Sterilization Costs Research Articles

Estimation of the Economic and Environmental Impact of Single-Use Instruments in Routine Cataract Surgery.

To estimate the economic and environmental impact of single-use instruments (SUIs) to perform standard cataract surgery in six ophthalmology centers located in Europe and in the United States. Online survey and interview. Comparative cost analysis based on an online survey with follow-up questionnaire and interview. The carbon footprint calculation was made by ClimatePartner. Annual costs of reusable instruments (RUIs) were calculated based on data provided by the centers. Annual costs of SUIs were estimated based on the average-selling price of a single-use cataract set of 5 instruments and the reported annual volume of cataract surgery. The calculation carbon footprint of a cataract instrument covered the whole life cycle from production to end-of-life. Annual costs for SUIs were found inferior or similar to the annual costs for RUIs for 4 out of the 6 centers included in this study. The centers where SUIs were demonstrated to be the most cost-effective were also associated with the highest costs of sterilization per instrument. The carbon footprint of 5-years usage of a cataract instrument was found to be 5478.2 kg CO2 eq for SUIs without recycling, 4639.9 kg CO2 eq for SUIs with recycling and 20.6 kg CO2 eq for RUIs. The study demonstrated that SUIs can be an alternative solution to using RUIs in multispecialty hospitals associated with high sterilization costs.

662 A Sustainable Laparoscopic Cholecystectomy Tray

Abstract Aim The aim was to develop and trial a systematic methodology in order to streamline laparoscopic cholecystectomy trays across all sub-specialties in Leeds Teaching Hospitals Trust (LTHT), and to inform rationalisation principles nationally in partnership with NHS England’s sustainability team. Method 70 laparoscopic cholecystectomies across all sub-specialties were independently observed and audited for instrument usage at LTHT from January to March 2023. The findings were summarised and a usage heatmap was developed. A subsequent ‘hackathon’ event was held in the form of a consensus session with key stakeholders from each sub-specialty to agree a proposed single instrument tray. Carbon and financial savings calculations were then undertaken to measure the impact of the changes. Results Audit results demonstrated an average of 112 instruments across four separate trays opened. The heat map demonstrated 42% of items were used from 0-5% of procedures. The hackathon event agreed a consolidated single tray of 65 items. With over 800 laparoscopic cholecystectomies taking place in LTHT per year predicted financial savings in sterilisation costs were over £22,000 and over 3 tonnes of CO2e annually. Conclusions Tray rationalisation and standardisation has significant financial and carbon savings and can be extrapolated to many types of procedures. Sustainable change is vital to meet NHS net zero targets and requires urgent attention. Stakeholder engagement was crucial to ensure changes were agreeable and would be sustained. Following the successfully trialled methodology and implementation NHS England have produced a guide for other trusts to implement similar changes.

Impact of a Local Government Funded Free Cat Sterilization Program for Owned and Semi-Owned Cats.

In most states of Australia, local governments (councils) are responsible for the enforcement of legislation relating to domestic cats. Traditional methods used for cat management based on trap-adopt or euthanize programs have been ineffective, with cat-related calls and cat impoundments continuing to increase, resulting in many healthy cats being euthanized. This has detrimental effects on the mental health of animal management officers, staff in shelters and council facilities, and cat caregivers. The city of Banyule, Victoria, implemented a free cat sterilization, microchipping, and registration (licensing) program in 2013/14. Initially, it was targeted at three low-socioeconomic suburbs with the highest cat-related calls and intake, and was microtargeted at call locations. An average of 4.1 cats/1000 residents per year were sterilized over eight years. The program included stray cats being fed by caregivers, provided they took ownership. The program was later expanded city-wide. Over eight years, city-wide cat intake decreased by 66%, euthanasia by 82%, and cats reclaimed by owners increased from 6% of intake (2012/13) to 16% (2020/21). Cat-related calls decreased in the target area by 51%, and city-wide by 36%. The council realized cost savings of AU $440,660 associated with reduced costs for cat-related calls to council (AU $137,170) and charges from the contracted welfare agency (AU $303,490), for an outlay of AU $77,490 for sterilization costs. Instead of the traditional management of urban cats, proactive management based on targeted sterilization should be utilized by government and animal welfare agencies in Australia and internationally. These types of programs are effective at reducing cat intake and euthanasia and are cost-effective.

Analysis of sterilization efficiency and application cost of three low temperature sterilization methods.

This paper discusses the sterilization efficiency of three low temperature sterilization methods used in thermosensitive medical devices and makes a preliminary analysis of sterilization costs so as to provide the basis for reasonable selection of low temperature sterilizer in Central Sterile Supply Department. Medical devices compatible with the three sterilization methods were selected for sterilization, and two packaging materials were selected for the three low-temperature sterilization equipment according to the compatibility of the packaging materials. The equipment packed with the same packaging materials were sterilized for five times, and each low-temperature sterilizer was sterilized for a total of ten times. The sterilization effect, sterilization cycle time, energy consumption, and cost of the three sterilizers were compared. The cycle time of ethylene oxide sterilizer was 393.6min, and the cycle time of hydrogen peroxide low temperature plasma sterilizer was 56.1min. The cycle time of low temperature steam and formaldehyde sterilizer was 105.7min. The hydrogen peroxide low temperature plasma sterilizes single cycle power consumption at a maximum of 5 kWh. The single cycle energy consumption of compressed air ethylene oxide sterilizer is up to 12 l. In terms of sterilization application cost, hydrogen peroxide low temperature plasma sterilization has the highest cost, followed by ethylene oxide sterilization, and low temperature steam and formaldehyde sterilization is the lowest. The sterilization efficiency of hydrogen peroxide low temperature plasma sterilization is the highest, followed by low temperature steam and formaldehyde sterilization, and the lowest is ethylene oxide sterilization. The three low temperature sterilization methods can achieve effective sterilization of devices. Each hospital can choose an appropriate low temperature sterilization method according to the characteristics of thermosensitive instruments, turnover efficiency requirements, and financial status.

Barriers to Office Hysteroscopy in Fellowship Education and Practice

Study objectivesTo identify the top 3 perceived barriers to performing office hysteroscopy by MIGS faculty and fellows and identify opportunities for education on this key topic that will be most effective in fellowship training and MIGS practice. DesignCross-sectional survey study targeted at all AAGL-accredited FMIGS fellows, program directors, and associate program directors in February-April 2022. The survey was designed by faculty who have extensive experience in office hysteroscopy procedures. Additionally, a literature search was performed to aid with question design. Setting, patients and interventionsThis was a RedCap electronic survey administered through the FMIGS listserv. No additional follow-up was performed after survey completion. The 15-minute survey was sent to 60 program directors, 92 assistant program directors, and 158 fellows, including the incoming class of 2024 and the 2022 fellowship graduates. Measurements and main results93 responses were received. 67% of respondents performed office hysteroscopy (OH) but 73% of those performed 5 procedures or less per month. The majority of participants controlled pain with NSAIDs +/- paracervical block. The most common perceived barrier to performing OH was concern over pain management. Other commonly cited concerns were equipment costs, sterilization costs, and office staff training. 37-44% of respondents also cited lack of departmental support and insufficient clinic time, respectively, as barriers. 56% indicated they are interested in educational materials on OH. ConclusionOur study suggests general interest in, but low volume of OH amongst MIGS fellows and faculty. The most common perceived barrier was concern regarding pain management. This has been well studied in the literature and likely presents an area for greater education to improve OH utilization. We also uncovered concerns regarding systemic barriers, such as equipment costs, departmental support, and clinic structure. This is an area for further research and advocacy efforts to address barriers to OH on a system level.

A Prospective Evaluation of Cost and Space Utilization Following Implementation of an Intelligent Delivery Platform for Forefoot Single-use Implants and Instrumentation in the ASC Setting

Category: Midfoot/Forefoot; Other Introduction/Purpose: The transition of the US healthcare system from a fee-for-service model to a value-based care model calls for a deeper evaluation of patient care in order to uphold quality and efficiency. Sterile-packed single-use instruments have been introduced as a tool to help facilities streamline operating room logistics and reduce sterilization needs and requirements thus reducing cost, time, and valuable shelf space. With the added intelligent delivery platform, procedure mapping (physician specific stocking of implants) and automatic restocking is now possible1-3. The purpose of this study was to examine the efficiencies of cost savings and reduction of shelf space required for storage of an intelligent delivery platform (Pulse Intelligent Delivery Platform, Stryker, Memphis, TN) with single-use surgery-ready forefoot implants. Methods: A total of 19 cases were performed during a 3-month period (August to November 2022) at a single ambulatory surgery center. Instrument tray reduction was tabulated and compared to the number of trays typically utilized using reusable instruments. Tray management time was evaluated clinically by direct observation. A cost analysis of reprocessed instrumentation trays was then performed looking at sterilization, surgical delay, and instrumentation costs per tray and then compared to pricing for the sterile instrument kits. The instrument, sterilization, and case delay costs/tray at the facility were calculated2. A comparison of space utilization was also performed between the two groups (reprocessed trays versus sterile kits). Results: There was a substantial decrease in the need for reusable instrument trays by 80%. 70% of cases did not require even one tray of reusable instruments to be opened. The delivery platform was shown to lower instrument tray cost per case by 74.25%. Space was also evaluated, and the sterile kits were found to have an 85.9% reduction in space when compared to the reprocessed trays2,3. Conclusion: A forefoot single-use surgery ready intelligent delivery platform has been shown to effectively lower overall instrument tray cost per case by 74.25% in a highly efficient ASC. In addition, an 85.9% reduction in shelf space per tray was also seen comparing reprocessed instrumentation to sterile instrument kits. Pricing is variable per facility, and sterilization and usage processes vary1-6. However, we believe that sterile kits can be more cost effective than reprocessed sets. In addition, space can be saved with the use of sterile instrument kits adding to the established benefits of the delivery platform of procedure mapping and automatic restocking1-3.

Investigating the energy, environmental, and economic challenges and opportunities associated with steam sterilisation autoclaves

Abstract Despite steam sterilisation in autoclaves being a common industrial method of sterilisation, very little research has been conducted into quantifying the resources these processes demand and their associated environmental impacts. This paper aims to investigate industrial steam sterilisation in autoclaves with particular application to the biopharmaceutical industry. A mathematical model of a steam autoclave was developed to examine relationships between load size, load material properties and autoclave capacity with energy consumption, environmental impact and cost of sterilisation. The two main energy requirements are thermal energy to produce the clean steam for sterilising, and electrical energy for the vacuum pump. The study showed that thermal energy is dominant, particularly as load increases. The percentage of the maximum load at which the autoclave is operated has a major impact on the specific energy requirement or the energy required to sterilise per unit mass of load. For a given autoclave, the energy requirement increases with increased load but the specific energy requirement decreases. This in turn impacts on the emissions and the energy cost. It is thus shown that it is much more energy efficient to operate at higher loads, making the autoclave much more energy and cost effective, and with less environmental impact. There is potential for applying the analysis presented in this work for conducting optimisation studies for determining the sizes of autoclaves that could minimise the energy requirement, environmental impact and economic cost (3E) of investments for specified load versus time profiles.

To Dispose or to Reuse? Analyzing the Life Cycle Impacts and Costs of Disposal, Sterilization, and Reuse of Electrophysiological Catheters

Given the growing ecological footprint of anthropomorphic activities, considering the environmental impacts of any process is becoming increasingly important. This is especially true for the healthcare industry, whose objective of maintaining human health standards is impeded by its own unsustainable practices. To this end, life cycle analysis is particularly helpful. There have not been many life cycle analyses performed on a healthcare device or on medical procedures. Many medical devices are single use, which leads to a significant waste management problem, particularly as plastic is widely used in their composition. The objective of this study is to present a life-cycle-thinking-based approach to compare the environmental impacts associated with single-use electrophysiological catheters with the sterilization of reusable electrophysiological catheters using hydrogen peroxide, ethylene oxide, and peracetic acid. A life cycle assessment was conducted considering different use, disinfection, and disposal scenarios for electrophysiological catheters, using ReCiPe midpoint and endpoint analysis with the SimaPro software. The findings indicate that using single-use disposable electrophysiological catheters, instead of sterilizing a single catheter using either ETO or hydrogen peroxide and reusing multiple times, is preferable from a purely environmental perspective. However, the costs reduce drastically when equipment is sterilized and reused instead of disposing them after using one time. This in turn illustrates that depending on the process, sanitizing and reusing medical devices may not always be more resource-efficient than single device usage. From a cost perspective, ETO sterilization has the lowest costs, and yet it leads to an aggregate environmental impact of over 20 times compared to the single-use scenario, mainly due to the required detoxification process. The outcomes of this research will assist the health care industry in identifying the most suitable operational procedures considering patient safety, economics, and environmental stewardship, and in developing policies and guidelines for a more sustainable healthcare sector.

Mini-Review of Biofilm Interactions with Surface Materials in Industrial Piping System

The growth of biofilm, which is caused by microorganism accumulation and growth on wetted surfaces, may damage industrial piping systems, increase maintenance and cleaning costs for the system sterilization, and even divulge the immune system into high risk. This article systematically analyzes the biofilm interactions with piping surface materials from the perspectives of physical convection, and biological and chemical adhesion. The thermodynamics of the flow, bacterial surface sensing, and bio-communication are the most critical factors for biofilm attachment. Furthermore, experimental analysis methods as well as biofilm control and removal approaches, are also included in this study. Finally, the resistance and growth of biofilm, as well as the practical and advanced methodology to control the biofilm and challenges associated with technology, are also discussed. Moreover, this paper may also offer a significant reference for the practice and strategic applications to address the biofilm resistance issues in industrial piping.

A race we must win: reuse of disposable products in the operating theater : The example of a nearly failed recycling concept

Climate change due to the carbon footprint left by the modern lifestyle has become an irrefutable topic in today's media. The healthcare sector alone contributes ca.5% of the world's CO2 emissions of which 25% comes from the operating theater. In order to spare personnel costs for sterilization, most medical suppliers of operating equipment have switched to the use of disposable products. In our pilot project in the department for thoracic surgery, we aim to recycle disposable Ethicon staplers used regularly in almost every operating theater. Since August 2022 we have succeeded in making the process routine for all surgical departments in all Asklepios Clinics in Hamburg. This project clearly demonstrates the various possibilities available to reduce carbon emissions through something as simple as recycling. Although the process is practically and politically arduous to implement we have demonstrated that with close partnerships with regulatory bodies, the process can be streamlined to meet the needs of every healthcare provider.

Cost minimization analysis of indication-specific osteosynthesis material in oral and maxillofacial surgery

PurposeFollowing the introduction of the Regulation (EU) 2017/745 by the European Parliament, any bioactive substance or surgical implant introduced into the human body must be documented. The regulation requires any implant to be traced back to the manufacturer. Lot numbers need to be available for every single medical implant. Also, the manufacturer is required by law to provide implants individually packaged and sterilized. Previously, model tray systems (MOS tray) were used for osteosynthesis in oral and maxillofacial surgery, in which the individual implants could not be registered separately. The new regulation made it impossible to use such processes during surgery anymore and a need for a change in the medical practice surged. We examined a possible solution for the new legislation. The aim of this prospective cohort study is to analyze the MOS tray systems to osteosynthesis materials prepackaged in sets. We record and evaluate parameters such as surgical time and documentation time. We perform a short cost analysis of our clinic. The primary aim is to determine how much time is gained or lost by the mandatory increased patient safety. The secondary aim is to describe change in costs.MethodsPatients that underwent standard surgical procedures in the clinic of oral and maxillofacial surgery of the faculty hospital Carl Gustav Carus in Dresden were included. We chose open reduction and internal fixation (ORIF) of anterior mandibular corpus fractures as well as mandibular advancement by means of bilateral sagittal split osteotomies (BSSO) as standardized procedures. Both of these procedures require two osteosynthesis plates and at least four screws for each plate. MOS trays were compared to prepackaged sterilized sets. The sets include a drill bit, two plates, and eight 5-mm screws.A total number of 40 patients were examined. We allocated 20 patients to the ORIF group and the other 20 patients to the BSSO group. Each group was evenly subdivided into a MOS tray group and a prepackaged group. Parameters such as the incision-suture time (IST) as well as the documentation time (DT) by the operating room (OR) staff to complete documentation for the implants are the main focus of investigation.ResultsFor open reduction, the incision-suture time was significantly different in favor of the MOS tray (p < 0.05). There was no difference in the BSSO groups. However, we observed a significantly different (p < 0.01) documentation time advantage for the prepackaged sets in both the ORIF and BSSO groups. On top of that, we find that by using the prepackaged kits, we are able to reduce sterilization costs by €11.53 per size-reduced container. Also, there is also a total cut of costs of €38.90 and €43.70, respectively, per standardized procedure for implant material.ConclusionsBy law, a change in the method of approaching surgery is necessary. For standardized procedures, the right choice of implants can lead to a reduction of documentation time and costs for implant material, sterilization, as well as utilizing less instruments. This in turn leads to lower costs for perioperative processing as well as provision of state-of-the-art implant quality implementing higher patient security.

Study of Operative Outcomes of Hernioplasty Using Mosquito Net Mesh at a Tertiary Hospital.

BackgroundSynthetic mesh is the most efficient way to repair groin hernias. However, many patients in low and middle-income countries cannot afford the above-mentioned mesh. This study's goal was to describe the mosquito net mesh's (MNM) safety, viability, complications, and recurrence rate in hernioplasty done in rural populations.Material and methodsThis study was a single-centre, prospective, descriptive study, conducted in patients >18 years of age, of either gender, with unilateral or bilateral primary inguinal hernias (reducible/irreducible/bilateral hernia), admitted for elective or emergency open inguinal hernia mesh repair. The surgery was performed using reasonably priced (affordable to people of low socioeconomic status) polyethylene mosquito net mesh, which was cut into 8x16 cm rectangles and wrapped in two sealed plastic bags. They were sterilised using the ethylene oxide sterilisation (EtO) method. The type of hernia (unilateral or bilateral), post-operative pain, and complications were noted.ResultsAmong 400 study participants, the incidence of inguinal hernia was highest in the 60-79 year age group (51.5%). Direct inguinal hernia (67.5 %) was higher compared to indirect inguinal hernia (32.5 %). While a majority of the participants had a hernia on the right side (50%), 164 patients (41%) had a hernia on the left side, and 36 patients (9%) had a bilateral inguinal hernia. The average operative time for unilateral inguinal hernia was 73.96 minutes and for bilateral inguinal hernia was 106.66 minutes. Out of 400 patients, 355 patients (88.75%) had no complications. Among the postoperative patients, 14 patients (3.5%) experienced surgical site infection; 9 patients (2.25%) experienced headache; 5 patients (1.25%) experienced hematoma; 12 patients (3%) experienced urinary retention; and 5 patients (1.25%) experienced testicular pain. The average hospital stay of patients was 4.25 days. Patients returned to their daily activities and employment in an average of 7.29 days. The market cost of a single standard polypropylene mesh was Rs.1,660/-. For making a single mosquito net mesh of the same size, we had an expenditure of Rs. 11.83/- including the cost of sterilization. In this study, 382 patients (95.5%) gave us good feedback, 11 patients (2.75) gave satisfactory feedback, and 7 patients (1.75%) gave excellent feedback.ConclusionIn environments with limited resources, using mosquito net mesh for hernioplasty is reasonable, acceptable, doable, and economical.

Baseline proteomics characterisation of the emerging host biomanufacturing organism Halomonas bluephagenesis

Despite its greener credentials, biomanufacturing remains financially uncompetitive compared with the higher carbon emitting, hydrocarbon-based chemical industry. Replacing traditional chassis such as E. coli with novel robust organisms, are a route to cost reduction for biomanufacturing. Extremophile bacteria such as the halophilic Halomonas bluephagenesis TD01 exemplify this potential by thriving in environments inherently inimical to other organisms, so reducing sterilisation costs. Novel chassis are inevitably less well annotated than established organisms. Rapid characterisation along with community data sharing will facilitate adoption of such organisms for biomanufacturing. The data record comprises a newly sequenced genome for the organism and evidence via LC-MS based proteomics for expression of 1160 proteins (30% of the proteome) including baseline quantification of 1063 proteins (27% of the proteome), and a spectral library enabling re-use for targeted LC-MS proteomics assays. Protein data are annotated with KEGG Orthology, enabling rapid matching of quantitative data to pathways of interest to biomanufacturing.

SP11.10 Assessing the utility of surgical instruments in breast surgery at a tertiary referral centre

Abstract Introduction Most surgical specialties have standardised surgical trays, which are used for a variety of their operations. Any unused instruments require re-sterilisation, with costs relating directly to the number of instruments. This has further environmental implications. In 2019, we performed over 1600 breast surgeries in our unit. This study aimed to look at the utility of the breast reconstruction tray (BRT), which is the most commonly used surgical tray, in the unit to see if there was scope for cost efficiencies. Methods All BRTs (averaging 55 instruments) used for breast operations were recorded from October to November 2021. Data collection included operation type, individual instruments used and additional instruments requested during the procedure. Quantitative analysis was performed on the collected data. Results A total of 55 BRTs were used during the study period. 17 were bilateral cases. An average of 42% (n=23, range 10–33) of instruments were used from each tray, with 16% (n=9) of instruments never used. There was no difference in instruments used in relation to the type of surgery performed (range 42%-46% across operation types). 67% (n=12) of bilateral cases required an additional tray to allow simultaneous operating on both sides. Despite this, 20% (n=11) of the operations required specific additional instruments to be opened. Conclusions This study has shown a significant number of instruments remaining unused but being re-sterilised. If a reconfiguration of the standard instruments were to occur this could lead to a potential cost saving of over £25000 per annum purely on sterilisation costs.

Comparative Cost Analysis of Single-use Sterile versus Reprocessed Distal Radius Volar Plate Sets.

With the rise in distal radius fracture (DRF) incidence and treatment through open reduction internal fixation, there are increasing concerns in the current medical cost containment climate. To help reduce costs, manufacturers are introducing sterile packed kits. The purpose of this study is to compare the costs of the single use kit (SK) against conventional reprocessed DRF surgical sets (RS). A four-year retrospective review at three surgical centers was performed to determine a company's RS average sterilization and processing costs. RS instrumentation cost was estimated by straight-line depreciation from the original purchase price. RS implant costs were calculated from the list price. SK list cost was obtained from the same company. Incidence of surgical delays was estimated by a survey of 23 hand surgeons and cost of delays was obtained from surgical center reports. Sensitivity analysis on delay frequency was performed to assess a range of overall costs. OR delays were estimated at one out of 100 cases, with an average cost of $11 per case. For RS, average instruments, implants, and sterilization costs per case was $47, $2882, and $39. The total RS cost of $2,978 and the SK was $1,667 with a difference of $1,313 per case. RS was found to cost $1,313 more per case than the SK in an ambulatory surgical setting and potentially more cost effective. Ultimately, pricing is highly variable at each center based on negotiated and contractual pricing.

Five-in-one: a novel, cost-effective yet simple use of micro needle holder.

To achieve a balance between efficiency and cost in the management of medical instrument by the use of micro needle holder. In this study, the novel multifunctional use of micro needle holders was performed between 2018 and 2019 at the Department of Ophthalmology in the 4 hospitals in Shaanxi Province. In this innovation, the micro needle holders were initially used as micro forceps to remove sutures, as eye spud to safety extract foreign body from cornea, as ciliary forceps to remove trichiasis, as well as punctal dilator to dilate most small puncta. Using this technique, the medical costs of both procurement and sterilization were cut off in the selected 4 hospitals. The purchase cost has dropped by roughly 50%. The sterilization cost was decreased by about 30%. The innovation in the five-in-one multifunctional use of micro needle holders saves the medical costs.

The use of preoperative planning to decrease costs and increase efficiency in the OR.

BackgroundShoulder arthroplasty (SA) incurs up to $1.8B per year in societal costs. With the increasing demand for SA and the steady decrease of annual reimbursements for orthopedic procedures, it has become crucial to control costs. In SA, there has been an interest in using preoperative planning software to improve accuracy in positioning and implant selection, ultimately optimizing outcomes. However, the use of preoperative planning to increase efficiency has not been studied. The purpose of this study was to determine if preoperative planning could increase efficiency and decrease costs in the operating room.MethodsThis retrospective review included 94 patients who underwent shoulder arthroplasty and had a CT scan with a preoperative plan by a single orthopedic surgeon between 2017 and 2020. The patients were divided based on the use of the preoperative plan during surgery. Group 1 included 65 patients with a preoperative plan used during surgery, and group 2 included 29 patients without a preoperative plan utilized during surgery. Average preparation time, surgical time, time in the operating room, the number of trays sterilized, and postoperative outcomes were analyzed between the two groups. Subanalysis was done to find a statistical difference in the cost of sterilization for both groups.ResultsThe cohort had 55% males, with an average age of 71 years and an average BMI of 29.9. There were no significant differences between the groups for age, BMI, or ASA class. There was no significant difference between groups in preparation time (group 1: 53.3 min, group 2: 53.1 min P = .924), surgical time (group 1: 119.7 min, group 2: 111.9 min; P = .25), or time in the OR (group 1: 183.2 min, group 2: 173.2 min; P = .156). There was a statistical difference in the number of trays (5 vs. 8; P < .01) and cost of sterilization between groups ($487.30 vs. $842.86; P < .01). No correlation between the number of trays and preparation time (group 1: −0.05, group 2: −0.28) or trays and surgical time was found for either group (group 1: r = −0.31, group 2: r = −0.22). There were no significant differences in postoperative outcomes between the groups.ConclusionWhile preoperative planning did not reduce time in the OR for shoulder arthroplasty, it was correlated to a significant reduction in the number and cost of sterilized trays with comparable postoperative outcomes.

High-temperature solar steam generation by MWCNT-HfTe2 van der Waals heterostructure for low-cost sterilization

Conventional steam sterilization for medical equipment requires electricity and significant initial capital cost, impeding its uses in many resource-constrained areas and exposing patients to nosocomial infections. The urgent need for a low-cost and environmentally friendly approach for the sterilization process can be addressed by utilizing abundant solar irradiance and an efficient solar absorber. Herein, for the first time, 1D–2D metallic MWCNTs and HfTe2 van der Waals heterostructure are used for realizing broadband solar absorption with an evaporation efficiency of 87.43% under one sun illumination resulting in an increase in steam temperature to 132 °C in < 20 mins. The facile fabrication process and minimalist design substantially reduced sterilization cost to only ¢0.21 per liter capacity. Furthermore, a proof-of-concept sterilizing demonstration resulted in a 99.04% reduction in E. coli bacteria, exceeding the requirements of the World Health Organization. Such a sterilization system would reduce 2.45 tons of CO2 emissions annually by substituting a 10 L capacity conventional autoclave. Hence, the MWCNT-HfTe2@Cu foam-based medical sterilizing system could be a promising and low-cost sterilization solution in off-grid and resource constrained areas due to its superb sterilizing performance, dramatic capital and operating cost reduction capability, ease of maintenance, and a significant reduction in carbon footprint.

Rationalization of Orthopaedic Surgical Instrument Trays: Three Years' Experience of a Practical Approach to Cut Down Unnecessary Costs.

BackgroundThis study aimed to rationalize the surgical instrument trays (SITs) used in some trauma and orthopedic (T&O) procedures to reduce unnecessary costs.MethodsSITs for several T&O procedures at our trust were assessed to judge the utility of each instrument. SITs for hip, knee, and shoulder arthroscopy, dynamic hip screw (DHS), rotator cuff repair, shoulder stabilization, total shoulder arthroplasty (TSR), and proximal humerus fracture fixation were reviewed. Infrequently used and irrelevant instruments were removed to minimize the number of used trays for each procedure. A qualitative survey was conducted following SIT rationalization to assess the practicality and suitability of these changes.ResultsThe number of SITs was rationalized from four to two for DHS, three to one for hip, knee, and shoulder arthroscopy, five to two for rotator cuff repair and shoulder stabilization, three to one for TSR, and proximal humerus fracture fixation. Based on the local database figures for these procedures, the estimated number of used trays reduced from 2,785 to 1.015 (36.4%) trays per year. Based on the sterilization cost of £35 per tray, annual savings amounted to about £61,950. Qualitative analysis of theatre staff feedback showed increased time efficiency and a positive feeling of practicality.ConclusionThe critical appraisal of the departmental operating practice is an effective tool to achieve cost-efficient practice. The rationalization of SITs for orthopedic procedures can result in significant savings by reducing sterilization costs alone.

Accuracy of one-dimensional templating on linear EOS radiography allows template-directed instrumentation in total knee arthroplasty

BackgroundTemplating for total knee arthroplasty (TKA) is routinely performed on two-dimensional standard X-ray images and allows template-directed instrumentation. To date, there is no report on one-dimensional (1D) anteroposterior (AP) templating not requiring specific templating software. We aim to describe a novel technique and explore its reliability, accuracy and potential cost-savings.MethodsWe investigated a consecutive series of TKAs at one institution between January and July 2019. Patients with preoperative low-dose linear AP EOS radiography images were included. Implant component sizes were retrospectively templated on the AP view with the hospitals imaging viewing software by two observers who were blinded to the definitive implant size. Planning accuracy as well as inter- and intra-observer reliability was calculated. Cost-savings were estimated based on the reduction of trays indicated by the 1D templating size estimations.ResultsA total of 141 consecutive TKAs in 113 patients were included. Accuracy of 1D templating was as follows: exact match in 53% femoral and 63% tibial components, within one size in 96% femoral and 98% tibial components. Overall 58% of TKA components were planned correctly and 97% within one size. Inter- and intra-rater reliability was good (κ = 0.66) and very good (κ = 0.82), respectively. This templating process can reduce instrumentation from six to three trays per case and therefore halve sterilisation costs.ConclusionsThe new 1D templating method using EOS AP imaging predicts component sizes in TKA within one size 97% of the time and can halve the number of instrumentation trays and sterilisation costs.