Organising theatre list

Question 1

Important things not to miss when handwriting list

Answer 1

-Comorbidities
-Anticoagulants
-Surgical details e.g. laterality
-Sign, date, add time to bottom of list

Question 2

What preoperative measures can reduce surgical site infection?

Answer 2

-Hair removal at surgical site
-Theatre staff removing hand jewellery

Question 3

What perioperative measures can reduce surgical site infection rates?

Answer 3

-Tight glycaemic control
-Oxygen supplementation
-Maintain normothermia
-Careful prepping and draping
-Well ventilated theatre
-Antibiotic prophylaxis if indicated
-Sterile gowns for theatre staff

Question 4

Postoperative mesures to reduce SSI

Answer 4

-Aseptic dressings for wounds
-Wound care advice to pt
-Appropriate ward care by staff with regular review

Question 5

How would you classify measures to reduce infection?

Answer 5

Preoperative
Perioperative
Post operative

Question 6

How many doses of antibiotics would you give if indicated prophylactically?

Answer 6

-Clean-contaminated: single dose
-Contaminated: 3 doses
-Dirty: Prolonged

Question 7

What are high risk patient factors for infection?

Answer 7

-Immunocompromise
-Poorly controlled diabetes
-Malnutrition
-High BMI

Question 8

What are procedures with high consequence for infection?

Answer 8

-Orthopaedic or vascular implant surgery
-Entry into bone cavities e.g. sternotomy
-Metallic or other prosthetic heart valves

Question 9

When are prophylactic antibiotics indicated in surgery?

Answer 9

-When risk of infection is high (>4%)
-Patients with risk factors
-High risk procedures

Question 10

What are the current guidelines for perioperative glycaemic control in the diabetic patient?

Answer 10

Patients with diabetes must be prioritised on waiting list

Routine overnight admission is unneccesary

Starvation time should be no more than 1 missed meal

Analgesia and antiemetics should be used to enable early return to diet and usual insulin regime

Insulin infusions should only be used if pt expected to miss more than 1 meal

Hrly BMs with target 6-10

0.45% nacl with 5% glucose and 0.15 or 3% kcl is recommended IV fluid

Question 11

When should metformin be stopped before an operation?

Answer 11

omit metformin on morning of procedure to reduce lactic acidosis and renal impairment

Question 12

Why should diabetics go first in list?

Answer 12

-Prevents complications of hypoglycaemia
-Allows early return to normal glycaemic control
-Peri and post op normoglycaemia reduces risk of SSI

Question 13

How should pt’s with latex allergy be managed?

Answer 13

-1st on list
-requires clean theatre, time must be given for previous latex ‘dust’ to settle
-All latex products should be removed from theatre or clearly labelled

Question 14

How should children me managed?

Answer 14

Early in list
Minimises distress to child and patients

Question 15

how should local patients be managed?

Answer 15

1st or last on list as professional courtesy
Small cases can be between cases to allow recovery of previous pt and anaesthetisation of next

Question 16

How should major procedures and cancers be managed?

Answer 16

-Should not be cancelled due to time constraints
-Should be early on list

Question 17

How should patients with infections be managed?

Answer 17

-e.g. MRSA + C.dif should go last on list to avoid contamination between patients
-If possible, order list clean, clean-contaminated, dirty

Question 18

What are factors that affect list decision making?

Answer 18

Diabetics
Latex allergies
Children
Procedure under LA
Major procedures
Patients with infection
Clinical priority: NCEPOD criteria

Question 19

What are factors that affect list decision making?

Answer 19

Diabetics
Latex allergies
Children
Procedure under LA
Major procedures
Patients with infection
Clinical priority: NCEPOD criteria

Question 20

How is an operating theatre laid out? How does this help avoid infections?

Answer 20

-Located near relevant facilities: A + E, radiology, ITU
-Away from main entrances/public areas
-Large enough to hold staff/equipment/pt
-Access to th from anaesthetic room, scrub room, prep room, recovery area
-Easy access to control temp/humidity/ventilation/light

Question 21

What does WHO checklist involve?

Answer 21

Sign in
Time out
Sign out

Question 22

What does sign in involve?

Answer 22

Before induction anaesthesia

Pt has confirmed:
-Identity
-Site
-Procedure
-Consent

Site marked

Anaesthesia safety check confirmed

Confirm allergies

Airway + bleeding risks highlighted + appropriate precaution taken (e.g. difficult airway trolley, G+ S

Question 23

Time out (before skin incision)

Answer 23

Introduce all members of team + roles
Confirm pt name, site + procedure
Surgeons highlight anticipated critical events e.g. blood loss
Anaesthetic team highlight specific concerns (glycaemic control, cardiac risks, problems at induction)
Antibiotic prophylaxis given/needed
Thromboprophylaxis given/needed
Essential imaging displayed

Question 24

Sign out (before pt leaves operating room)

Answer 24

Confirm name + site of procedure
Confirm swab + instrument count correct
Confirm specimens labelled
Equipment problems
Any concerns for recovery

Question 25

How can lay out of theatre complex affect pt safety>

Answer 25

-ITU nearby and on same level
-Close proximity to emergency/radiology departments
-Away from main entrance + general hospital traffic
-Theatres should be next to each other to reduce staff movement
-Anaesthetic rooms should be adjacent to theatres
-Sterile services in unit

Question 26

What measures do you know to improve operative safety?

Answer 26

Surgical: appropriate experience/supervision, communication, anticipating events + planning, e.g. ensuring x matched blood available

Environmental: theatre design and layout, appropriate monitoring

Others: regular auditing of results, pre op assessment

Question 27

How would you prepare skin before surgery?

Answer 27

Hair removal
Operation site cleaned with swab impregnated with detergent
skin prepped with alcohol based chlorhexadine or povidone-iodine. Should be dried completely and not pool
Skin should be prepped cleanest area to dirtiest

Question 28

What are the criteria for consideration of day surgery?

Answer 28

-ASA 1 or 2
-BMI <35
-Projected operative time < 1hr
-Acceptable to pt
-Home support on discharge + home phone
-Must live close to hospital