When it comes to outfitting an OR, few decisions hold more opportunity and peril than choosing surgical lights. On the upside, today's lights are better than ever, offering better maneuverability, focusability and shadow and heat control - to the point where even one industry expert says "you can't make a wrong choice" with regard to the light itself. The challenge comes in predicting the future. Lights cost up to $20,000 per OR and last for as long as 15 years, so the decision you make will be one you and your surgeons and staff will have to live with for a long time. Complicating matters are current OR design trends, which involve hanging more and more equipment off the central boom. If your crystal ball says you won't need to partake in this trend of more flexible and fully integrated ORs, you may be able to save tens of thousands because you can purchase non-upgradeable lights. But if the crystal ball is wrong, you may be holding the bag. The facility managers we talked to have five tips for making it a decision you'll be happy with for the next decade-plus.

Are your lights integration-ready?
Today's buzzword in buying surgical lights is integration. Integrating your lights with power booms can be a great way to maximize the flexibility of the OR while minimizing the number of mounts in the ceiling. With the advent of centralized OR controls that let you adjust surgical tables and lights or direct flat-screen monitors and equipment suspended from ceiling-mounted booms with the touch of a screen or a voice command, know if the lights you're considering are compatible with such systems. "Even if you don't plan to use it in the short term, you may adopt this technology in the future. Your lights and their operating room should be prepared," says Andy Reding of Berchtold Corp.

Selecting a light system could have a far-reaching impact on the design efficiency of your ORs and even on which procedures you perform in them.

"Now when you think about surgical lights, you need to consider modularity, upgradeability, flexibility," says Jim Norris of Steris Corp. "Many items can be integrated into the light suspension, such as camera systems and monitors. You're not looking only at a light, but to a system and how it integrates with other equipment."

Lights are no longer a discrete piece of equipment. Instead, they're designed to interface with the other capital equipment, including video cameras attached to the lightheads. "Integration with the entire OR environment is one of the key facets of light design," says Robert Von Kaenel, vice president of Getinge. He says lights purchased today should come pre-wired for video. Cynthia Ansari, Stryker's director of marketing communications, agrees. "The wiring and positioning of equipment in that room is crucial to the long-term functionality of the OR," she says.

You may mount flat-screen monitors on the light mount, eliminating the space-consuming carts that carried monitors up till now. "The flat-screen monitor can be placed on some existing light mounts. Or the facility may consider purchasing new lights that incorporate the monitor. Given that many surgical procedures now involve the use of a scope, monitors are part of everyday procedures in surgical facilities," says Nuvo Surgical's Kevin Grant.

Get out and about.
Facility managers advise that you attend professional meetings or trade shows where you can compare lighting products.

"And if you can't make it to vendor shows, many companies will take you on-site to a location using their lights," says Diana Procuniar, RN, nurse administrator at Winter Haven Ambulatory Surgical Center in Winter Haven, Fla.

Another option is to contact other facilities and ask to visit those using the lights you're considering. "That was where we got the best feedback," says Marlene Brunswick, RN, the director of nursing at Findlay Surgery Center in Findlay, Ohio. She says such visits will give you an idea of what each brand offers and which features may be most important to consider. As Rosy McGregor, RN, puts it, you have to put your hands on it to know. "Go to different facilities, play with the lights. I did that, and it was helpful. Some lights were not near as maneuverable as expected," says Ms. McGregor, OR manager for St. Peter Hospital in St. Peter, Minn.

Consider the basics.
The first feature is intensity, or brightness, which is measured in footcandles (in the United States) or lux (by the rest of the world). A mobile, small-procedure or exam light might be adequate at 6,000 footcandles (64,560 lux; two of these would be used for a minor surgical procedure), and 20,000-plus footcandles (215,200 lux) might be what you need in large ceiling-mounted lights.

In general, brighter is better, but brightness has a quality. As the intensity of light gets higher, the light can become blindingly bright. Manufacturers have made the brightest light at the center of the vertical column so that it's focused on the surgical field - a 6-inch to 11-inch area you control from within the sterile field - with less intensity toward the outside of the column, says Randy Tomaszewski, BSN, MBA, of Skytron Medical Equipment.

As important, say facility managers, is the maneuverability (or articulation) of the lights. "If the surgeon can't shine the light where he wants it," says Julie Macuch, RN, "nothing matters." She suggests you look for a light that can be moved in any direction and up or down, to accommodate varying surgeon height, as well as to bring the light closer or further from the surgical site. Other features to look at:

• Shadow control. A larger-diameter light face usually means better shadow control; the light is maintained on the surgical site even if part of the light is blocked by a surgeon's head or arm.
• Heat control. If the lights have halogen bulbs, they'll produce a lot of heat. The light design should channel the heat to the top of the light and ventilate it away from the surgeon and surgical site.
• Color. Look for a light head that filters infrared, which lets the light head cast white light - which lets the surgeon see tissue color as it really is in the patient (the infrared filter should fall between 3,800 and 4,400 Kelvin degrees).

Ms. Brunswick also points out that the bulbs should be easy to replace. In that vein, Mary Sartiano, RN, the manager of day surgery at Bardmoor Outpatient Surgery Center in Largo, Fla., says you should note the availability and cost of bulbs.

Check out the latest.
Several new technologies you may want to consider:

• Xenon or xenon-halogen bulbs. Xenon bulbs emit more light with less power than standard halogen bulbs: a 150-watt halogen might produce about 12,550 footcandles (135,000 lux), while a 70-watt xenon bulb produces nearly 15,000 footcandles (160,000 lux). In addition, halogen bulbs generally last 1,000 hours, and xenon bulbs last 5,000 hours (three years in a typical surgery setting). On the downside, xenon bulbs cost more, have a fire-up time of two minutes once they're turned on and need to cool between eight and 15 minutes after they're shut off before they can be turned on again. These last two factors can be problematic if you have to turn off your lights during surgery, which is often the case when a scope is in use.

"The user has to learn a new protocol, timing the start-up of the lights prior to surgery. It doesn't pay to shut them off during a closed or minimally invasive procedure, so the light can just be turned against the wall. We believe the benefits outweigh the downside because it is a more efficient and cost-effective light," says Mike Troy, vice president of marketing and business development for Trumpf Medical Systems, which introduced the Xenion light in 2003.

• High-intensity LED lighting. These lights, which emit less heat, can produce about 3,700 footcandles (40,000 lux) to about 4,650 footcandles (50,000 lux). Improvements in the light head will let these produce the higher amounts of footcandles or lux needed for most surgeries, experts say.

Get the best price.
Don't hold yourself to a strict price standard, but do what you can to get the best price. "A good starting point is to call the manufacturers for list prices," says Ms. Procuniar "Nearly all companies will discount their list, and many have contracts with the GPOs. Also, many will sell you a demo set (which is what she bought) or refurbish your lighting."

In addition to the lights themselves, take installation costs into account. And don't forget to consider whether your ceiling is adequate to support a light.

"There's a wide range of prices," says Larry Debord, the vice president of sales and marketing at Medical Illumination International. "For example, does the light model come with everything you need except for the bolts you will put into the ceiling? On some, the mounting is separate. Is your facility ceiling adequate to support [the new lights]? Have a qualified mechanical contractor certify this."

Take your time with a lighting purchase decision, and think long-term, experts say. Your purchase decision will be more likely to pay off over time.