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This paper introduces the principium and application of the embedded intelligence control platform (EICP) in the clean operating room in our hospital. It can be a master of automatic control for air decontamination, temperature, humidity, lighting lamps, shadowless lamp, etc..
In 711 consecutive total hip arthroplasty operations, approximately 80% of patients were followed one to 7 years. Per priman operations outnumbered hips having had previous operations 511 to 200. The incidence of infection was higher in the hips having had previous operations (1.6 vs 3.5%). The overall incidence of deep infection was 16/711, or 23%. Analysis of the influences of operating room environment and preventative antibiotics revealed that there was a marked decrease in the attack rate of deep infection (7.6 vs 0.6%) when the Clean Room, personnel-isolator system, and preventative antibiotics were used. Reduced intraoperative wound bacterial contamination is accompanied by a reduced incidence of sepsis.
Morbidity and mortality related to sedation or anesthesia outside the operating room has not been investigated so far, but it is assumed to be a relevant problem because the increasing needs for sedation/analgesia in remote locations for a wide range of diagnostic and operative procedures (endoscopy, radiology, magnetic resonance...) and the lack of monitoring, inadequate training of personnel,insufficient staffing. Many complications could occur to patients, like anaphylactic shock,accidental hypothermia,difficult airway maintenance, aspiration,nausea and vomiting, and anesthesiologists, like exposure to pollution, radiation, electromagnetic fields, falls and trauma. Recent guidelines and personal experience are presented and discussed.
It is not a trivial matter to achieve a high level of utilization in the operation room (OR). The surgeon must give attention to schedule efficiency to contain medical costs. Surgeons should also be aware that 100% utilization of OR time is unrealistic except when there are repetitive, uniform-length procedures. A regular utilization rate below 50% should suggest overstaffing, overbuilding, or poor schedule management. Lessons from scheduling computer use can help make OR utilization more efficient. If a selective, effective algorithm is used in scheduling, norms of utilization should be above 60% and peaks should exceed 75%. For efficiency of scheduling, all ORs should be completely modular and should be large enough to accommodate any type of surgery.
Although convective warming therapy is effective in preventing hypothermia in anesthetized patients, little is known concerning the potential risks of its use. Hence, this balanced cross-over study was designed to determine if the use of convective warming therapy increased the risk of wound contamination. For 4 h, eight healthy male volunteers (aged 20-25 yr) lay supine on an operating room table with their lower bodies and legs covered with a warming cover and sterile surgical drape. The convective warming therapy was administered for 2 h. The other 2 h served as the control. In each session, culture plates were placed directly on the subject's abdomen through an opening in the drape. Tympanic membrane and leg skin temperatures were significantly higher with active warming. No significant differences in the number of bacterial colonies were observed between the two study periods. It was concluded that convective warming therapy, when appropriately applied, does not increase the risk for airborne bacterial wound contamination in the operating room.
OBJECTIVES: To assess knowledge of risk factors of blood exposure in operative room and management after blood exposure. METHODS: A national survey was conducted towards 5000 surgeons drawn with hazard. RESULTS: The knowledge of the risk of viral contamination stay imperfect and the management after blood exposure is doubtful, and this last point is probably favoured by the absence of regulation in spite of guidelines from professional associations or societies. CONCLUSION: Knowledge of risk factors and more clear regulations could permit a better attitude in case of blood exposure.
OBJECTIVE: To assess the learning styles and educational strategy preferences among critical care nurses, operating room nurses, and infection control practitioners. DESIGN: Descriptive multicenter survey using a self-report questionnaire. SETTING: 108 hospitals from nine geographic regions of the United States. PARTICIPANTS: A random sample of 303 (93%) nurses in the three specialties responded to the survey questionnaires. RESULTS: The majority of participants (64%) had an abstract learning style and preferred the self-directed, discovery approach to learning. CONCLUSIONS: Nurses may be more abstract in their learning styles than previously reported. Experiential learning theory is an effective means of identifying nurses' learning styles and teaching/learning preferences, which can then be used to plan basic and continuing educational programs.
During the last two decades, an increasing number of permanent pacemakers have been implanted outside of the operating room (OR) by nonsurgeons. Previous investigators have demonstrated that pacemakers can be safely implanted in the cardiac catheterization laboratory with no increase in complications or infections. This is the first study of its kind to simultaneously evaluate cost, length of hospitalization, and complications between pacemakers implanted in the OR by surgeons with those implanted in the catheterization laboratory by an electrophysiologist. A total of 254 consecutive pacemaker implants were analyzed over a 2-year period. The OR group consisted of 122 patients with a mean age of 64 +/- 21 years versus 132 patients in the catheterization laboratory group with a mean age of 65 +/- 17 years. The indication and type of pacemaker implanted were similar among both groups with 78% of OR patients and 73% of catheterization laboratory patients receiving dual chamber devices. The average cost for pacemaker implantation in our study was significantly higher in the OR group $5,464 +/- $1,670 versus $2,682 +/- $8 for the catheterization laboratory group (P < 0.001). There was a reduction in preimplant days in the catheterization laboratory group 3.16 +/- 12.40 days versus 5.65 +/- 9.54 days in the OR group (P < 0.05). Complications were minimal and there were no significant differences between the two groups. This study confirms that pacemakers can be safely implanted in the catheterization laboratory by nonsurgeons with no increase in complications and a significant reduction in hospital costs.
BACKGROUND: The rapid adoption of laparoscopic surgery since the late 1980s added tremendous complexity into the operating room (OR) environment. For each case, a plethora of additional equipment-including monitors, video equipment, wiring, tubing, and cords-had to be set up, prolonging OR turnover time and decreasing OR efficiency. In 1993, the concept of designated minimally invasive surgery (MIS) suites was introduced. MIS suites integrated monitors and video equipment into the OR on ceiling-mounted columns and moved the controls to a centralized nursing station. The overall effect of this innovation on OR efficiency has not been measured. METHODS: Five RNs with varying degrees of MIS experience were instructed on video setup and put-away criteria and then timed while performing a set of standardized tasks. Each set of tasks was performed twice using a standardized surgery model. Differences in setup and put-away times between MIS suites and standard ORs were tested using the t-test for paired comparisons. RESULTS: The mean +/- standard deviation (SD) video setup times were 27.9 +/- 5.3 sec (MIS) and 254.3 +/- 54.0 sec (standard); the put-away times were 19.8 +/- 2.7 sec (MIS) and 222.3 +/- 26.0 sec (standard). The mean difference +/- standard error (SE) in both the setup (226.4 +/- 16.9 sec, p = 0.0001) and put-away times (202.5 +/- 8.6, p = 0.0001) were large and statistically significant. CONCLUSION: Using a simulation model, we have demonstrated that the use of a MIS suite reduces video setup and put-away time significantly, with the potential for significant associated cost savings. This provides just one justification for the high cost of building such "ORs of the future."
STUDY OBJECTIVE: To determine the influence of anesthetic technique and primary drug on operating room (OR) exit time (time between end of surgery until time patient exists the OR) after addition of desflurane to the hospital formulary. DESIGN: Prospective study. SETTING: Ambulatory surgery unit of a university hospital. PATIENTS: 1,568 outpatients requiring anesthesia. INTERVENTIONS: Addition of desflurane to the hospital formulary, and substitution of desflurane vaporizers for enflurane vaporizers in the ambulatory surgery unit. MEASUREMENTS AND MAIN RESULTS: The following information was recorded for all anesthetic encounters over a six-month time interval: demographics, duration of surgery, primary anesthetic technique, primary anesthetic drug, and exit times. General anesthesia was used in 907 patients [desflurane: 209 patients, isoflurane: 429 patients, halothane: 192 patients, propofol: 72 patients, other intravenous (i.v.): 5 patients], major conduction anesthesia (spinal and epidural) in 43 patients, peripheral nerve blocks in 90 patients, and i.v. sedation in 528 patients. The exit time was significantly greater ( < 0.05) in patients who received general anesthesia (mean +/- SEM 14 +/- 0.2 min) compared with spinal/epidural (8 +/- 0.7 min), nerve blocks (8 +/- 0.4 min) and i.v. sedation (7 +/- 0.2 min). Exit times were longer in older patients receiving general anesthesia (exit time = 12.3 + 0.04 x age, SE = 6.7 min, p < 0.0009), whereas exit times were shorter in older individuals receiving i.v. sedation (exit time = 8.97 - 0.038 x age, SE = 3.6 min, p < 0.0001). For patients receiving i.v. sedation, exit times were shorter as duration of surgery increased (exit time = 7.86 - 0.015 x duration of surgery, SE = 3.6 min, p < 0.0002). Primary anesthetic drug did not affect exit times. CONCLUSION: Regional anesthesia and i.v. sedation were associated with faster OR exit times compared with general anesthesia. Despite desflurane's shorter elimination kinetics and recovery characteristics, use of this drug did not result in shorter exit times.
OBJECTIVES: Personnel exposure to anaesthetic gases in the health sector, whether in the operating room, recovery room, or in the context of outpatient clinics, may entail a health risk. The goal of this research was to study the cytogenetic effects of chronic exposure to small doses of pollutants in operating theatres. METHODS: Results of cytogenetic analyses [structural chromosomal aberrations (SCAs), sister chromatid exchange (SCE) and micronucleus (MN) test] of anaesthetists and other personnel handling anaesthetic gases, who only occasionally work in zones of ionizing radiation, were compared with results from radiologists, occupationally exposed to ionizing radiation only, and with the results obtained from a group of Slovene citizens who were never exposed to genotoxic agents. RESULTS: This study involved 153 workers handling anaesthetic gases. The average frequency of SCAs in the group working with anaesthesia was 2.693. The result was statistically significantly higher than in the group of radiologists and Slovene citizens. The frequency of SCE and MN was also statistically significant. A number of authors, who used the same cytogenetic tests, found similar results in the group of anaesthetist. CONCLUSION: The results of our study indicate that exposure to anaesthetic gases induced changes in human chromosomes.
PURPOSE: To examine the perceived urgency of 13 auditory warning alarms commonly occurring in the hospital operating room. METHODS: Undergraduate students, who were naïve with respect to the clinical situation associated with the alarms, judged perceived urgency of each alarm on a ten-point scale. RESULTS: The perceived urgency of the alarms was not consistent with the actual urgency of the clinical situation that triggers it. In addition, those alarms indicating patient condition were generally perceived as less urgent than those alarms indicating the operation of equipment. Of particular interest were three sets of alarms designed by equipment manufacturers to indicate specific priorities for action. Listeners did not perceive any differences in the urgency of the 'information only', 'medium' and 'high' priority alarms of two of the monitors with all judged as low to moderate in urgency. In contrast, the high priority alarm of the third monitor was judged as significantly more urgent than its low and medium urgency counterparts. CONCLUSION: The alarms currently in use do not convey the intended sense of urgency to naïve listeners, and this holds even for two sets of alarms designed specifically by manufacturers to convey different levels of urgency.
Observation of surgical personnel in four specialties (cardiothoracic, general, gynecologic, and orthopedic) in the operating room was performed prior to implementation of an educational intervention designed to improve compliance with Universal Precautions and at 1- and 2-years post-intervention. Use of protective eyewear and double gloving increased following the intervention, whereas the incidence of documented blood and body fluid exposures decreased.
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