Preventing surgical site infection using operating room bundle of care in patients undergoing elective exploratory laparotomy cholecystectomy surgery

Objective:Surgical procedures manifest immense risks to patients.One of the adverse events that healthcare professionals see as a threat to the patient’s health is the development of complications known as surgical site infection(SSI).Although several effor ts are being under taken to determine the proper means to reduce such complications,there is still a high incidence of SSI worldwide.Surgery requires knowledge in infection control and high precision in maintaining a clean surgical site.This study tested the effectiveness of an operating room(OR)bundle of care in preventing SSI in patients undergoing elective exploratory laparotomy cholecystectomy surgery.Methods:A quasi-experimental pretest and posttest design was utilized to determine its effectiveness.The study was composed of 60 par ticipants divided into two groups:30 subjects were selected to receive the OR bundle of care,while the other 30 subjects received the usual care.The groupings were determined through a systematic random sampling technique.The OR bundle of care had three interventions,namely:(1)maintaining perioperative normothermia,(2)no pre-operative surgical site hair removal,and(3)changing gloves before abdominal wall closure.These patients were evaluated using the standard instrument,Bates–Jensen Wound Assessment Tool(BWAT)in the post-intervention phases of the wound healing process,which are as follows:hemostasis,inflammatory,and proliferative phases.To describe the difference in the patients’wound status after implementation of the OR bundle of care in each post-intervention phase,Friedman’s test was used.To describe the difference in the patients’wound status in both groups after implementation of the OR bundle of care,the Mann–Whitney U test was used.Results:The patient’s wound status was lower,indicating a more healing process.Differences between the wound status of the control and the experimental group were observed on the third postoperative day.This indicates that the experimental group’s wound status healed much faster and more effectively than the control group based on the BWAT scoring severity scoring.A significant difference in the patient’s wound status from the hemostasis phase compared with the proliferative phase was observed.Conclusions:The OR bundle of care has been shown to be effective in preventing SSI in patients who had undergone exploratory laparotomy cholecystectomy surgery in the selected hospital,if there is uniform and consistent implementation of the said intervention.

FINAL SUCCESS AND LONG TERM TNTERESTS COMES FROM CAREFUL OPERATIONAL RESEARCH——A visit to Cai JingHua,executive director and Wu JiaLe,vice general manager of Guangdong Investment Limited

The leading role of undertaking most part of business activities bytapping fund through public listing for Guangdong Enterprises(Holdings)Limited.(here-in-after called GDE)is Played by one of its affiliate,GuangdongInvestment Limited (Here-in-after called GDI).In ten years of activeties,GDIPolicy makers deeply felt that their supreme responsibility was to create thebiggest wealth at present and in the future for the property owner,to achievethe biggest increase of property value,and in the meantime to contribute a bitfor the continuous progress of society.

Surgical first aid and nursing care of a parturient with massive hemorrhage in natural delivery

Objective:To summarize the first aid and nursing of the operating room due to serious complications caused by postpartum massive bleeding.Methods:One case of emergency hemorrhage was ineffective in emergency hysterectomy.Results:The uterus was successfully removed and the bleeding was successfully stopped.It was transferred to the ICU under general anesthesia.Conclusion:For pregnant women with postpartum massive bleeding and hemorrhagic shock and diffuse intravascular coagulation(DIC),targeted surgical treatment and complete operating room emergency care are of great significance to save maternal lives.

Comment on profitability analysis of a femtosecond laser system for cataract surgery using a fuzzy logic approach

Dear Editor,We read with interest the recently published study by Trigueros et al（[1]）,highlighting the financial and management conditions of femtosecond laser-assisted cataract surgery（FLACS）.The authors derived a simulation to estimate.

Mathematical Models for a Social Partitioning Problem

In this paper we develop modeling techniques for a social partitioning problem. Different social interaction regulations are imposed during pandemics to prevent the spread of diseases. We suggest partitioning a set of company employees as an effective way to curb the spread, and use integer programming techniques to model it. The goal of the model is to maximize the number of direct interactions between employees who are essential for company’s work subject to the constraint that all employees should be partitioned into components of no more than a certain size implied by the regulations. Then we further develop the basic model to take into account different restrictions and provisions. We also give heuristics for solving the problem. Our computational results include sensitivity analysis on some of the models and analysis of the heuristic performance.

Pediatric endoscopy across multiple clinical settings:Efficiency and adverse events

BACKGROUND Endoscopic procedures are becoming increasingly important for the diagnosis and treatment of gastrointestinal disorders during childhood,and have evolved from a more infrequent inpatient procedure in the operating room to a routine outpatient procedure conducted in multiple care settings.Demand for these procedures is rapidly increasing and thus there is a need to perform them in an efficient manner.However,there are little data comparing the efficiency of pediatric endoscopic procedures in diverse clinical environments.We hypothesized that there are significant differences in efficiency between settings.AIM To compare the efficiency and examine adverse effects of pediatric endoscopic procedures across three clinical settings.METHODS A retrospective chart review was conducted on 1623 cases of esophagogastroduodenoscopy(EGD)or combined EGD and colonoscopy performed between January 1,2014 and May 31,2018 by 6 experienced pediatric gastroenterologists in three different clinical settings,including a tertiary care hospital operating room,community hospital operating room,and free-standing pediatric ambulatory endoscopy center at a community hospital.The following strict guidelines were used to schedule patients at all three locations:age greater than 6 mo;American Society of Anesthesiologists class 1 or 2;normal craniofacial anatomy;no anticipated therapeutic intervention(e.g.,foreign body retrieval,stricture dilation);and,no planned or anticipated hospitalization post-procedure.Data on demographics,times,admission rates,and adverse events were collected.Endoscopist time(elapsed time from the endoscopist entering the operating room or endoscopy suite to the next patient entering)and patient time(elapsed time from patient registration to that patient exiting the operating room or endoscopy suite)were calculated to assess efficiency.RESULTS In total,58%of the cases were performed in the tertiary care operating room.The median age of patients was 12 years and the male-to-female ratio was nearly equal across all locations.Endoscopist time at the tertiary care operating room was 12 min longer compared to the community operating room(63.3±21.5 min vs 51.4±18.9 min,P<0.001)and 7 min longer compared to the endoscopy center(vs 56.6±19.3 min,P<0.001).Patient time at the tertiary care operating room was 11 min longer compared to the community operating room(133.2±39.9 min vs 122.3±39.5 min,P<0.001)and 9 min longer compared to the endoscopy center(vs 124.9±37.9 min;P<0.001).When comparing endoscopist and patient times for EGD and EGD/colonoscopies among the three locations,endoscopist,and patient times were again shorter in the community hospital and endoscopy center compared to the tertiary care operating room.Adverse events from procedures occurred in 0.1%(n=2)of cases performed in the tertiary care operating room,with 2.2%(n=35)of cases from all locations having required an unplanned admission after the endoscopy for management of a primary GI disorder.CONCLUSION Pediatric endoscopic procedures can be conducted more efficiently in select patients in a community operating room and endoscopy center compared to a tertiary care operating room.

Influence of Robot-Assisted Tumor Surgery Nursing on Patient Rehabilitation in Operating Room and Discussion on Nursing Strategies

Objective: To evaluate the effect of operating room nursing on the outcome of patients undergoing robot-assisted tumor surgery. Methods: This research starts from October 2021 to October 2022. The number of patients with robot-assisted tumor surgery included in our hospital is 769. The patients are treated in the operating room, and the prognosis of the patients is summarized. Results: The intraoperative blood loss in patients undergoing robot-assisted tumor surgery was (57.51 ± 12.01) ml;the operation time was (3.57 ± 0.66) h;and the hospital stay was (6.04 ± 0.53) d. There were 21 cases of complications after robot-assisted tumor surgery, accounting for 2.73%. After surgery, all robot-assisted tumor surgery patients recovered and were discharged smoothly after being checked by doctors. Conclusion: Robot-assisted tumor surgery nursing has a definite effect on patients’ rehabilitation in the operating room.

Using a priority queuing approach to improve emergency department performance

Emergency department over-crowding has been a growing problem throughout the world.This paper presents a practical approach to estimate the waiting times for multi-class patients and apply the approach to reduce the waiting time for high priority patients.Patient flows with different levels of acuity are formulated based on the priority queue models.It derives explicit expressions of the wait time for the Markov queue and uses the concept of isomorphism to approximate the wait time in the general queue.Numerical results with simulation experiments are reported to display the accuracy of the approach.A case study from an emergency department indicates that the proposed approach can efficiently prioritize patient flows in decreasing waiting times.The queuing models have two features.First,the approximation applies to the general priority queues and reduces to the exact results of the Markov priority queue.Second,the models requires no iterative algorithm.