The use of electronics in the operating room, hospitals or doctors’ offices are becoming the norm with doctors and nurses carrying around many different types of gadgets to record patient information. How do they keep their gadget germ free and sterile in an environment that must remain sterile and safe? 
The eShield is the only cover approved by the FDA for use in an operating room. Dr. Alexander K. Meininger, an orthopedic surgeon, in Steamboat Springs, Colo., created it so doctors could access their tablets and smartphones in the surgical field.
The eShield is a clear polyethylene pouch that creates a barrier from contaminants. The devices’ touchscreen can still be accessed through the material even while wearing surgical gloves. The eShield covers come in a variety of sizes and can also be used to protect SLR cameras during procedure documentation.
Dr. Meininger recently discussed his unique invention in an interview with Surgical Products.
Surgical Products: How did you come up with the idea for the eShield?
Dr. Meininger: The eShield was conceived originally as a means to bring digital cameras into the sterile field for intra-operative photography. The only means available at the time for taking pictures during surgery usually employed non-sterile personnel. The disadvantages with using a circulating nurse or other staff are multiple:
1. Vantage point is often not ideal in an effort to maintain sterility. For instance, the nurse or tech is often leaning over a shoulder to gain visualization.
2. Comprehension of what is pertinent to the photo may not be relayed or understood properly leading to lost opportunity should the photos turn out imperfect.
3. Lastly, staff may not be familiar with the camera or equipment leading to images out of focus, or extended time for instruction and frustration on both the surgeon and the staff.
4. Dedicated hospital based multi-media teams can be assembled; though are costly and time consuming.
The eShield gives surgeons the opportunity to take first-person photographs and video during surgery from an ideal vantage point capturing the most important aspects as desired while maximizing use of the device’s potential (ie MACRO settings, zoom, auto-focus, etc).
Camera containers are not new ideas. There are multitudes available on the market for protection or use underwater. However, most of these devices are bulky, hard-sided cases, designed for multiple uses. Never before had a low-cost, single use, disposable sterile device been employed for photographs and video.
Thanks to my partner, Steve Whitney, at Whitney Medical Solutions, we were able to design an optically clear sterile polyethylene that could capture crystal clear images from within the bag without distortion. One of our early discoveries was that camera flashes could often be reflected from within the bag; or wrinkles in the bag could blur the photos. Steve helped conceive of a double-sided adhesive ring that when applied to the camera bevel on one side, could be adhered to the polyethylene within the bag creating a taut plastic cover free of wrinkles and a light seal to reduce flash reflection.
The advantage of the eShield is its low-profile, flat peel-pak packaging for ease of storage within the OR and as a single use disposable device. The surgeon should have no hesitation to request an eShield for photographs or video intra-operatively and its ease of use enhances efficiency.
SP: Why is the eShield so important for medical staff within the OR?
Dr. Meininger: Since inception, the design has been extrapolated to digital tools inside the operating room beyond cameras and video. The use of tablets and smartphones are everywhere and wireless technology can now allow surgeons access to digital records, images and multimedia right from their fingertips.
Picture archived computer systems, or PACS, for radiology studies can be complicated and difficult software for the uninitiated to use properly. Often times a wall mounted monitor may display images during surgery. However, alternating between images within an advanced study (CT or MRI) or employing advanced functions like zoom, contrast enhancement or measurement tools is impossible from within the sterile field; and instructing the staff can be frustrating for all involved.
With an iPad or tablet within the operative field that is fully functional, wirelessly connected to the PACS network, and usable by the gloved surgeon within the bag, eShield allows the surgeon ultimate freedom to access, manipulate and manage intra-operative images.
Similarly, electronic health records present similar challenges to the operating room personnel particularly when the physician’s clinic-based technology differs from the hospital-based system. A tablet at the surgeon’s fingertips allows complete access to records.
SP: How long have you worked as an orthopedic surgeon? What are some of the biggest changes in technology you’ve seen since you started in the OR? How has technology helped the OR?
Dr. Meininger: I have been in private practice for 4 years after completing my training at the University of Chicago. Technological advancements have made logarithmic leaps and bounds forward. For instance, intraoperative infrared orthopaedic navigation tools, image guided and robotic surgery, or high-definition arthroscopy video have revolutionized the field of orthopedic surgery.
SP: What has been some of the feedback you’ve received from medical professionals who have used the eShield?
Dr. Meininger: The response has been overwhelming. Surgeons have enjoyed the low cost, single use option increasing the likelihood they will request an eShield opened; even but for a single photo or video during an interesting case. I think the fields of plastic surgery and oncology have been most receptive and carry the most promise. After all, a photo speaks a thousand words!
More surprising have been the non-physician healthcare practitioners that have reached out. For instance, dental hygienists have expressed interest in using the eShield; as have medical students and trainees. These are surprising because they are not so much as in a sterile field; but a clean environment to prevent device contamination. It is amazing what people can come up with when introduced to new technology – things you’ll never think of!
SP: With technology ever changing, how do you see eShield affecting ORs in the future?
Dr. Meininger: Wireless connectivity and multimedia are a possibility I can see the eShield employed in the future. For instance, a surgeon in a rural environment or abroad could wirelessly connect with readily available apps and software today to another surgeon across the world during surgery with an eShield tablet. Applications like Skype, FaceTime, and Google Hangouts, could be used professionally for consultation, guidance or education using technology that each of us use every day.
