Bacterial contamination of propofol in the operating theatre.

There have been several reports of propofol becoming extrinsically contaminated with bacteria. These reports have usually related to infusions or delays in administration after the ampoule has been opened. This observational study was performed to examine bacterial contamination of propofol during usual practice in the operating theatres of a single large hospital group. One hundred samples of propofol were collected and cultured. Samples were taken immediately after administration in cases where the delay between opening the ampoule and administration was at least 15 minutes. The samples were classified according to whether the propofol was kept in the ampoule or a syringe after opening the ampoule and whether the intended use was for a single patient or multiple patients. The time between opening the ampoule and administration was recorded. There were three positive bacterial cultures. These samples all came from ampoules used for more than one patient, without the later dose (does) being drawn into a syringe at the time the ampoule was opened. This common clinical practice, especially in paediatric anaesthesia, does not comply with the manufacturer's recommendations. The clinical significance of the bacterial contamination detected is not clear. It is recommended that propofol should be handled in an aseptic fashion and measures taken to minimize the risk of bacterial contamination.     

Patient monitoring in the operating theatre

The vital importance of patient monitoring during anaesthesia is well recognised. There is little information available, however, on the actual practice of instrumental monitoring in the operating theatre. This study examined present-day practice and compared it with that of 1976. The main findings were an increase in frequency of electrocardiographic monitoring, especially for non-major surgery, and a smaller increase in blood pressure recording. Monitoring of other variables remained essentially unchanged. Possible reasons for this are given and suggestions made for improvements.     

From a radial operating theatre to a self-contained operating table

Equipment congestion and a disarray of wires, tubes and lines (the spaghetti syndrome) is a common scenario in operating theatres. The radial arrangement of input and output signals and their interconnecting lines has been identified as the main source of clutter and congestion in this environment. Our aim was to present a comprehensive design concept for reducing electrical and physical clutter in the operating theatre. Data were collected from different operating theatres, including identification and sorting of equipment, cables, tubes and lines according to the direction and the features of the transmitted information and materials. We suggest a concept of a self-contained, 'built-in' operating table as a design solution for avoiding the clutter and congestion caused by the radial configuration. The operating table will function as a central integrated unit for management of the entire process of patient flow and control of supply systems and environmental conditions.     

Suction tip contamination in the ultraclean-air operating theatre.

The surgical suction tip forms a reservoir for microorganisms during total hip replacement in conventional operating theatres. We assessed the colonisation of the tip in an ultraclean-air operating theatre in 39 patients, and found that 41% of them had evidence of bacterial colonisation with one or more bacteria. To avoid contamination we suggest that the suction tip is changed before preparation of the femoral canal and insertion of cement and prosthesis.