Safety measures in the operating room.
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Humans↗
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[Electric installations of operating rooms].
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Electricity↗
Essence of operating room nursing.
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Operating Room Nursing↗
Systemic reaction to methylmethacrylate in an operating room nurse.
A case of a systemic reaction in an operating room nurse to methylmethacrylate is reported. The reaction was marked by hypertension, dyspnea, and generalized erythroderma; the patient made an uneventful recovery. A review of the toxicologic and epidemiologic literature on methylmethacrylate monomers shows that they affect the nervous cardiovascular, cutaneous, gastrointestinal, and respiratory systems.
Adult↗
Elements of the employee selection process: interviewing operating room staff.
Selecting the right staff for employment in an operating room (OR) is critical to the success of any OR manager. Legal considerations limit the ability to gather certain information. However, by applying the correct skills and techniques, the manager can develop an information base that will lead to better decisions when selecting employees who can contribute to an efficiently run department.
Humans↗
Streamlining environmental safety in the operating room: a common bond between surgeons and hospital engineers.
The operating room presents environmental safety concerns unlike any problems in other parts of a health care facility. Special disciplines must be utilized to ensure that risk is minimized during surgery. This document addresses the needs of both the surgeon and the plant engineer in order for both groups to learn more about the other's concerns and problems.
Electric Wiring↗
Design, devices, and discipline in operating room infection control.
The prevention of surgical infection in the operating theatre is a complex pursuit. Every facet of activity, whether it is part of the surgical act itself or a remote activity with indirect effects on the surgical operation, constitutes part of the whole realm of infection control. These many facets may be divided into four main components, all interdependent: (a) the surgeon and his team (surgical technique; adherence to surgical anatomic, physiologic, and aseptic principles; discipline); (b) education and communiction--a functioning infections committee, repeated tutorials for all prefessional and technical operating room personnel, constant review of methods and systems, effective reporting of offenses, enforcement of discipline; (c) dependable support services--sterilizing techniques, barrier materials, apparel, laundry methods; materials handling and processing methods; efficiency and personal hygiene of all techincal and support personnel; discipline; and (d) environmental factors--architecture, engineering, and air handling; electrical and mechanical requirements; communication; discipline).
Air Microbiology↗
Overcoming barriers to operating room inventory control.
Simple controls can reduce a hospital's operating room (OR) inventory by 10 percent to 30 percent. Controlling OR inventory involves a four-step plan: count the materials, estimate their value, reduce the value, and implement controls. This process provides valuable information for negotiating with vendors. Armed with inventory data, financial managers may be able to save their healthcare organizations $200,000.
Cost Control↗
A new standard of care: administration of preoperative antibiotics in the operating room.
Surgical site infections increase total hospital expenses and extend the length of hospital stay. Properly administered antibiotics are successful in minimizing postoperative subcutaneous wound infection secondary to perioperative bacterial contamination at the surgical site and are effective in most clean-contaminated surgical procedures. It is imperative that therapeutic levels of antibiotics be present during the time when the wound is open to maximize their effect to prevent the development of surgical wound infections. Only 32 per cent of 97 patients sampled from 1992 to 1994 at the Louisville Veterans Affairs Medical Center were administered preoperative antibiotics within 1 hour prior to surgical incision. Changing the responsibility for preoperative antibiotic administration from ward or holding room nurses to the anesthesiologist in the operating room rendered such antibiotics delivered closer to the induction of anesthesia and subsequent incision. Eighty-eight per cent of 220 patients sampled in 1995 had antibiotics administered within 1 hour of incision. This change in institutional policy of antibiotic administration maximizes the likelihood of appropriate antibiotic tissue levels and thereby their potential efficacy. Routine prophylaxis should be administered as close to the time of induction of anesthesia as possible to provide the best chance for appropriate tissue levels above the minimum inhibitory concentration for potential bacterial contamination.
Antibiotic Prophylaxis↗
Operating-room venting of trace concentrations of inhalation anesthetic agents.
Operating-room personnel exposed over a long period to trace concentrations of anesthetic gases may acquire both organic disturbances and impairment of cerebral function, though this has not been proven. However, the dangers of miscalculations due to disturbances of cerebral function and the fact that all working personnel should be breathing unpolluted air are sufficient indications to make scavenging of anesthetic gases mandatory. Scavenging has been carried out in many hospitals. At Vancouver General Hospital venting of the gases has decreased the nitrous oxide pollution to what is considered an acceptable level.
Air Pollutants, Occupational↗
Operating room air pollution: influence of anaesthetic circuit, vapour concentration, gas flow and ventilation.
Atmospheric halothane was sampled from three selected operating theatres and anaesthetic rooms during the middle of operating sessions. Two of the operating theatres studied were ventilated with total air exchange once every six minutes; the third operating theatre had no ventilation. End-tidal samples were obtained from anaesthetists. Halothane vapour concentrations were analysed by gas-liquid chromatography. The effect of commonly used anaesthetic circuits on the level of contamination in the ambient atmosphere was studied. Concentrations of halothane vapour in the theatre atmosphere were found to vary with sampling site, anaesthetic circuit used, total gas flow and vapour concentration, the scavenging system employed and the efficiency of ventilation system. Although the ventilation system considerably reduced the level of halothane in the operating room atmosphere, it did not totally eliminate the contaminating vapour. A significant reduction in operating-room pollution was obtained by use of simple scavenging equipment. Scavenging of anaesthetic vapours outside the operating room led to 97.3 per cent reduction of overall mean concentration of halothane in the operating room atmosphere and reduction of 72 per cent in end-tidal samples of anaesthetists, with the Magill semiclosed circuit. The implications of these findings are discussed.
Air↗
[On-line data management system using a portable blood gas analyzer in the operating room].
It is very important to establish a clinical testing system which is not only prompt, simple and accurate but also safe for the patients and medical staff in the operating room, emergency room and intensive care unit. In our institution an i-STAT portable blood gas analyser has been widely used for point of care testing in all the operating rooms. This clinical testing system has been upgraded by adding an i-STAT communication protocol to our online data management system. The analysed data transmitted by the i-STAT as an infrared signal is transformed to an electronic signal through the IR link and sent to the central data station (CDS) via RS232C. The data received by the CDS is then sent to the upper grade computer system where the data is recorded on the hard disk. One advantage of this system is that it is connected to the hospital computer system. Not only does this new system meet the need for accurate, safe, effective and economical laboratory testing, but also retrospective and multifactorial analysis of intraoperative events can be easily carried out. In the future this system can be applied to telemedicine through the Internet and contribute to the treatment of critically ill patients.
Blood Gas Analysis↗
Cost-effective use of operating room supplies based on the REMEDY database of recovered unused materials.
It is estimated that $200 million worth of prepared materials are discarded unused in operating rooms in the United States each year. Although some of these materials have been successfully recovered for overseas donation, they nevertheless constitute an undesirable burden on health care efficiency. This situation has prompted a reevaluation of the procedures that result in the overpreparation of surgical supplies, in the hope of reducing hospital, patient, and third-party payer expenditures. A database, which was initially developed to track the overseas donation of recovered supplies from Yale-New Haven Hospital, is now being applied to measure approaches to waste reduction. This report summarizes the application of this database to an integrated program designed to modify nursing procedures and physician prespecified supply lists.
Budgets↗
Assessment of the economic impact of an overage reduction program in the operating room.
STUDY OBJECTIVES: To delineate excessive supply preparation in the operating rooms (ORs) of Yale-New Haven Hospital, and to measure the reduction in such overage as a result of nursing and administration cost-containment efforts. DESIGN: Before and after trial. SETTING: Inpatient ORs of Yale-New Haven Hospital. INTERVENTIONS: After the initial documentation of overage, several cost-containment measures were instituted, including nursing education, review of overage data, and updating of surgical request lists. MEASUREMENTS AND MAIN RESULTS: The hospital cost of case-specific overage generated by all surgical procedures performed during two 2.5-month periods in 1992 and 1994 (before and after the interventions) were compared. One-thousand three hundred eighteen cases in 1992 were compared with 1,367 cases in 1994. A 45% reduction in mean per case overage occurred between the two assessment periods. Extrapolation of the data to the incidence of similar cases throughout the United States projected a comparable savings. CONCLUSIONS: Efforts to increase the efficiency of OR supply management can be measured, in part, by overage evaluation, which can serve as a resource for focusing efforts at cost-containment.
Cost Control↗
Distribution of waste anesthetic gases in the operating room air.
Epidemiologic and animal studies identify a strong relationship between chronic exposure to anesthetic gases and health hazards. Efforts to reduce exposure of personnel require an understanding of the distribution of anesthetic waste gases in the operating room air. Concentrations of nitrous oxide and halothane were measured at numerous stations throughout an operating room and a delivery room in the absence of personnel. Air conditioning flow rates and flow patterns were varied, as was the height of the anesthetic gas source. Air flow patterns were found to dominate the anesthetic gas distribution, while buoyancy effects were negligible. Venting waste gases at the floor does not significantly reduce exposure of personnel. Areas of high concentration were observed; their occurrences and locations varied strongly with air flow patterns. The exhaust grille is the best location for a single measurement of the average room concentration. Recirculating air-conditioning systems reduce energy costs; however, only the non-recirculating portion of the air exchanges reduces waste gas concentrations.
Air↗
Changing allocations of operating room time from a system based on historical utilization to one where the aim is to schedule as many surgical cases as possible.
UNLABELLED: Many facilities allocate operating room (OR) time based on historical utilization of OR time. This assumes that there is a fixed amount of regularly scheduled OR time, called "block time". This "Fixed Hours" system does not apply to many surgical suites in the US. Most facilities make OR time available for all its surgeons' patients, even if cases are expected to finish after the end of block time. In this setting, OR time should be allocated to maximize OR efficiency, not historical utilization. Then, cases are scheduled either on "Any Workday" (i.e., date chosen by patient and surgeon) or within a reasonable time (e.g., "Four Weeks"). In this study, we used anesthesia billing data from two facilities to study statistical challenges in converting from a Fixed Hours to an Any Workday or Four Weeks patient scheduling system. We report relationships among the number of staffed ORs (i.e., first case of the day starts), length of the regularly scheduled OR workday, OR efficiency, OR staffing cost, and changes in services' OR allocations. These relationships determine the expected changes in each service's OR allocation, when a facility using Fixed Hours considers converting to the Any Workday or Four Weeks systems. IMPLICATIONS: We investigated the complex relationships among the number of surgical services, number of staffed operating rooms (ORs), length of the regularly scheduled OR workday, efficiency of use of OR time, OR staffing cost, and changes in each services' allocated OR time.
Ambulatory Surgical Procedures↗
[A patient for craniotomy with ECG abnormality occurring on admission to the operating room].
We report a 72 year old male patient for craniotomy with ECG abnormality occurring on admission to the operating room. His preoperative ECG showed normal sinus rhythm without ST-T change and T wave abnormality. On admission to the operating room, negative T wave was noted on the ECG monitor. Therefore, we applied isosorbide dinitrate tape after the induction of anesthesia. When the dura mater was opened, subarachnoid hemorrhage was noticed. Intraoperative pathological examination revealed a glioblastoma multiforme. The tumor bled from inside and outside. The perioperative T wave abnormality was probably due to subarachnoid hemorrhage or bleeding from the tumor itself. The T wave abnormality disappeared on the 10th postoperative day.
Aged↗
Accidental hand burns caused by operating room lights.
Three patients sustained burns of the hand in the operating room because of the lack of heat shields in the lights. A 54 degrees F increase in temperature in the operating field was noted when the heat shields were not in place.
Accidents↗