Handling Of Surgical Instruments Research Articles

COVID-19 pandemic and its impact on dental education: digitalization – progress or regress? Example of an online hands-on course

BackgroundDue to the SARS-CoV-2 pandemic and the accompanying contact restrictions, a new challenge arose for dental education. Despite the limited overall situation, it must be ensured that, in addition to theoretical content, practical skills in particular continue to be taught. Therefore, the aim of this study was to develop and implement an online hands-on course for dental students that ensures practical training, even during the pandemic.MethodsThe newly developed course was held from April 2020 to March 2021. A total of six groups (each consisting of approximately 40–50 students) took part in the course. The participating students were in their 3rd, 4th or 5th year of study. The course taught theoretical basics (via an online platform) and promoted the learning of practical/surgical techniques on models such as bananas, pork bellies, or chicken thighs with live demonstrations (via ZOOM) and interactive post-preparation by students at home (and in a rotating small group of 3–7 students on site). Student self-evaluation (at the beginning and end of the course) and course evaluation were performed using questionnaires. The learning success was analyzed (through self-evaluations) using Wilcoxon signed-rank tests (significance level alpha = 0.05).ResultsConcerning students´ self-evaluations, the theoretical knowledge, general surgical skills (such as surgical instrument handling), and specific surgical skills (such as performing a kite flap) improved during the course, with significant results (p < 0.001 for each). About 60% of the students rated the course overall as excellent (grades 9 or 10 on a Likert scale of 1 to 10). The technical implementation of the course was rated with a median of 9 (= very good, on a Likert scale of 1 to 10). 38.5% described the applicability of the skills learned for their later professional life as extremely good.ConclusionsThe results of this work suggest that, within the limitations of this study, the introduced concept of an online hands-on course could be an appropriate form of teaching practical dental skills, even during a pandemic. Further research is needed in the field of digital education for dental students.

Acquisition of endoscopic nasal surgery skills with a lamb’s head model

ObjectivesTo evaluate the acquisition of surgical skills by otolaryngology residents and established the minimum number of dissections of a lamb’s model to be performed before practicing on human patients. MethodsNineteen second-year otolaryngology residents performed ten dissections each, five on each nasal cavity, always practicing the same three surgical procedures on the lamb model. Each student’s training lasted 2-months, and the entire training intervention lasted 4-years, over four generations of residents. All dissections were recorded and were selected at random for examination by two independent otolaryngology surgeons, who were otherwise not involved in the research. Assessment of the 190 dissections used an instrument validated for surgical training of medical residents. ResultsTo a 1% significance level, statistical analysis revealed increased performance and satisfactory results were observed after the sixth dissection. Furthermore, after the eighth dissection, skill acquisition was relevant and sustained. ConclusionTraining in endoscopic nasal surgery on a lamb’s head model improves surgical skills and handling of surgical instruments. Our results showed the relevance of the lamb model for training in otolaryngology surgery, impacting on patient safety. Level of evidence2.

Basic surgical skills training in United Kingdom foundation year doctors: Can we do more?

ObjectiveRecent changes to the structure of medical training have placed increasing pressure on foundation year 1 (FY1) doctors to decide upon careers earlier. The deadline for application to core surgical training (CST) at the start of the foundation year 2 (FY2) may deter doctors from pursuing careers in surgery due to insufficient experience and confidence in its practical aspects. We piloted a four-week basic surgical skills (BSS) programme near the start of the FY1 year to a small cohort of FY1s and assessed its impact on confidence in basic surgical competencies and attitudes to a career in surgery. MethodsFY1 doctors at Whipps Cross University Hospital (WXUH) were selected to participate in a four week BSS programme within three months of starting their posts. We devised the BSS programme based on relevant key competencies in the Intercollegiate Surgical Curriculum Programme (ISCP). Using questionnaires we assessed confidence in basic surgical skills, competencies and attitudes to surgery before, immediately after and at 8 months after completion of the course and compared this with non-participating FY1s. ResultsOut of 31 FY1 doctors, 14 (4 males, 10 females) participated in the BSS programme and 17 (10 males, 7 females) were non-participants (control group). Using the Mann–Whitney test, there was a statistically significant increase in confidence at 8 month follow-up of course participants (versus control group) in tying knots (p = 0.0112), suturing skills (p = 0.0455) performing fine needle aspiration (FNA) cytology (p = 0.0017), obtaining tru-cut biopsy samples (p = 0.0031), suturing lacerations in accident and emergency (A&E) (p = 0.0009), incising and draining abscesses (p = 0.0034), performing skin closure (p = 0.0042), surgical sharps handling (p = 0.0402) and surgical instrument handling (p = 0.0066). Course participants were significantly more likely than non-participants to receive additional training in BSS from senior members of the team (p = 0.0076). Importantly, they also demonstrated a statistically significant increase in interest in a career in surgery at 8 month follow-up in comparison to non-participants (p = 0.0016). ConclusionsA structured, challenging BSS teaching programme early on during the FY1 year increases confidence in key surgical skills and competencies and can increase interest in surgery as a career.

Education for Endonasal Endoscopic Surgery: Evaluation and Guiding of Surgical Skill and Ability with the Technique of Behavioral Engineering

We present a step-up training system for endonasal endoscopic surgery based on the evaluation by the trainers and self-assessments. Step 1: The trainees are taught basic anatomy and the pre-operative planning. The navigation system is useful in this step. Step 2: We developed a surgical skill training system (HyperMirror interface). We analyzed the difference of a handling of surgical instruments, a loading force, and invasiveness between trainees and trainers using a precise nasal model. In easy tasks, the surgical time got comparable between the trainees and trainers after the repeated training. In difficult tasks, however, the surgical time depended on personal ability, and simple repeated training was not enough to improve the surgical time. Large difference was found between the trainees and trainers in the force power of the instruments to a model and the range of bone dissection. Using a precise nasal model and a navigation system, it was possible to compare endoscopic view and macroscopic observation in a three-dimensional manner. Step 3: In the operation theater, the instructor do the surgery using a precise nasal model made on the patients’ own CT scan. The trainees can learn the safe / precise operation by following the surgical field made by the instructor using a model. To improve the quality of surgery education, it will be necessary to evaluate an ability of instructors and the mental load of trainees. Finally, we hope to develop a new educational program that every trainee can learn standard surgical techniques efficiently.

Acquisition of proteinaceous contamination through the handling of surgical instruments by hospital staff in sterile service departments

Using Episcopic Differential Interference Contrast (EDIC) microscopy, this study has investigated the potential reapplication of prote ina ceouscontami napotential reapplication of proteinaceous contamination onto surgical instruments following a washer-disinfector cycle through the handling of staff within the clean room. The deposition of 0.51 ng/mm2 of protein onto surgical grade stainless steel by one finger print alone has been demonstrated. Moreover, using a previously described contamination index, a 5 to 10-fold increase in protein present on surgical instruments was noted following handling by clean-room staff under current departmental practices, relative to instruments handled by staff wearing gloves. While unlikely to pose a direct risk to patient health, subsequent sterilisation will fix protein to an instrument surface thereby decreasing the effectiveness of further decontamination cycles. Current guidelines make no recommendations surrounding the use of gloves by staff working within the clean room. However it is clear that this matter must be reviewed to limit the unnecessary transference of protein to surgical instruments.

0050 DEVELOPMENT OF AN EARLY DETECTION NETWORK IN FRANCE

Recent changes to the structure of medical training have placed increasing pressure on foundation year 1 (FY1) doctors to decide upon careers earlier. The deadline for application to core surgical training (CST) at the start of the foundation year 2 (FY2) may deter doctors from pursuing careers in surgery due to insufficient experience and confidence in its practical aspects. We piloted a four-week basic surgical skills (BSS) programme near the start of the FY1 year to a small cohort of FY1s and assessed its impact on confidence in basic surgical competencies and attitudes to a career in surgery.FY1 doctors at Whipps Cross University Hospital (WXUH) were selected to participate in a four week BSS programme within three months of starting their posts. We devised the BSS programme based on relevant key competencies in the Intercollegiate Surgical Curriculum Programme (ISCP). Using questionnaires we assessed confidence in basic surgical skills, competencies and attitudes to surgery before, immediately after and at 8 months after completion of the course and compared this with non-participating FY1s.Out of 31 FY1 doctors, 14 (4 males, 10 females) participated in the BSS programme and 17 (10 males, 7 females) were non-participants (control group). Using the Mann–Whitney test, there was a statistically significant increase in confidence at 8 month follow-up of course participants (versus control group) in tying knots (p = 0.0112), suturing skills (p = 0.0455) performing fine needle aspiration (FNA) cytology (p = 0.0017), obtaining tru-cut biopsy samples (p = 0.0031), suturing lacerations in accident and emergency (A&E) (p = 0.0009), incising and draining abscesses (p = 0.0034), performing skin closure (p = 0.0042), surgical sharps handling (p = 0.0402) and surgical instrument handling (p = 0.0066). Course participants were significantly more likely than non-participants to receive additional training in BSS from senior members of the team (p = 0.0076). Importantly, they also demonstrated a statistically significant increase in interest in a career in surgery at 8 month follow-up in comparison to non-participants (p = 0.0016).A structured, challenging BSS teaching programme early on during the FY1 year increases confidence in key surgical skills and competencies and can increase interest in surgery as a career.

Infection control plan for the equine surgery suite: instrument sterilisation and clinic design

Alarming discoveries have shown that some pathogenic bacteria have become resistant to all antibiotics (Block 2001). Many threatening microbial assaults have been witnessed, such as ‘mad cow’ disease (bovine spongiform encephalitis [BSE]) caused by prions emerging unexpectedly and spread around the world by international transportation of people and animals (Block 2001). Man and horses are the most ‘frequent flyers’ in international travel (Ostlund 2001). The use of insufficiently disinfected endoscopes during a prepurchase examination might spread infection and have serious consequences (McEvoy et al. 1998). A contaminated cannula resulted in an infection in 3 human patients following arthroscopic meniscus repair (Blevins et al. 1999). In the past, it was difficult to prove a casual relationship between a contaminated instrument and a subsequent nosocomial infection. However, state-of-the-art clinical epidemiology using molecular typing tools (pulsed-field gel electrophoresis, genome sequencing) can prove a causal relationship between the use of reprocessed but still contaminated instruments and cross-infection between patients (Widmer and Frei 1999). A thorough understanding of sterilisation and disinfection measures are necessary to prevent infection. Utilising current healthcare techniques to provide a desirable environment for the equine patient at a reasonable cost for the investor (clinic owner) is not an easy task. Many techniques developed for human medicine have been adopted by veterinary medicine and design innovations are encouraged to contribute to an equivalent level of performance in veterinary medicine. The goal is to provide and maintain a safe environment for patients, personnel and public. The equine surgeon should have a desire for the highest possible standards, even in private practice, to prevent wound infection (McIlwraith and Turner 1987; Turner and McIlwraith 1989). Quality control of autologous tissues (i.e. skin grafts) or engineered tissue products are not considered in this article and readers are referred to Brockbank and Battjes Siler (2001). The rate of surgical wound infection in veterinary medicine is between 5 and 10% (MacDonald et al. 1994; Vasseur et al. 1998). Infections are a dangerous complication after surgical procedures (Southwood and Baxter 1996; Trostle and Hartmann 1999). Various risk factors for infection after colic surgery have been identified (Honnas and Cohen 1997). Preventing infections is the responsibility of all personnel and surgeons should serve as a role model for proper hygiene techniques (von Hagen 1992). Proper gowning and scrubbing techniques are adequately addressed in most surgery textbooks. Infection prophylaxis in surgery begins with uncontaminated instruments. Exogenous (nonpatient-related) sources of microorganisms are operating room personnel, environment and the air. Advancing technique has developed improved air systems for the surgical suite. Whereas personnel can make only slight improvements, major improvements have been made in the sterilisation of instruments. In order to reuse instruments, they must be properly cleaned, sterilised and stored. Even correct handling of surgical instruments cannot always prevent infections, but validating and documenting properly processed instruments can limit future successful litigation.

Handling of surgical instruments in a presymptomatic familial carrier of Creutzfeldt-Jakob disease

A presymptomatic familial carrier of Creutzfeldt-Jakob disease (CJD) returned to our 250-bed acute care community hospital for repeat lumbar laminectomy. Originally, the Centers for Disease Control and Prevention approach was used to manage the instruments in a high-risk patient undergoing a potentially high-risk procedure. On repeat scheduling for laminectomy, we assumed the possibility of CJD infectivity and set aside the used instruments for future use on this patient only.

Effect of puncture resistant surgical gloves, finger guards, and glove liners on cutaneous sensibility and surgical psychomotor skills

New puncture and cut resistant hand protection systems have been developed to enhance the barrier to cuts and needle puncture injuries during surgical procedures. It is important, however, that these new hand protection systems do not reduce tactile sensitivity or dexterity during surgery. Consequently, it was the purpose of this report to compare the cutaneous sensibility and dexterity of physicians' hands covered by these new puncture and cut resistant hand protection systems to that of the standard surgical latex glove. The hide (Medak) portion of the Life Liner and the polyethylene (Spectra) portion of the FingGuard, which offered the greatest resistance to needle puncture, were associated with the greatest reduction in cutaneous sensibility, as determined by moving and static two-point discrimination, aesthesiometer pressure sensation, and discrimination of suture size and configuration. In addition, the physicians believed that the puncture and cut resistant Life Liner glove liner markedly interfered with their handling of surgical instruments. The ultimate benefit of these puncture and cut resistant hand protection systems must be determined in well-controlled clinical trials.