Attitude toward perioperative safety among operation room clinicians at Ethiopian University Hospital.

Patient safety is a fundamental of good quality and also a high priority for the health-care system. Maintaining patient safety reduces errors and harm that patients can suffer during health care. The operating room clinicians have a vital role in ensuring patient safety. The general objective of this study was to assess attitudes towards perioperative safety and associated factors among the operation room clinicians at the University of Gondar Comprehensive Specialized Hospital (UoGCSH), Northwest Ethiopia, 2022. A cross-sectional study was conducted on operation room clinicians at UoGCSH. The data were collected by using a self-administered structured questionnaire that included the Safety Attitude Questionnaire (SAQ). Binary logistic regression analysis was employed, and the strength of association was described in adjusted odds ratios with a 95% confidence interval (CI). A total of 260 (76% response rate) operation room clinicians have participated in this study. The mean ± SD of attitude toward perioperative safety was 57.8 ± 0.9. Only 32 (12.3%) operation room clinicians have shown a favorable attitude toward perioperative safety. Most of the clinicians were found to have unfavorable attitudes toward all domains of SAQ except the stress recognition domain. Age >30 years [adjusted odds ratios (AOR): 3.1, CI: 1.1, 8.7, P = .035], working for ≥40 h/week (AOR: 3.9, CI: 1.4, 11.1, P = .01), working in ophthalmologic (AOR: 12.0, CI: 3.8, 38.8, P < .001) and gynecologic (AOR: 3.6, CI: 1.1, 12.7, P = .04) operation rooms, and having training on perioperative safety (AOR: 2.6, CI: 1.1, 6.5, P < .03) were found associated with having favorable attitude toward perioperative safety. Most operation room clinicians had an unfavorable attitude toward perioperative safety and all the domains of SAQ except the stress recognition domain. Older age ≥ 30 years, working for ≥40 h/week, having safety-related training, and working in ophthalmologic and gynecologic operation rooms were found associated with having a favorable attitude toward perioperative safety.

One-Stage Combined Open and Endovascular Treatment Using a Hybrid Operating Room is Safe and Effective for Distal Middle Cerebral Artery Aneurysms.

BACKGROUND: Aneurysms located in the distal middle cerebral artery (DMCA) are relatively rare and lack an established treatment strategy. For DMCA aneurysms, we performed a one-stage combined procedure of endovascular parent artery occlusion (PAO) with coils and superficial temporal artery to middle cerebral artery (STA-MCA) bypass in a hybrid operating room (HOR). The aim of this study was to evaluate the safety and efficacy of this procedure. METHODS: Cases of unruptured DMCA aneurysms treated with the one-stage combined PAO and STA-MCA bypass in HOR were retrospectively examined, and patients' and aneurysmal backgrounds, surgical procedures, and treatment outcomes were analyzed. RESULTS: Six patients were included in the study. The average maximum diameter of the aneurysms was 14.4 mm. One aneurysm was located at M2 and five at M3. All aneurysms had a fusiform shape. No cases were associated with infection, trauma, or malignant tumors. In all 6 cases, the combined PAO and STA-MCA bypass was successfully completed. No postoperative hemorrhagic complications occurred. A symptomatic ischemic complication occurred in 1 case whose symptom disappeared in a week. Three months after surgery, complete obliteration of the aneurysm and patency of the bypass was confirmed in all cases. CONCLUSIONS: The one-stage combined PAO and STA-MCA bypass in the HOR is safe and effective for DMCA aneurysms, potentially serving as a treatment option for this complex aneurysm.

Effect of an automated dispensing cabinet system on drug distribution effectiveness in a surgical unit.

The use of the automated dispensing cabinet (ADC) for drug distribution in hospitals has become increasingly common and has numerous benefits. This retrospective study assessed the effectiveness of an ADC that uses integrated information technology in the drug distribution process in a surgical unit as part of a smart medical process improvement project at Taichung Veterans General Hospital in 2019. The outcomes include medicine delivery time, working time of healthcare professionals, transportation manpower, dispensing errors, and satisfaction of nursing staff with the medication distribution process. After ADC implementation, the average waiting time of standing orders decreased significantly for both on and off duty periods (40.0 ± 27.6 to 3.0 ± 3.9 min, P < 0.001; 45.2 ± 25.8 to 2.9 ± 2.9 min, P < 0.001; respectively). Similar results were observed with immediate or temporary medication orders (54.4 ± 31.5 to 2.0 ± 3.0 min, P < 0.001; 64.0 ± 47.5 to 1.5 ± 1.8 min, P < 0.001; respectively). The average time spent by operation room and post-operation room (OR/POR) nurses on communicating with ward nurses for medication delivery to OR/POR was shortened by 46.9 ± 4.4 h per month, and the average time pharmacists spent on dispensing immediate or temporary medication orders was shortened by 5.6 ± 0.2 h per month. The satisfaction of nursing staff with the OR/POR drug delivery process was significantly improved after ADC implementation (3.2 ± 0.8 vs 4.2 ± 0.7, P < 0.001). Our results showed that ADC implementation in surgical units simplified drug delivery processes, shortened drug delivery time, improved drug delivery timeliness for surgical patients, decreased dispensing errors, and increased nursing staff satisfaction. In conclusion, the implementation of ADC was beneficial for surgical units. To the best of our knowledge, there have been no studies on a similar ADC system.

[The benefits of a hybrid operation room in neurosurgery.] / A hibrid muto elonyei idegsebészeti mutétek során.

INTRODUCTION: The hybrid operation room - with a robotic arm equipped angiographic device - started its operation in November 2019 at the Department of Neurosurgery, Szeged, Hungary. OBJECTIVE: We report the benefits of the hybrid operation room in the neurosurgery practice based on our results and experiences of the last 1.5 years. METHOD: 576 operations took place between 15. 11. 2019 and 01. 03. 2021, which include 332 neurointerventions amd 244 skull-brain and spine surgeries. By using Siemens ARTIS pheno®, we performed purely catheter only interventions or surgical only interventions, but combined treatments were also performed in several cases (catheter and surgical intervention). Thanks to ARTIS pheno® versatility, it is used as a modern imaging system in preoperative examination or as navigation system in spine surgery and control imaging for intra- and postoperative examinations. DISCUSSION: We created three categories based on the results of the last months according to the need of using the hybrid operation room for the given operation: (1) strongly recommended, (2) recommended, (3) advantageous. Strongly recommended: if the two teams (surgical and interventional team) have to work together during the operation. Recommended: if the two teams are not participating together in the operation, but the other team is on standby and may join the operation if necessary. Advantageous: this category means the possibility of performing control imaging before the wound closure. CONCLUSION: Based on our experience, the hybrid operation room provides significant help in neurosurgery. It has become part of our daily care, and we think it is indispensable in the work of a neurosurgery center. Orv Hetil. 2023; 164(43): 1701-1711.

Evidence-based guidelines on infection prevention and control in operation theatres for anesthetists in a resource-limited setting: systematic review/meta-analysis.

Surgical site infections and nosocomial infections are the most frequent source of prolonged hospital stay and cross-contamination of infection in the operating room. Despite the perception, the operating rooms are not sterile environments as it has sterile and nonsterile areas, as well as sterile and nonsterile personnel. The contaminated environment, like the anesthesia environment, is the most potent transmission vehicle for pathogens. Objective: The objective of this review is to develop evidence-based guidelines on infection prevention and control in operation theaters for anesthesia care providers in a resource-limited setting. Methodology: This review is reported based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol. Articles published in the English language were searched from different sources to identify studies for the review using the keywords. Database search was done by using Boolean operators like AND, OR, NOT, or AND NOT from Cochrane review, Hinari, PubMed, Google Scholar, and Medline databases, and filtering was made based on the intervention, outcome, data on population, and methodological quality. The conclusion was made based on the level of evidence that was referred to by the Oxford Center for Evidence-Based Medicine. Results: Generally, 1672 articles were identified through database searching strategies. Articles were searched by filtering systems such as publication year, level of evidence, and duplicates that were unrelated to the topics. Finally, 20 articles (9 randomized controlled trials, 4 meta-analyses and systematic reviews, 4 reviews, and 3 observational studies) were identified by using keywords from different databases by different search strategies from 10 July to 14 August 2022. Conclusion: As primary patient patrols anesthetists face significant infection risk and also contaminate the operating room environment. Precautions that are practical, affordable, and efficient in the anesthesia setting are needed considering the limited availability of personal protective equipment.

Operating Room Performance Optimization Metrics: a Systematic Review.

Literature proposes numerous initiatives for optimization of the Operating Room (OR). Despite multiple suggested strategies for the optimization of workflow on the OR, its patients and (medical) staff, no uniform description of 'optimization' has been adopted. This makes it difficult to evaluate the proposed optimization strategies. In particular, the metrics used to quantify OR performance are diverse so that assessing the impact of suggested approaches is complex or even impossible. To secure a higher implementation success rate of optimisation strategies in practice we believe OR optimisation and its quantification should be further investigated. We aim to provide an inventory of the metrics and methods used to optimise the OR by the means of a structured literature study. We observe that several aspects of OR performance are unaddressed in literature, and no studies account for possible interactions between metrics of quality and efficiency. We conclude that a systems approach is needed to align metrics across different elements of OR performance, and that the wellbeing of healthcare professionals is underrepresented in current optimisation approaches.

Endovascular assisted vertebrobasilar junction aneurysm clipping in a hybrid operation room. Case report.

Introduction: We present a case of a 60-year-old female that underwent surgery for clipping a right vertebrobasilar junction aneurysm (VBJA) in a hybrid operation room. Research question: Does the retrograde suction technique with a proximal balloon is safe and effective as an adjuvant technique in surgery of VBJA? Material and methods: After an extended retrosigmoid approach was performed, a 6F Neuron catheter with an intermediate multipurpose catheter were navigated to the right vertebral artery (VA) through a 6-French sheath, which caused a severe catheter-induced vasospasm in the right VA. The aneurysm was then deflated and clipped. After the withdrawal of the catheter the vasospasm was resolved. Results: The patient had a good recovery, with VI cranial nerve palsy and mild dysphagia due to mild right vocal cord palsy, both improving at 1-month follow-up and fully recovered at 6-month follow-up. Discussion and conclusion: The combination of endovascular procedures and microsurgery at the same hybrid operation room in that case resulted in a safe and effective technique. It is an interesting tool that could help neurosurgeons deal with certain selected cases of VBJA. Intraoperative angiography offers the possibility to reposition a misplaced clip in the same surgery. Good collaboration between interventional neuroradiologists and vascular neurosurgeons helps in achieving good results in such difficult cases.

Bacterial Contamination Level of Indoor Air and Surface of Equipment in the Operation Room in Dil-Chora Referral Hospital, Dire Dawa, Eastern Ethiopia.

Purpose: This study investigated the bacterial contamination level of the indoor air and surface of the operation room, surgical, and gynecology wards of Dilchora Referral hospitals between January and August 2020. Methods: A laboratory based cross-sectional study was carried out on the OR and wards of Dilchora referral hospital in Eastern Ethiopia. A passive air sampling method was used to collect 128 indoor air samples; the bacterial load was enumerated and the result was expressed as colony forming units (CFU/m3). Additional qualitative analysis was carried out to identify particular bacterial species that were isolated from the indoor air and swabs taken from the surface of the equipment using conventional techniques. All laboratory data were entered and analyzed using MS Excel 2007 and SPSS version 20. Results: The mean bacterial counts of 94.63 CFU/dm/hr in major OR during active time as well as 509.75 and 509.38 CFU/dm/hr in male and female clothing rooms during the afternoon were unacceptable (>450 CFU/dm2). Similarly, 43.75% of the bacterial counts found in the afternoon samples fell short of Fisher's criterion. The difference between the bacterial counts recorded in the morning and afternoon was significant (p=0.000). A total of 54 (42.2%) indoor air samples and 28 (93.3%) cotton swabs were positive for bacterial growth, with S. aureus (51.04%) and Bacillus sp (55%) being the dominant bacteria isolated from indoor air and the surface of equipment, respectively. Conclusion: The bacterial load of investigated wards is considerably "high" to "very high", which implies a significant risk of hospital acquired infections. Therefore, devising effective control strategies targeted on surface cleansing and sterilizing of the air environment and practicing periodic microbial surveillance of the hospital environment is a paramant.

Practice towards perioperative care of cesarean delivery in Debre Tabor Comprehensive Specialized Hospital, North Central Ethiopia: Cross-sectional study.

Background: Perioperative obstetric care is vital in clinical practice to improve maternal and neonatal outcomes. The standardized practice of perioperative obstetrics care service has a great role in the reduction of both expected and unexpected adverse outcomes. So, the purpose of this study was to assess the implementation of perioperative obstetric care services based on standards of Enhanced Recovery after Cesarean Delivery and the Society of Anesthesiology and Perinatology. Method and materials: A cross-sectional study was conducted on 161 mothers with an elective cesarean delivery from August 10, 2021, to May 15, 2022. The standard of this study was taken from evidence-based practice guidelines of perioperative practice for an elective cesarean delivery. Informed consent was taken from all study participants. The data was collected through direct observation using a standard checklist changed to standardized question forms with two checking components ("Yes", and "No"), and data were entered into SPSS version 20 for analysis and interpretation. Descriptive analysis was done and the results were expressed in numbers and percentages using a table. Results: A total of 161 elective cesarean sections were involved to identify the level of perioperative care. Administration of first-generation antibiotics prophylaxis, aqueous povidone-iodine solution-based skin preparations, and preparation for immediate neonatal resuscitation were fully performed based on the standards. Conclusions: The majority of elective caesarian deliveries were carried out below the recommended level as per the checklists for perioperative practice. So, added interventions are needed to improve perioperative obstetrics care services on those standards which are not totally applied and partially performed.

Risk of Surgeon Contracting COVID-19 while Operating on COVID-19-Positive Patient, Impact of Safety Measures: Lessons Learnt.

Introduction On March 11, 2020, the novel coronavirus disease 2019 (COVID-19) was declared as a pandemic. General surgeons provide care to COVID-19 positive patients requiring emergency surgeries and hence are exposed to the virus. Surgery on COVID-19-positive patient itself is a major risk factor for surgeon to contract COVID-19 infection. Noticeably, there is no data regarding number of surgeons who have contracted COVID-19 after operating on COVID-19-positive patients. Hence, the aim of this study was to find out the exact incidence of COVID-19 among surgeons operating on COVID-19-positive patients and to analyze the impact of safety measures practiced by us. Methodology The study was conducted in a tertiary care center in Mumbai. It was a retrospective observational study with duration of 5 months from May 1, 2020, to September 30, 2020. Only those surgeons (faculty and resident doctors) were included who performed surgeries on COVID-19-positive patients (diagnosed by reverse-transcription polymerase chain reaction [RT-PCR] test) and gave consent for participation. As an institutional protocol, all patients undergoing surgery were tested by RT-PCR test (irrespective of chest X-ray or symptoms). Nasopharyngeal swabs for COVID-19 disease were collected prior to procedure but in some of these, results came after surgery. Still such patients were included in this study. Irrespective of COVID-19 status, same precautions were taken for all surgeries. The details of the patients like date of surgery, age, sex, surgery performed, duration of surgery, type of anesthesia used, and operating surgeon were noted from operation room (OR) register. Details of surgeons (faculty and resident doctors) who fulfilled inclusion criteria were noted by interview in terms of their demographic parameters, such as age, sex, designation, experience in years after completing postgraduation, comorbidities, whether they ever contracted COVID-19 (if yes, date), and safety measures practiced (yes, no, or cannot recollect). Patient was assumed to be the source only if the surgeon contracted COVID-19 within 14 days of surgery. Results A total of 34 surgeons (7 faculty and 27 residents) conducted 41 surgeries on COVID-19-positive patients during the study period. All of them gave consent for participation in the study. More than one surgeon was involved in a particular surgery. Hence, there were 78 occasions (faculty during 16 occasions and resident doctors on 62 occasions) when surgeons were at risk to contract COVID-19 while operating on patients ( n = 78). These surgeries had similar/comparable risk of COVID-19 exposure to surgeons and procedures with excessive exposure risk like airway procedures did not happen during the study period. The mean age of surgeon was 27.92 years ( n = 78, standard deviation = 5.71) and median experience of faculty after completion of postgraduate degree was 7 years ( n = 16, interquartile range [IQR] = 1.25-11.0). Only one faculty had comorbidity (diabetes mellitus). Duration of surgeries ranged from 50 to 420 minutes with median being 190 minutes ( n = 41, IQR = 120-240). Only one surgeon (male faculty) contracted COVID-19 within 14 days of surgery (1.3% incidence, n = 78), a total of seven surgeons contracted COVID-19 during study period but not within 14 days of surgery (source other than patient operated) and all remaining surgeons were asymptomatic throughout the study period. The surgeon who contracted COVID-19 (within 14 days) performed surgery for 260 minutes and under general anesthesia. All the surgeons followed standard steps of donning and doffing, used personal protective equipment (PPE) body cover, shoe cover, hood, double pair of gloves, and N-95 masks at all times ( n = 78). Intubation box was used in 100% cases of general anesthesia ( n = 19). Fogging of OR after each surgery and interval of 20 minutes between surgeries was followed in 100% cases. Also, patient was wearing mask at all possible times and anesthetist and support staff used PPE during all surgeries. Hence the relationship between COVID-19 status and these safety measures cannot be assessed. Goggles and face shields were not used on 88.5% ( n = 78) and 93.2% ( n = 73, because five surgeons could not recollect whether they used face shields or not) occasions, respectively. Also, immediate shower after surgery was not taken on 93.6% occasions ( n = 78). The surgeon who contracted COVID-19 had neither used goggles nor face shield. Also, he did not take shower immediately after surgery. However, there was no significant association between use of goggles, face shields, or shower after surgery and contraction of COVID-19 after operating patients (Fisher's exact p = 1.000). Air conditioner was switched-off only in 7.3% surgeries ( n = 41). Smoke evacuator (cautery with attached suction) was not used in 97.6% cases. Clinical documentation (handling of patient's files) was done outside OR in only 17.1% surgeries ( n = 41). However, there was no significant association between these safety measures and contraction of COVID-19 (Fisher's exact p = 1.000). General anesthesia was used in 19 surgeries (46.3%) while spinal anesthesia in 16 surgeries (39%), local anesthesia in 5 surgeries (12.2%), and total intravenous anesthesia (TIVA) in one surgery (2.4%). However, there was no significant association between type of anesthesia given during surgery and contraction of COVID-19 after operating on patients with Fisher's exact p -value of 1.000. Conclusion Even though safety measures, like goggles, face shield, switching-off of air conditioner, use of smoke evacuator, and shower, immediately after surgery were not practiced in majority of cases, surgeon positivity rate was significantly less. Also, there was no use of negative pressure in OR. Hence, their significance becomes questionable. Although adopting all universal safety measures is in everyone's best interest, it is seldom cost-effective. To reduce resource exhaustion, especially in a pandemic situation, the use of various safety measures and staff must be balanced. Use and promotion of unnecessary safety measures leads to added health care costs and fear among health care workers in case of unavailability. Even though our study has a small sample size and has its own limitations, it can guide future studies to strengthen recommendations and reduce health care costs. This will also help in future epidemics/pandemics.

Type, management, and associated factors of failed spinal anesthesia in cesarean section. Prospective cohort study.

Background: Spinal anesthesia is an anesthesia technique suitable for cesarean section to avoid respiratory complications. However, the management of spinal anesthesia is very important because spinal anesthesia may fail and the patient may be exposed to pain and discomfort. Objective: To assess the type, management, and related factors of failure of spinal anesthesia at cesarean section. Methods: Multicenter prospective cohort study was conducted at a public hospital in Addis Ababa on 794 mothers who met the criteria for cesarean section under spinal anesthesia. Data collection methods were adopted, including chart reviews and observations of spinal anesthesia procedures. The data collected was entered in Epi info version 7 and analyzed in SPSS version 20. Independent variables with dependent variables were analyzed using logistic regression. A p-value of 0.05 for & it; was considered a statistically significant test cutoff. Result: Of 121 failed spinal anesthesia 35 were complete and 86 were partial failed spinal anesthesia from those complete failed spinal anesthesia were managed by repeating spinal and converting to general anesthesia and partial failed spinal anesthesia were managed by the supplementary drug. Experience of the anesthetist <1 (AOR = 4.12, 95% CI, 2.47-6.90), patient position (AOR = 14.43,95%CL, 2.65-78.61), number of attempts>1 (AOR = 9.26, 95% CI, 5.69-15.01), bloody CSF (AOR = 6.37, 95%CI, 2.90-13.96), BMI ≥30kgm2 (AOR = 2.03, 95%CI, 1.12-3.68) and dose of bupivacaine <10 mg (AOR = 2.72, 95% CI, 1.33-5.53) were found to be statistically significant associated with failed spinal anesthesia. Conclusion and recommendation: Experience of anesthetists (<1 year), obesity, bupivacaine dose <10 mg, bloody appearance of CSF, number of attempts> 1 were associated factors for failed spinal anesthesia in cesarean section. Our failed spinal management is not the same among hospitals and does not follow recommended failed spinal management. Up-skilling of anesthesia professionals should be considered on identified associated factors of failed spinal anesthesia and management of failed spinal anesthesia should be based on the recommended guidelines.

Venovenous extra corporeal life support in an infant with foreign body aspiration: A case report.

Background: Foreign body aspiration (FBA) is a life-threatening emergency and a common cause of morbidity and morbidity in children. FBA can lead to rapidly progressive respiratory failure. Stabilizing patients after FBA for bronchoscopic removal of the aspirated object can be complex and may necessitate advanced support such as high-frequency oscillatory ventilation (HFOV) or extracorporeal membrane oxygenation (ECMO). This case report presents the feasibility of using ultrasound (US) in percutaneous catheterization in infants and the benefit of using venovenous ECMO (VV-ECMO) as rescue therapy in FBA. Case summary: A 10-month-old girl accidently aspirated a metallic piece that was dislodged further to the right main bronchus after failed trials to remove it. She was intubated and mechanically ventilated, complicated by milk aspiration and bilateral pneumothoraces secondary to high-pressure lung ventilation. She had refractory mixed respiratory failure despite high settings of HFOV and inhaled nitric oxide. Venovenous ECMO (VV-ECMO) was initiated for stabilization and a bridge for bronchoscopic foreign body removal and awaiting lung recovery. She was weaned off ECMO after 166 hours. The patient was extubated after a few days and discharged home 28 days after admission without clinical evidence of neurological or respiratory complications. ECMO has been described in the literature as rescue therapy for FBA resulting in respiratory failure. However, ECMO cannulation in children under these circumstances is challenging because of vessel size restrictions. Two-vessel cannulation or dual-lumen cannulation are available options via open cut-down or percutaneous cannulation techniques, depending on the general expertise. The use of vascular ultrasound to assess vessel size is a helpful tool for cannulating infants. Conclusion: VV-ECMO support is expanding for respiratory failure in pediatric patients. Percutaneous cannulation in infants and children for VV-ECMO is safe and feasible.

Application of flipped classroom teaching mode in clinical teaching of gynecological operating room / 中华医学教育探索杂志

Objective:To study the application value of flipped classroom teaching mode in clinical teaching of gynecological operating room.Methods:A total of 146 cases of gynecological operating room intern nursing students in The People's Hospital of Liaoning Province from January 2020 to April 2020 were selected as the research objects and divided into two groups according to different time. Before the flipped classroom teaching mode was carried out from January 2020 to February 2020, 73 cases were included in the control group, and after the flipped classroom teaching mode was carried out from March 2020 to April 2020, 73 cases were included in the observation group. The theory and operation scores of the two groups before and after teaching were compared, and the satisfaction of the practice nurses to the teaching and the evaluation of the observation group to the flipped classroom teaching mode were observed. After the teaching, the performances of the two groups of nursing students and the teaching satisfaction were compared using SPSS 22.0 to conduct t test, chi-square test and rank sum test. Results:The theoretical results[(88.52±8.99) points] and operational results[(89.79±7.51) points] of the observation group were significantly higher than those[(72.40±7.45) points and (73.66±7.77) points] of the control group, with statistical significance ( P<0.05). The teaching methods and self-evaluation satisfaction of the observation group were significantly higher than those of the control group ( P<0.05). Conclusion:The application of flipped classroom teaching mode in the teaching of nursing students in gynecological operating room can improve the students' operation and theoretical level, and the students have a high degree of recognition and satisfaction with the teaching mode.

Prevalence and factors associated with work-related musculoskeletal disorder among health care providers working in the operation room.

BACKGROUND: Work-related musculoskeletal disorder is a major and frequently underappreciated problem on people, countries, healthcare services, and society as a whole. Not only have detrimental health impacts, but it had considerable damage on healthcare services and costs. OBJECTIVE: The aim of this study was to determine the prevalence and factors associated with work-related musculoskeletal diseases among health care providers working in the operating room of University of Gondar comprehensive specialized hospital and Tibebe Ghion comprehensive specialized hospital, North West Ethiopia, 2021. METHOD: Institution-based cross-sectional study was conducted on 394 healthcare providers. Purposive sampling was used to select the study participants. Data were collected through a self-administer questionnaire using the standard Nordic Musculoskeletal Questionnaire. Descriptive statistics and bivariate logistic regression were done to identify factors associated with work-related musculoskeletal disorders. Variables with P-value≤ 0.05 with 95% confidence interval in a multivariate model were taken as statistically significant. Finally, AOR with 95% confidence interval at a P-value<0.05 was reported. RESULT: The prevalence of work-related musculoskeletal disorder among study participants was 64.2% with 95% CI: (59.4, 69.0). In multivariate logistic regression analysis; working overtime [AOR:1.74; 95% CI (1.05, 2.86)], previous history of MSD [AOR:6.85; 95%CI:(1.91, 22.7)], being diploma holder [AOR:5.27; 95% CI (1.12, 24.68)], being 1st degree holder [AOR:2.65; 95% CI (1.11, 6.28)], absence of assistance during procedures [AOR:1.73; 95% CI (1.02, 2.85)], and working in night shifts [AOR:1.72; 95% CI (1.08, 2.74)] were significantly associated with work related musculoskeletal disease among health care providers working in operation room. CONCLUSION: A high proportion of hospital care providers working in the operation room reported MSD at different body parts. Lower back pain was the most often complained. Working overtime, not having assistance during procedures, educational status (diploma and 1st degree holder), and working at night shifts were statistically significant associated with musculoskeletal disorders.

Non-medical risk factors associated with postponing elective surgery: a prospective observational study.

BACKGROUND: Operation room (OR) planning is a complex process, especially in large hospitals with high rates of unplanned emergency procedures. Postponing elective surgery in order to provide capacity for emergency operations is inevitable at times. Elderly patients, residents of nursing homes, women, patients with low socioeconomic status and ethnic minorities are at risk for undertreatment in other contexts, as suggested by reports in the medical literature. We hypothesized that specific patient groups could be at higher risk for having their elective surgery rescheduled for non-medical reasons. METHODS: In this single center, prospective observational trial, we analysed 2519 patients undergoing elective surgery from October 2018 to May 2019. A 14-item questionnaire was handed out to illicit patient details. Additional characteristics were collected using electronic patient records. Information on the timely performance of the scheduled surgery was obtained using the OR's patient data management system. 6.45% of all planned procedures analysed were postponed. Association of specific variables with postponement rates were analysed using the Mann-Whitney U test and Fisher's exact test/χ2-test. RESULTS: Significantly higher rates of postponing elective surgery were found in elderly patients. No significant differences in postponing rates were found for the variables gender, nationality (Germany, EU, non-EU), native language, professional medical background and level of education. Significantly lower rescheduling rates were found in patients with ties to hospital staff and in patients with a private health insurer. CONCLUSIONS: Elderly patients, retirees and nursing home residents seem to be at higher risk for having their elective surgery rescheduled. However, owing to the study design, causality could not be proven. Our findings raise concern about possible undertreatment of these patient groups and provide data on short-term postponement of elective surgery. Trial registration DRKS00015836. Retrospectively registered.

Evaluating factors associated with the cancellation and delay of elective surgical procedures: a systematic review.

BACKGROUND: Elective surgery cancellation is considered a fundamental problem in health care services-it causes considerable disruption to patient flow, further eroding often already stretched operating capacity, and consequentially reduces both hospital performance and patient satisfaction. This research presents a systematic review (SR) of the reasons for surgery cancellation among different hospitals and countries. By highlighting these causes, we identify how to reduce cancellations, thereby improving the use of surgical capacity and resources and creating a more predicable patient flow. METHODS: An SR was performed on elective surgery cancellation in compliance with the Preferred Reporting Items for Systematic Review and Meta-Analysis and by assessing the methodological quality of SR with Measurement Tool to Assess Systematic Reviews guidelines. RESULTS: There are different reasons for surgery cancellation that vary between hospitals. This SR demonstrates that hospital-related causes (e.g. unavailable operation room time, inappropriate scheduling policy and lack of beds) are the primary reason for surgery cancellation, followed by work-up related causes (e.g. medically unfit and changes in the treatment plan) and patient-related causes (e.g. absence of a patient and patient refusal). CONCLUSION: This review demonstrates that the main causes for surgery cancellation can be controlled by hospital managers, who can aim to improve areas such as patient flow and capacity management. Ultimately, this will improve the quality of healthcare delivered by hospitals.

Fellows and Observers Are Not a Problem for Infection in the Operating Rooms of Teaching Centers.

PURPOSE: The aim of the present study was to determine whether the risk of complications increases with the number of people in the operating room (OR). Several studies have stated that an increased number of people in the OR increases not only the risk of infection but also the risk of intraoperative complications due to distractions during the surgery. MATERIALS AND METHODS: This retrospective study included all patients who had surgery between January 2017 and January 2018 in an OR with the usual surgical team and three or more observers. Patient demographic data, surgical details (duration of the surgery, the surgery being open or arthroscopic, and whether a graft was used), and intraoperative and postoperative complications were recorded. RESULTS: A total of 165 surgeries were recorded, with a mean operating time of 70 min (40% open surgeries, 37% arthroscopic surgeries, and 23% combined open and arthroscopic procedures). The main intraoperative complications were vessel damage, nerve damage, premature cement setting, and leg-length discrepancy, with 1 case each. The main postoperative complications were rigidity (8 cases), unexplained pain (11 cases), failed meniscal suturing (3 cases), a postoperative stress fracture (1 case), correction loss in osteotomy (1 case), and wound problems not related to infection (1 case). There were no cases of infection. DISCUSSION: The present study shows that the complication rate when having observers in the OR is comparable to the reported data. The key to avoiding complications is for everyone to comply with basic OR behavior.

One-Stage Treatment in a Hybrid Operation Room to Cure Brain Arteriovenous Malformation: A Single-Center Experience.

OBJECTIVE: To report the principles and techniques of using a hybrid operation room in the treatment of brain arteriovenous malformation (BAVM). METHODS: From October 1, 2016 to December 31, 2018, we treated 54 consecutive patients with nonemergent BAVM in a hybrid operation room. The clinical data, radiologic images, and outcomes were collected to establish a prospective database for evaluation. RESULTS: Thirty-two male and 22 female patients were enrolled with a mean age of 32.6 ± 13.1 years (range, 10-61 years). Bleeding (n = 32, 59.3%) was the main clinical presentation, followed by headache (n = 27, 50.0%), seizures (n = 14, 25.9%), neurofunctional deficits (n = 16, 29.6%), and no symptoms (n = 2, 3.7%). Thirty-one patients (57.4%) accepted resection without intraoperative embolization, 18 (33.3%) were treated with combined embolization and resection, and 5 (9.3%) were cured with intraoperative embolization and resection was cancelled. All patients achieved total BAVM obliteration confirmed with intraoperative angiography. There were no significant differences in outcomes between low-grade (Spetzler-Martin grades I, II, and modified grade III-) and high-grade (Spetzler-Martin grades ≥IV and modified grade III+) groups, except that the high-grade group had more blood loss (667.9 ± 647.5 vs. 284.3 ± 148.6 mL; P = 0.046) and longer postoperative hospitalization (17.1 ± 9.1 vs. 10.8 ± 5.4 days; P = 0.026). At discharge, 52 patients (96.3%) had favorable outcomes (Glasgow Outcome Scale score ≥4). Forty-three patients (79.6%) received 1 year follow-up after treatment; 97.7% (n = 42) of these had ongoing favorable outcomes. However, 4 patients with low-grade BAVM had recurrence. CONCLUSIONS: The hybrid operation room can ensure safe, comprehensive treatment of BAVM, offering the opportunity for a favorable curative treatment in 1 stage.

The development of inguinal hernia surgical standardization and the research progress of inguinal hernia quality control / 中华消化外科杂志

The quality control of inguinal hernia is a key point of herniology development in China, which is on the basis of continuous clinical quality improvement. The standardized operation of inguinal hernia repair requires the tacit cooperation of surgeons and the operating room nursing team. According to the existing mature seven step method in inguinal hernia surgery, the authors summarize the seven step nursing process of operation, in order to provide smoother and better operation guarantee in open and laparoscopic hernioplasty.