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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
Role of Preoperative Dexamethasone Nebulization in Reducing Bougie Complications Encountered After Sleeve Gastrectomy: a Prospective Double-Blind Control Interventional Study
IntroductionThe usage of bougie devices in guiding the extent of sleeve gastrectomies has been associated with several laryngeal and pharyngeal complications. Despite these being distressing for patients, they draw little attention in current literature.ObjectivesTo study the role of preoperative nebulized dexamethasone in relieving the symptoms related to bougie insertion during laparoscopic sleeve gastrectomy postoperatively.Materials and MethodsA prospective interventional study that included 80 patients. The patients were assigned to two groups, 40 patients in each group: the dexamethasone group (D) which received nebulized dexamethasone 8 mg 1 h before surgery and the control group (S) which received saline nebulizer instead. Assessment of postoperative sore throat, nausea and vomiting, odynophagia, and change of voice was used as an outcome comparative tool.ResultsThe patient’s age ranged from 17 to 61 years, and the mean age of patients was 34.51 (± 9.5) years. Patients were composed of 13 (16.3%) males and 67 (83.8%) females. The study found a significant preference of outcome values in the dexamethasone group. Sore throat mean and medians were less at all-time intervals: 0 h (p < 0.001), 1 h (p < 0.001), 6 h (p < 0.004), and 24 h (p < 0.001). Nineteen patients of the saline group suffered from a change of voice (p < 0.001), compared to only 4 patients in the dexamethasone group. On the contrary, no significant differences are noted in the incidences of PONV and odynophagia.ConclusionPreoperative nebulized dexamethasone was found to be an effective measure in reducing bougie insertion complications in laparoscopic sleeve gastrectomy.
Journal Article
Clinical Comparison of CAD/CAM vs. KLS L1® Mandible ReconGuide in Fibula Free Flap Mandible Reconstruction: A Retrospective Clinical Study
Introduction: The fibula free flap (FFF) is regarded as the workhorse for lower jaw reconstruction in maxillofacial surgery. Imitating the preexisting shape of the mandible by an FFF while meeting various clinical and geometric aspects can be challenging, even for an experienced surgeon. To enhance the quality and reproducibility of the reconstruction process, several tools are available, mainly based on CAD/CAM techniques and the KLS L1 Mandible ReconGuide. The objective of this study was to examine the clinical use of the KLS L1® Mandible ReconGuide compared to CAD/CAM templates. Material and Methods: In this study, we compared 25 patients who underwent mandibular reconstruction by a FFF with either the KLS L1® Mandible ReconGuide (G1, n = 17) or personalized CAD/CAM-based cutting guides (G2, n = 8). We performed a pre- and postoperative 3D image reconstruction using standard triangle language (STL) to quantify the anatomical results in terms of volume deviations, intercondylar distance, and gonial angle, as well as clinical criteria such as surgery time, function, and postoperative complications. Results: The analysis of pre- and postoperative clinical outcomes in 25 patients revealed no statistically significant differences between the groups. However, it was observed that longer surgery time was group-independent, associated with a 5.63% increase in the length of hospital stays (p = 0.0002). In terms of geometric criteria, the only significant difference referred to the postoperative length of the symphysis, which measured 34.32 mm in G2 versus 34.78 mm in G1 (p = 0.046). Conclusions: Both the KLS L1® Mandible ReconGuide and CAD/CAM templates seem equivalent, effective devices for standardized mandibular reconstruction, with their suitability depending on the specific indications and the segments involved.
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
Procedimiento de sutura de una herida con técnica discontinua (puntos simples). Guía para la actividad docente
Esta obra pone al alcance del docente y del profesional en formación un documento útil que sintetiza los instrumentos, la técnica y los insumos básicos y necesarios para efectuar una sutura en cualquier nivel de la atención primaria de salud. Recoge los aspectos más importantes para orientar al principiante, desde el conocimiento de los materiales quirúrgicos más utilizados en niveles básicos de atención hasta la ejecución de una sutura con puntos simples y el retiro del material. Además, constituye un insumo para estandarizar el manejo de una herida. Este documento presenta los pasos detallados, con justificación basada en evidencia científica, además de una herramienta para la evaluación, lo que complementa el proceso docente de enseñanza-aprendizaje.
eBook
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