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PubMed2001

Candida osteomyelitis and diskitis after spinal surgery: an outbreak that implicates artificial nail use.

Postoperative wound infection after laminectomy is uncommon. In February 1997, 3 patients were confirmed to have postlaminectomy deep wound infections due to Candida albicans. No similar case had been seen during the previous 10 years. The infections were indolent, with a mean time from initial operation to diagnosis of 54 days (range, 26-83 days). All patients were successfully treated. Pulsed-field gel electrophoresis revealed the Candida isolates to be identical. A case-controlled study and medical record review revealed that a single operating room technician scrubbed on all 3 infected case patients but on only 32% of the uninfected controls. The technician had worn artificial nails for a 3-month period that included the dates of laminectomy site infections, and C. albicans was isolated from her throat. She was treated with fluconazole and removed from duty. No subsequent cases have occurred during the ensuing 3 years. Artificial nails are known to promote subungual growth of gram-negative bacilli and yeast. This may be clinically relevant, and hospitals should enforce policies to prevent operating room personnel from wearing artificial nails.

Adult↗
PubMed1996

The psychological outcome of breast reconstruction.

My first experience with breast cancer as a nurse was in 1974. I was a 23-year-old nursing student and working as an operating room technician. A radical mastectomy was being performed on a 52-year-old woman. As I passed clamps and scissors to the two surgeons, I struggled to conceal the shock I was experiencing. "Is it really necessary to remove so much tissue for such a small lump?" "Yes," the doctor replied, "It's either this or she'll die." It was 10 years later that I would begin my work with patients undergoing breast reconstruction. During the 7-1/2 years that I worked as an operating room supervisor and assistant to a plastic surgeon, I responded to the needs of a number of women during their time of crisis. We would see each other every week or two for a year, become friends, and treatment would come to an end. Their lives would go on, and I would continue my work with a new patient, then another and another. My work with reconstruction patients continues as Patient Information Coordinator for Mentor H/S, a breast implant manufacturer. Hundreds of women who have had breast cancer call me each year. I provide information, answer questions, and help educate. Etched in my memories are emotion-filled faces and voices of shock, fear, confusion, sorrow, and resignation followed by acceptance. Individual women of various lifestyles and personalities as well as different levels of financial and social status, all have one thing in common--breast cancer, mastectomy, decisions, and reconstruction. Many were experiencing an interruption in their lives, a stress on their relationships and a drain on their finances. But the even greater challenge they faced was the life and death crisis of an illness that is both life threatening an disfiguring. Researchers such as Schain, Goldberg and Kasper have documented the psychological effects of breast-loss for women and their relationships (Schain, 1991; Goldberg, Stoltzman, & Goldberg, 1984; Kasper, 1995). Jones, Matheson, and Rowland looked at psychological adjustment, counseling needs and patients' response to their altered body image (Jones & Reznikoff, 1989; Matheson & Drever, 1990; Rowland, Holland, Chaglassian, & Kinner, 1993). The alteration of body image first occurs with mastectomy and continues with reconstruction. Goin, Cederna and Wellisch provide insight into the effects of various types of reconstruction (Goin & Goin, 1988; Cederna, Yates, Chang, Cram, & Ricciardelli, 1995; Wellisch, Schain, Noone, & Little, 1987). The following article is a compilation of my personal experience, and excerpts from literature presented as an overview of the psychological effects of mastectomy and reconstruction.

Adaptation, Psychological↗
PubMed2004

Randomized trial to compare perioperative outcomes of Filshie clip vs. Pomeroy technique for postpartum and intraoperative cesarean tubal sterilization: a pilot study.

OBJECTIVE: To compare, by conducting a randomized trial, Filshie clip and Pomeroy techniques for postpartum and intrapartum cesarean sterilizations in a United States teaching hospital with respect to surgeon preference and perioperative outcomes. METHOD: Thirty-two obstetric patients consented for sterilization were randomized to Pomeroy technique or Filshie clip placement. Following the surgical procedure, surgeons and operating room technicians completed a survey regarding their experience with the procedures and preference. Patient demographic data, time for procedure and follow-up visits were obtained by chart review. RESULTS: For most postpartum sterilizations, the mean duration of the procedure was almost 7 min faster for the Filshie clip technique (p = 0.08); perioperative outcomes were equivalent (p = 0.05). Application of the Filshie clip was rated easier than Pomeroy suture application and, overall, the Filshie clip sterilization procedure was rated less difficult (p = 0.03). Seventy percent of surgeons preferred the Filshie clip technique and would choose it if only one postpartum sterilization method was available. CONCLUSION: For obstetric sterilization, surgeons preferred the Filshie clip over the Pomeroy technique. In addition, operating time was shorter for the Filshie clip. This pilot study suggests that use of the Filshie clip technique has the potential to establish a new standard of care for postpartum and intrapartum cesarean sterilization.

Adult↗
PubMed1995

Strategies for success in academic surgery.

BACKGROUND: A growing concern among university surgeons is a perceived threat to the traditional academician role. Factors that have led to this concern include (1) changes in reimbursement and patient referral patterns, both of which have resulted in reduced income; (2) mounting external pressure from the departmental chairperson/dean to generate professional fees; (3) pervasive ambiguity in the criteria for promotion and tenure; (4) intensified competition for research dollars in recent years; and (5) a perception that fellow academicians view surgeons as operating room technicians incapable of laboratory research. These cogent issues have the means to place academic goals in jeopardy. Potentially they lead to dissatisfaction, unhappiness, and eventual departure from academia. A healthy solution to the problem includes departmental recognition and reward for whichever primary role/s the academic surgeon embraces--clinical, educational, research, or administrative. Clear chairperson-faculty communication on the issues of expectation and reward is a key ingredient in the solution. METHODS: A mail survey was conducted with chairpersons of surgical departments and academic surgeons addressing the issues of retention, promotion, and benefits. RESULTS: Results revealed significant differences in perceptions, suggesting the need for improved communication between faculty and chairpersons and a team approach to help maintain academic viability in the future. CONCLUSIONS: When the quadruple threat can be mutually described as a departmental rather than individual quality, the joys and rewards of academic surgery can be considerable for faculty and chairpersons alike.

Academic Medical Centers↗
PubMed1999

A survey of percutaneous/mucocutaneous injury reporting in a public teaching hospital.

Our objective was to determine if healthcare workers were reporting all percutaneous and/or mucocutaneous injuries and to use such data to formulate appropriate interventions. The Infection Control Department distributed anonymous surveys of healthcare personnel between 1992 and 1995. The elicited information included the number of percutaneous and mucocutaneous injuries experienced and reported in the last five years and the reasons for not reporting every exposure when applicable. Five hundred and forty nine surveys were received, from physicians, dentists, registered nurses, licensed vocational nurses, nurses aides, and operating room technicians. Overall, of the 549 respondents, 45% (245) had no injuries, 30% (163) had been injured and had reported all injuries, and 26% (141) had not reported all injuries. Reasons for not reporting included sterile/clean needlestick (39%), little or no perception of risk to employee (26%), too busy (9%), and dissatisfaction with follow-up procedures (8%). Reasons stated for not reporting injuries indicate a need for continued education in the risk of acquiring blood-borne pathogens from such injuries. The results also illustrate the importance of targeting prevention efforts to specific groups, such as physicians, that would not be identified by routine reporting mechanisms.

Attitude of Health Personnel↗
PubMed2002

Differences in bone-cement porosity by vacuum mixing, centrifugation, and hand mixing.

The mean pore size and percent porosity of vacuum-mixed cement were compared with centrifuged cement and cement hand mixed by skilled specialized operating room technicians. Centrifuged cement samples had the smallest mean pore size when compared with vacuum-mixed specimens. The mean pore size for the hand-mixed specimens was intermediate and not significantly different from the other 2 mixing techniques. Results were reversed, however, for mean percent porosity. Centrifuged cement had the highest percent porosity; vacuum-mixed cement, the lowest; and hand-mixed cement, intermediate. The porosity of vacuum-mixed Simplex P (Howmedica, Rutherford, NJ) bone-cement was similar from the initial to the remnant cement extruded from the cement gun. There was no reduced cement porosity with vacuum mixing or centrifugation as anticipated. Reversion to hand mixing by highly skilled technicians could result in a significant cost savings without negative effects on cement porosity.

Bone Cements↗
PubMed1984

The microsurgical assistant.

The increasing indications for microsurgical reconstruction, and the expansion of the field into multiple surgical subspecialities, have led to a need to find ways to conserve operating time, promote increased surgical skill and efficiency, and train and maintain an interest among capable surgeons. The trained microsurgical assistant is a solution to many of these goals and requirements. Since 1979, we have trained 15 nurses, surgeons' assistants, and operating room technicians in this capacity.

Curriculum↗
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↗
PubMed1996

Intra-operative pneumatic tourniquet--perceptions of use and complications in the orthopaedic community of South Africa.

OBJECTIVES: To assess views on use, maintenance and side-effects of the pneumatic tourniquet in the South African orthopaedic community. METHODS: A census-type questionnaire study was conducted of all 475 orthopaedic surgeons registered with the Orthopaedic Association of South Africa during 1993/94. The chi-square test was used to determine statistical significance between different groups of respondents. RESULTS: Seventy-seven per cent of the questionnaires were returned. Ninety-nine per cent of respondents used a pneumatic tourniquet. Eighty-four per cent believed that the tourniquet may damage underlying tissue both as a result of applied pressure effects and ischaemic consequences. Fifty-four per cent of respondents personally checked the calibration of the pneumatic tourniquet, although 76% of respondents believe that the apparatus needs to be checked at least once per month. More respondents who did not check the tourniquet apparatus than respondents who did check it believe that applied pressure does not cause tissue damage (P < 0.001), that the operating room technician or hospital engineer should be responsible for checking equipment (P < 0.001), and that equipment did not need to be checked more than once every 6 months (P < 0.001). CONCLUSIONS: Although most orthopaedic surgeons are aware of the pneumatic tourniquet's side-effects, a minority appear to be unaware of the hazards of excessive applied pressure alone or excessive applied pressure caused by use of faulty equipment. It needs to be emphasised to these surgeons that regular checking of the pneumatic tourniquet apparatus is necessary in order to prevent postoperative complications ascribed to use of the tourniquet.

Bandages↗
PubMed2006

Interdisciplinary work flow assessment and redesign decreases operating room turnover time and allows for additional caseload.

HYPOTHESIS: Operating room turnover time (TOT) and daily caseload can be improved by analyzing the routine tasks of the operating team and minimizing inefficiencies. DESIGN: In this prospective study, the assigned tasks and work flow patterns of the anesthesiologist, circulating nurse, and surgical technologist during operations and operating room turnover were studied and changes were implemented where inefficiencies were observed. A brief pilot followed by a broader-scale study was conducted. SETTING: Tertiary care center. PARTICIPANTS: Circulating nurses and surgical technicians were routinely assigned to work with one anesthesiologist and one surgeon during the pilot study; 4 surgeons and 32 anesthesiologists participated in the follow-up study. INTERVENTIONS: The work flow diagram of each individual was redrawn, and changes were implemented. Critical moments were identified, in which brief assistance from other personnel was needed to improve efficiency. MAIN OUTCOME MEASURES: Operative TOT and number of daily operations were the main outcomes. A 2-tailed t test was used to compare the TOTs; chi(2) analysis was used to compare the number of cases completed. Significance was defined as P<.05. RESULTS: A total of 401 operations and 253 turnovers were evaluated. Redesign decreased operating room TOT from 43.7 to 27.7 minutes (P<.001). The mean number of cases completed per day increased from 1.78 to 2.34 (P<.001). CONCLUSION: Interdisciplinary work flow assessment and redesign resulted in decreased operating room TOTs and additional cases being completed each day for 4 different surgeons.

Anesthesiology↗
PubMed1981

Anaesthesia technicians in Quebec: the background and the role.

Anaesthesia technicians are respiratory technologists who received their education in CEGEPs. Every respiratory technologist, when he finishes his course, is specially trained to become an anaesthesia technician. The tasks are delegated to anaesthesia technicians according to the task description of the anaesthetist. This specialist in the current practice must comply with the principles of the art of medicine: he makes a diagnosis by evaluating the risk of each patient who will be anaesthetised and by evaluating the patient's state along the course of anaesthesia and operation; then he decides on the treatment, i.e. he chooses the anaesthetic technique that is suitable for him and he modifies it during the operation according to the needs of the patient. In the diagnosis-treatment procedure, we find a part of decision and a part of execution. It is clear that the decision is reserved exclusively to the anaesthetist but the execution of certain tasks may be delegated to technicians. The task description for the anaesthesia technician has been developed in accordance with these principles and in accord with the new "Guide to Anaesthesia Practice" of the Corporation of Physicians of the Province of Quebec that does not agree with double booking of anaesthetists. Finally, we discuss employment of the technicians in the various operating rooms according to the variety of surgery that is done in each room and the work load that is generated. Experience with this organization has convinced us that the anaesthesia technicians, through their clinical and technical contribution, provide an infrastructure in a department of anaesthesia which permits smooth and efficient functioning of the department. It also relieves the anaesthetist of certain energy-consuming and time-consuming tasks.

Anesthesia↗