Global medical practice is constantly changing, partly due to the greater availability of information supplied by new technologies, which in turn improves the precision of medical care, and enables its delivery in a more personalised way
Information management technologies supporting health data control are a feature within the surgical set-up at Hospital Alemán in Argentina, where a new information system is being established to integrate the local Health Centre’s care areas. Hospital Alemán was established in the 19th century as a free care centre for German expats and their descendants
Another key project feature are new prefabricated construction technologies used in the development of modular operating theatres, with considerable design flexibility built in. The result has been the construction of multifunctional and surgically sterile spaces, with a pleasant atmosphere, excellent durability, and ease of operation.
AFS Arquitectos, with the collaboration of Hospital Alemán’s technical and medical teams, is now at the end of a hard journey – setting into operation the new modular surgical equipment and its integrated information management system at the Juncal Health Care Centre, located on Pueyrredon Av. and Juncal St., Buenos Aires, Argentina
Adaptation to new technologies
The integration technology allows communication, visualisation, and information management to be connected between all areas, improving both the efficiency of surgical procedures, and enhancing communication and data flow throughout the patient journey.
The prefabricated modular system complies with infection control protocols, its panels are easy to assemble, and the ceilings are made up of easily accessible suspended removable plates. The system allows for the inclusion of modular panels with touchscreens of different dimensions for medical use, as well as separate control panels for all key operating theatre functions. The equipment is flush-mounted, achieving smooth, continuous, and easy-to-clean surfaces in all panels.
Hospital Alemán’s surgical floor
With cutting-edge technology, a modern surgical facility has been designed and built, with a pleasant and comfortable ambience The distribution of the physical plant responds to a surgical equipment model that AFS has been implementing since 1980 – with good results. It proposes a graduation of spaces that go from a series of support and transfer rooms to a ‘clean’ circulation area for patients and doctors, up to the entrance of the operating theatres organised around the clean core. This graduation of spaces is accompanied by a corresponding cascade of airconditioning pressures.
The surgical floor contains three distinct areas:
Perimeter circulation and support areas, where surgical beds circulate.
Surgical rooms, where operations are performed.
Clean core, restricted space for pharmacy and instrument management.
Construction technologies
This new surgical floor is one of the most modern treatment facilities in Buenos Aires. Its patients enjoy optimum medical treatment in a sophisticated environment, which also benefits the staff of the facility
A successful operation requires perfect conditions that protect the patient and allow the medical team to concentrate exclusively on the procedure. Surgeries always involve working in an open human body, so the highest priority – keeping the risk of infection to an absolute minimum – requires an an operating room equipped and fitted out to the highest standard. The integrated technology within the operating theatres is located in control panels so that the medical team can easily visualise the operation of all the equipment and applications.
The innovative OR (operating room) data integration solution adapts to user needs. The focus is on improving working processes and efficiency, together with future-orientated technologies. Integration systems facilitate centralised medical device control from the sterile and non-sterile areas of the operating room. These controls allow the management of audio and video in 4K quality, providing high definition streaming and communication by video conference. The system allows users to record, edit, manage, and consult images and videos centrally. The screens are installed behind glass panels, facilitating cleaning and promoting hygiene.
The system allows the centralising of generated content throughout the patient journey, while the integration system gives doctors and other personnel an overview of everything that happens in the operating theatre. Information on theatre occupancy, as well as the status of all operating rooms, through interfaces compatible with the existing hospital systems, guarantees data protection and security. The system allows users also to control air pressure, lights, and all automated parameters via a control panel located at the OR entrance
Depending on the given requirements, both sliding and swing doors were installed to provide access to the ‘cores’. The individualised door control system with touchless sensor operation was integrated into the services housed within the ceilings, floors, and partitions. The walls also feature viewing and blackout functions, and various outlets for the theatres.
Energy efficiency
Through the modernisation of operating theatres, more environmentally friendly operations have been achieved.
Operating theatres are traditionally the areas with the highest concentration of devices and the highest energy consumption in the entire hospital. They require constant ventilation, air conditioning, lighting, and medical equipment to ensure optimal working conditions for surgeons.
It is clear that constant ventilation of an operating room is mandatory, remaining under positive air pressure, to prevent the entry of bacteria into the room, significantly minimising the risk of infection to the patient. However, ventilation plant need not operate at maximum levels when no operation is in progress. Integrated control systems allow efficient use of energy, automatically adjusting ventilation and other key parameters when there is no surgery taking place.
The biggest challenge
The biggest challenge to the successful completion of the new theatres was the time at which the project took place. In 2020, Hospital Alemán completed the purchase of a comprehensive system of modular operating rooms from Karl Storz Company. Then the pandemic started and travel restrictions came into force. However, against all odds, the plan to build a surgical facility incorporating the latest technology continued.
Process
In the first stage, programming and design were developed remotely. The meetings were held online, where the client – Hospital Alemán – AFS Arquitectos, and the system provider, agreed on the way to meet various different needs.
In a second stage, the construction progressed through collaboration between the local and international personnel involved, and with the equipment supplier able to view progress via video. This also helped to resolve any installation issues. Then the materials and integration equipment arrived from Germany.
To cater for the distances between those in charge of this great project (part of the team was in Germany, another part in Brazil, and the work was being carried out in Argentina), weekly meetings were held to show the progress made. The supplier company subcontracted a local business to carry out the work, making its own staff from Germany available to train those ‘on the ground’. They stayed for a certain time, and then had to return. Thereafter, any issues were resolved through video calls
Despite some difficulties along the way, but always with perseverance, as a team we managed to successfully build this new modular and integrated system of state-of-the-art operating rooms
Maria Julia Souto
Maria Julia Souto graduated in Architecture at Buenos Aires University (Argentina) in 2012. After a journey of collaborations with architects and companies, she has acquired extensive design-build healthcare project experience at AFS Arquitectos.
She specialises in highly complex area development within healthcare buildings. Her key projects to date have included Sanatorio Finochietto (2014), Sanatorio Anchorena San Martín (2018), and, most recently, Hospital Alemán Torre Juncal II (2022).
Acknowledgment This article, titled ‘Innovative solutions for operating rooms’, first appeared in the IFHE Digest 2023. HEJ would like to thank the author, the Digest’s Editor, and the IFHE, for allowing its reproduction in slightly edited form here