ABSTRACT
The efficiency of the OR is one of the key indicators for the hospitals revenue.
Reduction of OR down time ,a perfect workflow and an ergonomic environment are just a a couple of items influencing this efficiency.

This presentation describes the current status and way of the OR design process and suggests new processes for planning and design the OR of the future.
Early involvement of users (engineers, doctors, nurses, technicians, etc.) in the pre-construction phase and possibilities and ways to have a streamlined and effective design process with all related groups involved is a main part of the presentation.

The conclusion of this presentation describes a scenario in which all partners of the project will face a win-win situation: The architects will have a decreasing number of drawings and less changes what makes them faster. The technicians can give appropriate input and the clinicians can create the environment they need to be efficient and effective in their tailored OR they like to work in.

This presentation is based on the design experience of more than 3500 ORs around the world and is not product related since it describes the design process from the very beginning

ABSTRACT
The new standard IEC 62353 is designed to be applied to the field:
« Recurent test and tests after repair of Medical equipment »
Applicable to all the Medical devices and Systems, before the first use, during the maintenance, inspection, regular tests and tests after repair.

We present a summary of the main articles. The paper deals with the common and different points of both standards, IEC606601 / IEC 62353 compared .We point out the new values and new limits for IEC 62353 , Earth Bond Test with 20 mA , Leakage current, etc

Methods, notions on direct, differential, alternative. Very fast way for the leaking current checking. Considerations are exposed on the future and changes of IEC 60601 standard to be compatible with the new IEC 62353.

Description of the compatibility of the Safety Testers and the instruments in the market that can work wit the new Standard
Guidelines for the standard application and procedures to confirm that after a repair the medical device still keeps its electrical safety parameters

ABSTRACT
New technologies have inspired radical changes in efficiency, quality and cost of modern operating theatres. These sites are, increasingly, filled up with a lot of different equipments and medical devices whose effective functioning is the basis of a successful business and a profitable investment in technology. Lately, there has been, as a result of actual needs and commercial inputs from companies producers of endoscope equipments among others, a proliferation of integrated systems aimed to improve the operating rooms efficiency , but in some cases many not coordinated investment were implicated , We think that a right approach to using modern operating rooms has to be based on standards of completeness considering all opportunities, and for this reason we’ll try to schematize functioning priorities from the point of view of the availability of equipments.
Integration and simplicity of use of equipment are essential concepts in places with many equipments and relatively few people who work with them .To improve the efficiency it is advisable that the users could start any function just by pushing a button.
Integrated operating rooms appears as a solution , connecting all equipment in the room and integrating commands so that the staff (even the doctor) can manage, using touch screen monitor (or remote control or voice command), the operation of various equipment .
We also take care of the efficient location of the room monitor (a wall, hanging on scialitica) as well as the integration of all signals of several available sources.

These principles have been applied to the new operating rooms of the Hospital of Rieti, which design is presented in the paper with a photographic report

ABSTRACT
It is the responsibility of clinical engineering practitioners and hospital technical management to develop maintenance policies and procedures at hospitals to ensure reliable and safe medical devices that contribute to patient safety. Internationally accepted standards like ECRI and the manufacturer’s recommendations are often used as reference to develop these procedures. In many instances the preventive maintenance and repairs are outsourced and over servicing is often applied because of the emphasis placed on a risk management approach.
Being a developing country, clinical engineering practitioners in South Africa have an important role to play in providing cost effective healthcare. Specialists in the various fields should take up the responsibility in striving for cost effective maintenance policies applicable to the South African healthcare environment
We will discuss current policies applied in South African hospitals. It will highlight the value of preventive maintenance programmes in ensuring safe equipment, but also indicate the cost implication of excessive preventive maintenance policies. Reliability centred maintenance can be applied successfully on a number of medical devices as an alternative to preventive maintenance. This paper will look at the criteria used in developing alternative maintenance protocols without creating risk to our patients.
The current shortage of skilled technical staff adds to the challenge to find cost effective maintenance. A balanced training ethic for clinical engineering staff members is essential in developing the ideal mix between in-house and outsourced work. Results and practical examples of savings achieved will be discussed

ABSTRACT
Modern health care is not thinkable without medical and information technology. There is a rapid growing market of devices dedicated to support diagnostic, therapeutic and rehabilitation procedures and purposes. But to avoid miss-investment and to meet requirements of hospitals, physicians, nurses and patient needs there have to be a systematic organizational approach to make a “best choice” and to establish a reliable IT-based service infrastructure .

To our experience it is extremely important not only to focus on efficacy of medical devices but also on efficiency, reliability and safety during the life-time of a system. Also failures and breakdowns have to be anticipated .
Strategic equipment management will miss its objectives if it focuses only on the single unit but takes not into account the surrounding “system of devices” and the overall equipment and treatment system. Any failure in the surrounding and overall system, any missing link in the operating scheme and networks may cause an equipment failure or breakdown.An overall strategic approach on equipment management eventually has to be based on an appropriate web-based knowledge-management system and controlling and specific equipment management-information tools.

Based on more than 25 years of experience in equipment planning, management, consulting and service business development the lecture will give an overview on objectives and tasks for Technical Service Centres , TSC

( Medical Equipment )
FRESH FOCUS ON MEDICAL EQUIPMENT PLANNING
Author : Ray Bielby – MIHEA, RN, MHSM –Australia
ABSTRACT
How medical equipment planning can encompass sustainability goals is explored in this article. The concept of sustainable development and management is not new in healthcare, but restraints on budget, the lack of champions, poorly developed green strategies and the unavailability of appropriate materials , generally mean that sustainable hospitals or healthcare environment have struggled to become a reality. This article hopes to answer this question

Abstract :From imaging to mini-invasive surgery
Authors : Jean-Marie MARGAS Ingénieur Biomédical CHU de Tours
Professeur Laurent SALOMON APHP


Evolution and revolution in urology surgical techniques: from open surgery to mini-invasive surgery –

The history of surgery is closely related to technological progress. In Greek, surgery means work done with the hands, and medical practice rapidly came to use instruments such as scissors, forceps etc.
The history of surgery can be broken down over several periods:
 The first involved individualisation of surgery within medical practice leading to the creation of the Royal Academy of Surgery in the 18th Century.
 The second relates to the three “A”s: the discovery of antisepsis and asepsis, anaesthesia and antibiotics, associated with the development of physiology and medical imaging, making all types of medical procedure possible. This period also saw the creation of biomaterials, the development of resuscitation techniques, transfusion and medicines, such as anticoagulants, immunotherapy and organ transplant.
 Finally the third saw the development of mini-invasive surgery: in 1986, Professor Mouret performed the first cholecystectomy by laparoscopy. This “second French Revolution” as it was named by the Anglo-Saxons, was based on the concept of a minimal approach to the musculo-aponeurotic wall, to create a working space by insufflation of a gas in the area in which surgery is to be carried out, thus improving post-operative care in terms of pain, bleeding and resumption of activity. Mini-invasive surgery came about through the development of new surgical instruments and new optical systems.
In urology specifically, technological progress has enabled mini-invasive surgery to develop. Calculi, initially treated by open surgery have been treated by per-cutaneous surgery, followed by extracorporeal lithotripsy and finally endourology using rigid then flexible uteroscopes and laser techniques. Surgery to correct prostatic hypertrophy today involves bipolar resection in saline and surgery on bladder tumours benefits from new contrast products such as Hexvix. Functional surgery is performed by percutaneous route with placement of suburethral tape. Ablation is generally carried out by laparoscopy, whether by transperitoneal or extraperitoneal route. This type of surgery can currently only be carried out by one route of access through which all instruments are inserted (NOTES System).
If the first stage involves surgeons avoiding having to place their hands in a patient’s abdomen, the second involves removing surgeons from the operating theatre. This is related to the development of robot assisted surgery in which the surgeon controls the 3-D operating field from a console, from where he is able to handle the instruments, which unlike the human hand, use the six degrees of movement. This type of surgery is mainly indicated in total prostatectomy.
So what is the next step? If the pharmaceutical industry does not replace the surgeons’ hands, change will come once again in the reduction of surgical injury by reducing the size of the cameras which will be “dropped” into the working space, by the development of medical imaging enabling closer views of lesions and their individual treatment by targeted therapies. As in urology, surgery is becoming an increasingly high-technology and highly-specific medicine. However, behind these technical developments it must not be forgotten that surgery involves work by a team comprising the surgeon, anaesthetist and nurse at the service of patients.