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Reducing the risk of viral contamination during the coronavirus pandemic by using a protective curtain in the operating room
KTH, School of Architecture and the Built Environment (ABE), Civil and Architectural Engineering, Sustainable Buildings.ORCID iD: 0000-0001-7032-3049
NTNU University .
NTNU University.
KTH, School of Architecture and the Built Environment (ABE), Civil and Architectural Engineering, Sustainable Buildings.ORCID iD: 0000-0002-9361-1796
2022 (English)In: Patient Safety in Surgery, E-ISSN 1754-9493, Vol. 16, no 1Article in journal (Refereed) Published
Abstract [en]

Background: Airborne transmission diseases can transfer long and short distances via sneezing, coughing, and breathing. These airborne repertory particles can convert to aerosol particles and travel with airflow. During the Coronavirus disease 2019 (COVID-19) pandemic, many surgeries have been delayed, increasing the demand for establishing a clean environment for both patient and surgical team in the operating room.

Methods: This study aims to investigate the hypothesis of implementing a protective curtain to reduce the transmission of infectious contamination in the surgical microenvironment of an operating room. In this regard, the spread of an airborne transmission disease from the patient was evaluated, consequently, the exposure level of the surgical team. In the first part of this study, a mock surgical experiment was established in the operating room of an academic medical center in Norway. In the second part, the computational fluid dynamic technique was performed to investigate the spread of airborne infectious diseases. Furthermore, the field measurement was used to validate the numerical model and guarantee the accuracy of the applied numerical models.

Results: The results showed that the airborne infectious agents reached the breathing zone of the surgeons. However, using a protective curtain to separate the microenvironment between the head and lower body of the patient resulted in a 75% reduction in the spread of the virus to the breathing zone of the surgeons. The experimental results showed a surface temperature of 40 ˚C, which was about a 20 ˚C increase in temperature, at the wound area using a high intensity of the LED surgical lamps. Consequently, this temperature increase can raise the patient's thermal injury risk.

Conclusion: The novel method of using a protective curtain can increase the safety of the surgical team during the surgery with a COVID-19 patient in the operating room.

Place, publisher, year, edition, pages
Springer Nature , 2022. Vol. 16, no 1
National Category
Other Civil Engineering
Research subject
Civil and Architectural Engineering, Fluid and Climate Theory
Identifiers
URN: urn:nbn:se:kth:diva-311612DOI: 10.1186/s13037-022-00332-xISI: 000836781800001PubMedID: 35933393Scopus ID: 2-s2.0-85135582680OAI: oai:DiVA.org:kth-311612DiVA, id: diva2:1655197
Funder
Swedish Research Council Formas, 2017-01088Swedish National Infrastructure for Computing (SNIC), 2018-05973
Note

QC 20220912

Available from: 2022-05-01 Created: 2022-05-01 Last updated: 2023-12-15Bibliographically approved
In thesis
1. Computational fluid dynamics application in indoor air quality and health
Open this publication in new window or tab >>Computational fluid dynamics application in indoor air quality and health
2022 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Indoor air quality directly affects the comfort, performance, and well-being of occupants. Indoor pollution can cause immediate or long-term health effects and has been responsible for 4.1% of global deaths in recent decades. In operating rooms, providing a high indoor air quality is especially critical as surgical site infection can occur in patients due to air contamination in operating rooms.

Surgical site infections due to antibiotic resistant bacteria may threaten the safety and lives of millions of people each year. To moderate and reduce indoor contamination, it is necessary to select a proper ventilation strategy.Improving ventilation system performance requires a deep understanding of airflow patterns and contamination distribution.

This thesis adopted computational fluid dynamics to evaluate airflow patterns and the spread of airborne contaminations in indoor environments. Moreover, we sought to provide an approach to facilitate transferring the obtained knowledge to medical experts and decisionmakers to reduce the infection risk after the surgery.

The use of warming blankets has raised the concern about surgical site infections. Warming blankets are used to prevent hypothermia in patients during surgery. However, our results showed that these warming blankets reduce the bacteria-carrying particles level at the wound due to warm upward airflows.

Surgical lamps can block the airflow and generate a low-velocity area under the lamp that increases the accumulation of contaminants. The simulation results revealed that a novel fan-mounted surgical lamp reduced the contamination level to an acceptable range for infection-prone surgeries. This novel surgical lamp successfully reduced contamination in the operating room supplied with both turbulent mixing and laminar airflow ventilations.

In another study, we implemented a protective curtain and showed that this strategy could significantly reduce the exposure level of the medical team to a patient with infectious respiratory disease. This novel protective curtain is located between the patient’s upper body and the lower part during surgery. We found a 57% reduction in bacteria-carrying particle concentration at the wound by adopting this curtain. Thus, using this protective curtain can reduce the exposure level of both patient and surgical team in the operating room.

Besides investigating the performance of ventilation systems in hospitals, we investigated the application of diffuse ceilings ventilations in clinics, especially waiting rooms. Diffuse ceiling ventilation systems are common air distribution systems in offices and schools. Based on simulation results, a diffuse ceiling with a central opening and evenly distributed heat loads resulted in the highest cooling capacity and thermal comfort in clinic waiting rooms.

We have visualised the airflow field and airborne particles in operating rooms with the help of virtual reality techniques. We found the virtual reality environment more engaging to understand the airflow field and particle movements in operating rooms.

Abstract [sv]

Luftkvaliteten inomhus påverkar människors komfort, ochprestationsförmåga. Luftföroreningar inomhus kan orsaka omedelbaraoch långvariga hälsoeffekter och har orsakat 4,1 % av de globala dödsfallenunder de senaste decennierna. I operationssalar på sjukhus är det viktigtatt tillhandahålla god luftkvalitet. Infektioner i samband med operationkan drabba patienter på grund av förorenad luft i operationssalen.

Förekomst av infektioner i samband med kirurgiska ingrepp, och tillföljd av antibiotikaresistenta bakterier kan hota patientsäkerheten förmiljontals personer varje år. För att kontrollera och minska föroreningarinomhus är det nödvändigt att välja en korrekt ventilationsstrategi. För attförbättra ventilationssystemets prestanda krävs förståelse av hurventilationsluften strömmar och hur föroreningar sprider sig i rum.

I denna avhandling används numerisk strömningsmekanik ochexperimentella data för att utvärdera luftflödesmönster och spridning avluftburna föroreningar i inomhusmiljöer. Dessutom avser detta arbete atttillhandahålla ett tillvägagångssätt för att underlätta kunskapsöverföringtill medicinska experter och beslutsfattare för att minska infektionsriskenefter operationer.

Det finns oro för att patienter ska drabbas av postoperativasårinfektioner på grund av användning av medicintekniska produkter ioperationssalar, såsom värmande filtar. Värmefiltar används för attförhindra hypotermi hos patienter. Våra resultat visade dock attvärmefiltar minskar nivån av bakteriebärande partiklar vid såret på grundav uppåtgående varma luftflöden.

Operationslampor blockerar luftflödet och genererar ett område medlåg lufthastighet som ökar risken för ansamling av kontaminanter.Simuleringsresultaten visade att en ny fläktmonterad operationslampaminskade kontamineringsnivån till acceptabel nivå för infektionskänslig kirurgi. Den nya fläkten minskade kontaminationen i operationssalen vidsåväl turbulent som vid laminärt luftflöde.

I en annan studie implementerade vi en skyddande gardin som visadeatt den avsevärt minskade exponeringsnivån för det kirurgiska teametunder operation av en patient med infektion i luftvägarna. Dessutomrapporterades en 57 % minskning av den bakteriebärandepartikelkoncentrationen vid såret då gardinen användes. Skyddsgardinenförbättrar således säkerheten både för patienten och för operationsteamet.

Vi undersökte användning av diffunderande takventilation på kliniker.Diffunderande takventilation är vanligt förekommandeluftdistributionssystem i kontor och skolor. Baserat på simuleringar, gavinnertak med diffunderande tilluft ur central öppning, vid jämnt fördeladevärmelaster, den högsta kylkapaciteten och termiska komforten iklinikernas väntrum.

För visualisering av numeriska simuleringar användes teknik förvirtuell verklighet. Den virtuella verklighetsmiljön gav ökad upplevelse ochförståelse av luftflödesfältet och partikelrörelserna i operationssalar.

Place, publisher, year, edition, pages
Stockholm: KTH Royal Institute of Technology, 2022. p. 66
Series
TRITA-ABE-DLT ; 2211
Keywords
Ventilation systems, Indoor air quality (IAQ), Bacteria-carrying particles (BCP), Infectious respiratory disease, Operating room (OR), Thermal comfort, Computational fluid dynamics (CFD), ventilationssystem, bakteriebärande partiklar, infektionssjukdomar i luftvägarna, operationsrum, termisk komfort, numerisk strömningsmekanik
National Category
Other Civil Engineering
Research subject
Civil and Architectural Engineering, Fluid and Climate Theory
Identifiers
urn:nbn:se:kth:diva-311616 (URN)978-91-8040-188-3 (ISBN)
Public defence
2022-05-30, Kollegiesalen, Brinellvägen 8, KTH Campus, Videolänk: https://kth-se.zoom.us/meeting/register/u50tcuqoqzMiHd3HTd5gSLH46ifFK7UG_Gu5, Stockholm, 13:00 (English)
Opponent
Supervisors
Funder
Swedish Research Council Formas, 2017-01088Swedish National Infrastructure for Computing (SNIC), 2018-05973
Note

QC 20220502

Available from: 2022-05-02 Created: 2022-05-01 Last updated: 2022-06-25Bibliographically approved

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Sadeghian, ParastooSadrizadeh, Sasan

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