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PubMedDate not supplied

Preparation of nonmedical personnel in the operating room environment.

The nonmedical visitor to the operating room often provides vital expertise in the effective care and treatment of the surgical patient using today's sophisticated technology. By becoming aware of the special environment in the operating room and following the guidelines set up by each institution, the biomedical equipment technician, clinical engineer, or manufacturer representative will enhance his or her effectiveness when the need for entering the operating room suite arises. Guidelines cover personal hygiene and clothing and antisepsis techniques (scrubbing, gowning, draping, patient preparation, and equipment cleaning) to prepare for the operating. The visitor in the OR must also observe rules of etiquette to guard against interference with the established procedure routine.

Antisepsis↗
PubMed2003

The operating room of the future: a view from Europe.

The Operating Room of the Future will be characterized by meticulous preoperative planning, full integration of the operating room into the general flow of information, more comprehensive intraoperative diagnostic imaging procedures, and the use of sophisticated visualization processes including augmented reality. Mechatronic support (partially autonomous robots) enhances safety and allows reduction of staff. Integrated operating room systems will allow the wide spectrum of new devices and functionalities to be easily controlled by the operating team. The Operating Room of the Future will no longer be isolated from the rest of the clinical endeavor. Intraoperative teleconsultation and telepresence will help to promote and teach safer evidence-based endoscopic therapeutic surgery. Traditional surgical intervention will expand its definitions by procedures via an interdisciplinary, cooperative approach that will replace the sequential therapeutic process of today.

Europe↗
PubMed2002

Sampling error can significantly affect measured hospital financial performance of surgeons and resulting operating room time allocations.

UNLABELLED: Hospitals with limited operating room (OR) hours, those with intensive care unit or ward beds that are always full, or those that have no incremental revenue for many patients need to choose which surgeons get the resources. Although such decisions are based on internal financial reports, whether the reports are statistically valid is not known. Random error may affect surgeons' measured financial performance and, thus, what cases the anesthesiologists get to do and which patients get to receive care. We tested whether one fiscal year of surgeon-specific financial data is sufficient for accurate financial accounting. We obtained accounting data for all outpatient or same-day-admit surgery cases during one fiscal year at an academic medical center. Linear programming was used to find the mix of surgeons' OR time allocations that would maximize the contribution margin or minimize variable costs. Confidence intervals were calculated on these end points by using Fieller's theorem and Monte-Carlo simulation. The 95% confidence intervals for increases in contribution margins or reductions in variable costs were 4.3% to 10.8% and 6.0% to 8.9%, respectively. As many as 22% of surgeons would have had OR time reduced because of sampling error. We recommend that physicians ask for and OR managers get confidence intervals of end points of financial analyses when making decisions based on them. IMPLICATIONS: The common approach of using one fiscal year of perioperative accounting data can be insufficient to prevent random error from influencing important management decisions. When accounting data are used for hospital and operating room management decision making, confidence intervals should be calculated for the key financial variables (e.g., variable cost per hour of operating room time).

Costs and Cost Analysis↗
PubMed1993

The role of duplex and color Doppler imaging in the operating room.

For years vascular surgeons have used objective methods in the operating room to assess the technical quality of vascular procedures. Black and white (duplex) and color Doppler imaging are critical to the preoperative work-up and postoperative follow-up of many patients. With advancing technology it is possible to adapt these imaging techniques for use in the operating room as well. Anatomic and hemodynamic results can therefore be ascertained before the patient leaves the operating room. Over the past 31 months, vascular surgeons at St. John's Mercy Medical Center (SJMMC) have regularly used duplex and color Doppler imaging in the operating room after carotid thromboendarterectomy and renal artery bypass. A peripheral vascular laboratory nurse is called to the operating room and brings the imaging equipment and videotape recorder. The imaging transducer is draped with a sterile sheath and positioned directly on the vessel. Longitudinal and transverse views are obtained; the presence of intimal flap or turbulent color flow is noted. Sound spectral analysis and peak systolic velocity are obtained in centimeters per second (cm/sec) at various locations proximal and distal to the arteriotomy and within the graft or endarterectomized segment. Results are classified as normal or abnormal. Abnormal findings are further classified as accepted or warranting reexploration. Of 81 carotid scans, 55 (67%) were normal and 26 (33%) abnormal by imaging. Of 28 abnormal sites, 14 (17%) were reexplored and the abnormality repaired. The other 14 abnormalities were accepted. Duplex and color Doppler imaging have proved helpful to surgeons in assessing technical results before the patient leaves the operating room.(ABSTRACT TRUNCATED AT 250 WORDS)

Carotid Arteries↗
PubMed2005

Molecular epidemiology of microbial contamination in the operating room environment: Is there a risk for infection?

BACKGROUND: Modern operating rooms are considered to be aseptic environments. The use of surgical mask, frequent air exchanges, and architectural barriers are used to reduce airborne microbial populations. Breaks in surgical technique, host contamination, or hematogenous seeding are suggested as causal factors in these infections. This study implicates contamination of the operating room air as an additional etiology of infection. METHODS: To investigate the potential sources of perioperative contamination, an innovative in situ air-sampling analysis was conducted during an 18-month period involving 70 separate vascular surgical procedures. Air-sample cultures were obtained from multiple points within the operating room, ranging from 0.5 to 4 m from the surgical wound. Selected microbial clonality was determined by pulse-field gel electrophoresis. In a separate series of studies microbial nasopharyngeal shedding was evaluated under controlled environmental conditions in the presence and absence of a surgical mask. RESULTS: Coagulase-negative staphylococci were recovered from 86% of air samples, 51% from within 0.5 m of the surgical wound, whereas Staphylococcus aureus was recovered from 64% of air samples, 39% within 0.5 m from the wound. Anterior nares swabs were obtained from 11 members of the vascular team, clonality was observed between 8 strains of S epidermidis, and 2 strains of S aureus were recovered from selected team members and air-samples collected throughout the operating room environment. Miscellaneous Gram-negative isolates were recovered less frequently (<33%); however, 7 isolates expressed multiple patterns of antimicrobial resistance. The traditional surgical mask demonstrated limited effectiveness at curtailing microbial shedding, especially during symptomatic periods of rhinorrhea. CONCLUSIONS: Gram-positive staphylococcal isolates were frequently isolated from air samples obtained throughout the operating room, including areas adjacent to the operative field. Nasopharyngeal shedding from person participating in the operation was identified as the source of many of these airborne contaminants. Failure of the traditional surgical mask to prevent microbial shedding is likely associated with an increased risk of perioperative contamination of biomedical implants, especially in procedures lasting longer than 90 minutes.

Air Microbiology↗
PubMed1997

[Analysis of influential factors of suspended bacteria in air in operating rooms].

In order to control the air borne bacterial contamination of operation in operating rooms, we designed to do air sampling with FA-1 suspending air bacterial particle sampling kits. Samples were from purified operating rooms and nonpurified operating rooms, aseptic operation and contaminated operation. Data were collected in 7 different stages and 3 different altitudes. Data were statistically analysed by means of logistic linear model. The results help us understand the influencing factors of air contamination. Strategies of control of those factors were discussed.

Air Microbiology↗
PubMed1992

Operating room productivity. An evaluation format.

Operating room (OR) directors are frequently faced with the challenge of explaining or justifying OR productivity and the OR staffing budget. This justification may occur annually in conjunction with their budget submission or when consultants are employed to evaluate and improve OR productivity. Whatever the circumstance, a simple step-by-step format that helps physicians and administrators understand the impact of productivity on the nursing budget can be most useful. The authors present a format that was successfully used at a Boston teaching hospital.

Boston↗
PubMed2005

Governance in operating room nursing: nurses' knowledge of individual surgeons.

This paper explores governance and control in operating room nurses' clinical practice. Traditionally, operating room nurses have been portrayed as "handmaidens" to the surgeons, a position which implies that nurses' bodies and the knowledge they use in practice are sites of discursive control by others. This paper unsettles this understanding by showing how operating room nurses studied ethnographically in an Australian setting are both disciplined by and actively shape practice through knowing surgeons' technical requirements for surgery, through inscribing them in discourses of time, and through having deep knowledge of the surgeons' "soul". We argue that as a form of governance, nurses' knowledge of surgeons is a subjugated form of knowledge, located low down on a hierarchy of knowledges. Furthermore, as a form of governance that has previously been unarticulated in the literature, it transcends the traditional lines of authority and control in the nurse-doctor relationship. The data in this paper are drawn from an ethnographic study that explored a range of nurse-nurse and nurse-doctor communication practices in operating room nursing.

Anthropology, Cultural↗
PubMed1992

Automated situational analysis for operating room anesthesia monitoring.

The hospital operating room (OR) is an environment that requires up-to-the-minute, reliable information on a patient's state. Data is usually provided by a heterogeneous mixture of independent monitors that, due to their isolated nature, give complex and sometimes erroneous presentations of a patient's state. This complex presentation introduces the possibility of operating room personnel overlooking data items that indicate certain pending patient states, such as cardiac arrest. A computer based system that collects the various monitor data, summarizes its content, and provides concise discourse on a patient's state (including potential life threatening situations), would be beneficial.

Anesthesia↗
PubMedDate not supplied

[A study on job satisfaction and its depressive factors in human relations among operating room nursing].

This study was done for the purpose of analyzing the job-satisfaction and its depressive factors in human relation of operating room nurses of university hospital. Therefore, it makes an offer the basic data to help the resolution and prevention of the problems in operating room nurses. Furthermore, this study was conducted in order to find out some kinds of scientific data for the better control of depressive factors of job-satisfaction expressed by the operating room nurses. The structured questionnaire reports of 246 operating room nurses who were employed in 5 different university hospitals which have over 1,000 beds located in Seoul, Korea were used, which wer collected from August 24th to August 30th of 1992. The author visited supervisors of operating room in each university hospital and explained the aim of this study. The most of them (90.0%) answered to the questionnaires. Analysis of the collected data were done by mean, standard deviation, percentage, t-test, F-test, Q-test, correlation analysis, one-way ANOVA, and stepwise multiple regression analysis. Major findings of this study were as follows: 1. The job of the operating room nurses were remarkably related with the satisfaction in human relation, which was defined as the behavioral job with thoughtful action rather than with mechanical action. However, the degree of satisfaction in human relation with personnel in other departments was found to be the lowest and its the main depressive factors were appeared due to the absence of interaction and uncooperative attitudes. Therefore, it was required that the members of other job need more cooperative attitude to the actual works in the operating room nurses. 2. The depressive factors in the satisfaction degree of human relation with official seniors wer significantly related with their irresponsibility and partialness. Moreover, the job attitude of the operating room nurses is abundantly required to be improved. 3. The depressive factors in the satisfaction of human relation with medical doctors were significantly related with their insincerity and the class-consciousness. It is clearly suggested that the medical doctors do more cooperative behaviors for the jobs of the operating room without the suggested that the medical doctors do more cooperative behaviors for the jobs of the operating room without the superiority feeling of class-consciousness. 4. There was a significantly positive association between the satisfaction degree of human relation of the nurses with the following characteristics.(ABSTRACT TRUNCATED AT 400 WORDS)

Analysis of Variance↗
PubMed2006

Staffing and case scheduling for anesthesia in geographically dispersed locations outside of operating rooms.

PURPOSE OF REVIEW: Scheduling and staffing for anesthetics outside of the operating room that are geographically dispersed is different than for operating room cases. Whereas methods to predict how long such cases take were published recently, this article reviews staffing and case scheduling. RECENT FINDINGS: Methods have been developed based on the assumption that physicians doing procedures requiring anesthesia are provided open access to anesthesia time within a reasonable number of days (e.g., 2 weeks) or on any future workday. The latter is commonly used in operating rooms. Outside of operating rooms, the former is more practical economically. Statistical forecasting of anesthesia staffing months ahead is conducted by using billing data with the objective of maximizing the efficiency of use of anesthesia time. Calculations assume that anesthesia time that would otherwise be underutilized is released for use by services that would otherwise work in overutilized anesthesia time. Forecasting is different for services with many patients hospitalized preoperatively (e.g., electroconvulsive therapy). Implementation encourages longer-term changes benefiting the anesthesia group (e.g., services choose to work longer hours for fewer days of the week). SUMMARY: Plan staffing based on providing open access to anesthesia time within a reasonable number of days (e.g., 2 weeks). Schedule cases and release allocated time based on reducing overutilized anesthesia time.

Anesthesia↗
PubMed1999

The real incidence of percutaneous injuries in the operating room--a prospective study.

Despite the frequent exposure of operating room personnel to blood and other body fluids and the obvious risk of occupational transmission of HIV infection, the real incidence of injuries after needle sticks or cuts in the operating room has not been well investigated. Every injury occurring in the operating room during one thousand consecutive elective and emergency procedures was studied and the risk for acquiring an HIV infection was calculated. There were 50 injuries during 761 elective procedures (6.6%) and 23 injuries during 239 emergency operations (9.6%). There was one single injury during 91 minimally invasive endoscopical procedures (1.1%). The surgeon was the person most frequently injured (3.5%). The injury rate of the scrub nurse varied between 1.4% and 2.8% according to the surgeon's experience. The operating room personnel is at risk for an occupational transmission of blood born pathogens. If the seroprevalence of HIV in surgical patients is estimated at 0.4% the calculated probability for a surgeon to acquire HIV infection over a 30-year career amounts to 0.3%.

Accidents, Occupational↗
PubMed1989

Operating room controls: liability and responsibility.

In the operating room, responsibilities for quality assurance extend to the tools and products selected. It is the responsibility of nurses to ensure there are no lapses in observing minimum standards of care. In the operating room, efforts must be directed at establishing written policies and procedures, assuring compliance with, and adherence to, guidelines, and conducting monitoring activities. An OR nurse may be liable if a hazardous product is used, recommended procedures are not followed, or an accepted safer alternative is not used.

Humans↗
PubMed1997

Staffing the operating room. Time and space factors.

Staffing the operating room requires a different approach than staffing inpatient units. Of course, there are similarities, namely: assuring safe, cost-effective care; dealing with fluctuating workloads; using various types of caregivers; and maximizing and maintaining resources in a responsible manner. However, many differences also exist. This article details the fundamental requirements for determining operating room staffing.

Anesthesiology↗