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checkLighting: Surgical Task Lighting

All PIM content was independently developed and reviewed to be vendor-, product-, and service provider-neutral.

Description

Rapid improvement in lighting technologies such as Light Emitting Diodes (LED’s) provides a viable alternative to traditional tungsten-halogen (halogen) and High Intensity Discharge (HID) lighting.  The benefits include reduced energy use, heat load, longer bulb life, and greater comfort for your OR staff when compared with traditional surgical lighting systems. 

  • Project Talking Points

    • Surgical area lighting is some of the most important in a hospital that must meet the demands of different medical personnel who may have varying lighting requirements for neurosurgery, orthopedic surgery, plastic surgery, optical surgery, endoscopic surgery, and obstetrics/delivery procedures.   
    • The use of LED lighting for surgical field illumination is not just about energy savings and reductions, it contributes to a lower, stable room temperature that  helps maintain normothermia in patients, which ultimately limits surgical site infection risks, improves wound healing, and promotes patient satisfaction and timely discharges with the added benefit of improving  staff comfort.
    • Surgical field illumination systems generally include single and/or dual light heads attached to a pivot arm or track suspension that are equipped with sufficient light reflection, spectral characteristics, focus, pattern and intensity adjustments to minimize shadows creation.
    • LED lights illuminate their subjects' true colors more accurately than bulb lights and the benefit of multiple arrangements of small light sources fixed at different angles minimizes shadows for a more consistent light, even when surgical personnel lean into the spot.
    • Advances in lighting technology such as LED’s offer numerous advantages for use as surgical lighting over traditional tungsten halogen and gas discharge fixtures including reduced electricity use (up to 70% compared to halogen or direct discharge lighting), longer life (up to 25 hours of service), reduced heat generation, and lower ultra-violet (UV) radiation (typically, LED’s for common home/commercial use do not emit UV radiation) which reduces the potential to dry exposed tissue.
    • LED lighting for surgical field illumination provides better visualization for the surgeon, smaller footprint due to the compact luminaire designs and lower HVAC load requirements to provide greater comfort for patient, surgeon and staff. 
  • Triple Bottom Line Benefits

    Cost Benefit –

    • LED’s help reduce facility electricity use and associated costs
    • LED’s are most compact, requiring less space to achieve similar or better lighting quality than traditional halogen and direct discharge lighting options.
    • Reduced waste disposal costs associated with longer life.
    • Reduced heat emanating from LED’s requires less HVAC resources to offset the lighting heat load from halogen and gas discharge lights.

    Environmental Benefits–

    • LED’s achieve Energy use reductions of up to 70% when compared to halogen or direct discharge lighting which leads to lower GHG emissions
    • The longer life of LED’s requires less maintenance and less frequent disposal of used bulbs
    • The heat generated from LED’s is much less than traditional lighting technologies requiring less HVAC resources to offset the heat load.

    Social Benefits–

    • Longer life leads to less waste disposal needs.
    • LED technology eliminates mercury from the lighting waste stream allowing for less expensive and more flexible waste disposal options.
    • More comfortable surgical experience for doctors and support staff.
    • LED’s generally do not emit UV’s reducing the potential to dry exposed tissue.
  • Purchasing Considerations

    The following items should be considered when procuring surgical lighting luminaires and systems:

    General considerations:

    • Lighting fixtures that are complete, grounded, fungi‑proof, adequately enclosed for asepsis, and designed for use in human operating rooms;
    • Lighting systems should be complete with suspension systems, lightheads, transformers, and controls
    • Suspension components shall not flex during normal use (i.e. light head position should be maintained even when articulated without drift)
    • Surfaces shall be free of burrs and sharp edges and shall be painted with a corrosion resistant primer and lacquer finish (except for stainless steel, aluminum, chrome, nickel or brass metal surfaces)

    Fixture Type – specify the type of fixture desired such as the following:

    • Single light head with pivot arm
    • Dual light head with pivot arm
    • Single light head with pivot arm on track suspension
    • Dual light head with pivot arm on track suspension

    Light head – specify the type of light head including the following characteristics:

    • Size of the light head – specify limit on size.
    • Rated useful lifetime, defined as the hours of operation at greater than 80% of initial light output, shall be no less than [specify value, Ex: 25000] hours.
    • Light head illumination characteristics – for example the lighthead shall have:
      •  Central illuminance shall be no less than [specify value not less than 40,000] lux, or dimmable to this value.
      • Central illuminance shall be no greater than [specify value not greater than 160,000] lux.
      • Remaining illuminance shall be no less than
        • ––[specify value] % with one mask
        • ––[specify value] % with two masks
        • ––[specify value] % with tube and no mask
        • ––[specify value] % with tube and one mask
        • ––[specify value] % with tube and two masks.
        • Nominal correlated color temperature (CCT) shall be no less than [specify value, Ex: 40000] K and no greater than [specify value, Ex: 45000] K, or adjustable across this range.
        • Measured CCT and Duv shall comply with NEMA/ANSLG tolerances for white light.
        • Measured R9 shall be no less than [specify value].
        • Light field diameter d10 shall be no less than [specify value] and no greater than [specify value], or adjustable across this range.
        • Depth of illumination shall be no less than [specify value] and no greater than [specify value], or adjustable across this range.
        • Radiant heat energy in the light beam 42 in [1070 mm] below the lighthead shall not exceed 25,000 microwatts per square cm at maximum intensity in the light pattern.
        • Color Rendering Index (CRI) shall be a minimum of 92, as measured on the ASTM E 308 chromaticity diagram.
    • Dimming, if implemented, shall not compromise the above criteria or cause excessive flicker, harmonic distortion, or electromagnetic interference.
    • Adjustable focus and pattern size – may want to specify the smallest focal range (i.e. 6 or 8 inches)
    • Shadow reduction – Example specification (for information purposes only): Lighting system shall provide a minimum level of 10 percent of the unshadowed level when measured inside and at the bottom of a tube 50 mm 2 inch in diameter, and 76 mm 3 inch long, from a distance of 1070 mm 42 inches when the beam is obstructed by a disk 254 mm 10 inch in diameter, 580 mm 23 inches above the operating table, and normal to the axis of the tube.
    • Control handle – easily accessible to the surgeon.

    Controls

    • Intensity control unit for each light head (for example an LED dimming range from 100% to 30%).
    • Wall-mounted control unit with On/Off switch and intensity adjustment, minimum.
    • Radio frequency suppression to avoid interference with sensitive medical equipment
  • How-To

    1. Determine who is on the Procurement team and Operations and Maintenance team to ensure that those affected by the change are involved in the decision – Example team members include  – Chief Surgeon, Head of OR Nursing, Building engineer, Energy Manager, Maintenance Personnel, Procurement, OR Representative, Chief Operation Officer, and Environmental services.
    2. Develop and monitor KPI’s including the following:
      1.  kilowatt-hours of energy saved
      2. percent reduction in energy use for installed base
      3. percent of installed base converted to LED
      4. owner satisfaction with quality and quantity of light – initial and maintained
      5. Spectral characteristics
    1. Review energy usage data generated by the surgical area to      establish a baseline electricity load for typical use and generate a cost      benefit to establish the highest efficiency under normal operating      conditions.
    2. Catalog which lighting systems should be targeted for an upgrade      or retrofit considering purchasing, installation, operating, maintenance      and end-of-life disposal costs.
    3. Verify that existing lighting systems are appropriate for      retrofitting or upgrading – wiring requirements, controls, etc.
    4. Install lighting systems and monitor performance obtaining real      time data on electricity usage and comfort of OR personnel.

    Measurement and verification to determine actual versus installed savings will be primarily via power monitoring associated with case studies and demonstration projects.  The data collected for measurement and verification, along with current electricity prices, will be used to compare the conserved cost of energy calculations resulting from the engineering estimates with that calculated based on measured data to determine cost-curve effectiveness

  • Case Studies

    Technical Guidance Document:  Surgical Task Lighting, U.S. DOE, Energy Efficiency and Renewable Energy Building Technologies Program, August 2011

    LED Surgical Task Lighting Scoping Study:  A Hospital Energy Alliance Project, U.S. DOE, Pacific Northwest National Laboratory, January 2011.

  • Regulations, Codes and Standards, Policies

    Applicable Standards

    • IES publication, RP-29-06, Lighting for Hospitals and Healthcare Facilities and in the 10th Edition IES Handbook, Chapter 27. 
    • Illuminating Engineering Society of North America (IESNA):
      • RP-29-06.................... Lighting for Hospitals and Health Care Facilities
      • HB-9-00...................... Lighting Handbook Reference and Application
      • National Fire Protection Association (NFPA):
        • 70-08.......................... National Electrical Code (NEC)
        • 99-05.......................... Health Care Facilities
        • Underwriters Laboratories, Inc. (UL):
          • 60601-1...................... Medical Electrical Equipment, Part 1: General Requirements for Safety
          • 1598-08           Luminaires
  • Cross References: LEED

    • LEED Building Category (EB, HC, NB), version.  Name of credit and [link if there is one].   E.g.,
      • LEED (list version) Existing Buildings: Operations and Management (Credit #).    Energy & Atmosphere Prerequisite 2: Minimum Energy Performance
        LEED 2009 for Healthcare (or LEED HC 2009): New Construction and Major Renovations; Water Efficiency, Credit 4.2 - 'Water Use Reduction—Cooling Towers. 1 credit
  • More Resources

    • Hospitals Energy Alliance
    • 21 CFR 878.4580 “Surgical lamp.” Code of Federal Regulations, U.S. Food and Drug Administration.
    • ANSI/IESNA RP-29-06. “Lighting for Hospitals and Health Care Facilities.” American National Standards Institute, Washington, DC.
    • EERE-U.S. Department of Energy, Office of Energy Efficiency and Renewable Energy. 2009.  Lifetime of White LEDs. PNNL-SA-50969. June 2009. Developed by Pacific Northwest National Laboratory for the EERE Building Technologies Program, U.S. Department of Energy, Washington, DC.
    • EERE – U.S. Department of Energy, Office of Energy Efficiency and Renewable Energy. 2010 a. CALiPER Program. Accessed on October 25, 2010, (last updated December 23, 2010).
    • EERE –U.S. Department of Energy, Office of Energy Efficiency and Renewable Energy. 2010b. Solid State Lighting Research and Development: Multi-Year Program Plan. March 2010. Washington, DC. Accessed April 1, 2010 (undated webpage).
    • EERE - U.S. Department of Energy, Office of Energy Efficiency and Renewable Energy. Three-Part TINSSL Webinar Series: Understanding and Evaluating LM-79 & LM-80 Reports for SSL Technology. Accessed on September 21, 2010 (last updated September 8, 2010).
    • FDA - U.S. Food and Drug Administration. 1998. Guidance Document for Surgical Lamp 510(k)s – Guidance for Industry, FDA Reviewers/Staff and Compliance. July 13, 1998. U.S. Department Of Health and Human Services, Food and Drug Administration, Center for Devices and Radiological Health, General Surgical Devices Branch, Division of General and Restorative Devices, Office of Device Evaluation, Washington, DC.
    • FDA – U.S. Food and Drug Administration. 2011. Establishment Registration & Device Listing. Accessed December 9, 2010, product code FSY (last updated January 6, 2011).
    • IEC 60601-2-41. “Medical Electrical Equipment,” Part 2-41: Particular Requirements for the Safety of Surgical Luminaires and Luminaires for Diagnosis. International Electrotechnical Commission, Geneva, Switzerland.
    • IESNA – Illuminating Engineering Society of North America. 2000. The IESNA Lighting Handbook, 9th edition. June 2000. Illuminating Engineering Society of North America. New York, NY.
    • IESNA/NALMCO RP-36-03. “Recommended Practice for Planned Indoor Lighting Maintenance.” Illuminating Engineering Society of North America, New York, NY.
    • IES LM-79-08. “Electrical and Photometric Measurements of Solid-State Lighting Products.” Illuminating Engineering Society, New York, NY.
    • Sandahl, L. 2010. Commercial Building Energy Alliances: Deploying Emerging Technologies. November 8, 2010. Innovation in ET Programs Emerging Technologies Summit, Sacramento, CA.
  • PIM Descriptors

    Energy, Supply Chain

    Level: Intermediate

    Category List:

    • LEDs
    • Lighting
    • Surgical Lighting

    PIM Attributes:

    • Energy
    • Optimize Operations
    • System Upgrades

    Improvement Type:

    • Retrofit/Renovations
    • New Buildings
    • Operations and Maintenance

    Department:

    • Engineering/Facilities Management
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