scholarly journals Important but Impractical: Hand Hygiene Among Operating Room Anesthesia Providers

2020 ◽  
Vol 41 (S1) ◽  
pp. s285-s286
Author(s):  
Sadie Mae Moseley ◽  
Andrea Ankrum ◽  
Normidaris Jimenez ◽  
Alyssa Guthrie ◽  
Felicia Scaggs Huang ◽  
...  
Keyword(s):  
Hand Hygiene ◽  
Operating Room ◽  
Likert Scale ◽  
Nurse Anesthetists ◽  
Individual Interviews ◽  
Anesthesia Providers ◽  
Performance Barriers ◽  
High Adherence ◽  
Suboptimal Adherence ◽  
Inductive Thematic Analysis

Background: Use of the WHO 5 Moments of Hand Hygiene (HH) by operating room (OR) anesthesia personnel has been called by some logistically unfeasible, despite evidence that HH can reduce patients’ risk of pathogen acquisition. We developed and implemented a set of 7 moments based on WHO guidance (Fig 1) with high adherence. We conducted this study 6 months later to determine whether the improvement was sustained. In addition, we sought to understand practices, beliefs, barriers, and perceptions among anesthesia providers regarding HH. Methods: We measured HH adherence by direct observation using locally developed 7 moments tailored to the anesthesia workflow during June–August 2019. Adherence was defined as the percentage of observed HH performed when a moment occurred. We used the theory of planned behavior (TPB) as a framework to conduct 11 individual interviews (8 attending anesthesiologists and 3 certified nurse anesthetists) with a semistructured instrument that included Likert scale and open-ended questions. Interview transcripts were reviewed and a codebook of themes was created through inductive thematic analysis. Resultant themes and Likert scale averages were grouped by the 3 key TPB variables. Results: In total, 294 HH moments were observed for 50 anesthesia providers during 36 cases. The average HH adherence was 21.1% with the highest adherence moment being after patient contact (61.7%). Interview participants stated universally that HH was important for patient care, but acknowledged barriers to performance. Barriers cited included interruption in workflow, a lack of evidence, lack of clarity of HH standard, and limited availability of product. Conclusions: Adherence to the 7 moments of HH for anesthesia providers was not sustained after 6 months. Providers identified numerous barriers to HH, including a lack of knowledge of a standard, as reasons for suboptimal adherence. These data suggest future interventions could be designed to address gaps in knowledge and remove barriers to improve HH adherence among OR anesthesia providers.Funding: NoneDisclosures: None

Randomized Crossover Study Evaluating the Effect of a Hand Sanitizer Dispenser on the Frequency of Hand Hygiene among Anesthesiology Staff in the Operating Room

2014 ◽  
Vol 35 (6) ◽  
pp. 717-720 ◽  
Author(s):  
L. Silvia Munoz-Price ◽  
Zalak Patel ◽  
Shawn Banks ◽  
Kristopher Arheart ◽  
Scott Eber ◽  
...  
Keyword(s):  
Hand Hygiene ◽  
Crossover Study ◽  
Operating Room ◽  
Anesthesia Machine ◽  
Infect Control Hosp ◽  
Hand Sanitizer ◽  
Anesthesia Providers ◽  
Randomized Crossover Study

Forty anesthesia providers were evaluated with and without hand sanitizer dispensers present on the anesthesia machine. Having a dispenser increased the frequency of hand hygiene only from 0.5 to 0.8 events per hour (P = .01). Other concomitant interventions are needed to further increase hand hygiene frequency among anesthesia providers.Infect Control Hosp Epidemiol 2014;35(6):717–720

scholarly journals Out-of-hospital endotracheal intubation experience, confidence and confidence-associated factors among Northern Japanese emergency life-saving technicians: a population-based cross-sectional study

BMJ Open ◽  
2018 ◽  
Vol 8 (7) ◽  
pp. e021858
Author(s):  
Yuko Ono ◽  
Koichi Tanigawa ◽  
Takeyasu Kakamu ◽  
Kazuaki Shinohara ◽  
Ken Iseki
Keyword(s):  
Operating Room ◽  
Endotracheal Intubation ◽  
Associated Factors ◽  
Response Rate ◽  
Likert Scale ◽  
Population Based ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Cross Sectional ◽  
Life Saving

ObjectiveClinical procedural experience and confidence are both important when performing complex medical procedures. Since out-of-hospital endotracheal intubation (ETI) is a complex intervention, we sought to clarify clinical ETI experience among prehospital rescuers as well as their confidence in performing ETI and confidence-associated factors.DesignPopulation-based cross-sectional study conducted from January to September 2017.SettingNorthern Japan, including eight prefectures.ParticipantsEmergency life-saving technicians (ELSTs) authorised to perform ETI.Outcome measuresAnnual ETI exposure and confidence in performing ETI, according to a five-point Likert scale. To determine factors associated with ETI confidence, differences between confident ELSTs (those scoring 4 or 5 on the Likert scale) and non-confident ELSTs were evaluated.ResultsQuestionnaires were sent to 149 fire departments (FDs); 140 agreed to participate. Among the 2821 ELSTs working at responding FDs, 2620 returned the questionnaire (response rate, 92.9%); complete data sets were available for 2567 ELSTs (complete response rate, 91.0%). Of those 2567 respondents, 95.7% performed two or fewer ETI annually; 46.6% reported lack of confidence in performing ETI. Multivariable logistic regression analysis showed that years of clinical experience (adjusted OR (AOR) 1.09; 95% CI 1.05 to 1.13), annual ETI exposure (AOR 1.79; 95% CI 1.59 to 2.03) and the availability of ETI skill retention programmes including regular simulation training (AOR 1.31; 95% CI 1.02 to 1.68) and operating room training (AOR 1.44; 95% CI 1.14 to 1.83) were independently associated with confidence in performing ETI.ConclusionsETI is an uncommon event for most ELSTs, and nearly half of respondents did not have confidence in performing this procedure. Since confidence in ETI was independently associated with availability of regular simulation and operating room training, standardisation of ETI re-education that incorporates such methods may be useful for prehospital rescuers.

Reengineering Intravenous Drug and Fluid Administration Processes in the Operating Room

2002 ◽  
Vol 97 (1) ◽  
pp. 139-147 ◽  
Author(s):  
Deborah B. Fraind ◽  
Jason M. Slagle ◽  
Victor A. Tubbesing ◽  
Samuel A. Hughes ◽  
Matthew B. Weinger
Keyword(s):  
Operating Room ◽  
De Novo ◽  
Significant Proportion ◽  
Cost Of Care ◽  
Fluid Administration ◽  
Intravenous Drug ◽  
Anesthesia Care ◽  
Drug Preparation ◽  
Anesthesia Providers ◽  
Set Up

Background A reengineering approach to intravenous drug and fluid administration processes could improve anesthesia care. In this initial study, current intravenous administration tasks were examined to identify opportunities for improved design. Methods After institutional review board approval was obtained, an observer sat in the operating room and categorized, in real time, anesthesia providers' activities during 35 cases ( approximately 90 h) into 66 task categories focused on drug/fluid tasks. Both initial room set-up at the beginning of a typical workday and cardiac and noncardiac general anesthesia cases were studied. User errors and inefficiencies were noted. The time required to prepare de novo a syringe containing a mock emergency drug was measured using a standard protocol. Results Drug/fluid tasks consumed almost 50 and 75%, respectively, of the set-up time for noncardiac and cardiac cases. In 8 cardiac anesthetics, drug/fluid tasks comprised 27 +/- 6% (mean +/- SD) of all prebypass clinical activities. During 20 noncardiac cases, drug/fluid tasks comprised 20 +/- 8% of induction and 15 +/- 7% of maintenance. Drug preparation far outweighed drug administration tasks. Inefficient or error prone tasks were observed during drug/fluid preparation (e.g., supply acquisition, waste disposal, syringe labeling), administration (infusion device failure, leaking stopcock), and organization (workspace organization and navigation, untangling of intravenous lines). Anesthesia providers (n = 21) required 35 +/- 5 s to prepare a mock emergency drug. Conclusions Intravenous drug and fluid administration tasks account for a significant proportion of anesthesia care, especially in complex cases. Current processes are inefficient and may predispose to medical error. There appears to be substantial opportunity to improve quality and cost of care through the reengineering of anesthesia intravenous drug and fluid administration processes. General design requirements are proposed.

Development and Acquisition of Knowledge of Youth Parasport Coaches

2020 ◽  
Vol 37 (1) ◽  
pp. 72-89
Author(s):  
Pierre Lepage ◽  
Gordon A. Bloom ◽  
William R. Falcão
Keyword(s):  
Thematic Analysis ◽  
Social Factors ◽  
Physical Disability ◽  
Learning Experiences ◽  
Learning Opportunities ◽  
Future Generations ◽  
Trial And Error ◽  
Individual Interviews ◽  
Use Of Technology ◽  
Inductive Thematic Analysis

The purpose of this study was to understand the learning experiences and acquisition of knowledge of youth parasport coaches. Five able-bodied male participants (M = 39 years old), who coached youth with a physical disability for an average of 7.4 years, participated in individual interviews. An inductive thematic analysis identified patterns within and across the data, allowing for description and interpretation of the meaning and importance of the themes. The results showed that coaches learned mostly from informal experiences, particularly through mentoring, trial and error, or use of technology. In addition, these learning opportunities were influenced by personal, environmental, and social factors. These findings can help to guide current and future generations of coaches of youth participants with a physical disability by highlighting available resources and addressing several barriers and facilitators to their learning.

Anesthesia Outside of the Operating Room

2011 ◽  
Author(s):  
Richard Urman ◽  
Wendy Gross ◽  
Beverly Philip
Keyword(s):  
Quality Assurance ◽  
Patient Care ◽  
Operating Room ◽  
Patient Monitoring ◽  
Patient Care Team ◽  
Anesthetic Techniques ◽  
Anesthesia Care ◽  
Post Procedure ◽  
Anesthesia Providers ◽  
Physical Resources

This is a comprehensive, up-to-date resource that covers all aspects of anesthesia care in OOR settings, from financial considerations to anesthetic techniques to quality assurance. With increasing numbers of procedures such as cardiac catheterization and imaging taking place outside of the main OR, anesthesia providers as well as non-anesthesia members of the patient care team will find this resource critical to their understanding of the principles of anesthesia care in unique settings which may have limited physical resources. Topics include patient monitoring techniques, pre-procedure evaluation and post-procedure care, and procedural sedation performed by non-anesthesia providers.

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