Explore the vast range of titles available.

The aim of this study was to verify the efficacy of wound protection with a plastic ring wound protector (ring drape) and using new sterile instruments when closing the abdominal wall (wound closure set), both of which were used to prevent incisional surgical site infection (SSI) after hepatectomy. The incidence of incisional SSIs and the clinical courses of 572 patients who underwent hepatectomy between January 2010 and December 2015 were studied retrospectively. The patients were divided into three period groups according to the period when each infection countermeasure was started. Incisional SSI incidence decreased significantly with additional countermeasures: 1 period 10.1%; 2 period 2.08% (p=0.0114); 3 period, 1.63% (1st vs. 3 period, p=0.0016). A multivariate analysis showed that postoperative bile leakage [odds ratio (OR)=4.12, p=0.012] and not using a ring drape (OR=0.176, p=0.003) were independent factors for incisional SSI. Incisional SSI incidence was significantly reduced by using ring drape after hepatectomy.

IntroductionRigorous evaluation of innovative invasive procedures and medical devices is uncommon and lacks reporting standardisation. Devices may therefore enter routine practice without thorough evaluation, resulting in patient harm. Detailed guidance on how to select and report outcomes at each stage of evaluation is lacking. Development of reporting guidance and core outcome sets (COS) is one strategy to promote safe and transparent evaluation.Methods and analysisA COS, comprising outcome domains applicable to all phases of evaluation of procedure/device introduction and modification and, if necessary, supplementary domains relevant to specific phases or types of innovation (procedure or device), will be developed according to principles outlined by Core Outcome Measures in Effectiveness Trials (COMET) and Core Outcome Set-Standards for Development (COS-STAD) guidelines. Reporting guidance will be developed concurrently. The study will have the following three phases:1. Generation of a list of relevant outcome domains and reporting items identified from (a) published studies, (b) hospital policy documentation, (c) regulatory body documentation and (d) stakeholder qualitative interviews. Identified items/domains will be categorised using a conceptual framework and formatted into Delphi consensus survey questionnaire items.2. Key stakeholders, including 50 patients and 150 professionals (surgeons, researchers, device manufacturers, regulatory representatives, journal editors) sampled from multinational sources, will complete a Delphi survey to score the importance of each reporting item and outcome.3. A consensus meeting with key stakeholders will discuss and agree the final content of the reporting guidance and COS(s).Ethics and disseminationEthical approval has been granted by North East-Newcastle and North Tyneside 1 Health Research Authority Research Ethics Committee (18/NE/0378). Dissemination strategies include scientific meeting presentations, peer-reviewed journal publications, development of plain English summaries/materials, patient engagement events, development of a social media identity, workshops and other events.

Reprocessing single‐use surgical supplies and devices is an option for hospitals and ambulatory surgery centers (ASCs). The US Federal Government has recognized the practice since 2000, and regulatory oversight has increased dramatically since that time. Reprocessing single‐use devices is safe when personnel use approved methods, and health care facilities can experience significant cost savings by participating in this type of initiative. This article explores reprocessing and its benefits in ASCs, including a review of the oversight that the US Food and Drug Administration currently has for reprocessing and a discussion of the results of studies pertaining to this practice. The article also describes some issues that ASC leaders need to be aware of when considering the implementation of a reprocessing program. Single‐use device reprocessing can be an effective tool for ASC leaders to conserve and manage resources.

Background. The rate of surgical site infections (SSIs) has decreased in parallel to advances in sterilization techniques. Such infections increase morbidity and hospitalization costs. The use of iodine-impregnated sterile wound drapes (SWDs) is recommended to prevent or reduce the incidence of these infections. However, there is a paucity of data regarding their use in thoracic surgical procedures. The aim of the present study was to evaluate the effectiveness of sterile wound drapes in the prevention of these infections and the effects on hospitalization costs. Methods. Perioperative iodine-impregnated SWDs have been used since January 2015 in the Thoracic Surgery Clinic of our hospital. A retrospective evaluation was made of patients who underwent anatomic pulmonary resection via thoracotomy with SWD in the period January 2015–2017, compared with a control group who underwent the same surgery without SWD in the 2-year period before January 2015. Factors that may have increased the risk of surgical site infection were documented and the occurrence of SSI was recorded from postoperative follow-up data. The cost analysis was performed as an important criterion to investigate the benefits of SWD. Results. Evaluation was made of 654 patients in the study group (n:380) using SWD, the operation time was significantly longer, and perioperative blood transfusion was significantly higher, whereas treatment costs (p=0.0001) and wound culture positivity (p=0.004) were significantly lower and less surgical wound debridement was performed (p=0.002). Conclusion. The findings suggest that the use of sterile wound draping in thoracic surgery procedures reduces surgical site infections and hospitalization costs.

Technology is constantly changing, and it is important for perioperative nurses to stay current on new products and technologies in the perioperative setting. AORN's “Recommended practices for electrosurgery” addresses safety standards that all perioperative personnel should follow to minimize risks to both patients and staff members during the use of electrosurgical devices. Recommendations include how to select electrosurgical units and accessories for purchase, how to minimize the potential for patient and staff member injuries, what precautions to take during minimally invasive surgery, and how to avoid surgical smoke hazards. The recommendations also address education/competency, documentation, policies and procedures, and quality assurance/performance improvement. Perioperative nurses should consider the use of checklists and safety posters to remind staff members of the dangers of electrosurgery and the steps to take to minimize the risks for injury.

Background The Penumbra system uses a coaxial separator and continuous extracorporeal suction to remove a clot from a cerebral artery. Forced-suction thrombectomy (FST) involves aspirating clots through the same reperfusion catheter using only a syringe, decreasing the procedure time and supplies needed. Objective To evaluate multiple combinations of catheters and syringes to determine the optimal pairing for use in FST. Methods Tests were performed using both the Penumbra system and syringes to aspirate water through Penumbra 0.041 inch (041), 4Max, 0.054 inch (054) and 5Max reperfusion catheters and a shuttle sheath. Dynamic pressure and flow at the catheter tip were calculated from the fill times for each system. Static pressure and force for each aspiration source were determined with a vacuum gauge. Results All syringes provided significantly higher dynamic pressure at the catheter tip than the Penumbra system (p<0.001). Increasing syringe volume significantly increased static pressure (p<0.001). Both flow and aspiration force significantly increased with catheter size (p<0.001). Cases are presented to demonstrate the clinical value of the laboratory principles. Conclusions Maximizing static and dynamic pressure when performing FST is achieved by aspirating with a syringe possessing both the largest volume and the largest inlet diameter available. Maximizing aspiration force and flow rate is achieved by using the largest catheter possible.

Background To investigate the influence of the working surface height on task performance and muscle workload in hand-assisted laparoscopic surgery. Methods The standard task used was closure of 5-cm enterotomy inside a hand-assisted laparoscopic surgery trainer. Surgeons were instructed to place the sutures 3–5 mm apart and from the enterotomy edge. Ten surgeons participated in each experiment and one task was performed with each level. The first experiment compared the quality of task performance and muscle workload with the working surface at: elbow level, 10 cm above, 15 cm above and 10 cm below the elbow. Further narrower levels (5 cm below, at the elbow and 5 cm above the elbow) were investigated in the second experiment. Outcome measures were execution time (s), placement error score (mm), leakage pressure (mmHg), number of execution errors, muscle workload as measured by integrated electromyography (mV·s) and visual analogue score of back discomfort (mm). Results The first experiment showed that 15 cm above the elbow level was associated with the longest execution time and similar quality of task performance. This level resulted in a higher workload of the deltoid of the extracorporeal limb, the arm extensor of the intracorporeal side and the trapezius and paraspinal muscles of both intra- and extracorporeal limbs. Also, the 10 cm above the elbow level was associated with increased muscle workload of the deltoid of extracorporeal limb and the trapezius of both limbs compared with the elbow height. The 10 cm below the elbow level was associated with increased back discomfort. The second experiment showed that 5 cm below the elbow height was associated with increased muscle workload of the arm flexor group of the intracorporeal dominant limb. Conclusions The optimum table height for hand-assisted laparoscopic surgery allows the working surface of the extracorporal instrument handle to be at or 5 cm above the elbow level.

National registries must be created so that this technology can be properly evaluated

In a roundtable discussion, several executives expressed their views on the challenges of sterile processing. Rose Seavey, president/CEO of Seavey Healthcare Consulting, said that a lack of resources and education. Some sterile processing staff don't know what they don't know because they have not been exposed to the most current recommendations. Donna Swenson, president and CEO of Sterile Processing Quality Services, Inc, thinks that the biggest issue has to do with designing medical devices that can be easily cleaned, disinfected, and sterilized but that perform the way the user/surgeon wants. Damien Berg, performance improvement consultant for University of Colorado Health, said that healthcare facilities should develop a training program with or without an educator, and they should dedicate a couple of hours each month for all shifts to participate in education. They also should understand what is being measured for productivity and learn how to utilize their staff the correct way.

OPERATING ROOM RENOVATION PROJECTS require planning and collaboration among physicians, hospital staff members, and vendors. RENOVATION INVOLVES many details, from how many electrical plugs to install in each OR to integration of the latest technologies. DETAILS OF A MULTIPHASE OR renovation project undertaken at Saint Francis Medical Center in Cape Girardeau, MO, provide information and tools that any facility planning a renovation can use. AORN J 88 (December 2008) 917–941. © AORN, Inc, 2008.