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PubMed1991

[The effect of Federal Public Health Service guidelines on air, surface and floor germ count in a general surgery and an orthopedic operating room].

In a prospective study the environmental contamination in an old and a new operating theatre was investigated. The old operating rooms were constructed in 1936 whereas the new rooms were built in 1986. The study was conducted in surgical and orthopedic surgical operating rooms. There was a slight increase in floor as well as in surface contamination in the new operating rooms. On the other hand there was a slight decrease in the airborne microorganisms in the orthopedic surgery and nearly identical colony counts in the general surgery operating rooms. All the differences were statistically not significant. The spectrum of microorganisms and the occurrence of Staphylococcus aureus in the old and the new operating rooms showed no difference.

Air Microbiology↗

PubMed1975

Working in operating rooms, an unhealthy existance?

A literature survey indicates that some complaints occur relatively frequently among anesthetists and nurses working in operating rooms. Pollution of the air in the operating rooms by anesthetic gases is often considered as a possible cause. On account of this the degree of pollution has been determined. Concentrations of nitrous oxide and halothane were measured using an infrared absorption spectrophotometer. In each room the concentrations were measured at several different sites. In naturally ventilated operating rooms the concentrations increased steadily during operation. The measured values lied mostly between 1500 and 3000 ppm (vol/vol) for nitrous oxide and between 15 and 35 ppm for halothane. In mechanically ventilated operating rooms where no recirculation is applied a constant level was found some time after the beginning of an operation. The concentrations varied from about 100 to 500 ppm for nitrous oxide and from 1 to 5 ppm for halothane. In naturally ventilated operating rooms the anesthetic gases were rather homogeneously spread, while in mechanically ventilated rooms there was an inhomogeneous distribution. Scavenging of waste anesthetics is recommended.

Adult↗

PubMed1992

Permanent pacemaker implantation in the cardiac catheterization laboratory versus the operating room: an analysis of hospital charges and complications.

Permanent pacemakers may be implanted in operating rooms, special procedure laboratories, or cardiac catheterization laboratories. Previous investigators have shown no difference in efficacy or complications in the operating room versus the cardiac catheterization laboratory. We retrospectively analyzed the hospital bills of 30 patients undergoing permanent pacemaker implantation at our institution. Group I was 15 consecutive patients implanted in the operating room and group II was 15 consecutive patients implanted in the cardiac catheterization laboratory, all by the same operators. Hospital charges that were specific to the site of implantation were analyzed. Physician charges for implantation, anesthesiologist, and radiologist charges were not analyzed. There were no in-hospital complications in either group. The mean charges for group I were $1,856.00 and group II were $1,075.00 (P < 0.001). We conclude that implantation of permanent pacemakers in the cardiac catheterization laboratory is associated with significantly lower hospital charges compared to implantation in the operating room and has an equally low complication rate.

Aged↗

PubMed1991

Physics and function of operating room suction.

A study was done to evaluate the performance of suction apparatus in the operating room. The investigation was prompted by perceived poor suction performance in a suite of new operating rooms built in accordance with Standards Australia (SA) specifications. SA performance tests were conducted on each of four suction outlets in nine operating rooms. All 36 outlets complied with SA standards for flow-rate (minimum 40 L/min) and occluded negative pressure (ONP; minimum -60 kPa). However, 24 collection units failed to comply with standards (ONP) of -40 kPa achieved in less than 4 s when a 4 L disposable suction apparatus was connected (mean time to ONP: 6.1 s, 95% confidence interval: 4.9, 7.3). When smaller capacity suction jars were substituted, more units met SA standards. The standards therefore need revision to include specification of the capacity of the collecting apparatus. Other factors that were found to degrade suction performance significantly were air leakage and defective shut-off valves. The physical principles involved in operating room suction are described. Surgeons and anaesthetists should understand these principles, and it is recommended that a simple pre-operative check of the suction apparatus should be carried out, as follows: (1) Turn the wall control knob fully on, and disconnect the suction apparatus. The gauge should register zero. (2) Connect the suction jars. If the indicated gauge pressure is in excess of -15 kPa, investigate the equipment for excessive resistance, particularly in the shut-off valve, which should be replaced with a new unit if necessary.(ABSTRACT TRUNCATED AT 250 WORDS)

Australia↗

PubMed1991

Ultraviolet radiation compared to an ultra-clean air enclosure. Comparison of air bacteria counts in operating rooms.

Clean air in the operating room is important during joint replacement surgery. We compared monochromatic ultraviolet radiation of 254 nm with the use of a Charnley-Howorth air enclosure by bacterial air-sampling during 113 total hip arthroplasties. Air samples were taken continuously at the edge of the wound and every 15 minutes at a site 130 cm from the operating table. We also tested the effect of occlusive clothing for all personnel. Ultraviolet light was more efficient than the ultra-clean air enclosure, and occlusive clothing on its own or in combination also produced improvement. The implications of these findings are discussed.

Air Microbiology↗

PubMed1991

Blood contact and exposure in the operating room.

We prospectively studied 684 operations from all surgical specialties to describe the frequency and character of blood contact and exposure during the procedures. Blood contact was defined as percutaneous, mucous membrane, nonintact skin or intact skin contact of patient blood with any member of the operative team. Blood exposure was defined as contact in any of the preceding categories excluding intact skin. Over-all, 28 per cent of the patients had one or more blood contact events that involved 293 operating room personnel. Risk of blood contact was significantly greater for cardiothoracic (p less than 0.001), trauma (p less than 0.003) and obstetric cesarean section (p less than 0.021) procedures when compared with all other procedures. Three services (Ophthalmology, Transplant and Oral Surgery) had no contact events. The remaining nine had rates ranging from 17 to 33 per cent. Eight per cent of the procedures (n = 54) resulted in blood exposure to 63 individuals. Percutaneous exposure occurred in 3 per cent of all procedures. Blood contact events increased with increasing operative time. Blood contact most commonly occurred among circulating nurses (n = 79), anesthesia personnel (n = 65), surgeons (n = 59) and first assistants (n = 49). Despite increased concerns over the risk of occupationally acquired viral diseases, blood contact and exposure continue to be frequent events. Surgeons must assume that all patients are potentially infected and should adopt universally applied standards of behavior to minimize contact with blood.

Allied Health Personnel↗

PubMed1976

Influence of operating room surface contamination on surgical wounds: a prospective study.

The influence of operating room contamination on wound infection rates in clean, clean-contaminated, contaminated, and septid procedures was studied by a prospective randomized study of 2,020 surgical wounds. Operating room surface contamination was assessed by the RODAC bacterial plate method. Control rooms uniformly received Wet-Vac cleaning between operations. Experimental rooms were not cleaned between consecutive clean operations, but were cleaned after contaminated operations. The difference in surface contamination between groups of experimental and control rooms was found to be significant at the P less than .05 level. Patients operated on in experimental and control rooms were followed up postoperatively to assess whether they experienced wound infection. No statistically significant differences in wound infection rates were found between experimental and control room operations as total groups, clean procedures, or operations of long duration.

Bacteria↗

PubMed1975

The operating room environment as affected by people and the surgical face mask.

The microbiological counts were determined in an operating room suite of 8 rooms and a hallway. The bacterial counts in an empty operating room jumped statistically from 13 CFU/ft2/hr (+/- 31) to 24.8 (+/- 58.8) when the doors were left open (people in the hallways) and 447.3 (+/- 186.7) when 5 people were introduced. The wearing of a surgical face mask had no effect upon the overall operating room environmental contamination and probably work only to redirect the projectile effect of talking and breathing. People are the major source of environmental contamination in the operating room.

Air Microbiology↗

PubMedDate not supplied

Nitrous oxide exposure in the operating room.

One-hundred and eight-five pairs of gas samples were collected from inspired gas (10 cm behind the head at nose level) and end-tidal gas of persons administering anesthesia in 3 operating rooms during daily routine anesthesia. Mean operating-room N2O concentrations from 22 to 144 ppm (volume/volume [V/V]) were measured by gas chromatography, and large moment-to-moment variations (temporal gradients) were seen in individual operating rooms. Mean end-tidal N2O concentrations from 51 to 114 ppm (V/V) were observed. There were low correlations between inspired and end-tidal N2O concentrations (r values as low as r = 0.35). This poor relationship is presumably due to spatial and temporal gradients of N2O in the operating rooms. We conclude that the temporal and spatial gradients in N2O concentrations within active operating rooms are sufficiently large to invalidate estimation of exposure of anesthetic personnel to N2O from "spot" or "grab" samples collected in the breathing area.

Air Pollutants↗

PubMed1992

Exposure of hospital operating room personnel to potentially harmful environmental agents.

Epidemiologic studies of risk to reproductive health arising from the operating room environment have been inconclusive and lack quantitative exposure information. This study was undertaken to quantify exposure of operating room (OR) personnel to anesthetic agents, x-radiation, methyl methacrylate, and ethylene oxide and to determine how exposure varies with different operating room factors. Exposures of anesthetists and nurses to these agents were determined in selected operating rooms over three consecutive days. Each subject was asked to wear an x-radiation dosimeter for 1 month. Exposure to anesthetic agents was found to be influenced by the age of the OR facility, type of surgical service, number of procedures carried out during the day, type of anesthetic circuitry, and method of anesthesia delivery. Anesthetists were found to have significantly greater exposures than OR nurses. Exposure of OR personnel to ethylene oxide, methyl methacrylate, and x-radiation were well within existing standards. Exposure of anesthetists and nurses to anesthetic agents, at times, was in excess of Ontario exposure guidelines, despite improvements in the control of anesthetic pollution.

Environmental Monitoring↗

PubMed1976

Total hip replacement without deep infection in a standard operating room.

In a consecutive series of 298 total hip-joint replacements performed by a single surgeon using a standard operating room, early deep infection was eliminated by simple inexpensive methods of controlling contamination in the operating room. Settling-plate monitoring revealed an average of 4.8 colonies of bacterial growth per hour of exposure. All patients received prophylactic antibiotics. One patient had a superficial wound infection which was controlled with antibiotic therapy. No deep infections were encountered in the 252 hips followed for two to five years after operation. We conclude that total hip arthroplasty can be performed in the standard operating room without undue risk of infection by consistently employing strict measures of operating-room discipline to limit contamination.

Air Microbiology↗

PubMed1992

Sister-chromatid exchanges in operating room personnel.

Sister-chromatid exchange (SCE) analysis was carried out in 67 operating room personnel (anaesthetists M.D.; anaesthesia nurses and anaesthesia unit technicians) exposed to waste anaesthetic gases such as halothane, nitrous oxide and isoflurane and in 50 healthy unexposed controls. The SCE frequencies were increased significantly in operating room personnel as compared to controls. A significant increase in SCEs was found in non-smoking operating room personnel as compared to non-smoking controls. This study supports the existence of an association between occupational exposure to mutagens and an increase in SCEs in lymphocytes.

Adult↗

PubMed1992

Implementation and financial analysis of an operating room satellite pharmacy.

The rationale and implementation of an operating room (OR) pharmacy satellite is described, and the first-year savings are evaluated. The OR in an 874-bed university teaching hospital, consisting of 17 rooms for inpatients, 6 rooms for ambulatory patients, and a postanesthesia care unit, lacked comprehensive pharmacy services; this resulted in poor drug-use control and accountability, varied controlled-substance audit trails, and suboptimal patient services. A task force examined other institutions' OR pharmacy satellites and chose to implement a satellite that provides all pharmaceuticals and i.v. admixtures by using case trays for each surgical patient. One year after implementation of the satellite, inventory in the operating-room areas was reduced by 56.5%, annual pharmaceutical costs by 2.6% (adjusted for inflation), and average cost per patient by 8.0% (adjusted for inflation). First-year cost reductions and revenue identification exceeded operating costs for materials, supplies, and labor by $271,755. Implementation of an OR pharmacy satellite reduced the net cost of providing pharmaceutical services to the OR.

Ambulatory Care↗

PubMed1979

[Contamination of the operating room with anesthetic gases and vapors. Analytical methods].

An approach for the measurement of the contamination of the operating room air is presented. The measurements were performed in three operating rooms used for general surgery, partly in model experiments and partly while anesthesia was in progress. During anesthesia, the measurements were taken when oxygen 3 l/min containing ethrane 1.0--1.5% was passed into a semi-closed circle and the exhaled gas vented directly to the environmental air with no scavenging system in use. The daily exposure of operating room personnel was determined by adsorption of ethrane on glass tubes containing activated charcoal. The ethrane was subsequently desorbed in toluol and quantified by gas chromatography. The concentration of contaminant was found to be significantly greater in the anesthesiologist's position than in the areas of surgeon and circulating nurse. Some pitfalls in sampling, standardization, and analysis are indicated. Attention is drawn to the numerous factors influencing the extent of contamination.

Air Pollution↗

PubMed1976

Atmospheric derivatives of anaesthetic gases as a possible hazard to operating-room personnel.

During surgical procedures in which nitrous oxide (N2O) anaesthesia was administered there was an increased concentration of both nitric oxide (NO) and nitrogen dioxide (NO2) in operating-room air. Preliminary studies suggest that the use of certain devices (e.g., electric cauteries, X-ray machines) capable of releasing energy in the operating-room produce the oxidation of nitrous oxide. Further evaluation of gas phase reactions of anaesthetic agents within the operating-room appear warranted, particularly in relation to the occupational risks of operating-room personnel.

Abnormalities, Drug-Induced↗

PubMed1978

Operating room nurses' psychomotor and driving skills after occupational exposure to halothane and nitrous oxide.

Concentrations of halothane and nitrous oxide were assayed by gas chromatography throughout a working day in three operating theatres and in the end-tidal air of 19 nurses 15 and 60 min after leaving the theatres. Perceptual, psychomotor and driving skills were measured in these nurses and in 11 younger nurses working in the wards of the same hospital. A complicated psychomotor test battery and a driving simulator were used. End-tidal air concentrations of halothane and nitrous oxide were positively correlated with the exposure level of these gases in the operating theatres. Some of the operating room nurses had greater amounts of halothane in their end-tidal air (average 15 to 10 ppm) than student volunteers 4.5 h after 3.5 min of general anaesthesia with a combination of halothanenitrous-oxide oxygen (10 ppm halothane). These volunteers had worse psychomotor and driving performances when measured than controls who had not been anaesthetized. No correlations were found between the concentrations of halothane or nitrous oxide in end-tidal air and psychomotor or driving performance. Despite their higher age and exposure to the operating room environment, the driving skills of the operating room nurses were similar to those of the ward nurses. The results suggest that tolerance to anaesthetic gases develops among operating room personnel. No impairment of driving skills can be expected after daily exposure to halothan and nitrous oxide among long-term employees in operating theatres.

Air Pollutants↗

PubMedDate not supplied

Operating room scheduling by computer.

The surgical operating room schedule has been produced automatically for more than 2 years in our large teaching hospital. In order to apply computer technology to the complex surgical scheduling problem a special programming approach was devised. We discuss this approach under the headings of Expand, Sort, Order and Assign. Consistent, reliable schedules, unaffected by weekends and holidays, are produced by a clerk trained to use a computer terminal. Our program is adapttable to other institutions once the scheduling parameters and operating priorities are delineated.

Anesthesiology↗

PubMed1979

Environmental bacteriology in the unidirectional (vertical) operating room.

An integrated body exhaust/clean air operating room system was evaluated in terms of the microbiologic and particulate contamination control it afforded. The clean air unit was of a vertical unidirectional airflow design and employed high-efficiency particulate air filters to provide air low in both microbes and particulates. The body exhaust portion of the system was composed of an exhaust tube the surgeon's mask, a transparent plastic faceplate, and a microbe-retentive surgical gown and hood. Measurements were made of airborne and surface contamination at the wound site and of microbial burden levels associated with the surgical team. Sampling techniques were designed to parallel those used in a previous study of a horizontal flow/body exhaust system so as to provide comparative data on the effect of airflow configuration on wound site contamination. The data showed the vertical flow room to exhibit significantly lower (P less than .05) contamination levels than the horizontal flow enclosure. Surgical lights, draping techniques, and personnel and material positoning unobstructive to the airstream were judged to the prime factors in reducing wound site contamination.

Air↗