scholarly journals Minimal Custom Pack Design and Wide-Awake Hand Surgery: Reducing Waste and Spending in the Orthopedic Operating Room

Hand ◽  
2017 ◽  
Vol 14 (2) ◽  
pp. 271-276 ◽  
Author(s):  
Cassandra L. Thiel ◽  
Rafaela Fiorin Carvalho ◽  
Lindsay Hess ◽  
Joelle Tighe ◽  
Vincent Laurence ◽  
...  
Keyword(s):  
Operating Room ◽  
Hand Surgery ◽  
Driving Factor ◽  
Waste Generation ◽  
Use Of Time ◽  
Environmental Footprints ◽  
The Us ◽  
Small Hand ◽  
Anxiety Levels ◽  
Wide Awake

Background: The US health care sector has substantial financial and environmental footprints. As literature continues to study the differences between wide-awake hand surgery (WAHS) and the more traditional hand surgery with sedation & local anesthesia, we sought to explore the opportunities to enhance the sustainability of WAHS through analysis of the respective costs and waste generation of the 2 techniques. Methods: We created a “minimal” custom pack of disposable surgical supplies expressly for small hand surgery procedures and then measured the waste from 178 small hand surgeries performed using either the “minimal pack” or the “standard pack,” depending on physician pack choice. Patients were also asked to complete a postoperative survey on their experience. Data were analyzed using 1- and 2-way ANOVAs, 2-sample t tests, and Fisher exact tests. Results: As expected, WAHS with the minimal pack produced 0.3 kg (13%) less waste and cost $125 (55%) less in supplies per case than sedation & local with the standard pack. Pack size was found to be the driving factor in waste generation. Patients who underwent WAHS reported slightly greater pain and anxiety levels during their surgery, but also reported greater satisfaction with their anesthetic choice, which could be tied to the enthusiasm of the physician performing WAHS. Conclusions: Surgical waste and spending can be reduced by minimizing the materials brought into the operating room in disposable packs. WAHS, as a nascent technique, may provide an opportunity to drive sustainability by paring back what is considered necessary in these packs. Moreover, despite some initial anxiety, many patients report greater satisfaction with WAHS. All told, our study suggests a potentially broader role for WAHS, with its concomitant emphases on patient satisfaction and the efficient use of time and resources.

In-office wide-awake hand surgery versus traditional surgery in the operating room

2019 ◽  
Vol 30 (5) ◽  
pp. 429-434 ◽  
Author(s):  
Justin Rabinowitz ◽  
Thomas Kelly ◽  
Ann Peterson ◽  
Eric Angermeier ◽  
Kyle Kokko
Keyword(s):  
Operating Room ◽  
Hand Surgery ◽  
Wide Awake

scholarly journals The production of valuable products and fuel from plastic waste in Africa

2021 ◽  
Vol 2 (1) ◽  
Author(s):  
M. Opoku Amankwa ◽  
E. Kweinor Tetteh ◽  
G. Thabang Mohale ◽  
G. Dagba ◽  
P. Opoku
Keyword(s):  
Environmental Protection Agency ◽  
Road Construction ◽  
Plastic Waste ◽  
Liquid Fuels ◽  
Environmental Costs ◽  
Waste Generation ◽  
Sustainable Environment ◽  
Trade Offs ◽  
The Us ◽  
Shipping Containers

AbstractGlobal plastic waste generation is about 300 million metric tons annually and poses crucial health and environmental problems. Africa is the second most polluted continent in the world, with over 500 shipping containers of waste being imported every month. The US Environmental Protection Agency (EPA) report suggests that about 75% of this plastic waste ends up in landfills. However, landfills management is associated with high environmental costs and loss of energy. In addition, landfill leachates end up in water bodies, are very detrimental to human health, and poison marine ecosystems. Therefore, it is imperative to explore eco-friendly techniques to transform plastic waste into valuable products in a sustainable environment. The trade-offs of using plastic waste for road construction and as a component in cementitious composites are discussed. The challenges and benefits of producing liquid fuels from plastic waste are also addressed. The recycling of plastic waste to liquid end-products was found to be a sustainable way of helping the environment with beneficial economic impact.

scholarly journals Development of a Low-Resource Operating Room and a Wide-Awake Orthopedic Surgery Program During the COVID-19 Pandemic

2021 ◽  
pp. 155335062110035
Author(s):  
Justin J. Turcotte ◽  
Jeffrey M. Gelfand ◽  
Christopher M. Jones ◽  
Rubie S. Jackson
Keyword(s):  
Operating Room ◽  
Orthopedic Surgery ◽  
Physical Space ◽  
Surgical Care ◽  
Low Resource ◽  
High Acuity ◽  
Institutional Experience ◽  
Provider Shortages ◽  
Resource Replacement ◽  
Wide Awake

Introduction. The COVID-19 pandemic resulted in significant medication, supply and equipment, and provider shortages, limiting the resources available for provision of surgical care. In response to mandates restricting surgery to high-acuity procedures during this period, our institution developed a multidisciplinary Low-Resource Operating Room (LROR) Taskforce in April 2020. This study describes our institutional experience developing an LROR to maintain access to urgent surgical procedures during the peak of the COVID-19 pandemic. Methods. A delineation of available resources and resource replacement strategies was conducted, and a final institution-wide plan for operationalizing the LROR was formed. Specialty-specific subgroups then convened to determine best practices and opportunities for LROR utilization. Orthopedic surgery performed in the LROR using wide-awake local anesthesia no tourniquet (WALANT) is presented as a use case. Results. Overall, 19 limited resources were identified, spanning across the domains of physical space, drugs, devices and equipment, and personnel. Based on the assessment, the decision to proceed with creation of an LROR was made. Sixteen urgent orthopedic surgeries were successfully performed using WALANT without conversion to general anesthesia. Conclusion. In response to the COVID-19 pandemic, a LROR was successfully designed and operationalized. The process for development of a LROR and recommended strategies for operating in a resource-constrained environment may serve as a model for other institutions and facilitate rapid implementation of this care model should the need arise in future pandemic or disaster situations.

scholarly journals Use of Personal Protective Equipment and Operating Room Behaviors in Four Surgical Subspecialties: Personal Protective Equipment and Behaviors in Surgery

1999 ◽  
Vol 20 (02) ◽  
pp. 110-114 ◽  
Author(s):  
Deniz Akduman ◽  
Lynn E. Kim ◽  
Rodney L. Parks ◽  
Paul B. L'Ecuyer ◽  
Sunita Mutha ◽  
...  
Keyword(s):  
Operating Room ◽  
Personal Protective Equipment ◽  
Healthcare Workers ◽  
Tertiary Care ◽  
Hand Surgery ◽  
Occupational Exposures ◽  
Protective Equipment ◽  
Care Hospital ◽  
Exposure Rate ◽  
Total Exposure

AbstractObjective:To evaluate Universal Precautions (UP) compliance in the operating room (OR).Design:Prospective observational cohort. Trained observers recorded information about (1) personal protective equipment used by OR staff; (2) eyewear, glove, or gown breaks; (3) the nature of sharps transfers; (4) risk-taking behaviors of the OR staff; and (5) needlestick injuries and other blood and body-fluid exposures.Setting:Barnes-Jewish Hospital, a 1,000-bed, tertiary-care hospital affiliated with Washington University School of Medicine, St Louis, Missouri.Participants:OR personnel in four surgical specialties (gynecologic, orthopedic, cardiothoracic, and general). Procedures eligible for the study were selected randomly. Hand surgery and procedures requiring no or a very small incision (eg, arthroscopy, laparoscopy) were excluded.Results:A total of 597 healthcare workers' procedures were observed in 76 surgical cases (200 hours). Of the 597 healthcare workers, 32% wore regular glasses, and 24% used no eye protection. Scrub nurses and medical students were more likely than other healthcare workers to wear goggles. Only 28% of healthcare workers double gloved, with orthopedic surgery personnel being the most compliant. Sharps passages were not announced in 91% of the surgical procedures. In 65 cases (86%), sharps were adjusted manually. Three percutaneous and 14 cutaneous exposures occurred, for a total exposure rate of 22%.Conclusion:OR personnel had poor compliance with UP. Although there was significant variation in use of personal protective equipment between groups, the total exposure rate was high (22%), indicating the need for further training and reinforcement of UP to reduce occupational exposures.

Mycobacterium chimaera infections among cardiothoracic surgery patients associated with heater-cooler devices—Kansas and California, 2019

2021 ◽  
pp. 1-6
Author(s):  
Kerui Xu ◽  
Lauren E. Finn ◽  
Robert L. Geist ◽  
Christopher Prestel ◽  
Heather Moulton-Meissner ◽  
...  
Keyword(s):  
Operating Room ◽  
Environmental Samples ◽  
Chart Review ◽  
Whole Genome ◽  
Environmental Isolates ◽  
Outbreak Strain ◽  
Medical Chart Review ◽  
The Us ◽  
Control And Prevention ◽  
Cleaning And Disinfection

Abstract Background: In 2015, an international outbreak of Mycobacterium chimaera infections among patients undergoing cardiothoracic surgeries was associated with exposure to contaminated LivaNova 3T heater-cooler devices (HCDs). From June 2017 to October 2020, the Centers for Disease Control and Prevention was notified of 18 patients with M. chimaera infections who had undergone cardiothoracic surgeries at 2 hospitals in Kansas (14 patients) and California (4 patients); 17 had exposure to 3T HCDs. Whole-genome sequencing of the clinical and environmental isolates matched the global outbreak strain identified in 2015. Methods: Investigations were conducted at each hospital to determine the cause of ongoing infections. Investigative methods included query of microbiologic records to identify additional cases, medical chart review, observations of operating room setup, HCD use and maintenance practices, and collection of HCD and environmental samples. Results: Onsite observations identified deviations in the positioning and maintenance of the 3T HCDs from the US Food and Drug Administration (FDA) recommendations and the manufacturer’s updated cleaning and disinfection protocols. Additionally, most 3T HCDs had not undergone the recommended vacuum and sealing upgrades by the manufacturer to decrease the dispersal of M. chimaera–containing aerosols into the operating room, despite hospital requests to the manufacturer. Conclusions: These findings highlight the need for continued awareness of the risk of M. chimaera infections associated with 3T HCDs, even if the devices are newly manufactured. Hospitals should maintain vigilance in adhering to FDA recommendations and the manufacturer’s protocols and in identifying patients with potential M. chimaera infections with exposure to these devices.

A National Survey of Hand Surgeons: Understanding the Rural Landscape

Hand ◽  
2021 ◽  
pp. 155894472110588
Author(s):  
Joseph Meyerson ◽  
Andrew Liechty ◽  
Tyler Shields ◽  
David Netscher
Keyword(s):  
Employment Status ◽  
Community Hospital ◽  
Hand Surgery ◽  
Rural Landscape ◽  
Metropolitan Region ◽  
The Us ◽  
Case Type ◽  
American Society ◽  
Multispecialty Group ◽  
Shed Light

Background: Twenty percent of the US population is described as being rural and may have limited access to hand surgeons, especially on an emergency basis. Little is known about case type, call hours, employment status, and other relevant details of rural hand surgery. Methods: We surveyed members of the American Society of Surgery for the Hand to begin to describe the problem. Results: There were 471 responses from 2256 members surveyed with 387 completing 100% of questions asked. Ninety (19%) identified themselves as primarily located in a rural population and 381 (81%) in a metropolitan region. In our study, rural hand surgeons were more likely to be employed by a community hospital, followed by independent private practice, multispecialty group, academics, and then locum tenens. Rural surgeons’ practices were 80% solely hand surgery, while metropolitan surgeons’ practices were 89% ( P < .01). Metropolitan surgeons felt that of the transfers from rural facilities, 46% did not need emergency hand care and that 60% of the time, there was not actually a need for specialty hand surgery care. Conclusions: Our survey begins to shed light on the details of rural hand surgery practice. We found that rural surgeons are more likely to be employed in community hospitals and take more call. When available, hand surgery specialists could prevent unnecessary transfer of patients to metropolitan areas. More work needs to be done to describe the differences between rural and metropolitan hand surgery practices as well as create rural hand surgeons.

Global Advances in Wide Awake Hand Surgery

Hand Clinics ◽  
2019 ◽  
Vol 35 (1) ◽  
pp. i
Author(s):  
Donald H. Lalonde ◽  
Jin Bo Tang
Keyword(s):  
Hand Surgery ◽  
Wide Awake

Wide Awake Hand Surgery Under Local Anesthesia No Tourniquet in South America

Hand Clinics ◽  
2019 ◽  
Vol 35 (1) ◽  
pp. 51-58 ◽  
Author(s):  
Pedro José Pires Neto ◽  
Samuel Ribak ◽  
Trajano Sardenberg
Keyword(s):  
South America ◽  
Local Anesthesia ◽  
Hand Surgery ◽  
Wide Awake ◽  
No Tourniquet

scholarly journals Wide-Awake Hand Surgery

2018 ◽  
Vol 23 (1) ◽  
pp. 1
Author(s):  
Sang-Woo Kang ◽  
Young-Woo Kim ◽  
Ji-Kang Park
Keyword(s):  
Hand Surgery ◽  
Wide Awake
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