Number Of Door Openings Research Articles

Is there a need for new kitchen design? Assessing the adaptative capacity of space to enable circularity in multiresidential buildings

This paper aims to contribute to the development of spatial criteria for adaptive capacity, which is identified as one important factor for the transition towards more circular housing design. The paper focuses on the kitchen, as an important function of the home which is connected to large resource flows and is exposed to frequent renovations and replacements. This paper identifies spatial characteristics of the kitchen and evaluates their potential to accommodate circular solutions focusing on adaptive capacity. As a first step, previous literature on the spatial characteristics of kitchens and indicators that support adaptability is reviewed. These are then used to develop an analytical framework to assess the adaptive capacity and circularity potential of 3624 kitchens in contemporary Swedish apartments. A qualitative approach in combination with quantitative methods is employed to analyse the selected sample. The main contributions of this paper include its spatial analytical framework, its descriptive presentation of contemporary kitchen and apartment designs, and its adaptive capacity assessment of the studied kitchens. The results point out that although the over-capacity of the floor area of kitchens and apartments can have significance for adaptability, it is not the only determinative spatial characteristics. The windows' location and distribution, the number of door openings and traffic zones, the shafts’ location and accessibility from multiple rooms, the room typology and the kitchen typology can improve the adaptive capacity and circularity potential of kitchens and dwellings. The findings show that in contemporary floorplans advantageous design solutions connected to the identified spatial characteristics are not applied in a systematic way. Further research is necessary to define the exact measures of the individual spatial characteristics and their combined application in multiresidential floorplan design.

Influence of surgical team activity on airborne bacterial distribution in the operating room with a mixing ventilation system: a case study at St. Olavs Hospital

Operating rooms (ORs) have strict requirements regarding cleanliness. While existing standards concerning the ventilation and staff guidelines are theoretically sufficient to subvert the threats posed by micro-organisms within the room, there exist potential sources of contamination due to human activity around the area. Studies exploring this influence of human activity on distribution of micro-organism contamination in ORs have relied on manual observations, or indirect methods such as number of door openings. To utilize depth registration sensing technology to identify the activities of surgical staff and investigate their effect on the distribution of airborne micro-organism contamination in ORs. A mock surgical experiment was performed using a depth registration technique for the dynamic capturing of human presence and activity levels. Field measurements were carried out in one real OR to analyse its influence on the bacterial distribution in ORs with mixing ventilation system. Bacterial contamination levels tended to correlate with higher activity levels, albeit with some inconsistencies. The highest activity levels were around the surgical bed when the patient was placed, and around the instrument table during the surgical procedure. Locations with obstructions had the highest cfu densities, indicating that airflow patterns are important in such spaces. Our activity monitoring methods demonstrate a novel means of studying the influences of human activities in hospital rooms.

OR Traffic and Surgical Site Infections: A Quality Improvement Project.

Operating rooms are dynamic places with a lot of movement and people working as a concerted team. Operating room traffic can be necessary (eg, retrieving an unusual supply) or unnecessary (eg, a social visit). This quality improvement project aimed to reduce the amount of OR traffic to only necessary traffic and reduce the surgical site infection rates for the orthopedic ORs in a northern California community hospital. There were three principle interventions: door signs discouraging traffic, staff member relief in batches, and preference card review for accuracy. During the six-week post-intervention period, there were no reported surgical site infections for orthopedic procedures, and the standardized infection ratio decreased from 1.75 to 0 in 10 weeks. Operating room traffic decreased after implementation by 46.9%. The number of door openings per minute decreased from 1.96 per minute to 1.04 per minute at the project's conclusion. Staff members' awareness of OR traffic increased.

Evaluation of Air Contamination in Orthopaedic Operating Theatres in Hospitals in Southern Italy: The IMPACT Project.

Postoperative infections are a concern, especially in total knee and total hip arthroplasty. We evaluated the air quality in orthopaedic operating theatres in southeastern Italy to determine the level of bacterial contamination as a risk factor for postoperative infection. Thirty-five hospitals with operating theatres focused on total knee and total hip arthroplasty participated. We sampled the air passively and actively before surgeries began for the day (at rest) and 15 min after the surgical incision (in operation). We evaluated bacterial counts, particle size, mixed vs turbulent airflow systems, the number of doors, number of door openings during procedures and number of people in the operating theatre. We found no bacterial contamination at rest for all sampling methods, and significantly different contamination levels at rest vs in operation. We found no association between the number of people in the surgical team and bacteria counts for both mixed and turbulent airflow systems, and low bacterial loads, even when doors were always open. Overall, the air quality sampling method and type of ventilation system did not affect air quality.

Door openings in the operating room are associated with increased environmental contamination

Door openings in the operating room (OR) have been hypothesized to increase OR environmental contamination. This study measured average colony-forming units (CFU) in the OR as a function of door openings and other potentially important variables. Bacterial settle plates were placed inside and outside of laminar airflow (LAF) by both exit doors, on the instrument table, and on the back instrument table (if applicable) for 48 orthopedic and general surgery procedures. CFU data were paired to Staphylococcus aureus colonization status, door openings, surgery duration, time of day, OR location, number of staff, use of warming devices, temperature, and humidity. The number of door openings in the OR and surgery duration were significantly associated with increased CFU in the OR overall and outside of LAF. However, under LAF conditions, only the number of OR personnel was significantly associated with increased CFU.

The Influence of Traffic, Area Location, and Other Factors on Operating Room Microbial Load.

OBJECTIVE To determine how the movement of patients, equipment, materials, staff, and door openings within the operating room (OR) affect microbial loads at various locations within the OR. DESIGN Observation and sampling study. SETTING Academic health center, public hospital. METHODS We first analyzed 27 videotaped procedures to determine the areas in the OR with high and low numbers of people in transit. We then placed air samplers and settle plates in representative locations during 21 procedures in 4 different ORs during 2 different seasons of the year to measure microbial load in colony-forming units (CFU). The temperature and humidity, number of door openings, physical movement, and the number of people in the OR were measured for each procedure. Statistical analysis was conducted using hierarchical regression. RESULTS The microbial load was affected by the time of year that the samples were taken. Both microbial load measured by the air samplers and by settle plates in 1 area of the OR was correlated with the physical movement of people in the same area but not with the number of door openings and the number of people in the OR. CONCLUSIONS Movement in the OR is correlated with the microbial load. Establishing operational guidelines or developing OR layouts that focus on minimizing movement by incorporating desirable internal storage points and workstations can potentially reduce microbial load, thereby potentially reducing surgical site infection risk. Infect Control Hosp Epidemiol 2018;39:391-397.

Room Traffic in Orthopedic Surgery: A Prospective Clinical Observational Study of Time of Day.

High rates of operating room (OR) traffic may contribute to surgical air contamination and surgical site infections (SSIs). The purpose of this study was to evaluate room traffic patterns in orthopedic implant procedures to determine the frequency of door openings and if time of day had an effect on room traffic. In 2015, OR traffic was assessed in orthopedic implant cases. Room traffic was reported as the number of door openings per minute. Counts of how many people were present in the operating room were noted in 5-minute intervals from the time of sterile case opening to dressing placement. Operative cases were observed and categorized into 3 periods (6:00-9:59, 10:00-13:59, and 14:00-17:59) to assess if time of day affected room traffic. Forty-six cases were observed for the present study. Among all cases, the mean room traffic rate was 35.2 openings per hour (SD, 10; range, 13.2-60.8). One-way analysis of variance revealed no statistically significant difference among groups (6:00-9:59 [n = 29], 10:00-13:59 [n = 10], and 14:00-17:59 [n = 7]) as it relates door openings per minute (room traffic rate) (P = 0.9237) or mean number of people in the OR (P = 0.3560). Pearson correlation revealed no correlation between case start time and room traffic rates (P = 0.6129, r2 = 0.0059) or between case start time and mean number of people in the OR (P = 0.3435, r2 = 0.0214). Room traffic rates and mean number of people in the OR do not correlate with time of day of case in orthopedic implant procedures.

Operating Room Traffic Increases Aerosolized Particles and Compromises the Air Quality: A Simulated Study

BackgroundStrategies to prevent bacterial fallout and reduce particle count in the operating room (OR) are key components of preventing periprosthetic joint infection. Although OR traffic control is an important factor, a quantitative study has not been performed to investigate the influence of personnel and door opening on OR air quality. This simulated study aimed to examine the influence of these 2 factors on particle density in OR with and without the laminar air flow (LAF). MethodsBoth experiments took place within an empty OR of an arthroplasty unit equipped with an LAF system. First, the number of particles in the air was counted using a particle counting apparatus while 9 persons entered the room, one every 15 minutes. Second, the door was opened and closed starting with zero door openings per minute and increasing to 4 in 15-minute increments. Both experiments were performed once with the LAF turned on and once without. ResultsThe number of personnel in the OR and the number of door openings per minute correlate with the density of particles. Both relationships were significantly reduced by turning the LAF on (correlation coefficients <0.4). With the LAF being turned on, the particle density per person decreased from 211.19 to 18.19 particles/ft3 (P < .001) and the particle density per rate of door openings declined from 117.80 to 1.90 particles/ft3 (P = .017). ConclusionThis study confirms that personnel and door opening are a major source of particles in the OR air. Controlling traffic is critical for reduction of particles and is likely to be a key preventative strategy in reducing periprosthetic joint infection. LAF is protective against the negative influence of number of people and door openings.

Operating room team member role affects room traffic in orthopaedic surgery: a prospective observational study

Background: Operating room (OR) traffic is an increasing topic of concern for potential risks of surgical site infections (SSIs). We evaluated room traffic rates during orthopaedic surgery cases to better understand how OR team member roles contribute to room traffic. Our hypothesis was that OR traffic differs among team member groups. Methods: We evaluated 46 orthopaedic surgery cases involving implantation of a device at an academic medical center during the summer of 2015. Room traffic rates were recorded as the number of door openings per minute in each case. OR team member groups were defined as follows: Group (A) charge nurse, nurse, scrub technician, scrub technician student; (B) anesthesiology attending physician, anesthesiology resident, anesthesiology medical student, certified nurse anesthetist; (C) orthopaedic surgery attending, orthopaedic surgery resident, orthopaedic surgery medical student; (D) medical sales representative/vendor; (E) radiology technician. Results: The number of door openings ranged from 48 to 259 (mean 127±47). The overall mean room traffic rate per minute per case ranged from 0.2193-1.014 (mean 0.5856±0.1663). Operative length ranged from 90–521 min (mean 226±89.1). There was a statistically significance difference between the median room traffic rate per minute per case by different group (A, B, C, D, and E) types (χ 2 (4) =127.085, P=0.0001). Conclusions: Room traffic rates and number of door openings per case are different among different OR team member groups. Better understanding of room traffic characteristics allows for strategic intervention to decrease room traffic among team members in each group.

A Smart Sensor Node for the Internet-of-Elevators—Non-Invasive Condition and Fault Monitoring

The signal processing scheme of a smart sensor node for the Internet-of-Elevators is presented. The sensor node is a self-contained black box unit only requiring power to be supplied, which enables a cost efficient way to modernize existing elevator systems in terms of condition monitoring capabilities. The sensor node monitors the position of the elevator using an inertial navigation system in conjugation with a simultaneous localization and mapping framework. Features reflecting the elevator system’s operation and health condition are calculated by evaluating the ride quality parameters defined by the ISO 18738-1 standards, the vibration versus frequency spectrum, and the vibration versus position spectrum. Abnormal stops are identified by detecting decelerations that deviate from the typical deceleration pattern of the elevator or when the stopping position of the elevator does not match the learned floor levels. Furthermore, the condition of the door system is monitored by tracking the magnetic field variations that the motion of the doors creates; the number of door openings and the time required for the doors to close are estimated. The capability and performance of the blacksignal processing scheme are illustrated through a series of experiments. The experiments show, inter alia , that using low-cost sensors similar to those in a smartphone, the position of the elevator car can, with 99.9% probability, be estimated with an error of less than 1 m for travels up to 43 s long. The experiments also indicate that small degradations in the doors’ closing time can be detected from the magnetic field measurements.

The Effect of Door Openings on Numbers of Colony Forming Units in the Operating Room during Hip Revision Surgery.

The aim of this study was to investigate the effect of door opening rates on air quality in the operation room during hip revision surgery by measuring the number of colony forming units per cubic meter (CFU/m(3)). During 70 hip revision operations the number of CFU/m(3) was measured at four time points. Factors that may influence air quality were recorded, including the number of persons present, duration of surgery, and door opening rates. The measured CFU/m(3) was dichotomized as either acceptable (≤20 CFU/m(3)) or not acceptable (>20 CFU/m(3)). To determine whether door openings were associated with CFU/m(3) values, we used generalized linear mixed models to model the dichotomized repeatedly measured CFU/m(3) values. The median number of door openings per operation was eight (range, 0-72), the median duration of surgery was 145 min (range, 60-285), and the median number of persons present during surgery was eight (range, 5-10). Adjusted for number of persons in the operation room and duration of surgery, the number of door openings per operation was associated (odds ratio [OR] 1.05 [95% confidence interval {CI} 1.02-1.09]; p = 0.003) with an unacceptable number of CFU/m(3). In conclusion, a substantial association between number of door openings and an unacceptable number (>20) of CFU/m(3) was found. Adjusted for number of persons in the operation room and duration of surgery, every door opening increased the odds of unacceptable CFU/m(3) values by 5%. Number of persons present during surgery and duration of surgery were not related to CFU/m(3).

Operating theatre ventilation systems and microbial air contamination in total joint replacement surgery: results of the GISIO-ISChIA study

Recent studies have shown a higher rate of surgical site infections in hip prosthesis implantation using unidirectional airflow ventilation compared with turbulent ventilation. However, these studies did not measure the air microbial quality of operating theatres (OTs), and assumed it to be compliant with the recommended standards for this ventilation technique. To evaluate airborne microbial contamination in OTs during hip and knee replacement surgery, and compare the findings with values recommended for joint replacement surgery. Air samplings were performed in 28 OTs supplied with unidirectional, turbulent and mixed airflow ventilation. Samples were collected using passive sampling to determine the index of microbial air contamination (IMA). Active sampling was also performed in some of the OTs. The average number of people in the OT and the number of door openings during the sampling period were recorded. In total, 1228 elective prosthesis procedures (60.1% hip and 39.9% knee) were included in this study. Of passive samplings performed during surgical activity in unidirectional airflow ventilation OTs (U-OTs) and mixed airflow OTs (M-OTs), 58.9% and 87.6% had IMA values >2, respectively. Of samplings performed during surgical activity in turbulent airflow OTs (T-OTs) and in turbulent airflow OTs with the surgical team wearing Steri-Shield Turbo Helmets (TH-OTs), 8.6% and 60% had IMA values ≤ 2, respectively. Positive correlation was found between IMA values and the number of people in the OT and the number of door openings (P < 0.001). In addition, correlation was found between active and passive sampling (P < 0.001). These findings challenge the belief that unidirectional systems always provide acceptable airborne bacterial counts.

Computer simulation with TRNSYS for a mobile refrigeration system incorporating a phase change thermal storage unit

This paper presents a new TRNSYS model of a refrigeration system incorporating phase change material (PCM) for mobile transport. The PCTSU is charged by an off-vehicle refrigeration unit and the PCM provides cooling when discharging and the cooling released is utilized to cool down the refrigerated space. The advantage of this refrigeration system compared to a conventional system is that it consumes less energy and produces significantly lower greenhouse gas emissions. A refrigeration system for a typical refrigerated van is modelled and simulations are performed with climatic data from four different locations. The main components of the TRNSYS model are Type 88 (cooling load estimation) and Type 300 (new PCTSU component), accompanied by other additional components. The results show that in order to maintain the temperature of the products at −18°C for 10h, a total of 250kg and 390kg of PCM are required for no door opening and 20 door openings during the transportation, respectively. In addition, a parametric study is carried out to evaluate the effects of location, size of the refrigerated space, number of door openings and melting temperature of the PCM on the thermal performance.

Timing of C-Arm Drape Contamination

Surgical site infection remains a concern in orthopedic surgery, and contamination of C-arm covers is a potentially modifiable risk factor. A single-cohort study was conducted using 30 consecutive patients undergoing operative fracture fixation. Cultures were obtained from the C-arm cover after initial draping and every 20 min thereafter. The total number of persons in the operating room (person-hours/h of study time) and the number of door openings were recorded. The C-arm position changes and the time to contamination were monitored. The median time from the start of the operation to contamination was 20 min. There was a 17% contamination rate on initial draping, 50% at 20 min, 57% at 40 min, and 80% by 80 min. The C-arms in five cases were not contaminated during the surgery. Time to contamination correlated significantly with lateral position changes (correlation [r]=0.64; p=0.003) but was not related to C-arm position changes (r=0.22; p=0.34), number of door openings (r=0.20; p=0.39), or person-hours/h (r=0.04; p=0.85). Contamination of the C-arm drape occurs often and early during surgery for orthopedic fractures. We recommend minimal contact with the C-arm to avoid contamination of the surgical field.