Single-use Instruments Research Articles

A cradle-to-grave life cycle assessment of the endoscopic sinus surgery considering materials, energy, and waste.

Operating rooms generate 1.8 million tons of waste annually, or 20%‒30% of the total healthcare waste in the United States. Our objective was to perform a life cycle assessment (LCA) for endoscopic sinus surgeries (ESSs) in order to analyze its environmental impact. A comprehensive LCA of ESS was performed considering energy, climate, and water use impacts associated with the materials and processes used. It focuses on the ESS performed at a large tertiary academic hospital and then extends the impacts to consider annual US surgeries. The assessment considers end-of-life waste management at both landfills and incinerators. Single-use instrument production constitutes 89%‒96% of the total impacts throughout the life cycle of an ESS. Waste-to-energy incineration is shown to be a preferred end-of-life destination, as it recovers much of the input production energy of plastic items, ultimately reducing the input to 36%, although this is done at the expense of higher greenhouse gas emissions. For multi-use items, decontamination dominates environmental impact (>99% of totals), but consideration of reusable items reduces overall energy consumption and global warming potential (GWP) by 25%‒33%. Single-use items dominate the total environmental impact of ESS. While multi-use items require additional decontamination over their lifetimes, results show that their incorporation reduces energy consumption and GWP by 25%‒33%, demonstrating the clear environmental benefit.

Potential of polyethylene terephthalate (PET) in a circular economy from a life cycle assessment perspective - a case study for anaesthesia and surgical instrument packaging waste in Australia

Plastics are a versatile material group with many applications in the healthcare sector. Clinicians, particularly in the operating rooms, have become increasingly dependent on single-use instruments and consumables typically packaged in Polyethylene Terephthalate (PET) resulting in significant amounts of PET waste. In this study, a life cycle assessment (LCA) methodology based on ISO 14040/44 is conducted to assess the environmental impacts of existing and potential future end-of-life options for PET anaesthesia and surgical instrument packaging waste in an Australian hospital context. The results show the reduction potential of environmental impacts by recycling of PET waste via direct collection or in Materials Recovery Facility (MRF) in Australia, Indonesia and New Zealand. When replacing end-of-life options such as landfill or incineration with recycling, a reduction of 88% of total Climate Change (CC) impact can be seen. Furthermore, there is a reduction in environmental impacts across other impact categories through this change. Even if the recyclate quality (up to 30%) was reduced, there is a significant reduction in the environmental impacts. The transition of end-of-life options to recycling offers the potential for reduction of emissions and enables a circular economy for plastics. Furthermore, based on the results of LCA, opportunities and challenges of circular economy pathways in health industry are identified and discussed in this study.

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.

Making minimally invasive procedures more sustainable: A systematic review comparing the environmental footprint of single-use versus multi-use instruments.

Healthcare systems contribute 5%-10% of the global carbon footprint. Given the detrimental impact of climate change on population health, health systems must seek to address this environmental responsibility. This is especially relevant in the modern era of minimally invasive procedures (MIP) where single-use instruments are increasingly popular. We compared the environmental footprint of single-use versus multi-use instruments in MIP. We conducted a systematic review across five databases to identify relevant original studies, following the PRISMA guidelines. We extracted environmental impact data and performed a quality assessment of included studies. We included 13 studies published between 2005 and 2024. Eight employed Life Cycle Analysis (LCAs), which is the gold standard methodology for studies evaluating environmental impact. The instruments studied included laparoscopy systems, endoscopes, cystoscopes, bronchoscopes, duodenoscopes, and ureteroscopes. Six studies, including three high quality LCAs and one fair quality LCA, showed that single-use instruments have a significantly higher environmental footprint than their multi-use counterparts. Six studies suggested a lower environmental footprint for single-use instruments, and one study presented comparable results. However, these studies were of poor/fair quality. Although our systematic review yielded mixed results, all high quality LCAs suggested multi-use instruments may be more environmentally friendly than their single-use counterparts. Our findings are limited by inter-study heterogeneity and methodological quality. There is an urgent need for additional research employing gold standard methodologies to explore the interplay between environmental impact and operational factors such as workflow efficiency and cost-benefit ratio to allow health systems to make more informed decisions.

Sustainability in Obstetrics and Gynecology

ABSTRACT The greatest threat to human health, otherwise known as the climate crisis, disproportionately affects women and pregnant people via exposure to air pollution, heat, extreme weather events, and toxic substances. These effects lead to increased mortality and morbidity in patient populations, but the overall role of the healthcare system and its contribution remains unknown to medical professionals. This review aims to educate clinicians on the effects of the climate crisis on health outcomes and how the current US healthcare system practices drive climate change. Solutions for decarbonizing operating rooms (ORs), neonatal intensive care units (and nurseries), and labor and delivery units are also addressed. The impact on health can be categorized by the effect of heat (rising temperatures), air pollution, and toxic substances such as microplastics. These have variously been shown to impact fertility; rates of miscarriage, stillbirth, and preterm birth; and hypertensive disorders of pregnancy. Notably, the healthcare industry contributes more carbon emissions than even global aviation, with the US healthcare industry producing 27% of the world’s healthcare carbon emissions through its energy and water usage, but also via the supply chain, its waste, and pharmaceuticals. Petroleum-based plastic single-use supplies (ie, gowns, instruments, drapes) in hospitals are also a major contributor to this crisis. Up to 95% of the environmental imprint of the healthcare supply chain stems from these single-use supplies. In addition, biohazard waste must be incinerated prior to landfill disposal, further adding to the environmental impact. Evidence supports the immediate impact of systemic change in terms of decarbonizing healthcare. Replacing single-use instruments with sterilized reusable ones, for instance, has a major impact, such as replacing acrylic specula with stainless steel ones. Another study indicated lower rates of surgical site infections when single-use materials were unavailable in the OR. Beyond this, many single-use supplies are never utilized for patients and go directly to waste. In addition, over carbon dioxide, inhaled anesthetics such as desflurane have 2540 times the potential for global warming while lacking noticeable benefit over other anesthetics. Instead, intravenous anesthetic use can greatly decarbonizing surgeries due to the lower carbon footprint of these medications. Finally, decreasing energy use in climate control measures within buildings can also impact the environment for the better. Powering down unused ORs saved one institution $33,000 annually. Powering down computers over weekends and on nights can also greatly reduce carbon emissions.

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.

Environmental Impact of Bronchoscopy: Analysis of Waste Mass and Recyclability of Bronchoscopic Equipment and Consumables

Background: Greenhouse gases (GHGs) are significant contributors to climate change, and CO2 equivalent (CO2-e) is measured to compare emissions from GHGs. The healthcare sector contributes 4.4% of global CO2-e emissions, mainly with energy consumption and, in lesser extent, waste production. In this regard, bronchoscopy procedures produce a large amount of waste and are responsible for a significant consumption of energy. Objective: We aimed at quantifying the impact on waste mass production, energy consumption, and recyclability of bronchoscopic procedures. Methods: We conducted a prospective single-centre observational study; for each type of procedure (performed with either reusable or single-use instruments), the number of items used, their weight, and recyclability were evaluated, as well as the material of which recyclable waste was made of. We then calculated the total amount of waste produced, its recyclability, energy consumption, and CO2-e produced over 10 days of activity in our Interventional Pulmonology Unit. Results: Sixty procedures generated 61,928 g of waste, of which only 15.8% was potentially recyclable. Single-use instruments generated nearly twofold more recyclable waste than reusable ones, 80% during the procedure phase. Reusable instruments generated 45% of waste during the reprocessing phase, of which 50% was recyclable. The recyclable material was totally composed of paper and plastic. During 10 days of activity, we consumed 64 kWh and produced more than 67 kg of CO2-e due to non-recyclable waste and energy consumption. Conclusions: Our results confirm the compelling need to recycle as many materials as possible, even if the amount of recyclable waste is limited. In this respect, official documents issued by international societies are urgently needed to align our activity with climate requirements and improve the sustainability of our work.

The Cost of Operating: Analysis of Single-Use Instrument Costs for Craniotomies.

Introduction All-cause craniotomies comprise a significant portion of neurosurgical practice as well as hospital costs. While some instruments are reusable with a fixed cost, price variability for similar single-use instruments exists. A better understanding of these cost variations within cranial procedures can better inform operating physicians to be cost-sensitive stewards. Objective In this study, we examine how single-use items contribute to the overall cost of cranial procedures. Methods A de-identified institutional database containing records of all single-use items from craniotomies between July 1, 2019, and June 30, 2020, was subject to a longitudinal analysis by three independent parties (one senior surgeon, one resident, and one medical student). Four hundred and sixty-nine unique single-use items were identified and classified by function. Similar items were combined, and a range of costs was provided. Three sample cases with sum costs were reviewed for cost division and primary contributors. Results The category with the highest median cost across all cases was non-specialty implants comprising dural onlays, mesh, aneurysm clips, and plates. The category with the lowest median cost was personal protective equipment. The items with the most cost variability were sterile surgical patties due to the variety of sizes and preset multipacks. The proportion of cost generators varies from craniotomy indication. Conclusion While institution dependent, awareness of cost generators in cranial cases is important for economic stewardship. For single-use items, costs are highly variable and not insignificant.Surgeons and neurosurgical departments are responsible for allocating single-use items in a responsibleand efficient manner.

Variables affecting surgeons' use of, and preferences for, instrumentation in veterinary laparoscopy.

To investigate the impact of variables on use and preference of common laparoscopic instruments. Online survey. Surgeons (n = 140) with 3 years or more laparoscopic experience. Electronic survey distributed via specialty group LISTSERVEs and Facebook groups. Responses collected included surgeon attributes, preferences, and surgical practice data. Statistical analysis was performed using Fishers exact, ANOVA, Tukey Kramer honestly significant difference (HSD) test, linear regression, and logistic regression. Ninety-eight of 140 respondents answered instrument-related questions and the completion rate of these questions was 76%: 48% of females and 49% of males responded to the survey. The median glove size of respondents was size 7 (range, 5.5 to 8.5). Closing laparoscopic Babcock forceps (p = .018), rotating cup biopsy forceps (p = .003), and manipulating endoscopic staplers (p < .001) were more difficult for surgeons with smaller glove sizes. The median difficulty score for the endoscopic stapler was 4/10 and the median percentage of time this was found difficult was 25%. Reusable instruments were preferred over disposable single-use instruments. The pistol grip was preferred for grasping and retracting (54/98, 55%) and fine dissection (46/96, 48%), while the axial grip was preferred for suturing and knot tying (61/98, 62%). Surgeons with smaller glove sizes (<6.5) experience more difficulty when using common laparoscopic instruments. The endoscopic stapler was the most difficult to use. When purchasing laparoscopic instrumentation, surgeons should review all available options in handle size and design to improve ergonomics during minimally invasive procedures.

ArtiSential&amp;lt;sup&amp;gt;TM&amp;lt;/sup&amp;gt; Revolutionizes Traditional Laparoscopy in Urology by Introducing the Dexterity of a Robotic System to a Laparoscopic Instrument &amp;lt;br/&amp;gt;—First Experiences in Urology in Europe by the Ukrb in Neuruppin

We describe the first two conventional, laparoscopic renal operations with a new multi-degree of freedom articulated single-use laparoscopic instrument (ArtiSentialTM). The two patients underwent different laparoscopic interventions at Ukrb University (Neuruppin, Germany): nephrectomy and Anderson-Hynes-pyeloplasty. All procedures were completed, with no need for conversion or placement of additional ports. No intraoperative complications or technical failure of the instrument was recorded. The mean operative time was 180 min median length of stay was 11.5 d. The instrument could be opened out of the sterile packaging and used at once when it was needed, because it is a single-use instrument. There was real haptical feedback and the costs are minimal compared to robot surgery. The use was straightforward and rapid processes after an intensive training of 4 h in a dry lap. Awaiting future investigations in larger series, this study proves the safety and feasibility of renal surgery with ArtiSentialTM and provides relevant data that may help early adopters of this surgical instrument.

589 Reducing Single-Use Surgical Instruments During Laparoscopic Appendicectomy: Using Sustainable Quality Improvement as a Catalyst to Encourage Wider Behavioural Change in a Surgical Department

Abstract Aim Consumables are responsible for 32% of surgery associated CO2 emissions after excluding anaesthetic gases. We aimed to reduce the carbon footprint of laparoscopic appendicectomies by addressing equipment issues whilst also meeting the triple bottom line of financial, environmental, and social impacts. Method In a single-centre, a questionnaire was distributed to establish the frequency of, and reasons for, single-use instrument use. A separate questionnaire identified areas for improvement within existing appendicectomy sets. An evaluation of 25 appendicectomies was undertaken, documenting single-use instrument usage. New appendicectomy sets were developed, including additional reusable instruments, and procuring new ports, trialling these in subsequent appendicectomies. Financial impact was calculated based on current procurement prices. Environmental impact was calculated by carbon costing the production, transport and disposal of consumables using published emission factors. Social impact was assessed using staff surveys. Results 110 single-use instruments were opened in 25 appendicectomies. Our trust performs ∼500 appendicectomies/year, therefore equating to ∼2180 instruments/year that could be avoided by using reusable alternatives. Based on an estimated 75% reduction in consumables, the new set saves £34,423 and 512kg CO2e per year over the predicted seven-year life span of the instruments. Based on existing practice, the capital investment required for new instruments (£19,731) will pay for itself within six months. Reduced consumable reliance decreases the volume of waste being incinerated, tackling scope one emissions and local air pollution. Conclusions These results demonstrate that sustainable changes can be cost saving and reduce carbon emissions. This approach has translational potential across all surgical specialities using single-use instruments.

The Carbon Footprint of Single-Use Flexible Cystoscopes Compared with Reusable Cystoscopes.

Introduction: Single-use devices for endourologic procedures are becoming more popular. The environmental impact of single-use instruments is relatively unknown. This study aimed to compare the carbon footprint of single-use vs reusable flexible cystoscopes based on waste production and estimated carbon emissions. Methods: An analysis of the solid waste produced when using the aScope™ 4 Cysto (Ambu®) single-use flexible cystoscope compared with the reusable Cysto-Nephro Videoscope CYF-VA2 (Olympus®) was performed. The solid waste generated was measured (grams) and recorded as either recyclable, landfill, or contaminated, and carbon dioxide (CO2) produced by disposal, manufacture, and cleaning was calculated. Results: A total of 40 flexible cystoscopies (20 single-use and 20 reusable) were analyzed. Median total weight of waste produced was 622 g (interquartile range [IQR] 621-651) for the single-use cystoscope compared with 671.5 g (IQR 659-677.5) for the reusable cystoscope (p < 0.0001). More waste was disposed of by incineration after single-use than reusable cystoscopy (496 g [IQR 495-525] vs 415 g [IQR 403-421.5], p < 0.0001). However, more waste went to landfill after reusable cystoscopy (256 g ± 0 vs 126 g ± 0, p < 0.0001). There was no difference in weight of waste produced based on the indication for cystoscopy (p = 0.1570). A total of 2.41 kg of CO2 (IQR 2.40-2.44) was produced per case for the single-use flexible cystoscope compared with 4.23 kg of CO2 (IQR 4.22-4.24) for the reusable cystoscope (p < 0.0001). Conclusion: Environmental accountability is essential in modern health care. This study highlights that disposable flexible cystoscopes have a significantly lower impact on the environment in terms of carbon footprint and landfill. We propose that environmental impact studies should be a routine part of device development for a sustainable future.

Use of resources in cataract surgery-More waste is (not) always possible

Aspects of ecological sustainability are becoming more important in the healthcare system. The use of resources is particularly high in the operating theater. Cataract surgery is one of the most frequent procedures in ophthalmology and even in medicine overall. Its CO2 footprint is therefore quantitatively relevant. Approaches to conserve resources can be implemented at the levels of production and transport of materials and also in the form of reduction and management of waste. In this paper the sources of the waste load, the management of waste separation, the implementation of single-use instruments and the influence of innovative technologies during cataract surgery are presented based on the current literature. Particularly the use of plastic materials for packaging and single-use instruments, also for reasons of hygiene, lead to an increased waste production. The simple separation of compound materials is difficult and only meaningful if the materials used in eye operations can be recycled; however, international comparisons show that cataract surgery can be performed with the same quality of results while conserving resources. Measures in organization and infrastructure are presented. In the future, innovative strategies should be developed and the use of resources in Germany should also be critically questioned in order to reduce the CO2 footprint of cataract surgery.

The use of single-use ancillaries does not increase the cost of osteosynthesis in orthopaedic surgery: A case study of plate osteosynthesis for distal radius fractures

ObjectiveTo compare the cost of using single-use instruments (SUIs) and conventional ancillary instruments (CAIs) during osteosynthesis for distal radius fracture (DRF). Material and methodsWe conducted a prospective, monocentric study of ancillary instruments, including a cost minimisation analysis by micro-costing. DRF reduction and postoperative complications were monitored for 3 months. ResultsIn 103 procedures, the overall cost and operating times were similar between the two groups. The costs of using unit screws, sterilisation, and operating room and pharmacy staff were superior when using SUIs, compared with CAIs. The postoperative outcomes were comparable between groups. ConclusionIn our centre, SUI use was associated with logistical advantages, but it was not associated with increased costs. However, the SUI kit should be optimised in the future.

Clinical Evaluation of Single-Use, Fiber-Optic, and Digital Ureterorenoscopes in the Treatment of Kidney Stones

Introduction: Indication of ureteroscopy for the treatment of urolithiasis has expanded immensely over the last decade. Fiber-optic and digital reusable instruments present the standard in clinical practice, but various newly available single-use devices might offer an exciting alternative. To date, the evidence is limited to clinical evaluation and efficacy of single-use ureteroscopes (URS) compared to standard instruments. Therefore, we evaluate a single-use instrument’s clinical characteristics and efficacy in direct comparison with a fiber-optic and digital device. Methods: A prospective study was conducted for patients undergoing endoscopic therapy for urolithiasis at a tertiary care center. We evaluated the different instruments’ clinical performance in categories of visibility, the stability of visibility, irrigation flow, and surgeon’s satisfaction. Statistical analyses were performed by SPSS using the Chi-Quadrat and Kruskal-Wallis test. A p value of p ≤ 0.05 was defined as statistically significant. Results: A total number of 77 patients were included and distributed as follows: 35 (46.7%) single-use, 19 (25.3%) digital, and 23 (28%) fiber-optic URS. Patients’ characteristics were homogenous over the three cohorts in sex, stone amount, and localization. The stone-free rate was equal in all three cohorts (p = 0.31). We identify stability of visibility, irrigation flow, and satisfaction were equal in all cohorts (p = 0.73; p = 0.20; p = 0.20). We report a significant difference in visibility, with 100% rated excellent in the digital URS group (p = 0.028). Discussion/Conclusions: Single-use URS achieve comparable clinical outcomes with equal stone-free rates in direct comparison with fiber-optic and digital reusable instruments. Accordingly, single-use devices present an adequate alternative for endoscopic therapy of urolithiasis.

User satisfaction with single-use instruments versus reusable instruments for treating distal radius fractures with locking volar plates

IntroductionThe adoption of single-use instruments (SUI) in orthopedic and trauma surgery continues at a rapid pace. Economics studies on this topic have come to contradictory conclusions about whether these SUI have a cost advantage. The aims of our study were to (1) compare the satisfaction of operating room staff between SUI and reusable instruments (RUI) in the context of distal radius fracture fixation with locking volar plates; (2) compare the immediate postoperative and medium-term radiological outcomes of patients operated these two types of instrument sets. We hypothesized that users will be more satisfied with SUI in the context of distal radius fracture fixation with locking volar plates. Materials and methodsThis was a prospective, single-center study performed between April 2019 and July 2020. The inclusion criteria were patients more than 18 years of age who had a distal radius fracture with indication for fixation with volar locking plate, and whose initial treatment and follow-up were completed in our surgery department. Two groups of patients were created: SUI and RUI. The satisfaction of the surgeons and scrub nurses was determined using a 10-item questionnaire. ResultsThe analysis was done on 91 procedures for which a satisfaction questionnaire was completed by the primary surgeon and the scrub nurse. The satisfaction scores were always significantly better in the RUI group than in the SUI group (p<0.05). DiscussionThis study found that surgeons and scrub nurses in our surgery department liked the RUI better than the SUI. At a time when SUI kits become more popular in orthopedic and trauma surgery, based on cost arguments that still need to be confirmed, taking into account the operating room staff's opinion is an important criterion for improving RUI kits. Level of evidenceII.

Improving Operating Room Efficiency with Single-Use Disposable Instruments for Total Knee Arthroplasty.

Many strategies have been employed to improve operating room efficiency when performing total knee arthroplasty. The goals of efficiency improvements are to decrease operative time and reduce healthcare expenses while providing patients the best quality surgical care. Single-use disposable instruments are one technique to accomplish efficiency. The authors describe their experience with a specific implant manufacturer's disposable single-use instruments for total knee arthroplasty and analyze the cost and time savings compared to traditional instrumentation. Single-use disposable instruments are a viable option to improve OR efficiency, decrease sterile processing burden, and ensure sterile instrumentation for total knee arthroplasty. Furthermore, cost savings can be realized based on an institution's sterile processing expenses and whether the manufacturer or facility covers the cost of the single-use instruments.

Effect of animated and interactive video variations on learners' motivation in distance Education.

One of the objectives of this research is to develop and validate the Instructional Material Motivation Scale for Single-Use (IMMS-SU) instrument in the Turkish context. The IMMS-SU was developed and validated in a two-phased process on a sample of 1654 students. The Exploratory Factor Analysis revealed that IMMS-SU included 14 items (χ2 = 332.59; sd = 74; p < 0.001), the fitness indices were found to be RMSEA = .077; SRMR = .040; AGFI = .88; NFI = .95; CFI = .96; and GFI = .92. The Cronbach’s Alpha coefficients regarding the whole scale was calculated as α = 0.95. Thereafter, in the second study, the animated and interactive video materials used in distance education were scrutinized in the context of openness to different materials, time spent viewing, motivation, and cognitive load. A total of 933 students participated who had a distance education experience. In order to collect data, the extraneous cognitive load instrument (Kalyuga et al., Human Factors, 40(1), 1-17, Kalyuga, S., Chandler, P., & Sweller, J. (1998). Levels of expertise and instructional design. Human Factors, 40(1), 1–17. 10.1518/001872098779480587), IMMS-SU, and questionnaire items were used. According to the findings, it was determined that animation and interactive video materials did not cause a higher level of cognitive load on the participants, and both groups had higher material motivation. In addition, it was revealed that interactive video materials caused a higher extraneous cognitive load in participants than animation group. It was figured out that as the openness levels of the participants watching the animation and interactive materials decreased, their cognitive load levels increased. In the light of the results, some suggestions have been recommended for further research.

Percutaneous exposure injuries amongst dental staff and students at a university dental clinic in Australia: A 6-year retrospective study.

Dental care providers are at risk of percutaneous exposure injuries (PEIs) due to the intimate nature of the patient-dentist environment and the routine use of sharp instruments. They are the most vulnerable to accidental exposure of blood-borne viruses. The aim of this study was to determine the types of PEIs sustained by staff and students at the Griffith University Dental Clinic over a 6-year period. Data were collected regarding PEIs sustained amongst dental staff and students between 2014 and 2019. Data were obtained from the risk incident reporting system (GSafe) and the patient management Software (Titanium), and then analysed using IBM SPSS. The chi-squared tests and multinomial logistic regressions were performed with significance set at <.05. Over the 6-year period, there were 308 PEIs with an incidence rate of 0.109%, with 67 being needle stick injuries (0.023%). These injuries happened more often in restorative procedures, followed by local anaesthesia and oral surgery. Dental students were at a greater risk of sustaining PEIs (65.6%) when compared with professional staff (34.4%). Most common instruments included needles (21.8%), probes (20.5%) and burs (18.2%). Overall, the incidence of percutaneous injuries at the Griffith University Dental Clinic was low. The most common instruments were needles, probes and burs, and dental students were at greatest risk of sustaining injuries. Prevention of injuries by not recapping needles, immediate removal of burs from handpieces, the use of cassettes and single-use instruments has effectively decreased PEIs experienced by dental students and staff.

Advantages of patient-specific cutting guides with disposable instrumentation in total knee arthroplasty: a case control study

BackgroundTotal knee arthroplasty (TKA) is most frequently planned using conventional two-dimensional weight-bearing lower limb radiographs and is performed with conventional femoral and tibial cutting guides. Questions have been raised about the accuracy of conventional TKA instrumentation and planning for an anatomically standard or complex joint. Use of computed tomography (CT)-based three-dimensional (3D) templating and patient-specific cutting guides printed in 3D has shown improved postoperative lower limb alignment parameters. This case-control study compared costs and operative times of using CT-based, patient-specific, single-use instruments versus conventional metal instruments for TKA.MethodsIn this case-control, retrospective chart review, all TKAs were performed by one senior surgeon, using the F.I.R.S.T. posterior-stabilised knee prosthesis (Symbios, CH), with a similar protocol and identical operating room setup. Group A included 51 TKAs performed with patient-specific cutting guides and conventional metal instruments. Group B included 49 TKAs performed with patient-specific cutting guides and patient-specific, single-use instrumentation. Operation duration, number of instrumentation trays and sterilisation costs were evaluated.ResultsThe groups were similar for age, body mass index, hip-knee-ankle angle and operation duration. The mean number of instrumentation trays was 8.0 ± 0.8 for group A (controls) and 5.1 ± 0.9 for group B (p<0.001). The mean sterilisation costs were 380 ± 47 Swiss Francs (CHF) for group A and 243 ± 55 CHF for group B (p<0.001), for a mean cost reduction of 130.50 CHF per intervention in group B. The time interval between two consecutive surgeries was 24 min for group A and 18 min for group B. There were no adverse events or complications, instrument-related or otherwise.ConclusionCompared to conventional instrumentation, use of patient-specific, single-use instruments for TKA reduced the number of instrumentation trays by more than one-third and saved 36% in sterilisation costs. If fabrication costs of single-use instruments are included by the company, the total cost is significantly diminished. There was no operative time advantage for single-use instrumentation.