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Objective: To understand views of staff in relation to attitudes, enablers, and barriers to implementation of environmentally sustainable surgery in operating theatres. This will ultimately help in the goal of successfully implementing more sustainable theatres. Background: Global health care sectors are responsible for 4.4% of greenhouse gas emissions. Surgical operating theatres are resource intensive areas and improvements will be important to meet Net-Zero carbon emissions within health care. Methods: Three databases were searched (Web of Science, Ovid, and PubMed), last checked January 2024. We included original manuscripts evaluating staff views regarding sustainable operating theatres. The Mixed Methods Appraisal Tool was used for quality appraisal and data analysed using thematic synthesis. Results: A total of 2933 articles were screened and 14 fulfilled inclusion criteria, using qualitative (1), quantitative (2), and mixed methods (11). Studies were undertaken in a variety of clinical (Department of Anaesthesia, Surgery, Otolaryngology, Obstetrics and Gynaecology and Ophthalmology) and geographical settings (Australia, Canada, France, Germany, New Zealand, United States, United Kingdom, and Ireland). Across studies there was a lack of evidence exploring enablers to implementation, but barriers mainly related to the following themes: education and awareness, leadership, resistance to change, facilities and equipment, time, and incentive. Conclusions: This systematic review identified attitudes and barriers perceived by clinicians towards improving environmental sustainability within operating theatres, which may inform future strategy towards sustainable surgery. Most studies used a survey-design, whereas use of interviews may provide deeper insights. Future work should be extended to wider stakeholders influencing operating theatres. In addition, implementation studies should be carried out to examine whether barriers do change in practice. [ABSTRACT FROM AUTHOR]

Abstract Background Digitalization in the health sector requires adaptive change in human attitudes and skills. The operating theatres have been introduced to digital innovations through centuries. The aim of this study was to explore operating room (OR) nurses’ and Nurse Anesthetists’ (NAs) experiences with digitalization in the operating theatre. Methods The study had a qualitative design, using individual interviews with OR nurses and NAs at a Norwegian hospital. Data were analyzed using reflexive thematic analysis in-line with recommendations from Braun & Clarke. Results Two themes were identified, namely (1) Impacting the work processes, and (2) Implications for patient safety. The OR nurses and NAs experienced that digitalization impacted on their work processes positively through making these smoother, but also negatively making the work processes vulnerable for disruptions, leading to a need for parallel actions. Digitalization was experienced to positively impact patient safety for example through making information more accessible. However, digital tools reduced focus on the patient, and then represented a risk to patient safety. Conclusion OR nurses and NAs perceive that digitalization on one side may facilitate work processes and information flow. However, on the other side digitalization may steel focus on the patient. These aspects should be taken into consideration in quality improvement initiatives and when introducing new digital tools.

Background Methods Results Conclusion Replacing single‐use operating theatre equipment with reusables might be one strategy for reducing the carbon footprint of operating theatres. However, in Australia, where the energy mix is predominantly fossil‐fuel‐based, the re‐sterilization of reusables may increase the carbon footprint. We analyzed the financial and environmental impacts of introducing reusable operating theatre light handles in two NSW hospitals.The effects on cost, waste, and carbon footprint of replacing disposable light handle covers with reusable handles in each hospital were analyzed over 12 months using procurement, waste and sterilization data, and life cycle assessment.Energy requirement for sterilization of reusable handles, increasing alongside weight of the handle, resulted in higher carbon footprint than using disposable covers. At one hospital, using a heavy handle increased carbon emissions sixfold, while the cost of handle sterilization exceeded the cost of disposable covers, resulting in 11% higher cost per use. At the other hospital, using a lighter handle increased carbon emissions by 40% per use, while sterilization cost was less than the cost of disposable covers, resulting in 14.8% lower cost per use. Scenario modelling indicated that sterilizing handles as part of a hollowware set rather than as individual items would significantly reduce cost and carbon footprint. At both hospitals, associated clinical waste was essentially eliminated.Judicious replacement of disposable covers with lightweight yet durable reusable handles can reduce costs, but increases carbon footprint in the current Australian energy context. Adopting predominantly renewable energy and more efficient sterilization practice would mitigate this. [ABSTRACT FROM AUTHOR]

Debriefing in operating theatre environments leads to benefits in mortality, efficiency, productivity, and safety culture; however, it is still not regularly performed. TALK© is a simple and widely applicable team self-debriefing method to collaboratively learn and improve. An interventional study introducing TALK© for voluntary clinical debriefing was carried out in operating theatre environments in a UK National Health Service hospital over 18 months. It explored compliance with the Five Steps to Safer Surgery and changes in behaviour in surgical teams regarding consideration and completion of debriefing. Team briefing and compliance with the WHO surgical safety checklist were performed consistently (>95% and >98%, respectively) throughout the study, which included 460 surgical lists. Consideration of debriefing increased at all data collection periods after intervention, from 35.6% to 60.3–97.4% (P ≤0.003). Performance of debriefing, which was 23.3% at baseline, reached 39% at 6 months (P =0.039). Team planning of actions for improvement during debriefing also increased (P <0.001). A decline in performance of debriefing and subsequent improvement actions was observed after 6 months, albeit rates were above baseline at 18 months. The most reported reason not to carry out a debriefing was 'lack of issues'. After implementation, nurses and allied healthcare professionals increased their contribution to initiating and leading debriefing. Reported barriers were <18% at baseline, and decreased after intervention. A simple intervention introducing TALK© for voluntary debriefing in theatres prompted significant changes in team behaviour and sustained growth regarding consideration and performance of debriefing, especially in the first 6 months. [ABSTRACT FROM AUTHOR]

Background: Exposure to excessive noise volumes is an occupational health and safety risk. Australian guidelines recommend a time weighted exposure maximum of 85 dB (dB) or a maximum peak noise level of up to 140 dB, as chronic and repeated high dB exposure can result in significant hearing impairment. The aim of this study was to assess the volume of noise generated by common surgical instruments while utilizing the National Institute for Occupational Safety and Health (NIOSH) app. Methods: Sound levels were measured using the NIOSH app. The NIOSH app was used to take equivalent continuous A‐weighted sound levels (LAeq) and the C‐weighted peak sound pressure (LCpeak) measurements for specific instruments while in use in theatre. A minimum of three readings per instrument were taken at immediate and working distances. Results: LAeq measurements ranged from 62.9 to 89.3 dB. The Padgett Dermatome and Frazier Sucker exceeded recommended exposure limits with an averaged LAeq reading of 85.7 dB(A) and 85.1 dB(A) respectively. LCpeak readings ranged from 89.9 to 114.7 dB(C) with none of the instruments exceeding a peak sound level beyond the recommended level of 140 dB(C). Conclusion: The cumulative effect of loud surgical instruments across prolonged or combined operations may result in theatre staff being exposed to hazardous noise levels, impacting the health and wellbeing of staff, staff performance and patient care. Utilization of a phone app can improve the awareness of noise pollution in theatres, thereby empowering staff to be proactive about their health and improvement of their work environment. [ABSTRACT FROM AUTHOR]

A report on participant views of a two-person check confirming tracheal intubation implemented in their institution found that this check was generally considered feasible and useful, but there was some resistance and some concerns that it would not solve the problem. Social, cultural, and cognitive factors play a role in airway management in the operating theatre, partly because of the pre-eminence of airway management as a cornerstone of the profession of anaesthesia. These factors contribute to loss of situation awareness in airway failure. Although situation awareness might be better maintained by the two-person check, there could be advantages if airway management became the responsibility of the whole operating theatre team. Potential strategies to overcoming the ongoing problem of failed airway management are proposed, including multidisciplinary team training in airway management and a new airway point in the surgical safety checklist time out. [ABSTRACT FROM AUTHOR]

The perioperative maintenance of a patient’s core temperature is a challenge during burn care. While patient warming devices are sometimes used to prevent intraoperative hypothermia, raising the ambient temperature of the theatre is the most common practice. Theatre temperature can impact on the performance and comfort of surgery staff but standards for theatre temperatures in burn care are poorly defined. Therefore, in this study we investigated the current, global, clinical practices in burn care with respect to the ambient temperature of theatres that are used to treat severe burn injuries. An internet-based, descriptive, QualtricsXM survey was distributed electronically to 81 burn professionals to identify the temperatures at which the surgical teams operate on severe burn injuries. The survey was completed by 33 participants from 15 countries and revealed that there is a wide range of temperatures (24–45°C) at which burn injuries are treated. The prevention of hypothermia was the clinical justification most reported for those theatre temperatures. Temperatures between 26 and 30°C appear to be most comfortable for the staff. One respondent mentioned that surgeries are often limited to 5 h to avoid hypothermia in patients, however, others noted surgery durations of up to 8–12 h in raised temperatures, which may impact the physiology and performance of the team, potentially impacting the safety of the patients. The adoption of an optimal theatre temperature to address the surgical team’s comfort levels, their performance, and patient hypothermia, may improve outcomes in cases of severe burn injury.

Abstract Background Perioperative missed nursing care is a serious issue that can compromise patient safety and quality of care. However, little is known about the factors that influence perioperative missed nursing care. Aim This study aimed to examine the effects of job embeddedness and polychronicity on perioperative missed nursing care as well as to test the mediating role of polychronicity on the relationship between job embeddeness and perioperative missed nursing care. Method This was a cross-sectional correlational study that used a convenience sample of 210 operating room nurses from nine hospitals in Egypt. Data were collected using self-administered questionnaires that measured job embeddedness, polychronicity, and perioperative missed nursing care. Structural equation modeling was used to test the hypothesized relationships among the variables. Results The findings demonstrated a significant negative and moderate association between missed perioperative care and both nurses’ job embeddedness and polychronicity. Moreover, there was a moderately positive and significant correlation between polychronicity and job embeddedness. Path analysis revealed a significant positive causal effect between job embeddedness and polychronicity. The results of mediation revealed that the indirect effect of job embeddedness on missed care through polychronicity was statistically significant; suggesting that polychronicity partially mediated this relationship. Conclusion This study sheds light on the intricate relationship between nurses’ job embeddedness, missed care, and polychronicity in the operating theater context. By enhancing job embeddedness and fostering polychronicity among nurses, healthcare organizations can reduce perioperative missed care and ultimately improve patient care outcomes in this critical healthcare setting.

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Hong-Xia Duan, Xiu-Mei Wang, Yue Guo, Ling Wei, Rui-Xia Hao, Zhen-Shan Guo Department of Surgery, Shanxi Bethune Hospital (Shanxi Academy of Medical Sciences), Taiyuan, Shanxi, People’s Republic of ChinaCorrespondence: Hong-Xia Duan, Department of Surgery, Shanxi Bethune Hospital (Shanxi Academy of Medical Sciences), No. 99 Longcheng Street, Taiyuan, Shanxi, People’s Republic of China, Tel +86-3518379228, Email Duan_hongxia@yeah.netObjective: To investigate the application of a multidisciplinary collaboration model to optimise the configuration management of orthopaedic external device sets in general hospitals.Methods: A pretest–post-test study design was used. Sixty patients who underwent unilateral total knee arthroplasty and 60 patients who underwent posterior lumbar interbody fusion between March and May 2022 were recruited as the control stage. Additionally, a total of 120 patients, 60 of each, who underwent the two procedures between September and November 2022, were recruited as the experimental stage. For the control stage, conventional external equipment management was used, and for the experimental stage, an external device management programme was implemented based on multidisciplinary collaboration with the control stage. Based on the PDSA cycle, the configuration management of orthopaedic external device sets was optimised, and the differences in collating and counting external devices, nurses’ overtime in the external device stage and orthopaedic surgeon satisfaction were compared between the two stages.Results: Compared with the control stage, the collation count took less time (8.65 ± 0.25 min vs 5.37 ± 0.13 min; 13.55 ± 1.10 min vs 7.85 ± 0.82 min), the number of overtime hours was shorter (175.80 ± 12.19 min vs 96.68 ± 13.66 min) and orthopaedic surgeon satisfaction was improved (4.58 ± 0.62 vs 4.10 ± 0.68; 4.33 ± 0.73 vs 3.87 ± 0.77; 4.20 ± 0.71 vs 3.82 ± 0.71; 4.12 ± 0.69 vs 3.87 ± 0.72; 4.05 ± 0.68 vs 3.79 ± 0.68) in the experimental stage (all P < 0.05).Conclusion: Multidisciplinary collaboration offers various benefits for optimising the configuration of external device sets, such as reducing the time taken for the preoperative sorting and counting of external devices, enhancing nurses’ work efficiency and improving surgeons’ job satisfaction; therefore, it is worthy of reference in clinical practice.Keywords: operating theatre, optimisation configuration, external instruments, item counting, scientific management, work efficiency

Objective: The operating room is a unique learning experience that has visual, aural, kinesthetic learning stimuli and provides benefits to the medical students such as development of sound clinical knowledge and skills, and gaining personal insight into ones' career choice. However, this can be a challenging place due to the unfamiliar learning environment. We aimed to study the Sri Lankan Medical students' perception and attitudes on operating theatre learning experience. Design and setting: A descriptive cross-sectional survey was carried out among medical students undergoing surgical clinical training on the perspectives of the teaching and learning experience in the operating theatre in Sri Lanka. Participants: Our study group consisted of 390 medical students from four different medical faculties in Sri Lanka representing all levels of surgical clinical rotations. Results: A majority of the students had actively participated in the operating theater. Despite this, the students' clarity of the learning outcomes and expectations in a theatre varied greatly. Majority of the students felt that the surgeons were willingly to teach but also noted that there was no standardization in teaching. This study clearly shows a significant correlation between positive emotions and surgical teams welcoming attitude towards the medical students. Long standing hours were considered a negative emotion by a majority of students. We also observed that theatre environment can be physically and mentally exhausting. Conclusions: Thus, empathy, feeling welcome and giving breaks to refresh can go a long way in making the learning experience better. Regular feedback to trainers on students' perception of the theatre experience is important to value the students' opinion and improve the quality of the surgical theatre. We strongly recommend initiation of clear induction sessions with introduction of well-structured teaching learning activities in the operating theatre.

Background: The operating theatre (OT) complex of hospitals represents areas of considerable expenditure with regard to costs and requires maximum use to ensure optimum cost benefit for both patients and the hospital. Inefficient use of an operating theatre room (OTR) may result in hospital wasteful expenditure and frustrations for patients owing to surgery delays, cancellations and prolonged hospitalisation while waiting. Aim: The aim of the study was to explore and describe using a consensus method, factors impacting the use of an emergency orthopaedic theatre that can be optimised in a selected public hospital in Gauteng province. Setting: The study was conducted by a professional nurse and orthopaedic surgeon working in the theatre of a selected public hospital in Gauteng province. Method: A qualitative, explorative and descriptive design was adopted. Data were collected using a nominal group technique (NGT) among professional nurses and orthopaedic surgeons. Data analysis was done through cross-analysis where participants reached a consensus on the voted ideas from the group. Results: Consensus was reached and three main themes emerged: (1) inadequate resources; (2) poor organisation and (3) communication. Conclusion: The optimal use of an emergency orthopaedic theatre is influenced by the availability of resources being human and material, good organisation and clear communication. Contribution: The study has demonstrated that a variety of factors needs to be considered to optimise the use of an orthopaedic emergency theatre. The management of an OT requires a concerted effort from the nurses and doctors.

Background: To reduce the risk for surgical site infections, nurses in the operating theatre environment must have knowledge of and adhere to recommended practices regarding the use of surgical attire. Aim: To evaluate the effect of an educational intervention on nurses' knowledge related to recommended practices regarding the use of surgical attire in operating theatre. Setting: Operating theatres in two public and two private hospitals in the Eastern Cape province, South Africa. Methods: An educational pilot study, using a quasi-experimental, two-group pre- and posttest design, was conducted. A convenience sample of n = 85 nurses was purposively allocated to a control group and an intervention group. An existing educational intervention consisting of an interactive training session, brochures based on the Association of periOperative Registered Nurses' (AORN) guidelines and a summary of these guidelines was implemented for the intervention group, while the control group received only the summary of the guidelines. Data were collected through self-administered pre- and post-test questionnaires from March 2019 to August 2019. Results: The overall knowledge score for nurses in the intervention group post-intervention improved with a large significance (p ≤ 0.000 and Cohen's d = 1.26). Conclusion: The intervention has shown potential to improve the knowledge related to recommended practices of nurses in operating theatres regarding the use of surgical attire. Contribution: This pilot study encourages the implementation of the intervention on the use of surgical attire but requires further development and a wider implementation to measure its impact, and access to resources, enhancing and sustaining its success. [ABSTRACT FROM AUTHOR]

Background: The operating theatre (OT) complex of hospitals represents areas of considerable expenditure with regard to costs and requires maximum use to ensure optimum cost benefit for both patients and the hospital. Inefficient use of an operating theatre room (OTR) may result in hospital wasteful expenditure and frustrations for patients owing to surgery delays, cancellations and prolonged hospitalisation while waiting. Aim: The aim of the study was to explore and describe using a consensus method, factors impacting the use of an emergency orthopaedic theatre that can be optimised in a selected public hospital in Gauteng province. Setting: The study was conducted by a professional nurse and orthopaedic surgeon working in the theatre of a selected public hospital in Gauteng province. Method: A qualitative, explorative and descriptive design was adopted. Data were collected using a nominal group technique (NGT) among professional nurses and orthopaedic surgeons. Data analysis was done through cross-analysis where participants reached a consensus on the voted ideas from the group. Results: Consensus was reached and three main themes emerged: (1) inadequate resources; (2) poor organisation and (3) communication. Conclusion: The optimal use of an emergency orthopaedic theatre is influenced by the availability of resources being human and material, good organisation and clear communication. Contribution: The study has demonstrated that a variety of factors needs to be considered to optimise the use of an orthopaedic emergency theatre. The management of an OT requires a concerted effort from the nurses and doctors. [ABSTRACT FROM AUTHOR]

The fluoroscopy environment poses a potential occupational radiation exposure risk to theatre personnel. Risks can be mitigated with effective application of radiation protection knowledge and methods. This review aimed to determine the link between orthopaedic surgeon's knowledge and the use of appropriate safety methods when using fluoroscopy. A keyword search of three databases discovered six articles, totalling 2209 orthopaedic surgeons, who completed surveys to assess knowledge on various aspects of radiation safety and training. Participants had varying levels of experience. Moreover 1981 participants always wore a lead gown (89 %), while only 1052 participants wore thyroid protection (47 %). 449 participants (20 %) received some form of training. Although surveys asked a range of questions it appeared that there was low knowledge of the ALARP principles. Usage of protective equipment is a legal requirement and thus was observed throughout, however, there were a number of incidences of disregarding some protective measures. Although there appeared to be limited knowledge surrounding radiation protection measures and lack of training provided, no clear link was demonstrated between compliance with protective methods and knowledge of the risks. Formal and continuous training should be provided for the enhancement of knowledge to ensure the safety of all staff and help prevent the long-term effects of ionising radiation when using fluoroscopy. [ABSTRACT FROM AUTHOR]

Background Perioperative missed nursing care is a serious issue that can compromise patient safety and quality of care. However, little is known about the factors that influence perioperative missed nursing care. Aim This study aimed to examine the effects of job embeddedness and polychronicity on perioperative missed nursing care as well as to test the mediating role of polychronicity on the relationship between job embeddeness and perioperative missed nursing care. Method This was a cross-sectional correlational study that used a convenience sample of 210 operating room nurses from nine hospitals in Egypt. Data were collected using self-administered questionnaires that measured job embeddedness, polychronicity, and perioperative missed nursing care. Structural equation modeling was used to test the hypothesized relationships among the variables. Results The findings demonstrated a significant negative and moderate association between missed perioperative care and both nurses’ job embeddedness and polychronicity. Moreover, there was a moderately positive and significant correlation between polychronicity and job embeddedness. Path analysis revealed a significant positive causal effect between job embeddedness and polychronicity. The results of mediation revealed that the indirect effect of job embeddedness on missed care through polychronicity was statistically significant; suggesting that polychronicity partially mediated this relationship. Conclusion This study sheds light on the intricate relationship between nurses’ job embeddedness, missed care, and polychronicity in the operating theater context. By enhancing job embeddedness and fostering polychronicity among nurses, healthcare organizations can reduce perioperative missed care and ultimately improve patient care outcomes in this critical healthcare setting. [ABSTRACT FROM AUTHOR]

Training in healthcare team communication has largely focused on strategies to improve information transfer with less focus on interpersonal dynamics and emotional aspects of communication. The Operating Room (OR) may be one of the most emotionally charged hospital environments, and is one requiring excellent team communications. We aimed to identify literature reporting on the emotional aspects of OR team communication. Our research questions were: what are the triggers in the environment that provoke an emotional response affecting communication, and what are the emotional responses to communication between OR team members; and how do these emotional aspects of communication affect the function of the OR team? We undertook a Scoping Review of literature across relevant databases following published guidelines, and narrative synthesis of the identified studies. From the 10 included studies we identified three themes: (1) Emotional experiences in the OR and their contributors; (2) Effects of emotional experiences on team communication; and (3) Solutions to manage the emotional experiences in the OR. Theme 1 sub-themes were: (1) Range of emotions experienced in the OR; (2) Hierarchical culture and (3) Leadership expectations as contributors to negative emotions. The OR is an emotionally charged environment. The hierarchical culture can inhibit staff from speaking up, and failure of leaders to meet team expectations, e.g., through appropriate and timely communication, may cause frustration and stress. The consequences of emotions include poor team dynamics, ineffective communication and potential negative impact on patient care. Few studies described strategies to manage emotions in the OR. The studies reviewed describe an environment where emotions can run high, affecting interpersonal communications, team function and patient care. The few identified studies relevant to our research questions demonstrate a need to better understand the emotional aspects of OR team communication and the effectiveness of interventions to improve these. [ABSTRACT FROM AUTHOR]

• The OSATS scale is a benchmark in the scientific literature for assessing skills in the operating theatre. • It is a generic scale applicable to all types of surgery. • Its French translation was validated, with good inter-assessor reproducibility. • This scale can be incorporated into the assessment of surgical interns in French-speaking countries. The OSATS rating scale is one of the tools most widely used in the scientific literature for assessing technical surgical skill. The aim of this study was to translate this scale into French (OSATS-FR) and validate it. OSATS was translated into French by two independent translators. The two translations were pooled and back-translated by a third translator into English to produce a consensus version (OSATS-FR). Three independent assessors then used it to assess surgical skill in tracheostomy videos. The reproducibility of the scoring was measured. The OSATS-FR version was easily understood and used by all three assessors. In all, 18 procedures were assessed, performed by 14 interns and 4 senior surgeons. The mean OSATS-FR score was 18.6 ± 4.08 for the interns and 31.6 ± 1.62 for the seniors (p < 0.0001). The Pearson correlation coefficient was 0.937 CI95% [0.867–1.269] between assessors 1 and 2, 0.977 CI95% [0.899–1.149] between assessors 1 and 3, and 0.965 CI95% [0.876–1.196] between assessors 2 and 3. Cronbach's alpha was greater than 0.9 for each assessor. OSATS-FR can distinguish between two groups with different surgical expertise and assess surgical skill with an inter-assessor reproducibility and internal consistency comparable to those of the English version. [ABSTRACT FROM AUTHOR]

Background: To reduce the risk for surgical site infections, nurses in the operating theatre environment must have knowledge of and adhere to recommended practices regarding the use of surgical attire. Aim: To evaluate the effect of an educational intervention on nurses’ knowledge related to recommended practices regarding the use of surgical attire in operating theatre. Setting: Operating theatres in two public and two private hospitals in the Eastern Cape province, South Africa. Methods: An educational pilot study, using a quasi-experimental, two-group pre- and post-test design, was conducted. A convenience sample of n = 85 nurses was purposively allocated to a control group and an intervention group. An existing educational intervention consisting of an interactive training session, brochures based on the Association of periOperative Registered Nurses’ (AORN) guidelines and a summary of these guidelines was implemented for the intervention group, while the control group received only the summary of the guidelines. Data were collected through self-administered pre- and post-test questionnaires from March 2019 to August 2019. Results: The overall knowledge score for nurses in the intervention group post-intervention improved with a large significance (p ≤ 0.000 and Cohen’s d = 1.26). Conclusion: The intervention has shown potential to improve the knowledge related to recommended practices of nurses in operating theatres regarding the use of surgical attire. Contribution: This pilot study encourages the implementation of the intervention on the use of surgical attire but requires further development and a wider implementation to measure its impact, and access to resources, enhancing and sustaining its success.

Purpose: This study reviews evidence and provides recommendations for the ideal setting of intravitreal injection (IVI) administration of vascular endothelial growth factor (VEGF) inhibitors. Methods: A multi-step approach was employed, including content analysis of regulations and guidelines, a systematic literature review, and an international survey assessing perioperative complications and endophthalmitis incidence in relation to injection settings. The literature review searched PubMed and Cochrane databases from 2006 to 2022, focusing on studies reporting correlations between complications and treatment settings. The survey utilized a web-based questionnaire distributed to clinical sites and the international ophthalmic community, with data managed using electronic capture tools. Results: We reviewed regulations and guidelines from 23 countries across five continents, finding significant variation in IVI administration settings. In most countries, IVI is primarily administered in outpatient clean rooms (96%) or offices (39%), while in others, it is restricted to ambulatory surgery rooms or hospital-based operating theatres (4%). The literature review found that endophthalmitis risk after IVI is generally low (0.01% to 0.26% per procedure), with no significant difference between office-based and operating room settings. The international survey (20 centers, 96,624 anti-VEGF injections) found low overall incidences of severe perioperative systemic adverse events and endophthalmitis, independent of injection settings. Conclusion: No significant differences in perioperative complications were observed among various settings, including operating theatres, ambulatory surgery rooms, offices, hospitals, or extra-hospital environments. Choosing the appropriate clinical setting can optimize patient management, potentially increasing effectiveness, quality, productivity, and capacity. [ABSTRACT FROM AUTHOR]

Learning in the operating theatre forms a critical part of postgraduate medical education. Postgraduate doctors present a diverse cohort of learners with a wide range of learning needs that will vary by their level of experience and curriculum requirements. With evidence of both trainee dissatisfaction with the theatre learning experience and reduced time spent in the operating theatre, which has been exacerbated by the effects of the Covid-19 pandemic, it is vital that every visit to the operating theatre is used as a learning opportunity. We have devised 12 tips aimed at both learners and surgeons to optimise learning in the operating theatre, set out into four domains: educational context, preparation, learning in theatre, feedback and reflection. These tips have been created by a process of literature review and acknowledgment of established learning theory, with further discussion amongst surgical trainees, senior surgical faculty, surgical educators and medical education faculty. [ABSTRACT FROM AUTHOR]

The operating theatre is the most crucial and costly department in a hospital due to its expensive resources and high patient admission rate. Efficiently allocating operating theatre resources to patients provides hospital management with better utilization and patient flow. In this paper, we tackle both tactical and operational planning over short-term to medium-term horizons. The main goal is to determine an allocation of blocks of time on each day to surgical specialties while also assigning each patient a day and an operating room for surgery. To create a balance between improving patients welfare and satisfying the expectations of hospital administrators, we propose six novel deterioration rates to evaluate patients total clinical condition deterioration. Each deterioration rate is defined as a function of the clinical priorities of patients, their waiting times, and their due dates. To optimize the objective functions, we present mixed integer programming (MIP) models and two dynamic programming based heuristics. Computational experiments have been conducted on a novel well-designed and carefully chosen benchmark dataset, which simulates realistic-sized instances. The results demonstrate the capability of the MIP models in finding excellent solutions (maximum average gap of 4.71% across all instances and objective functions), though, requiring large run-times. The heuristic algorithms provide a time-efficient alternative, where high quality solutions can be found in under a minute. We also analyse each objective function's ability in generating high quality solutions from different perspectives such as patients waiting times, the number of scheduled patients, and operating rooms utilization rates. We provide managerial insights to the decision makers in cases where their intention is to meet KPIs and/or maintaining trade-offs between patients and administrators expectations, more fair assignments, or ensuring that the most urgent patients are taken care of first. [ABSTRACT FROM AUTHOR]

The South African perioperative field has lagged behind other countries in developing a glossary of terms that can be used to compare individual operating rooms (ORs) within the same hospital, perioperative services across different systems, and larger elements of the country's health service. In 1998, the Association of Anesthesia Clinical Directors (AACD) in the United States of America (USA) established the procedural times glossary (PTG). We have developed an adaptation of the AACD's PTG with familiar South African terminology which will allow for better comparison between South African operating rooms as well as more informed comparison with the international literature. This first iteration is intended to start the conversation about procedural times and indices, and initiate a process aimed at refining these terms as further versions are required and developed. [ABSTRACT FROM AUTHOR]

Introduction. Good quality of sleep and feeling well are important issues for health and employee productivity especially for people with highly demanding jobs. Nursing personnel have to confront with significant mental and physical challenges. Shift work can lead to many health problems including: anxiety, insomnia, obesity or high blood pressure. Aim. The study examined the occurrence of sleep disorders among nursing personnel employed in operating theatres and intensive therapy units. Material and Methods. The study was prospective, comparative and descriptive nature. The project was carried out between January 1th and April 31th 2019. The study covered 180 medical personnel employed in Anaesthesiology and Intensive Therapy Departments in five different hospitals. Data were collected on the basis of a standardised tool of the Athens Insomnia Scale (AIS) as well as an original interview questionnaire. Results. The study showed that 65.6% (N = 118) of respondents experienced sleeping problems, manifested by frequent awakenings at night. For more than forty-five percent (45.6%; N = 82) of nurses, the time of their sleep is not sufficient, and more than 60% (N = 109) of respondents feel sleepiness. The in-depth analyses provide a statistically significant dependence between the quality of sleep and the use of sleeping drugs (Z = –1.95; p = 0.050). Conclusions. A nursing personnel working in the intensive therapy and operating room theatre wards suffer from sleep disorders related to insomnia; the symptoms of insomnia in this professional group include awakening at night and sleepiness during the day; male nurses have a far better quality of sleep compared to females nurses. (JNNN 2022;11(3):105–113)

The Model Hospital is an NHS online resource summarising performance data for, amongst other things, operating theatres categorised by NHS Trust and specialty. As an official source of information, it might be assumed that metrics, such as 'average late start time', 'average early finish time', and 'average late finish time', are calculated in a way to reflect performance in these domains, but this is not the case. These values are, respectively, only for those lists that start late, finish early, and finish late, with the number of lists in each category unreported. The Model Hospital reports utilisation appropriately as 'touch time' (the time delivering anaesthesia and surgery) but prefers a 'capped' measure, in which any touch time occurring in late finishes is ignored. The Model Hospital aggregates utilisations across lists in a mathematically invalid way, which leads to the assumption that small aliquots of unused time on lists can be combined to create larger time blocks, in which to complete more operations. We present alternative, more intuitive, and mathematically conventional methods to derive performance metrics using the same data. The results have implications for hospitals developing their own dashboards and international organisations seeking to create national databases for operating theatre performance. [ABSTRACT FROM AUTHOR]

Surgical plume poses a risk to perioperative nurses and the perioperative team as a whole, as well as the operative patient. Surgical plume contains various hazardous components which pose multiple health risks to the perioperative staff who are exposed to it. Further research is required in order to definitively understand the risks to perioperative staff from long-term exposure to surgical plume and to advance current policies and procedures. The current practice standard on surgical plume management from the Australian College of Perioperative Nurses (ACORN) sets out methods of reducing these risks. However, this standard's utility in practice and barriers to its implementation lead to ongoing unnecessary plume exposure. Through adhering to current practice standards and educating perioperative nurses, the risks posed by surgical plume can be mitigated. Thorough education on this topic will empower nurses to advocate for their safety and the safety of their patients, leading to the reduction of surgical plume exposure. [ABSTRACT FROM AUTHOR]

Background: Nowadays, mobile phones are an indispensable tool in multiple settings, particularly in the field of health care. Consequently, it is important to understand the impact of their use by health care professionals in the operating theatre - an environment that should be as 'sterile' as possible, to ensure patient safety. Purpose: To map the available scientific evidence on the impact of the multidisciplinary team's use of personal mobile phones in the operating theatre. Methods: A scoping review was conducted, following the methodology recommended by the Joanna Briggs Institute. The bibliographic search was carried out in the 'PubMed' and 'Web of Science' databases and on the 'EBSCOhost' platform, employing the selected DeCS/MeSH descriptors. Additionally, relevant grey literature was searched, using Google Scholar and the 'Repositórios Científicos de Acesso Aberto de Portugal' (RCAAP) portal. The resulting articles underwent a selection process, which consisted of reading the respective title, abstract and full text. The review included works published in Portuguese, English and Spanish, without establishing a specific publication time frame. Results: After applying the inclusion criteria, 15 articles were identified. The results were then organised, taking into account the inherent positive and negative aspects of using mobile phones in the context under study. The negative aspects included bacterial contamination of the devices and the occurrence of events that might distract the professionals. The positive aspects included the effectiveness of the devices to distract children and enable adequate care (e.g. during anaesthetic induction) and to improve professional knowledge and skills. Conclusion: When considering the impact of using personal mobile phones in the operating theatre, we often focus on the positive aspects of that practice. Nevertheless, in 11 studies included in the present review, the reported negative effects were more significant than the positive ones. There is evidence that patient safety may be threatened in such situations, due to the risk of cross-infection and the potential for distraction of multidisciplinary team members. [ABSTRACT FROM AUTHOR]

Vasovagal presyncope and syncope while attending operating theatres have been reported among medical trainees. However, no such studies are available in relation to dental trainees. The aim of this study was to investigate the prevalence, preventative measures and attitudes towards these events among dental trainees. An anonymised online questionnaire was sent to all dental core trainees in the Thames Valley and Wessex regions (n = 34). Nineteen of these participated (56% response rate). Ten (53%) had experienced a presyncopal or syncopal episode. The majority had experienced an episode during a major operation. High operating room temperatures and needing to stand for a long time were reported as the most common predisposing factors (60%). Several different actions were taken to prevent further episodes, with 90% of respondents reporting that these helped. Seven trainees expressed their desire to pursue a surgical career; five of these had experienced a vasovagal event. Most (78%) felt that this would not discourage them from following a career in surgery. Seven respondents felt that there was a perceived stigma about trainees who experienced such an episode. This study revealed that operating theatre related syncope is common among dental trainees. We highlight the importance of educating trainees on preventative strategies. [ABSTRACT FROM AUTHOR]

Background: Effective communication and teamwork is increasingly recognized as an important mechanism for enhancing the safety of healthcare. However, there is dearth of study on the pattern of communication among surgeons, nurses and anaesthetists in South Western part of Nigeria Purpose: This study assessed the patterns of communication and teamwork among operating theatre personnel and also identified barriers to communication and teamwork in the operating theatre in selected hospitals in Lagos State, Nigeria. Methods: A descriptive research design was adopted and a convenience sampling technique was used to select 215 nurse and doctor respondents for the study. With a 53-item self-developed structured questionnaire, data were collected. Results were presented descriptively (frequency tables and bar charts), and inferential statistics (Chi-square) were used to test the hypotheses. Results: Results revealed that 41.9% of the respondents had a fair knowledge of communication and teamwork in the operating theatre. Respondents described their pattern of communication as follows; the majority (99.5%) of the respondents communicate through written, spoken words or visual media, and 99.1% also communicate with other theatre personnel irrespective of their hierarchies. In addition, 90.7% reported that upward communication from patients to surgical team members is common in the theatre, while 87% submitted that they communicate through telephone conversations in this theatre. Individual bias, pressure to complete work, workload, poor leadership/lackadaisical attitudes and conflict of interest were identified as barriers to communication and teamwork in the operating theatre. Conclusion: The study concluded that the majority of theatre personnel lack adequate knowledge of communication and teamwork in the operating room. Hence, there is a need for periodic training for operating personnel to improve communication and teamwork, and surgical outcomes.

Summary: Purpose: The COVID-19 pandemic has put tremendous strain on healthcare systems. Surgical societies worldwide have advised minimizing non-essential surgeries in order to preserve hospital resources. Given the medical resources and COVID-19 incidence between countries across the world differ, so should colorectal practices. No formal guidelines have emerged from Asia. We wanted to find out what the current practice was in Asian colorectal centres outside China. Introduction: The COVID-19 pandemic has significantly impacted surgical practice worldwide. At the time of the writing of this paper, there are over 4.2 million cases reported with deaths exceeding 290 000 patients.1 With an abrupt disruption to worldwide supply chains, societal lockdowns and surge of cases into many hospitals, resource allocation was diverted and prioritised for all COVID-19 related services. Methods: A questionnaire survey of current colorectal practice was carried out involving 3 major colorectal cancer centres, one each from 3 major cities: Singapore, Taichung and Daegu. Components of the survey include infrastructure and manpower, case selection, surgical approach, operating room management and endoscopy practice. Results: All 3 centres continued to provide standard-of-care colorectal cancer surgery despite the COVID-19 pandemic. Two centres deferred surgery for benign colorectal conditions. Minimally Invasive Surgery (MIS) was still the preferred approach when indicated but with protocolized precautions undertaken. Other services such as pelvic exenteration, TATME and pelvic lymph node dissection were still offered if oncologically indicated. Elective diagnostic endoscopy services have also continued in two centres. Conclusion: Elective colorectal services continue to take place in the 3 surveyed Asian hospitals with heightened precautions. Provided there is adequate resource, colorectal cancer services should still continue to prevent consequences of neglecting or delaying cancer treatment. Practice should hence be tailored to the local resource of individual centres accordingly.

Background: Observing hand hygiene compliance (HHC) among non-sterile healthcare workers (HCW) in the operating theatre (OT) is challenging, since there are no tailored protocols or observation tools.Aim: To develop and test a hand hygiene protocol tailored to non-sterile HCW in the OT.Methods: In this prospective observational study, nine hospitals in the Rotterdam-Rijnmond region provided input on a draft protocol on hand hygiene in the OT, resulting in a new consensus protocol for the region. An observation tool based on the protocol was developed and tested. HHC rates with 95%-confidence intervals (CI) were calculated by type of hospital and type of HCW.Findings: The protocol contains three sections: 1. written general hand hygiene rules, 2. written hand hygiene rules specific for anaesthesia and surgery, and 3. visual representation of the OT, divided into four hand hygiene areas. Hand hygiene should be applied when changing from area. An average HHC of 48.0% (95%-CI:45.2%-61.2%) was observed in OTs across all hospitals. The two specialized hospitals (64.0%, 95%-CI: 30.6%-89.8% and 76.7%, 95%-CI:62.8%-84.5%) scored the highest HHC, while the academic teaching hospital scored the lowest (23.1%, 95%-CI: 0.0%-45.8%). The average HHC of anaesthesiologists was the lowest (31.6%, 95%-CI: 19.2%-62.4%), the OT-assistants scored the highest (57.4%, 95%-CI: 50.1%-78.2%).Conclusion: This uniform way of observing HHC in the OT, enables evaluation of the effectiveness of interventions in the OT and facilitates friendly competition. In the Rotterdam-Rijnmond region, HHC in the OT was below 50% and needs to be addressed in teaching hospitals and among physicians. [ABSTRACT FROM AUTHOR]

Summary: Cardiac arrest in the peri‐operative period is rare but associated with significant morbidity and mortality. Current reporting systems do not capture many such events, so there is an incomplete understanding of incidence and outcomes. As peri‐operative cardiac arrest is rare, many hospitals may only see a small number of cases over long periods, and anaesthetists may not be involved in such cases for years. Therefore, a large‐scale prospective cohort is needed to gain a deep understanding of events leading up to cardiac arrest, management of the arrest itself and patient outcomes. Consequently, the Royal College of Anaesthetists chose peri‐operative cardiac arrest as the 7th National Audit Project topic. The study was open to all UK hospitals offering anaesthetic services and had a three‐part design. First, baseline surveys of all anaesthetic departments and anaesthetists in the UK, examining respondents' prior peri‐operative cardiac arrest experience, resuscitation training and local departmental preparedness. Second, an activity survey to record anonymised details of all anaesthetic activity in each site over 4 days, enabling national estimates of annual anaesthetic activity, complexity and complication rates. Third, a case registry of all instances of peri‐operative cardiac arrest in the UK, reported confidentially and anonymously, over 1 year starting 16 June 2021, followed by expert review using a structured process to minimise bias. The definition of peri‐operative cardiac arrest was the delivery of five or more chest compressions and/or defibrillation in a patient having a procedure under the care of an anaesthetist. The peri‐operative period began with the World Health Organization 'sign‐in' checklist or first hands‐on contact with the patient and ended either 24 h after the patient handover (e.g. to the recovery room or intensive care unit) or at discharge if this occured earlier than 24 h. These components described the epidemiology of peri‐operative cardiac arrest in the UK and provide a basis for developing guidelines and interventional studies. [ABSTRACT FROM AUTHOR]

Background: A locally installed air purifier unit (Novaerus Protect 800) has been shown to reduce the air bioburden in an intensive care unit and the incidence of healthcare-associated infections.Aim: To explore whether this type of air purifying unit could reduce bacterial concentrations in the air of an operating room (OR) during orthopaedic surgery, thereby reducing the risk of surgical site infections.Methods: In this prospective experimental study, undertaken in 2018, three air purifying units were installed in an OR in a Swedish hospital in 2018. The air was actively sampled during 11 operations by a slit-to-slit agar impactor with the air purifying units either switched on or switched off. Air movements were visualized with the aid of smoke in mock-up studies.Findings: No significant difference in bacterial concentrations in air was found between the two conditions (air purifying units switched off or on) (P=0.54). Air movements around and above the surgical wound were disordered and resembled those of dilution mixing air.Conclusion: The three air purifying units installed in the OR did not reduce the airborne bacterial levels in the critical zone during orthopaedic surgery. [ABSTRACT FROM AUTHOR]

Perioperative processes and adherence to scheduled times are crucial for efficient performance in operating theatres. This systematic review investigated the effects of efficient perioperative systems on the timeliness of upstream and downstream processes in surgical care pathways, looking at how these methods could reduce overall patient waiting times for elective surgery. The authors searched PubMed, EMBASE, SCOPUS, Web of Science and Cochrane databases for articles published after 1 January 2014. Both randomised and non-randomised studies were considered. A total of 7543 publications were screened, of which 20 were eligible for analysis. The studies varied widely in design, scope, reported outcomes and overall quality. Analysis demonstrated that a substantial amount of time could be saved through efficient scheduling and planning of perioperative processes, which could reduce overall patient waiting time for elective surgeries. Further evaluation with higher quality study designs and rigour is recommended for firmer conclusions. [ABSTRACT FROM AUTHOR]

Bakgrunn: Operasjonssykepleiere arbeider sammen med anestesisykepleiere, anestesileger og kirurger i det kirurgiske team. Dårlig kommunikasjonen mellom teammedlemmene, manglende respekt og liten arbeidserfaring påvirker teamarbeidet negativt. Det mangler kunnskap om hva som fremmer et godt kirurgisk teamarbeid. Det er derfor behov for mer kunnskap om hvilke erfaringer og oppfatninger operasjonssykepleiere har om hva som er fremmende for teamarbeidet på operasjonsstua. Hensikt: Å få mer kunnskap om hvordan operasjonssykepleiere erfarer og oppfatter det å arbeide i det kirurgiske team, og belyse hva som kan fremme teamarbeidet. Metode: Studien har et utforskende og beskrivende kvalitativt design. Åtte semistrukturerte individuelle intervju med operasjonssykepleiere fra to sykehus i Helse Vest ble gjennomført i februar 2021. Kvalitativ innholdsanalyse ble benyttet i dataanalysen. Resultater: I analysen kom det frem fire kategorier: betydningen av en god tone og trivsel på operasjonsstua, pasienten i fokus, lydhør og tydelig ledelse, og trygghet i yrkesrollen. I kategorien betydningen av en god tone og trivsel på operasjonsstua ble det identifisert tre underkategorier: god og tydelig kommunikasjon, respekt og likeverd, og ulike personligheter i et team. Konklusjon: Operasjonssykepleierne erfarte at god kommunikasjon mellom medlemmene i det kirurgiske team var avgjørende for et godt teamarbeid. Respekt og likeverd skapte en god tone og gjorde det lettere å stille spørsmål og ha konstruktiv kommunikasjon. Personlige egenskaper, en støttende ledelse og trygghet i yrkesrollen var viktig for et godt teamarbeid. Felles teamtrening med alle profesjonene i teamet vil kunne bidra til å utvikle gode ikke-tekniske ferdigheter. ENGLISH ABSTRACT Promoting teamwork in the operating theatre—a qualitative study of operating room nurses’ experiences and perceptions Background: The surgical team consists of operating room nurses, anesthesia nurses, surgeons, and anesthetists. Research shows that collaboration within the interdisciplinary surgical team in the operating theatre can be a challenge and may influence the teamwork negatively. Aim: To gain more knowledge about what operating room nurses’ experience as important to promote surgical teamwork. Methods: The study had a qualitative design with eight semi-structured interviews. Qualitative content analysis was used to analyze the data. Results: Operating room nurses experiences of promoting surgical teamwork were categorized in four main categories: (1) the meaning of a good atmosphere in the operating theatre, (2) the patient in focus, (3) sensitive and clear leadership, and (4) confidence in the professional role. Conclusion: Achieving sufficient communication in the multidisciplinary surgical team is crucial to enhance the quality of the teamwork and patient safety. Promoting teamwork is complex, and personal characteristics, supportive leadership, and confidence in the professional role are significant aspects. To maintain a pleasant atmosphere in the operating theatre, respect and equality between the members of the team is essential. Joint team training may contribute to the development of non-technical skills within the surgical team.

Background: Simulation methodology and frameworks were used to build teamwork and a safety culture, and to establish efficient clinical services within the procedure centre of a newly constructed, stand-alone, fully digital greenfield hospital. Rapid ramp up of surgical services required significant recruitment, and onboarding necessitated training of nursing and other perioperative support staff. Methods: A two-day, immersive integrated simulation activity was carried out with the interprofessional onboarding staff participating in their usual roles. During the simulation, staff had the opportunity to apply newly acquired skills and knowledge to all stages of a patient's clinical journey through the procedure centre, including use of the integrated electronic medical record (ieMR) and non-technical skills. Results: Department processes and workflows were rehearsed in real time before the procedure centre opened to patients. A safe environment was created for staff with formal prebriefing and debriefing delivered at the commencement and conclusion of the simulation activity. Discussion: The integrated simulations reduced uncertainty and streamlined service delivery for staff who participated in the training, with simulations also used to foster interprofessional team training for clinical workflows. The simulation process allowed interprofessional teams (e.g. nurses, support staff, surgeons) to interact with one another prior to the facility opening. [ABSTRACT FROM AUTHOR]

Background: Effective communication and teamwork is increasingly recognized as an important mechanism for enhancing the safety of healthcare. However, there is dearth of study on the pattern of communication among surgeons, nurses and anaesthetists in South Western part of Nigeria Purpose: This study assessed the patterns of communication and teamwork among operating theatre personnel and also identified barriers to communication and teamwork in the operating theatre in selected hospitals in Lagos State, Nigeria. Methods: A descriptive research design was adopted and a convenience sampling technique was used to select 215 nurse and doctor respondents for the study. With a 53-item self-developed structured questionnaire, data were collected. Results were presented descriptively (frequency tables and bar charts), and inferential statistics (Chi-square) were used to test the hypotheses. Results: Results revealed that 41.9% of the respondents had a fair knowledge of communication and teamwork in the operating theatre. Respondents described their pattern of communication as follows; the majority (99.5%) of the respondents communicate through written, spoken words or visual media, and 99.1% also communicate with other theatre personnel irrespective of their hierarchies. In addition, 90.7% reported that upward communication from patients to surgical team members is common in the theatre, while 87% submitted that they communicate through telephone conversations in this theatre. Individual bias, pressure to complete work, workload, poor leadership/lackadaisical attitudes and conflict of interest were identified as barriers to communication and teamwork in the operating theatre. Conclusion: The study concluded that the majority of theatre personnel lack adequate knowledge of communication and teamwork in the operating room. Hence, there is a need for periodic training for operating personnel to improve communication and teamwork, and surgical outcomes. [ABSTRACT FROM AUTHOR]

A holistic approach to each patient presents a challenge for every nurse - regardless of whether the care involves a patient in the treatment ward or in the operating theatre. In their nursing activities, in the multi-faceted and highly specialized patient care, the aim should be to eliminate, or minimize the fears, anxiety or distress resulting from the illness that the patient faces. Patients have the right to expect safety and protection when receiving health services. In fact, patients play a significant role in assessing safety, thus, they should be educated and offered the opportunity to provide feedback which contributes to the improvement of the process of anaesthesia. Furthermore, it is vital to ensure patient comfort by means of creating a friendly atmosphere for the patient, providing mental and physical comfort, ensuring a sense of dignity and intimacy, i.a. by covering the patient's naked body, both in the operating theatre and outside the room, as well as when repositioning the patient. Therefore, it is essential to reassure the patient, or try to distract the patient from the health issue in question. Patient safety constitutes an integral part of the care system and depends on the staff competencies as well as their attitude, views and behavioural patterns. Hence, contemporary nursing aims to ensure patient safety through activities aimed at minimizing the occurrence of adverse events. [ABSTRACT FROM AUTHOR]

Background: Adequate storage of sterile surgical devices must prevent contamination and the introduction of microbial contaminants inside the operating room. For functional and economic purposes, stacker cranes (STCs) could replace the traditional sterile storage room (TSSR). STCs are large, multi-stage, computer-assisted systems used to automatically store and retrieve loads from defined locations. However, their microbiological performance has not been evaluated.Aim: As part of the opening of a new building that included an operating theatre, we qualified a new STC and compared its microbiological control performance to that of the previous TSSR.Methods: From December 2020 to March 2021, 590 environmental specimens (air, N = 56; surfaces, N = 534) were collected and interpreted according to the NF S90-351 French Association for Standardization standards.Findings: Thorough surface disinfection was not sufficient for controlling microbial contamination in the STC. Thus, the initial qualification testing was conducted following an aggressive aerial chemical decontamination of the STC. Despite the lack of a HEPA filtered air system, the overall non-conformity rates were lower in the STC than in the TSSR (8.3% vs 21.4%, P=0.33 for air, respectively, and 9.7% vs 41.7% P<0.001 for surfaces). The air-controlled barrier in front of the loading zone appeared to be sufficient to prevent bacterial contamination. The presence of fungi must be carefully monitored.Conclusion: This is the first study supporting the contribution of STCs in saving space and improving the maintenance of sterile surgical device storage and availability under acceptable environmental conditions. Further studies are needed to assess the long-term microbiological contamination inside the STC. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Hip spica casting is a standard treatment for children with femur fractures. This study compares the outcomes of spica cast application, in terms of quality of fracture reduction and hospital charges when performed in operating theatre versus outpatient clinics at a local institution. MATERIALS AND METHODS: A total of 93 paediatric patients, aged between 2 months to 8 years, who underwent spica casting for an isolated femur fracture between January 2008 and March 2019, were identified retrospectively. They were separated into inpatient or outpatient cohort based on the location of spica cast application. Five patients with metaphyseal fractures and four with un-displaced fractures were excluded. There were 13 and 71 patients in the outpatient and inpatient cohort respectively who underwent spica casting for their diaphyseal and displaced femur fractures. Variables between cohorts were compared. RESULTS: There were no significant differences in gender, fracture pattern, and mechanism of injury between cohorts. Spica casting as inpatients delayed the time from assessment to casting (23.55 ± 29.67h vs. 6.75 ± 4.27h, p

The COVID-19 pandemic has put tremendous strain on healthcare systems. Surgical societies worldwide have advised minimizing non-essential surgeries in order to preserve hospital resources. Given the medical resources and COVID-19 incidence between countries across the world differ, so should colorectal practices. No formal guidelines have emerged from Asia. We wanted to find out what the current practice was in Asian colorectal centres outside China. The COVID-19 pandemic has significantly impacted surgical practice worldwide. At the time of the writing of this paper, there are over 4.2 million cases reported with deaths exceeding 290 000 patients. 1 With an abrupt disruption to worldwide supply chains, societal lockdowns and surge of cases into many hospitals, resource allocation was diverted and prioritised for all COVID-19 related services. A questionnaire survey of current colorectal practice was carried out involving 3 major colorectal cancer centres, one each from 3 major cities: Singapore, Taichung and Daegu. Components of the survey include infrastructure and manpower, case selection, surgical approach, operating room management and endoscopy practice. All 3 centres continued to provide standard-of-care colorectal cancer surgery despite the COVID-19 pandemic. Two centres deferred surgery for benign colorectal conditions. Minimally Invasive Surgery (MIS) was still the preferred approach when indicated but with protocolized precautions undertaken. Other services such as pelvic exenteration, TATME and pelvic lymph node dissection were still offered if oncologically indicated. Elective diagnostic endoscopy services have also continued in two centres. Elective colorectal services continue to take place in the 3 surveyed Asian hospitals with heightened precautions. Provided there is adequate resource, colorectal cancer services should still continue to prevent consequences of neglecting or delaying cancer treatment. Practice should hence be tailored to the local resource of individual centres accordingly. [ABSTRACT FROM AUTHOR]