CIBW062 Symposium 2013
A study of measurement performance evaluation for toilet systems with an uroflowmeter in hospital facility
H. Yamasaki(1)，M.Otsuka(2) [email protected] [email protected] 1. TOTO Ltd., Japan 2. College of Architecture and Environmental Design, Kanto-gakuin Univ., Japan.
Abstract
The voided volume of urine or the uroflowmetry of the patients are routinely examined in urology department of healthcare facilities in order to diagnose urinary system diseases or manage systemic metabolism. Conventional uroscopy has several problems. Patients often suffer mental anguish with a sense of shame on ground that they discharge their urine and leave it in the public eye at inspection rooms. Nurses have heavy workload with the preparation of urine sampling or disposal after clinical examination. Medical doctors may run a risk of occurrence of hospital infection unless the urine is properly disposed. Toilet with an uroflowmeter is evaluated in hospital facility in this study. We demonstrated the effectiveness of the calibration system in experimenting on the drainage load before and after the completion. As results, the toilet system can measure the characteristics of urine of the patients precisely during their usual defecation under within ±200Pa of the jurisdiction pressure fluctuation in loop ventilation method of SHASE-S206. We designed and developed the first reliable toilet system with an uroflowmeter to measure the voided volume of urine or the uroflowmetry in the world. It is found that the toilet in actual healthcare facilities can solve most problems of conventional uroscopy according to our availability for hundreds of clinical uses. The toilet system as medical equipment saved the load of the nurses and brought comfort to the patients.
Keywords
Drainage system, Toilet, Uroflowmeter, Drainage load, Pressure fluctuation
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1 Introduction
The number of elderly people increases rapidly in Japan shown in Fig.11). The death rate of prostate cancer of geriatric condition will increase in near future. In the medical institution, they have to measure the voided volume of urine or the urine flow rate not only for diagnosis of their urinary diseases but also for control of systemic metabolism, so the workload of nurses may increase with more opportunities of handling urine than before. Patients often suffer mental anguish with a sense of shame on ground that they discharge their urine and leave it in the public eye at inspection room2). Medical doctors may run a risk of the occurrence of hospital infection unless the urine is properly disposed. We have developed the world's first toilet systems with an uroflowmeter to solve several clear and present problems in the examination of the voided volume of urine or the uroflowmetry in hospital facilities. This device released the patients from a sense of shame, nurses from slavery labour, and medical doctors from unsanitary environment or the risks of hospital infection. This report is the summary of the equipment configuration of the toilet systems and its clinical evaluation results. ( Year's Old)
80
60 Man Woman
40
20
0 120 80 40 0 0 40 80 120 ( Million People) ( Million People) Figure 1 - Population pyramid of Japan
2 Problems of measurement of the voided volume and the flow rate
Generally, the urinalysis means the qualitative and/or quantitative analysis of the specified substances in urine of patients such as glucose, protein, and occult blood. In medical institution, the physical indexes of urine are routinely measured. The voided volume of urine, the urine flow rate and the urine flow rate waveform are important to allow the diagnosis of several diseases and to control their systemic metabolism. There are several problems in measuring the physical index summarized in Table 1.
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Table 1 Problems of measurement the characteristics of urine Patient Nurse Medical doctor
Measurement “The load of the “A filth room is dirty. “By wrong data, the urine urine collection is big There might be the result of voided and it is difficult. nosocomial infection. measurements are not volume I feel the mental pain A smell occurs.” reliable.” such as the sense of shame.” Measurement “I cannot urinate as “Because sterilizing of “I am worried about the urine usual because of the urine receiving the influence of the flow rate pressure,” container is laborious , mental status of the I do not want to patient on the perform examination measurement.” many times. ”
3 Overview of the toilet systems with an uroflowmeter
Fig.2 shows system block diagram of the toilet systems with an uroflowmeter. The toilet adjusts its water level to the control point under trap ware by watering after the toilet ejects some water of the bowl by means of its water nozzle control of rim and jet in flushing. The pressure fluctuation of the water level of toilet bowl is cancelled by calibration of the pressure in drain pipe measured simultaneous with pressure sensor. The toilet system determines the voided volume of urine and the urine flow rate with the corrected water level of the toilet bowl pressure and its calibration curve of water level and the water in its toilet bowl. The calibration curve is made each toilet system in test-drive in installation3),4). From Civil Qater Water Level Addjusting Units
Printer Rim Duct
Jet Duct
Tank Unit
Control Unit Stage Measurement Unit
Operation And Drainage Pressure Sensor Indication Department Water Level Sensor
Junction To In-Hospital LAN Department
Figure 2 - System block diagram of the toilet systems with an uroflowmeter
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Patients can start and stop a urine flow particular measurement and flush by the operation and display unit. In addition, medical personnel can operate various setting such as data retention period and choice of measurement items by it. Fig.3 shows an example of a system configuration diagram that links with the medical institution. The personal computer in nurse station can link with the existing systems of healthcare facility by dedicated tabulation software. Patients are generally authenticated by the individual bar code described in their tag list in Japan. The toilet system has an option to recognize each patient by the bar code without contact.
The personal identification device患者バーコード読取りによる of the non-contact using非接触の個人認証 reading of the bar code of the list tag.
Measurement Measurement 測定結果result 測定結果 Measurement result 測定結果 result 患者情報Patient 患者情報Patient information information
Nursing Support 尿流量測定装置Toilet Systems With Exclusive尿流量管理くん Software Joint Ownership An Uroflowmeter. 共有フォルダFolder 看護支援システムSystem フロースカイ （専用集計ソフト）
Figure 3 - One case of the system that planned cooperation with the medical institution
4 Installation and Usage
4.1 Installation
The toilet system needs water supply, drainage and 100V of power supply. It is installed like a western-style water closet with floor drain in an exactly similar way.
4.2 Attention in installation
The toilet system has to be installed the following steps to measure urine characteristics.
4.2.1 Configuration of calibration curve Western-style stool water closet is manufactured with lower dimensional accuracy than general machine parts. So the calibration curve of water level and volume of bowl must be made individually with several constant drain levels of bowl by metering pump after filled to trap ware.
4.2.2 Configuration of initial water level for measurement This toilet is watered over water level of the trap ware in a different manner of general toilet stools.
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4.3 usage
Fig.4 shows a setting example and a schematic view of the usage. The measurement start button is shared with a personal identification button to determine the result of each patient. The patients need only press the button after using the toilet normally.
Measurement start button (Shared A Personal Identification Button)
Urination
Measurement End Button
Flushing Button
Figure 4 - A setting example and a schematic view of the usage
5 The effect of drainage pressure fluctuation on the measured result
5.1 Method of confirmation
5.1.1 Evaluation method Test equipment, effluent load method and measurement method of Otsuka et al.5),6) are adopted.
5.1.2 Confirmation of the validity of the measurement results The measured voided volume of urine Wu and maximum urine flow rate qumax by the toilet system needs less than ±10% of fluctuation range under the influence of the pressure fluctuation of effluent load to establish a correct diagnosis according to the result of our previous experiments. The suitable pressure range to get right Wu and qumax was found over -200Pa and under +400Pa. In contrast, the urine flow curve Qu (t) is required to preserve the characteristics of each symptom, so Qu (t) need have the similar waveforms after effluent loads. We determined the suitable pressure fluctuation mathematically. Further, the similarity of urine flow curves was determined by nine urological physicians using the Qu(t) with/without the effect of drain pressure.
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5.2 Required range of drain pressure fluctuation
The positive and negative pressure of drain pipe caused by an increase of effluent load alters Qu(t) and leads to worsening of the correlativity. Fig. 5 shows the relationship between the correlation coefficient r and Pmin, Pmax. The correlation coefficient r is over 0.82 with good coincidence of Qu(t) as far as the pressure fluctuation between ±200Pa. It was suggested that the strains of Qu(t) mislead the clinical judgment out of this range. The experiment showed that Q(t) is more susceptible to the effect of pressure fluctuation of drain pipe than Wu and qumax. The toilet system which measures simultaneously important urinary characteristic value of Wu, qumax, Q(t) must be connected to drainage systems with smaller pressure fluctuation under ±200Pa than ones specified in SHASE-S 2187) .
測定階Floor 投入量Input ① ② 測定階Floor 投入量Input ③ ④ 測定階Floor 投入量Input ① ② 測定階Floor 投入量Input ③ ④ 7階 200mL 2階 200mL 7階 200mL 2階 200mL 7F 400mL 2F 400mL 7F 400mL 2F 400mL r r
1.0 1.0 n n o Questionnaire o i i t 0.9 t 0.9 a r a r l level l Questionnaire e e r r
r 0.8 r 0.8 level o o c c
f 0.7 f 0.7 o o
t Statistic Statistic t n 0.6 Measurable n 0.6 e e 相関係数 相関係数
i level level i Measurable c
range c i i f f f 0.5 f 0.5 range e e o o C 0.4 C 0.4 -600 -400 -200 0 200 400 600 -600 -400 -200 0 200 400 600
管内最小、最大圧力Jurisdiction pressurePmin Pmin,、 PPmaxmax [p [Pa]a] 管内最小、最大圧力Jurisdiction pressurPmine Pmin、, PmaxPmax [[Pa]pa] (1) Normalcy (2) Benign prostatic hyperplasia (BPH) Figure 5 - Relations with jurisdiction pressure Pmin, Pmax and coefficient of correlation r
6 The verification of the toilet system in real hospital facility 8)
6.1 Methods
The effectiveness of the toilet system verified at 86.6m of high-rise general hospital facility of 19 stories with 482 beds in Tokyo. Fig.6 shows the outline drawing of its stack. Fig. 7 shows the outline drawing of horizontal branch drain pipe at typical floor and mount conditions of the pressure sensors. A, B, C and D are the installation point of the toilet system. Table 2 shows Building Overview of the hospital and outline of the experiment. Measurement system is identical to previous section.
Table 2 A building summary and an experiment summary. Building use Hospital Plottage 6,850.45[m^2] Building area 3,674.83[m^2] Total of floor space [Hospitalization ridge] 28,748.19[m^2] [Master plan] 38,455.85[m^2] Structure Steel constraction Reinforced concrete construction Number of floors Basement 2 floors 19 floors above thePenthouse 2 floors The best height 86.600[m] Eaves High 81.375[m] Hospital bed capacity 482[beds] The number of the setting these device 37[sets] Sufficiency rate of the sickbed It fluctuates in 75-90% (In an experiment period after the completion)
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9000 3600 5400 ⑤通気立て管⑤Vent Stack 125A 125A 通気立て管 125A ▽PH 排水立て管 150A PSPS H1 H1 WB1 ⑥伸頂通気管⑥Tensile ventilation 150A pipe150A 別系統へ 3900 3900 病室 6000 ▽19階19F H2 L1 ①通気立て管 150A ＡA ①Vent Stack 150A150A WC1 P1
3900 WC2 P1 18F ▽18階 L2 Drainage排水 P5 H1
load負荷 100A 通気横枝管ループ通気管 65A 65A 病室 6000 800
②排水立て管② 150A 3900 WB2 Ｂ Wast Stack 150A L3 B P2 ▽17階17F WC3
40A P2 Drainage排水 load負荷
40A P3 WC4 P3 3900 C WB3 L4Ｃ ▽11階11F
100A 病室 76200
P6 排水横枝管 100A こう配 1/100 6000
L5 廊下 3900 WC5 ▽10階10F WC6 P7 75A L6
3900 病室 6000 ④ループ通気管④Loop Vent Pipe 65A ▽9階9F WB4 L7 ＤD P4 WC7 P4 ①Horizontal①排水横枝管 Branch 3900 100A 100A オフセット配管200A WC8 ③排水立て管③The Offset Plumbing 200A ▽8階8F WB5 L8 オフセット部 200A Ｅ 病室 6000 4500 * [mm] *To低層階の排水立て管へ Wast Stack at Low Floor EPS 低層To Vent階の通気管へ Stack at Low Floor ▽7階7F
[mm] Figure 6 - The drainage stack Figure 7 - A drainage offshoot pipe t system becoming the standard floor
6.2 Results of verification
6.2.1 Drainage experiments of stack Fig. 8 shows the relationship between the Drainage Characteristic qd' measured by 9) SHASE-S220 and pipe pressure of Pmin and Pmax. The horizontal branch drain pipe with 100A diameter and 1/100 gradient of the Loop Vent System in SHASE-S 20610) is designed under 5.6L/s of to control the pressure fluctuation of drain pipe under acceptable value of ±400Pa. The diagnosis with the toilet system in the facility possessed higher reliability within ±200Pa of pressure fluctuation at 5.6L/s of effluent load.
400 e r u s
] SHASE-S206 s
[P a] 300 a e r P Permission flow rate 5.6L/s [ p
n i
m 200 Pmin , u m m P i ,
n 100 x i
a Pmax M m d P
0 n n a o
i t e c r -100 i u d s s s i e r r
u -200 j p
e m h t u
-300
m n i i x 管内最小、最大圧力
a -400 M 024681012
Appliance器具平均排水流量 average drainagqd'e fl [L/s]ow rate qd'[L/s]
Figure 8 - Drainage pipe connection appliance average drainage flow quantity qd' and relations of Pmin, Pmax
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6.2.2 Clinical evaluation experiment We confirmed the measurement deviation of the toilet system with 5.6L/s of effluent load to drainage system and input of simulated urine into the toilet bowl to check the influence of pressure fluctuation to clinical laboratory test results. Fig. 9 shows the measurement deviation of Wu. Fig. 10 shows that of qumax. The toilet system obtained accuracy of measurement for practical use because both of test results shifted under ±10%.
] % [ ]
60 60 x % f [ a
投入量 200mL 400mL
投入量 200mL 400mL
o Input Input f
u m o r
40 40 o u Horizontal排水横枝管 Branch Horizontal排水横枝管 Branch r r W o
q r
r e
e Wast Stack e Wast Stack r 20 排水立て管 20
排水立て管 t m t e
a u n t r l
e n o 0 0 e w m v 測定誤差 [％]測定誤差
o e l m d r f e
e -20 -20 u r
Ｗu d s i m u o a s u -40 v e -40 a Measurable
Measurable m 尿量 e i e M range range x h M -60 a -60 t m -600 -400 -200 0 200 400 600 -600 -400 -200 0 200 400 600 e
Maxi mum pressure and Minimum pressure in the jurisdiction Pmax, Pmin [Pa] h , t Maxi mum pressure and Minimum pressure in the jurisdiction Pmax, Pmin [Pa] (1) Normalcy ] (1) Normalcy ] % [
60 60 % f x [
o a
f u r 40
m 40 o o
W r u r
r o e q
e 20 r 20
e m r t t e u n
a l t e r o 0 0 n v 測定誤差 [％] 測定誤差 m
e w e d o r m -20 l -20 e f u e
Ｗu d r s i
m Measurable o a -40 Measurable u -40 s u v e
range range 尿量 a e m M e i h
-60 x -60 t M -600 -400 -200 0 200 400 600 a -600 -400 -200 0 200 400 600 m
Maxi mum pressure and Minimum pressure in the jurisdiction Pmax, Pmin [Pa] e Maxi mum pressure and Minimum pressure in t,he jurisdiction Pmax, Pmin [Pa] h t (2) Benign prostatic hyperplasia (BPH) (2) Benign prostatic hyperplasia (BPH)
Figure 9 - Relations with the Figure 10 - Relations of the measurement error of the voided measurement error of maximum flow volume Wu for minimum and rate qumax for minimum and maximum pressure maximum pressure
7 Operational evaluation
7.1 Operational evaluation at Ｌ Clinic 11)
The toilet system was confirmed of its benefits based on the operational evaluation in women's clinic L for urinology. Fig.11 shows the results of 100 women's urine flow measurement with the conventional measuring instrument and the toilet system. Fig.11 also summarizes the patients’ impression of the inspection methods. Over half of patients said that the toilet system was far superior to the conventional method in terms of easily operation and their usual urination with statistically-significant difference (p<0.05). Additionally, 50% of patients felt no longer ashamed why they can discharge their urine out of sight. These results show this kind of the toilet system with urine flow measurement are considered as an effectual inspection apparatus which improves patients’ QOL and saves labor of healthcare providers. The clinical laboratory test results under embarrassing circumstances were partially reliable in general, so the toilet system can improve the accuracy of measurement.
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p<0.05
90% 90% 80% 80% 70% 70% 60% 60% 50% 50% 40% 40% 30% 30% 20% 20% 10% 10% 0% 0% Not Able Not Able Able To Do Not Able Not Able Able To Do To Do To Do To Do To Do Very Buch Very Buch Conventional uroflowmeter Toilet systems with an uroflowmeter
(MMM;UD-1030) (TOTO;CES44)
Figure 11 - “Were you able to urinate in the same way as usual times?”
7.2 Operational evaluation at M Hospital (A note : These data which we collected in the same facilities at chapter 6)
7.2.1 Performance stability 8) We examined the reliability of the measurements the toilet system installed in the booth No.C by means of introducing simulated urine continuously. Table 3 The results is the summary of the results. Since, as shown in, all of the measurement error is within ±5%. The toilet system can measure the urine characteristics validly and stably under the pressure fluctuation of drain pipe.
Table 3 Use frequency of the toilet systems with an uroflowmete. (the 16th floor) Normalcy Benign prostatic hyperplasia (BPH)
Input[mL] Measurements[mL] error[%] Input[mL] Measurements[mL] error[%]
192.9 -3.6 192.5 -3.8 200 200 195.7 -2.2 205.9 3.0
397.4 -0.7 407.3 1.8 400 400 399.4 -0.2 407.5 1.9
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7.2.2 Odor 12) The concentration of ammonia as the basic component of odor in festering urine at urological ward was measured by gas chromatography. Fig. 12 shows the results with the control odor of urinary retention chamber of another clinic. The toilet system achieves odor free clinic under threshold concentration of ammonia, but the conventional clinic without the toilet system had strong odor very possibly caused spilling or spread of urine.
1600 1600ppb 1400 ]
b 1200 p p [
s l
e 1000
v The Sensuality e
L Threshold Of The
a 800 i Ammonia n
o 150 ppb
m 600 m A 400 48ppb 74ppb 150ppb 200
0 0123457F 17F At The Time Of At The Time Of Safe Keeping The Disposal Applicable Facilities Conventional Filth Room Figure 12 - The comparison graph with the before method for the ammonia odor
7.2.3 Questionnaire of patient 12) Fig.13 shows the results of attitude survey of the toilet system among 17 persons with experience of conventional inspection method in his stay in the hospital. Automatic urine volume measuring system is desired by patients with urinary problems, because a large majority of them said that the toilet system was superior to the conventional method.
80% 70% 60% 50% 40% 30% 20% 10% 0% " I Worsened.悪かった " " I Do変わらない Not Change. " " I 良かったImproved. "
Figure 13 - Attitude survey result of the patient
7.2.4 Questionnaire of clinical nurse 12) Fig 14 shows the results of attitude survey of the toilet system among 161 clinical nurses. The ratio of respondents was 55%. The toilet system triggered a positive response of many nurses because of its secure urine collection. 30% of nurses
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answered that patients couldn’t operate the toilet system despite of only one push of a button to start. We must attain further easy operation of the toilet system on the assumption that many old people or dementia patients use it.
161 Nurses (55% Of Answer Rates)
A Work Load Decreased
A Bad Smell Decreased
The Burden On Patient Decreased
I Hope For Setting In All Restrooms
Safety Improves
An Appearance Is Good
Patients Does't Hate Urine Collection
There Is The Patient Whom I Cannot Understand
0% 10% 20% 30% 40% 50% 60% 70%
Figure 14 - Consciousness about the urine discharge measurement stool device of the nurse
7.2.5 Substitution of urine volume measurement method in the clinic 12) Fig. 15 shows the change of urine volume measurement method in the clinic between the toilet system and the conventional methods in the hospital. The toilets system gained the acceptance of medical doctors and nurses judging from urine volume management with the toilet system went on increasing. Also the toilet system had effect to minimize the number of urine gathering.
8% 調査From日： 2210 1to0 年227 on月 July21～ in22 2010日 Chamber瓶蓄 Pot尿 16% 調From査日 3 ：to2 051 on0年 March3月3～ in5 2010日 4% 分注畜尿器 Urinalysis Devise 2%
88% 尿Toilet流量 Systems測定大 With便器 An Uroflowmeter 82%
0 20 40 60 80 100 頻Frequency度（％） (%)
Figure 15 - Change of the voided volume method for measurement
8 Conclusion
The toilet can measure the characteristics of urine of the patients precisely during their usual defecation under within ±200Pa. It is found that the toilet in actual healthcare facilities can solve most problems of conventional uroscopy according to the result of our availability for hundreds of clinical uses.
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9 References
1) Population by Statistics Bureau , 2010 2) Osam Ishizuka et.al; Here of the examination for urology department is point, Clinical urology department extra number, pp.128-130, 64, 4, April, 2010 3) Hironori Yamasaki; Health care monitoring in the restroom environment, next- generation sensor, 18, 2, Jan., 2009 4) Hironori Yamasaki; Urine flow measurement device, Flow sky, BE architecture facilities, April, 2012 5) Masayuki Otsuka et.al ; Experiment study on the influence of pressure fluctuation in the drainage stack pipe on the measurement performance indicators for toilets with an uroflowmeter, .J. environ. eng., AIJ, Vol.76 No.661,265-272,Mar.,2011 6) Yuta Takahashi , Masayuki Otsuka , Hironori Yamasaki ; A Study on Evaluation for Toilet System with an Uroflowmeter , CIBW062 Symposium 2019 7) Testing Method of Flow Capacity for Drainage System in Apartment Houses , SHASE-S218-2008 8) Masayuki Otsuka et.al ; Study of measurement performance evaluation when faces of toilets with an uroflwmeter are used in hospital facility, AIJ J. Technol. Des. Vol. 18, No.39, 617-622, Jun., 2012. 9) Testing Methods of Discharge Characteristic for Plumbing Fixtures , SHASE-S220-2000 10) Standard for Plumbing and Sanitary System , SHASE-S206-2000 11) Yuki Sekiguchi et.al : Does the restroom setting type urine flow measurement device improve improvement and patient QOL in inspection environment? , The clinical urology department, Vol.62(9), pp.699-704, Aug. ,2008 12) Hitomi Moriyama et.al ; Improvement of the urine collection duties using one restroom type urine flow measurement device, the 61st Japan Hospital society, July 2011
10 Presentation of Authors
Hironori Yamasaki is a Senior Engineer, Restroom Producs Research Dept., Sanitary Ware Product Research Sect., TOTO LTD.. He is a member of NBS (Neurogenic Bladder Society), JSME (Japan Society of Mecanical Engineering) , AIJ (Architectural Institute of Japan) and SHASE (Society of Heating, Air-Conditioning and Sanitary Engineers of Japan). His current research interest is the Physical Monitoring for Medical and Health Care.
Masayuki Otsuka is a professor at the Department of Architecture,Kanto Gakuin University. He is a member of AIJ（ArchitecturalInstitute of Japan）and SHASE（Society of Heating, Air-Conditioning and Sanitary Engineers of Japan, academic director）. His current research interests are the performances of plumbing systems, drainage systems with drainage piping systems for SI（Support and Infill） housing.
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