Infection Control Today - 07/2001: Technology is Revolutionizing SurgicalLighting

Technology is Revolutionizing SurgicalLighting
The digital age helps surgeons improve outcomes thanks to new lighting andrecording options

By Andrew P. Reding

Everyday surgeons make critical judgments about the treatment of their patients basedupon what they see in the surgical field. Has the entire malignancy beenexcised? Is the anastomosis complete? In an instant, surgeons gain criticalinformation and make pivotal decisions that affect the outcome of surgicalprocedures.

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 thetissue in the surgical field, hitting the retina, and turning into informationto be processed by the brain. Thus, the quality of lighting in the OR cangreatly 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 orin residency programs, but they are critical concepts in patient care. A HCWmust understand these concepts and set clear criteria to evaluate each of themany products on the market.

Narrowing the Field

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

HCWs should gather literature, meet with sales people, browse the exhibits ofthe medical meetings, and talk to peers about their experiences with surgicallighting. Leave no stone unturned, because the surgical lighting market isevolving and there are many options available. HCWs will live with new lightsfor 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 clinicalevaluations. The management of this evaluation is the critical step in thedecision 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 newinformation with which to make a decision. The lighting evaluation is more thansimply getting the lights into an operating room. Simultaneous evaluations mustbe done of all the products, which is not easy. Getting commitments from severalcompanies to hang their lights at the same time is challenging, but it ispossible. Just be clear about the desire to conduct simultaneous evaluations andmake it a criterion for inclusion in the evaluation process. HCWs will get muchclearer feedback from the evaluators when they can use the various productswithin a short period of time. Finally, promoting the evaluation and having themost vocal surgeons and nurses committed to participating in the evaluation iscrucial.

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 theopportunity to use all of the lights. This is the most challenging part of theprocess, as people often say they want to be part of the decision, but loseinterest over time and become less committed. Also, certain surgeons who arereluctant to move from their usual rooms must be convinced to work in otherrooms during the lighting evaluation. The bottom line is that unless HCWs arevigilant about managing this evaluation, the operating room director or thepurchasing department will be forced to make purchase decisions with inadequatefeedback. Inevitably, there will be dissenters, and the OR manager will wish heor she had the existing lights.

Integrated Ceiling Solutions

Most newly constructed or newly renovated operating rooms haveceiling-mounted power booms. While surgical lights and power booms can bepurchased from different vendors, the two product groups are closely tied to oneanother and most companies that sell lights also sell power booms. Many powerboom solutions are integrated with surgical lighting systems. For example, videomonitors can be attached to an arm that is part of the surgical lightingsuspension system. This gives the operating room additional utility from asingle mount in the ceiling.

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

Documentation and Control

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

In the digital age, many institutions are conducting digital documentation ofsurgical procedures. Still and video images are captured, displayed on monitorswithin the operating room, transmitted via local area networks, and madeavailable for a myriad of uses at the touch of a button. Capturing images fromopen surgery can be challenging with all of the people and equipment surroundingthe surgical field. For the lens to have the best view of the surgical field, itmust be placed above the patient, exactly where the surgical lights are. Sincethe view to the field is unobstructed, there is no better place to put a cameralens than in the surgical light. If digital documentation is in the plans, HCWsshould evaluate surgical lights that have the capability to house a high-qualitysurgical video camera.

Controlling the Devices

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

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

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