WO2003064792A1

WO2003064792A1 - Novel surgical unit structure

Info

Publication number: WO2003064792A1
Application number: PCT/FR2003/000144
Authority: WO
Inventors: Jean-François RAYNAUD
Original assignee: Acentino S.A.
Priority date: 2002-02-01
Filing date: 2003-01-17
Publication date: 2003-08-07
Also published as: FR2835555A1

Abstract

The invention relates to a surgical unit structure which is characterised in that it comprises at least two operating theatres (2, 3) which are separated by a sterilising room (4). Said sterilising room communicates with each of the operating theatres solely by means of openings (14, 15, 16, 17) that are intended exclusively for the passage of non-disposable surgical instruments which can be resterilised.

Description

NEW SURGICAL UNIT STRUCTURE

The invention relates to a new chirargical unit structure.

In the following description, the surgical unit which is the subject of the invention is more particularly described in its application to ambulatory surgery. However, this use is in no way limiting since the structure of the invention can also be implemented within "traditional" hospitalization units, that is to say units in which the duration d hospitalization is more than 24 hours.

The existing hospital units have structures that no longer meet the functional requirements of modern surgery. The improvement of operative techniques, the reduction of hospital costs, the progress of local anesthesia as well as the evolution of mentalities of the patients mean that ambulatory surgery is today in full expansion. Ambulatory surgery can only be considered in the case of surgical procedures of a relatively short duration requiring so-called "day" hospitalization. More precisely, this expression designates a hospitalization carried out during working hours and the postoperative risk of which does not require keeping the patient beyond a few hours only. Surgical procedures that meet these criteria fall in particular in ophthalmological surgery, and correspond in particular to cataract operations but also arthroscopic, aesthetic, ENT surgery, without this list being exhaustive.

In the particular case of cataract surgery, global studies conducted by WHO have shown that in the next twenty years, more than a fifth of the population will necessarily have to undergo a cataract operation. cataract, which in keeping of affected population, corresponds to nearly a billion people to operate. If we take the case of France, which currently has about sixty million inhabitants, it will be necessary to operate twelve million people, or therefore about 600,000 individuals per year. At present, only around 300,000 operations are carried out on French territory, with long waiting lists and a take-over time of more than six months.

It therefore appears clearly that the existing hospital structures are not adapted not only in number but also in terms of functionality, to meet this demand, mainly for the following reasons.

First of all, ^' all the operating theaters, still designated "operating theaters" present in the current hospital structures have a generalist vocation so that one finds in the same block, both equipment used for ophthalmic surgery, as for artliroscopic surgery or thoracic surgery, etc. Given the large quantity of equipment, the various instruments are positioned both on the ceiling and at ground level, singularly hampering the passage and thus encumbering the effectiveness of the nursing staff. In addition, the majority of operating rooms have a central operating table, fixed, bulky and impractical.

The number of operations performed daily is also limited due to the considerable distance separating, most of the time, the anesthesia and recovery rooms from the operating theater itself. Indeed, the transfer of the patient from one room to another requires a minimum time which, accumulated, represents several tens of minutes at the end of the day. In addition, it imperatively requires the mobilization of a stretcher bearer, the presence of which is not without eliminating any risk, in particular of the patient falling from the stretcher. Finally, from these multiple manipulations, it results in congestion in the corridors access by all of the carts, which is not without impact on the safety of both the patient and the nursing staff.

Safety is even more jeopardized when it is noted that the sterilization rooms, in which sterile non-consumable surgical material is sterilized, are also located at a considerable distance from the operating theaters. In fact, this distance leads first of all to a considerable loss of time at the end of the intervention to transport the dirty instruments to be sterilized. Then, the transfer of contaminated instruments to the sterilization room through corridors, accessible without restriction, poses a significant risk of infections and in particular nosocomial infections for the entire hospital or the clinical.

In addition, all the clinical structures are provided with a phamiacie room intended to group together not only all of the drugs necessary for surgical procedures, and in particular, anesthetic products, but also all of the consumables (operating fields, gloves, implants, surgical packs ...).

Most of the time, however, the pharmacy is distant, both from operating theaters and anesthesia rooms, and requires incessant round trips to supply the latter with drugs and equipment.

All these arrangements and the resulting manipulations mean that even under optimized operating conditions, current hospital structures cannot allow more than one operation every 45 minutes. It follows that even for short surgical procedures, of the order of twenty minutes, one cannot hope to perform more than 4 to 5 operations per half-day. In addition, because of this particularly cumbersome organization, medical personnel cannot work at 100% of their capacities. Furthermore, this malfunction is at the origin of a real financial loss as long as the clinic or hospital only for the surgeon himself insofar as the hourly cost of an operating room is fixed and unchanging, whether one, two or three operations are performed per hour.

The problem which the invention proposes to solve is therefore to develop an optimized structure which allows to significantly increase the number of daily surgical procedures while maintaining optimum safety and a reduced number of operators.

To do this, the Applicant has developed a new type of structure which is that of a surgical imitation arranged so as to rationalize and secure the operation of an operating theater.

More specifically, the subject of the invention is a structure of surgical imitation which is characterized in that it comprises at least two operating rooms each separated by a sterilization room, said sterilization room commimicating with each of the operating rooms only by the through openings intended for the exclusive passage of non-disposable chirargical instruments that can be re-sterilized.

In the description and in the claims, by the expression:

- "reusable non-disposable surgical instruments", denotes all of the material necessary for the surgeon to perform a specific determined surgical act, - "operating room", denotes the room in which the patient is operated,

- "permanent equipment" means all the bulky equipment permanently remaining in the operating room, namely in particular, microscope, respirator, arthroscopy columns,

- "consumable material" means useful drugs, anesthetics and all disposable material such as gloves, gowns, surgical drapes, compresses ... In other outfits, the invention proposes a structure in which no door communicates between the two operating rooms and the sterilization room thus preventing any passage of an individual from one room to another and limiting this fact, the risks of contamination. In addition, the direct proximity to the sterilization room saves considerable time for nursing staff and optimizes the effectiveness of surgical procedures.

According to an advantageous embodiment, each operating room is separated from the sterilization room by two openings respectively, a first opening intended for the passage of sterilized non-disposable surgical instruments, a second opening intended for the passage of non-disposable surgical instruments to be sterilized.

This dual circulation system has the advantage of limiting the risk of septic accidents due to possible accidental contact between sterilized instruments and contaminated instruments. In addition, movements in the operating room with contaminated material are reduced to their strict minimum.

In practice, said openings are equipped with a shelf intended to support the non-disposable surgical instruments on standby. Of course, any other equivalent means can be envisaged.

The structures of the operating and sterilization rooms will now be described in more detail.

According to a first characteristic of the invention, the operating room has a ceiling at which is arranged all of the permanent equipment necessary for the execution of the surgical act. An arrangement of this type thus makes it possible to avoid any congestion of the floor and therefore an easy and pleasant circulation in the room. Advantageously, the operating room is devoid of a fixed operating table, the patient being operated directly on his transfer trolley of the type for example

"Striker". Such a configuration makes it possible to have an operating room having no element on the ground, so that cleaning, as easy as it is rapid, can be carried out between each intervention.

Furthermore, the choice of permanent equipment will vary depending on the nature of the surgery performed to the extent that the surgical units developed by the Applicant are assumed to have a specific vocation and not a generalist vocation, as is the case for current structures. As a result, the number of instruments is reduced and limited depending on the surgery performed.

Each operating room can therefore be equipped according to the specialty of the surgeon involved. However, and always for the sake of optimization, it is advantageous for two operating rooms, communicating with the same sterilization room, to be equipped with the same equipment. A first advantage is that the same surgeon has the possibility of operating a first patient in the first operating room, then, after the first intervention, operating a second patient in the second room for that the first room is cleaned and so on. A second advantage is to concentrate in the sterilization room a common surgical material, without risk of confusion.

Whatever the specificity of the operating room, each room is equipped with a ceiling having a micro-perforated structure allowing the passage of air pressure previously filtered in a downward flow. The operating room thus contains constantly renewed filtered air, the air escaping outside at the bottom of the walls through specific outlets. In an advantageous embodiment, the operating room is equipped, at one of the partitions, with a screen connected to a computer system making it possible to view all of the characteristics of each of the patients and capable of managing the monitoring of intervention.

Of course, each operating room is provided with at least one door opening onto a peripheral access corridor.

In another embodiment, each room includes two doors opening onto a peripheral access corridor, one of which is reserved for emergency exits or entrances to the block.

Regarding the sterilization room, it is equipped with a means of sterilizing non-disposable material, in practice - an autoclave, material well known to those skilled in the art. As in the operating rooms, the sterilization room is provided with at least one door opening onto a peripheral access corridor.

To resolve all of the problems linked to the transfer of the patient between the anesthesia and recovery room and the operating room, the surgical unit of the invention further comprises two anesthesia and recovery rooms, each room communicating with a corresponding operating room through an opening for the passage of the patient.

In addition to this first opening, each anesthesia room also has a second opening opening onto a peripheral corridor and intended for the entry of the patient, making it possible to avoid any passage through the operating room, and therefore additional manipulations.

In this advantageous configuration, the patient enters directly into the anesthesia room then exits through the operating room once the intervention tenninée. He then returns to the anesthesia room which has become the recovery room via the peripheral corridor.

Each anesthesia room includes two zones, respectively a first zone intended for the anesthesia of a first patient, a second zone intended for the awakening of this same patient, once the surgical intervention carried out and so on. The presence of two zones or boxes in each anesthesia room therefore allows the surgeon to operate "continuously" insofar as he has a patient ready for the surgery on a permanent basis. profession, each anesthesia and wake-up zone is equipped with at least one ECG and blood pressure screen. Each of them is furthermore fitted with wall holders for oxygen, vacuum and compressed air. In addition, there is a general anesthesia machine on standby, as well as a wall-mounted defibrillator, in permanent standby.

As for the operating room, no arrangement is provided at ground level, the patient being anesthetized and awakened on the same stretcher as the one to which he was transferred from his room.

To overcome problems related to the remoteness of the pharmacy, such as those mentioned above, the surgical unit of the invention further comprises i local pharmacy interposed between the two anesthesia and recovery rooms and the sterilization and communicating with them by means of doors.

In an advantageous embodiment, the local pharmacy also communicates with each of the two operating rooms by means of at least one opening intended exclusively for the passage of "consumable material". As before, an opening of this type is advantageously equipped with a shelf intended to support the waiting material. The phamiacie room is in practice accessible by the wake-up anesthesia rooms or by the sterilization room. Consequently, the direct proximity of the operating theater to phannacia is a guarantee of security, since all the medicinal substances are available on site. In another embodiment, the pharmacy room is provided with a fourth direct access opening from a peripheral corridor.

In an advantageous embodiment, the surgical unit of the invention therefore comprises two operating rooms, a sterilization room, two anesthesia / awakening rooms, a phannacia communicating with each other according to the detailed diagram above.

In another embodiment, the surgical unit comprises two operating rooms and an additional sterilization room arranged opposite the two revival anesthesia rooms and the phannacie room, respectively. In this configuration, the operating theaters are separated two by two by a sterilization room.

The invention and the advantages which result therefrom will emerge more clearly from the following exemplary embodiments in support of the appended figures.

Figure 1 is a schematic representation of the surgical unit of the invention comprising two operating rooms.

Figure 2 is a schematic representation of the surgical unit of the invention comprising four operating rooms.

As shown in Figure 1, the improved surgical unit (1) of the invention has a substantially rectangular surface divided into six compartments, respectively two operating rooms (2, 3), a room ^{sterilization} (4) two anesthesia / recovery rooms (5, 6) and finally a phamiacie room (7). In addition, the anesthesia / recovery rooms are equipped with two zones (not shown), respectively one for anesthesia, one for awakening the patient, each zone being equipped with usual equipment as described above.

All of the anesthesia rooms, operating rooms and the sterilization room open via doors (8, 8 ', 9, 9', 10, 11, and 12) onto a peripheral corridor (13 ) access to the rooms and generally to the rest of the hospital. The doors (8 'and 9') can be used exclusively as emergency doors.

According to a first characteristic of the invention, the sterilization room (4) separates the two operating rooms (2 and 3), each operating room communicating with the sterilization room by means of openings (14, 15 , 16, and 17) respectively ensuring the passage of non-disposable sterilized surgical instruments in the operating rooms or contaminated from the operating rooms. These openings are in practice equipped with a shelf (not shown) on which the material to be recovered is placed on either side. To sterilize the equipment, the sterilization room is equipped with an autoclave.

As shown in Figure 1, and in accordance with one of the many advantages of the invention, no opening allowing the passage of an individual is provided between the sterilization room and the two operating rooms, so that the risk contamination is almost nonexistent. Although not shown, each operating room is equipped with a micro-perforated ceiling allowing an outlet of filtered air under overpressure and causing a downward flow above the operating field. As already said, this device makes it possible to constantly maintain filtered air in the operating room, the air being sucked in at ground level by specific vents only when the doors, between corridor and block and sterilization and block, are open. Due to the overpressure, the ambient air in the operating room can never be contaminated and the movement of the knees is always in one direction leaving the operating room. Likewise, each operating room is equipped with usual permanent surgical equipment and defined according to the surgery performed (ophthalmic, arthroscopic, etc.). Each device is positioned on the ceiling by means of an adjustable telescopic arm.

Furthermore and according to another characteristic, the operating room includes, incorporated directly into a partition, an infoimatic system making it possible to manage the monitoring of each patient from his arrival at the hospital until his discharge and comprising in particular the details of the conditions of the chinirgical intervention and the complete medical file.

Each anesthesia / recovery room (5, 6) communicates with the corresponding operating room via a door (18, 19) ensuring rapid and secure transfer from the patient to the operating room.

The chinirgical unit of the invention is furthermore equipped with a pharmacy (7) communicating with the two anesthesia / wake-up rooms by means of doors (20, 21) and with the sterilization room by means of a door (22).

According to another characteristic, the pharmacy coimnunique with the operating rooms (2, 3) by means of two openings (23, 24) intended only for the transfer of the consumable surgical material and the drugs, and in particular anesthetics.

Such a structure makes it possible to considerably increase the number of surgical procedures performed daily, with optimum security. Indeed and in practice, for relatively rapid surgical acts, such as for example a cataract operation, which requires a maximum of twenty minutes, such a structure can accommodate a single Chinirgian or two surgeons according to the following process. Two patients are taken from their room to the anesthesia rooms (5 and 6) on a "striker" type cart from where they will not move until they return to their room, each patient entering said room by the doors (11 and 12). Once asleep, patients are directly transferred to the operating rooms through the doors (18 and 19). During the intervention, two other patients were taken to the anesthesia room under the same conditions. Once the first two operated patients, who should be remembered, are kept on the same cart, they are transferred to the recovery room by the corridor (13) from the doors (8 'and 9') to the doors ( 11, 12). After each operation, the operating room floor is systematically cleaned and then dried. These operations are very fast since nothing is arranged at ground level. Compliance with such a procedure theoretically allows 8 cataracts to be operated per room per half-day, or 16 patients in a half-day, instead of the 4 or 5 patients operated on in current structures.

In FIG. 2, an improved embodiment has been shown in which the surgical unit of the invention comprises 2 operating theaters and a complementary sterilization room. In this case, the two complementary operating rooms (25, 26), open directly through doors (27, 28) on the two anesthesia rooms (5, 6) communicating (18, 19) already with the first two operating theaters (2, 3). Likewise, the pharmacy communicates not only with the first sterilization room (4), but also with the second sterilization room (27) by means of a door (29).

Of course, such a structure can be duplicated several times depending on the surface to be occupied.

The invention and the advantages which ensue from it emerge clearly from the above description. Note in particular the original layout of the operating rooms, sterilization, anesthesia, pharmacy between them, allowing to optimize the number of surgical procedures performed daily while maintaining exemplary safety conditions.

Claims

1 / Structure of a chinirgical unit, characterized in that it comprises at least two operating rooms (2, 3) each separated by a sterilization room (4), said sterilization room communicating with each of the operating rooms only through openings (14, 15, 16, 17) intended for the exclusive passage of sterilizable non-disposable surgical devices.

2 / Surgical unit structure according to claim 1, characterized in that each operating room. (2, 3) is separated from the sterilization room (4) by two openings respectively, a first opening (14, 15) intended for the passage of sterilized non-disposable chinirgical instiαiments, a second opening (16, 17) intended for the passage of Non-disposable surgical items to be sterilized.

3 / chinirgical unit structure according to claim 2, characterized in that said openings are equipped with a shelf intended to support the waiting surgical instruments.

4 / Structure of chinirgical unit according to one of claims 1 to 3, characterized in that the operating room has a ceiling at which is arranged all the permanent equipment necessary for the execution of the surgical act.

5 / Structure of chinirgical unit according to one of claims 1 to 4, characterized in that the operating room is devoid of a fixed operating table. 61 Structure of chinirgical unit according to one of claims 1 to 5, characterized in that each operating room and the sterilization room are provided with at least one door (8, 8 ', 9, 9', 10 ) opening onto a peripheral access corridor (13).

Il Surgical unit structure according to one of claims 1 to 6, characterized in that it further comprises two anesthesia and recovery rooms (5, 6), each room communicating with an operating room (2, 3 ) corresponding through an opening (18, 19) intended for the passage of the patient.

8 / Surgical unit structure according to claim 7, characterized in that each anesthesia room (5, 6) also has a second opening (11, 12) opening onto a peripheral corridor (13).

9 / structure of chinirgical unit according to one of claims 7 to 8, characterized in that each anesthesia room comprises two zones, respectively a first zone intended for the anesthesia of a first patient, a second zone intended for the awakening of the same patient.

10 / structure of chinirgical unit according to one of claims 7 to 9, characterized in that it further comprises a local phannacia (7) interposed between the two anesthesia and recovery rooms (5, 6) and the sterilization room (4) and communicating with them by means of doors (20, 21, 22).

11 / Structure of the surgical unit according to claim 10, characterized in that the pharmacy room (7) communicates with each of the two operating rooms (2, 3) by means of at least one opening (23, 24) intended exclusively the passage of consumable material. 12 / Clunu'gicale unit structure according to one of claims 7 to 11, characterized in that it comprises two operating rooms (25, 26) and an additional sterilization room (4) arranged opposite the two rooms respectively awakening anesthesia (5, 6) and local phannacia (7).