Supply Room Research Articles

Preparation of the iodine-coating titanium implant in orthopedics and evaluation of antibacterial activity

Objective Iodine loading would be carried out on orthopedic titanium Kirschner-wire by electrophoretic deposition. And by this, a kind of orthopedic iodine-coated implant with antibacterial properties was supposed to be developed, that would provide a theoretical basis for the development of clinical orthopedic implants with antibacterial properties. Methods Iodine loading on the surface of titanium Kirschner-wire was carried out by electrophoretic deposition. PVP-I solution as 1 000 ppm, 2 000 ppm and 4 000 ppm was prepared respectively (1 ppm=1 mg/kg=1 mg/L). Three kinds of iodine-coated orthopedic titanium Kirschner-wires with different iodine content were prepared by electrophoretic deposition at 200 V voltage for 30 min and then stoved after being washed with distilled water. The surface signs and composition structure of iodine coated titanium Kirschner-wire were studied through scanning electron microscopy (SEM) and energy dispersive spectrometer (EDS). Antibacterial experiments of Iodine coating titanium Kirschner needle were performed in vitro. Antimicrobial test: 10 pieces of uncoated titanium Kirschner-wires; 10 pieces of iodine-coated titanium Kirschner-wires with 1 000 ppm;10 pieces of iodine-coated titanium Kirschner-wires with 2 000 ppm; 10 pieces of iodine-coated titanium wires with 4 000 ppm. Because iodine is easy to sublimate and does not withstand high temperature, all the titanium Kirschner needles are fumigated and disinfected by ethylene oxide (supported by the supply room of our hospital). Titanium wires were immersed respectively in 106 CFU/ml (ATCC25923) bacterial suspension of standard Staphylococcus aureus so that bacteria would be fully inoculated on the surface of the titanium wire. The sterilized titanium Kirschner needle was placed in a sterile culture cup and 30 ml suspension was added into the culture cup. The sterilized titanium Kirschner needle was completely immersed in the bacterial solutionand was kept at 37℃ for 6 h before taking out. Take out the titanium Kirschner needle slowly, rinse the titanium Kirschner needle with 5 ml sterile PBS buffer, after rinsing the surface of titanium Kirschner needle, transfer the titanium Kirschner needle to the new sterile culture cup and add 5 ml sterile saline until the titanium Kirschner needle is completely immersed. Then put the titanium Kirschner needle into the ultrasonic oscillator to wash the surface of the bacteria fully. After 10 000 times dilution, 100 μl was smeared on agar medium for culture (37℃) and the number of colonies was observed and counted 24 h later. Results The surface of three kinds of iodine coating titanium Kirschner-wires was covered with uniform iodized compound coating and had a brown look. The film structure was stable and there was no falling off after ultrasonic cleaning. SEM exhibited that the surface of Titanium Kirschner-wire is covered with a compact coating; the appearance structure is relatively flat and a slight collapse can be seen scattered in the surface of the wire. The results of EDS showed that the iodine content in the surface coating of 3 groups was 4.38 wt%, 9.05 wt% and 14.48 wt%. The bacteria growing on the surface of titanium needle were shaken down by ultrasonic vibration. The CFU counting was carried out after the bacterial solution being diluted, coated and cultured for 24 h. It can be seen that the antibacterial property increases continuously with the increase of iodine coating content. The antibacterial properties of iodine-coated implant which content 14.48 wt% iodine was more than 1 orders of magnitude than the control group. The results showed that the plants coated with iodine had obvious antibacterial effect. Conclusion The iodine coated titanium wire was prepared by electrophoretic deposition, after being characterized by SEM, EDS and quantitative measurement, the successful loading of iodine was proved, the antibacterial experiment proved that the iodine-coated orthopedic titanium Kirschner-wire has a stronger antibacterial properties than the ordinary titanium Kirschner-wire under laboratory conditions. Key words: Iodine; Internal fixators; Electrophoresis; Comparative study

Equivalent room air temperature based cooling load estimation method for stratum ventilation and displacement ventilation

Cooling load estimation is the base for the design and control of the air conditioning system. The indoor air temperature stratification of stratum ventilation and displacement ventilation contributes to the energy saving, but challenges the cooling load estimation. The existing building simulation tools are generally equipped with only the fully mixed air model and ignore the indoor air temperature stratification. This study proposes an equivalent room air temperature based cooling load estimation method to enable the fully mixed air model to accurately estimate the cooling load of stratum ventilation and displacement ventilation. The equivalent room air temperature is the air temperature with which the fully mixed air model can produce the same cooling load as that of stratum ventilation/displacement ventilation. The equivalent room air temperature is modelled as a function of the supply air temperature, supply airflow rate and room air temperature of stratum ventilation/displacement ventilation using response surface methodology. Case studies using the experimentally validated multi-node models are conducted to demonstrate the effectiveness of the proposed method. The mean absolute errors in the cooling load estimation by the proposed method for the constant-air-volume system and the variable-air-volume system are 0.02% and 5.78% respectively under stratum ventilation, and 0.07% and 4.78% respectively under displacement ventilation. Compared with the conventional method, the proposed method improves the accuracy in the cooling load estimation by 70.92%–99.94%.

Study on the correlation between work-related musculoskeletal disorders and work ability among nurses at three level general hospital in Xinjiang

Objective: To investigate the correlation between work-related musculoskeletal disorders (WMSDs) and work ability (WA) among nurses in Xinjiang. Methods: A total of 1 873 nursing staff in the Departments of Internal Medicine, Surgery, Emergency and ICU Department, Operating Room and Supply Room of 6 Grade 3 General Hospitals in Xinjiang Beijiang Region were randomly selected by means of random sampling, and revised Nordic National Musculoskeletal Disorders Standard Questionnaire and Work Ability Index Scale were used to evaluate the status of nursing WMSDs and WA. Results: (1) The symptom incidence of work-related musculoskeletal disorders among nursing staff in the past year was 77.42%; The highest symptom incidence in all parts of the body was waist, neck, shoulder and back, and the symptom incidence was 63.59%, 59.80%, 47.78% and 37.32%, respectively; (2) The total score of nursing staff's work ability was (35.91±5.143) ; The proportion of "poor" , "middle" , "good" and "excellent" were 5.23%, 47.41%, 41.43% and 5.93% respectively; (3) The total working capacity of the sick group was (35.11±5.044) , The working ability of the non-diseased group was (38.64±4.507) , The difference between the two groups was statistically significant (t=13.773, P<0.01) ; There was a significant difference in the level of work ability between the two groups (z=-12.335, P<0.01) ; The working ability of "poor" and medium in the injury group was significantly higher than that of the non injury group, while the working ability was "better" and "excellent" than that of the non injury group; (4) The working ability of nursing staff of different age in WMSDs injury group was lower than that in non injury group, the difference was statistically significant (P<0.01) ; There was a negative correlation between the working ability of the injury group and the length of service, that is, with the increase of the length of service, the working ability index decreased (P<0.01) ; There was a positive correlation between the working ability of the non injury group and the length of service, that is, with the increase of the length of service, the work ability index increased gradually, but the correlation was not statistically significant (r=0.063, P=0.195) ; (5) The working ability of nursing staff of different departments in WMSDs injury group was lower than that in non injury group, the difference was statistically significant (P<0.01) . (6) Multiple linear regression analysis showed that the factors influencing the working ability of nursing staff were: past medical history, WMSDs disease, length of service and night shift frequency; Conclusion: The symptom incidence of WMSDs was high among nurses; Work Ability at a moderate level; work-related musculoskeletal disorders is associated with reduced ability of nursing staff; work-related musculoskeletal disorders are associated with reduced working capacity of nursing staff.

Development of self-label method to distinguish supply air from room air without tracer in numerical simulations

Traditionally, the tracer method has been used to distinguish the supply air and room air in buildings by labeling the target air with a tracer. However, due to difference in the physical properties of the target air and the tracer, use of the tracer method inevitably produces tracer error. Furthermore, due to the lack of an exact comparative reference, it is difficult to determine which tracer is the best to represent the target air distribution. In this study, a method (i.e. self-label method) which can distinguish supply air from ambient air without tracer in numerical simulations has been developed. In this paper, the principle, governing equations, accuracy, and applications of the self-label method are presented. Further, due to its simple and typical mixing characteristics of supply air and ambient air, a jet has been used to validate the numerical model by comparing the numerical results with the classical theoretical and experimental results in the earlier studies. The validity of the self-label method has been verified by comparing the flow rate and the velocity field of the jet with those by the single air approach. The tracer gas error has been compared with the exact reference obtained by self-label method. The results show that the tracer gas error increases with increasing tracer concentration or decreasing air velocity under isothermal conditions. Finally, the dynamic mechanism of the tracer gas error has been analyzed. It shows that an additional concentration buoyancy force can occur, which can cause tracer gas error under isothermal conditions.

Effect analysis of handover record applying in supply room

Objective To explore the effects of handover record applying in supply room. Methods From July to December 2017, 9 staff in Supply Department of Children's Hospital Affiliated to Capital Institude of Pediatrics were selected as the research subjects by purposive sampling method. The handover policy was established and a handover record sheet was designed with Excel software. The occurrence of nursing events and the nursing managers' satisfaction towards supply room were compared before and after the application of handover record. Results There were 11 nursing events before the application of handover record, and none after. The service satisfaction rate after the intervention was (52.50±5.25) , which was higher than that before (49.09±8.15) , the difference was statistically significant (t=-2.301, P=0.032) . Conclusions The application of handover record sheet can make the communication smoothly, and improve the quality of shift and the satisfaction of nurse managers. Key words: Nurses; Central supply, hospital; Handover record sheet

An identification method for room temperature dynamic model based on analytical solution in VAV system

Variable Air Volume (VAV) system is a typical time delay system with multiple variables, and it is difficult to build a dynamic response model for describing room temperature regulation process. This paper firstly proposes a novel model of dynamic response of room temperature based on the analytical solution of heat balance equation in VAV air conditioning zone. According to the solution, inertia time constant and magnification coefficient of room temperature response can be directly calculated by initial environmental parameters. The model is further extended to a Multi-Input Single-Output (MISO) model with airflow regulating actuators as input and room temperature as model output. Experimental studies are carried out to test practical supply airflow and room temperature response and corresponding model parameters are identified according to the measured data in the VAV experimental platform. The proposed identification method based on analytical solution is validated through simulation and compared with classical identification method. Results indicate that the proposed identification method could describe the room temperature dynamic characteristics of VAV system well, and it can be applied in control simulation and engineering application in future work.

Shielding a high-sensitivity digital detector from electromagnetic interference.

PurposeTo document a study in shielding a high‐sensitivity digital mammography system detector from AC magnetic fields of magnitudes great enough to induce imaging artifacts.Methods/materialsPreliminary evaluation of AC magnetic fields at a site designated for a digital breast tomosynthesis (DBT) system raised concerns that the magnetic component of electromagnetic interference (EMI) may be great enough to induce imaging artifacts. Subsequent measurements using digital detector arrays from two separate manufacturers verified this concern, and AC magnetic fields were mapped, spatially and temporally, throughout the area of concern. A simple shielding model was developed to elucidate the physics of extremely low‐frequency (ELF) EMI shielding and independently verify a commercial group's proposed shielding design and installation. Postshielding measurements were performed to demonstrate that the EMI fields were reduced to acceptable levels.ResultsPreshielding measurements showed AC magnetic fields significantly exceeding manufacturers’ tolerances for artifact‐free imaging in DBT. Continuous measurements demonstrated that the EMI fields varied significantly over time. Some locations in the room routinely averaged above 30 mG and occasionally exceeded 100 mG. The source was attributed to an adjacent electrical supply room, and temporal changes of the EMI were attributed to variations of the building electrical loads. The proposed shielding primarily consisted of continuous aluminum (6.35 mm thickness) and was installed by a group specializing in electromagnetic field shielding. Postshielding measurements demonstrated that the EMI fields were significantly reduced, generally to less than 0.5 mG, and that the shielding effectively dampened the large variations due to dynamic building electrical loads. Subsequent installation and evaluation of a DBT system revealed no issues with imaging artifacts.ConclusionsThe successful shielding of ELF EMI involves physical principles that are not commonly encountered by medical physicists. Modern high‐sensitivity digital detectors may be successfully shielded against imaging artifacts with careful application of these principles.

Time, Resident Involvement, and Supply Drive Cost Variability in Septoplasty with Turbinate Reduction.

Objective To determine factors that influence cost variability in septoplasty with inferior turbinate reduction. Study Design Case series with chart review. Setting Tertiary care hospital and affiliated ambulatory surgical center. Subjects and Methods Surgical costs were reviewed for adult patients undergoing septoplasty with inferior turbinate reduction between December 2014 and September 2017. Cases where additional procedures were performed were excluded. Operative supply costs, operative time, room time, and resident involvement were determined. Contribution of these factors to total costs and variability were analyzed. Results The study included 116 patients (mean age, 38 years) and 4 faculty surgeons. Total cost was primarily driven by operative time (74%), with a smaller portion of total cost arising from supplies (26%). Time cost ( P < .0001) and supply cost ( P = .006) varied significantly among surgeons. A resident was involved in 46.6% of cases. When subanalyzed by resident year, no-resident and senior resident (postgraduate years 4 and 5) cases had nearly identical mean times, while junior resident (postgraduate years 1-3) cases had mean times and operative time costs that were 39% greater ( P < .001). Conclusion For septoplasty with inferior turbinate reduction, the greatest driver of cost variation was operative time. Resident involvement correlated with increased time and cost. Supply costs had a much smaller impact. When subanalyzed by resident year, junior resident-involved cases were significantly longer than no-resident cases.

Experimental investigation on airflow pattern for active chilled beam system

Experimental results of the airflow pattern for Active Chilled Beams (ACB) system are investigated in this paper, where the air velocity and turbulence intensity for the air jet near the ceiling are tested and recorded under both isothermal and non-isothermal conditions. Based on the results, the velocity profile along streamwise direction is found to be significant in analyzing air detachment from the ceiling. It is revealed that the Coandă effect can be enhanced by a high pressure drop of ACB terminal unit and impeded by the temperature difference between supply air and room air. The self-similarity for the air jet is observed to be feasible for a certain downstream distance where the vertical maximum velocity is within 1.25 slot heights. A comparison study has been conducted for two mathematical models describing the self-similarity with the experimental data. It turns out that Verhoff's model has an overall better performance than Schwarz and Cosart's model. The turbulence intensity, which tends to be larger for points with lower velocity, is higher in areas where the entrainment effect is stronger.

Influencing factors of valid period of sterile items

Objective To investigate the related factors that affect the valid period of sterile items. Methods Sterile items after well cleaning and disinfection were stored in the supply room with a standard storage conditions, as well as in different storage conditions such as neural therapy room, general surgery dressing room, outpatient and emergency injection room, clean operating room with 120 items respectively. Bacterial culture was performed regularly on the sterile items in different storage rooms. Results At 90 d after sterilization, 3 sterile items stored in the outpatient and emergency injection room with paper-plastic packaging had the bacterial growth. At 105 d after sterilization, 2 samples in the general surgery dressing room with paper-plastic packaging were found to have the bacterial growth. At 150 d after sterilization, 1 sample in the general surgery dressing room with non-woven packaging had the bacterial growth. Up to the end of the experiment, no bacterial growth was observed in the sterile items stored in disinfection supply center, neural therapy room and clean operating room. Conclusions The factors that affect the valid period of the sterilized items are related to the time. It is necessary to evaluate influencing factors of the valid period of sterile items from various perspectives. Specification, industry standards and provision should be executed to ensure the quality of the sterilized items and prevent nosocomial infection. Key words: Disposable packaging material; Sterilized items; Valid period; Influencing factor

Comparative study in the effects of two different cleaning methods combined with hypothermia sterilization for rigid endoscopic instruments

Objective To investigate the effects of different cleaning methods combined with hypothermia sterilization for rigid endoscopic instruments. Methods A total of 300 thoracoscopes, 60 mediastinoscopes and 200 titanic clips were selected in the supply room of Nanjing Chest Hospital from March to September 2015 and randomly divided into two groups. The control group underwent traditional hand-washing combined with hypothermia sterilization, while the observation group underwent enzymatic ultrasonic cleaning combined with hypothermia sterilization. The cleaning effects of two groups were compared using three different methods: visual method, protein clean & testing stick, and pharynx swab culture. Results All the endoscopic instruments in the observation group has a higher qualified rate than those in the control group, with statistically significant differences between two groups (P<0.05) . Both groups have a qualified rate of 100%. Conclusions The enzymatic ultrasonic cleaning combined with ethylene oxide or hydrogen peroxide hypothermia sterilization for endoscopic instruments guarantes the quality of cleaning and sterilization and is worthy to be promoted. Key words: Hypothermia; Sterilization; Endoscopic instruments; Cleaning

Application of failure mode and effect analysis in management of precision instrument in operating room of ophthalmology department

Objective To explore the application of failure mode and effect analysis in management of precision instrument in operating room of ophthalmology department. Methods We designed the handover process between operating room of ophthalmology department and supply room, the process of using precision instrument, the workflow of instrument management in nurses. And then, we assessed and analyzed the potential failure mode in the management of precision instrument with the method of failure mode and effect analysis. Besides, failure mode was also evaluated and improved. Results There were failure modes with high risk in the management of precision instrument including that the handover process between operating room of ophthalmology department and supply room was not precise enough (risk priority number, RPN=448) ; the staff of handover process was not fixed (RPN=360) ; there was no full-time cleaning staff in supply room (RPN=288) ; use registers in nurses and the check in precision instrument were all in a lack of standardization (RPN=210, 180) and so on. After adopting targeted corrective actions, the corresponding scores of RPN fell to 0, 0, 40, 70, 90. Conclusions The application of failure mode and effect analysis in management of precision instrument in operating room of ophthalmology department has good effects with no related adverse event on precision instrument. Key words: Failure mode and effect analysis; Process management; Precision instrument

Comparison of economic and clinical outcomes between patients undergoing laparoscopic bariatric surgery with powered versus manual endoscopic surgical staplers

Aims: To compare economic and clinical outcomes between patients undergoing laparoscopic Roux-en-Y gastric bypass (LRY) or laparoscopic sleeve gastrectomy (LSG) with use of powered vs manual endoscopic surgical staplers.Materials and methods: Patients (aged ≥21 years) who underwent LRY or LSG during a hospital admission (January 1, 2012–September 30, 2015) were identified from the Premier Perspective Hospital Database. Use of powered vs manual staplers was identified from hospital administrative billing records. Multivariable analyses were used to compare the following outcomes between the powered and manual stapler groups, adjusting for patient and hospital characteristics and hospital-level clustering: hospital length of stay (LOS), total hospital costs, medical/surgical supply costs, room and board costs, operating room costs, operating room time, discharge status, bleeding/transfusion during the hospital admission, and 30, 60, and 90-day all-cause readmissions.Results: The powered and manual stapler groups comprised 9,851 patients (mean age = 44.6 years; 79.3% female) and 21,558 patients (mean age = 45.0 years; 78.0% female), respectively. In the multivariable analyses, adjusted mean hospital LOS was 2.1 days for both the powered and manual stapler groups (p = .981). Adjusted mean total hospital costs ($12,415 vs $13,547, p = .003), adjusted mean supply costs ($4,629 vs $5,217, p = .011), and adjusted mean operating room costs ($4,126 vs $4,413, p = .009) were significantly lower in the powered vs manual stapler group. The adjusted rate of bleeding and/or transfusion during the hospital admission (2.46% vs 3.22%, p = .025) was significantly lower in the powered vs manual stapler group. The adjusted rates of 30, 60, and 90-day all-cause readmissions were similar between the groups (all p > .05). Sub-analysis by manufacturer showed similar results.Limitations: This observational study cannot establish causal linkages.Conclusions: In this analysis of patients who underwent LRY or LSG, the use of powered staplers was associated with better economic outcomes, and a lower rate of bleeding/transfusion vs manual staplers in the real-world setting.

Cost-benefit analysis of paper-plastic packaging materials and medical non-woven fabrics

Objective To analyze the cost composition of paper-plastic packaging materials and medical non-woven fabrics applied in sterilization treatment packages in the supply room, in order to reduce health-care costs and medical costs and provide guidance for the control of nosocomial infection. Methods In Ningbo City Medical Treatment Center Lihuili Hospital, the single consumption cost composition and the total cost (retrospective material) of disposable medical non-woven packaging materials (bags for removing stitches) used from January 2014 to October 2014 and paper-plastic packaging materials (bags for removing stitches) used from January 2015 and October 2015 were compared and analyzed. Results The single consumption cost of paper-plastic packaging materials (0.21 yuan) was lower than disposable medical non-woven packaging materials. The total cost of paper-plastic packaging materials used in the hospital from January 2015 and October 2015 was compared to the total cost of disposable medical non-woven packaging materials used in the hospital from January 2014 to October 2014. It was found that for paper-plastic packaging materials, the number of clinical small medical items (bags for removing stitches and bags for expanding stitching) was 5 437 less than disposable medical non-woven packaging materials, when the number of patients entering and discharging from the hospital slightly increased. The total packaging cost saved 23 025.3 yuan. Conclusions Not only can paper-plastic packaging materials reduce the loss of medical resources, reduce the workload, save expenses for hospitals and clinical departments, but also it has advantages in guaranteeing the medical quality and reducing the hospital infection risk. It realizes the double win situation of hospital economic benefits and social benefits. Key words: Paper-plastic packaging; Medical non-woven fabrics; Cost analysis; Sterilization supply center

Studying comfort in a room with cold air system using computational fluid dynamics

Cold air system has proven to offer economic and environmental benefits. However, these systems did not spread because of the fear from cold draft formation leading to unaccepted indoor conditions. In this paper, Computational Fluid Dynamics (CFD) was used to evaluate the performance of cold air system inside a 2D space. The flow of cold air was studied at different supply temperatures, velocities, and room thermal loads. The velocity field and the temperature distribution were used to calculate the effective draft temperature. And hence, the comfort level was assessed using the Air Diffusion Performance Index, ADPI. The effect of each factor was studied independently at different loads. It was shown that reduction in supply temperature and velocity each causes limited enhancement on the ADPI. The main source of drafts was the heat flux from the floor. The velocities induced by the floor heat flux were sometimes higher than the jet velocity.

Prevalence of Work-Related Musculoskeletal Disorders in the Nurses Working in Hospitals of Xinjiang Uygur Autonomous Region.

Objective To investigate the status of work-related musculoskeletal disorders (WMSDs) in nurses working in the hospitals in Xinjiang Uygur Autonomous Region. Methods The prevalence of WMSDs since working and in the previous 12 months was evaluated using self-administrated modified musculoskeletal questionnaire based on North European questionnaire. In this cross-sectional study, 6674 nurses involved in the nursing profession were selected from 16 hospitals using the stratified cluster sampling method. Results The most commonly affected regions by WMSDs were lower back, neck, shoulder, and back, with an annual prevalence of 62.71%, 59.77%, 49.66%, and 39.50%, respectively. Statistical differences were noticed in the annual prevalence of WMSDs in those with different ages (P < 0.01) and working durations (P < 0.01). Logistic regression analysis indicated that the following risk factors were associated with the prevalence of WMSDs: working duration of ≥6 years; working in the Emergency Department, Department of Anesthesia, or Supply Room; night shift of more than once, working duration of >40 hrs per week; poor health status; and feeling of fatigue. Rest time of >10 min and no history of WMSDs were the protective factors of WMSDs. Conclusions Shift and working/rest duration was closely related to WMSDs.

Experimental evaluation of a cooling radiant wall coupled to a ground heat exchanger

A building prototype was built in the experimental set-up located in Puigverd de Lleida (Spain) to study the energy performance of a radiant wall with ventilated facade cooled with a ground coupled heat-exchanger. The installed geothermal heat pump operates only as a ground coupled heat exchanger on cooling mode, thus providing free-cooling. In this case, only the circulation pumps consume power. The summer experimental campaign showed the energy savings potential and the peak load shifting ability of the system. On continuous operation and taking as reference a cubicle equipped with a conventional air-to-air heat pump, the radiant wall cooled with the ground coupled heat-exchanger achieved savings up to 54.17% and 82.08% at set-point temperatures of 24°C and 26°C, respectively. The thermal storage capacity of the system was studied in night charging test, when the cubicles were pre-cooled during night-time. During the day, the temperature raise caused by heat loads was small and the system kept the temperature inside comfort range despite it only operated overnight. However, the performance was very sensitive to set-point temperature. Free-cooling was limited by the temperatures in the boreholes, showing that with lower set-points the gradient between supply temperature and room temperature was small, and thus it required a higher water flow to achieve the necessary cooling power. Intermittent operation of the system according to different schedules also affected the radiant walls performance as they interacted with the thermal inertia of the system, which could even have a negative impact on energy use.

Applying HFMEA for the prevention of human error during instrument sterilization procedures: A case study on a medical center in central Taiwan

ABSTRACTThis study aimed to demonstrate two main points: (1) not only employees from medical equipment supply rooms, but also others who use germ-free equipment, need to be educated; and (2) employee training on the comprehensive concept of asepsis is effective. A medical center in Central Taiwan was investigated for a case study, and 100 samples were stratified and randomly selected from the clinical units exhibiting three top defective rates. Healthcare failure mode and effect analysis (HFMEA) was adopted to evaluate the entire process of equipment sterilization. Hazard analysis and a decision tree were used to identify potential failure modes and factors that should be improved. This study indicates that the causes for failure are mostly human errors, including a lack of knowledge regarding precaution and professional knowledge, busyness, carelessness, cost saving, and unsuitable packages. The second part of our results showed that comprehensive knowledge of the equipment sterilization procedure is required; this can reduce the defect rate from 49% to 3.7%. The results showed that HFMEA could be applied for reducing risk factors in potential failure modes, thereby not only enhancing patient safety but also improving the effectiveness of the management of medical instruments and supplies.

Relationship of Hospital Architecture to Nursing Staff Caring for Self, Caring for Patients, and Job Satisfaction

Historically, the fields of architecture (design) and nursing (health) have been separate disciplines without much intersection. In recent years, the healthcare building boom has created a specialty practice for architects, focusing on healthcare design. With this new focus and specialty within architecture, the science of evidence-based design and the collaboration with clinical care staff have created a new partnership paradigm that is improving the built environment.&#x0D; Ten dimensions of caring have been espoused by Watson’s Caritas Theory to comprise the construct of caring, which in turn facilitates healing for both the care giver and care recipient (Nelson &amp; Watson, 2012). This article describes a study that examined the relationship between selected elements of architectural design and other factors (recent architectural change, unit size and shape, intersecting hallways, number and proximity of bathrooms and supply rooms, availability of nourishment, number and availability of computers, and rooms for staff gathering, for solitude, and for practice of Watson Caring Factors) and outcomes of caring that are important to nursing, including clinical staff caring for self, caring for others, and job satisfaction. The study took place in a hospital that was implementing Watson’s concepts of caring within their framework of care delivery. Statistically significant relationships were:&#x0D; Caring for self was negatively related to number of supply rooms and number of Watson rooms or boxes. Caring for patients as reported by staff was negatively related to number of Watson rooms or boxes. Job satisfaction was positively related to number of bathrooms and negatively related to number of supply rooms. A small sample size required adjustment of the alpha to .15 and an effect size of .25, suggesting that replication studies with larger sample sizes may assist with development of a model of architecture that promotes behaviors as proposed by Watson and better outcomes for both patient and staff.

안전한 매선요법 시술을 위한 멸균, 소독 및 무균법

Objective : Thread embedding acupuncture has become popular as a minimally invasive treatment for facial wrinkles and laxity. However, there is little published clinical practice guidelines about disinfection, sterilization and aseptic technique for thread embedding acupuncture. This study is to introducing a specific guidelines about disinfection, sterilization and aseptic technique for thread embedding acupuncture.Method : We reviewed internal regulations and guidelines about hospital infection, and Traditional Korean medicine doctors, nurses, and director of central supply room discussed in depth and established a regulation of disinfection, sterilization and aseptic technique for thread embedding acupuncture.Result : The regulation of disinfection, sterilization and aseptic technique for thread embedding acupuncture consisted of ① management of supplies, ② guidelines of disinfection, sterilization, and reuse, ③ aseptic technique for thread embedding acupuncture.Conclusion : Microbial management is an essential element of medical care and quality. Traditional Korean medicine doctors will care for disinfection, sterilization, and this should not neglect to comply with the procedures and guidelines in the medical field as well as to understand the aseptic techniques.