OFFICE BASED SURGERY (OBS) PART 3

OFFICE BASED SURGERY (OBS) PART 3

By Bob King on Nov 18, 2015 4:40:37 PM

Office Based Surgery (OBS) Part 3

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Bob King discusses in Part 3 common misconceptions and mistakes when designing Procedure Suite for OBS

QUES – What are the most common planning misconceptions regarding office based surgery (OBS) architectural or mechanical specifications?

ANS – Since OBS planning is relatively new, the architects and engineers that either design or review the designs of others often don’t appraise themselves of the Codes and Regulations that govern OBS, specifically “procedure rooms”. We’ve had to conduct what amounts to teaching “continuing education” to large engineering firms that specialize in “hospital design” to adapt to the rules of OBS – they have a hard time relating to the notion of a “healthy” patient. This leads to a common misperception on “air handling” and air filtration systems – basically, it’s just a system of “normal” air filters changed & cleaned regularly utilizing normal commercial grade HVAC package units or central systems – air isolation & ducted returns are not required. This is because the patients are not infected with contagious diseases! A hospital operating room air scrubber (HEPA) is about the same size as the operating room with a complex series of filters that literally remove almost all particulate matter & dust from the air entering and capture this with metal ductwork on the return end as well for recirculation – very similar to computer assembly “clean rooms” and the like in manufacturing.  This is not a requirement of OBS.

QUES – Do office based surgery (OBS) areas require emergency backup power?

ANS – Yes. NYS as well as most other jurisdictions require back-up for most procedures where a patient is anesthetized and power interruption would endanger the patient. For most procedure rooms – back up power is required for all equipment, power and lighting for the express purpose of maintaining the “essential” components of a surgical procedure and/or recovering patient(s) that may yet be incapacitated or under anesthesia – these devices would be identified as such. In addition this part of the electrical system must follow the rules of NFPA 99 etc. in which extra color coded redundantly grounded wiring is specifically required. This to help prevent an incapacitated patient from being accidentally electrocuted or a fire started in the presence of oxygen & other gases that may be in the area.

QUES – How much backup power is required in an office based surgery (OBS) suite?

ANS - Emergency backup power must provide the designed power load for the amount of time the surgeon believes he or she will need in order to shut down or close out a procedure and bring the recovering patient back to normal ambulatory status. Usually this is at least 2 hours, but sometimes more. We specify packaged UPS (Uninterrupted Power Supply) systems – basically a series of Lithium-ion batteries in a “box”. This “box” is connected to the ordinary service panel in the office via a service switch. The “box” in turn is connected to a second service “sub-panel” and from there the protected circuits are wired to the procedure suite. Since the procedure suite is running on an ever re-charging battery system, the surgeons & staff will never lose power – if main power goes out & the system is not being re-charged, the staff will get an audible alarm and/or alert on the computer system that they are in “outage mode” and must start the steps and schedules for stabilizing their work in progress – this becomes part of the certification statement.