[Environmental microbiological control]. / Control microbiológico ambiental.

The environmental microbiological control is necessary to prevent infections associated with certain procedures that are performed at the hospital. In this review the procedures for control of water and dialysis fluids, and air in operating rooms and immunocompromised units are addressed. The dialysis quality management guidelines define the highest levels of chemical, microbiological and endotoxin in purified water and dialysis fluids based on the recommendations of scientific societies. The microbiological control of water and dialysis fluids should include detection of microorganisms and endotoxin levels. Regarding the microbiological air sampling of operating rooms and immunocompromised units the types of clean rooms in which is recommended to perform microbiological air monitoring; the sample collection methods; culture media; incubation conditions; the most common microorganisms, and permissible levels depending on the type of surgery are described.

Clinical trial on nurse training through virtual reality simulation of an operating room: assessing satisfaction and outcomes.

INTRODUCTION: Virtual reality (VR) provides a firsthand active learning experience through varying degrees of immersion. The aim of this study is to evaluate the use of VR as a potential tool for training operating room nurses to perform thoracic surgery procedures. METHODS: This is an open parallel-group randomized clinical trial. One group received basic formation followed by an assessment module. The experimental group received the same basic formation, followed by thoracic surgery training and an assessment module. RESULTS: Fifty-six nurses participated in the study (51 females), with a mean age of 41.6 years. Participants achieved a median evaluation mode score of 480 points (IQR = 32 points). The experimental group (520 points) achieved an overall higher score than the control group (440 points; P = .04). Regarding age, women in the second quartile of age among the participants (35-41 years) achieved significantly better results than the rest (P = .04). When we evaluated the results based on the moment of practice, exercises performed in the last 10 min obtained better results than those performed in the first 10 min (1064 points versus 554 points; P < .001). Regarding adverse effects blurred vision was the most frequent. The overall satisfaction rating with the experience was 8.5 out of 10. CONCLUSION: Virtual reality is a useful tool for training operating room nurses. Clinical trial with ISRCTN16864726 registered number.

Intraoperative scrub nurse turnover in orthopaedic surgery procedures: An opportunity for improved operating room efficiency.

BACKGROUND: Scrub nurses play a crucial role in facilitating orthopaedic surgeries, and thus intraoperative scrub nurse turnover may disrupt the workflow of the surgical team and prolong duration of surgery (DOS). The purpose of this study was to quantify the impact of intraoperative scrub nurse turnover on operative time of orthopaedic surgeries lasting less than 3h in duration. METHODS: Prospectively collected databases from two institutions were retrospectively queried to identify all orthopaedic procedures of maximum mean duration of 180min from March 4th, 2018 to August 31st, 2022. Cases were divided into two groups, those with scrub nurse turnover and those without. Propensity score matching was conducted to match groups by surgeon, hospital, patient age, gender, and ASA classification. Unpaired t-tests were used to compare mean DOS for each surgical procedure. Average treatment effect on treated (ATET) with 95% confidence intervals (CIs) were calculated. RESULTS: Scrub nurse turnover significantly prolonged DOS for both bone forearm facture open reduction and internal fixation (ORIF) (ATET=21.08, p=0.001), ankle ORIF (ATET=21.26, p<0.001), clavicle ORIF (ATET=16.16, p=0.028), femur intramedullary nail (ATET=11.52, p=0.003), rotator cuff repair (ATET=16.88, p<0.001), partial discectomy (ATET=10.52, p=0.001), total knee arthroplasty (TKA) (ATET=5.69, p<0.001), anterior total hip arthroplasty (THA) (ATET=8.80, p<0.001), lateral THA (ATET=7.02, p<0.001), and uncemented hip hemiarthroplasty (ATET=16.79, p=0.049). CONCLUSION: Intraoperative scrub nurse turnover significantly prolongs surgical times in orthopaedic surgeries lasting up to 3h in duration. This highlights the importance of developing strategies to prevent intraoperative scrub nurse turnover to improve OR efficiency and decrease healthcare costs.

Risk factors for PPCs in laparoscopic non-robotic vs. laparoscopic robotic abdominal surgery (LapRas): rationale and protocol for a patient-level analysis of LAS VEGAS and AVATaR.

INTRODUCTION: Postoperative pulmonary complications (PPCs) vary amongst different surgical techniques. We aim to compare the incidence of PPCs after laparoscopic non-robotic versus laparoscopic robotic abdominal surgery. METHODS AND ANALYSIS: LapRas (Risk Factors for PPCs in Laparoscopic Non-robotic vs Laparoscopic robotic abdominal surgery) incorporates harmonized data from 2 observational studies on abdominal surgery patients and PPCs: 'Local ASsessment of VEntilatory management during General Anaesthesia for Surgery' (LAS VEGAS), and 'Assessment of Ventilation during general AnesThesia for Robotic surgery' (AVATaR). The primary endpoint is the occurrence of one or more PPCs in the first five postoperative days. Secondary endpoints include the occurrence of each individual PPC, hospital length of stay and in-hospital mortality. Logistic regression models will be used to identify risk factors for PPCs in laparoscopic non-robotic versus laparoscopic robotic abdominal surgery. We will investigate whether differences in the occurrence of PPCs between the two groups are driven by differences in duration of anesthesia and/or the intensity of mechanical ventilation. ETHICS AND DISSEMINATION: This analysis will address a clinically relevant research question comparing laparoscopic and robotic assisted surgery. No additional ethical committee approval is required for this metanalysis. Data will be shared with the scientific community by abstracts and original articles submitted to peer-reviewed journals. REGISTRATION: The registration of this post-hoc analysis is pending; individual studies that were merged into the used database were registered at clinicaltrials.gov: LAS VEGAS with identifier NCT01601223, AVATaR with identifier NCT02989415.

Off-clamp laparoscopic partial nephrectomy in a hybrid room after tumor embolization versus conventional partial nephrectomy: A propensity score matched pair analysis.

OBJECTIVE: Off-clamp laparoscopic partial nephrectomy in a hybrid operating room after superselective arterial embolization (hLPN) is a promising minimally invasive approach. In this study, we compared the perioperative surgical outcomes of this innovative technique with the conventional standard of care laparoscopic partial nephrectomy (cLPN) technique. PATIENTS AND METHODS: Overall, 86 and 127 patients treated with hLPN and cLPN, respectively, were included. These two techniques were compared in terms of surgical complications, estimated blood loss (EBL), operative time, length of stay (LOS), surgical margins, and Trifecta achievement rate (defined as warm ischemia duration <25 min, negative surgical margins and absence of complications). A propensity score based on age, gender, BMI, preoperative eGFR and tumor size was used for a 1:1 matching of patients of each group. After matching, 2 groups of 67 patients with similar characteristics were obtained. RESULTS: Conversion rate to open surgery, complications and EBL were similar in both groups. Conversely, operative time, LOS and Trifecta rates favored hLPN. The multivariate analysis showed that hLPN had a 70% higher chance of Trifecta achievement than cLPN in all age groups and for all tumor size across the study population. CONCLUSION: Compared to a conventional approach, off-clamp laparoscopic partial nephrectomy in a hybrid room after superselective arterial embolization showed satisfying immediate surgical outcomes and reached a higher rate of Trifecta achievement. Mid and long-term functional and oncological results are needed to establish this minimally invasive surgical alternative.

Practical recommendations for the perioperative management of the patient with suspection or serious infection by coronavirus SARS-CoV. / Recomendaciones prácticas para el manejo perioperatorio del paciente con sospecha o infección grave por coronavirus SARS-CoV-2.

In December 2019, the Wuhan Municipal Health and health Commission (Hubei Province, China) reported a series of cases of pneumonia of unknown etiology. On January 7, 2020, the Chinese authorities identified as a causative agent of the outbreak a new type of virus of the Coronaviridiae family, called SARS-CoV-2. Since then, thounsands of cases have been reported with global dissemination. Infections in humans cause a broad clinical spectrum ranging from mild upper respiratory tract infection, to severe acute respiratory distress syndrome and sepsis. There is not specific treatment for SARS-CoV-2, which is why the fundamental aspects are to establish adequate prevention measures and support treatment and management of complications.

Health care notifications related to surgery in a university hospital / Notificaciones sanitarias relacionadas con cirugías en un hospital universitario / Notificações de assistência à saúde relacionadas a cirurgia em um hospital universitário

Objective: To characterize healthcare notifications related to surgery reported in a university hospital in Rio Grande do Sul. Method: A cross-sec-tional study conducted at a university hospital in the Southern Region of Brazil, analyzing notifications of surgery-related incidents contained in the Health Surveillance and Hospital Care Risk Management Application (Vigilância em Saúde e Gestão de Riscos Assistenciais Hospitalares - VIGIHOSP) data-base, from 2014 to 2022. Data analysis was performed using descriptive statistics. Results: A total of 258 notifications were identified, with a notable inci-dence of material-related incidents (24%), of which 57.8% were classified as incidents without harm. The most prevalent type of incident was related to medical-hospital articles (21%). Contributing factors to these events included organizational culture (58.1%), communication (57.4%), protocols/poli-cies/procedures (53.1%), and team organization (51.9%). Conclusion: The study findings contribute to the improvement of work processes, serving as indicators of care outcomes and assisting in the prevention of incidents and enhancement of care for surgical patients. (AU)

Objetivo: Caracterizar las notificaciones de asistencia sanitaria relacionadas con cirugías notificadas en un hospital universitario de Rio Grande do Sul. Método: Estudio transversal realizado en un hospital universitario ubicado en la Región Sur de Brasil, en el cual se analizaron las notificaciones de incidentes relacionados con cirugías, contenidas en la base de datos del Aplicativo de Vigilancia en Salud y Gestión de Riesgos Asistenciales Hospitalarios (VIGIHOSP), en el período de 2014 a 2022. El análisis de los datos se realizó mediante estadística descriptiva. Resultados: Se identificaron 258 notifica-ciones, destacándose los incidentes relacionados con materiales (24%), de los cuales el 57,8% fueron clasificados como incidentes sin daño. En cuanto al tipo de incidente, la prevalencia estuvo relacionada con los artículos médico-hospitalarios (21%) y, entre los factores contribuyentes a estos eventos, se destacaron la cultura organizacional (58,1%), la comunicación (57,4%), el protocolo/políticas/procedimientos (53,1%) y la organización del equipo (51,9%). Conclusión: Los hallazgos del estudio contribuyen al perfeccionamiento de los procesos de trabajo, ya que se configuran como indicadores del resultado de la asistencia, ayudando en la prevención de incidentes y en las mejoras en el cuidado del paciente quirúrgico. (AU)

Objetivo: Caracterizar as notificações de assistência à saúde relacionadas a cirurgia notificadas em um hospital universitário do Rio Grande do Sul. Método: Estudo transversal realizado em um hospital universitário localizado na Região Sul do Brasil, no qual foram analisadas as notificações de incidentes relacionados a cirurgia, contidas no banco de dados do Aplicativo de Vigilância em Saúde e Gestão de Riscos Assistenciais Hospitalares (VIGIHOSP), no período de 2014 a 2022. A análise dos dados deu-se por meio da estatística descritiva. Resultados: Foram identificadas 258 notificações, com destaque para os incidentes relacionados a materiais (24%), das quais 57,8% foram classificadas como incidente sem dano. Quanto ao tipo de inci-dente, a prevalência foi relacionada aos artigos médico-hospitalares (21%) e, dentre os fatores contribuintes desses eventos, destacaram-se a cultura orga-nizacional (58,1%), a comunicação (57,4%), o protocolo/políticas/procedimentos (53,1%) e a organização da equipe (51,9%). Conclusão: Os achados do estudo contribuem para o aperfeiçoamento dos processos de trabalho, visto que se configuram como indicadores do resultado da assistência, auxiliando na prevenção de incidentes e melhorias no cuidado com o paciente cirúrgico. (AU)

[Radiation protection measures: Implications on the design of neurosurgery operating rooms]. / Medidas de protección radiológica: implicaciones en el diseño de quirófanos de neurocirugía.

OBJECTIVE: To describe pros and cons of some radiation protection measures and the implications on the design of a neurosurgery operating room. MATERIAL AND METHODS: Concurring with the acquisition and use of an O-arm device, a structural remodeling of our neurosurgery operating room was carried out. The theater was enlarged, the shielding was reinforced and a foldable leaded screen was installed inside the operating room. Radiation doses were measured in front of and behind the screen. RESULTS: The screen provides whole-body radiation protection for all the personnel inside the theater (effective dose <5µSv at 2,5 m from the gantry per O-arm exploration; 0,0µSv received behind the screen per O-arm exploration; and undetectable cumulative annual radiation dose behind the screen), obviates the need for leaded aprons and personal dosimeters, and minimizes the circulation of personnel. Enlarging the size of the operating room allows storing the equipment inside and minimizes the risk of collision and contamination. Rectangular rooms provide greater distance from the source of radiation. CONCLUSION: Floor, ceiling and walls shielding, a rectangular-shaped and large enough theater, the presence of a foldable leaded screen, and the security systems precluding an unexpected irruption into the operating room during irradiation are relevant issues to consider when designing a neurosurgery operating theater.

Metrics of efficient use of operating rooms during the SARS-CoV-2 (COVID-19) pandemic / Métrica de indicadores de uso eficiente de quirófano durante la pandemia por SARS-CoV-2 (COVID-19)

Abstract: Introduction: the COVID-19 pandemic has induced a transformation in the way hospitals function, causing a decrease in the time and efforts dedicated to surgical activity, which in turn has caused delays in the surgery schedule of most hospitals. This represents a major public health problem, significantly compromising the principle of equity that inspires public health systems throughout the world. To address this problem, it would be of the utmost importance to put in place initiatives to measure and improve surgical efficiency. Objective: evaluate indicators of efficiency in the use of operating rooms during the COVID-19 pandemic. Material and methods: a descriptive, longitudinal retrospective study was conducted on 3554 patients scheduled for surgery during a one-year period of the COVID-19 pandemic. Indicators of efficiency in they use of operating rooms were measured. The data was processed using SPSS v-25.0. Results: a total of 3,554 surgeries were scheduled, 1,309 of them emergency surgeries, 1,979 elective surgeries, and 266 deferred surgeries. The following parameters were estimated: Starting time of the procedure (42.32 ± 37.04 min); opportunity for emergency surgeries (104.69 ± 102.55 min); starting time of anesthesia (10.11 ± 9.85 min); starting time of surgery (40.03 ± 24.68 min); time of admission to post-anesthesia care unit/intensive care unit (PACU/ICU) (15.35 ± 29.94 min); turnover or replacement time (177.97 ± 174.33 min); active surgery time (27.70%). Conclusions: the COVID-19 pandemic negatively impacted the indicators of efficient use of operating rooms, posing new challenges for the management and organization of surgical work.

Resumen: Introducción: la pandemia por COVID-19 ha emplazado una transformación hospitalaria, esto acarreó un decremento de la actividad quirúrgica e implicó un aplazamiento en la programación, lo que representó un problema, ya que comprometió sensiblemente el principio de equidad que inspira a los sistemas sanitarios. Así, resultó imperativa la implementación de iniciativas para medir y mejorar la eficiencia quirúrgica. Objetivo: medir los indicadores de uso eficiente del quirófano durante la pandemia por COVID-19. Material y métodos: se realizó un análisis descriptivo, longitudinal y retrospectivo en 3,554 pacientes programados para cirugía, durante la pandemia en un período de un año, además se midieron los indicadores de uso eficiente del quirófano. Los datos fueron procesados en SPSS v-25.0. Resultados: se programaron 3,554 cirugías, 1,309 urgencias, 1,979 electivas, 266 diferidas. Se estimó un tiempo de inicio del procedimiento 42.32 ± 37.04 min, oportunidad para urgencias quirúrgicas 104.69 ± 102.55 min, tiempo de inicio de anestesia 10.11 ± 9.85 min, tiempo de inicio de cirugía 40.03 ± 24.68 min, tiempo para la admisión en la unidad de cuidados postanestésicos/unidad de terapia intensiva (UCPA/UTI) 15.35 ± 29.94 min, tiempo de rotación o recambio 177.97 ± 174.33 min y tiempo quirúrgico activo 27.70%. Conclusiones: la pandemia por COVID-19 impactó negativamente en los indicadores de uso eficiente del quirófano, lo que implicará nuevos retos en la gestión y organización de la jornada quirúrgica para su mejora.

Ética en instrumentación quirúrgica / Ethics in surgical instrumentation

Es imprescindible en la práctica de la cirugía no sólo estudiar técnicas e instrumental en profundidad, sino también lo referido a las virtudes y valores morales del grupo humano quirúrgico para proveer una conducta ética intachable en el quirófano. La calidad de asistencia se valora a través del resultado de los servicios propuestos y obtenidos, sin dejar de lado aspectos ético-morales del instrumentador quirúrgico, cuya función principal es no dañar al paciente no sólo desde el punto de vista técnico, sino también desde el moral. Durante la presencia del enfermo en el quirófano siempre se exigen respuestas éticas al coordinar y proporcionar los cuidados para cubrir las necesidades detectadas, ya sean fisiológicas, psicológicas (el miedo, la ansiedad ante la cirugía) e incluso espirituales, pero con respeto a sus creencias y valores morales. El instrumentador, como parte esencial del grupo quirúrgico, debe refinar esos valores personales (por ejemplo, no participar en una cirugía urgente de un delincuente si existe un conflicto de interés), identificar sin sesgos o prejuicios el conocimiento de las leyes y códigos de conducta (evitar el abandono de una persona necesitada) y comprender los valores, creencias y principios éticos de los demás para así tomar una decisión racional ante un dilema principalmente ético. El equipo quirúrgico ostentará tanto los valores científico-técnicos como los personales sin entrar en conflicto con las creencias del paciente, porque, al tomar decisiones moral y éticamente válidas, actuará como protector de los derechos del enfermo en una cirugía.(AU)

In the practice of surgery it is essential not only to study techniques and instruments in depth, but also that referred to the virtues and moral values of the surgical team to provide an impeccable ethical conduct in the operating room. The quality of care is assessed through the result of the services proposed and obtained, without neglecting ethical-moral aspects of the surgical instrumentator whose main function is not to harm the patient not only from the technical point of view but morally. During the presence of the patient in the operating room, ethical responses are always required when coordinating and providing care to cover the needs detected, whether physiological, psychological (fear, anxiety before surgery) or spiritual, but with respect for their beliefs and moral values. The assistant or auxiliary surgical, as an essential part of the surgical team, must refine these personal values (for example, not participate in an urgent surgery of an offender if there is a conflict of interest), identify without bias or prejudice the knowledge of the laws and codes of conduct (avoid abandonment of a person in need) and understand the values, beliefs and ethical principles of others in order to make a rational decision in the face of a mainly ethical dilemma. The surgical team will hold both scientific-technical and personal values with beliefs without conflicting with those of the patient, because when making morally and ethically valid decisions, act as a protector of the rights of the patient in a surgery.(AU)

Música como promotora da saúde na sala de espera de cirurgia: percepções de acompanhantes / Music as a health promoter in the surgery waiting room: companions' perceptions / La música como promotora de salud en la sala de espera de cirugía: percepciones de los acompañantes

Objetivo: compreender as percepções dos acompanhantes que aguardam notícias de seus entes queridos que estão em cirurgia, sobre a utilização da música como estratégia para promover saúde no hospital. Método: estudo descritivo, exploratório, qualitativo, fundamentado nos pressupostos teóricos da Promoção da Saúde, com a participação de 15 acompanhantes que aguardavam notícias de seus entes queridos em uma sala de espera no ambiente hospital. Realizaram-se entrevistas semiestruturadas e os dados foram organizados e analisados conforme análise de conteúdo. Resultados: os participantes destacaram algumas possibilidades para promover saúde na sala de espera de cirurgia do hospital, como a música, a qual proporciona distração da realidade preocupante, felicidade, vida, alegria, esperança, sensações boas, ânimo e tranquilidade. Considerações finais: a música destaca-se como tecnologia para promover saúde, despertando sentimentos positivos durante as intervenções musicais no hospital. Portanto, faz-se necessário ampliar a discussão e utilização da música como estratégia para promover saúde no âmbito hospitalar

Objective: to understand the perceptions of companions awaiting news from their loved ones who are undergoing surgery, about the use of music as a strategy to promote health in the hospital. Method: a descriptive, exploratory, qualitative study, based on the theoretical assumptions of Health Promotion, with the participation of 15 companions who were waiting for news from their loved ones in a waiting room in the hospital environment. Semi-structured interviews were carried out and the data were organized and analyzed according to content analysis. Results: the participants highlighted some possibilities to promote health in the hospital surgery waiting room, such as music, which provides distraction from the worrying reality, happiness, life, joy, hope, good feelings, cheer and tranquility. Final considerations: music stands out as a technology to promote health, arousing positive feelings during musical interventions in the hospital. Therefore, it is necessary to expand the discussion and use of music as a strategy to promote health in the hospital environment

Objetivo: comprender las percepciones de acompañantes en espera de noticias de sus seres queridos que están siendo operados, sobre el uso de la música como estrategia de promoción de la salud en el hospital. Método: estudio descriptivo, exploratorio, cualitativo, basado en los presupuestos teóricos de la Promoción de la Salud, con la participación de 15 acompañantes que esperaban noticias de sus seres queridos en una sala de espera del ambiente hospitalario. Se realizaron entrevistas semiestructuradas y los datos fueron organizados y analizados según el análisis de contenido. Resultados: los participantes destacaron algunas posibilidades para promover la salud en la sala de espera de cirugía hospitalaria, como la música, que proporciona distracción de la realidad preocupante, alegría, vida, alegría, esperanza, buenos sentimientos, alegría y tranquilidad. Consideraciones finales: la música se destaca como tecnología para promover la salud, despertando sentimientos positivos durante las intervenciones musicales en el hospital. Por lo tanto, es necesario ampliar la discusión y el uso de la música como estrategia de promoción de la salud en el ámbito hospitalario

The challenges for implementing the perioperative nursing process / Los desafíos para implementar el proceso de enfermería perioperatoria / Os desafios para a implementação do processo de enfermagem perioperatório

Objective: To analyze the challenges of the perioperative nursing process in the surgicenter, identifying the facilities and difficulties in its imple-mentation. Method: Descriptive research, with a mixed approach (quantitative and qualitative) and snowball sampling, encompassing 16 nurses. Data col-lection was through an online, self-administered and semi-structured form, containing 12 questions aimed at analyzing the development of the nursing process in the surgicenter. Results: The majority of participants reported that the nursing process was implemented in the institutions where they wor-ked, half of them (n=8) found it easy to implement the nursing process, and all of them (n=16) stated that there are challenges in implementing it and cited staffing and lack of professional knowledge as difficulties. Conclusion: It was found that there is a gap in the sequencing of actions in the nursing process, and that the physical examination in the nursing consultation, the evolution in the immediate preoperative period and the reformulation of the planning of actions in the postoperative period are important practices that are not adhered to by the majority of nurses. Therefore, it is understood that they find more difficulties than facilities in implementing the nursing process. (AU)

Objetivo: Analizar los desafíos del proceso perioperatorio de enfermería en el centro quirúrgico, identificando las facilidades y dificultades en su implementación. Método: Investigación descriptiva, con enfoque mixto (cuantitativo y cualitativo) y muestreo en bola de nieve, englobando a 16 enfer-meros. La recolección de datos se realizó a través de un formulario en línea, autoadministrado y semiestructurado, que contenía 12 preguntas orienta-das a analizar el desarrollo del proceso de enfermería en el centro quirúrgico. Resultados: La mayoría de los participantes informaron que el proceso de enfermería fue implementado en las instituciones donde trabajaban, a la mitad (n=8) les resultó fácil implementar el proceso de enfermería y todos (n=16) afirmaron que existen desafíos para implementarlo, y citaron la dotación de personal y la falta de conocimientos profesionales como dificulta-des. Conclusión: Se encontró que existe un vacío en la secuenciación de acciones en el proceso de enfermería, y que el examen físico en la consulta de enfermería, la evolución en el preoperatorio inmediato y la reformulación de la planificación de acciones en el postoperatorio son prácticas importan-tes que no son seguidas por la mayoría de las enfermeras. Por lo tanto, se entiende que encuentran más dificultades que facilidades para implementar el proceso de enfermería. (AU)

Objetivo: Analisar os desafios do processo de enfermagem perioperatório no centro cirúrgico, identificando as facilidades e as dificuldades em sua implementação. Método: Pesquisa descritiva, com abordagem mista (quantitativa e qualitativa) e amostragem em bola de neve, englobando 16 enfermeiros. A coleta de dados foi por meio de um formulário online, autoaplicável e semiestruturado, contendo 12 perguntas voltadas para a análise do desenvolvimento do processo de enfermagem no centro cirúrgico. Resultados: A maioria dos participantes relatou que o processo de enfermagem era implementado nas instituições em que trabalhavam, metade (n=8) encontrou facilidades na implementação do processo de enfermagem, e todos (n=16) afirmaram que existem desafios para implementá-lo e citaram como dificuldades o dimensionamento de pessoal e a falta de conhecimento profissional. Conclusão: Constatou-se que existe uma lacuna no sequenciamento das ações do processo de enfermagem, e que o exame físico na consulta de enferma-gem, a evolução no pré-operatório imediato e a reformulação do planejamento das ações no pós-operatório são práticas importantes que não são aderidas pela maioria dos enfermeiros. Logo, entende-se que eles encontram mais dificuldades do que facilidades para implementar o processo de enfermagem. (AU)

Atividades do enfermeiro de centro cirúrgico no cenário brasileiro: scoping review / Actividades de los enfermeros de quirófano en el escenario brasileño: scoping review / Perioperative nurses' activities in the brazilian scenario: a scoping review

Resumo Objetivo Mapear as principais atividades do enfermeiro de Centro Cirúrgico no cenário brasileiro, explicitadas na literatura vigente. Métodos Trata-se de uma scoping review elaborada de acordo com as diretrizes vigentes do Joanna Briggs Institute, utilizando o checklist para condução e relatório do estudo. A busca foi realizada por duas pesquisadoras independentes, no período entre agosto e dezembro de 2021, em seis bases de dados da área da saúde, utilizando os descritores: nurses, nurse role, intraoperative period, perioperative nursing, surgical centers . Fizeram parte da amostra artigos publicados entre janeiro de 2011 e outubro de 2022, nos idiomas inglês, português ou espanhol. As informações foram extraídas, classificadas, sintetizadas e apresentadas descritivamente. Resultados Foram incluídos 18 na síntese da pesquisa. A análise dos resultados possibilitou evidenciar como as atividades prevalentes na assistência a implementação de medidas de segurança cirúrgica (50%); na gestão, o gerenciamento de materiais, insumos e equipamentos (72%) e preparo das salas (39%); no ensino, educação permanente da enfermagem (50%). Não foram identificados estudos relacionados à atividade de pesquisador. Conclusão No cenário brasileiro, as atividades do enfermeiro de Centro Cirúrgico circundam-se entre gerenciais, assistenciais com menor proporção no ensino, destacando-se sua posição estratégica na mobilização das ações que promovem segurança e qualidade nos processos perioperatórios.

Resumen Objetivo Mapear las principales actividades de los enfermeros de quirófano en el escenario brasileño mencionadas en la literatura vigente. Métodos Se trata de una scoping review elaborada de acuerdo con las directrices vigentes del Joanna Briggs Institute, utilizando la lista de chequeo para la conducción e informe del estudio. La búsqueda fue realizada por dos investigadoras independientes, entre agosto y diciembre de 2021, en seis bases de datos del área de la salud, utilizando los descriptores: nurses, nurse role, intraoperative period, perioperative nursing, surgical centers . Artículos publicados entre enero de 2011 y octubre de 2022, en inglés, portugués y español formaron parte de la muestra. La información se extrajo, se clasificó, se sintetizó y se presentó descriptivamente. Resultados Se incluyeron 18 artículos en la síntesis del estudio. El análisis de los resultados permitió evidenciar las siguientes actividades predominantes: en la atención, la implementación de medidas de seguridad quirúrgica (50 %); en la gestión, la administración de material, insumos y equipos (72 %) y la preparación de las salas (39 %); en la enseñanza, la educación permanente de la enfermería (50 %). No se identificaron estudios relacionados con la actividad del investigador. Conclusión En el escenario brasileño, las actividades de los enfermeros de quirófano giran en torno de la gestión, la atención con menor proporción la enseñanza, y se destaca su posición estratégica en la movilización de las acciones que promueven seguridad y calidad en los procesos perioperatorios. Registro do protocolo na plataforma Open Science Framework: https://osf.io/8jmq6/

Abstract Objective To map perioperative nurses' main activities in the Brazilian scenario, explained in the current literature. Methods This is a scoping review prepared in accordance with current JBI guidelines, using the checklist for conducting and reporting the study. The search was carried out by two independent researchers, between August and December 2021, in six databases in the health area, using the descriptors nurses, nurse role, intraoperative period, perioperative nursing, surgical centers. Articles published between January 2011 and October 2022, in English, Portuguese or Spanish, were part of the sample. The information was extracted, classified, synthesized and presented descriptively. Results Eighteen were included in the research synthesis. The analysis of results made it possible to highlight the implementation of surgical safety measures as prevalent activities in care (50%); in management, material, input and equipment (72%) and room preparation (39%) management; in teaching, permanent nursing education (50%). No studies related to researcher activity were identified. Conclusion In the Brazilian scenario, perioperative nurses' activities range from management to assistance with a smaller proportion in teaching, highlighting their strategic position in mobilizing actions that promote safety and quality in perioperative processes. Protocol registration on the Open Science Framework platform: https://osf.io/8jmq6/

Aplicativos móveis voltados ao preparo para procedimentos cirúrgicos: uma prospecção tecnológica / Mobile applications aimed at preparation for surgical procedures: a technological prospecting / Aplicaciones móviles para la preparación de procedimientos quirúrgicos: una prospección tecnológica

Objetivo: analisar as principais características dos aplicativos móveis, disponíveis em lojas virtuais, que tratam sobre a temática da realização de procedimentos cirúrgicos. Método: prospecção tecnológica, de abordagem qualitativa do tipo exploratória, realizada por busca de aplicativos nas lojas virtuais Apple Store ® e Google Play ®, utilizando as palavras-chave: Centro Cirúrgico, Cirurgia, Simulador de cirurgia e Jogos de cirurgia, em português, inglês e espanhol. Realizou-se análise temática categorial dos achados. Resultados: 67 ocorrências foram classificadas em quatro categorias: 'Aplicativos destinados à orientação para procedimento cirúrgico', 'Aplicativos sobre o trabalho em centro cirúrgico', 'Aplicativos voltados à equipe de saúde', e 'Aplicativos relacionados a jogos de entretenimento'. Conclusões: os aplicativos voltam-se tanto para indivíduos que buscam orientações sobre procedimentos, quanto a profissionais da área da saúde. No entanto, há uma lacuna referente à orientações pré-operatórias específicas para pediatria, onde nenhuma ocorrência foi registrada

Objective: to analyze the main characteristics of mobile applications available in virtual stores, which deal with performing surgical procedures. Method: technological prospection, with a qualitative exploratory approach, carried out by searching for applications in the Apple Store® and Google Play® virtual stores, using the keywords: Surgical Center, Surgery, Surgery Simulator, and Surgery Games, in Portuguese, English, and Spanish. We performed a categorical thematic analysis of the findings. Results: 67 occurrences were classified into four categories: 'Applications intended to guide the surgical procedure,' 'Applications about working in the operating room,' 'Applications aimed at the health team,' and 'Applications related to entertainment games. Conclusions: the applications are aimed both at individuals seeking procedure guidance and healthcare professionals. However, there is a gap regarding specific preoperative guidelines for pediatrics, where no occurrence was recorded

Objetivo: analizar las principales características de las aplicaciones móviles, disponibles en las tiendas virtuales, que tratan el tema de la realización de procedimientos quirúrgicos. Método: prospección tecnológica, con enfoque exploratorio cualitativo, realizada mediante la búsqueda de aplicaciones en las tiendas virtuales Apple Store® y Google Play®, utilizando las palabras clave: Centro Quirúrgico, Cirugía, Simulador de Cirugía y Juegos de Cirugía, en portugués, inglés y español. Se realizó un análisis temático categórico de los hallazgos. Resultados: 67 ocurrencias fueron clasificadas en cuatro categorías: 'Aplicaciones destinadas a orientar el procedimiento quirúrgico', 'Aplicaciones sobre el trabajo en quirófano', 'Aplicaciones dirigidas al equipo de salud' y 'Aplicaciones relacionadas con juegos de entretenimiento'. Conclusiones: las aplicaciones están dirigidas tanto a personas que buscan orientación sobre procedimientos como a profesionales de la salud. Sin embargo, existe un vacío con respecto a las pautas preoperatorias específicas para pediatría, donde no se registró ninguna ocurrencia

Surgical nursing care in the operating room: an integrative review / Cuidado cirúrgigo de enfermagem em salas de cirurgia: uma revisão integrativa / Cuidado quirúrgico de enfermería de sala de operaciones: una revisión integrativa

ABSTRACT Objective: to identify the state-of-the-art developed about surgical Nursing care in the operating room. Method: an integrative review with search and selection of primary studies conducted in April and May 2022 in four major data sources in the health field, namely: LILACS, SciELO, BDENF and PubMed, from 2018 to 2022. The sample consisted of 13 studies, 8 selected from a universe of 293 articles and 5 obtained through the manual search. Results: three categories were generated: Associating surgical care with care, people and material resources management for patient safety; Surgical care and ethical sensitivity in the search for patients' well-being; and Operating room nurses' manifestation and omission experiences and surgical care. Conclusions: surgical Nursing care in the operating room is varied and is manifested through meeting the administrative demands, ethical sensitivity, body temperature maintenance, preservation of individuality and meeting all the needs in the intraoperative period when patients are more vulnerable, including being duly informed as a way to provide safe surgical care. On the other hand, nurses acknowledge the need to change their world view and direct surgical care towards a more human, social and cultural perspective.

RESUMO Objetivo: identificar o estado da arte que foi desenvolvido sobre os cuidados cirúrgicos do enfermeiro da sala de cirurgia. Método: revisão integrativa com pesquisa e seleção de estudos primários realizada entre abril e maio de 2022 em quatro fontes de dados destacadas no campo da saúde: LILACS, SciELO, BDENF e PubMed de 2018 a 2022. A amostra consistiu-se de 13 estudos, 8 selecionados de um total de 293 artigos e 5 pesquisados manualmente. Resultados: foram geradas três categorias: associação do cuidado cirúrgico com a gestão dos cuidados, pessoas e recursos materiais para a segurança do paciente; cuidado cirúrgico e sensibilidade ética na busca do bem-estar do paciente e as experiências de manifestação e omissão do enfermeiro da sala de cirurgia e o cuidado cirúrgico. Conclusões: o cuidado cirúrgico na sala de cirurgia é variado e se manifesta através da atenção às exigências administrativas, sensibilidade ética, manutenção da temperatura corporal, preservação da individualidade e atenção a todas as necessidades no ambiente intra-operatório onde o paciente é mais vulnerável, incluindo o dever de estar informado como um meio de proporcionar um cuidado cirúrgico seguro. Por outro lado, reconhece a necessidade de mudar sua cosmovisão e direcionar os cuidados cirúrgicos para uma perspectiva mais humana, social e cultural.

RESUMEN Objetivo: identificar el estado de arte que se ha desarrollado sobre el cuidado quirúrgico de la enfermera de sala de operaciones. Método: revisión integrativa con indagación y selección de estudios primarios efectuada en abril y mayo de 2022 en cuatro fuentes de datos destacadas en el campo de la salud: Lilacs, SciELO, BDENF y PubMed de 2018 a 2022. La muestra se conformó por 13 estudios, 8 seleccionados de un universo de 293 artículos y 5 de búsqueda manual. Resultados: se generaron tres categorías: asociando cuidado quirúrgico con gestión de cuidado, de personas y de recursos materiales para la seguridad del paciente; el cuidado quirúrgico y la sensibilidad ética en la búsqueda de bienestar para el paciente y las experiencias de manifestación y omisión del enfermero de quirófano y el cuidado quirúrgico. Conclusiones: el cuidado quirúrgico en la enfermera de sala de operaciones es variado y se manifiesta a través de la atención a las demandas administrativas, la sensibilidad ética, el mantenimiento de la temperatura corporal, conservación de la individualidad y atención a todas las necesidades en el intraoperatorio donde el paciente es más vulnerable, incluyendo el estar informada como una forma de brindar un cuidado quirúrgico seguro. Por otro lado, reconoce la necesidad de cambiar su visión de mundo y dirigir el cuidado quirúrgico hacia una mirada más humana, social y cultural.

Implementation of transoperative and immediate postoperative nursing diagnoses in the computerized management system / Implementación de diagnósticos de enfermería intraoperatorios y postoperatorios inmediatos en el sistema de gestión informatizado / Implementação dos diagnósticos de enfermagem do transoperatório e pós-operatório imediato no sistema de gestão informatizado

ABSTRACT Objective: To implement, on health management software, electronic records of the perioperative nursing process and the stages of transoperative and immediate postoperative nursing diagnoses, based on the NANDA International taxonomy. Method: Experience report conducted from the completion of the Plan-Do-Study-Act cycle, which allows improvement planning with a clearer purpose, directing each stage. This study was carried out in a hospital complex in southern Brazil, using the software Tasy/Philips Healthcare. Results: For the inclusion of nursing diagnoses, three cycles were completed, predictions of expected results were established, and tasks were assigned, defining "who, what, when, and where". The structured model covered seven possibilities of aspects, 92 symptoms and signs to be evaluated, and 15 nursing diagnoses to be used in the transoperative and immediate postoperative periods. Conclusion: The study allowed implementing electronic records of the perioperative nursing process on health management software, including transoperative and immediate postoperative nursing diagnoses, as well as nursing care.

RESUMEN Objetivo: Implementar, en un software de manejo de la salud, registros electrónicos del proceso de enfermería perioperatorio y la etapa de diagnósticos de enfermería transoperatorios y postoperatorios inmediatos, con base en la taxonomía NANDA internacional. Método: Informe de experiencia realizado a partir de la consecución del ciclo Plan-Do-Study-Act), que permite planificar la mejora con un propósito más claro, dirigiendo cada etapa. Este estudio fue realizado en un complejo hospitalario en el sur de Brasil, utilizando el Software Tasy/Philips Healthcare. Resultados: Para la inclusión de diagnósticos de enfermería, se concluíran tres ciclos, se estableceran predicciones de los resultados esperados, y se asignaron tareas, definiendo "quién, qué, cuándo y dónde". El modelo estructurado contempló siete posibles aspectos, 92 signos y síntomas para ser evaluados y 15 diagnósticos de enfermería para ser utilizados en el transperatorio y postoperatorio inmediato. Conclusión: El estudio permitió implementar, en un software de manejo de la salud, registros electrónicos del proceso de enfermería perioperatorio, que comprende diagnósticos de enfermería transoperatoria y postoperatoria inmediata, además de los cuidados de enfermería.

RESUMO Objetivo: Implementar, em um software de gestão em saúde, os registros eletrônicos do processo de enfermagem perioperatório e a etapa de diagnósticos de enfermagem transoperatório e pós-operatório imediato, fundamentados na taxonomia NANDA International. Método: Relato de experiência conduzido a partir da realização do ciclo PDSA (Plan-Do-Study-Act), o qual permite o planejamento de melhoria com um propósito mais claro, direcionando cada etapa. Este estudo foi realizado em um complexo hospitalar da região sul do Brasil, utilizando o software Tasy/Philips Healthcare. Resultados: Para a inclusão dos diagnósticos de enfermagem, rodaram-se três ciclos, estabeleceram-se previsões de resultados esperados, e as tarefas foram atribuídas, definindo "quem, o quê, quando e onde". O modelo estruturado contemplou sete possibilidades de aspectos, 92 sinais e sintomas a serem avaliados e 15 diagnósticos de enfermagem para serem utilizados no transoperatório e pós-operatório imediato. Conclusão: O estudo possibilitou implementar, em um software de gestão em saúde, os registros eletrônicos do processo de enfermagem perioperatório, compreendendo diagnósticos de enfermagem do transoperatório e pós-operatório imediato, além de cuidados de enfermagem.

Optimización de los procesos de gestión en cirugía electiva / Optimizing procedures for elective surgery

The ward chiefs are team leaders and, as such, they must have the ability to adequately manage their unit in such a way as to meet the real needs of the population they are responsible for serving. To achieve this, it is essential to optimize the management of operating rooms, oriented to a strategic management of resources, which allows the best performance and productivity. In this document we will provide you with some tools, such as: definitions of concepts, analysis of the sub-processes that make up the surgical process and suggestions to improve the management of each of its parts.

Los jefes de pabellón son líderes de equipo y, como tales, deben tener la capacidad de gestionar adecuadamente su unidad de tal modo de satisfacer las necesidades reales de la población que le corresponde atender. Para lograr esto, es fundamental optimizar el manejo de los quirófanos, orientado a una gestión estratégica de recursos, que permita el mejor rendimiento y productividad. En este documento les entregaremos algunas herramientas, tales como: definiciones de conceptos, análisis de los subprocesos que componen el proceso quirúrgico y sugerencias para mejorar la gestión de cada una de sus partes.

Estudio comparativo en intubación orotraqueal entre anestesiólogos (Quirófano) e intensivistas (Unidad De Terapia Intensiva) en un hospital del Gobierno de la Ciudad de Buenos Aires (GCBA) / Comparative study in orotracheal intubation between anesthesiologists (Operating Room) and intensivists (Intensive Therapy Unit) in a hospital in the Government of the City of Buenos Aires (GCBA), argentina

La intubación orotraqueal (IOT) como otros procedimientos, no se lleva a cabo de igual manera acorde a las distintas especialidades médicas. Para analizar estas diferencias, se han comparado especialistas en terapia intensiva y de anestesiología en diferentes contextos: unidad cerrada y quirófano. Material y Método: Se realizó un estudio de tipo observacional, prospectivo y comparativo con 18 especialistas, 8 anestesiólogos y 10 intensivistas, analizando 20 prácticas de IOT en cada ámbito. Se excluyeron médicos sin especialidad, pacientes menores de 18 años, embarazadas, pacientes con traumatismo cervical y en parada cardiorrespiratoria. Resultados: No se demostraron diferencias en la dificultad en la instrumentación de la vía aérea entre los pacientes intubados por ambas especialidades. Existió mayor utilización de elementos para posicionar la cabeza a favor del grupo de anestesiología (p < 0.05). La pre oxigenación fue utilizada en igual proporción en ambos grupos y el uso de relajantes musculares fue mayor en anestesiologos (p < 0.05). El tiempo de apnea fue superior en los anestesiólogos 58 seg vs 12,8 seg. La técnica de secuencia de intubación rápida fue usada por el 100% de los anestesiólogos contra el 40% de los intensivistas. El éxito y la intubación en un intento fue igual entre los grupos. Las complicaciones: hipoxemia e hipotensión arterial fue mayor entre los intensivistas (p < 0.05). Conclusión La eficacia en la IOT fue igual entre ambos grupos con mayor seguridad en el grupo de anestesiólogos.

Orotracheal intubation (OTI) like other procedures isn´t performed in the same way in different medical specialities. In order to study these differences we have compared the procedure in intensive care units and in operating rooms performed by intensivists and anesthesiologists repectively.. Design: observational, prospective and compared study. Material: 18 specialists, 8 anesthesiologists and 10 intensivists, measuring 20 OTIs in each site. Non-specialist physicians, patients younger than 18 years old, pregnant women, cervical trauma and cardiac arrest patients were excluded. It was approved by the Bioetics Institution Committee. Results: Differences between specialities regarding airway instrumentation difficulty in intubated patients were not observed. More head positioning devices were required by anesthesiologists than by intensivists (p < 0.05). Preoxygenation was used in the same proportion in both groups, whereas neuromuscular blocking drug use was greater among anesthesiologists (p < 0.05). Apnea time was superior in anesthesiologists (58 seconds vs. 12.8 seconds). Rapid sequence intubation technique was used by 100% of anesthesiologists compared to 40% of intensivists. Successful OTI at first attempt was equal between groups. Hypoxemia and arterial hypotension complications were more frequent among intensivists (p < 0.05). Conclusion: OTI effectiveness was equal in both groups, with more safety among anesthesiologists.

Importancia de la temperatura del quirófano de cirugía ortopédica y traumatología / Importance of temperature in the orthopedic operating room

La infección en la cirugía ortopédica y la trau-matología puede ser catastrófica, entre los facto-res implicados está la temperatura. Trabajar en un rango térmico óptimo es indispensable para el control de las infecciones asociadas a la asisten-cia sanitaria, el mantenimiento de las funciones vitales del paciente y la realización de un trabajo seguro y eficiente. La temperatura de los quirófanos de COT debe oscilar de los 18°C a los 24°C para reducir el riesgo de infecciones nosocomiales y, a la par, proporcionar confort al cirujano ortopédico en su trabajo, aunque ello suponga que el resto de pro-fesionales deban abrigarse. (AU)

Infection in orthopedic surgery and traumato-logy can be catastrophic, among the factors invol-ved is temperature. Working in an optimal thermal range is essential for the control of healthcare-as-sociated infections, the maintenance of vital pa-tient functions, and the performance of safe and efficient work. The temperature in the operating room of a COT should range from 18°C to 24°C to reduce the risk of nosocomial infections and, at the same time, provide comfort to the orthopedic surgeon in his work, even if this means that the other profes-sionals must wrap up warm. (AU)

Clinical experience with desflurane for paediatric anaesthesia outside the operating room. / Experiencia clínica con desflurano para anestesia pediátrica fuera de quirófano.

BACKGROUND: Desflurane has been used in paediatric patients for several surgical indications. This article analyses the efficacy and safety of desflurane for diagnostic-therapeutic procedures in remote areas far from operating room in a group of selected patients with no known associated respiratory disease. MATERIAL AND METHODS: A retrospective analysis was performed on 2,072 general anaesthesia procedures stored in a computer database, in which desflurane was used in a Paediatric Pain Unit during the years 2013 and 2014. An analysis was also performed using the patient demographics, type of procedure, anaesthetic technique, type of airway management, patient cooperation, and incidence of anaesthetic complications. RESULTS: The study included 876 patients, with a mean age of 8.8 years. The main procedures were bone marrow aspirates (23%), lumbar punctures (20%), panendoscopies (15%), and colonoscopies (5%). Induction was intravenous with propofol (26%) or inhalation with sevoflurane in the remaining 74%. Maintenance consisted of remifentanil and desflurane at mean end tidal concentrations of 6.2±2.1%. The airway was managed through a nasal cannula or face mask in spontaneous ventilation. The effectiveness was 98%, and the incidence of side effects was 15%, which included agitation (6%), headache (4%), nausea-vomiting (3%), and laryngospasm (2%). CONCLUSION: The maintenance with desflurane (at concentrations close to the hypnotic-MAC in spontaneous ventilation) was effective, with a rapid recovery, and with a low incidence of adverse effects.