The goals to be pursued by this paper are to highlight the effect of different ionising radiation methods, considered low temperature sterilisation over protective clothing (surgical gowns) used in the operating theatre through microscopical examination. In order to investigate the influence of the radiation on the properties of nonwoven based surgical gowns, two types of radiation (gamma and electron beam radiation) were considered in this study. The Scanning Electron Microscope (SEM) is widely used in studies of polymers, although for this kind of nonwoven based structures, that goes through sterilisation treatments it isn´t commonly used. So, this article also intends to relate the results of the evaluation of comfort and barrier properties after irradiated at several doses in a range from 0 to 160 kGy.
This study describes the development of a simulated operating theatre for the training and assessment of technical and team skills during the performance of a simulated surgical procedure. It establishes and validity and reliability of measures used for the assessment of performance of a group of surgical trainees.
Conventional loose-weave cotton operating garments were compared with clothing of a non-woven fabric to test their efficacy in reducing the dispersal of skin bacteria into theatre air. When men wore operating suits made of the non-woven fabric dispersal of skin bacteria was reduced by 72%. When all the operating-theatre staff wore suits and dresses of this fabric air bacterial counts during operating sessions were reduced by 55%; no reduction occurred when the fabric was worn by only the scrubbed team. The lowest levels of microbial contamination of the air in the operating theatre occurred when both the unscrubbed and scrubbed theatre staff wore clothes of non-woven fabric.
Background: Operating theatre personnel are at increased risk for transmission of blood borne pathogens when passing sharp instruments. The hands-free technique, whereby a tray or other means are used to eliminate simultaneous handling of sharp instruments, has been recommended.
Surgical excellence is traditionally defined in terms of technical performance, with little regard for the importance of interpersonal communication and leadership skills. Studies in the aviation industry have stressed the role of human factors in causing error and, in an attempt to reduce the occurrence of adverse events, led to the organisation of simulation based training scenarios. Similar strategies have recently been employed for the surgical team with the development of a simulated operating theatre project. This enables technical and non-technical performance of the surgeon and circulating staff to be assessed by experts situated in an adjacent control room, and provides an opportunity for constructive feedback. The scenarios have good face validity and junior surgeons can benefit from the process of learning new technical skills in a realistic environment. The effect of external influences such as distractions, new technology, or a crisis scenario can also be defined, with the ultimate aim of reducing the number of adverse events arising in the real operating room.
In operating theatres the air is mainly contaminated with bacteria shed from the human skin. The emission of bacteria can be prevented by wearing clothing of impervious material, while normal cotton clothing does not decrease the shedding of bacteria. In this study shedding of viable bacteria from 20 test-persons wearing an operating theatre suit, composed of 65% polyester and 35% cotton (Diolen), was investigated in a test-chamber and compared with that when normal clothing was worn. The use of this operating-theatre suit resulted in a significant reduction (50--75%) in the number of bacteria-carrying particles in the air of the test-chamber and in an operating room when everyone present wore this suit. A combination of the suit with knee-high boots showed a further reduction in the dispersal of colony forming units. The dispersion from female subjects wearing an operating-theatre frock was significantly higher than when wearing an operating-theatre suit.
A recent report by the National Audit Office found that only 50% to 60% of weekday operating time was being used. This report was examined by the Committee of Public Accounts and much of the blame for underutilization of operating theatres was attributed to poor working practices among surgeons. We investigated theatre utilization in our hospital and found underutilization on the same scale as the National Audit Office. Twenty-five per cent of theatre sessions were not allocated for use, 23% of general surgical lists were cancelled and, of the lists which did take place, a further 23% of theatre time was not utilized. The single largest cause of underutilization was understaffing. To increase theatre utilization higher levels of staffing and expenditure are needed rather than changes in the working practices of surgeons.
The effect of scheduling on the use of operating theatre time has been studied. Scheduling involved determining the average length of common operations and fitting them into the calculated available operating time. The technique has been shown to reduce significantly the variation in length of operating sessions, and it ensures the best use of available operating time.
The surgical suction tip forms a reservoir for microorganisms during total hip replacement in conventional operating theatres. We assessed the colonisation of the tip in an ultraclean-air operating theatre in 39 patients, and found that 41% of them had evidence of bacterial colonisation with one or more bacteria. To avoid contamination we suggest that the suction tip is changed before preparation of the femoral canal and insertion of cement and prosthesis.
Airborne bacteria introduced during routine joint replacement surgery are known to be an important source of joint sepsis with disastrous results. Recently, Robinson et al. [Robinson AHN, Bentley G, Drew S, Anderson J, Ridgway GL. Suction tip contamination in the ultraclean air operating theatre. Ann R Coll Surg Engl 1993; 75: 254-6] have demonstrated that the conventional surgical sucker forms a focus for airborne pathogens which results in septic loosening of hip prostheses. Similarly, the potential contamination of theatre light handles, commonly used during total hip and knee replacements, gives cause for concern. To assess if there was any evidence of contamination, we cultured bacterial swabs taken from the light handles before and after 15 such procedures, all of which were held in a conventional orthopaedic operating theatre. Fortunately, our study found no reason to stop the use of light handles in joint replacement operations.
A patient with a medial and posterior dislocation of the right sterno-clavicular (SC) joint and displacement of the trachea and brachiocephalic artery by the medial head of the clavicle underwent general anaesthetic in the operating theatre for an open reduction procedure. The surgeon initially attempted a closed reduction, but this required imaging to check SC alignment. The patient was transferred to an adjacent hybrid operating theatre for imaging. Cone beam computed tomography (CBCT) was performed, which successfully demonstrated a significant reduction in the dislocation of the SC joint. The trachea and brachiocephalic artery were no longer compressed or displaced. This case study demonstrates an alternative to the patient being transferred to the medical imaging department for multi-slice CT. It also describes a novel use of the hybrid operating theatre and its CBCT capabilities.
Objective To assess the accuracy of surgeons and anaesthetists in predicting the time it will take them to complete an operation or procedure and therefore explain some of the difficulties encountered in operating theatre scheduling.
We present a case report of an auxiliary nurse who developed an adenoid cystic carcinoma in her left maxillary sinus following occupational exposure to formaldehyde in the operating theatre. Currently, the epidemiological evidence that formaldehyde can cause cancer in humans is considered to be limited. Previous case-control-studies of formaldehyde and sinonasal cancer have mainly investigated subjects who were concomitantly exposed to wood dust, a known risk factor to the development of sinonasal adenocarcinoma of intestinal type. Our case report presents a patient who has developed an adenoid cystic carcinoma following exposure to formaldehyde. We suggest that the occupational physician remains alert to formaldehyde as an occupational hazard among health care workers.
In the center of the image, four nurses in short-sleeved gowns stand with their arms folded atop an operating table. Above the table is a sixteen-bulb electric light fixture. In the background, tiered rows of seating are visible.
Surgical patients are highly susceptible to preventable harm in health systems that tolerate inadequate patient safety: the World Health Organization recognises that half of preventable adverse events happen in surgical care. Each year, seven million surgical patients are estimated to suffer serious complications from adverse events and up to one million die. Improving safety culture and non-technical skills can reduce adverse events and improve patient safety. This study explores safety culture in operating theatres in Saudi Arabia, where many employees work in an environment that is radically different from their own, in a language that they know imperfectly. It targets cultural differences and their relevance to safety culture dimensions, including teamwork, communication, job satisfaction, stress recognition, working conditions, and perceptions of management. The concept of safety culture is complex, and to achieve sufficient breadth and depth this study employs a sequential explanatory mixed methods design. All health care professionals working in operating theatres in the Saudi Arabian Ministry of Health hospitals in Riyadh City were surveyed using the internationally validated Safety Attitudes Questionnaire, administered in both English and Arabic. Items pertaining to local culture were added to assist in measuring cultural factors related to patient safety. Furthermore...
Sixty staff working in a hospital operating theatre, where a case of humidifier fever had been identified, were studied together with 49 subjects working in other parts of the hospital. They each had a blood test for serology, a skin test, and a chest radiograph and completed a questionnaire. The theatre staff also had pulmonary function tests. The theatre humidifier was found to contain several organisms including amoebae and antigens cross-reacting highly with those implicated in previous outbreaks of humidifier fever. Of the 60 exposed subjects, 25 had developed antibodies, nine had probable symptoms of humidifier fever, and six possible symptoms. There was a strong association between symptoms and antibodies (p = 6 x 10(-5) by Fisher's exact test). The development of antibodies was also related to duration of exposure in the theatre (p less than 0.01 by X2 test for trend) and inversely to smoking (p = 0.0073 by Fisher's exact test) but not to history of atopy. Because of the presence of antigens and because certain biocides added were ineffective in controlling antigenic build-up the humidifier was switched off. Eight months later specific IgG levels in the theatre staff sera, estimated by an enzyme-linked immunosorbent assay technique...
Aim: To improve admission temperatures of preterm infants ≤31 weeks gestation by increasing the ambient temperature in the operating theatre and wrapping in polyethylene wrap at caesarean section. Methods: A review of admission temperature of infants wi
This paper provides a classification of real scheduling problems. Various
ways have been examined and described on the problem. Scheduling problem faces
a tremendous challenges and difficulties in order to meet the preferences of
the consumer. Dealing with scheduling problem is complicated, inefficient and
time-consuming. This study aims to develop a mathematical model for scheduling
the operating theatre during peak and off peak time. Scheduling problem is a
well known optimization problem and the goal is to find the best possible
optimal solution. In this paper, we used integer linear programming technique
for scheduling problem in a high level of synthesis. In addition, time and
resource constrained scheduling was used. An optimal result was fully obtained
by using the software GLPK/AMPL. This model can be adopted to solve other
scheduling problems, such as the Lecture Theatre, Cinemas and Work Shift.; Comment: Presented at the International Seminar on the Application of Science
& Mathematics 2011