Sterile Services Department Research Articles

Reusable Medical Device Pre-Cleaning in Care Units: What Are the Indicators to Prevent Biofilm Formation and Control Occupational Biological Risk?

The pre-cleaning of reusable medical devices is essential for successful cleaning, as it prevents biofilm formation that can compromise disinfection and sterilization. This study aimed to reflect on the recommendations regarding the pre-cleaning of reusable medical devices carried out in care units, such as wards, based on recommendations from guidelines/standards related to this important step in reusable medical device reprocessing. However, recommendations for pre-cleaning in care units are not unanimous and contrast with detailed recommendations on reusable medical device reprocessing in the Central Sterile Services Department (CSSD). This topic is an unresolved issue, strongly related to patient and worker safety, which points to the lack of investigations to provide indicators of best practice and highlights the need for shared responsibility management between care units and CSSD.

Fungal contamination of the water distribution system of a tertiary hospital water supply system in a resource-limited setting.

Fungal contamination of hospital water distribution systems has been implicated in outbreaks of healthcare-associated infections. To evaluate the prevalence of fungi in the water distribution system of a tertiary hospital in Nigeria. This was a descriptive cross-sectional study. Swabs and water samples were collected from taps and faucets in the hospital categorized into low (Accidents and Emergency Unit, Children Emergency Unit, Acute Stroke Unit and the 24 in-patient hospital wards) and high-risk (Renal Dialysis Unit, Central Sterile Services Department, Theatres and Intensive Care Units (ICUs)) units based on the vulnerability of patients being managed there. The membrane filtration method for water analysis was used. Where possible, isolates cultured were identified to species level. In total, 105 water and 49 swab samples were collected for analysis. All analysed water samples grew fungi. A total of 289 (high-risk; n = 178; low-risk; n = 111) and 76 fungi isolates were recorded from water and swab samples, respectively, with 31 different species identified. Aspergillus was the most predominant genus with five different species: Aspergillus niger (9.9%), terreus (4.4%), flavus (3.3%), fumigatus (8.8%) and versicolor (2.20%) isolated. Twenty-five and 18 species of fungi were identified in the low and high-risk units, respectively. The labour ward (n = 46; 25.8%) and modular theatre (n = 47; 42.3%) were the most contaminated units. Cladosporium spp. and Paecilomyces spp. were the most frequently isolated fungi in the low and high-risk units, respectively. The dialysis centre (n = 9; 8.1%) and renal transplant theatre (n = 7; 6.31%) had the lowest contamination rates in the high-risk units. Aspergillus niger, Cephalosporium curtipes, Penicillium chrysogenum and Penicillium glabrum were each identified in 4/6 units from which swabs were taken. The facility had no documented protocol for its water safety and quality. Our data reveal a high rate of contamination of hospital water sources by fungi, some of which are known to cause life-threatening infections. For better water treatment and water tank cleaning and disinfection, a standard protocol is advised. Ensuring that the water distribution systems in hospital settings are free of fungal contaminants is important to prevent the possibility of waterborne mycosis outbreaks.

SG-APSIC1177: Improving the quality of sterile medical devices to international standards

Objectives: The central sterile services department (CSSD) offers a variety of procedures, including collecting contaminated medical equipment from various agencies through a process of washing, cleaning, packing, and sterilization, followed by storage and distribution to internal and external departments. Plans to expand and open service to the Center of Excellence continue, which will result in a rapid increase in the processing of specialized medical devices. The Center of Excellence is a source of education, learning, teaching, and practice in the cleaning, disposal, and sterile treatment of medical devices. We sought to improve the quality of sterile medical equipment to satisfy international standards of safety. Methods: We implemented a 7-stage process in the CSSD and we developed a checklist with 8 categories of environmental development based on APSIC guidelines. We provided knowledge to CSSD employees, developed their skills, and promoted attitudes in various areas, including sterile work standards, the use of sterilization machines, and infection prevention and control both inside and outside the facility. Results: We established inventory control systems, storage guidelines, and disbursement of medical supplies and equipment in the CSSD. To improve machine use in sterilization treatment or disposal, we educated staff and provided practice of machine skills according to instructions for use. Information technology (IT) was used for the distribution process, medical device identification, recording sterilization, and statistical logging of sterilization and sterile services. Conclusions: Overall, we improved the quality of CSSD services and knowledge and practice of CSSD staff, and we achieved compliance with international standards. These measures ensure the safety of service providers and patients and build trust in the quality of CSSD services and output.

Evaluation of the Microbiota and Integrity of Respirators Reused by Health Professionals in a Hospital Environment

The shortage of PFF2, N95, and KN95 respirators and their equivalents for the respiratory protection of the population and health professionals during COVID-19 pandemic has driven the adoption of alternative measures to address the lack of personal protective equipment (PPE). The use of surgical masks, handmade masks, and even the prolonged use of respirators were some of the measures adopted in response to the high demand for these products, and their consequent shortage. In this context, the present study evaluated the microbiota and integrity of reused PFF2 respirators in the central sterile services department of a hospital. Respirators that had been used for 0 h, 12 h, 24 h, and 36 h were sampled for the inoculation and cultivation of fungi and bacteria and the identification of their microbiota. To assess the integrity of the respirators, a filtration efficiency assessment test was conducted of the respirators used for 36 h. The results obtained showed that the microbiota of the respirators comprised commensal fungi and bacteria from the oral and nasal regions of human beings. It was also found that after 36 h of use, the respirators did not demonstrate a decrease in filtration efficiency; that is, they retained their 97% filtration efficiency Considering the findings regarding the presence and pathogenicity of microorganisms, it is possible that the reuse of respirators for up to 36 h does not harm the health of immunocompetent users. In terms of PPE efficiency, no compromises were evidenced.

Evaluation of the Efficacy of Nitrile Gloves Exposed to Chemical Germicide on Medical Devices in Central Sterile Services Department

Nitrile gloves are commonly used in Central Sterile Services Department in order to be often used when manually cleaning medical equipment such as personal protective equipment. As a result they are resistant to a wide range of chemicals and germicides, including alcohols, peroxides, and other sterilizing agents. In addition to providing chemical protection, nitrile gloves are resistant to punctures and tears, which is important when working with sharp medical instruments. This research focuses on the efficacy of gloves in relation to the multi-chemicals or compounds of nitrile gloves and observation at the point of use to remove soil and contact with chemicals on medical devices at the Central Sterile Supply Department. The powder-free nitrile exam gloves and extended cuff methods of chemical analysis of permeation testing of standard practice for assessment of resistance of medical gloves to permeation by chemotherapy drugs (ASTM D 6978-05), EN455 Part 1: 2000 were used to test the test method for single-use medical gloves. The standard of protective gloves against dangerous chemicals and microorganisms was tested by EN 420:2003 + A1:2009, EN388: 2016, ISO 374-1:2016, and ISO 374-5:2016. The testing of chemotherapy drugs and UV/NIS absorption spectrometry were used to measure the absorbance of test chemicals, which permeated through the specimens into the collection medium. The collection medium was circulated in a closed loop at an 11 ml/minute flow rate through the testing period. As a result, a glove user must protect against the specific chemicals or chemical mixtures to which they were exposed while manually cleaning medical devices. The physical properties of the gloves were evaluated by visual observations at the point of use for soil removal and chemical exposure to medical devices at the Central Sterile Supply Department of five hospitals. The results showed that nitrile gloves protected chemical exposure during manual cleaning of medical equipment at the point of use.

Time is Money! Influence on Operating Theater and Sterilization Times of Patient-specific Cutting Guides and Single-use Instrumentation for Total Knee Arthroplasty: A Full Factorial Design of 136 Patients.

BackgroundPatient-specific cutting guides (PSGs) and single-use disposable instrumentation (SUI) have emerged as potential beneficial innovations for total knee arthroplasty. The aim of this study was to evaluate the impact of PSG and SUI for total knee arthroplasty on operating room (OR) and sterilization times.MethodsA monocentric, prospective, interventional, full factorial design study, including 136 patients, compared patient-specific (PSG, n = 68) to conventional cutting guides (n = 68) and SUI (n = 68) to conventional instrumentation (CVI, n = 68). In the OR, we recorded the number of instrument trays, operating time, and room occupancy time. In the central sterile services department, the total sterilization duration was assessed. The primary outcome was operating time and sterilization duration. Secondary outcomes were difference in the number of trays, Oxford Knee Score, and postoperative mechanical axis.ResultsThe median operating time was 80 minutes (Q1-Q3: 73-90) and was significantly increased for SUI compared to that for CVI (+5 minutes, P = .0072). The median sterilization duration was 1261 minutes (Q1-Q3: 934-1603). It was significantly in favor of SUI (936 minutes) over CVI (1565 minutes) (+629 minutes, P < .0001). The total number of instrument trays was 404 for 136 patients: 252 for CVI and 152 for SUI (P < .0001) and 189 for PSG and 215 for conventional cutting guides (P = .0006). There was no significant difference in OKS (P = .86) nor in the postoperative alignment which was between 177° and 183° (75% patients, P = .24).ConclusionsSUI lowers the number of instrument trays and sterilization duration. PSG is not associated with significant OR or sterilization time reduction. The use of SUI could reduce the risk of noncompliance of instrument trays.

Comparative Double-Blind Study of Efficacy of Pre-Cleaners for Surgical Instruments and Medical Devices in the Central Sterile Services Department

The Central Sterile Supply Department (CSSD) is one of the hospital's critical support services. It is a place to receive medical equipment blood-stained from the other departments to be cleaned. It is responsible for cleaning, receiving, storing, sterilizing, and returning medical equipment to everyone and delivered to different departments within the hospital. Nowadays, various cleaning and dissolving blood stains are used to clean and remove blood stains. This research aimed to compare the efficacy of pre-cleaning spray and pre-cleaning spray foam cleaners for blood-contaminated surgical instruments and medical devices in the Central Sterile Services Department. The pre-cleaning spray was significantly higher than the pre-cleaning spray foam (p ≤ .005). A significant difference in the 2-minute pre-cleaning spray was observed by using cleaning indicators. The pre-cleaning spray foam started dissolving blood after 5 minutes. Therefore, from the study, using the pre-cleaning spray for dissolving blood stains and pre-cleaning has a more practical effect than pre-cleaning foam.

A study on the understanding of sterilisation in the central sterile services department by the healthcare personnel in a tertiary care hospital in Sikkim

Background: Globally, hundreds of millions of people are affected every year by avoidable infections in healthcare (healthcare-associated infections, [HAIs]). Through knowledge, best practices and infection prevention and control (IPC), we can prevent HAI to patients and health workers. Following recent threats caused by widespread epidemics and increasing awareness about the spread of antimicrobial resistance, several countries are paying more attention and investing resources to strengthening IPC infrastructures and improving practices. Objective: The objective was to assess the practices by the healthcare staff regarding the sterilisation process in the central sterilisation service department (CSSD) and to bring about improvements in the practices in the hospital. Materials and Methods: A cross-sectional study was conducted where the healthcare staff were given a set of questionnaires on sterilisation in the CSSD. The staff who participated in the study included doctors, intensive care unit nursing staff, infection control nurses, operation theatre nursing staff, CSSD staff and outpatient department nursing staff. Results: The questionnaire was administered to 120 health staff. All the staff agreed that instruments should be cleaned at the source. The majority of the participants (82%) believed that medical devices should be reprocessed centrally in CSSD; however, very few of them (18%) have felt otherwise. Almost 70% of staff did not know about the indicators used in CSSD and the zones in CSSD. The expiry date of the items once received from CSSD, 60% said it is not mentioned on the pack and 40% of participants agreed that it is mentioned on the pack. Conclusion: The processes of sterilisation and decontamination are complex, require specific infrastructure and equipment and involve several steps that need to be correct, from device collection, receipt by the unit, processing, storage and distribution them throughout the facility. Quality control measures to evaluate the proper functioning of the equipment are of the utmost importance.

Central sterile services department: screening of automated cleaning in liposuction cannulae.

To evaluate the effectiveness of automated cleaning of 4 mm liposuction cannulas using ultrasonic washer machine, screening for dirt using a cannulate microscope device and the screening of viable strains of Staphylococcus aureus, with microbiological analysis. Experimental study with 14 units of 4 mm liposuction cannulas performed at the Central Sterile Services Department and at the Microbiology Laboratory of a Hospital Complex, located in Porto Alegre, RS, Brazil, from October 2018 to April 2019. Of the 14 liposuction cannulas that constituted the sample, 42.9% remained dirty despite automated cleaning, and all of them showed recovery of viable microrganisms in the microbiological laboratory. The study showed that it is not possible to ensure the cleaning efficacy of automated cleaning of 4 mm liposuction cannulas, especially due to the conformation of the material with internal spaces with accumulation of dirt.

Central sterile services department: screening of automated cleaning in liposuction cannulae

RESUMO Objetivo: Avaliar a eficácia da limpeza automatizada realizada com lavadora ultrassônica de cânulas de aspiração de 4 mm, por meio do rastreamento de sujidade interna feito com aparelho de microscopia para canulados e o rastreamento de cepas viáveis de Staphylococcus aureus, por análise microbiológica. Métodos: Estudo experimental realizado com 14 cânulas de lipoaspiração de 4 mm em um Centro de Material e Esterilização e no laboratório de microbiologia de um hospital de Porto Alegre, Brasil, no período de outubro de 2018 a abril de 2019. Resultados: Das 14 cânulas de lipoaspiração que constituíram a amostra, 42,9% permaneceram com sujidade mesmo após a limpeza automatizada e todas apresentaram recuperação de microrganismos viáveis nos testes do laboratório de microbiologia. Conclusão: O estudo mostrou não ser possível garantir a eficácia da limpeza automatizada nas cânulas de lipoaspiração de 4 mm, em especial devido à conformação do material com locais onde acumula sujidade.

Robust capacity planning for sterilisation department of a hospital

ABSTRACT Sterile services departments are special units designed to perform sterilisation operations in an efficient way within a hospital. The delays in sterilisation services cause significant disruptions on surgery schedules and bed management. To prevent the delays, an upper time limit can be imposed on the time spent in the sterilisation services. In this paper, we propose a mathematical modelling approach for the optimum capacity planning of a sterilisation service unit considering the uncertainties in the sterilisation process. The model aims to find the optimum capacity on four tandem steps of the sterilisation whilst at the same time minimising the total cost and keeping the maximum time in the system below a limit. Assuming general distributions for service and interarrival times, an approximation structure based on robust optimisation is used to formulate the maximum time spent in the system. We analysed the structural property of the resulting model and found that the relaxed version of the model is convex. The real data from a large sterilisation services unit is used for computational experiments. The results indicated that the approximation fits well against the simulated maximum time in the system. Other experiments revealed that an upper limit of 7 hours for the sterilisation services balances the cost vs. robustness trade-off.

Improved surveillance of surgical instruments reprocessing following the variant Creutzfeldt–Jakob disease crisis in England: findings from a three-year survey

Sensitive, direct protein-detection methods are now recommended for the inspection of reprocessed reusable surgical instruments in England to reduce the risk of prion transmission. To implement an established, highly sensitive method to quantify proteinaceous residues on reprocessed instruments in a Sterile Services Department (SSD) and evaluate its potential impact on service provision. We introduced highly sensitive epifluorescence (EDIC/EF) microscopy in a large SSD. Over three years, we periodically tested two models of washer disinfector using stainless-steel tokens spiked with mouse brain homogenate or Browne test soil for comparison. We also obtained data and feedback from staff who had been using EDIC/EF to examine almost 3000 reprocessed instruments. All reprocessed test surfaces harboured residual contamination (up to 258.4 ng from 1-μg spikes). Proximity between surfaces affected decontamination efficacy and allowed cross-contamination. Up to 50 ng de novo proteinaceous contamination was deposited on control surfaces after a single automated washer disinfector (AWD) cycle. The test soil behaved differently than real tissue contamination. SSD staff observed proteinaceous residues on most reprocessed instruments using EDIC/EF, which can detect far smaller amounts than the currently accepted national threshold of 5 μg per side. Implementing recent national guidelines to address the prions concern proved an eye-opener. Microscopic levels of proteins remain on many reprocessed instruments. The impact most of these residues, potentially including prions, may have on subsequent patients after sterilization remains debatable. Improving surveillance capability in SSDs can support decision making and raise the standards of surgical instruments reprocessing.

Quality control of rigid endoscopes: a comparative study between ScopeControl® and surgeons' evaluation.

In central sterile services departments (CSSD), the functionality of rigid endoscopes, which are complex and fragile reusable devices, is usually controlled visually and is considered a complex and subjective task. ScopeControl® was developed to provide an automated quality control of rigid endoscopes by measuring the value of six parameters: viewing angle (VA), field of view (FV), color correctness (CC), light transmission (LT), fibers transmission (FT), and focus (FC). The aim of the present study was to assess the ability of ScopeControl® to pre-emptively identify endoscope defects before the surgeon considers them as defective. The same endoscope was evaluated by surgeons during surgery using a scoring scale as well as the CSSD staff using the ScopeControl® during reprocessing. The ScopeControl® categorized the endoscope into 3 groups: "passed," "in danger," and "failed." Correlations between the surgeon's evaluation and results of the ScopeControl® were calculated. One hundred sixty-six controls were carried out concerning 51 different endoscopes. According to the surgeon's evaluation, 78.9% and 80.7% of controls were considered as satisfactory for image and brightness quality, respectively. Results obtained using ScopeControl® found that 13.3% of controls were considered as "passed," 31.3% "in danger," and 55.4% "failed," with poor correlation with the surgeons' evaluation. LT and FT parameters represented 95.2% of the reasons for failures. The ability of the ScopeControl® to detect endoscope defects earlier than surgeons was validated by tracking the results of endoscopes used and controlled several times. The ScopeControl® achieved an objective and consistent quality control of endoscopes and showed poor correlation with the surgeon's opinion. In practice, the ScopeControl® could avoid the use of defective endoscopes in the surgery unit and thus improve the quality of the surgical procedure.

Central Sterile Services Department: psychosocial risks related to the prescribed organization of nursing work.

The aim of this study is to investigate the characteristics of work-flow organization of the Central Sterile Services Department and analyze whether nursing workers are subject to psychosocial risks. Mixed study, carried out between November 2017 and July 2019 with nursing workers of the Department of Central Sterile Services of a university hospital. Sampling for the quantitative stage of this study consisted of 36 professionals who have filled the Prescribed Work Organization Scale form, followed by statistical analysis. Qualitative sampling was obtained through collective interview with 19 members of the nursing team. Of the 36 nursing workers, 68.3% were female, 69.4% were over 45 years of age and 75% of the professionals assessed reported as being exposed to a medium psychosocial risk with the emergence of two categories. The aspects related to pleasure at work were highlighted as being the importance of the unit, indirect patient care, professional recognition, and teamwork. The main reported suffering triggers were the lack of human resources, supplies, maintenance, communication, and the devaluation of the unit. The prevalence of medium psychosocial risks indicated the need for actions aiming at improving work processes.

Evaluation of working conditions at a central sterile services department in northern Brazil.

Introduction:Environmental conditions and the work process in the Central Sterile Services Department expose workers to many hazards.Objectives:To analyze the working conditions that have an influence on the overall health of workers at a Central Sterile Services Department of a hospital in northern Brazil.Methods:This study used employed the ergonomic analysis of work. Three data collection tools were applied to characterize sociodemographic and occupational profiles. Furthermore, physical environmental hazards were analyzed using specific equipment. Descriptive and bivariate analyses were performed in Stata®13 software.Results:Thirty-five workers participated in the study, most of whom were women, aged above 40 years, and worked as nursing technicians. It became evident that workers were exposed to inappropriate lighting and to noises coming from autoclaves, from the central air conditioning, and from the use of medicinal gas. The risks for musculoskeletal injuries on spine, shoulders, and lower limbos were specifically related to overload resulting from the posture maintained for long periods. Female sex was associated with severe or excruciating pain” (p = 0.04).Conclusions:Sound, mechanical, and visual hazards were found. Most participants complained of musculoskeletal pain, and the cervical spine was the site with the most frequent reports of excruciating pain. These results point out to the need of a policy to improve the quality of work in the health care unit studied; however, these findings may also bring light to the problem in other institutions that have a physical structure similar to that found in this research.

Re-purposing of domestic steam disinfectors within the hospital-at-home setting.

BackgroundVulnerable patients being cared for in hospital-at-home settings require safe disinfection of their medical devices, including nebulisers and other respiratory equipment. The scale of patients now being cared for in hospital-at-home settings as a result of COVID19 places huge pressure on hospital central sterile services departments (CSSDs) to provide consumable items to safely support such patients’ care. This places new importance on the disinfection of mundane objects, including crockery, cutlery and frequently touched objects in the home environment. This study examined temperature performance of steam disinfectors and the consequences of potential operator misuse on the survival of 62 bacteria and yeast organisms.MethodsThermal performance of steam disinfectors was evaluated using calibrated thermocouple probes in multiple permutations of device usage with 62 test organisms.ResultsThermocouple data demonstrated disinfection A0 values of 6000 (upper layer) and 60 (lower layer). Steam disinfection of baby bottles had a thermal lethality of at least A0 = 600. Variation in disinfector temperatures were noted, depending on the geometric location of thermocouples. Additional notable temperature reductions occurred with device underfilling with suboptimal water volumes. Steam disinfection eradicated all 62 non-spore-forming Gram-positive, Gram-negative and yeast organisms tested and eradicated all organisms in the inner teat space of contaminated babies' dummies, rendering safe steam disinfection of babies’ dummies.ConclusionDomestic steam disinfection offers an inexpensive, simple, versatile and widely available technology for the elimination of common non-spore-forming nosocomial pathogens and safe disinfection of medical devices, fomites and other mundane objects within the hospital-at-home scenario, thereby enhancing patient safety.

Status of Infection Prevention and Control in Selected Hospitals in Sierra Leone

Background: Improved infection prevention and control (IPC) reduces healthcare-associated infections (HAIs). Following the Ebola virus disease (EVD) outbreak in West Africa (2014–2016), Sierra Leone made substantial investments in strengthening IPC in health facilities. The WHO identified 8 core components of IPC and developed an accompanying assessment framework (IPCAF) to monitor IPC capacity and progress. The IPCAF reflects the 8 WHO core components of IPC. The core component constitute a consistent universal outline that supports guidance to healthcare decision makers and service providers at national and international levels. We conducted an in-depth assessment of IPC practices in Sierra Leone using the IPCAF tool. Methods: This assessment was conducted in in July 2019 over a 2-week period. Data were collected through interview with IPC focal persons as well as observations and corroboration of document and immediate feedback on findings given to facilities through brief exit meetings. All areas of the facility were assessed (ie, all wards, operation theatres, laboratories maternity units, sterile service departments, waste management units, etc). The main objective was to identify the gaps and challenges faced by health facilities. Each component was scored based on the responses and observations, with the scores ranging from zero to 100 and the maximum score was 800. The IPCAF allocated hospitals to 4 different “IPC levels”: inadequate, basic, intermediate, and advanced. Results: Moreover, 13 hospitals were assessed, including 12 primary level hospitals and 1 secondary level hospital. The median score was 367. 5 (IQR, 110), which corresponds to a basic level of IPC. Primary-level hospitals scored higher (median, 373; IQR, 112.5) compared to secondary-level hospitals (median, 280; IQR, 0). The lowest score was in healthcare-associated infection surveillance (median, 0; IQR, 5), and the highest score was in the built environment, availability of materials, and equipment to support IPC (median, 62.5; IQR, 22.5). Conclusions: The assessment provides a baseline of the status of IPC in Sierra Leone in the post-EVD period using the IPCAF tool. These results can be used to guide healthcare facilities and policy makers in developing strategies for IPC quality improvement projects to improve low-performing healthcare facilities. Significant gaps were observed in key IPC areas, especially in secondary-level health facilities. There is need to establish national surveillance for healthcare-associated infections, to institutionalize monitoring of IPC practices, and to ensure an appropriate staffing–workload ratio in health facilities.Funding: NoneDisclosures:If I am presenting research funded by a commercial company, the information presented will be based on generally accepted scientific principals and methods, and will not promote the commercial interest of the Funding: company. DisagreeAnna MarutaIf I am discussing specific healthcare products or services, I will use generic names to extent possible. If I need to use trade names, I will use trade names from several companies when available, and not just trade names from any single company.DisagreeChristiana Kallon

Dermatosurgery Practice and Implications of COVID-19 Pandemic: Recommendations by IADVL SIG Dermatosurgery (IADVL Academy).

Dermatosurgery Practice and Implications of COVID-19 Pandemic: Recommendations by IADVL SIG Dermatosurgery (IADVL Academy).

Control of an outbreak of post-transplant cutaneous mucormycosis by removing the vehicle: An intervention study of contiguous cohorts

An outbreak of post-kidney transplant cutaneous mucormycosis (PK-CM), a severe and even fatal complication in immunocompromised patients, occurred in our institution. The objective of this study was to compare the usual fixation of sterile wound dressings with non-sterile elastic bandages and fixation with sterile bandages processed at our centralized sterile services department with regard to PK-CM prevention. We conducted a before-and-after trial in a private tertiary care hospital. The pre-intervention cohort (n = 16) included all patients who had undergone kidney transplant (KT) during the outbreak (June 2010-April 2011), and the post-intervention cohort (n = 49) included all patients who had undergone KT between May 2011 and October 2013. From May 2011, only bandages sterilized by the centralized sterile services department were used to fix wound dressings of KT patients. Differences in age (50.2 years vs 51.3 years), sex (43.8% male vs 59.2% female), weight (63.3 kg vs 69.7 kg), hemodialysis vintage (55.6 months vs 47.8 months), and other risk factors were not observed between the pre- and post-intervention cohorts, respectively. PK-CM incidence dropped from 25% in the pre-intervention cohort (4/16) to 0% in the post-intervention cohort (0/49). Relative risk was 0 (P = .003). With regard to KT patients and sterile wound dressing fixation with non-sterile bandages versus the use of autoclaved bandages, fixation with autoclaved bandages proved to be effective for cutaneous mucormycosis outbreak control and prevention in our institution.

Developing an aggregate metric to measure and benchmarking energy performance

As key elements of energy planning, ISO 50001 recommended inter alia identifying appropriateindicators to monitor and measure energy performance. Benchmarking can be a helpful tool toestablish energy efficiency or performance indicators. While we agree that is hard to get anabsolutely universal indicator aggregating several physical indicators defined in differing units; itis however possible to expand the area of cases covered or improve its characteristics such asaccuracy, representativeness and simplicity. In this paper, we developed an aggregateddimensionless “Indicator for Energy Benchmarking” (IEB) to enhance the range of models ofindicators dedicated to the engineering field. The systems targeted are low and middle levelsystems of the energy indicators pyramid. We built the proposed indicator based on specificcharacteristics: process decomposition-oriented, increasing when energy consumption decreases,dimensionless, with limited threshold value to 1. Consequently, the indicator provides manyadvantages in comparison to simple metrics and complex indicators such as: direct detection ofenergy use failure processes, creating interdependence between benchmarked systems scores, noneed for data history to start benchmarking of a multisystem. IEB can be implemented as anintegral part of many energy management or energy efficiency standards, methodologies or toolssuch as EN 16231:2012 and ISO 50001:2018. In last section, we calculate the indicator for2 central sterile service departments of 2 university hospitals in Morocco to show its potential andoperating mode.