Excising Infection in the Surgical Environment [ExISE]

Exise致力于AHRC抗菌素耐药性号召的关键领域3，“室内/建筑环境中的创造性、协作性和颠覆性创新、实验和设计”。其首要目标是消除手术室OTS中的气传获得性外科部位感染(SSI)，这是传统上用抗生素对抗的。我们的微生物学家同事强调，任何抗生素的使用，无论是次优或最佳，都会造成AMR，因此避免使用抗生素，在这种情况下，术后是至关重要的。Exise建议通过基于证据的外科手术实际物理环境(手术室OT)的改造来实现这一目标。消除空气传播的SSI将减少感染数量和在恢复和疗养过程中被动使用抗生素，在某些情况下还会重复手术和新的风险。感染通过空气传播一直是人们担心的问题，战后对其机制的习俗和实践立场一直主导着OT的设计。SSI在当代OTS中并没有被淘汰。这一立场并未完全得到证实。外科医生不会质疑OT的设计。还有其他方法吗？Exise将寻找替代方法：它的科学、艺术和建筑历史学家将研究约150年来运作剧院设计的历史，研究如何在设计师和赞助人的理论和信仰中创造合适的手术环境。搜索将扩展到挖掘在其设定的环境中进行的手术的静止和运动图像。皇家外科医师学会认为，这是一段尚未成文的历史。该团队将寻找环境意图的附带证据，以使他们的剧院和环境能够按照最初的成功标准进行有意义的重建。他们认为健康的环境和健康的空气是什么样子的？Exise的科学家将从OTS的历史重建中组装实验室模型和环境，同时还将安装当代的“超清洁”OT，即熟悉的“炉罩”，在OT的所有居住者和内容物上释放出真正惊人的冷空气流动，高达每小时40次的空气更换，为外科团队创造了一个奇怪而不是完全受欢迎的工作环境。同时，Exise将通过访问团队并在现场和皇家学院采访他们，更好地了解外科团队和支持人员在当代OT中/在其中工作的生理和心理体验。我们希望将这些见解转化为有意义的评论，从中得出设计和重新设计的线索，导致OTS设计的基本方法发生根本性的变化。吸引我们的利益相关者和合作伙伴的方法将通过模拟和理论模型进行实物测试和测试，以便能够真正自信地广泛传播研究成果，从而对手术环境的期望和期望产生重大影响。追寻我们早先的强健医院项目电影在国际上的成功，我们将用我们绘制的OTS重建图制作一个4-5分钟的动画，我们重新设计OT的想法叠加了流体流动模型和计算的环境性能。我们的合作伙伴将为他们的支持者发布这部电影，剑桥大学也将在其流媒体网站和YouTube上发布这部电影。要将这种全新的OTS付诸实践，还需要付出更多详细和艰苦的工作，但Exise应该会实现打破60多年标准做法的“大跃进”。

ExISE addresses Key Area 3 of the AHRC Antimicrobial Resistance Call, 'Creative, Collaborative and Disruptive Innovation, Experiments and Design in Indoor/Built Environments'. Its overarching Aim is to eliminate airborne acquired Surgical Site Infections (SSI) in operating theatres OTs, traditionally countered with antibiotics. Our microbiologist colleagues emphasise that any antibiotic use, suboptimal or optimal, creates AMR and so avoidance of antibiotic use, in this case post-operative, is paramount. ExISE proposes to achieve this aim through the evidence-based reinvention of the actual physical environment in which surgery is practised, the Operating Theatre OT. Eliminating airborne SSI will reduce the number of infections and the reactive use of antibiotics in recovery and recuperation and in some cases repeat surgery and renewed risk. Airborne transmission of infection has long been feared, the post war custom and practice position on its mechanisms has dominated OT design. SSI is not eliminated in contemporary OTs. The position is not wholly substantiated. Surgeons do not question OT design. Is there another way?ExISE will search for alternative approaches: its historians of science, art and architecture will research a history of Operating Theatre design, of making 'safe', appropriate environments for surgery within their designers' and patrons' theories and beliefs over some 150 years. The search will extend to exhuming still and moving images of surgery in action within its set environments. The Royal College of Surgeons believes this is an as yet unwritten history. The team will be searching for accompanying evidence for environmental intent to enable meaningful reconstructions of their theatres and environments against the original criteria for success. What did they think a healthy environment with healthy air looked like? ExISE scientists will assemble laboratory models and environments from the historical reconstructions of OTs alongside a contemporary 'Ultraclean' OT, the familiar 'cooker hood' issuing truly prodigious flows of cool air through the OT over all the occupants and contents, up to 40 air changes/hr, making a bizarre and not wholly welcome working environment for surgical teams. In parallel, ExISE will achieve greater understanding of the physical and psychological experience of being in/working in a contemporary OT for surgical teams and support staff by visiting teams and interviewing them in situ and at the Royal College. We hope to translate these insights into a meaningful critique from which design and redesign leads can be drawn, leading to a radical step change in fundamental approaches to the design of OTs. Approaches which appeal to our stakeholders and partners will be interrogated and tested physically with both analogue and theoretical models to enable wide dissemination of research outputs with real confidence and thence make significant impacts on the aspirations for and expectations of environments for surgery. Pursuing the international success of our earlier Robust Hospitals project film, we will make a 4-5minute animation out of our drawn reconstructions of OTs, our ideas for redesigning the OT superimposing the fluid flow modelling and calculated environmental performance. Our partners will post the film for their constituencies as will Cambridge University on its streaming media site and YouTubeMuch detailed and painstaking work will be required subsequently to implement such radically new OTs in practice but ExISE should achieve the 'great leap forward' that breaks more than 60 years of standard practice.