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PubMed2002

Prevalence of adverse reactions to latex gloves in Korean operating room nurses.

This study was conducted to determine the prevalence rate of adverse reactions to latex gloves. Among hospital personnel working in operating rooms, 41.4% reported adverse reactions to latex. Especially among OR nurses, the prevalence rate of adverse reactions was 80.3%, and that of latex allergy was 9.8%. Common symptoms were rash, skin itching, dizziness, and eye itching. Atopics had more latex allergy than the non-atopics. There was no difference in the incidence rate of latex allergy among the five gloves by the prick test. But with the exposure test, ordinary gloves had a higher latex allergy incidence than hypoallergenic gloves.

Adult↗
PubMed1979

Pharmacy practice in an operating room complex.

The steps involved in establishing a comprehensive pharmaceutical service in an operating and recovery room complex is described. Objectives of the operating room pharmaceutical satellite were to: (1) improve control of distribution, storage and charging for all drugs, especially Schedule II controlled substances; (2) reduce inventory costs and loss of revenue; (3) improve compliance with the drug formulary; and (4) establish patient-oriented pharmaceutical services. The pharmacy satellite improved inventory control and patient charging, assured continual access to all drugs and appropriate security for controlled substances, and expanded the pharmacy department's clinical, drug information and research activities.

Alabama↗
PubMed2006

The pretrained novice: using simulation-based training to improve learning in the operating room.

Enabling trainees to acquire advanced technical skills before they begin the operating room experience benefits both trainee and patient. Whether medical students who had received exclusively simulation-based training could perform laparoscopic suturing and knot-tying as well as senior surgery residents was determined. Simulators were used to train 11 fourth-year medical students with no previous suturing experience to perform intracorporeal suturing and to successfully tie a free-hand intracorporeal knot. Students' skills were assessed by the performance of the fundal suturing portion of a Nissen fundoplication in a porcine model. Their operative performance was evaluated for time, needle manipulations, and total errors. Results were compared to those of 11 senior-level surgery residents performing the same task. The study concluded that trainees could learn advanced technical skills such as laparoscopic suturing and knot tying by using simulation exclusively. The trainees and senior level surgery residents had a similar number of needle manipulations.

Clinical Competence↗
PubMed2003

Tumor resection in a shared-resource magnetic resonance operating room: experience at the University of Cincinnati.

INTRODUCTION: At the University of Cincinnati, we have developed a shared-resource magnetic resonance operating suite that facilitates performance of both neurosurgical and diagnostic procedures in a single unit. METHODS: The shared-resource magnetic resonance operating suite utilizes a Hitachi AIRIS II, 0.3-T, vertical field, open MRI unit located in the MROR. This magnet can be used for both diagnostic and interventional procedures. The addition of a rotating-operating table permits neurosurgical procedures to be performed outside of the 5-G line using standard neurosurgical equipment and operating microscopes. RESULTS: We review our results with the shared-resource magnetic resonance operating room including the tabulated results from 30 transsphenoidal procedures and 63 glioma procedures. In addition, 2832 diagnostic procedures have been performed in the first 4 years of use. CONCLUSION: The shared-resource intraoperative MRI facility produces high-quality intraoperative imaging studies, equal to those of high-resolution magnets, and is valuable in enabling the surgeon to achieve the planned degree of resection of glioma and pituitary tumors. The ability to perform diagnostic procedures in a shared unit has been a cost-effective solution for our institution.

Brain Neoplasms↗
PubMed2005

The LifeShirt system for wireless patient monitoring in the operating room.

We examined the functionality and reliability of a wearable physiological monitoring system (LifeShirt) during normal daily activities and in a hospital operating room (OR) environment. The garment collects physiological data such as oxygen saturation, and stores them in a recorder from which it can be read afterwards. Ten normal subjects wore the shirt continuously for 8 h per day. Feedback from the testers was quite positive, although the collected data varied in quality. Ten hospital patients also wore the shirt during endoscopy. The data collected during the hospital stay were qualitatively adequate. Measuring respiratory function caused the biggest problems. The study showed that intelligent garment technology could be used in an OR environment for patient monitoring, albeit not in realtime. It may also be useful in home follow-up.

Activities of Daily Living↗
PubMed2005

Surgical resident supervision in the operating room and outcomes of care in Veterans Affairs hospitals.

BACKGROUND: There has been concern that a reduced level of surgical resident supervision in the operating room (OR) is correlated with worse patient outcomes. Until September 2004, Veterans' Affairs (VA) hospitals entered in the surgical record level 3 supervision on every surgical case when the attending physician was available but not physically present in the OR or the OR suite. In this study, we assessed the impact of level 3 on risk-adjusted morbidity and mortality in the VA system. METHODS: Surgical cases entered into the National Surgical Quality Improvement Program database between 1998 and 2004, from 99 VA teaching facilities, were included in a logistic regression analysis for each year. Level 3 versus all other levels of supervision were forced into the model, and patient characteristics then were selected stepwise to arrive at a final model. Confidence limits for the odds ratios were calculated by profile likelihood. RESULTS: A total of 610,660 cases were available for analysis. Thirty-day mortality and morbidity rates were reported in 14,441 (2.36%) and 63,079 (10.33%) cases, respectively. Level 3 supervision decreased from 8.72% in 1998 to 2.69% in 2004. In the logistic regression analysis, the odds ratios for mortality for level 3 ranged from .72 to 1.03. Only in the year 2000 were the odds ratio for mortality statistically significant at the .05 level (odds ratio, .72; 95% confidence interval, .594-.858). For morbidity, the odds ratios for level 3 supervision ranged from .66 to 1.01, and all odds ratios except for the year 2004 were statistically significant. CONCLUSIONS: Between 1998 and 2004, the level of resident supervision in the OR did not affect clinical outcomes adversely for surgical patients in the VA teaching hospitals.

Female↗
PubMed1999

Correlation between surface and air counts of particles carrying aerobic bacteria in operating rooms with turbulent ventilation: an experimental study.

Airborne contamination with bacteria-carrying particles (cfu/m3) and their sedimentation rate (cfu/m2/h) was compared in an operating room (OR) equipped with two turbulent ventilation systems. One was a thermally based system with inlet of cool clean air at the floor level and evacuation of the air at the ceiling by convection (17 air changes/h). The other was a conventional plenum pressure system with air supply at the ceiling and evacuation at the floor level (16 air changes/h). The study was made during rigidly standardised sham operations (N = 20) performed in the same OR by the same six member team wearing non-woven disposable or cotton clothing. Airborne contamination in the wound and instrument areas was related to the surface contamination rate in the same areas and in addition, on the patient chest and in the periphery of the OR. With the exception of the periphery of the OR, the surface and air contamination rates were highly correlated in both ventilation systems (P = 0.02-0.0006, r2 = 0.52-0.79). This was also true particularly when disposable clothing was used while the correlation was weaker in cotton clothing experiments. An equation describing the relation between surface and air counts is given. Typically, the surface counts were numerically 16-fold the air counts, i.e., the number of colonies sedimenting on four 14 cm-diameter agar plates during 1 h will almost equal the number of airborne cfu per m3. We propose, that sedimentation plates represent not only a technically easier method than air sampling but when correctly used, are also the most realistic indicator of airborne bacterial OR contamination in areas critical for surgery.

Air Microbiology↗
PubMed2006

Prophylactic inferior vena cava filter insertion for trauma: intensive care unit versus operating room.

The frequency of insertion of prophylactic inferior vena cava filters (IVCF) among traumatized patients has increased nationally. That has placed a substantial operational and economic burden upon trauma centers. The purpose of this study was to compare and contrast successful implantation, morbidity, and cost-effectiveness of prophylactic IVCF insertion in a surgical-trauma intensive care unit (STICU) versus an operating room (OR). A retrospective chart review was conducted of all trauma patients who received a prophylactic IVCF at an urban Level I trauma center between January 1999 and December 2003. Data were collected to identify patient demographics, indications, anatomical site of insertion, hospital location of insertion, hospital days before insertion, and complications associated with insertion. One hundred thirty-four patients underwent prophylactic IVCF during the study period: seventy-eight (58%) in the OR and fifty-six (42%) in the STICU. The average age of patients for the OR and STICU groups were 38.6 years and 39.6 years, respectively. The average number of days to IVCF insertion was 6.5 days and 7.0 days in the OR and STICU groups, respectively. Indications for IVCF among patients who had placement in the OR were orthopedic injury (60%), spinal cord injury (25%), and head injury (15%). Indications for IVCF among patients who had placement in the STICU were head injury (38%), orthopedic injuries (34%), and spinal cord injury (25%). Three (3.8%) patients in the OR group and two (3.6%) patients in the STICU group required a change of anatomic insertion site from the femoral to the internal jugular vein. There were two (2.6%) complications associated with IVCF insertion in the OR and two (3.5%) complications associated with IVCF insertion in the STICU (P > 0.05). Insertion of IVCF in the STICU decreased patient-cost by an average of dollar 1636 per patient. Prophylactic IVCF insertion in an STICU is cost-effective and can be performed with similar success and complication rates to IVCF insertion in an OR.

Adult↗
PubMed2005

Bayesian prediction bounds and comparisons of operating room times even for procedures with few or no historic data.

BACKGROUND: Lower prediction bounds (e.g., for fasting), upper prediction bounds (e.g., to schedule delays between sequential surgeons), comparisons of operating room (OR) times (e.g., when sequencing cases among ORs), and quantification of case uncertainty (e.g., for sequencing a surgeon's list of cases) can be done accurately for combinations of surgeon and scheduled procedure(s) by using historic OR times. The authors propose that when there are few or no historic data, the predictive distribution of the OR time of a future case be centered at the scheduled OR time, and its proportional uncertainty be based on that of other surgeons and procedures. When there are a moderate or large number of historic data, the historic data alone are used in the prediction. When there are a small number of historic data, a weighted combination is used. METHODS: This Bayesian method was tested with all 65,661 cases from a hospital. RESULTS: Bayesian prediction bounds were accurate to within 2% (e.g., the 5% lower bounds exceeded 4.9% of the actual OR times). The predicted probability of one case taking longer than another was estimated to within 0.7%. When sequencing a surgeon's list of cases to reduce patient waiting past scheduled start times, both the scheduled OR time and the variability in historic OR times should be used together when assessing which cases should be done first. CONCLUSIONS: The authors validated a practical way to calculate prediction bounds and compare the OR times of all cases, even those with few or no historic data for the surgeon and the scheduled procedure(s).

Algorithms↗
PubMed1996

[Analysis of the utilization of the operating room using a computer].

With this study, we intended to verify the possibility of settling a time control of the activities developed at the operating room of an University Hospital, which has more than 500 beds, through the introduction of a computer program. The results indicate that this kind of systematic time control, which is used by nurses, anaesthesia and surgery staff is able to offer a more rational utility to human and material resources.

Hospital Bed Capacity, 500 and over↗
PubMed2002

[Participation--oriented analysis of the anesthesia workplace. A work system for anesthesia in a multidisciplinary operating room].

INTRODUCTION: The aim of this study was the detection and understanding of weak points in the ergonomic design of anaesthesia workplaces in a multidisciplinary operating room facility. METHODS: Analysis of workplaces and of working processes by means of observations, computer-supported task recording and video-photo documentation. During guided interviews the participants were provided with material for naming-by-pointing and drawing. Subsequently, the background of the problems encountered and possible improvements were visualised. RESULTS: Important deficits were devices not positioned within reach and view, difficulties in operating the lines connecting the patient and the devices, and inconsistent workplace layouts. These were caused by erroneous planning of the facility and disregarding ergonomic principles in equipment design. The initial improvements implemented were the development of a new concept for a flexible equipment positioning and the design of a tool for cable handling. DISCUSSION AND CONCLUSION: Although from the very beginning of the study the anaesthesia personnel quoted the handling of the lines connecting patients and devices as the main cause for working difficulties, the external ergonomist could contribute to a broader view of the problems. The method presented here initiated a mutual learning process between ergonomist and users and resulted in a common understanding of the problems and their causes. Compared to the traditional consulting process, more time and efforts were necessary but were offset by the users' acceptance of the improvements and the prevention of design errors.

Anesthesia↗
PubMed1987

Albumin/hetastarch drug utilization review in an operating room pharmacy.

A prospective drug utilization review (DUR) was performed on the colloids albumin 5% and hetastarch 6% at the University of Illinois Hospital Operating Room Pharmacy. This DUR's purpose was to evaluate the usage patterns of the two colloids. With the addition of hetastarch 6% to the formulary, an alternative colloid was available that could be therapeutically substituted for albumin 5% at a cost savings. Its usage, however, was not what would have been expected. Usage information was obtained by placing utilization forms inside the individual boxes of albumin 5% and hetastarch 6%. These forms were completed by the anesthesiologists and returned to the pharmacy, where the remainder of each form was completed. It was concluded that 93 percent of the patients administered albumin 5% could have received hetastarch 6%. Hence, potential yearly savings of approximately $12,346.00 could be realized by the Department of Pharmacy.

Albumins↗
PubMed2006

Determining the impact of a surgical liaison nurse role in the paediatric operating room.

A two-group (N = 92) quasi-experimental pre-post test design was used to examine the effects of intra-operative communication by a surgical liaison nurse (SLN) on parental anxiety. Group I received in person progress reports from the SLN. Group II received routine perioperative care. The Speilberger's State-Trait Anxiety Inventory (STAI) Scale and investigator developed family rating scales were distributed to both groups and used as a quantitative as well as a qualitative approach to determine what was helpful for the family members during the operative period. Two hundred and eighty feedback forms were dispersed to various health care professionals including all anaesthetists, surgeons, nurses and other staff in the perioperative care team, including the operating room, day surgery unit and the post anaesthetic recovery room areas. Feedback forms were also circulated to staff from the intensive care unit and the surgical in-patient units. The results showed the anxiety levels were lower for the families who received in person progress reports but the difference by group was not statistically significant. Thematic written responses provided examples of improved care and effective time management behaviours on the part of the health care professionals. Written responses provided validation for the scale scores for both families and health care professionals and were an indication of the support for the role of the surgical liaison nurse. Qualitative findings implied that the surgical liaison nurse facilitated the transfer of necessary information between the perioperative care team and the family thus providing a support mechanism for families under stress.

Anxiety↗
PubMed2001

Radiofrequency transmission to monitoring devices in the operating room: a simulation study.

We evaluated radiofrequency (RF) transmission to various monitoring devices using circuits that simulated potentially hazardous conditions for patients in the operating room. Right heart ejection fraction (REF) pulmonary artery catheters, transesophageal atrial pacing stethoscopes, and temperature-sensing esophageal stethoscopes were subjected to RF transmission from an electrosurgery unit. Peak voltage and spark intensity were measured in circuits between the electrocautery dispersive pad and conductive elements of the various medical devices. All monitoring devices with an exposed conductive surface were found to have induced voltages and even spark generation. The ranking for peak voltage from least to most was as follows: disrupted esophageal stethoscope (620 volts), the transesophageal pacemaker (640 volts), and the REF pulmonary artery catheter (PAC) (680 volts). Peak voltage measurements of the REF PAC significantly decreased from 388 +/- 23 to 142 +/- 22 volts (P < 0.0001, Student's t-tests) in a fluid medium compared to air. In a fluid medium, peak voltage significantly decreased from 142 +/- 22 to 85 +/- 15 volts (P < 0.0001, Student's t-tests) when the REF PAC was connected to the cardiopulmonary monitor.

Humans↗
PubMed1992

Paramedic intubation training in a pediatric operating room.

The authors conducted a prospective study to assess the performance of paramedics with prior adult endotracheal intubation experience in pediatric intubation in the operating room of a teaching hospital. Nineteen paramedic students were observed attempting endotracheal intubation on a total of 57 anesthetized pediatric patients undergoing scheduled surgical procedures. The average age of patients was 5.1 years (range, 6 months to 15.2 years). Average duration of intubation attempts was 22.7 +/- 10.7 seconds, with a success rate on first attempt of 74%. Only minor complications occurred, and were limited to intubation attempts of greater than 45 seconds duration in four cases (6%), and patient oxygen saturation less than 90% in one case (2%). The study suggests that paramedics may be successfully incorporated into a hospital's clinical training program, and can receive closely supervised experience in pediatric endotracheal intubation without compromising patient care. Such training may increase the willingness of paramedics to attempt emergent prehospital endotracheal intubation of children, as well as increase their success with this potentially life-saving procedure.

Adolescent↗
PubMed2006

Mean operating room times differ by 50% among hospitals in different countries for laparoscopic cholecystectomy and lung lobectomy.

We explored whether there were large differences in operating room (OR) times for two common procedures performed by multiple surgeons at each of several hospitals thousands of miles apart. Mean OR time, "wheels in" to "wheels out," for ten consecutive cases of each of laparoscopic cholecystectomy and lung lobectomy were obtained for each of ten hospitals in eight countries from their OR logs. After log transformation, the OR times were analyzed by analysis of variance. Mean OR times differed significantly among hospitals (P = 0.006, laparoscopic cholecystectomy; P < 0.001, lung lobectomy). The second longest average OR time was 50% longer than the second shortest average OR time for both laparoscopic cholecystectomy and lung lobectomy. Differences in OR times among the hospitals we studied were large enough to affect the productivity of OR nurses and anesthesia providers. Thus, international benchmarking studies to understand differences in OR times worldwide may be beneficial.

Analysis of Variance↗