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Leonardsen ACL, Brevik L. Cell Phones in the OR: A Cross-Sectional Study of Norwegian Perioperative Nurses' Knowledge, Practice, and Attitudes. AORN J 2024; 119:e1-e10. [PMID: 38661447 DOI: 10.1002/aorn.14127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Revised: 07/13/2023] [Accepted: 07/24/2023] [Indexed: 04/26/2024]
Abstract
Few studies have focused on the use of cell phones in the OR. In Norway, researchers sought to assess perioperative nurses' knowledge, practice, and attitudes associated with cell phone use in the OR and distributed a nationwide questionnaire via a social media platform. More than 80% of the 332 respondents thought that cell phones were contaminated and that pathogens could contaminate hands. Almost all respondents brought their phone to work; approximately 61% of respondents carried it in their pocket in the OR. Responses to questions about phone cleaning showed that 39 (11.7%) of the respondents routinely cleaned their phone before entering the OR and 33 (9.9%) of the respondents cleaned it when leaving the OR. Less than 20% of respondents indicated their facility had guidelines for cleaning personal cell phones. Opportunities for improvement in cell phone cleaning in ORs exist and additional research involving all perioperative team members is needed.
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Ninow B, Staudacher D, Meier B. [Patient safety counts: Counting control in the OR]. Urologie 2023; 62:961-964. [PMID: 37286778 DOI: 10.1007/s00120-023-02115-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/08/2023] [Indexed: 06/09/2023]
Affiliation(s)
- Beate Ninow
- Universitätsspital Zürich, Rämistraße 100, 8091, Zürich, Schweiz
| | - Diana Staudacher
- Universitätsspital Zürich, Rämistraße 100, 8091, Zürich, Schweiz
| | - Bernadette Meier
- Universitätsspital Zürich, Rämistraße 100, 8091, Zürich, Schweiz.
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von Schudnat C, Schoeneberg KP, Albors-Garrigos J, Lahmann B, De-Miguel-Molina M. The Economic Impact of Standardization and Digitalization in the Operating Room: A Systematic Literature Review. J Med Syst 2023; 47:55. [PMID: 37129717 DOI: 10.1007/s10916-023-01945-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 03/29/2023] [Indexed: 05/03/2023]
Abstract
Hospital face increased resource constraints and competition. This escalates the need for efficiency optimization especially in resource-intense areas, such as the Operating Room (OR). Efficiency cannot happen at expenses of patient outcomes. Innovative digital support systems (DSS) have been introduced into the market to support established standardization methods of intraoperative workflows further. This review aimed to analyze whether applied standardization methods and implemented DSS of intraoperative surgical workflows lead to increasing efficiency and demonstrate economic improvements. A systematic review of intraoperative surgical workflows standardization and digitalization was performed. Journal articles and reviews from 2000 to 2023 were retrieved from EBSCO, PubMed, and Scopus databases, as well as the internal database of Johnson & Johnson. 17 articles showed a significant increase in efficiency through standardization, which led to cost reductions between $70.20 to $3,516 per case without negatively impacting quality. Five additional articles on DSS demonstrated a significant positive impact on efficiency and quality. Reduction in OR-time between 6 to 22% per case was one main contributor. No literature on DSS revealed any correlated economic impact. Selected standardization methods and introduced DSS for intraoperative surgical workflows effectively increase efficiency while maintaining or even improving quality. Demonstrated cost-effectiveness of non-digital standardization methods across surgical areas requires more research on complex and resource-intensive procedures and the economic value of DSS to support hospital management's strategic decisions to overcome the increasing economic burden.
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Affiliation(s)
- Christian von Schudnat
- Department of Business Organization, Faculty of Business Management, Universitat Politecnica de Valencia, Cami de Vera, s/n, 46022, Valencia, Spain.
| | - Klaus-Peter Schoeneberg
- Department of Economic and Social Sciences, Berliner Hochschule für Technik, Berlin, Luxemburger Str. 10, 13353, Berlin, Germany
| | - Jose Albors-Garrigos
- Department of Business Organization, Faculty of Business Management, Universitat Politecnica de Valencia, Cami de Vera, s/n, 46022, Valencia, Spain
| | - Benjamin Lahmann
- Department of Statistics and Operation Analysis, Faculty of Business and Economics, Mendel University Brno, Zemědělská 1, 61300, Brno, Czech Republic
| | - María De-Miguel-Molina
- Department of Business Organization, Faculty of Business Management, Universitat Politecnica de Valencia, Cami de Vera, s/n, 46022, Valencia, Spain
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Liu HL, Liu YL, Sun FY, Li ZC, Tan HY, Xu YC. Hand Hygiene among Anesthesiologists and Microorganisms Contamination in Anesthesia Environments: A Single-Center Observational Study. Biomed Environ Sci 2022; 35:992-1000. [PMID: 36443252 DOI: 10.3967/bes2022.128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 08/18/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVE To investigate the baseline levels of microorganisms' growth on the hands of anesthesiologists and in the anesthesia environment at a cancer hospital. METHODS This study performed in nine operating rooms and among 25 anesthesiologists at a cancer hospital. Sampling of the hands of anesthesiologists and the anesthesia environment was performed at a ready-to-use operating room before patient contact began and after decontamination. RESULTS Microorganisms' growth results showed that 20% (5/25) of anesthesiologists' hands carried microorganisms (> 10 CFU/cm 2) before patient contact began. Female anesthesiologists performed hand hygiene better than did their male counterparts, with fewer CFUs ( P = 0.0069) and fewer species ( P = 0.0202). Our study also found that 55.6% (5/9) of ready-to-use operating rooms carried microorganisms (> 5 CFU/cm 2). Microorganisms regrowth began quickly (1 hour) after disinfection, and increased gradually over time, reaching the threshold at 4 hours after disinfection. Staphylococcus aureus was isolated from the hands of 20% (5/25) of anesthesiologists and 33.3% (3/9) of operating rooms. CONCLUSION Our study indicates that male anesthesiologists need to pay more attention to the standard operating procedures and effect evaluation of hand hygiene, daily cleaning rate of the operating room may be insufficient, and we would suggest that there should be a repeat cleaning every four hours.
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Affiliation(s)
- Hong Lei Liu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education, Beijing), Department of Anesthesiology, Peking University Cancer Hospital & Institute, Beijing 100142, China;Graduate School, Capital Medical University, Beijing 100069, China
| | - Ya Li Liu
- Department of Laboratory Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Beijing 100730, China;Graduate School, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China;Beijing Key Laboratory for Mechanisms Research and Precision Diagnosis of Invasive Fungal Diseases (BZ0447), Beijing 100730, China
| | - Fang Yan Sun
- Infection Control Department, Peking Union Medical College Hospital, Peking Union Medical College, Beijing 100730, China
| | - Zong Chao Li
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education, Beijing), Department of Anesthesiology, Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - Hong Yu Tan
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education, Beijing), Department of Anesthesiology, Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - Ying Chun Xu
- Department of Laboratory Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Beijing 100730, China;Graduate School, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China;Beijing Key Laboratory for Mechanisms Research and Precision Diagnosis of Invasive Fungal Diseases (BZ0447), Beijing 100730, China
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5
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Onuoha O, Heins SJ, Clapp JT, Muralidharan M, Baranov DY, Fleisher LA, Gordon EKB. Improving Formative Feedback in the Operating Room Setting: Developing and Implementing an Initiative to Improve Feedback Quality and Culture. Acad Med 2022; 97:222-227. [PMID: 34232152 DOI: 10.1097/acm.0000000000004229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
PROBLEM Formative feedback, given in an ongoing fashion during the learning process, is fundamental to clinical education. However, dissatisfaction with formative feedback among residents is common. Difficulties with formative feedback are intensified in the operating room (OR) setting due to fast pace, space limitations, and frequent rotation of residents and attendings. APPROACH In the anesthesiology and critical care department at the University of Pennsylvania Perelman School of Medicine, the authors launched the Feedback Moment initiative from January 2018 to May 2018 in which 24 first-year residents and attendings were given a short series of prompts designed to facilitate regular, high-quality formative feedback. The authors conducted semistructured interviews with residents before and after the initiative to evaluate its impact. OUTCOMES In baseline interviews, 18 participating residents stressed the importance of formative feedback but described feeling unsure of their performance due to lack of ongoing constructive input from attendings. They felt hesitant to approach attendings for feedback due to a desire not to interrupt OR workflow or appear incompetent. In follow-up interviews, residents described the initiative as helping to normalize constructive formative feedback but difficult to execute regularly due to OR workflow issues and frequent rotation of attendings with varying approaches. NEXT STEPS Challenges faced by participants in this initiative highlight several considerations for effective OR-based formative feedback. Alternative timings for initiating feedback must be considered in light of the hectic nature of the OR workflow. Residents should be equipped with the skills necessary to adapt to varying practice patterns and frequent rotation between attendings, while attendings should be trained to provide a clear rationale for constructive feedback that allows residents to quickly adapt to practice variation. Finally, establishing clear goals among resident-attending pairs is critical to ensuring that formative feedback given in necessarily brief sessions is focused and productive.
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Affiliation(s)
- Onyi Onuoha
- O. Onuoha was associate professor, Department of Anesthesiology and Critical Care, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania at the time of writing. She is currently associate professor of anesthesiology, McGovern Medical School at UTHealth, Houston, Texas
| | - Sarah J Heins
- S.J. Heins is a medical student, Georgetown University School of Medicine, Washington, DC
| | - Justin T Clapp
- J.T. Clapp is assistant professor, Department of Anesthesiology and Critical Care, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Madhavi Muralidharan
- M. Muralidharan is a medical student, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Dimitry Y Baranov
- D.Y. Baranov is associate professor, Department of Anesthesiology and Critical Care, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Lee A Fleisher
- L.A. Fleisher is professor, Department of Anesthesiology and Critical Care, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Emily K B Gordon
- E.K.B. Gordon is associate professor and vice chair of education, Department of Anesthesiology and Critical Care, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
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Nieboer P, Huiskes M, Cnossen F, Stevens M, Bulstra SK, Jaarsma DADC. The Supervisor's Toolkit: Strategies of Supervisors to Entrust and Regulate Autonomy of Residents in the Operating Room. Ann Surg 2022; 275:e264-e270. [PMID: 32224741 DOI: 10.1097/sla.0000000000003887] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To identify what strategies supervisors use to entrust autonomy during surgical procedures and to clarify the consequences of each strategy for a resident's level of autonomy. BACKGROUND Entrusting autonomy is at the core of teaching and learning surgical procedures. The better the level of autonomy matches the learning needs of residents, the steeper their learning curves. However, entrusting too much autonomy endangers patient outcome, while entrusting too little autonomy results in expertise gaps at the end of training. Understanding how supervisors regulate autonomy during surgical procedures is essential to improve intraoperative learning without compromising patient outcome. METHODS In an observational study, all the verbal and nonverbal interactions of 6 different supervisors and residents were captured by cameras. Using the iterative inductive process of conversational analysis, each supervisor initiative to guide the resident was identified, categorized, and analyzed to determine how supervisors affect autonomy of residents. RESULTS In the end, all the 475 behaviors of supervisors to regulate autonomy in this study could be classified into 4 categories and nine strategies: I) Evaluate the progress of the procedure: inspection (1), request for information (2), and expressing their expert opinion (3); II) Influence decision-making: explore (4), suggest (5), or declare the next decision (6); III) Influence the manual ongoing action: adjust (7), or stop the resident's manual activity (8); IV) take over (9). CONCLUSIONS This study provides new insights into how supervisors regulate autonomy in the operating room. This insight is useful toward analyzing whether supervisors meet learning needs of residents as effectively as possible.
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Affiliation(s)
- Patrick Nieboer
- Department of Orthopedic Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Mike Huiskes
- Center for Language and Cognition, University of Groningen, Groningen, The Netherlands
| | - Fokie Cnossen
- Department of Artificial Intelligence, Bernouilli Institute of Mathematics, Computer Science and Artificial Intelligence, University of Groningen, Groningen, The Netherlands
| | - Martin Stevens
- Department of Orthopedic Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Sjoerd K Bulstra
- Department of Orthopedic Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Debbie A D C Jaarsma
- Center for Research and Innovation in Medical Education, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Shrimpton AJ, Gregson FKA, Brown JM, Cook TM, Bzdek BR, Hamilton F, Reid JP, Pickering AE. A quantitative evaluation of aerosol generation during supraglottic airway insertion and removal. Anaesthesia 2021; 76:1577-1584. [PMID: 34287820 DOI: 10.1111/anae.15542] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/18/2021] [Indexed: 12/30/2022]
Abstract
Many guidelines consider supraglottic airway use to be an aerosol-generating procedure. This status requires increased levels of personal protective equipment, fallow time between cases and results in reduced operating theatre efficiency. Aerosol generation has never been quantitated during supraglottic airway use. To address this evidence gap, we conducted real-time aerosol monitoring (0.3-10-µm diameter) in ultraclean operating theatres during supraglottic airway insertion and removal. This showed very low background particle concentrations (median (IQR [range]) 1.6 (0-3.1 [0-4.0]) particles.l-1 ) against which the patient's tidal breathing produced a higher concentration of aerosol (4.0 (1.3-11.0 [0-44]) particles.l-1 , p = 0.048). The average aerosol concentration detected during supraglottic airway insertion (1.3 (1.0-4.2 [0-6.2]) particles.l-1 , n = 11), and removal (2.1 (0-17.5 [0-26.2]) particles.l-1 , n = 12) was no different to tidal breathing (p = 0.31 and p = 0.84, respectively). Comparison of supraglottic airway insertion and removal with a volitional cough (104 (66-169 [33-326]), n = 27), demonstrated that supraglottic airway insertion/removal sequences produced <4% of the aerosol compared with a single cough (p < 0.001). A transient aerosol increase was recorded during one complicated supraglottic airway insertion (which initially failed to provide a patent airway). Detailed analysis of this event showed an atypical particle size distribution and we subsequently identified multiple sources of non-respiratory aerosols that may be produced during airway management and can be considered as artefacts. These findings demonstrate supraglottic airway insertion/removal generates no more bio-aerosol than breathing and far less than a cough. This should inform the design of infection prevention strategies for anaesthetists and operating theatre staff caring for patients managed with supraglottic airways.
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Affiliation(s)
- A J Shrimpton
- Pain and Critical Care Sciences and School of Physiology, Pharmacology and Neuroscience, University of Bristol, Bristol, UK
| | - F K A Gregson
- School of Chemistry, University of Bristol, Bristol, UK
| | - J M Brown
- Department of Anaesthesia and Intensive Care Medicine, North Bristol NHS Trust, Bristol, UK
| | - T M Cook
- Department of Anaesthesia and Intensive Care Medicine, Royal United Hospital NHS Trust, Bath, UK
| | - B R Bzdek
- School of Chemistry, University of Bristol, Bristol, UK
| | - F Hamilton
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - J P Reid
- School of Chemistry, University of Bristol, Bristol, UK
| | - A E Pickering
- Pain and Critical Care Sciences and School of Physiology, Pharmacology and Neuroscience, University of Bristol, Bristol, UK
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8
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Sotto KT, Burian BK, Brindle ME. Impact of the WHO Surgical Safety Checklist Relative to Its Design and Intended Use: A Systematic Review and Meta-Meta-Analysis. J Am Coll Surg 2021; 233:794-809.e8. [PMID: 34592406 DOI: 10.1016/j.jamcollsurg.2021.08.692] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 08/26/2021] [Accepted: 08/27/2021] [Indexed: 01/02/2023]
Abstract
BACKGROUND The aim of this study was to identify what parts of the World Health Organization Surgical Safety Checklist (WHO SSC) are working, what can be done to make it more effective, and to determine if it achieved its intended effect relative to its design and intended use. STUDY DESIGN We conducted a qualitative thematic analysis and meta-meta-analyses of findings in WHO SSC systematic reviews following Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. RESULTS Twenty systematic reviews were included for qualitative thematic analysis. Narrative information was coded in 4 primary areas with a focus on impact of the WHO SSC. Four themes-Clinical Outcomes, Process Measures, Team Dynamics and Communication, and Safety Culture-pertained directly to the aims or purposes behind the development of the SSC. The other 2 themes-Efficiency and Workload involved in using the checklist and Checklist Impact on Institutional Practices-are associated with SSC use, but were not focal areas considered during its development. Included in the 20 systematic reviews were 24 unique observational cohort studies that reported pre-post data on a total of 18 clinical outcomes. Mortality, morbidity, surgical site infection, pneumonia, unplanned return to the operating room, urinary tract infection, blood loss requiring transfusion, unplanned intubation, and sepsis favored the use of the WHO SSC. Deep vein thrombosis was the only postoperative outcome assessed that did not favor use of the WHO SSC. CONCLUSIONS The WHO SSC positively impacts the things it was explicitly designed to address and does not positively impact things it was not explicitly designed for.
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Affiliation(s)
| | - Barbara K Burian
- Human Systems Integration Division, NASA Ames Research Center, Moffett Field, CA
| | - Mary E Brindle
- Cumming School of Medicine, University of Calgary, Calgary, AB; Ariadne Labs, Harvard TH Chan School of Public Health, Brigham and Women's Hospital, Boston, MA
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Ernst H, Sowerby L, Sahovaler A, Macneil D, Nichols A, Yoo J, Hilsden R, Strychowsky J, Fung K. Rapid standardized operating rooms (RAPSTOR) in thyroid and parathyroid surgery. J Otolaryngol Head Neck Surg 2021; 50:44. [PMID: 34238389 PMCID: PMC8265141 DOI: 10.1186/s40463-021-00525-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 06/13/2021] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To evaluate the impact of a high efficiency rapid standardized OR (RAPSTOR) for hemithyroid/parathyroid surgery using standardized equipment sets (SES) and consecutive case scheduling (CCS) on turnover times (TOT), average case volumes, patient outcomes, hospital costs and OR efficiency/stress. METHODS Patients requiring hemithyroidectomy (primary or completion) or unilateral parathyroidectomy in a single surgeon's practice were scheduled consecutively with SES. Retrospective control groups were classified as sequential (CS) or non-sequential (CNS). A survey regarding OR efficiency/stress was administered. Phenomenography and descriptive statistics were conducted for time points, cost and patient outcome variables. Hospital cost minimization analysis was performed. RESULTS The mean TOT of RAPSTOR procedures (16 min; n = 27) was not significantly different than CS (14 min, n = 14) or CNS (17 min, n = 6). Mean case number per hour was significantly increased in RAPSTOR (1.2) compared to both CS (0.9; p < 0.05) and CNS (0.7; p < 0.05). Average operative time was significantly reduced in RAPSTOR (32 min; n = 28) compared to CNS (48 min; p < 0.05) but not CS (33 min; p = 0.06). Time to discharge was reduced in RAPSTOR (595 min) compared to CNS (1210 min, p < 0.05). There was no difference in complication rate between all groups (p = 0.27). Survey responses suggested improved efficiency, teamwork and workflow. Furthermore, there is associated decrease in direct operative costs for RAPSTOR vs. CS. CONCLUSION A high efficiency standardized OR for hemithyroid and parathyroid surgery using SES and CCS is associated with improved efficiency and, in this study, led to increased capacity at reduced cost without compromising patient safety. LEVEL OF EVIDENCE Level 2.
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Affiliation(s)
- Hannah Ernst
- Department of Otolaryngology-Head & Neck Surgery, Western University, London, Ontario, Canada
| | - Leigh Sowerby
- Department of Otolaryngology-Head & Neck Surgery, Western University, London, Ontario, Canada
| | - Axel Sahovaler
- Department of Head and Neck Surgery Unit, General Surgery Department, Italian Hospital of Buenos Aires, Buenos Aires, Argentina
- Department of Otolaryngology- Head and Neck Surgery and Surgical Oncology, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Danielle Macneil
- Department of Otolaryngology-Head & Neck Surgery, Western University, London, Ontario, Canada
| | - Anthony Nichols
- Department of Otolaryngology-Head & Neck Surgery, Western University, London, Ontario, Canada
| | - John Yoo
- Department of Otolaryngology-Head & Neck Surgery, Western University, London, Ontario, Canada
| | - Richard Hilsden
- Department of Surgery, Division of General Surgery, Western University, London, Ontario, Canada
| | - Julie Strychowsky
- Department of Otolaryngology-Head & Neck Surgery, Western University, London, Ontario, Canada
| | - Kevin Fung
- Department of Otolaryngology-Head & Neck Surgery, Western University, London, Ontario, Canada.
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Landford WN, Ngaage LM, Lee E, Rasko Y, Yang R, Slezak S, Redett R. Occupational exposures in the operating room: Are surgeons well-equipped? PLoS One 2021; 16:e0253785. [PMID: 34214125 PMCID: PMC8253435 DOI: 10.1371/journal.pone.0253785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 06/14/2021] [Indexed: 12/05/2022] Open
Abstract
Background Occupational health hazards are ubiquitously found in the operating room, guaranteeing an inevitable risk of exposure to the surgeon. Although provisions on occupational health and safety in healthcare exist, they do not address non-traditional hazards found in the operating room. In order to determine whether surgeons or trainees receive any form of occupational health training, we examine the associations between occupational health training and exposure rate. Study design A cross-sectional survey was distributed. Respondent characteristics included academic level, race/ethnicity, and gender. The survey evaluated seven surgical disciplines and 13 occupational hazards. Multivariable logistic regression was used to examine the association between academic level, surgical specialty, and exposure rate. Results Our cohort of 183 respondents (33.1% response rate) consisted of attendings (n = 72, 39.3%) and trainees (n = 111, 60.7%). Surgical trainees were less likely to have been trained in cytotoxic drugs (OR 0.22, p<0.001), methylmethacrylate (OR 0.15, p<0.001), patient lifting (OR 0.43, p = 0.009), radiation (OR 0.40, p = 0.007), and surgical smoke (OR 0.41, p = 0.041) than attending surgeons. Additionally, trainees were more likely to experience frequent exposure to bloodborne pathogens (OR 5.26, p<0.001), methylmethacrylate (OR 2.86, p<0.001), cytotoxic drugs (OR 3.03, p<0.001), and formaldehyde (2.08, p = 0.011), to name a few. Conclusion Although surgeon safety is not a domain in residency training, standardized efforts to educate and change the culture of safety in residency programs is warranted. Our study demonstrates a disparity between trainees and attendings with a recommendation to provide formal training to trainees independent of their anticipated risk of exposure.
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Affiliation(s)
- Wilmina N. Landford
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
- * E-mail:
| | - Ledibabari M. Ngaage
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Erica Lee
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Yvonne Rasko
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Maryland Medical Center, Baltimore, Maryland, United States of America
| | - Robin Yang
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Sheri Slezak
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Maryland Medical Center, Baltimore, Maryland, United States of America
| | - Richard Redett
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
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Kim NY, Jeong SY. Perioperative patient safety management activities: A modified theory of planned behavior. PLoS One 2021; 16:e0252648. [PMID: 34170919 PMCID: PMC8232430 DOI: 10.1371/journal.pone.0252648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Accepted: 05/20/2021] [Indexed: 11/18/2022] Open
Abstract
Patient safety is an important healthcare issue worldwide, and patient accidents in the operating room can lead to serious problems. Accordingly, we investigated the explanatory ability of a modified theory of planned behavior to improve patient safety activities in the operating room. Questionnaires were distributed to perioperative nurses working in 12 large hospitals in Korea. The modified theory of planned behavior data from a total of 330 nurses were analyzed. The conceptual model was based on the theory of planned behavior data, with two additional organizational factors—job factors and safety management system. Individual factors included attitude, subjective norms, perceived behavioral control, behavioral intention, and patient safety management activities. Results indicated that job factors were negatively associated with perceived behavioral control. The patient safety management system was positively associated with attitude, subjective norm, and perceived behavioral control. Attitude, subjective norm, and perceived behavioral control were positively associated with behavioral intention. Behavioral intention was positively associated with patient safety management activities. The modified theory of planned behavior effectively explained patient safety management activities in the operating room. Both organizations and individuals are required to improve patient safety management activities.
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Affiliation(s)
- Nam Yi Kim
- Department of Nursing, Daejeon Institute of Science and Technology, Daejeon, Republic of Korea
| | - Sun Young Jeong
- College of Nursing, Konyang University, Daejeon, Republic of Korea
- * E-mail:
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12
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Ranney SE, Tsai MH, Breidenstein MW, Sexton KW, Malhotra AK. Using performance frontiers to differentiate elective and capacity-based surgical services. J Trauma Acute Care Surg 2021; 90:935-941. [PMID: 34016917 DOI: 10.1097/ta.0000000000003137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Acute care surgery (ACS) model of care delivery has many benefits. However, since the ACS surgeon has limited control over the volume, timing, and complexity of cases, traditional metrics of operating room (OR) efficiency almost always measure ACS service as "inefficient." The current study examines an alternative method-performance fronts-of evaluating changes in efficiency and tests the following hypotheses: (1) in an institution with a robust ACS service, performance front methodology is superior to traditional metrics in evaluating OR throughput/efficiency, and (2) introduction of an ACS service with block time allocation will improve OR throughput/efficiency. METHODS Operating room metrics 1-year pre-ACS implementation and post-ACS implementation were collected. Overall OR efficiency was calculated by mean case volumes for the entire OR and ACS and general surgery (GS) services individually. Detailed analysis of these two specific services was performed by gathering median monthly minutes-in block, out of block, after hours, and opportunity unused. The two services were examined using a traditional measure of efficiency and the "fronts" method. Services were compared with each other and also pre-ACS implementation and post-ACS implementation. RESULTS Overall OR case volumes increased by 5% (999 ± 50 to 1,043 ± 46: p < 0.05) with almost all of the increase coming through ACS (27 ± 4 to 68 ± 16: p < 0.05). By traditional metrics, ACS had significantly worse median efficiency versus GS in both periods: pre (0.67 [0.66-0.71] vs. 0.80 [0.78-0.81]) and post (0.75 [0.53-0.77] vs. 0.83 [0.84-0.85]) (p < 0.05). As compared with the pre, GS efficiency improved significantly in post (p < 0.05), but ACS efficiency remained unchanged (p > 0.05). The alternative fronts chart demonstrated the more accurate picture with improved efficiency observed for GS, ACS, and combined. CONCLUSION In an institution with a busy ACS service, the alternative fronts methodology offers a more accurate evaluation of OR efficiency. The provision of an OR for the ACS service improves overall throughput/efficiency.
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Affiliation(s)
- Stephen E Ranney
- From the Department of Surgery (S.E.R., A.K.M.) and Department of Anesthesia (M.H.T., M.W.B.), Larner College of Medicine, Burlington, Vermont; and University of Arkansas for Medical Sciences (K.W.S.), Little Rock, Arkansas
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13
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Etherington C, Burns JK, Kitto S, Brehaut JC, Britton M, Singh S, Boet S. Barriers and enablers to effective interprofessional teamwork in the operating room: A qualitative study using the Theoretical Domains Framework. PLoS One 2021; 16:e0249576. [PMID: 33886580 PMCID: PMC8061974 DOI: 10.1371/journal.pone.0249576] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 03/20/2021] [Indexed: 11/18/2022] Open
Abstract
Background Effective teamwork is critical for safe, high-quality care in the operating room (OR); however, teamwork interventions have not consistently resulted in the expected gains for patient safety or surgical culture. In order to optimize OR teamwork in a targeted and evidence-based manner, it is first necessary to conduct a comprehensive, theory-informed assessment of barriers and enablers from an interprofessional perspective. Methods This qualitative study was informed by the Theoretical Domains Framework (TDF). Volunteer, purposive and snowball sampling were conducted primarily across four sites in Ontario, Canada and continued until saturation was reached. Interviews were recorded, transcribed, and de-identified. Directed content analysis was conducted in duplicate using the TDF as the initial coding framework. Codes were then refined whereby similar codes were grouped into larger categories of meaning within each TDF domain, resulting in a list of domain-specific barriers and enablers. Results A total of 66 OR healthcare professionals participated in the study (19 Registered Nurses, two Registered Practical Nurses, 17 anaesthesiologists, 26 surgeons, two perfusionists). The most frequently identified teamwork enablers included people management, shared definition of teamwork, communication strategies, positive emotions, familiarity with team members, and alignment of teamwork with professional role. The most frequently identified teamwork barriers included others’ personalities, gender, hierarchies, resource issues, lack of knowledge of best practices for teamwork, negative emotions, conflicting norms and perceptions across professions, being unfamiliar with team members, and on-call/night shifts. Conclusions We identified key factors influencing OR teamwork from an interprofessional perspective using a theoretically informed and systematic approach. Our findings reveal important targets for future interventions and may ultimately increase their effectiveness. Specifically, achieving optimal teamwork in the OR may require a multi-level intervention that addresses individual, team and systems-level factors with particular attention to complex social and professional hierarchies.
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Affiliation(s)
- Cole Etherington
- Department of Anaesthesiology and Pain Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Joseph K. Burns
- Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Simon Kitto
- Department of Innovation in Medical Education, University of Ottawa, Ottawa, Ontario, Canada
| | - Jamie C. Brehaut
- Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- School of Epidemiology & Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Meghan Britton
- Main Operating Room, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Sukhbir Singh
- Department of Obstetrics & Gynecology, University of Ottawa, Ottawa, Ontario, Canada
| | - Sylvain Boet
- Department of Anaesthesiology and Pain Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Innovation in Medical Education, University of Ottawa, Ottawa, Ontario, Canada
- Francophone Affairs, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Institut du Savoir Montfort, Ottawa, Ontario, Canada
- Faculty of Education, University of Ottawa, Ottawa, Ontario, Canada
- * E-mail:
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14
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Nguyen DL, Kay-Rivest E, Tewfik MA, Hier M, Lehmann A. Association of In-Ear Device Use With Communication Quality Among Individuals Wearing Personal Protective Equipment in a Simulated Operating Room. JAMA Netw Open 2021; 4:e216857. [PMID: 33871614 PMCID: PMC8056284 DOI: 10.1001/jamanetworkopen.2021.6857] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE The COVID-19 pandemic has brought forth new challenges for health care workers, such as the daily use of personal protective equipment, including reusable facial respirators. Poor communication while wearing respirators may have fatal complications for patients, and no solution has been proposed to date. OBJECTIVE To examine whether use of an in-ear communication device is associated with improved communication while wearing different personal protective equipment (N95 mask, half-face elastomeric respirator, and powered air-purifying respirator [PAPR]) in the operating room. DESIGN, SETTING, AND PARTICIPANTS This quality improvement study was conducted in June 2020. Surgical residents from the Department of Otolaryngology-Head and Neck Surgery at McGill University in Montreal, Quebec, Canada, were recruited. All participants had normal hearing, were fluent in English, and had access to the operating rooms at the Royal Victoria Hospital. EXPOSURES All participants performed the speech intelligibility tasks with and without an in-ear communication device. MAIN OUTCOMES AND MEASURES Speech intelligibility was measured using a word recognition task (Modified Rhyme Test) and a sentence recognition task (AzBio Sentence Test). A percentage correct score (0% to 100%) was obtained for each speech intelligibility test. Listening effort was assessed using the NASA Task Load Index. An overall workload score, ranging from 0 points (low workload) to 100 points (high workload), was obtained. RESULTS A total of 12 participants were included (mean [SD] age, 31.2 [1.9] years; 8 women [66.7%]). AzBio Sentence Test results revealed that, while wearing the N95 mask, the mean (SD) speech intelligibility was 98.8% (1.8%) without the in-ear device vs 94.3% (7.4%) with the device. While wearing the half-face elastomeric respirator, the mean speech intelligibility was 58.5% (12.4%) without the in-ear device vs 90.8% (8.9%) with the device. While wearing the PAPR, the mean speech intelligibility was 84.6% (9.8%) without the in-ear device vs 94.5% (5.5%) with the device. Use of the in-ear device was associated with a significant improvement in speech intelligibility while wearing the half-face elastomeric respirator (32.3%; 95% CI, 23.8%-40.7%; P < .001) and the PAPR (9.9%; 95% CI, 1.4%-18.3%; P = .01). Furthermore, use of the device was associated with decreased listening effort. The NASA Task Load Index results reveal that, while wearing the N95 mask, the mean (SD) overall workload score was 12.6 (10.6) points without the in-ear device vs 17.6 (9.2) points with the device. While wearing the half-face elastomeric respirator, the mean overall workload score was 67.7 (21.6) points without the in-ear device vs 29.3 (14.4) points with the in-ear device. While wearing the PAPR, the mean overall workload score was 42.2 (18.2) points without the in-ear device vs 23.8 (12.8) points with the in-ear device. Use of the in-ear device was associated with a significant decrease in overall workload score while wearing the half-face elastomeric respirator (38.4; 95% CI, 23.5-53.3; P < .001) and the PAPR (18.4; 95% CI, 0.4-36.4; P = .04). CONCLUSIONS AND RELEVANCE This study found that among participants using facial respirators that impaired communication, a novel in-ear device was associated with improved communication and decreased listening effort. Such a device may be a feasible solution for protecting health care workers in the operating room while allowing them to communicate safely, especially during the COVID-19 pandemic.
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Affiliation(s)
- Don Luong Nguyen
- Laboratory for Brain, Music and Sound Research (BRAMS), Centre for Research on Brain, Language or Music (CRBLM), Royal Victoria Hospital, Department of Otolaryngology–Head and Neck Surgery, McGill University, Montreal, Quebec, Canada
| | - Emily Kay-Rivest
- Royal Victoria Hospital, Department of Otolaryngology–Head and Neck Surgery, McGill University, Montreal, Quebec, Canada
| | - Marc A. Tewfik
- Royal Victoria Hospital, Department of Otolaryngology–Head and Neck Surgery, McGill University, Montreal, Quebec, Canada
| | - Michael Hier
- Jewish General Hospital, Department of Otolaryngology–Head and Neck Surgery, McGill University, Montreal, Quebec, Canada
| | - Alexandre Lehmann
- Laboratory for Brain, Music and Sound Research (BRAMS), Centre for Research on Brain, Language or Music (CRBLM), Royal Victoria Hospital, Department of Otolaryngology–Head and Neck Surgery, McGill University, Montreal, Quebec, Canada
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15
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Sampieri G, Namavarian A, Levin M, Philteos J, Lee JW, Koskinen A, Lin V, Lee J. Noise in Otolaryngology - Head and Neck Surgery operating rooms: a systematic review. J Otolaryngol Head Neck Surg 2021; 50:8. [PMID: 33573705 PMCID: PMC7879658 DOI: 10.1186/s40463-020-00487-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Accepted: 12/21/2020] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE Noise in operating rooms (OR) can have negative effects on both patients and surgical care workers. Noise can also impact surgical performance, team communication, and patient outcomes. Such implications of noise have been studied in orthopedics, neurosurgery, and urology. High noise levels have also been demonstrated in Otolaryngology-Head and Neck Surgery (OHNS) procedures. Despite this, no previous study has amalgamated the data on noise across all OHNS ORs to determine how much noise is present during OHNS surgeries. This study aims to review all the literature on noise associated with OHNS ORs and procedures. METHODS Ovid Medline, EMBASE Classic, Pubmed, SCOPUS and Cochrane databases were searched following PRISMA guidelines. Data was collected on noise measurement location and surgery type. Descriptive results and statistical analysis were completed using Stata. RESULTS This search identified 2914 articles. Final inclusion consisted of 22 studies. The majority of articles analyzed noise level exposures during mastoid surgery (18/22, 82%). The maximum noise level across all OHNS ORs and OHNS cadaver studies were 95.5 a-weighted decibels (dBA) and 106.6 c-weighted decibels (dBC), respectively (P = 0.2068). The mean noise level across all studies was significantly higher in OHNS cadaver labs (96.9 dBA) compared to OHNS ORs (70.1 dBA) (P = 0.0038). When analyzed together, the mean noise levels were 84.9 dBA. CONCLUSIONS This systematic review demonstrates that noise exposure in OHNS surgery exceeds safety thresholds. Further research is needed to understand how noise may affect team communication, surgical performance and patient outcomes in OHNS ORs.
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Affiliation(s)
| | | | - Marc Levin
- Department of Otolaryngology Head and Neck Surgery, University of Toronto, Toronto, ON, Canada
| | - Justine Philteos
- Department of Otolaryngology Head and Neck Surgery, University of Toronto, Toronto, ON, Canada
| | - Jong Wook Lee
- Department of Otolaryngology Head and Neck Surgery, University of Toronto, Toronto, ON, Canada
| | - Anni Koskinen
- Department of Otorhinolaryngology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Vincent Lin
- Department of Otolaryngology Head and Neck Surgery, University of Toronto, Toronto, ON, Canada
| | - John Lee
- Department of Otolaryngology Head and Neck Surgery, University of Toronto, Toronto, ON, Canada.
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Accardo D, Isaac J, Strube P, MacKinnon M, Dabney C. Methods to Reduce the Risk of Exposure to Airborne Pathogens in the Operating Room. AANA J 2021; 89:71-75. [PMID: 33501911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
The ongoing coronavirus disease 2019 (COVID-19) pandemic has created many changes and difficulties in healthcare, and the anesthesia specialty is no exception. Both the increased need for personal protective equipment (PPE) and the potential for infection and contamination through respiratory droplets have been sources of much concern. Policies and protocols have been adapted worldwide to help neutralize infection risk and exposure. Transmission of the virus to healthcare workers has been a major concern, and the risk of infection is exceptionally high for Certified Registered Nurse Anesthetists (CRNAs) because of their close contact with infected patients. CRNAs are in a unique position to help decrease exposure for themselves and other members of the healthcare team by taking extra precautions during airway manipulation. A great deal of focus has been placed on reducing risks during intubation, but reports describing methods of reducing contamination and exposure to respiratory droplets during emergence and extubation are scarce. The authors have reviewed techniques to reduce coughing, thereby decreasing the potential of virus exposure through contact with large respiratory droplets and aerosolized particles that may remain suspended in air.
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Affiliation(s)
- Dwayne Accardo
- is an assistant professor and program director, Nurse Anesthesia Concentration, University of Tennessee Health Science Center, College of Nursing, Memphis, Tennessee.
| | - Jordan Isaac
- is an assistant professor at the University of Tennessee Health Science Center, College of Nursing
| | - Peter Strube
- is an assistant program director, Nurse Anesthesia Program at the University of Wisconsin, Oshkosh, Wisconsin
| | - Michael MacKinnon
- is an associate professor and assistant program director, National University, Fresno, California.
| | - Cindi Dabney
- is an assistant professor at the University of Tennessee Health Science Center, Memphis, Tennessee
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17
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Lawrence RJ, O'Donoghue GM, Kitterick P, Hartley DEH. Use of a novel drape 'tent' as an infection prevention control measure for mastoid surgery. J Laryngol Otol 2020; 134:1115-1117. [PMID: 33261677 PMCID: PMC7729150 DOI: 10.1017/s0022215120002637] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/25/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND Mastoid surgery is an aerosol-generating procedure that involves the use of a high-speed drill, which produces a mixture of water, bone, blood and tissue that may contain the viable coronavirus disease 2019 pathogen. This potentially puts the surgeon and other operating theatre personnel at risk of acquiring the severe acute respiratory syndrome coronavirus-2 from contact with droplets or aerosols. The use of an additional drape designed to limit the spread of droplets and aerosols has been described; such drapes include the 'Southampton Tent' and 'OtoTent'. OBJECTIVES To evaluate the use of a novel drape 'tent' that has advantages over established 'tent' designs in terms of having: (1) a CE marking; (2) no requirement for modification during assembly; and (3) no obstruction to the surgical visual field. RESULTS AND CONCLUSION During mastoid surgery, the dispersion of macroscopic droplets and other particulate matter was confined within the novel drape 'tent'. Use of this drape 'tent' had no adverse effects upon the surgeon's manual dexterity or efficiency, the view of the surgical field, or the sterility. Hence, our findings support its use during mastoid surgery in the coronavirus disease 2019 era.
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Affiliation(s)
- R J Lawrence
- National Institute for Health Research Nottingham Biomedical Research Centre, UK
- Hearing Sciences, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, UK
- Department of Otolaryngology, Nottingham University Hospitals NHS Trust, UK
| | - G M O'Donoghue
- National Institute for Health Research Nottingham Biomedical Research Centre, UK
- Hearing Sciences, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, UK
- Department of Otolaryngology, Nottingham University Hospitals NHS Trust, UK
| | - P Kitterick
- National Institute for Health Research Nottingham Biomedical Research Centre, UK
- Hearing Sciences, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, UK
- Department of Otolaryngology, Nottingham University Hospitals NHS Trust, UK
| | - D E H Hartley
- National Institute for Health Research Nottingham Biomedical Research Centre, UK
- Hearing Sciences, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, UK
- Department of Otolaryngology, Nottingham University Hospitals NHS Trust, UK
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18
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Moslem AR, Rezaei H, Yektay S, Miri M. Comparing BTEX concentration related to surgical smoke in different operating rooms. Ecotoxicol Environ Saf 2020; 203:111027. [PMID: 32888595 DOI: 10.1016/j.ecoenv.2020.111027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 07/03/2020] [Accepted: 07/09/2020] [Indexed: 06/11/2023]
Abstract
The available evidence on the indoor air quality of operating rooms (ORs) in the Low- and Middle-income Countries (LMICs) is very scarce. Moreover, there is no study on the comparing the concentration of indoor air pollutants in different ORs. Therefore, this study aimed to measure and compare the benzene, toluene, ethylbenzene and xylene (BTEX) concentrations in the air of different ORs in hospitals of Sabzevar, Iran. Moreover, carcinogenic and non-carcinogenic risk of exposure to these pollutants were assessed using Monte Carlo simulations technique. This cross-sectional study was based on volatile organic compounds (VOCs) passive sampling of eight ORs including General surgery, Curettage, Eye surgery, Neurosurgery, Orthopedic, Laparoscopic, Cesarean and Ear, nose, throat (ENT) in two monthly campaigns from November 2019 to February 2020. One-way ANOVA and Post-hoc analyses were used to compare the concentration of BTEX compounds in different ORs. The overall mean (standard deviation (SD)) of benzene, toluene, ethylbenzene, xylene and total BTEX concentrations were 10.0 (1.8), 7.2 (1.9), 1.8 (0.6), 0.4 (0.2) and 19.4 (4.1) μg/m3. The Curettage OR had the highest (12.93 μg/m3) and ENT OR had the lowest (7.42 μg/m3) benzene concentrations. The highest concentrations of toluene, ethylbenzene and total BTEX were observed in General surgery OR. The cancer risks of exposure to benzene in all ORs were higher than the acceptable range recommended by Unite State Environmental Protection Agency (USEPA, 1 × 106). However, the hazard quotient (HQ) values for all ORs were at safe level (HQ < 1). Overall, our study suggested that the concentrations of BTEX compounds were significantly difference in different ORs and benzene had a carcinogenic risk for personnel and surgical staff in different ORs.
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Affiliation(s)
- Ali Reza Moslem
- Cellular and Molecular Research Center, Sabzevar University of Medical Sciences, Sabzevar, Iran
| | - Hossein Rezaei
- Student Research Committee, Department of Environmental Health, School of Public Health, Sabzevar University of Medical Sciences, Sabzevar, Iran
| | - Sima Yektay
- Student Research Committee, Department of Environmental Health, School of Public Health, Sabzevar University of Medical Sciences, Sabzevar, Iran
| | - Mohammad Miri
- Non-communicable Diseases Research Center, Department of Environmental Health, School of Public Health, Sabzevar University of Medical Sciences, Sabzevar, Iran.
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Thiruvenkatarajan V, Wong DT, Kothandan H, Sekhar V, Adhikary SD, Currie J, Van Wijk R. Airway Management in the Operating Room and Interventional Suites in Known or Suspected COVID-19 Adult Patients: A Practical Review. Anesth Analg 2020; 131:677-689. [PMID: 32502132 PMCID: PMC7288783 DOI: 10.1213/ane.0000000000005043] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/02/2020] [Indexed: 01/25/2023]
Abstract
Current evidence suggests that coronavirus disease 2019 (COVID-19) spread occurs via respiratory droplets (particles >5 µm) and possibly through aerosol. The rate of transmission remains high during airway management. This was evident during the 2003 severe acute respiratory syndrome epidemic where those who were involved in tracheal intubation had a higher risk of infection than those who were not involved (odds ratio 6.6). We describe specific airway management principles for patients with known or suspected COVID-19 disease for an array of critical care and procedural settings. We conducted a thorough search of the available literature of airway management of COVID-19 across a variety of international settings. In addition, we have analyzed various medical professional body recommendations for common procedural practices such as interventional cardiology, gastroenterology, and pulmonology. A systematic process that aims to protect the operators involved via appropriate personal protective equipment, avoidance of unnecessary patient contact and minimalization of periprocedural aerosol generation are key components to successful airway management. For operating room cases requiring general anesthesia or complex interventional procedures, tracheal intubation should be the preferred option. For interventional procedures, when tracheal intubation is not indicated, cautious conscious sedation appears to be a reasonable approach. Awake intubation should be avoided unless it is absolutely necessary. Extubation is a high-risk procedure for aerosol and droplet spread and needs thorough planning and preparation. As updates and modifications in the management of COVID-19 are still evolving, local guidelines, appraised at regular intervals, are vital in optimizing clinical management.
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Affiliation(s)
- Venkatesan Thiruvenkatarajan
- From the Department of Anesthesia, The Queen Elizabeth Hospital, Woodville, South Australia, Australia
- Department of Acute Care Medicine, University of Adelaide, Adelaide, South Australia, Australia
| | - David T. Wong
- Department of Anesthesia, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
| | | | - Vimal Sekhar
- From the Department of Anesthesia, The Queen Elizabeth Hospital, Woodville, South Australia, Australia
| | - Sanjib Das Adhikary
- Department of Anesthesiology and Perioperative Medicine, Penn State Medical Center, Penn State College of Medicine, Hershey, Pennsylvania
| | - John Currie
- From the Department of Anesthesia, The Queen Elizabeth Hospital, Woodville, South Australia, Australia
| | - Roelof Van Wijk
- From the Department of Anesthesia, The Queen Elizabeth Hospital, Woodville, South Australia, Australia
- Department of Anaesthesiology, Singapore General Hospital, Singapore
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20
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Kort NP, Barrena EG, Bédard M, Donell S, Epinette JA, Gomberg B, Hirschmann MT, Indelli P, Khosravi I, Karachalios T, Liebensteiner MC, Stuyts B, Tandogan R, Violante B, Zagra L, Thaler M. Resuming elective hip and knee arthroplasty after the first phase of the SARS-CoV-2 pandemic: the European Hip Society and European Knee Associates recommendations. Knee Surg Sports Traumatol Arthrosc 2020; 28:2730-2746. [PMID: 32844246 PMCID: PMC7446739 DOI: 10.1007/s00167-020-06233-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Accepted: 08/10/2020] [Indexed: 01/01/2023]
Abstract
PURPOSE The Covid-19 pandemic has disrupted health care systems all over the world. Elective surgical procedures have been postponed and/or cancelled. Consensus is, therefore, required related to the factors that need to be in place before elective surgery, including hip and knee replacement surgery, which is restarted. Entirely new pathways and protocols need to be worked out. METHODS A panel of experts from the European Hip Society and European Knee Association have agreed to a consensus statement on how to reintroduce elective arthroplasty surgery safely. The recommendations are based on the best available evidence and have been validated in a separate survey. RESULTS The guidelines are based on five themes: modification and/or reorganisation of hospital wards. Restrictions on orthopaedic wards and in operation suite(s). Additional disinfection of the environment. The role of ultra-clean operation theatres. Personal protective equipment enhancement. CONCLUSION Apart from the following national and local guidance, protocols need to be put in place in the patient pathway for primary arthroplasty to allow for a safe return.
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Affiliation(s)
- N P Kort
- CortoClinics, Schijndel, The Netherlands
| | - E Gómez Barrena
- Department of Orthopaedic Surgery and Traumatology, Hospital La Paz, Universidad Autónoma de Madrid, Madrid, Spain
| | - M Bédard
- Département de Chirurgie Orthopédique, CHU de Québec-Université Laval, Quebec City, QC, Canada
| | - S Donell
- Norwich Medical School, University of East Anglia, Norwich, UK.
| | - J-A Epinette
- Center for Research and Documentation in Arthroplasty, Lille, France
| | - B Gomberg
- OA Centers for Orthopaedics, Portland, ME, USA
| | - M T Hirschmann
- Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland, (Bruderholz, Liestal, Laufen), 4101, Bruderholz, Switzerland
- University of Basel, Basel, Switzerland
| | - P Indelli
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, CA, USA
- International Committee American Academy Hip and Knee Surgeons (AAHKS), Rosemont, IL, USA
| | - Ismail Khosravi
- Department of Orthopaedic Surgery, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - T Karachalios
- Orthopaedic Department, University General Hospital of Larissa, School of Health Sciences, Faculty of Medicine, University of Thessaly, Volos, Greece
| | - M C Liebensteiner
- Department of Orthopaedic Surgery, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - B Stuyts
- Department of Orthopedic Surgery and Traumatology, GZA Hospitals, Antwerp, Belgium
| | - R Tandogan
- Ortoklinik and Cankaya Orthopedics, Ankara, Turkey
| | - B Violante
- Orthopaedic Department, Istituto Clinico Sant'Ambrogio IRCCS Galeazzi, Milan, Italy
| | - L Zagra
- Hip Department IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - M Thaler
- Department of Orthopaedic Surgery, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
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Affiliation(s)
- V Agrawal
- Division of Pediatric Surgery, Department of Surgery, Jabalpur, India
| | - D Sharma
- Department of Surgery, Netaji Subhash Chandra Bose Medical College and Hospitals, Jabalpur, India
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22
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Pandey AS, Ringer AJ, Rai AT, Kan P, Jabbour P, Siddiqui AH, Levy EI, Snyder KV, Riina H, Tanweer O, Levitt MR, Kim LJ, Veznedaroglu E, Binning MJ, Arthur AS, Mocco J, Schirmer C, Thompson BG, Langer D. Minimizing SARS-CoV-2 exposure when performing surgical interventions during the COVID-19 pandemic. J Neurointerv Surg 2020; 12:643-647. [PMID: 32434798 PMCID: PMC7298685 DOI: 10.1136/neurintsurg-2020-016161] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Revised: 04/28/2020] [Accepted: 04/29/2020] [Indexed: 01/26/2023]
Abstract
BACKGROUND Infection from the SARS-CoV-2 virus has led to the COVID-19 pandemic. Given the large number of patients affected, healthcare personnel and facility resources are stretched to the limit; however, the need for urgent and emergent neurosurgical care continues. This article describes best practices when performing neurosurgical procedures on patients with COVID-19 based on multi-institutional experiences. METHODS We assembled neurosurgical practitioners from 13 different health systems from across the USA, including those in hot spots, to describe their practices in managing neurosurgical emergencies within the COVID-19 environment. RESULTS Patients presenting with neurosurgical emergencies should be considered as persons under investigation (PUI) and thus maximal personal protective equipment (PPE) should be donned during interaction and transfer. Intubations and extubations should be done with only anesthesia staff donning maximal PPE in a negative pressure environment. Operating room (OR) staff should enter the room once the air has been cleared of particulate matter. Certain OR suites should be designated as covid ORs, thus allowing for all neurosurgical cases on covid/PUI patients to be performed in these rooms, which will require a terminal clean post procedure. Each COVID OR suite should be attached to an anteroom which is a negative pressure room with a HEPA filter, thus allowing for donning and doffing of PPE without risking contamination of clean areas. CONCLUSION Based on a multi-institutional collaborative effort, we describe best practices when providing neurosurgical treatment for patients with COVID-19 in order to optimize clinical care and minimize the exposure of patients and staff.
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Affiliation(s)
- Aditya S Pandey
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Andrew J Ringer
- Neurosurgery, Mayfield Clinic, University of Cincinnati, Cincinnati, Ohio, USA
| | - Ansaar T Rai
- Interventional Neuroradiology, West Virginia University Hospital, Morgantown, West Virginia, USA
| | - Peter Kan
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
| | - Pascal Jabbour
- Neurological Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | | | - Elad I Levy
- Neurosurgery and Radiology and Canon Stroke and Vascular Research Center, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
- Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA
| | - Kenneth V Snyder
- Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA
- Neurosurgery and Neurology and Canon Stroke and Vascular Research Center, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
| | - Howard Riina
- Department of Neurosurgery, New York University - Langone Medical Center, New York, New York, USA
| | - Omar Tanweer
- Department of Neurosurgery, New York University - Langone Medical Center, New York, New York, USA
| | - Michael R Levitt
- Neurological Surgery, Radiology and Mechanical Engineering, University of Washington, Seattle, Washington, USA
| | - Louis J Kim
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA
| | - Erol Veznedaroglu
- Drexel Neuroscience Institute and GNI, Philadelphia, Pennsylvania, USA
| | - Mandy J Binning
- Drexel Neurosciences Institute, Philadelphia, Pennsylvania, USA
| | - Adam S Arthur
- Semmes-Murphey Neurologic and Spine Institute, Memphis, Tennessee, USA
- Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - J Mocco
- The Mount Sinai Health System, New York, New York, USA
| | - Clemens Schirmer
- Department of Neurosurgery and Neuroscience Institute, Geisinger Health System and Geisinger Commonwealth School of Medicine, Wilkes-Barre, PA, USA
- Research Institute of Neurointervention, Paracelsus Medical University, Salzburg, Austria
| | | | - David Langer
- Neurosurgery, Lenox Hill Hospital, New York, New York, USA
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Carmona MJC, Quintão VC, de Melo BF, André RG, Kayano RP, Perondi B, Miethke-Morais A, Rocha MC, Malbouisson LMS, Auler-Júnior JOC. Transforming operating rooms into intensive care units and the versatility of the physician anesthesiologist during the COVID-19 crisis. Clinics (Sao Paulo) 2020; 75:e2023. [PMID: 32555950 PMCID: PMC7279628 DOI: 10.6061/clinics/2020/e2023] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Maria José Carvalho Carmona
- Disciplina de Anestesiologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
- *Corresponding author. E-mail:
| | - Vinícius Caldeira Quintão
- Disciplina de Anestesiologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Brigite Feiner de Melo
- Disciplina de Anestesiologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Rodrigo Guerson André
- Disciplina de Anestesiologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Rafael Priante Kayano
- Disciplina de Anestesiologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Beatriz Perondi
- Diretoria Clinica, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Anna Miethke-Morais
- Diretoria Clinica, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Marcelo Cristiano Rocha
- Departamento de Cirurgia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Luiz Marcelo Sá Malbouisson
- Disciplina de Anestesiologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - José Otávio Costa Auler-Júnior
- Disciplina de Anestesiologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
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24
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Velly L, Gayat E, Quintard H, Weiss E, De Jong A, Cuvillon P, Audibert G, Amour J, Beaussier M, Biais M, Bloc S, Bonnet MP, Bouzat P, Brezac G, Dahyot-Fizelier C, Dahmani S, de Queiroz M, Di Maria S, Ecoffey C, Futier E, Geeraerts T, Jaber H, Heyer L, Hoteit R, Joannes-Boyau O, Kern D, Langeron O, Lasocki S, Launey Y, le Saché F, Lukaszewicz AC, Maurice-Szamburski A, Mayeur N, Michel F, Minville V, Mirek S, Montravers P, Morau E, Muller L, Muret J, Nouette-Gaulain K, Orban JC, Orliaguet G, Perrigault PF, Plantet F, Pottecher J, Quesnel C, Reubrecht V, Rozec B, Tavernier B, Veber B, Veyckmans F, Charbonneau H, Constant I, Frasca D, Fischer MO, Huraux C, Blet A, Garnier M. Guidelines: Anaesthesia in the context of COVID-19 pandemic. Anaesth Crit Care Pain Med 2020; 39:395-415. [PMID: 32512197 PMCID: PMC7274119 DOI: 10.1016/j.accpm.2020.05.012] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVES The world is currently facing an unprecedented healthcare crisis caused by the COVID-19 pandemic. The objective of these guidelines is to produce a framework to facilitate the partial and gradual resumption of intervention activity in the context of the COVID-19 pandemic. METHODS The group has endeavoured to produce a minimum number of recommendations to highlight the strengths to be retained in the 7 predefined areas: (1) protection of staff and patients; (2) benefit/risk and patient information; (3) preoperative assessment and decision on intervention; (4) modalities of the preanaesthesia consultation; (5) specificity of anaesthesia and analgesia; (6) dedicated circuits and (7) containment exit type of interventions. RESULTS The SFAR Guideline panel provides 51 statements on anaesthesia management in the context of COVID-19 pandemic. After one round of discussion and various amendments, a strong agreement was reached for 100% of the recommendations and algorithms. CONCLUSION We present suggestions for how the risk of transmission by and to anaesthetists can be minimised and how personal protective equipment policies relate to COVID-19 pandemic context.
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Affiliation(s)
- Lionel Velly
- Aix-Marseille University, AP-HM, Department of Anaesthesiology and Critical Care Medicine, University Hospital Timone, 13005 Marseille, France; Aix-Marseille University, CNRS, Institut Neuroscience Timone, UMR7289, Marseille, France.
| | - Etienne Gayat
- Department of Anaesthesiology and Critical Care, Lariboisière Hospital, DMU Parabol, AP-HP Nord, University of Paris, Paris, France; Inserm UMR-S 942, Cardiovascular Markers in Stress Conditions (MASCOT), University of Paris, Paris, France
| | - Hervé Quintard
- Intensive Care Unit, Centre Hospitalier Universitaire de Nice, Pasteur 2 Hospital, Nice, France
| | - Emmanuel Weiss
- Department of Anaesthesiology and Critical Care, Beaujon Hospital, DMU Parabol, AP-HP Nord, Paris, France; Inserm UMR_S1149, Inserm, Université de Paris, Paris, France
| | - Audrey De Jong
- Department of Anaesthesia and Intensive Care unit, Regional University Hospital of Montpellier, St-Éloi Hospital, Montpellier, France; PhyMedExp, University of Montpellier, Inserm U1046, CNRS UMR, 9214, Montpellier, France
| | - Philippe Cuvillon
- Department of Anaesthesiology, Beaujon Hospital, CHU Carémeau, Nîmes, France
| | - Gérard Audibert
- Department of Anaesthesia and Intensive Care, Lorraine University, Nancy University Hospital, 54000 Nancy, France
| | - Julien Amour
- Cardiovascular and Thoracic Surgery Department, Hôpital Privé Jacques-Cartier, 91300 Massy, France
| | - Marc Beaussier
- Département d'Anesthésie, Institut Mutualiste Montsouris, 75014 Paris, France
| | - Matthieu Biais
- Department of Anaesthesiology and Critical Care, Pellegrin Hospital, CHU de Bordeaux, Bordeaux, France; Inserm UMR-S 1034, Biology of Cardiovascular Diseases, Bordeaux University, Bordeaux, France
| | - Sébastien Bloc
- CMC Ambroise-Paré, Département d'anesthésie, 92200 Neuilly-sur-Seine, France
| | - Marie Pierre Bonnet
- Department of Anaesthesiology and Critical Care, Armand-Trousseau University Hospital, Assistance publique-Hôpitaux de Paris, Paris, France; Centre for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), Université de Paris, Obstetrical Perinatal and Paediatric Epidemiology Research Team (EPOPé), Inserm INRA, Paris, France; Department of Anaesthesiology and Critical Care, Cochin-Port Royal University Hospital, Assistance publique-Hôpitaux de Paris, Paris, France
| | - Pierre Bouzat
- Department of Anaesthesiology and Intensive Care Medicine, Grenoble University Hospital, 38000 Grenoble, France
| | - Gilles Brezac
- Anaesthesiology, Lenval Children's Hospital, 06200 Nice, France
| | - Claire Dahyot-Fizelier
- Anaesthesia and Intensive Care, University Hospital of Poitiers, Poitiers, France; Inserm UMR1070, Pharmacology of Anti-infective Agents, University of Poitiers, Poitiers, France
| | - Souhayl Dahmani
- Department of Anaesthesia and Intensive Care, Robert-Debré University Hospital, AP-HP, DHU PROTECT, Inserm U1141, Paris, France
| | - Mathilde de Queiroz
- Department of Paediatric Anaesthesia and Intensive Care, Femme-Mère-Enfant Hospital, Lyon, France
| | - Sophie Di Maria
- Department of Anaesthesiology and Critical Care, AP-HP, Hôpital Pitié-Salpêtrière, Paris, France
| | - Claude Ecoffey
- Department of Anaesthesia and Intensive Care, CHU de Rennes, Inserm UMR 991, CIC 1414, Rennes 1 University, Rennes, France
| | - Emmanuel Futier
- Department of Anaesthesiology and Critical Care, Estaing Hospital, CHU de Clermont-Ferrand, Clermont-Ferrand, France; Université Clermont Auvergne, CNRS, Inserm U-1103, Clermont-Ferrand, France
| | - Thomas Geeraerts
- Pôle Anesthésie-Réanimation, Inserm, UMR 1214, Toulouse Neuroimaging Centre (ToNIC), université Toulouse 3 - Paul-Sabatier, CHU de Toulouse, 31059 Toulouse, France
| | - Haithem Jaber
- Departments of Anaesthesia and Intensive Care, Caen University Hospital, Caen, France
| | - Laurent Heyer
- Intensive Care Unit, Department of Anaesthesiology and Intensive Care Medicine, Croix-Rousse Hospital, Lyon, France
| | - Rim Hoteit
- Department of Anaesthesia and Intensive Care unit, Regional University Hospital of Montpellier, St-Éloi Hospital, Montpellier, France
| | - Olivier Joannes-Boyau
- Service d'Anesthésie-Réanimation Sud, Centre Médico-Chirurgical Magellan, Centre Hospitalier Universitaire (CHU) de Bordeaux, 33000 Bordeaux, France
| | - Delphine Kern
- Departments of Anaesthesia and Intensive Care, Children Hospital, University Hospital of Toulouse, Toulouse, France
| | - Olivier Langeron
- Department of Anaesthesiology and Critical Care Medicine, Henri-Mondor University Hospital, University Paris-Est Créteil (UPEC), Assistance publique-Hôpitaux de Paris, Paris, France
| | - Sigismond Lasocki
- Department of Anaesthesiology and Critical Care Medicine, UBL Université d'Angers, CHU d'Angers, Angers, France
| | - Yoan Launey
- Department of Anaesthesiology and Critical Care Medicine, Centre Hospitalier Universitaire de Rennes, Rennes, France
| | - Frederic le Saché
- Department of Anaesthesiology and Intensive Care, DMU DREAM, AP-HP, 6 Sorbonne Université, Paris, France; Clinique Remusat, 75016 Paris, France; Clinique Jouvenet, 75016 Paris, France
| | - Anne Claire Lukaszewicz
- University of Lyon, EA 7426: Pathophysiology of Injury-Induced Immunosuppression (PI3), Lyon, France; Department of Anaesthesiology and Critical Care, Neurological hospital, Hospices Civils de Lyon, Lyon, France
| | | | - Nicolas Mayeur
- Anaesthesiology and intensive care medicine, Clinique Pasteur, 31076 Toulouse, France
| | - Fabrice Michel
- Department of Paediatric Intensive Care Unit, Assistance publique-Hôpitaux de Marseille, La Timone Hospital, Marseille, France
| | - Vincent Minville
- Department of Anaesthesiology and Intensive Care, Toulouse University Hospital, 31432 Toulouse, France; Inserm, U1048, Université Paul-Sabatier, Institute of Metabolic and Cardiovascular Diseases, I2MC, 31432 Toulouse, France
| | - Sébastien Mirek
- Department of Anaesthesiology and Intensive Care, Dijon University Hospital, 21079 Dijon, France; U-SEEM, Healthcare Simulation Centre of University Hospital of Dijon, 21079 Dijon, France
| | - Philippe Montravers
- Department of Anaesthesiology and Critical Care, CHU Bichat-Claude-Bernard, DMU Parabol, AP-HP Nord, University of Paris, Paris, France; Inserm UMR-S 1152, Epidemiology and Physiopathology of Respiratory Diseases, University of Paris, Paris, France
| | - Estelle Morau
- Department of Anaesthesiology and Critical Care Medicine, Hôpital Universitaire Arnaud-de-Villeneuve, Montpellier, France
| | - Laurent Muller
- Department of Anaesthesiology and Intensive Care, Pain and Emergency Medicine, Nîmes-Caremeau University Hospital, Université Montpellier, place du Professeur-Robert-Debré, 30029 Nîmes cedex 9, France; Physiology Department, EA 2992, Faculty of Medicine, Université Montpellier, Montpellier-Nimes University, Nîmes, France
| | - Jane Muret
- Institut Curie PSL Research University, 75005 Paris, France
| | - Karine Nouette-Gaulain
- Department of Anaesthesiology, Intensive Care and Pain, Institut Curie, 75005 Paris, France
| | - Jean Christophe Orban
- Department of Anaesthesiology and Intensive Care Medicine, Nice University Hospital, Nice, France
| | - Gilles Orliaguet
- Surgical Paediatric Intensive Care Unit, Universitary Hospital Necker-Enfants-Malades, Paris, France; EA08 Pharmacologie et Évaluation des Thérapeutiques chez l'Enfant et la Femme Enceinte, Paris Descartes University (Paris V), Paris, France
| | - Pierre François Perrigault
- Department of Anaesthesia and Critical Care Medicine, Montpellier University, Gui-de-Chauliac Hospital, Montpellier, France
| | - Florence Plantet
- Service d'Anesthésie-Réanimation, Clinique Générale, 4, chemin de la Tour-la-Reine, Annecy, France
| | - Julien Pottecher
- Department of Anaesthesiology and Critical Care, Les Hôpitaux Universitaires de Strasbourg (HUS), Strasbourg, France; Fédération de Médecine Translationnelle de Strasbourg (FMTS), Strasbourg, France
| | - Christophe Quesnel
- Inserm UMR-S 1152, Epidemiology and Physiopathology of Respiratory Diseases, University of Paris, Paris, France; Department of Anaesthesiology and Critical Care, Tenon Hospital, DMU DREAM, AP-HP, 6 Sorbonne Université School of Medicine, Paris, France
| | - Vanessa Reubrecht
- Department of Anaesthesiology and Critical Care, AP-HP, Hôpital Pitié-Salpêtrière, Paris, France
| | - Bertrand Rozec
- Anesthésie-Réanimation, CHU Nantes, Hôpital Laennec, 1, boulevard Jacques-Monod, 44093 Nantes cedex, France
| | - Benoit Tavernier
- Department of Anaesthesiology and Critical Care, CHU de Lille, Pôle d'Anesthésie-Réanimation, 59000 Lille, France
| | - Benoit Veber
- Department of Anaesthesiology and Critical Care, Université de Rouen Normandie, Rouen, France
| | - Francis Veyckmans
- Department of Paediatric Anaesthesia, Jeanne-de-Flandre Hospital, University Hospitals of Lille, Lille, France
| | - Hélène Charbonneau
- Anaesthesiology and intensive care medicine, Clinique Pasteur, 31076 Toulouse, France
| | - Isabelle Constant
- Anaesthesiology Department, Hôpital Armand-Trousseau, Sorbonne Université, Assistance publique-Hôpitaux de Paris, DMU DREAM, Sorbonne Université, Paris, France
| | - Denis Frasca
- Department of Anaesthesiology and Critical Care, Poitiers University, CHU de Poitiers, Poitiers, France
| | - Marc-Olivier Fischer
- Department of Anaesthesiology and Critical Care, Normandie Université, UNICAEN, CHU de Caen Normandie, 14000 Caen, France
| | - Catherine Huraux
- Department of Anaesthesiology, Clinique des Cèdres, 38130 Échirolles, France
| | - Alice Blet
- Inserm UMR-S 942, Cardiovascular Markers in Stress Conditions (MASCOT), University of Paris, Paris, France; Department of Anaesthesiology, Critical Care and Burn Centre, Lariboisière-Saint-Louis Hospitals, DMU Parabol, AP-HP Nord, University of Paris, Paris, France; University of Ottawa Heart Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Marc Garnier
- Inserm UMR-S 1152, Epidemiology and Physiopathology of Respiratory Diseases, University of Paris, Paris, France; Department of Anaesthesiology and Critical Care, Saint-Antoine Hospital, DMU DREAM, AP-HP, 6 Sorbonne Université, Paris, France; Sorbonne Université School of Medicine, Paris, France
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25
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Wong J, Goh QY, Tan Z, Lie SA, Tay YC, Ng SY, Soh CR. Preparing for a COVID-19 pandemic: a review of operating room outbreak response measures in a large tertiary hospital in Singapore. Can J Anaesth 2020; 67:732-745. [PMID: 32162212 PMCID: PMC7090449 DOI: 10.1007/s12630-020-01620-9] [Citation(s) in RCA: 389] [Impact Index Per Article: 97.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 03/04/2020] [Accepted: 03/04/2020] [Indexed: 02/07/2023] Open
Abstract
The coronavirus disease 2019 (COVID-19) outbreak has been designated a public health emergency of international concern. To prepare for a pandemic, hospitals need a strategy to manage their space, staff, and supplies so that optimum care is provided to patients. In addition, infection prevention measures need to be implemented to reduce in-hospital transmission. In the operating room, these preparations involve multiple stakeholders and can present a significant challenge. Here, we describe the outbreak response measures of the anesthetic department staffing the largest (1,700-bed) academic tertiary level acute care hospital in Singapore (Singapore General Hospital) and a smaller regional hospital (Sengkang General Hospital). These include engineering controls such as identification and preparation of an isolation operating room, administrative measures such as modification of workflow and processes, introduction of personal protective equipment for staff, and formulation of clinical guidelines for anesthetic management. Simulation was valuable in evaluating the feasibility of new operating room set-ups or workflow. We also discuss how the hierarchy of controls can be used as a framework to plan the necessary measures during each phase of a pandemic, and review the evidence for the measures taken. These containment measures are necessary to optimize the quality of care provided to COVID-19 patients and to reduce the risk of viral transmission to other patients or healthcare workers.
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Affiliation(s)
- Jolin Wong
- Division of Anaesthesiology, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore.
| | - Qing Yuan Goh
- Division of Anaesthesiology, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore
| | - Zihui Tan
- Division of Anaesthesiology, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore
| | - Sui An Lie
- Division of Anaesthesiology, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore
| | - Yoong Chuan Tay
- Division of Anaesthesiology, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore
| | - Shin Yi Ng
- Division of Anaesthesiology, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore
| | - Chai Rick Soh
- Division of Anaesthesiology, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore
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26
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Hussain K, Javed S, Jillani SAA. Precautions in the Operating Room during COVID-19 Pandemic. J Coll Physicians Surg Pak 2020; 30:82. [PMID: 32723464 DOI: 10.29271/jcpsp.2020.supp1.s82] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 06/13/2020] [Indexed: 06/11/2023]
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27
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Abstract
Sterile protective gloves are used to reduce the risk of infection for patients and clinicians in all healthcare settings. This is particularly important in operating theatres, where surgical site infection is a common and serious complication for perioperative patients. These gloves have traditionally been made from natural rubber latex and dusted with cornstarch powder. However, frequent use of latex gloves can lead to a hypersensitivity or allergy to latex. A latex allergy causes discomfort and inconvenience, and it may reduce productivity, impose significant financial burdens and even be life threatening. There has not been sufficient evidence to ban the clinical use of latex; however, in cases of suspected latex allergy, guidelines recommend the use of either latex-free gloves or powder-free, low-protein latex gloves. The use of these alternative gloves has typically been limited to cases of allergy, because they have previously been associated with reduced dexterity and durability compared with latex gloves. This article presents four case studies, in which health professionals in a perioperative setting compare the advantages and disadvantages of using traditional latex surgical gloves with those of latex-free gloves manufactured by Cardinal Health. The findings of these case studies suggest that these latex-free gloves are equal to latex gloves in terms of establishing asepsis and providing comfort and dexterity to the wearer, without presenting the risk of developing latex sensitivity and/or allergy.
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Affiliation(s)
- Nader Henry
- Plastic Surgery Trainee, The Queen Elizabeth Hospital, Birmingham
| | - Romelyn Icot
- Scrub Nurse, University College London Hospitals, NHS Foundation Trust
| | - Steve Jeffery
- Consultant Burns and Plastic Surgeon, University Hospitals Birmingham, NHS Foundation Trust
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28
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Arndt C, Audrun F, Bodaghi B, Caujolle JP, Cassoux N, Defoort S, Delyfer MN, Denis P, Doan S, Fenolland JR, Giraud JM, Kodjikian L, Labetoulle M, Lasudry J, Leveziel N, Rousseau A, Saadoun D, Speeg-Schatz C, Touhami S, Touitou V, Vignal C, Zech C. [Categorization of the degree of urgency according to ophthalmology procedures or situations]. J Fr Ophtalmol 2020; 43:525-528. [PMID: 32409227 DOI: 10.1016/j.jfo.2020.04.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 04/27/2020] [Indexed: 11/19/2022]
Affiliation(s)
- C Arndt
- Société française d'ophtalmologie, 17, VLA d'Alésia, 75014 Paris, France
| | - F Audrun
- Société française d'ophtalmologie, 17, VLA d'Alésia, 75014 Paris, France
| | - B Bodaghi
- Société française d'ophtalmologie, 17, VLA d'Alésia, 75014 Paris, France
| | - J-P Caujolle
- Société française d'ophtalmologie, 17, VLA d'Alésia, 75014 Paris, France
| | - N Cassoux
- Société française d'ophtalmologie, 17, VLA d'Alésia, 75014 Paris, France
| | - S Defoort
- Société française d'ophtalmologie, 17, VLA d'Alésia, 75014 Paris, France
| | - M-N Delyfer
- Société française d'ophtalmologie, 17, VLA d'Alésia, 75014 Paris, France
| | - P Denis
- Société française d'ophtalmologie, 17, VLA d'Alésia, 75014 Paris, France
| | - S Doan
- Société française d'ophtalmologie, 17, VLA d'Alésia, 75014 Paris, France
| | - J-R Fenolland
- Société française d'ophtalmologie, 17, VLA d'Alésia, 75014 Paris, France
| | - J-M Giraud
- Société française d'ophtalmologie, 17, VLA d'Alésia, 75014 Paris, France
| | - L Kodjikian
- Société française d'ophtalmologie, 17, VLA d'Alésia, 75014 Paris, France.
| | - M Labetoulle
- Société française d'ophtalmologie, 17, VLA d'Alésia, 75014 Paris, France
| | - J Lasudry
- Société française d'ophtalmologie, 17, VLA d'Alésia, 75014 Paris, France
| | - N Leveziel
- Société française d'ophtalmologie, 17, VLA d'Alésia, 75014 Paris, France
| | - A Rousseau
- Société française d'ophtalmologie, 17, VLA d'Alésia, 75014 Paris, France
| | - D Saadoun
- Société française d'ophtalmologie, 17, VLA d'Alésia, 75014 Paris, France
| | - C Speeg-Schatz
- Société française d'ophtalmologie, 17, VLA d'Alésia, 75014 Paris, France
| | - S Touhami
- Société française d'ophtalmologie, 17, VLA d'Alésia, 75014 Paris, France
| | - V Touitou
- Société française d'ophtalmologie, 17, VLA d'Alésia, 75014 Paris, France
| | - C Vignal
- Société française d'ophtalmologie, 17, VLA d'Alésia, 75014 Paris, France
| | - C Zech
- Société française d'ophtalmologie, 17, VLA d'Alésia, 75014 Paris, France
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Grelat M, Pommier B, Portet S, Amelot A, Barrey C, Leroy HA, Madkouri R. Patients with Coronavirus 2019 (COVID-19) and Surgery: Guidelines and Checklist Proposal. World Neurosurg 2020; 139:e769-e773. [PMID: 32344143 PMCID: PMC7194971 DOI: 10.1016/j.wneu.2020.04.155] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 04/18/2020] [Accepted: 04/20/2020] [Indexed: 01/08/2023]
Abstract
The management of patients with novel coronavirus 2019 (COVID-19) represents a new challenge for medical and surgical teams. Each operating room in the world should be prepared thoughtfully, and the development of a protocol and patient route seems mandatory. An adequate degree of protection must be used. We propose recommendations to help different professionals in the establishment of protocols for the management of patients with COVID-19. We also offer a checklist that could be used in the operating room.
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Affiliation(s)
- Michael Grelat
- Department of Neurosurgery, Dijon University Hospital, Dijon, France.
| | - Benjamin Pommier
- Department of Neurosurgery, Saint-Etienne University Hospital, Saint Etienne, France
| | - Sylvain Portet
- Department of Neurosurgery, Lyon University Hospital, Lyon, France
| | - Aymeric Amelot
- Department of Neurosurgery, Tours University Hospital, Tours, France
| | - Cédric Barrey
- Department of Neurosurgery, Lyon University Hospital, Lyon, France
| | | | - Rachid Madkouri
- Department of Neurosurgery, Dijon University Hospital, Dijon, France
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Carr MM, Patel VA, Soo JC, Friend S, Lee EG. Effect of Electrocautery Settings on Particulate Concentrations in Surgical Plume during Tonsillectomy. Otolaryngol Head Neck Surg 2020; 162:867-872. [PMID: 32228131 DOI: 10.1177/0194599820914275] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To describe the effect of monopolar electrocautery (EC) settings on surgical plume particulate concentration during pediatric tonsillectomy. STUDY DESIGN Cross-sectional study. SETTING Tertiary medical center. SUBJECTS AND METHODS During total tonsillectomy exclusively performed with EC, air was sampled with a surgeon-worn portable particle counter. The airborne mean and maximum particle concentrations were compared for tonsillectomy performed with EC at 12 W vs 20 W, with smoke evacuation system (SES) and no smoke evacuation (NS). RESULTS A total of 36 children were included in this analysis: 9 cases with EC at 12 W and SES (12SES), 9 cases with EC at 20 W and SES (20SES), 9 cases with EC at 12 W without SES (12NS), and 9 cases with EC at 20 W without SES (20NS). Mean particle number concentration in the breathing zone during tonsillectomy was 1661 particles/cm3 for 12SES, 5515 particles/cm3 for 20SES, 8208 particles/cm3 for 12NS, and 78,506 particles/cm3 for 20NS. There was a statistically significant difference in the particle number concentrations among the 4 groups. The correlation between the particle number concentration and EC time was either moderate (for 12SES) or negative (for remaining groups). CONCLUSION Airborne particle concentrations during tonsillectomy are over 9.5 times higher when EC is set at 20 W vs 12 W with NS, which is mitigated to 3.3 times with SES. Applying lower EC settings with SES during pediatric tonsillectomy significantly reduces surgical plume exposure for patients, surgeons, and operating room personnel, which is a well-known occupational health hazard.
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Affiliation(s)
- Michele M Carr
- Department of Otolaryngology-Head and Neck Surgery, West Virginia University, Morgantown, West Virginia, USA
| | - Vijay A Patel
- Department of Otolaryngology, The Pennsylvania State University, Hershey, Pennsylvania, USA
| | - Jhy-Charm Soo
- National Institute for Occupational Safety and Health, Morgantown, West Virginia, USA
| | - Sherri Friend
- National Institute for Occupational Safety and Health, Morgantown, West Virginia, USA
| | - Eun Gyung Lee
- National Institute for Occupational Safety and Health, Morgantown, West Virginia, USA
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Karahan A, Budak Ertürk E, Uğurlu Z, Ünlü H, Akovalı N, Tepe A, Özhan Elbaş N. Factors Affecting the Thermal Comfort of Perioperative Personnel in the OR. AORN J 2020; 111:333-344. [PMID: 32128769 DOI: 10.1002/aorn.12963] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Thermal comfort is an important component of any work setting and can be difficult to achieve in the complex OR environment. This comparative descriptive study sought to identify factors affecting the thermal comfort of perioperative personnel in the OR (N = 68). Researchers used the American Society of Heating, Refrigerating and Air-Conditioning Engineers Thermal Sensation Scale and researcher-developed surveys to collect data. The mean reported thermal comfort level was -0.44 (standard deviation 1.3), which is within acceptable parameters. Factors affecting thermal comfort were gender, professional role, and wearing additional clothing. Additionally, participants who complained about temperature or ventilation were less likely to report thermal comfort levels in the normal range. Health care facility leaders should consider the comfort needs of perioperative personnel when making purchasing decisions about ventilation systems and surgical clothing; however, they also should consider other factors (eg, surgeon comfort, permeability of protective clothing to blood and other body fluids).
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Abstract
AIMS To compare the compliance of the Surgical Safety Checklist in two groups of users: early (Group A) and late (Group B) adopters, and to detect change over time. METHOD Observational study. We collected all Surgical Safety Checklist protocols in one calendar month period and, eight months later, we repeated collection for another month. Analysis was then performed to compare the compliance in different groups and over time. UNLABELLED There was no statistical difference in the overall compliance between the two groups or between elective and emergency cases. Equally, there was no significant change in compliance over time in Group A. In Group B, however, there was a trend to an improved compliance over time. Compliance to the Surgical Safety Checklist was significantly lower during operations performed by consulting surgeons in comparison to internally employed surgeons.
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Affiliation(s)
- Romain Seppey
- Department of Surgery, Hospital Center Biel/Bienne, Biel/Bienne, Switzerland
| | - Antoine Oesch
- Department of Surgery, Hospital Center Biel/Bienne, Biel/Bienne, Switzerland
| | - Carsten T Viehl
- Department of Surgery, Hospital Center Biel/Bienne, Biel/Bienne, Switzerland
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Pasquarella C, Balocco C, Colucci ME, Saccani E, Paroni S, Albertini L, Vitali P, Albertini R. The Influence of Surgical Staff Behavior on Air Quality in a Conventionally Ventilated Operating Theatre during a Simulated Arthroplasty: A Case Study at the University Hospital of Parma. Int J Environ Res Public Health 2020; 17:E452. [PMID: 31936699 PMCID: PMC7013425 DOI: 10.3390/ijerph17020452] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 01/07/2020] [Accepted: 01/08/2020] [Indexed: 11/28/2022]
Abstract
Surgical staff behavior in operating theatres is one of the factors associated with indoor air quality and surgical site infection risk. The aim of this study was to apply an approach including microbiological, particle, and microclimate parameters during two simulated surgical hip arthroplasties to evaluate the influence of staff behavior on indoor air quality. During the first hip arthroplasty, the surgical team behaved correctly, but in the second operation, behavioral recommendations were not respected. Microbiological contamination was evaluated by active and passive methods. The air velocity, humidity, temperature, and CO2 concentration were also monitored. The highest levels of microbial and particle contamination, as well as the highest variation in the microclimate parameter, were recorded during the surgical operation where the surgical team behaved "incorrectly". Turbulent air flow ventilation systems appeared more efficient than in the past and very low air microbial contamination was reached when behavior was correct. Therefore, adherence to behavioral recommendations in operating theatres is essential to not undermine the effectiveness of the heating, ventilation, and air conditioning systems and employed resources.
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Affiliation(s)
- Cesira Pasquarella
- Department of Medicine and Surgery, University of Parma, via Volturno, 39, 43125 Parma, Italy; (M.E.C.); (E.S.); (S.P.); (R.A.)
| | - Carla Balocco
- Department of Industrial Engineering, University of Florence, via S. Marta 3, 50139 Firenze, Italy;
| | - Maria Eugenia Colucci
- Department of Medicine and Surgery, University of Parma, via Volturno, 39, 43125 Parma, Italy; (M.E.C.); (E.S.); (S.P.); (R.A.)
| | - Elisa Saccani
- Department of Medicine and Surgery, University of Parma, via Volturno, 39, 43125 Parma, Italy; (M.E.C.); (E.S.); (S.P.); (R.A.)
| | - Samuel Paroni
- Department of Medicine and Surgery, University of Parma, via Volturno, 39, 43125 Parma, Italy; (M.E.C.); (E.S.); (S.P.); (R.A.)
| | | | - Pietro Vitali
- Hygiene Unit, University Hospital of Parma, Parma, via Gramsci 14, 43126 Parma, Italy;
| | - Roberto Albertini
- Department of Medicine and Surgery, University of Parma, via Volturno, 39, 43125 Parma, Italy; (M.E.C.); (E.S.); (S.P.); (R.A.)
- Clinical Immunology Unit, University Hospital of Parma, Parma, via Gramsci 14, 43126 Parma, Italy
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Bidone S, Baldina V, Di Pietrantonj C. [The ubiquitous use of the mobile phone in operating rooms: what we know about the risks and what can be done]. Assist Inferm Ric 2019; 38:165-173. [PMID: 31834301 DOI: 10.1702/3273.32393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
. The ubiquitous use of the mobile phone in operating room: what we know about the risks and what can be done. INTRODUCTION Mobile phones are often used in the operating theatres, with possible health risks for patients. Phone surfaces can be contaminated with pathogens causing infections (infectious risk). In addition, mobile phones can interfere with attention by becoming a possible cause of error (risk of error). Finally, electromagnetic waves can interfere with equipment (risk of interference). METHODS This paper consists of two parts, the first dedicated to the review of the literature regarding the three risks associated with the use of mobile phones in the operating room. The second presents the results of a field observation carried out during surgery in 4 hospital facilities with the aim of describing the use of the mobile phone by health professionals. RESULTS The literature review highlights that a. several resistant Methicillin bacteria and negative Grams survive on phone surfaces, but effective disinfection protocols are available; b. the presence of the mobile phone is a source of distraction during the performance of a task. However, mobile phone communication can improve care and reduce communication errors. Field observations have confirmed both the tendency to bring mobile phones into the operating room and the habit of using them (especially by anesthetists and nurses). Ninety per cent of interviewed personnel admitted to take with them mobile phones. CONCLUSIONS The presence of the mobile phone exposes to risks that can be controlled through appropriate procedures. It is essential to regulate the entry of the mobile phone into the operating room and provide for treatment protocols, as well as to plan training activities on their correct use.
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Keller S, Tschan F, Semmer NK, Timm-Holzer E, Zimmermann J, Candinas D, Demartines N, Hübner M, Beldi G. "Disruptive behavior" in the operating room: A prospective observational study of triggers and effects of tense communication episodes in surgical teams. PLoS One 2019; 14:e0226437. [PMID: 31830122 PMCID: PMC6907803 DOI: 10.1371/journal.pone.0226437] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Accepted: 11/26/2019] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Tense communication and disruptive behaviors during surgery have often been attributed to surgeons' personality or hierarchies, while situational triggers for tense communication were neglected. Goals of this study were to assess situational triggers of tense communication in the operating room and to assess its impact on collaboration quality within the surgical team. METHODS AND FINDINGS The prospective observational study was performed in two university hospitals in Europe. Trained external observers assessed communication in 137 elective abdominal operations led by 30 different main surgeons. Objective observations were related to perceived collaboration quality by all members of the surgical team. A total of 340 tense communication episodes were observed (= 0.57 per hour); mean tensions in surgeries with tensions was 1.21 per hour. Individual surgeons accounted for 24% of the variation in tensions, while situational aspects accounted for 76% of variation. A total of 72% of tensions were triggered by coordination problems; 21.2% by task-related problems and 9.1% by other issues. More tensions were related to lower perceived teamwork quality for all team members except main surgeons. Coordination-triggered tensions significantly lowered teamwork quality for second surgeons, scrub technicians and circulators. CONCLUSIONS Although individual surgeons differ in their tense communication, situational aspects during the operation had a much more important influence on the occurrence of tensions, mostly triggered by coordination problems. Because tensions negatively impact team collaboration, surgical teams may profit from improving collaboration, for instance through training, or through reflexivity.
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Affiliation(s)
- Sandra Keller
- Institute of Work and Organizational Psychology, University of Neuchâtel, Neuchâtel, Switzerland
- Virginia Tech, Blacksburg, VA, United States of America
| | - Franziska Tschan
- Institute of Work and Organizational Psychology, University of Neuchâtel, Neuchâtel, Switzerland
| | | | - Eliane Timm-Holzer
- Institute of Work and Organizational Psychology, University of Neuchâtel, Neuchâtel, Switzerland
| | - Jasmin Zimmermann
- Institute of Work and Organizational Psychology, University of Neuchâtel, Neuchâtel, Switzerland
| | - Daniel Candinas
- Department of Visceral Surgery and Medicine, University Hospital of Bern, Bern, Switzerland
| | - Nicolas Demartines
- Department of Visceral Surgery, Lausanne University Hospital CHUV, Lausanne, Switzerland
| | - Martin Hübner
- Department of Visceral Surgery, Lausanne University Hospital CHUV, Lausanne, Switzerland
| | - Guido Beldi
- Department of Visceral Surgery and Medicine, University Hospital of Bern, Bern, Switzerland
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Abstract
Surgical smoke is formed when energy-generating devices (ie, electrosurgery units, lasers, powered instruments) raise the intracellular temperature of tissue to at least 100º C (212º F), causing tissue vaporization in the form of surgical smoke. Surgical smoke contains components that are known health hazards, such as benzene, toluene, hydrogen cyanide, formaldehyde, volatile organic compounds, viruses, and bacteria. There have been case reports of human disease tied to the inhalation of surgical smoke; therefore, it is important for perioperative team members to minimize their exposure and patient exposure. In spite of the health risks, many perioperative departments do not consistently and effectively evacuate surgical smoke. This Back to Basics article provides basic steps that perioperative team members can take to protect themselves and their patients from the harm caused by surgical smoke exposure.
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Hoffman CR, Horrow J, Ranganna S, Green MS. Operating room first case start times: a metric to assess systems-based practice milestones? BMC Med Educ 2019; 19:446. [PMID: 31791314 PMCID: PMC6889181 DOI: 10.1186/s12909-019-1886-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Accepted: 11/21/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Resident competence in peri-operative care is a reflection on education and cost-efficiency. Inspecting pre-existing operating room metrics for performance outliers may be a potential solution for assessing competence. Statistical correlation of problematic benchmarks may reveal future opportunities for educational intervention. METHODS Case-log database review yielded 3071 surgical cases involving residents over the course of 5 years. Surgery anticipated and actual start times were evaluated for delays and residents were assessed using the days of resident training performed at the time of each corresponding case. Other variables recorded included day of week, attending anesthesiologist name, attending surgeon name, patient age, sex, American Society of Anesthesiologists physical status classification (ASA PS), and in-patient versus day surgery status. Mixed-effect, multi-variable, linear regression determined independent determinants of delay time. RESULTS The analysis identified day of the week (F = 25.65, P < 0.0001), days of training (F = 8.39, P = 0.0038), attending surgeon (F = 2.67, P < 0.0001), and anesthesiology resident (F = 1.67, P = 0.0012) as independent predictors of delay time for first-start cases, with an overall regression model F = 3.09, r2 = 0.186, and P < 0.0001. CONCLUSIONS The day of the week and attending surgeon demonstrated significant impact of case delay compared to resident days trained. If a learning curve for first-case start punctuality exists for anesthesiology residents, it is subtle and irrelevant to operating room efficiency. The regression model accounted for only 19% of the variability in the outcome of delay time, indicating a multitude of additional unidentified factors contributing to operating room efficiency.
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Affiliation(s)
- Christopher Ryan Hoffman
- Department of Anesthesiology & Perioperative Medicine, Drexel University College of Medicine, Hahnemann University Hospital, 245 N. 15th Street, Suite 7502, MS 310, Philadelphia, PA, 19102, USA.
- Department of Anesthesiology, Sidney Kimmel Medical College, Thomas Jefferson University Hospital, 111 S. 11th Street, Suite 8490G, Philadelphia, PA, USA.
| | - Jay Horrow
- Department of Anesthesiology & Perioperative Medicine, Drexel University College of Medicine, Hahnemann University Hospital, 245 N. 15th Street, Suite 7502, MS 310, Philadelphia, PA, 19102, USA
| | - Shreyas Ranganna
- Department of Anesthesiology & Perioperative Medicine, Drexel University College of Medicine, Hahnemann University Hospital, 245 N. 15th Street, Suite 7502, MS 310, Philadelphia, PA, 19102, USA
| | - Michael Stuart Green
- Department of Anesthesiology & Perioperative Medicine, Drexel University College of Medicine, Hahnemann University Hospital, 245 N. 15th Street, Suite 7502, MS 310, Philadelphia, PA, 19102, USA
- Department of Anesthesiology, Sidney Kimmel Medical College, Thomas Jefferson University Hospital, 111 S. 11th Street, Suite 8490G, Philadelphia, PA, USA
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Birnbach DJ, McKenty NT, Rosen LF, Arheart KL, Everett-Thomas R, Lindsey SF. Does Adherence to World Health Organization Hand Hygiene Protocols in the Operating Room Have the Potential to Produce Irritant Contact Dermatitis in Anesthesia Providers? Anesth Analg 2019; 129:e182-e184. [PMID: 31743176 DOI: 10.1213/ane.0000000000004112] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Anesthesia providers have the burden of constant hand hygiene during task dense periods. The requirement for hand hygiene often demands frequent application of alcohol-based hand rub. To assess whether frequent alcohol-based hand rub use leads to skin changes or irritant contact dermatitis, volunteers cleaned their hands with alcohol-based hand rub every 15 minutes for 8 hours for 5 sequential days. They were examined by a dermatologist before and after and asked about subjective skin changes. Results suggest an increase in irritant contact dermatitis scores and subjective complaints.
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Affiliation(s)
- David J Birnbach
- From the Department of Anesthesiology, University of Miami Miller School of Medicine
- University of Miami-Jackson Memorial Hospital Center for Patient Safety, Miami, Florida
- Department of Public Health Sciences, University of Miami Miller School of Medicine
| | - Nathan T McKenty
- From the Department of Anesthesiology, University of Miami Miller School of Medicine
| | - Lisa F Rosen
- University of Miami-Jackson Memorial Hospital Center for Patient Safety, Miami, Florida
| | - Kristopher L Arheart
- Department of Public Health Sciences, University of Miami Miller School of Medicine
| | | | - Scott F Lindsey
- Department of Dermatology, University of Miami Miller School of Medicine
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Denny NA, Guyer JM, Schroeder DR, Marienau MS. Operating Room Waste Reduction. AANA J 2019; 87:477-482. [PMID: 31920201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
One-fourth of all operating room (OR) waste is attributed to anesthesia-related material. The goal of this project was to reduce the waste and increase cost savings of opened and unused endotracheal (ET) tubes and disposable laryngoscope handles and blades in 2 separate OR environments. The production of these unused anesthesia supplies was assessed weekly in each of 2 OR environments for 8 weeks before an educational intervention, and for 8 weeks following the intervention. The average weekly waste production was summarized for each study period, compared between periods (preintervention vs postintervention), and analyzed per 100 surgeries using the 2-sample t test. The overall average weekly waste for ET tubes was significantly reduced from 26.7 ± 10.7 to 10.0 ± 6.1 from pre to post intervention (P = < .001), representing a 62.6% reduction. A similar significant reduction in waste was observed for laryngoscope handles (15.9 ± 8.1 vs 7.2 ± 3.1; P = .004; a 54.7% reduction) and laryngoscope blades (21.5 ± 11.0 vs 9.9 ± 4.4; P = .004; a 54.0% reduction). These results highlight the significance and feasibility of an educational intervention in reducing the environmental and economic waste produced by anesthetic practices in the OR.
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Affiliation(s)
- Nolan A Denny
- was a student in the Doctor of Nurse Anesthesia Practice Program at Mayo Clinic School of Health Sciences, Rochester, Minnesota at the time this article was written
| | - Jean M Guyer
- is a codirector of nurse anesthesia at Mayo Clinic Rochester in Rochester, Minnesota
| | - Darrell R Schroeder
- is a statistician for Mayo Clinic College of Medicine in Rochester, Minnesota, and supports the Department of Anesthesiology
| | - Mary Shirk Marienau
- is program director of the Doctor of Nurse Anesthesia Practice Program at Mayo Clinic School of Health Sciences
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Abstract
STUDY DESIGN Observational simulation study. OBJECTIVE The goal of this study was to investigate the relationship between technical and nontechnical skills (NTS) in a simulated surgical procedure. SUMMARY OF BACKGROUND DATA Although surgeons' technical and NTS during surgery are crucial determinants for clinical outcomes, little literature is available in spine surgery. Moreover, evidence regarding how surgeons' technical and NTS are related is limited. METHODS A mixed-reality and full-scale simulated operating room environment was employed for the surgical team. Eleven surgeons performed the vertebroplasty procedure (VP). Technical skills (TS) were assessed using Objective Structured Assessment of Technical Skill scores and senior expert-evaluated VP outcome assessment. NTS were assessed with the Observational Teamwork Assessment for Surgery. Kendall-Tau-b tests were performed for correlations. We further controlled the influence of surgeons' experience (based on professional tenure and number of previous VPs performed). RESULT Surgeons' NTS correlated significantly with their technical performance (τ = 0.63; P = 0.006) and surgical outcome scores (τ = 0.60; P = 0.007). This association was attenuated when controlling for surgeons' experience. CONCLUSION Our results suggest that spine surgeons with higher levels of TS also apply better communication, leadership, and coordination behaviors during the procedure. Yet, the role of surgeons' experience needs further investigation for improving surgeons' intraoperative performance during spine surgery. LEVEL OF EVIDENCE 3.
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Affiliation(s)
- Michael Pfandler
- Institute and Outpatient Clinic for Occupational, Social, and Environmental Medicine, University Hospital, Ludwig Maximilians University, Munich, Germany
| | - Philipp Stefan
- Chair for Computer Aided Medical Procedures & Augmented Reality, Department of Informatics/I-16, Technical University of Munich, Munich, Germany
| | - Christoph Mehren
- Spine Center Schön Clinic Munich Harlaching, Munich, Germany; Academic Teaching Hospital Paracelsus Medical University (PMU), Salzburg, Austria
| | - Marc Lazarovici
- Institute for Emergency Medicine and Management in Medicine (INM), University Hospital, Ludwig Maximilians University, Munich, Germany
| | - Matthias Weigl
- Institute for Emergency Medicine and Management in Medicine (INM), University Hospital, Ludwig Maximilians University, Munich, Germany
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Abstract
The purpose of the Toyota Production System (TPS) Lean 5S methodology project is to improve the efficiency and effectiveness in a process by eliminating identified process waste of (1) defects (errors), (2) overproduction, (3) waiting, (4) confusion, (5) motion/travel, (6) excess inventory, (7) overprocessing, and (8) human potential. The specific aim of this quality improvement project was to evaluate the impact of the TPS 5S tool process, a problem-solving, space-organizing tool, on distractions and interruptions in the neurosurgery operating room (OR) workflow with a goal to decrease neurosurgery craniotomy infection rates in a neurosurgery OR suite within a 3-month period.
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Affiliation(s)
- Treasa 'Susie' Leming-Lee
- Vanderbilt University School of Nursing, 461 21st Avenue South, 226 Godchaux Hall, Nashville, TN 37240, USA.
| | - Shea Polancich
- Clinical Innovation for Quality Improvement, UAB Nursing Partnership, UAB School of Nursing and UAB Hospital, University of Alabama, Birmingham, Birmingham, AL MEB 314B, USA
| | - Bonnie Pilon
- Vanderbilt University School of Nursing, Vanderbilt University, 461 21st Avenue South, 220 Godchaux Hall, Nashville, TN 37240, USA
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Abstract
The dedicated orthopaedic trauma room (DOTR) has emerged over the last decade as an effective approach to improving workflow while reducing the complications and costs that are associated with musculoskeletal trauma care. We surveyed the top 20 hospitals in the United States and found that 14 (70%) utilize a DOTR. Coupled with recent data on improved outcomes and patient flow, we see evidence that the availability of a DOTR has become a best practice for orthopaedic trauma care.
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Affiliation(s)
- Joseph Featherall
- Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio
- National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, Maryland
| | - Timothy Bhattacharyya
- Clinical and Investigative Orthopedics Surgery Unit, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, Maryland
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Alidina S, Kuchukhidze S, Menon G, Citron I, Lama TN, Meara J, Barash D, Hellar A, Kapologwe NA, Maina E, Reynolds C, Staffa SJ, Troxel A, Varghese A, Zurakowski D, Ulisubisya M, Maongezi S. Effectiveness of a multicomponent safe surgery intervention on improving surgical quality in Tanzania's Lake Zone: protocol for a quasi-experimental study. BMJ Open 2019; 9:e031800. [PMID: 31594896 PMCID: PMC6797473 DOI: 10.1136/bmjopen-2019-031800] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Revised: 08/07/2019] [Accepted: 09/12/2019] [Indexed: 12/04/2022] Open
Abstract
INTRODUCTION Effective, scalable strategies for improving surgical quality are urgently needed in low-income and middle-income countries; however, there is a dearth of evidence about what strategies are most effective. This study aims to evaluate the effectiveness of Safe Surgery 2020, a multicomponent intervention focused on strengthening five areas: leadership and teamwork, safe surgical and anaesthesia practices, sterilisation, data quality and infrastructure to improve surgical quality in Tanzania. We hypothesise that Safe Surgery 2020 will (1) increase adherence to surgical quality processes around safety, teamwork and communication and data quality in the short term and (2) reduce complications from surgical site infections, postoperative sepsis and maternal sepsis in the medium term. METHODS AND ANALYSIS Our design is a prospective, longitudinal, quasi-experimental study with 10 intervention and 10 control facilities in Tanzania's Lake Zone. Participants will be surgical providers, surgical patients and postnatal inpatients at study facilities. Trained Tanzanian medical data collectors will collect data over a 3-month preintervention and postintervention period. Adherence to safety as well as teamwork and communication processes will be measured through direct observation in the operating room. Surgical site infections, postoperative sepsis and maternal sepsis will be identified prospectively through daily surveillance and completeness of their patient files, retrospectively, through the chart review. We will use difference-in-differences to analyse the impact of the Safe Surgery 2020 intervention on surgical quality processes and complications. We will use interviews with leadership and surgical team members in intervention facilities to illuminate the factors that facilitate higher performance. ETHICS AND DISSEMINATION The study has received ethical approval from Harvard Medical School and Tanzania's National Institute for Medical Research. We will report results in peer-reviewed publications and conference presentations. If effective, the Safe Surgery 2020 intervention could be a promising approach to improve surgical quality in Tanzania's Lake Zone region and other similar contexts.
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Affiliation(s)
- Shehnaz Alidina
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, United States
| | - Salome Kuchukhidze
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, United States
| | - Gopal Menon
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, United States
| | - Isabelle Citron
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, United States
| | - Tenzing N Lama
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, United States
| | - John Meara
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, United States
- Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, MA, United States
| | - David Barash
- GE Foundation, Boston, Massachusetts, United States
| | | | - Ntuli A Kapologwe
- Department of Health, Social Welfare and Nutritional Service, President's Office - Regional Administration and Local Government, Dodoma, Tanzania
| | | | | | - Steven J Staffa
- Departments of Anesthesiology and Surgery, Boston Childrens Hospital, Boston, Massachusetts, United States
| | - Alena Troxel
- The Innovations Unit, JHPIEGO, Baltimore, Maryland, United States
| | | | - David Zurakowski
- Departments of Anesthesiology and Surgery, Boston Childrens Hospital, Boston, Massachusetts, United States
| | - Mpoki Ulisubisya
- Ministry of Health, Community Development, Gender, Elderly and Children, Dodoma, Tanzania
| | - Sarah Maongezi
- Department of Adult Non-Communicable Diseases, Ministry of Health, Community Development, Gender, Elderly and Children, Dodoma, Tanzania
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Kane P, Marley R, Daney B, Gabra JN, Thompson TR. Safety and Communication in the Operating Room: A Safety Questionnaire After the Implementation of a Blood-Borne Pathogen Exposure Checkpoint in the Surgical Safety Checklist Preprocedure Time-Out. Jt Comm J Qual Patient Saf 2019; 45:662-668. [PMID: 31451354 DOI: 10.1016/j.jcjq.2019.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 07/18/2019] [Accepted: 07/22/2019] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The Surgical Safety Checklist (SSC) decreases patient morbidity and mortality and improves operating room (OR) communication. However, the SSC does not currently include any discussion on employee safety. One institution has implemented a blood-borne pathogen exposure (BBPE) checkpoint in the SSC in order to improve employee safety and to further improve communication. The aim of this study was to determine if the implementation of a BBPE checkpoint improved caregiver safety and communication in the OR. METHODS This was a multidisciplinary prospective survey study in which an anonymous questionnaire was distributed to all OR personnel who handle sharps. Survey responses were analyzed for demographics and BBPE safety attitudes. The frequency of reported BBPE incidents collected from quality improvement data 12 months before and after the implementation of the BBPE checkpoint were reviewed. RESULTS Caregivers feel safer in the OR with the BBPE checkpoint (p < 0.001). Communication was improved. Compliance in trauma surgeries was less than elective. Reported BBPE incidents were significantly decreased based on quality improvement data (p = 0.045). CONCLUSION The BBPE checkpoint was implemented in the SSC at one institution in order to emphasize employee safety and improve communication. The results shed light on the attitudes of OR personnel by suggesting an improvement in safety and communication. In addition, there has been decrease of reported BBPE incidents among OR personnel. Universal implementation of a BBPE checkpoint could improve provider safety and communication in all ORs.
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Lagoo J, Singal R, Berry W, Gawande A, Lim C, Paibulsirijit S, Havens J. Development and Feasibility Testing of a Device Briefing Tool and Training to Improve Patient Safety During Introduction of New Devices in Operating Rooms: Best Practices and Lessons Learned. J Surg Res 2019; 244:579-586. [PMID: 31446322 DOI: 10.1016/j.jss.2019.05.056] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 04/06/2019] [Accepted: 05/30/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Introducing new surgical devices into the operating room (OR) can serve as a critical opportunity to address patient safety. The effectiveness of OR briefings to improve communication, teamwork, and safety has not been evaluated in this setting. METHODS Ariadne Labs and Johnson and Johnson (J&J) collaborated to develop and assess an intervention including a Device Briefing Tool (DBT) and novel multidisciplinary team training for clinicians (surgeons and nurses) around the introduction of a new device in the OR. J&J sales representatives trained clinicians to use the DBT, a communication tool to improve patient safety when a new device is used for the first time. Surveys were administered to representatives (n = 10), surgeons (n = 15), and nurses (n = 30) at the baseline, after trainings, and after using the DBT in an operation at six different Thai hospitals. RESULTS Familiarity with the Surgical Safety Checklist (SURGICAL SAFETY CHECKLIST) varied but increased post-training. Regarding trainings, 90% of representatives felt they very much or completely met all learning objectives but 50% felt only slightly prepared to train clinicians on using DBT. Post-training, clinician confidence in using a new device rose from 47 to 85%. Regarding the DBT, 90% of clinicians felt confident using it and reported they were very likely to use it in the future. Overall, over 90% of all clinicians and representatives felt safe having surgery in their hospitals. CONCLUSIONS There is high acceptability and feasibility of the multidisciplinary trainings and the DBT among representatives and clinicians, albeit in a limited number of participants from a small number of institutions.
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Affiliation(s)
- Janaka Lagoo
- Ariadne Labs, Brigham and Women's Hospital, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
| | - Robbie Singal
- Ariadne Labs, Brigham and Women's Hospital, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - William Berry
- Ariadne Labs, Brigham and Women's Hospital, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Atul Gawande
- Ariadne Labs, Brigham and Women's Hospital, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Brigham and Women's Hospital, Boston, Massachusetts
| | - Christine Lim
- Johnson and Johnson (Medical Devices), Thailand, Medical Device Medical Safety, Bangkok, Thailand
| | - Sompob Paibulsirijit
- Johnson & Johnson (Medical Devices), US, Medical Device Medical Safety, New Brunswick, New Jersey
| | - Joaquim Havens
- Ariadne Labs, Brigham and Women's Hospital, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Brigham and Women's Hospital, Boston, Massachusetts
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Armellino D, Walsh TJ, Petraitis V, Kowalski W. Assessing the Feasibility of a Focused Multivector Ultraviolet System Between Surgery Cases with a Parallel Protocol for Enhanced Disinfection Capabilities. Am J Infect Control 2019; 47:1006-1008. [PMID: 30904373 DOI: 10.1016/j.ajic.2019.02.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 02/12/2019] [Accepted: 02/12/2019] [Indexed: 11/17/2022]
Abstract
A focused multivector ultraviolet (FMUV) light system was used in a parallel process with manual chemical disinfection during operating room (OR) turnovers to assess the impact on cleaning time. The average time to disinfect an OR using only chemical wipes and mops was 19.0 minutes (n = 68); for the FMUV process, the average time was 18.8 minutes (n = 61). The mean cleaning times were equivalent within a 7% margin (P < .17), and total turnover time was not significantly affected.
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Affiliation(s)
| | - Thomas J Walsh
- Infectious Diseases Translational Research Laboratory, Weill Cornell Medicine, Cornell University, New York, NY
| | - Vidmantas Petraitis
- Infectious Diseases Translational Research Laboratory, Weill Cornell Medicine, Cornell University, New York, NY
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Abstract
The aviation industry calls the most frequently recurring factors that lead to incidents ‘the Dirty Dozen.’ The ‘Dirty Dozen’ includes, for example, stress, distractions and interruptions, team norms etc. The article adapts the concept of the Dirty Dozen from aviation to explore resilience in operating theatres. Taking a Safety II perspective, the article introduces the ‘Durable Dozen’: 12 regulatory, organisational, team and individual behaviours that enable theatre teams to resolve safety threats.
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Affiliation(s)
- M Susan Hallbeck
- Department of Health Sciences Research/ Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic
| | - Victor Paquet
- Department of Industrial and Systems Engineering, University at Buffalo, State University of New York
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Tambe TA, Nkfusai NC, Nsai FS, Cumber SN. Challenges faced by nurses in implementing aseptic techniques at the surgical wards of the Bamenda Regional Hospital, Cameroon. Pan Afr Med J 2019; 33:105. [PMID: 31489083 PMCID: PMC6711692 DOI: 10.11604/pamj.2019.33.105.16851] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Accepted: 05/12/2019] [Indexed: 11/30/2022] Open
Affiliation(s)
- Tabe Armstrong Tambe
- Department of Public Health, School of Health Sciences, Catholic University of Central Africa, Yaounde, Cameroon
| | - Ngwayu Claude Nkfusai
- Department of Microbiology and Parasitology, Faculty of Science, University of Buea, Buea, Cameroon
- Cameroon Baptist Convention Health Services (CBCHS), Yaounde, Cameroon
| | - Frankline Sanyuy Nsai
- Cameroon Baptist Convention Health Services (CBCHS), Yaounde, Cameroon
- Department of Public Health and Hygiene, University of Buea, Buea, Cameroon
| | - Samuel Nambile Cumber
- Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa
- School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria Private Bag X323, Gezina, Pretoria, South Africa
- Section for Epidemiology and Social Medicine, Department of Public Health, Institute of Medicine (EPSO), The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
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