Clean Operating Room Research Articles

Influence of resilience on depression among nurses in clean operating departments: The mediating effect of life satisfaction.

A clean operating room is an important part of surgical and critical treatment in hospitals. The workload is substantial, the pace is rapid, and the working environment is intense; therefore, nurses who work in clean operating rooms are constantly challenged, which can lead to anxiety, depression, and other mental health issues. Life satisfaction and resilience are important factors that ensure mental health. Therefore, exploring the mediating role of life satisfaction in the influence of resilience on depression among nurses in clean operating rooms can help improve nursing services and teamwork. To explore the mediating effect of satisfaction on the influence of resilience on depression among nurses in a clean operating department. From April to November 2022, 196 nurses from the Department of Clean Operating at Harbin Medical University Cancer Hospital participated in this study. Participants were selected using convenience sampling. Participants' gender, age, marital status, position, length of service, personal monthly income, daily working hours, employment status, and professional title were collected, and the Connor-Davidson resilience scale, satisfaction with life scale, and self-rating depression scale were used to evaluate resilience, life satisfaction, and depression. The researchers conducted professional training in advance, introduced the research methods to the participants before the investigation, and explained the study's significance and purpose. Surveys were distributed and collected on-site. Each questionnaire took 30 min to complete. The average scores for life satisfaction, resilience, and depression were 3.13 (± 0.28), 4.09 (± 0.78), and 56.21 (± 8.70), respectively. The correlation between resilience and depression was negative (r = -0.829, P < 0.01). Life satisfaction was positively related to resilience (r = 0.855, P < 0.01) and negatively related to depression (r = -0.778, P < 0.01). The relationship between resilience and depression was partially mediated by life satisfaction. The value of the mediating effect was -6.853 (26.68% of the total effect). Life satisfaction partially mediates the link between resilience and depression among nurses in clean operating departments.

Revisiting the question of endolymphatic therapy

Lymphotropic therapy was the first step in the development of endolymphatic therapy. Lymphotropic therapy was carried out by creating a subcutaneous depot of a contrast agent or injecting the drug directly into the lymph node. The next step was the introduction of the drug into the lymphatic system by a single puncture of the peripheral lymphatic vessel. After G. V. Bondar put his idea into action by making a special tool, it became possible to do long-term endolymphatic infusion.&#x0D; Lymphatic catheterization is performed in a clean operating room. Catheterization of the thigh lymphatic vessels is the most common technique. A network of superficial lymphatic vessels extends from the medial edge of the sartorius muscle into the subcutaneous fat, reaching the lower superficial inguinal lymph nodes. The deep lymphatic vessels of the thigh are adjacent to the femoral vein. The use of a longitudinal or longitudinal-oblique skin incision is preferable. The benefits of this access are that lymphatic vessels can be catheterized more than once during chemotherapy and wounds heal faster because the skin is cut along the fibers instead of across them.&#x0D; When comparing endolymphatic and intravenous methods of administration of platinum group chemotherapy drugs in combination with fluorouracil or methotrexate in 289 patients with T3N0-1 M0-1 ovarian cancer, the vast majority of whom had serous adenocarcinomas (85.62±2.77 and 84.93±3.17), a significantly higher frequency of complete and partial regressions was registered (59.63±3.87%) with the endolymphatic technique than with intravenous administration (32.03±4.14%).&#x0D; Endolymphatic chemotherapy with fluorouracil 700–800 m g/m daily for 5 days in combination with intravenous administration of doxorubicin 40 mg/m in the treatment of patients with advanced, inoperable gastric cancer (n=33) increased overall efficacy to 39.4%±8.5% when compared to patients (n=32) who received the same drugs intravenously (12.5%±5.84%). The compared groups had significantly different median survival (35 and 19 weeks) and life expectancy (41.3±4.4 and 23.8±3.4 weeks).&#x0D; The endolymphatic administration of cytostatics, which demonstrates less toxicity compared to the intravenous one, has the right to exist and the potential to further develop improved techniques of administration.

Implementation of Medical Behavior Management System in Operating Rooms

Objective: To strengthen personnel management for a clean operating room and ensure an automatic, intelligent, and scientific workflow. Methods: The medical behavior management system has been implemented to monitor and manage medical personnel entering and exiting the operating room, so as to meet the standard requirements of the operating room. Results: The flow of personnel has been controlled effectively, the flow in and out of the operating room has been optimized, the management level of the operating room has improved, and the cost has been cut down. Conclusion: With the advent of the information age and the continuous improvement of the management system, the management of operating rooms has become more reasonable and humanized; the management mode, working environment, and the overall quality of nursing work in operating rooms have improved.

НЕКОТОРЫЕ ОСОБЕННОСТИ ФОРМИРОВАНИЯ РУБЦА ПОЧКИ ПОСЛЕ РЕЗЕКЦИИ В ЭКСПЕРИМЕНТЕ

Objective. To study the features of scar formation and structural changes in the remaining renal parenchyma in rats after the kidney resection in various terms. Methods. A layeredclosure of midline laparotomy and the caudal part of the left kidney removal was performed in rats under general inhalation ether anesthesia in a clean operating room. The morphology of the remaining kidney part after resection was studied using light microscope in different terms. Results. Athrombusfrom blood leaking outof the cut vessels is formed on the damaged surface of the kidney immediately after the resection. This clot with the parenchyma is gradually replaced by the connective tissue along the edge of the defect with the subsequently formation of a thin connective or fibrous tissue scar. However, in many cases, the number of which in rats can reach 40%, the processes of kidney damage continue for a long time after surgery, and leading to total or subtotal nephrosclerosis. The detected cystic change in tubular structures, apparently, occurred firstly due to their intersection during the resection, clamping by a blood clot and / or compression by edema distal to the observation site. Then, the forming extensive scar again clamped the adjacent tubular structures with subsequent cystic degeneration and sclerosis. In this case, detritus formed from non-viable renal tissues is eliminated by macrophages, which can form multinucleated cells with fused cytoplasm. Conclusion. Structural changes in the nephrosclerosis progression after kidney resection consist in the gradual replacement of the all renal cortical and medullar parenchyma by the connective tissue. This is not associated with the autoimmune process, but is more likely due to both impaired urine outflow after intercut of the tubular structures at resection and/or compression by edema, inflammatory infiltrate, forming or organizing scar, and vascular disorders associated with these causes. The inflammation accompanying necrosis and sclerosis of the renal structures can become granulomatous. What this paper adds For the first time, it has been shown that the progressively enlarging scar can be formed after the kidney resection, resulting in total nephrosclerosis. Such changes develop both due to the intersection of the tubular structures during the resection and their compression by edema, inflammatory infiltrate, forming or organizing a scar, and vascular disorders due to the above-mentioned causes.

Analysis of Air Purification Methods in Operating Rooms of Chinese Hospitals.

This research demonstrates the current use of air purification methods in the operating rooms (ORs) in China. 154 hospitals from 6 provinces were included in this survey to reflect the air purification methods of ORs in 2017. Air cleaning technology (ACT) is used in 124 (80.52%) hospitals. We find that the rates of using grade I, III, or IV clean operating room (COR) in tertiary hospitals are all higher than in lower level hospitals; the rate of using ACT in the ORs is higher, too. In addition, general hospitals have higher rate in using ACT in the ORs than specialized hospitals. The highest rate of using ACT in the ORs is in the eastern region of China. The number of hospitals using ACT, ultraviolet light disinfection, and air sterilizers (such as circulating air UV sterilizer) increased yearly. All grades of CORs can be maintained as required by more than 90% hospitals except grade II COR. In this research, we found air purification methods, especially the ACT, are widely used in hospitals' ORs. However, finding the way to select and use different air purification methods correctly is an urgent problem to be solved next.

Experimental study on influence of personnel activity and surgical smoke on indoor environment inside clean operating room

With the wide application of electronic surgical equipment, the generation of surgical smoke is inevitable. Surgical smoke will not only obstruct the operator's visibility, but also release toxic and harmful substances into the air, which will make the operator a headache and cause inflammation of the eyes and mucous membranes. In order to evaluate whether the existing operating room ventilation system can give priority to control the diffusion of surgical smoke, it is necessary to understand the generation, release, transmission and elimination performance of surgical smoke. This paper studied the rule of the influence of surgical smoke in different areas of the operating room through experiments, and verified by the three-area heterogeneous model. At a static state, the cleanliness level of the operating area and the surrounding area is ISO4 and ISO6. When there is staff activity, the operating room is in a dynamic state, and the operating area and the surrounding area are ISO7. When there is surgical smoke, the cleanliness level of the operating area is reduced to ISO8, and the surrounding area has little influence. This indicates that personnel activities and surgical smoke in the operating room have a great impact on the operating room environment.

Study on Influencing Factors and Control Strategies of Surgical Smoke Concentration Distribution

Paroxysmal fumes during surgical operations endanger the health of medical staff. Special measures for removing surgical smoke are lacking. Article Real-time monitoring of particulate matter concentrations in surgical smoke at different locations under different surgical conditions were explored, and a particulate matter purification control strategy was proposed. The PM2.5 and PM10 concentrations in the operating and respiratory zones near the operating table were about 3.0 times more than the specified value, but both surgical procedures met the requirements of PM concentration in the public zone. Therefore, a clean operating room is not clean for medical staff. The smoke produced by the three scalpels resulted in particle sizes of 0.30 - 2.50 μm in the respiratory zone, and calculate apparent density of powders to be 1.21g cm-3. The surgical smoke produced by the ultrasound scalpel resulted in the highest median PM10 concentration in the operating area. The results show that the smoke produced by different surgical conditions is mainly ultra-fine particles, which are more likely to harm the health of medical staff. A small surgical smoke circulation purification and dust removal system was designed, which could effectively suppress the spread of surgical smoke and reduce the occupational hazards of medical staff. The optimized control plan could significantly reduce the PM2.5 concentration value at measurement point a when the electric knife was turned on by approximately 200.0 %. The PM2.5 concentration of breathing zone was close to 75.0 μg m-3, which basically met the occupational health requirements. The decrease in the PM2.5 concentration of operating zone was about 50.0 %, but it still exceeded the limit. It had a reference value for the occupational health protection of the first-line medical staff of existing epidemics.

The effect of PDCA cycle combined with SOP applied in periodic cleaning of object surfaces in the clean operating room

Objective To explore the application effect of PDCA cycle combined with standardized operation procedure in periodic cleaning of objects surfaces of clean operating room, so as to provide reference for management and control of surgical infection. Methods PDCA cycle was applied to analyze the periodic cleaning conditions of 336 surgical rooms in the operating room from July to December 2016.The results showed that the clearance rate of surface fluorescence labeling was 75.30%, the average time of periodic cleaning was 3.5 hours per operation room, the ratio of periodic cleaning personnel to room was 57.14%, the average defect rate of surface cleaning was 37.80%, the quality control rate was 27.38%, etc.Improvement measures were formulated: the cleaning table of periodic objects between clean operations was formulated to clarify the contents of periodic cleaning, and standardized operation procedure manual and video were developed accordingly for the training of general practitioners, and the responsibility was transferred to people.Comparison was made between January and June 2017 after the intervention. Results Compared with before intervention, the clearance rate of fluorescent label monitoring on the interoperative table was increased to 93.75%, the average time of periodic cleaning was reduced to 2.2 hours, the room ratio of periodic cleaning personnel was 28.57%, the defect rate of surface cleaning was 3.2%, and the quality control rate was 7.8%. All the differences were statistically significant (P<0.05). Conclusion PDCA cycle combined with standardized operation procedure can significantly improve the qualified rate of periodic cleaning of the surface of the clean operating room.It can reduce the defect rate of surface cleaning, shorten the cleaning time, reduce labor cost, improve work efficiency, enhance the quality of infection control in operating room, and it is worth popularizing and applying in clinic. Key words: Plan-Do-Check-Action; Standardized operation procedure; Operating room; Object surfaces clean; Infection control

The RECOVER initiative: Supply recovery and donation beyond the operating room

Background: Similar to previous models for recovery and donation of clean and unused operating room (OR) supplies, that would otherwise be discarded, a new program was started at our institution in 2016. Subsequently, the initiative was expanded to units outside the OR. This study aims to explore the output of these other units on top of our current program. We hypothesize that expansion is feasible and productive, with minimal added effort. Materials and Methods: Clean and unused supplies, in original packaging or open box, which would otherwise be discarded were collected in marked bins from the OR, Surgical Intensive Care Unit (SICU), and the trauma bay (TB) of our urban, academic center. Supplies were sorted, weighed, and inventoried weekly by qualified volunteers. Totals were calculated through proprietary inventory software. Results: The program salvaged 9024 individual items of 129 unique types grouped into 7 categories. In total, 1065 kg of supplies worth an estimated $20,550 USD were collected from the three patient care areas over 7 months. Adding the SICU and TB resulted in a 33% increase in recovered weight and 13% increase in value. Twenty-nine new items were added to our inventory. If this program was expanded to recover supplies from the other ICUs in our hospital, we estimate an additional 951 kg worth $9443 USD could be collected. Conclusions: Thousands of clean, unused supplies, weighing over a metric ton, are discarded in our hospital annually. The OR is the largest source of such material; however, expanding beyond the OR generates significant additional yield. Expansion is feasible with minimally added volunteer hours. Supply recovery initiatives undertaken nationwide and may help mitigate the economic and environmental costs associated with excess medical waste generation and produce staggering quantities of supplies for donation. The following core competencies are addressed in this article: Systems-based practice.

Prospective Evaluation of Operating Room Inefficiency.

Previously, they identified that 60 per cent of their facility's total operative time is nonoperative. They performed a review of their operating room to determine where inefficiencies exist in nonoperative time. Live video of operations performed in a burn operating room from June 23, 2017 to August 16, 2017 was prospectively reviewed. Preparation (end of induction to procedure start) and turnover (patient out of room to next patient in room) were divided into the following activities: 1) Preparation: remove dressing, position patient, clean patient, drape patient, and 2) Turnover: clean operating room, scrub tray setup, anesthesia setup. Ideal preparation time was calculated as the sum of time needed to perform preparation activities consecutively. Ideal turnover time was calculated as the sum of time needed to clean the operating room and to set up either the scrub tray or anesthesia (the larger of the two times as these can be done in parallel). They reviewed 101 consecutive operations. An average of 2.4 ± 0.8 cases per day were performed. Ideal preparation and turnover time were 16.6 and 30.1 minutes, a 38.3 and 32.5 per cent reduction compared with actual times. Attending surgeon presence in the operating room within 10 minutes of a patient's arrival was found to significantly decrease time to incision by 33 per cent (52.7 ± 14.3 minutes down to 35.7 ± 20.4, P < .0001). A reduction in preparation and turnover time could save $1.02 million and generate $1.76 million in additional revenue annually. Reducing preparation and turnover to ideal times could increase caseload to 4 per day, leading to millions of dollars of savings annually.

Influencing factors of valid period of sterile items

Objective To investigate the related factors that affect the valid period of sterile items. Methods Sterile items after well cleaning and disinfection were stored in the supply room with a standard storage conditions, as well as in different storage conditions such as neural therapy room, general surgery dressing room, outpatient and emergency injection room, clean operating room with 120 items respectively. Bacterial culture was performed regularly on the sterile items in different storage rooms. Results At 90 d after sterilization, 3 sterile items stored in the outpatient and emergency injection room with paper-plastic packaging had the bacterial growth. At 105 d after sterilization, 2 samples in the general surgery dressing room with paper-plastic packaging were found to have the bacterial growth. At 150 d after sterilization, 1 sample in the general surgery dressing room with non-woven packaging had the bacterial growth. Up to the end of the experiment, no bacterial growth was observed in the sterile items stored in disinfection supply center, neural therapy room and clean operating room. Conclusions The factors that affect the valid period of the sterilized items are related to the time. It is necessary to evaluate influencing factors of the valid period of sterile items from various perspectives. Specification, industry standards and provision should be executed to ensure the quality of the sterilized items and prevent nosocomial infection. Key words: Disposable packaging material; Sterilized items; Valid period; Influencing factor

Design and Simulation of an Air Conditioning Project in a Hospital Based on Computational Fluid Dynamics

AbstractThis study aims to design a novel air cleaning facility which conforms to the current situation in China, and moreover can satisfy our demand on air purification under the condition of poor air quality, as well as discuss the development means of a prototype product. Air conditions in the operating room of a hospital were measured as the research subject of this study. First, a suitable turbulence model and boundary conditions were selected and computational fluid dynamics (CFD) software was used to simulate indoor air distribution. The analysis and comparison of the simulation results suggested that increasing the area of air supply outlets and the number of return air inlets would not only increase the area of unidirectional flow region in main flow region, but also avoid an indoor vortex and turbulivity of the operating area. Based on the summary of heat and humidity management methods, the system operation mode and relevant parameter technologies as well as the characteristics of the thermal-humidity load of the operating room were analyzed and compiled. According to the load value and parameters of indoor design obtained after our calculations, the airflow distribution of purifying the air-conditioning system in a clean operating room was designed and checked. The research results suggested that the application of a secondary return air system in the summer could reduce energy consumption and be consistent with the concept of primaiy humidity control. This study analyzed the feasibility and energy conservation properties of cleaning air-conditioning technology in operating rooms, proposed some solutions to the problem, and performed a feasible simulation, which provides a reference for practical engineering.

The Prevention of Periprosthetic Joint Infections

Periprosthetic joint infection (PJI) following total joint arthroplasty (TJA) adversely affects patient quality of life and health status, and places a huge financial burden on the health care. The first step in combating this complication is prevention, which may include implementation of strategies during the preoperative, intraoperative, or postoperative period. Optimization of the patient with appreciation of the modifiable and non-modifiable factors is crucial. Preoperative optimization involves medical optimization of patients with comorbidities such as diabetes, anemia, malnutrition and other conditions that may predispose the patient to PJI. Among the intraoperative strategies, administration of appropriate and timely antibiotics, blood conservation, gentle soft tissue handling, and expeditious surgery in an ultra clean operating room are among the most effective strategies. During the postoperative period, all efforts should be made to minimize ingress or proliferation of bacteria at the site of the index arthroplasty from draining the wound and hematoma formation. Although the important role of some preventative measures is known, further research is needed to evaluate the role of unproven measures that are currently employed and to devise further strategies for prevention of this feared complication.

Reasons analysis and prevention of unqualified static air in laminar flow clean operation room

Objective To analyze the unqualified air reasons of laminar flow clean operation room when monitored, to strengthen the prevention and make sure static air of the laminar flow clean operating room air 100% qualified. Methods Each two of the 100 and 1 000 class laminar flow operation room had unqualified air before November 2013, and our department tried to find the reasons and countermeasures. From December 2013 to February 2014, we monitored air four times after carrying out countermeasures, and compared the qualified rate of operation room air with the air qualified rate before countermeasures used. Results The infection rate of Ⅰtype operative incision were always below 0.2% in our hospital. After comprehensive improvement of operation room, the air qualified rate was beyond the rate of before improvement 85.7% with statistical significance (P<0.05). Conclusions It can increase air qualified rate of laminar flow clean operation room by the operational management, cleaning management, aseptic management for maintaining operation room clean system and the training of air sampling personnel. Key words: Air quality monitoring; Reasons analysis; Prevention; Laminar flow clean operation room

Investigation and analysis on monitoring results in clean operating rooms of some hospitals in Huizhou City in 2013

Objective To analyze the differences of the hospital clean operating room in the two levels of City and District in Huizhou City.To promote and improve the comprehensive ability and management level of clean operating room in the medical institutions.In order to achieve the purpose of decreasing and control the nosocomial infection.Methods According to Hospital clean operation Department building technical specifications GB 50333 -2002,32 clean operations in 6 hospitals in Huizhou were chosen randomly (including 2 municipal hospitals and 4 country hospitals) as the sample to detect particle concentration (≥ 0.5 μ m),settling bacteria number,surface bacteria number of instruments.Settling bacteria number was detect in different stage of operations to evaluate the ability of controlling bacteria amount in all chosen operation rooms.The disparity of clean condition was evaluated by statistical analysis.Results The qualified rate reached 80％ in all chosen operation rooms and didn't reveal significant difference (P ＞ 0.05) in Ⅰ-Ⅲ operation rooms of country hospitals and municipal hospitals.Qualified rate and population mean of static particle concentration detection and dynamic bacteria amount detection showed significant difference in Ⅳ operation rooms of two tevel hospitals.Conclusions In hospitals of Huizhou,Ⅰ-Ⅲ operation rooms achieved fine qualified rate while some deficiency existed in individual hospitals.In terms of the controlling of bacteria amount and particle concentration,Ⅳ operation rooms in country hospitals,which needed improvement,were not so effective as those in municipal hospitals. Key words: Clean operation rooms; Static detection; Dynamic detection

Reducing and Recycling in Joint Arthroplasty

Reducing the need for costly contaminated waste processing after total hip arthroplasties (THAs) and total knee arthroplasties (TKAs) could decrease hospital overhead and the environmental impact. From March through April 2011, we prospectively identified 20 consecutive patients undergoing primary THA or TKA by 1 surgeon in 1 operating room at our institution. For each case, waste (excluding liquids) was collected and sorted as it was produced. The 10 THAs and 10 TKAs produced an average of 30.0 lb (range, 27.1-32.5) and 33.2 lb (range, 30.9-35.2) of waste per procedure, respectively, of which 6.8 lb (range, 6.0-7.8; 22.8%) and 7.3 lb (range, 5.4-8.7; 22.0%), respectively, were potentially recyclable paper or plastic. Waste management programs should focus on recycling clean operating room waste.

The effects of different disinfectants on polluted surfaces in clean operating room

Objective To compare the effects of ethanol,benzalkonium bromide and chlorine - containing disinfectant on polluted surface in clean operating room.Methods Three rooms of cleanliness class 10 000 were selected.At the end of non - infectious operations,the stuff surfaces which were polluted by blood,body fluids were cleaned firstly by clean water and then wiped by 75％ ethanol,0.5％benzalkonium bromide and chlorine -containing disinfectant respectively..After 30 minutes,samples from the different surfaces were collected,and the clones of bacteria were examined,and the effects of the disinfection were compared.Results There was no significant difference among the three disinfectants ( P ＞ 0.05).Conclusions Ethanol,benzalkonium bromide and chlorine - containing disinfectant can all achieve satisfactory disinfection results on the surfaces in clean operating room. Key words: Disinfectants; Clean operating room; Effect of disinfection

B-67 バイオロジカルクリーン手術室における空気清浄評価

B-67 バイオロジカルクリーン手術室における空気清浄評価