Main Operating Room Research Articles

Evaluation of prepectoral reconstruction surgical outcomes: Main operating room vs ambulatory surgery center

IntroductionDuring the height of the recent Coronavirus (COVID-19) pandemic, many surgeries were transitioned to ambulatory surgery centers to reserve inpatient resources and reduce transmission risks. Our study evaluated surgical outcomes of patients who underwent prepectoral breast reconstruction in the operating rooms of two full-service main hospitals versus their associated surgery centers. MethodsA retrospective chart review was conducted of patients who underwent immediate prepectoral breast reconstruction at a single hospital between 2018 and 2022. Eligible patients had at least 3 months of post-expander follow-up, with the majority also having 3 months of post-implant follow-up. Patient demographics, reconstructive characteristics, post-expander outcomes, and post-implant outcomes were evaluated between the surgery center and main operating room with Chi-square (or Fisher’s exact) and Wilcoxon rank-sum tests. ResultsThis study included 301 patients, outcomes of 509 post-expander breasts, and outcomes of 410 post-implant breasts. The patient characteristics were similar with the only significant difference being the hospital length of stay (increased stay at the main hospital). There were no statistically significant differences in any of the surgical outcomes between the two groups in the post-expander or post-implant period. ConclusionThe COVID-19 pandemic disrupted elective procedures, prompting a shift towards outpatient surgery to optimize hospital resources and reduce inpatient exposure risks. While breast reconstruction is elective, delays can pose risks for cancer patients. Our results show that surgical outcomes for prepectoral prosthetic breast reconstruction remain consistent whether performed in outpatient surgical centers or main hospitals.

Main Operating Room Versus Field Sterility in Hand Surgery: A Review of the Evidence.

Introduction: Many of the guidelines that are generally accepted as main operating room best practices are not evidence based. They are based on the concept that if some sterility is good, more must be better. They are not derived from evidence-based sterility. Evidence-based sterility is the study of which of our various sterility practices increase or decrease our infection rates, as opposed to guidelines based on how many bacteria are in the operating room. Methods: This article adds the most important evidence we could find that is not included in the first paper on evidence-based sterility in hand surgery published in 2019. In this review, we also balance the evidence with common sense opinion. Results: The 21st century has seen a rapid rise in the number and reports of hand surgery procedures performed with field sterility outside the main operating room. There is now an abundance of good evidence to support that the rate of infection is not higher when many hand operations are performed with field sterility in minor procedure rooms. Conclusion: Moving hand surgery out of the main operating room to minor procedure rooms should be supported by healthcare providers. The higher cost, increased solid waste, and inconvenience of main operating room surgery are not justifiable for many procedures because it does not reduce the risk of postoperative infection.

Main operating room deliveries for patients with high-risk cardiovascular disease

BackgroundHigh-risk cardiovascular disease (CVD) prevalence in pregnant patients is increasing. Management of this complex population is not well studied, and little guidance is available regarding labour and delivery planning for...

Evaluation of Detected Medication Errors Within the Operating Room at an Academic Medical Center.

Background: Medication errors are preventable events that lead to inappropriate medication use and potential patient harm. This is especially prevalent within the operating room (OR) where one practitioner is involved in the entire medication-use process. Despite recent implementation of BD Pyxis™ Anesthesia ES, Codonics Safe Label System, and Epic One Step at the University of Kentucky Healthcare (UKHC) to prevent medication errors, errors continue to be reported. Curatolo et al found human error was the most frequent cause of medication error within the OR. Clumsy automation may be an explanation for this, which imposes burdens and promotes work arounds. This study endeavors to assess potential medication errors via chart review to identify risk reduction strategies. Methods: This a single-center retrospective cohort review of patients admitted to a UK HealthCare Main Operating Room, defined OR1A-OR5A and OR7A-OR16A, who were administered medications from 8/1/2021 to 9/30/2021. Results: Over a 2-month period, 145 cases were conducted at UK HealthCare. Of the 145 cases, 98.6% (n = 143) involved a medication error and 93.7% (n = 136) of the errors involved a high-alert medication. The top 5 classes of drugs involved in errors were all high-alert medications. Lastly, 46.6% (n = 67) of cases had documentation that Codonics was utilized. In addition to analyzing medication errors, the financial analysis found that $3154.04 in drug cost was lost in the study period. When extrapolating these results to all BD™ Pyxis Anesthesia Machines at UK HealthCare, $107 237.36 of drug cost is potentially lost per year. Conclusions: These findings add to previous data that have described the increased rate of medication errors when conducting chart review rather than rely on self-reported data. In this study, 98.6% of all cases involved a medication error. In addition, these findings provide additional insight in the increased use of technology within the operating room despite medication errors still occurring. These results can be applied to like institutions to critically evaluate anesthesia workflow to determine risk reduction strategies.

K-wire Fixation of Closed Hand Fractures Outside the Main Operating Room Does Not Increase Infections

A multicenter prospective analysis of patients undergoing CRIF of metacarpal or phalangeal fractures inside or outside the OR was performed. Demographic data, injury characteristics, surgery information and postoperative infectious complications were recorded, including cellulitis, frank pus, and osteomyelitis. The study involved 1042 patients with a total of 2265 Kirschner-wires (K-wires). Infection rates were not statistically higher in the 719 patients who had CRIF outside of the OR (cellulitis 2.5%, frank pus 1.4%) compared with the 323 patients with CRIF in the OR group (cellulitis 3.4%, frank pus 2.5%). The OR group had a longer time to operation and a longer procedure time, but a shorter time with the K-wires in place. K-wire fixation of closed hand fractures outside of the OR under field sterility is safe because it does not increase infectious complications compared to CRIF in the main OR under full sterility.

Hysteroscopic Removal of Deeply Embedded IUD

<h3>Study Objective</h3> Highlight deeply embedded IUD as a potential complication of IUD placement and review surgical techniques for hysteroscopic removal of malpositioned IUD. <h3>Design</h3> N/A. <h3>Setting</h3> Main operating room suite, lithotomy position. <h3>Patients or Participants</h3> N/A. <h3>Interventions</h3> Operative hysteroscopy to remove deeply embedded IUD. <h3>Measurements and Main Results</h3> Successful recognition and removal of deeply embedded IUD via hysteroscopy including pre-operative ultrasound and MRI to localize IUD position. <h3>Conclusion</h3> Malpositioned IUD is a common complication of IUD use. A hysteroscopic approach is a safe and effective tool in removal of malpositioned or embedded IUD, including those deeply or completely embedded in the myometrium.

Ten Questions About Wide Awake Local Anaesthesia No Tourniquet (WALANT) Surgery.

The aim of this review article is to provide many important tips and tricks for surgeons to start Wide Awake Local Anaesthesia No Tourniquet (WALANT) hand surgery in their practice. The massive cost reduction of this disruptive new approach will enable them to increase access to hand surgery for their patients who cannot afford unnecessary sedation or unnecessary sterility of the expensive main operating room environment. Evidence-based sterility will permit surgeons to move a lot of their surgery out of the main operating room to minor procedure rooms without a significant increase in infection rates. Important pointers on how to inject minimally painful local anaesthesia will have patients thinking the surgeon injector is a bit of a magician. WALANT enables surgeons to improve the outcomes of many hand surgery procedures. Level of Evidence: Level V (Therapeutic).

Sterility of Miniature C-arm Fluoroscopy in Hand and Upper Extremity Surgery

Previous studies have demonstrated that sterile equipment is frequently contaminated intraoperatively, yet the incidence of miniature c-arm (MCA) contamination in hand and upper extremity surgery is unclear. To examine this incidence, a prospective study of MCA sterility in hand and upper extremity cases was performed in a hospital main operating room (MOR) (n = 13) or an ambulatory surgery center operating room (AOR) (n = 16) at a single tertiary care center. Case length, MCA usage parameters, and sterility of the MCA through the case were examined. We found that MOR surgical times trended toward significance (p = 0.055) and that MOR MCAs had significantly more contamination prior to draping than AOR MCAs (p < 0.001). In MORs and AORs, 46.2 and 37.5% of MCAs respectively were contaminated intraoperatively. In MORs and AORs, 85.7 and 80% of noncontaminated cases, respectively, used the above hand- table technique, while 50 and 83.3% of contaminated MOR and AOR cases, respectively, used a below hand-table technique. Similar CPT codes were noted in both settings. Thus, a high-rate of MCA intraoperative contamination occurs in both settings. MCA placement below the hand-table may impact intraoperative contamination, even to distant MCA areas. Regular sterilization of equipment and awareness of these possible risk factors could lower bacterial burden.

The impact of COVID-19 pandemic and national lockdown on the surgical care of ophthalmic patients in a tertiary health care institution

Introduction/Objective. World Health Organization in January 2020 declared a pandemic of the coronavirus disease named COVID-19. The state of emergency in the Republic of Serbia began on March 15 2020, which greatly influenced the treatment of those patients who were not affected by COVID-19. The aim of this paper is to compare the most common ophthalmic surgeries during quarantine with those performed in 2019 in the same period. Methods. This is a retrospective study. We collected data from the operating protocol of the main ophthalmic operating room. We have followed the changes related to surgical procedures during these two years. Results. During the state of emergency, significantly more operations were performed on male patients than on female patients compared to the same period in 2019 (p = 0.043). In the observed period, in 2019 significantly more patients older than 65 were surgically treated (p &lt; 0.001). During 2019, there were 397 (64.3%) elective and 220 (35.7%) urgent procedures, while for the same period next year there were 9 (9.1%) elective and 90 (90.9%) urgent procedures. Significantly more urgent interventions were performed during 2020 compared to 2019 (p &lt; 0.001). Conclusion. The coronavirus pandemic has led to numerous changes in the treatment of ophthalmic patients. Many patients did not have access to adequate treatment, which certainly led to the impairment of many ophthalmic diseases.

Techniques of Laparoscopic Needle Entry

<h3>Study Objective</h3> Demonstrate techniques of laparoscopic large needle entry when using 5mm port-sites. <h3>Design</h3> 10 randomly assigned patients undergoing laparoscopic hysterectomy were selected in the past 3 months. 5 of the patient's surgery were recorded using the backloading needle technique and the other 5 patient's surgery were recorded using the vaginal approach. The techniques performed were based on surgeon's preference. The videos were only recorded during the introduction of a CT-1 needle into the abdomen when only 5mm trocars were present. <h3>Setting</h3> Academic Private Hospital in South Florida in the Main Operating Room in lithotomy position. <h3>Patients or Participants</h3> 10 randomly assigned patients undergoing laparoscopic hysterectomy. 5 of the patient's surgery were recorded using the backloading needle technique and the other 5 patient's surgery were recorded using the vaginal approach. <h3>Interventions</h3> None. <h3>Measurements and Main Results</h3> one video from each technique from each technique was selected for this educational. presentation based on quality of the image and demonstration of the technique. These demonstrate good alternative techniques of introduction of large needle into the abdomen without the need to extend the skin or fascial incision. These techniques are easy to incorporate in the gynecologic surgical practice. <h3>Conclusion</h3> There are two main techniques for introducing a large suture needle through the abdomen when using 5mm port-site while decreasing the risk of port-site incisional hernias and further extending surgery time for fascial closure at the end of the case.

An educational initiative to reduce costs associated with volatile agent use

Background: Inhalational anesthetic agents represent a large portion of hospital pharmacy budgets due to their use in enormous quantities. In June of 2008, the scholarly project of an anesthesiology resident discovered a dramatic difference in the price of our volatile agents in MAC-hours, identifying an opportunity to reduce spending on volatile agents. By educating staff on the specific benefits and cost of each agent in MAC-hours, we have driven change in our drug selection algorithm. Time series analysis shows that an educational initiative in 2008 has had a sustained decrease in volatile agent expenditure for 10 years.Methods: To implement a new drug selection algorithm across our organization, key stakeholders were identified to include the operating room pharmacy and the nurse anesthetists that performed most of the anesthetics. Champions in the main inpatient operating room helped to implement default isoflurane use in that suite and it was sustained for the subsequent decade. Detailed volatile anesthetic purchasing data and data from our electronic medical record were analyzed. Following an initial educational intervention emphasizing the pharmacokinetic and economic benefits of isoflurane, a new volatile agent selection algorithm was implemented at Wake Forest in the hope that it would become the default agent chosen when there was not a compelling reason to use another drug. Our pharmacy was asked to maintain a new monthly par stock of volatile anesthetic agents and to adjust their subsequent monthly purchasing of volatile agents so as to replace only what was used the prior month. This newly implemented algorithm has persisted for a decade in the inpatient operating suite through the orientation of onboarding providers and the ongoing education of trainees.We obtained the monthly pricing and acquisition data from Wake Forest Baptist Health for the 12 year period ending in 2019, and we measured the total amount spent on volatile agents each year. We queried our electronic medical record for the number of cases using volatile agents, the average dose of volatile anesthetic given each year, and the average fresh gas flow rate. We then used an interrupted time series analysis of monthly cost per unit data using autoregressive integrated moving average (ARIMA) modeling, with the monthly cost per unit being the amount spent per bottle of anesthetic per month.Results: Following the implementation of the new drug selection algorithm, there was a statistically significant decrease in volatile agent expenditure (t = -2.754, p = 0.007) that has been sustained (t = 0.867, p = 0.387) for 10 years. Isoflurane has been the predominant agent purchased each year since implementation. One operating room suite implemented this drug selection algorithm and drove cost reduction that was sustained for the subsequent decade.Conclusions: We have kept all inhalational agents and their vaporizers on the anesthesia machine and available for selection, but encourage the default use of isoflurane because of its lower price and favorable pharmacokinetic properties. Through continuing education of trainees and onboarding of providers, isoflurane has remained the predominant volatile anesthetic chosen in the main inpatient operating suite at Wake Forest for the past decade. All three agents have continued to be used in great quantity as anesthetic case volumes increased over the past decade. However, our expenditure for volatile anesthetics has still been decreased by hundreds of thousands of dollars each year compared to the pre-intervention cost because of the successful implementation of this educational initiative in a single operating suite.

Evaluation of Risk Factors for Prolonged Stay in Post Anaesthesia Care Unit (PACU) in a Tertiary Care Hospital of Saudia Arabia

Background Delayed discharges and transfers from PACU result in congestion and bottleneck at various stages along perioperative care. We did this retrospective cross-sectional study to evaluate the incidence and risk factors for prolonged length of stay (LOS) in PACU. This study was conducted at Security Forces Hospital, Riyadh, Kingdom of Saudi Arabia. Materials and methods We included patients who stayed postoperatively in PACU for more than 2 hours. We collected the data of patients having surgical procedures in main operation room from April 2019 to February 2020. We collected preoperative, operative and postoperative variables of all included patients. The reasons for prolonged LOS in PACU were recorded as documented in patient notes. Results There was a total of 206 prolonged stays in PACU of our hospital. Perioperative cardiovascular and respiratory adverse events accounted for most of cases of prolonged PACU stays followed by surgical reasons like bleeding and extended surgery. Conclusion The main reasons for prolonged stay in PACU were cardiovascular and respiratory adverse events in perioperative period.

Factors Affecting the Main Operation Room Utilization Time at King Abdullah Medical City

Background: Hospitals and operating room departments aim to improve quality and safety, as well as utilization and efficiency. Operating rooms are cost-intensive, multi professional parts of health care organizations. Thus, efficient usage of OR capacity is crucial. Aim of the study: The aim of the current study is to determine the factors affecting the main operation room utilization time at King Abdullah Medical City (KAMC). Subjects and Methods: A retrospective descriptive research design was utilized to achieve the aim of the study. Four hundred forty-eight days included in this study with no missing data. Data was collected from the operations registration office and the quality department at KAMC in Saudi Arabia in terms of data inventory and reliability and was analyzed by statistical package for social sciences (SPSS) version 24. Results: 94.2% of ICU beds post-operative were available. Also, 77.9 % of surgeon' attendance on time and 75.5% of the first cases started on time. Highly statistical significant difference between 2017 and 2018 in relation to predictor factors of operation room utilization time was found. Conclusion: Availability of intensive care unit beds, starting the first case start on time and surgeon' attendance on time are the predictor factors for operating room utilization time. Recommendations: Ministry of health should work as much as possible to provide enough intensive care beds for operation theatre. Also, surgeons should attend to work at operation room at the right time and they should start working with the first case at the right time. The staff should be motivated by different incentives to start the operation on time.

Anti-vascular endothelial growth factor in the management of retinopathy of prematurity: A survey among the members of Indian Retinopathy of Prematurity Society.

Purpose:To report the results of the survey for the role of anti-VEGF in the management of retinopathy of prematurity (ROP) among the members of Indian ROP (iROP) society.Methods:A questionnaire was designed in English using Google forms and its link was circulated to the members of the iROP society on their mobile numbers. The survey included questions pertaining to demographics, anti-VEGF agents, injection technique, post-injection follow-up, and documentation pertaining to their ROP practice. Anonymous responses were obtained and analyzed for individual questions.Results:226 members of the society were contacted and 157 responded (69.4%) to the survey. 137 (87.2%) respondents used anti-VEGF in the management of ROP. Aggressive posterior ROP (APROP) was the most common indication (78, 52.7%). The procedure was carried out in the main operation room (102, 70.3%) simultaneously for both the eyes (97; 68%) under topical anesthesia (134; 86.4%) by most of the respondents. One-hundred thirteen (77.9%) respondents used half of the adult dose, irrespective of the agent used; however, more than half of them preferred bevacizumab (85, 54%). 53 (36.3%) respondents followed up infants as per disease severity rather than a fixed schedule while only 33 (23%) performed photo documentation. 151 (96.2%) respondents felt the need for guidelines regarding the usage of anti-VEGF in ROP.Conclusion:There is an increase in the trend towards the use of anti-VEGF in the management of severe ROP, particularly APROP. However, there are considerable variations among the ROP practitioners regarding the agent, dosage, follow-up schedule, and documentation, suggesting the need for uniform guidelines.

Evaluation of switch from satellite laboratory to central laboratory for testing of intraoperative parathyroid hormone

ObjectivesThe aim of this study was to evaluate testing turnaround time (TAT) and incision to close time in parathyroid surgeries before and after switching intraoperative parathyroid hormone (PTH) testing from a near point of care location to a central clinical laboratory. Design and MethodsThis retrospective study covered a ten-year period. Both testing locations used the same Roche Diagnostics PTH immunoassay but on different analyzers. The predominant site for surgeries was the main operating rooms (ORs) in an adjacent building, with a limited number of parathyroid surgeries performed at a more distant ambulatory surgery center (ASC). Under ideal conditions, TAT for near point-of-care testing was 20 ​min, although multiple factors could increase TAT. Incision to close time from the electronic health record was used to define time of surgery. ResultsA total of 897 unique patients were identified for which 3031 orders for intraoperative PTH were placed (383 unique patients and 1244 orders after switch in testing site). The average total TAT times for testing (mean ​± ​SD) in the central laboratory were 23.9 ​± ​16.0 ​min (median, 22 ​min) for all specimens, 22.8 ​± ​7.9 ​min (median, 21 ​min) for main OR specimens, and 26.4 ​± ​7.1 ​min (median, 25 ​min) for ASC specimens. Incision to close time for parathyroidectomies showed decreases in mean, median, and standard deviation following testing change. ConclusionsSurgery time for parathyroidectomies may remain consistent or decrease if intraoperative PTH testing is moved from a near point of care to a central laboratory.

Evidence-based Sterility: The Evolving Role of Field Sterility in Skin and Minor Hand Surgery.

Summary:Field sterility is commonly used for skin and minor hand surgery performed in the ambulatory setting. Surgical site infection (SSI) rates are similar for these same procedures when performed in the main operating room (OR). In this paper, we aim to look at both current evidence and common sense logic supporting the use of some of the techniques and apparel designed to prevent SSI. This is a literature review of the evidence behind the ability of gloves, masks, gowns, drapes, head covers, footwear, and ventilation systems to prevent SSIs. We used MEDLINE, EMBASE, and PubMed and included literature from the inception of each database up to March 2019. We could not find substantial evidence to support the use of main OR sterility practices such as head covers, gowns, full patient draping, laminar airflow, and footwear to reduce SSIs in skin and minor hand surgery. Field sterility in ambulatory minor procedure rooms outside the main OR is appropriate for most skin and minor hand surgery procedures. SSIs in these procedures are easily treatable with minimal patient morbidity and do not justify the cost and waste associated with the use of main OR sterility.

Abstract P5-16-09: Same-day surgery impact on breast reconstruction program in a public healthcare system: An affordable booster

Abstract Background Breast cancer represents the most common malignancy in Latin America, and since 2006 it is the cancer type with the highest incidence among Mexican women. Providing multidisciplinary high-quality care for the growing population of patients with breast cancer represents a challenge to low and middle-income countries, which have limited economic resources and limited health staff and facilities. Since 2007, Seguro Popular insurance program has provided coverage for the treatment of women with breast cancer, including surgery, radiotherapy, chemotherapy, endocrine therapy and Her2-targeted treatments; before this program up to 50% of the Mexican population did not have healthcare coverage, and had to pay out of pocket for cancer care. Unfortunately, due to financial constraints, this does not include other interventions which may be relevant, such as supportive care and reconstructive surgery. National Cancer Institute of Mexico (INCan) is a part of the Mexican federal government and as such provides care to uninsured individuals with all types of malignancies, including breast cancer. Since the start of Seguro Popular insurance program (2007), INCan has provided oncological care to over 5,000 women with breast cancer. In 2012, INCan received a grant from the federal government (P017 Reproductive Health and Gender Equality in Health Grant) in order to establish the “Post-Mastectomy Program” (PMP), which aimed providing free patient navigation, supportive care and breast reconstruction for women after mastectomy. Starting on july 2016, derived from PMP, it was possible the setting of a Same-Day Surgery Facility (SDSF) at INCan: two small, fully equipped operation rooms with a small recovery area; and the hiring of 4 nurses and 2 anesthesiologists, adding all this to the one main operation room already set for breast cancer surgery. This allowed an increase in all kind of breast cancer surgery: conservative surgery, mastectomy with sentinel lymph node and breast reconstruction procedures. One of this rooms was assigned to breast reconstructive surgeries. Material and Methods Data were retrospectively collected from a 5 year period, 30 months before SDSF and 30 months after SDSF. Before SDSF an average 66.4 (54-73) of breast reconstruction surgeries were done by six month period, total of 332 breast reconstruction surgeries. After implementation of SDSF an average of 124 (107-138) by six month period, with a total 621 surgeries, which represents an 87% increase in breast reconstruction procedures for the same time period. Conclusion Same day surgery has been proven before to be safe in breast cancer surgery and in breast reconstructive surgery when co-morbidities are accounted for. This work shows that implementation of Same-Day Surgery could be a tool to increase the offer of breast reconstruction in economically restrained systems, in early or experienced breast reconstruction programs in developing economies, and even in developed ones. In our experience, this approach achieved an 87% increase in breast reconstruction procedures, in a 30 month period, which allowed us to benefit more women and offer them a better quality of life. Citation Format: Bargalló-Rocha JE, Gutiérrez-Zacarías LM, Maciel-Miranda A, Figueroa-Padilla J, Drucker-Zertuche M, Esparza-Arias N, Elizalde-Méndez A, Cabrera-Galeana PA. Same-day surgery impact on breast reconstruction program in a public healthcare system: An affordable booster [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P5-16-09.

Improving operating room efficiency in academic children's hospital using Lean Six Sigma methodology

Background/purposeLean Six Sigma (LSS) is a process improvement methodology that utilizes a collaborative team effort to improve performance by systematically identifying root causes of problems. Our objective was to determine whether application of LSS could improve efficiency when applied simultaneously to all services of an academic children's hospital. MethodsIn our tertiary academic medical center, a multidisciplinary committee was formed, and the entire perioperative process was mapped, using fishbone diagrams, Pareto analysis, and other process improvement tools. Results for Children's Hospital scheduled main operating room (OR) cases were analyzed, where the surgical attending followed themselves. ResultsSix hundred twelve cases were included in the seven Children's Hospital operating rooms (OR) over a 6-month period. Turnover Time (interval between patient OR departure and arrival of the subsequent patient) decreased from a median 41min in the baseline period to 32min in the intervention period (p<0.0001). Turnaround Time (interval between surgical dressing application and subsequent surgical incision) decreased from a median 81.5min in the baseline period to 71min in the intervention period (p<0.0001). ConclusionThese results demonstrate that a coordinated multidisciplinary process improvement redesign can significantly improve efficiency in an academic Children's Hospital without preselecting specific services, removing surgical residents, or incorporating new personnel or technology. Study typeProspective comparative study, Level II.

Assessing complications from the use of trailer operating rooms in single-staged renovations

Renovations of an operating room can result in compromised care and loss of revenue. The objective of this study is to determine if Trailer Operating Rooms (TOR) are associated with increased complication rates and/or decreased productivity during renovations of Main Operating Rooms (MOR). Exposure was defined as MOR or TOR. Veterans Affairs Surgical Quality Improvement Program (VASQIP) observed and expected counts of perioperative morbidity and mortality were compared. Complication rates, from a prospective database, and case volume between TOR and MOR were analyzed. Mortality was higher for vascular surgery in TOR vs. MOR but not in any other specialties. Higher all-cause morbidity was noted in two of the nine surgical specialties in the TOR period. There was no significant difference in rates of surgical site infection (SSI) or venous thromboembolism (VTE) between groups. The average total cases per month was significantly higher in MOR compared to TOR (326.8±49.6 vs. 275.1±22.9, p<0.001) as were the VASQIP eligible cases (183.7±28.4 vs. 155.0±14.6, p<0.001). TORs are efficient and safe for providing continuity of surgical care during renovation or emergency. Further studies are required to assess whether the decrease in case load is truly attributable to the mobile platform.

Adherence to surgical hand rubbing directives in a hospital district of Southwest Finland*

Background: The primary objective was to measure the compliance with alcohol-based surgical hand rubbing (SHR) among operation room personnel. The secondary objective was to evaluate the effect of feedback sessions on compliance. Methods: This was a prospective observational before-after intervention study. Between October 2010 and June 2012 the hygiene nurses observed SHR among operation room personnel in the hospital district of Southwest Finland. After feedback sessions a second observation round was conducted in the main operation room of Turku University Hospital. The first observation round comprised 477 observations: 259 (54%) were doctors, 190 (40%) nurses and 28 (5%) other personnel. In the second observation round a total of 210 observations were made. Results: During the first round in 42% of observations the 3 min SHR time recommended by WHO was used. Median times for SHR were 1 min 50 s (range 0 min to 5 min 44 s) for doctors and 3 min 25 s (range 1 min 1 s to 8 min 15 s) for nurses, respectively (p < 0.0001). In 40% of observations hands were not properly dried after a wash before applying SHR and in 45% hands were not allowed to dry properly after SHR before donning surgical gloves. After feedback, time for SHR did not significantly improve but technique did. Conclusions: SHR was performed incorrectly in most observations even after feedback. The results stress the importance of more effective education, helping techniques and positive role models for operation room personnel to promote SHR.