Lack of Association of Pediatric Surgical Patient Outcomes With Increased Disposable Operating Room Supply Costs.

INTRODUCTION: There is wide variation in the cost of disposable operating room supplies between surgeons performing the same operation at the same institution. The general relationship between variation in disposable supply cost and patient outcomes is unknown. We aimed to evaluate the relationship between disposable supply cost and patient outcomes for sixteen common operations. METHODS: Cost data were reviewed for the most common procedures performed by five surgical divisions at a single children's hospital over a six-month period in 2021. For procedure, the median disposable OR costs were calculated. Each operation performed was categorized as low cost (below the group median) or high cost (above the group median. We compared the rates of adverse events (clinic visit within 5 days, 30-day emergency department visit, unplanned reoperation, unplanned readmission, anesthesia complications, prolonged hospital length of stay, need for blood product transfusion, or death) between procedures with low and high disposable supply costs. RESULTS: 1139 operations performed by 48 unique surgeons from five specialties were included; 596 (52%) were low-cost and 543 (48%) high-cost. The low and high-cost groups did not differ regarding most demographic characteristics. Overall, 21.9% of children suffered any adverse outcome; this rate did not differ between the low and high-cost groups when evaluated individually or in aggregate (20.5% vs 23.6%, p = 0.23). CONCLUSION: Our data demonstrate that across a wide range of pediatric surgical procedures, the cost of disposable operating room supplies was not associated with the risk of adverse outcomes. LEVEL OF EVIDENCE: Level 3.

The Effect of COVID-19 on Israeli Ophthalmology Departments: Directors' Perspectives.

BACKGROUND: The coronavirus disease-2019 (COVID-19) pandemic presented a major medical management challenge to ophthalmology departments throughout Israel. OBJECTIVES: To examine the managerial challenges, actions taken, and insights of directors of ophthalmology departments in Israel during the COVID-19 pandemic. METHODS: We conducted a cross sectional survey of directors of ophthalmology departments during the COVID-19 pandemic while the Israeli population was quarantined. RESULTS: All 21 directors answered the survey. The majority of the COVID-19 admissions were located in the center of Israel (53%) and Jerusalem (30%). E-communication took a central role in coping with the pandemic with 80% of the directors satisfied with this form of communication; 75% reported a reduction in clinical and surgery volume of at least 25%, and 40% reported reallocations of manpower. Most of the medical staff used gloves, a face shield, disposable robe, and a mask with no uniformity across departments. Cross satisfaction was noted regarding a hospital's ability to equip the departments. Lack of preparation for post-pandemic era was reported by all directors, but one (95%). Directors sought guidelines and uniformity regarding outpatient referral to the hospital (p = 0.035). CONCLUSIONS: Guidelines via safe digital platforms aid in management decisions and uniformity across departments. Advanced preparation is needed to prevent adverse clinical outcomes and to maintain treatment continuum. Our results can be used to guide and help improve the preparedness of ophthalmology departments during COVID-19 and for future pandemics.

Performance and impact of disposable and reusable respirators for healthcare workers during pandemic respiratory disease: a rapid evidence review.

OBJECTIVES: To synthesise evidence concerning the range of filtering respirators suitable for patient care and guide the selection and use of different respirator types. DESIGN: Comparative analysis of international standards for respirators and rapid review of their performance and impact in healthcare. DATA SOURCES: Websites of international standards organisations, Medline and Embase, hand-searching of references and citations. STUDY SELECTION: Studies of healthcare workers (including students) using disposable or reusable respirators with a range of designs. We examined respirator performance, clinician adherence and performance, comfort and impact, and perceptions of use. RESULTS: We included standards from eight authorities across Europe, North and South America, Asia and Australasia and 39 research studies. There were four main findings. First, international standards for respirators apply across workplace settings and are broadly comparable across jurisdictions. Second, effective and safe respirator use depends on proper fitting and fit testing. Third, all respirator types carry a burden to the user of discomfort and interference with communication which may limit their safe use over long periods; studies suggest that they have little impact on specific clinical skills in the short term but there is limited evidence on the impact of prolonged wearing. Finally, some clinical activities, particularly chest compressions, reduce the performance of filtering facepiece respirators. CONCLUSION: A wide range of respirator types and models is available for use in patient care during respiratory pandemics. Careful consideration of performance and impact of respirators is needed to maximise protection of healthcare workers and minimise disruption to care.

Factors that affect the duration of wearing disposable personal protective equipment by healthcare professionals in Wuhan during treatment of COVID-19 patients: An epidemiological study.

The purpose of this study of healthcare workers who cared for COVID-19 patients was to identify factors that affected the duration of wearing personal protective equipment (PPE). The results of this study will provide initial guidance to practicing clinicians and a foundation for further research on this topic. This cross-sectional study examined 139 frontline healthcare professionals who worked at a single hospital in Wuhan, China, from March 16 to April 1, 2020. General and demographic data, physical and mental status, use of personal protective equipment, type of hospital work, and duration of wearing personal protective equipment were recorded. The mean duration of wearing personal protective equipment was 194.17 min (standard deviation: 3.71). Multiple linear regression analysis indicated that the duration of wearing personal protective equipment was significantly associated with the presence of a chronic disease, working hours when feeling discomfort, lack of patient cooperation and subsequent psychological pressure, prolonged continuous wearing of personal protective equipment, feeling anxious about physical strength, and the presence of fatigue when wearing personal protective equipment. These factors should be considered by practicing healthcare professionals and in future studies that examine the optimal duration of wearing personal protective equipment.

Environmental Sustainability in Canadian Critical Care: A Nationwide Survey Study on Medical Waste Management.

BACKGROUND: To date, the literature surrounding healthcare sustainability has focused largely on operating rooms, energy efficiency and biohazardous waste management. Few studies have looked at the sustainability within intensive care units (ICUs). OBJECTIVE: Our study sought to capture the array of sustainability initiatives undertaken by Canadian ICUs and gain a better understanding of current practices with regard to the management of single-use equipment waste. METHODS: We conducted a nationwide e-mail survey through the Canadian Critical Care Network. RESULTS: We received responses from a total of 81 hospital sites representing all 10 Canadian provinces and approximately 28.3% of all Canadian ICUs. The vast majority of responses came from ICU managers or nursing leadership. Our study identified variable waste management practices across the country and showcased successful initiatives undertaken by Canadian ICUs toward increased environmental sustainability.

Cold Technique in Adult Tonsillectomy Reduces Waste and Cost.

OBJECTIVES: To quantify differences in waste and cost of disposable equipment between different tonsillectomy techniques. METHODS: Prospective study of waste attributable to disposable waste produced by tonsillectomy surgery. Disposable equipment required for tonsillectomy using cold, monopolar electrocautery (ME), and coblation techniques was measured; and differences in mass, volume, and cost of equipment between the 3 techniques were quantified. RESULTS: Cold technique was found to produce the least waste and have the lowest cost attributable to disposable surgical equipment. Projected single-case savings in mass and volume of waste resulting from using cold technique compared to ME were 1.272 kg and 1.013 L, respectively, and 1.043 kg and 1.723 L compared to coblation. Projected single-case savings in cost of disposable equipment for cold technique compared to ME were US$9.35 and US$185.05 compared to coblation. DISCUSSION: Using cold technique for adult tonsillectomy reduces waste and cost of disposable equipment compared to ME and coblation. Implications for Practice: Surgeons desiring to reduce cost and waste associated with tonsillectomy surgery may consider transitioning to cold technique.

Soft contact lens wearers' compliance during the COVID-19 pandemic.

AIM: Contact lens wearers need to maintain optimal hygiene practices during the COVID-19 pandemic to minimise contact-lens complications including microbial keratitis and corneal infiltrative events. This online survey (UK and Ireland) explored contact lens wearers' compliance behaviours, attitudes and concerns during the pandemic. METHOD: The 60-item anonymous online survey was distributed during a 1-month period via Qualtrics (starting on 14/04/20). The survey captured: a) demographic information, b) type of lenses worn and compliance with lens wear and care procedures, c) adherence to recommendations and d) concerns associated with contact lens wear during the pandemic. RESULTS: Two hundred and forty seven responses were received (34.3 ±â€¯11.7 years old, 79% female). Seventy nine percent of participants reported that they were self-isolating or rigorously following social distance advice. Fifty-six percent of participants reported using their lenses less during the pandemic. Eighty-seven percent of respondents reported following the recommended 20-second rule most times/every time and 96% used soap and water during handwashing. Eleven percent of respondents admitted not following recommendations regarding disposal of lenses and 18% would not consider ceasing lens wear if unwell (with flu/cold) during the pandemic. CONCLUSION: Respondents reported wearing their contact lenses less than usual. Good compliance with handwashing was observed but soft reusable lens wearers showed a statistically significant lower compliance with lens wear and care compared to daily disposable lens wearers (p=<0.001).

COVID-19 Solutions Are Climate Solutions: Lessons From Reusable Gowns.

The COVID-19 pandemic has laid bare the inadequacy of the U.S. healthcare system to deliver timely and resilient care. According to the American Hospital Association, the pandemic has created a $202 billion loss across the healthcare industry, forcing health care systems to lay off workers and making hospitals scramble to minimize supply chain costs. However, as the demand for personal protective equipment (PPE) grows, hospitals have sacrificed sustainable solutions for disposable options that, although convenient, will exacerbate supply strains, financial burden, and waste. We advocate for reusable gowns as a means to lower health care costs, address climate change, and improve resilience while preserving the safety of health care workers. Reusable gowns' polyester material provides comparable capacity to reduce microbial cross-transmission and liquid penetration. In addition, previous hospitals have reported a 50% cost reduction in gown expenditures after adopting reusable gowns; given the current 2000% price increase in isolation gowns during COVID-19, reusable gown use will build both healthcare resilience and security from price fluctuations. Finally, with the United States' medical waste stream worsening, reusable isolation gowns show promising reductions in energy and water use, solid waste, and carbon footprint. The gowns are shown to withstand laundering 75-100 times in contrast to the single-use disposable gown. The circumstances of the pandemic forewarn the need to shift our single-use PPE practices to standardized reusable applications. Ultimately, sustainable forms of protective equipment can help us prepare for future crises that challenge the resilience of the healthcare system.

Economic and Environmental Impact of Single-use Plastics at a Large Ophthalmology Outpatient Service.

PRéCIS:: The use of disposable tonometer prisms and gonioscopy lenses at a large ophthalmology outpatient service incurs significant financial and environmental waste that may not be justified given the limited data surrounding arguments for their use. PURPOSE: To quantify the economic and environmental burden of single-use plastics from an ophthalmology outpatient service at a large tertiary hospital and describe the relative value and evidence for the safety of disposable versus nondisposable tonometer prisms and gonioscopy lenses. METHODS: The total number of single-use applanation tonometer prisms and gonioscopy lenses used per year at Boston Medical Center (BMC) was estimated, and the average dollars spent and plastic waste generated in kilograms per year were then determined. These values were compared with the total spending and waste that would be produced if the clinic were to use nondisposable tonometer prisms and gonioscopy lenses exclusively. RESULTS: Single-use tonometer prisms cost an average of $70,282 per year and produce ~100.8 kg of plastic waste per year at BMC. Single-use gonioscopy lenses cost ~$9,040 per year and produce 8.8 kg of plastic waste per year at BMC. An excess of $65,185 and 109.6 kg of plastic waste could be avoided each year by only using nondisposable tonometer prisms and gonioscopy lenses at the BMC ophthalmology outpatient service. CONCLUSIONS: Single-use plastics in ophthalmology outpatient services generate significant environmental waste and financial cost compared with nondisposable instruments. This cost may outweigh the benefits of these instruments given the limited data surrounding arguments for their use.

Assessing the Burden of Packaging and Recyclability of Single-Use Products in Interventional Radiology.

PURPOSE: With a shift to single-use products in interventional radiology (IR) centres for sterility and cost reasons, it is prudent to consider the burden of packaging and employ efforts to assess and reduce waste, as well as promote recycling wherever possible. This study aimed to quantify the amount of waste in IR packaging and what proportion is recyclable. MATERIALS AND METHODS: A range of IR products were weighed using mass scales. Products were assessed for total weight, overall waste, and potentially recyclable waste. Waste was defined as any packaging which was not considered vital to the product to perform its duty and thus was for packaging or shipping purposes. Products were pooled into one of the following categories: catheters and sheaths, wires, needles, devices, coils, and packs/ancillary. RESULTS: Seventy-two different products were collected from 26 manufacturers to represent a range of items. The weight of all products was 12,466 g (median 51, range 2-1600), and weight of waste was 6830.7 g (median 34, range 1.1-732). The weight of recyclable waste was 5202.2 g (median 11.5, range 0-701). There were median 2 waste packages per item (range 1-5). The proportion of waste of the overall weight was 54.8% and of this, 76% of all waste was potentially recyclable. CONCLUSION: There is a significant burden of waste in manufactured IR products, and while a high proportion is recyclable, we encourage manufacturers of IR products and devices to consider alternative means of transport and packaging of products which will reduce the overall waste burden. LEVEL OF EVIDENCE: Level 3.

The Effect on Fit of Multiple Consecutive Donning and Doffing of N95 Filtering Facepiece Respirators.

BACKGROUND: N95 filtering facepiece respirators (FFRs) are widely used in healthcare to reduce transmission of airborne infectious diseases. These respirators are generally described as single use or limited reuse devices, but cost and operational issues mean that they may be donned and doffed multiple times. There is scant research on the effect of this practice on adequacy of fit. OBJECTIVE: The purpose of this study was to measure the effect on respirator fit of multiple donning and doffing of N95 FFRs. METHODS: This was an experiment in which 16 women and 9 men employed by the National Institute for Occupational Health (NIOH), Johannesburg, donned their same N95 FFR six times. All 25 were trained in the correct wearing of the devices before the experiment. Four models of respirators were used: the six who did not use respirators at work (novice subjects) were issued a 3M 1860 FFR and the others used their currently supplied one. During the experiment subjects donned their respirators under the supervision of the tester. Quantitative fit testing was done in the NIOH Occupational Hygiene laboratory after each donning according to the OSHA-Accepted Fit Test Protocol using the TSI PortaCount Pro+ Model 8038 Respirator Fit Tester. During the test, fit was measured after each of seven exercises and then an overall fit factor was computed. Only individuals who achieved an initial overall fit factor of ≥100 were allowed to continue participation in the study. Median overall fit factors were calculated for the 25 subjects for each donning and changes across them was examined using Wilcoxon rank sum tests. Men and women and frequent and infrequent users were compared across the six tests. Infrequent use was defined as subjects who wore respirators ≤ once per week, and novice subjects. RESULTS: Two subjects (8%) had an overall fit factor <100 at fit Test 2, 6 (24%) at Test 3, and 8 (32%) at Tests 4, 5, and 6. Thirteen respirator users (52%) achieved ≥100 throughout the fit testing, so 12 had at least one failure at either Tests 2-6. Five of the 12 subjects with at least one failure showed persistent failures on all subsequent donnings. Six subjects out of 12 (50%) who failed a fit test achieved an overall fit factor >100 at a subsequent test. There was a significant difference between the median first and sixth overall fit factors (195 versus 150; P = 0.0271), but not between the second and sixth (161 versus 150; P = 0.3584). Men and women had similar overall fit factors, but infrequent users had larger average overall fit factors than frequent users after all six donnings. CONCLUSION: Forty-eight percent of study subjects failed at least one fit test after re-donning an N95 FFR. The fit test data suggest that donning practices probably accounted for the fit test failures. The 50% of subjects who produced overall fit factors ≥100 after a test of <100 supports this contention.

[Reduced climate impact by resource-efficient surgeries]. / Resurssmarta operationer för lägre klimatpåverkan - Projekt i Västra Götalandsregionen minskade avfallet samtidigt som arbetet blev effektivare.

The Västra Götaland region carried out a project to develop resource-efficient surgeries using standardized hip prosthesis surgery as case. The purpose was to reduce and streamline the use of consumables and thus reduce the climate impact. At the surgery departments of three hospitals, significant variations were found in the supply and use of consumables during operations for total hip replacement (5.0-6.6 kg dry weight/operation). The major part of disposables consisted of surgery textiles, and choosing fossil-free products has the beneficial impact on a carbon footprint. Customized surgical procedure trays significantly reduce the number of packages and result in reduced work load for the staff. However, since there is a long term trend to increase the use of consumables in such sets, there is a need of continuous monitoring of such choices. In summary, a critical review of routines for care and use of materials is a powerful tool for streamlining healthcare and reducing its climate impact.

Reprocessing Single-Use Devices in the Ambulatory Surgery Environment.

Reprocessing single-use surgical supplies and devices is an option for hospitals and ambulatory surgery centers (ASCs). The US Federal Government has recognized the practice since 2000, and regulatory oversight has increased dramatically since that time. Reprocessing single-use devices is safe when personnel use approved methods, and health care facilities can experience significant cost savings by participating in this type of initiative. This article explores reprocessing and its benefits in ASCs, including a review of the oversight that the US Food and Drug Administration currently has for reprocessing and a discussion of the results of studies pertaining to this practice. The article also describes some issues that ASC leaders need to be aware of when considering the implementation of a reprocessing program. Single-use device reprocessing can be an effective tool for ASC leaders to conserve and manage resources.

A study of contact lens compliance in a non-clinical setting.

PURPOSE: To evaluate soft contact lens replacement, overnight (ON) wear, and contact lens case compliance in a non-clinical sample. METHODS: Subjects (n = 297) were recruited at the Center for Science and Industry (COSI) in Columbus, Ohio. Adult (≥ 18 years) soft contact lens wearers completed a survey about contact lens replacement, ON contact lens wear, and contact lens case replacement habits. RESULTS: Two-week replacement lenses (according to the manufacturer's replacement schedule [MRS]) were most common (45.5%), followed by monthly (34.3%) and daily replacement (20.2%). Non-compliance with replacement schedule was reported in 38.7% of subjects. Age (p = 0.02), years of lens wear (p = 0.02), and MRS (p <0.0001) affected replacement compliance. Post-hoc analysis showed daily replacement wearers were more compliant than two-week (p <0.0001) and monthly (p <0.0001) replacement wearers with prescribed lens replacement. Non-compliance with prescribed ON wear was reported in 23.9% of subjects. Subjects who were non-compliant with lens replacement were more likely to be non-compliant with ON wear (p = 0.02) and had worn contact lenses for less time (p = 0.02). Of the subjects who used contact lens cases, 74.6% were unsure when they should replace their case. Frequency of case replacement was not associated with age (p = 0.5), gender (p = 0.5), years of contact lens wear (p = 0.7), MRS (p = 0.4), replacement compliance (p = 0.3), or ON wear compliance (p = 0.7). CONCLUSIONS: Daily replacement wearers were most likely to be compliant with contact lens replacement, but all subjects, including daily replacement wearers, had similar ON wear non-compliance. Non-compliant lens replacement was associated with non-compliant ON wear, but contact lens case replacement was not related to either compliance category. The majority of subjects had no knowledge of proper contact lens case replacement, despite compliance in other categories.

Bladder management practices in spinal cord injury patients: A single center experience from a developing country.

Context/Objective: Inadequate bladder management in spinal cord injury (SCI) patients results in significant morbidity and even mortality. Clean intermittent catheterization (CIC) is the recommended option for SCI patients. The objective of the study was to document the bladder management practices of SCI patients in a developing country.Design: Questionnaire based cross sectional surveySetting: Armed Forces Institute of Rehabilitation Medicine, Rawalpindi, PakistanParticipants: All patients with SCI (irrespective of duration, level and etiology)Interventions: Data documentation included demographics, level, severity and time since injury, bladder management techniques used, details of CIC, results of Urodynamic studies (if available), complications resulting from bladder management technique and patient awareness of the yearly follow up. SPSS V 20 was used for analysis.Outcome Measures: Not applicableResults: Thirty four consenting patients were enrolled. All were males. Mean age was 31.24 ± 10.9. Most (17) of the patients were thoracic level paraplegics, while 12 patients had sustained a cervical SCI. Majority (23) had complete injury (ASIA A). Fifteen patients used CIC for bladder management followed by in dwelling Foley catheters in thirteen patients. Those using CIC performed the procedure every four hours and used disposable catheters. The same 'disposable' catheter was used for 5-7 days by half of these patients. Only Six patients independently performed CIC. Three patients on CIC reported urinary tract infection.Conclusions: In the largest spinal rehabilitation unit of a developing country; Pakistan CIC was the preferred method of bladder management followed by indwelling catheter. Re-use of disposable catheters is a common practice due to cost issues. The rate of UTI was significantly lower in patients on CIC.

Source of Education, Source of Care, Access to Glucometers, and Independent Correlates of Diabetes Knowledge in Ethiopian Adults with Diabetes.

BACKGROUND: Knowledge, self-care and access to diabetes-related resources is critical to diabetes management. However, there is paucity of data on source of education, source of care, and access to diabetes-related resources in the developing world, including Ethiopia. OBJECTIVE: To examine source of education, source of care, access to diabetes-related resources, and correlates of diabetes knowledge in a random sample of adults with diabetes in Ethiopia. METHODS: A sample of 337 subjects was selected using systematic random sampling. Validated questionnaires were used to obtain data on source of education, source of care, access to diabetes-related resources, and diabetes knowledge. Multiple logistic and linear models were used to assess independent correlates of owning a glucometer and good diabetes knowledge. RESULTS: Response rate was 91.1%. Correlates of access to glucometer were being ≥55 years of age (OR = 2.6 95% CI 1.0 to 6.73), having high school (OR = 3.5; 95% CI: 1.17 to 10.41) and college education (OR = 5.2; 95% CI: 1.67 to 16.27), higher income (OR = 3.3; 95% CI: 1.19 to 9.19), and receiving DM care in private hospital/clinics (OR = 9.4; 95% CI: 2.24 to 39.31). Independent correlates of poor diabetes knowledge were being age 40-54, being single, lack of education, lower monthly income (0-499 birr or $0 - $18.11), getting DM care from public hospitals, treatment with oral medications, and not owning a glucometer. CONCLUSIONS: This study provides new insights on source of education, source of care, access to diabetes-related resources (e.g. glucometers, test strips), and correlates of diabetes knowledge in developing countries like Ethiopia that are experiencing an increasing prevalence of diabetes.

Operating Room Waste Reduction.

One-fourth of all operating room (OR) waste is attributed to anesthesia-related material. The goal of this project was to reduce the waste and increase cost savings of opened and unused endotracheal (ET) tubes and disposable laryngoscope handles and blades in 2 separate OR environments. The production of these unused anesthesia supplies was assessed weekly in each of 2 OR environments for 8 weeks before an educational intervention, and for 8 weeks following the intervention. The average weekly waste production was summarized for each study period, compared between periods (preintervention vs postintervention), and analyzed per 100 surgeries using the 2-sample t test. The overall average weekly waste for ET tubes was significantly reduced from 26.7 ± 10.7 to 10.0 ± 6.1 from pre to post intervention (P = < .001), representing a 62.6% reduction. A similar significant reduction in waste was observed for laryngoscope handles (15.9 ± 8.1 vs 7.2 ± 3.1; P = .004; a 54.7% reduction) and laryngoscope blades (21.5 ± 11.0 vs 9.9 ± 4.4; P = .004; a 54.0% reduction). These results highlight the significance and feasibility of an educational intervention in reducing the environmental and economic waste produced by anesthetic practices in the OR.