A modular OT is an Operation theatre which consists of wall, ceiling and slanted panels which is capable of housing or incorporating electrical, medical gases, lighting gears and any other equipment needed for the operation.

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It is called a Modular OT since it is usually constructed by using steel and glass structures inside the hospital in the form of a module. It should have enough flexibility to accommodate any type of equipment needed for different operations.

Why do we need Modular OT?

1. Sterility : To have complete infection free cases

• To achieve a very low level of Bacteria count in the OT
• To have Non-porous, seamless, easily cleanable surfaces
• To reduce the need of frequent disinfestation.

2. Work-Flow Management

• To have concealed wiring and medical pipeline system
• To have a complete hassle free floor area leading to enhanced equipment and personal movement
• To have effective lighting system to operate under better conditions.

3. Aesthetics – Pleasing work environment

• Effective lighting by maintaining LUX levels
• Clean air quality and effective ventilation
• Pleasing work environment through the use of different walls and floor colors

Features of a Modular OT?

• A continuous flow of highly filtered “Bacteria free” air into the the operation theatre.
• A continuous removal of contaminated air out of the Operation theatre
• Durable anti-bacterial paint
• Easy to clean and maintain
• Permeability of vapor to escape which protects against the growth of yeast and microbes
• Moisture and Thaw resistance
• Easy to move and get hands on the instruments
• Should be able to accommodate a number of doctors inside.

Main systems of a Modular Operation theatre

• The wall and ceiling
• Laminar flow unit- Plenum
• Light
• Pendants
• Hermetically door
• Control Panel
• X-ray
• Pressure relief damper
• Scrub sink
• Writing board
• Hatch Box

Major Components of Modular OT System

1. The Wall and ceiling

A modular OT is a free standing structure constructed inside a hospital room. The panels of Modular OT are made of Steel or glass. A 200 micron coat of anti-microbial paint is sprayed on the inside of the panels facing the OT table. 

All four corners of the room will have provisions for air duct. Sufficient room should be given inside the Operation theatre for easier operation procedure and the remaining space should be used for storage. The joints and cavities must be filled with epoxy and sanded flush to provide a joint less surface.

2. Laminar air flow unit – Plenum

A Modular OT consists of a laminar air flow unit which supplies air into the Modular OT. Laminar flow is defined as the flow of fluid in which the entire flow is steady with uniform velocity in which the flow of lines is parallel to each other.

• Laminar flow unit is used in Modular OTs 
• To control the temperature and humidity of space,
• To assist in the removal and dilution of waste anesthetic gases
• To dilute airborne bacterial contamination 
• To control the movement of air within the department, such that the amount of airborne bacteria is minimal.

3. Light

Lights of a Modular OT are fixed to its ceilings. Clear and effective lighting is crucial to the operation. Integral lighting systems provide illuminations in excess of 1300Lux.

4. Pendants 

Pendants are used in Modulat OTs for convenient positioning of Medical gas pipeline, Equipment and other tools. These are flexible enough to be fixed at variable heights and distances. 

Pendants are available in various styles.

• Power Supply
• data points
• mounting medical devices, among others
• Medical Gas Supply
• Shelves for some equipment
• drawer for accessories

5. Hermetically Sliding  door

The use of hermetically sliding door is to maintain the correct air pressure inside the modular OT. Also Hermetically sliding doors use very less space compared to hinges or any other types of doors. The door should have rubber wheels and made to run on a nylon platform to reduce the abrasion. The doors can be either automatic with controls or manual. It should also be worked manually at the time of power failure.

6. OT Control panel

OT Control panel is an electric control panel fixed to the wall of modular OT. Nearly 9 types of controls can be mounted on the panel. These controls include Medical gases, Medical equipment, Ventilation system etc…

7. Anti-Static Flooring 

Anti-static flooring is used in industries where static can cause interference or damage to employees and/or equipment. Anti-static industrial floors inhibit the generation of electrostatic discharge or ESD, which is the pulse of static electricity that happens when a charged person or surface comes into contact with another object.

What is NABH – What is the full form of NABH

The full name of NABH is National Accreditation Board for Hospitals.

NABH (National Accreditation Board for Hospitals & Healthcare Providers) is an autonomous organization established by the Indian government to provide accreditation to hospitals and healthcare providers in India.

NABH is a constituent board of the Quality Council of India (QCI), and its accreditation is considered a certification of quality for healthcare providers.

NABH accreditation is a voluntary process that involves a comprehensive evaluation of a healthcare organization’s processes and systems to ensure that they meet the highest quality and safety standards.

The accreditation process includes an assessment of the organization’s infrastructure, processes, patient safety and care, clinical outcomes, and continuous quality improvement.

NABH accreditation is recognized as a benchmark for quality in healthcare in India and is increasingly sought after by healthcare providers in the country.

It is also recognized by international bodies such as the International Society for Quality in Healthcare (ISQ) and the Asia-Pacific Accreditation Cooperation (APAC).

NABH Standards for Modular OT

This article highlights various aspects of the NABH Modular OT Standards. Modular OT has become a standard in all newly constructed hospitals.

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What are NABH standards?

The National Accreditation Board for Hospitals and Healthcare Providers (NABH), is part of the Indian Quality Council. The board was set up to create and run accreditation programs for healthcare organizations.

The NABH Standards are updated every five years. NABH latest released in the year 2020. The Indian healthcare system values NABH accreditation more.

The NABH document contains standards for everything from Facility management, to Personnel, to Operation and maintenance.

Values of NABH standards for Modular OT

Credibility – Provide services that are credible and add value

Responsiveness – Willingness and ability to improve services

Transparency – Openness and transparency in communication with stakeholders

Innovation: Using change, creativity, learning and new ideas in order to improve services

Design Considerations for New Operation Theatres OT construction according to NABH Standards

• Each OT built should have a dedicated AHU and not share the air conditioning with any other areas.
• Paint- antibacterial, anti-fungal
• Clean Room Lights
• Protection against static charge.
• Separate power supply for laser equipment.
• The flooring, walls, and ceilings should be smooth, without corners, and non-porous. They should also be easy to clean. Material should be selected accordingly. Anti-static Flooring, seamless and skirting included, should be made of non-porous stone, as this material absorbs moisture, which could lead to bio-burden.

Air Conditioning according to NABH Standards Modular OT

After extensive discussion with manufacturers, engineers and members of the technical committee, as well as other stakeholders, the following guidelines were finalized.

To this end, the theatres of operation have been divided up into different groups:

1. Super specialty OT: Operation theatres are for Neurosciences (Joint Replacement), Orthopedics and Cardiothoracic Surgery (Renal Surgery, Liver Surgery, etc.).
2. General OT – This includes all basic surgical disciplines, including FRU OT, district hospital OTs and Ophthalmology. Day care center: The admission of patients for planned surgery and return home the same day would fall under general OT.
3. The following basic assumptions were kept in mind:

• The OT must be occupied by a standard of 5-8 people at any time. * Equipment load: A standard equipment load of 5 to 7 kW is considered for each OT, and a lighting load of one kW. Equipment load for super specialty OT can be 7 – 9KW.
• The ambient temperature and humidity levels at each location should be taken into consideration when designing the system.

Requirements – General OT 

1. Air Changes per Hour

• According to international guidelines, the minimum total air change should be 20, although this will vary depending on the biological load and location.
• Minimum 4 air changes of fresh air is required out of a total of minimum 20 air changes.

2. Air Velocity should be the same as in previous guide.
3. Positive Pressure: It is necessary to maintain a positive pressure differential in OT and adjacent areas to prevent air from outside entering OT.
4. The same should apply to air handling and filtration. If this is not possible, then the OTs must be ventilated and have 2 levels of filters with the same efficiencies specified before (micro vee and pre filters at the AHU).
5. Temperature and Humidity. Installing appropriate devices that monitor and display the conditions in the OT is possible.

Maintenance according to NABH standards for modular OT

The AHU will run continuously (without temperature control) during the non-functional times. To conserve energy, variable frequency devices (VFDs) can be used. VFD can reduce air changes by 25% when not in operation, provided that the positive pressure relationship does not change.

NABH (National Accreditation Board for Hospitals & Healthcare Providers) has specific guidelines for the maintenance of modular operation theaters (OTs) to ensure the safety and well-being of patients. The following are some of the key aspects of maintenance that are required as per NABH standards:

Regular cleaning and disinfection: The OT should be cleaned and disinfected regularly to maintain hygiene and prevent infections. The frequency of cleaning and disinfection should be determined based on the usage of the OT and the type of procedures performed.

Maintenance of HVAC system: The HVAC (Heating, Ventilation, and Air Conditioning) system in the OT should be maintained regularly to ensure that the air quality is of the highest standard. This includes regular inspection, cleaning, and replacement of filters.

Proper functioning of equipment: All equipment used in the OT should be regularly checked for proper functioning and calibration.

Regular inspections: The OT should be inspected regularly by a qualified engineer to ensure that all systems are functioning properly. The engineer should provide a report of the inspection and any necessary corrective actions.

Documentation and record keeping: All maintenance activities should be properly documented, including details of the maintenance performed, any corrective actions taken, and the date of the next scheduled maintenance.

Training of staff: All staff members who work in the OT should receive appropriate training on the maintenance and operation of equipment and systems.

Cleaning of micro vee and pre filters is recommended every 15 days. As per the manufacturer’s recommendations, all parts of AHU should be maintained.

Adherence to these NABH standards for maintenance of modular OTs can help ensure the safety and well-being of patients undergoing surgical procedures.