Kenneth Nolasco – Independent Project

Kenneth Nolasco – Independent Project

Class of 2017

Introduction to Topic

Sterilization is one of the top priorities in an operating room, there exists a strict list of standards hospitals and clinics of all kinds must abide by for the sterilization of them. Operating rooms must be decontaminated in between all cases to prevent any risk of cross contamination, however it has been found in some studies that not all pieces of equipment, such as supply carts, are not cleaned on a regular basis. Automating almost every piece of equipment, taking out the factor of human error, is the best way to minimize the amount would  touch surfaces in an operating room, effectively decreasing the risk for contamination. Automating pieces of equipment has been applied to multiple aspects in both healthcare and daily life to reduce bacteria and viruses from spreading, applying this to supply carts in operating rooms is another step towards reducing the risks of contamination to zero.

Project Description

An automated supply cart would be an effective way to minimize the risk for contamination and transferring bacteria, reducing the amount a doctor or nurse would touch surfaces like the supply cart. The idea of an automated supply cart came to while I was observing a nissen fundoplication on a six month old baby, I was instructed to get a piece of gauze from a supply cart in the operating room, one of the surgeons pointed to the one she needed and I got it, brought it over to the table, and then opened it for her, however I was not supposed to touch it, but I did, and I contaminated it. If my automated supply cart was put into operating rooms, the surgeon could operate it hands free and it would have dispensed the supplies directly to the surgeon, minimizing the transfer of bacteria on surfaces and people, it could have prevented me from contaminating the piece of gauze.

Experience Description

All of my 80 shadowing hours were done at the University of Maryland Medical center under the supervision of Stephanie L. Kahntroff MD, a general anesthesiologist and an assistant professor at the University of Maryland Medical Center. My days consisted of following Dr. Kahntroff around in both the operating rooms and the postanesthesia care unit (PACU), observing multiple surgeries everyday, and staying with patients until they wake up from surgery. There were several operations that I remember distinctly because of the emotions that had an effect on me because it was performed on babies and small children. On March 31, 2017, a four month old baby was waiting to have a nissen fundoplication to be performed on him. The baby was post transposition, meaning that he had already had a procedure called an arterial switch performed on him a few months ago. An arterial switch is done when a baby is born when the two major arteries, the aorta and pulmonary artery are essential switched, so blood is not being oxygenated properly and spread throughout the body. The arterial switch procedure corrected it, however the baby will never be at 100%. The procedure he was receiving that day was a nissen, a procedure done to strengthen the valves between the esophagus and stomach to prevent acid from backing up into the esophagus. When they rolled the baby into the operating room, one of the surgeons began rubbing betadine on the baby’s stomach to prevent irritation during surgery. After waiting for about 10 minutes for the other surgeon to arrive to the operating room the team began to mark three incision points for the ports where the two arms and camera will enter. One of the surgeons and his resident began to open up the ports. They made the incisions and pushed through the I was watching on the screen and I saw the arms moving around in the baby’s body. I saw them burning through some tissue to expose the stomach and esophagus, I saw the smoke and wrinkled tissue and I was at an awe because I had never seen anything like that in person before. Once the stomach and esophagus was exposed the surgeons grabbed the stomach and wrapped it around the base of the esophagus, and then they sewed it together. During the entire procedure I felt so conflicted because it was being done on a baby, he was so small and seeing him on the table crying while they were anesthetizing him made me feel extremely uncomfortable. Even when I watched the other countless procedures on older children, it did not evoke any emotions such as this, but this baby was the exception. Before the operation, Dr. Kahntroff had to call the baby’s birth mother for consent to anesthetize him during the procedure, the reason why she called the mother was because she had abandoned her son, after he was born she sound out about his transposition of the great arteries, she left him in the care of the hospital. He has spent the majority of his life at the University of Maryland St. Joseph Medical Center, but he was then transferred to the University of Maryland Medical Center to have the nissen performed on him, throughout the majority of his life he has had no one familiar taking care of him, and whenever someone would pick him up all he would do was just cling on and want to be held. Babies naturally want to be held, and by doing so they develop relationships, depriving them of that, like the baby who had been abandoned by his mother, it can hinder their development. Dr. Kahntroff told me that situations like these are very common in inner city hospitals, it is just part of the job, knowing that just made me so angry that someone would do that to their own child. Watching procedures performed on children was quite an experience, seeing them get better, made me want to pursue something involved in an operating room, it was exciting, no one was sitting down, and there was always something to do.

Innovation Description

The innovation I have devised is an automated supply cart for an operating room, created to prevent to risk for any transfer of bacteria from surface to surface or contamination. The idea for the automated supply cart came to me on March 31, 2017, I was at the University of Maryland Medical Center in one of the operating rooms, trying to think of ways to keep things in the room sterile. In the hall outside of the operating room, I walked out of the operating room to think about what I could create to do this, I then saw the sink were doctors wash their hands prior to performing an operation, it was foot operated, as a way to prevent the doctor’s hands from being compromised from touching other surfaces that may harbor harmful and infectious bacteria. After seeing the foot operated sink I knew that I would want to have something that would be hands free, either foot or voice operated.

When I walked back into the operating room I tried to think of things in the room I could have applied this concept to. While thinking of ways to apply the foot operated concept to things in the operating room, one of the doctors asked me to get her a piece of gauze from the supply cart, she walked directly over to the cart, and pointed at the specific type she wanted, at first I wondered why she could not just grab it herself, then it occurred to me that surgeons have to keep themselves sterile, meaning that they can not touch anything that is considered to be compromised, only sterile surfaces. I then grabbed the gauze and opened it for her, however I was not meant to touch it, but I did, therefore contaminating it, and I had to get another one. At that moment I knew that I wanted to apply the foot operation and automation to the supply cart.

I modeled the automated supply cart after a claw machine, at the end of the line is a small vacuum that would suck up any piece of supplies that may be needed such as gauze, coflex bands, etc, and would then drop it onto a platform that would then move it up the cart onto a trapdoor that would drop the piece of equipment onto the surgeons hands. Adding the foot operated aspect, making it hands free so a surgeon can get supplies without compromising their hands. The top of the supply cart is made of glass, making it easy for a surgeon to see inside of it and select the piece of equipment they would want. Refilling the automated supply cart has to be done in a hermetically sealed facility, placing the pieces of equipment in a magazine that could then be loaded into the supply cart, reducing the amount of time it spends exposed to outside air, therefore reducing the risk for contamination. The pieces of equipment such as gauze, coflex bands, etc. are normally placed in wrappers to keep them sterile, however with the supply cart itself being sterile and the method of reloading is sterile, it will be placed in the cart unwrapped, getting rid of the need for it to be opened from its package by someone other than the surgeon, it can be dropped directly into the surgeon’s hands effectively reducing the risk contamination because it is passed on by less people.

+ Project Topic

Introduction to Topic

Sterilization is one of the top priorities in an operating room, there exists a strict list of standards hospitals and clinics of all kinds must abide by for the sterilization of them. Operating rooms must be decontaminated in between all cases to prevent any risk of cross contamination, however it has been found in some studies that not all pieces of equipment, such as supply carts, are not cleaned on a regular basis. Automating almost every piece of equipment, taking out the factor of human error, is the best way to minimize the amount would  touch surfaces in an operating room, effectively decreasing the risk for contamination. Automating pieces of equipment has been applied to multiple aspects in both healthcare and daily life to reduce bacteria and viruses from spreading, applying this to supply carts in operating rooms is another step towards reducing the risks of contamination to zero.

+ Project Overview

Project Description

An automated supply cart would be an effective way to minimize the risk for contamination and transferring bacteria, reducing the amount a doctor or nurse would touch surfaces like the supply cart. The idea of an automated supply cart came to while I was observing a nissen fundoplication on a six month old baby, I was instructed to get a piece of gauze from a supply cart in the operating room, one of the surgeons pointed to the one she needed and I got it, brought it over to the table, and then opened it for her, however I was not supposed to touch it, but I did, and I contaminated it. If my automated supply cart was put into operating rooms, the surgeon could operate it hands free and it would have dispensed the supplies directly to the surgeon, minimizing the transfer of bacteria on surfaces and people, it could have prevented me from contaminating the piece of gauze.

+ Experience

Experience Description

All of my 80 shadowing hours were done at the University of Maryland Medical center under the supervision of Stephanie L. Kahntroff MD, a general anesthesiologist and an assistant professor at the University of Maryland Medical Center. My days consisted of following Dr. Kahntroff around in both the operating rooms and the postanesthesia care unit (PACU), observing multiple surgeries everyday, and staying with patients until they wake up from surgery. There were several operations that I remember distinctly because of the emotions that had an effect on me because it was performed on babies and small children. On March 31, 2017, a four month old baby was waiting to have a nissen fundoplication to be performed on him. The baby was post transposition, meaning that he had already had a procedure called an arterial switch performed on him a few months ago. An arterial switch is done when a baby is born when the two major arteries, the aorta and pulmonary artery are essential switched, so blood is not being oxygenated properly and spread throughout the body. The arterial switch procedure corrected it, however the baby will never be at 100%. The procedure he was receiving that day was a nissen, a procedure done to strengthen the valves between the esophagus and stomach to prevent acid from backing up into the esophagus. When they rolled the baby into the operating room, one of the surgeons began rubbing betadine on the baby’s stomach to prevent irritation during surgery. After waiting for about 10 minutes for the other surgeon to arrive to the operating room the team began to mark three incision points for the ports where the two arms and camera will enter. One of the surgeons and his resident began to open up the ports. They made the incisions and pushed through the I was watching on the screen and I saw the arms moving around in the baby’s body. I saw them burning through some tissue to expose the stomach and esophagus, I saw the smoke and wrinkled tissue and I was at an awe because I had never seen anything like that in person before. Once the stomach and esophagus was exposed the surgeons grabbed the stomach and wrapped it around the base of the esophagus, and then they sewed it together. During the entire procedure I felt so conflicted because it was being done on a baby, he was so small and seeing him on the table crying while they were anesthetizing him made me feel extremely uncomfortable. Even when I watched the other countless procedures on older children, it did not evoke any emotions such as this, but this baby was the exception. Before the operation, Dr. Kahntroff had to call the baby’s birth mother for consent to anesthetize him during the procedure, the reason why she called the mother was because she had abandoned her son, after he was born she sound out about his transposition of the great arteries, she left him in the care of the hospital. He has spent the majority of his life at the University of Maryland St. Joseph Medical Center, but he was then transferred to the University of Maryland Medical Center to have the nissen performed on him, throughout the majority of his life he has had no one familiar taking care of him, and whenever someone would pick him up all he would do was just cling on and want to be held. Babies naturally want to be held, and by doing so they develop relationships, depriving them of that, like the baby who had been abandoned by his mother, it can hinder their development. Dr. Kahntroff told me that situations like these are very common in inner city hospitals, it is just part of the job, knowing that just made me so angry that someone would do that to their own child. Watching procedures performed on children was quite an experience, seeing them get better, made me want to pursue something involved in an operating room, it was exciting, no one was sitting down, and there was always something to do.

+ Innovation

Innovation Description

The innovation I have devised is an automated supply cart for an operating room, created to prevent to risk for any transfer of bacteria from surface to surface or contamination. The idea for the automated supply cart came to me on March 31, 2017, I was at the University of Maryland Medical Center in one of the operating rooms, trying to think of ways to keep things in the room sterile. In the hall outside of the operating room, I walked out of the operating room to think about what I could create to do this, I then saw the sink were doctors wash their hands prior to performing an operation, it was foot operated, as a way to prevent the doctor’s hands from being compromised from touching other surfaces that may harbor harmful and infectious bacteria. After seeing the foot operated sink I knew that I would want to have something that would be hands free, either foot or voice operated.

When I walked back into the operating room I tried to think of things in the room I could have applied this concept to. While thinking of ways to apply the foot operated concept to things in the operating room, one of the doctors asked me to get her a piece of gauze from the supply cart, she walked directly over to the cart, and pointed at the specific type she wanted, at first I wondered why she could not just grab it herself, then it occurred to me that surgeons have to keep themselves sterile, meaning that they can not touch anything that is considered to be compromised, only sterile surfaces. I then grabbed the gauze and opened it for her, however I was not meant to touch it, but I did, therefore contaminating it, and I had to get another one. At that moment I knew that I wanted to apply the foot operation and automation to the supply cart.

I modeled the automated supply cart after a claw machine, at the end of the line is a small vacuum that would suck up any piece of supplies that may be needed such as gauze, coflex bands, etc, and would then drop it onto a platform that would then move it up the cart onto a trapdoor that would drop the piece of equipment onto the surgeons hands. Adding the foot operated aspect, making it hands free so a surgeon can get supplies without compromising their hands. The top of the supply cart is made of glass, making it easy for a surgeon to see inside of it and select the piece of equipment they would want. Refilling the automated supply cart has to be done in a hermetically sealed facility, placing the pieces of equipment in a magazine that could then be loaded into the supply cart, reducing the amount of time it spends exposed to outside air, therefore reducing the risk for contamination. The pieces of equipment such as gauze, coflex bands, etc. are normally placed in wrappers to keep them sterile, however with the supply cart itself being sterile and the method of reloading is sterile, it will be placed in the cart unwrapped, getting rid of the need for it to be opened from its package by someone other than the surgeon, it can be dropped directly into the surgeon’s hands effectively reducing the risk contamination because it is passed on by less people.

By | 2017-05-15T15:11:20+00:00 May 15th, 2017|Biomed Capstone Project 2017|0 Comments

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