Numerical evaluation of the operating room ventilation performance: ultra-clean ventilation (UCV) systems

Document Type : Article

Authors

1 School of Mechanical Engineering, College of Engineering, University of Tehran, Tehran

2 School of Mechanical Engineering, Sharif University of Technology, Tehran

3 Department of Mechanical and Aeronautical Engineering, Wallace H. Coulter School of Engineering, Clarkson University, Potsdam, NY

Abstract

The surgical site infection (SSI) is one of the most important infectious problems in hospitals which may be happened in 2.6% of all surgeries. According to the literature, the primary source of SSI is the flakes released from the exposed skin of surgical staffs or patients. It is well known that appropriate ventilation strategy is the most effective way to control bacteria-carrying airborne particles responsible for SSI. In this research, the effect of the most dominant design parameter, namely inlet air velocity, on the ultra-clean ventilation (UVC) systems performance is evaluated in detail using the computational fluid dynamics (CFD). The results show an optimum value for the inlet air velocity which is mainly due to formation of a thermal plume over the wound tissue. This thermal plume protects the wound from contaminants deposition like a shield and may be disturbed at too high inlet air velocity. In addition, the effect of critical factors including the particle size the wound temperature, the operating lights boundary condition, and the existence of fixed and removable partitions on the optimum inlet air velocity is also investigated and discussed extensively.

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Main Subjects


1. Malone, D.L., Genuit, T., Tracy, J.K., Gannon, C., and Napolitano, L.M. Surgical site infections: reanalysis of risk factors", Journal of Surgical Research, 103, pp. 89-95 (2002). 2. Kirkland, K., Briggs, J.P., Trivette, S.L., Wilkinson, W.E., and Sexton, D.J. The impact of surgical-site infections in the 1990s: attributable mortality, excess length of hospitalization, and extra costs", Infection Control and Hospital Epidemiology, 20, pp. 725-730 (1999). 3. Mangram, A.J., Horan, T.C., Pearson, M.L., Silver, L.C., and Jarvis, W.R. Guideline for prevention of surgical site infection", Infection Control and Hospital Epidemiology, 20, pp. 247-278 (1999). 4. Stevenson, T.C. Experimental investigation of hospital operating room air distribution", M.Sc. Thesis, Georgia Institute of Technology, Atlanta, GA (2008). 5. Woods, J.E., Brayman, D., Rasmussen, R.W., and Montag, G.M. Ventilation requirements in hospital operating rooms - Part I: Control of airborne particles", ASHRAE Transactions, 92, pp. 396-426 (1996). 6. Goldman, M. Operating room airow and distribution", ASHRAE Winter Meeting, Dallas, TX (2000). 7. Noble, W.C. Dispersal of bacteria from human skin", International Symposium on Contamination Control, Copenhagen, Denmark (1976). 8. Zamuner, N., ASHRAE Technical Data Bulletin: Hospital and Operating Room Ventilation, ASHRAE, Atlanta, GA (1986). 9. Memarzadeh, F. and Manning, A. Reducing risks of surgery", ASHRAE Journal, 45, pp. 28-33 (2003). 10. Lewis, J.R. Operating room air distribution e_ectiveness", ASHRAE Transactions, 99, pp. 1191-1199 (1993). 11. Turner, R.S. Laminar air ow", Journal of Bone and Joint Surgery, 56, pp. 430-435 (1974). B. Sajadi et al./Scientia Iranica, Transactions B: Mechanical Engineering 26 (2019) 2394{2406 2405 12. Lidwell, O.M., Elson, R.A., Lowbury, E.J., Whyte, W., Blowers, R., Stanley, S.J., and Lowe, D. Ultra clean air and antibiotics for prevention of postoperative infection: A multi-center study of 8052 joint replacement operations", Acta Orthopaedica Scandinavica, 58, pp. 4-13 (1987). 13. Charnley, J. Postoperative infection after total hip replacement with special reference to air contamination in the operating room", Clinical Orthopedics, 87, pp. 167-187 (1972). 14. Ferrazzi, P., Allen, R., Crupi, G., Reyes, I., Parenzan, L., and Maisonnet, M. Reduction of infection after cardiac surgery: A clinical trial", Annuals of Thoracic Surgery, 42, pp. 321-325 (1986). 15. Whyte, W., Cleanroom Technology, John Wiley & Sons, Chichester, UK (2001). 16. Health Technical Memorandum (2025): Ventilation in Healthcare Premises, National Health Service (NHS) Estates, London, UK (1994). 17. Humphreys, H., Stacey, A.R., and Taylor, E.W. Survey of operating theatres in Great Britain and Ireland", Journal of Hospital Infection, 30, pp. 245- 252 (1995). 18. Chow, T.T. and Yang, X.Y. Performance of ventilation system in a non-standard operating room", Building and Environment, 38, pp. 1401-1411 (2003). 19. Liu, J., Wang, H., andWen, W. Numerical simulation on a horizontal airow for airborne particles control in hospital operating room", Building and Environment, 44, pp. 2284-2289 (2009). 20. Woloszyn, M., Virgone, J., and Stephane, M. Diagonal air distribution system for operating rooms experiment and modeling", Building and Environment, 39, pp. 1171-1178 (2004). 21. Sadrizadeh, S. and Holmberg, S. E_ect of a portable ultra-clean exponential airow unit on the particle distribution in an operating room", Particuology, 18, pp. 170-178 (2015). 22. Loomans, M.G.L.C., de Visser, I.M., Loogman, J.G.H., and Kort, H.S.M. Alternative ventilation system for operating theaters: Parameter study and full-scale assessment of the performance of a local ventilation system", Building and Environment, 102, pp. 26-38 (2016). 23. Sadrizadeh, S., Holmberg, S., and Tammelin, A. A numerical investigation of vertical and horizontal laminar airow ventilation in an operating room", Building and Environment, 82, pp. 517-525 (2014). 24. Chen, Q. and Jiang, Q.Z. Signi_cant questions in predicting room air motion", ASHRAE Transactions, 98, pp. 929-939 (1992). 25. Chen, Q., Zhai, J., and Moser, A. Control of airborne particle concentration and draught risk in an operating room", Indoor Air, 2, pp. 154-167 (1992). 26. Murakami, S., Kato, S., and Suyama, Y. Numerical and experimental study on turbulence di_usion _elds in conventional clean rooms", ASHRAE Transactions, 94, pp. 469-493 (1988). 27. Murakami, S., Kato, S., and Suyama, Y. Numerical study of di_usion _eld as a_ected by arrangement of supply and exhaust openings in conventional ow type clean room", ASHRAE Transactions, 95, pp. 113-127 (1989). 28. Chow, T.T. and Yang, X.Y. Ventilation performance in the operating theatre against airborne infection: Numerical study on an ultra-clean system", Journal of Hospital Infection, 59, pp. 138-147 (2005). 29. Humphreys, H. and Taylor, E.W. Operating theatre ventilation standards and the risk of postoperative infection", Journal of Hospital Infection, 50, pp. 85- 90 (2002). 30. Salvati, E.A. Infection rates after 3,175 total hip and total knee replacements performed with and without a horizontal unidirectional _ltered airow system", Journal of Bone and Joint Surgery, 64, pp. 525-535 (1982). 31. Hinds, W.C., Aerosol Technology, John Wiley & Sons, Chichester, UK (1999). 32. Memarzadeh, F. and Manning, A. Comparison of operating room ventilation systems in the protection of the surgical site", ASHRAE Transactions, 108, pp. 3-5 (2002). 33. Rui, Z., Guangnei, T., and Jihong, L. Study on biological contaminant control strategies under di_erent ventilation models in hospital operating room", Building and Environment, 43, pp. 793-803 (2008). 34. HVAC Design Manual for Hospitals and Clinics, ASHRAE, Atlanta, GA (2003). 35. Guidelines for design and construction of hospitals and health care facilities", AIA, Washington, DC (2006). 36. Sadrizadeh, S., Pantelic, J., Sherman, M., Clark, J., and Abouali, O. Airborne particle dispersion to an operating room environment during sliding and hinged door opening", Journal of Infection and Public Health, 11(5), pp. 631-635 (2018). https://doi.org/10.1016/j.jiph.2018.02.007 37. Sadrizadeh, S., Tammelin, A., Ekolind, P., and Holmberg, S. Inuence of sta_ number and internal constellation on surgical site infection in an operating room", Particuology, 13, pp. 42-51 (2014). 38. Sadrizadeh, S. and Holmberg, S. Surgical clothing systems in laminar airow operating room: a numerical assessment", Journal of Infection and Public Health, 7, pp. 508-516 (2014). 39. Sadrizadeh, S., Afshari. A., Karimipanah, T., Hakansson, U., and Nielsen, P.V. Numerical simulation of the impact of surgeon posture on airborne particle distribution in a turbulent mixing operating theatre", Building and Environment, 110, pp. 140-147 (2016). 40. Chow, T.T. and Wang, J. Dynamic simulation on impact of surgeon bending movement on bacteriacarrying particles distribution in operating theatre", Building and Environment, 57, pp. 68-80 (2012). 2406 B. Sajadi et al./Scientia Iranica, Transactions B: Mechanical Engineering 26 (2019) 2394{2406 41. Zoon, W.A.C. On the applicability of the laminar ow index when selecting surgical lighting", Building and Environment, 45, pp. 1976-1983 (2010). 42. MPROG 287: Healthcare Facilities - Guidelines for Mechanical Installations, MPROG, Tehran, Iran (2006). 43. DIN 4799: Heating, Ventilation and Air Conditioning- Testing of Air Distribution Systems Serving Operating Theatres, DIN, Berlin, Germany (1990). 44. Chen, C.J. and Jaw, S.Y., Fundamentals of Turbulence Modeling, Taylor & Francis, Washington, DC (1998). 45. Chen, Q. Comparison of di_erent k-" models for indoor airow computations", Numerical Heat Transfer: Part B, 28, pp. 353-369 (1995). 46. Tian, Z.F., Tu, J.Y., Yeoh, G.H, and Yuen, R.K.K. On the numerical study of contaminant particle concentration in indoor airow", Building and Environment, 41, pp. 1504-1514 (2006). 47. Mendez, C., San Jose, J.F., Villafruela, J.M., and Castro, F. Optimization of a hospital room by means of CFD for more e_cient ventilation", Energy and Buildings, 40, pp. 849-854 (2008). 48. Chen, Q. Prediction of room air motion by Reynoldsstress models", Building and Environment, 31, pp. 233-244 (1996). 49. Costa, J.J., Oliveira, L.A., and Blay, D. Test of several versions for the k-" type turbulence modeling of internal mixed convection ows", International Journal of Heat and Mass Transfer, 42, pp. 4391-4409 (1999). 50. Stamou, A. and Katsiris, I. Veri_cation of a CFD model for indoor airow and heat transfer", Building and Environment, 41, pp. 1171-1181 (2006). 51. ANSYS FLUENT 12.1 User's Guide, ANSYS Inc., Canonsburg, PA (2009). 52. Versteeg, H.K. and Malalasekera, W. An Introduction to Computational Fluid Dynamics: The Finite Volume Method, Addison-Wesley, Boston, MA (1996). 53. Davidson, L. and Fontaine, J.R. Calculation of the ow in a ventilated room using di_erent _nite di_erence schemes and di_erent treatments of the walls", CLIMA 2000, Yugoslavia, Sarajevo (1989). 54. Sajadi, B., Saidi, M.H., Ahmadi, G., Kenney, S.M., and Taylor, J. On the induced airow and particle resuspension due to a falling disk", Particulate Science and Technology, 31, pp. 190-198 (2013). 55. Tian, Z.F., Tu, J.Y., Yeoh, G.H, and Yuen, R.K.K. Numerical studies of indoor airow and particle dispersion by large eddy simulation", Building and Environment, 42, pp. 3483-3492 (2007). 56. Posner, J.D., Buchanan, C.R., and Dunn-Rankin, D. Measurement and prediction of indoor air ow in a model room", Energy and Buildings, 35, pp. 515-526 (2003). 57. Sajjadi, H., Salmanzadeh, M., Ahmadi, G., and Jafari, S. Simulations of indoor airow and particle dispersion and deposition by the lattice Boltzmann method using LES and RANS approaches", Building and Environment, 102, pp. 1-12 (2016). 58. Luscuere, P.G., Lemaire, T.D., and Ham, P.J. Improvement capabilities of operating theatres with the help of computer ow modeling", Proceedings of Indoor Air, Helsinki, Finland (1993). 59. Tinker, J.A. and Roberts, D. Indoor air quality and infection problems in operating theatres", Proceedings of the 2nd European Conference on Energy Performance and Indoor Climate in Buildings (EPIC), Lyon, France (1998).