Sterilization Of Instruments Research Articles

Exploring sterilizer performance through external biological indicator testing: a retrospective study

BackgroundQuality assurance policies mitigate the risk of nosocomial infections from dental office instrument sterilization by assessing sterilizer performance through biological indicator (BIs) testing. This study aimed to evaluate the prevalence of failed sterilization cycles and their causes of failure for a period of eight years through database analysis of a quality assurance laboratory in the province of Saskatchewan, Canada.MethodsA database of BIs (n = 198,771) performed by an independent quality assurance laboratory from 2015 to 2022 was analyzed. Dental offices (n = 362) inserted Sporview® Biological Sterility Indicators strips in full sterilizer loads and mailed the processed BI tests to an external quality assurance laboratory for analysis. Samples were assessed based on a colorimetric method checking for changes in color and turbidity. Data was collected and statistical analyses were performed using IBM SPSS 28.0.ResultsThe overall failure rate throughout the study was 0.20%, and it decreased gradually from 0.51% (2015) to 0.15% (2022). On average, retests were conducted within 2 days of failure notification. The preferred method of processing was steam sterilization (98%), which had a steadily increasing utilization over time and displays a statistically lower failure rate (0.20%) as opposed to dry heat (1.30%) and chemical vapour (1.40%) sterilizers. Most BI failures were attributable to human error (91.80%), and equipment failures were significantly more likely to occur with dry heat or chemical vapour sterilizers (p < .001).ConclusionThis study significantly contributes to the understanding of dental sterilizer performance in Canada. The low and decreasing sterilizer failure rates over the study period indicate safe dental office procedures and reduced potential for disease transmissions. The study highlights the effectiveness of steam sterilizers with remarkably low failure rates, while human error remains the primary cause of failures. Further research should focus on identifying factors leading to human error and interventions to minimize sterilization failures in dental settings.

Impact of storage on sterility of surgical instruments in autoclave bags

Background: There is no published veterinary research to support an optimal storage duration and method of sterile surgical instrumentation (SI) when using self-seal autoclave bags (SSABs), although aspects of research from human healthcare are transferable. Multiple pieces of research in human healthcare have demonstrated the ability of sterilisation packaging materials to maintain barrier integrity and sterility for several months poststerilisation. Research on an optimal storage method is inconclusive. Aims: To determine an ideal storage duration and method of single SI, packaged in SSABs and sterilised via an autoclave. To determine the current practice of sterilisation, storage methods and durations using SSABs in small animal practice. Methods: This mixed methods study consisted of an online questionnaire to investigate the current procedures for autoclave sterilisation in veterinary practice. Alongside this, a non-randomised control study was conducted to assess the sterility of single SI, packaged in SSABs and sterilised via autoclave, to determine an ideal storage duration and method. SI was sterilised and stored for one, three and six months, in open (on a shelf) and closed (in a box) environments. Results: The questionnaire indicated veterinary professionals are adopting a cautious approach to storage durations with 75.5% (n=40) storing sterile single SI for between one and three months, prior to reprocessing. The experimental study did not identify an optimal storage method and either open or closed could be used for effective storage in undisturbed conditions. It is highly probable that most SI were sterile at the end of the storage durations and for up to 6 months. Conclusions: Laboratory findings are mostly consistent with those in existing literature. Results suggest the storage of sterile SI, in either open or closed environments for up to 6 months was not detrimental to the sterility of the instruments. To encourage good sustainability performance, practices could extend the storage times of sterilised SI prior to reprocessing.

Short-Cycle Autoclave Sterilization of Instruments in Same-Day Ophthalmic Surgeries

What Is the Issue? The volume of ophthalmic surgeries is increasingly high, with cataract surgery being 1 of the most performed surgeries in Canada. Infections following ophthalmic surgeries, while rare, can cause severe complications that may lead to irreversible vision loss. Reducing postsurgery infections is a high priority in clinical practice. Running a full wrapped, terminal steam sterilization cycle for ophthalmic instruments in autoclaves may be inefficient for ophthalmic surgeries and may cause unnecessary heavy economic and environmental burdens due to high surgical volumes. Using instruments sterilized on a short cycle between sequential same-day ophthalmic surgeries may help improve efficiency and reduce resources used. These instruments are generally processed using autoclaves (i.e., steam sterilizers); the effectiveness of a shorter-cycle method of sterilization is unclear. What Did We Do? To inform decisions regarding the use of autoclaves for short-cycle sterilization for sequential same-day instrument use in ophthalmic surgery, we sought to identify and summarize evidence comparing this method to full-cycle sterilization of wrapped instruments and identify any relevant recommendations. We searched key resources, including journal citation databases, and conducted a focused internet search for relevant evidence published since 2012. One reviewer screened articles for inclusion based on predefined criteria. What Did We Find? In a laboratory setting to simulate sequential same-day procedures, short-cycle sterilization with interrupted dry time for unwrapped ophthalmic instruments is feasibly as effective as full-cycle sterilization for wrapped instruments using the STATIM autoclave. Similarly, short-cycle sterilization with interrupted dry time for contained ophthalmic instruments is feasibly as effective as full-cycle sterilization for contained instruments using the AMSCO autoclave. For sequential same-day ophthalmic procedures, wet instruments sterilized by a short-cycle process with an interrupted dry time can remain sterile for at least 3 minutes if kept in a covered sterilizer containment device. One guideline recommends that wrapped or unwrapped ophthalmic instruments sterilized by a short-cycle process without full drying should be stored in a covered containment device until retrieved by staff wearing sterile gloves and gowns in the operating room for the subsequent surgery after a short delay. Phaco handpieces should be immediately primed with a balanced salt solution and remain wet as they sit on the sterile instrument table. We did not identify any clinical setting evidence from studies or autoclave manufacturers. It is unclear if clinical outcomes differ between patients undergoing sequential same-day ophthalmic surgeries using short-cycle sterilized instruments and those undergoing surgery using full-cycle sterilized instruments. What Does This Mean? Preliminary laboratory evidence and guideline recommendations supporting the use of autoclaves for short-cycle sterilization of instruments for sequential same-day ophthalmic surgeries are available. However, there is no clinical effectiveness evidence available on this process in patient settings. Future research is necessary to understand the clinical safety of using instruments sterilized by short cycles for sequential same-day use for patients undergoing ophthalmic surgeries. In addition to the evidence and recommendations identified, other factors, such as environmental influence, may be useful considerations when making decisions about short-cycle sterilization for sequential same-day instrument use for ophthalmic surgery.

SP5.2 - Reducing Elective Colorectal Surgical Site Infections with Change of Gloves and Instruments Prior to Abdominal Closure; A Multicycle Audit

Abstract Aims Surgical site infections (SSI) carry a significant impact on patient morbidity, length of stay and antibiotic resistance. Our local colorectal unit has made several interventions over many years with no significant nor sustained improvement in the rate of SSI. The ChEETAh trial (Lancet, 2022) demonstrated a reduction in the rate of 30-day SSI by 13% with routine change of gloves and instruments (COGI) prior to abdominal closure. We aim to reduce our rate of SSI through implementation of COGI prior to abdominal closure; involving whole scrub team change of gloves and use of sterile instruments. Methods Adults undergoing elective colorectal surgery with an abdominal wound greater than 5cm were eligible for this study. Diagnosis of SSI was made based on at least one clinical indicator of infection or at least one symptom of SSI with data collection over 3 cycles spanning 11 months using clinical notes, imaging and microbiology results. The primary outcome was the diagnosis of a SSI involving the skin, subcutaneous, muscle or fascial layer up to 30 days post-operatively. Results The baseline SSI rate prior to intervention was audited at 29%. After implementation of COGI the rate fell to 23%. Further reinforcement of COGI and team education has demonstrated a further decrease in SSI to 15%. This has been sustained across a 6-month period post intervention. Conclusions Change of gloves and instruments is an effective, reliable and sustainable method to reduce the rate of surgical site infection in elective colorectal abdominal surgery.

Carbon footprint of non-melanoma skin cancer surgery.

Climate change poses a significant global health threat and healthcare, including surgery, contributes to greenhouse gas emissions. Efforts have been made to promote sustainability in surgery, but the literature on sustainability in plastic surgery remains limited. A life-cycle analysis was used to assess and quantify the environmental emissions associated with three distinct reconstructive methods utilized in non-melanoma skin cancer surgery: direct closure, split-thickness skin graft, and full-thickness skin graft. Analyses were conducted in March 2023 in Morriston Hospital, Swansea, UK. The carbon footprints for non-melanoma skin cancer surgery in England and Wales were then estimated. The mean carbon emissions for non-melanoma skin cancer surgery ranged from 29.82 to 34.31 kgCO₂eq. Theatre energy consumption (4.29-8.76 kgCO₂eq) and consumables (16.87 kgCO₂eq) were significant contributors. Waste produced during non-melanoma skin cancer surgery accounted for 1.31 kgCO₂eq and sterilization of reusable surgical instruments resulted in 1.92 kgCO₂eq of carbon emissions. Meanwhile, transportation, dressings, pharmaceuticals, and laundry accounted for 0.57, 2.65, 1.85, and 0.38 kgCO₂eq respectively. The excision of non-melanoma skin cancer with direct closure (19.29-22.41 kgCO₂eq) resulted in the lowest carbon emissions compared with excision with split-thickness skin graft (43.80-49.06 kgCO₂eq) and full-thickness skin graft (31.58-37.02 kgCO₂eq). In 2021, it was estimated that non-melanoma skin cancer surgery had an annual carbon footprint of 306 775 kgCO₂eq in Wales and 4 402 650 kgCO₂eq in England. It was possible to predict that, by 2035, carbon emissions from non-melanoma skin cancer surgery will account for 388 927 kgCO₂eq in Wales and 5 419 770 kgCO₂eq in England. This study highlights the environmental impact of non-melanoma skin cancer in plastic surgery departments and emphasizes the need for sustainable practices. Collaboration between surgeons and policymakers is essential and further data collection is recommended for better analysis.

Auditing the microbiological quality of the air in operating theatres.

The critical relationship between airborne microbiological contamination in an operating theatre and surgical site infection (SSI) is well known. The aim of this annotation is to explain the scientific basis of using settle plates to audit the quality of air, and to provide information about the practicalities of using them for the purposes of clinical audit. The microbiological quality of the air in most guidance is defined by volumetric sampling, but this method is difficult for surgical departments to use on a routine basis. Settle plate sampling, which mimics the mechanism of deposition of airborne microbes onto open wounds and sterile instruments, is a good alternative method of assessing the quality of the air. Current practice is not to sample the air in an operating theatre during surgery, but to rely on testing the engineering systems which deliver the clean air. This is, however, not good practice and microbiological testing should be carried out routinely during operations as part of clinical audit.

DIELECTRIC BARRIER DISCHARGE BASED PLASMA DEVICE FOR COLD STERILIZATION IN WATER WITH ADDITIONAL ULTRASONIC CAVITATION

A prototype of plasma sterilizer based on dielectric barrier discharge (DBD) with additional ultrasonic cavitation for cold sterilization has been developed. It provides sterilization of reusable small dental instruments, and components made from corrosion-resistant metals and alloys (stainless steel, titanium, etc.), as well as surgical instruments, implants, small drills, plastic sundries, ozone resistant medical rubbers (silicone, etc.), polymers, epoxy resins and glass. The sterilizer is well suited for dentistry and can be used in medical, sanatorium, outpatient and other medical institutions, as well as in military field surgery. The volume of the sterilization bath is 2.5 l. The ozone concentration at the output of the ozone generator is 35…52 mg/l, the ozone concentration in the sterilizer chamber is 6.5…8 mg/l, depending on the water temperature and its volume in the bath. The dependence of the increase of ozone concentration in water on time at different oxygen flow rates is monitored.

A New Technique of Sterile Polyethylene Instrument Cover as Temporary Corneal Patch to Reconstruct Anterior Chamber in Penetrating Keratoplasty Combined with Intraocular Surgery.

Complications such as explosive choroidal hemorrhage, residual cortex, and capsule rupture often occur during intraocular surgery combined with penetrating keratoplasty (PKP) due to poor maintenance of the anterior chamber. To address these challenges, we have innovatively utilized a sterile polyethylene instrument cover to temporarily reconstruct the anterior chamber. In this report, we describe a technique where a 'temporary corneal patch' was created from a sterile instrument cover, using a trephine to ensure a diameter approximately 1-2 mm wider than the corneal bed or perforation. This patch was then sutured into the host corneal bed or the perforation with 10-0 nylon sutures during intraocular surgery combined with PKP. Each case was evaluated for surgical efficacy and complications. We successfully applied this technique in three cases of combined corneal transplantation surgery. In two cases, PKP, phacoemulsification, and intraocular lens implantation were successfully performed. In the third case, PKP, vitrectomy, and other intraocular procedures were performed. No intraoperative or postoperative complications were observed. The use of a sterile polyethylene material as a temporary corneal patch for anterior chamber reconstruction represents a safe, effective, and cost-efficient approach for intraocular surgery combined with PKP or posterior segment surgery as a keratoprosthesis.

Advantages of surgical instrument traceability for the hospital, staff and patient

Introduction: Traceability is the sterilization of surgical instruments, performed by the Materials and Sterilization Center (MSC), resulting in a reduction in the incidence of Healthcare-Associated Infections (HAIs) associated with the cleaning, disinfection and sterilization processes of health products. Objectives: To analyze in the literature the advantages and means of traceability of surgical instruments in the MSC managed by the nurse for the hospital institution, surgical team and patients. Methodology: This is a narrative review, in which seven articles were selected from electronic databases. Results: Two thematic categories were created for discussion: the advantages of traceability of surgical instruments and the traceability means currently used. Final considerations: The traceability of the process steps, control of inputs, costs and maintenance records of instruments by the MSC assists in the planning of investments in new instruments, contributing to the management and care aspects.

Impact of Updating Surgical Instrumentation Preference Cards on Operating Room Operations

Hospital systems across the United States have implemented quality improvement initiatives designed to mitigate unnecessary waste and decrease healthcare costs that are frequently passed on to patients. One key source of waste is excess sterile instrumentation in surgical operating rooms. This quality improvement project identified waste by auditing and updating surgical instrumentation preference cards (SIPCs) for the three most common procedures at a multi-center academic health system. Unnecessary items were recorded and savings calculated using 2022 supplier price data. Forty-nine procedures were audited, resulting in changes to 111 unique SIPCs. Although this process produced significant savings for the health system, it was limited to fewer than 10% of the total cases performed. Total savings were observed at $337,007 with savings of $56,254 for open instrumentation. A manual audit of all SIPCs across the institution and regular updates has the potential to decrease instrumentation waste and annual expenditures by approximately $4 million.

Mycotic flora characteristics of the endontic flora in patients affected by COVID-19

BACKGROUND: Owing to the fact that, presently, at a dental appointment, it is possible to observe a wide range of consequences arising after COVID-19, among which are observed lesions of the pulp and periodontium of the tooth, additional diagnostic methods should be introduced before choosing treatment tactics. In our previous study, we analyzed the contents of root canals of teeth in patients who had COVID-19 using bacterioscopy. Coccus flora was detected in all cases and elements of Candida yeast-like fungi were recorded in 89 cases (76.1%). Based on the obtained data, it was advantageous to perform microbiological examination of the endodontium in this group of patients to further study their physical and chemical properties and correct the treatment regimen in gangrenous form of chronic pulpitis and aggravated forms of periodontitis, which determined the relevance of the present study. AIM: To reveal the characteristics of the mycotic flora of the endodontium in patients who previously had COVID-19. MATERIALS AND METHODS: A bacteriologic study of root canal contents in patients who had previously undergone a new coronavirus infection at different times, diagnosed as “exacerbation of chronic periodontitis”, “chronic gangrenous pulpitis”, and “acute suppurative periodontitis”, was conducted to detect fungi of the genus Candida in the tooth root canal system, which was obtained during mechanical treatment with a sterile endodontic instrument. The patients (n=49) were divided into groups according to their final diagnosis: group 1, chronic gangrenous pulpitis (27 patients); group 2, acute purulent periodontitis (9 patients); and group 3, exacerbation of chronic periodontitis (13 patients). Then, the collected material was placed in a tube with Amies transport medium and sent to the laboratory. Seeding of the material was performed in sterile Petri dishes on Sabouraud agar by rubbing with a plastic spatula. Further, Petri dishes were placed in the thermostat for 24–48 hours of incubation at 37±10 °C. Then, the study was carried out according to the generally accepted scheme: the obtained cultures were identified to species by the character of growth on dense medium. RESULTS: The given bacteriological study of the patients’ endontic contents confirmed the data of bacterioscopy and concretized the previously obtained results. On final examination, black colonies of Candida albicans were observed in 95.92% of cases. No growth of Candida albicans colonies was observed in two cases (4.08%). CONCLUSION: The bacteriologic study performed after bacterioscopy of diagnosis confirmed the presence of fungi of the genus Candida in the root canals of teeth in patients who previously had COVID-19. The study showed that when treating similar patients, the high risk of infection of periodontal complex tissues by Candida fungi should be considered. It is advisable to supplement the standard protocols of endodontic treatment with physical exposure, for example, laser radiation, or additional medication with antifungal drugs, such as fluconazole.

Measurement of the electron beam profile by the multiangle scanning method

Nowadays, ionizing radiation beams with relatively large transverse dimensions are widely used not only for research purposes but also in technological processes related to metal and food treatment, as well as medical instrument sterilization. Thus, control of beam characteristics is required, and in particular, the intensity distribution in the transverse plane must be accurately measured. The multiangle scanning method, based on mathematical transformations, allows overcoming the limitations of modern detectors used for these purposes. In this study, the method was applied to an electron beam. A detection system based on scintillating fiber was used. The beam profile was measured using the proposed method and a conventional detector — a film dosimeter. Experimental results allowto conclude that the beam intensity distribution obtained using the multiangle scanning method is close to the results obtained using a film dosimeter, which is most often used in medical institutions. Thus, we can consider the multiangle scanning method as an effective approach for determining the intensity distribution of an electron beam.

Instrument fracture in periodontal therapy: ethical disclosure and clinical management - a case report

Periodontal instrument fractures are rare events in dentistry, with limited literature available on their occurrence and management. This case report highlights an incident involving the fracture of a periodontal sickle scaler blade during manual instrumentation for the removal of calculus. The fracture occurred during instrumentation on the mesial surface of the maxillary right second molar, and the separated blade was subsequently pushed into the sulcus. A radiographic assessment was performed to verify the precise location of the fractured segment. Following confirmation, the broken blade was subsequently retrieved using curved artery forceps. The case report highlights factors contributing to instrument fractures, emphasizing the importance of instrument maintenance, sterilization cycles, and operator technique. Ethical considerations regarding patient disclosure, informed consent, and instrument retrieval methods are well discussed. This case underscores the importance of truthful communication, the proper use of instruments, equipment maintenance in dentistry, and the significance of ongoing professional development to enhance treatment safety, proficiency, and ethical standards in dental care.

Assess The Workload Management Model and Enhanced Quality Control in The Central Sterile Supply Department: A Study Protocol.

Introduction The Central Sterile Supply Department (CSSD) plays a crucial role in ensuring the safety and efficacy of medical instruments and equipment used in healthcare settings. Effective workload management and quality control are essential for maintaining high standards of patient care and minimizing the risk of healthcare-associated infections. This study protocol aims to assess the implementation and impact of a new workload management model and enhanced quality control measures in a CSSD setting. Methods The study will employ a mixed-methods approach, including quantitative analysis of workload data, qualitative interviews with CSSD staff, and observational assessments of workflow and quality control procedures. The workload management model under investigation involves the allocation of resources based on demand patterns and the implementation of scheduling algorithms to optimize staff efficiency. Enhanced quality control measures include the implementation of advanced sterilization technologies, rigorous inspection protocols, and continuous staff training initiatives. Results The study expects to provide insights into the effectiveness of the workload management model in optimizing resource allocation and improving staff productivity. Additionally, it aims to evaluate the impact of enhanced quality control measures on the reliability and safety of instrument sterilization processes. Findings from this study will inform recommendations for further improvements in CSSD operations and contribute to the advancement of best practices in sterile supply management. Conclusion The successful implementation of an effective workload management model and enhanced quality control measures in the CSSD is crucial for maintaining patient safety and ensuring the efficient functioning of healthcare facilities. By systematically evaluating the implementation and impact of these interventions, this study protocol seeks to contribute to the ongoing improvement of CSSD operations and the enhancement of healthcare quality.

Clinical and microbiological profiling of infections in open tibia fractures at Muhimbili Orthopaedic Institute

Background: Fracture-Related Infection (FRI) is a challenging complication after surgical fracture treatment. Consequences include reoperations, increased medical costs, loss of function and even amputation. Objectives: This study aimed to analyze the rate, predictors of infection, clinical-radiological presentation and microbial profiles of open tibia FRI. Methods: Between January 2022 and June 2022, a descriptive cross-sectional observational study was conducted at Muhimbili Orthopaedic Institute (MOI) involving patients aged 18 years and above with surgically managed open tibial shaft fractures in the preceding 12 months. Microbiological culture of three intraoperative tissue and bone specimens were taken by sterile techniques using separate and sterile instruments. Results: There were 190 patients between 18-72 years with a mean age of 35.6 ±10 years. After surgical debridement, all 190 (100%) were managed with either an external fixator or an intramedullary nail. It was found, 49 (25.8%) patients had FRI. A smoking history was identified as a predictor of infection (AOR= 2.21 95% CI 0.84-5.59, P value 0.108). Delayed union was a complication found in 70.3% of patients with infection attending 12th week follow-up and beyond. Almost all (96.5%) intraoperative tissue samples were culture positive, yielding most isolates as polymicrobial (57.9%) and the predominant pathogen identified being Gram-negative bacteria in delayed and late infections. Conclusion: About one-quarter of open tibial shaft fractures are at risk of FRI. The risk is higher among smokers. Intraoperative tissue sampling provides significant cultural yield with predominant gramnegative infection in delayed and late presentation.

Evaluation of microbial occurrence in reusable robotic instruments for minimally invasive surgery: A pilot study.

In recent decades, minimally invasive surgery has become the favoured surgical technique, with increasing utilisation of robotic surgery to enhance patient outcomes. However, the design complexity of surgical robotic instruments can pose challenges in maintaining adequate cleaning, disinfection and sterilisation-particularly of the device's interior. In our hospital, robotic instruments are reused for a maximum of ten successive patients, following the manufacturer's guidelines. To the best of our knowledge, neither the manufacturer nor ISO standards have specified any methods to determine the sterility of robotic instruments after cleaning, disinfection and sterilisation procedures. In a small pilot study, we used a locally developed protocol to evaluate the sterility of 20 da Vinci SI robotic instruments, with the aim of determining whether the recommended cleaning, disinfection and sterilisation process is adequate to achieve safe usage in subsequent patients. None of the 20 instruments showed viable micro-organisms, therefore the robotic instruments were considered sterile, and suitable for re-use. We recommend our protocol to other hospitals, to be used as an essential control element in the assessment of their unique reprocessing technique for robotic instruments.

Fostering innovation and sustainable thinking in surgery: an evaluation of a surgical hackathon.

Surgery represents a major source of carbon emissions, with numerous initiatives promoting more sustainable practices. Healthcare innovation and the development of a digitally capable workforce are fundamental in leveraging technologies to tackle challenges, including sustainability in surgery. A surgical hackathon was organised with three major themes: (1) how to make surgery greener, (2) the future of plastic surgery in 10 years, and (3) improving healthcare outcomes using machine learning. Lectures were given on sustainability and innovation using the problem, innovation, market size, strategy and team (PIMST) framework to support their presentations, as well as technological support to translate ideas into simulations or minimum viable products. Pre- and post-event questionnaires were circulated to participants. Most attendees were medical students (65%), although doctors and engineers were also present. There was a significant increase in delegates' confidence in approaching innovation in surgery (+20%, p < 0.001). Reducing waste packaging (70%), promoting recyclable material usage (56%) and the social media dimension of public perceptions towards plastic surgery (40%) were reported as the most important issues arising from the hackathon. The top three prizes went to initiatives promoting an artificial intelligence-enhanced operative pathway, instrument sterilisation and an educational platform to teach students research and innovation skills. Surgical hackathons can result in significant improvements in confidence in approaching innovation, as well as raising awareness of important healthcare challenges. Future innovation events may build on this to continue to empower the future workforce to leverage technologies to tackle healthcare challenges such as sustainability.

Beyond the operating room: built environment design knowledge supportive of resilient surgical services

PurposeSurgical services are settings where resilient performance (RP) is necessary to cope with a wide range of variabilities. Although RP can benefit from a supportive built environment (BE), prior studies have focused on the operating room, giving scant attention to support areas. This study takes a broader perspective, aiming at developing BE design knowledge supportive of RP at the surgical service as a whole.Design/methodology/approachSeven BE design prescriptions developed in a previous work in the context of internal logistics of hospitals, and thus addressing interactions between workspaces, were used as a point of departure. The prescriptions were used as a data analysis framework in a case study of the surgical service of a medium-sized private hospital. The scope of the study included surgical and support areas, in addition to workflows involving patients and family members, staff, equipment, sterile instruments and materials, supplies, and waste. Data collection included document analysis, observations, interviews, and meetings with hospital staff.FindingsResults identified 60 examples of using the prescriptions, 77% of which were related to areas other than the operating rooms. The developed design knowledge is framed as a set of prescriptions, examples, and their association to workflows and areas, indicating where it should be applied.Originality/valueThe design knowledge is new in surgical services and offers guidance to both BE and logistics designers.

Health management risks in developing countries: Case of a sterilization unit in a Moroccan public hospital

BackgroundThe sterilization of instruments is a critical process to perform the activity in the operating rooms and ensure the safety of patients. The best approach to improve the performance of the sterilization is the risk management. Nevertheless, improving the performance in sterilization units in developing countries presents a real challenge. PurposeDesigning an effective risk management project in health sector, specifically in sterilization units, adaptable to the context of developing countries (DC). MethodsThis study uses Failure Modes and Effects Analysis (FMEA) to manage risks in healthcare in DC. Modifications to the implementation of the recommended tool mode. A case study of the sterilization unit of a tertiary Moroccan national reference university hospital was conducted to verify the effectiveness of the model. FindingsThe present study demonstrated that the proposed model is adaptable to the DC context. This model was implemented with minimal resources and was highly efficient. ConclusionsThe increase of risks in healthcare is a challenge for managers in DC. This study highlights the first successful experience of risk management in Moroccan healthcare sector.

DBD plasma as a practical approach to sterilization of dental instruments

Microbe control and decontamination are necessary for medical equipment that will be used again. Several wet and dry sterilizer technologies, like as autoclaves, ovens, UV systems, and chemical agents, have been widely used to eliminate the possibility of cross-infection between contaminated dental instruments or materials and dental patients. The development of a sterilizer device capable of sterilizing dental equipment through non-toxic materials has been shown to significantly decrease the overall procedure time compared to conventional approaches. Therefore, an investigation was conducted to assess the efficacy of a dielectric barrier discharge (DBD) plasma device in sterilizing dental instruments under atmospheric pressure conditions. Also, due to Reactive Oxygen and Nitrogen Species (RONS) existence at low temperatures, researchers have been examining the biological effects of cold plasmas for medical applications with promising results. The dental Tweezer, one of the dental tools, was chosen to perform the sterilization process using the DBD plasma device. The Dental Tweezers samples were contaminated with Escherichia coli and Staphylococcus aureus bacteria, and then the DBD plasma device was used to sterilize them for 1, 2, 3, and 4 min, respectively, to figure out the best time to do this. The DBD plasma device successfully killed E. coli and S. aureus. Based on the findings derived from our present investigation, the cold plasma device has impressively proven its efficiency in sterilization.