The Motor in the Machine: A Lesson in Surgical Processing

Maziar M. Nourian

摘要

When physicians-in-training think about surgery they usually imagine clean, shiny operating rooms (ORs) with fancy equipment and monitors. They imagine bright, focused lights directed toward the operating table, where a surgical team actively engages in addressing an urgent health concern. They think of physicians and nurses gowned and huddled over sterile equipment, ready to operate. Likely, the last thing that learners think about is how ORs function safely and efficiently. One key player in this scene is the surgical processing department, which acts as the motor in the machine that is the OR. The surgical processing department of the OR can be described as a “magical” place where dirty instruments go in, and then reappear clean and ready to use. As one spends time observing this, there has to be appreciation for the individuals who pride themselves on improving patient care through efficiently directing the behind-the-scenes operations. As medical students or residents, we learn relatively little about how a hospital functions. We learn the pathophysiology of disease, and try to keep up on rounds until we move onto the next service. Knowing virtually nothing about surgical processing, I was baffled by the prodigious amount of organization and attention to detail. The backrooms of the OR are filled with cabinets packed with bins of sutures, tape, synthetic skin, and other supplies. These cabinets are linked to a system that rolls and compresses them for efficient use of space. Every sterilized item (both disposable and reusable) is placed into this highly organized system with a code that allows searching for the cabinet, row, or bin that holds the item. Everything about this setting reflects a system that is carefully planned and has efficiency in mind, from how to set up an OR cart to where items in a surgical kit are arranged. The intent is to make the surgeons' life easier, reduce OR time, and improve patient care. This attention to detail can be viewed as an art, as surgical processing staff proactively foresee problems and strive for excellence. It is important for anyone involved in surgery to understand and appreciate the service surgical processing provides to ensure safe patient care. For instance, the perioperative nursing staff work with the surgical processing department on an ongoing basis.1 Understanding what goes on behind-the-scenes is how future physicians can be real partners in preventing hospital-acquired infections. Process errors in surgical processing can be fatal. As an example, “the largest disinfection failure on record involved the distribution of an inactive lot of glutaraldehyde disinfectant solution to 60 hospitals in Belgium and involved 34?879 patients.”2 In 2006, failure to reprocess prostate biopsy equipment in the US Department of Veterans Affairs exposed 2075 patients.2 Recently, a drug-resistant organism in endoscopic equipment resulted in scopes being cleaned to a high level of disinfection regardless of prior use.3 With surgical site infections representing 22% of the 722?000 yearly health care–associated infections, it is important for all physicians to understand what must be done to reduce these numbers.4 It is particularly important for future surgeons to understand the difference between instruments that are sanitized and those that are sterilized, and to deeply comprehend the ramifications of dropping sterile equipment or using an endoscope that has not been properly stored. I suggest that surgery residency programs include a half-day shadowing requirement to allow interns to observe the processes, reports, and quality control measures involved in surgical processing. My experience with surgical processing has provided better insight into how this service makes surgeons' lives easier and helps them provide the best service to patients.

机译：当接受培训的医生考虑手术时，他们通常会想到带有豪华设备和监视器的干净，明亮的手术室（OR）。他们想象着明亮，聚焦的光射向手术台，在那儿，外科团队积极参与解决紧急健康问题。他们想到医生和护士穿着无菌手术设备，准备手术。学习者可能想到的最后一件事是OR如何安全有效地运作。该场景中的一个关键角色是外科手术处理部门，它充当OR机器中的电机。手术室的外科手术部门可以说是一个“神奇”的地方，脏仪器进入其中，然后重新出现，干净并可以使用。随着人们花时间观察这一点，必须对那些以有效地指导幕后操作而改善患者护理为荣的个人表示赞赏。作为医学生或居民，我们对医院的运作了解得很少。我们学习疾病的病理生理学，并努力保持步调一致，直到我们进行下一个服务为止。几乎对外科手术一无所知，我对如此庞大的组织和对细节的关注感到困惑。手术室的后室装满了装有缝线，胶带，人造皮肤和其他用品的箱子的柜子。这些机柜链接到一个滚动和压缩它们的系统，以有效利用空间。每个经过消毒的物品（一次性和可重复使用的）都被放置在这个高度组织的系统中，其代码允许搜索容纳该物品的柜子，行或箱。从如何设置“手术室”推车到安排手术套件中的物品的位置，有关此设置的所有内容均反映了经过精心计划并牢记效率的系统。目的是使外科医生的生活更轻松，减少手术时间并改善患者护理。这种对细节的关注可以被视为一门艺术，因为外科手术处理人员会积极地预见问题并追求卓越。对于参与手术的任何人来说，重要的是要了解和欣赏手术过程所提供的服务，以确保患者得到安全的护理。例如，围手术期的护理人员一直在与外科手术部门合作。1了解幕后情况是未来的医生如何成为预防医院获得性感染的真正伙伴。外科手术过程中的过程错误可能是致命的。例如，“有史以来最大的消毒失败案例是向比利时的60家医院分发了一批无效的戊二醛消毒液，涉及34至879名患者。” 2 2006年，美国卫生部未能重新处理前列腺活检设备退伍军人事务部（Veterans Affairs）暴露了2075名患者。2最近，内窥镜设备中的一种抗药性生物导致将内窥镜清洗至高度消毒状态，而不论以前使用过什么。3手术部位感染占每年722,000例医疗保健的22％–对于所有相关的感染，对所有医生而言，了解减少这些数量所必须采取的措施非常重要。4对于未来的外科医生而言，了解经过消毒的器械与经过消毒的器械之间的差异以及深刻理解其后果是特别重要的。掉落无菌设备或使用未正确存放的内窥镜。我建议外科住院医师计划包括半天的遮蔽要求，以允许实习生观察外科手术中涉及的过程，报告和质量控制措施。我在外科手术处理方面的经验使我们可以更好地了解这项服务如何使外科医生的生活更轻松，并帮助他们为患者提供最佳服务。

The Motor in the Machine: A Lesson in Surgical Processing

摘要

著录项

相似文献

相关主题

期刊订阅