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PubMed1997

Risk of spontaneous abortion in women occupationally exposed to anaesthetic gases: a meta-analysis.

OBJECTIVES: To determine the association between maternal occupational exposure to anaesthetic gases and risk of spontaneous abortion. METHODS: A meta-analysis was performed of published epidemiological studies identified from literature reviews, unsystematic perusal of reference lists of relevant publications, and two Medline searches (1984-92, keywords: anaesthetic gases; anaesthetics; anaesthetics, local; operating rooms; operating room nursing; pregnancy; abortion; 1985-92, keywords: anaesthetics; adverse effects; occupational exposure; anaesthesia, inhalation; operating room nursing; pregnancy; abortion). All peer reviewed studies were retained. Student theses were excluded, as were conference abstracts, unpublished material, and two studies in which data on paternal and maternal occupational exposures were pooled. The relative risk of spontaneous abortion was estimated. RESULTS: One study found no increase in risk of abortion when gases were scavenged or when the exposure to unscavenged gases was low. None of the studies included ambient gas sampling. 24 comparisons between exposed and unexposed women, obtained from 19 reports, were included. The overall relative risk was 1.48 (95% confidence interval (95% CI), 1.4 to 1.58). To test whether this result was influenced by the quality of the studies, the validity of the reviewed papers was rated on the basis of three criteria: appropriateness of the unexposed comparison group, control for non-occupational confounding variables, and response rate. The estimate of risk increased to 1.9 (95% CI, 1.72 to 2.09) when analysis was restricted to the six comparisons which were rated the most rigorous. CONCLUSIONS: Epidemiological studies based on data obtained in the prescavenging era indicate an increased risk of spontaneous abortion. The estimated increased risk was not diminished but rather increased by exclusion of the more methodologically flawed studies.

Abortion, Spontaneous↗

PubMed2001

Preliminary study of cytogenetic damage in personnel exposed to anesthetic gases.

Occupational exposure to anesthetic gases is associated with various adverse health effects. Genetic material has been shown to be a sensitive target of numerous harmful agents. The aim of this study was to examine whether chromosomal damage could serve to indicate exposure to anesthetics. A group of 43 hospital workers of three professions (anesthesiologists, technicians and operating room nurses) and 26 control subjects were examined for chromosome aberrations, sister chromatid exchanges and micronucleus frequency. The exposed groups matched in duration of exposure to anesthetics, but not in age. An equal ratio between women and men was possible in all groups except nurses. Likewise, the ratio between smokers and non-smokers was also not comparable. An increase in chromosome damage was found in all exposed groups. While the increase in sister chromatid exchange frequency was not significant, chromosome aberrations and micronucleus frequency increased significantly, showing higher rates in women. The results suggest that the micronucleus test is the most sensitive indicator of changes caused by anesthetic gases. The observed difference between sexes with respect to exposure risk call for further, targeted investigations.

Adult↗

PubMed1989

Perioperative nursing: the neglected specialty.

1. Changes in nursing curricula have caused two problems for perioperative nursing: it is difficult to recruit nurses since few understand the specialty, and there is a perception that the perioperative nurse is a handmaiden to the physician. 2. In ambulatory surgery settings, the perioperative nurse is often the only caregiver patients encounter; thus, patient care must be at the highest level possible. 3. Although associate and baccalaureate curricula offer few perioperative nursing experiences, future nurses must be recruited from these programs. 4. Many issues need to be addressed so that desirable programs for perioperative nurses can be developed.

Curriculum↗

PubMed1999

Preoperative visiting in Wales.

There is clear evidence in the nursing literature that preoperative visits conducted by theatre nurses have a therapeutic benefit for surgical patients. However, it would appear that the actual uptake of this practice is limited (Wicker 1995). The aim of this study is to investigate the prevalence of preoperative visiting in Wales and to identify factors associated with its occurrence or non-occurrence.

Attitude of Health Personnel↗

PubMed2000

Minimally invasive treatment of twin-to-twin transfusion syndrome.

Selective laser photocoagulation of communicating vessels (SLPCV) is an application of minimally invasive endoscopic fetal surgery (i.e., surgical fetoscopy) performed for severe cases of twin-to-twin transfusion syndrome (TTTS), a complication of monochorionic twin pregnancies. Advances in ultrasound and endoscopy have aided the identification and treatment of this potentially lethal or fatal condition. Surgical fetoscopy, an innovation in the field of surgery and maternal-fetal medicine, benefits patients by reducing the morbidity and mortality associated with TTTS, with minimal risks to the mother.

Amniocentesis↗

PubMed1992

Microbiology, infection control, immunizations, and infectious disease exposure: education and practices in United States nursing schools.

BACKGROUND: Previous data suggest that nursing students in the United States are inadequately protected against hepatitis B. This survey focused on the immunization and education practices, infection control knowledge, and follow-up to infectious disease exposure by U.S. nursing schools. METHODS: To ascertain education requirements, immunization practices, and infectious disease postexposure follow up, a survey was sent to the director or dean of 1164 U.S. nursing schools. RESULTS: Seven hundred sixty-five schools (65.7%) responded to the survey. A microbiology course was required before clinical experience by 49% of schools. Clinical experience in the operating room was given by 16%, 65% of schools offered infectious and communicable disease courses, and 98% offered universal precaution instructions. The hepatitis B vaccine was required by 11%; 2% required yearly influenza vaccination. In a comparison of programs, the diploma schools were more likely to have written policies for infectious disease exposure follow-up and to use appropriate agencies for exposure follow-up (p = 0.0001). CONCLUSIONS: A microbiology course before clinical experience should be encouraged. Immunization policies and infectious disease exposure follow-up are currently inadequate in U.S. associate degree and baccalaureate nursing programs.

Curriculum↗

PubMed1995

The training of non-medical theatre personnel.

Highly trained, dedicated assistants with relevant occupational skills are essential for safe medical practice. A vocational qualification has been introduced as a potential common training for non-medical personnel wishing to pursue a career in operating department practice. Approval of extended role options gives an opportunity for specialist support, and may also be of use in relieving some of the problems associated with the reduction of the hours of trainee doctors. This paper briefly traces the evolution of theatre training and reviews current developments.

Accreditation↗

PubMed2003

[Surgery in children and adolescents].

The authors explain in a standardized model of nursing care for children and adolescents durning pre-operative phase, the first part in the global surgical process. This phase commences at the moment a surgical intervention is deemed necessary and finalizes when the child/adolescent is transported to the operating room. The authors perform a systematic and holistic evaluation, using the Gordon Functional Health Patterns. Special emphasis is given to aspects such as the perception-management health pattern, the nutritional-metabolic pattern, the elimination pattern, the exercise-activity pattern, the dream-rest pattern, the self-perception pattern and the adaptation-stress tolerance pattern. They evaluate the perception and responses children of varying ages provide to being separated from parents. They highlight the cultural factors which must be born in mind in order to achieve an adequate evaluation and individualized care. The authors select the Nursing Diagnoses of NANDA, the North American Nursing Diagnosis Association, which most frequently appear in this pre-operative phase: fear/anxiety, risk of aspiration, risk of an alteration in health maintenance, and risk of infection. Finally, the authors describe the nursinginterventions related with these diagnoses.

Adolescent↗

PubMed1994

Intraoperative molar pregnancy crisis.

Molar pregnancy is a gestation in which the ovum is transformed into a fleshy tumor mass or mole. Of all gynecologic tumors, it is one of the most feared. It is characterized by first trimester bleeding, hyperemesis, and toxemia and can be diagnosed using pelvic ultrasound. Suction currettage is the treatment of choice for molar pregnancy when a patient desires to have more children; however, hysterectomy may be necessary. Abdominal hysterectomy reduces the risk of malignant sequelae. Complications associated with molar pregnancy usually are a result of suction curettage and include pulmonary insufficiency syndrome, choriocarcinoma, hyperthyroidism, theca lutein cysts, and disseminated intravascular coagulation. The perioperative nurse can be instrumental in assessing, planning, organizing, and directing intervention for potential complications associated with the management of a molar pregnancy crisis. The perioperative nurse is encouraged to review all aspects of molar pregnancy to understand the ramifications of the surgical procedures.

Female↗

PubMed2000

A comparison of the costs and efficacy of ondansetron versus dolasetron for antiemetic prophylaxis.

UNLABELLED: The optimal dose and timing of 5-HT(3) antagonist administration for prophylaxis against postoperative nausea and vomiting (PONV) remains controversial. Although 5-HT(3) antagonists seem to be most effective when administered near the end of surgery, there are no data on the comparative efficacy or costs associated with the 5-HT(3) antagonists dolasetron and ondansetron when administered at the end of the operation. In this double-blinded study, 200 outpatients undergoing otolaryngologic procedures with a standardized general anesthetic received 4 (O4) or 8 mg (O8) of ondansetron or 12.5 (D12.5) or 25 mg (D25) of dolasetron IV within 30 min before the end of surgery. A blinded observer recorded the emetic episodes, maximum nausea score, recovery room resource and drug use, nursing time spent managing PONV, times to achieve discharge criteria from the Phase 1 and 2 recovery units, postdischarge emesis, and patient satisfaction. Total costs were calculated by using the perspective of a free-standing surgicenter. There were no differences in patient demographics, incidence of PONV, need for rescue medications, time spent in the recovery areas, unanticipated hospital admissions, or patient satisfaction among the four treatment groups. The mean total costs (95% confidence intervals) to prevent PONV in one patient were lowest in the D12.5 group: $23.89 (17.18-28.79) vs $37.81 (30.29-45.32), $33.91 (28.92-39.35), and $75.18 (61.13-89.24) for D25, O4, and O8, respectively. Excluding nursing labor costs did not alter this finding: $18.51 (14.18-22.85), $34.77 (28.03-41.49), $31.77 (28. 92-39.35), and $71.76 (58.17-85.35) for D12.5, D25, O4, and O8, respectively. We conclude that 12.5 mg of dolasetron IV is more cost effective than 4 mg of ondansetron IV for preventing PONV after otolaryngologic surgery and is associated with similar patient satisfaction. IMPLICATIONS: When administered at the end of surgery, 12.5 mg of dolasetron IV is as effective as 25 mg of dolasetron IV, 4 mg of ondansetron IV, and 8 mg of ondansetron IV in preventing emetic symptoms after otolaryngologic surgery and was associated with similar patient satisfaction at a reduced cost. There were no differences in the antiemetic efficacy of the 4 and 8 mg doses of ondansetron.

Ambulatory Surgical Procedures↗

PubMed2000

Identification of factors that disrupt negative air pressurization of respiratory isolation rooms.

OBJECTIVES: To investigate the airflow characteristics of respiratory isolation rooms (IRs) and to evaluate the use of visible smoke as a monitoring tool. METHODS: Industrial hygienists from the New York State Department of Health evaluated 140 designated IRs in 38 facilities within New York State during 1992 to 1998. The rooms were located in the following settings: hospitals (59%), correctional facilities (40%), and nursing homes (1%). Each room was tested with visible smoke for directional airflow into the patient room (ie, negative air pressure relative to adjacent areas). Information was obtained on each facility's policies and procedures for maintaining and monitoring the operation of the IRs. RESULTS: Inappropriate outward airflow was observed in 38% of the IRs tested. Multiple factors were associated with outward airflow direction, including ventilation systems not balanced (54% of failed rooms), shared anterooms (14%), turbulent airflow patterns (11%), and automated control system inaccuracies (10%). Of the 140 tested rooms, 38 (27%) had either electrical or mechanical devices to monitor air pressurization continuously. The direction of airflow at the door to 50% (19/38) of these rooms was the opposite of that indicated by the continuous monitors at the time of our evaluations. The inability of continuous monitors to indicate the direction of airflow was associated with instrument limitations (74%) and malfunction of the devices (26%). In one facility, daily smoke testing by infection control staff was responsible for identifying the malfunction of a state-of-the-art computerized ventilation monitoring and control system in a room housing a patient infectious with drug-resistant tuberculosis. CONCLUSION: A substantial percentage of IRs did not meet the negative air pressure criterion. These failures were associated with a variety of characteristics in the design and operation of the IRs. Our findings indicate that a balanced ventilation system does not guarantee inward airflow direction. Devices that continuously monitor and, in some cases, control the pressurization of IRs had poor reliability. This study demonstrates the utility of using visible smoke for testing directional airflow of IRs, whether or not continuous monitors are used. Institutional tuberculosis control pro grams should include provisions for appropriate monitoring and maintenance of IR systems on a frequent basis, including the use of visible smoke.

Air Pressure↗

PubMedDate not supplied

Laparoscopic gastrostomy/jejunostomy.

1. Laparoscopic gastrostomy or jejunostomy provides a safe and effective method for providing nutritional support to patients who are unable to maintain an adequate intake for metabolic requirements. 2. The advantages of the laparoscopic technique include direct intra-abdominal visualization, a shorter anesthesia time, the decreased need for postoperative narcotics, elimination of the need for endoscopy and suturing, and the prevention of complications associated with open abdominal procedures. 3. The perioperative nurse, who is prepared for and knowledgeable about the nursing implications of the laparoscopic approaches to gastrostomy and jejunostomy, will successfully contribute to an optimal patient outcome.

Gastrostomy↗

PubMed1989

Hypersensitivity to natural latex.

Rubber hypersensitivity is well described but usually as a contact dermatitis caused by chemicals added during the process of making natural latex or synthetic rubber. IgE-mediated reactions, mainly contact urticaria, have rarely been reported in Europe. We report a case of immediate hypersensitivity to latex. A 34-year-old female operating room nurse developed hand eczema to natural latex. On two occasions, while she was gloving for surgery, she had the following reactions: flushing, tachycardia, urticaria, angioedema, wheezing, and light-headedness. Prick and patch testing to thiuram mix, mercaptobenzothiazole, phenylenediamine mix, and carbamate mix (common rubber additives) were negative. Prick tests to natural latex elicited a 4+ reaction associated with immediate flushing, tachycardia, urticaria, and light-headedness. Five control subjects did not react. IgE antibodies to latex by RAST demonstrated 17.7% binding (control, 4%). This case demonstrates that natural latex can cause IgE-mediated symptoms. The route of exposure was cutaneous absorption of relevant latex allergens. As the use of latex rubber products continues to escalate, more cases are likely to occur.

Adult↗

PubMed1983

Intraoperative autotransfusion.

Because nursing assessments may determine when autotransfusion is advised or contraindicated, it is the nurse's responsibility to understand the procedures and problems associated with autotransfusion. The OR nurse cannot only serve as trouble-shooter and educator, but also suggest protocols for adoption and selection of autotransfusion equipment and protocols for patient use.

Blood Transfusion, Autologous↗

PubMed1994

Perioperative considerations of vascular access for dialysis.

Perioperative nurses can be advocates for dialysis patients by being knowledgeable about various access routes, advantages and disadvantages of each, and associated nursing care. The longevity of vascular access devices depends on avoiding infection and blood clot formation. Perioperative nurses need to assess the knowledge level of the dialysis patient before surgical intervention in any situation.

Arteriovenous Shunt, Surgical↗

PubMed2001

Safety first--five years later. Belgian standards for patient safety in anaesthesia revisited.

Belgian Standards for Patient Safety in Anaesthesia, established in 1989 by a joint effort of the Belgian Professional Association of Anesthesiologists and the Belgian Scientific Society of Anaesthesia and Resuscitation, were intended to be fully implemented within hospital practice by January 1st, 1995. In order to gather follow-up data with regard to this deadline, the Professional Association of Anesthesiologists conducted a survey in 1995: a questionnaire was circulated to all Belgian anaesthetists in order to evaluate the extent to which these guidelines had been implemented in clinical practice and to determine the areas in which residual noncompliance remained. 71% of responders complied with the safety guidelines as far as monitoring in the operating room was concerned. Nursing help was available to 95% of the responders. Concerning the requirement for continuous attendance during anaesthesia by a doctor anaesthetist, some questions remain: although the principle was accepted by 53% of responders, the practical consequences are such that flexibility in working conditions is hampered by the obligation to stay at the side of the anaesthetised patient, under all circumstances. The survey reveals that 65% of responders do not totally comply with this guideline of continuous attendance by a doctor. Many of them propose professional assistance by nursing staff with a specific education and training in anaesthesia.

Anesthesiology↗

PubMed2001

Dedicated minimally invasive surgery suites increase operating room efficiency.

BACKGROUND: The rapid adoption of laparoscopic surgery since the late 1980s added tremendous complexity into the operating room (OR) environment. For each case, a plethora of additional equipment-including monitors, video equipment, wiring, tubing, and cords-had to be set up, prolonging OR turnover time and decreasing OR efficiency. In 1993, the concept of designated minimally invasive surgery (MIS) suites was introduced. MIS suites integrated monitors and video equipment into the OR on ceiling-mounted columns and moved the controls to a centralized nursing station. The overall effect of this innovation on OR efficiency has not been measured. METHODS: Five RNs with varying degrees of MIS experience were instructed on video setup and put-away criteria and then timed while performing a set of standardized tasks. Each set of tasks was performed twice using a standardized surgery model. Differences in setup and put-away times between MIS suites and standard ORs were tested using the t-test for paired comparisons. RESULTS: The mean +/- standard deviation (SD) video setup times were 27.9 +/- 5.3 sec (MIS) and 254.3 +/- 54.0 sec (standard); the put-away times were 19.8 +/- 2.7 sec (MIS) and 222.3 +/- 26.0 sec (standard). The mean difference +/- standard error (SE) in both the setup (226.4 +/- 16.9 sec, p = 0.0001) and put-away times (202.5 +/- 8.6, p = 0.0001) were large and statistically significant. CONCLUSION: Using a simulation model, we have demonstrated that the use of a MIS suite reduces video setup and put-away time significantly, with the potential for significant associated cost savings. This provides just one justification for the high cost of building such "ORs of the future."

Cost-Benefit Analysis↗

PubMedDate not supplied

Monitoring monitors.

A centralized, remote alarm system was implemented to alert nursing personnel when patient monitors located in isolation rooms go into alarm. The design includes a method of confirming the ON/OFF status of individual monitors to avoid operator error. This system utilizes low-cost individual patient monitors and includes interface devices, an alarm panel, and indicator panels. The design logic is based on the need for nursing personnel to also be alerted in the event of any abnormality associated with the patient monitors, the alarm panel itself, or with the interconnections. The system will also accommodate infusion pumps, respirators, or any other devices equipped with a remote alarm (nurse call) output.

Equipment Failure↗