Experiencia de reconversión de un servicio clínico anestésico-quirúrgico en unidad de pacientes críticos COVID-19 en un hospital universitario / Experience of transforming a clinical surgical-anesthetic unit into a COVID-19 critical patient one in a teaching hospital

INTRODUCTION: The experience of restructuring a clinical surgical-anesthetic unit into a critical patient unit in charge of surgical- anesthetic personnel is presented during the period from May to July 2020 in the context of a SARS-CoV-2 pandemic. OBJECTIVES: Describe the unit's restructuring process, considering technical aspects, changes in staff functions, clinical outcomes of the patients, quality indicators obtained and the psychological impact on the healthcare team. MATHERIAL AND METHODS: The strategies implemented by the responsible experts were described (ie: engineering). Clinical data were obtained from an insti- tutional database and electronical medical records. The management of human resources was described using administrative records of the services of anesthesiology, OR and critical patient unit. The psychological impact on the unit staff was evaluated by applying the Maslach questionnaire. The quality of the clinical management of the unit was obtained from the compilation of standardized quality indicators for the critical patient units of the institution. RESULTS: 25 patients were admitted in the unit. The mean age was 62 ± 12 years. About the complications, 52% had pulmonary embolism, 36% had acute kidney injury, and 1 patient died. The prevalence of Burnout Syndrome was 73.6%. The occurrence of adverse events was minimal. DISCUSSION: The transformation of an anesthetic-surgical unit into a COVID critical patient one, demands a complex net of coordinated strategies to allow facing the attention demand with positive clinical results, at the expense of the health care team mental health.

INTRODUCCIÓN: Se presenta la experiencia de reconversión de una unidad de cuidados posanestésicos a una unidad de cuidados intensivos a cargo de personal anestésico-quirúrgico entre mayo y julio de 2020, en contexto de pandemia por SARS-CoV-2. OBJETIVOS: Describir el proceso de reconversión considerando aspectos técnicos, pertinentes al recurso humano, resultados clínicos, indicadores de calidad e impacto psicológico en el equipo de salud. MATERIALES Y MÉTODOS: Se describen las estrategias implementadas por los expertos responsables. Se obtienen datos clínicos desde base de datos institucional y ficha clínica electrónica. Se describe la gestión del recurso humano utilizando registros administrativos de los servicios involucrados. El impacto psicológico en el personal fue evaluado aplicando el cuestionario de Maslach. La calidad de la gestión clínica se obtiene a partir de indicadores de calidad estandarizados para las unidades de pacientes críticos de nuestro establecimiento. RESULTADOS: Se atendieron 25 pacientes en la unidad. La edad promedio fue 62 ± 12 años. El 52% presentó tromboembolismo pulmonar, 36% injuria renal aguda como complicación. Un paciente falleció. La prevalencia de síndrome de Burnout fue de 73,6%. La ocurrencia de eventos adversos fue baja. CONCLUSIONESConclusiones: La reconversión de una unidad anestésico-quirúrgica a una unidad crítica COVID-19, demanda un complejo entramado de estrategias coordinadas que permiten responder a la demanda de atención con resultados clínicos positivos, a expensas del costo de la salud mental del equipo de salud involucrado.

Protocolo de cirurgia segura: análise da produção e execução em dois hospitais terciários / Surgical safety checklist: analysis of its elaboration and implementation in two tertiary hospitals / Protocolo de cirugía segura: análisis de producción y ejecución en dos hospitales terciarios

Objetivo: Analisar o processo de produção e execução do protocolo de cirurgia segura em dois hospitais terciários do município de Manaus. Método: Pesquisa guiada pelo design thinking, com ênfase na técnica do duplo diamante, realizada em dois hospitais públicos no município de Manaus, de julho de 2018 a março de 2019. Foi feita nas etapas: investigativa (observação e questionário) e interventiva (síntese, ideação e entrega). Resultados: Na primeira etapa, com 120 horas de observação, constatou-se que as três fases do protocolo não foram cumpridas; analisando-se as repostas a 63 questionários, reforçou-se a não adesão ao checklist. Com base nesses achados, na etapa de síntese, elegeu-se como foco a aplicação do checklist do protocolo; na etapa de ideação, realizou-se a proposição de solução e a testagem-piloto; a etapa de entrega da solução aos hospitais encerrou o ciclo. Conclusão: A análise do processo de execução do protocolo indicou seu descumprimento, o que sugere o comprometimento da segurança do paciente. A solução testada poderá, após entrega e implementação, contribuir para a execução efetiva do protocolo.

Objective: To analyze the process of elaboration and implementation of the surgical safety checklist in two tertiary hospitals in the city of Manaus. Method: This study was based on design thinking, focusing on the double diamond technique. It was conducted in two public hospitals in Manaus, from July 2018 to March 2019. The following stages were adopted for this research: investigation (observation and questionnaire) and intervention (synthesis, ideation, and delivery). Results: The first stage, consisting of 120 hours of observation, showed the non-fulfillment of the three phases of the process. After analyzing the answers to the 63 questionnaires, we confirmed the non-adherence to the checklist. Based on these findings, the synthesis phase focused on the use of the checklist; the ideation phase involved the proposal of solutions and the pilot testing; the delivery phase concluded the cycle by providing solutions to the hospitals. Conclusion: The analysis of the process of implementation of the checklist indicated non-compliance, suggesting risk to patient safety. After delivery and implementation, the tested solution may contribute to the effective execution of the checklist.

Objetivo: Analizar el proceso de producción y ejecución del Protocolo de Cirugía Segura en dos hospitales terciarios de la ciudad de Manaus. Método: Investigación guiada por Design Thinking, con énfasis en la técnica Double Diamond, llevada a cabo en dos hospitales públicos de la ciudad de Manaus, desde julio de 2018 hasta marzo de 2019. Se realizó por etapas: de investigación (observación y cuestionario) e intervencionista (síntesis, ideación y entrega). Resultados: En la primera etapa, con 120 horas de observación, se encontró que las tres fases del protocolo no se cumplieron; En base a las respuestas a 63 cuestionarios, se reforzó la no adhesión a la lista de verificación. Con base en estos hallazgos, en la etapa de síntesis, la aplicación de la lista de verificación del protocolo fue elegida como el foco; en la etapa de ideación, se llevaron a cabo la propuesta de solución y la prueba piloto;La etapa de entrega de la solución a los hospitales finalizó el ciclo. Conclusión: El análisis del proceso de ejecución del protocolo indicó incumplimiento, lo que sugiere comprometer la seguridad del paciente. La solución probada puede, después de la entrega y la implementación, contribuir a la ejecución efectiva del protocolo.

Practical Considerations for Converting Operating Rooms and Post-anaesthesia Care Units into Intensive Care Units in the COVID-19 Pandemic - Experience from a Large Singapore Tertiary Hospital

COVID-19 has spread globally, infecting and killing millions of people worldwide. The use of operating rooms (ORs) and the post-anaesthesia care unit (PACU) for intensive care is part of surge response planning. We aim to describe and discuss some of the practical considerations involved in a large tertiary hospital in Singapore. Firstly, considerations for setting up a level III intensive care unit (ICU) include that of space, staff, supplies and standards. Secondly, oxygen supply of the entire hospital is a major determinant of the number of ventilators it can support, including those on non-invasive forms of oxygen therapy. Thirdly, air flows due to positive pressure systems within the OR complex need to be addressed. In addition, due to the worldwide shortage of ICU ventilators, the US Food and Drug Administration has granted temporary approval for the use of anaesthesia gas machines for patients requiring mechanical ventilation. Lastly, planning of logistics and staff deployment needs to be carefully considered during a crisis. Although OR and PACU are not designed for long-term care of critically ill patients, they may be adapted for ICU use with careful planning in the current pandemic.

Surgical practice in the current COVID-19 pandemic: a rapid systematic review

The coronavirus disease (COVID-19) outbreak </mac_aq>started in Wuhan, China, in December 2019, and evolved into a global problem in a short period. The pandemic has led to many social and health-care challenges. In this context, surgery is an area that is facing the need for many adaptations. In this systematic literature review, we analyzed different perspectives concerning this situation, aiming to provide recommendations that could guide surgeons and </mac_aq>entities toward screening, elective and emergency surgeries, decision making, and operating room management. A computerized search in PubMed, Scopus, and Scientific Electronic Library Online (SciELO) for relevant literature up to April 4, 2020, was performed. Articles were included if they were related to surgery dynamics in the context of the COVID-19 pandemic. Of the 281 articles found in our initial search and 15 articles from alternative sources, 39 were included in our review after a systematic evaluation. Concerning preoperative testing </mac_aq>for severe acute respiratory syndrome coronavirus 2 infection, 29 (74.4%) articles recommended some kind of </mac_aq>screening. Another major suggestion was postponing all (or at least selected) elective operations (29 articles, </mac_aq>74.4%). Several additional recommendations with respect to surgical practice or surgical staff were also assessed and discussed, such as performing laparoscopic surgeries and avoiding the use of electrocauterization. On the basis of the current literature, we concluded that any surgery that can be delayed should be postponed. COVID-19 screening is strongly recommended for all surgical cases. Moreover, surgical staff should be reduced to the essential members and provided with institutional psychological support.

Impacto de un programa de prevención de infecciones en la conducta de cirujanos y anestesistas en un hospital público / Impact of an infection prevention program on the behavior of surgeons and anesthetists in a public hospital

Introducción: El control de las infecciones de sitio quirúrgico (ISQ) es importante en los programas de vigilancia y control de infecciones nosocomiales. Hay evidencias de que hasta un 60% podrían evitarse. Nuestro objetivo fue determinar si el porcentaje de cumplimiento de las medidas de prevención de ISQ fue mayor luego de la implementación de un programa en un hospital público.Material y métodos: Estudio comparativo inter-sujeto, observacional, retrospectivo y transversal. Se analizaron fichas de registro de cumplimiento de medidas de prevención pre y post instrumentación del programa, que consistió en entrega de ropa quirúrgica al ingreso al quirófano, difusión de las recomendaciones de prevención de ISQ y auditoría diaria. Variables: categoría profesional, uso adecuado de barbijo, de ambo y de camisolín, higiene de manos quirúrgica, cambio de ropa cuando se mancha, y manejo de efectos personales dentro del quirófano. Los datos fueron analizados empleando VCCstat3.0. Se estimaron intervalos de confianza del 95%.Resultados: En el control de la categoría "Profesional" hubo diferencias significativas en todas las variables auditadas entre cirujanos y anestesistas. Por lo tanto, se realizó un análisis de las poblaciones por separado. Cirujanos y anestesistas mejoraron el cumplimiento de ambo adecuado, cambio de ropa cuando se mancha y manejo de efectos personales dentro del quirófano. Los anestesistas, además, presentaron mejoras significativas en el uso adecuado de barbijo e higiene de manos quirúrgica. Conclusiones: La instrumentación del programa fue exitosa. Es importante continuar con los esfuerzos de la mejora. El efecto en las tasas de ISQ es un dato a medir.

Introduction: Surgical site infections (SSI) occupy a prominent place in nosocomial infection surveillance and control programs. There is evidence that up to 60% could be avoided. Our objective was to determine if the percentage of compliance with surgical infection prevention measures is higher after the implementation of a program in a public hospital.Methods: Intersubject, observational, retrospective and cross-sectional comparative study. Record of compliance with prevention measures before and after instrumentation of the Program were analyzed. The Program consisted of: delivery of surgical clothing upon admission to the operating room, dissemination of SSI prevention recommendations, daily audit. Variables: professional category, proper use of surgical mask, scrubs, and surgical gowns, surgical hand hygiene, change of clothes when stained, and handling of personal effects within the operating room. The data were analyzed using VCCstat 3.0. 95% confidence intervals were estimated.Results: In the control "Professional Category" variable, there were significant differences in all audited variables between surgeons and anesthetists, therefore, a separate population analysis was performed.Surgeons and anesthetists improved the compliance of both adequate, change of clothes when stained and handling of personal effects within the operating room. The anesthetists also presented significant improvements in proper use of chinstrap and surgical hand hygiene.Discussion: Program implementation was successful. Continuous efforts in the continuation of improvement is important. The effect on ISQ rates is a fact to be measured

Descripción de las herramientas de comunicación utilizadas en el área quirúrgica y la perspectiva de los instrumentadores quirúrgicos / Description of communication tools practices in the surgical area and the perspective of surgical instrumenters

La comunicación efectiva dentro de las organizaciones es uno de los factores más importantes para lograr un trabajo positivo y eficaz. Se realizó una investigación cuyo objetivo fue identificar y describir las herramientas de comunicación en el área de Quirófano Central del Hospital Italiano de Buenos Aires y las distintas perspectivas de los instrumentadores quirúrgicos respecto de su utilización. Métodos: se realizó un estudio de corte transversal con un componente de observación participativa de los medios de comunicación y una encuesta a los instrumentadores quirúrgicos de la institución. Resultados: se identificaron ocho tipos de herramientas de comunicación en el área quirúrgica. El correo electrónico (e-mail) como herramienta de comunicación es muy utilizado según los instrumentadores quirúrgicos, pero estos sugirieron otras herramientas más directas, como reuniones y capacitaciones solas o en combinación para determinados tipos de información. Conclusiones: los instrumentadores quirúrgicos utilizan una amplia gama de medios de comunicación en el área quirúrgica. La distribución de preferencias según el tipo de información indica que la elección de estos medios debería ser personalizada. (AU)

Effective communication within organizations is one of the most important factors to achieve a positive and effective work. An investigation was carried out and its objective was to identify and describe the communication tools in the surgical area of the Hospital Italiano de Buenos Aires and the different perspectives of the surgical nurses regarding its use. Methods: a cross-sectional study was carried out with a component of participative observation of the communication tools and a survey of the surgical nurses of the institution. Results: eight types of communication tools were identified in the surgical area. The implementation of email as a communication tool is widely used by surgical nurses, but they suggested other more direct tools such as meetings and training sessions alone or in combination for certain types of information. Conclusions: Surgical nurses use a wide range of communication tools in the surgical area. The distribution of preferences according to the type of information indicates that the choice of these tools should be personalized. (AU)

Enfrentando el dilema de las suspensiones: características e incidencia de las suspensiones quirúrgicas en un centro académico en Chile / Facing the dilemma of cancellations: incidence and characteristics of surgical cancellations in a Chilean academic hospital

Resumen Introducción: Las suspensiones quirúrgicas constituyen una problemática compleja en el ámbito de la administración de pabellones, que afecta tanto a pacientes como al personal de pabellón, y que compromete la eficiencia financiera de las instituciones de salud. Existe escasa información acerca de la incidencia y características de las suspensiones quirúrgicas en nuestro país. Objetivo: Caracterizar las suspensiones quirúrgicas en un centro académico chileno, describiendo su incidencia global y por especialidad. Materiales y Métodos: Se incluyó información recopilada de manera prospectiva acerca de la programación y actividad de pabellón, y de una cohorte de pacientes suspendidos de cirugía entre el 1 de enero de 2016 y el 20 de mayo de 2017. Para calcular el porcentaje de suspensiones se utilizaron 3 grupos en base a 6 períodos de 4 semanas. Se aplicó la transformación de doble arcoseno de Freeman-Turkey y el test-t de Student. Resultados: Durante el período del estudio se programaron 11.398 cirugías, de ellas 492 fueron suspendidas. La incidencia de suspensiones de los 3 períodos fue de 4,38% (IC 95% de 3,78% a 5,01%), 4,15% (IC 95% de 3,51% a 4,85%) y 4,10% (IC 95% de 3,50% a 4,74%) respectivamente. Al menos en un 57% de los casos la principal causa de suspensión se identificó como un cambio en la condición médica del paciente. Discusión y Conclusiones: Nuestros resultados muestran, de manera consistente, que las suspensiones se encuentran entre un 3% y un 5%, lo que está dentro de los estándares internacionales, y pueden ser utilizados como un "benchmarking" para comparaciones a nivel nacional.

Introduction: Surgical cancellations are a complex problem in the field of Operating Room Management, affecting patients, staff, including surgeons and anesthetists, and compromising the finances of health institutions. The available information about the incidence and characteristics of surgical cancellations in our country are scarce. Objective: The aim of this article is to characterize the surgical cancellations in a Chilean academic center, describing its global incidence and by specialty. Materials and Methods: Prospective information on surgical schedule and Operating Room activity was included in this cohort study of surgical case cancellations occurring from January 1, 2016 through May 20, 2017. To calculate the percentage of cancellations, 3 groups were used based on 6 periods of 4 weeks. The Freeman-Turkey double-arcsine transformation and Student's t-test were applied. Results: During the study period, 11,398 surgeries were programmed, of which 492 were cancelled. The incidence of cancellations for the 3 periods was 4.38% (95% CI 3.78% to 5.01%), 4.15% (95% CI 3.51% to 4.85%) and 4.10% (95% CI of 3.50% to 4.74%) respectively. In at least 57% of cases the main identifiable cause of cancellation was a change in the patient's medical condition. Discussion and Conclusions: Our results consistently show that the cancellation rates range between 3% and 5%, which is within international standards, and can be used as benchmarking for comparisons at a national level.

Applications for a hybrid operating room in thoracic surgery: from multidisciplinary procedures to ­­image-guided video-assisted thoracoscopic surgery / Usos da sala híbrida em cirurgia torácica: de procedimentos multidisciplinares à cirurgia toracoscópica videoassistida guiada por imagem

ABSTRACT The concept of a hybrid operating room represents the union of a high-complexity surgical apparatus with state-of-the-art radiological tools (ultrasound, CT, fluoroscopy, or magnetic resonance imaging), in order to perform highly effective, minimally invasive procedures. Although the use of a hybrid operating room is well established in specialties such as neurosurgery and cardiovascular surgery, it has rarely been explored in thoracic surgery. Our objective was to discuss the possible applications of this technology in thoracic surgery, through the reporting of three cases.

RESUMO O conceito de sala híbrida traduz a união de um aparato cirúrgico de alta complexidade com recursos radiológicos de última geração (ultrassom, TC, radioscopia e/ou ressonância magnética), visando a realização de procedimentos minimamente invasivos e altamente eficazes. Apesar de bem estabelecido em outras especialidades, como neurocirurgia e cirurgia cardiovascular, o uso da sala hibrida ainda é pouco explorado na cirurgia torácica. Nosso objetivo foi discutir as aplicações e as possibilidades abertas por essa tecnologia na cirurgia torácica através do relato de três casos.

Cómo planificar, diseñar y organizar un centro de cirugía ambulatoria / How to plan, design and organize an ambulatory surgery center

Los centros de cirugía ambulatoria han contribuido al progreso de esta cirugía y se caracterizan por ser eficientes, productivos, rentables y generar alta satisfacción. Construir un centro de cirugía ambulatoria requiere constituir un equipo multidisciplinario encargado de desarrollar un proyecto que evalúe la viabilidad económica, seleccione el tipo de centro a construir, determine el tamaño y el diseño del centro y defina la dotación de personal; con esta información se realiza la evaluación económica final que decide la factibilidad de construir el centro. Organizar el inicio de actividades y el funcionamiento de este servicio requiere determinar horarios, modalidad de trabajo, flujos de circulación y funciones del personal, a través de protocolos que definan, describan y coordinen todos los procesos clínicos y administrativos involucrados desde la indicación de la cirugía hasta el alta del paciente. La eficiencia del pabellón quirúrgico es determinante en el funcionamiento de un centro de cirugía ambulatoria. Varios factores contribuyen a la eficiencia de pabellón, y el más crítico de estos es el tiempo entre cirugías o tiempo de recambio de pacientes, el cual es factible de optimizar. La cirugía ambulatoria es una modalidad de trabajo quirúrgico que requiere un servicio clínico propio, adecuadamente planificado, diseñado y organizado para lograr sus objetivos y ventajas.

Ambulatory surgery centers have contributed to the progress of ambulatory surgery and they are characterized by its efficiency, productivity and to produce high satisfaction. To build an outpatient surgery center a multidisciplinary team should be responsible to develop a project that to assess the economic viability, to select the type of center, to determine the size and the design of center and to set de staffing; with this information the final economic evaluation that decide the feasibility to build the center must be performed. To organize the launch activities and the operation of this service requires determining schedules, working mode, traffic flows and staff functions through protocols that to define, to describe and to coordinate all clinic and administrative process involved from the surgery indication to the patient discharge. The operating room efficiency is determining factor in the ambulatory surgery center functioning. Several factors contribute to the operating room efficiency, the most critical of which is the time between surgical procedures o turnover time and this time is feasible to optimize. Ambulatory surgery is a mode of surgical work requiring its own clinical service properly planned, designed and organized to achieve its objectives and advantages.

Descripción de la aplicación de la lista de verificación quirúrgica en el servicio de cirugía del Hospital Privado de Córdoba Argentina. durante el periodo de agosto 2014-diciembre 2015

El problema de la seguridad de la cirugía es ampliamente reconocido en todo el mundo. Los datos estadísticos reflejan cifras preocupantes de complicaciones y muerte, en el porcentaje poblacional que se somete a intervenciones quirúrgicas, sean programadas o de emergencia. Existen antecedentes a lo largo de la historia enfatizando que el acto médico debe estar libre de daño. En las últimas décadas del siglo pasado, diversos estudios pusieron en el centro de la atención, tanto de la comunidad médica como de sociedad en general, la ocurrencia de errores durante la atención médica. Si bien es innegable que el desarrollo tecnológico ha producido avances importantes en el terreno de la salud, incrementando considerablemente la esperanza de vida, transitando hacia los procedimientos de mínima invasión y medicamentos con mayor eficacia, entre otros, sin embargo, la complejidad de éstos incrementa la posibilidad de que se presenten eventos adversos, mismos que no podemos anular, lo que sí está al alcance de todos es reducir al máximo los riesgos

ABSTRACT: The problem of safety of surgery is widely recognized throughout the world. Statistical data show alarming figures of complications and death in the population percentage who undergo surgery, whether planned or emergency. There are precedents throughout history emphasizing that the medical act must be free of damage. In the last decades of the last century, several studies put into the center of attention of both the medical community and society at large, the occurrence of errors in medical care. While it is undeniable that technological development has produced significant advances in the field of health, greatly increasing life expectancy, moving towards minimally invasive procedures and more effective drugs, among others, however, the complexity of these increases the possibility of adverse, same events that we can not cancel arise, which itself is accessible to all is to minimize the risks

Ergonomía: Factor de aplicación en los procesos de aprendizaje en cirugía / Ergonomics: Factor of application during surgery learning processes

La ergonomía pretende que los cirujanos dispongan de un material de trabajo adecuado, reduciendo la aparición de la fatiga muscular y de dolencias asociadas,aumentando la precisión en el acto quirúrgico. Objetivo: Identificar cuáles son los factores ergonómicos quepueden causar modificaciones en el rendimiento del cirujano. Observar cómo es el cambio ergonómico del cirujano a medida que avanza en el desarrollo de su actividad. Material y Método: Se realizaron 48 encuestas estandarizadas, normalizadas y anónimas a médicos residentes de cirugía general. Diciembre/2008 a Mayo/2013. Resultados: En el primer año de residencia los ítems considerados desfavorables fueron 13 (31,71%), y dentro de los considerados muy desfavorables 7 (31,82%) ambos en la postura física. En segundo año fueron considerados desfavorables 2(7,41%) por espacio en quirófano y muy desfavorables 4 (28,57%) en la postura física. En tercer año se observó 1 (8,34%) como desfavorable por espacio en quirófano y 2 (66,66%) comomuy desfavorable en la postura física. En cuarto año se consideró como desfavorable 1 (25%) por el espacio enquirófano, y como muy desfavorable 1 (100%) por síntomas dolorosos post-cirugía. Con los 2 jefes de residentes se observaron como desfavorable 1 (100%) por síntomas dolorosos post-cirugía. Conclusión: El desarrollo, el conocimiento y aplicación de criterios ergonómicos en el ámbito quirúrgico supone beneficios relacionados con la disminución de la fatiga física y la mejora de la eficiencia en el acto quirúrgico. Consideramos positiva la introducción en los programas formativos de la educaciónmédico-quirúrgica a la ergonomía como tema de estudio...

Ergonomics aims at surgeons having suitableworking material, reducing the beginning of muscle fatigue andassociated ailments, increasing accuracy during surgery. Objectives: Identify the ergonomic factors that can cause changes in the surgeon’s performance. Observe how theergonomic change develops as the surgeon is working. Material and methods: 48 standardized surveys of general surgery resident physicians were performed. December/2008 toMay/2013. Results: First year residents considered 13 items to be unfavorable (31.71%) and 7 very unfavorable (31.82%) both in the physical posture. Second year residents considered 2 items to be unfavorable (7.41%) due to space in the operating room, and 4very unfavorable (28.57%) due to the physical posture. Third year residents considered 1 item to be unfavorable (8.34%) due to space in the operating room, and 2 very unfavorable (66.66%)due to the physical posture. Fourth year residents considered 1 item to be unfavorable (25%) due to space in the operating room, and 1 very unfavorable (100%) for post-surgery pain symptoms. Two head of residents considered 1 item very unfavorable (100%) due to post-surgery pain symptoms. Conclusion: Development, knowledge and application of ergonomic principles in the surgical field will result in the decrease of physical fatigue and efficiency improvement surgical procedures. We consider it positive the study of ergonomicsduring medical surgery training programs...

Montserrat. Managing health care in a volcanic crisis

The volcano on Montserrat, after being dormant for over 400 years, has been active for the past two years, last erupting on 27 June, 1997. With the capital, Plymouth, in the unsafe zone, major dislocation of people, facilities and services has occurred. The Health Department is splintered over five sites across an eight mile span and the temporary 30 bed hospital, sited at a primary school, is separated from its Casualty and Out-patient Department and Operating Theatre by 0.25 mile. In order to maintain continuity of care for communities, efforts have been made to keep evacuated clients and their community health workers as close together as possible. The mass emigration has depleted the health services, creating severe stress for those remaining. Elderly relatives have frequently been left behind, necessitating the establishment of special geriatric care facilities to cater to their needs. Increased and continuous health surveillance and mass media education have been integral to the prevention of major disease outbreak--particularly with added challenges to food safety, and management of liquid and solid waste disposal. Cooperation from neighbouring states, particularly Antigua, Barbados and Guadeloupe, as well as from the United Kingdom, has been critical in the management of the continuing crisis.

Análise da utilizaçäo de sala de cirurgia com apoio da informática / Analysis of the operating room utilization with the support of informatics

Procurou-se com este estudo verificar a possibilidade de estabelecer sistematicamente um controle de tempo do perfil das atividades desenvolvidas em salas de operaçäo (SO) de um hospital-escola com mais de 500 leitos através da implementaçäo de um programa informatizado. Os resultados indicam que o controle sistemático do tempo utilizado pelas equipe de enfermagem, de anestesia e de cirurgia proporcionará um aproveitamento mais racional e equitativo das potencialidades de recursos humanos e recursos materiais existentes.

Manual de organización y funcionamiento del Servicio Centro Quirúrgico / Manual of organization and operation of the Servicio Centro Quirúrgico

El Hospital Nacional desde su apertura fue creciendo progresivamente, aumentando las demandas de los Usuarios, entre ellos el uso del Centro Quirúrgico, para cirugías programadas como las de las urgencias, lo que creó la necesidad de actualizar la organización del Centro Quirúrgico y dotarlo de un instrumento técnico-administrativo, en el cual se normatice su funcionamiento. Este manual establece la organización del Centro Quirúrgico, la dependencia administrativa de las estructuras y funcionarios, normas y rutinas inicialmente consideradas imprescindibles para el funcionamiento del Centro Quirúrgico. Con este manual se pretende tener un documento de referencia para los funcionarios a fin de que las prestaciones se adecuen al ideal buscado.

Since its opening, the Hospital National has progressively grown, increasing the demands of Users, including the use of the Surgical Center, for scheduled surgeries such as emergencies, which created the need to update the organization of the Surgical Center and provide it with a technical-administrative instrument, in which its operation is regulated. This manual establishes the organization of the Surgical Center, the administrative dependency of the structures and officials, norms and routines initially considered essential for the operation of the Surgical Center. The purpose of this manual is to have a reference document for officials so that the benefits meet the ideal sought.

Estudio prospectivo de un año sobre seguridad en el quirófano / A year prospective study on safety in the operating room

En un trabajo prospectivo se registraron todos los hechos no esperados ocurridos durante el acto quirúrgico en un año, en una clínica privada con condiciones edilicias y equipamiento adecuados, personal entrenado y médicos con título de especialistas. En 2.752 operaciones se detectaron 10 (0.36%) problemas que por su poca jerarquía hubieran pasado inadvertidos, pero sirvieron para hacer correcciones y aumentar las medidas de seguridad