Reusable Equipment Research Articles

Reusable Tourniquets as Potential Transmitters of Infection: A Microbiological Analysis

Introduction: Healthcare-associated infections (HAIs) pose a significant global challenge, resulting in prolonged hospital stays, higher healthcare costs, and increased morbidity and mortality rates. Reusable medical equipment, such as tourniquets, represents a potential vector for infection transmission. Despite frequent use and close contact with patients’ skin, infection control protocols often overlook these devices. This study examines microbial contamination on the surface of reusable tourniquets in both emergency department and operating theatre settings. Methods: A cross-sectional study was conducted between March and September 2024 in Gdansk, Poland. Samples from tourniquets used in the emergency department and the operating theatre were collected after an indefinite period, 14 days, and 28 days. Bacterial contamination on the surfaces of the tourniquets was measured using Columbia agar blood medium and expressed as colony-forming units (CFUs) per cm2. Results: Significant bacterial loads were detected on reusable tourniquets, with contamination levels varying by location and duration of use. The average number of CFU/cm2 across all stages of this study was 545 CFU/cm2 for the emergency department and 101 CFU/cm2 for the operating theatre. Tourniquets used in the emergency department exhibited higher bacterial counts compared to those from the operating theatre, which showed a greater diversity of bacterial species. These findings underscore the need to revise infection control protocols for reusable tourniquets. Conclusion: This study provides critical data that may influence future policy changes aimed at reducing the risk of HAIs through the improved management of reusable medical devices.

Infections acquired in barbershops - A review.

Barbershops are important venues for men to get their hair and beards done and hence, play an important role in men's social life. But barbershops can also be a source of infections. The barber's profession brings the barber into direct contact with customers who may carry pathogens, and contaminated instruments or skin-to-skin contacts might transmit infectious agents. Since barbers work with non-sterile and reusable sharp objects, a simple nick might facilitate blood-borne infections. In our review article we summarize current knowledge regarding barbershop-acquired infections including transmission routes and preventive measures. In fact, shaving in barbershops, particularly when reusing non-disinfected razor blades increases the transmission risk for the human immunodeficiency virus (HIV) and hepatitis B or C viruses. Furthermore, distinct bacteria like Staphylococcus aureus, fungi (in particular dermatophytic Trichophyton species) as well as ectoparasitic lice could be identified upon screening of the barbers' equipment and working places. However, knowledge regarding and compliance in hygiene practices varied considerably among barbers. Notably, since in certain countries barbershops are venues to contact sex workers, sexually transmitted diseases might also be acquired in barbershops. In conclusion, improving hygiene standards including disinfection of reusable equipment, and surveillance of the preventive measures would reduce the risk for barbershop-acquired infections.

Sustainability in Reconstructive Breast Surgery: An Eco-audit of the Deep Inferior Epigastric Perforator Flap Pathway.

The deep inferior epigastric perforator (DIEP) flap provides an effective and popular means for autologous breast reconstruction. However, with the complexity of the pathway, the environmental impact of the pathway has yet to be evaluated. A retrospective analysis of 42 unilateral DIEPs at a single reconstructive center was performed. Process mapping and life-cycle analyses were performed for equipment, staff, patients, and land. A bottom-up approach was adopted to calculate carbon dioxide equivalent estimates for the initial consultation, preoperative, intraoperative, and immediate postoperative periods. This study estimated the carbon footprint of a patient undergoing DIEP flap surgery to be approximately 233.96 kg CO2eq. Induction, maintenance, and running of anesthesia had the highest overall contribution to the carbon footprint (158.17 kg CO2eq, 67.60% overall). Patient and staff travel contributed more than 15% overall carbon emissions in this study. The impact of sterilization was less than half of that from waste management (0.81 versus 1.81 kg CO2eq, respectively). Waste management alone contributed 4.21 kg CO2eq of the overall carbon emissions, the majority of which was accountable to the incineration of 14.75 kg of noninfectious offensive waste. This study estimates the carbon footprint of the DIEP pathway. Strategies to mitigate the impact of carbon emissions including usage of reusable vs single-use equipment, virtual consultations, standardization of equipment packs, and optimizing waste disposal were suggested areas for improvement. Data from manufacturers on life-cycle assessments were limited, and further work is needed to fully understand and optimize the impact of DIEP surgery on the environment.

Switching to reusable operating theatre equipment: lessons learnt from sterile light handle projects in two Australian hospitals.

Replacing single-use operating theatre equipment with reusables might be one strategy for reducing the carbon footprint of operating theatres. However, in Australia, where the energy mix is predominantly fossil-fuel-based, the re-sterilization of reusables may increase the carbon footprint. We analyzed the financial and environmental impacts of introducing reusable operating theatre light handles in two NSW hospitals. The effects on cost, waste, and carbon footprint of replacing disposable light handle covers with reusable handles in each hospital were analyzed over 12 months using procurement, waste and sterilization data, and life cycle assessment. Energy requirement for sterilization of reusable handles, increasing alongside weight of the handle, resulted in higher carbon footprint than using disposable covers. At one hospital, using a heavy handle increased carbon emissions sixfold, while the cost of handle sterilization exceeded the cost of disposable covers, resulting in 11% higher cost per use. At the other hospital, using a lighter handle increased carbon emissions by 40% per use, while sterilization cost was less than the cost of disposable covers, resulting in 14.8% lower cost per use. Scenario modelling indicated that sterilizing handles as part of a hollowware set rather than as individual items would significantly reduce cost and carbon footprint. At both hospitals, associated clinical waste was essentially eliminated. Judicious replacement of disposable covers with lightweight yet durable reusable handles can reduce costs, but increases carbon footprint in the current Australian energy context. Adopting predominantly renewable energy and more efficient sterilization practice would mitigate this.

Environmental Sustainability in Dermatological Surgery. Part 1: Reducing Carbon Intensity.

This two-part review addresses the pressing need for environmental sustainability in dermatological surgery, driven by the NHS's commitment to net-zero emissions. Part 1 focuses on strategies to reduce the carbon intensity of dermatological procedures by adopting low-carbon alternatives and optimising operational resource usage. Key strategies for a system-wide reduction in environmental impact include using leveraging local suppliers to reduce transport emissions, streamlining care models, promoting efficient waste management, and using mindful prescribing practices. Another aspect is integrating sustainability into dermatological education whilst minimising the carbon footprint of surgical education. Additionally, the review provides a comprehensive overview of optimising resource use in dermatological surgery, focusing on efficient management of consumables, equipment, and energy. This includes recycling, waste segregation, transitioning to reusable personal protective equipment and surgical instruments, and applying energy-saving and sustainable water use practices. By implementing these strategies, dermatological surgery can significantly reduce its environmental impact while upholding high standards of patient care.

Uncovering the Evidence for Sustainability in Urology: A Scoping Review.

This article focuses on the environmental impact of urology devices and procedures in hospitals and identifies practices that can reduce greenhouse gas emissions associated with urology services. A scoping review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was conducted using MEDLINE, EMBASE, and Google Scholar to find studies on the carbon footprint of urologic procedures and sustainable practices. We identified 14 studies, 6 of which used life cycle assessments to compare the environmental impact of single-use and reusable urology devices. Three studies favored single-use devices, 2 favored reusable ones, and 1 found no significant difference, with the sterilization of reusable devices being a major carbon contributor. To enhance sustainability in urology, 8 articles suggested measures including day-case procedures, minimizing low-value care, drapeless cystoscopy, fluid management systems, using quick response (QR) codes in documentation, telehealth initiatives, and low-emission anesthetics. Promoting sustainability in healthcare requires more than just using reusable equipment; it necessitates a comprehensive approach from manufacturing to disposal, including the carbon footprint of sterilization. Encouraging low-emission anesthetics, QR codes, and telemedicine can significantly reduce emissions in urology.

Perspectives and Awareness of Environmental Sustainability in the Infection Prevention and Control Community Nationally

Background: Healthcare contributes significantly to waste production and greenhouse gas emissions. This became especially apparent during the COVID-19 pandemic. Yet there is modest recognition of this issue, particularly within decision-making in Infection Prevention and Control (IPC). The aim of our study was to gauge general knowledge and attitudes of hospital epidemiologists (HEs) and infection preventionists (IPs) around the intersection of environmental sustainability and IPC, and to identify related institutional practices. Methods: An online survey, composed of ten questions related to environmental sustainability in IPC, was created and emailed to members of the SHEA Research Network (SRN), a national consortium of healthcare facilities collaborating on IPC research, from August - October 2023. Survey answers were collated via Redcap© and descriptive results were obtained. Results: Forty-two individuals (33 HEs, 7 directors of IPC, and 2 IPs) from unique institutions completed the survey. Thirty (71.4%) were from academic medical centers, 5 (11.9%) were from VA medical centers and 7 (16.7%) were from community hospitals. Over half of participants correctly estimated the amount of waste and carbon emissions produced annually by the US healthcare system (6 million tons and 8.5% of national emissions, respectively). However, only 42.9% considered environmental sustainability concerns important or very important when making IPC decisions. Fifteen (34.9%) had an environmental sustainability committee at their institution and of these, 8 had an established relationship with the IPC department. The most common techniques to promote sustainability amongst institutions were water/energy conservation (59.5%), reusable personal protective equipment (52.4%) and Leadership in Energy and Environmental Design (LEED) certification (47.6%). When asked which efforts they would support at their institution, 28.6% would eliminate the use of single-use endoscopes and one third would avoid use of ethylene oxide for sterilization. In deciding whether to support environmental sustainability measures, key considerations participants articulated were patient safety concerns, knowledge about effectiveness and costs, and administrative support. Conclusion: Although there is growing awareness around the contribution of the healthcare industry to carbon emissions and waste production, IPC professionals have not yet universally adopted measures to promote environmental sustainability. In our survey, many participants acknowledged the importance of balancing patient safety and sustainability concerns. Our study demonstrates the need for more research and education to inform decisions around environmentally sustainable efforts in IPC that also preserve patient safety. Additionally, professional and regulatory bodies must acknowledge and promote the importance of environmental sustainability in IPC decision-making.

The environmental impact of nitrous oxide inhalation sedation appointments and equipment used in dentistry.

This paper reports a life cycle impact assessment (LCIA) to calculate the environmental footprint of a dental appointment using N2O, comparing single-use equipment with reusable equipment. Nitrous oxide (N2O) is used successfully in dentistry to provide sedation and pain relief to anxious patients, most commonly in children. However, N2O is a powerful climate pollutant 298 times more damaging than carbon dioxide over a 100-year estimate. The functional unit chosen for this LCIA was 30min delivery of N2O to oxygen in a 50:50 ratio at 6L per minute flow rate as inhalation sedation to one patient. Two types of equipment were compared to deliver the anaesthetic gas: reusable and disposable items. The use of disposable equipment for N2O sedation produces a significantly larger environmental impact across nearly all of the environmental impact scores, but the overall global warming potential is comparable for both types of equipment due to the vast environmental pollution from N2O itself. N2O sedation is a reliable treatment adjunct but contributes to climate change. Single-use equipment has a further deleterious effect on the environment, though this is small compared to the overall impact of N2O. Dental priorities should be to deliver safe and effective care to patients that protects staff, minimises waste and mitigates impact on the environment alongside promoting research into alternatives.

Real-world utility of overnight oximetry for the screening of obstructive sleep apnea in children

BackgroundObstructive sleep apnea (OSA) is a common problem in children and can result in developmental and cognitive complications if untreated. The gold-standard tool for diagnosis is polysomnography (PSG); however, it is an expensive and time-consuming test to undertake. Overnight oximetry has been suggested as a faster and cheaper initial test in comparison to PSG as it can be performed at home using limited, reusable equipment. AimThis retrospective case control study aims to evaluate the effectiveness of a home oximetry service (implemented in response to extended waiting times for routine PSG) in reducing the time between patient referral and treatment. MethodsPatients undergoing diagnostic sleep evaluation for suspected OSA who utilized the Queensland Children's Hospital screening home oximetry service in the first year since its inception in 2021 (n = 163) were compared to a historical group of patients who underwent PSG in 2018 (n = 311). Parameters compared between the two groups included time from sleep physician review to sleep test, ENT review, and definitive treatment in the form of adenotonsillectomy surgery (or CPAP initiation for those who had already undergone surgery). ResultsThe time from sleep physician review and request of the sleep-related study to ENT surgical treatment was significantly reduced (187 days for the HITH oximetry group vs 359 days for the comparable PSG group; p-value <0.05), and time from sleep study request to the report of results was significantly lower for patients in the oximetry group compared to those in the PSG group (11 days vs 105 days; p-value <0.05). ConclusionThese results suggest that for children referred to a tertiary sleep center for possible obstructive sleep disordered breathing, a home oximetry service can be effective in assisting sleep evaluation and reducing the time to OSA treatment.

Healthcare sustainability in cardiothoracic surgery.

Climate change is the greatest threat to human health. Cardiothoracic patients suffer direct consequences from poor environmental health and we have a vested interest to address this in our practice. As leaders of complex high-end surgery, we are uniquely positioned to effect practical and immediate changes to significantly pare down emissions within the operating theatre, outside the operating theatre and beyond the confines of the hospital. We aim to spotlight this pressing issue, take stock of our current efforts, and encourage fellow specialists to drive this agenda. Sustainability in healthcare needs to be formalized as part of the core curriculum in surgical training and awareness generated via carbon audits and life cycle analyses. Practical actions such as reducing unnecessary equipment usage, choosing reusable equipment over single use disposables, judicious use of investigations rooted in clinical reasoning and sharing of resources across services and health systems help reduce the carbon output of our specialty. The 'Triple Bottom Line' serves as a good template to calibrate efforts that balance quality against environmental costs. More can be done to advocate for and find solutions for sustainable healthcare with cardiothoracic surgery.

Handheld Magnetometer-Assisted Localization andRemoval ofa Foreign Body From the Chest Wall.

Foreign bodies fully embedded in soft tissues present a unique challenge to surgeons attempting excision. Small fragments can be nonpalpable, and many prove difficult to visualize intra-operatively by means of classic radiologic techniques. A 35-year-old active duty soldier presented requesting excision of ballistic fragment embedded in his chest wall that had previously failed a previous attempt at removal. The metallic foreign body was successfully localized intra-operatively using a handheld magnetometer probe and removed without complication. This case demonstrates the utility and cost-effectiveness of the handheld magnetometry for intra-operative localization of metallic foreign bodies. Metallic foreign bodies may be localized intra-operatively using inexpensive and reusable equipment that does not require radiation or bulky radiographic imaging equipment.

A Cost and Waste-Savings Comparison Between Single-Use and Reusable Pulse Oximetry Sensors Across US Operating Rooms.

Operating room (OR) expenditures and waste generation are a priority, with several professional societies recommending the use of reprocessed or reusable equipment where feasible. The aim of this analysis was to compare single-use pulse oximetry sensor stickers ("single-use stickers") versus reusable pulse oximetry sensor clips ("reusable clips") in terms of annual cost savings and waste generation across all ORs nationally. This study did not involve patient data or research on human subjects. As such, it did not meet the requirements for institutional review board approval. An economic model was used to compare the relative costs and waste generation from using single-use stickers versus reusable clips. This model took into account: (1) the relative prices of single-use stickers and reusable clips, (2) the number of surgeries and ORs nationwide, (3) the workload burden of cleaning the reusable clips, and (4) the costs of capital for single-use stickers and reusable clips. In addition, we also estimated differences in waste production based on the raw weight plus unit packaging of single-use stickers and reusable clips that would be disposed of over the course of the year, without any recycling interventions. Estimated savings were rounded to the nearest $0.1 million. The national net annual savings of transitioning from single-use stickers to reusable clips in all ORs ranged from $510.5 million (conservative state) to $519.3 million (favorable state). Variability in savings estimates is driven by scenario planning for replacement rate of reusable clips, workload burden of cleaning (ranging from an additional expense of $618k versus a cost savings of $309k), and cost of capital-interest gained on investment of capital that is freed up by the monetary savings of a transition to reusable clips contributes between $541k (low-interest rates of 2.85%) and $1.3 million (high-interest rates of 7.08%). The annual waste that could be diverted from landfill by transitioning to reusable clips was found to be between 587 tons (conservative state) up to 589 tons (favorable state). If institutions need to purchase new vendor monitors or cables to make the transition, that may increase the 1-time capital disbursement. Using reusable clips versus single-use stickers across all ORs nationally would result in appreciable annual cost savings and waste generation reduction impact. As both single-use stickers and reusable clips are equally accurate and reliable, this cost and waste savings could be instituted without a compromise in clinical care.

Leveraging lean 4.0 technologies in healthcare: An exploration of its applications

Lean 4.0, a fusion of lean manufacturing and digital technologies, is a powerful tool for implementing Industry 4.0. Its widespread use across sectors is driven by its ability to eliminate waste, reduce errors, boost revenue, and enhance customer care and efficiency. In the healthcare sector, this fourth lean revolution is particularly beneficial, as it helps to curb wastage and enhance efficiency, leading to more effective outcomes. Lean 4.0, a globally recognized best practice for industrial organisations, has proven its worth in enhancing performance and competitiveness. Its success has led to its adoption not only in manufacturing but also in non-manufacturing sectors such as Healthcare, finance, telecommunications, construction, and logistics. Its ease of use and effectiveness make it a superior alternative to traditional medical waste management techniques. Relevant papers on Lean 4.0 for Healthcare in the current literature are identified and studied to evaluate the impact of Lean 4.0 principles in Healthcare. This review-based research studies Lean 4.0 technologies and their needs in Healthcare. It discusses sustainable support for the healthcare sphere through Lean 4.0. Paper briefs several modalities of Lean 4.0 for the healthcare domain. Finally, the paper identifies and discusses the significant applications of Lean 4.0 in Healthcare. Lean 4.0 is essential to lowering errors that lead to medical mistakes since this business deals with life-or-death situations. Healthcare institutions need to reduce their overall waste reduction. With Lean 4.0, staff members working in quality management, clinical operations, consulting, and patient experience can progress into leadership roles in the healthcare sector. Lean 4.0 technologies can reduce waste production, including employing reusable medical equipment or cutting down on packaging waste. The possible difficulty of integrating digital technologies with healthcare systems and practices is Lean 4.0's limitations for the healthcare industry. Healthcare institutions can use refillable syringes and other disposable items to reduce waste rather than disposable plastic syringes. In future, healthcare institutions may save costs and lessen their environmental effect by minimising trash by using lean 4.0 technologies.

Study on the Treatment of Reusable Care Equipment in Public and Private Dental Practices in the City of Conakry

Study on the Treatment of Reusable Care Equipment in Public and Private Dental Practices in the City of Conakry

The carbon footprint of total knee replacements.

Objective Detailed quantifications of the environmental footprint of operations that include surgery, anaesthesia, and engineering are rare. We examined all such aspects to find the greenhouse gas emissions of an operation. Methods We undertook a life cycle assessment of 10 patients undergoing total knee replacements, collecting data for all surgical equipment, energy requirements for cleaning, and operating room energy use. Data for anaesthesia were sourced from our prior study. We used life cycle assessment software to convert inputs of energy and material use into outputs in kg CO2 e emissions, using Monte Carlo analyses with 95% confidence intervals. Results The average carbon footprint was 131.7kg CO2 e, (95% confidence interval: 117.7-148.5kg CO2 e); surgery was foremost (104/131.7kg CO2 e, 80%), with lesser contributions from anaesthesia (15.0/131.7kg CO2 e, 11%), and engineering (11.9/131.7kg CO2 e, 9%). The main surgical sources of greenhouse gas emissions were: energy used to disinfect and steam sterilise reusable equipment (43.4/131.7kg CO2 e, 33%), single-use equipment (34.2/131.7kg CO2 e, 26%), with polypropylene alone 13.7/131.7kg CO2 e (11%), and the knee prosthesis 19.6kg CO2 e (15%). For energy use, the main contributors were: gas heating (6.7kg CO2 e) and heating, cooling, and fans (4kg CO2 e). Conclusions The carbon footprint of a total knee replacement was equivalent to driving 914km in a standard 2022 Australian car, with surgery contributing 80%. Such data provide guidance in reducing an operation's carbon footprint through prudent equipment use, more efficient steam sterilisation with renewable electricity, and reduced single-use waste.

Biofilms on medical instruments and surfaces: Do they interfere with instrument reprocessing and surface disinfection

Biofilms are surface-attached communities of bacteria embedded in an extracellular matrix. This matrix shields the resident cells from desiccation, chemical perturbation, invasion by other bacteria, and confers reduced susceptibility to antibiotics and disinfectants. There is growing evidence that biofilms on medical instruments (especially endoscopes) and environmental surfaces interfere with cleaning and disinfection. The English literature on the impact of biofilms in medicine was reviewed with a focus on the impact of biofilms on reusable semicritical medical instruments and hospital environmental surfaces. Biofilms are frequently present on hospital environmental surfaces and reusable medical equipment. Important health care...associated pathogens that readily form biofilms on environmental surfaces include Staphylococcus aureus, Pseudomonas aeruginosa, and Candida auris. Evidence has demonstrated that biofilms interfere with cleaning and disinfection. New technologies such as ..úself-disinfecting..Ñ surfaces or continuous room disinfection systems may reduce or disrupt biofilm formation and are under study to reduce the impact of the contaminated surface environment on health care...associated infections. Future research is urgently needed to develop methods to reduce or eliminate biofilms from forming on implantable medical devices, reusable medical equipment, and hospital surfaces.

O017 Real-World Utility of Overnight Oximetry for the Screening of Obstructive Sleep Apnoea in Children

Abstract Obstructive sleep apnoea (OSA) is a common problem in children, and can result in developmental and cognitive complications if untreated. The gold-standard tool for diagnosis is polysomnography (PSG); however, it is an expensive and time-consuming test to undertake. Overnight oximetry has been suggested as a faster and cheaper alternative to PSG as it can be performed at home using limited, reusable equipment. This study aims to evaluate the effectiveness of a home oximetry service (implemented in response to extended waiting times for routine PSG) in reducing the time between patient referral and treatment. All patients who utilised the Queensland Children’s Hospital home oximetry service since its inception in 2021 (n=165) were compared to a historic group of patients who underwent PSG in 2018 (n=313). The time from request of the sleep-related study to definitive treatment (ENT surgery or continuous positive airway pressure trial) was significantly reduced (161 days for the HITH oximetry group vs 348 days for the comparable PSG group; p-value &amp;lt;0.02), and time from sleep study request to the report of results was significantly lower for patients in the oximetry group compared to those in the PSG group (12 days vs 86 days p-value &amp;lt;0.01). These results suggest that a home oximetry service can be effective in reducing the waiting time for patients diagnosed with OSA to receive treatment. Further research should examine larger sample sizes to confirm the study findings, investigate the health economic impacts of the service and explore patient/family perspectives.

Environmentally sustainable gastroenterology practice: Review of current state and future goals.

The health-care sector contributes 4.6% of global greenhouse gas emissions, with gastroenterology playing a significant role due to the widespread use of gastrointestinal (GI) endoscopy. In this review, we aim to understand the carbon footprint in gastroenterology practice associated with GI endoscopy, conferences and recruitment, identify barriers to change, and recommend mitigating strategies. A comprehensive search of PubMed, Embase, and the Cochrane Library was conducted to explore the carbon footprint in gastroenterology practice, focusing on endoscopy, inpatient and outpatient settings, and recruitment practices. Recommendations for mitigating the carbon footprint were derived. This narrative review analyzed 34 articles on the carbon footprint in gastroenterology practice. Carbon footprint of endoscopy in the United States is approximately 85,768 metric tons of CO2 emission annually, equivalent to 9 million gallons of gasoline consumed, or 94 million pounds of coal burned. Each endoscopy generates 2.1 kg of disposable waste (46 L volume), of which 64% of waste goes to the landfill, 28% represents biohazard waste, and 9% is recycled. The per-case manufacturing carbon footprint for single-use devices and reusable devices is 1.37 kg CO2 and 0.0017 kg CO2, respectively. Inpatient and outpatient services contributed through unnecessary procedures, prolonged hospital stays, and excessive use of single-use items. Fellowship recruitment and gastrointestinal conferences added to the footprint, mainly due to air travel and hotel stays. Gastrointestinal endoscopy and practice contribute to the carbon footprint through the use of disposables such as single-use endoscopes and waste generation. To achieve environmental sustainability, measures such as promoting reusable endoscopy equipment over single-use endoscopes, calculating institutional carbon footprints, establishing benchmarking standards, and embracing virtual platforms suchas telemedicine and research meetings should be implemented.

Single-use versus reusable ancillaries for dual mobility cup in total hip replacement. A prospective randomized short-term safety and feasibility comparison

BackgroundSingle-use (SU) ancillaries for cup preparation in total hip arthroplasty (THR) aim to reduce the costs of hip replacement surgery. These devices have been recently introduced, but their safety and feasibility have not been studied. Therefore, we performed a prospective randomized study aiming to assess the impact in our department of using these SU ancillaries versus standard reusable ancillaries for dual mobility THR regarding 1) the cost, 2) operative time, 3) quality of primary fixation. HypothesisWe hypothesized that the use of SU ancillaries for acetabular preparation would reduce maintenance costs, and so optimise the operating procedure, reduce the overall cost of surgery, save time, while maintaining the same quality of prosthesis fitting. MethodWe conducted a randomised, controlled, open-label, two-arm, single-centre, prospective therapeutic trial with a medico-economic objective. Inclusions were made prospectively from patients hospitalised and surgically managed in our department for arthrosis over 18 years old treated with dual mobility THR. ResultsIn the current study, 18/20 (90%) of the cases required the use of one SU reamer when using SU ancillaries. Only two cases (10%) required a second SU reamer (without SU failure regarding the acetabular implant) because there was too much subchondral bone left and not enough cancellous bone allowing correct cup fitting. We also found that the test implant supplied in the SU kit had a less secure press-fit than the reusable metal test implants. There was one of primary press-fit failure in the SU group requiring a different cup with additional screws. The estimated cost to the supplier per procedure was 20,105 euros using single-use reamers versus 26,666 euros using conventional ancillary kits, a saving of 6561 euros (p<0.001). For the healthcare institution, the median price per intervention on the differentiating points was 2648 euros versus 2580 euros, with no significant difference (p=0.297). The results show an average societal cost of 52,199 euros using single-use and 53,572 euros using reusable ancillary equipment, with a significant difference between the two groups (p<0.003). The average cost of Healthcare Risk Waste (HCRW) disposal in the SU group was 5.2 euros per intervention against 5.1 euros in the RU group, without significant difference (p=0.910). We found a similar result for the cost of disposal of non-HCRW waste per procedure: 0.37 euros in the SU group versus 0.34 in the RU group, without significant difference (p=0.345). ConclusionSU ancillaries significantly reduce the table set up time and have the potential to facilitate time and cost savings but further research is needed in this direction. Our study shows that the daily workload, operating times, and the number of boxes of instruments to be sterilised are decreased. The associated environmental gain is significant. Nevertheless, the economic promise of these SU ancillaries is only partially supported in this trial owing to the small number of patients. Further work will be needed to obtain a more powerful medico-economic assessment of this promising ancillary product. Level of evidenceII; prospective randomized study.

PURPOSE OF NURSES IN INFECTION CONTROL AND PREVENTION IN MEDICAL MANAGEMENT. A NEW APPRAISAL

Infection Control activity works in tandem with all healthcare disciplines to provide quality patient care through education and practical application of the principles of microbiology, epidemiology, and infection prevention and control.Infection prevention and control (IPC) is a practical, evidence-based approach that prevents patients and health workers from being harmed by avoidable infection as a result of antimicrobial resistance. No one should catch an infection while receiving health care, yet, these infections can spread through outbreaks and many regular care practices, affecting hundreds of millions of people across the world every year. Infection prevention and control is one of the first topics introduced in nursing programs, yet its main tenets are often lost or forgotten. Objectives: The main objective of these guidelines is to prevent the health care workers and the environment from the transmission of infections. The specific objectives of these guidelines are to provide directions and information in relation to facilities, equipment, and procedures necessary to implement standard and additional (transmission-based) precautions for control of infections Cleaning, disinfecting and reprocessing of reusable equipment, Waste management, Protection of health care workers from transmissible infections, Prevention of HAI in patients, Infection control practices in special situations.