Sterile Packs Research Articles

Microbial Penetration of Muslin- and Paper-Wrapped Sterile Packs Stored on Open Shelves and in Closed Cabinets

Microbial penetration of sterile packs was studied using single-wrap (two layers) muslin, double-wrap (four layers) muslin, and two-way crepe paper (single layer) to wrap 20 gauze sponges (2 by 2 inch). These packs were stored in the central sterile supply departments of two hospitals and processed for sterility at predetermined intervals. Microorganisms penetrated single-wrap muslin as early as 3 days and double-wrap muslin and single-wrap two-way crepe paper in 21 to 28 days stored in open shelves. The time required for microbial penetration was at least twice as long when closed cabinets were used. Single-wrap muslin packs stored in sealed, impervious plastic bags remained sterile for at least 9 months. All sterile materials in pervious wrappers should be handled as little as possible and then only with extreme care and caution. Closed cabinets offer more protection than open shelves, and single wrappers are not recommended.

Net Present Value: A Case Study

INTRODUCTION This paper presents a strategy for teaching Monte Carlo simulation using the case of a capital expansion decision for ArkMed Corporation, a small biomedical device manufacturer located in Houston, Texas. The company is considering investing in a facility that can provide custom products using 3d printing. The facility would serve the custom orthotics and solid implant needs of the medical community of the greater Houston metropolitan area. A simulation of the financial feasibility of the new facility is appropriate since the manufacturing method is unfamiliar to the firm's management, and because the facility would serve a custom ordered product that would be expeditiously provided, within a few hours to a few days, unlike the company's current business. The case provides an opportunity to augment coverage of capital budgeting scenario analysis, and to give students an exercise that requires multi-page referencing in Excel. It also can provide output data that can be summarized into a histogram and frequency distribution chart. This process allows for a visual of the risk that a project could return a negative NPV result. The distribution of NPVs thus provides better information on which to base a capital asset expansion decision than would a discrete NPV value based on averages of sales growth, expense ratios, and tax rate. CASE ASSIGNMENT GIVEN TO STUDENTS Mark Findley finished off the last of the coffee and started a new pot brewing. He was waiting for a message from the Vice President of ArkMed Corporation. A new expansion project had been proposed, and it would be Mark's responsibility to analyze the project. The firm had never invested in a project of this type before, a production facility that would custom print biomedical devices with a 3d printer. The firm had other types of custom manufacture, so Mark figured he could use knowledge from those facilities for cost estimates, but the potential sales could range from disappointing, making little use of the capacity of the plant--to full capacity, where the plant would be used around the clock. Randle Gere, the Vice President, finally called. Mark! I've asked Roberts in operations to coordinate with Atwood in cost accounting to get you operating cost estimates for the new plant. They should be emailing you a spreadsheet soon. What is our timing, Mr. Gere? asked Mark. Do 1 need to stay late today? No, no--not necessary. In fact they are both staying late to provide you with the information. You can just do it tomorrow. Can you get me your output and a report by the end of the day tomorrow? Not a problem, Mark responded. I will get it to you around mid-afternoon. Because of the unfamiliarity of 3d printing technology and the range of possible sales, Mark planned to carry out a simulation for the net present value of the project. The simulation was similar to other NPV analyses he had carried out in the past. He had been with ArkMed for four years and had taken over the Chief' position for the forecasting and analytics office after his boss had retired last year. Mark had already heard from the firm's marketing manager, who had done a breakdown of expected revenues by sales region, based on custom manufacturing sales for other products the firm offered. The facility under consideration was sort of a wild card, though, because business would be based mainly on quick turnaround. Measurements and specifications would be provided by technicians dealing with patients, an order submitted electronically, and then ArkMed would print the custom device, coat it with sterile coatings, package it in sterile packing, and expedite delivery to the hospital or medical office where the procedure was being done. While these devices could be delivered in as little as half a day, it was also possible that quick delivery would not be so critical, and that the firm could schedule production within a three to four day window. …

Sterility preservation of surgical dressing packs wrapped in gumstick lining material

Background: Post-sterilisation contamination is the ability of the organisms to penetrate through the wrapping material and settle on the enclosed instruments. Safeguarding the sterility of sterile dressing packs during transportation and storage is an important requirement of a sterile supply packaging system. We evaluated the use of locally available and affordable tailoring lining material popularly known as gumstick. The objective of this study was to ascertain the efficacy of gumstick lining material in safeguarding the sterility of wrapped surgical dressing instrument. Materials and Methods: The post-sterilisation sterility was confirmed by culturing the sterile packs and then exposed to contaminants by leaving the packs on a microbiology working bench. The wrapped packs were then contaminated with suspensions of control strains of some selected bacteria, then swabbed and cultured. The surgical packs were also exposed to environmental contaminants, swabbed and cultured. Results: All cultures yielded no growth proving that the wrapped surgical instruments are bacteriologically sterile and gumstick provides the needed protection against contamination of surgical packs. Conclusion: Gumstick lining material is therefore recommended as packaging material for surgical instrument particularly in resource-constrained settings.

Improved spinal manometer.

The use of a glass manometer for measuring spinal fluid pressures has several disadvantages. The manometer is breakable and awkward to use, especially if it is a two-piece apparatus. Often it is unavailable when needed most, and frequently it is misplaced. A cheaper, easier, and better method of measuring spinal fluid dynamics employs a standard intravenous tube pack. It is light in weight, unbreakable, readily available, and reliable. Regular intravenous tubing from a sterile pack is inserted into the spinal needle after the tap has been made, and the tube is elevated into a vertical position. The column of cerebral spinal fluid is measured by the doctor as the nurse supports the measuring scale (see figure). Beside being easy to use for the measurement of the cerebral spinal fluid pressure and dynamics (Queckenstedt's method), the tube can be lowered and cerebral spinal fluid can be collected more easily. On completion

The importance of the air shadow of the cisterna magna in encephalographic diagnosis.

The cisterna magna frequently is the site of clinically obscure lesions that do not increase the intracranial pressure and that can be outlined by pneumoencephalography. Little has been written on this subject because, as a rule, neurological surgeons have preferred to use ventriculography in cases of suspected surgical lesions and, in addition, unless a special effort is made, the cisterna magna is seldom visualized. The value of pneumoencephalography in this respect is demonstrated by the analysis of an experience of one year to be presented here. Precautions In our institution, pneumoencephalography in itself has always been regarded as a surgical procedure. Therefore, the positioning of the patient, the induction of anesthesia, the injection of air, the radiography, the development and the examination of the films, all are carried out on the operating floor, where every surgical and anesthetic facility is at hand. Sterile packs of instruments for craniotomy and for ventricular tap are kept available at all times. If signs of increased intracranial pressure are present, the instruments are laid out and the scalp is prepared for craniotomy before the spinal air injection is started. The films are processed in a rapid developer; they are examined in the wet state and, if a surgical lesion is disclosed, the patient is kept under continuous observation in the surgical pavilion until the operation has been performed. When papilledema is present and obstructive hydrocephalus is suspected, encephalography is seldom employed and never without a preceding ventricular tap to relieve the intracranial tension. The technic of performing emergency ventricular tap has been simplified so that a cannula can be introduced into the ventricle within two minutes should indications arise. With this planning and these precautions, emergency situations will seldom develop. Over a period of twenty-eight years pneumoencephalography has proved, in our experience, to be a safe procedure and has disclosed many surgical lesions which could not have been diagnosed by any other method short of exploratory craniotomy. To employ ventriculography in place of encephalography in cases of suspected cerebral tumor without increased intracranial pressure, is not in the patient's best interest. Neither encephalography nor ventriculography, for that matter, should be undertaken without the precautions described above, since an expanding lesion will occasionally be disclosed even under the most unlikely circumstances. This possibility plus the hazards inherent in the use of any anesthetic agent can lead to disaster, if circumstances do not permit prompt counter measures. Technic Thiopental (Pentothal) sodium is the anesthetic agent usually employed. Ten milliliters of air is introduced before starting the removal of fluid, and thereafter the fluid is replaced with air in 5-ml. amounts, with pressure readings at frequent intervals.

A new type of catheter for urethral drainage of the bladder.

SUMMARY It is suggested that the time is opportune for a reconsideration of present apparatus and techniques for urethral drainage of the bladder. The advent of new materials makes it possible to adopt smaller diameters and improved designs. A new catheter is presented which appears to offer many advantages. Made up in a dry sterile pack, and used in combination with a plastic collecting bag, it should postpone and minimise urethritis and cystitis, and contribute to the elimination of cross‐infection. The Portex catheters described above are produced by Portland Plastics Ltd., Bassett House, Hythe, Kent, and it is a pleasure to acknowledge here the help given by Dr S. A. Leader, of that firm, in the development of the instrument. His unique combination of technical knowledge and clinical sympathies has proved invaluable.

223. Bacteriological studies of canned milk products

1. A survey of evaporated milk and canned cream samples from three condensed milk factories and from general sources has been undertaken to determine to what extent non-sterility occurred in commercial practice. In addition to the examination of sound samples many others have been tested which were obviously defective or which were associated with defective packs. 100% of the tins examined from general sources were sterile. The factory samples, especially those of canned cream, had a lower sterility percentage, although it appeared that this was associated with some special circumstance of operation and that a sterile pack should ordinarily be quite attainable.2. An account is given of the methods used for sampling the can contents and for the recovery of bacteria from unsterile cans and their identification. The necessity for a large inoculum in such sampling is emphasized, since although the bacteria may survive for many months in the tins, they may be present in small numbers.3. Data are presented regarding the types of defective samples encountered and the associated bacteriological flora. “Bloats” in evaporated milk and thin bitter and putrid cream were the two main causes of spoilage encountered.4. By using the heat resistance of the organisms which were recovered from the cans as a basis of classification the. defects have been divided into two groups, namely (1) a mixed general flora which does not withstand high temperatures, and (2) a restricted heat resistant flora which is of the sporeforming type.