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. (+info)
Scattered radiation during fixation of hip fractures. Is distance alone enough protection?
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. (+info)
The operating room charge nurse: coordinator and communicator.
To achieve the potential inherent in the use of computer applications in distributed environments, we need to understand the information needs of users. The purpose of this descriptive study was to document the communication of an operating room charge nurse to inform the design of technological communication applications for operating room coordination. A data collection tool was developed to record: 1) the purpose of the communication, 2) mode of communication, 3) the target individual, and 4) the length of time taken for each occurrence. The chosen data collection categories provided a functional structure for data collection and analysis involving communication. Study findings are discussed within the context of application design. (+info)
Use of linear programming to estimate impact of changes in a hospital's operating room time allocation on perioperative variable costs.
BACKGROUND: Administrators at hospitals with a fixed annual budget may want to focus surgical services on priority areas to ensure its community receives the best health services possible. However, many hospitals lack the detailed managerial accounting data needed to ensure that such a change does not increase operating costs. The authors used a detailed hospital cost database to investigate by how much a change in allocations of operating room (OR) time among surgeons can increase perioperative variable costs. METHODS: The authors obtained financial data for all patients who underwent outpatient or same-day admit surgery during a year. Linear programming was used to determine by how much changing the mix of surgeons can increase total variable costs while maintaining the same total hours of OR time for elective cases. RESULTS: Changing OR allocations among surgeons without changing total OR hours allocated will likely increase perioperative variable costs by less than 34%. If, in addition, intensive care unit hours for elective surgical cases are not increased, hospital ward occupancy is capped, and implant use is tracked and capped, perioperative costs will likely increase by less than 10%. These four variables predict 97% of the variance in total variable costs. CONCLUSIONS: The authors showed that changing OR allocations among surgeons without changing total OR hours allocated can increase hospital perioperative variable costs by up to approximately one third. Thus, at hospitals with fixed or nearly fixed annual budgets, allocating OR time based on an OR-based statistic such as utilization can adversely affect the hospital financially. The OR manager can reduce the potential increase in costs by considering not just OR time, but also the resulting use of hospital beds and implants. (+info)
A comparison of communication needs of charge nurses in two operating room suites.
To achieve the potential inherent in the use of computer applications in distributed environments, we need to understand the information needs of users. Communication is the method by which information is transferred and is essential for all organizational interaction. The primary goal of operating room coordination is to insure the prompt, safe, and effective care of surgical patients. Nevertheless, larger organizational goals and characteristics can influence individual operating room information needs. The purpose of this paper is to describe the differing information needs in two operating suites by documenting the communication of OR charge nurses. A data collection tool was developed to record: 1) the purpose of the communication, 2) mode of communication, 3) the target individual, and 4) the length of time taken for each occurrence. The chosen data collection categories provided a functional structure for data collection and analysis involving communication. Study findings are discussed within the context of opportunities for application design (+info)
Practising evidence-based occupational health in individual workers: how to deal with a latex allergy problem in a health care setting.
BACKGROUND: Natural rubber latex, mainly contained in disposable medical gloves, is an important cause of occupational allergy in health care workers. Management of latex allergy includes education, reduction of cutaneous or mucosal contact with rubber products and minimization of exposure to latex allergens in the work environment. METHODS: This paper reports a case study dealing with the latex allergy health problem of an operating theatre nurse. The examination was required because of a recent onset rhino-conjunctivitis crisis and asthma during usual working activities. The case was investigated and a solution provided according to the evidence-based medicine (EBM) paradigm using the PICO model. RESULTS: The literature search was conducted using Medline and the Cochrane Library. Twenty-one papers were considered to offer appropriate solutions. Two main types of interventions were suggested: (i) changing the work setting, (ii) limiting the work activities. The evidence obtained was discussed with the nurse, who was considered unfit to continue her work in the operating theatre where her colleagues used latex gloves. The resident proposed that she could relocate to a work environment where only non-latex gloves were used and latex medical devices were not present. CONCLUSION: The case study shows that, as for other clinicians, the occupational physician can use the EBM paradigm according to the PICO model as a tool for providing appropriate solutions for the individual worker. (+info)
Glove perforation and contamination in primary total hip arthroplasty.
We conducted a randomised, controlled trial to determine whether changing gloves at specified intervals can reduce the incidence of glove perforation and contamination in total hip arthroplasty. A total of 50 patients were included in the study. In the study group (25 patients), gloves were changed at 20-minute intervals or prior to cementation. In the control group (25 patients), gloves were changed prior to cementation. In addition, gloves were changed in both groups whenever there was a visible puncture. Only outer gloves were investigated. Contamination was tested by impression of gloved fingers on blood agar and culture plates were subsequently incubated at 37 degrees C for 48 hours. The number of colonies and types of organisms were recorded. Glove perforation was assessed using the water test. The incidence of perforation and contamination was significantly lower in the study group compared with the control group. Changing gloves at regular intervals is an effective way to decrease the incidence of glove perforation and bacterial contamination during total hip arthroplasty. (+info)
"Near misses" in a cataract theatre: how do we improve understanding and documentation?
AIM: Near miss event reporting is widely used in industry to highlight potentially unsafe areas or practice. The aim of this study was to see if a descriptive method of recording near misses was an appropriate method for use in an ophthalmic operating theatre and to quantify how many untoward events were recorded using this system. METHODS: The study was wholly conducted in a cataract theatre in the United Kingdom. The theatre nurse assigned to the patient in their journey through the operating theatre was asked to note any untoward events. As, at present, there is no consensus definition of near misses in ophthalmology the nurses recorded, in free text, any events that they considered to be a deviation from the normal routine in that theatre. RESULTS: Of the 500 cases randomly chosen, 96 "deviations from normal routine" were described in 93 patients-that is, 19% of cases. All forms distributed to the nurses were returned (100% response rate). The commonest abnormal events were intraoperative (69), with a lesser number being recorded preoperatively (27). When these events were further classified, it was thought that 25 could be classified as near misses. One true adverse event was recorded during the study. CONCLUSIONS: The results suggest that experienced nursing staff in an ophthalmic theatre are a reliable source for collecting data regarding near misses. A consensus is now required to define near misses in ophthalmology and to devise a user friendly input system that can use these definitions to consistently record these potentially vital events. (+info)