SummaryA computerised database of operating theatre activity was used to estimate the costs of regional and general anaesthesia for varicose vein and inguinal hernia surgery. Data retrieved for each procedure included the anaesthetic technique and drugs used, and the duration of anaesthesia, surgery and recovery. The costs of anaesthetic drugs and disposables, salary costs of the anaesthetic personnel and maintenance costs for anaesthetic equipment were considered. Drugs and disposables accounted for < 25% of the total cost of an anaesthetic. Anaesthetic times were 5 min longer for regional anaesthesia, but recovery times were 10 min shorter following regional anaesthesia for varicose vein surgery. Staff costs were dependent on the length of time each staff member spent with the patient. Although the number of cases was small, provision of a field block and sedation for inguinal hernia repair was considerably cheaper than other anaesthetic techniques.Keywords Anaesthetic costs: regional; general. Cost containment has become a priority in all areas of health care. Clinicians must work within tightly controlled budgets in spite of increasing demand for services, expectations of higher standards, and the introduction of new drugs and techniques. A common view is that anaesthetic costs are insignificant because they are a relatively small component of the total for each surgical episode. This is superficially true; the Audit Commission reported that anaesthetic services comprised only 3% of NHS trust expenditure [1]. However, this adds up to a large sum of money across the service. Anaesthesia for any surgical procedure involves a wide choice of drugs, techniques and monitoring procedures, each with very different cost implications. Selection of any particular method must be determined by the relative costs, as well as the clinical benefits, if the challenge of providing highquality care within limited resources is to be met.The cost of each anaesthetic is the sum of a number of components. Information about the price of drugs (the commonest focus for debate) is readily available, but choices based solely on drug acquisition costs ignore many other factors that contribute to the cost of an anaesthetic, including capital and recurrent expenditure on equipment, the prices of disposable equipment, and the salaries of the anaesthetist, anaesthetic assistant and recovery staff. Personnel costs are dependent on the time spent by the patient in the anaesthetic room, operating theatre and recovery area, each of which may be affected by the anaesthetic technique or drugs used. This study used data from a computerised database of operating theatre activity to compare the costs of general and regional anaesthesia for patients undergoing varicose vein and inguinal hernia surgery. Methods Data collectionThe Ninewells Hospital operating theatre management system was established in 1989 using the Financial Information Project (FIP) Galaxy Theatre System, a software package marketed by Sanderson GA Ltd (1±2 Venture Way, Aston Scien...

SUMMARYCooling towers have been demonstrated to be amplifiers and disseminators of legionella, the causative organism of Legionnaires' disease. Community outbreaks associated with cooling towers have been reported with several common factors. Small towers (< 300 kW) have predominantly been implicated in outbreaks. Cooling tower-associated outbreaks are most frequent in autumn, and frequently implicated systems have been operated after a period of shutdown.This paper reports field study data relating system operation to legionella colonization of systems. Operating systems have been shown to be more frequently colonized by legionella than shutdown systems. In some cases operation of systems after periods of shutdown raised legionella concentrations from below detection limits to between 50 and 950 c.f.u./ml within 10 min.These data and previously reported data relating to biofilm and sediment colonization of the systems, and community outbreaks of Legionnaires' disease, have been used to develop a model explaining the seasonal nature of outbreaks associated with irregularly operated, small cooling tower systems.

Legionella and amebae populations in 16 cooling towers were challenged with three commercially available biocide formulations. The active agents were: a chlorinated phenolic thioether (CPTE), bromo-nitro-propane-diol (BNPD), and bromo-chloro-dimethylhydantoin (BCD, in briquette form). The towers were dosed with these biocides for approximately 4 weeks. BCD was effective against Legionella in each of nine challenge experiments, and CPTE in eight of nine challenges. BNPD was effective in only five of 11 challenges. None of the biocides had any significant effect in reducing planktonic amebae concentrations during the challenges.

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