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PubMed2003

Hygiene and room climate in the operating room.

The ventilation system is not the most important source to cause surgical site infections via the air. More important is the skin of both staff and patients. The literature did not reveal any reduction of the risk of surgical site infections resulting from the employment of ultra-clean air-systems during surgical procedures, the one exception being high risk operations such as orthopaedic implant surgery. Both ultra-clean air and antimicrobial prophylaxis can reduce the incidence of surgical site infections. If HEPA filters are used, they are only necessary directly in the operating rooms. Other rooms such as the washroom, the anaesthesia preparation room or corridors which are connected to the OR do not have to be treated with HEPA filters. If a laminar air-flow system is installed, there are some factors which have to be considered. The number of operating lamps and the heads of the operating team affect the function of the air ceiling as they form thermic and air-flow resistance and create turbulences. Also, forced air-warming systems, which are used to maintain normal body temperatures for patients during surgery, disturb the ultra-clean field through the air emitted from the blankets used. Moreover, any medical equipment which is cooled by integrated cooling blowers can influence an ultra-clean air system. Existing ventilation systems are not able to create good room conditions for all persons inside the OR. Therefore new ways have to be found to create a room climate taking into account the level of activity.

Journal Article↗
PubMed2005

A case of a power failure in the operating room.

In the operating room, safely administering anesthesia amidst a major power failure can instantly present one with a formidable challenge. A case is presented involving a 23-year-old healthy woman who underwent a complex oral and maxillofacial surgery to correct a dentofacial deformity. Three hours into the case and with the patient's maxilla downfractured, the overhead surgical lights blacked out, and there was an apparent loss of the anesthesia machine's ability to function. Providing adequate oxygenation, ventilation, anesthesia levels, monitoring of vital signs, and transportation of the patient were some of the challenges faced, and the response to this unexpected event is recounted. The importance of one's familiarity with an anesthesia machine's backup battery supply, routinely checking machinery, ensuring that appropriate and sufficient supplies are readily available, exercising calm leadership with clear communication, and formulating a clear plan with backup alternatives are discussed. Various recommendations are proposed with respect to the preparation for and the prevention of a power failure in the operating room. This report's account of events is aimed to "shed some light" on this topic, serve as a check of one's own preparedness, and facilitate the optimal management of a similarly unexpected incident.

Adult↗
PubMed1992

Advanced technology in the operating room.

Today's operating room is a high-tech environment. Minimally invasive procedures are fast becoming a standard for certain conditions. Lasers have taken their place as routine surgical tools in many specialties. On the horizon are new imaging technologies. If you are planning for new ORs, you'll want to consider the role of advanced technology in your new suite.

Endoscopes↗
PubMed1989

A simple method for preventing blood-borne contamination to operating room personnel during vascular reconstructive operations.

Although the risk of infection with hepatitis or HIV remains low, and the effectiveness of steps to reduce even this small risk is difficult to assess, the sequelae of the infection with either virus are often devastating. We described herein the use of a sterile Petri dish to inspect vascular anastomoses during arterial reconstructive operations. This simple, inexpensive precaution has been in use at the University of Cincinnati for two years and has proved so effective in preventing the contamination of operating room personnel with blood from a patient that it has recently become a routine part of all vascular reconstructive operations.

Acquired Immunodeficiency Syndrome↗
PubMed2003

Operating room utilization: information management systems.

PURPOSE OF REVIEW: Advances during the past year in operational decision making using information management systems data have been predominantly in better understanding of how to allocate operating room time based on operating room efficiency, not just operating room utilization. RECENT FINDINGS: Each quarter, operating room allocations based on maximizing operating room efficiency can be calculated with 6-10 months of data. Analysis can be performed using operating room or anesthesia information management system data. Uncertainty in knowing the operating rooms in which cases were performed (i.e. in knowing turnover times) has little effect on operating room allocations or efficiency. It is important, however, that when a service has filled its allocated operating room time and has a new case to schedule, the case be scheduled into the operating room time of another service. The service whose operating room time is released can be the service with the largest difference between allocated and scheduled operating room time at the time when the new case is scheduled. If optimal operating room allocations and case scheduling based on maximizing operating room efficiency are not implemented, the resulting increase in anesthesia group labor costs can be used in negotiations as a statistically sound estimate for the increased labor cost to the group. SUMMARY: During the last couple of years there has been continual advancement in our understanding of how to analyze operating room information system data based on operating room efficiency. Work has expanded from operating room allocations to case scheduling, releasing allocated operating room time, and addressing implementation challenges including poor data quality or lack of interest in change.

Journal Article↗
PubMed1976

Bacterial dispersion in relation to operating room clothing.

The effect of operating clothing on the dispersal of bacterial particles from the wearers was studied in a dispersal chamber. A comparison was made of six gowns as well as four types of trousers. The gowns were of three basic types, namely a conventional cotton type, disposable types made of non-woven fabric and those of the total-body exhaust system (Charnley type). The dispersal chamber could simulate conditions as expected both in down-flow unidirectional ultra-clean systems and in a conventional turbulent plenum-ventilated system. It was found that the disposable gowns would reduce the dispersal rate by about 30% in the simulated conventionally ventilated system and about 65% in the laminar flow system. The total-body exhaust system (Charnley) would reduce the count by 10-fold in the conventional ventilated system and by 66-fold in the laminar-flow system. The poor performance of the gowns in conventionally ventilated systems was caused by the dispersal of bacterial particles from underneath the gown (about 80%). This was not reduced by the disposable gown and only partially by the Charnley type. This small drop would be further decreased in a conventionally ventilated operating-room as only scrubbed staff would wear the gown. In order to overcome this poor performance in conventionally ventilated operating-rooms impervious trousers would be required. Four types were studied and it was demonstrated that those made either from Ventile or non-woven fabric would reduce the bacterial dispersion fourfold. As these tests had been carried out in an artificial environment checks were carried out in the unidirectional-flow operating-room during total-hip arthroplasty. This was done by comparing conventional cotton gowns with non-woven gowns and total-body exhaust gowns. The results showed good correlation between the operating room and the chamber with the non-woven fabric gown but the total-body exhaust system did not perform as well in the operating room (12-fold compared to 66-fold) the difference being possibly due to the contribution from the patient. However, as this comparison was that which would be most open to influence from other variables confidence could be placed on the chamber test results. Values were also obtained for the total number of bacterial particles dispersed by persons during a standard exercise wearing different clothing. This count was dependent on the clothing worn but a median count of between 1000 and 1500 bacterial particles/min. would be expected when conventional clothing was worn, with a range of between 300 and 19,000. This count could be reduced to about 100/min. if a total-body exhaust suit was worn (range 30-400).

Air Microbiology↗
PubMed1988

[Isoflurane pollution in operating rooms].

In three operating rooms of a Sardinian hospital, the Authors have measured the air levels of isoflurane using static samplers. Anaesthetic mean daily concentrations ranged from 3.5 to 41.5 ppm in room A, from 4.1 to 24.4 ppm in room B, from 9.5 to 30.4 ppm in room C above all depending on the length and the number of surgical operations. The Authors emphasize the need of suitable prevention measures.

Air Pollutants, Occupational↗
PubMed1977

An improved operating room demagnetizer.

An operating room demagnetizer that utilized a pulsed, smoothly decaying oscillating magnetic field is described. The instrument can demagnetize a number of surgical instruments at one time and can provide instantaneous and complete demagnetization.

Magnetics↗
PubMed2004

Variables influencing medical student learning in the operating room.

BACKGROUND: The operating room (OR) is an important venue where surgeons do much of medical student teaching and yet there has been little work evaluating variables that influence learning in this unique environment. We designed this study to identify variables that affected medical student learning in the OR. METHODS: We developed a questionnaire based on surgery faculty observations of learning in the OR. The medical students completed the questionnaire on 114 learning episodes in the OR. Pearson correlation coefficient was used to establish the strength of association between various variables and the student's overall perception of learning. RESULTS: The students evaluated 27 variables that might impact their learning in the OR. Strong correlations were identified between the attending physician's attitude, interactions and teaching ability in the OR and the environment being conducive to learning. CONCLUSIONS: Surgical faculty behavior is a powerful determinant of student perceptions of what provides for a favorable learning environment in the OR.

Behavior↗
PubMed1994

Infectious risk factors related to operating rooms.

Risk factors related to operating rooms include patient-associated risks, the operating room environment, ventilation systems, cleansing and sterilization, and operating room personnel. Although constantly debated, surgical wound infection surveillance with appropriate feedback to surgeons is one of the few effective measures that helps reduce surgical infection rates, and we strongly recommend its use. We also recommend the further study of other potential components of effective infection control programs for surgical patients.

Air Microbiology↗
PubMedDate not supplied

[Efficient use of the operating room].

BACKGROUND: To know whether the operating room is efficient requires continual evaluation of the equipment, the competency of personnel included and the level of complexity of the surgical procedures. This evaluation is in the institutional hospital center. The centers. The centers use them for internal control. However, they are slightly or not at all going in the productivity analysis of the operating room for decision making. OBJECTIVE: To identify the elements that favor suboptimal use of operating rooms and in each case, to propose solution for more efficient use. TYPE OF STUDY: Prospective, observational, transversal and comparative. MATERIAL AND METHODS: The study was carried out means of structured questionnaires with the times for surgical interventions in two operating rooms over sixty days. They were conducted the gynecology and general surgery areas. We compared real times against ideal times, and also the complexity levels. STATISTICAL ANALYSIS: Fisher's test p < 0.05 was considerate significant. RESULTS: One hundred and twenty-five surgical procedure were performed, 57.6% during the morning shift (MS) and 42.2% during the evening shift (ES). A total of 66.4% corresponded to complexity level IIII, 84.8% were elective surgeries, 58.4% corresponded to general surgeries, and 41.6% to gynecologic surgical interventions. The delay in times entering the operating room was 20.5 min in MS compared to 4.3 min in ES p < 0.05. In more complex procedures, we found greater delay in surgical time. CONCLUSIONS: The efficient use of the operating room depends on the complying of specific functions in the programmed time of the surgical equipment involved, systematic supervision, and the complexity level.

Cross-Sectional Studies↗
PubMed2002

[Clinical aspects of a virtual operating room for the prediction of operative interventions in some disease of the middle ear].

Clinical aspects of creating a software system for simulation and prediction of operative interventions and hearing function changes are considered. The system will make simulation and prediction transparent and convenient for the user. The technical challenge is to create mediation languages which enforce rigorous mathematical computation while supporting intuitive behaviour. The prevalent textual interface of command lines and pull-down menus is replaced by physical behaviour within an environment. The system is based on new possibilities of computer-integrated environments for problem solving such as virtual environments and it will be presented in a form of a virtual operating room. The following aspects are taken into consideration: a model of the middle ear, database for existing methods of operative interventions, x-ray and computed tomography imaging of the temporal bone, determination and localization of otosclerosis foci, modeling and determination of acoustic parameters for transplantation materials, simulation and prognosis of potential complications.

Ear, Middle↗