Influence of operating room conduct on wound infections.
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The audibility and the identification of 23 auditory alarms in the intensive care unit (ICU) and 26 auditory alarms in the operating rooms (ORs) of a 214-bed Canadian teaching hospital were investigated. Digital tape recordings of the alarms were made and analysed using masked-threshold software developed at the Université de Montréal. The digital recordings were also presented to the hospital personnel responsible for monitoring these alarms on an individual basis in order to determine how many of the alarms they would be able to identify when they heard them. Several of the alarms in both areas of the hospital could mask other alarms in the same area, and many of the alarms in the operating rooms could be masked by the sound of a surgical saw or a surgical drill. The staff in the OR (anaesthetists, anaesthesia residents, and OR technologists) were able to identify a mean of between 10 and 15 of the 26 alarms found in their operating theatres. The ICU nurses were able to identify a mean of between 9 and 14 of the 23 alarms found in their ICU. Alarm importance was positively correlated with the frequency of alarm identification in the case of the OR, rho = 0.411, but was not significantly correlated in the case of the ICU, rho = 0.155. This study demonstrates the poor design of auditory warning signals in hospitals and the need for standardization of alarms on medical equipment.
Staffing the operating room requires a different approach than staffing inpatient units. Of course, there are similarities, namely: assuring safe, cost-effective care; dealing with fluctuating workloads; using various types of caregivers; and maximizing and maintaining resources in a responsible manner. However, many differences also exist. This article details the fundamental requirements for determining operating room staffing.
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The study in a group of 24 (11 anaesthetists and 13 support staff) was planned to ascertain the cytogenetic risk in a group of theatre personnel who worked in various city hospitals. Their exposure in terms of duration of service vary from 3-30 years. The control group (n = 24) consisted of people with different occupations matched for possible confounding variables. Cytogenetic risk was assessed in terms of chromosome aberration and sister chromatid exchange in 72-hour lymphocyte cultures. A significant increase in the percentage of chromosome aberration was observed. The sister chromatid exchange was double that of the baseline value in 20% of the exposed individuals. These findings indicate the possible risk of cytogenetic damage for staff working in unscavenged rooms.
Assistant theatre practitioners (ATPs) are healthcare assistants (HCAs) with additional training, extending their practice to include limited, supervised roles in scrub and recovery support. They have the potential to increase the flexibility of the theatre team and aid retention of critical staff. Will they become an essential member of your perioperative team? What are the risks and issues associated with the role? How can they be implemented safely? Theatre teams around the country are addressing these, and many other questions. This article will tackle some of the concerns and report progress so far.
The expansion of support staff roles throughout the NHS was identified as a key element in the drive for service improvements set out in the NHS plan (Department of Health 2000). However, while examination of the literature identified the opinions of professional representative bodies (Perioperative Care Collaborative 2002a&b), little published data is available of the opinions of staff 'on the shop floor'.
We measured the scattered radiation received by theatre staff, using high-sensitivity electronic personal dosimeters, during fixation of extracapsular fractures of the neck of the femur by dynamic hip screw. The dose received was correlated with that received by the patient, and the distance from the source of radiation. A scintillation detector and a water-filled model were used to define a map of the dose rate of scattered radiation in a standard operating theatre during surgery. Beyond two metres from the source of radiation, the scattered dose received was consistently low, while within the operating distance that received by staff was significant for both lateral and posteroanterior (PA) projections. The routine use of lead aprons outside the 2 m zone may be unnecessary. Within that zone it is recommended that lead aprons be worn and that thyroid shields are available for the surgeon and nursing assistants.
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A new approach to anterior circulation aneurysms is described in which the position of the surgeon is radically different from usual, allowing an enhanced view along the plane of the parent artery with minimal retraction and proximal control. The position of the surgeon and assistant are comfortable, and the scrub nurse's access to the surgeon's hands is greatly enhanced.
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The findings of a comparative study of cost awareness amongst particular groups of health service staff are reported. The study is a repeat of that undertaken in 1987 by Fairbrass and Chaffe. The findings are compared to assess how awareness of the cost of anaesthetic drugs, fluids and disposables has changed as a result of the publicity since 1987. Without prior warning, the study group were asked to estimate the cost of twenty-eight items. The results show that their degree of accuracy remains poor. Overall the tendency was to overestimate costs, whilst a small number of expensive items such as volatile agents were consistently underpriced. The results show that, over the last three years, there has been no significant change in the knowledge of cost awareness. At a time when the effective use of scarce resources is being emphasised, a staff programme of continuing cost awareness training is recommended.
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