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PubMed2000

Spread of coagulase-negative staphylococci during cardiac operations in a modern operating room.

BACKGROUND: Coagulase-negative staphylococci cause 33% to 62.5% of wound infections after cardiac operations. The aim of this study was to investigate the sources of coagulase-negative staphylococci in the sternal wound. METHODS: Twenty operations performed in zonal ventilated operating rooms were investigated prospectively. Cultures were taken from all persons present in the room, the sternal wound, and the air. Isolates macroscopically judged to be coagulase-negative staphylococci were metabolically classified, and similar isolates were investigated by pulsed-field gel electrophoresis. RESULTS: Bacterial counts in the operating room air were very low. Wound contamination was found in 13 of 20 operations. Six wound isolates could be traced, three to the patients' sternal skin, one to the patient's groin, one to the surgeon's nose, and one to the surgeon's arm and forehead and the assistant's nose. Three operating field air cultures could be traced to the scrubbed theatre staff. The single case of superficial sternal wound infection was caused by Staphylococcus aureus, which was not isolated from the wound at operation. CONCLUSIONS: In an ultraclean environment, bacteria in the sternal wound originated from the patients' own skin and from the surgical team.

Adult↗
PubMed2003

[The endoscopic operating room OR 1].

During the last few years, the development of surgical laparoscopy has been the major turning point, and the most important progress in the field of surgery. The specific installation requirements of surgical laparoscopy, as well as the technological progress proper to this surgical technique, justify the need of a new organization of the operating theatre. The new operating room OR 1 is especially designed to fit and satisfy the requirements of a modern operating theatre, where surgical laparoscopy plays a major role. The organization and the design of this new operating room (OR 1) rely on 2 main concepts: architectural, and computerized, through 2 PC systems SCB and AIDA. The main objectives of this new concept are: allowing the surgeon to control and command all the functions and the instruments, as well as the lighting of the room and the operating field; managing the surgical data and images required for medical files; establishing a communication network either from the inside or outside the sterile zone.

Facility Design and Construction↗
PubMed1991

[Pollution of operating rooms. Measurements made during five anesthesias].

The purpose of this study is to measure amounts of anaesthetic vapours present in operating rooms and anaesthetic places without any gas scavenging system except air conditioning with fifteen air changes per hour. Nitrous oxide, halothane and isoflurane were measured. Halothane and isoflurane concentration is slightly higher than the French standard for anaesthetic places and lower for operating rooms. Nitrous oxide concentration is five to eight times greater than recommended standard. Although no international agreement exists concerning an acceptable pollution standard, it seems that only nitrous oxide pollution is disquieting. It would seem sensible to avoid needles contamination by use of waste gas scavenging devices.

Abdomen↗
PubMed2001

[Annual study of perioperative mortality and morbidity for the year of 1999 in Japan: the outlines--report of the Japan Society of Anesthesiologists Committee on Operating Room Safety].

Anesthetic mortality and morbidity in Japan Society of Anesthesiologists (JSA) Certified Training Hospitals (CTH) for the year 1999 were reported as continuation of annual studies started in 1993. The JSA Committee on Operating Room Safety (CORS) sent confidential questionnaires to 774 CTH and received valid responses from 60.3% of hospitals. A total number of 793,840 anesthetics were documented. The respondents were asked to report all cases of cardiac arrests and other critical incidents (serious hypotension, serious hypoxemia and others), and their outcomes (death in operating room, death within 7 days, transfer to vegetative state and rescue without sequelae) as well as one principal cause for each incident from list of 52 items. They were also requested to submit the tabulation of patients by ASA physical status, age distribution, surgery sites and anesthetic methods. Analysis was made by total incidents under anesthesia/surgery, and also by incidents totally attributable to anesthetic management (AM), due to preoperative complications (PC), due to intraoperative pathological events (IP) and due to surgery (SG), with special reference to each of four tabulation groups and the whole group of patients. This paper focused analysis on all patients, as analyses with special reference to ASA physical status, age distribution, surgery sites and anesthetic methods were previously reported. Total incidence of cardiac arrest under anesthesia/surgery was 6.53 per 10,000 anesthetics. PC, IP and SG represented principal causes in 42.9%, 22.0% and 21.4% causes of total cardiac arrest cases, respectively. AM was noted as the principal cause in 12.0% of cases, with an incidence rate of 0.78 per 10,000. In 52 more detailed classification of principal causes, the most frequent cause of cardiac arrest was preoperative hemorrhagic shock, 20.3% of all cardiac arrests. The second cause was massive hemorrhage and/or hypovolemia due to surgical procedures (13.1%), and the third was intraoperative myocardial infarction/coronary ischemia/coronary spasm (9.5%). Prognoses of cardiac arrest cases declined due to PC: 71.1% of cardiac arrests died in the operating room or within 7 days after surgery and only 19.8% survived without sequelae. The best prognoses were found in cardiac arrest cases due to AM: 69.4% survived without sequelae and 12.9% died. The mortality rate post-cardiac arrest was 3.44 per 10,000 anesthetics, of those 0.10 due to AM, 0.57 due to IP, 1.99 due to PC and 0.76 due to SG. The mortality rate after critical incidents other than cardiac arrest such as severe hypotension and severe hypoxemia was 3.75, of those 0.03 due to AM, 0.28 due to IP, 2.31 due to PC and 1.13 due to SG. The final mortality rate attributable to anesthesia/surgery including deaths post-cardiac arrest and after other critical incidents was 7.19 per 10,000 anesthetics and very close to 7.18 [6.22, 8.13], that of mean [95% C.I.] in 1994-1998. The final mortality rate totally attributable to anesthesia was 0.13 per 10,000 anesthetics, which was significantly improved from 0.21 [0.15, 0.27], that of mean [95% C.I.] in 1994-1998. IP, PC and SG showed the final mortality rate of 0.84, 4.30 and 1.89, respectively. Five major causes of all critical incidents were massive hemorrhage due to surgical procedures (20.8%), preoperative hemorrhagic shock (10.7%), surgical technique (8.0%), inappropriate airway management (5.2%) and intraoperative myocardial infarction and coronary ischemia (4.5%). Drug overdose or selection error (3.9%) and overdose of main anesthetic (2.9%) as a result of human error occupied the 7th and 10th places. As far as anesthetic management to reduce mortality and morbidity related to anesthesia is concerned, we should increase vigilance to avoid human errors in addition to improving preanesthetic preparations and assessment of cardiovascular status as well as intraoperative management of cardiovascular events.

Anesthesia↗
PubMed1994

[Differentiation of allotments for occupationally necessary and hygiene relevant costs of air technology designs for operating rooms].

The aeration of operation theatres serves multiple purposes. It is necessary for the regulation of room temperature (waste heat generated by the operation team and technical appliances), air exchange for oxygen supply, removal of narcotic gases and of smells (occupational limit values) as well the elimination of germs and particles emitted during operations by staff and from instruments (avoidance of germ transfer by air). This paper tries on the one hand to estimate the investment and running costs of different indoor air supplies according to the specifications given by DIN 1946, parts 2 and 4) and on the other hand to differentiate the hygienically relevant expenses of turbulent and laminar flow air supply systems. It can be seen that, due to the high heat production generated during operations, no cost can be saved through decreases in air flow volume. Depending on the operation frequency (e.g. 4 operations daily, 200-300 days per year) a hygienically relevant cost of DM 2.8-6.7 per patient is calculated for laminar flow supplies and DM 4.5-6.7 per patient for the turbulent air supply systems ("Stützstrahl"). Thus laminar flow systems are also cost-saving in comparison to turbulent air supply systems in addition to their significant technical and hygienic advantages.

Air Conditioning↗
PubMedDate not supplied

[The stress of the multiprofessional team in the operating room].

This article is a case study that presents common stressors, answers to professional's individual and collective handling in the operating room. The data was collected through interview of 32 persons of the surgical team, submitted to content analysis, arising eight differentiated categories from them: significant stress experiences; stressing situations; individual behavior in the operating room; stress handling; responsibilities and compromises; behavioral responses. Even though relationship with patients generates important life experiences, the patient was considered the minor stressor agent, being the interpersonal relations the most significant one. To cope with stressful situations the professionals use the handling focused on the problem, on emotion, on relief maneuvers, and on development of social relationships.

Humans↗
PubMed1997

Operating room: 2010.

Using expert systems, virtual reality, and commercial and futuristic technology, visionary operating room (OR) nurses will have the opportunity in the 21st century to dramatically improve the way the OR functions. Eliminating counting, decreasing occurrences of patient injuries, and improving staff and patient education are just some of the possibilities!

Forecasting↗
PubMed1992

Recognition accuracy of current operating room alarms.

This prospective study was performed to determine whether anesthesia clinicians (i.e., both anesthesiologists and nurse anesthetists) can identify operating room alarms by their distinctive sounds and to identify factors related to alarm recognition accuracy. Nineteen alarms from 15 commonly used devices were recorded. These sounds were played, in a quiet room, to 44 anesthesia clinicians. The clinicians were asked to choose from a list the device that produced the alarm. After this recognition test, the clinicians rated the importance of each alarm and the frequency with which they heard it in the clinical situation. Clinicians correctly identified the alarm source 34% of the time. The recognition rate was higher for alarms rated as heard more frequently; however, alarms that were rated as more important were less likely to be correctly identified. Complexity of the sound did not influence accuracy of recognition. Most errors were attributed to similarities in sound or function, or both, among alarms. We conclude that anesthetists cannot reliably identify current operating room alarms by their distinctive sounds.

Anesthesiology↗
PubMed1974

An evaluation of a partial-walled laminar-flow operating room.

This paper contains an assessment of the physical performance of a permanently installed down-flow laminar-flow operating room at the London Hospital. This system employs partial walls extending 0.76 m (2.5 ft.) from the ceiling, from which the air is allowed to issue freely downwards at an initial velocity of about 0.4 m./sec. (80 ft./min.).The usefulness of the partial wall, as compared with a free issuing system, was demonstrated and a comparison made with a fully walled system. It was shown that a fully walled system would be more efficient than a partial-walled system as there was a loss in air velocity of about 20-25% with the partial wall due to the nonconstrained flow of air. This loss would be reflected in an increase in airborne bacterial count and would mean that an increase of 20-25% in the air volume would be required to obtain the same conditions as with the full-walled system. Entrainment of contaminated air was demonstrated but it was concluded that this would be of little consequence in the centre of the clean area, i.e. at the wound site. Sterile instruments, etc., however, on the outside of the clean area, would be more liable to airborne contamination.Bacterial and dust airborne counts taken during total hip operations gave a very low average figure (0.3 bacteria/ft.(3) or 10.5/m.(3)) from which we conclude that the system was about 30 times cleaner in terms of airborne bacteria than a well ventilated conventional operating-room. We concluded that although the partial-walled system was slightly less efficacious than a normal full-walled system, the freedom of movement and of communication for the operating team could in some circumstances outweigh this disadvantage.Sound levels were such that normal conversation was possible with little or no awareness of background noise.

Air↗
PubMed1998

Use of alkaline comet assay (single cell gel electrophoresis technique) to detect DNA damages in lymphocytes of operating room personnel occupationally exposed to anaesthetic gases.

Here, we report the possible in vivo induction DNA damage by exposure to various waste anaesthetic gases such as halothane, nitrous oxide and isoflurane. The alkaline comet assay (single cell gel electrophoresis technique) was carried out on 66 operating room personnel (anaesthetists [doctors]; anaesthesia nurses and anaesthesia unit technicians) currently employed at the Ankara Hospital in Turkey. A significant increase in the number of lymphocytes with DNA migration was observed in operating room personnel as compared to controls. Also, the extent of damage in exposed smokers were significantly higher than exposed nonsmokers. This study supports the existence of an association between DNA damage and occupational exposure to inhalation anaesthetics.

Adult↗
PubMed2004

Trauma and tribulation: the experiences and attitudes of operating room nurses working with organ donors.

BACKGROUND: In the past two decades, significant medical advances have resulted in remarkable success and survival rates for organ recipients. However, the rates of donation have not kept pace with the demand, resulting in a critical shortage of available healthy organs. It has been suggested that the attitudes of medical personnel towards organ retrieval is a key success factor in improving organ donation. Yet there is evidence that those closest to the process of procurement are the most negative. AIMS AND OBJECTIVES: This study sought to examine the attitudes towards organ donation of operating room nurses and their experiences of participating in the procurement of organs for transplant, in order to unravel factors that contribute to their attitudes. METHODS: This study relied upon in-depth qualitative interviews with 14 operating room nurses who participated in organ procurement in a large urban trauma centre. RESULTS: The results of this study suggest that the process of organ procurement is highly stressful and raises many concerns for operating room nurses. Factors, which added to participants' distress, include organizational factors such as strained relationships within surgical teams, concerns about the dignity of the patient and the well-being of the family and exposure to death and trauma. CONCLUSIONS: Experiences of nurses participating in surgical removal of organs for transplantation resulted in personal feelings of distress and negative attitudes to the issue of organ donation which may be transmitted to others and undermine organ procurement efforts. RELEVANCE TO CLINICAL PRACTICE: The concerns of these vital members of the organ procurement team should be heeded and actions taken to reduce their distress and improve their attitudes towards donation.

Adaptation, Psychological↗