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At least 19 recordsLinked to original sources
PubMed1991

Blood contacts during surgical procedures.

Operating room personnel are at risk for infection with blood-borne pathogens through blood contact. To describe the nature and frequency of blood contact and its risk factors, trained observers monitored a sample of operations performed by six surgical services at Grady Memorial Hospital, Atlanta, Ga, for 6 months. In 62 (30.1%) of 206 operations, at least one blood contact was observed. Of 1828 operating room person-procedures observed, 96 (5.3%) had 147 blood contacts (133 skin contacts [90%], 10 percutaneous injuries [7%], and four eye splashes [3%]). The mean number of blood contacts per 100 person-procedures was highest for surgeons (18.6). The frequency of percutaneous injury was similar among surgeons and scrub staff (mean, 1.2 per 100 worker-procedures for each group). Risk factors for surgeons' blood contacts were (1) performing a trauma, burn, or orthopedic emergency procedure (odds ratio [OR], 4.1; 95% confidence interval [CI], 2.0 to 8.7); (2) patient blood loss exceeding 250mL (OR, 2.1; 95% CI, 1.2 to 3.7); and (3) being in the operating room longer than 1 hour (OR, 3.3; 95% CI, 1.6 to 7.1). Of 110 blood contacts among surgeons, 81 (74%) were potentially preventable by additional barrier precautions, such as face shields and fluid-resistant gowns. Twenty-one (84%) of 25 blood contacts among surgeons in procedures in which all three risk factors were present were potentially preventable by additional barriers. Of 29 blood contacts among anesthesia and circulating personnel, 20 (69%) would have been prevented by glove use. For surgical procedures in which operating room personnel are at increased risk of blood contact, reevaluation of surgical technique, use of appropriate barrier precautions, and development of puncture-resistant glove materials are indicated.

Accidents, Occupational↗
PubMed1990

Environmental concerns in surgery in the 1990s.

1. The surgical environment is the sum of the physical and the functional milieu in which surgical operative procedures are carried out in the course of patient care. 2. Although we acknowledge advances in surgical technology that have made possible a whole array of new procedures, we must be concerned with their effects on the surgical environment of the 1990s. These concerns include control of the spread of blood borne diseases and the lagging field of infectious and hazardous waste disposal. 3. The needs are clear for better departmental and institutional master planning, better systems analysis, better inservice training of personnel, and more precise and functional programming and planning. All must be accomplished within a framework of safety, efficiency, and economy.

Environment, Controlled↗
PubMed1977

[Combined surgical procedures in operations of stomach, duodenum and biliary system (author's transl)].

In a period of 4 years in the Clinic of Abdominal- and Transplantation Surgery of the Medical School Hannover in 52 patients with operations of the biliary system 56 combined surgical procedures and in 48 patients with operations of stomach and duodenum 51 combined surgical procedures were performed. In comparison with groups of patients, treated with similar operations as single procedures, the increase of risk was studied. It was found, that combined procedures of medium-sized trauma, which mostly depended on simultaneous injuries of both organs, caused an elevation of operation stress as well as an increase of complications. Small combined procedures indicated no elevation of risk. In accordance with our results, we postulate a very careful reflection on indication of combined surgical procedures together with operations of stomach, duodenum or biliary system.

Age Factors↗
PubMed1986

Role of preoperative hemodynamic monitoring in intraoperative fluid management.

In this study the hemodynamic factors which contribute to postoperative mortality and morbidity were evaluated in 41 patients. Preoperative data were prospectively collected over a 5-year period. The patients underwent vascular and general surgical operative procedures. Among them, 23 patients had minor or no postoperative complications (group 1) and 18 patients suffered serious complications or died (group 2). Preoperative cardiac function was better in group 1, but both groups achieved their best cardiac index (CI) with fluids or pharmacologic manipulation preoperatively. Group 2 patients had longer operations, more blood loss, and were significantly hypovolemic postoperatively as indicated by lower pulmonary arterial wedge pressure (PAWP) and CI in comparison to the best preoperative values. When postoperative PAWP was higher than or within 3 mm Hg of the best preoperative level, complication rate was 14 per cent (3 of 21). In 15 of the 19 or 79 per cent of the patients, postoperative complications developed when PAWP decreased by 4 mm Hg or more. The difference in complications was significant (P less than 0.01). However, commonly measured parameters such as the amount of fluid infused, urine output, immediate postoperative heart rate, blood pressure, central venous pressure, and hemoglobin failed to reveal hemodynamically significant hypovolemia or lacticacidemia in group 2. The authors were unable to demonstrate a reduction in mortality or morbidity in group 2 patients in whom serious technical operative difficulties were also encountered.

Aged↗
PubMed1991

Surgical wound infection rates by wound class, operative procedure, and patient risk index. National Nosocomial Infections Surveillance System.

To perform a valid comparison of rates among surgeons, among hospitals, or across time, surgical wound infection (SWI) rates must account for the variation in patients' underlying severity of illness and other important risk factors. From January 1987 through December 1990, 44 National Nosocomial Infections Surveillance System hospitals reported data collected under the detailed option of the surgical patient surveillance component protocol, which includes definitions of eligible patients, operations, and nosocomial infections. Pooled mean SWI rates (number of infections per 100 operations) within each of the categories of the traditional wound classification system were 2.1, 3.3, 6.4, and 7.1, respectively. A risk index was developed to predict a surgical patient's risk of acquiring an SWI. The risk index score, ranging from 0 to 3, is the number of risk factors present among the following: (1) a patient with an American Society of Anesthesiologists preoperative assessment score of 3, 4, or 5, (2) an operation classified as contaminated or dirty-infected, and (3) an operation lasting over T hours, where T depends upon the operative procedure being performed. The SWI rates for patients with scores of 0, 1, 2, and 3 were 1.5, 2.9, 6.8, and 13.0, respectively. The risk index is a significantly better predictor of SWI risk than the traditional wound classification system and performs well across a broad range of operative procedures.

Centers for Disease Control and Prevention, U.S.↗
PubMed1977

[Risk of combined surgical procedures in operations of colon and rectum (author's transl)].

In a period of 4 years in the Clinic of Abdominal- and Transplantationsurgery of the Medical School Hannover 63 combined surgical procedures were performed in 56 patients with operations of colon and rectum. In comparison with a group of patients, who were treated with similar operations as a single procedure, the increase of risk was studied. Small combined procedures like appendectomia, herniotomia, exstirpation of cysts or removal of diverticula indicate no elevation of the operative risk. Cholecystectomy or prostatectomy, though increasing the entire trauma of operation, did not elevate the rate of complications significantly. In accordance with our results outlines regarding the performance and indication of operations in combination with colon- and rectum surgery are discribed.

Adult↗
PubMed1992

[A new approach to the intraoperative diagnosis of cholangitis and to the choice of surgical procedure in operations on the bile ducts].

The authors have developed a prompt and informative method for assessment of the depth and reversibility of the morphofunctional changes in the common bile duct (CBD) wall with the use of staining by hematoxylin basic, fuchsin-picric acid. Four types of the morphologic changes in CBD wall, which characterize the different degree of reversibility, were established. Depending of presence of these types, the corresponding surgical tactics is recommended.

Adult↗
PubMed1978

Prevention of surgical wound infection.

Operative wound infection is examined through classifications based on estimation of frequency, severity, and sources of infection. These classifications help in identifying preventive and corrective measures. All surgeons are concerned with postoperative infection because it can convert a superior technical result into a disaster. The analysis of postoperative infection is complicated by the complex and constantly changing relations among host, challenging microbe, and the existing antimicrobial measures. The effect of physical, pharmacologic, and biological variables is estimated with emphasis on measures that promise further control of infection in the surgical patient. Proposals are offered for further efforts in controlling this hazard.

Anti-Bacterial Agents↗