BACKGROUND: In 2020, routine cataract surgery was halted in most countries due to the COVID-19 pandemic in order to reduce transmission. With a consequent lack of theatre space, we developed a safe cataract pathway in outpatient department clean rooms to minimize patient exposure and time spent in hospital using a sterile laminar air flow device. We describe our initial experiences of restarting elective cataract surgery in the UK outpatient setting, outside of the operating theatre environment.

METHODS: This was a prospective consecutive study of our clinical practice. A sterile air zone unit, the Toul Meditech Operio Mobile device, was used to create a sterile surgical site in three separate outpatient clean rooms from May 2020 to December 2021 in different geographical locations within Herefordshire, UK. Observations of the time spent in the department and a formal patient satisfaction survey were carried out for the initial 100 patients. All patients were followed up to assess development of postoperative complications.

RESULTS: 1269 patients were included in the study. No patients sustained post-operative infection (n = 0/1269, 0%). For the initial 100 patients, the average time spent within the department was 74.3 min (unilateral cases, range 45–115 min) and 93.1 min (bilateral, 55–135 min). Patient satisfaction was high.

CONCLUSION: Initial results demonstrate a safe, efficient and effective cataract surgery pathway with high patient satisfaction by converting outpatient clean rooms into ophthalmic operating theatres using the Toul Meditech Operio Mobile.

Read more at https://www.nature.com/articles/s41433-022-02317-7

Efforts to protect patients from avoidable harm should include a focus on the space surrounding the sterile field, suggests a recent study.

Publishing in the journal Surgery, the researchers say that although the accepted standard on the ventilation of ORs requires a minimum of 20 air changes per hour with a minimum of four outdoor air exchanges, externally sourced air can still present microbial and chemical contaminates to the OR.

Read the article in Outpatient Surgery Magazine

https://www.aorn.org/outpatient-surgery/articles/enews-briefs/nov-17-2022

Studien utfördes vid Sahlgrenska/Mölndals sjukhus.

188 prover från luften och 124 prover över instrumenten samlades in under 48 kirurgiska operationer med implantat. Analysen visade att lokalt riktat luftflöde ovanför de kirurgiska instrumenten signifikant minskade antalet bakterier i luften ovanför assistentbordet (P<0,001) och instrumentbordet (P=0,002), såväl som på de simulerade instrumenten på assistentbordet (P=0,001).

Läs hela studien på engelska på: https://www.sciencedirect.com/science/article/pii/S2590088922000233?via%3Dihub

Läs hela artikeln på engelska här:

https://journals.sagepub.com/eprint/HKEZTE4ZDVKUJC3HK5B5/full

Several important steps were introduced that contributed to achieve these positive results.

During the time when the study was carried out the Toul Meditech air flow technology was used for more than 5000 joint replacements and over 3000 spinal surgeries, as well as other surgeries. The Toul Meditech air flow technology has become a part of the Hospital’s infection control system according to Dr. Lukas Maansson, who is one of the authors of the study.

To read the article go to:

https://bmjopenquality.bmj.com/content/10/4/e001134