Cleanliness is essential for every healthcare setting. The healthcare industry is tasked with protecting the health of millions of people every day. Part of maintaining patients’ well-being is protecting them from bacteria that may be present in a facility that provides medical treatment. Regular cleaning is important to most businesses, but it’s absolutely essential for any healthcare setting, whether it’s a small doctor’s office or a large regional hospital.
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Working with professional janitorial providers focused on meeting environmental cleaning standards for healthcare facilities can provide many benefits for employees and patients. The patient-centered healthcare cleaning programs from the experts at ServiceMaster Clean were designed to help your business achieve three critical goals:
The Occupational Safety and Health Administration (OSHA) mandates that healthcare settings in the U.S. follow specific healthcare cleaning standards. Healthcare businesses that don’t comply may be subject to fines and even closure. Facilities that don’t prioritize compliance may also be held legally liable, should serious health issues occur for patients or employees because of an unclean setting.
To maintain a clean healthcare facility, it’s important to work with an environmental services agency that’s well-versed in OSHA standards, as well as the standards recommended by the following industry associations and organizations:
Before hiring a commercial janitorial provider for your facility, make sure its procedures are based on the above regulatory requirements to provide adequate, patient-centered cleaning.
A messy or unsanitary healthcare business is unlikely to be a profitable one. Patients aren’t going to want to return to medical settings that aren’t professionally maintained. Healthcare businesses should not only keep the medical side of their offices disinfected, but also thoroughly clean the public areas of their facility - or risk patient attrition. Dirty seat cushions in the waiting room, filled waste cans, or visible dirt or grime on floors and furnishings suggest that the facility does not take the responsibility of maintaining a safe, healthy environment seriously.
To maintain a professional medical setting, routine cleaning is essential. Whether the business concerned is a busy outpatient facility or a small dental practice, professional environmental cleaning services can help ensure your patients' expectations are being met every day.
Healthcare facilities depend on skilled employees with extensive training and qualifications. Due to the high costs of medical malpractice claims, licensed physicians and nurses are unlikely to stick with a healthcare business that does not meet environmental cleaning standards and regulations. In addition to retaining staff, strict cleaning standards can help improve the healthcare work environment and help increase productivity and worker satisfaction.
Healthcare workers come into contact with countless germs. Professional healthcare cleaning services help protect both staff and patients from potentially serious and even deadly infections. When choosing a cleaning service to maintain your healthcare environment, select a provider committed to meeting the standards and expectations for healthcare environments.
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The technical knowledge of surgeons and trainees varies widely in the area of laparoscopy-related troubleshooting. This systematic, practical algorithm would help and guide all surgeons to adopt a uniform approach, thereby improving patient safety.
There are a number of approaches that have been published for troubleshooting laparoscopy stack. We explore and discuss some of them along with their advantages and disadvantages and how they relate to our methodology and approach. As a product of the discussion, we suggest a systematic way forward to troubleshooting laparoscopic tower equipment problems.
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Despite this widespread adoption and acceptance, many surgeons struggle to understand how the laparoscopy stacks work despite having the skills to perform the operation. Most hospitals rely on operating theatre assistants to troubleshoot in the event of problems. This could be potentially unsafe for patients if laparoscopic vision or pneumoperitoneum is lost at a critical point of the operation.
Laparoscopic surgery has progressed rapidly since the early 1990s. For some surgical operations, it has become the standard of care to the extent where open surgery is sometimes looked down upon by some surgical colleagues as well as by patients.
The core equipment in laparoscopic surgery has largely remained unchanged since the 1990s and this includes the scope, the laparoscopic tower or stack and the connection cables [ 1 ]. However, as the laparoscopic procedures undergo new innovations and become more complex, equipment continue to evolve to keep up with the latest surgical techniques as well as technological advancement [ 2 ]. With this, the maintenance and troubleshooting of laparoscopic equipment in the event of technical problems also become challenging. To optimise patient safety, theatre staff including surgeons need to have a basic understanding and knowledge of laparoscopic equipment [ 3 , 4 ]. Currently, many surgical training programmes do not seem to have dedicated curricula addressing this issue among surgical trainees. Furthermore, different companies that manufacture the same type of surgical equipment may have a wide variety of modifications [ 5 ].
There are various laparoscopic skill courses that are conducted by training bodies. The Royal Australian College of Surgeons (RACS) conducts Australian and New Zealand Surgical Skills Education and Training (ASSET), where trainees are taught the basics of laparoscopic skills [ 7 , 8 ]. This is equivalent to the Basic Surgical Skills Course (BSS) in England and the Fundamentals of Laparoscopic Skills (FLS) in the United States. These courses are conducted over 2–3 days. The half-day session that addresses laparoscopy on this course is entitled “Principles and Practice of Rigid Endoscopy”. The objective, as stated in its curriculum, is to ensure that the candidate “displays competency in a variety of basic practical skills relating to different endoscopic environments and the mechanics of instrumentation”. During this course, candidates are introduced to various elements of laparoscopy, such as camera, scope, fibre optic cable, light source, gas connection and operations of the basic mechanics, and connections and operations of these elements. Candidates are then guided toward performing a number of simple laparoscopic tasks and practicing them. However, they are not taught methods regarding troubleshooting if any issues arise, except for checking connections and attempting to obtain a clearer image by adjusting settings on the camera head itself. In addition, the FLS course covers elements such as operating room setup, ergonomics, general use of laparoscopic instruments and equipment, safety consideration using the laparoscopic stack, laparoscopic training box and virtual reality trainers [ 9 ]. The breadth and depth of the curriculum required to teach laparoscopic equipment troubleshooting techniques are limited by time constraints.
Laparoscopy as a technique is common in general surgery, with aspiring trainees being exposed to the various aspects of laparoscopy even before they enter training. So, what is the current understanding and skill set of trainees regarding the troubleshooting of laparoscopic equipment, including the laparoscopic tower? Many of these surgical trainees are competent in basic laparoscopic skills before application for training. In fact, it is a requirement in many countries for prospective applicants to training programme to have that basic knowledge of laparoscopy [ 6 ]. This implies that prospective and current surgical trainees have good understanding of the principles of basic laparoscopy. However, the question remains: does this translate to good understanding and troubleshooting technique among trainees?
The commonest source of problems when having trouble with laparoscopy equipment seem to be the scope, camera head, light cable, light source, insufflation tube and gas insufflator [10]. There are a number of ways that problems could be addressed. A large proportion of the problems are due to user error. Different companies producing slightly different types of laparoscopic equipment, which is continuously evolving, adds another element of difficulty to the process of troubleshooting [5].
Verdaasdonk et al. [11] suggested that any approach to troubleshooting laparoscopic equipment challenges should be systematic and standardised and incorporate a form of checklist. They showed a 53% decrease in the adverse incidents while using such a systematic approach. The usage of checklist taking into account the fact that there are different types of laparoscopic stack and adjuncts has its own challenges, and one may need different checklists for different manufacturers.
Mees et al. [10] from Adelaide proposed an approach represented in the form of a flow diagram and followed a series of checklists. Their approach was to start with the monitor and work the way toward various leads and connections and then to the camera head and scope itself. Their study, however, specifically addressed poor image quality and how to solve those issues. It did not address issues related to gas insufflation.
Tichansky et al. [12] suggested a method where the whole laparoscopic equipment and its various adjuncts were divided into three groups, and problems associated with each group were addressed individually. They were (a) the laparoscopic stack that included the monitor, image enhancement system, gas insufflator (thermoflator) and light source; (b) leads that included fibre optic cable for light transmission, camera lead connected to the camera head, and the gas insufflation tube; and (c) the laparoscope itself. The image enhancement system is in turn connected to the monitor (up to two monitors could be connected), image link modules (up to three), light source, and documentation system (keyboard, printer and screen). The image enhancement system is connected to the monitor with visual interface cables. The most commonly used interface cables (digital) are digital visual interface (DVI) and/or serial digital interface (SDI).
It seems logical to group the equipment into categories and try to address the issues separately from each component. However, all these groups of equipment are interconnected and they work in unison and harmony to produce a clear picture. At times the issue may lie with part of the laparoscopic equipment that belongs to two different groups and so cannot be dealt with in isolation. Furthermore, the issue may lie with the patient and the effect of anaesthetic agents on the patient.
We suggest a method of troubleshooting laparoscopic tower problems by categorising them into either image quality problems or insufflation problems. The rationale behind this approach is that, when an issue arises, a surgeon relates that to an outcome that he can visualise. Image and lighting are intricately related, so we consider them a single entity for the purposes of problem solving. We have developed a chart we recommend to be used as a problem-solving chart in operating theatres ( and ).
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