That's why a group of doctors working with a charity called Lifebox
got together to design an inexpensive headlamp for use in low- and
middle-income countries, "where electricity outages are disruptive,
dangerous and ubiquitous," the group writes in JAMA Surgery.
If they can find a manufacturer to partner with, the lights could be
available as soon as 2019, said the article's lead author, Dr.
Thomas Weiser, an associate professor of surgery in the section of
trauma and critical care at the Stanford University School of
Medicine in California.
"Our experience has been that when we were working in countries
where the lighting was problematic, surgeons have had to come up
with workaround solutions," said Weiser. "Most pull out a flashlight
or cell phone light or figure out some other kind of makeshift,
stopgap measure."
Even when a hospital has a backup generator, it can take a solid 10
minutes for the power to kick back on, Weiser said. "Obviously, this
is a huge safety problem," he added.
Often, even when the power is on, the overhead lighting is not
enough, Weiser said. "In the United States many surgeons wear
surgical headlights when they are operating. In the body cavity,
you're looking down a hole and want to be able to see clearly."
Lifebox has already made advances in anesthesia and infection
reduction, Weiser said. And lighting seemed like an obvious place to
look for improvements next, especially with the advent of cheaper,
brighter LED lights.
The availability of a good surgical light could have a major impact
on patient safety in poorer countries, where more than 125 million
operations are performed annually, the researchers note. These are
places where electricity is unreliable in up to 30 percent of
surgical facilities because of power cuts.
Weiser and his co-authors estimate that at least 24 million patients
annually are at risk of harm from the loss of lighting during
surgery.
The need is clear: 80 percent of surgeons in low- and middle-income
countries have reported that their current lighting presents a
patient safety risk and 18 percent say they have direct knowledge of
a patient harmed because of poor surgical lighting, the team writes.
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To develop some specifications for a surgical headlight that would
be useful and affordable for surgeons in poorer countries, Weiser
and his colleagues first purchased eight LED lights that were
currently on the market. They measured the illumination intensity at
about 16 inches from the light source and tested maximum and minimum
acceptable light intensity under conditions where there was no other
light, ambient light and overhead surgical light at three hospitals
in Ethiopia and one in the U.S.
With that data and feedback from surgeons participating in the
tests, the group came up with a set of specifications for an ideal
surgical light.
"It's brilliant to focus on this one kernel that can change the
safety of an operation," said Dr. Rochelle Dicker, vice chair for
surgical critical care at the University of California, Los Angeles,
and founder of the Center for Global Surgical Studies. "The
compelling thing is to realize that just by having proper lighting
you could do safer surgery, and to realize that millions could have
life-saving surgeries."
There are three basic needs that could make surgery so much safer in
poorer countries, said Dicker, who wasn't involved in the design
project. "Water, so you can wash your hands; gloves that we take for
granted in this country but not necessarily in those countries; and
lighting," she said. "When you're operating in the body cavity
sometimes it can be really hard to see. In a lot of places I have
been, like Tanzania and Uganda, there are masonry structures that
don't allow a lot of natural light in."
A headlight such as the one Weiser and his colleagues have designed
would be welcomed by surgeons in low- and middle-income countries,
Dicker said. "I know my colleagues in Uganda that I've worked
alongside for 12 years, if they saw these their eyes would pop. They
would be so thrilled to be able to incorporate them."
SOURCE: https://bit.ly/2OG23qo JAMA Surgery, online November 14,
2018.
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