Noisy Operating Rooms May Jeopardize Patient Safety

WEDNESDAY, May 15 (HealthDay News) -- Background noise in the operating room -- such as the sounds of surgical equipment, chatter or music -- can affect surgeons' ability to understand what is being said to them and might result in a breakdown of communication among surgical team members, according to a new study.

This is particularly worrisome since miscommunication is cited as a common reason for medical errors that could have been prevented, the study authors said. Surgeons have critical conversations during operations, and information on medications, dosing and blood supply could sound similar. The researchers emphasize that clear communication during surgical procedures is essential to ensure the safety of patients.

The study was published in the May issue of the Journal of the American College of Surgeons.

"The operating room is a very fast-paced, high-demand, all-senses-running-on-all-cylinders type of environment," study co-author Dr. Matthew Bush, an assistant professor of surgery at the University of Kentucky Medical Center, in Lexington, said in a journal news release. "To minimize errors of communication, it is essential that we consider very carefully the listening environment we are promoting in the operating room."

The researchers gave an example of a possible miscommunication: A request for heparin might be heard as "Hespan," an entirely different drug.

In conducting the study, the researchers simulated a noise environment similar to the noise levels found in an operating room. Fifteen surgeons with between one and 30 years of experience were tested on their ability to understand and repeat words under four different conditions: quiet, noise filtered through a surgical mask, background noise without music and background noise with music.

The surgeons were tested while performing a specific surgical task as well as when they were not engaged in a task.

Noise interfered with the surgeon's speech comprehension when the words spoken to them were unpredictable, the study showed. This interference with speech comprehension was worse when there was noise in the operating room.

Background music also impaired the surgeons' ability to understand what was said to them while they were performing a surgical task.

The researchers concluded that background noise in operating rooms could impair surgeons' ability to process what they hear, particularly when music is being played. The situation becomes even more problematic when surgical teams are trying to communicate critical and unpredictable information.

"Our main goal is to increase awareness that operating room noise does affect communication and that we should foster the best environment in which we can communicate better," Bush said. "This effort means that the surgical team needs to work diligently to create the safest environment possible, and that step may mean either turning the music off or down, or limiting background conversations or other things in the environment that could lead to communication errors and medical mistakes."

The researchers plan to continue their research on a larger scale and also examine the effects of operating room noise on anesthesiologists, nurses and surgeons who are hearing impaired.

"I think it's important to demonstrate the effect of environmental operating noise on communication on a variety of different players in the operating room setting," Bush said. "Another step from here is to not only see how noise affects our understanding of speech, but how it affects our tasks and how it affects our ability to perform surgical procedures efficiently and effectively."

-- Mary Elizabeth Dallas
Copyright © 2013 HealthDay. All rights reserved. SOURCE: Journal of the American College of Surgeons, news release, May 10, 2013

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Closed Windows in Hospital Rooms May Raise Infection Risk

FRIDAY, April 19 (HealthDay News) -- Closed windows in large hospital wards may increase patients' risk of getting an infection, a new study suggests.

British researchers used carbon dioxide as a tracer gas to simulate how airborne infections spread in a traditional hospital ward, which typically includes two rows of up to 30 beds.

The carbon dioxide represented potentially infectious exhaled breath, and was released by popping carbon dioxide-filled balloons. Carbon dioxide detectors were placed where beds might be located in a functioning ward.

"By measuring the concentration of the gas over time, we were able to quantify the exposure at each bed and therefore the potential risk to a patient in that bed," study team member Laura Pickin said in a University of Leeds news release. "We were also able to use the same data to measure the overall ventilation rate in the ward."

When the windows were open, ventilation in the ward was generally good and the risk of airborne infection low. But the danger of infection increased fourfold when the windows were closed, according to the study in the current online issue of the Building and Environment Journal.

"These wards are still in operation and, although they have often been subdivided into smaller areas with six to eight beds, their ventilation and structure is still fundamentally the same," lead investigator Cath Noakes, from the University of Leeds' School of Civil Engineering, said in the news release.

With natural ventilation from windows, the wards are safe. But that changes when the windows are closed during the winter or permanently sealed to lower energy costs.

"Some of these wards were designed by the Victorians, and our results show that they knew what they were doing. But there is a danger that we could be adapting our buildings to improve efficiency without thinking how it might affect patients," Noakes said.

-- Robert Preidt
Copyright © 2013 HealthDay. All rights reserved. SOURCE: University of Leeds, news release, April 16, 2013

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'Nonsmoking' Hotel Rooms May Not Fully Protect Guests

Partial smoking bans still left study participants with signs of tobacco exposure

By Mary Elizabeth Dallas

HealthDay Reporter

TUESDAY, May 14 (HealthDay News) -- People who opt for nonsmoking rooms in hotels with a partial smoking ban are not fully protected from harmful exposure to so-called "thirdhand" smoke, according to a new study.

Smoking in hotels leaves a trail of tobacco pollution in the air and on surfaces in both smoking and nonsmoking rooms, researchers Georg Matt and colleagues at San Diego State University found. New hotels should enforce total smoking bans to protect their guests and employees, said the study authors, who also advised people to avoid hotels that allow smoking in designated areas.

"Our findings demonstrate that some nonsmoking guest rooms in smoking hotels are as polluted with [third-hand smoke] as are some smoking rooms," the researchers wrote. "Moreover, nonsmoking guests staying in smoking rooms may be exposed to tobacco smoke pollutants at levels found among nonsmokers exposed to secondhand smoke."

The study involved 40 budget-priced to mid-range hotels in San Diego. Of these hotels, 10 had complete smoking bans. Thirty hotels had partial smoking bans with designated nonsmoking rooms. The findings appeared online May 13 in the journal Tobacco Control.

The researchers examined the hotel rooms' surfaces and air quality for evidence of nicotine and 3EP, a marker of tobacco smoke. Urine and finger wipe samples were also taken from nonsmokers who spent the night at any of the hotels to assess their exposure to nicotine and a carcinogen found in tobacco smoke known as NKK.

Nonsmoking rooms in hotels with partial smoking bans had evidence of air pollution. These designated nonsmoking rooms had levels of surface nicotine that were more than twice as high as rooms in hotels with total smoking bans, according to a journal news release.

These nonsmoking rooms had air levels of 3EP that were more than seven times as high as the rooms in hotels that did not permit any smoking.

In rooms designated as smoking areas, the researchers found that surface and air nicotine levels were 35 and 22 times higher than the rooms in hotels that had total smoking bans. The air nicotine levels in smoking rooms were also much higher than nonsmoking rooms.

Even the nonsmoking rooms of hotels with partial smoking bans had air nicotine levels that were 40 percent higher than in rooms in hotels with total smoking bans.

The effects of smoking were not confined to the hotel rooms. The study also showed that hallway surfaces outside of smoking rooms had higher nicotine levels than the surfaces outside nonsmoking rooms.

The samples taken from nonsmokers who stayed in hotels with partial smoking bans had higher levels of nicotine and NKK than those staying in nonsmoking hotels.

"Guests who wish to protect themselves from exposure to tobacco smoke should avoid hotels that permit smoking and instead stay in completely smoke-free hotels," the researchers wrote.

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