[The response of the architect and the engineer to the medical and surgical requirements concerning the operating room].
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Humans↗
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[Considerations on micro-climate in operating rooms].
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Climate↗
The use of simple diffusion tube samplers for the measurement of nitrogen dioxide in an operating room using nitrogen oxide as an anaesthetic (July - November 1999).
Estimates have been made of the amounts of nitrogen dioxide (NO2) in the operating room of University of Benin Teaching Hospital (UBTH) where nitrous oxide (N2O) a potential source of NO is used as an anaesthetic agent Measurements were made using palmes diffusion tubes, a device which is capable of taking samples of NO2 gas from the atmosphere through diffusion or permeation of this compound to the interior and subsequently trapping it by means of adsorption on reactive material, but which does not involve the active movement of the gas through the sampler. Results obtained indicate a low concentration of NO2 in the operating room with a minimum of 5.83 microg/m3 and a maximum concentration of 6.22 microg/m3 NO2. This result therefore suggests that the use of nitrous oxide in the operating room does not contribute significantly to the concentration of NO2.
Adsorption↗
Are women occupying positions of power online? Demographics of chat room operators.
Internet statistics indicate a reduction in the gender discrepancy online. Yet, what is the situation within specific online communities like Internet Relay Chat (IRC)? Likewise, what is the gender status of those occupying positions of power online? An exploratory study of chat room operators (those who govern chat rooms) was conducted to investigate gender differences in operator's demographic characteristics and IRC experience. Whether those less satisfied with their real-life occupation were attracted to chat room operator positions was also investigated. A survey of 423 chat room operators was administered, comprising 25% women. Real-life occupations of chat room operators covered a broad spectrum, from professional and managerial to service, sales, and production workers, as well as those not employed. The most common occupational category cited was student, with very similar proportions of men and women occupying high-status positions. Of the occupations listed, 23% fell within the IT industry, with significantly more male than female operators working in this area. Majorities of both genders were satisfied with their real-life occupation. There was no relationship between job satisfaction and IRC experience or time spent as chat room operator. There were no gender differences for IRC experience. Majorities of both genders had been using IRC for 1 to 3 years or more, used IRC daily, and spent most or all of their time on IRC as operators. Ages ranged from 11 to 66 years, with the mean age 25 years. Women were significantly older than men. A significant proportion of men and women were from North America.
Adolescent↗
Exposure of operating room personnel to anaesthetic agents: an examination of the effectiveness of scavenging systems and the importance of maintenance programs.
Ten Alberta hospitals were monitored to assess the exposure of operating room personnel to nitrous oxide, halothane and enflurane during the average work day. Exposure to these agents in operating rooms without scavenging systems was determined to be well above the recommended guidelines. Contaminants were significantly lower in operating rooms with scavenging systems of either the wall suction type or the air-conditioning exhaust type. In the majority of studies, leakage points of anaesthetic gases were found throughout the anaesthesia systems. Where maintenance programs for the anaesthesia equipment were designed for the detection and elimination of leakage, contaminant levels were significantly lower than in those hospitals where the maintenance programs were concerned solely with proper equipment function as it relates to patient care. A regular, frequent maintenance program for all anaesthesia and scavenging systems designed to identify and correct leakage points is therefore recommended. We consider a nitrous oxide monitor to be the ideal tool for detection of leakage.
Air Pollutants↗
Anaesthesiologists' views on the need for point-of-care information system in the operating room: a survey of the European Society of Anaesthesiologists.
BACKGROUND AND OBJECTIVE: In this preliminary study we wanted to explore the attitudes of anaesthesiologists to a point-of-care information system in the operating room. The study was conducted as a preliminary step in the process of developing such a system by the European Society of Anaesthesiologists (ESA). METHODS: A questionnaire was distributed to all 2240 attendees of the ESA's annual meeting in Gothenburg, Sweden, which took place in April 2001. RESULTS: Of the 329 responders (response rate of 14.6%), 79% were qualified specialists with more than 10 yr of experience (68%), mostly from Western Europe. Most responders admitted to regularly experiencing lack of medical knowledge relating to real-time patient care at least once a month (74%) or at least once a week (46%), and 39% admitted to having made errors during anaesthesia due to lack of medical information that can be otherwise found in a handbook. The choice ofa less optimal but more familiar approach to patient management due to lack of knowledge was reported by 37%. Eighty-eight percent of responders believe that having a point-of-care information system for the anaesthesiologists in the operating room is either important or very important. CONCLUSIONS: This preliminary survey demonstrates that lack of knowledge of anaesthesiologists may be a significant source of medical errors in the operating room, and suggests that a point-of-care information system for the anaesthesiologist may be of value.
Adult↗
Managing rumor and gossip in operating room settings.
The unique features of the operating room (OR) make it an ideal setting for the proliferation of gossip and rumor. Although not always negative, these "grapevine" communications can reduce productivity and work satisfaction. Hence, OR managers need to understand these forms of communication and prevent or control their negative consequences. The authors offer suggestions for undertaking this challenge.
Communication↗
Increasing operating room efficiency through parallel processing.
OBJECTIVE: Because of rising costs and shrinking reimbursements, hospitals must continually find ways to improve efficiency and productivity. This study attempts to increase caseloads in ambulatory surgery operating rooms while maintaining patient satisfaction and safety. SUMMARY BACKGROUND DATA: In most hospitals, patients move through their operative day in a linear fashion, starting at registration and finishing in the recovery room. Given this pattern, only 1 patient may occupy the efforts of the operating room team at a time. By processing patients in a parallel fashion, operating room efficiency and patient throughput are increased while costs remain stable. METHODS: Patients undergoing hernia repairs under local anesthesia with intravenous sedation were divided into a control group and an experimental group. Patients in the control group received their local anesthesia in the operating room at the start of the surgery. The experimental group patients received their local anesthesia in the induction room by the surgeon while the operating room was being cleaned and set up. RESULTS: While operative time for the control group and the experimental group were nearly identical, the turnover time and the induction time were significantly shorter for the experimental group. The cumulative reduction in time during the operative day was sufficient to allow the addition of new operative cases. CONCLUSIONS: This study demonstrates a system of increasing operating room efficiency by changing patient flow rather than simply working to streamline existing steps. This increase in efficiency is not associated with the expansion of hospital budgets or a decrease in patient safety or satisfaction.
Ambulatory Surgical Procedures↗
AANA journal course: update for nurse anesthetists--treatment of avulsed teeth in the operating room.
Teeth that are avulsed in the operating room either during intubation, extubation, or other orally related procedures must be treated immediately in order to provide the best opportunity for success following replantation. New treatment methods have been developed that can significantly increase the success of replanted avulsed teeth. These methods utilize special pH balanced reconstituting fluids, cushioning devices, topical fluorides, and antibiotics that permit the storage of avulsed teeth for up to 96 hours with good success following replantation. This Journal course reviews the biologic background for these procedures and makes specific treatment recommendations.
Education, Nursing, Continuing↗
[Occupational exposure to enflurane and laughing gas in operating rooms].
Current scientific evidence suggests that chronic exposure to trace concentrations of anaesthetic gases may result in various forms of untoward health responses in operating room personnel. Although there are no clear dose-effect-relationships, in Germany threshold values (MAK-values) exist for nitrous oxide of 100 ppm and for enflurane of 20 ppm. Aim of this investigation was, to determine the exposure of the operating room personnel under modern working conditions using a standardized anaesthetic procedure. By means of a direct-reading, high sensitive gas monitor trace concentrations of nitrous oxide and enflurane were measured at three personnel-related (surgeon, anaesthetist, auxiliary nurse) and a potential leakage source (patient's mouth). The calculation and assessment of the measured concentrations followed the prescriptions of the technical rules for hazardous substances 402 and 403 (TRGS 402 and 403). The personnel-related concentrations were clearly under the MAK-values of 100 ppm nitrous oxide and/or 20 ppm enflurane. The time weighted averages were for the personnel-related measurement points, indicated in ppm for nitrous oxide and enflurane, respectively: "surgeon" 28.3/0.25, "anaesthetist" 39.3/0.34 and "auxiliary nurse" 64.6/0.57. At the leakage source "patient's mouth" time weighted averages of 317 ppm nitrous oxide and 3.79 ppm enflurane were measured. Under air-conditioning with a high air change rate, a central scavenging system and low leakage anaesthesia machine low trace concentrations of anaesthetic gases were measured. Despite an average contamination of approx. 300 ppm nitrous oxide at the "patient's mouth" personnel-related values remained clearly under the MAK-values. Outside the mainstream of the air-conditioning system the group "auxiliary nurse" had an approximately 30% higher exposure than the other groups. Under the described conditions, the working environment "operating room" can be classified as a low exposure working area.
Air Pollutants, Occupational↗
Hospital profitability per hour of operating room time can vary among surgeons.
The operating margins (i.e., profits) of hospitals are decreasing. An important aspect of a hospital's finances is the profitability of individual surgical cases, which is measured by contribution margin. We sought to determine the extent to which contribution margin per hour of operating room (OR) time can vary among surgeons. We retrospectively analyzed 2848 elective cases performed by 94 surgeons at the Stanford University School of Medicine. For each case, we subtracted variable costs from the total payment to the hospital to compute contribution margin. We found moderate variability in contribution margin per hour of OR time among surgeons, relative to the variability in contribution margins per OR hour among each surgeon's cases (Cohen's f equaled 0.29, 95% lower confidence interval bound 0.27). Contribution margin per OR hour was negative for 26% of the cases. These results have implications for hospitals for which OR utilization is extensive, and for which elective cases are only scheduled if they can be completed during regularly scheduled hours. To increase or achieve profitability, managers need to increase the hours of lucrative cases, rather than encourage surgeons to do more and more cases. Whether the variability in contribution margin among surgeons should be used to more optimally (profitably) allocate OR time depends on the scheduling objectives of the surgical suite.
Aged↗
Operating room surveillance: a new approach in reducing hip and knee prosthetic wound infections.
A prospective study of surgical wound infections (SWI) in hip prosthesis surgery and total hip and knee replacements at two community hospitals with common surgical staffs was begun in May 1982. The rates of SWI during the first 7 months for four orthopedic surgeons were 9% (3/32) for hip prosthesis surgery and 16.7% (3/18) for total hip and knee replacement, with 12% (6/50) overall. To reduce infections, each orthopedic surgeon agreed to intraoperative surveillance (IOS) of two procedures (hip prosthesis or total hip or knee replacement) by the infection control nurse at each hospital. Significant IOS findings were too many persons in the operating room (five to nine persons), operating room doors opened frequently (25 to 50 times), inconsistent use of prophylactic antibiotics, and excessive conversation. In January 1984, IOS data and recommendations were shared with each orthopedic surgeon, the operating room staff, and the anesthesia personnel. Subsequently, a statistically significant drop in SWI was realized for total hip and knee replacement (1/36 versus 5/36, p = 0.05) and overall (3/73 versus 14/116, p = 0.05). The drop in SWI for hip prosthesis surgery was not statistically significant (2/37 versus 9/80, p greater than 0.10). IOS and individualized communication were effective in reducing SWI.
Aged↗
Mutagenicity of inhalation anaesthetics studied by the sister chromatid exchange test in lymphocytes of patients and operating room personnel.
Retrospective studies have indicated that operating room personnel may have increased risks of spontaneous abortion, congenital malformations in offspring, and cancer (Cohen et al 1980, Buring et al 1985). Occupational exposure to waste anaesthetic gases may be responsible for these possible adverse health effects, but a cause-effect relationship has never been proved. Induction of changes in the DNA in the chromosomes leading to mutations may play a role in teratogenicity and carcinogenicity. Along with an increasing concern in society regarding occupational diseases and working and living environment in general, cytogenetic methods have been developed for rapid detection of potential mutagenicity in vitro of chemical agents. One such method is the SCE test, which is based on examination of sister chromatid exchanges (SCEs), i.e. exchanges of chromatid-segments between the two chromatids in a chromosome, during cell replication. SCEs are not mutations, but an increased frequency of SCE is a sensitive indicator of exposure to agents that are capable of producing damage to the DNA and thus possibly mutations. In vitro tests like the SCE test are very useful for evaluation of specific chemical agents, which may be added to the culture in known concentrations. In studies of possible hazards from chemical agents in the working or living environment, the exposure is often poorly defined. Also, biotransformation may be different in different species, and the duration and the level of the exposure may play a role. Examination of SCEs is, therefore, increasingly performed directly on human lymphocytes from peripheral blood. Thus, although the examination of SCEs is still performed in vitro, the exposure has taken place in vivo. Increased SCE levels are then regarded as a non-specific indicator that the donor has been exposed to potentially mutagenic agents in the environment. The author and his associates used the SCE test to investigate the possible mutagenicity of anaesthetic gases after exposure in vivo. From extensive methodologic studies of possible confounding factors it was concluded that each of the factors sex, age, and smoking habits contributed significantly to the interpersonal variation of SCE frequencies, whereas use of oral contraceptives did not influence the SCE rates. The potential mutagenicity of inhalation anaesthetics was studied after exposure in vivo in two settings: (1) Acute exposure to anaesthetic concentrations, and (2) Chronic occupational exposure to trace concentrations.(ABSTRACT TRUNCATED AT 400 WORDS)
Allied Health Personnel↗
A comparative study of hysteroscopic sterilization performed in-office versus a hospital operating room.
STUDY OBJECTIVE: To compare hysteroscopic female sterilization procedures performed in-office versus a hospital operating room (OR) among newly trained physicians. DESIGN: Multisite hospital operating rooms and physician offices. PATIENTS: Women desiring permanent hysteroscopic sterilization. INTERVENTION: Hysteroscopic female sterilization with the Essure system. MEASUREMENTS AND MAIN RESULTS: Procedure time (scope in/scope out time), device placement rates, and incidence of complications and adverse events were compared. There was no significant difference in scope time between the 2 settings. There was no significant difference in placement rates, although the placement rate was somewhat higher in-office (91% vs 88%). There were no complications among any of the procedures, and the incidence of minor adverse events was extremely low in both settings (OR=2%, in-office=1%). CONCLUSION: There is no clear advantage to performing hysteroscopic sterilization in a hospital OR. Hysteroscopic sterilization can be performed safely and efficiently in an office setting.
Adult↗
[Critical events in the operating room among 1,440,776 patients with ASA PS 1 for elective surgery].
BACKGROUND: The Japanese Society of Anesthesiologists (JSA) survey of critical incidents in the operating room has shown that preoperative complications are the leading causes of critical incidents, and affect the occurrence, severity and outcome of critical incidents which are due to causes other than preoperative complications. Causes of critical events in the operating room were examind in patients for elective surgery with American Society of Anesthesiologists physical status (ASA PS) 1. METHODS: JSA has conducted annual surveys of critical incidents in the operating room by sending and collecting confidential questionnaires to all JSA Certified Training Hospitals. From 1999 to 2002, 3,855,384 anesthesia patients were registered. Among these, 1,440,776 patients with ASA PS 1 for elective surgery were analyzed. The causes of critical incidents were classified as follows: totally attributable to anesthetic management (AM), mainly to intraoperative pathological events (IP), to preoperative complications (PC), and to surgical management (SM). IP consists of coronary ischemia mainly due to coronary vasospasm, arrhythmias, pulmonary embolism, and other conditions. RESULTS: The incidences of cardiac arrest, critical incidents other than cardiac arrest and subsequent death were 9.86, 59.41 and 3.12 per 100,000 anesthesia cases, respectively. IP and SM were responsible for 36.6% and 34.5% of cardiac arrest, respectively. AM and SM were responsible for 46.7% and 26.8% of critical incidents other than cardiac arrest, respectively. SM, IP and AM were responsible for 66.7%, 22.2% and 4.4% of subsequent deaths (within 7 postoperative days), respectively. Coronary ischemia and pulmonary embolism were the main causes of death due to IP. The incidences of cardiac arrest and death totally attributable to AM were 1.87 and 0.14 per 100,000 anesthesia cases, respectively. Medication problems were responsible for 48.1% of arrests, while airway/ventilation problems were for 57.2% of critical incidents other than arrest. Human factors (SM combined with AM) were responsible for 53.5%, 73.5%, and 71.1% of cardiac arrest, critical incidents other than arrest and death, respectively. CONCLUSIONS: Even in elective patients with good physical status, non-lethal incidents were not rare, and lethal incidents were also reported. We should pay significant attention to the following findings, and take some measures to overcome these problems especially related to human factors. Firstly, SM badly harmed some operative patients. Secondly, coronary vasospasm and pulmonary embolism were the main causes of death due to IP. Thirdly, drug administration and airway/ventilation management were the major causes of critical incidents totally attributable to AM. Human factors were responsible for 70.6% of critical incidents and 71.1% of deaths.
Anesthesia↗
The effect of a portable HEPA-filtered body exhaust system on airborne microbial contamination in a conventional operating room.
OBJECTIVE: To study the effect of a portable HEPA-filtered air exhaust system (Stackhouse Freedom Surgical Helmet System) on airborne microbial contamination in a modern conventional operating room. DESIGN AND SETTING: Microbial air sampling was done with a two-stage Anderson sampler at the wound site during 46 total joint replacements. All operations were performed by the same surgeon in the same operating room at a large community hospital. RESULTS: In 18 cases done without air exhaust hoods, the number of bacterial and fungal colony-forming units (CFU) ranged from 0.6 to 11.7 (mean, 3.6). Air sampling during 28 operations with the operating team in air exhaust hoods revealed a mean of 3.6 CFU (range, 0 to 11.4). Bacterial CFU averaged 3.4 without hoods and 3.2 with exhaust hoods. Coagulase-negative staphylococci were the most common isolates (48% of isolates with hood, 55% without hood). No infections occurred. CONCLUSION: We concluded that these air exhaust hoods did not lower airborne microbial contamination detectable with this air sampling method, as compared to standard head cover and mask, in a modern conventional operating room.
Air Microbiology↗
The interventional neuroradiology suite as an operating room.
The evolution of new neurointerventional techniques, along with improved imaging and catheter developments, has changed the interventional suite into a subspecialized operating room. This article discusses this operating room as a combination of neuroanesthesia, neuromonitoring, nursing, and technician support coordinated by the neruointerventionalist. The coordination of elective and emergent intervention is also discussed, from conception to completion of the plan, including arteriovenous emoblization, endovascular aneurysm obliteration, intra-arterial thrombolysis, extracranial and intracranial carotid angioplasty, and stenting. Specific examples are illustrated, including pharmacologic intervention complementing these techniques.
Cerebrovascular Disorders↗
CONVENIENT SAMPLING OF AIR BACTERIA IN OPERATING ROOMS.
A convenient arrangement for sampling air bacteria in operating rooms with a slit sampler (the Fort Detrick sampler) is described. Its purpose is to contribute as far as possible to the convenience of the surgical staff and thereby to the safety of the patient. It has the advantages of recording minute-to-minute changes in bacterial air count; it is unobtrusive and yet can be continually observed by a technician; it is not noisy and avoids the dangers of explosion and static electricity; it is inexpensive, and parts are easily replaced; and finally it provides a means of keeping permanent photographic records of bacterial counts. Results of a preliminary trial of this method appeared to be satisfactory.
Air Microbiology↗