The Canadian Forces' (CF) deployable hospital, 1 Canadian Field Hospital, was deployed to Haiti after an earthquake that caused massive devastation. Two surgical teams performed 167 operations over a 39-day period starting 17 days after the index event. Most operations were unrelated to the earthquake. Replacing or supplementing the destroyed local surgical capacity for a brief period after a disaster can be a valuable contribution to relief efforts. For future humanitarian operations/disaster response missions, the CF will study the feasibility of accelerating the deployment of surgical capabilities.
The present study concerns the air quality and microbiological contamination in two newly built operating theatres; one with laminar air flow (LAF) equipment for cardio-thoracic operations, and one with conventional ventilation for urological operations. Both theatres had an identical number of air exchanges (17/h), identical microclimatic conditions and they employed the same cleaning procedures. In the LAF-ventilated operating theatre bacterial contamination of the air was effectively reduced to less than 10 colony-forming units (CFU)/m3 in all 125 samples (1 m3 per sample) tested. In most samples, 118/125, the bacterial count was less than 5 CFU/m3, despite the presence of ten persons. The conventionally ventilated theatre reached values up to 120 CFU/m3 during the most active period of the day when approximately seven persons were present. The LAF ventilation reduced both the content of particles in the air and contamination by bacteria on the floor. In both theatres cleaning procedures had only a low impact on CFU in the air and on the floor. The use of diathermia markedly increased the level of small particles in the air, and this may influence the air quality in the operating theatres.
"On Good Friday, March 27, 1964, the Alaska earthquake occurred which was probably the largest or equal to the largest earthquake that has ever been recorded," Dr. Karl Bowman writes. "Those of us living in Anchorage were quickly isolated, and, since the badly damaged part of the city was roped off and no one allowed inside of it, and since I was completely occupied with things at the Alaska Psychiatric Institute, I have very little firsthand information about some of the early days of the earthquake except in this one special site."
Delivery of obstetrical care in rural Alaska can be very challenging, due to remoteness, lack of medical resources and transportation difficulties. This descriptive study looks at what the current delivery systems for obstetrical care in Alaska are. Alaska's obstetrical delivery systems can be divided into three basic systems. 1) Full comprehensive obstetrical care limited only by lack of neonatal ICU capability. 2) Cesarean delivery capable, but with limited resources. 3) Low risk vaginal deliveries with no cesarean delivery capability except by transports approaching 6 hours. This study raises questions about which system is most effective for which communities. Further studies need to be undertaken to better understand how to provide effective obstetrical care in rural and bush Alaska at an acceptable risk, and at reasonable cost.
A comprehensive peer review programme for anaesthesia departments in Nova Scotia was implemented in 1987 by the anaesthesia community. Departments are reviewed by peers at the request of the Head, Department of Anaesthesia, and the President of the Medical Staff. A confidential report with recommendations is written. Twenty-six reviews have been completed (to June 1993) and have most often documented deficiencies in: design of the anaesthesia record, anaesthesia staff recruitment, inadequate documentation of policies for anaesthesia and post-anaesthesia care, peer review/quality assurance processes, organizational structure of hospital medical staffs and operating room committees, and use of anaesthesia equipment that does not meet current (at date of review) CSA standards. In the four hospitals that have been reviewed twice, 24 of the 30 deficiencies noted on the first review had been corrected before the second review which occurred three to five years later. Nine new deficiencies were noted. Departments are encouraged to request a review every four or five years.
Comment In: Can J Anaesth. 1994 Aug;41(8):661-67605416
Perioperative monitoring systems produce a large amount of uninterpreted data, use threshold alarms prone to artifacts, and rely on the clinician to continuously visually track changes in physiological data. To address these deficiencies, we developed an expert system that provides real-time clinical decisions for the identification of critical events. We evaluated the efficacy of the expert system for enhancing critical event detection in a simulated environment. We hypothesized that anesthesiologists would identify critical ventilatory events more rapidly and accurately with the expert system.
We used a high-fidelity human patient simulator to simulate an operating room environment. Participants managed 4 scenarios (anesthetic vapor overdose, tension pneumothorax, anaphylaxis, and endotracheal tube cuff leak) in random order. In 2 of their 4 scenarios, participants were randomly assigned to the expert system, which provided trend-based alerts and potential differential diagnoses. Time to detection and time to treatment were measured. Workload questionnaires and structured debriefings were completed after each scenario, and a usability questionnaire at the conclusion of the session. Data were analyzed using a mixed-effects linear regression model; Fisher exact test was used for workload scores.
Twenty anesthesiology trainees and 15 staff anesthesiologists with a combined median (range) of 36 (29-66) years of age and 6 (1-38) years of anesthesia experience participated. For the endotracheal tube cuff leak, the expert system caused mean reductions of 128 (99% confidence interval [CI], 54-202) seconds in time to detection and 140 (99% CI, 79-200) seconds in time to treatment. In the other 3 scenarios, a best-case decrease of 97 seconds (lower 99% CI) in time to diagnosis for anaphylaxis and a worst-case increase of 63 seconds (upper 99% CI) in time to treatment for anesthetic vapor overdose were found. Participants were highly satisfied with the expert system (median score, 2 on a scale of 1-7). Based on participant debriefings, we identified avoidance of task fixation, reassurance to initiate invasive treatment, and confirmation of a suspected diagnosis as 3 safety-critical areas.
When using the expert system, clinically important and statistically significant decreases in time to detection and time to treatment were observed for the endotracheal tube cuff Leak scenario. The observed differences in the other 3 scenarios were much smaller and not statistically significant. Further evaluation is required to confirm the clinical utility of real-time expert systems for anesthesia.
Current methods of treatment for retinopathy of prematurity, using laser photocoagulation, require surgeons to assume awkward standing positions, which can result in occupational injury. A new infant surgical table was designed for improving this surgical procedure. To quantify its benefits, an ergonomic comparison of the standard and modified procedures was carried out, using specialized checklists, Nordic Musculoskeletal Questionnaires, and analysis of videotaped procedures using an Ovako Working Posture Analysing System method. Analysis of the typical laser photocoagulation procedure revealed a high risk for cumulative trauma disorders. The majority of the risk factors were lowered considerably with use of the new table. Improvement was largely due to the new table allowing seated postures during surgery, relieving muscular stress on the back, shoulders and legs. This study demonstrates risk reduction through engineering design of new medical devices, and illustrates how combining different assessment approaches can help evaluate ergonomic impact of medical technologies.
To determine whether alcohol hand disinfection is an effective alternative to traditional agents for the pre-surgical scrub.
A prospective clinical trial of a 70% isopropanol pre-surgical hand disinfectant.
The operating room suites at two hospital sites in British Columbia.
Cases were selected to evaluate both short and longer procedures. The hand disinfectant was compared to agents in current use as surgical scrubs (4% chlorhexidine and 7.5% povidone-iodine). Surgical technique and glove use were not modified. Pre- and postoperative fingertip impression and "glove-juice" cultures were used to determine microbial burden, and hands were evaluated for skin integrity.
There was no statistical difference between the microbial hand counts following use of the alcohol-based product or the current agents, for cases less than 2 hours' duration. Comparison of longer surgical cases revealed significantly better pre- and postoperative culture results with the alcohol hand rinse, but analysis of matched pairs showed no significant difference in microbial counts. The alcohol hand rinse was equivalent to the operative scrub in terms of skin integrity and user acceptability.
An alcohol hand rinse was equivalently effective in reducing microbial hand counts as the traditional pre-surgical scrub, both immediately after hand disinfection and at the end of the surgical procedure.