Department: Cancer Center

As the leading hospital in cancer care, the 500-bed-capacity NCC Hospital provides the general
public with the highest quality of care. Greater effectiveness in therapy and improved patient
quality-of-life can be attributed to, among others, the state-of-the-art equipment. The hospital
offers IMRT(Intensity Modulated Radiation Therapy), Tomotherapy, PET/CT, CT simulation,
Gamma cameras, Coincidence Cameras and Superconducting MRI. Moreover, the NCC
introduced the proton therapy system with a cyclotron capable of generating a 230-MeV proton
beam at its Proton Therapy Center in march 2007. As the first and only establishment in Korea
equipped with this most advanced radiation therapy facility, the NCC hospital will undoubtedly
be able to better serve the various needs of cancer patients in Korea.

Tomotherapy
Tomotherapy looks like a CT scanner because it is a MV-CT scanner, allowing efficient 3D CT
imaging to be used for ensuring the accuracy of treatment for every patient, every day. This is
what is called the *Image-Guided Radiation Therapy (IGRT). IGRT allows doctors to better
target the cancer while avoiding nearby healthy tissue. For this unique designed gantry, we can
deliver the intensity-modulated radiation Therapy (IMRT) from all angles around the patient.
Tomotherapy was designed so that highly-precise treatment plans could result in more effective
treatment deliveries, with minimized side effects for patients.
What is IGRT (Image Guided Radiation Therapy) technology
IGRT assists in delivering radiation therapy to cancerous tumors better than before. This is very
useful since tumors can move between treatments due to differences in organ filling or
movements while breathing and daily setup error. IGRT involves conformal radiation treatment
guided by specialized imaging tests, such as CT scans, MVCT scans, ultrasound or X-rays.
These tests are done in a treatment room just before a patient receives daily radiation therapy
treatment. We can support the IGRT technology by using MVCT image in Tomotherapy. Also,
Proton machine have orthogonal two X-ray imagers for precise cancer targeting.

Linear Accelerators (Varian Clinac 600CD, 2100CD,21EX series)

We also have 4 linear accelerators. This machine can make make high& low energy high & low
energy X-ray (photon) and electron for cancer treatment. Additionally, 21EX Clinac can deliver
Intensity-Modulated Radiation Therapy (IMRT). IMRT technique is the last trend in the world. It
can modulate the radiation intensity at the tumor shape. The modulation increases cure rate with
minimized side effects for patients.
How to make beam-shapes for each patient
(Multi-leaf collimators systems and 3-Dimentional conformal technology ) (Intensity Modulated
Radiation Therapy) In principle, every cancerous tumor has its own shape. Before the reatment,
we use computers and special imaging techniques such as CT, MR or PET scans to show the
size, shape and location of the tumor as well as surrounding organs.
Oncologist can then precisely tailor the radiation beams to the size and shape of your tumor with
multi-leaf collimators.
We can provide 3mm, 5mm, 10mm sized multi-leaf collimators(MLC). Specially, 3mm sized
(micro-size) MLC is dedicated for stereotactic radio surgery.
Intensity modulated radiation technique (IMRT) can modulate beam intensity during irradiation.
It helps to save healthy tissue and give enough dose to tumor. As a result, we expect IMRT has
much higher curable rate than 3D conformal radiation therapy.

Conventional Simulator AND CT- simulator

We also have the 4 linear accelerators. This machine can make the high & low energy X-ray
(photon) and electron for cancer treatment. Additionally, 21EX Clinac can delivers Intensity-
Modulated Radiation Therapy (IMRT). IMRT technique is the last trend in the world. It can
modulate the radiation intensity at the tumor shape. So increase the cure rate with minimized side
effects for patients.

How to deliver beam to the target precisely in moving organs

(4D CT and Real-time Position Management Systems )
Breathing causes some organs keep going move during a treatment (ex. Lung, Upper abdominal
Sites). In turn, we trace patient’s respiration cycles and make the treatment plan by reflecting that
data in some cases. 4D-CT and Real-time Position Management Systems (RPM) allows
clinicians to correlate tumor position in relation to the patient's respiratory cycle.
4D-CT provides clean images for planning so that clinicians can visualize the target more clearly
with fewer of the image artifacts associated with respiratory motion.
This system also helps to minimize dose to healthy tissue during the radiation therapy. In
addition, we have GE high speed 4-D CT scanner and Varian RPM systems that are widely used
in the world.

What is the Brachytherapy?

Brachytherapy (from the Greek word brachy, meaning "short-distance"), also known as internal
radiotherapy or sealed source radiotherapy, is a form of radiotherapy where a radiation source is
placed inside or next to the area requiring treatment.
Brachytherapy is commonly used as an effective treatment for cervical, prostate, breast, and skin
cancer and can also be used to treat tumors in many other body sites.
A key feature of brachytherapy is that the irradiation only affects a very localized area around the
radiation sources. We have high-dose rate brachytherapy machine from Neucletron. It is armed
with high-dose rate radiation source (Ir-192) which allows patient to be treated as outpatient-
based.

Positron Emissing Tomograph Computed Tomography (PET-CT)

PET-CT is a medical imaging device which combines in a single gantry system both a Positron
Emission Tomography (PET) and an x-ray Computed Tomography, so that images acquired
from both devices can be taken sequentially, in the same session from the patient and combined
into a single superposed (co-registered) image. Thus, functional imaging obtained by PET,
which depicts the spatial distribution of metabolic or biochemical activity in the body can be
more precisely aligned or correlated with anatomic imaging obtained by CT scanning. Two-
and three- dimensional image reconstruction may be rendered as a function of a common
software and control system.
Magnetic Resonance Imaging (MRI)

MRI is primarily a medical imaging technique most commonly used in radiology to visualize
detailed internal structure and limited function of the body. MRI provides much greater contrast
between the different soft tissues of the body than computed tomography (CT) does, making it
especially useful in neurological (brain), musculoskeletal, cardiovascular, and oncological
(cancer) imaging. Unlike CT, it uses no ionizing radiation, but uses a powerful magnetic field to
align the nuclear magnetization of (usually) hydrogen atoms in water in the body. Radio
frequency (RF) fields are used to systematically alter the alignment of this magnetization,
causing the hydrogen nuclei to produce a rotating magnetic field detectable by the scanner. This
signal can be manipulated by additional magnetic fields to build up enough information to
construct an image of the body.
64-Channel Computed Tomography (CT)
The 64-Channel CT embodies completely the philosophies of sense and simplicity applied to more
effective patient care. With a range of new and targeted dvancements, including low-dose cardiac
imaging, 3D volume software and expanded portal capabilities, this system takes the raw capabilities of
volume imaging and makes them work harder for patients by making the physician’s work easier. This
system can expand clinical boundaries in cardiac, pulmonary, trauma, and pediatric imaging.
 Department: Accident and Emergency

Pdf file saved.

Department : Cardiology
The Department of Cardiology provides state-of-the-art investigation facilities like:

 Echocardiogram
 Echo Color Doppler
 Stress Test (TMT)
 Holter monitor
 Electrophysiological Study (EPS) & Ablation
 Electrocardiogram (ECG)
 MRI
 Chest x-ray
 Lab tests

INTERVENTIONAL CARDIOLOGY
Advanced Interventional Cardiology procedures are provided by the department in the hospital’s ultramodern Cath Lab. Common
procedures performed include:

Due to its self-contained design, Micra which is 93% smaller than conventional pacemakers, can be placed in the heart through a
vein in the leg, leaving no incision scars while eliminating potential medical complications from wires running in the heart.
 Laser angioplasty
 CT Coronary angiography
 Peripheral angiogram & angioplasty (carotid, subclavian, lilac femoral, renal, etc.)
 Radial angiography & angioplasty
 Directional coronary artery stenting
 Rotablation
 Bradycardia pacing
 Coronary artery stenting
 Intra-vascular ultrasound
 Balloon valvuloplasty
 Non-surgical closure of holes in the heart such as ASD, VSD and PDA
 Pacemaker implant/ ICD/ CRT implant

EMERGENCY CARDIAC CARE

For patients with emergency conditions like stroke, heart attack or heart failure, the hospital represents a coordinated effort by its
24-hour Accident & Emergency Centre, as well as medical, nursing and allied health staff to ensure that patients go through
timely treatment and monitoring according to clinical guidelines. Our emergency services offer round-the-clock ventilator and
life support equipped ambulances with trained paramedic team on site. Emergency patients are sent directly to Coronary Care
Unit (CCU) or Cath Lab (as needed). For more information on our emergency services and facilities, please click  Accident &
Emergency Centre.

CARDIO-PULMONARY REHABILITATION
Patients are provided with specialized out-patient and in-patient rehabilitation services through our Physical Medicine &
Rehabilitation Centre, and are offered comprehensive services and care of the highest quality. We have expert Physical Medicine
& Rehabilitation Consultant who supervises the patient’s rehabilitation through a wide range of therapies, including occupational
therapy and physiotherapy. For more information on our Physical Medicine & Rehabilitation services and facilities, please
click Physical Medicine & Rehabilitation Centre.  .

IMPORTANT POINTS ABOUT

TESTS/PROCEDURES/SURGERIES, YOUR REPORTS &
BILLING ENQUIRIES
 Tests/Investigations:
 To schedule a test/investigation, please call the relevant OPD front desks.
 Your lab investigation samples are to be deposited in the Sample Collection
Room located in the hospital’s atrium, which is open on working days (Saturday-Thursday)
from 7.00 am to 10:00 pm, and on Fridays and holidays from 7.00 am to 3.00 pm.
 Your investigation reports can be collected from Report Delivery Room by
showing the receipt of payment. The hospital shall not be responsible for reports not
collected within 30 days after the tests were done. Report Delivery Room is also located in
the hospital’s atrium, and is open on working days (Saturday-Thursday) from 8.00 am to 8.30
pm, and on Fridays and holidays from 9.00 am to 5.00 pm.
 You will not be able to collect your investigation reports without your receipt
of payment. If you have lost your receipt, you may collect a duplicate copy from our Billing
Executives (Corporate Desk, Atrium – level 1).
  You can request duplicate copy of your investigation reports from the Report
Delivery Room, inclusive of BDT 100 additional charge.
 Procedures & Surgeries:
 If you are interested in undergoing a procedure or surgery, please see our
relevant Consultant first.
 To search for a Consultant, go to Find a Consultant page and for
appointments, go to Make an Appointment page.
 In-patient Reports
 A Discharge Summaryis provided to a patient upon his/her discharge from the
hospital. A discharge summary is a summary of the events during hospitalization of the
patient. It outlines the patient’s chief complaint, the diagnostic findings, the therapy
administered and the patient’s response to it, and recommendations on discharge.
 To request for detailed in-patient medical reports or to make an insurance
claim, refer to our Medical Report page.
 Fo

A typical Hospital has OPD, IPD, Emergency/ Casualty, Pharmacy, Laboratory and Imaging
departments, OT, CSSD, ICU departments (Read for basic common equipment used in a
hospital). For a Cardiac Specialty, in addition to regular equipment required for the various
departments in the hospital, the following equipment are required, based on the case mix the
hospital wishes to handle. A typical Cardiac Hospital would have – a Cath Lab, Cardio Vascular
Thoracic Surgery (CVTS) ORs, EP Lab, Cardiac ICU, Physiotherapy & Rehabilitation and
specific diagnostic equipment.

DIAGNOSTICS & IMAGING

ECG, Echo, Ultrasound and Spirometer are the most common/basic diagnostic equipment
available in all cardiac hospitals. Typical diagnostic equipment needed and related procedures
that may be done in a cardiac facility are as follows:
 ECG machine

 Electrocardiogram (ECG) for 12-lead resting, ambulatory and Stress ECG

 Echocardiography (Cardiac ultrasound) for transthoracic echocardiography (2D, 3D and Doppler
echo), Contrast echocardiography, Transesophageal echocardiography, Stress echocardiography
etc.
 Ultrasound – investigations of the blood vessels in the neck, arms and legs
 Spirometry to help diagnose and monitor certain lung conditions by measuring how much air
one can breathe out in one forced breath.
 Cardiac CT for non-invasive angiography or vascular imaging
 Cardiac MRI
 TMT (Treadmill Test/ Stress Test system)

CATHETERIZATION LAB

The most basic equipment required in a cardiac unit is the Cath Lab consisting of Angiography
X-Ray system. All other advanced systems are used less frequently today in India and their usage
depends on the case load and complexity being handled in the hospital.

 Cath Labs – A catheterization laboratory or cath lab is an examination room in a hospital or clinic
with diagnostic imaging equipment used to visualize the arteries of the heart and the chambers
of the heart and treat any stenosis or abnormality found. Cath Labs are commonly used for
coronary angiography and angioplasty procedures. Popular makes and models in Cath Labs are
Philips Allura Xper FD20/10, Philips Allura FC 9, FD 10, Siemens Artis family (Artis Pheno, Axiom
Artis, Artis Z, Artis U), Toshiba Infinix 8000, GE Innova, Optima and Discovery family products.
 Optical Coherence Tomography

 Intravascular ultrasound (IVUS) for the sonographic visualization or OCT (Optical Coherence
Tomography) for Optical Visualization of coronary stenosis. Main IVUS makers are Boston
Scientific, Volcano Therapeutics and Terumo. Abbots (St Jude Medical) OCT is popular.
 Intracoronary pressure measurements or Fractional Flow Reserve (FFR) using pressure wires,
which is used as an assessment of the severity of coronary stenosis. Cardiac CTs are also getting
popular for FFR measurements in a non-invasive manner. Both GE and Siemens have Cardiac
CTs.
 Ablation devices such as Excimer laser for the removal of scar tissue as part of device lead
extraction procedures involving pacemakers and ICD devices or Rotablator for atherectory (An
atherectomy is a procedure that utilizes a catheter with a sharp blade on the end to remove
plaque from a blood vessel)
 Electrophysiology systems for the invasive diagnosis and treatment of cardiac arrhythmias
 3D mapping systems allowing precise visualization and 3D guidance during procedures to treat
complex cardiac arrhythmias and pulmonary vein isolation
 Robotic navigation system used in the treatment of complex cardiac arrhythmias and pulmonary
vein isolation
 Fibrillator

 
 Heart & Lung machine

CVTS – OPERATING ROOMS

 Cardiopulmonary bypass – Heart and lung machine or Mini extracorporeal circuit

cardiopulmonary (MECC) bypass machine
 Intra-aortic balloon pump (IABP)
 OT Table, OT Light, Anesthesia workstation and Cautery machine

INTENSIVE CARE UNIT

 Ventilators
 Patient monitors
 Hemodynamic monitoring and management
 Dialysis
 Defibrillator

PHYSIOTHERAPY & REHABILITATION

Physiotherapy involved in rehabilitation of Cardiac patient post procedure may involve – Manual

therapy and massage, Hot packs and wraps, Hydroelectric bath, massage, Ultrasound therapy,
Breathing exercises as well as Treatment on the traction/suspension table.

Posted in CardiologyTagged Cardiology, cath lab, CVTS, defibrillator, ECG

machine, Echocardiography, heart and lung machine, IABP, IVUS, OCT, Rotablator, Ultrasound, used
medical equipment

Post navigation

Department: Dialysis and Kidney

 The different options available for patients of end-stage renal disease (ESRD) include dialysis
(hemodialysis or peritoneal dialysis) or kidney transplantation . Dialysis helps to remove the excess
waste products (including urea and creatinine), fluid, and salt from the body.
Hemodialysis apparatus includes:

 Dialyzer;
 Dialysis solution (dialysate);
 Tubing for the transport of blood and dialysis solution; and
 Hemodialysis machine to power
Dialyzers consist of polyurethane capsule or shell, within which
hollow fibers or parallel membrane plates are suspended. The fibers or plates function as a
semipermeable membrane across which blood and dialysate flow. Solutes move across the
membrane along a concentration gradient (diffusion – smaller molecules) and solvent drag
(convection – larger molecules) between the patient’s intravascular compartment and the dialysis
fluid. Hemodialysis cleanses the blood mainly by diffusion technique. Fluid removal occurs via a
hydrostatic pressure gradient across the dialyzer membrane, which is generated by
the dialysis machine.
Though in most HD units single usage of the dialyzer is preferred as it reduces the risk of infection
and improves the efficiency of dialysis, however, due to cost implications including reverse osmosis,
deionization resins, and activated charcoal (RO system).

Dialyzer synthetic tubing (arterial line) carries blood from the arteriovenous access to the dialyzer
(via dialyzer inlet), whereas a venous line simultaneously carries dialyzed blood (via dialyzer outlet)
back to the patient.
Dialyzer machine includes a blood pump to move blood between patient and dialyzer, a delivery
system to transport dialysis solution, and monitoring devices. Pressure monitors, guard against
excessive suction of blood from, and excessive resistance of blood return to, the patient’s vascular
access site. Additional quintessential monitoring devices in the machine include an air detector and
air trap device to prevent air from entering the circuit, solute concentrate measurement device,
temperature sensor, and dialysate urea sensor.
Hemodiafiltration (HDF) is a blood purification method that incorporates a convective, adsorptive-
type driving force (with a specially designed filter for more solute removal) in addition to diffusional
type. The transmembrane pressure (maintained by a suction pump) causes patient’s plasma to flow
across the membrane, pulling large-molecular-weight uremic toxins across the membrane as well.
HDF requires the addition of a purified or sterile substitution fluid to be infused back (pre- or post-
dialysate) into the blood (via a pump connected to the external dialysate circuit) to replace the
outflowing uremic plasma water.
Advantages over standard HD. Enhanced middle- or large- molecule uremic solute clearance,
better maintenance of blood pressure and hemoglobin, improved phosphorous clearance, lesser
chances of infection as HDF uses ultrapure water, higher clearance of cytokines and other
inflammatory mediators, improvement of nutritional parameters of the patient. Retrospective studies
have also indicated a survival and cardiovascular benefit of HDF over HD.
Disadvantages. In 4 hours of HDF, an extra 30 L of replacement fluid is infused directly to the
patient (versus HD). HDF is at least 1.5 times more expensive (ultrapure water in larger quantity)
than HD in Indian scenario and also removes some essential beneficial compounds from the body
including protein, albumin, vitamin C , amino acids, peptides, calcium, and the like.
A single hemodialysis session in India with a new dialyzer can cost between 1800 and 3400 (versus
500 dollars in the USA), while a reuse session would cost between 1600 to 2700. The cost of single-
use hemodiafiltration would range between 3200 and 4500. If there are no-cost constraints, HDF is a
preferred option to conventional HD and most big dialysis units in India are progressively increasing
the numbers of HDF machines (Nipro/Fresenius).
In our Dialysis unit, we have a total of 18 HD machines (14 for negative patients, 3 for hepatitis C
patients, and 1 machine for hepatitis B or HIV) and 2 HDF machines. We have budgeted two more
HDF machines for the current financial year.

Market trends. As kidney transplant is still an elusive procedure in India, most patients are put on
hemodialysis. The driving force for the ever-increasing demand of dialysis equipment is the
exponential rate of growth of non-communicable diseases like diabetes , obesity, and hypertension;
and the continuous increase in the geriatric population (most likely to suffer from ESRD). India
dialysis market was valued at USD 3.1 billion in 2017. The global kidney dialysis equipment market
is touted to accumulate USD 16.5 billion at a stupendous 5.7 percent CAGR (compound annual
growth rate) during the assessment period (2018–2023). Hemodialysis segment accounted for over
90 percent revenue share in 2017 and is projected to grow over the forthcoming years. In the center,
dialysis accounted for more than 70 percent share in 2017.
Market challenges. Consistent innovation in the dialysis equipment market is leading to the
creation of complex systems that patients and clinicians are having trouble getting accustomed to.
The greatest challenge is the lack of instructive training and ease of accessibility of the equipment.
Portable dialysis equipment. Quanta Dialysis Technologies, a United Kingdom organization, has
invented the compact portable dialysis machine called the SC+ which is less prone to infections.
Outset Medical Inc., a US-based healthcare company has innovated and created Tablo, in which
treatment data can easily be sent to cloud storage through wireless connectivity, to perform real-time
dialysis.
George Institute of Global Health in Australia recently won an award for developing the world’s first
affordable dialysis machine, which uses only a solar panel, a water purifier, and a care station. Key
market players of the dialysis equipment market are moving toward miniaturization of the machines
due to the ease of its portability and for providing a more affordable form of hemodialysis at home.

Latest in Indian dialysis equipment market:

Duty Exemptions. Union Budget 2016 entailed details of various duty exemptions on certain
dialysis equipment thus cutting costs significantly.
National Dialysis Service Program. Announced in the Budget 2016, this program has the potential
of increasing the growth of public dialysis equipment (in all district hospitals) to approximately 17
percent as opposed to the current 5 percent growth.
Current challenges in the dialysis equipment market in India:
Hike in import duty. The government recently announced a hike in the import duty which will
negate any benefits of duty exemptions. This is because 70 percent of parts of complete dialysis are
still imported in India.
Operational constraints. equipment such as Reverse Osmosis (RO) facilities, accessory
equipment, dialysis beds, continuous supply of water, and availability of trained technicians and
nurses are of scarce supply. Even though duty exemptions will make it easier for district hospitals to
get dialysis equipment, they will also require supporting equipment to effectively treat kidney
patients.
Indian dialysis Market
Currently, some players in the Indian dialysis equipment market include Fresenius, B Braun, Baxter-
Gambro, and Nipro. At present, business in the Indian dialysis market is valued as USD 50.0 billion
and is expected to grow further. One of the latest developments in the market is the proposed launch
of a portable dialysis system by Medtronic. Such a machine will be easily transportable in rural India
and will require less water, less treatment, and less technician expertise.

Fresenius Kabi and DaVita will augment dialysis market growth in the near future. Fresenius Kabi
has focused its efforts on providing superior-quality dialysis. Baxter is implementing strategic
initiatives to add improvement in dialysis devices. However, complications associated with dialysis
treatment may restrain business growth in upcoming years.
Department : icu

Equipment and systems[edit]

Common equipment in an ICU includes mechanical ventilators to assist breathing through
an endotracheal tube or a tracheostomy tube; cardiac monitors for monitoring Cardiac condition;
equipment for the constant monitoring of bodily functions; a web of intravenous lines, feeding
tubes, nasogastric tubes, suction pumps, drains, and catheters, syringe pumps; and a wide array
of drugs to treat the primary condition(s) of hospitalization. Medically induced comas, analgesics,
and induced sedation are common ICU tools needed and used to reduce pain and
prevent secondary infections.

Quality of care[edit]
The available data suggests a relation between ICU volume and quality of care for mechanically
ventilated patients.[8] After adjustment for severity of illnesses, demographic variables, and
characteristics of different ICUs (including staffing by intensivists), higher ICU staffing was
significantly associated with lower ICU and hospital mortality rates. A ratio of 2 patients to 1 nurse is
recommended for a medical ICU, which contrasts to the ratio of 4:1 or 5:1 typically seen on medical
floors. This varies from country to country, though; e.g., in Australasia and the United Kingdom, most
ICUs are staffed on a 2:1 basis (for high-dependency patients who require closer monitoring or more
intensive treatment than a hospital ward can offer) or on a 1:1 basis for patients requiring extreme
intensive support and monitoring; for example, a patient on a mechanical ventilator with associated
anaesthetics or sedation such as propofol, midazolam and use of strong analgesics such
as morphine, fentanyl and/or remifentanil.
International guidelines recommend that every patient gets checked for delirium every day (usually
twice or as much required) using a validated clinical tool. The two most widely used are the
Confusion Assessment Method for the ICU (CAM-ICU) and the Intensive Care Delirium Screening
Checklist (ICDSC). There are translations of these tools in over 20 languages and they are used
globally in many ICU's.[9]

Equipment and systems[edit]

Common equipment in an ICU includes mechanical ventilators to assist breathing through
an endotracheal tube or a tracheostomy tube; cardiac monitors for monitoring Cardiac condition;
equipment for the constant monitoring of bodily functions; a web of intravenous lines, feeding
tubes, nasogastric tubes, suction pumps, drains, and catheters, syringe pumps; and a wide array
of drugs to treat the primary condition(s) of hospitalization. Medically induced comas, analgesics,
and induced sedation are common ICU tools needed and used to reduce pain and
prevent secondary infections.

Quality of care[edit]
The available data suggests a relation between ICU volume and quality of care for mechanically
ventilated patients.[8] After adjustment for severity of illnesses, demographic variables, and
characteristics of different ICUs (including staffing by intensivists), higher ICU staffing was
significantly associated with lower ICU and hospital mortality rates. A ratio of 2 patients to 1 nurse is
recommended for a medical ICU, which contrasts to the ratio of 4:1 or 5:1 typically seen on medical
floors. This varies from country to country, though; e.g., in Australasia and the United Kingdom, most
ICUs are staffed on a 2:1 basis (for high-dependency patients who require closer monitoring or more
intensive treatment than a hospital ward can offer) or on a 1:1 basis for patients requiring extreme
intensive support and monitoring; for example, a patient on a mechanical ventilator with associated
anaesthetics or sedation such as propofol, midazolam and use of strong analgesics such
as morphine, fentanyl and/or remifentanil.
International guidelines recommend that every patient gets checked for delirium every day (usually
twice or as much required) using a validated clinical tool. The two most widely used are the
Confusion Assessment Method for the ICU (CAM-ICU) and the Intensive Care Delirium Screening
Checklist (ICDSC). There are translations of these tools in over 20 languages and they are used
globally in many ICU's.[9]

Departments : OT

Operating rooms are spacious, easy to clean in a cleanroom,

and well-lit, typically with overhead surgical lights, and may have viewing screens and monitors.
Operating rooms are generally windowless and feature controlled temperature and humidity. Special
air handlers filter the air and maintain a slightly elevated pressure. Electricity support has backup
systems in case of a black-out. Rooms are supplied with wall suction, oxygen, and possibly other
anesthetic gases. Key equipment consists of the operating table and the anesthesia cart. In addition,
there are tables to set up instruments. There is storage space for common surgical supplies. There
are containers for disposables. Outside the operating room is a dedicated scrubbing area that is
used by surgeons, anesthetists, ODPs (operating department practitioners), and nurses prior to
surgery. An operating room will have a map to enable the terminal cleaner to realign the operating
table and equipment to the desired layout during cleaning.
Several operating rooms are part of the operating suite that forms a distinct section within a health-
care facility. Besides the operating rooms and their wash rooms, it contains rooms for personnel to
change, wash, and rest, preparation and recovery rooms(s), storage and cleaning facilities, offices,
dedicated corridors, and possibly other supportive units. In larger facilities, the operating suite is
climate- and air-controlled, and separated from other departments so that only authorized personnel
have access.
Temperature and surgical site infections (SSI). The current operating room design temperature is
between 65 and 75°.[1][2] Operating rooms are typically kept below 23 °C (73.4 °F) & room
temperature is the most critical factor in influencing heat loss.[3] Surgeons wear multiple layers
(surgical gowns, lead aprons) and may perspire into an incision if not kept cool and may decrease
concentration and increase errors.[3] Higher temperatures increased subjective physical demand and
frustration of the surgical staff.[1] One option is to heat the patient to prevent surgical site infections
(SSI) and keep the surgical team cool. There is a 3 fold increase in infection for every 1.9 degree
Celsius body temperature decrease [4] and radiation is the major cause of heat loss in patients, and
convection (through air) is the second cause of heat loss. [5] In the first hour it is common for healthy
patient’s temp decrease 0.5-1.5 °C as anesthesia causes rapid decrease in core temperature. [5] One
study found that the most efficient method of maintaining normothermia included using warm wraps
and a heating blanket [6]. Additionally, pre-warming for thirty minutes may prevent hypothermia. [3]
Operating room equipment[edit]
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 The operating table in the center of the room can be raised, lowered, and tilted in any
direction.
 The operating room lights are over the table to provide bright light, without shadows, during
surgery.
 The anesthesia machine is at the head of the operating table. This machine has tubes that
connect to the patient to assist them in breathing during surgery, and built-in monitors that help
control the mixture of gases in the breathing circuit.
 The anesthesia cart is next to the anesthesia machine. It contains the medications,
equipment, and other supplies that the anesthesiologist may need.
 Sterile instruments to be used during surgery are arranged on a stainless steel table.
 An electronic monitor (which records the heart rate and respiratory rate by adhesive patches
that are placed on the patient's chest).
 The pulse oximeter machine attaches to the patient's finger with an elastic band aid. It
measures the amount of oxygen contained in the blood.

Hybrid operating room for cardiovascular surgery at Gemelli Hospital in Rome

 Automated blood pressure measuring machine that automatically inflates the blood pressure
cuff on patient's arm.
 An electrocautery machine uses high frequency electrical signals to cauterize or seal off
blood vessels and may also be used to cut through tissue with a minimal amount of bleeding.
 If surgery requires, a heart-lung machine or other specialized equipment may be brought into
the room.
 Advances in technology now support hybrid operating rooms, which integrate diagnostic
imaging systems such as MRI and cardiac catheterization into the operating room to assist
surgeons in specialized neurological and cardiac procedures.

Surgeon and assistants' equipment[edit]

People in the operating room wear PPE (personal protective equipment) to help prevent bacteria
from infecting the surgical incision. This PPE includes the following:

 Similar to normal cleanrooms, germless.

 A protective cap covering their hair
 Masks over their lower face, covering their mouths and noses with minimal gaps to prevent
inhalation of plume or airborne microbes
 Shades or glasses over their eyes, including specialized colored glasses for use with
different lasers. a fiber-optic headlight may be attached for greater visibility
 Sterile gloves; usually latex-free due to latex sensitivity which affects some health care
workers and patients
 Long gowns, with the bottom of the gown no closer than six inches to the ground.
 Protective covers on their shoes
 If x-rays are expected to be used, lead aprons/neck covers are used to prevent
overexposure to radiation
The surgeon may also wear special glasses that help him/her to see more clearly. The circulating
nurse and anesthesiologist will not wear a gown in the OR because they are not a part of the sterile
team. They must keep a distance of 12-16 inches from any sterile object, person, or field.