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PubMed1968

Comparison of microbial contamination levels among hospital operating rooms and industrial clean rooms.

Microbial contamination in industrial clean rooms was compared quantitatively and qualitatively with that of hospital operating rooms. The number of aerobic mesophilic microorganisms which accumulated on stainless-steel strips exposed for periods up to 21 weeks to the intramural air of four operating rooms was at least 1 log higher than the accumulation on strips exposed in four clean rooms, and was essentially the same as that found in two factory areas. Volumetric air samplings showed that there were significantly higher numbers of airborne viable particles per cubic foot of air in operating rooms than in industrial clean rooms. In contrast to clean rooms, where most of the airborne contaminants were those associated with human hair, skin, and respiratory tract, the hospital operating rooms showed a very high level of microorganisms associated with dust and soil.

Air Microbiology↗
PubMed1991

Blood contact and exposure in the operating room.

We prospectively studied 684 operations from all surgical specialties to describe the frequency and character of blood contact and exposure during the procedures. Blood contact was defined as percutaneous, mucous membrane, nonintact skin or intact skin contact of patient blood with any member of the operative team. Blood exposure was defined as contact in any of the preceding categories excluding intact skin. Over-all, 28 per cent of the patients had one or more blood contact events that involved 293 operating room personnel. Risk of blood contact was significantly greater for cardiothoracic (p less than 0.001), trauma (p less than 0.003) and obstetric cesarean section (p less than 0.021) procedures when compared with all other procedures. Three services (Ophthalmology, Transplant and Oral Surgery) had no contact events. The remaining nine had rates ranging from 17 to 33 per cent. Eight per cent of the procedures (n = 54) resulted in blood exposure to 63 individuals. Percutaneous exposure occurred in 3 per cent of all procedures. Blood contact events increased with increasing operative time. Blood contact most commonly occurred among circulating nurses (n = 79), anesthesia personnel (n = 65), surgeons (n = 59) and first assistants (n = 49). Despite increased concerns over the risk of occupationally acquired viral diseases, blood contact and exposure continue to be frequent events. Surgeons must assume that all patients are potentially infected and should adopt universally applied standards of behavior to minimize contact with blood.

Allied Health Personnel↗
PubMed2005

[Implementation of modern operating room management -- experiences made at an university hospital].

Caused by structural changes in health care the general need for cost control is evident for all hospitals. As operating room is one of the most cost-intensive sectors in a hospital, optimisation of workflow processes in this area is of particular interest for health care providers. While modern operating room management is established in several clinics yet, others are less prepared for economic challenges. Therefore, the operating room statute of the Charité university hospital useful for other hospitals to develop an own concept is presented. In addition, experiences made with implementation of new management structures are described and results obtained over the last 5 years are reported. Whereas the total number of operation procedures increased by 15 %, the operating room utilization increased more markedly in terms of time and cases. Summarizing the results, central operating room management has been proved to be an effective tool to increase the efficiency of workflow processes in the operating room.

Cost Control↗
PubMed2004

Morbidity and mortality related to anaesthesia outside the operating room.

PURPOSE OF REVIEW: The purpose of this review is to provide information related to morbidity and mortality associated with anaesthesia outside the operating room. RECENT FINDINGS: There is an increasing demand for anaesthesia at remote locations. Because of its specific characteristics, resulting from the location and the patient, morbidity and mortality rates of remote location anaesthesia could differ from conventional operating room anaesthesia. However, no studies are currently available. On the basis of morbidity and mortality data from conventional operating room anaesthesia, we reached some important conclusions with regard to the safety of anaesthesia outside the operating room. A well-equipped anaesthesia machine, standard monitoring (electrocardiogram, oxygen saturation and non-invasive blood pressure), trained personnel and adequate planning should be standard for all out of the operating room procedures. When all these are in place, the incidence of morbidity or mortality should be comparable to that of anaesthesia provided in the operating room. SUMMARY: There is certainly a need for studies concerning morbidity and mortality at remote location anaesthesia. Special care for the prevention of hypothermia should be given to those patients undergoing long-lasting diagnostic procedures, e.g. magnetic resonance imaging scans or cardiological investigations.

Journal Article↗
PubMed1976

Influence of operating room surface contamination on surgical wounds: a prospective study.

The influence of operating room contamination on wound infection rates in clean, clean-contaminated, contaminated, and septid procedures was studied by a prospective randomized study of 2,020 surgical wounds. Operating room surface contamination was assessed by the RODAC bacterial plate method. Control rooms uniformly received Wet-Vac cleaning between operations. Experimental rooms were not cleaned between consecutive clean operations, but were cleaned after contaminated operations. The difference in surface contamination between groups of experimental and control rooms was found to be significant at the P less than .05 level. Patients operated on in experimental and control rooms were followed up postoperatively to assess whether they experienced wound infection. No statistically significant differences in wound infection rates were found between experimental and control room operations as total groups, clean procedures, or operations of long duration.

Bacteria↗
PubMed2003

Determining optimum operating room utilization.

UNLABELLED: Economic considerations suggest that it is desirable to keep operating rooms fully used when staffed, but the optimum utilization of an operating room (OR) is not known. We created a simulation of an OR to define optimum utilization. We set operational goals of having cases start within 15 min of the scheduled time and of having the cases end no more than 15 min past the scheduled end of the day. Within these goals, a utilization of 85% to 90% is the highest that can be achieved without delay or running late. Increasing the variability of case duration decreases the utilization that can be achieved within these targets. IMPLICATIONS: Using a simulated operating room (OR), the authors demonstrate that OR utilization higher than 85% to 90% leads to patient delays and staff overtime. Increased efficiency of an OR comes at a cost of patient convenience.

Adenoidectomy↗
PubMed1984

New versatile operating room table and mobile C-arm fluoroscopic system.

The rapid development of endourologic procedures and ultrasonic renal stone surgery has left most hospital operating rooms without a suitable radiolucent operating table and a safe up-to-date C-arm fluoroscopic unit for these operations. A new radiolucent operating room table top combined with a new mobile C-arm fluoroscopy unit will allow versatility in the operating room for these percutaneous antegrade renal and ureteral operations. This table offers the additional benefits of being excellent for transurethral resection of the prostate, bladder tumors, litholapaxy, and cystoscopy as well as open bladder, prostate, trauma, and renal surgery. It also offers adequate space under it so that the microsurgeon can get his knees under the table while seated to do vasovasostomy and vasoepididymostomy with comfort. The urologist can thus perform all types of surgery on one table top and also relieve the cystoscopy room of a crowded schedule by doing some endoscopic surgery in the regular operating room.

Fluoroscopy↗
PubMed1993

Validation of surgical wound classification in the operating room.

OBJECTIVE: To determine the accuracy with which circulating nurses (CNs) classify surgical procedures by risk of contamination in the operating room. DESIGN: Classification of surgical procedures by CNs was compared with the classification of surgical procedures by a physician observer. SETTING: University-affiliated, tertiary care hospital. METHODS: Circulating nurses used the traditional wound classification system of clean, clean-contaminated, contaminated, and dirty-infected to classify surgical wounds in the operating room. A physician remained in the operating room throughout each of 100 surgical procedures and simultaneously classified surgical wounds without the knowledge of the CNs. RESULTS: Classification of surgical wounds by CNs was compared with classification by the physician observer for 50 cases in general surgery and 50 cases in trauma surgery. Compared with the physician observer, the overall accuracy of classification by CNs was 88% (95% confidence interval [CI] of 81.6% to 94.4%; Kappa statistic, 0.83). Classification of surgical wounds was more difficult in trauma surgery (accuracy of 82%) than in general surgery (accuracy of 94%). Accuracy increased for both services when surgical wounds were classified into just two categories (clean or clean-contaminated versus contaminated or dirty-infected). CONCLUSIONS: Surgical wounds can be classified in the operating room with a high degree of accuracy by CNs. Classification was more difficult in trauma than in general surgery, but classification in trauma surgery improved with feedback to and additional education of CNs. The accuracy of classification by CNs was even higher when classifications were divided into just two categories.

Hospital Bed Capacity, 300 to 499↗
PubMed1999

Operating room environment.

Sepsis after total joint replacement is related directly to environmental contamination. Therefore, to control the source of environmental contamination, and ultimately sepsis, it must be realized that the operating room personnel are the major source of the bacteria as evidence by the rise in the colony forming units per square foot per hour from 13 units in an operating room without people to greater than 400 units during actual surgery. The use of inclusive gowns, such as hooded body exhaust, is most helpful. However, all operating room personnel including anesthesia personnel, circulating nurses, visitors, and the operating room team must wear inclusive gowns. Face masks and head covers offer no environmental protection. Some type of an environmental control, such as laminar airflow or ultraviolet light, is the most helpful with greater than 90% reduction of airborne bacteria at the wound and 60% reduction of airborne bacteria in the operating room. Therefore, to reduce environmental bacteria contamination the number of personnel in the operating room and the length of time for the actual surgery should be reduced, because wound contamination occurs first by direct fall out from the environment and second by contaminated equipment and gloved hands that initially were contaminated by the environment.

Arthroplasty, Replacement↗
PubMed1975

The operating room environment as affected by people and the surgical face mask.

The microbiological counts were determined in an operating room suite of 8 rooms and a hallway. The bacterial counts in an empty operating room jumped statistically from 13 CFU/ft2/hr (+/- 31) to 24.8 (+/- 58.8) when the doors were left open (people in the hallways) and 447.3 (+/- 186.7) when 5 people were introduced. The wearing of a surgical face mask had no effect upon the overall operating room environmental contamination and probably work only to redirect the projectile effect of talking and breathing. People are the major source of environmental contamination in the operating room.

Air Microbiology↗
PubMedDate not supplied

Nitrous oxide exposure in the operating room.

One-hundred and eight-five pairs of gas samples were collected from inspired gas (10 cm behind the head at nose level) and end-tidal gas of persons administering anesthesia in 3 operating rooms during daily routine anesthesia. Mean operating-room N2O concentrations from 22 to 144 ppm (volume/volume [V/V]) were measured by gas chromatography, and large moment-to-moment variations (temporal gradients) were seen in individual operating rooms. Mean end-tidal N2O concentrations from 51 to 114 ppm (V/V) were observed. There were low correlations between inspired and end-tidal N2O concentrations (r values as low as r = 0.35). This poor relationship is presumably due to spatial and temporal gradients of N2O in the operating rooms. We conclude that the temporal and spatial gradients in N2O concentrations within active operating rooms are sufficiently large to invalidate estimation of exposure of anesthetic personnel to N2O from "spot" or "grab" samples collected in the breathing area.

Air Pollutants↗
PubMed1983

Sister chromatid exchanges and structural chromosome aberrations in lymphocytes in operating room personnel.

Information on possible chromosomal damage in humans after long-term exposure to trace concentrations of waste anaesthetic gases is scarce. We examined peripheral lymphocytes in operating room personnel for both chromosome aberrations and sister chromatid exchanges (SCE). Following a standardized procedure of cultivation and staining, 30 cells from each person were scored for SCE and 100 cells from each person were examined for chromosome aberrations. A total of 45 persons were examined, representing anaesthetists (n = 15), operating room nurses assisting the surgeon (n = 10), nurses circulating in the operating room (n = 8) and healthy, unexposed controls (n = 12). The median duration of working in the operating room was 102 months, 66 months and 66 months, respectively. Time-weighted concentration levels of 2.5-4.3 p.p.m. of halothane and 25-400 p.p.m. of nitrous oxide were measured in the breathing zones of the anaesthetists during mask anaesthesia. Examination of SCE and chromosome aberrations yielded corresponding qualitative results. With both tests, no statistically significant difference was observed between the four groups of persons. It was concluded that by examination of both SCE and chromosome aberrations in peripheral lymphocytes in operating room personnel, no indication was found of a mutagenic effect of long-term exposure to trace concentrations of waste anaesthetic gases.

Anesthesiology↗
PubMed1992

Exposure of hospital operating room personnel to potentially harmful environmental agents.

Epidemiologic studies of risk to reproductive health arising from the operating room environment have been inconclusive and lack quantitative exposure information. This study was undertaken to quantify exposure of operating room (OR) personnel to anesthetic agents, x-radiation, methyl methacrylate, and ethylene oxide and to determine how exposure varies with different operating room factors. Exposures of anesthetists and nurses to these agents were determined in selected operating rooms over three consecutive days. Each subject was asked to wear an x-radiation dosimeter for 1 month. Exposure to anesthetic agents was found to be influenced by the age of the OR facility, type of surgical service, number of procedures carried out during the day, type of anesthetic circuitry, and method of anesthesia delivery. Anesthetists were found to have significantly greater exposures than OR nurses. Exposure of OR personnel to ethylene oxide, methyl methacrylate, and x-radiation were well within existing standards. Exposure of anesthetists and nurses to anesthetic agents, at times, was in excess of Ontario exposure guidelines, despite improvements in the control of anesthetic pollution.

Environmental Monitoring↗
PubMed2000

Scheduling surgical cases into overflow block time- computer simulation of the effects of scheduling strategies on operating room labor costs.

UNLABELLED: "Overflow" block time is operating room (OR) time for a surgical group's cases that cannot be completed in the regular block time allocated to each surgeon in the surgical group. Having such overflow block time increases OR utilization. The optimal way to schedule patients into a surgical group's overflow block time is unknown. In this study, we developed a scheduling strategy that balances the OR manager's need to reduce staffing costs and the needs of patients and surgeons for flexibility in choosing the dates and times of cases. We used computer simulation to evaluate our scheduling strategy. Surgeons and patients (i) can schedule the case into any overflow block within 2 wk; (ii) can only schedule the case into a "first case of the day" start time more than 2 wk in the future if there is not enough open time for the case within 2 wk; (iii) must schedule the case to be done within 4 wk; and (iv) are encouraged to perform the case on the earliest possible date. Staffing costs were lowest when the OR manager did not incorporate surgeon and patient preferences when scheduling cases into overflow block time. The strategy we developed provides surgeons and patients with some flexibility in scheduling, while only increasing OR staffing costs slightly over the minimum achieved when the OR manager controls scheduling. IMPLICATIONS: The strategy we developed provides surgeons and patients with some flexibility in scheduling, while increasing OR staffing costs only slightly over the minimum achieved when the OR manager controls scheduling. Staffing costs were lowest when the operating room (OR) manager did not incorporate surgeon and patient preferences when scheduling cases into overflow block time.

Appointments and Schedules↗
PubMed2001

Ocular discomfort and conjunctival alterations in operating room workers. A single-institution pilot study.

OBJECTIVES: The aim of this pilot study was to relate the eye symptoms complained of by subjects working in the operating rooms of a hospital in southern Italy, with the observations of alterations of the ocular surface. METHODS: An epidemiological study was carried out by a questionnaire aimed at investigating the prevalence of ocular discomfort symptoms among 213 subjects working in operating rooms and 40 subjects working in the wards. The investigated symptoms were the following: tiredness, heaviness, burning, redness, tearing, itching, blinking, foreign body sensation, and photophobia. A randomised comparative study of the ocular surface and conjunctival cytology was also carried out, comparing two groups of age- and gender-matched subjects. Group 1 included 24 subjects randomly chosen from the operating room workers with ocular discomfort symptoms; group 2 included ten subjects randomly enrolled from hospital personnel working in the wards. Ophthalmological examination of the ocular surface was performed on each subject in the following order: slit-lamp examination, break-up time (BUT) of the pre-corneal tear film, corneal fluorescein stain, lachrymal basal secretion test, conjunctival impression cytology. RESULTS: A high prevalence (72.3%) of ocular discomfort symptoms was reported by operating room workers, while in ward personnel the prevalence was 55% (P = 0.04). The ocular tests showed that the conjunctival features and BUT were statistically significantly altered in subjects in group 1. Also, the conjunctival impression cytology study showed statistically significant alterations of all the investigated parameters: specimen cellularity, cell-to-cell contacts, nucleus/cytoplasm ratio, chromatin pattern, goblet cell distribution, keratinisation and the total cytological score. CONCLUSIONS: Our results show that self-reported eye complaints and ocular surface alterations have a high prevalence in subjects working in the operating rooms. This seems to indicate that the operating room environment could play a role in the onset of the eye disturbances.

Adult↗
PubMed2002

[Assessment of preoperative anxiety in patients entering the operating room on foot using state-trait anxiety inventory].

The purpose of this prospective study was to assess the effect of walking into the operating room on preoperative anxiety level. Sixty non-premedicated patients scheduled for elective surgery were randomly divided into two groups based on how they were transported into the operating room. One group was carried on a stretcher (n = 30) and the other entered on foot under their own power (n = 30). A subjective assessment of anxiety was performed using a state-trait anxiety inventory (STAI) the day before surgery and on arrival at the operating room. STAI values were not increased in the operating room as compared to the day before surgery for either group and did not differ between groups, though they showed a high level of anxiety throughout the preoperative period. We conclude that walking into the operating room has no significant influence on preoperative anxiety level.

Adolescent↗