Plastic wrap combined with alcohol wiping is an effective method of preventing bacterial colonization on mobile phones.

INTRODUCTION: Using mobile phones for communication in emergency departments is a common practice; however, several studies have demonstrated that they may act as vectors for bacteria and viruses. This study evaluated the effectiveness of plastic wrapping in decreasing bacterial contamination on mobile phone surfaces. METHOD: We used culture dishes and a luminometer to detect bacterial colonies and contamination on the phone surfaces. RESULT: Our experiment showed that bacterial colonies exist on mobile phones before and after work. We found that wiping with 75% alcohol sanitizers effectively reduces the number of colonies on either a mobile phone or a temporary plastic covering. In addition, we found that bacterial colonies do not contaminate or adhere to plastic wrap any easier than to mobile phones. CONCLUSION: These results demonstrated the effectiveness of plastic wrap for protecting mobile phone surfaces against bacterial colonization. In addition, applying a layer of plastic wrap protects the phone from potential damage due to the alcohol.

Management of ophthalmic surgical instruments and processes optimization: mixed method study.

AIM: Analysis of the use of ophthalmic instruments during surgical procedures in order to propose a material management method. METHOD: Mixed method study, sequential exploratory design, performed from January to June 2015, at a university hospital in southern Brazil. First, a qualitative approach was held from brainstorming and field observation. Themes were grouped into thematic categories. By connection, the quantitative stage happened through matrix arrangement and linear programming, culminating in the instrument management proposal. RESULTS: Given categories - instruments reorganization according to the time of the surgical procedure and the need surgical instruments for in each procedure - guided the definition of existing restrictions and application of mathematical models. There was an average reduction of 13.10% in the number of surgical instruments per tray and an increase of 17.88% in surgical production. FINAL CONSIDERATIONS: This proposal allowed the rationalization and optimization of ophthalmic instruments, favoring sustainability of the organization.

Tracking health commodity inventory and notifying stock levels via mobile devices: a mixed methods systematic review.

BACKGROUND: Health systems need timely and reliable access to essential medicines and health commodities, but problems with access are common in many settings. Mobile technologies offer potential low-cost solutions to the challenge of drug distribution and commodity availability in primary healthcare settings. However, the evidence on the use of mobile devices to address commodity shortages is sparse, and offers no clear way forward. OBJECTIVES: Primary objective To assess the effects of strategies for notifying stock levels and digital tracking of healthcare-related commodities and inventory via mobile devices across the primary healthcare system Secondary objectives To describe what mobile device strategies are currently being used to improve reporting and digital tracking of health commodities To identify factors influencing the implementation of mobile device interventions targeted at reducing stockouts of health commodities SEARCH METHODS: We searched CENTRAL, MEDLINE Ovid, Embase Ovid, Global Index Medicus WHO, POPLINE K4Health, and two trials registries in August 2019. We also searched Epistemonikos for related systematic reviews and potentially eligible primary studies. We conducted a grey literature search using mHealthevidence.org, and issued a call for papers through popular digital health communities of practice. Finally, we conducted citation searches of included studies. We searched for studies published after 2000, in any language. SELECTION CRITERIA: For the primary objective, we included individual and cluster-randomised trials, controlled before-after studies, and interrupted time series studies. For the secondary objectives, we included any study design, which could be quantitative, qualitative, or descriptive, that aimed to describe current strategies for commodity tracking or stock notification via mobile devices; or aimed to explore factors that influenced the implementation of these strategies, including studies of acceptability or feasibility. We included studies of all cadres of healthcare providers, including lay health workers, and others involved in the distribution of health commodities (administrative staff, managerial and supervisory staff, dispensary staff); and all other individuals involved in stock notification, who may be based in a facility or a community setting, and involved with the delivery of primary healthcare services. We included interventions aimed at improving the availability of health commodities using mobile devices in primary healthcare settings. For the primary objective, we included studies that compared health commodity tracking or stock notification via mobile devices with standard practice. For the secondary objectives, we included studies of health commodity tracking and stock notification via mobile device, if we could extract data relevant to our secondary objectives. DATA COLLECTION AND ANALYSIS: For the primary objective, two authors independently screened all records, extracted data from the included studies, and assessed the risk of bias. For the analyses of the primary objectives, we reported means and proportions where appropriate. We used the GRADE approach to assess the certainty of the evidence, and prepared a 'Summary of findings' table. For the secondary objective, two authors independently screened all records, extracted data from the included studies, and applied a thematic synthesis approach to synthesise the data. We assessed methodological limitation using the Ways of Evaluating Important and Relevant Data (WEIRD) tool. We used the GRADE-CERQual approach to assess our confidence in the evidence, and prepared a 'Summary of qualitative findings' table. MAIN RESULTS: Primary objective For the primary objective, we included one controlled before-after study conducted in Malawi. We are uncertain of the effect of cStock plus enhanced management, or cStock plus effective product transport on the availability of commodities, quality and timeliness of stock management, and satisfaction and acceptability, because we assessed the evidence as very low-certainty. The study did not report on resource use or unintended consequences. Secondary objective For the secondary objectives, we included 16 studies, using a range of study designs, which described a total of eleven interventions. All studies were conducted in African (Tanzania, Kenya, Malawi, Ghana, Ethiopia, Cameroon, Zambia, Liberia, Uganda, South Africa, and Rwanda) and Asian (Pakistan and India) countries. Most of the interventions aimed to make data about stock levels and potential stockouts visible to managers, who could then take corrective action to address them. We identified several factors that may influence the implementation of stock notification and tracking via mobile device. These include challenges tied to infrastructural issues, such as poor access to electricity or internet, and broader health systems issues, such as drug shortages at the national level which cannot be mitigated by interventions at the primary healthcare level (low confidence). Several factors were identified as important, including strong partnerships with local authorities, telecommunication companies, technical system providers, and non-governmental organizations (very low confidence); availability of stock-level data at all levels of the health system (low confidence); the role of supportive supervision and responsive management (moderate confidence); familiarity and training of health workers in the use of the digital devices (moderate confidence); availability of technical programming expertise for the initial development and ongoing maintenance of the digital systems (low confidence); incentives, such as phone credit for personal use, to support regular use of the system (low confidence); easy-to-use systems built with user participation (moderate confidence); use of basic or personal mobile phones to support easier adoption (low confidence); consideration for software features, such as two-way communication (low confidence); and data availability in an easy-to-use format, such as an interactive dashboard (moderate confidence). AUTHORS' CONCLUSIONS: We need more, well-designed, controlled studies comparing stock notification and commodity management via mobile devices with paper-based commodity management systems. Further studies are needed to understand the factors that may influence the implementation of such interventions, and how implementation considerations differ by variations in the intervention.

Orientações para boas práticas em alimentação e nutrição hospitalar no enfrentamento da COVID-19 / Guidelines for good practices in hospital food and nutrition in coping with COVID-19

Baseado em informações oficiais já disponíveis, "Orientações para boas práticas em alimentação e nutrição hospitalar no enfrentamento da COVID-19" foi elaborado por um grupo de profissionais nutricionistas do Brasil, atuantes em diversas áreas (clínica, hospitalar, unidades de alimentação e nutrição, docência e pesquisa universitária, consultoria em gestão de qualidade e segurança de alimentos), com o objetivo de contribuir com as adaptações nos processos de trabalho de nutricionistas e gestores de unidades hospitalares. Apresenta orientações: quanto à higienização de ambientes e materiais específicos, quanto aos cuidados no transporte e distribuição de refeições, dicas também para profissionais de saúde que trabalham na área de isolamento, orientações para os pacientes hospitalizados e apresenta condutas de avaliação nutricional. O resultado do trabalho foi de reforçar a condutas adequadas e contribuir significativamente com a segurança alimentar e nutricional de pacientes e colaboradores

Based on official information already available, "Guidelines for good practices in food and hospital nutrition in coping with COVID-19" was prepared by a group of nutritionists from Brazil, working in several areas (clinic, hospital, food and nutrition units, teaching and university research, consultancy in quality management and food safety), in order to contribute to adaptations in the work processes of nutritionists and hospital unit managers. It presents guidelines: regarding the cleaning of specific environments and materials, regarding care in the transportation and distribution of meals, tips also for health professionals working in the isolation area, guidelines for hospitalized patients and presents nutritional assessment procedures. The result of the work was to reinforce adequate conduct and significantly contribute to the food and nutritional security of patients and employees

Management of ophthalmic surgical instruments and processes optimization: mixed method study / Gestión de instrumentales quirúrgicos oftalmológicos y optimización de procesos: estudio de método misto / Gerenciamento de instrumentais oftalmológicos e otimização de processos: estudo de método misto

ABSTRACT Aim: Analysis of the use of ophthalmic instruments during surgical procedures in order to propose a material management method. Method: Mixed method study, sequential exploratory design, performed from January to June 2015, at a university hospital in southern Brazil. First, a qualitative approach was held from brainstorming and field observation. Themes were grouped into thematic categories. By connection, the quantitative stage happened through matrix arrangement and linear programming, culminating in the instrument management proposal. Results: Given categories - instruments reorganization according to the time of the surgical procedure and the need surgical instruments for in each procedure - guided the definition of existing restrictions and application of mathematical models. There was an average reduction of 13.10% in the number of surgical instruments per tray and an increase of 17.88% in surgical production. Final considerations: This proposal allowed the rationalization and optimization of ophthalmic instruments, favoring sustainability of the organization.

RESUMEN Objetivo: Analizar el uso de instrumentos oftalmológicos durante los procedimientos quirúrgicos y proponer un método de gestión de materiales. Método: Estudio de método mixto, exploratorio secuencial, realizado entre enero y junio de 2015, en un hospital universitario en el sur de Brasil. Primero, se realizó un enfoque cualitativo a partir de la reflexión y la observación de campo. Los temas se agruparon en categorías temáticas. Por conexión, la etapa cuantitativa ocurrió por arreglos de matrices y programación linear, culminando con la propuesta de gestión de instrumentales. Resultados: Las categorías - reorganización del instrumental conforme tiempo del procedimiento quirúrgico y necesidad de piezas para cada procedimiento - orientaron la definición de las restricciones existentes y aplicación de los modelos matemáticos. Verificó una reducción media del 13,10% en el número de piezas por bandejas y aumento del 17,88% de la producción quirúrgica. Consideraciones finales: Esta propuesta permitió la racionalización y optimización de instrumentos oftalmológicos, favoreciendo la sostenibilidad de la organización.

RESUMO Objetivo: Analisar o uso de instrumentais oftalmológicos durante os procedimentos cirúrgicos e propor um método de gerenciamento de materiais. Método: Estudo de método misto, exploratório sequencial, realizado entre janeiro e junho de 2015, em hospital universitário no sul do Brasil. Primeiramente, fez-se uma abordagem qualitativa a partir de brainstorming e observação de campo. Os temas foram agrupados em categorias temáticas. Por conexão, a etapa quantitativa aconteceu por arranjos de matrizes e programação linear, culminando à proposta de gerenciamento de instrumentais. Resultados: As categorias - reorganização do instrumental conforme tempo do procedimento cirúrgico e necessidade de peças para cada procedimento - orientaram a definição das restrições existentes e aplicação dos modelos matemáticos. Verificou-se uma redução média de 13,10% no número de peças por bandejas e aumento de 17,88% da produção cirúrgica. Considerações finais: Esta proposta permitiu a racionalização e otimização de instrumentais oftalmológicos, favorecendo a sustentabilidade da organização.

Implementation and Evaluation of a RFID Smart Cabinet to Improve Traceability and the Efficient Consumption of High Cost Medical Supplies in a Large Hospital.

The efficiency of a smart cabinet with RFID technology to improve the information about inventory management for cardiothoracic surgery as well as for time savings, was assessed in a large reference hospital. In a 6-month study, the implemented operational RFID process (StocKey® Smart Cabinet) consisted of: i) product reception, registration and labelling in the general warehouse; ii) product storage in the cabinet and registered as inputs by radiofrequency; iii) products registered as outputs as required for surgery; iv) product assignment to a patient in the operating room; and v) return of products not used to the cabinet. Stock-outs, stock mismatches, urgent restocking, assignment of high-value medical products to patients, and time allocated by the supervisory staff to the stock management, were assessed on a monthly basis. 0% stock-outs and 0% stock mismatches using RFID were observed during the study. Monthly percentages of products requiring urgent restocking ranged from 0% to 13.3%. No incorrect assignments to patients of surgery products or prostheses were detected. The percentage of correct assignments increased from 36.1%-86.1% to 100% in the first 4-5 months. The total average time allocated by the supervisory staff to the whole logistic chain was reduced by 58% (995 min with the traditional manual system vs. 428 min with RFID). The RFID system showed the ability to monitor both the traceability and consumption per patient of high-value surgery products as well as contributed to significant time savings.

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.

Purpose-orientated stocking of procedure trolleys saves time in busy emergency centres.

BACKGROUND: Inefficient storage and sourcing of routinely required consumables located on procedure trolleys result in time wasted when preparing for common procedures in emergency centres (ECs), contributing to poor efficiency and quality of care. OBJECTIVES: We designed a novel purpose-orientated procedure trolley and evaluated its impact on time spent on procedure preparation and efficiency. METHODS: In an urban EC, eight participants were measured each day over 24 days, once using the standard setup and once using the modified procedure setup. During each simulation, efficiency markers were assessed (time spent on procedure preparation, steps taken, stops made, and time spent opening drawers to locate required items). RESULTS: The mean (standard deviation) time required to collect the required items for intravenous cannulation and blood sampling from the purpose-orientated trolley was 22.7 (3.66) seconds, compared with 49.2 (15.45) seconds using the standard trolley. There was a significant difference between the two trolleys in mean collection time (p<0.0005) and in all the other categories: steps taken, stops made and drawer opening (p<0.0005). CONCLUSIONS: In our setting, stocking procedure trolleys in a purpose-orientated manner has the potential to improve efficiency by reducing time spent on procedure preparation.

Case Study: Supply Chain Transformation in the Mercy Health System.

The Mercy case study documents evidence of a clinically integrated supply chain strategy implemented in the peri-operative programs in three of the 46 hospitals in the Mercy system. Mercy became the first US health system to achieve "the perfect order," a supply chain industry standard with end-to-end integration of supply chain best practice in the Mercy system. To date, the Mercy strategy has demonstrated revenue growth of $8 billion, a 70% reduction in Never Events, a 33.3% reduction in supplies cost/case and a 29.5% reduction in labour costs/case in the perioperative programs in three hospitals.

Comparison through a prospective and randomized study of two replenishment methods at polyvalent hospitalization units with two-bin storage systems / Comparación mediante un estudio prospectivo y aleatorizado de dos métodos de reposición en unidades de enfermería en hospitalización polivalente de agudos con almacenamiento mediante doble cajetín.

OBJECTIVE: Two-bin storage systems increase nursing staff satisfaction and decrease inventories, but the implications that logistic staff would determine the needs of replenishment are unknown. This study aimed to evaluate whether entrust to logistics staff this responsibility at the polyvalent hospitalization units with two-bin storage is associated with higher risk of outstanding orders. METHODS: This was a prospective randomized experiment whit masking. Outstanding orders were considered variable response, those corresponding to assessments of the logistics staff were included in the control group and those corresponding to the nursing staff in the control group. Concordance between observers was analyzed using the Bland-Altman method; the difference between groups, with the U of Mann-Whitney and the cumulative incidence of outstanding orders and their relative risk was calculated. RESULTS: The mean amount requested by the logistic and nursing staff was 29.9 (SD:167.4) and 36 (SD:190) units respectively, the mean difference between observers was 6.11 (SD:128.95) units and no significant differences were found between groups (p = 0.430). The incidence of outstanding orders was 0.64% in the intervention group and 0.15% in the control group; the relative risk, 2.31 (0.83 - 6.48) and the number of cases required for an outstanding order, 516. CONCLUSIONS: Outstanding order relative risk is not associated with the category of the staff that identifies the replenishment needs at the polyvalent hospitalization units.

OBJETIVO: Los sistemas de almacenamiento mediante doble cajetín aumentan la satisfacción del personal de enfermería y disminuyen los inventarios, pero no se conocen las implicaciones de que sea el personal de logística quién determine la necesidad de reposición. El objetivo de este estudio fue evaluar si encomendar dicha responsabilidad a este personal en unidades de hospitalización polivalente de agudos entraña un mayor riesgo de pedidos extraordinarios. METODOS: Se realizó un estudio experimental, prospectivo aleatorizado con enmascaramiento. Los pedidos extraordinarios se consideraron variable de respuesta; los correspondientes a valoraciones del personal de logística se incluyeron en el grupo de intervención y los del personal de enfermería, en el de control. La concordancia entre observadores se analizó con el método de Bland-Altman; la diferencia entre grupos, con la U de Mann-Whitney y se calculó la incidencia acumulada de pedidos extraordinarios y su riesgo relativo. RESULTADOS: La cantidad media solicitada por el personal de logística y el de enfermería fue 29,9 (DE:167,4) y 36 (DE:190) unidades respectivamente, la diferencia media entre observadores fue 6,11 (DE:128,95) unidades y no se encontraron diferencias significativas entre los grupos (p =0,430). La incidencia de pedidos extraordinarios fue 0,64% en el grupo de intervención y 0,15% en el de control; el riesgo relativo, 2,31 (0,83 ­ 6,48) y el número de casos necesarios para un pedido extraordinario, 516. CONCLUSIONES: El riesgo de pedidos extraordinarios en unidades de hospitalización con almacenamiento mediante doble cajetín no está asociado con la categoría profesional del personal que identifica las necesidades de reposición.

Prevalence of Medical Conditions Potentially Amenable to Cellular Therapy among Families Privately Storing Umbilical Cord Blood.

Introduction Little is known about the prevalence of conditions potentially amenable to cellular therapy among families storing umbilical cord blood in private cord blood banks. Methods A cross-sectional study of families with at least one child who stored umbilical cord blood in the largest private cord blood bank in the United States was performed. Respondent families completed a questionnaire to determine whether children with stored cord blood or a first-degree relative had one or more of 16 conditions amenable primarily to allogeneic stem cell transplant ("transplant indications") or 16 conditions under investigation for autologous stem cell infusion ("regenerative indications"), regardless of whether they received a transplant or infusion. Results 94,803 families responded, representing 33.3 % of those surveyed. Of respondent families, 16.01 % indicated at least one specified condition. 1.64 % reported at least one first-degree member with a transplant indication potentially treatable with an allogeneic stem cell transplant. The most common transplant indications reported among first-degree family members were Non-Hodgkin's Lymphoma (0.33 %), Hodgkin's Lymphoma (0.30 %), and Acute Lymphoblastic Leukemia (0.28 %). 4.23 % reported at least one child with a regenerative indication potentially treatable with an autologous stem cell infusion. The most common regenerative indications among children with stored umbilical cord blood were Autism/Autism Spectrum Disorder/Apraxia (1.93 %), Other Developmental Delay (1.36 %), and Congenital Heart Defect (0.87 %). Discussion Among families storing umbilical cord blood in private cord blood banks, conditions for which stem cell transplant or infusion may be indicated, or are under investigation, appear to be prevalent, especially for regenerative medicine indications.

Inventory management strategies that reduce the age of red blood cell components at the time of transfusion.

BACKGROUND: There has been interest concerning patient outcomes when older red blood cell (RBC) components are utilized. Inventory management is key to maintaining a stock of fresher RBCs for general transfusion needs. We have altered our practice for RBC management to reduce RBC age at the time of transfusion. STUDY DESIGN AND METHODS: Retrospective review of RBC age at time of transfusion at a tertiary care hospital with active trauma service was performed. The baseline nonirradiated RBC inventory was decreased from 12 to 15 days of stock to 7 to 10 days of stock, with request made to the blood supplier for fresher RBCs, specified at 75% of RBCs less than 14 days old. The age of RBCs at time of receipt and at time of transfusion was tracked on a monthly basis for the next 12 months. RESULTS: The mean age of RBCs at transfusion was decreased by 9 days on average for the year. Significant decreases in the mean age of RBCs at transfusion were seen in the second half of the year, with 4 of 6 months seeing a mean age of less than 20 days. There were no documented incidences of hospital blood shortages after the reduction in inventory; no surgery was canceled or delayed because of inventory. CONCLUSION: Inventory age depends on active management, combined with vendor cooperation to receive fresher components. Reducing the age of RBC components transfused is possible without experiencing blood component shortages. Longer periods of observation may allow for further adjustment of stocking levels on a seasonal basis.

Saving Time Under Pressure: Effectiveness of Standardizing Pediatric Resuscitation Carts.

BACKGROUND: Resuscitation situations are high risk and high stress, and delays in care can have significant influences on outcomes. Standardization of care protocols and equipment is postulated to decrease some of the stress and risk. The objective of this study was to document increased efficiency in finding resuscitation equipment in a standardized resuscitation cart. METHODS: A new standardized resuscitation cart design was created, and a multimedia education program addressing the new design was launched. A goal was set to find required equipment in <15 seconds. Five cohorts of 10 nurses were timed at finding randomly chosen items 1, 12, 49, 152, and 351 days after new cart launch. t tests were used to compare estimated acquisition times of requested items using the new cart system to the old cart system (baseline), and a separate regression analysis was used to model skill degradation. RESULTS: All pairwise comparisons showed significant decreases in mean acquisition time compared with baseline. One day after launch, the mean time to find items was reduced by 46%. Mean time to find requested items was below the goal of 15 seconds 12, 49, and 152 days after launch. This effect was lost by 351 days from launch. Regression analysis predicted the time to find items would exceed 15 seconds 287 days after launch. CONCLUSIONS: Standardizing the resuscitation cart design greatly reduced time to find items and was accomplished with reduced financial cost. Skill degradation did occur over time, and refresher training was required.

Benefits and Barriers of Implementation and Utilization of Radio-Frequency Identification (RFID) Systems in Transfusion Medicine.

Radio-frequency identification (RFID) technology is used by hospital supply chains to track medical products and monitor inventories. Hospitals have also begun incorporating RFID technology as part of their transfusion processes. The purpose of this review was to analyze how healthcare organization supply chains can benefit from the utilization of RFID systems in transfusion service departments. The methodology for this study was a literature review following the steps of a systematic review with a total of 52 sources referenced. RFID technology is used to manage and track blood products from the initial donor phlebotomy to final disposition or product transfusion. RFID-enabled transfusion practices have successfully increased provider productivity and product quality through work-time reduction and error reduction. Findings of this research study suggest that RFID has provided improvements in quality of care and efficiency, while initial costs, security, and privacy appear to be the principal barriers to adoption.