Surgical Holding Areas
These areas are intended for retention of patients on gurneys after initial sedation.
Some patient observation may take place, requiring higher level illumination, but generally a subdued slumber type lighting condition is preferred. Luminaire placement should keep luminance out of the patient’s line of sight. In some cases, this area may be used as a surgical induction space where intravenous or anesthetic procedures may be started. Flexible wall-hung luminaires will serve this purpose.
Surgical Induction Areas
Here, a patient is transferred to an operating table. Anesthesia and intravenous lines are inserted and a variety of monitoring sensors are attached,
Low level general illumination is preferred, in particular for the insertion of a lighted laryngoscope device into the patient’s trachea by the anesthesiologist. Local task lighting is required for insertion of intravenous needles.
The lighting in these areas is some of the most important in the hospital. The lighting must meet the demands of different medical personnel: surgeons, surgical nurses, anesthesiologist and room turnover staff and the wide range of specialized tasks they perform. Specialized operating rooms (e.g. neurosurgery, orthopedic surgery, plastic surgery, optical surgery, endoscopic surgery, obstetrics/delivery) have their own specific lighting requirements that must be taken into account. These are covered in detail in the IES publication, RP-29-06, Lighting for Hospitals and Healthcare Facilities and in the 10th Edition IES Handbook, Chapter 27.
Effective performance in the operating room is enhanced by lighting which does not cause visual, operational and environmental difficulties such as glare, shadowing or visual stress. The operating room environment requires a combination of:
General ambient lighting
Direct and indirect task lighting including:.
External surgical field illumination systems
Fiber optic illumination systems
Microscopy illumination systems
The ability of surgical field illumination systems to be adjustable and work well together, will enable the surgical team to perform more effectively. In a typical multi-use operating room, a large amount of equipment often competes for ceiling space:
The general room lighting system
Track, pedestal and pedestal/bridge mounted surgical field lights
X-ray and image intensifiers
Surgeon’s microscope or enlarger
Anesthesia column with booms or masts for gas and electric cables
Patient status display monitors
For visual comfort of surgical team:
There should be no shadows preventing surgeon from seeing past hands and instruments and into the patient’s body cavities.
Surgeons must be able to work without heat discomfort from overhead light sources
Surgeon must not have to adjust to appreciable luminance differences when looking away from the surgical procedure. Recommended luminance ratios:
Between wound and surgical fields not more than 1:3
Between surgical field and instrument table not more than 5:1.
For safety of patient:
UV energy emitted by surgical lights must be minimized to avoid irradiating, heating or drying body tissues.
Fluorescent luminaires must be constructed with special lenses and electrically grounded conductive coating to prevent EMI from affecting sensitive monitoring equipment.
Color temperature of general light sources and surgical light sources should be matched so patient appearance does not shift significantly. Fluorescent lamps with a color temperature of 5000K are recommended.
Surgical task lighting should provide a minimum of 2500 footcandles in the center of a 78 square inch circle. In specialized cases, adjustability for higher illuminances, focal planes and light distribution patterns is desirable.
To avoid shadows, light should reach the surgical field from wide oblique angles.
To avoid total lamp failure, use multiple lighthead units or single lighthead units with multiple lamps.
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LED systems in the operating room provide more light and less heat
For many years, the light sources used in surgical field illumination systems have been halogen types with some more advanced systems using discharge sources like metal halide and xenon. Recently, many of the leading surgical lighting manufacturers have begun introducing state-of-the-art surgical task lighting containing LED light sources.
Already gaining acceptance in the commercial, entertainment and consumer markets, LEDs for surgical applications have three major advantages: a minimum 20,000 hours life, 70% lower energy consumption than halogen and most important for medical applications, they operate at extremely low temperatures compared to halogen light sources. This means greater comfort for the surgeon, and no UV irradiation to dry exposed tissue. Also their small size allows for much more compact luminaire designs.
Operating Room Corridors &Scrub Areas
To allow the eyes to adapt to the operating room lighting, the illuminance levels, color rendering and color temperature of light sources in these areas should be similar to those in the operating room. Higher illuminance levels are appropriate above scrub sinks and lower levels in patient holding areas. Lighting systems should be dimmable if upcoming surgery will be in a low light environment and when the operating suite is unoccupied.
Tasks performed in the emergency suite or individual emergency rooms run the gamut from general examination and assessment, to performing minor surgical procedures such as repairing lacerations and wounds. The surgical field is usually smaller but these tasks are meticulous and require the same quality of illuminance as the general operating room.
A balance between task and general illuminance is required. Task lighting is usually provided by a ceiling mounted or portable single head surgical light. General lighting should be at a lower illuminance level than task lighting. Both lighting systems need to offer high color rendering indices for quick and accurate diagnoses.
Some emergency suites include a trauma room. It has the same lighting needs as an operating room. Since patients arriving here often have multiple wounds, the task lighting system needs to be able to light multiple surgical fields at one time.