scholarly journals Impact on the Service Volume of a Single Hand Surgery Center during the COVID-19 Pandemic Period in Daegu

2021 ◽  
Author(s):  
Sang Ho Oh ◽  
Young Woo Kim ◽  
Sang Hyun Woo
Keyword(s):  
Emergency Room ◽  
Hand Surgery ◽  
Significant Negative Correlation ◽  
Protective Equipment ◽  
Hand Trauma ◽  
Early Recovery ◽  
Peak Period ◽  
Wrist Fractures ◽  
Protective Strategy ◽  
Surgery Center

Purpose: We investigated what changes occurred at single hand surgery center during the coronavirus disease 2019 (COVID-19) pandemic in Daegu, Korea using patient data of 4 years (2018–2021).Methods: This is a single-center retrospective study of patients visiting our center during the COVID-19 pandemic for 4 years (January 22 to May 6). Service volumes (SVs) including the number of in/outpatient, emergency room, elective, and emergency surgery were analyzed. During the peak period of the COVID-19 (February 24 to March 9, 2020), patient’s demographics, injury mechanism, and place of injury of hand trauma were analyzed.Results: SVs were significantly reduced in 2020 as compared with other years. The SVs except for the number of emergency surgeries have recovered after 2 months from the first confirmed case of COVID-19 in Daegu, Korea. At the peak period, the effect of COVID-19 was weak on emergency room-related SVs. In addition, a daily number of in/outpatients and elective surgeries had a statistically significant negative correlation with the number of COVID-19 confirmed (p<0.05). During the peak period, superficial laceration increased and finger and wrist fractures decreased. The number of cases occurring in workplace increased, however, occurring outside during daily life decreased.Conclusion: COVID-19 pandemic greatly reduces service volume in our center. Thorough protective strategy from COVID-19 such as personal protective equipment was essential for early recovery of hospital functions during the pandemic. In addition, manpower for the emergency room must be preserved during the pandemic. The results of our study, which reported SVs through the pandemic will help maintain the function of hand surgery centers.

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.

scholarly journals Profile of Hand Surgery Cases at Kirtipur Hospital

2018 ◽  
Vol 14 (2) ◽  
pp. 41-43
Author(s):  
Bikash Karki ◽  
Kiran Nakarmi ◽  
Mangal Gharti Magar ◽  
Krishna Nagarkoti ◽  
Shankar Man Rai
Keyword(s):  
Birth Defects ◽  
Reconstructive Surgery ◽  
Hand Surgery ◽  
Health Concern ◽  
Age Group ◽  
Hand Trauma ◽  
Public Health Concern ◽  
Cross Sectional ◽  
Common Cause ◽  
Male Preponderance

Background: There can be multiple hand problems with which patients can present. Such hand problems can be because of any kind of trauma, birth defects, tumours, infection or other conditions. Hand surgery is a special field of plastic surgery, which deals with these hand problems. The Department of Burns, Plastic & Reconstructive Surgery of Kirtipur Hospital run by Public Health Concern Trust-Nepal has been providing hand surgery service to the patients with these hand problems.Aim of Study: To analyse the various types of surgical hand problems in patients attending Kirtipur Hospital.Material and Methods: It is a cross sectional retrospective  observational study of the patients with different hand problems done at the Department of Burns, Plastic & Reconstructive surgery of Kirtipur Hospital from January to December 2016.Results: There were 124 patients who presented with various hand problems. There was male preponderance and the most common age group affected was between 15-60 years. Hand trauma was the most common cause of hand problems followed by post burn contractures.Conclusion: Hand is a complicated organ which can give rise to various problems. Hand surgery is an essential component of reconstructive surgery to deal with these problems. JNGMC,  Vol. 14 No. 2 December 2016, Page: 41-43

scholarly journals Global trends of hand and wrist trauma: a systematic analysis of fracture and digit amputation using the Global Burden of Disease 2017 Study

2020 ◽  
Vol 26 (Supp 1) ◽  
pp. i115-i124 ◽  
Author(s):  
Christopher Stephen Crowe ◽  
Benjamin Ballard Massenburg ◽  
Shane Douglas Morrison ◽  
James Chang ◽  
Jeffrey Barton Friedrich ◽  
...  
Keyword(s):  
Global Burden ◽  
Hand Trauma ◽  
Uncertainty Interval ◽  
Global Pattern ◽  
Systematic Analysis ◽  
Fatal Injury ◽  
Global Trends ◽  
Wrist Fractures ◽  
Wrist Trauma ◽  
Global Burden Of Diseases

BackgroundAs global rates of mortality decrease, rates of non-fatal injury have increased, particularly in low Socio-demographic Index (SDI) nations. We hypothesised this global pattern of non-fatal injury would be demonstrated in regard to bony hand and wrist trauma over the 27-year study period.MethodsThe Global Burden of Diseases, Injuries, and Risk Factors Study 2017 was used to estimate prevalence, age-standardised incidence and years lived with disability for hand trauma in 195 countries from 1990 to 2017. Individual injuries included hand and wrist fractures, thumb amputations and non-thumb digit amputations.ResultsThe global incidence of hand trauma has only modestly decreased since 1990. In 2017, the age-standardised incidence of hand and wrist fractures was 179 per 100 000 (95% uncertainty interval (UI) 146 to 217), whereas the less common injuries of thumb and non-thumb digit amputation were 24 (95% UI 17 to 34) and 56 (95% UI 43 to 74) per 100 000, respectively. Rates of injury vary greatly by region, and improvements have not been equally distributed. The highest burden of hand trauma is currently reported in high SDI countries. However, low-middle and middle SDI countries have increasing rates of hand trauma by as much at 25%.ConclusionsCertain regions are noted to have high rates of hand trauma over the study period. Low-middle and middle SDI countries, however, have demonstrated increasing rates of fracture and amputation over the last 27 years. This trend is concerning as access to quality and subspecialised surgical hand care is often limiting in these resource-limited regions.

Safety and Efficacy of DEET and Permethrin in the Prevention of Arthropod Attack

1998 ◽  
Vol 163 (5) ◽  
pp. 324-330 ◽  
Author(s):  
G. David Young ◽  
Sandra Evans
Keyword(s):  
Occupational Health ◽  
Infectious Diseases ◽  
Personal Protective Equipment ◽  
Synthetic Pyrethroid ◽  
Protective Equipment ◽  
Insect Repellent ◽  
First Line ◽  
Protective Measures ◽  
Safety And Efficacy ◽  
Protective Strategy

Abstract Many preventable diseases affecting troop strength are directly attributed to disease-carrying insects. The first line of defense against arthropod vectors is the use of personal protective measures. The concurrent application of DEET (N,N-diethyl-m-toluamide) repellent on the skin and permethrin [(3-phenoxy-phenyl)methyl(±)cis,trans-3-(2,2-dichloroethenyl)-2,2-dimethylcyclopropane-carboxylate] insecticide on the battle dress uniform, while the uniform is worn properly, is a personal protective strategy officially known as the DOD Insect Repellent System. It is important for troop commanders and field leaders to enforce the use of personal protective measures to prevent insect-borne infectious diseases and to ensure troop and soldier readiness. DEET is a safe and effective repellent. Permethrin is a synthetic pyrethroid insecticide and repellent. Used in conjunction with proper clothing and other personal protective equipment, these repellents provide the best known protection available and are critical in minimizing the occupational health threat of arthropod-borne diseases to troops in the field.

SOCIAL DEPRIVATION AND HAND INJURY

2007 ◽  
Vol 32 (3) ◽  
pp. 256-261 ◽  
Author(s):  
T. C. HORTON
Keyword(s):  
Census Data ◽  
Social Deprivation ◽  
Hand Surgery ◽  
Socioeconomic Deprivation ◽  
Hand Trauma ◽  
Process Of Care ◽  
Older Children ◽  
Unit Costs ◽  
Using Data ◽  
Patterns Of Injury

This study investigated the relationship between socioeconomic deprivation and the incidence, patterns of injury, process of care and outcome of hand trauma using data collected prospectively on 1,234 injuries presented during six months. The Index of Multiple Deprivation 2004 was derived from census data and postcodes. Socioeconomic deprivation is significantly associated with hand trauma. The odds ratio for suffering hand injuries in the most deprived quintile is 1.6 (SE 0.09 95% CI 1.45, 1.83) compared to the least deprived quintile. This is most marked among older children and adults. Fractures, sprains and ligament injuries showed the strongest association with the degree of deprivation. Injuries related to sport were not associated with deprivation. Surgical time utilised is greater in more deprived patients and their self reported physical outcome is worse. Hand surgery units working in areas of high socioeconomic deprivation will have higher trauma workloads and unit costs. Social deprivation may also influence physical outcomes.

scholarly journals Carpometacarpal Joint Dislocations: Management and Long-Term Outcomes at a Specialized Hand Surgery Center in Latin America

2020 ◽  
Vol 28 (4) ◽  
pp. 210-214
Author(s):  
Jose E. Telich-Tarriba ◽  
Osvaldo I. Guevara-Valmaña ◽  
David F. Navarro-Barquín ◽  
Andre Victor-Baldin
Keyword(s):  
Closed Reduction ◽  
Hand Surgery ◽  
High Energy ◽  
Dash Score ◽  
X Rays ◽  
Percutaneous Pinning ◽  
Carpometacarpal Joint ◽  
Joint Dislocations ◽  
Surgery Center

Carpometacarpal joint dislocations are uncommon hand injuries. These dislocations are usually misdiagnosed due to their non-specific clinical signs and tend to be difficult to identify in simple X-rays. We report our experience in the management of carpometacarpal bone dislocations at a specialized hand surgery center. Patients with carpometacarpal dislocations seen at the emergency department between 2013 and 2017 were included. All patients were treated with either closed reduction and percutaneous pinning (CRPP) or open reduction and internal fixation (ORIF). Postoperative functional assessment was performed at 6 and 18 months using the Disabilities of the Arm, Shoulder, and Hand (DASH) score. Eleven patients were included, 8 (72%) were managed with CRPP and the rest required ORIF (28%). For the functional outcome, we found an average DASH score of 27.9 at the 6 months threshold and of 1.5 at the 18 months threshold. Carpometacarpal dislocations are uncommon and easy to misdiagnose; the hand surgeon should have a high clinical suspicion in patients who sustained high-energy trauma, and imaging studies should be thoroughly evaluated. Closed reduction and percutaneous pinning is a safe and effective treatment option, with long-term good functional results.

scholarly journals Lessons From Other Disciplines About Communication, Human Performance and Situational Awareness While Wearing Personal Protective Equipment

2020 ◽  
Vol 6 ◽  
pp. 237796082096376
Author(s):  
Margaret Scott ◽  
John Unsworth
Keyword(s):  
High Risk ◽  
Personal Protective Equipment ◽  
Human Performance ◽  
Situational Awareness ◽  
Fire Service ◽  
Team Work ◽  
Protective Equipment ◽  
Peak Period ◽  
New Ways Of Working ◽  
Multi Phase

Introduction The spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2/COVID-19) has quickly accelerated into a pandemic. As COVID-19 has swept across the globe, health systems have adapted, including the cessation of routine surgery and the re-deployment of staff to critical care settings. Prompt interventions such as endotracheal (ET) intubation, are deemed essential in patients with Acute Respiratory Distress Syndrome. Intubation requires a coordinated approach and effective teamwork, as it is a high-risk procedure not least because it is an aerosol-generating intervention with increased infection risk. As a result, teams responsible for performing ET intubation are required to wear Personal Protective Equipment (PPE), which in turn hinders communication and situational awareness, and can hamper team work. Method This review considers the effects of wearing PPE on performance and situational awareness in a healthcare environment. Drawing on literature from the fire service and military, the review will explore approaches to improving communication and situational awareness for teams who, at times, are unfamiliar with one another. The review will consider human factors and, identify approaches that assist teams, including teams that are unfamiliar with one another, to adapt to new ways of working while performing high-risk procedures. Conclusion Literature indicates that standardisation, pre-brief and training are important elements of developing improved situational awareness and team working in individuals whose senses may be affected by PPE. In addition, checklists provide a useful way of standardising procedures and can form the basis of a structured pre-brief. Checklists exist for both intubation and patient proning, which, alongside simulation-based team training, provide a useful method of preparing an often unfamiliar workforce for their roles during an epidemic or pandemic. The multi-phase nature of most pandemics provides an opportunity to review processes and implement such procedures, and to develop staff using team-based training during the post-peak period.

474 Increasing the Availability of Operation Notes at Hand Surgery Follow-Up Through the Use of Electronic Operation Notes

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
P Macneal ◽  
S Brar ◽  
S Dassanayake ◽  
K Jones ◽  
A Ghareib ◽  
...  
Keyword(s):  
Clinical Audit ◽  
Hand Surgery ◽  
Adult Patients ◽  
Hand Trauma ◽  
Prospective Audit ◽  
Operative Care ◽  
Before And After ◽  
Operation Note ◽  
Paper Format

Abstract Introduction The availability of operation notes is crucial to provide high-quality post-operative care. This clinical audit evaluates the availability of operation notes at post-operative follow-up, in a Tertiary Hand Unit, before and after implementation of electronic operation notes. Method This was a prospective audit analysing the availability of operation notes at the first post-operative hand surgery appointment. The initial data collection was over a 6-week period (July – August 2019). Following this, a standardised electronic operation note template was created in line with BSSH Hand Trauma Guidelines and RCS Good Surgical Practice. Six months later, a re-audit was conducted over a 4-week period (March 2020). Results The initial audit included 104 adult patients, with operation notes available for 64% (n = 67) of patients, and 94% (n = 63) of those were in paper format. Following implementation of electronic operation notes, the re-audit included 53 adult patients. For these patients, 96% (n = 51) of their operation notes were available, and 96% (n = 49) of the operation notes were electronic. Conclusions These findings demonstrate that electronic operation notes greatly increased the availability of operation notes at follow-up This innovation has significant implications for upholding well-coordinated continuity of care for patients undergoing surgery.

Addressing Surgical Instrument Oversupply: A Focused Literature Review and Case-Study in Orthopedic Hand Surgery

Hand ◽  
2021 ◽  
pp. 155894472110172
Author(s):  
Joshua K. Helmkamp ◽  
Elliot Le ◽  
Ian Hill ◽  
Rachel Hein ◽  
Suhail Mithani ◽  
...  
Keyword(s):  
Cost Analysis ◽  
Ambulatory Surgery ◽  
Cost Savings ◽  
Hand Surgery ◽  
Optimization Methods ◽  
Surgical Instrument ◽  
Potential Cost ◽  
Ambulatory Surgery Center ◽  
Instrument Tracking ◽  
Surgery Center

Background Instrument oversupply drives cost in the operating room (OR). We review previously reported methodologies for surgical instrument reduction and report a pilot methodology for optimizing instrument supply via ethnographic instrument tracking of thumb carpometacarpal (CMC) arthroplasties. Additionally, we report a cost analysis of instrument oversupply and potential savings of tray optimization methods. Methods Instrument utilization was tracked over 8 CMC arthroplasties conducted by 2 surgeons at an ambulatory surgery center of a large academic hospital. An optimized supply methodology was designed. A cost analysis was conducted using health-system-specific data and previously published research. Results After tracking instrument use in 8 CMC arthroplasties, a cumulative total of 59 out of the 120 instruments in the Hand & Foot (H&F) tray were used in at least 1 case. Two instruments were used in all cases, and another 20 instruments were used in at least 50% of the cases. Using a reduced tray with 59 instruments, potential cost savings for tray reduction in 60 cases were estimated to be $2086 without peel-packing and $2356 with peel-packing. The estimated cost savings were lower than those reported in literature due to a reduced scope and exclusion of OR time cost in the analysis. Conclusions Instrument oversupply drives cost at our institution’s ambulatory surgery center. Ethnography is a cost-effective method to track instrument utilization and determine optimal tray composition for small services but is not scalable to large health systems. The time and cost required to observe sufficient surgeries to enable supply reduction to motivate the need for more efficient methods to determine instrument utility.

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