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Efficacy of Ring Drape and Unused Sterile Instruments for Incisional SSI After Hepatectomy
The aim of this study was to verify the efficacy of wound protection with a plastic ring wound protector (ring drape) and using new sterile instruments when closing the abdominal wall (wound closure set), both of which were used to prevent incisional surgical site infection (SSI) after hepatectomy.
The incidence of incisional SSIs and the clinical courses of 572 patients who underwent hepatectomy between January 2010 and December 2015 were studied retrospectively. The patients were divided into three period groups according to the period when each infection countermeasure was started.
Incisional SSI incidence decreased significantly with additional countermeasures: 1
period 10.1%; 2
period 2.08% (p=0.0114); 3
period, 1.63% (1st vs. 3
period, p=0.0016). A multivariate analysis showed that postoperative bile leakage [odds ratio (OR)=4.12, p=0.012] and not using a ring drape (OR=0.176, p=0.003) were independent factors for incisional SSI.
Incisional SSI incidence was significantly reduced by using ring drape after hepatectomy.
Journal Article
A discrete event simulation model for coordinating inventory management and material handling in hospitals
Inventory management of surgical instruments and material handling decisions of perioperative services are critical to hospitals’ and operating rooms’ (ORs) service levels and costs. However, efficiently coordinating these decisions is challenging due to their interdependence and the uncertainties faced by hospitals. These challenges motivated the development of this study to answer the following research questions: (R1) How does the inventory level of surgical instruments, including owned, borrowed and consigned, impact the service level provided by ORs? (R2): How do material handling activities impact the service level provided by ORs? (R3): How do integrating decisions about inventory and material handling impact the service level provided by ORs? Three discrete event simulation models are developed here to address these questions. Model 1, Current, assumes no coordination of material handling and daily inventory management operations. Model 2, Two Batch, assumes partial coordination, and Model 3, Just-In-Time (JIT), assumes full coordination. These models are verified and validated using real life-data from a partnering hospital. A thorough numerical analysis indicates that, in general, coordination of inventory management of surgical instruments and material handling decisions has the potential to improve the service level provided by ORs. More specifically, a JIT delivery of instruments used in short-duration surgeries leads to lower inventory levels without jeopardizing the service level provided.
Journal Article
Pilot study: Post-surgical infections could be related with lack of sharpness in surgical tools
Despite rigorous sterilization protocols placed in surgical procedures, there is demonstrated evidence that show patients contract infections while hospitalized. This study aims to investigate the presence of biological materials in osteotome surgical tools after sterilization processes, determine the relationship between lack of sharpness and cross-contamination, and evaluate the influence of materials surface coating as a potential contamination preventive. Three commercially available osteotomes with different surface coatings were studied and submitted to a procedure of bone-cutting cycles. After use, each was sterilized and examined under SEM and EDS. Bone contaminants were detected in each osteotome although the PVD coated osteotome demonstrated significantly less contamination than either the as-supplied or electroless nickel coated one. According to the results, there is an association between blade sharpness and post-sterilization bone contamination. These findings suggest either disposable osteotomes should be used in surgical procedures, or an effective sharpen process should both be established and monitored to minimise post-operative infections.
Journal Article
Reprocessing Single‐Use Devices in the Ambulatory Surgery Environment
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.
Journal Article
Presence of digital dermatitis treponemes on cattle and sheep hoof trimming equipment
Digital dermatitis (DD) is an infectious foot disease causing severe lameness in dairy cattle (worldwide) and sheep (UK). This study investigated whether DD Treponema phylogroups can be present on equipment used to trim ruminant hooves and, therefore, consider this trimming equipment as a possible vector for the transmission of DD. Equipment was tested after being used to trim DD symptomatic and asymptomatic cattle and sheep hooves, and subsequently after disinfection of equipment. After trimming, ‘Treponema medium/Treponema vincentii-like’, ‘Treponema phagedenis-like’ and ‘Treponema denticola/T putidum-like’ DD spirochaetes, were shown to be present on 23/37 (62%), 21/37 (57%) and 20/37 (54%) of knives, respectively. After disinfection, detection rates for the DD treponemes were 9/37 (24%), 6/37 (16%) and 3/37 (8%), respectively. Following culture of a swab, an isolate belonging to the T phagedenis-like spirochaetes was identified from a knife sample after trimming a DD positive cow. No isolates were obtained from knife samples after disinfection. This new data has, for the first time, identified treponemes in the farm environment, and highlighted disinfection of hoof trimming equipment between animals and between farms, as a logical precaution to limit the spread of DD.
Journal Article
Cardiopulmonary Bypass and Mechanical Support
Offering a unique, multidisciplinary approach to the complexities of CPB, the 4th Edition of Cardiopulmonary Bypass and Mechanical Support: Principles & Practice remains the gold standard in the field. This edition brings you fully up to date with every aspect of cardiopulmonary bypass, including new information on management of pediatric patients, CPB's role with minimally invasive and robotic cardiac surgery, mechanical circulatory support, miniaturized circuits and CPB, sickle cell disease and CPB management, and much more. A newly expanded title reflects the rapidly evolving nature of extracorporeal technology, encompassing both short-term and long-term forms of cardiac and pulmonary support.
eBook
Global Public Health Impact of Recovered Supplies from Operating Rooms: A Critical Analysis with National Implications
Background
In modern operating rooms, clean and unused medical supplies are routinely discarded and can be effectively recovered and redistributed abroad to alleviate the environmental burden of donor hospitals and to generate substantial health benefits at resource-poor recipient institutions.
Methods
We established a recovery and donation program to collect clean and unused supplies for healthcare institutions in developing nations. We analyzed items donated over a 3-year period (September 2010–November 2013) by quantity and weight, and estimated the projected value of the program under potential nationwide participation. To capture the health benefits attributable to the donated supplies at recipient institutions, we partnered with two tertiary-care centers in Guayaquil, Ecuador and conducted a pilot study on the utility of the donated supplies at the recipient institutions (October 2013). We determined the disability-adjusted life years (DALY) averted for all patients undergoing procedures involving donated items and estimated the annual attributable DALY as well as the cost per DALY averted both by supply and by procedure.
Results
Approximately, 2 million lbs (907,185 kg) per year of medical supplies are recoverable from large non-rural US academic medical centers. Of these supplies, 19 common categories represent a potential for donation worth US $15 million per year, at a cost-utility of US $2.14 per DALY averted.
Conclusions
Hospital operating rooms continue to represent a large source of recoverable surgical supplies that have demonstrable health benefits in the recipient communities. Cost-effective recovery and need-based donation programs can significantly alleviate the global burden of surgical diseases.
Journal Article
The Fundamentals of SURGICAL INSTRUMENTS
This text provides a sound introduction to surgical instrumentation, including their recognition, use, and care. It provides useful information that is essential for operating department practitioners, nurses, scrub practitioners, surgeons under training, surgical technologists, junior doctors, and medical students. Descriptions of how and where the instruments are used will also aid in the knowledge required for their application, providing an understanding of instruments for specific procedures.
eBook
Stenotrophomonas maltophilia endophthalmitis caused by surgical equipment contamination: an emerging nosocomial infection
We report three cases of Stenotrophomonas maltophilia endophthalmitis after uneventful extracapsular cataract extraction with intraocular lens implantation-related to surgical equipment contamination.
All patients developed acute, culture-positive endophthalmitis in a period ranging from 2 to 13 days. Cultures from vitreous tap, as well as those obtained from the hand-piece of the irrigation-aspiration system, revealed S. maltophilia as the causing infectious agent. All patients received intravitreal antibiotic treatment as initial therapy, nevertheless, visual disturbance continued to be present, hence pars plana vitrectomy was required.
Contamination of surgical-reusable equipment should be considered in addition to the well-known risk factors associated with development of endophthalmitis by S. maltophilia.
Journal Article