Effects of vacuum suctioning and strategic drape tenting on oxygen concentration in a simulated surgical field.

STUDY OBJECTIVE: To investigate the isolated and combined effects of vacuum suctioning and strategic drape tenting on oxygen concentration in an experimental setting. DESIGN: Experimental. SETTING: Clinical simulation center of a university-affiliated hospital. PARTICIPANTS: Mannequin simulation of a patient undergoing facial surgery under sedation anesthesia. Supplemental oxygen was delivered via nasal cannula. INTERVENTIONS: Vacuum suctioning and strategic drape tenting. MEASUREMENTS: The experimental trials entailed measuring oxygen concentration around the nasal cannula continuously either in the presence or absence of a standard operating room vacuum suction system and strategic tenting of surgical drapes. The primary outcome was the time required for oxygen concentration to reach 21%. MAIN RESULTS: In the control group (without suction or strategic tenting), a mean time of 180 seconds elapsed until the measured oxygen concentration reached 21% after cessation of oxygen delivery. Use of a vacuum suction device alone (110 seconds; P < .01) or in combination with strategic tenting (110 seconds; P < .01) significantly reduced this time. No significant benefit was seen when tenting was used alone (160 seconds; P < .30). CONCLUSION: Use of a vacuum suction device during surgery will lower local oxygen concentration, and this in turn may decrease the risk of operating room fires. Although strategic tenting of surgical drapes has a theoretical benefit to decreasing the pooling of oxygen around the surgical site, further investigation is necessary before its routine use is recommended.

Uphill grime: process improvement in surgical instrument cleaning.

After its investigation of cross-contamination from arthroscopic shavers, the US Food and Drug Administration issued an alert to hospitals about medical device reprocessing methods. In response to this, a team of risk management and instrument room personnel at a university hospital undertook a project that tested the manufacturer's recommended cleaning methods for surgical instruments with the objective of determining the efficacy of automated instrument reprocessing and identifying a process that would produce a verifiably clean instrument after the cleaning process is performed. The quality improvement project focused on suction tips because they are used in most surgical procedures, are exposed to high levels of organic debris, and are difficult to clean. A variety of suction tips were cleaned and tested with a variety of processes and products to determine best instrument cleaning practices. Results of the project were eye-opening--debris was found where debris should not be, and the manufacturer's recommended cleaning methods--the current practices-were not effective.