Impact of Surgical Smoke on the Surgical Team and Operating Room Nurses and its Reduction Strategies: A Systematic Review

Background: Surgical smoke is an integral part of surgical operations that the surgical team has been exposed to for so long. This study aimed to investigate the effects of smoke, on members of the surgical team. Methods: A systematic review was conducted focusing on the complexity of surgical smoke. PubMed, Scopus and web of science databases were searched until May 2020 without any time or language limitation. All documents were reviewed by title or abstract according to the search strategy. The screening process of articles was performed by two independent authors. The articles were selected according to the inclusion and exclusion criteria. Results: Overall, 37 studies in this systematic study were investigated. The effects of many surgical smokes were found in a nutshell including complications such as carcinogenic, toxicity, mutation, irritant, transmission of tumor cells, virus transmission, headaches, dizziness, sleepiness, headache, the bad odor in head hair, the tearing of the eye on the surgical team and staff. Conclusion: Surgical smoke, produced during surgical operations, is one of the risks and threats to which the surgical team and operating room staff are at risk then can affect the organs of different bodies from the body of all operating room staff and surgical team.

The relationship between ethical climate and moral distress from the perspective of operating room staff: A correlational study

Background The organizational climate in the operating room is special due to the specific conditions of the patient, and the ethical climate may affect moral distress of the operating room staff. Objective This study determined the relationship between ethical climate and moral distress from staff working in operating rooms of hospitals affiliated to Mashhad University of Medical Sciences. Method This analytical study was performed on 169 operating room staff in Mashhad, Iran. The operating room staff was selected using stratified random sampling. The data were collected via Olson's Hospital Ethical Climate Survey and the Corley Moral Distress Scale and analyzed with IBM Statistical Package for the Social Sciences (SPSS) software version 21. Results The results showed no relationship between the ethical climate, the frequency, and intensity of moral distress of the operating room staff ( p > 0.05). In addition, the mean score of the ethical climate was 3.32 ± 0.48, indicating the average ethical climate in the operating room. The mean frequency and intensity of moral distress were 36.36 ± 11.68 and 48.8 ± 15.92, showing a moderate rate. There was a significant inverse relationship between the dimensions of ethical climate, the relationship with physicians, and the intensity of moral distress ( p <0.05). A significant relationship was found between the intensity of moral distress, the level of education, and field of study ( p <0.05). Conclusion The results of the current study showed that interventional programs should be implemented to reduce moral distress and improve the ethical climate in the operating room.

Comparison of Radiation Exposure of AIRO Intraoperative CT with C-Arm Fluoroscopy during Posterior Lumbar Interbody Fusion

Navigation systems used during minimally invasive spine procedures have evolved from uniplanar, two-dimensional C-arm fluoroscopy to multiplanar, 3D intraoperative computed tomography (iCT). In this study, the radiation exposure to the patient and operating room staff in posterior intervertebral lumbar fusion procedures is compared between iCT and C-arm fluoroscopy. The effective dose of the surgeon, operating nurse, and anesthesiologist was measured during surgery with personal dosimeters, and the effective dose of the patient was measured with GafchromicTM films. The time efficiency of the procedure was evaluated by recording the duration of pedicle screw fixation and the duration of the total surgery time. A total of 75 patients participated in the study; 30 patients had surgery guided by iCT and 45 by C-arm fluoroscopy. The radiation dose of the surgeon, the operating nurse, and the anesthesiologist was thirteen fold lower with surgeries assisted by iCT compared to C-arm fluoroscopy. In contrast, the effective dose of the patient significantly increased with iCT. Using iCT, radiation exposure of the operating room staff can be significantly reduced. iCT increases the effective dose of the patient and prolongs the operative time.

A comparison of the ethical climate of operating rooms from the perspective of operating room nursing students and staff: An analytical study

Background The ethical climate is an essential component of organizational climate or culture. The ethical climate is necessary for clinical practice in operating rooms. Objective This study aimed to compare the ethical climate from the perspective of operating room nursing students and operating room staff of hospitals affiliated with Mashhad University of Medical Sciences, Iran. Method This analytical study was performed on 95 operating room nursing students and 169 operating room staff of hospitals in Mashhad, Iran. The students were selected through the census method and the staff were selected by using stratified random sampling. The data were collected via Olson’s Hospital Ethical Climate Survey and analyzed by using BMI SPSS version 21. Results The total mean scores of the ethical climate were 3.44 ± 0.45 and 3.32 ± 0.48 from students and staff’s perspectives, and the independent t-test showed no significant difference between them ( p < 0.05). In addition, from the students’ and staff’s points of view, the scores of communication with nurse managers were (3.95 ± 0.59), and (3.61 ± 0.91), the scores of communication with peers were (3.75 ± 0.43) and (3.48 ± 0.59), the scores of communication with patients and staff were (3.18 ± 0.6) (3.33 ± 0.62), respectively with no significant difference ( p > 0.05). Furthermore, the results of the study indicated a significant difference in communication with physicians’ score between operating room staff (2.82 ± 0.49) and students’ views (3.25 ± 0.6) ( p < 0.05). Conclusion Although it is difficult to create a right ethical climate in operating rooms, but hospital managers should implement practical programs to improve the ethical climate of operating rooms and inter-professional teamwork. Besides, deans of faculties can provide ethical-based education for students, who can effectively create an ethical climate.

Reduced radiation fluoroscopy technique for implantation of sacral neuromodulation

Introduction: Sacral neuromodulation (SNM) is a Food and Drug Administration–approved treatment option for urinary urgency and fecal incontinence. Fluoroscopic imaging is used at various steps during lead placement, which exposes the operating room staff and patient to the harmful effects of radiation. The aim of this study is to describe a reduced radiation technique during lead placement for treatment with SNM. Methods: A retrospective cohort of 51 consecutive patients who underwent lead insertion and SNM placement at a single academic institution were investigated. Reduced fluoroscopy (RF; n=11) involved C-arm settings to 1 pulse/second and an activated “low-dose” setting, while conventional fluoroscopy (CF; n=40) involved 30 pulses/second and a deactivated “low-dose” setting. The automatic brightness control and collimation were used optionally in both groups. Comparison of imaging quality, fluoroscopy settings, and radiation exposure during RF and CF was performed. Results: RF settings resulted in significant reduction of radiation compared to CF settings, including the fluoroscopy time (8.61 vs. 48.16 seconds; p<0.001), dose (2.66 vs. 26.25 mGy; p=0.001), and current (1.67 vs. 4.18 mAs; p<0.001). There was no significant difference in total operative time (59.18 vs. 61.33 minutes; p=0.77) and the rate of progression from stage 1 to stage 2 during follow-up (75% vs. 84%; p=0.55). Conclusions: Lead placement for treatment with SNM can be achieved using RF settings without compromising clinical outcomes. Applying the RF technique reduces overall radiation exposure to the patient and the operating room staff. Further validation of RF in a larger prospective cohort study is needed. Level of evidence: Level 4.