This article is from in the September 2007 issue of DOTmed Business News. A list of registered users that provide sales & service can be found at the end.

Operating room lights don't usually make headlines. But in July, the lights went out (and back-up generators failed) in the middle of an appendectomy in a small-town hospital in Argentina. Quick-thinking family members of the patient collected cell phones from the waiting room so that surgeons could use the screen displays for light.

It would certainly take a skilled surgeon to work without the accustomed 12,000-plus foot candles worth of light shed by many surgical lighting systems in hospitals. (That would take thousands of cell phones to equal.) In addition to the illumination power from multi-head O/R lighting systems, the quality and color of the light is specifically designed for the application and for surgeons' preferences. For instance, invasive or deep cavity procedures require filtered, high-intensity light.

O/R lights can be ceiling or wall mounted, recessed or mobile. They are paired or in clusters to prevent shadows. The basic design of O/R lights combines the electrical source with a ring for commutators, or rotary switching devices, that are part of the mechanism to maintain contact while the light is swiveled. Brushes convey power from the main stem to the light head. To control heat, some systems include transformers to reduce voltage. Bulbs vary in strength, type and complexity from halogen and LED to older, sealed bulbs not unlike automobile headlights. (One complicated older design included an automatic back-up bulb activated when the main bulb blew out.)




O/R lighting is intense; most surgical lights are 80,000 to 160,000 lux; one lux equals the illumination of a surface one meter away from a candle. It would take hundreds of fluorescent kitchen lights to equal the intensity of O/R lights. And surgical lighting is superior to sunlight since it can be either focusable or fixed in focus. O/R lights also allow selection or adjustment of color and whiteness to improve contrast and vividness of tissue, while reflecting infrared rays and heat away from the patient and surgical team. A state-of-the-art example is Skytron's Aurora LED system which boasts bright, cool, high-intensity optics with color-correct light that surgeons can adjust for color temperature. In addition to Skytron, leading manufacturers and brands of O/R lighting include ALM, DRE, STERIS (which makes Amsco products), Midmark, Burton, Medical Illumination, Castle, Hanaulux (owned by Siemens), and Sunnex, among others.

Consider Pre-Owned Marketers

Not every facility requires new, cutting-edge lighting. A thriving after-market in used systems provides the right balance of cost and benefits for many clinical applications at hospitals as well as clinics, surgical centers, and private offices.

"We buy the lights from hospitals and sell them to end users - surgery centers, some hospitals, doctors offices...plastic surgeons," says Jim Kleyman, President of ACE Medical Equipment, Inc., Clearwater, FL. The company, an independent service organization (ISO), also rebuilds and repairs lights and stocks bulbs and parts for hard-to-fix older equipment. "We completely disassemble, reassemble and rebuild the lights, pull new wire, new connections, replace bulbs, repaint the lights with durable paint, and take out dents in the domes so they're like new." ACE Medical Equipment also tests the illumination output to ensure the equipment is comparable to its new condition in terms of performance.

"The needs for refurbishing are relative to the specific lights," explains Robert Bean, Purchasing Director, DRE, Inc., which is headquartered in Louisville, KY and distributes its own brand as well as OEM lighting worldwide. (The company has the apt tagline "Operating within your budget!") "Most lights are rewired, with brushes and commutators typically replaced and connections rewired as well," Bean says. "Bulbs are replaced and our refurbished and new lights will meet or exceed the original specifications."

For hospitals trying to reduce operating costs, ISOs provide three important services-they will buy, sell, and/or service the equipment.

ISOs can liquidate hospital inventory that is expensive to store. O/R lights often sit in storage, costing money in terms of overhead when they could be resold, refurbished and moved to the asset column. Old equipment often finds a new life at smaller or rural facilities that may not have the budget for new lighting.




"I went to a hospital several years ago that had four lights in storage. I bought them, and as I was leaving the guy said, 'by the way I have two more in the trash pile'...he didn't have room in storage," Kleyman says.

Hospitals in need of additional lighting systems look to ISOs for cost-effective pre-owned solutions, according to industry experts at DOTmed.com. "A hospital can save as much as 60 to 70 percent of new," notes Juan Sandoval, Monterrey Medical Equipment, San Antonio, TX. The company sells and services O/R lights in southern Texas and in Mexico.

Yet another value of ISOs to hospitals is to fill in resource gaps for the internal biomedical staff. "I go into hospitals when their biomed team gets overloaded. Miami Children's Hospital and Baptist will call me when their workload exceeds what they can handle," says Randy Lowers, L&R Services, Miramar, FL. The company services lighting primarily in private practices and outpatient surgery centers.




Lights, Camera, Medical Gases!

If the O/R is an operating theater, as it's often called, today's sophisticated surgical lighting systems could be thought of as special effects for the production.

The biggest trend lately is the installation of overhead boom systems, which are electrical hubs that position equipment including the lights, video monitors, communications, medical gases, IVs and other clinical tools.

As with most medical equipment, surrounding systems and the facility size can greatly influence your lighting choices. Ceiling height in the O/R procedure room is the most critical limitation, with a minimum requirement of more than 9 feet for most lighting systems. The articulating arms of the lights need a wide berth to swing, typically at least 14 feet. The light heads themselves are also quite large. For example O/R lights for cardiac surgical procedures measure three feet in diameter. Electrical support and clearance from ventilation are other factors in room design. The building structure must also be strong enough to support the lighting stem, boom, track or plate.

"When we sell a light, we never just sell the light," Kleyman says. "We always communicate with the building and electrical contractor. We have to make sure the structure is done right and we have to understand the wiring."

The other constraint is the surgeon who is probably accustomed to hospital lighting of 12,000 to 15,000 foot candles and will notice the difference if refurbished lighting does not match the illumination they expect.

Overall features to compare in lighting include light intensity, color temperature, heat and shadow reduction, focus, maneuverability, flexibility, and surgeons' comfort. In addition to initial cost, consider life expectancy of the equipment, and maintenance costs.

"Like any other piece of equipment, if the units are refurbished properly, refinished, and all worn parts replaced, the units should give the same life expectancy as new at about half of the cost," says Billy Dean, Manager, Sales/Marketing, Medequip Engineering Service, Inc., Central Point, OR. "The key is finding a vendor that refurbishes the units correctly and doesn't just spray paint them, test them, and send them out."

To ensure the quality of refurbished O/R lighting, it is important to work with a reputable ISO. Here are some tips on choosing a trusted Independent Service Organization:

-Make sure they understand and can explain the constraints in choosing lighting, such as the space limitations, including ceiling height of the site.

-Make sure you are dealing with someone knowledgeable of the supporting structure and the electrical requirements of the site and equipment; someone who can coordinate with your contractor and electrician.

-If you choose refurbished lighting make sure the company supports the light, has parts and bulbs, and can troubleshoot over the phone.

-Get a warranty on the output of that light to make sure it has been measured and you know how close it is to the manufacturers' specifications.

-Check out the company on www.dotmed.com to see if they are rated or if professionals are DOTmed Certified.

"The refurbished market is like a pyramid. There are a few companies at the top that are really thorough with everything they do. Their profit margins are smaller," Kleyman said of his company. They are doing more to the equipment but can't sell it for that much more because most customers aren't willing to pay. Then as you get down to the base of that pyramid you have a thousand companies who do the bare minimum. When something goes wrong they tell the doctor to find someone local to handle it."

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DOTmed Registered O/R Lights Sales & Service Companies

Domestic
Art Botnik, Art-Y-Bil Ent. Inc., FL
Robert Bean, DRE Inc., KY
Randy Lowers, L & R Services, FL
DOTmed Certified
Billy Dean, Medequip Engineering Service, Inc., OR
DOTmed Certified
Juan Sandoval, Monterrey Medical Equipment, TX
Amaury T. Agoncillo, Morigon Technologies, LLC, Inc., CA
Clinton Courson, Quest Medical Supply, Inc.,FL
Jim Kleyman, Ace Medical Equipment, Inc.,FL
DOTmed Certified

International
Necati Unal, Elektromar Ltd., Turkey

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