The Government has approved one the most significant programmes of capital investment in healthcare facilities for decades, the New Hospitals Programme. Central to this investment is the drive to harness emerging hospital design, developments in medical technology, the digitisation of process, modern construction techniques and robust plans to achieve net zero carbon. Equipment plays a critical part in the delivery of patient care, the wider hospital and patient experience, and increasingly, a recognised importance in supporting Trust’s to effectively manage their buildings to support national ambitions to reach net zero.

The days of standalone medical equipment is quickly transitioning to an era of connected technology with a growing ambition for data collection, transmission, integration and storage. Modern medical devices are increasingly being developed to integrate with Electronic Patient Records or use middleware to generate alerts to be sent to smart phones and digital white boards to escalate responses to a patient in deteriorating condition.

Equipping for the future will require a stronger alliance between Medical Engineering and IT departments working in partnership with clinical teams to select new or replacement technology. Our equipment selection should fit with:
• The hospital digital strategy, in terms of network connectivity and interface with standardised Trust software such as EPR
• Local cyber security and information governance standards.
• Network and storage capacity within the planned digital infrastructure.
• Energy consumption and Net Zero
• The local strategic equipment replacement program

This presentation is unique in taking a complex agenda of how Leeds Teaching Hospitals NHS Trust starts to plan the delivery of the vision for digitised, sustainable modern healthcare facilities, but from an equipment lens which can often be an after-thought in hospital developments in an environment where there is a tendency to primarily focus on architecture and engineering and where there are pressures on capital budgets and value and cost reduction strategies have been applied.

It will explore the benefits of an equipment strategy, key procurement decisions and benefits of transferring existing equipment.

The use of ultra clean air operating theatres was pioneered in the UK by Professor Sir John Charnley during the development of total hip replacement. When conventional operating theatres were replaced with ultra clean theatres there were dramatic reductions in infection rates. Although much has changed in the subsequent 50 years the basic conclusion that prevention of infection is better than cure remains valid.

We have and taken detailed 3-D and anemometry measurements of airflow in an ultra clean theatre and, working with the Department of Chemical Engineering, University of Birmingham and other international collaborators we have produced an highly detailed Computational Fluid Dynamic model of one of the theatres at the Royal Orthopaedic Hospital, Birmingham. This model enables particle tracking experiments to be carried out, which have identified what best practice looks like in this type of theatre.

In the present environment reducing energy consumption and avoiding waste of materials is of vital importance, however changes in practice need to be supported by robust evidence that microbiological safety will be maintained. The human cost of infected joint replacements, the energy cost and financial costs will be discussed. The potential problems of replacing single use plastics with reusable items will be reviewed.

Methods of measuring infection rates in joint replacements using the National Joint Registry and the UKHSA infection surveillance systems are both valuable, but there are inconsistencies in their outcomes. In the UK and elsewhere it is not routine to test the microbiology of operating theatres whilst they are in use. This stands in sharp contrast to pharmaceutical production facilities where millions of microbiology plates are used every year to monitor the environment. This approach is now changing with pilot studies and an ongoing national audit, which are designed to produce quality improvements in this area.

Panellists for this session are:

Giles Hartley, Equipment Project Manager- Leeds Teaching Hospitals NHS Trust

Panellists in this session are:

Andrew Poplett, Chair- IHEEM Ventilation Technical Platform

Panellists in this session are:

Dr Nick Hill, IHEEM AE(W)12

Summary of Presentation by IHEEM Registered AE Ventilation – David Livingstone – Chartered Engineer and Fellow of IHEEM

Presentation Title: Critical Air Handling Units – Commissioning new and refurbished units – the role of the AE Ventilation and independent validators to ensure compliance

Healthcare providers are constantly replacing Air Handling Units or carrying out major refurbishments.

It is vital to the continued compliant operation of the air supply systems to ensure safety of patients, staff and visitors that the commissioning is planned and involves the Authorising Engineer Ventilation. It is also part of the standard that is followed for AHU commissioning – HTM03-01 Part A – that commissioning is witnessed by people independent of the contractors and tests are carried out by “Validation experts” – normally the same contractors who carry out annual verifications.

David will discuss commissioning using his experience of witnessing this is in a number of settings including:

1. Refurbishment of operating theatres in Royal Hallamshire – tower block building which underwent major refurbishment of a number of Theatres
2. New build of Aseptic suites at NHS Blood Transfusion HQ – Filton, Bristol
3. Refurbishment of theatres at Kings College Hospital
4. Refurbishment of theatres at Sheffield Northern General Hospital
5. Nightingale hospital at Excel Centre – London. Commissioning the field hospital built to absorb Covid-19 spillover from London hospitals

David has developed a commissioning matrix which he will explain and make available to attendees of this talk. He has used this system in a number of commissioning scenarios to great effect and the matrix has been highly praised by a number of his clients.

During 2023 the royal college of midwifes sent out a letter to all registered midwifery staff informing them of their employers duties to ensure that they are not exposed to Nitrous oxide levels above the safe limit. In short, we needed to look at how we upgrade our 1980's building infrastructure to ensure thee safety of our staff. The timeline for this started way back in 2017 when we took the decision to install the purair 750 made by MEC ltd. These were installed by a sub-contractor and maintained by the in house team. Rightly or wrongly the system was left in this way until 2023 when the letter from RCM landed and many trusts withdrew Entonox as a form of pain relief until systems were put into place. Our trust set up a incident management team that worked to ensure mitigations were in place to protect staff whilst in estates, we started to formulate a design to ensure that we did not put staff at risk. Within 7 days we had installed low level extract fans in each delivery room that had to be manually turned on when entonox was being used. This design has since progressed and now each extract fan is individually controlled by a nitrous oxide sensor situated at low level within the room. This activates the fan and brings in air from the corridor at high level down across the patient and out at low level. This has also increased the air change rates within all delivery rooms and achieved cross flow ventilation within the room, further protecting staff. The system also allows us to log via the BMS the nitrous oxide levels for all rooms and also alert midwifery team of any rooms where the levels become too high for use in that room to continue. Liaison with clinical teams has also enabled the delivery unit to switch to re-breather masks that when connected to the purair 750 collect much more of the exhaled gas.

The Patient Safety Operation Room of the Future at the New karolinska University Hospital

The First part - A New Patient Safety System in the OR of Future at Karolinska Ortopedic Department

Objective
The purpose of this system is to enable
- real time digitalized monitoring of air quality in the OR
- digitalizing manual critical routines and
- to develop an investigative tool assessing known risk factors for prosthetic joint infections (PJI).

Methods
The system includes one OR Ipad-checklist one real time Bio Aerosol Monitoring System, door opening logging devices, air climate indicators and a TV-screen on the wall in the OR showing air quality and alarms in real time. Parallel measurements between a traditional air sampler (Sartorius MD8, Sartorius AG, Germany) and the real time monitoring system (BAMS) were made in 15 live elective arthroplasty surgeries.

Results
Digital feedback in the OR and in the corridor had an immediate positive effect on the outcome of the routines. Real time values of Fluorescence Bio Particles (FBP) during elective arthroplasty surgery showed a high correlation with parallel traditional aerobic (CFU/m3) measurements. The R-value between mean values of FBP/50dm3 ≥3µm and CFU/m3 sampled during 15 operations was 0.85.

Discussion and Conclusion
Real time data feedback is important to create awareness and optimize patent safety.
This system has the potential to minimize complications, engage staff, give feedback, and create a learning culture for the entire staff. By serving as a real-time checklist, it has the potential to prevent complications in complex situations. It can also serve as a means for cognitive support.

Real time values of FBP during arthroplasty surgery can be used as a surrogate measure of air bacterial load. Together with the routines logged and visualized, the OR staff are made aware of and can improve routines and logistics. The results of this feasibility study indicate that this quality system has the potential to lower PJI and strengthen the OR staff´s knowledge over time.

The second part - New Nordic Guideline in OR Design
The New Karolinska and the Nordic Ortopedic Surgeon Teams and have changed their approach of how to Design new Operation rooms. Presentation of a new Guideline on Hospital Ventilation. This design guide provides guidance and solid basis for design as well as for verification of the technical performance of ventilation systems. It also gives guidance for the users to assess the realization of the critical indoor parameters
as well as life-cycle quality assurance of the systems performance. The guideline outlines basic requirements for proper design of ventilation systems for hospital applications. The guideline expresses what is perceived to be best practice in the field