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Reynier T, Berahou M, Albaladejo P, Beloeil H. Moving towards green anaesthesia: Are patient safety and environmentally friendly practices compatible? A focus on single-use devices. Anaesth Crit Care Pain Med 2021; 40:100907. [PMID: 34153533 DOI: 10.1016/j.accpm.2021.100907] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 04/07/2021] [Accepted: 04/09/2021] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Discuss if the use of disposable or reusable medical devices leads to a difference in terms of hospital-acquired infection or bacterial contamination. Determine which solution is less expensive and has less environmental impact in terms of carbon footprint, energy and water consumption and amount of waste. METHODS We carried out a narrative review. Articles published in English and French from January 2000 to April 2020 were identified from PubMed. RESULTS We retrieved 81 articles, including 12 randomised controlled trial, 21 literature reviews, 13 descriptive studies, 6 experimental studies, 9 life-cycle studies, 6 cohort studies, 2 meta-analysis, 4 case reports and 8 other studies. It appears that pathogen transmission in the anaesthesia work area is mainly due to the lack of hand hygiene among the anaesthesia team. The benefit of single-use devices on infectious risk is based on weak scientific arguments, while reusable devices have benefits in terms of costs, water consumption, energy consumption, waste, and reducing greenhouse gas emissions. CONCLUSION Disposable medical devices and attire in the operating theatre do not mitigate the infectious risk to the patients but have a greater environmental, financial and social impact than the reusable ones. This study is the first step towards recommendations for more environmental-friendly practices in the operating theatre.
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Affiliation(s)
- Thibault Reynier
- Grenoble-Alpes University Hospital, Department of Anaesthesia and Intensive Care Medicine, F-38000 Grenoble, France
| | - Mathilde Berahou
- University of Rennes, CHU Rennes, Inserm, CIC 1414, COSS U1242, Anaesthesia and Intensive Care Medicine, F-35000 Rennes, France
| | - Pierre Albaladejo
- Grenoble-Alpes University Hospital, Department of Anaesthesia and Intensive Care Medicine, F-38000 Grenoble, France.
| | - Hélène Beloeil
- University of Rennes, CHU Rennes, Inserm, CIC 1414, COSS U1242, Anaesthesia and Intensive Care Medicine, F-35000 Rennes, France
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Svetanoff WJ, Dekonenko C, Briggs KB, Sujka JA, Osuchukwu O, Dorman RM, Oyetunji TA, St Peter SD. Debunking the Myth: What You Really Need to Know about Clothing, Electronic Devices, and Surgical Site Infection. J Am Coll Surg 2021; 232:320-331.e7. [PMID: 33453379 DOI: 10.1016/j.jamcollsurg.2020.11.032] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 11/10/2020] [Accepted: 11/11/2020] [Indexed: 12/13/2022]
Affiliation(s)
- Wendy Jo Svetanoff
- Department of General and Thoracic Surgery, Children's Mercy Hospital, Kansas City, MO
| | - Charlene Dekonenko
- Department of General and Thoracic Surgery, Children's Mercy Hospital, Kansas City, MO
| | - Kayla B Briggs
- Department of General and Thoracic Surgery, Children's Mercy Hospital, Kansas City, MO
| | - Joseph A Sujka
- Department of General Surgery, Tampa General Hospital, Tampa, FL
| | - Obiyo Osuchukwu
- Department of General and Thoracic Surgery, Children's Mercy Hospital, Kansas City, MO
| | - Robert M Dorman
- Department of General and Thoracic Surgery, Children's Mercy Hospital, Kansas City, MO; Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, OH
| | - Tolulope A Oyetunji
- Department of General and Thoracic Surgery, Children's Mercy Hospital, Kansas City, MO; University of Missouri-Kansas City (UMKC) School of Medicine, Kansas City, MO
| | - Shawn D St Peter
- Department of General and Thoracic Surgery, Children's Mercy Hospital, Kansas City, MO; University of Missouri-Kansas City (UMKC) School of Medicine, Kansas City, MO.
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3
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Ball CM, Featherstone PJ. Hygiene and personal protection: The anaesthetist’s journey. Anaesth Intensive Care 2020; 48:258-261. [DOI: 10.1177/0310057x20933801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Christine M Ball
- Department of Anaesthesia and Perioperative Medicine, Alfred Hospital, Melbourne, Australia
- Department of Anaesthesia and Perioperative Medicine, Monash University, Melbourne, Australia
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Baldini A, Blevins K, Del Gaizo D, Enke O, Goswami K, Griffin W, Indelli PF, Jennison T, Kenanidis E, Manner P, Patel R, Puhto T, Sancheti P, Sharma R, Sharma R, Shetty R, Sorial R, Talati N, Tarity TD, Tetsworth K, Topalis C, Tsiridis E, W-Dahl A, Wilson M. General Assembly, Prevention, Operating Room - Personnel: Proceedings of International Consensus on Orthopedic Infections. J Arthroplasty 2019; 34:S97-S104. [PMID: 30360975 PMCID: PMC7111314 DOI: 10.1016/j.arth.2018.09.059] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
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Cawich SO, Harding HE, Crandon IW, McGaw CD, Barnett AT, Tennant I, Evans NR, Martin AC, Simpson LK, Johnson P. Leadership in surgery for public sector hospitals in Jamaica: strategies for the operating room. Perm J 2014; 17:e121-5. [PMID: 24355903 DOI: 10.7812/tpp/12-117] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The barriers to health care delivery in developing nations are many: underfunding, limited support services, scarce resources, suboptimal health care worker attitudes, and deficient health care policies are some of the challenges. The literature contains little information about health care leadership in developing nations. This discursive paper examines the impact of leadership on the delivery of operating room (OR) services in public sector hospitals in Jamaica.Delivery of OR services in Jamaica is hindered by many unique cultural, financial, political, and environmental barriers. We identify six leadership goals adapted to this environment to achieve change. Effective leadership must adapt to the environment. Delivery of OR services in Jamaica may be improved by addressing leadership training, workplace safety, interpersonal communication, and work environment and by revising existing policies. Additionally, there should be regular practice audits and quality control surveys.
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Affiliation(s)
- Shamir O Cawich
- Lecturer in Surgery at the University of the West Indies in Kingston, Jamaica. E-mail:
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Bunyan D, Ritchie L, Jenkins D, Coia J. Respiratory and facial protection: a critical review of recent literature. J Hosp Infect 2013; 85:165-9. [PMID: 24035256 PMCID: PMC7132472 DOI: 10.1016/j.jhin.2013.07.011] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2013] [Accepted: 07/31/2013] [Indexed: 01/17/2023]
Abstract
Infectious micro-organisms may be transmitted by a variety of routes. This is dependent on the particular pathogen and includes bloodborne, droplet, airborne, and contact transmission. Some micro-organisms are spread by more than one route. Respiratory and facial protection is required for those organisms which are usually transmitted via the droplet and/or airborne routes or when airborne particles have been created during 'aerosol-generating procedures'. This article presents a critical review of the recently published literature in this area that was undertaken by Health Protection Scotland and the Healthcare Infection Society and which informed the development of guidance on the use of respiratory and facial protection equipment by healthcare workers.
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Affiliation(s)
- D. Bunyan
- Health Protection Scotland, NHS National Services Scotland, Glasgow, UK
| | - L. Ritchie
- Health Protection Scotland, NHS National Services Scotland, Glasgow, UK
| | - D. Jenkins
- Department of Clinical Microbiology, University Hospitals of Leicester NHS Trust, Leicester Royal Infirmary, Leicester, UK
| | - J.E. Coia
- Department of Clinical Microbiology, Glasgow Royal Infirmary, Glasgow, UK
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Webster J, Croger S, Lister C, Doidge M, Terry MJ, Jones I. Use of face masks by non-scrubbed operating room staff: a randomized controlled trial. ANZ J Surg 2010; 80:169-73. [PMID: 20575920 DOI: 10.1111/j.1445-2197.2009.05200.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Ambiguity remains about the effectiveness of wearing surgical face masks. The purpose of this study was to assess the impact on surgical site infections (SSIs) when non-scrubbed operating room staff did not wear surgical face masks. METHODS Eight hundred twenty-seven participants undergoing elective or emergency obstetric, gynecological, general, orthopaedic, breast or urological surgery in an Australian tertiary hospital were enrolled. Complete follow-up data were available for 811 patients (98.1%). Operating room lists were randomly allocated to a 'Mask group' (all non-scrubbed staff wore a mask) or 'No Mask group' (none of the non-scrubbed staff wore masks). The primary end point, SSI was identified using in-patient surveillance; post discharge follow-up and chart reviews. The patient was followed for up to six weeks. RESULTS Overall, 83 (10.2%) surgical site infections were recorded; 46/401 (11.5%) in the Masked group and 37/410 (9.0%) in the No Mask group; odds ratio (OR) 0.77 (95% confidence interval (CI) 0.49 to 1.21), p = 0.151. Independent risk factors for surgical site infection included: any pre-operative stay (adjusted odds ratio [aOR], 0.43 (95% CI, 0.20; 0.95), high BMI aOR, 0.38 (95% CI, 0.17; 0.87), and any previous surgical site infection aOR, 0.40 (95% CI, 0.17; 0.89). CONCLUSION Surgical site infection rates did not increase when non-scrubbed operating room personnel did not wear a face mask.
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Affiliation(s)
- Joan Webster
- Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.
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Thiele RH, Huffmyer JL, Nemergut EC. The "six sigma approach" to the operating room environment and infection. Best Pract Res Clin Anaesthesiol 2009; 22:537-52. [PMID: 18831302 DOI: 10.1016/j.bpa.2008.06.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
The patient's external environment plays a significant, and in some cases dominant, role in his or her infection risk. The use of ultraclean air for certain procedures, as well as avoidance of hypothermia have been proven to reduce the risk of infection. There is no data to support the routine use of surgical masks (by surgeons or staff), ventilating helmets, or routine cleaning of all environmental surfaces in between cases. More research needs to be done in order to determine whether OR design changes, in addition to increasing OR efficiency and thus reducing case times, can also reduce infection rates. Further research is also needed to determine whether or not double gloves and/or the use of antiseptic scrubbing in addition to painting are efficacious.
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Affiliation(s)
- Robert H Thiele
- Department of Anesthesiology, University of Virginia Health Sciences Center, Charlottesville, VA 22908, USA
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Schulz-Stübner S, Pottinger JM, Coffin SA, Herwaldt LA. Nosocomial infections and infection control in regional anesthesia. Acta Anaesthesiol Scand 2008; 52:1144-57. [PMID: 18840117 DOI: 10.1111/j.1399-6576.2008.01712.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Although rare, infectious complications from regional anesthesia and analgesia can be devastating. The literature on this topic consists primarily of surveys, case reports, case series, and studies in which used supplies were cultured. We derived infection control recommendations from the existing literature and compared these recommendations with existing guidelines. METHODS Structured literature search of the Cochrane Central Register of Controlled Trials, MEDLINE, including old MEDLINE and EMBASE until 2005. Descriptive statistics were cited when applicable. MAIN RESULTS Incidence rates for infectious complications vary substantially between studies and range from 3.7 to 7.2/100,000 for spinal anesthesia-associated meningitis and from 0.2 to 83/100,000 for epidural anesthesia-associated epidural abscesses. Few comprehensive prospective trials have been conducted and most case reports do not provide complete information about infection control practices. CONCLUSION Studies using more robust methods are necessary to define the rates of infection after different regional anesthesia procedures and to identify risk factors for infections. Data on risk factors would allow anesthesiologists to develop evidence-based guidelines for placement and care of catheters used for regional anesthesia. A multicenter surveillance system may help anesthesiologists address some of the unanswered questions and to develop evidence-based infection control recommendations.
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Affiliation(s)
- S Schulz-Stübner
- Beratungszentrum für Hygiene (BZH), Universitätsklinikum Freiburg, Freiburg, Germany.
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Abstract
Infection is the commonest cause of serious neurologic sequelae of neuraxial anesthesia. The incidence depends on operator skill and patient population. Meningitis, a complication of dural puncture, is usually caused by viridans streptococci. The risk factors are dural puncture during labor, no mask and poor aseptic technique, vaginal infection and bacteremia. Epidural abscess is a complication of epidural catheterization, route of entry the catheter track and the organism usually the staphylococcus. Principal risk factors are prolonged catheterization, poor aseptic technique and traumatic insertion. Prevention includes wearing a mask, using a full sterile technique, avoiding prolonged catheterization and prescribing antibiotics in a high-risk situation.
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McDonald R, Waring J, Harrison S. ‘Balancing risk, that is my life’: The politics of risk in a hospital operating theatre department. HEALTH RISK & SOCIETY 2005. [DOI: 10.1080/13698570500390705] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Alwitry A, Jackson E, Chen H, Holden R. The use of surgical facemasks during cataract surgery: is it necessary? Br J Ophthalmol 2002; 86:975-7. [PMID: 12185118 PMCID: PMC1771269 DOI: 10.1136/bjo.86.9.975] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
AIM To assess whether facemask utilisation by the surgeon during cataract surgery has any effect on the bacterial load falling onto the operative site. METHOD Prospective randomised masked study. Consent was obtained from 221 patients. Cases were randomised to wearing a new mask or not wearing any mask throughout the procedure. Blood agar settle plates were placed adjacent to the patient's head in the operative field. Duration of procedure was noted. Plates were incubated and read at 48 hours. Colony forming bacteria were counted and identified. RESULTS There were significantly fewer organisms cultured when the surgeon used a facemask (p=0.0006). The majority of organisms were Staphylococcus epidermidis, Bacillus spp, and Diphtheroid spp; however Staphylococcus aureus and Pseudomonas aeruginosa were cultured on several occasions. There were no cases of infective complication. CONCLUSIONS The main purpose of an operating mask is to prevent bacteria falling on to the operative site from the surgeon's oropharynx or nasopharynx with the concomitant theoretical risk of infective complication. Operating masks were shown to have a significant effect on the volume of bacterial organisms falling to the operative site; however, whether this is clinically significant is unknown.
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Affiliation(s)
- A Alwitry
- Department of Ophthalmology, Derbyshire Royal Infirmary, UK.
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Merchant RN. Surgical face masks in the operating theatre. J Hosp Infect 2002; 50:234; author reply 234-5. [PMID: 11886204 DOI: 10.1053/jhin.2001.1167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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