Propuesta de modelo para el cálculo de desperdicio asociado al procesamiento de instrumental quirúrgico consignado / Model proposal for calculating waste associated with processing consigned surgical instruments / Proposta de modelo para cálculo de desperdício associado ao processamento de instrumentais cirúrgicos consignados

Objetivo: evaluar el desperdicio generado por el procesamiento de instrumental quirúrgico consignado en cirugías ortopédicas electivas y proponer un modelo para el cálculo del desperdicio asociado al procesamiento de instrumental quirúrgico consignado. Método: estudio de caso, cuantitativo, descriptivo-exploratorio, realizado en un hospital universitario grande, en dos fases: (1) retrospectiva, mediante la consulta de registros administrativos de cirugías ortopédicas electivas canceladas, con previsión de uso de materiales consignados, para identificar las subespecialidades con mayor demanda; y (2) prospectiva, por medio de observaciones directas, no participantes, del procesamiento de instrumental quirúrgico consignado preparado para las cirugías identificadas, y de la propuesta de un modelo para el cálculo del desperdicio asociado al procesamiento de estos materiales. Resultados: se identificaron las cirugías de artroplastia de cadera, artrodesis de columna y artroplastia de rodilla con mayor demanda, resultando en 854 cajas de instrumental quirúrgico consignado procesado y sin uso. El desperdicio del procesamiento se estimó en R$ 34.340,18 (US$ 6,359.30). Conclusión: la ecuación propuesta permitió calcular el desperdicio relacionado con la producción y la no utilización de cajas de instrumental quirúrgico consignado para procedimientos ortopédicos, y puede equipar a los enfermeros para la planificación basada en datos institucionales, asistenciales y financieros, con el objetivo de aprovechar mejor los recursos por medio de la identificación del desperdicio.

Objective: to evaluate the waste generated from processing surgical instruments consigned in elective orthopedic surgeries and propose a model for calculating waste associated with processing consigned surgical instruments. Method: a quantitative, descriptive-exploratory case study carried out in a large university hospital in two phases: (1) retrospective by consulting administrative records of canceled elective orthopedic surgeries, with provision for the use of consigned materials for identification of the sub-specializations with the greatest demand; and (2) prospective through direct, non-participant observations of processing consigned surgical instruments prepared for the identified surgeries and proposition of a model for calculating waste associated with processing these materials. Results: hip arthroplasty, spine arthrodesis and knee arthroplasty surgeries were identified as presenting the greatest demand, resulting in 854 boxes of consigned surgical instruments processed and unused. Processing waste was estimated at R$34,340.18 (US$6,359.30). Conclusion: the proposed equation made it possible to calculate the waste related to the production and non-use of boxes of surgical instruments consigned for orthopedic procedures and can equip nurses for planning based on institutional, care and financial data, aiming to make better use of resources through waste identification.

Objetivo: avaliar o desperdício gerado pelo processamento de instrumentais cirúrgicos consignados em cirurgias ortopédicas eletivas e propor um modelo de cálculo de desperdício associado ao processamento de instrumentais cirúrgicos consignados. Método: estudo quantitativo, descritivo-exploratório, do tipo estudo de caso, realizado em hospital universitário de grande porte, em duas fases: (1) retrospectiva pela consulta aos registros administrativos de cirurgias ortopédicas eletivas canceladas, com previsão de uso de materiais consignados para identificação das subespecialidades com maior demanda e (2) prospectiva por meio de observações diretas, não participantes, do processamento de instrumentais cirúrgicos consignados preparados para as cirurgias identificadas e proposição de modelo de cálculo de desperdício associado ao processamento desses materiais. Resultados: foram identificadas as cirurgias de artroplastia de quadril, artrodese de coluna e artroplastia de joelho, com maior demanda, resultando em 854 caixas de instrumentais cirúrgicos consignados processados e não utilizados. O desperdício do processamento foi estimado em R$ 34.340,18 (US$ 6,359.30). Conclusão: a equação proposta permitiu calcular o desperdício relacionado à produção e não utilização de caixas de instrumentais cirúrgicos consignados para procedimentos ortopédicos e pode instrumentalizar os enfermeiros para o planejamento pautado em dados institucionais, assistenciais e financeiros, visando ao melhor aproveitamento dos recursos através da identificação do desperdício.

Radiofrequency Identification Track for Tray Optimization: An Instrument Utilization Pilot Study in Surgical Oncology.

BACKGROUND: Surgical instrument tray reduction attempts to minimize intraoperative inefficiency and processing costs. Previous reduction methods relied on trained observers manually recording instrument use (i.e. human ethnography), and surgeon and/or staff recall, which are imprecise and inherently limited. We aimed to determine the feasibility of radiofrequency identification (RFID)-based intraoperative instrument tracking as an effective means of instrument reduction. METHODS: Instrument trays were tagged with unique RFID tags. A RFID reader tracked instruments passing near RFID antennas during 15 breast operations performed by a single surgeon; ethnography was performed concurrently. Instruments without recorded use were eliminated, and 10 additional cases were performed utilizing the reduced tray. Logistic regression was used to estimate odds of instrument use across cases. Cohen's Kappa estimated agreement between RFID and ethnography. RESULTS: Over 15 cases, 37 unique instruments were used (median 23 instruments/case). A mean 0.64 (median = 0, range = 0-3) new instruments were added per case; odds of instrument use did not change between cases (OR = 1.02, 95%CI 1.00-1.05). Over 15 cases, all instruments marked as used by ethnography were recorded by RFID tracking; 7 RFID-tracked instruments were never recorded by ethnography. Tray size was reduced 40%. None of the 25 eliminated instruments were required in 10 subsequent cases. Cohen's Kappa comparing RFID data and ethnography over all cases was 0.82 (95%CI 0.79-0.86), indicating near perfect agreement between methodologies. CONCLUSIONS: Intraoperative RFID instrument tracking is a feasible, data-driven method for surgical tray reduction. Overall, RFID tracking represents a scalable, systematic, and efficient method of optimizing instrument supply across procedures.

Eficacia y seguridad de la estabilización quirúrgica con sistema de clips y barras en pacientes adultos con tórax inestable debido a fractura costal múltiple / Efficacy and safety of surgical stabilization with clips and rods system in adult patients with flail chest due to multiple rib fracture

INTRODUCCIÓN: El presente documento de evaluación de tecnología sanitaria (ETS) expone la evaluación de la eficacia y seguridad del procedimiento de estabilización quirúrgica haciendo uso del sistema de clips y barras de titanio (SCBT), en comparación con la estabilización neumática con ventilación mecánica (ENVM) en pacientes adultos con tórax inestable debido a fractura costal múltiple. El tórax inestable es una condición potencialmente mortal que se produce como consecuencia de traumatismo generalmente cerrado de tórax. La condición está definida como presencia de tres o más costillas fracturadas en dos o más lugares en cada costilla que se presenta de forma concomitante con respiración paradójica (depresión de los fragmentos costales fracturados en la inspiración y protrusión hacia el exterior de los mismos en la expiración). La presencia de tórax inestable puede ocasionar desestabilización en la función respiratoria del paciente, que cursa con ventilación inefectiva e hipercapnia, asimismo, puede causar complicaciones como consecuencia de una estancia prolongada en hospitalización, y en casos severos, la muerte del paciente. El tratamiento de la condición casi siempre requiere de oxigenación median

Surgical Instrument Optimization to Reduce Instrument Processing and Operating Room Setup Time.

OBJECTIVE: As health care expenditures rise, novel ways to increase efficiency are sought. The operating room (OR) represents an area where there is opportunity to optimize work flow and supply use. Evidence suggests that instrument redundancy in the OR tends to be high and that direct cost savings can be achieved by "optimizing" surgical trays. The purpose of this study was to quantify the potential time savings associated with surgical tray optimization. METHODS: Instrument utilization was reviewed for 4 procedures: tonsillectomy, sinus surgery, septoplasty, and septorhinoplasty. Instruments used in <20% of cases were excluded. Data on tray assembly time in the central processing department and instrument setup time in the OR were prospectively collected over a 3-month period before and after tray optimization. Student's t test (α = 0.05) was used to determine whether times were significantly different following optimization. RESULTS: Tray assembly times were found to be significantly shorter following optimization, with percentage reduction in time ranging from 58% to 66% (P < .05). In the OR, percentage reduction in setup time ranged from 26% to 37% (P < .05). Variability in assembly and setup times was also found to be narrower postoptimization. DISCUSSION: Tray optimization may reduce stress and adverse events and allow managers to better estimate staffing requirements. Cost-benefits could not be determined given a limited understanding of how departments choose to redistribute time savings. IMPLICATIONS FOR PRACTICE: Measurable and significant time savings can be achieved by assessing instrument utilization rates and reducing tray redundancy, leading to lower performance variability and improved efficiency.

ABC, VED and lead time analysis in the surgical store of a public sector tertiary care hospital in Delhi.

BACKGROUND: An efficient inventory control system would help optimize the use of resources and eventually help improve patient care. OBJECTIVES: The study aimed to find out the surgical consumables using always, better, and control (ABC) and vital, essential, and desirable (VED) technique as well as calculating the lead time of specific category A and vital surgical consumables. METHODS: This was a descriptive, record-based study conducted from January to March 2016 in the surgical stores of the All India Institute of Medical Sciences, New Delhi. The study comprised all the surgical consumables which were procured during the financial year 2014-2015. Stores ledger containing details of the consumption of the items, supply orders, and procurement files of the items were studied for performing ABC analysis and calculating the lead time. A list of surgical consumables was distributed to the doctors, nursing staff, technical staff, and hospital stores personnel to categorize them into VED categories after explaining them the basis for the classification. RESULTS: ABC analysis revealed that 35 items (14%), 52 items (21%), and 171 items (69%) were categorized into A (70% annual consumption value [ACV]), B (20% ACV), and C (10% ACV) category, respectively. In the current study, vital items comprised the majority of the items, i.e., 73% of the total items and essential (E) category of items comprised 26% of all the items. The average internal, external, and total lead time was 17 days (range 3-30 days), 25 days (range 5-38) and 44 days (range 18-98 days), respectively. CONCLUSIONS: Hospitals stores need to implement inventory management techniques to reduce the number of stock-outs and internal lead time.

Can the number of surgery delays and postponements due to unavailable instrumentation be reduced? Evaluating the benefits of enhanced collaboration between the sterilization and orthopedic surgery units.

INTRODUCTION: The development of outpatient surgery, cost-reduction pressures and instrumentation storage limitations have led to their use "just-in-time". A recent study showed that stoppage of surgical procedures immediately before the incision (No-Go) was often due to the management of supplies and implantable medical devices. To our knowledge, since the development of outpatient surgery and the shortening of hospital stays, managing the flow of instrumentation has not been optimized. At our hospital, we used a two-prong approach consisting of a tool to manage instrumentation and working group from the sterilization and orthopedic surgery units. The aims of this study were to: 1) evaluate whether this approach led to better notification of the risk of supply shortage for instrumentation and 2) determine whether it could reduce by at least half operating room disruptions such as delays or cancellation of surgical procedures. HYPOTHESIS: This approach results in better notification of the risk of supply shortage for instrumentation and reduces by at least half operating room disruptions such as delays or cancellation of surgical procedures. MATERIAL AND METHODS: A tool was developed to manage instrumentation flow based on a retrospective analysis of data from 2015. This tool consisted of: (1) a list of instrumentation needed for each surgical procedure from an analysis of the surgical schedule and verification of traceability labels of the instrumentation actually used, (2) a list of reasons for supply shortage identified from an analysis of non-conformities occurring in the sterilization process of instrumentation kits. These analyses resulted in the development of checklists for instrument sets for each procedure, while identifying those with a high risk of shortage. In 2017, a working group focused on instrumentation was set up with personnel from the sterilization unit and the orthopedic surgery unit. Based on the check-lists and the schedule 24hours before the surgery, the sterilization unit alerted the surgery unit by email of the risk of material shortage; the surgery ward replied with potential changes to the material or the surgery planning. This approach (instrumentation management tool and working group) was named just-in-time (JIT). The main outcome was the number of notifications of potential supply shortage with and without JIT over a 10-week period. The secondary outcomes were the number of notifications resolved in time and the occurrence of operating room disruptions (delay>30min or postponement of surgery) related to unavailable instrumentation. RESULTS: Nine reasons for potential supply shortage were identified such as instrumentation kits used for several types of procedures, those with fast rotation and low stock, or in double pathways (on loan and on deposit). The working group reported 163 potential shortages with JIT versus 41 without (p<10-5), of which 150 (92.5%) were resolved. Thirteen operating room disruptions occurred; only one was not detected by the JIT approach. CONCLUSION: Our JIT approach (instrumentation management tool and working group) is effective at preventing instrumentation supply shortages. LEVEL OF EVIDENCE: III, prospective comparative study.

Global perspective of paediatric surgery in low and middle income countries.

There is huge burden of paediatric surgical diseases in low and middle income countries. Issues behind such a scenario include lack of trained paediatric surgeons, higher mortality due to infections, and poor postoperative care. The possible solution is improvement in the existing structure, which is government hospitals, because they are the most prevalent form of healthcare delivery in such countries. Proper coding system, research and identification of paediatric bellwether procedures can improve the existing health system. Task shifting and sharing can help in many areas. The doctors leaving their countries for better training and employment options should be properly incentivised locally. A lot can be done in terms of providing infrastructure, finances, changing mind-sets, developing expertise, making registry and rehabilitation. By doing so, millions of paediatric mortalities can be prevented in low and middle income countries.

Implementation and Impact of a Hospital-Wide Instrument Set Review: Early Experiences at a Multisite Tertiary Care Academic Institution.

A multidisciplinary team of nurses, sterile processing technicians, and surgeons reviewed 609 otolaryngology-head and neck surgery (OHNS) surgical instrument sets at the study institution's 3 hospitals. Implementation of the 4-phase instrument review resulted in decreased OHNS surgical instrument set types from 261 to 234 sets, and a decreased number of instruments in these sets from 18 952 to 17 084. The instrument set review resulted in an estimated savings of $35 665 in sterile processing costs for the OHNS department. Instrument review applied to all 10 surgical specialties at the institution would result in an estimated annual savings of $425 378. Through effective leadership, multidisciplinary participation of all key stakeholders, and a systematic approach, this study demonstrates that a hospital-wide quality improvement intervention for instrument set optimization can be successfully performed in a large, multisite tertiary care academic hospital.

A Worst-Case Scenario-Undiagnosed Ruptured Arteriovenous Malformation Managed with Limited Resources.

BACKGROUND: Treatment of arteriovenous malformations (AVMs) is currently performed at specialized neurosurgical centers well equipped with microscopes with green filters, neurosurgical catheterization laboratories, and experienced neurosurgical teams. Patients in whom AVMs are diagnosed at smaller hospitals should be referred to such specialized centers. This case report describes the unavoidable worst-case scenario of an emergency unplanned surgical excision of an undiagnosed ruptured AVM with large hematoma. CASE DESCRIPTION: A 26-year-old man was brought to the emergency department with episodes of seizures and sudden loss of consciousness. His Glasgow Coma Scale score was 5. He had anisocoria. Computed tomography of the head showed right occipital hematoma with mass effect and herniation. Suspected diagnosis was spontaneous tumor or hypertensive bleed. Emergency surgery was performed. Intraoperatively, ruptured AVM was found. After explaining to family members about nonavailability of conventional instruments (i.e., microscope, clips, indocyanine green), we planned for excision of AVM with available resources. CONCLUSIONS: Postoperatively the patient recovered satisfactorily with right-side vision loss. He underwent cranioplasty after 6 weeks. In such a worst-case scenario, remaining calm, following basic surgical steps, using blood transfusion, and employing lateral thinking regarding using available resources can result in satisfactory management of the patient.

Inventory management of reusable surgical supplies.

We investigate the inventory management practices for reusable surgical instruments that must be sterilized between uses. We study a hospital that outsources their sterilization services and model the inventory process as a discrete-time Markov chain. We present two base-stock inventory models, one that considers stockout-based substitution and one that does not. We derive the optimal base-stock level for the number of reusable instruments to hold in inventory, the expected service level, and investigate the implied cost of a stockout. We apply our theoretical results to a dataset collected from a surgical unit at a large tertiary care hospital specializing in colorectal operations. We demonstrate how to implement our model when determining base-stock levels for future capacity expansion and when considering alternative stockout protocols. Our analysis suggests that the hospital can reduce the number of reusable instrument sets held in inventory if on-site sterilization techniques (e.g., flash sterilization) are employed. Our results will guide future procurement decisions for surgical units based on costs and desired service levels.

Code Grey: Stained Surgical Instruments and Their Impact on One Canadian Health Authority.

In 2016, NL's largest RHA was faced with serious challenges stemming from the discovery of stained surgical instruments at its two largest hospitals. This discovery prompted a series of postponed surgeries, an extensive internal mobilization of labour and the purchase of millions of dollars of new equipment. In tackling these challenges, the organization not only acquired a better understanding of its surgical tools, but it also gained renewed appreciation for the resilience of its human resources. By describing this incident and the lessons learned, we hope to offer insight to providers in similar circumstances.

Alerta monitoramento do horizonte tecnológico: MITRACLIP® para insuficiência mitral grave em pacientes de alto risco cirúrgico / Alert technological horizon monitoring: MITRACLIP® for severe mitral regurgitation in high surgical risk patients

DESCRIÇÃO DA TECNOLOGIA: O dispositivo Mitraclip®, através do acesso femoral, chega ao átrio esquerdo por meio de uma punção transeptal. As extremidades livres dos folhetos da valva mitral são clipadas, criando um duplo orifício e reduzindo o volume regurgitante. O procedimento é guiado através da ecocardiografia transesofágica (ETE), e se a insuficiência mitral não for controlada de maneira satisfatória, um segundo clipe pode ser utilizado, ou o clipe pode ser removido sem aparente dano do folheto. REGISTRO DA TECNOLOGIA NO MUNDO: Trata-se de uma tecnologia nova em fase de adoção, pois já possui registro na Agência Nacional de Vigilância Sanitária (Anvisa). Aprovado para utilização no Brasil sob o número 25351.099555/2013-99, publicado no diário oficial em 24 de março de 2014. Também aprovado pelo CE Mark em 2008 e pelo FDA em 2013, o Mitraclip® foi aprovado para uso restrito nos casos de regurgitação mitral degenerativa moderada à grave ou grave, em pacientes sintomáticos e com risco cirúrgico considerado proibitivo. PESQUISA CLÍNICA: Para coletar informações sobre eficácia e segurança do dispositivo, foram selecionados ensaios clínicos randomizados, concluídos e em andamento. Estudos concluídos: Embora muitas intervenções percutâneas estejam em desenvolvimento, apenas duas encontram-se atualmente disponíveis no mercado internacional: MitraClip® e Carillon®. A MitraClip®, única aprovada pelo FDA e pela Anvisa, possui uma base de evidências mais desenvolvida, embora ainda limitada, com apenas um ensaio clínico randomizado, o EVEREST II. ESTUDOS EM ANDAMENTO: Foram identificados dois estudos em andamento. O estudo COAPT (NCT01626079), ainda recrutando, está selecionando pacientes com IM funcional moderada à grave ou grave, sintomáticos, considerados inaptos à cirurgia. Os pacientes, estimativa de 610, serão randomizados para Mitraclip® ou tratamento padrão. Estudo com término programado para 201416. O segundo estudo, RESHAPE-HF (NCT02444338) também randomizou pacientes com IM funcional e tem como comparador o tratamento padrão. Os resultados, inicialmente programados para 2015, foram adiados devido ao lento recrutamento, expectativa de término em 2017. Os resultados destes dois estudos podem impactar significativamente a indicação do Mitraclip® nos pacientes com IM funcional.

Physician Engagement in Improving Operative Supply Chain Efficiency Through Review of Surgeon Preference Cards.

STUDY OBJECTIVE: To reduce operative costs involved in the purchase, packing, and transport of unnecessary supplies by improving the accuracy of surgeon preference cards. STUDY DESIGN: Quality improvement study (Canadian Task Force classification II-3). SETTING: Gynecologic surgery suite of an academic medical center. PARTICIPANTS: Twenty-one specialized and generalist gynecologic surgeons. INTERVENTIONS: The preference cards of up to the 5 most frequently performed procedures per surgeon were selected. A total of 81 cards were distributed to 21 surgeons for review. Changes to the cards were communicated to the operating room charge nurse and finalized. MEASUREMENTS AND MAIN RESULTS: Fourteen surgeons returned a total of 48 reviewed cards, 39 of which had changes. A total of 109 disposable supplies were removed from these cards, at a total cost savings of $767.67. The cost per card was reduced by $16 on average for disposables alone. Three reusable instrument trays were also eliminated from the cards, resulting in savings of approximately $925 in processing costs over a 3-month period. Twenty-two items were requested by surgeons to be available on request but were not routinely placed in the room at the start of each case, at a total cost of $6,293.54. The rate of return of unused instruments to storage decreased after our intervention, from 10.1 to 9.6 instruments per case. CONCLUSIONS: Surgeon preference cards serve as the basis for economic decision making regarding the purchase, storing, packing, and transport of operative instruments and supplies. A one-time surgeon review of cards resulted in a decrease in the number of disposable and reusable instruments that must be stocked, transported, counted in the operating room, or returned, potentially translating into cost savings. Surgeon involvement in preference card management may reduce waste and provide ongoing cost savings.

Multicentre observational study of surgical system failures in aortic procedures and their effect on patient outcomes.

BACKGROUND: Vascular surgical care has changed dramatically in recent years with little knowledge of the impact of system failures on patient safety. The primary aim of this multicentre observational study was to define the landscape of surgical system failures, errors and inefficiency (collectively termed failures) in aortic surgery. Secondary aims were to investigate determinants of these failures and their relationship with patient outcomes. METHODS: Twenty vascular teams at ten English hospitals trained in structured self-reporting of intraoperative failures (phase I). Failures occurring in open and endovascular aortic procedures were reported in phase II. Failure details (category, delay, consequence), demographic information (patient, procedure, team experience) and outcomes were reported. RESULTS: There were strong correlations between the trainer and teams for the number and type of failures recorded during 88 procedures in phase I. In 185 aortic procedures, teams reported a median of 3 (i.q.r. 2-6) failures per procedure. Most frequent failures related to equipment (unavailability, failure, configuration, desterilization). Most major failures related to communication. Fourteen failures directly harmed 12 patients. Significant predictors of an increased failure rate were: endovascular compared with open repair (incidence rate ratio (IRR) for open repair 0·71, 95 per cent c.i. 0·57 to 0·88; P = 0·002), thoracic aneurysms compared with other aortic pathologies (IRR 2·07, 1·39 to 3·08; P < 0·001) and unfamiliarity with equipment (IRR 1·52, 1·20 to 1·91; P < 0·001). The major failure total was associated with reoperation (P = 0·011), major complications (P = 0·029) and death (P = 0·027). CONCLUSION: Failure in aortic procedures is frequently caused by issues with team-working and equipment, and is associated with patient harm. Multidisciplinary team training, effective use of technology and new-device accreditation may improve patient outcomes.

Where are my instruments? Hazards in delivery of surgical instruments.

BACKGROUND: Unavailability of instruments is recognised to cause delays and stress in the operating room, which can lead to additional risks for the patients. The aim was to provide an overview of the hazards in the entire delivery process of surgical instruments and to provide insight into how Information Technology (IT) could support this process in terms of information availability and exchange. METHODS: The process of delivery was described according to the Healthcare Failure Mode and Effects Analysis methodology for two hospitals. The different means of information exchange and availability were listed. Then, hazards were identified and further analysed for each step of the process. RESULTS: For the first hospital, 172 hazards were identified, and 23 of hazards were classified as high risk. Only one hazard was considered as 'controlled' (when actions were taken to remove the hazard later in the process). Twenty-two hazards were 'tolerated' (when no actions were taken, and it was therefore accepted that adverse events may occur). For the second hospital, 158 hazards were identified, and 49 of hazards were classified as high risk. Eight hazards were 'controlled' and 41 were 'tolerated'. The means for information exchange and information systems were numerous for both cases, while there was not one system that provided an overview of all relevant information. CONCLUSIONS: The majority of the high-risk hazards are expected to be controlled by the use of IT support. Centralised information and information availability for different parties reduce risks related to unavailability of instruments in the operating room.

Um novo instrumento para marcação intraoperatória / A new tool for intraoperative marking

Este artigo descreve a adaptação de um mandril de micro-punch - normalmente empregado em transplantes capilares - para uso em marcações intraoperatórias. O mandril foi usado como cabo para manuseio de palitos de dente esterilizados nas demarcações de procedimentos cirúrgicos diversos, como abdominoplastias, mamoplastias e ritidoplastias. O emprego deste instrumento oferece um meio confortável, acessível, preciso e de baixo custo para todos os tipos de marcações cirúrgicas em cirurgia plástica, sendo mais barato e eficiente do que canetas demarcatórias descartáveis.

This article describes the adaptation of a micro-punch mandrel, which is usually used in hair transplants, in intraoperative markings. The mandrel was used as a wire for sterile toothpick handling in different surgical marking procedures, such as those in abdominoplasties, mammoplasties, and rhytidectomies. The use of this instrument offers a comfortable, affordable, precise, and low-cost tool for all types of surgical marking performed in plastic surgery. It is cheaper and more efficient than disposable pens.

Instrumentais nas caixas cirúrgicas: avaliação de custo / Instrumental in surgical boxes: cost evaluation

Avaliar o número de instrumentais das caixas cirúrgicas que não são utilizados durante as cirurgias, em um hospital do interior do Estado de São Paulo. Método: A coleta de dados resultou da observação direta dos instrumentais utilizados nas cirurgias, registrando o número real de instrumentais na caixa, número de instrumentais utilizados na cirurgia e número de não utilizados. Resultados: Em média, cerca de 52% dos materiais existentes nas caixas cirúrgicas não são utilizados, gerando custos elevados para a instituição. Calculando o desperdício, foi obtida uma média no valor de R$ 8,00 (oito reais) por caixa cirúrgica utilizada, podendo chegar ao valor de R$ 1.584,17 por mês. Conclusões: Conclui-se que há um desperdício de materiais que são esterilizados e não são utilizados nos procedimentos cirúrgicos, refletindo diretamente na qualidade e nos custos do gerenciamento do centro de material e esterilização...

Quality of antenatal and childbirth care in selected rural health facilities in Burkina Faso, Ghana and Tanzania: similar finding.

OBJECTIVES: To measure pre-intervention quality of routine antenatal and childbirth care in rural districts of Burkina Faso, Ghana and Tanzania and to identify shortcomings. METHODS: In each country, we selected two adjoining rural districts. Within each district, we randomly sampled 6 primary healthcare facilities. Quality of care was assessed through health facility surveys, direct observation of antenatal and childbirth care, exit interviews and review of patient records. RESULTS: By and large, quality of antenatal and childbirth care in the six districts was satisfactory, but we did identify some critical gaps common to the study sites in all three countries. Counselling and health education practices are poor; laboratory investigations are often not performed; examination and monitoring of mother and newborn during childbirth are inadequate; partographs are not used. Equipment required to provide assisted vaginal deliveries (vacuum extractor or forceps) was absent in all surveyed facilities. CONCLUSION: Quality of care in the three study sites can be improved with the available human resources and without major investments. This improvement could reduce maternal and neonatal mortality and morbidity.