Single-use device reuse risks.

Efforts to reduce both costs and medical waste have led many health systems to start reusing single-use medical devices (SUDs) after cleaning and sterilizing (i.e. reprocessing). There is a currently a wide range of SUD types being reused in many health systems. The objective of this paper is to provide a brief summary of risk issues associated with critical SUDs, based on a rapid review of the available literature. The specific focus is on risk issues, but includes discussion of economic and legal/ethical issues as well. The evidence in the literature regarding the safety of reuse of SUDs indicates that for certain devices (e.g. heart catheters) reuse can be safe (in terms of patient infection) and cost-effective as long as stringent reprocessing protocols are followed. However, potential risks associated with reusing SUDs are not just limited to infection of patients. There are staff and environmental risks, plus important legal, ethical, and financial issues to consider in a reuse policy. There are currently no Canadian guidelines on reuse or reprocessing SUDs, although a national Scientific Advisory Panel on Reprocessing of Medical Devices has made recommendations. Additionally, reuse of SUDs is interwoven with the issue of infection control and reprocessing procedures in general and as applied to multiple-use devices. With limited healthcare resources, there will always be a trade-off between the human resources and costs required to clean and sterilize reused devices with costs associated with purchasing and disposing of non-reused SUDs. Evaluation of complete operational pathways, especially for more expensive and commonly used SUDs, will be useful to properly determine the balance of benefits, risks, and costs under a reuse policy.

Tempo de presa, resistência à compressäo e capacidade seladora de materiais restauradores provisórios e intermediários / Setting time, compressive strength and sealing capacity of temporary and intermediary restorative materials

As pastas Lumicon, Coltosol e Provit e os cimentos IRM, FYNAL, FINEP RO21 e FINEP P foram objetos desta investigaçäo envolvendo o tempo de presa, resistência à compressäo e impermeabilizaçäo marginal. O endurecimento das pastas foi ativado por imersäo em saliva natural ou artificial. O tempo de presa, estabelecido segundo especificaçöes da ADA, ocorreu entre 180 e 720 minutos, nas pastas, e de 4 a 10 minutos, nos cimentos. A resistência à compressäo foi avaliada também conforme a ADA, impondo-se modificaçöes no preparo dos corpos de prova das pastas. A resistência destas aumentou com o tempo de ativaçäo de 24 para 168 horas; aumentou quando ativadas por saliva artificial em relaçäo à natural, principalmente no período de 24 horas (p<0,01); aumentou ainda quando manipuladas bidigitalmente antes da imersäo em saliva natural, principalmente no período de 168 horas (p<0,01)...