Health experiences of operating room personnel

In an attempt to evaluate health experiences of operating room personnel using previously published reports, the authors calculated summary relative risks (RRs) for each outcome under investigation by combining data from six studies. For each summary RR, they also calculated 95% confidence limits; when the range of the confidence interval excludes 1.0, the increased risk is statistically significant at the 0.05 level. The most consistent evidence was for spontaneous abortion among pregnant physicians and nurses who work in operating rooms, where the RR was 1.3 (95% confidence limits from 1.2 to 1.4). For liver disease there were statistically significant increased RRs among both men (1.6, 1.3-1.9) and women (1.5, 1.2-1.9), but these were based on smaller numbers of studies. Although the results of pooled analyses are suggestive, most studies of this issue have relied on voluntary responses and self-reported outcomes, so that response and/or recall bias could explain these findings. In addition, these investigations generally have examined working in operating rooms rather than actual exposure to anesthetic gases. Finally, there have been considerable improvements in operating room scavenging systems during the last decade. Thus, prospective cohort studies are needed to determine whether there is a relationship between current levels of occupational exposure to anesthetic gases and adverse outcomes, particularly spontaneous abortion and liver disease.     

Teamwork in the operating room: frontline perspectives among hospitals and operating room personnel

BACKGROUND: The Joint Commission on Accreditation of Healthcare Organizations is proposing that hospitals measure culture beginning in 2007. However, a reliable and widely used measurement tool for the operating room (OR) setting does not currently exist. METHODS: OR personnel in 60 US hospitals were surveyed using the Safety Attitudes Questionnaire. The teamwork climate domain of the survey uses six items about difficulty speaking up, conflict resolution, physician-nurse collaboration, feeling supported by others, asking questions, and heeding nurse input. To justify grouping individual-level responses to a single score at each hospital OR level, the authors used a multilevel confirmatory factor analysis, intraclass correlations, within-group interrater reliability, and Cronbach's alpha. To detect differences at the hospital OR level and by caregiver type, the authors used multivariate analysis of variance (items) and analysis of variance (scale). RESULTS: The response rate was 77.1%. There was robust evidence for grouping individual-level respondents to the hospital OR level using the diverse set of statistical tests, e.g., Comparative Fit Index = 0.99, root mean squared error of approximation = 0.05, and acceptable intraclasss correlations, within-group interrater reliability values, and Cronbach's alpha = 0.79. Teamwork climate differed significantly by hospital (F59, 1,911 = 4.06, P < 0.001) and OR caregiver type (F4, 1,911 = 9.96, P < 0.001). CONCLUSIONS: Rigorous assessment of teamwork climate is possible using this psychometrically sound teamwork climate scale. This tool and initial benchmarks allow others to compare their teamwork climate to national means, in an effort to focus more on what excellent surgical teams do well.     

Risk of blood contamination and injury to operating room personnel.

The potential for transmission of deadly viral diseases to health care workers exists when contaminated blood is inoculated through injury or when blood comes in contact with nonintact skin. Operating room personnel are at particularly high risk for injury and blood contamination, but data on the specifics of which personnel are at greater risk and which practices change risk in this environment are almost nonexistent. To define these risk factors, experienced operating room nurses were employed solely to observe and record the injuries and blood contaminations that occurred during 234 operations involving 1763 personnel. Overall 118 of the operations (50%) resulted in at least one person becoming contaminated with blood. Cuts or needlestick injuries occurred in 15% of the operations. Several factors were found to significantly alter the risk of blood contamination or injury: surgical specialty, role of each person, duration of the procedure, amount of blood loss, number of needles used, and volume of irrigation fluid used. Risk calculations that use average values to include all personnel in the operating room or all operations performed substantially underestimate risk for surgeons and first assistants, who accounted for 81% of all body contamination and 65% of the injuries. The area of the body contaminated also changed with the surgical specialty. These data should help define more appropriate protection for individuals in the operating room and should allow refinements of practices and techniques to decrease injury.     

Sevoflurane in exhaled air of operating room personnel

Evidence on potential health hazards arising from exposure to volatile anesthetics remains controversial. Exposure may, in principle, be supervised by monitoring of ambient air or, alternatively, in vivo. We used the Proton Transfer Reaction-Mass Spectrometry to screen the breath of 40 operating room staff members before operating room duty, 0, 1, 2, and 3 h after duty, and before commencing duty on the consecutive day, and control persons. Staff members exhibited significantly increased sevoflurane levels in exhaled air after duty, with a mean of 0.80 parts per billion as compared with baseline values of 0.26 parts per billion (P < 0.05). Analysis of variance with adjustment for within correlation (repeated measurements) showed a statistically significant time-effect (P < 0.001). We conclude that (a) Proton Transfer Reaction-Mass Spectrometry biomonitoring of exhaled sevoflurane can serve as a simple and rapid method to determine volatile anesthetic excretion after occupational exposure, and (b) significant concentrations of sevoflurane may be continuously present in persons exposed to sevoflurane on a daily basis. IMPLICATIONS: The present study depicts the profile of volatile anesthetics, isoflurane and sevoflurane, in exhaled air of ambulatory patients. Biomonitoring of expired anesthetic concentrations is a noninvasive and rapid method to determine volatile anesthetic excretion.     

Contamination of operating room personnel during total arthroplasty

The authors prospectively evaluated the degree of contamination to the operating room team during 60 consecutive total joint arthroplasties. Each member of the team was required to wear a hood, mask, protective eyewear, and shoecovers. At the conclusion of each procedure, all members were assessed in terms of degree and location of contamination. One hundred percent of the surgeons and first assistants were exposed. The face and eyewear were noted to be the area of greatest contamination. The authors found orthopedic surgeons to be at significant risk of contamination with blood and body fluids during total joint arthroplasty.     

Exposure of operating room personnel to nitrous oxide during paediatric anaesthesia

This study was undertaken to quantify the exposure of operating room staff to nitrous oxide during routine paediatric otolaryngeal surgery and to determine the influence of the method of induction of anaesthesia on this exposure. The nitrous oxide exposure of the anaesthetist, the surgeon and the circulating nurse were measured, using body-worn passive atmospheric samplers, during twelve routine paediatric otolaryngeal surgical lists. During six of the lists an inhalational technique, with nitrous oxide, oxygen and halothane, was used for the induction of anaesthesia. During the other six lists anaesthesia was induced using intravenous thiopentone. In all cases, anaesthesia was maintained using nitrous oxide, oxygen and halothane. Regardless of the induction technique used, the mean nitrous oxide exposures of the anaesthetist, the surgeon and the nurse all exceeded the maximum level of 25 ppm.hr-1 recommended by the United States National Institute for Occupational Safety and Health (NIOSH). The use of an intravenous technique for the induction of anaesthesia reduced the nitrous oxide exposure of the anaesthetist and the circulating nurse. This suggests that, although the use of an intravenous induction may reduce exposure to nitrous oxide, the NIOSH recommendations for maximum exposure of operating room personnel to nitrous oxide are currently unattainable in practice.     

Radiation exposure to the patient and operating room personnel during percutaneous nephrolithotomy

Introduction: The increased use of fluoroscopy during percutaneous nephrolithotomy (PCNL) places the urologist and operating room personnel at an occupational risk for measurable radiation exposure. We evaluated the degree of radiation exposure received by the patient and operating room personnel at our endourology facility during PCNL. Patients and method: The incident radiation dose to the patient and the urologist during 50 consecutive PCNL procedures was monitored using lithium fluoride thermo-luminescent dosimeter chips (TLD chips). A hand held radiation survey meter was used to measure the radiation in air at different positions occupied by various operating room personnel. The approximate distances of the various personnel from the X-ray tube were also measured. Results: PCNL was performed upon 35 males and 15 females. The average time for the procedure was 75 minutes (range: 30–150 min). The mean fluoroscopy screening time during the procedure was 6.04 min (range 1.8–12.16 min) with a mean fluoroscopy tube potential of 68 kVp and a mean tube current of 2.76 mA. The mean radiation exposure dose to the patient was 0.56 mSv (SD ± 0.35), while the mean incident radiation exposure to the finger of the urologist was 0.28 mSv (SD ± 0.13). Conclusion: The various operating room personnel are within safe radiation dose limits during PCNL. Efficient fluoroscopy further reduces the radiation scatter. All occupational personnel should ‘achieve as low as reasonably achievable’ dose by adhering to good practices.     

Noise pollution in the operating room: a hazard to surgeons, personnel, and patients.

Noise levels up to 118 dB--a level that is potentially damaging to the hearing--were measured in the operating room, notably during the use of high-speed gas turbine bone-cutting drills. Suction tips, which had trapped tissue "whistles" inside, yielded noise levels of up to 96 dB. Surgeons, staff, and patients should be cautioned against such noises and shielded in prolonged cases. We offer a review of acoustical criteria for various practical noises and duration of safe exposure.     

疑似或确诊新型冠状病毒肺炎患者相关手术室感染防控建议

根据新型冠状病毒肺炎的流行病学特点,结合国家近期印发的有关该疾病的相关防控方案、指引和感染防控的相关法律、法规,结合手术室工作特点,组织我省手术室护理专家制订首版-该疾病患者手术在手术室过程的感染防控指引,内容包括手术间准备、用物准备、手术人员准备、患者转运、手术中和手术后的管理等各个环节,以预防和控制新型冠状病毒肺炎手术患者在手术过程中造成交叉感染,并供全国各地医院手术室参考。     

Direct transport to the operating room for resuscitation of trauma patients

Two hundred forty trauma patients were transported directly from the scene to a specially designed operating room (OR) for resuscitation, bypassing the Emergency Department (ED). Triage criteria included a systolic BP less than or equal to 80 mm Hg, penetrating torso trauma, multiple long-bone fractures, major limb amputation, extensive soft-tissue wounds, severe maxillofacial hemorrhage, and witnessed arrest (WA). The mechanism of injury, transport mode, age, sex, admitting Revised Trauma Score (RTS), Injury Severity Score (ISS), Abbreviated Injury Scale (AIS), operative procedures, and outcome were recorded. Utilizing the current weights from the Major Trauma Outcome Study, the predicted survival (TRISS) of the total group and of several subgroups was compared to the observed survival. The mean ISS was 29.3. The survival rate for the total group was 70.4%. For the 58.7% who required major operative intervention, the mean time of OR arrival to anesthesia induction was 8.5 minutes. Non-arrested, hypotensive blunt trauma victims requiring therapeutic laparotomy had a higher than predicted survival observed survival = 0.75 versus average TRISS = 0.55; p less than 0.0002) and therefore appeared to benefit from this technique. Patients suffering witnessed arrest in the field did not benefit.     

手术室医护人员对设备性手术器械安全使用知识的认知调查

目的了解参与手术的医护人员对手术室设备性手术器械安全使用知识的掌握情况,为进一步提高其知识水平提供参考依据。方法对武汉某所三级甲等医院的68名手术室护士和42名医生使用自行设计的问卷调查其对设备性手术器械安全使用知识的认知及知识的获取途径。结果护士对设备性手术器械安全使用知识的总得分为49～100(76.73±2.94)分;医生得分为52～98(69.13±3.55)分,两者比较,差异有统计学意义(P0.01)。护士对手术室内电源的配备和常用设备性手术器械使用中安全隐患以及故障的排除方法知识方面的认知评分高于医生(P0.05,P0.01)。44.12%护士主要通过同事间介绍和经验交流获得手术室设备性手术器械的安全使用知识,而35.71%医生主要通过查阅相关文献而获得。结论护士和医生对手术室设备性手术器械安全使用知识的认知水平需进一步提高,手术医生更需要加强设备性手术器械安全使用相关知识的培训。