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At our quaternary teaching hospital in Queensland, Australia, there has been a rapid increase from 2019 to 2022 in the usage of fibrinogen concentrate (FC) in preference to cryoprecipitate for cardiac surgery. FC is indicated for patients having major trauma requiring haemostatic resuscitation, major intraoperative haemorrhage, or liver transplant patients with major intraoperative haemorrhage. These patients must exhibit severe hypofibrinogenaemia, which is assessed using assay cut‐offs of thromboelastogram (TEG) (citrated functional fibrinogen [CFF] ≤ 10 mm) or rotational thromboelastometry (ROTEM) (FIBTEM A5 ≤ 8 mm). FC usage over cryoprecipitate for cardiac surgery is an ongoing debate due to advantages such as dose predictability, rapid reconstitution, viral inactivation, and minimal transfusion‐related adverse events; however, it is expensive. The aim of this study was to capture prescribing patterns of FC and appropriateness against local guidelines. Retrospective data were analysed, and the practice was compared to hospital guidelines. Data from 52 patients over a 4‐year period (2019–2022) showed intraoperative haemorrhage was the leading indication for FC use (65%, n = 34), followed by liver transplantation (27%, n = 14), and major trauma (8%, n = 4). When breaking down the cause of intraoperative haemorrhage, cardiothoracic surgery, both elective (50%, n = 17) and emergency procedures (41%, n = 14), accounted for 91% of all operative bleeding requiring FC. There were 34 (65%) of 52 patients who received a differing dose of FC compared to what was recommended in the hospital guideline, with 50% (n = 17) receiving a higher than recommended dose and 50% (n = 17) receiving lower than recommended doses. This project was exempt due to the local policy requirements that constitute research by the Metro South Human Research Ethics Committee (Reference no: CM2305202303). The justification for this exemption was as follows: the study presented no foreseeable risk of patient harm as it involved evaluation of standard care involved the use of existing non‐identifiable patient records. [ABSTRACT FROM AUTHOR]

Abstract The National Health Service (NHS) in England has set hospitals a target of achieving > 85% in a metric called ‘capped theatre utilisation’ (CTU), as central to its post-pandemic surgical waiting list recovery planning. This could serve as a model internationally, as other countries seek to improve operating theatre efficiency. Our review presents an analysis of what CTU means in the context of other measures of theatre ‘utilisation’, serving as a tutorial for clinical leaders, managers and all staff involved in theatres better to understand the metrics sometimes being used to assess their performance. We present results of a theoretical sensitivity analysis to assess how CTU values vary for hypothetical operating lists of three different structures (number of cases, their duration, and intercase gap times), as the stated start and finish times are shifted backwards and forwards in time. We then present results of our interrogation of the NHS Model Health Operating Theatres database to assess hospitals' CTU performance over three years. We discovered that in theory, CTU was especially sensitive to both stated list start times and list structure. The relationship to start time was asymmetric: early starts in one list did not compensate for loss of CTU value with late start in another list, when values were averaged across lists. This sensitivity analysis also predicted wide weekly CTU fluctuations, with values 85%, especially for tertiary referral centres predominantly undertaking long, complex procedures. Our interrogation of the database confirmed these predictions. Moreover, we discovered many instances of implausible CTU values and underlying patterns indicating fundamental flaws in the CTU algorithm, rather than data entry errors. We conclude that CTU, and the NHS target of 85%, is not a suitable metric for operating theatre performance. It has proved unachievable in any sustainable way, and its underlying algorithm produces aberrant values. We discuss the serious consequences of basing other national policies or funding models on a fundamentally flawed metric. These results have lessons for international healthcare systems.

The National Health Service (NHS) in England has set hospitals a target of achieving > 85% in a metric called ‘capped theatre utilisation’ (CTU), as central to its post-pandemic surgical waiting list recovery planning. This could serve as a model internationally, as other countries seek to improve operating theatre efficiency. Our review presents an analysis of what CTU means in the context of other measures of theatre ‘utilisation’, serving as a tutorial for clinical leaders, managers and all staff involved in theatres better to understand the metrics sometimes being used to assess their performance. We present results of a theoretical sensitivity analysis to assess how CTU values vary for hypothetical operating lists of three different structures (number of cases, their duration, and intercase gap times), as the stated start and finish times are shifted backwards and forwards in time. We then present results of our interrogation of the NHS Model Health Operating Theatres database to assess hospitals' CTU performance over three years. We discovered that in theory, CTU was especially sensitive to both stated list start times and list structure. The relationship to start time was asymmetric: early starts in one list did not compensate for loss of CTU value with late start in another list, when values were averaged across lists. This sensitivity analysis also predicted wide weekly CTU fluctuations, with values < 85% more likely than > 85%, especially for tertiary referral centres predominantly undertaking long, complex procedures. Our interrogation of the database confirmed these predictions. Moreover, we discovered many instances of implausible CTU values and underlying patterns indicating fundamental flaws in the CTU algorithm, rather than data entry errors. We conclude that CTU, and the NHS target of 85%, is not a suitable metric for operating theatre performance. It has proved unachievable in any sustainable way, and its underlying algorithm produces aberrant values. We discuss the serious consequences of basing other national policies or funding models on a fundamentally flawed metric. These results have lessons for international healthcare systems. [ABSTRACT FROM AUTHOR]

Ensuring air quality in operating rooms is crucial for the health and safety of healthcare professionals and patients. This study, focused on 141 operating theatres in the Campania Region from 2015 to 2022, highlights the importance of air monitoring in operating rooms. Microclimatic parameters, air exchanges, thermal comfort indices, air pressure differences, and anesthetic gas concentrations were measured using standardized procedures. Results indicate that 19% of microclimatic checks exceeded acceptable limits, with significant non-compliance in air velocity (0.01–0.04 m/s, mean 0.03 m/s) and air changes (1–14 h−1, mean 6 h−1). Additionally, levels of anesthetic gases such as nitrous oxide (54.7–197.31 ppm, mean 142.92 ppm) and sevoflurane (2.05–19.45 ppm, mean 5.90 ppm) frequently exceeded recommended exposure limits, raising health concerns. These findings underscore the importance of rigorously adhering to environmental standards and continuously monitoring for optimal conditions in operating rooms. The study also stresses the necessity of ongoing education and training for healthcare personnel on preventive measures to reduce risks. In conclusion, maintaining optimal environmental conditions not only safeguards the comfort and safety of healthcare professionals and patients, but also improves team productivity and clinical outcomes. The study advocates for regularly updating national guidelines and rigorously enforcing safety protocols in healthcare facilities. [ABSTRACT FROM AUTHOR]

Background: the aim of the study was to assess microbiological air quality in operating theatres by determining the level of microbiological contamination of the air and critical surfaces using the passive air sampling method and compliance of the operating theatre staff with infection control measures. Materials and methods: The prospective study was conducted in the surgical block of the University Medical Centre Maribor. For two months continuously, ten operating theatres were assessed for microbial contamination of air and surfaces during quiet and active times of the day. A passive air sampling method with Petri dishes on an agar specially adapted for this purpose (plate count agar) was used. In addition, ten surgical procedures were observed to assess staff compliance with recommended practises. Results: Air samples met microbiological standards in all operating theatres. In both sampling sessions of the day (quiet and active periods), microbial contamination of the air was always within the limit of 10 CFU/m3. The average number of bacterial colonies was zero to two during quiet phases and one to four during active phases. Approximately 60% of the isolates from the operating theatres belonged mainly to the genus Staphylococcus: S. epidermidis (36% of the isolates), S. hominis (17.5%) and S. haemolyticus (5.5%). The rest were identified as Streptococcus anginosus (23%) and Bacillus sp. (18%). Pathogenic bacteria and moulds were not present. In regard to staff compliance with good surgical practise, the former varied by behaviour and function, with non-compliance in pre-operative skin preparation and operating theatre congestion being notable. The cleanliness of the environment was satisfactory. Conclusions: Microbiological air control is extremely important for the safety and success of both surgical and postoperative practises. In spite of good results obtained in the study, further improvements in surgical staff compliance with good surgical practise are essential to reduce surgical site infections. [ABSTRACT FROM AUTHOR]

Shortages in the physician anaesthesia workforce have led to proposals to introduce new staff groups, notably in the UK National Health Service (NHS) Anaesthesia Associates (AAs) who have shorter training periods than doctors and could potentially contribute to workflow efficiencies in several ways. We analysed the economic viability of the most efficient staffing model, previously endorsed by both the UK Royal College of Anaesthetists and the Association of Anaesthetists, wherein one physician supervises two AAs across two operating lists (1:2 model). For this model to be economically rational (something which neither national organisation considered), the employment cost of the two AAs should be equal to or less than that of a single supervisor physician (i.e. AAs should be paid <50% of the supervisor's salary). As the supervisor can be an autonomous specialty and specialist (SAS) doctor, this sets the economically viable AA salary envelope at less than £40,000 per year. However, we report that actual advertised AA salaries greatly exceed this, with even student AAs paid up to £48,472. Economically, one way to justify such salaries is for AAs to become autonomous such that they eventually replace SAS doctors at a lower cost. We discuss some other options that might increase AA productivity to justify these salaries (e.g. ≥1:3 staffing ratios), but the medico-political consequences of each of them are also profound. Alternatively, the AA programme should be terminated as economically nonviable. These results have implications for any country seeking to introduce new models of working in anaesthesia. [ABSTRACT FROM AUTHOR]

Background: The health sector contributes significantly to the climate crisis. Operating theatres (OTs) in particular are a major contributor of greenhouse gas emissions and waste, and while there are several evidence-based guidelines to reduce this impact, these are often not followed. The authors systematically reviewed the literature to identify barriers and facilitators of sustainable behaviour in OTs, categorising these using the Theoretical Domains Framework (TDF). Materials and Methods: Medline, Embase, PsychInfo, and Global Health databases were searched for articles published between January 2000 and June 2023, using the concepts: barriers and facilitators, sustainability, and surgery. Two reviewers screened abstracts from identified studies, evaluated quality, and extracted data. Identified determinants were mapped to TDF domains and further themes as required. The results were reported in line with PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) and AMSTAR (A MeaSurement Tool to Assess Systematic Reviews) guidelines. Results: Twenty-one studies were selected for analysis and assessment (17 surveys and four interview studies) comprising 8286 participants, including surgeons, nurses, and anaesthetists. Eighteen themes across 10 TDF domains were identified. The most common barriers to adoption of green behaviours in OTs were in domains of: 'knowledge' (N=18), for example knowledge of sustainable practices; 'environmental context and resources' (N=16) for example personnel shortage and workload and inadequate recycling facilities; 'social influences' (N= 9) for example lack of leadership/organisational mandate or support; 'beliefs about consequences' (N=9) for example concerns regarding safety. Intention was the most common facilitator, with 11 studies citing it. Conclusions: Despite intentions to adopt sustainable practices in OTs, this review identified several barriers to doing so. Interventions should focus on mitigating these, especially by improving staff's knowledge of sustainability practices and working within the environmental context and time pressures. Furthermore, institutional change programmes and policies are needed to prioritise sustainability at the hospital and trust level. Additional qualitative work should also be conducted using behavioural frameworks, to more comprehensively investigate barriers and determinants to decarbonise OTs. [ABSTRACT FROM AUTHOR]

Ensuring air quality in operating rooms is crucial for the health and safety of healthcare professionals and patients. This study, focused on 141 operating theatres in the Campania Region from 2015 to 2022, highlights the importance of air monitoring in operating rooms. Microclimatic parameters, air exchanges, thermal comfort indices, air pressure differences, and anesthetic gas concentrations were measured using standardized procedures. Results indicate that 19% of microclimatic checks exceeded acceptable limits, with significant non-compliance in air velocity (0.01–0.04 m/s, mean 0.03 m/s) and air changes (1–14 h−1, mean 6 h−1). Additionally, levels of anesthetic gases such as nitrous oxide (54.7–197.31 ppm, mean 142.92 ppm) and sevoflurane (2.05–19.45 ppm, mean 5.90 ppm) frequently exceeded recommended exposure limits, raising health concerns. These findings underscore the importance of rigorously adhering to environmental standards and continuously monitoring for optimal conditions in operating rooms. The study also stresses the necessity of ongoing education and training for healthcare personnel on preventive measures to reduce risks. In conclusion, maintaining optimal environmental conditions not only safeguards the comfort and safety of healthcare professionals and patients, but also improves team productivity and clinical outcomes. The study advocates for regularly updating national guidelines and rigorously enforcing safety protocols in healthcare facilities.

Background: the aim of the study was to assess microbiological air quality in operating theatres by determining the level of microbiological contamination of the air and critical surfaces using the passive air sampling method and compliance of the operating theatre staff with infection control measures. Materials and methods: The prospective study was conducted in the surgical block of the University Medical Centre Maribor. For two months continuously, ten operating theatres were assessed for microbial contamination of air and surfaces during quiet and active times of the day. A passive air sampling method with Petri dishes on an agar specially adapted for this purpose (plate count agar) was used. In addition, ten surgical procedures were observed to assess staff compliance with recommended practises. Results: Air samples met microbiological standards in all operating theatres. In both sampling sessions of the day (quiet and active periods), microbial contamination of the air was always within the limit of 10 CFU/m3. The average number of bacterial colonies was zero to two during quiet phases and one to four during active phases. Approximately 60% of the isolates from the operating theatres belonged mainly to the genus Staphylococcus: S. epidermidis (36% of the isolates), S. hominis (17.5%) and S. haemolyticus (5.5%). The rest were identified as Streptococcus anginosus (23%) and Bacillus sp. (18%). Pathogenic bacteria and moulds were not present. In regard to staff compliance with good surgical practise, the former varied by behaviour and function, with non-compliance in pre-operative skin preparation and operating theatre congestion being notable. The cleanliness of the environment was satisfactory. Conclusions: Microbiological air control is extremely important for the safety and success of both surgical and postoperative practises. In spite of good results obtained in the study, further improvements in surgical staff compliance with good surgical practise are essential to reduce surgical site infections.

The NHS accounts for 5.4% of the UK's total carbon footprint, with the perioperative environment being the most resource hungry aspect of the hospital. The aim of this systematic review was to assimilate the published studies concerning the sustainability of the perioperative environment, focussing on the impact of implemented interventions. A systematic review was performed using Pubmed, OVID, Embase, Cochrane database of systematic reviews and Medline. Original manuscripts describing interventions aimed at improving operating theatre environmental sustainability were included. 675 abstracts were screened with 34 manuscripts included. Studies were divided into broad themes; recycling and waste management, waste reduction, reuse, reprocessing or life cycle analysis, energy and resource reduction and anaesthetic gases. This review summarises the interventions identified and their resulting effects on theatre sustainability. This systematic review has identified simple, yet highly effective interventions across a variety of themes that can lead to improved environmental sustainability of surgical operating theatres. Combining these interventions will likely result in a synergistic improvement to the environmental impact of surgery. • Perioperative environments use 3–6 times more energy than the hospital in general. • Paper/cardboard recycling bins in operating areas led to a 50–67% recycling rate. • Reusable items can lead to 70% reduction in waste generation. • Alcohol scrub solutions vs handwashing saves ∼930,000 L/year/hospital of water. • Dispensing propofol in 20 mL bottles instead of 50/100 mL reduces drug wastage by 90%. [ABSTRACT FROM AUTHOR]

• Despite improvements made since 2018, many NHS trusts do not comply with national guidelines in protecting new and expectant mothers from risk. • 77% of NHS trusts said they have no relevant guidelines put in place to protect pregnant women from orthopaedic-related risks. • Female surgeons need to continue seeking occupational health advice from professional bodies where the NHS fails to inform them. • NHS trusts must be encouraged to accurately signpost new and expectant mothers to relevant guidance. Trauma & Orthopaedic (T&O) surgery presents several occupational hazards to pregnant women and the unborn child. National bodies have produced guidelines to mitigate these risks as far as possible but individual trusts must be aware of them and implement them in their local policies. Our study aims to re-assess whether national guidelines for the protection of pregnant women are better adhered to nationally by providing a comparison to a previous study in 2018. A national observational study of 146 NHS trusts in the UK was conducted. Each trust was asked to complete a freedom of information request regarding all orthopaedic guidelines relating to pregnant theatre staff, which specifically related to the protection of the mother and foetus from exposure to harmful activity in theatre. Compliance was ascertained by cross-checking local policies with national guidelines. 82/146 (52.0%) of NHS trusts responded to the Freedom of Information request. 31/75 (41.3%) respondents followed Health and Safety Executive (HSE) guidance for New and Expectant Mothers with 17/75 (22.7%) following multiple national guidelines. 16/75 (21.3%) NHS trusts do not follow any national guidelines in protecting new and expectant mothers from occupational hazards in the orthopaedic theatre setting. Although an improvement has been made since 2018 in complying with national guidelines protecting new and expectant mothers from orthopaedic-related hazards, a sizeable proportion of NHS trusts do not comply with any national guidelines, putting employees at undue risk. There is a continued need for pregnant surgeons to be aware of and seek occupational health advice from dedicated professional bodies if the NHS trust does not provide specific guidance. Simultaneously, a sustained effort must be present to continue to inform NHS employers of their duty to protect new and expectant mothers and signpost them to relevant guidance. [ABSTRACT FROM AUTHOR]

The continuing bacterial contamination in hospitals operating units and theaters has an important role in the spread of hospital infections. The current study evaluated the level of bacterial contamination in the operating theatres at Al-Hussein Teaching Hospital in Al-Samawah, Iraq. For the purpose of sample collection from surgical equipment surfaces, the swab plate method conducted by nurses and laboratory workers was used to collect the samples in the operating theater. The samples were then transferred to the laboratory unit for diagnosis by standard methods. The present study found different rates among operating theatres. According to bacterial contamination rate, especially for the operating theatre in emergency wings with 334 contaminated isolates, the highest rates of contaminated bacterial isolates were Staphylococcus epidermidis (n=171; 26.1%), Bacillus species (spp.) (n=118; 18%), S. aureus (n=111; 16.9%), Klebsiella spp. (n=92; 14%), Enterobacter spp. (n=82; 12.5%), P.aurogenosa (n=24; 3.7%), and Escherichia coli (n=23; 3.7%). Despite the use of all methods of sterilization among the hospital wards, especially the surgical halls in the hospital wards, bacterial contamination is still widespread among these units. It was noted that the bacteria isolated in this study posed a risk as pathogenic bacteria.

The psychological impact (second victim effect) of in-theatre critical incidents is increasingly recognised. Different styles of psychological support programme have recently been published, including some utilising 'near in time' peer support. Most of these programmes either target their support to individuals, or focus on one vocational group rather than the multidisciplinary team. However, the in-theatre team consists of different craft groups who nonetheless function as a single team and are therefore 'peers'. This paper sets out the design and implementation of a critical incident peer response programme at Waikato Hospital, New Zealand, which provides peer-led group psychological first aid to full theatre teams. The programme is administered by trained representatives from multiple in-theatre craft groups including nurses, midwives, anaesthetic technicians, recovery room nurses, surgeons and anaesthetists. It emphasises team education and peer support, and has a wholly welfare focus. The programme has voluntary participation but mandatory activation triggers so that individuals do not need to seek support actively at a time when they may not recognise the need to do so. The programme is becoming embedded in the Waikato Hospital theatre culture so that participating in psychological support is normalised following a critical event. This framework is shared in the hope that it will assist other hospitals to develop welfare interventions to support full theatre teams. [ABSTRACT FROM AUTHOR]

Objective: The measurement of patient safety climate within hospitals, and specifically in operating rooms is a basic tool for the development of the patient's safety policy. There are no validated Spanish versions of instruments to measure safety climate. The objective of this research was to validate the Spanish version of the Hospital Survey on Patient Safety (HSOPS®), with the addition of a module for surgical units, to evaluate the patient safety climate in operating rooms. Methods: Survey validation study. The Hospital Survey on Patient Safety (HSOPS®) was applied to health workers from 6 acute general hospitals, from Medellín (Colombia), with surgical procedures greater than 300 per month, 18 items were added considered specific for Operating Rooms. For construct validation, an exploratory factor analysis (EFA) was used, utilizing principal components as the extraction method. Reliability was evaluated with Cronbach's α. Results: A 10 dimensions model was obtained with EFA, most of the dimensions of the original questionnaire were conserved, although the factorial structure was not reproduced. Two new dimensions emerged from the added items. The Cronbach's α ranged between 0.66 and 0.87. Conclusions: We found the HSOPS questionnaire is valid and reliable for measuring patient safety climate in Spanish speaking Latin American countries. Two additional dimensions are proposed for Operating Rooms. [ABSTRACT FROM AUTHOR]

Background: Surgical smoke or plume is produced by a variety of surgical coagulators and dissectors. A number of jurisdictions have recently introduced policies to reduce the associated occupational health risks including WorkSafe Victoria and New South Wales Health. Method: This paper is a narrative review of potential risks, including any associated with COVID‐19, and options for mitigation. Results: Surgical smoke or plume contains potentially toxic chemicals, some of which are carcinogens. Plume may also contain live virus, notably Human Papilloma and Hepatitis B, though any possible viral transmission is limited to a few case reports. Despite identifying COVID‐19 ribonucleic acid fragments in various body tissues and fluids there are no current reports of COVID‐19 transmission. Although plume is rapidly removed from the atmosphere in modern operating rooms, it is still inhaled by the operative team. Mitigation should include ensuring diathermy devices have evacuators while plume extraction should be standard for laparoscopic procedures. Consideration needs to be given to the potential to compromise the operating field of view, or the noise of the extractor impairing communication. There is an increasing range of suitable products on the market. The future includes pendant systems built into the operating room. Conclusion: The potential risks associated with surgical plume cannot be ignored. Health services should invest in plume extraction devices with a view to protecting their staff. The conduct of the operation should not be compromised by the devices chosen. Future operating theatres need to be designed to minimize exposure to plume. Surgical plume is a potential occupational health and safety issue for the operative team. It contains potentially hazardous chemicals and possibly may able to transmit viruses. Health services need to invest in smoke evacuation devices but these also require surgical team buy‐in to ensure smoke elimination measures are adopted in practice. [ABSTRACT FROM AUTHOR]

The continuing bacterial contamination in hospitals operating units and theaters has an important role in the spread of hospital infections. The current study evaluated the level of bacterial contamination in the operating theatres at Al-Hussein Teaching Hospital in Al-Samawah, Iraq. For the purpose of sample collection from surgical equipment surfaces, the swab plate method conducted by nurses and laboratory workers was used to collect the samples in the operating theater. The samples were then transferred to the laboratory unit for diagnosis by standard methods. The present study found different rates among operating theatres. According to bacterial contamination rate, especially for the operating theatre in emergency wings with 334 contaminated isolates, the highest rates of contaminated bacterial isolates were Staphylococcus epidermidis (n=171; 26.1%), Bacillus species (spp.) (n=118; 18%), S. aureus (n=111; 16.9%), Klebsiella spp. (n=92; 14%), Enterobacter spp. (n=82; 12.5%), P.aurogenosa (n=24; 3.7%), and Escherichia coli (n=23; 3.7%). Despite the use of all methods of sterilization among the hospital wards, especially the surgical halls in the hospital wards, bacterial contamination is still widespread among these units. It was noted that the bacteria isolated in this study posed a risk as pathogenic bacteria. [ABSTRACT FROM AUTHOR]

Summary: Infection prevention and control team members (IPCTM) are often intimidated by aspects of ventilation as they relate to healthcare, because they consider them technical and outside their area of comfort and expertise. However, engineers, estates departments and planners need IPCTM input to ensure appropriate design and use. The main areas of importance centre on the operating theatre, the provision of air-controlled ventilated isolation rooms, and how to respond to major outbreaks/pandemics. Concentrating on basic principles of infection prevention and control, developing relationships with key departments and individuals, and applying best practice to these and other areas as they arise, are of great value. Some background, information and suggestions are provided for IPCTM with a view to providing simple practical advice in these areas.

In this paper, we address the multiple operating room (OR) surgical case sequencing problem (SCSP). The objective is to maximise total OR utilisation during standard opening hours. This work uses a case study of a large Australian public hospital with long surgical waiting lists and high levels of non-elective demand. Due to the complexity of the SCSP and the size of the instances considered herein, heuristic techniques are required to solve the problem. We present constructive heuristics based on both a modified block scheduling policy and an open scheduling policy. A number of real-time reactive strategies are presented that can be used to maintain schedule feasibility in the case of disruptions. Results of computational experiments show that this approach maintains schedule feasibility in real-time, whilst increasing operating theatre (OT) utilisation and throughput, and reducing the waiting time of non-elective patients. The framework presented here is applicable to the real-life scheduling of OT departments, and we provide recommendations regarding implementation of the approach. [ABSTRACT FROM AUTHOR]

Abstract Background Environmental cleaning practice plays an important role in reducing microbial contamination in hospital surfaces and contributes to prevent Healthcare Associated Infections. Adenosine Triphosphate (ATP) bioluminescence assay is a commonly used method for assessing environmental cleanliness on healthcare surfaces. This study tested the feasibility of using ATP-bioluminescence assay for evaluating the efficiency of cleaning procedures in the operating theatre settings, comparing the ATP-bioluminescence test with the traditional culture method. Methods The surfaces of 10 operating rooms of two public hospitals (140 samples in total) were examined “at rest”, in two moments of the same daily session: before the first scheduled operation (Pre), and before the second, after a clean environment was re-established (Post). Surface contamination was assessed using the cultural method to detect Total Viable Counts (TVC36°C) and ATP-bioluminescence assay (RLU). Results The examined surfaces presented very low TVCs (geometric means: 1.8 CFU/plate; IC95%: 1.6–2.0), always compliant with the relative reference standards. No statistical correlation was found between ATP values and TVCs. However, considering the results in terms of general evaluation of hygienic quality of surfaces, the two methods were consistent in identifying the most contaminated areas (Hospital A > Hospital B; Pre > Post; most contaminated surfaces: scialytic lamp). Furthermore, the ATP mean values showed a progressive increase from surfaces with TVC = 0 to surfaces with TVC > 15 CFU/plate. Conclusions Although not an alternative to cultural methods, the ATP-bioluminescence-assay can be a useful tool to measure the efficiency of cleaning procedures also in environments with very low microbial counts. Each health facility should identify appropriate reference values, depending on the devices used and on the basis of the analysis of the data collected through spatial and temporal sampling series. By providing a rapid feedback, the ATP-assay helps to increase the awareness of operators and allows immediate action to be taken in critical situations.

Prone positioning is frequently used for spinal surgery and is associated with risks including perioperative visual loss and stroke. Frequent eye checks and careful neck positioning are recommended. In our hospital's current model, anesthesia providers are required to kneel on the operating room floor beneath operating room table, exposing themselves to hazards such as bodily fluids and back and knee strain. This maneuver is both time consuming and unpleasant. While new devices that enable easier visualization of patients in the prone position exist, they are costly and not universally compatible with all operating room tables. Our objective for this feasibility pilot study was to determine if simple, extendable mirrors increase anesthetist comfort during these cases. A nonrandomized survey-based feasibility pilot study was performed, evaluating comfort while performing eye checks with extendable lighted mirrors compared to the standard kneeling practice. A total of 41 nurse anesthetists and anesthesiology residents were analyzed. A mixed model logistic regression demonstrates a three-fold improvement in comfort with the prone position after mirror use (OR = 3.34; 95% CI: 1.06–10.48; p = 0.039). The frequency of eye checks did not change significantly with introduction of the mirror. Use of the extendable mirror improves anesthesia provider comfort with patients in the prone position. We postulate that it may be a useful addition to our practice. [ABSTRACT FROM AUTHOR]

Medical incidents in public hospitals in Hong Kong have persisted for years. The operating theatres are one of the places where medical accidents occur, especially affecting service quality. The surgical team is a substantial cause of medical incidents, possibly because of human mistakes, environmental, equipment, and system failures. Not all surgery departments will implement uniform working styles. The Hospital Authority may set a management plan to unify practice and to identity the problems faced. Therefore, the government and Hospital Authority should focus on human resources, especially in terms of professional training and retention of staff. After all, surgery is a task of teamwork. [ABSTRACT FROM AUTHOR]

Aim: The aim of the study was to explore the value of debriefing to enhance learning within operating theatres., Methods: A sequential mixed method study was undertaken at a local District General Hospital Trust in 2020. A total of 106 surveys were distributed to all multidisciplinary team members based in the trauma and orthopaedic theatres. Following the survey stage, 11 in-depth semi-structured qualitative interviews were undertaken with volunteers from the survey stage which included a range of health care professionals., Findings: Participants identified debriefing as a valuable tool for learning and reflection. However, significant barriers were identified, including lack of time and conflicting priorities. Some interviewees referred to the current debriefing process as a 'tick box' and a 'herding cats' exercise, attributing it to a lack of structure, leadership and organisational buy-in., Conclusions: Debriefing in the operating theatre is a valuable tool for individual and team learning. However, formalising the structure of the debriefing, along with joint team and organisational commitment, was deemed vital in optimising the value of debriefings in the future.

Disasters are increasing globally, requiring flexible strategic approaches from healthcare organisations to manage the resultant influx of patients requiring care while also maintaining normal operational services. Theatre practitioners play a key role in disaster response and recovery; however, a lack of appropriate skill utilisation may be reducing overall organisational adaptive capacity and leading to poorer outcomes for organisations, staff and patients. Understanding what skills individual practitioners have, and how they can be deployed to the greatest effect, is a concern for managers to ensure optimal use of resources and to reduce negative impacts of disaster response upon healthcare personnel. This is especially pertinent in the post-COVID healthcare climate where a paucity of operating theatre practitioners and poor workforce planning has led to a lack of surgical capacity at a time when it is most needed., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship and/or publication of this article.

Objective: Analytical techniques are being implemented with increasing frequency to improve the management of surgical departments and to ensure that decisions are well informed. Often these analytical techniques rely on the validity of underlying statistical assumptions, including those around choice of distribution when modelling uncertainty. The aim of the present study was to determine a set of suitable statistical distributions and provide recommendations to assist hospital planning staff, based on three full years of historical data. Methods: Statistical analysis was performed to determine the most appropriate distributions and models in a variety of surgical contexts. Data from 2013 to 2015 were collected from the surgical department at a large Australian public hospital. Results: A log-normal distribution approximation of the total duration of surgeries in an operating room is appropriate when considering probability of overtime. Surgical requests can be modelled as a Poisson process with rate dependent on urgency and day of the week. Individual cancellations could be modelled as Bernoulli trials, with the probability of patient-, staff- and resource-based cancellations provided herein. Conclusions: The analysis presented herein can be used to ensure that assumptions surrounding planning and scheduling in the surgical department are valid. Understanding the stochasticity in the surgical department may result in the implementation of more realistic decision models. What is known about the topic?: Many surgical departments rely on crude estimates and general intuition to predict surgical duration, surgical requests (both elective and non-elective) and cancellations. What does this paper add?: This paper describes how statistical analysis can be performed to validate common assumptions surrounding surgical uncertainty. The paper also provides a set of recommended distributions and associated parameters that can be used to model uncertainty in a large public hospital's surgical department. What are the implications for practitioners?: The insights on surgical uncertainty provided here will prove valuable for administrative staff who want to incorporate uncertainty in their surgical planning and scheduling decisions. [ABSTRACT FROM AUTHOR]

We discuss how Aspen Healthcare measurably reduced patient harm by engaging staff in ‘STEP-up’, a programme to improve the culture of patient safety. This focused on helping staff to understand their role in the reduction of preventable harm. The organisation admits 45,000 inpatients and has 300,000 outpatient contacts per year. We describe how we worked with all our 1500 staff, across nine sites, during a 12-month period. We used a short film and a four-level programme of training and development, which included elements specifically aimed at sustaining cultural changes. The results have been substantial: 95% reduction in never events, 77% reduction in serious incidents, 38% fewer falls with harm and 19% fewer falls overall. We have seen a 24% increase in incident reporting, on a background of an 11% increase in activity. Overall, the number of incidents with harm has fallen by 5%. Staff perception of our organisation as ‘extremely’ or ‘very’ safe has increased from 73% to 77%. The financial cost of this has been modest and has, we estimate, been recouped in reduced cost of serious incidents. We make the case that a programme such as this is possible, at minimal cost, in any healthcare organisation. Given the results, we argue that all healthcare leaders have a duty to implement something similar. [ABSTRACT FROM AUTHOR]