APSIC guidelines for disinfection and sterilization of instruments in health care facilities.

Background: The Asia Pacific Society of Infection Control launched its revised Guidelines for Disinfection and Sterilization of Instruments in Health Care Facilities in February 2017. This document describes the guidelines and recommendations for the reprocessing of instruments in healthcare setting. It aims to highlight practical recommendations in a concise format designed to assist healthcare facilities at Asia Pacific region in achieving high standards in sterilization and disinfection. Method: The guidelines were revised by an appointed workgroup comprising experts in the Asia Pacific region, following reviews of previously published guidelines and recommendations relevant to each section. Results: It recommends the centralization of reprocessing, training of all staff with annual competency assessment, verification of cleaning, continual monitoring of reprocessing procedures to ensure their quality and a corporate strategy for dealing with single-use and single-patient use medical equipment/devices. Detailed recommendations are also given with respect to reprocessing of endoscopes. Close working with the Infection Prevention & Control department is also recommended where decisions related to reprocessing medical equipment/devices are to be made. Conclusions: Sterilization facilities should aim for excellence in practices as this is part of patient safety. The guidelines that come with a checklist help service providers identify gaps for improvement to reach this goal.

The well baby certificate for puerperal sterilization,a critical appraisal.

From August 2004 to July 2005 at Coimbatore Medical College Hospital, Tamilnadu, the process of issuing well baby certificate to 1668 babies of 1658 mothers electing to undergo puerperal sterilization within a week of delivery was analyzed. 1553 babies (93.1%) were issued well baby certificates. Certificates were deferred in 88 babies (5.3%) and it was refused in 27 (1.6%). Reasons are analyzed and discussed.

ACOG Practice bulletin no. 133: benefits and risks of sterilization.

Female and male sterilization are both safe and effective methods of permanent contraception used by more than 220 million couples worldwide . Approximately 600,000 tubal occlusions and 200,000 vasectomies are performed in the United States annually . For women seeking permanent contraception, sterilization obviates the need for user-dependent contraception throughout their reproductive years and provides an excellent alternative for those with medical contraindications to reversible methods. The purpose of this document is to review the evidence for the safety and effectiveness of female sterilization in comparison with male sterilization and other forms of contraception.

A fresh look at spay/neuter legislation: the journey to a middle ground.

A hybrid body of regulations is recommended containing both mandatory spay/neuter and low-cost spay/neuter provisions that will reduce accidental litters, impulse buying, and other irresponsible pet practices. The majority of pet owners are well-meaning but often lack the financial, intellectual, or other resources to properly control the breeding behaviors of their animals. Full compliance with spay/neuter regulations is the most desirable solution to the pet overpopulation problem. A comprehensive rule structure will facilitate spaying and neutering in some circumstances and require it on others.

Quarter of a century of female sterilization in Jos, Central Nigeria.

The study was to assess the types and trend of female sterilization between January 1985 and December 2009 (25 years) in Jos, Central Nigeria. There were 25,313 new acceptors of modern contraceptive methods out of which 4,951 (19.6%) were female sterilizations. Minilaparotomy was the commonest method of female sterilization. Local anaesthesia was the commonest anaesthetic utilized. The women were mostly women of relatively older age, grandmultiparous and with large family size. The women were of mean of 38.4 years, and 60% had more than 5 children at the time of sterilization. Interval sterilization constituted 78.5% of the female sterilizations. The acceptance of female sterilization, however, has declined over the years, as acceptance of the long acting contraceptive implants increases. Female sterilization by minilaparotomy under local anaesthesia was found to be feasible, cost effective and acceptable by majority of clients, and recommended for integration into minor gynaecological procedures in our institutions.

A comparison of novice and experienced physicians performing hysteroscopic sterilization: an analysis of an FDA-mandated trial.

OBJECTIVE: To assess the placement rates for experienced users versus newly trained physicians using the new ESS 305 delivery catheter for the Essure microinsert hysteroscopic sterilization system. DESIGN: Multicenter prospective cohort study. SETTING: Seventy-six sites throughout the U.S. comprising community hospitals, teaching institutions, surgery centers, and office-based practices. PATIENT(S): A total of 578 women seeking hysteroscopic sterilization. INTERVENTION(S): Hysteroscopic sterilization with the ESS 305 device by either experienced or novice physicians. MAIN OUTCOME MEASURE(S): Successful bilateral placement of the Essure 305 device. RESULT(S): A total of 625 patients were recruited with 578 eligible cases performed by 37 newly trained and 39 experienced physicians: 562/578 (97.2%) overall had successful placement, with 98% successful placement rate versus 96.1% for experienced versus novice physicians, respectively. Mean procedural time was 9 minutes (±7 SD), with experienced physicians completing it on average quicker at 7.9 minutes (±5.8 SD) and novices completing it in 10.7 minutes (±8.3 SD). There was no significant association between successful placement with patient characteristics such as body mass index, surgical history, parity, or prior vaginal deliveries observed. CONCLUSION(S): The Essure procedure can be performed quickly and safely with high bilateral placement rates regardless of physician experience or patient characteristics.

Contraceptive effectiveness of two insertions of quinacrine: results from 10-year follow-up in Vietnam.

BACKGROUND: This study was conducted to evaluate the long-term effectiveness of two insertions of quinacrine pellets for nonsurgical sterilization among women in northern Vietnam. STUDY DESIGN: Observational cohort study of 1335 women who received two quinacrine insertions between 1989 and 1993. RESULTS: About 90% of the study population participated in the last round of interviews. Cumulative follow-up time for this cohort was 14,294 person-years. The 1-, 5- and 10-year cumulative pregnancy probabilities for quinacrine were 3.3% (95% CI, 2.4-4.3), 10.0% (95% CI, 8.4-11.6) and 12.1% (95% CI, 10.4-13.9), respectively. Pregnancy estimates with quinacrine in this cohort were higher than that reported from US-based research on surgical tubal sterilization and higher than results of quinacrine sterilization in Chile. Quinacrine effectiveness was better among older women. CONCLUSION: The effectiveness of quinacrine in Vietnam was lower than other forms of sterilization. Factors such as inconsistent training and use of various insertion techniques may have contributed to the relatively high failure rate.

A new look at male sterilisation (no-scalpel vasectomy) in Orissa.

The author looks into the comparatively newly introduced procedure of 'no-scalpal vasectomy' as it is practiced in Orissa, compares it with the conventional vasectomy and other methods of sterilisation in terms of advantages and gives the outline of the NSV procedure along with postoperative advice in a brief manner.

Healthy law makes for healthy children: Cattanach v Melchior.

When courts are forced to consider issues surrounding birth and the sanctity of life, it is inevitable that divergence of judicial, academic and public opinion will result. However, the issue of whether parents can recover the expenses of rearing a healthy child has long vexed judges and commentators of law, ethics and medicine both in Australia and globally, with considerable disunity. A cogent example is the recent High Court of Australia decision in Cattanach v Melchior (2003) 215 CLR 1, where the court split four to three and handed down no less than six individual judgments. The case involved the birth of a healthy child following an unplanned pregnancy resulting from a failed surgical sterilisation. By allowing parents to recover the reasonable expenses of rearing an unintended child until the age of 18 years, the decision has provided some limited and temporary legal clarity to the issue of wrongful pregnancy in Australia. It is seen by some as a victory for the reproductive freedom of women and the rights of the child. However, with uncertainty remaining on the issue of wrongful life claims in Australia and with legislative changes in Queensland and New South Wales that partly reverse the High Court's decision, there remains doubt about the future of such claims in Australia.

Documentation of preoperative counselling for female sterilisation: a complete audit cycle.

BACKGROUND: Female sterilisation is a commonly performed gynaecological procedure that attracts a disproportionate number of complaints and litigation. Documentation of the key counselling issues provides an important record of the information given to the woman prior to undergoing sterilisation. METHODS: Auditable standards were obtained from published guidelines. After the initial audit of 100 cases a proforma was introduced in an effort to improve documentation. A re-audit of 50 cases was undertaken to ascertain compliance of documentation following the introduction of the proforma. RESULTS: The proforma was used in 62% of cases and in all such cases documentation was 100% compliant with the auditable standards. Overall, documentation of standards pre- and post-proforma, respectively, was as follows (all the figures quoted are percentage values, with the range given in parentheses): 33 (24-43) vs 68 (53-80) for long-term alternatives, 94 (87-98) vs 78 (62-87) for irreversibility, 96 (90-99) vs 78 (64-88) for failure rate, 48 (38-58) vs 66 (51-79) for ectopic pregnancy risk if sterilisation fails, 39 (29-49) vs 66 (51-79) for the intended method, 67 (57-76) vs 66 (51-79) for operative risks and 37 (28-47) vs 64 (49-77) for continuing current contraception until sterilisation performed. CONCLUSIONS: Documentation of preoperative counselling for female sterilisation is often incomplete and does not comply with published recommendations. The introduction of a proforma resulted in a mixture of both improvement and deterioration of documentation. When the proforma was used, compliance with recommendations was 100%.