RESUMO
BACKGROUND: Health care is shifting toward minimally invasive procedures requiring increasingly complex instruments and sophisticated processing technologies. Effective training methods are needed to ensure sterile processing professionals acquire and retain essential skills. This study aimed to develop and evaluate a new training model that supports mastery and retention of complex key skills. METHODS: The model was pilot-tested with training focused on visual inspection of endoscopes. Pre- and post-training tests were administered to enhance learning during a face-to-face workshop that interspersed lectures and hands-on practice, followed by structured homework, and an online booster session. Surveys assessed satisfaction and confidence levels. RESULTS: Mean test scores for nine certified sterile processing employees increased significantly following the workshop (41% vs 84%, P < .001). After the workshop, all trainees identified actionable visible defects on patient-ready endoscopes in their facilities. Test scores remained high after 2 months (90%), and trainees reported higher technical confidence and satisfaction levels after training. CONCLUSIONS: This study demonstrated effectiveness and clinical relevance of a new, evidence-based model for training sterile processing professionals that incorporated pretesting, lectures, hands-on practice, a training booster, and post-testing to enhance learning. This model may be applicable to other complex skills necessary for infection prevention and patient safety.
Assuntos
Competência Clínica , Relevância Clínica , Humanos , Projetos Piloto , Inquéritos e QuestionáriosRESUMO
BACKGROUND: Sterile processing personnel routinely decontaminate medical devices that are heavily soiled with blood, tissue, and secretions. Contamination may spread throughout processing areas, potentially exposing personnel and patient-ready devices, especially when there is insufficient separation between the dirty and clean areas. OBJECTIVE: This study aimed to identify activities that generate splash, determine how far droplets travel during manual cleaning, characterize the impact of practices on splash generation, and assess effectiveness of personal protective equipment (PPE) at preventing splash exposure to technicians and visitors in the decontamination unit. METHODS: Moisture-detection paper was affixed to PPE and environmental surfaces in a new processing department designed to optimize workflow and prevent cross-contamination. Droplet generation and dispersal were assessed during manual cleaning of a colonoscope and a transvaginal ultrasound probe. RESULTS: Splash was generated by most activities and droplets were detected up to 7.25 feet away. Transporting wet endoscopes dispersed droplets on a 15-foot path from the sink to the automated endoscope reprocessor. Extensive droplets were detected on PPE worn by technicians at the sink and observers 3-4 feet away. CONCLUSIONS: Manual cleaning of devices generated substantial splash, drenching technicians and the environment with droplets that traveled more than 7 feet. Engineering controls and better PPE are needed to reduce personnel exposure and risks associated with the potential dispersal of contaminated fluids throughout the facility.
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OBJECTIVE: The novel severe acute respiratory coronavirus virus 2 (SARS-CoV-2) was first reported in Wuhan, China, in December 2019 and is notable for being highly contagious and potentially lethal; and SARS-CoV-2 is mainly spread by droplet transmission. The US healthcare system's response to the COVID-19 pandemic has been challenged by a shortage of personal protective equipment (PPE), especially N95 respirators. Restricted use, reuse, and sanitation of PPE have been widely adopted to provide protection for frontline healthcare workers caring for often critically ill and highly contagious patients. Here, we describe our validated process for N95 respirator sanitation. DESIGN: Process development, validation, and implementation. SETTING: Level 1, urban, academic, medical center. METHODS: A multidisciplinary team developed a novel evidence-based process for N95 respirator reprocessing and sanitation using ultraviolet (UV) light. Dose measurement, structural integrity, moisture content, particle filtration, fit testing, and environmental testing were performed for both quality control and validation of the process. RESULTS: The process achieved UV light dosing for sanitation while maintaining the functional and structural integrity of the N95 respirators, with a daily potential throughput capacity of â¼12,000 masks. This process has supported our health system to provide respiratory PPE to all frontline team members. CONCLUSIONS: This novel method of N95 respirator sanitation can safely enable reuse of the N95 respirators essential for healthcare workers caring for patients with COVID-19. Our high-throughput process can extend local supplies of this critical PPE until the national supply is replenished.
Assuntos
COVID-19 , Pandemias , Descontaminação , Reutilização de Equipamento , Humanos , Máscaras , Respiradores N95 , SARS-CoV-2 , SaneamentoRESUMO
BACKGROUND: Cardiac disease is a significant cause of morbidity and mortality in children with end-stage renal disease (ESRD). This study aimed to report the frequency of cardiac disease diagnostic methods used in US pediatric maintenance hemodialysis patients. METHODS: A cross-sectional analysis of all US pediatric (ages 0.7-18 years, n = 656) maintenance hemodialysis patients was performed using data from the Centers for Medicare and Medicaid Services ESRD Clinical Performance Measures Project. Clinical and laboratory information was collected in 2001. Results were analysed by age, sex, race, Hispanic ethnicity, dialysis duration, body mass index (BMI), primary ESRD cause and laboratory data. RESULTS: Ninety-two percent of the patients had a cardiovascular risk factor (63% hypertension, 38% anemia, 11% BMI > 94th percentile, 63% serum phosphorus > 5.5 mg/dL and 55% calcium-phosphorus product ≥ 55 mg(2)/dL(2)). A diagnosis of cardiac disease was reported in 24% (n = 155) of all patients: left ventricular hypertrophy/enlargement 17%, congestive heart failure/pulmonary edema 8%, cardiomyopathy 2% and decreased left ventricular function 2%. Thirty-one percent of patients were not tested. Of those tested, the diagnostic methods used were chest X-rays in 60%, echocardiograms in 35% and electrocardiograms in 33%; left ventricular hypertrophy/enlargement was diagnosed using echocardiogram (72%), chest X-ray (20%) and electrocardiogram (15%). CONCLUSIONS: Although 92% of patients had cardiovascular risk factors, an echocardiography was performed in only one-third of the patients. Our study raises the question of why echocardiography, considered the gold standard for cardiac disease diagnosis, has been infrequently used in pediatric maintenance dialysis patients, a high-risk patient population.
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Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/etiologia , Falência Renal Crônica/complicações , Diálise Renal , Adolescente , Criança , Pré-Escolar , Estudos Transversais , Feminino , Seguimentos , Humanos , Incidência , Lactente , Falência Renal Crônica/terapia , Masculino , Prognóstico , Fatores de Risco , Taxa de SobrevidaAssuntos
Bases de Dados Factuais , Nefropatias/epidemiologia , Relatório de Pesquisa , Bases de Dados Factuais/tendências , Hospitalização , Humanos , Rim/fisiologia , Nefropatias/diagnóstico , Nefropatias/terapia , Falência Renal Crônica/diagnóstico , Falência Renal Crônica/epidemiologia , Falência Renal Crônica/terapia , Relatório de Pesquisa/tendências , Estados Unidos/epidemiologiaAssuntos
Insuficiência Renal Crônica , Gastos em Saúde , Hospitalização , Humanos , Falência Renal Crônica/diagnóstico , Falência Renal Crônica/economia , Falência Renal Crônica/epidemiologia , Falência Renal Crônica/terapia , Medicare Part D , Insuficiência Renal Crônica/diagnóstico , Insuficiência Renal Crônica/economia , Insuficiência Renal Crônica/epidemiologia , Insuficiência Renal Crônica/terapia , Estados Unidos/epidemiologiaRESUMO
BACKGROUND: Ischemia-reperfusion injury (IRI) is the main cause of acute renal failure in both allograft and native kidney. Studies using T cell knockout mice have established an important role for T cells in renal IRI. T cell depletion strategies are effective in human allograft rejection. However, it is not known whether those are effective in renal IRI. Therefore, the effect of T cell depletion in a murine model of renal IRI using well-characterized antibodies (Abs) that have been effective in preventing experimental allograft rejection was studied. METHODS: T cell depleting Abs to CD4 (GK1.5), CD8 (2.43) or pan-T cells (30.H12) were purified from hybridoma culture supernatant. Thymectomized C57BL/6 mice, treated with different combinations of T cell depleting Abs, underwent 30 min of bilateral renal IRI, followed by assessment of renal function, structure, and degree of T cell depletion in spleen, lymph nodes, and peripheral blood by flow cytometry. RESULTS: Mice given both GK1.5 and 2.43 had considerable CD4 and CD8 cell depletion but no protection of renal function after ischemia-reperfusion (I/R) as measured by the rise in serum creatinine. However, when GK1.5 and 2.43 was administered combined with 30.H12, which more effectively depleted CD4 T cell numbers, a significant protection of renal function and structure was observed after I/R. Antibody combinations did not significantly alter other leukocyte populations. CONCLUSIONS: These data demonstrate that T cell depletion can improve the course of experimental renal IRI. However, more aggressive T cell depletion strategies were required compared with that needed to prevent experimental allograft rejection.
Assuntos
Isquemia/terapia , Rim/irrigação sanguínea , Depleção Linfocítica/métodos , Traumatismo por Reperfusão/prevenção & controle , Linfócitos T/imunologia , Animais , Antígenos CD4/imunologia , Antígenos CD8/imunologia , Rejeição de Enxerto/prevenção & controle , Rim/patologia , Masculino , Camundongos , Camundongos Endogâmicos C57BL , TimectomiaRESUMO
BACKGROUND: Ischemia-reperfusion injury (IRI) is the major cause of delayed graft function in renal allografts. The present study was performed to investigate the validity of serum creatinine (SCr) level as an indicator of postischemic renal dysfunction in mice. METHODS: Renal IRI or sham surgery was induced in C57BL/6 mice, and SCr level and inulin clearance (Cin) were measured between 24 hr and 7 days after ischemia. RESULTS: Cin in IRI mice was reduced 75% at 72 hr after ischemia in association with a nearly threefold increase in SCr level. Cin in IRI mice did not recover between 72 hr and 7 days after ischemia, even though SCr level at 7 days was not different between control and IRI mice. In IRI mice, SCr level measured at 24, 48, and 72 hr after ischemia correlated inversely with Cin measured at 72 hr, but not 7 days, after ischemia. CONCLUSIONS: SCr level in the early postischemic period (24-72 hr) seems to be a valid indicator of early postischemic renal dysfunction, and that renal function remains markedly depressed at 7 days despite suggestion from the SCr value that renal function is improving.
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Creatinina/sangue , Transplante de Rim , Rim/fisiologia , Traumatismo por Reperfusão/sangue , Animais , Taxa de Filtração Glomerular , Camundongos , Camundongos Endogâmicos ICR , Complicações Pós-Operatórias/sangue , Complicações Pós-Operatórias/fisiopatologia , Valor Preditivo dos Testes , Traumatismo por Reperfusão/fisiopatologia , Transplante HomólogoAssuntos
Falência Renal Crônica , Transplante de Rim/estatística & dados numéricos , Diálise Renal/estatística & dados numéricos , Humanos , Falência Renal Crônica/economia , Falência Renal Crônica/epidemiologia , Falência Renal Crônica/terapia , Transplante de Rim/economia , Diálise Renal/economia , Estados Unidos/epidemiologiaAssuntos
Nefropatias , Adulto , Relatórios Anuais como Assunto , Criança , Doença Crônica , Humanos , Nefropatias/economia , Nefropatias/epidemiologia , Falência Renal Crônica/economia , Falência Renal Crônica/epidemiologia , Transplante de Rim/estatística & dados numéricos , Estados Unidos/epidemiologiaAssuntos
Nefropatias/epidemiologia , Falência Renal Crônica/epidemiologia , Falência Renal Crônica/terapia , Transplante de Rim/tendências , Diálise Renal/tendências , Adolescente , Adulto , Distribuição por Idade , Idoso , Doenças Cardiovasculares/complicações , Criança , Doença Crônica , Coleta de Dados , Complicações do Diabetes , Feminino , Gastos em Saúde/tendências , Hospitalização/tendências , Humanos , Nefropatias/complicações , Nefropatias/mortalidade , Nefropatias/terapia , Falência Renal Crônica/mortalidade , Transplante de Rim/economia , Transplante de Rim/estatística & dados numéricos , Masculino , Medicare/estatística & dados numéricos , Pessoa de Meia-Idade , Morbidade/tendências , Mortalidade/tendências , Diálise Renal/economia , Diálise Renal/estatística & dados numéricos , Estados Unidos/epidemiologiaAssuntos
Falência Renal Crônica/epidemiologia , Falência Renal Crônica/terapia , Adulto , Relatórios Anuais como Assunto , Doenças Cardiovasculares/complicações , Criança , Complicações do Diabetes , Feminino , Humanos , Falência Renal Crônica/complicações , Transplante de Rim/estatística & dados numéricos , Masculino , Diálise Peritoneal/estatística & dados numéricos , Estados Unidos/epidemiologiaRESUMO
BACKGROUND AND OBJECTIVES: Data are limited regarding BP distribution and the prevalence of hypertension in pediatric long-term dialysis patients. This study aimed to examine BP distribution in U.S. pediatric long-term hemodialysis patients. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: This cross-sectional study of all U.S. pediatric (aged 0-< 18 yr, n = 624) long-term hemodialysis patients was performed as part of the Centers for Medicare & Medicaid Services End-Stage Renal Disease (ESRD) Clinical Performance Measures Project. BP and clinical information were collected monthly in October, November, and December 2001. Hypertension was defined as the mean of pre- and postdialysis systolic or diastolic BP above the 95th percentile for age, height, and sex, or antihypertensive medication use. Results were calculated by age, sex, race, ethnicity, ESRD duration, body mass index percentile, primary cause of ESRD, and laboratory data. RESULTS: Hypertension was present in 79% of patients; 62% used antihypertensive medication. Five percent of patients were prehypertensive (mean BP at 90th to 95th percentile). Hypertension was uncontrolled in 74% of treated patients. Characteristics associated with hypertension included acquired kidney disease, shorter duration of ESRD, and lower mean hemoglobin and calcium values. Characteristics associated with uncontrolled hypertension were younger age and shorter duration of ESRD. CONCLUSIONS: Hypertension is common in U.S. pediatric long-term hemodialysis patients, uncontrolled in 74% of treated patients, and untreated in 21% of hypertensive patients. It is concluded that a more aggressive approach to treatment of hypertension is warranted in pediatric long-term hemodialysis patients.
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Hipertensão/epidemiologia , Falência Renal Crônica/epidemiologia , Falência Renal Crônica/terapia , Diálise Renal/estatística & dados numéricos , Adolescente , Anti-Hipertensivos/uso terapêutico , Pressão Sanguínea , Centers for Medicare and Medicaid Services, U.S./estatística & dados numéricos , Criança , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Hipertensão/tratamento farmacológico , Hipertensão/fisiopatologia , Lactente , Recém-Nascido , Falência Renal Crônica/fisiopatologia , Masculino , Prevalência , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Estados Unidos/epidemiologiaRESUMO
This study's objective was to determine the incidence and mortality of acute renal failure (ARF) in Medicare beneficiaries. Data were from hospitalized Medicare beneficiaries (5,403,015 discharges) between 1992 and 2001 from the 5% sample of Medicare claims. For 1992 to 2001, the overall incidence rate of ARF was 23.8 cases per 1000 discharges, with rates increasing by approximately 11% per year. Older age, male gender, and black race were strongly associated (P < 0.0001) with ARF. The overall in-hospital death rate was 4.6% in discharges without ARF, 15.2% in discharges with ARF coded as the principal diagnosis, and 32.6% in discharges with ARF as a secondary diagnosis. In-hospital death rates were 32.9% in discharges with ARF that required renal dialysis and 27.5% in those with ARF that did not require dialysis. Death within 90 d after hospital admission was 13.1% in discharges without ARF, 34.5% in discharges with ARF coded as the principal diagnosis, and 48.6% in discharges with ARF as a secondary diagnosis. Discharges with ARF were more (P < 0.0001) likely to have intensive care and other acute organ dysfunction than those without ARF. For discharges both with and without ARF, rates for death within 90 d after hospital admission showed a declining trend. In conclusion, the incidence rate of ARF in Medicare beneficiaries has been increasing. Those of older age, male gender, and black race are more likely to have ARF. These data show ARF to be a major contributor to morbidity and mortality in hospitalized patients.
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Injúria Renal Aguda/epidemiologia , Injúria Renal Aguda/mortalidade , Injúria Renal Aguda/terapia , Negro ou Afro-Americano , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Cuidados Críticos , Feminino , Humanos , Masculino , Medicare , Pessoa de Meia-Idade , Insuficiência de Múltiplos Órgãos/epidemiologia , Diálise Renal , Fatores de Risco , Sepse/epidemiologia , Fatores Sexuais , Fatores de Tempo , Estados Unidos/epidemiologia , População BrancaRESUMO
Recent data have demonstrated a role for CD4(+) cells in the pathogenesis of renal ischemia reperfusion injury (IRI). Identifying engagement of adaptive immune cells in IRI suggests that the other major cell of the adaptive immune response, B cells, may also mediate renal IRI. An established model of renal IRI was used: 30 min of renal pedicle clamping was followed by reperfusion in B cell-deficient ( mu MT) and wild-type mice. Renal function was significantly improved in mu MT mice compared with wild-type mice at 24, 48, and 72 h postischemia. mu MT mice also had significantly reduced tubular injury. Both groups of mice had similar renal phagocyte infiltration postischemia assessed by myeloperoxidase levels and similar levels of CD4(+) T cell infiltration postischemia. Peritubular complement C3d staining was also similar in both groups. To identify the contribution of cellular vs soluble mechanism of action, serum transfer into mu MT mice partially restored ischemic phenotype, but B cell transfers did not. These data are the first demonstration of a pathogenic role for B cells in ischemic acute renal failure, with a serum factor as a potential underlying mechanism of action.
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Subpopulações de Linfócitos B/imunologia , Subpopulações de Linfócitos B/patologia , Rim/irrigação sanguínea , Linfopenia/genética , Linfopenia/imunologia , Traumatismo por Reperfusão/imunologia , Traumatismo por Reperfusão/prevenção & controle , Transferência Adotiva , Animais , Subpopulações de Linfócitos B/transplante , Linfócitos T CD4-Positivos/patologia , Movimento Celular/genética , Complemento C3d/análise , Soros Imunes/administração & dosagem , Imunoglobulina G/sangue , Imunoglobulina M/sangue , Injeções Intravenosas , Rim/imunologia , Rim/patologia , Rim/fisiopatologia , Testes de Função Renal , Linfopenia/patologia , Linfopenia/fisiopatologia , Masculino , Camundongos , Camundongos Endogâmicos C57BL , Camundongos Mutantes , Fagócitos/patologia , Traumatismo por Reperfusão/genética , Traumatismo por Reperfusão/patologia , Traumatismo por Reperfusão/fisiopatologia , Coloração e RotulagemRESUMO
BACKGROUND: Increasing evidence supports an important role for inflammation in the pathogenesis of renal ischemia-reperfusion injury (IRI). Recently, HMG-CoA reductase inhibitors, 'statins', have demonstrated anti-inflammatory effects independent of cholesterol-lowering. HYPOTHESIS: We tested the hypothesis that a statin would improve outcome in a murine model of renal IRI. Upon finding a protective effect, we tested the hypothesis that the mechanisms by which statins protected in renal IRI was by reducing neutrophil and macrophage infiltration and upregulating the anti-inflammatory cytokine IL-6. METHODS: Cerivastatin at various dosing regimens was administered to NIH Swiss mice to evaluate the effects on renal IRI. Analysis of renal structure, function, neutrophil and macrophage infiltration, cytokine production, as well as mortality was performed in cerivastatin- and saline-treated groups. RESULTS: PRIMARY: Cerivastatin pretreatment for 3 days led to a significant improvement in renal function, tubular injury as well as survival after IRI compared to saline-treated mice. SECONDARY: Neutrophil and macrophage infiltration into kidney tissue was similar in both groups. IL-6 was markedly upregulated early in the kidneys of statin-treated compared to saline-treated mice. CONCLUSION: These data demonstrate that a statin compound can improve the course of ischemic acute renal failure. Induction of protective molecules such as IL-6 may underlie this effect.