Explore the vast range of titles available.

► Single-use disposable technologies in the manufacturing of biopharmaceuticals ► Advantages and limitations of single-use manufacturing ► Single-use systems for protein drug substance production process: key features, current scales and vendors ► Disposables reduce cost of clinical manufacturing and co-locating manufacturing. The manufacture of protein biopharmaceuticals is conducted under current good manufacturing practice (cGMP) and involves multiple unit operations for upstream production and downstream purification. Until recently, production facilities relied on the use of relatively inflexible, hard-piped equipment including large stainless steel bioreactors and tanks to hold product intermediates and buffers. However, there is an increasing trend towards the adoption of single-use technologies across the manufacturing process. Technical advances have now made an end-to-end single-use manufacturing facility possible, but several aspects of single-use technology require further improvement and are continually evolving. This article provides a perspective on the current state-of-the-art in single-use technologies and highlights trends that will improve performance and increase the market penetration of disposable manufacturing in the future.

Background Operating rooms contribute to over 40% of hospital expenses, with a portion attributed to waste from single-use, sterile surgical supplies (SUSSS). This research aimed to determine the amount of cost wastage due to not using SUSSS during laparotomy procedures. Methods A descriptive-analytical investigation was conducted in two prominent teaching hospitals in Mashhad, Iran 2018. Seventy-seven laparotomy surgeries were scrutinized, documenting both used and unused disposable devices, with their respective costs being assessed. Data analysis was performed using SPSS version 16 software. Results The study revealed that during surgery in the operating rooms, waste of SUSSS averaged 5.9%. Betadine solution and sterile Gauze types were the top two contributors to resource wastage. Sterile Gauze types incurred the highest cost loss. The study found a significant correlation between cost wastage and surgeon experience ( r  = 0.296, P  < 0.001) as well as surgery duration ( r  = 0.439, P  < 0.001). Conclusion Inadequate management of available and commonly used disposable supplies leads to increased hospital expenses. Enhancing the surgical team’s knowledge of sterile surgical supplies usage and making thoughtful selections can play a vital role in curbing health costs by minimizing waste of SUSSS in the operating rooms.

Major contributors to that carbon footprint include energy use and anaesthetic gases,6 but most UK hospitals are now transitioning to renewable energy sources and most of our anaesthetic colleagues have minimised or eliminated agents with potent greenhouse gas potential, such as desflurane and nitrous oxide.7 The other major carbon hotspot of an operation is single-use equipment, but to date our surgical community has afforded this little attention. [...]the world has moved on: under current UK regulations, all instruments are sterilised to robust and audited standards.14 Where transmission of infection has historically been documented, it had been using processes inconsistent with such standards,15 and there have been no definite recorded cases of surgically transmitted vCJD disease since exposures that occurred in the 1970s.16 In fact, many single-use items are sterilised outside of the UK, where standards may be less verifiable: recently the Italian company Steril Milano (no longer trading) was reported to have falsified data on sterilisation of products for at least 97 brands,17 including many used in the UK. The reputation of reusable hospital linens as a potential infection risk is also historical, with older studies analysing textiles not manufactured or quality assured to modern requirements.18 In a recent report of medical gowns, single-use versions were found to have lower barrier protection than reusable equivalents.19 This fact, coupled with UK standards and assurances for decontamination of linens,20 makes for a compelling argument that we should be using reusable rather than single-use drapes and gowns if we want to reduce risk of infection. To reduce costs, the production of many medical goods exploits the sorts of global value chains described for other manufactured products such as clothing: many of our surgical instruments are produced in sweatshops in Pakistan,25 most gloves are manufactured using forced immigrant labour in Malaysia,26 and some of our gowns and masks are made using state-sponsored modern slavery in China.27 The way forward Our over-reliance on single use equipment in the operating theatre is an archetypal example of the linear model of consumption and shows contempt for our planet.

Abstract The recent SARS-CoV-2 outbreak has placed immense pressure on supply chains, including shortages in nasopharyngeal (NP) swabs. Here, we report our experience of using 3D-printing to rapidly develop and deploy custom-made NP swabs to address supply shortages at our healthcare institution.

Reprocessing single‐use surgical supplies and devices is an option for hospitals and ambulatory surgery centers (ASCs). The US Federal Government has recognized the practice since 2000, and regulatory oversight has increased dramatically since that time. Reprocessing single‐use devices is safe when personnel use approved methods, and health care facilities can experience significant cost savings by participating in this type of initiative. This article explores reprocessing and its benefits in ASCs, including a review of the oversight that the US Food and Drug Administration currently has for reprocessing and a discussion of the results of studies pertaining to this practice. The article also describes some issues that ASC leaders need to be aware of when considering the implementation of a reprocessing program. Single‐use device reprocessing can be an effective tool for ASC leaders to conserve and manage resources.

Knowledge, self-care and access to diabetes-related resources is critical to diabetes management. However, there is paucity of data on source of education, source of care, and access to diabetes-related resources in the developing world, including Ethiopia. To examine source of education, source of care, access to diabetes-related resources, and correlates of diabetes knowledge in a random sample of adults with diabetes in Ethiopia. A sample of 337 subjects was selected using systematic random sampling. Validated questionnaires were used to obtain data on source of education, source of care, access to diabetes-related resources, and diabetes knowledge. Multiple logistic and linear models were used to assess independent correlates of owning a glucometer and good diabetes knowledge. Response rate was 91.1%. Correlates of access to glucometer were being ≥55 years of age (OR = 2.6 95% CI 1.0 to 6.73), having high school (OR = 3.5; 95% CI: 1.17 to 10.41) and college education (OR = 5.2; 95% CI: 1.67 to 16.27), higher income (OR = 3.3; 95% CI: 1.19 to 9.19), and receiving DM care in private hospital/clinics (OR = 9.4; 95% CI: 2.24 to 39.31). Independent correlates of poor diabetes knowledge were being age 40–54, being single, lack of education, lower monthly income (0–499 birr or $0 - $18.11), getting DM care from public hospitals, treatment with oral medications, and not owning a glucometer. This study provides new insights on source of education, source of care, access to diabetes-related resources (e.g. glucometers, test strips), and correlates of diabetes knowledge in developing countries like Ethiopia that are experiencing an increasing prevalence of diabetes.

ObjectiveProcedure-intense specialties, such as surgery or endoscopy, are a major contributor to the impact of the healthcare sector on the environment. We aimed to measure the amount of waste generated during endoscopic procedures and to understand the impact on waste of changing from reusable to single use endoscopes in the USA.DesignWe conducted a 5-day audit (cross-sectional study) of all endoscopies performed at two US academic medical centres with low and a high endoscopy volume (2000 and 13 000 procedures annually, respectively). We calculated the average disposable waste (excluding waste from reprocessing) generated during one endoscopic procedure to estimate waste of all endoscopic procedures generated in the USA annually (18 million). We further estimated the impact of changing from reusable to single-use endoscopes taking reprocessing waste into account.Results278 endoscopies were performed for 243 patients. Each endoscopy generated 2.1 kg of disposable waste (46 L volume). 64% of waste was going to the landfill, 28% represented biohazard waste and 9% was recycled. The estimated total waste generated during all endoscopic procedures performed in the USA annually would weigh 38 000 metric tons (equivalent of 25 000 passenger cars) and cover 117 soccer fields to 1 m depth. If all endoscopic procedures were performed with single-use endoscopes and accounting for reprocessing, the net waste mass would increase by 40%. Excluding waste from ancillary supplies, net waste generated from reprocessing and endoscope disposal would quadruple with only using single-use endoscopes.ConclusionThis quantitative assessment of the environmental impact of endoscopic procedures highlights that a large amount of waste is generated from disposable instruments. Transitioning to single-use endoscopes may reduce reprocessing waste but would increase net waste.

Introduction While laparoscopic appendectomy (LA) can be performed using a myriad of techniques, the cost of each method varies. The purpose of this study is to analyze the effects of surgeon choice of technique on the cost of key steps in LA. Methods Surgeon operative notes, hospital invoice lists, and surgeon instrumentation preference sheets were obtained for all LA cases in 2008 at Cambridge Health Alliance (CHA). Only cases ( N  = 89) performed by fulltime staff general surgeons ( N  = 8) were analyzed. Disposable costs were calculated for the following components of LA: port access, mesoappendix division, and management of the appendiceal stump. The actual cost of each disposable was determined based on the hospital’s materials management database. Actual hospital reimbursements for LA in 2008 were obtained for all payers and compared with the disposable cost per case. Results Disposable cost per case for the three portions analyzed for 126 theoretical models were calculated and found to range from US $81 to US $873. The surgeon with the most cost-effective preferred method (US $299) utilized one multi-use endoscopic clip applier for mesoappendix division, two commercially available pretied loops for management of the appendiceal stump, and three 5-mm trocars as their preferred technique. The surgeon with the least cost-effective preferred method (US $552) utilized two staple firings for mesoappendix division, one staple firing for management of the appendiceal stump, and 12/5/10-mm trocars for access. The two main payers for LA patients were Medicaid and Health Safety Net, whose total hospital reimbursements ranged from US $264 to US $504 and from US $0 to US $545 per case, respectively, for patients discharged on day 1. Discussion Disposable costs frequently exceeded hospital reimbursements. Currently, there is no scientific literature that clearly illustrates a superior surgical method for performing these portions of LA in routine cases. This study suggests that surgeons should review the cost implications of their practice and to find ways to provide the most cost-effective care without jeopardizing clinical outcome.

Rising health care costs have led to increasing focus on cost containment and accountability from health care providers. We sought to explore surgeon awareness of supply costs for open and laparoscopic distal gastrectomy. Surveys were sent in 2015 to surgeons at 8 academic hospitals in Toronto who performed distal gastrectomy for gastric adenocarcinoma. Respondents were asked to estimate the total cost, type and number of disposable equipment pieces required to perform open and laparoscopic distal gastrectomy. We determined the accuracy of estimates through comparisons with procedural invoices for distal gastrectomy performed between Jan. 1, 2011, and Dec. 31, 2015. All values are in 2015 Canadian dollars. Of the 53 surveys sent out, 12 were completed (response rate 23%). Surgeon estimates of total supply costs ranged from $500 to $3000 and from $1500 to $5000 for open and laparoscopic cases, respectively. Estimated supply costs for requested equipment ranged from $464 to $2055 for open cases and from $1870 to $2960 for laparoscopic cases. Invoices for actual equipment yielded a mean of $821 (standard deviation $543) (range $89–$2613) for open cases and $2678 (standard deviation $958) (range $835–$4102) for laparoscopic cases. Estimates of total cost were within 25% of the median invoice total in 1 response (9%) for open cases and 3 (27%) of those for laparoscopic cases. Respondents failed to accurately estimate equipment costs. The variation in true total costs and estimates of supply costs represents an opportunity for intraoperative cost minimization, efficient equipment selection and value-based purchasing arrangements. En raison de l’augmentation des coûts des soins de santé on attend des professionnels qu’ils mettent davantage l’accent sur les restrictions budgétaires et l’imputabilité. Nous avons voulu vérifier à quel point les chirurgiens sont conscients du coût des fournitures utilisés dans les cas de gastrectomie distale ouverte et laparoscopique. Des questionnaires ont été envoyés en 2015 aux chirurgiens de 8 hôpitaux universitaires de Toronto qui pratiquent la gastrectomie distale pour l’adénocarcinome de l’estomac. On demandait aux participants d’estimé le coût total, le type et le nombre de fournitures jetables requises pour une gastrectomie distale ouverte et laparoscopique. Nous avons déterminé l’exactitude des estimations en comparant les factures pour les interventions de gastrectomie distale effectuées entre le 1er janvier 2011 et le 31 décembre 2015. Toutes les valeurs sont présentées en dollars canadiens. Parmi les 53 questionnaires envoyés, 12 sont revenus complétés (taux de réponse 23 %). Les estimations des chirurgiens pour le coût total des fournitures allaient de 500 $ à 3000 $ et de 1500 $ à 5000 $ pour les interventions ouvertes et laparoscopiques, respectivement. Le coût estimé des fournitures pour l’équipement nécessaire variait de 464 $ à 2055 $ pour les interventions ouvertes et de 1870 $ à 2960 $ pour les interventions laparoscopiques. Les factures soumises pour les équipements réellement utilisés ont été en moyenne de 821 $ (écart-type 543 $) (éventail 89 $–2613 $) pour les interventions ouvertes et de 2678 $ (écart-type 958 $) (éventail 835 $–4102 $) pour les interventions laparoscopiques. Les estimations des coûts totaux se situaient à plus ou moins 25 % du montant total médian des factures dans 1 réponse (9 %) pour les interventions ouvertes et dans 3 réponses (27 %) pour les interventions laparoscopiques. Les participants n’ont pas été en mesure d’estimer avec exactitude le coût des fournitures. Cet écart entre les coûts totaux réels et estimés représente une occasion de réduire les coûts peropératoires, de sélectionner les équipements de façon efficiente et de conclure des contrats d’achat en fonction de la valeur.

Face masks, as they are used today in health care and in the community, can be largely traced back historically to a more recent period when a new understanding of contagion based on germ theory was applied to surgery. Red Cross workers fold reusable masks during the influenza pandemic, Boston, MA, USA, March, 1919 Courtesy National Archives (165-WW-269B-37) Medical researchers tested and compared the filtering efficiency of reusable masks with experiments involving the culture of bacteria nebulised though masks or spread by infectious volunteers wearing masks in an experimental chamber, as well as observational studies in clinical settings. [...]another reason for switching to disposable masks was a desire to reduce labour costs, facilitate the management of supplies, and to respond to the increased demand for disposables that aggressive marketing campaigns had created among health-care workers. The home production of reusable masks for use in the community offers last resort solutions to some and comfort to many, but is unlikely to contribute more than marginally to solving the shortage of personal protective equipment globally.