIout IIout IIout II
TESKON 2009 - TMMOB Makina Mühendisleri Odası Đzmir
Conclusion on hospital hygieneConclusion on hospital hygieneConclusion on hospital hygieneConclusion on hospital hygiene
� Applies to all operating theatres:Applies to all operating theatres:Applies to all operating theatres:Applies to all operating theatres:
Without a catalogue of flanking measures Without a catalogue of flanking measures Without a catalogue of flanking measures Without a catalogue of flanking measures and the application of due operational and the application of due operational and the application of due operational and the application of due operational discipline the best clean air technology discipline the best clean air technology discipline the best clean air technology discipline the best clean air technology can only be seen as an 'alibi exercise'. can only be seen as an 'alibi exercise'. can only be seen as an 'alibi exercise'. can only be seen as an 'alibi exercise'.
TESKON 2009 - TMMOB Makina Mühendisleri Odası Đzmir
HygieneHygieneHygieneHygiene ClassificationClassificationClassificationClassification of rooms of rooms of rooms of rooms based on the risk of infectionbased on the risk of infectionbased on the risk of infectionbased on the risk of infection
� General consideration
� Operating rooms and other rooms for surgical interventions
� Other rooms with increased hygienic-requirements
TESKON 2009 - TMMOB Makina Mühendisleri Odası Đzmir
Operating rooms and other rooms for Operating rooms and other rooms for Operating rooms and other rooms for Operating rooms and other rooms for surgical interventionssurgical interventionssurgical interventionssurgical interventions
� Outdoorair flow volume of 800 to 1000 m3/h
� for outdoorair three-stage filtering is required� work checked terminal H13-filters
� The danger of transmitting unidentified pathogen makes it necessary to provide efficiently ventilated waiting rooms (exhaust-air rate in excess of 75 m3/(h·P).
� Separate waiting rooms must be available for patients undergoing immunological suppression
TESKON 2009 - TMMOB Makina Mühendisleri Odası Đzmir
Basic requirements for rooms with Basic requirements for rooms with Basic requirements for rooms with Basic requirements for rooms with increased hygienic demandsincreased hygienic demandsincreased hygienic demandsincreased hygienic demands
TESKON 2009 - TMMOB Makina Mühendisleri Odası Đzmir
Rooms with increased Rooms with increased Rooms with increased Rooms with increased hyghyghyghyg....----requirementsrequirementsrequirementsrequirements
� Sterile-goods storage / sterile corridor
� Angiographie, heart catheter laboratory, surgical Angiographie where minor interventions serve to implant foreign material