Changing operating room practices: the effect on postoperative endophthalmitis rates following cataract surgery

PurposeTo determine whether four new operating room (OR) protocols instituted because of COVID-19 reduced the cataract surgical postoperative endophthalmitis rate (POE).DesignRetrospective, sequential, clinical registry study.Methods85 552 sequential patients undergoing cataract surgery at the Aravind Eye Hospitals between 1 January 2020 and 25 March 2020 (56 551 in group 1) and 3 May 2020 and 31 August 2020 (29 011 in group 2). In group 1, patients were not gowned, surgical gloves were disinfected but not changed between cases, OR floors were not cleaned between every case, and multiple patients underwent preparation and surgery in the same OR. In group 2, each patient was gowned, surgical gloves were changed between each case, OR floors and counters were cleaned between patients, and only one patient at a time underwent preparation and surgery in the OR.ResultsGroup 1 was older, had slightly more females, and better preoperative vision. More eyes in group 2 underwent phacoemulsification (p=0.18). Three eyes (0.005%) in group 1 and 2 eyes (0.006%) in group 2 developed POE (p=0.77). Only one eye that underwent phacoemulsification developed POE; this was in group 1. There was no difference in posterior capsule rupture rate between the two groups.ConclusionsAdopting a set of four temporary OR protocols that are often mandatory in the Western world did not reduce the POE rate. Along with previously published studies, these results challenge the necessity of these common practices which may be needlessly costly and wasteful, arguing for the reevaluation of empiric and potentially unnecessary guidelines that govern ophthalmic surgeries.

Optimised Reduction of Surgical Gloves Pinholes using Forward Search Method

This research investigates the factors that affect the existence of pinholes in surgical gloves during the manufacturing process. Since eight factors affect the existence of pinholes in surgical gloves, a two-level fractional factorial design 28-4 was used to study the main effects and the first-order interactions of the multiple variables. Multiple linear regressions are used to model the data. This paper also examines the presence of influential points in the data using the influential measures in linear regression such as Cook’s Distance, DFFITS, DFBETAS, Studentized Residual, Standardized Residual, Hadi's measure, and the robust forward search. The impact of influential points is further assessed through deletion of potential influential points and model selection using adjusted R2, information criterion, and stepwise selection to see whether these influential points significantly improved the existing model.

Comparison of the Colonies Number of the Germs Formed Post Operation between the Utilization of Single, Double, and Orthopedic Gloves in Closed Fracture Operations More Than 2 Hours

Post-operative infection is still one of the most common nosocomial diseases that can cause great losses because it will increase the length of stay, use of drugs, and reduce the quality of life of the patients. The risk will increase if the number of colonies is> 105 bacteria per gram of tissue. Various ways have been done to reduce the number of bacteria in the operation area, including the use of surgical gloves. This study analyzed the comparison of the level of bacterial colonies that grew on the surface of single, double, and orthopedic surgical gloves in closed fracture management for more than 2 hours at Hasan Sadikin Hospital. The statistical analysis was done with p-value = 0.011 (<0.05), which means a significant difference in the number of germ colonies that grow between single, double, and orthopedic gloves. Double gloves and orthopedic gloves have a better ability to reduce bacterial colony growth. Meanwhile, there was no significant difference in the number of bacterial colonies formed between double gloves and orthopedics. Perforation is a factor affecting the number of germ colonies that formed. The use of double gloves and orthopedic gloves in closed fracture surgery for more than 2 hours shows the number of bacterial colonies formed is less than single gloves. There was a significant difference in the rate of perforation between standard surgical gloves and orthopedic gloves. Keywords: Bacteria colony, Single glove, Double glove, Orthopaedic glove, Perforation

Using the MEAT VBP Framework to analyse and understand the value of surgical gloves: an explanatory case study

Background Value-based healthcare is being extensively piloted, scaled and implemented by healthcare providers and systems around the world. However, the ability of the healthcare supply chain function to strategically contribute to the improvement of value has been held back by a lack of practical tools for turning value-based procurement from concept into action. Two recently developed conceptual models – the American CQO Movement and the European MEAT VBP Framework – have been developed to support the implementation of value-based procurement in healthcare. We demonstrate how the latter of these models can be adapted and applied pragmatically to generate insights into the value of a specific medical device, technology or consumable. Methods We undertook an explanatory, qualitative, single-case study focused on a specific consumable – surgical gloves – that provide a critical example of a type of medical device usually procured in high volumes but at risk of commoditisation due to a widespread lack of understanding of their value. Since the global Covid-19 pandemic prevented fieldwork, structured interviews were conducted via Zoom and corroborated by a literature review. Results We identified ten cost criteria and eight outcome criteria with which the value of surgical gloves can be analysed and understood. For each of these criteria we propose definitions and value impact metrics that decision-makers can use during a procurement exercise to describe, quantify and compare glove value. Conclusion The MEAT VBP Framework provides a highly practical and adaptable means of imposing both structure and rigour on a value analysis process and of qualitatively describing the potential value impact of surgical gloves for patients, professionals, providers and health systems.

Surgical glove perforation during oral and maxillofacial surgical procedures: An experimental study

Propouse: surgical teams sometimes neglect surgical glove perforation. The aim of this study was to determine the prevalence of sterile glove perforation in maxillofacial surgical procedures. Methods: Two studies were performed. The first one evaluated 200 pairs of surgical gloves (50 in each group) used by first, second, and third-year residents (R1,R2,R3). In the second study, 150 pairs of surgical gloves were evaluated: 100 pairs were used by a third-year resident, including 50 pairs in oral surgery procedures and 50 pairs in trauma surgeries, and 50 pairs of unused gloves were tested as control. The gloves were examined for perforations by filling them with water and testing for leaks. Results: In the first study, 29 pairs (19.3%) were perforated. Of the 50 pairs of control gloves, 7 pairs (14%) showed perforations on either side. The thumb and index finger and the right-hand (dominant hand) gloves, were the most frequently perforated sites. In the second study, 6% of the gloves in the control group, 6% of the gloves used in oral surgeries, and 10% of the gloves used in trauma surgeries showed perforations. The index finger and thumb were the most affected sites. Conclusion: The perforation rate was higher for the dominant right hand. In both studies, the frequency of perforation of unused gloves was significant, indicating the need for better quality control of the gloves evaluated in this study.

Compression therapy using surgical gloves does not prevent paclitaxel-induced peripheral neuropathy: results from a double-blind phase 2 trial

Background Chemotherapy-induced peripheral neuropathy (CIPN) is a common adverse effect of paclitaxel (PTX). There is no known prophylactic measure, although there are some reports of prevention with compression therapy using surgical gloves. On account of its predominantly subjective symptoms, it is difficult to exclude bias when assessing for CIPN. In this study, we assessed the effectiveness of the same procedure for the prevention of paclitaxel-induced PN based on a double-blind study design. Methods The patients with early and recurrent breast cancer (with no prior PTX exposure) initiating weekly chemotherapy with PTX 80 mg/m2 were enrolled. Each patient donned two gloves on each hand at every PTX infusion. Two one-size-smaller gloves were donned on one hand (study side) and two normal-size gloves were donned on the other hand (control side) during 90 min from 30 min before the infusion to 30 min after the end of the infusion. Study side are blind for both patients and assessing physicians according to determination of the study side by research nurses in the chemotherapy unit. The primary outcome was the difference in the frequency of CIPN (motor/sensory) determined by the physician using the common terminology criteria for adverse events (CTCAE v4.0), with an evaluation at each cycle of PTX infusion. McNemar test was used to assess the primary outcome. Results Between July 2017 and November 2018, 56 patients were enrolled and 49 patients were evaluated. Overall, Grade ≥ 2 PN (sensory) was observed in 30.6 and 36.7% in the study and control sides, respectively (McNemar p = 0.25). PN (motor) was observed in 4.1 and 6.1% in the study and control sides, respectively (McNemar p = 1.0). Conclusion Surgical glove compression therapy showed no statistically significant effect on the incidence of PTX-induced PN. Trial registrations This study was registered with the University Hospital Medical Information Network (UMIN) Clinical Trials Registry managed by the National University Hospital Council of Japan (UMIN000027944). Registered 26 June 2017.

536 Use of A Cost-Efficient Colonoscopy Simulation Model to Improve Endoscopy Skills During the COVID Pandemic

Introduction The use of endoscopic simulators as a learning aid in surgical training has been well established. This has been emphasised during the challenging times of COVID-19. However, their utility for training is countered by the high cost of the equipment, with the most basic simulators costing upwards of £50,000. Method A simple polypectomy simulator model was created using a drain-pipe and surgical gloves. n = 9 junior doctors were timed in their ability to remove the 3 polyps from the simulator. The exercise was repeated over 6 sessions over the course of 3 weeks. Means were compared using ANOVA. Results There was a mean relative reduction of 75% in overall time taken to complete the task(p &lt; 0.0001). This improvement was seen for both surgical trainees(p = 0.005) and FY1 novices(p &lt; 0.0001) and junior doctors reported feeling more confident with basic Colonoscopic skills. Conclusions We have demonstrated an improvement in performance times across both surgical trainees and novices. In today’s era of COVID-19, when direct training opportunities may become more scarce, simple alternatives may become vital in ensuring progression of basic surgical skills such as endoscopy. This cheap polypectomy simulator can be easily re-created across surgical units and can be used as an adjunct to traditional endoscopic training