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Objective: This study aims to identify the obstacles to recycling and environmental sustainability habits in a university hospital's operating room (OR) environment in Turkey and lay the groundwork for potential solutions. Methods: A questionnaire was used to measure current views among the 140 OR staff members aged 20-54 years. The survey assessed awareness and behaviors of recycling at home and in the OR, as well as awareness of environmentally safe anaesthesia practices. Results: Half of the participants believed that ORs significantly affected their carbon footprint, and most agreed that these environmental effects could be reduced. The primary barriers to recycling were inadequate knowledge, negative staff attitudes and insufficient services. Notably, 76% of participants paid attention to segregating OR waste, yet many lacked formal education about the environmental impact of their practices. Approximately 89% agreed that the environmental effects of ORs could be further reduced, with education being a critical need. Conclusion: The healthcare sector's contribution to carbon emissions and waste production is significant, especially in ORs. The lack of education regarding ecological implications is concerning. Implementing standardized training programs and enhancing recycling services can substantially reduce the environmental impact of ORs, highlighting the need for a more sustainable healthcare system.

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INTRODUCTION: The operating room is no longer the ideal place for early surgica training of cardiothoracic surgery residents, forcing the search for simulation-based learning options. The study's aim was the construction and surgicaltraining of coronary anastomosis in a portable, low-cost, homemade simulator. METHODS: This is an observational, analytical, and multicenter study. The simulator was built with common materials and was evaluated with the Objective Structured Assessment ofTechnical Skills (or OSATS) Modified. All junior and senior residents from nine national cardiothoracic surgery centers were considered for 90 days. Operative skill acquisition and time in the creation of side-to-side (S-T-S), end-to-side (E-T-S), and end-to-end (E-T-E) coronary anastomoses were evaluated. All sessions were recorded and evaluated by a single senior cardiothoracic surgeon during two time periods. RESULTS: One hundred and forty residents were assessed in 270 sessions. In junior residents, a significant improvement in final scores was identified in S-T-S (use of Castroviejo needle holder, needle angles, and needle transfer) (P<0.05). In seniors, a significant improvement was identified in S-T-S (graft orientation, appropriate spacing, use of forceps, angles, and needle transfer) anastomoses (P<0.05). A significant improvement in the final anastomosis time of senior residents over junior residents was identified in S-T-S (8.11 vs. 11.22 minutes), E-T-S (7.93 vs. 10.10 minutes), and E-T-E (6.56 vs. 9.68 minutes) (P=0.039). CONCLUSION: Our portable and low-cost coronary anastomosis simulator is effective in improving operative skills in cardiothoracic surgery residents; therefore, skills acquired through simulation-based training transfer have a positive impact on the surgical environment.

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AIMS: To map the existing literature describing medical device-related pressure injuries in patients during surgery, including investigation of the incidence, types of medical devices, risk factors and strategies for preventing medical device-related pressure injuries. DESIGN: A scoping review. DATA SOURCES: In April 2023, three databases were searched. Studies about adult patients undergoing surgery, from 2014 onwards, in English and Chinese were included. Data were extracted about study characteristics and data related to research questions. The Patterns, Advances, Gaps, Evidence for practice and Research recommendations framework were used to synthesize findings. RESULTS: Two different types of evidence were included in this review; 14 research studies and two quality improvement studies. The incidence of medical device-related pressure injuries in the operating room was 0.56%-24.5% and respiratory devices were the most common medical devices investigated. Length of surgery, age and BMI were risk factors for medical device-related pressure injuries in a few studies. The application of a prophylactic dressing and dressing maintenance was the most common prevention strategy. CONCLUSION: Ongoing research is needed to confirm the incidence of, and risk factors for, medical device-related pressure injuries in the operating room. Additionally, more high-quality evidence is needed to underpin current prevention strategies. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: Operating room nurses need to be aware of the risks of medical device-related pressure injuries and assess and plan prevention strategies accordingly. Once more high-quality evidence is available, operating room nurses could implement prevention strategies like prophylactic dressings. REPORTING METHOD: Scoping Reviews (PRISMA-ScR) checklist. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

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Mixed Reality is a technology that has gained attention due to its unique capabilities for accessing and visualizing information. When integrated with voice control mechanisms, gestures and even iris movement, it becomes a valuable tool for medicine. These features are particularly appealing for the operating room and surgical learning, where access to information and freedom of hand operation are fundamental. This study examines the most significant research on mixed reality in the operating room over the past five years, to identify the trends, use cases, its applications and limitations. A systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines to answer the research questions established using the PICO (Population, Intervention, Comparator and Outcome) framework. Although implementation of Mixed Reality applications in the operations room presents some challenges, when used appropriately, it can yield remarkable results. It can make learning easier, flatten the learning curve for several procedures, and facilitate various aspects of the surgical processes. The articles' conclusions highlight the potential benefits of these innovations in surgical practice while acknowledging the challenges that must be addressed. Technical complexity, equipment costs, and steep learning curves present significant obstacles to the widespread adoption of Mixed Reality and computer-assisted evaluation. The need for more flexible approaches and comprehensive studies is underscored by the specificity of procedures and limited samples sizes. The integration of imaging modalities and innovative functionalities holds promise for clinical applications. However, it is important to consider issues related to usability, bias, and statistical analyses. Mixed Reality offers significant benefits, but there are still open challenges such as ergonomic issues, limited field of view, and battery autonomy that must be addressed to ensure widespread acceptance.

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BACKGROUND: The healthcare system plays a pivotal role in environmental sustainability, and the operating room (OR) significantly contributes to its overall carbon footprint. In response to this critical challenge, leading medical societies, government bodies, regulatory agencies, and industry stakeholders are taking measures to address healthcare sustainability and its impact on climate change. Healthcare now represents almost 20% of the US national economy and 8.5% of US carbon emissions. Internationally, healthcare represents 5% of global carbon emissions. US Healthcare is an outlier in both per capita cost, and per capita greenhouse gas emission, with almost twice per capita emissions compared to every other country in the world. METHODS: The Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) and the European Association for Endoscopic Surgery (EAES) established the Sustainability in Surgical Practice joint task force in 2023. This collaborative effort aims to actively promote education, mitigation, and innovation, steering surgical practices toward a more sustainable future. RESULTS: Several key initiatives have included a survey of members' knowledge and awareness, a scoping review of terminology, metrics, and initiatives, and deep engagement of key stakeholders. DISCUSSION: This position paper serves as a Call to Action, proposing a series of actions to catalyze and accelerate the surgical sustainability leadership needed to respond effectively to climate change, and to lead the societal transformation towards health that our times demand.

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Objective: To evaluate the effectiveness of mobile -based learning (MBL) in improving nursing students' knowledge and skills when performing procedures in the operating room. Methods: A quasi-experimental study with control group, pre- and post-intervention assessment was conducted. A total of 128 nursing students from India were recruited by purposive sampling and randomly assigned to the intervention (use of a telephone application containing videos on hand washing, surgical gown donning, gloving, and assisting during intubation) and conventional education groups. A validated Structured Knowledge Questionnaire and an Objective Structured Clinical Examination (OSCE) scale was used to assess nursing students' competencies in relation to operating room procedures and a mobile-based learning satisfaction opinion questionnaire was administered. Results: The findings showed that the improvement in the mean knowledge and skills score was greater in the intervention group than in the control group (p<0.001). The administration of the MBL was rated as highly satisfactory by 93.8% of the students exposed to this learning method. Conclusion: The MBL intervention was effective in improving nursing students' knowledge and skills in the evaluated operating room procedures.

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BACKGROUND: Initiation of pharmacy automation and automated dispensing cabinets (ADCs) in hospitals has shown to improve clinical, operational, and economical outcomes. Implementation of ADCs in surgical areas has lagged behind that of traditional hospitals settings. OBJECTIVES: To assess the documented impact of ADCs in ambulatory surgery centers (ASCs), perioperative, and surgical care areas. METHODS: A systematic literature review (SLR) was conducted in PubMed and Google Scholar in November 2022. The SLR was performed and reported according to the PRISMA guidelines. Original research studies were included if they reported empirical data on ADCs in ASCs, perioperative areas, and surgical settings. The search criteria consisted of site locations in North America or Europe, with articles written in English and published after 1992. Outcomes of the studies were categorized as medication errors, controlled substance discrepancies, inventory management, user experience, and cost effectiveness. RESULTS: A total of nine studies met the inclusion criteria. Six assessed ADC impact on controlled-substance inventory management, with all finding reductions in controlled-substance discrepancies ranging from 16% to 62.5%. Two studies showed a reduction in medication errors from 23% in one study to up to 100% after ADC implementation in the other. Three studies revealed a positive impact on user experience, with a range of 81%-100% of nurses across these settings being satisfied with ADC usage. Only one study showed post-ADC implementation labor cost savings due to reduction in labor hours but was based on data from three decades ago. CONCLUSIONS: ADC implementation in surgical settings was found to decrease medication errors, reduce controlled-substance discrepancies, improve inventory management, increase user experience, and reduce labor hours although the evidence consisted of smaller-scale studies. Larger-scale studies are needed to support these findings, thereby fostering a more comprehensive view of the multifactorial impact of ADCs in these settings.

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BACKGROUND: Surgical patients are at risk of postoperative complications, which may lead to increased morbidity, mortality, hospital length-of-stay and healthcare costs. Enhanced Recovery After Surgery (ERAS®) protocols are evidence-based and have demonstrated effectiveness in decreasing complications and associated consequences. However, their adoption in Australia has been limited and the reason for this is unclear. This study aimed to describe clinicians' perceptions of ERAS protocols in Australia. METHODS: A national online survey of anaesthetists, surgeons and nurses was undertaken. Invitations to participate were distributed via emails from professional colleges. The 30-item survey captured respondent characteristics, ERAS perceptions, beliefs, education and learning preferences and future planning considerations. The final question was open-ended for elaboration of perceptions of ERAS. Descriptive and inferential statistics were used to describe and compare group differences across disciplines relative to perceptions of ERAS. RESULTS: The sample included 178 responses (116 nurses, 65.2%; 36 surgeons, 20.2%; 26 anaesthetists, 14.6%) across six states and two territories. More than half (n = 104; 58.8%) had used ERAS protocols in patient care, and most perceived they were 'very knowledgeable' (n = 24; 13.6%) or 'knowledgeable' (n = 71; 40.3%) of ERAS. However, fewer nurses had cared for a patient using ERAS (p <.01) and nurses reported lower levels of knowledge (p <.001) than their medical counterparts. Most respondents agreed ERAS protocols improved patient care and financial efficiency and were a reasonable time investment (overall Md 3-5), but nurses generally recorded lower levels of agreement (p.013 to < 0.001). Lack of information was the greatest barrier to ERAS knowledge (n = 97; 62.6%), while seminars/lectures from international and national leaders were the preferred learning method (n = 59; 41.3%). Most supported broad implementation of ERAS (n = 130; 87.8%). CONCLUSION: There is a need to promote ERAS and provide education, which may be nuanced based on the results, to improve implementation in Australia. Nurses particularly need to be engaged in ERAS protocols given their significant presence throughout the surgical journey. There is also a need to co-design implementation strategies with stakeholders that target identified facilitators and barriers, including lack of support from senior administration, managers and clinicians and resource constraints.

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Objetivo: Promover a reflexão sobre os efeitos da transformação digital na enfermagem perioperatória. Métodos: Estudo reflexivo baseado em dados da literatura associado a prática do autor na enfermagem perioperatória e no projeto de automação. Resultados: evidenciou-se um misto de competências para enfermagem perioperatória, como atividades relacionadas a busca pelo hospital digital, uso da inteligência artificial e robótica. Conclusão: a reflexão deste tema incentiva o enfermeiro na busca de pesquisa, desenvolvimento digital e novos conhecimentos na área digital associados à sua prática clínica. (AU)

Objective: To promote reflection on the effects of digital transformation in perioperative nursing. Methods: Reflective study based on literature data associated with the author's practice in perioperative nursing and automation project. Results: a mix of skills for perioperative nursing was evidenced, such as activities related to the search for the digital hospital, use of artificial intelligence and robotics. Conclusion: the reflection on this theme encourages nurses to search for research, digital development and new knowledge in the digital area associated with their clinical practice. (AU)

Objetivo: Promover la reflexión sobre los efectos de la transformación digital en la enfermería perioperatoria. Métodos: Estudio reflexivo basado en datos de la literatura asociados a la práctica del autor en enfermería perioperatoria y proyecto de automatización. Resultados: se evidenció una mezcla de habilidades para la enfermería perioperatoria, como actividades relacionadas con la búsqueda del hospital digital, uso de inteligencia artificial y robótica. Conclusión: la reflexión sobre este tema anima al enfermero a buscar investigación, desarrollo digital y nuevos conocimientos en el área digital asociados a su práctica clínica. (AU)

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This review article provides a comprehensive examination of the evolution of cardiac anesthesia, emphasizing contemporary approaches beyond the traditional operating room (OR) setting. Tracing the historical roots of cardiac anesthesia from its inception in the mid-20th century, the narrative explores the significant paradigm shift driven by technological advancements and changing procedural approaches. The review highlights the emergence of non-OR environments, such as hybrid operating rooms, catheterization laboratories, and electrophysiology labs, as integral spaces for cardiac interventions. Key findings underscore the importance of patient selection, preoperative assessment, and specialized anesthetic management in optimizing outcomes. Implications for the future of cardiac anesthesia include the potential for enhanced patient-centered care, reduced complications, and improved resource utilization through the integration of advanced technologies. The call to action involves encouraging ongoing research and fostering collaboration among healthcare professionals to refine protocols further, address challenges, and propel the field toward continued innovation in contemporary cardiac interventions.

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This review summarizes the key applications of a hybrid operating room (HOR) in hepatobiliary surgery and explores the advantages, limitations, and future directions of its utilization. A comprehensive literature search was conducted in PubMed to identify articles reporting on the utilization of HORs in liver surgery. So far, the HOR has been limitedly applied in hepatobiliary surgery. It can offer an optimal environment for combining radiological and surgical interventions and for performing image-guided surgical navigation.

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Introducción. La nueva era de la cirugía es cada vez más dependiente de la tecnología, y un ejemplo de ello es el uso generalizado de electrocauterio como parte primordial de la práctica quirúrgica. El humo quirúrgico es un subproducto de la disección y la coagulación de los tejidos producidas por los equipos de energía, que representa múltiples riesgos potenciales para la salud del grupo quirúrgico, sin embargo, se han minimizado los peligros causados por la exposición de manera frecuente y acumulativa a este aerosol. Métodos. Se realizó un análisis crítico, desde una posición reflexiva de la información disponible, estableciendo los posibles riesgos relacionados con la exposición al humo quirúrgico. Discusión. Es visible la necesidad imperativa de establecer directrices nacionales, pautas normativas y recomendaciones estandarizadas para cumplir con las exigencias dadas por los sistemas de gestión en salud ocupacional y seguridad del trabajo, cuyo objetivo principal es hacer efectivo el uso de mascarillas quirúrgicas apropiadas, la implementación de programa de vigilancia epidemiológica ambiental en sala de cirugía, la priorización del uso constante de aspiradores y sistemas de evacuación, y la ejecución de programas educativos de sensibilización dirigidos al personal implicado. De igual manera, se abre la inquietud de la necesidad de nuevos estudios para definir con mayor precisión el peligro de este aerosol. Conclusión. Se recomienda de manera responsable utilizar todas las estrategias preventivas existentes para intervenir en salas de cirugía los riesgos minimizados y olvidados del humo quirúrgico.

Introduction. The new era of surgery is increasingly dependent on technology, and an example of this is the widespread use of electrocautery as a primary part of surgical practice. Surgical smoke is a byproduct of the dissection and coagulation of tissues produced by energy equipment, which represents multiple potential health risks for the surgical group; however, the dangers caused by cumulative exposure have been minimized. Methods. A critical analysis was carried out from a reflective position of the available information, establishing the possible risks related to exposure to surgical smoke. Discussion. The imperative need to establish national normative guidelines and standardized recommendations to comply with the demands given by the occupational health and work safety management systems, whose main objective is to make effective the use of appropriate surgical masks, implementation of environmental epidemiological surveillance program in the operating room, prioritizing the constant use of vacuum cleaners and evacuation systems, and carrying out educational awareness programs aimed at the personnel involved. Likewise, there is concern about the need for new studies to more precisely define the danger of this aerosol. Conclusion. It is recommended to responsibly use all existing preventive strategies to intervene in operating rooms to minimize the forgotten risks of surgical smoke.

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RESUMEN Objetivo: Determinar los tiempos quirúrgicos estándar de los cuatro procedimientos más comunes en cirugía general (hernioplastia inguinal unilateral, hernioplastia inguinal bilateral, hernioplastia umbilical y colecistectomía) de un hospital de segundo nivel y calcular la probabilidad de extensión de cada uno de los procedimientos. La eficiencia es un fenómeno ampliamente estudiado en el ámbito económico, pues hace referencia a la necesidad de menor cantidad de factores para la producción de un determinado nivel de bienes y servicios, por ello, es de vital importancia incluirlo en el ámbito quirúrgico. Materiales y métodos: Estudio observacional, descriptivo y retrospectivo. Se utilizaron los registros de quirófano de un hospital de segundo nivel del año 2017 al 2019 del servicio de Cirugía General. A partir de esta información, se estandarizó el tiempo necesario para cada procedimiento mediante la media de cada uno (hernioplastia umbilical, hernioplastia inguinal unilateral o bilateral y colecistectomía). Se calculó la probabilidad de extensión de las cirugías tomando en consideración los datos obtenidos y el intervalo de confianza. Resultados: Para el procedimiento de hernioplastia inguinal unilateral se obtuvo una media de 76 min (IC 95,00 %: 72-80 min, DE 23); en hernioplastia inguinal bilateral, una media de 104,38 min (IC 95,00 %: 91-116 min, DE 41,7); en hernioplastia umbilical, una media de 59,31 min (IC 95,00 %: 54-63 min, DE 29,9), y en colecistectomía, una media de 85,735 min (IC 95,00 %: 83-88 min). La probabilidad de que se programen tres cirugías y todas estén a tiempo (límite superior del IC) es de 92,69 %, la probabilidad de que se programen tres cirugías y todas se prolonguen es de 0,0016 % (límite inferior del IC). Conclusiones: Es posible realizar la planeación de las cirugías programadas mediante el uso de tiempos quirúrgicos estandarizados. Se requiere contar con estadística actualizada de los procedimientos quirúrgicos (promedios del tiempo de realización de cada procedimiento), ya que es posible detectar y supervisar de manera más precisa la dinámica de quirófano mediante la detección de las áreas de oportunidad, de esta manera, se eficientizará el tiempo de quirófano para beneficio de los sistemas de salud y los pacientes.

ABSTRACT Objective: To determine the standard surgical times of the four most common general surgery procedures (unilateral inguinal hernioplasty, bilateral inguinal hernioplasty, umbilical hernioplasty and cholecystectomy) in a second-level hospital and to estimate the probability of extending the time of each of the procedures. Efficiency is a widely studied subject in economics. It involves the need for fewer elements in the production of a certain level of goods and services. Therefore, it is extremely important to consider it in the field of surgery. Materials and methods: An observational, descriptive and retrospective study. It used the operating room records from 2017 to 2019 of the General Surgery service in a second-level hospital. Based on this information, the time required for each procedure was standardized using the mean for each one (umbilical hernioplasty, unilateral or bilateral inguinal hernioplasty and cholecystectomy). The probability of extending surgical times was estimated based on the obtained data and confidence interval. Results: The mean for unilateral inguinal hernioplasty was 76 min (95.00 % CI: 72-80 min, SD 23), for bilateral inguinal hernioplasty 104.38 min (95.00 % CI: 91-116 min, SD 41.7), for umbilical hernioplasty 59.31 min (95.00 % CI: 54-63 min, SD 29.99) and for cholecystectomy 85.735 min (95.00 % CI: 83-88 min). The probability of scheduling three surgical interventions and completing all of them on time (upper limit of the CI) is 92.69 %, and the probability of scheduling three surgical interventions and extending the time of all of them is 0.0016 % (lower limit of the CI). Conclusions: Planning scheduled operations using standardized surgical times is feasible. Updated statistics on surgical procedures (average time for each procedure) are required since it is possible to more accurately detect and supervise operating room dynamics by identifying opportunity areas. This will make operating room time more efficient for the benefit of health care systems and patients.

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Background and Aims: Healthcare workers (HCWs), which include surgeons, anaesthesiologists, nurses, technicians, and other non-medical staff working in the operation theatre (OT), change to surgical scrubs for providing designated services. This study was intended to investigate the association of moving in and out of OT to other hospital areas without changing scrubs and its impact on bacterial infection. Methods: After PROSPERO registration, we performed a systematic review to compare the occurrence of surgical site infections (SSIs) with or without the movement of HCWs outside OT. We searched PubMed, Scopus, and Cochrane Library using relevant keywords. RoB-2 and ROBINS-E tools were used to assess the risk of bias in randomised controlled trials (RCTs) and observational studies, respectively. Results: We identified six articles that fulfilled the inclusion criteria: three RCTs and three observational studies. A risk of bias assessment revealed an overall low bias in the RCTs and an overall high bias in the observational studies. The analysis revealed a comparable incidence of bacterial infection in terms of colony-forming units when scrubs when HCWs moved in and out of OT with the same scrubs. A meta-analysis was not performed due to heterogeneity in participants and the OT set-up, as well as fewer studies and sample size. Conclusion: The evidence is insufficient to suggest that wearing scrubs outside the OT could increase the incidence of SSI in surgical patients or transmit the organisms to patients, causing infection. The present review neither supports nor is against wearing surgical scrubs outside OT premises.

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INTRODUCTION: To improve situational awareness in the operating room (OR), a virtual online operating room of hazards (ROH) with deliberately placed risks was created. We hypothesized that subjects first participating in the virtual online ROH would identify more hazards during an in-person ROH exercise in a physical OR than those in the control group who only received didactic training. METHODS: We conducted a randomized controlled trial at a major academic medical center, enrolling 48 pre-clinical medical students with no previous OR exposure during their classes. Control and experimental group subjects participated in a brief, online didactic orientation session conducted live over Zoom (Zoom Video Communications, Inc., San Jose, CA) to learn about latent hazards in the OR. Experimental group subjects further interacted with a virtual online operating ROH in which latent hazards were present. The fraction of deliberately created latent hazards placed in a physical, in-person OR identified by subjects was calculated. RESULTS: Experimental group subjects identified a significantly larger fraction of the created hazards (41.3%) than the control group (difference = 16.4%, 95% CI: 11.3% to 21.4%, P < 0.0001). There was no difference in the number of non-hazards misidentified as hazards between the groups. CONCLUSIONS: Participation in the virtual online environment resulted in greater recognition of latent operating room hazards during a simulation conducted in a physical, in-person OR than in a didactic experience alone. Because creating an in-room experience to teach the identification of latent hazards in an OR is resource-intensive and requires removing the OR from clinical use, we recommend the virtual online approach described for training purposes. Adding items most misidentified as hazards is suggested for future implementation.

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BACKGROUND: Mini 'C'-arm machine is an advanced medical imaging device used primarily for intraoperative imaging during surgical, orthopaedic and emergency care procedures. Since the technology is based on ionising radiation, safe usage of Mini 'C'-arm machine is mandatory to protect patients and operating personnel. OBJECTIVE: The main objective is to describe the various components related to patients, operator and equipment to ensure safe usage of Mini 'C'-arm machine. A comprehensive search strategy using the PEO (Population, Exposure, Outcome) framework was conducted using Embase, PubMed, Google Scholar and ResearchGate databases to identify suitable literature. The keywords used for the search included 'Fluoroscopy', 'Ionising Radiation' and 'surgical safety'. KEY FINDINGS: Safe usage of Mini 'C'-arm equipment involves components of operator training, operator safety, patient safety, radiation dose, operating room logistics, handling of images and auditing of Mini 'C'-arm use. CONCLUSION: Mini 'C'-arm provides an invaluable, portable imaging tool in a spectrum of general surgical and orthopaedic interventional procedures. However, safe usage of Mini 'C'-arm machine requires a multifaceted approach including operator responsibility and safety, patient protection, equipment maintenance, radiation dose awareness, documentation and sound reporting mechanisms.

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PURPOSE: Preventing the spread of pathogens in the anesthesia work area reduces surgical site infections. Improved cleaning reduces the percentage of anesthesia machine samples with ≥ 100 colony-forming units (CFU) per surface area sampled. Targeting a threshold of < 100 CFU when cleaning anesthesia machines may be associated with a lower prevalence of bacterial pathogens. We hypothesized that anesthesia work area reservoir samples returning < 100 CFU would have a low (< 5%) prevalence of pathogens. METHODS: In this retrospective cohort study of bacterial count data from nine hospitals, obtained between 2017 and 2022, anesthesia attending and assistants' hands, patient skin sites (nares, axilla, and groin), and anesthesia machine (adjustable pressure-limiting valve and agent dials) reservoirs were sampled at case start and at case end. The patient intravenous stopcock set was sampled at case end. The isolation of ≥ 1 CFU of Staphylococcus aureus, methicillin-resistant Staphylococcus aureus, Enterococcus, vancomycin-resistant Enterococcus, gram-negative (i.e., Klebsiella, Acinetobacter, Pseudomonas, and Enterobacter spp.) or coagulase-negative Staphylococcus was compared for reservoir samples returning ≥ 100 CFU vs those returning < 100 CFU. RESULTS: Bacterial pathogens were isolated from 24% (7,601/31,783) of reservoir samples, 93% (98/105) of operating rooms, and 83% (2,170/2,616) of cases. The ratio of total pathogen isolates to total CFU was < 0.0003%. Anesthesia machine reservoirs returned ≥ 100 CFU for 44% (2,262/5,150) of cases. Twenty-three percent of samples returning ≥ 100 CFU were positive for ≥ 1 bacterial pathogen (521/2,262; 99% lower confidence limit, 22%) vs 3% of samples returning < 100 CFU (96/2,888; 99% upper limit, 4%). CONCLUSIONS: Anesthesia machine reservoir samples returning < 100 CFU were associated with negligible pathogen detection. This threshold can be used for assessment of terminal, routine, and between-case cleaning of the anesthesia machine and equipment. Such feedback may be useful because the 44% prevalence of ≥ 100 CFU was comparable to the 46% (25/54) reported earlier from an unrelated hospital.

RéSUMé: OBJECTIF: La prévention de la propagation des agents pathogènes dans la zone de travail de l'anesthésie réduit les infections du site opératoire. L'amélioration du nettoyage réduit le pourcentage d'échantillons de l'appareil d'anesthésie présentant ≥ 100 unités de formation de colonie (UFC) par surface échantillonnée. Le fait de cibler un seuil < 100 UFC lors du nettoyage des appareils d'anesthésie pourrait être associé à une prévalence plus faible d'agents pathogènes bactériens. Nous avons émis l'hypothèse que les échantillons des réservoirs de la zone de travail d'anesthésie < 100 UFC résulteraient en une faible prévalence (< 5 %) d'agents pathogènes. MéTHODE: Dans cette étude de cohorte rétrospective des données de décompte bactérien de neuf hôpitaux, obtenues entre 2017 et 2022, les mains des anesthésiologistes et des assistant·es en anesthésie, les sites cutanés des patient·es (narines, aisselles et aines) et les réservoirs de l'appareil d'anesthésie (soupape de réglage de limitation de pression et cadrans d'agent) ont été échantillonnés au début et à la fin de chaque cas. Les échantillons sur l'ensemble de robinets d'arrêt intraveineux des patient·es ont été prélevés à la fin de chaque cas. L'isolement de ≥ 1 UFC de staphylocoque doré, de staphylocoque doré résistant à la méthicilline, d'entérocoque, d'entérocoque résistant à la vancomycine, de staphylocoque à Gram négatif (c.-à-d. Klebsiella, Acinetobacter, Pseudomonas et Enterobacter spp.) ou à coagulase négative a été comparé pour les échantillons de réservoir retournant ≥ 100 UFC vs ceux qui comportaient < 100 UFC. RéSULTATS: Des bactéries pathogènes ont été isolées dans 24 % (7601/31 783) des échantillons de réservoir, 93 % (98/105) des salles d'opération et 83 % (2170/2616) des cas. Le rapport entre le nombre total d'isolats d'agents pathogènes et le nombre total d'UFC était de < 0,0003 %. Les échantillons pris sur les réservoirs d'appareils d'anesthésie ont retourné ≥ 100 UFC dans 44 % (2262/5150) des cas. Vingt-trois pour cent des échantillons retournés ≥ 100 UFC étaient positifs pour ≥ 1 agent pathogène bactérien (521/2262; limite de confiance inférieure à 99 %, 22 %) vs 3 % des échantillons retournant < 100 UFC (96/2888 ; 99 % de la limite supérieure, 4 %). CONCLUSION: Les échantillons pris sur les réservoirs de l'appareil d'anesthésie comportant < 100 UFC étaient associés à une détection négligeable d'agents pathogènes. Ce seuil peut être utilisé pour l'évaluation du nettoyage final, de routine et entre les cas de l'appareil et de l'équipement d'anesthésie. Une telle rétroaction peut être utile parce que la prévalence de 44 % de ≥ 100 UFC était comparable aux 46 % (25/54) rapportés précédemment dans un autre hôpital.

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Aim: To develop a measurement tool to evaluate the clinical learning environment for nursing students in operating rooms. Background: In this study, a scale for evaluating the clinical learning environment for nursing students in operating rooms was developed and subjected to reliability and validity tests. Design: A cross-sectional, methodological study. Methods: Qualitative interviews, the Delphi method, a literature review and pilot testing were employed to develop the scale. A purposive sampling method was used to select September 2021 through May 2022; a total of 227 nursing students with internship experience in operating rooms at several teaching hospitals in North China were selected to evaluate the reliability and validity of the scale. Results: The 32-item, four-dimensional evaluation scale was developed through two rounds of consultation with 17 experts. The reliability and validity test showed that the overall Cronbach's alpha was 0.984 and 0.96. The split-half reliability for the total scale was 0.937, indicating good reliability. Conclusion: The proposed scale has high reliability and validity in evaluating the clinical learning environment of nursing students in operating rooms and improving clinical nursing education.

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To control the efficiency of surgery, it is ideal to have actual starting times of surgical procedures coincide with their planned start time. This study analysed over 4 years of data from a large metropolitan hospital and identified factors associated with surgery commencing close to the planned starting time via statistical modelling. A web application comprising novel visualisations to complement the statistical analysis was developed to facilitate translational impact by providing theatre administrators and clinical staff with a tool to assist with continuous quality improvement.

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Introducción: La categorización de las urgencias quirúrgicas es una necesidad en razón al continuo desequilibrio entre la oferta y la demanda de servicios quirúrgicos en la mayoría de las instituciones donde se encuentra habilitada la prestación del servicio. Hay abordajes en el tema, con estrategias de priorización de los casos quirúrgicos, que consideran escalas y flujogramas, pero su ausente validez externa y las particularidades de las instituciones y aseguradores, han limitado una generalización de los resultados. Métodos: Se efectúa una conceptualización del triaje de las urgencias quirúrgicas con planteamientos críticos y reflexivos soportados en la evidencia. Se identifican, asimismo, las posibles oportunidades para la investigación. Discusión: Los beneficios potenciales de un triaje quirúrgico en situaciones de urgencia, son extensivos a todos los actores del sistema de salud, disminuyen la posibilidad de desenlaces y repercusiones económicas negativas para las instituciones y los aseguradores. La teoría de las colas ofrece el soporte para un entendimiento del tema y contribuye en las soluciones. Su adopción es escasa como parte de una estrategia local de priorización quirúrgica en un contexto de urgencia. Conclusión:La creación de estrategias que establezcan el triaje para el paciente con una urgencia quirúrgica están influenciadas por la participación continua y efectiva de los actores involucrados en el proceso y en su impacto en los desenlaces clínicos

Introduction: Categorizing surgical emergencies is necessary due to the continued imbalance between the supply and demand of surgical services in most institutions where the service is enabled. There are approaches to the subject, with strategies for prioritizing surgical cases, which consider scales and flowcharts, but their lack of external validity and the particularities of the institutions and insurers have limited the generalization of the results. Methods: A conceptualization of the triage of surgical emergencies is carried out with critical and reflective approaches supported by evidence. Potential research opportunities are also identified. Discussion: The potential benefits of surgical triage in emergent situations are extensive to all health system actors, reducing the possibility of adverse outcomes and economic repercussions for institutions and insurers. Queuing theory offers support for understanding the issue and contributes to solutions. However, its adoption is scarce in an emergency as part of a local surgical prioritization strategy. Conclusion: The creation of strategies that establish triage for the patient with a surgical emergency is influenced by the continuous and effective participation of the actors involved in the process and its impact on clinical outcomes

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