Incremental innovations in operation theaters

Background: The field of ophthalmology has been built upon continuous innovations. COVID?19 pandemic has been an important driving force behind many innovations in ophthalmology and other branches of medicine. Innovations in ophthalmology has been a key to surgical progress. The process of promoting innovation in surgery is imperative in the evolving practice of ophthalmology. Purpose: In this video we demonstrate some incremental innovations in operation theaters which help in increasing the efficiency and improving the performance of a surgeon. These innovations also provide a more comfortable environment for the patient undergoing the surgery. Synopsis: A few incremental innovations that are described in our video also help in preventing the spread of COVID infection during surgery. This video also showcases a few wet lab innovations that help train residents in their surgical skills. Highlights: Use and reuse of simple materials make it cost effective and ecofriendly. These incremental innovations help in the smooth running of operation theaters. Thus, they are small improvements in the existing setup and help in creating a smooth and error free OT flow

The impact on patients’ time-to-theatre following colour coding classification in emergency operation theatre, Sarawak General Hospital

@#Introduction: A proper prioritisation system of emergency cases allows appropriate timing of surgery and efficient allocation of resources and staff expertise. The aim of this study was to determine the impact of colour coding classification on Time-to- theatre (TTT) of patients in comparison with the normal practice. Method: Categorisation was a surgical judgment call after thorough clinical assessment. There were 4 levels of urgency with their respective TTT; Red (2 hours), Yellow (8 hours), Green (24 hours), Blue (72 hours). Caesarean cases were excluded in colour coding due to pre - existing classification. The data for mean TTT was collected 4 weeks before the implementation (Stage 1), and another 4 weeks after implementation (Stage II). As there was a violation in the assumption for parametric test, Mann Whitney U test was used to compare the means between these two groups. Using logarithmic (Ln) transformation for TTT, Analysis of Covariance (ANCOVA) was conducted for multivariate analysis to adjust the effect of various departments. The mean TTT for each colour coding classification was also calculated. Results: The mean TTT was reduced from 13 hours 48 min to 10 hours, although more cases were completed in Stage II (428 vs 481 cases). Based on Mann-Whitney U test, the difference in TTT for Stage I (Median=6.0, /IQR=18.9) and Stage II (Median=4.2, IQR=11.5) was significantly different (p=0.023). The result remained significant (p=0.039) even after controlled for various department in the analysis. The mean/median TTT after colour coding was Red- 2h 24min/1h, Yellow- 8h 26min/3h 45 min, Green- 15h 8min/8h 15min, and Blue- 13h 46min/13h 5min. Conclusion: Colour coding classification in emergency Operation (OT) was effective in reducing TTT of patients for non-caesarean section cases.

Robson ten groups classification system for caesarean section audit: are our operation theatre registers RTGC enabled?

Background: Rising caesarean section rate is a global problem. Robson ten groups classification (RTGC) system of audit has been recommended as the first step towards planning strategies to reduce caesarean section rate. Getting data for this audit is often difficult. If operation theatre (OT) registers are maintained properly this would become easy. The study proposes to know if enough information is available in the operation theatre registers to get caesarean section data for ten groups of Robson classification system. To suggest changes in OT register format for future convenience.Methods: We studied data from 100 consecutive caesarean section entries in OT registers from two medical college institutions to know if the information recorded is adequate to classify these 100 caesarean sections into ten groups given by Robson. Last 100 caesarean section entries into the OT register during the period 1st April 2018 till 31st March 2019 were studied.Results: Presentation of the foetus was the only factor which could be clearly known for all 100 cases. Labour onset whether spontaneous or induced was the least recorded observation in traditional operation theatre registers. The next information which was commonly not recorded was the labour status (woman in labour or not in labour) at the time of caesarean section.Conclusions: For Robson’s classification of caesarean sections to become useful tool to guide strategies in reducing caesarean sections we need to modify format of our OT registers. Traditional OT registers do not provide enough information to categorize caesarean section cases into Robson ten groups. Missing information makes caesarean section audit imperfect or impossible. We suggest a format for it to be incorporated into the operation theatre registers of centres providing maternity services.

Nurses' Knowledge and Practice of Aseptic Technique in the Operation Theatre at selected Hospitals of Bharatpur

Introduction: The nurses are involved in major part of patient care; they are thus important target population to determine their level of knowledge and practice of aseptic technique in the operation theatre. Methodology: A   descriptive study approach was   used   to   find   out the nurses' knowledge regarding aseptic technique in the operation theatre of selected hospitals, Bharatpur. Fifty six nurses working in operation theatre of the selected hospitals i.e. Chitwan Medical College, Bharatpur Hospital and College of Medical Sciences were taken for the study.   Observations: Data   were   collected   by using   semi-structured   self-administered questionnaire. The findings revealed that,   62.5 %   respondents   had   high   knowledge, 37.5%   had   average   knowledge   and   none of   the   respondents   had   low   knowledge on aseptic    technique. Conclusion: The   level   of   knowledge      on   aseptic   technique     is statistically significant (p=0.031)   with the age and educational qualification of the respondents.

Standard guidelines for setting up a dermatosurgery theatre.

Introduction, definition, rationale and scope: Dermatologists in India are now increasingly performing surgical and cosmetic procedures in their practice. This calls for minimum standards at the national level with the main focus of patient safety and hence the guidelines for setting up a dermatosurgical theatre. Facility: The dermatosurgery theatre can be created in either physician's clinic, or a hospital depending on the procedure to be performed. The dermatosurgery theatre requires careful planning with regards to - location, dimension, shell design, lighting, electrical requirements, operation table, chair, trolley, surgical instruments, sterilization of devices, asepsis and advanced life support. Apart from physical considerations, other considerations including theatre etiquettes, consent for surgery, safety of dermatosurgeon, theatre staff and lastly biomedical waste management should be looked into. These issues are discussed in detail in the recommendations.

Barreira microbiana das máscaras cirúrgicas descartáveis segundo o seu tempo de utilização / Microbial barrier of disposable masks in relation to their usage time

A prática da utilização de máscaras cirúrgicas durante a realização dos procedimentos cirúrgicos, como uma medida de prevenção da infecção do sítio cirúrgico (ISC), vem sendo questionada nos últimos tempos. Com o intuito de produzir evidências científicas, foi desenvolvida a presente investigação, com delineamento experimental, controlado, que teve como objetivo avaliar a eficácia da barreira microbiana das máscaras cirúrgicas descartáveis (Eficácia de Filtração Bacteriana - BFE- de 95%), segundo o seu tempo de utilização (1 hora, 2 horas, 4 horas e 6 horas). Os dados foram coletados em uma sala de operação de uma unidade de centro cirúrgico de um hospital privado do município de São Paulo cuja estrutura física atende às recomendações atuais propostas pelo Ministério da Saúde (RDC-50 - MS/2002). Para os experimentos, constituíram-se 2 grupos denominados controle e experimental. O primeiro sem utilização de máscaras cirúrgicas e o segundo com elas. A fim de reproduzir as conversações que normalmente ocorrem entre a equipe cirúrgica durante o ato operatório, uma variável que interfere no período de validade das máscaras cirúrgicas descartáveis, manteve-se o controle de palavras emitidas pelos colaboradores da coleta de dados, nos dois grupos, em todos os tempos estudados. Para controlar a influência do ambiente, foram mantidas placas de Petri no ambiente de sala de operações, próximas à entrada do ar condicionado. Realizou-se a contagem das Unidades Formadoras de Colônia (UFC) das unidades de análise das simulações em ambos os grupos, nos intervalos de tempo pré-estabelecidos (1, 2, 4 e 6 horas), por meio das placas de Petri com meio de cultura (Agar Triptona Soja -ATS) dispostas sobre a mesa cirúrgica. Foram identificados os microrganismos mais freqüentes encontrados nas simulações. Os dados foram submetidos à análise estatística e os resultados mostraram que a utilização da máscara cirúrgica diminuiu ) diminuiu (coeficiente de regressão = -20,10) a média de UFC das placas da mesa cirúrgica que simulou o campo operatório, em todos os tempos testados. Verificou-se que a sua utilização além de 2 horas aumentou a contaminação das placas da mesa cirúrgica. Nas análises estatísticas foram consideradas as interferências da contaminação ambiental e constatou-se que existiu uma correlação positiva alta (coeficiente de correlação = 0,886) entre as médias de UFC da mesa cirúrgica e do ambiente, estatisticamente significante (P< 0,001). Concluiu-se que as máscaras cirúrgicas descartáveis (BFE 95%) demonstraram constituir barreiras microbianas eficazes em todos os tempos estudados, diminuindo sua eficácia de filtração após 2 horas de sua utilização

The practice of the use of surgical masks during surgical procedures as a preventive measure against Infection of the Surgical Site (ISS) has been questioned lately. With the aim of producing scientific evidence, the present investigation was developed - with an experimental controlled basis - in order to evaluate the effectiveness of microbial barriers of disposable surgical masks (Bacterial Filtration Effectiveness - BFE - 95%) in relation to their usage time (one, two, four and six hours). Data were collected inside an operating room of the operation theatre unit of a private hospital in the city of São Paulo, whose physical structure meets the recommendations currently proposed by the Health Ministry (RDC - 50 - MS/2002). Two groups were formed for the carrying out of these experiments, respectively denominated control group and experimental group: in the first group no surgical masks were used; in the second surgical masks were used. In order to reproduce conversations that usually take place among the surgical team members during surgeries - a variable which interferes in the validity period of disposable surgical masks - control was kept of words uttered by those collaborating in the gathering of the data, in the two groups, for all the times studied. In order to control the influence of the environment, Petri dishes were maintained in the operating room environment, close to the air conditioning inlets. A count was taken of the Colony Forming Units (CFU) of the units of simulation analysis in both groups, at pre-established time intervals (1,2,4 and 6 hours), through Petri dishes with culture medium (Agar Trypton Soybean - ATS) placed on the surgical table. Identification was made of the most frequent micro organisms found in the simulations; these data were submitted to statistical analysis and the results demonstrated that the use of surgical masks decreased (regression coefficient = -20,10) the the average count of CFU in the Petri dishes placed on the surgical table which simulated the surgical field in all of the times tested. It was verified that their use beyond 2 hours increased contamination of the dishes placed on the surgical table. In the statistical analyses, the interferences of milieu contamination were considered and it was found that there was a high positive correlation (correlation coefficient = 0,886) between the average count of CFU in the surgical table and in the environment, which was statistically significant (P<0,001). The final conclusion was that disposable surgical masks (BFE 95%) proved to be effective microbial barriers in all of the times studied. Their BFE decreased after two hours of use