Lack of Association of Pediatric Surgical Patient Outcomes With Increased Disposable Operating Room Supply Costs.

INTRODUCTION: There is wide variation in the cost of disposable operating room supplies between surgeons performing the same operation at the same institution. The general relationship between variation in disposable supply cost and patient outcomes is unknown. We aimed to evaluate the relationship between disposable supply cost and patient outcomes for sixteen common operations. METHODS: Cost data were reviewed for the most common procedures performed by five surgical divisions at a single children's hospital over a six-month period in 2021. For procedure, the median disposable OR costs were calculated. Each operation performed was categorized as low cost (below the group median) or high cost (above the group median. We compared the rates of adverse events (clinic visit within 5 days, 30-day emergency department visit, unplanned reoperation, unplanned readmission, anesthesia complications, prolonged hospital length of stay, need for blood product transfusion, or death) between procedures with low and high disposable supply costs. RESULTS: 1139 operations performed by 48 unique surgeons from five specialties were included; 596 (52%) were low-cost and 543 (48%) high-cost. The low and high-cost groups did not differ regarding most demographic characteristics. Overall, 21.9% of children suffered any adverse outcome; this rate did not differ between the low and high-cost groups when evaluated individually or in aggregate (20.5% vs 23.6%, p = 0.23). CONCLUSION: Our data demonstrate that across a wide range of pediatric surgical procedures, the cost of disposable operating room supplies was not associated with the risk of adverse outcomes. LEVEL OF EVIDENCE: Level 3.

Biossegurança em serviço de embelezamento: conhecimento e práticas em uma capital do nordeste brasileiro / Bioseguridad en los centros de embellecimento: conocimientos y prácticas en una capital del nordeste brasileño / Biosafety in beauty centers: knowledge and practices in a state capital in Northeast Brazil

Resumo OBJETIVO Avaliar o conhecimento e as práticas de biossegurança adotadas por profissionais do segmento da beleza. MÉTODOS Pesquisa descritiva do tipo survey. Foram entrevistados 238 profissionais de serviços de embelezamento entre agosto de 2014 e 2015. As variáveis foram apresentadas por meio de frequências absolutas e relativas, bem como média e desvio padrão. RESULTADOS 62,6% dos profissionais tiveram contato com sangue de clientes sem uso de luvas; instrumentais para o atendimento e 32,8% dos entrevistados não utilizaram equipamentos de proteção individual durante suas atividades laborais. CONCLUSÕES As doenças mais citadas quanto ao risco de contágio e de transmissão na prática laboral foram as hepatites virais, HIV e fungos. Quanto aos procedimentos de biossegurança adotados, o autoclave é o equipamento menos usado na esterilização dos instrumentos.

Resumen OBJETIVO Evaluar el conocimiento y las prácticas de bioseguridad adoptadas por profesionales del segmento del embellecimiento. MÉTODOS Evaluar el conocimiento y las prácticas de bioseguridad adoptadas por profesionales del segmento del embellecimiento. RESULTADOS: 62,6% de los profesionales tuvieron contacto con sangre de clientes sin el uso de guantes; el 74,4% higienizaban las manos entre los atendimientos, el 16,8% reutilizaban materiales desechables. Ningún profesional informó la cantidad adecuada de instrumentos y el 32,8% de los entrevistados no utilizaban equipos de protección individual durante sus actividades laborales. CONCLUSIONES Las enfermedades más citadas con respecto al riesgo de contagio y de transmisión en la práctica laboral fueron las hepatitis virales, el VIH y los hongos. Acerca de los procedimientos de bioseguridad adoptados, el autoclave fue el aparato menos utilizado en la esterilización de los instrumentos.

Abstract OBJECTIVE To evaluate the knowledge and biosafety practices adopted by professionals of the beauty segment. METHODS Descriptive study, of survey type. 238 professionals of the beauty segment were interviewed between August 2014 and 2015. The variables were expressed by means of absolute and relative frequencies, as well as average and standard deviation. RESULTS 62.6% of the interviwed professionals reported having had contact with blood from customers when they were not wearing gloves; 74.4% said they washed their hands before and after each service, and only 16.8% of the respondents reported reusing nonsterilizable materials. None of them was able to inform the correct number of sets of tools needed , and 32.8% of the respondents did not use Personal Protective Equipment during their work activities. CONCLUSIONS The most frequently reported diseases associated with the risk of infection and transmission in the work activities were viral hepatitis, HIV and fungi. Regarding the biosafety procedures adopted, autoclave is the least used method for sterilizing devices. Keywords: Beauty and aesthetics centers. Exposure to biological agents. Prevention of diseases.

Contact with hospital syringes containing body fluids. Implications for medical waste management regulation

OBJECTIVE: To determine amount of syringes used in the hospital and extent of contact with blood and body fluids of these syringes. MATERIAL AND METHODS: Syringe use was surveyed at a tertiary care center for one week; syringes were classified into the following four categories according to use: a) contained blood; b) contained other body fluids (urine, gastric secretion, cerebrospinal fluid, wound drainage); c) used exclusively for drug dilution and application in plastic intravenous (IV) tubes, and d) for intramuscular (IM), subcutaneous (SC), or intradermic (ID) injections. RESULTS: A total of 7 157 plastic disposable syringes was used; 1 227 (17 percent) contained blood during use, 346 (4.8 percent), other body fluids, 5 257 (73 percent) were used exclusively for drug dilution and application in plastic IV lines, and 327 (4.5 percent) were utilized for IM, SC, or ID injections. An estimated 369 140 syringes used annually, or eight syringes per patient per in-hospital day. All syringes were disposed of as regulated medical waste, in observance of the law. CONCLUSIONS: There is an urgent need to review recommendations for medical waste management by both international agencies and local governments, based on scientific data and a cost-benefit analysis, to prevent resource waste and further environmental damage

A prática de utilização de seringas descartáveis na administração de insulina no domicílio / The use of disposable syringes in the administration of insulin at home

Estudo descritivo que tem por objetivo conhecer o comportamento de 113 portadores de diabetes mellitus, atendidos em um hospital de grande porte, em relação à utilização e reutilização de seringas descartáveis para a administração de insulina no domicílio, por meio de entrevista semi-estruturada. Os resultados obtidos mostram que 98,2 por cento utilizam seringa descartável para aplicação de insulina e apenas 5,3 por cento descartam a seringa. Desses, 94,6 por cento reutilizam a seringa descartável após o uso, adotando variados procedimentos. Acreditamos que esta prática é uma das facetas da educação em diabetes e em vista disso ressaltamos a necessidade de revisão da recomendação do DIMED — Portaria n.° 4/86, baseada em evidências científicas.

Lavado bronquioalveolar no broncoscópico: utilidad diagnóstica en pacientes portadores de virus de inmunodeficiencia humana e infección pulmonar / Nonbronchoscopic bronchoalveolar lavage: diagnostic utility in AIDS patients with pulmonary infection

Las infecciones respiratorias constituyen la primera causa de morbimortalidad en pacientes portadores de VIH. Debido a que un gran porcentaje de estos pacientes no tiene expectoración, se requiere de procedimientos invasivos para obtener muestras de secreciones del tracto respiratorio inferior. La fíbrobroncoscopia no está siempre disponible; además, no contamos con instrumentos sumergibles que aseguren una efectiva desinfección. Como alternativa hemos ensayado el LBANB con material enteramente desechable. Estudiamos 18 casos de pacientes portadores de VIH del Hospital Dr Lucio Córdova que. tenían por lo menos cuatro de los siguientes hallazgos: tos, fiebre, disnea, expectoración mucopurulenta e infiltrados pulmonares. Fueron sometidos a LBANB mediante la introducción, vía transnasal, de una sonda Levine Ng 14 modificada. Se instiló 120 mi de solución salina fisiológica estéril en dos alicuotas de 60 mi. Resultados: en 1 1 pacientes se observó P.carinii, en 3 se cultivó M. tuberculosis, en 1 S. aureus; en 2 pacientes se desarrolló flora saprófita. Un paciente rechazó el procedimiento y en otro, no fue posible realizarlo. El agente causal logró ser determinado en un 87,5 por ciento de los 16 pacientes. Concluimos que el LBANB es un procedimiento diagnóstico fácil de realizar, seguro, que no presenta complicaciones y con alto rendimiento diagnóstico en infecciones respiratorias en pacientes infectados por VIH