Maintenance of sterility in SMS packaging in dental environments: concern with biosafety

Healthcare services must be guided by biosafety practices and microbial control. This control is highly influenced by humidity, which directly impacts the maintenance of sterility of the materials used in the appointments. High concentration of moisture, in the form of aerosol, splashes and spills, is caused during dental care. During the COVID-19 times the contamination by aerosol and droplets worries greatly. Considering that it could cause harm to the sterility of an autoclaved material, especially in dental environments, the objective was to evaluate the behavior of SMS sterilization packages (Spunbonded / Meltblown / Spunbonded) against microbial penetration in an aqueous vehicle. SMS of three brands were challenged, equally divided into two groups: virgin and processed (subjected to a single autoclaving cycle). Each specimen was aseptically deposited on Macconkey agar. Subsequently, 5 µL of Escherichia coliATCC 25922 saline solution [108CFU mL-1] was deposited in center of the SMS specimen and the dish incubated at36°C/ 48h. Reading was performed by the presence or absence of bacterial growth typical of the species under the SMS, observed on the back of Petri dish. The lowest penetration rate observed was 60% for one of the brands in the virgin condition, and 75% for two brands in the processed condition. Statistical analysis showed an association between bacterial penetration and the evaluated group, this association being valid only in the virgin condition. The different SMS behave similarly in terms of resistance to bacterial penetration after being processed. The data show that moisture can assist in bacterial transport through sterilized SMS. Therefore, SMS packages are not able to prevent bacterial penetration, and possibly other microorganisms, when in aqueous vehicles, offering a potential risk of breaking the aseptic chain. Thus, care must be taken in routines for handling and storage sterile packaging.

Staff Knowledge and Attitudes Towards COVID-19 New Biosafety Practices at a Brazilian Dental School

ABSTRACT Objective To evaluate knowledge and attitudes towards biosafety recommendations during the COVID-19 pandemic at a Brazilian dental school. Material and Methods A cross-sectional study was performed in 2020 with the clinical staff of a Brazilian dental school. The whole clinical staff was sent pre-tested self-administered online questionnaires about knowledge and attitudes towards the recommendations for biosafety in dental settings in the context of the COVID-19 pandemic. Descriptive statistical analyses were carried out for proportion calculation. Results Disposable head covering caps, isolation gowns, and gloves were the most frequently reported personal protective equipment (PPE). The rates ranged from 52.9% to 88.5% for N95 respirators, from 68.6% to 92.6% for face shields, from 47.4% to 67.5% for conventional eye protection shields, and 45.1% to 77.4% for eye protection with solid side shields. Chlorhexidine gluconate was the most frequent mouthwash indicated before clinical dental care. The percentage of agreement to provide clinical care to patients with suspected COVID-19 varied from 23.5% to 50.0%. The percentage of respondents who agreed that bioaerosol-generating procedures should be avoided was higher than 74.5%. Less than 50% knew the correct sequence for doffing of PPE. Conclusion This study revealed important gaps in knowledge and attitudes towards prevention and control measures against infection in dental environments in the context of COVID-19, indicating the need for improvements.

Health technology assessment: Choice between a cytotoxic safety cabinet and an isolator for oncology drug reconstitution in Tunisia.

INTRODUCTION: In order to implement a centralized cytotoxic reconstitution unit (CCRU), a study was conducted to compare the implementation costs of a CCRU equipped with a cytotoxic safety cabinet (CSC) and one equipped with an isolator with negative pressure. MATERIALS AND METHODS: This study compares items such as infrastructure, air treatment and CCRU qualification costs, equipment's purchase and qualifications costs, as well as staff dressing costs. Two plans were elaborated according to the international recommendations in a way that they respond to the necessary requirements in both cases. Requests for quotes for the compared items were sent to different suppliers. RESULTS: The implementations' cost of a CCRU equipped with a CSC is cheaper than the one equipped with an isolator. The price of an isolator is much higher than a CSC; its qualification is also more expensive. However, the requirements and the costs for the air treatment and the dressing of the staff are less in the case of an isolator. The overall cost of the CCRU's implementation is approximately 1.3 times higher in the case of an isolator. However, by excluding the equipment purchase cost, the overall cost of a CSC's implementation becomes higher. CONCLUSION: For Tunisia, it seems that the CSC is the most adapted. However, this work should be completed by the comparison of the CCRU's operating costs in order to optimize the resources and figure out the cheapest system.

Lineamientos para la toma, envío y manejo de muestras provenientes de casos sospechosos inusitados, así como lineamientos de Bioseguridad en el manejo del COVID-19 / Guidelines for the collection, shipment and handling of samples from unusual suspected cases, as well as Biosafety guidelines in the management of COVID-19

Fecha de actualización: 22 de mayo 2020. Brindar los lineamientos generales para la toma de muestra, conservación y transporte para el diagnóstico de virus respiratorios, con su posterior envío al Centro Nacional de Influenza (NIC) del Laboratorio Nacional de Salud; aplicable a establecidos del nivel nacional en atención a pacientes que cumplen con la definición de caso y se tipifica como "sospechoso inusitado". Y lineamientos de bioseguridad para la toma de muestras de casos tipificados como "sospechosos inusitados" que presuntivamente contengan el virus influenza A(H5N1), A(H7N9) A(H9N2) y 2019-nCoV o cualquier otro virus proveniente de un paciente tipificado como caso Inusitado. Con aplicación a nivel nacional, en las dependencias dentro y fuera del Ministerio de Salud Pública y Asistencia Social, encargadas de la toma de muestra para el diagnóstico de Virus Respiratorios.

Requerimientos para uso de equipos de protección personal (EPP) para el nuevo coronavirus (2019-nCoV) en establecimientos de salud. Recomendaciones interinas, 2 febrero, 2020 / Requirements and technical specifications of personal protective. Interim recommendations, 2 February 2020

En diciembre de 2019, un nuevo coronavirus (2019-nCoV) fue identificado como el agente etiológico de una enfermedad respiratoria aguda severa en personas expuestas a un mercado de mariscos en Wuhan, China; • La transmisión interhumana ha sido documentada, incluso en trabajadores de salud y los procedimientos generadores de aerosoles (PGA)† pueden tener un rol en la diseminación de la enfermedad; • Hay muchas incertidumbres respecto a la historia natural de la enfermedad por el 2019-nCoV, incluyendo fuente(s), los mecanismos de transmisión, la capacidad de diseminación del virus, y la persistencia del virus en el ambiente y fómites; • Al 06 de febrero de 2020, se recomiendan las siguientes precauciones para el cuidado del pacientes sospechosos o confirmados de 2019-nCoV‡: o Para cualquier caso sospechoso o confirmado de 2019-nCoV: precauciones estándares + contacto + precauciones en la transmisión por gotitas o Para cualquier caso sospechoso o confirmado de 2019-nCoV y procedimientos generadores de aerosoles: precauciones estándares + contacto + transmisión aérea (aerosoles o núcleo de gotitas) • El uso de equipos de protección personal (EPP) por los trabajadores de salud requiere de la evaluación del riesgo relacionada a las actividades de salud; • Estas recomendaciones son preliminares y sujetas a revisión hasta que nuevas evidencias estén disponibles.

In December 2019 a novel coronavirus (2019-nCoV) was identified as the causative agent of a severe acute respiratory illness among people exposed in a seafood market in Wuhan, China; • Human-to-human transmission has been documented, including in healthcare workers, and aerosol-generating procedures (AGP)† may play a role in the spread of the disease; • There are uncertainties in the natural history of the 2019-nCoV, including source(s), transmissibility mechanisms, viral shedding, and persistence of the virus in the environment and on fomites; • As of 6 February 2020, the following precautions are recommended for the care of patients with suspected or confirmed cases of 2019-nCoV: o For any suspected or confirmed cases of 2019-nCoV: standard + contact + droplet precautions o For any suspected or confirmed cases of 2019-nCoV and AGP: standard + contact + airborne precautions • The use of personal protective equipment (PPE) by healthcare workers requires an evaluation of the risk related to healthcare-related activities; • These recommendations are preliminary and subject to review as new evidence becomes available. The figures presented in this technical recommendation are rough estimates and based upon simulation exercises on the use of PPE during previous outbreaks with similar transmission modes, such as Severe Acute Respiratory Syndrome (SARS) and Middle East Respiratory Syndrome (MERS). • The number of PPE units should vary according to disease severity and the number of aerosol-generating procedures per patient. • Suspected and confirmed cases of 2019-nCoV should be isolated in adequately ventilated single rooms. When single rooms are not available, patients suspected of being infected with 2019-nCoV should be grouped together (cohort). • For each patient/day it is recommended§: o Gown ­ 25 units. o Medical mask ­ 25 units.

Hazard Group 3 agent decontamination using hydrogen peroxide vapour in a class III microbiological safety cabinet.

AIMS: This study investigated the efficacy of hydrogen peroxide vapour (HPV) at inactivating hazard group 3 bacteria that have been presented dried from their growth medium to present a realistic challenge. METHODS AND RESULTS: Hydrogen peroxide vapour technology (Bioquell) was used to decontaminate a class III microbiological safety cabinet containing biological indicators (BIs) made by drying standard working suspensions of the following agents: Bacillus anthracis (Ames) spores, Brucella abortus (strain S99), Burkholderia pseudomallei (NCTC 12939), Escherichia coli O157 ST11 (NCTC 12079), Mycobacterium tuberculosis (strain H37Rv) and Yersinia pestis (strain CO92) on stainless steel coupons. Extended cycles were used to expose the agents for 90 min. The HPV cycle completely inactivated B. anthracis spores, B. abortus, B. pseudomallei, E. coli O157 and Y. pestis when BIs were processed using quantitative and qualitative methods. Whilst M. tuberculosis was not completely inactivated, it was reduced by 4 log10 from a starting concentration of 106 colony-forming units. CONCLUSIONS: This study demonstrates that HPV is able to inactivate a range of HG3 agents at high concentrations with associated organic matter, but M. tuberculosis showed increased resistance to the process. SIGNIFICANCE AND IMPACT OF THE STUDY: This publication demonstrates that HPV can inactivate HG3 agents that have an organic load associated with them. It also shows that M. tuberculosis has higher resistance to HPV than other agents. This shows that an appropriate BI to represent the agent of interest should be chosen to demonstrate a decontamination is successful.

New Post-COVID-19 Biosafety Protocols in Pediatric Dentistry

Abstract The most recent Severe Acute Respiratory Syndrome - COVID-19 - caused by coronavirus infection (SARS-CoV-2) has high-virulence transmission and direct human contagiousness by proximity. Thus, the considerable occupational risk in pediatric dentistry is evident, given the nature and form of procedures performed in an outpatient setting. Thus, the aim of this paper was to identify and contextualize technical and scientific information available to date aimed at preventing and minimizing risks for patients, caregivers and professionals. The results indicate that protective measures are being developed considering procedures according to risks and benefits, and five points stand out: 1. Regulation of resumption of elective procedures, screening and scheduling patients; 2. Restructuring clinical environment and infection control; 3. Improvement of personal protective equipment and biosafety recommendations; 4. Maximization of the use of non-invasive techniques, use of high-powered dental suction, and absolute isolation of the operative field; and 5. Minimization of the use of air-water syringe, dental spittoon and high-speed handpiece. The measures to be taken require reflection for the restart of a "new clinical practice", especially aiming at behavioral and structural changes regarding operational biosafety.

Dental Care and the COVID-19 Pandemic: The Precautionary Principle and the Best Available Evidence

Abstract The precautionary principle is part of evidence-based healthcare and is used both preventively and therapeutically when there is no available evidence about how to manage problems/diseases/conditions that are especially life-threatening. However, since it is not always based in the most qualified evidence, it is frequently questioned. The emergence of a highly contagious disease, with increased levels of morbimortality, an acute respiratory syndrome, the so called Coronavirus Disease 2019 (COVID-19), led health professionals to look for the best alternatives to save lives. In this sense, the precautionary principle was evocated. The aim of this paper is to make a reflection about the precautionary principle, the dental profession and COVID-19. It is important to have in mind that in such a disease, guidelines, protocols and approaches can change very fast, since a continuous evaluation of all policies is mandatory. During the pandemic, elective procedures may be restricted, but international organizations removed the recommendation to postpone elective procedures. Clinicians are advised to be updated about their local current policies. On the other hand, there are cases in which in-office dental care is unavoidable, such as individuals with pain, spontaneous bleeding and dental trauma. Biosafety is upmost importance when seeking patients during pandemic. In this sense, it was concluded that precautionary principle should be, therefore, used. However, caution needs to be taken and continuous surveillance necessary.

Consideraciones para la Atención de Urgencia Odontológica y Medidas Preventivas para COVID-19 (SARS-CoV 2) / Considerations for Emergency Dental Care and Preventive Measures for COVID-19 (SARS-CoV 2)

El siguiente artículo busca presentar diversas consideraciones para la atención odontológica a fin de disminuir riesgo de exposición al virus «Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)¼ para el profesional odontólogo. La higiene y el lavado de manos tanto de profesionales como de pacientes, es considerado uno de los puntos más críticos para reducir el contagio. Los odontólogos también deben preferir procedimientos electivos, en caso de atención de urgencias tomar medidas estrictas de bioseguridad para la protección de la piel y mucosas y considerar diferir en lo posible la atención odontológica en pacientes con signos y síntomas de Coronavirus (COVID-19).

Impacto del COVID-19 (SARS-CoV-2) a Nivel Mundial, Implicancias y Medidas Preventivas en la Práctica Dental y sus Consecuencias Psicológicas en los Pacientes / Global Impact of COVID-19 (SARS-CoV-2), Implications and Preventive Measures in Dental Practice and its Psychological Consequences in Patients

En diciembre de 2019, en China surgió un nuevo brote de neumonía la cual fue identificada como SARS-CoV-2 el cual tiene una rápida propagación al ser trasmitido principalmente mediante tos, estornudo o contacto. Presenta diversos síntomas como fiebre, tos seca y mialgia. Puede afectar a cualquier edad siendo principalmente leve y con resolución espontánea, pero en personas mayores y/o con comorbilidades puede presentar un curso severo o mortal. Para su diagnóstico es importante evaluar la presencia de fiebre, realizar una historia epidemiológica, TC de tórax y pruebas de laboratorio como RT-PCR o muestras del tracto respiratorio.Se realizó una revisión sistemática cualitativa realizando una búsqueda en las bases de datos Medline y ClinicalKey, se encontraron 72 artículos, los cuales se leyeron por completo, de ellos 16 cumplieron los criterios de inclusión y exclusión. La gran parte de las acciones odontológicas producen gotas o aerosoles, por esta razón se deben tomar medidas de protección, selección de pacientes y tipos de tratamientos para disminuir la posibilidad de infecciones en el personal de salud y pacientes, evaluar el uso de goma dique y colutorios previos a la atención, evitar instrumental generador de aerosoles, postergar atenciones electivas, tratar solamente emergencias dentales y extremar las medidas de desinfección de las instalaciones utilizando agentes biocidas efectivos contra el coronavirus. La trasmisión por fómites y aerosoles está comprobada por lo que debemos extremar precauciones. En situaciones de pandemia hay que considerar entregar un soporte psicológico a los pacientes, especialmente con patologías orales psicosomáticas las que pueden empeorar. La posibilidad de trasmisión en el periodo de recuperación no está comprobada ni descartada.

Consideraciones en la Atención Odontológica de Urgencia en Contexto de Coronavirus COVID-19 (SARS-CoV-2) / Urgency Dental Care Considerations in the Context of Coronavirus COVID-19 (SARS-CoV-2)

Los Coronavirus son una familia de virus de amplia distribución en la naturaleza presentes principalmente en los animales. El Covid-19 es la enfermedad causada por el coronavirus (SARS-CoV-2), que fue identificado y caracterizado en enero de 2020 en China. Los profesionales del área odontológica deben tomar todas las medidas de protección al tener que realizar una atención de urgencia, lavado de manos y utilización de equipos de protección personal. Para cada una de las urgencias odontológicas consideradas en la guía del Ministerio de Salud de Chile se dan recomendaciones para el actuar y posterior desechos e higienización de materiales. El objetivo de este artículo de revisión es entregar recomendaciones actualizadas y atingentes a nuestra realidad nacional a fin de disminuir las posibilidades de contagio ante la exposición inminente de pacientes sospechosos o que pudiesen presentar Covid-19.

Evaluating containment effectiveness of A2 and B2 biological safety cabinets.

PURPOSE: This study investigates the use of a canopy-connected recirculating class II type A2 biological safety cabinet (BSC) as an alternative to the B2 when preparing volatile, sterile compounded preparations. Selection of the appropriate BSC for processes that use subgram levels of volatile chemicals is difficult due to a lack of quantitative containment evidence by cabinet type. There is a perception that hazardous compounding must be done in a B2 cabinet due to the potential for vapors, and this study seeks to challenge that perception. METHODS: In total, 5 tests, 3 prequalification tests and 2 containment capability tests, were conducted on a single cabinet of each type at sterile compounding pharmacies. Prequalification tests were performed to verify that each BSC was operating properly. Each cabinet was certified to NSF-ANSI 49-2016, particle counted per ISO 14644-1:1999, and subjected to a qualitative video smoke study. Once these tests confirmed the expected working conditions, 2 containment capability tests were conducted. The containment testing included tracer gas testing per ASHRAE 110:2016 section 8.1.1 through 8.1.13, and cyclophosphamide sampling during sterile compounding of the drug material. RESULTS: Both cabinets passed all the prequalification tests. During the ASHRAE tracer gas testing the A2 cabinet was able to contain a tracer gas 92% to 160% as effectively as the B2 cabinet depending on the position of the gas ejection. During sterile compounding the airborne cyclophosphamide sampling captured samples of less than 1.0 ng at all locations for both the A2 and B2 cabinets. CONCLUSION: The data generated from this study demonstrate that use of an A2 for hazardous compounding can provide a comparable level of safety for the environment, users, and product while having less stringent airflow requirements relative to a B2. The simpler requirements for an A2 make them an appealing alternative as they have the potential to reduce the overall operating costs associated with a compounding pharmacy while maintaining safe levels of containment.

Cell Spillage after Contained Electromechanical Morcellation Using a Specially Designed In-Bag System for Laparoscopic Myomectomy: Prospective Cohort Pilot Study.

STUDY OBJECTIVE: Few reports have investigated the use of endoscopic retrieval bags in the context of laparoscopic myomectomy with electromechanical morcellation. We performed a leak test of a specially designed endoscopic bag system in women undergoing laparoscopic myomectomy with contained electromechanical morcellation. DESIGN CLASSIFICATION: Prospective study. SETTING: University hospital. PATIENTS: Thirty-one women undergoing laparoscopic myomectomy with contained electromechanical morcellation. INTERVENTIONS: Electromechanical morcellation was introduced for large specimen extraction during laparoscopic procedures. Complications such as retained/disseminated parasitic tissue were documented. MEASUREMENTS AND MAIN RESULTS: Systematic peritoneal washings were performed at 3 specific times: at baseline, T1, once the peritoneal cavity was accessed laparoscopically; T2, when the myometrial incision was closed after myomectomy; and T3, after contained electromechanical morcellation. After retrieval of the endoscopic bag from the abdominal cavity, visual inspection and water test on the bag with NaCl infiltration were performed to detect leaks attributed to intraoperative perforations. A pathologist performed cytologic analyses on the 3 washings. The mean endoscopic bag procedure duration was 9 minutes. The use of a specially designed endoscopic bag system was found to be easy in 45% of cases, and no complications were reported. Cytologic washings were positive for smooth muscle cell detection in 8 cases (25.8%) at T2 and 3 cases (9.7%) at T3. All positive cases at T3 already had detectable smooth muscle cells at T2. After retrieval from the abdominal cavity, perforations on the optic access of the endoscopic bag were observed in 3 cases. CONCLUSION: The results from this pilot study are encouraging. The use of a specially designed endoscopic bag system could be an adjuvant to reduce the risk of disseminating cells during myomectomy.

Magnitud del riesgo por accidentes con objetos cortopunzantes en la consulta odontológica / Magnitude of isk for Accidents with Sharps in the Dental Practice / Magnitude do risco para acidentes com perfurocortantes na prática odontológica

Antecedentes: El personal del área de la salud está constantemente expuesto a sangre y fluidos provenientes de los pacientes durante su jornada laboral. Por lo tanto, el personal de odontología corre el riesgo de contraer enfermedades infecciosas. Objetivo: Conocer la frecuencia del riesgo laboral por objetos punzocortantes en odontólogos de primer nivel de atención de los Centros de Salud urbano y rural de los Servicios de Salud de Nuevo León Monterrey Nuevo León, México. Métodos: diseño del estudio no experimental, descriptivo, transversal y prospectivo. Población de estudio: odontólogos aplicativos de los Servicios de Salud de Nuevo León con un muestreo probabilístico 108 odontólogos. Se utilizó un cuestionario diseñado con 12 preguntas relacionadas con los accidentes punzocortantes, con una confiabilidad de un alfa de Cronbach de .832. Resultados: el 38.8 % de los masculinos informó haber presentado accidente laboral y femeninas el 67.2 % señalaron haber sufrido un accidente con punzocortante. En relación al conocer si habían sufrido algún accidente por objetos punzocortantes, solo el 59.3 % lo reportó y un 40.7 % no había sufrido accidente; un 49 % si recibió capacitación en bioseguridad y un 51 % no ha recibido capacitación. Conclusión: Con base a estos resultados podemos concluir que aún falta por mejorar las capacitaciones y ampliar la cobertura de capacitación a los odontólogos en materia de normativas de bioseguridad y manejo de residuos peligrosos biológicos infecciosos, así como actualizar el conocimiento de infecciones transmitidas por objetos punzocortantes.

Background: The staff of the health area is constantly exposed to blood and / or fluids coming from patients during their workday. Therefore, dentistry personnel run the risk of contracting infectious diseases. Purpose: To know the frequency of occupational risk due to sharp objects in top-level dentists of the urban and rural Health Centers of the Health Services of Nuevo León. Methods: design of the non-experimental, descriptive, cross-sectional and prospective study. Study population: applicative dentists of the Health Services of Nuevo Leon with a probabilistic sampling 108 of dentists. A questionnaire designed with 12 questions related to sharps accidents with a reliability of a Cronbach's alpha of .832 was used. Results: 38.8 % of the men reported having presented an accident at work and 67.2 % of the women reported having suffered an accident with a sharp cut. In relation to knowing if they had suffered an infection due to an accident by sharp objects, 59.3 % had suffered an accident and 40.7 % had not suffered an accident; 49 % were trained in biosecurity and 51 % have not received training. Conclusion: Based on these results we can conclude that there is still a need to improve the training and expand the coverage of training to the dentist in matters of biosafety regulations and management of infectious biological dangerous wastes as well as to update the knowledge of puncture-borne infections.

Antecedentes: A equipe da área de saúde é constantemente exposta ao sangue e / ou fluidos provenientes dos pacientes durante o dia de trabalho. Portanto, o pessoal de odontologia corre o risco de contrair doenças infecciosas. Objetivo: Conhecer a frequência do risco ocupacional por objetos pontiagudos em dentistas de nível superior dos Centros de Saúde urbanos e rurais dos Serviços de Saúde de Nuevo León. Métodos: delineamento do estudo não experimental, descritivo, transversal e prospectivo. População do estudo: dentistas aplicativos dos Serviços de Saúde de Nuevo León com amostragem probabilística 108 de cirurgiões-dentistas. Foi utilizado um questionário elaborado com 12 questões relacionadas aos acidentes com perfurocortantes, com confiabilidade de um alfa de Cronbach de 0,832. Resultados: 38,8% dos homens relataram ter sofrido acidente no trabalho e 67,2% das mulheres relataram ter sofrido acidente com um corte acentuado. Em relação a saber se sofreram infecção por acidente por objetos pontiagudos, 59,3% sofreram acidente e 40,7% não sofreram acidente; 49% foram treinados em biossegurança e 51% não receberam treinamento. Conclusão: Com base nesses resultados, podemos concluir que ainda há uma necessidade de melhorar o treinamento e ampliar a cobertura do treinamento para o dentista em questões de regulamentos de biossegurança e gestão de resíduos infecciosos biológicos perigosos, bem como atualizar o conhecimento sobre punção. infecções suportadas.

Contained Morcellation for Laparoscopic Myomectomy Within a Specially Designed Bag.

A technique of contained morcellation of uterine myomas within a bag specially designed for 2-port morcellation during laparoscopic myomectomy is described. Ten patients underwent in-bag morcellation of myomas with a tissue isolation bag (MorSafe) between November 2014 and January 2015. The MorSafe tissue isolation bag is a retort-shaped bag made of medical-grade flexible plastic material with the wider opening of 134 mm in diameter and the tail end measuring 4 mm in diameter, allowing easy accomodation of specimens up to 12 cm in diameter. This technique involves placing the myomas into the isolation bag within the abdomen, exteriorizing the tail end of the bag, insufflating the bag within the peritoneal cavity, and morcellating the myomas under vision. Demographic and perioperative characteristics were studied. The mean operative time was 117 minutes (range, 75-195 minutes), the mean time for specimen introduction into the bag was 12.5 minutes (range, 7-22 minutes), and the mean time for morcellation and bag removal was 24.8 minutes (range, 10-50 minutes). There were no complications related to the in-bag morcellation technique, and there was no visual evidence of damage to the isolation bag. In-bag morcellation using this new bag is a feasible technique for morcellating uterine myomas in a contained manner and may provide an option to minimize the risks of open power morcellation while preserving the benefits of minimally invasive surgery.

Vaginal Uterine Morcellation Within a Specimen Containment System: A Study of Bag Integrity.

STUDY OBJECTIVE: To evaluate the integrity of the endoscopic bag after transvaginal in-bag morcellation of uteri that need to be removed by vaginal morcellation during total laparoscopic hysterectomy (TLH). DESIGN: Prospective pilot study (Canadian Task Force classification II-2). SETTING: University hospital. PATIENTS: Twelve patients with uteri that needed to be removed and who required vaginal morcellation underwent TLH from September 2014 to February 2015, without suspected or confirmed malignancy. INTERVENTIONS: After transvaginal in-bag morcellation of uteri at the end of TLH, careful visual inspection of the endoscopic pouch, using diluted methylene blue, was carried out, highlighting any minimal bag damage. MEASUREMENTS AND MAIN RESULTS: No gross rupture was encountered after morcellation; however, 4 minimal ruptures were recognized (33%) after filling up the bag with diluted methylene blue. CONCLUSIONS: Minimal lesions of the bag may occur after transvaginal morcellation of uteri that need to be removed by vaginal morcellation; this may potentially affect the spread of cancer cells into the abdominal cavity.

Preparing for renal replacement therapy in patients with the Ebola virus disease.

The Ebola virus disease (EVD) is a serious illness characterized by fever, severe vomiting and diarrhea, and, in severe cases, multi-organ failure requiring mechanical ventilation and renal replacement therapy. The current outbreak has centered in West Africa and affected over 15,000 individuals. EVD is transmitted by direct contact with blood or other infectious bodily fluid, and as such, numerous heath care workers caring for patients with EVD have become infected. During the current outbreak, a number of patients have received advanced supportive care for EVD in Europe and North America and therefore survived. Now, many hospitals in Europe and North America are planning to accept care for patients with EVD. In this review, we discussed the key issues related to the planning and delivery of advanced supportive care in patients with EVD with a focus on the factors necessary to provide renal replacement therapy (RRT). Since success in the treatment of patients with EVD rests on both patient outcome and prevention of transmission of disease to health care workers, we extensively discussed the modes of Ebola virus transmission and recommended protocols to protect health care workers. Experience now indicates that with appropriate planning and protocols, it is possible to successfully treat EVD patients with advanced supportive care (mechanical ventilation and RRT) while avoiding transmission to health care providers. Video Journal Club "Cappuccino with Claudio Ronco" at http://www.karger.com/?doi=371530.