Infection Control Today - 07/2001: Technology is Revolutionizing Surgical Lighting

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Technology is Revolutionizing Surgical Lighting
The digital age helps surgeons improve outcomes thanks to new lighting and recording options

By Andrew P. Reding

Every day surgeons make critical judgments about the treatment of their patients based upon what they see in the surgical field. Has the entire malignancy been excised? Is the anastomosis complete? In an instant, surgeons gain critical information and make pivotal decisions that affect the outcome of surgical procedures.

What a surgeon sees in the operative field is actually the result of light (measured in wavelengths) emanating from a surgical light, reflecting off of the tissue in the surgical field, hitting the retina, and turning into information to be processed by the brain. Thus, the quality of lighting in the OR can greatly aid or hamper a surgeon's abilities.

When buying surgical lights, there are three things a healthcare worker (HCW) should do:

  • Carefully evaluate all of the characteristics of the light source and perform a comprehensive and objective evaluation.
  • Consider how your surgical lights could integrate with other ceiling-mounted equipment within the room such as lightweight monitor supports or power booms, also known as ceiling pendants.
  • Determine how your surgical lights and their accessories will function within your strategy for image documentation and device control in the operating room.

Conducting an Objective Evaluation

Depth of field, color temperature, foot candles, lux, color rendering index, field diameter, visible light, infrared rays, maneuverability, heat filtration, and reserve illumination--they don't address these subjects in nursing school or in residency programs, but they are critical concepts in patient care. A HCW must understand these concepts and set clear criteria to evaluate each of the many products on the market.

Narrowing the Field

The first thing a HCW needs to do when evaluating surgical lighting is to narrow the field to a few companies that will evaluate the operating rooms in need.

HCWs should gather literature, meet with sales people, browse the exhibits of the medical meetings, and talk to peers about their experiences with surgical lighting. Leave no stone unturned, because the surgical lighting market is evolving and there are many options available. HCWs will live with new lights for a long time, so they should make sure the search is not limited.

Promote and Pre-Plan the Evaluation

When the field has been narrowed it is time to arrange for clinical evaluations. The management of this evaluation is the critical step in the decision process. If a HCW does not aggressively manage the clinical evaluation, he or she will spend two to four weeks looking at lights and will have no new information with which to make a decision. The lighting evaluation is more than simply getting the lights into an operating room. Simultaneous evaluations must be done of all the products, which is not easy. Getting commitments from several companies to hang their lights at the same time is challenging, but it is possible. Just be clear about the desire to conduct simultaneous evaluations and make it a criterion for inclusion in the evaluation process. HCWs will get much clearer feedback from the evaluators when they can use the various products within a short period of time. Finally, promoting the evaluation and having the most vocal surgeons and nurses committed to participating in the evaluation is crucial.

Managing the Evaluation

Each staff member who uses the light should complete an evaluation form. Surgeons and staff should be rotated through the rooms so that they have the opportunity to use all of the lights. This is the most challenging part of the process, as people often say they want to be part of the decision, but lose interest over time and become less committed. Also, certain surgeons who are reluctant to move from their usual rooms must be convinced to work in other rooms during the lighting evaluation. The bottom line is that unless HCWs are vigilant about managing this evaluation, the operating room director or the purchasing department will be forced to make purchase decisions with inadequate feedback. Inevitably, there will be dissenters, and the OR manager will wish he or she had the existing lights.

Integrated Ceiling Solutions

Most newly constructed or newly renovated operating rooms have ceiling-mounted power booms. While surgical lights and power booms can be purchased from different vendors, the two product groups are closely tied to one another and most companies that sell lights also sell power booms. Many power boom solutions are integrated with surgical lighting systems. For example, video monitors can be attached to an arm that is part of the surgical lighting suspension system. This gives the operating room additional utility from a single mount in the ceiling.

Before making a decision about which products to bring in for clinical evaluation, HCWs should make sure that all of the companies evaluated have acceptable ceiling-mounted power boom product offerings. They should offer heavy-duty power booms with 200-plus pound load capacities and the capability to deliver medical gases and electrical services. They should offer lightweight arm systems to support CRT and flat panel monitors, as well as an effective boom-mounted smoke evacuation system. Most importantly, they should offer planning and design services to assist in installing the equipment in the room, and they should demonstrate their experience in procedure-based planning and design of operating rooms. A company with all of these characteristics plus a high-quality surgical light, will help you create a more efficient work environment in your facility's operating rooms.

Documentation and Control

Most of the lighting systems on the market today have two abilities that only the most advanced lighting systems had five years ago. High quality, integrated surgical cameras for video and still-image documentation were just evolving five years ago and control of lighting and camera functions via voice or other integrated control systems were just a dream. Now they are both part of the rapidly changing surgical lighting market.

In the digital age, many institutions are conducting digital documentation of surgical procedures. Still and video images are captured, displayed on monitors within the operating room, transmitted via local area networks, and made available for a myriad of uses at the touch of a button. Capturing images from open surgery can be challenging with all of the people and equipment surrounding the surgical field. For the lens to have the best view of the surgical field, it must be placed above the patient, exactly where the surgical lights are. Since the view to the field is unobstructed, there is no better place to put a camera lens than in the surgical light. If digital documentation is in the plans, HCWs should evaluate surgical lights that have the capability to house a high-quality surgical video camera.

Controlling the Devices

Just as Microsoft Windows provides one point of control for the software and hardware on your desktop computer, there are operating systems for the devices in the operating room. Among the benefits of such systems is the control of apparatus from a central point so that the circulating nurse is not required to go to each individual device to adjust it or check its status. Also, surgeons can control the devices from within the sterile field by touching a sterile control panel or by issuing voice commands. Surgical lights and surgical camera systems are included in these systems, which are available now. These control systems increase efficiency in the surgical suite, which saves time and money for the hospital or surgery center.

Andrew P. Reding is the director of marketing for Berchtold Corporation of Charleston, SC.

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