Surgical training structures are not well established in about 50 % of the training hospitals from where we got answers to our survey. The training potential of daily surgical work is not used appropriately. It is therefore imperative to develop guidelines for surgical training, the use of log-books and rotation-programs.
BackgroundSurgical hand rub and healthy skin are basic requirements to prevent surgical site infections. Nevertheless, there is little knowledge about the current practice of skin protection and/or skin care products (SP/SC) using among surgeons as well as a lack of data pertaining to the influence of SP/SC on the antimicrobial efficacy of surgical hand rub.MethodsA 10 weeks-survey among German surgeons as well as an experimental crossover study involving 26 participants were conducted. The immediate and sustainable efficacy (IE/SE) of surgical hand rub and participants’ hand moisture were measured after an 8-day usage of SP/SC, as well as the influence on micro-perforations on surgical gloves.ResultsThe questionnaire was available to 16,000 German surgeons. Thereof, 1,771 surgeons accessed the questionnaire, representing a total participation rate of 11%. As 19% (n = 338) of questionnaires were incomplete, a total of 1,433 completed questionnaires were available for further analysis. More than 75% of the participants stated not to use any SP/SC, yet, almost 50% suffered from skin irritation or discomfort. Only 5% used SP/SC at the beginning of their shift. 10% refused to use SP/SC because of concerns that SP/SC may reduce the antimicrobial efficacy of surgical hand rub.After usage of SP/SC over 8-days, skin moisture was significantly higher (P < 0.001), whereas no significant influence on the antimicrobial efficacy of surgical hand rub was observed (IE: P = 0.135; SP: P = 0.681). Micro-perforations were detected in 8/52 surgical gloves (15%), with no statistical significant difference between SP/SC users (n = 2/26; 8%) and non-users (n = 6/26; 23%; P = 0.249).ConclusionsFollowing the results of this largest questionnaire base survey among German surgeons on skin care, there is a need to educate and inform surgeons on the correct application and the concept of SP/SC strategies. In the present study, the combination of selected SP/SC products and one alcohol-based hand rub formulation did not show a negative interaction with surgical hand rub or surgical glove perforation. However, it is advisable to ascertain the compatibility of SP/SC products with the used hand disinfectant prior to purchase.
The recently ratified Digital Healthcare Act – DVG – has paved the way, among other issues, for the prescription of health apps. The German DVG creates an entitlement to health apps for the very first time. However, this entitlement is initially limited to low-risk medical devices that have been included in the publicly accessible Register for Digital Health Applications by the German Federal Institute for Drugs and Medical Devices. Listing in the register is granted, if the manufacturer has submitted a health app and verified that it meets basic requirements for medical devices and data security as well as positive health care effects. It is questionable, whether the DVG will lead to sustainable improvements in future patient care. In order to pursue this question and align the DGOUCʼs digitization strategy closely with its basis, an online survey was conducted among the respective members on the DVGʼs content and its associated opportunities and risks. A total of 461 German-speaking, predominantly male, experienced and elderly physicians in leading positions took part in the survey. In this study, it was shown that the majority of the participating German orthopaedic and trauma surgeons is not familiar with the DVGʼs contents. Despite a fundamentally positive attitude towards digitization, scepticism about the use of “apps on prescription” and potential risks still prevails at present. The closing of ranks between medicine, IT and the legislature via interdisciplinary expert groups and the involvement of medical societies might be obligatory.
Focussing on possible mass casualty situations during events such as the soccer world championship in 2006, the Professional Board of Surgeons in Germany and the German Society for Surgery canvassed surgeons-in-chief in the last quarter of 2003 concerning disaster plans for hospitals. The rate of returned questionnaires amounted to 26% covering the following areas of interest: plans-ready to use, known by the employees as well as by the rescue coordination center, performance of exercises, and concepts on decontamination and detoxification. Based on past numbers of casualties during soccer disasters, an excursus into details also includes a description of an approach to reduce the danger of bottleneck effects at doors. A preliminary concept based on the upcoming system for funding hospitals in Germany and including new partnerships is outlined, succeeded by some hopefully helpful hints for a web-based hospital disaster plan.
A state of the art surgical training is crucial for the attraction of surgery as a medical profession. The German surgical community can only succeed in overcoming the shortage of young surgeons by the development of an attractive and professional training environment. Responsibility for surgical training has to be taken by the heads of department as well as by the surgical societies. Good surgical training should be deemed to be part of the corporate strategy of German hospitals and participation in external courses has to be properly funded by the hospital management. On the other hand residents are asked for commitment and flexibility and should keep records in logbooks and take part in assessment projects to gain continuing feedback on their learning progress. The surgical community is in charge of developing a structured but flexible training curriculum for each of the eight surgical training trunks. A perfect future curriculum has to reflect and cross-link local hospital training programs with a central training portfolio of a future Academy of German Surgeons, such as workshops, courses and e-learning projects. This challenge has to be dealt with in close cooperation by all surgical boards and societies. A common sense of surgery as a community in diversity is crucial for the success of this endeavour.
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