Mobile laminar air flow screen for additional operating room ventilation: reduction of intraoperative bacterial contamination during total knee arthroplasty

Background Surgical site infections are important complications in orthopedic surgery. A mobile laminar air flow (LAF) screen could represent a useful addition to an operating room (OR) with conventional turbulent air ventilation (12.5 air changes/h), as it could decrease the bacterial count near the operating field. The purpose of this study was to evaluate LAF efficacy at reducing bacterial contamination in the surgical area during 34 total knee arthroplasties (TKAs). Materials and methods The additional unit was used in 17 operations; the LAF was positioned beside the operating table between two of the surgeons, with the air flow directed towards the surgical area (wound). The whole team wore conventional OR clothing and the correct hygiene procedures and rituals were used. Bacterial air contamination (CFU/m3) was evaluated in the wound area in 17 operations with the LAF unit and 17 without the LAF unit. Results The LAF unit reduced the mean bacterial count in the wound area from 23.5 CFU/m3 without the LAF to 3.5 CFU/m3 with the LAF (P<0.0001), which is below the suggested limit for anORwith ultraclean laminar ventilation. There were no significant differences in the mean bacterial count in the instrument table area: 28.6 CFU/m3 were recorded with the LAF (N = 6) unit and 30.8 CFU/m3 (N = 6) without the LAF unit (P = 0.631). During six operations with LAF and six without LAF, particle counts were performed and the number of 0.5 lm particles was analyzed. The particle counts decreased significantly when the LAF unit was used (P = 0.003). Conclusion When a mobile LAF unit was added to the standard OR ventilation, bacterial contamination of the wound area significantly decreased to below the accepted level for an ultraclean OR, preventing SSI infections

Prospective Study of Infection, Colonization and Carriage of Methicillin-Resistant Staphylococcus Aureus in an Outbreak Affecting 990 Patients

In the three years between November 1989 and October 1992, an outbreak of methicillin-resistantStaphylococcus aureus (MRSA) affected 990 patients at a university hospital. The distribution of patients with carriage, colonization or infection was investigated prospectively. Nosocomial acquisition was confirmed in at least 928 patients, 525 of whom were identified from clinical specimens as being infected (n=418) or colonized (n=107) by MRSA. An additional 403 patients were identified from screening specimens, of whom 58 subsequently became infected and 18 colonized. Screening of the nose, throat and perineum detected 98 % of all carriers. Of the 580 infections in 476 patients, surgical wound, urinary tract and skin infections accounted for 58 % of the infections. Of the 476 infected patients, death was attributable to MRSA infection in 13 %. Colonization with MRSA was found in 127 patients and 42 % of 165 colonized sites were the skin. Auto-infection from nasal carriage or cross-infection, probably via staff hands, seemed to be the most common mode of acquisition of MRSA infections

The Shaping of Form: Exploring Designers’ Use of Aesthetic Knowledge

Research on design and designers has emphasized the tacit nature of the aesthetic knowledge that these professionals draw upon to make decisions about formal properties of objects and spaces, but is less clear about how design teams address the difficulties associated with expressing and sharing this type of knowledge. A ten-month ethnography in a design consultancy revealed a range of multimodal and cross-modal ways in which members of a design team compensate their imperfect capacity of articulating verbally their aesthetic knowledge in order to gradually construct a common knowledge base enabling creative collaboration. In so doing, our study offers two main contributions. It illuminates the interplay between designers’ aesthetic experiences, visceral responses, and intuitive cognitive processes that enable designers to draw upon their aesthetic knowledge to support the collective accomplishment of their task, and provides an interpretation of the design process as a form of ‘creative’ intuition driven by emotional reactions to environmental stimuli and emerging formal solutions

Equal opportunities: Do shareable interfaces promote more group participation than single users displays?

Computers designed for single use are often appropriated suboptimally when used by small colocated groups working together. Our research investigates whether shareable interfaces–that are designed for more than one user to inter-act with–can facilitate more equitable participation in colocated group settings compared with single user displays. We present a conceptual framework that characterizes Shared Information Spaces (SISs) in terms of how they constrain and invite participation using different entry points. An experiment was conducted that compared three different SISs: a physical-digital set-up (least constrained), a multitouch tabletop (medium), and a laptop display (most constrained). Statistical analyses showed there to be little difference in participation levels between the three conditions other than a predictable lack of equity of control over the interface in the laptop condition. However, detailed qualitative analyses revealed more equitable participation took place in the physical-digital condition in terms of verbal utterances over time. Those who spoke the least contributed most to the physical design task. The findings are discussed in relation to the conceptual framework and, more generally, in terms of how to select, design, and combine different display technologies to support collaborative activities

Dutch guideline on total hip prosthesis

Contains fulltext : 97840.pdf (publisher's version ) (Open Access

Reducing implant infection in orthopaedics (RIIiO): results of a pilot study comparing the influence of forced air and resistive fabric warming technologies on post-operative infections following orthopaedic implant surgery

BACKGROUND Active warming during surgery prevents perioperative hypothermia but the effectiveness and post-operative infection rates may differ between warming technologies. We report results of a pilot study in patients over the age of 65 undergoing hemiarthroplasty following fractured neck of femur. AIM To establish the recruitment and data management strategies needed for a full trial comparing post-operative infection rates associated with forced air versus resistive fabric warming. METHODS Participants were randomised 1:1 in permuted blocks to forced air or resistive fabric warming. Hypothermia was defined as a temperature of <36ºC at the end of surgery. Primary outcomes were the number of participants recruited and the number with definitive deep surgical site infections. FINDINGS 515 participants were randomised at 6 sites over a period of 18 months. Follow-up was completed for 70.1%. Thirty-seven participants were hypothermic (7.5% in the FAW group; 9.7 % in the RFW group). The mean temperatures before anaesthesia and at the end of surgery were similar. For the primary clinical outcome, there were 4 deep surgical site infections in the forced air warming group and 3 in the resistive fabric warming group. All participants who developed a post-operative infection had antibiotic prophylaxis, a cemented prosthesis and were operated under laminar airflow; none were hypothermic. There were no serious adverse events related to warming. CONCLUSION Surgical site infections were identified in both groups. Progression from the pilot to the full trial is possible but will need to take account of the high attrition rate. TRIAL REGISTRATION ISRCTN 74612906 (http://www.isrctn.com/ISRCTN74612906)

Human factors and ergonomics design principles and guidelines : helping designers to be more creative

This is a pre-copyedited version of a contribution published in: Proceedings of the 20th Congress of the International Ergonomics Association (IEA 2018). IEA 2018. Advances in Intelligent Systems and Computing, vol 824, edited by Bagnara S., Tartaglia R., Albolino S., Alexander T., Fujita Y., published by Springer, Cham. The definitive authenticated version is available online via https://doi.org/10.1007/978-3-319-96071-5_17.The knowledge and application of Human Factors/Ergonomics (HFE) principles and guidelines can help designers to develop better products and services. However, they may also include design constraints that may affect designers’ creativity. Although both HFE principles and guidelines and creativity are considered essential in the design of products and services, the link between them is little researched. In this article a discussion is presented on the influence that HFE principles and guidelines can exert on the creativity of designers. It also presents case studies of HFE principles and guidelines and discusses how they can influence designers’ creativity. In addition, a set of recommendations is suggested to help designers apply ergonomic design principles and guidelines to stimulate creativity. It is concluded that HFE principles and guidelines can assist designers in creating safer and more efficient products and services and can also broaden their creative process and therefore the originality and appropriateness of products and services

The production of a physiological puzzle: how Cytisus adami confused and inspired a century’s botanists, gardeners, and evolutionists

‘Adam’s laburnum’ (or Cytisus adami), produced by accident in 1825 by Jean-Louis Adam, a nurseryman in Vitry, became a commercial success within the plant trade for its striking mix of yellow and purple flowers. After it came to the attention of members of La Société d’Horticulture de Paris, the tree gained enormous fame as a potential instance of the much sought-after ‘graft hybrid’, a hypothetical idea that by grafting one plant onto another, a mixture of the two could be produced. As I show in this paper, many eminent botanists and gardeners, including Charles Darwin, both experimented with Adam’s laburnum and argued over how it might have been produced and what light, if any, it shed on the laws of heredity. Despite Jean-Louis Adam’s position and status as a nurseryman active within the Parisian plant trade, a surprising degree of doubt and scepticism was attached to his testimony on how the tree had been produced in his nursery. This doubt, I argue, helps us to trace the complex negotiations of authority that constituted debates over plant heredity in the early 19th century and that were introduced with a new generation of gardening and horticultural periodicals