Special Technical Committees

Healthcare and Controlled Environment

Patients having a hospital surgical procedure in Australia are under a greater risk of infection than in other countries. This risk can be exacerbated by inadequate operating theatre design, construction, commissioning, certification, and service practices. Substantial consequential issues are evident. These include the increase of antibiotic resistance, economic losses, and devastating personal losses to our fellow Australians.

About this topic

From 2013–14, there were more than 2.4 million hospital admissions in Australia that involved a surgical procedure within an operating theatre.*¹In Australia, there are approximately 168,000 annual cases where a surgical procedure has led to post-discharge surgical site infections (SSIs) *². This represents about 8 per cent of all surgical discharges.

About 1,600 people die annually in Australia from infection where existing antibiotic treatments are no longer effective.*³

The above facts ably demonstrate the magnitude of the issue regarding SSIs, and provide some understanding of the related cost – not only in losses to the Australian economy but to the wellbeing of the Australian population in general. We need to also note that these statistics do not record instances where a patient’s outcome was terminal. Not all infection ends with a good outcome.

In an article titled Operating Room Air Quality*⁴, the Institute of Healthcare Engineering, Australia (IHEA) noted there is a lack of applicable standards around air cleanliness targets for operating theatres. The article further noted a lack of understanding in the market on how to manage the air cleanliness within existing operating theatres.

Although there is an existing Australian Standard, AS1668.2*⁵, plus a number of state guidelines, these publications do not provide comprehensive design guidance for operating theatres. The lack of both design guidance and minimum standard definitions allows too much flexibility within a design. This is then manifested in a compromised clinical environment, with consequential failure of the control of infection.

Additionally, when we compare the available Australian standards and guidelines with other international standards – for example the German and British standards – it is also evident that there is a lack of compulsory third-party certification testing to verify that the design and installation meets requirements – either notional requirements or standards.

References:

• *¹ AIHW – Australian Institute of Health and Welfare. Statistics 2013/14
• *² Reducing harm to patients from healthcare associated infection – the role of surveillance, Australian Commission on Safety and Quality in Healthcare
• *³ Reducing antibiotic prescribing in Australian general practice, led by Professor Chris Del Mar from Bond University's Centre for Research in Evidence-Based Practice, Bond University, Australia
• *⁴ Operating Room Air Quality, Institute of Healthcare Engineering Australia Magazine, September 2014
• *⁵ Australian Standard AS1668:2 The use of ventilation and airconditioning in buildings. Ventilation design for indoor air contaminant control

Purpose and aims

The purpose of AIRAH’s Healthcare and Controlled Environment STG is to provide its members with strategic leadership in the development, implementation, and sustainability of programs, activities, and strategies that seek to analyse the current standards and guidelines for operating theatre design, construction, commissioning, certification, and service practices to improve the minimum set of parameters while always having infection control as a main consideration.

The committee aims to provide:

Provide advice, support, and assistance

The STG will collaborate with designers, facility managers, and hospital engineers on strategies that support the improvement of existing operating theatre environmental control.

Assist and promote good practice culture

The STG will assist in the promotion of a good practice culture for the design, construction, commissioning, certification, and service practices of operating theatre environmental control.

Monitor and advise on risks

Monitor both identified and emerging risks to patients and medical staff within the operating theatre environment, and advise on their prevention, mitigation, and management as appropriate.

Recognise and address barriers and enablers

Recognise barriers and enablers for good infection control practices related to the physical environment within operating theatres, and assist in developing initiatives to address these.

Promote analysis and cooperation

Act as a motivator to other organisations directly and indirectly related to the operating theatre workplace to promote internal analysis and further cooperation with this group.

Have a national and global perspective

Monitor trends in Australia and the world regarding operating theatre design, construction, commissioning, certification, and service good practices that can be implemented locally.

Identify limitations

Identify group limitations and assist in the incorporation of solutions to these limitations.

Analyse financial and energy consumption factors

With a view to what can affect operating theatre design, and properly address this by comparison with the cost of infection based on national and international infection control surveillance systems.

Seek third-party support

Seek government and private sector support for the group aims.

Set standards and design characteristics

Draft a minimum set of standards and design characteristics that enable the adoption of best practices for design, construction, commissioning, certification, and service of operating theatre environments to be presented to Standards Australia, government, and health departments.

Policy guidance

Be a reference point for government in shaping relevant policy relating to the environmental, economic, and social impact of HVAC&R and related systems in operating theatre environments.

Advocacy and influence

The STG will make submissions on behalf of members to influence policy setting (as collectively agreed upon), and work with government at all levels to establish workable regulations, frameworks, and guidelines.

Identify and seek funding for collaborative projects

The STG will identify and seek external funding for collaborative projects that support its objectives and aims of AIRAH and its members.

Considered, integrated, and technically objective guidance

The STG will provide guidance to the HVAC&R industry to develop a considered, integrated, and technically objective approach to infection control and operating theatre practices.

Although the Committee comprises AIRAH members and has a focus on HVAC&R elements of operating theatre design and practice, there is recognition that the Committee must consider a wider view and engage with the broader operating theatre design and infection control community. This includes experts and leaders in other related disciplines. AIRAH members and the Committee must only operate within their area of competence, but the Committee will engage widely to ensure that it can achieve the greatest possible impact.

The committee aims to deliver:

1. Advice, good practices culture, initiatives, and guidance to the HVAC&R industry in relation to operating theatre environments.
2. Input to AIRAH's formal responses to government and stakeholder policies and papers.
3. White papers, workshops, guidelines, and manuals.