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PubMed1999

Infection control during construction and renovation in the operating room.

This article describes a case study of reconstruction of an operating room suite. Suggestions for completing the renovations while controlling microorganisms are supplied. A comprehensive Infection Control Program is discussed, which includes essential environment controls in the operating room during any construction and renovation. A policy designed by the authors to minimize surgical infections during reconstruction is shared with the readers.

Air Microbiology↗
PubMed2005

Outbreak of infection with a multiresistant Klebsiella pneumoniae strain associated with contaminated roll boards in operating rooms.

An outbreak with a multiresistant Klebsiella pneumoniae (MRKP) strain among seven patients admitted to the adult intensive care unit (ICU) of a regional teaching hospital in The Netherlands was investigated. Epidemiologic investigations revealed a short delay between an operation and the acquisition of the MRKP strain. A case-control study comprising 7 cases and 14 controls was conducted to identify the risk factors associated with the acquisition of the MRKP strain. An operation at each of two operation rooms was strongly associated with the acquisition of the MRKP strain: odds ratio of 36 (95% confidence interval, 2.7 to 481.2; P=0.003, Fisher exact two-tailed test). Cultures of environmental specimens of the operation rooms revealed contamination of the roll boards used to transport patients from the bed to the operation table with the MRKP strains. Molecular genotyping of the isolates revealed clonal similarity between the isolates of the seven cases, isolates from environmental specimen cultures, and in addition, an MRKP isolate from a re-patriated ICU patient from earlier that year. The outbreak ended after cleaning and replacement of the roll boards in the operation rooms and implementation of additional barrier precautions for colonized or infected patients. It was concluded that two operation rooms played a significant role in the transmission of an MRKP strain between ICU patients during the presented outbreak.

Adult↗
PubMed1984

Ophthalmology operating room standards and infection control concerns.

Postoperative infection is a rare complication of intraocular surgery. Although the incidence is low, the morbidity is high in terms of long-term sequelae. Because some ophthalmologists have requested separate operating rooms to reduce the risk of exogenous sources of infection, ophthalmology training program directors were surveyed to determine national standards of practice. Among the 100 centers responding, most were university affiliated (73%), had more than 500-bed hospitals (67%), and had fewer than 50 practicing ophthalmologists (92%). A single operating room was used in 50 centers and only 33 did not permit nonophthalmology cases in the ophthalmology operating rooms. Centers with a greater ophthalmology volume did not differ from low-volume centers in the scheduling of ophthalmology and nonopthalmology clean or infected cases. Program directors from larger centers, however, were more frequently of the opinion that a separate ophthalmology operating room was needed: 86.2% vs. 63.5% (p = 0.04).

Cross Infection↗
PubMed2005

Office versus operating room insertion of the bone-anchored hearing aid: a comparative analysis.

BACKGROUND: The Bone-anchored Hearing Aid is indicated for patients with unilateral deafness and/or an irreversible conductive hearing loss. The insertion of this device is usually performed in the operating room under intravenous sedation or general anesthesia. We suggest that the placement of the abutment can occur easily and safely in the clinic setting, reducing time and costs for both the patient and the physician. STUDY DESIGN: Retrospective study. METHODS: Ten patients requiring 11 devices (1 bilateral) were implanted with the Bone-anchored Hearing Aid device in the outpatient clinic and another 8 patients were implanted in the operating room. All office procedures were done under local anesthesia; operating room procedures used either general anesthesia or intravenous sedation. Follow-up occurred over 12 months. Time required, cost of the procedure, and other logistical concerns between operating room and office-based insertion were evaluated and compared. RESULTS: When performed in the office, patient fees were reduced by 31%, and patient time investment was reduced 73%. Physician time was reduced by 50%. After office-based insertion, patients were able to return to their normal routine immediately after the procedure, and no chaperone or designated driver was required. No infection or complications occurred in either group. CONCLUSION: Bone-anchored Hearing Aid insertion in the clinic setting is safe and cost-effective, saving the patient and physician significant time and resources.

Aged↗
PubMed2004

Computerized control of the procedure for detecting and removing airborne particles in operating rooms.

Surgical-site infections are still a major problem in modern medicine. Normal skin fora of patients or healthcare workers causes more than half of all infections following clean surgery, but the importance of airborne particles in this setting remains controversial. The use of ultraclean air in operating rooms has been shown to reduce infection rates significantly. High efficiency particlulate air (HEPA) filters are used in some modern operating rooms. Although the uses of HEPA filters, the air quality should be controlled by another device to make safe the air in operating rooms and intensive care units. In this study, a computerized system was established to control the cleanliness of the air by measuring the presence of airborne particles of varying sizes and numbers in operating rooms. When the maximum values are exceeded, the system warns the authorized people by phone, sound, or displays.

Air Pollution, Indoor↗
PubMed1992

Prevalence of latex allergy in operating room nurses.

The twofold purpose of this study was to assess the prevalence of latex sensitivity in a large group of operating room nurses and to evaluate the relationship between questionnaire responses and skin tests. Of the total target population of 268 operating room nurses, 248 (93%) answered the questionnaire and 197 had skin prick tests to latex (1/10 wt/vol solution). Symptoms associated with glove wearing were acknowledged by 41.1% of nurses. Skin tests to latex were positive in 21 nurses (10.7%), 4.4 times more often in atopic nurses. Among nurses complaining of local symptoms, only 18.6% had positive skin tests. Itching of the hands during glove wearing correlated poorly with latex sensitivity, but correlation with local urticaria was better. Atopic nurses complaining of urticaria had latex allergy in 70% of cases. Thus latex allergy is common in nurses, especially atopic nurses. A questionnaire is unreliable in predicting latex sensitivity and must be supported by latex skin test. More data will be needed to assess the risk of anaphylactic perioperative reactions in operating room nurses.

Adult↗
PubMed1975

The importance of environmental conditions, especially temperature, in the operating room and intensive care ward.

Although most patients are essentially well enough to be able to resist or to adapt to unfavourable ambient conditions, this may not be so with an ill patient or one who is having or has had a serious operation. The climatic conditions necessary in the operating room to give an optimal environment are discussed. These are second in importance only to control of infectivity. Air-conditioning in operating suites should be obligatory; there is even official acceptance of this. Earlier recommendations that the operating room should be heated to up to 80 degree F (27-9 degree C) are obsolete. The temperature most favoured by surgeons is 18-5-21 degree C; some prefer a range of 21-22 degre C. The critical ambient temperature desirable is 21 degree C. For infants and children this may be increased up to 24 degree C. It is difficult or impossible to achieve climatic conditions in the operating room that are acceptable to all. The needs of the patient are of special importance and are largely neglected; he alone is unable to speak for himself. The disposition of air inlets in the operating room is fully discussed. Climatic conditions in the intensive care unit are of great importance and are discussed. The need for full air-conditioning is absolute although this is often ignored. The delivery of conditioned air within the intensive care unit is also fully presented, especially the need to avoid direct chilling of the patient. The advantages of horizontal laminar air flow are presented.

Air Conditioning↗
PubMed1979

Bacteriology of the operating room with the use of helmet aspiration systems.

The bacteriology of the operating room with the use of the helmet-aspirator system has been discussed. The surgical team predictably contaminates the operating room. Current cotton gowns worn loosely about the neck do not serve as effective barriers to bacterial penetration. Barrier draping of the surgical team is possible with impervious materials, but requires the use of a helmet-aspirator system to dissipate the heat and particulate debris. These are commercially available and their use has been shown to decrease colony-forming particles, decrease wound contamination, and decrease wound infection. Barrier draping of the surgical team through the helmet-aspirator system is effective and is to be recommended for infection-prone cases.

Air Microbiology↗
PubMed1996

Do not resuscitate orders in the operating room.

PURPOSE: The background to a current analysis of the management of "do not resuscitate" (DNR) orders in the operating room is reviewed, with an emphasis on the current status of resuscitation/DNR issues in Canada. SOURCE: The Joint Statement on Resuscitative Interventions published by the Canadian Medical Association and cooperating organizations and the report of the Senate of Canada Special Committee on Euthanasia and Assisted Suicide are examined for information relevant to the DNR issue. Guidelines on the management of DNR orders in the operating room, published by the American Society of Anesthesiologists and the American College of Surgeons are used to provide a perioperative DNR order management approach consistent with the Joint Statement on Resuscitative Interventions. PRINCIPAL FINDINGS AND CONCLUSIONS: The dominant principle is that of the patient's right to self determination. This right can be exercised either directly by the patient, or through an appropriate alternate, or in the form of an advance directive. DNR orders are not incompatible with subsequent surgical care in an operating room. It is wrong to suspend automatically DNR orders in the perioperative period. It is wrong to continue DNR orders automatically in the perioperative period. It is wrong to make assumptions about the meaning of an individual DNR order. An appropriate approach to the perioperative management of pre-existing DNR orders is one based on "required reconsideration." All anaesthetists must be aware of their responsibilities in managing patients with DNR orders in place.

Ethics, Medical↗
PubMed2003

Managing risk and expected financial return from selective expansion of operating room capacity: mean-variance analysis of a hospital's portfolio of surgeons.

UNLABELLED: Surgeons using the same amount of operating room (OR) time differ in their achieved hospital contribution margins (revenue minus variable costs) by >1000%. Thus, to improve the financial return from perioperative facilities, OR strategic decisions should selectively focus additional OR capacity and capital purchasing on a few surgeons or subspecialties. These decisions use estimates of each surgeon's and/or subspecialty's contribution margin per OR hour. The estimates are subject to uncertainty (e.g., from outliers). We account for the uncertainties by using mean-variance portfolio analysis (i.e., quadratic programming). This method characterizes the problem of selectively expanding OR capacity based on the expected financial return and risk of different portfolios of surgeons. The assessment reveals whether the choices, of which surgeons have their OR capacity expanded, are sensitive to the uncertainties in the surgeons' contribution margins per OR hour. Thus, mean-variance analysis reduces the chance of making strategic decisions based on spurious information. We also assess the financial benefit of using mean-variance portfolio analysis when the planned expansion of OR capacity is well diversified over at least several surgeons or subspecialties. Our results show that, in such circumstances, there may be little benefit from further changing the portfolio to reduce its financial risk. IMPLICATIONS: Surgeon and subspecialty specific hospital financial data are uncertain, a fact that should be taken into account when making decisions about expanding operating room capacity. We show that mean-variance portfolio analysis can incorporate this uncertainty, thereby guiding operating room management decision-making and reducing the chance of a strategic decision being made based on spurious information.

Analysis of Variance↗
PubMed1994

Localization of impalpable breast masses: value of sonography in the operating room and scanning of excised specimens.

OBJECTIVE: Despite the variety of techniques available, mammographically guided preoperative localization of impalpable masses in the breast can be a difficult procedure for radiologists. Furthermore, in a few cases, an impalpable lesion is clearly seen on sonograms and yet poorly seen or not visible on mammograms. Accordingly, we studied the value of localizing impalpable masses with sonography in the operating room and of scanning excised specimens to confirm successful removal of the mass. All of the lesions were visible on preoperative sonograms. SUBJECTS AND METHODS: Twenty-six patients had sonographic examination of the breast in the operating room to guide the localization of an impalpable mass previously seen on sonograms. In eight patients, the lesion was poorly seen or not seen on conventional mammograms. Localizing techniques included one or more of the following: insertion of a needle, injection of dye, or simple marking on the skin. In 18 cases, sonography of the freshly excised specimen was done in the operating room. The sizes of the masses (13 fibroadenomas, 10 carcinomas, two cysts, and one tubular adenoma) measured on the sonograms ranged from 0.6 to 2.7 cm (mean +/- SD, 1.2 +/- 0.5 cm). RESULTS: In all 26 cases, the mass was clearly identified on sonograms obtained in the operating room. In all 18 cases in which it was used, sonography of the specimen correctly showed the presence or absence of the lesion. In two cases, sonographic determination of the absence of the lesion in the specimen prompted immediate reexcision, which was successful. CONCLUSION: Our experience shows that sonography in the operating room is a rapid and efficient method of localizing impalpable breast masses that have been seen on sonograms. Sonography of the specimen can indicate within seconds whether the excision has been successful. This technique is particularly valuable for masses that are not visible or only poorly visible on mammograms.

Breast↗
PubMed1993

Blood contact and exposures among operating room personnel: a multicenter study.

Blood exposures are increasingly recognized as a risk for health care workers in the operating room. Trained circulating nurses supervised by site coordinators queried surgical team members about blood contact and collected data on 8502 surgical procedures from seven community and two university hospitals in 1992. Blood contact occurred during 864 cases (10.2% case-contact rate) in 1054 health care workers (12.4% person-contact rate). The parenteral exposure (punctures or cuts, mucous membranes, nonintact skin) rate was 2.2% and the cutaneous exposure (intact skin) rate was 10.2%. Blood contacts were twice as likely to be parenteral among surgeons as among other operating room personnel (odds ratio, 2.0; 95% confidence interval, 1.4 to 2.9). Of cutaneous exposures, 46.9% were from unknown sources or were surprise spatters. Logistic regression analyses indicated that risk factors associated with any blood contact (parenteral or cutaneous) were length of procedure (odds ratio, 1.51; 95% confidence interval, 1.46 to 1.56), emergency versus scheduled status (odds ratio, 1.44; 95% confidence interval, 1.21 to 1.66), selected surgical services, and the hospital. Logistic regression analyses of parenteral exposures, as compared with cases in which no contact occurred, indicated that risk factors were length (odds ratio, 1.39; 95% confidence interval, 1.31 to 1.47), thoracic surgery (odds ratio, 2.79; 95% confidence interval, 2.18 to 3.40), and university hospital versus community (odds ratio, 2.26; 95% confidence interval, 1.89 to 2.63). Parenteral exposures are clear risks to health care workers; however, it is also important to study all contact with blood in the operating room to appreciate potential risks and develop appropriate intervention strategies.

Blood-Borne Pathogens↗
PubMed2004

Improving operating room coordination: communication pattern assessment.

OBJECTIVE: To capture communication patterns in operating room (OR) management to characterize the information needs of OR coordination. BACKGROUND: Technological applications can be used to change system processes to improve communication and information access, thereby decreasing errors and adverse events. The successful design of such applications relies on an understanding of communication patterns among healthcare professionals. METHODS: Charge nurse communication was observed and documented at four OR suites at three tertiary hospitals. The data collection tool allowed rapid coding of communication patterns in terms of duration, mode, target person, and the purpose of each communication episode. RESULTS: Most (69.24%) of the 2074 communication episodes observed occurred face to face. Coordinating equipment was the most frequently occurring purpose of communication (38.7%) in all suites. The frequency of other purposes in decreasing order were coordinating patient preparedness (25.7%), staffing (18.8%), room assignment (10.7%), and scheduling and rescheduling surgery (6.2%). CONCLUSION: The results of this study suggest that automating aspects of preparing patients for surgery and surgical equipment management has the potential to reduce information exchange, decreasing interruptions to clinicians and diminishing the possibility of adverse events in the clinical setting.

Appointments and Schedules↗
PubMed2002

Mobile zoned/exponential LAF screen: a new concept in ultra-clean air technology for additional operating room ventilation.

A mobile screen (0.5 x 0.4 m) producing ultra-clean exponential LAF (air-flow central zone 0.6 m/s and peripheral zone 0.4 m/s) was investigated as an addition to conventional turbulent/mixing operating room ventilation. The evaluation was performed during strictly standardized sham operations reflecting conditions during major surgery. The study consisted of a pilot experiment designed to give high counts of sedimenting aerobic colony forming units (cfu). In a second main study, recording dust particles, air-borne and sedimenting aerobic cfu, the screen was associated with optimal operating room clothing. In the pilot experiment the use of the screen resulted in a substantial reduction of sedimenting bacteria from 3835-4940 to 0-390 cfu/m(2)/h. In the main study, the use of the additional LAF reduced the surface contamination from 416-329 to 7-78 cfu/m(2)/h up to 1.6 m from the screen (P=0.001-0.0001). Measured in the wound area the screen reduced the air counts of bacteria from 9-14 to 0.2-0.4 cfu/m(3) (P=0.008-0.0001) and a marked reduction of air-borne dust particles was recorded (P=0.007-0.009). In conclusion, the additional mobile LAF screen reduced the counts of aerobic air-borne and sedimenting bacteria-carrying particles as well as dust particles to the levels gained with complete ultra-clean LAF room ventilation. Thus, the screen might prove a valuable addition to operating room ventilation as well as in other areas where asepsis is essential.

Air Microbiology↗
PubMedDate not supplied

Continuous quality improvement efforts increase operating room efficiency.

The surgical service at the Philadelphia Department of Veterans Affairs Medical Center has been making a continuous effort toward improving efficiency in the operating room. A multidisciplinary task force was created in May 1994 to look at delays in operating room start times for the first case of the day. This article identifies problems that contributed to the delays and the changes implemented, along with a statistical analysis of the data collected. The team discovered that delays were related to system problems in the perioperative process and were not caused by any specific problem. Many of these problems proved correctable, as the statistical analysis shows, and the result was significant improvement in operating room efficiency.

Appointments and Schedules↗