Central Supply Research Articles

Application of batch reverse osmosis as an appropriate technology for inland desalination: Design, modeling, and operating strategies

Despite the recent development of desalination, water scarcity problems in rural areas with insufficient infrastructure cannot be easily resolved. Although batch reverse osmosis (BRO), with its compact design and high second-law efficiency, presents a promising solution for low-energy desalination, the implementation of BRO in rural or energy-deficient regions remains challenging. This study suggests a novel concept of BRO as an appropriate technology (BRO-AT) powered by alternative energy sources, particularly livestock, aiming to achieve high recovery and permeate flux without external electricity. To effectively utilize the BRO-AT, two operating strategies, center supply and village-sharing, are proposed according to local livestock availability. Livestock working schedules were considered to analyze the performance of BRO-AT practically. In high recovery and large permeate flux cases, maximum recovery and permeate flux reached 0.9165 and 3.72 m3/d, respectively. Average recoveries of 0.8296 and 0.6937, and water production rates of 1.15 m3/d and 0.96 m3/d, were achieved using the center supply and village-sharing methods, respectively. This analysis demonstrates the feasibility of BRO-AT for rural regions and highlights the importance of understanding the dynamic characteristics of alternative power sources. The findings provide design and operation guidelines for BRO-AT, offering insights for future utilization and application in energy-limited areas.

Tritium content in water bodies in regions of peaceful nuclear explosions

Sites of peaceful nuclear explosions pose a potential radiation hazard to the territories of the Russian Federation, primarily due to the possible release of radioactivity from the explosion cavity into aquifers and onto the earth's surface. Therefore, it is essential to conduct regular monitoring of anthropogenic radionuclides in drinking water sources in settlements located near the sites of peaceful nuclear explosions. Tritium serves as an indicator of the potential release of other anthropogenic radionuclides. Monitoring its levels in water bodies in regions where peaceful nuclear explosions were perfomed, and comparing this data with that from Roshydromet across the Russian Federation, allows for an assessment of the reliability of the engineering barriers between the central explosion zone and the environment with respect to preventing radionuclide migration into aquifers. One method for evaluating the reliability of these barriers is the assessment of tritium specific activity in drinking water sources. This article presents results of the study involving 220 water samples collected from drinking water sources (wells, boreholes, springs, central water supply systems) and surface waters within 167 settlements across 17 subjects of the Russian Federation, where 50 peaceful nuclear explosions were conducted between 1965 and 1988. The samples were collected between May and September 2024 in the settlements within a 30 km radius of a peaceful nuclear explosion site. Measurements of tritium specific activity were performed using the Quantulus 1220-003 alpha-beta spectrometric radiometer. The research revealed that the specific activity of tritium in underground water sources is significantly lower (Student's test p<0,05) than in surface waters. The average specific activity levels of tritium in boreholes, rivers, and lakes were 3.0, 3.45, and 4.31 Bq/kg, respectively. The specific activity of tritium in drinking water sources within the regions of peaceful nuclear explosions was found to be at the background levels recorded by Roshydromet, ranging from 1.1 to 5 Bq/kg.

Prevalence and Factors Associated with Work-Related Musculoskeletal Disorder among Central Sterile Supply Technicians in Nakhon Si Thammarat Province, Thailand

Prevalence and Factors Associated with Work-Related Musculoskeletal Disorder among Central Sterile Supply Technicians in Nakhon Si Thammarat Province, Thailand

Establishing Nursing-Sensitive Quality Indicators for the Central Sterile Supply Department: A Modified Delphi Study.

Previous studies have shown that improving quality management in the central sterile supply department (CSSD) is an effective measure to control and decrease hospital-acquired infections. This study aimed to establish nursing-sensitive quality indicators for CSSD nursing in China. We drafted nursing-sensitive quality indicators on the basis of the Structure-Process-Outcome model, and then conducted 2 rounds of consultation with experts using a modified Delphi method to determine the indicators and scientific methods of measurement. We identified five CSSD nursing-sensitive quality indicators. Recovery rates of the 2 rounds of valid questionnaires were 100%. Expert authority coefficients were 0.810 and 0.902, respectively. Kendall's coefficients of concordance were 0.168 and 0.210, respectively ( P < .05). Evidence-based nursing-sensitive quality indicators for the CSSD were established.

The Impact of Supply Chain Network Centrality on Sustainable Mergers and Acquisitions: Evidence from China

Mergers and acquisitions (M&amp;As) are key drivers for resource integration and the operational efficiency of enterprises. Companies that hold central positions within supply chains may leverage their strategic location to reduce information asymmetry, enhancing their ability to engage in sustainable activities. However, research on the role of supply chain network centrality in M&amp;A decisions remains underexplored. This study aims to empirically examine whether and how centrality in supply chain networks enhances the likelihood and success of M&amp;A activities, contributing to both theory and practice in corporate strategy. In particular, we construct a novel measure of firm centrality within the supply chain and utilize panel data from Chinese A-share listed companies spanning 2008 to 2021. Our findings reveal that the central position of supply chain networks promotes the probability and frequency of mergers and acquisitions. Mechanism analysis reveals that gaining information advantages and relieving financial constraints are two key channels through which the supply chain network promotes mergers and acquisitions. Furthermore, the effects are more pronounced for firms with non-state ownership, with closer proximity to customers or suppliers, with higher operational risk, and with growth and decline phases. A series of robustness tests support these results, including alternative measures, alternative estimating methods, and sub-sample tests. Moreover, central supply chain companies exhibit better long-term financial performance following mergers and acquisitions. This paper enriches our understanding of the roles of supply chain networks in firms’ mergers and acquisitions and holds important practical implications for companies seeking to achieve sustainable and long-term development.

Remotely Powered Two-Wire Cooperative Sensors for Bioimpedance Imaging Wearables.

Bioimpedance imaging aims to generate a 3D map of the resistivity and permittivity of biological tissue from multiple impedance channels measured with electrodes applied to the skin. When the electrodes are distributed around the body (for example, by delineating a cross section of the chest or a limb), bioimpedance imaging is called electrical impedance tomography (EIT) and results in functional 2D images. Conventional EIT systems rely on individually cabling each electrode to master electronics in a star configuration. This approach works well for rack-mounted equipment; however, the bulkiness of the cabling is unsuitable for a wearable system. Previously presented cooperative sensors solve this cabling problem using active (dry) electrodes connected via a two-wire parallel bus. The bus can be implemented with two unshielded wires or even two conductive textile layers, thus replacing the cumbersome wiring of the conventional star arrangement. Prior research demonstrated cooperative sensors for measuring bioimpedances, successfully realizing a measurement reference signal, sensor synchronization, and data transfer though still relying on individual batteries to power the sensors. Subsequent research using cooperative sensors for biopotential measurements proposed a method to remove batteries from the sensors and have the central unit supply power over the two-wire bus. Building from our previous research, this paper presents the application of this method to the measurement of bioimpedances. Two different approaches are discussed, one using discrete, commercially available components, and the other with an application-specific integrated circuit (ASIC). The initial experimental results reveal that both approaches are feasible, but the ASIC approach offers advantages for medical safety, as well as lower power consumption and a smaller size.

Current Status and Future Perspectives for Mobility Options Toward Sustainable Transportation With a Focus on Fuel Cells

ABSTRACTThis paper presents a comprehensive analysis of five different vehicle technologies with a particular emphasis on fuel cell vehicles (FCVs) in comparison to conventional gasoline and diesel ICEs, hybrid electric vehicle (HEV), and electric vehicle (EV) technologies. Key parameters in comparison included greenhouse gas emissions (GHG), social cost of carbon (SCC), energy efficiency, fuel consumption, fuel price, driving range, and total cost of ownership (TCO). A normalization approach is employed to rank the technologies across parameters, providing valuable insights for sustainable transportation decision‐making. FCV technology showed the highest average performance (5.343/10) followed by EV technology (4.760/10). The paper also presents current and anticipated hydrogen demand and supply centers, accompanied by a brief overview of commercially available fuel cell technologies. Finally, the sustainability of FCV technology as well as economic, legal, and infrastructural limitations associated with the widespread adoption are also discussed.

75% Reduction in Packing Variation of in-House Central Sterile Supply Unit Products in a Restructured Hospital in Singapore

75% Reduction in Packing Variation of in-House Central Sterile Supply Unit Products in a Restructured Hospital in Singapore

Surgical instrument tray optimization process at a university hospital: A comprehensive overview

ObjectiveThis study presents the results of a surgical instrument tray optimization process implemented across all surgical specialties within the largest university hospital in Denmark. MethodsData was extracted from a comprehensive instrument optimization process including all Operating Rooms at Aarhus University Hospital. Adopting a holistic perspective, the optimization process, involved aligning instrument trays across various surgical specialties. This included: a) Reduction in number of instruments, b) Consolidation or separation of trays, c) Modularization - introducing modular trays for specific purposes, and d) Standardization - standardizing commonly used instruments across specialties. Instruments per tray, total number of instruments, and changes in the number of trays were compared against existing tray contents to identify discipline-specific changes. ResultsSome specialties made substantial alterations to tray structures, while others primarily reduced number of instruments in existing trays. Across all specialties, optimization resulted in 17 % decrease in number of tray types (p = 0.01, 95%CI:1.0–6.8), 1 % increase in total number of trays (p = 0.36, 95%CI:-11.9–4.8), 18 % decrease in number of instruments per tray (p = 0.0002, 95%CI: 3.2–7.6) and 16 % reduction in total number of instruments for all specialties (p < 0.0001, 95%CI:404–758). ConclusionThis study underscores complexity of instrument tray design. The approach employed at Aarhus University Hospital, involving interdisciplinary experts in an iterative design process, demonstrated the feasibility of redesigning instrument trays with significant reduction in content. Additionally, data suggests that reducing the number of instruments could lead to a decrease in workload within the Central Sterile Supply Specialty. This presents opportunity to minimize wasted resources and streamlining cleaning processes for unused instruments.

Fruits and vegetables at the supply center of Bahia, Brazil: why not just supply, but also loss?

Food loss is a global challenge with significant economic, environmental, and social implications. In Brazil, it is estimated that fruit and vegetable losses range between 30% and 35% from production to the final consumer. This study analyzed the extent of fruit and vegetable loss and its determinants at the Supply Center of the State of Bahia (CEASA-Bahia), Brazil, taking into account the diversity of sales establishments. A cross-sectional study with a quantitative approach was conducted using questionnaires administered to sellers at the Salvador Supply Center in Bahia, Brazil. The sample consisted of 132 sellers, representing three categories: stalls, stones, and boxes. Over 85% of the sellers had not received any training in food handling. Precarious facilities and insufficient conservation technologies were observed, with only 12.9% of sellers having refrigeration facilities. Although 56.1% of the sellers denied experiencing losses, a weekly loss of 26.30 t of vegetables and 127.4 t of fruit was estimated, representing 2.26% of the acquired amount. In absolute values, this corresponds to over 150 t of wasted food. There was no policy in place at the Center to prevent or reduce food loss, with only timid initiatives such as donations (28.8%) and discounts (6.8%). The findings highlight the potential for implementing programs aimed at preventing food losses.

Optimising Surgical Instrument Trays for Sustainability and Patient Safety by Combining Actual Instrument Usage and Expert Recommendations

Annually, over 300 million surgeries occur globally, requiring numerous surgical instruments. However, many instruments on the tray are returned to the central sterile supply department (CSSD) unused, creating an unsustainable pattern of unnecessary consumption. To address this, we developed a method for optimising surgical instrument trays (SITs) that is straightforward to implement in other hospitals. This optimisation aims to enhance patient safety and sustainability and to improve working conditions and reduce costs. We identified actual instrument usage (IU) in the operating room (OR) and obtained expert recommendations (ERs). Data from both methods were combined in a computer model (CM) to adjust the SITs. The performance of the adjusted SITs was assessed over a year. IU of three different SITs was collected during 16 procedures (mean = 28.4%, SD = 6.4%). Combining IU and ERs resulted in a 36.7% reduction in instruments and a 31.3% weight reduction. These measures contribute to reducing the carbon footprint and enhancing sustainability. During the evaluation of the new SIT contents (n = 7 procedures), mean IU increased from 28.4% (SD = 6.4%) to 46.5% (SD = 11.0%), with no missing instruments during surgery. A one-year follow-up showed no need for further alterations. Combining both methods yields better results than using them individually, efficiently reducing unnecessary items in SITs without compromising patient safety.

PREEMPTIVE AND NON-PREEMPTIVE GOAL PROGRAMMING APPROACH TO INVENTORY OPTIMIZATION OF THE CENTRAL STERILE SUPPLY DEPARTMENT, UNIVERSITY COLLEGE HOSPITAL, IBADAN, NIGERIA

This research applied a multi-criteria optimization technique to analyse the inventory system of a Central Sterile Supply Department (CSSD) through preemptive and non-preemptive goal programming. Data on six raw materials and four finished products were collected, in addition to their costs, demand rates, shelf lives, and available capital. The developed objective function of the non-preemptive model combined four goals: inventory cost optimization (highest priority), inventory turnover, service level, and delivery lead time. The implemented model guaranteed zero stock-outs, reduced wait times between productions, timely product sales, and the elimination of unnecessary overall costs.

Emergency preparedness in the central sterile supply department: a multicenter cross-sectional survey

ObjectiveTo investigate the current situation of emergency preparation and emergency drill in the CSSD, and analyze its influence on the nurses’ emergency attitude and ability.MethodsThis study employed a multicenter stratified sampling method, conducted from January to June 2023 using the online survey, participants completed the general data, emergency preparedness and drill questionnaire, public health emergency response questionnaire and emergency capacity scale. An independent samples t test or Kruskal-Wallis test was used to analyse differences in nurses’ emergency capacity and attitudes.ResultsThe data from 15 provinces 55 hospitals in China. Overall, 77.58% of participants’ institutions set up emergency management teams, 85.45% have an emergency plan and revise it regularly. 92.12% store emergency supplies. All survey staff participated in the emergency drill, which predominantly consisted of individual drills (51.52%), with 90.30% being real combat drills, 49.09% of participants engaging in drills every quarter, and 91.52% of the drill’s participants exceeding 50%. The respondents’ emergency attitude score was (29.346 ± 6.029), their emergency ability score was (63.594 ± 10.413), and those with rescue experience showed a more positive attitude (Z = -2.316, P = 0.021). Different titles, education levels, rescue experience and the frequency of emergency drill affected the emergency rescue ability of the respondents (P < 0.05).ConclusionsMost medical institutions establish emergency management systems and plans, yet the content lacks geographical specificity.The duration and participation of emergency drills are high, but the effectiveness of the drills needs to be further improved, and the response capacity and attitudes of CSSD nurses are low. It is recommended that agencies develop comprehensive and targeted contingency plans to strengthen the inspection and evaluation of team strength, equipment and safeguards against the contingency plans, so as to ensure that the measures mandated by the contingency plans can be implemented promptly after the emergency response is initiated.

Status of Professional Identity, Self-Directed Learning Competence, and Self-Efficacy Among Central Sterile Supply Department Nurses.

BACKGROUND Previous studies on professional identity, self-directed learning competence, and self-efficacy among central sterile supply department (CSSD) nurses are rare. We investigated the status of these 3 characteristics among CSSD nurses and offered suggestions, to provide a reference for CSSD talent development. MATERIAL AND METHODS CSSD nurses working in 45 hospitals in southwest China were invited to participate in a questionnaire survey in August 2021. The survey comprised a general information questionnaire, a self-directed learning competence rating scale, a professional identity scale, and a general self-efficacy scale. RESULTS The CSSD nurses' scores for professional identity, self-directed learning competence, and self-efficacy were 109.92±17.161, 125.77±21.316, and 26.92±6.633, respectively. For professional identity, statistically significant differences were identified (P≤0.05) for 3 factors: monthly income, reason for studying nursing, and reason for working in the CSSD. For self-directed learning competence, statistically significant differences (P≤0.05) were identified for 5 factors: age, hospital grade, type of employee, monthly income, and reason for working in the CSSD. For self-efficacy, statistically significant differences were identified (P≤0.05) for 3 factors: age, reason for studying nursing and working in the CSSD, and whether the CSSD nurses wished their children to become nurses. CONCLUSIONS The professional identity, self-directed learning competence, and self-efficacy of the CSSD nurses in this study were at the medium level. More attention should be paid to career planning of young nurses and improvement of their professional identity and self-directed learning competence.

EVALUATION OF THE EFFICACY OF CHLORINE-CONTAINING COMMERCIAL PRODUCTS FOR WATER DECONTAMINATION AGAINST COLIFORM BACTERIA

Problem. Water is a key factor in the transmission of intestinal infections. During war conflicts, the risk of outbreaks of such infections increases due to infrastructure damage, the inaccessibility of central water supplies, and the impossibility of governmental institutions to control drinking water quality. In such situations, the need arises for household water treatment methods. Aim. To evaluate the efficacy of seven commercial water treatment products available in the Ukrainian market against enteric bacteria and to compare their efficacy. Methods. The activity of water purification products against the model microorganism Escherichia coli ATCC25922 was evaluated using serial dilution methods followed by viable count assessment. The main results: High efficacy of the studied preparations against enteric bacteria was detected. In each test, a significant decrease in the initial titer of Escherichia coli from 1,2·10 6 CFU/cm 3 to ˂ 10 CFU/cm 3 was observed after the exposure time declared by the manufacturer. Conclusions: The studied water treatment products from Ukrainian and foreign manufacturers were effective against enteric bacteria and met the WHO criteria for efficiency, regardless of the nature of the active compound (chlorine dioxide, sodium dichloroisocyanurate, or polyhexamethylene guanidine hydrochloride).

Establishment of a 24/7 robotic acute care surgery program at a large academic medical center.

For many years, robotic surgery has been an option for various elective surgical procedures. Though robotic surgery has not traditionally been the first choice for acute surgical patients, recent work has shown promise in broader applications. However, there are limited data regarding how to establish an institutional robotics program for higher acuity patients. This project aimed to map a pathway for the creation of an acute care surgery robotic program at a large academic medical center. Various stakeholders were gathered jointly with our surgical faculty: anesthesia, operating room leadership, surgical technologists, circulating nurses, Central Sterile Supply, and Intuitive Surgical Inc. representatives. Staff underwent robotics training, and surgical technologists were trained as bedside first assistants. Nontraditional robotic operating rooms were allocated for coordinated placement of appropriate cases, and pre-made case carts were arranged with staff to be available at all hours. A workflow was created between surgical faculty and staff to streamline add-on robotic cases to the daily schedule. Six faculty and two fellows are now credentialed in robotics surgery, and additional surgeons are undergoing training. Numerous staff have completed training to perform operative assistant duties. The operating capacity of robotic acute care surgeries has more than doubled in just one year, from 77 to 172 cases between 2022 and 2023, respectively. Two add-on cases can be accommodated per day. Select patients are being offered robotic surgeries in the acute surgical setting, and ongoing efforts are being made to create guidelines for which patients would best benefit from robotic procedures. Launching a successful robotic surgery program requires a coordinated, multidisciplinary effort to ensure seamless integration into daily operations. Additional assistance from outside technology representatives can help to ensure comfort with procedures. Further studies are needed to determine the acute patient population that may benefit most from robotic surgery.

Quantification of pesticide residues in milk by HPLC-UV analysis in Gilan province, Iran

ABSTRACT Eighty milk samples, comprising raw cow’s milk, pasteurised milk, ultra-high temperature milk, and camel milk, were collected randomly from supply centres from December 2022 to March 2023 in Gilan province, Iran. Aldrin, diazinon, and dichlorodiphenyltrichloroethane (DDT) were determined using high-performance liquid chromatography. Aldrin and diazinon were observed in all samples. Furthermore, 87.5% of the milk samples were contaminated with DDT. The raw milk sample showed the greatest concentration of aldrin, measuring 9.31 ± 0.80 µg L−1, and there was no significant difference with the camel milk. The samples of camel milk, raw milk, and ultra-high temperature milk demonstrated the greatest levels of DDT, whereas the lowest concentration was detected in pasteurised milk. In all samples, the maximum residue level (MRL) of Codex Alimentarius and the national Iran standard (20 µg L−1 for DDT) was only exceeded by 25.1% of the milk samples.

Steam quality monitoring as a strategy to reduce wet packs and sterilization failure

Hospital articles processed by steam are widely used in the Central Sterile Supply Department (CSSD), responsible for due sterilization. Steam sterilization is discussed worldwide, aiming to protect patients. If steam is outside the specified requirements, the sterilization process may fail, resulting in the wet packs at the end of the sterilization cycle. The present study evaluated the steam quality at Santa Catarina Hospital (São Paulo, SP, Brazil) from 2016 to 2022. Saturated steam containing noncondensable gases, excess condensate, or even superheat was characterized using the methodology indicated in the European Standard EN 285:2015. From 2016 to 2020, qualification tests showed that the saturated steam quality does not achieve standardlimit parameters. Infrastructural maintenance actions were taken to adjust the saturated steam quality. In 2021, the steam quality followed technical standards, and its adequacy was confirmed in 2022. The points developed by the hospital's maintenance department, the adoption of appropriate devices for this purpose, and the correct preventive maintenance in the autoclaves, together with the correct qualification of the equipment and proof of the steam quality, contributed to improve the safety of the hospital sterilization process and reduce the incidence of wet packages.

Research on the management effect and tangible and intangible results of PDCA management cycle method in the quality of hospital disinfection supply center.

Research on the management effect and tangible and intangible results of PDCA management cycle method in the quality of hospital disinfection supply center.

Improvements in Efficiency and Resident Satisfaction Following the Implementation of a Central Supply Closet

Introduction: In the 1970’s, the idea of burnout began and was defined as emotional exhaustion, depersonalization, and low sense of personal accomplishment (1). Recently, there has been a push by graduate medical education to counter resident burnout, as demonstrated by resident wellness initiatives becoming a requirement for residency programs in the United States (2). At our institution, a source of burnout was the time it took to gather supplies for critical bedside procedures, which was addressed by instituting a central supply closet. Methods: A checklist was made of the supplies needed for four common bedside procedures: central venous access, arterial line placement, thoracostomy tube placement, and incision and drainage. 9 surgery residents were individually timed to locate the equipment required for each individual procedure with the supply closet and without. A survey was used to evaluate resident satisfaction in the number of locations to search, timeliness, and ability to provide quality patient care before and after the supply closet. This survey was done on a scale of 1 to 5, with 1 being very dissatisfied, and 5 being very satisfied. Paired t-tests were used for data analysis; p&lt;0.05 was considered statistically significant. Results: For central line supplies, the average times were 542 seconds (s) without the closet, and 211s with the closet (p=0.0041), arterial line supplies took 570s without and 178s with (p=0.0114), thoracostomy tube supplies took 590s without, and 213s with (p=0.0017), and incision and drainage supplies took 518s without, and 239s with the closet (p=0.0066). Average resident satisfaction for the number of locations to search for supplies went from 1.5 to 4.8 with the closet, length of time to gather supplies went from 1.3 to 4.9 with the closet, and ability to provide quality patient care went from 1.4 to 4.8 (all p&lt;0.0001). Conclusions: The implementation of a supply closet with easy access to supplies allowed for improved speed in completing bedside procedures, leading to expedited patient care, improved resident satisfaction and well-being, and decreasing a source of surgery resident burnout.