Influence of multiple reuse and resterilization cycles on the performance of a bipolar vessel sealing device (LigaSure) intended for single use.

OBJECTIVE: To determine the number of use/cleaning/resterilization cycles that can be safely applied to a vessel sealing device intended for single use (LigaSure). STUDY DESIGN: Ex vivo study. SAMPLE POPULATION: LigaSure Small Jaw handsets (n = 6) and LigaSure Impact handsets (n = 6). METHODS: Handsets underwent simulated splenectomy/cleaning/resterilization cycles until failure, defined as leaking vascular seal or blade retraction failure. Functional testing included assessment of vascular seal integrity, handset activation/tissue release, and cutting blade wear/retraction. Vascular seal failure was defined as a leak occurring at <300 mm Hg. Cycles to failure were recorded. Sealed vessels were evaluated by histology at first handset use and failure. RESULTS: Vascular seals created with the Small Jaw handset failed at a mean (95% CI) of 17.2 cycles (9.6-24.8) and a minimum of 10 cycles. Vascular seals created with the Impact failed at a mean of 20 cycles (18.4-21.6) and a minimum of 17 cycles. The majority of seal failures (73%; 95% CI 39%-94%) immediate leaked during vessel filling. The rate of vascular seal failure increased after the initial failure. Failure was associated with histologic disparities in tissue apposition. CONCLUSION: Repeated use and resterilization resulted in failure of the vascular seal due to inadequate tissue apposition after a minimum of 10 cycles. CLINICAL SIGNIFICANCE: Surgeons reusing and resterilizing LigaSure handsets (ForceTriad platform) should consider discarding handsets after 9 cycles for the Small Jaw and after 16 cycles for the Impact. Handsets should be immediately discarded after any intraoperative identification of vascular seal failure.

Evaluating Quality and Adequacy of Gastrointestinal Samples Collected using Reusable or Disposable Forceps.

BACKGROUND: Sample quality of gastrointestinal endoscopic biopsies is of paramount importance for accurate histological diagnosis. Many veterinary practices use reusable forceps as a result of perceived decreased cost. With reusable forceps, it remains unknown whether sample quality declines with repeated use and becomes inferior to single-use forceps and is therefore more or less cost effective than single-use forceps. HYPOTHESIS/OBJECTIVES: The study hypothesis was that reusable forceps sample quality would deteriorate after repeated use as compared to single-use forceps. ANIMALS: Sixty-five dogs undergoing gastrointestinal endoscopy for diagnostic investigations at the Hospital for Small Animals, Edinburgh University. METHOD: A prospective, pathologist-blinded study comparing single-use and reusable alligator standard cup biopsy forceps (Olympus 2.0 mm 1550 mm) with 5 randomized reusable forceps. Sample quality (stomach, duodenum, ileum, and colon) was assessed by a single pathologist using the WSAVA guidelines. RESULTS: There was no difference in the adequacy, depth, villi number, or crush artifact in the 4 intestinal areas between forceps type with at least 10, and up to 15, repeated uses of the reusable forceps. CONCLUSIONS AND CLINICAL IMPORTANCE: This study demonstrates that reusable cup biopsy forceps provide equivalent biopsy quality after repeated uses to single-use forceps and are cost effective at 10-case use.

Efficacy of decontamination and sterilization of a single-use single-incision laparoscopic surgery port.

OBJECTIVE: To determine the efficacy of decontamination and sterilization of a disposable port intended for use during single-incision laparoscopy. SAMPLE: 5 material samples obtained from each of 3 laparoscopic surgery ports. PROCEDURES: Ports were assigned to undergo decontamination and ethylene oxide sterilization without bacterial inoculation (negative control port), with bacterial inoculation (Staphylococcus aureus, Escherichia coli, and Mycobacterium fortuitum) and without decontamination and sterilization (positive control port), or with bacterial inoculation followed by decontamination and ethylene oxide sterilization (treated port). Each port underwent testing 5 times; during each time, a sample of the foam portion of each port was obtained and bacteriologic culture testing was performed. Bacteriologic culture scores were determined for each port sample. RESULTS: None of the treated port samples had positive bacteriologic culture results. All 5 positive control port samples had positive bacteriologic culture results. One negative control port sample had positive bacteriologic culture results; a spore-forming Bacillus sp organism was cultured from that port sample, which was thought to be an environmental contaminant. Bacteriologic culture scores for the treated port samples were significantly lower than those for the positive control port samples. Bacteriologic culture scores for the treated port samples were not significantly different from those for negative control port samples. CONCLUSIONS AND CLINICAL RELEVANCE: Results of this study indicated standard procedures for decontamination and sterilization of a single-use port intended for use during singleincision laparoscopic surgery were effective for elimination of inoculated bacteria. Reuse of this port may be safe for laparoscopic surgery of animals.

A survey of surgical draping practices in small-animal practice in the UK.

Veterinary practices in the United Kingdom were surveyed to compare their surgical draping practices with Royal College of Veterinary Surgeons (RCVS) accreditation tier and other surgery-related factors. Using descriptive statistics and logistic or ordinal regression analysis (where appropriate), the relationships between draping material and accreditation tier and other surgery-related factors were assessed. Procedures were categorised as short or long. Two hundred and sixty-nine surveys were completed. Reusable drapes were used in 66 per cent of practices. Antibiotics were administered routinely in 38 per cent of short and 93 per cent of long procedures. Practices accredited as a Veterinary Hospital (VH) were 6.3-7.2 (short and long surgeries, respectively) times more likely to use disposable drapes, when compared with non-accredited practices. Use of dedicated surgical attire, draping the whole animal/table, and routine antibiotic usage were also positively correlated with disposable drape usage. Fifty-one per cent of practices rated infection rate as most important when choosing drape material. 'Best practice' techniques are associated with lower importance given to infection rate, and higher importance given to financial cost, when choosing drape material. Disposable drape use correlates with RCVS accreditation and with other aspects of surgical technique. Importance ratings awarded correlate with best practice procedures. Clinical relevance 'Best practice' draping procedures, that are not governed by RCVS accreditation scheme, are also more frequently performed in accredited VHs.

Possible risks of transmission of bloodborne infection via acupuncture needles in Guizhou province, southwest China.

BACKGROUND: Acupuncture is in widespread use in China, a country where the prevalence of infection with hepatitis B (HBV) is high and that of other bloodborne viruses is growing. Policies to reduce iatrogenic transmission have so far focused on injections, overlooking the risks connected with acupuncture. OBJECTIVE: To assess knowledge, attitudes, and practice relevant to the potential iatrogenic transmission of bloodborne viruses in Guizhou province, southwest China. MATERIALS AND METHODS: Semi-structured interviews and focus groups were conducted (in 2005) with 80 health care workers, patients, and other key informants in health facilities at provincial, county, and village levels. RESULTS: In village clinics, reusable acupuncture needles were disinfected with alcohol rather than being sterilized, because of concerns that sterilization might blunt the needles. Sterilization of equipment by acupuncturists in the informal sector may be inadequate, but official monitoring of their practice appears not to be taking place. Acupuncturists working in hospitals are not included in formal training on bloodborne diseases and do not routinely receive HBV immunization. Some health workers lack clear understanding of asymptomatic infections. CONCLUSION: Policy on iatrogenic transmission of bloodborne viruses in China needs to place a greater emphasis on safe acupuncture, taking account of prevailing beliefs that may lead to hazardous practices, while enforcing safe procedures.

Disposable plastic rodent feeders for use in an automated filling system.

Rodent feeder devices are often made of reusable, sanitizable materials such as glass and stainless steel. As part of an initiative at the authors' facility to automate the feeder filling process, disposable plastic feeding cups were proposed as a preferable alternative to standard feeders for use in a filling machine. The authors tested and validated designs for rodent meal-type feeder assemblies that incorporated plastic cups. Assemblies included stainless steel shields that prevented rats and mice from chewing on the plastic cups while allowing them full access to food. The use of disposable feeder cups that are filled and sealed automatically reduces labor associated with sanitation, enables staff to prepare feeders for several weeks in advance and limits personnel contact with feed that may contain harmful chemicals.

A disposable vaginal speculum for the chimpanzee (Pan troglodytes).

The unanticipated underutilization of chimpanzees (Pan troglodytes) by the National Institutes of Health (NIH) for current NIH-supported research has prompted the application of a variety of contraceptive forms. Among the many methods attempted, the intrauterine device (IUD) has been described as having an efficacy similar to that described for humans. In addition, the device is both a financially sound and practical solution to prevention of overpopulation, while minimizing disruption of normal cyclic hormonal fluctuations. However, variations in the size and shape of the sexual skin of the female chimpanzee and the depth of the vaginal vault have posed physical constraints on the use of instrumentation developed for humans for assisting with insertion of the device. In addition the literature is lacking in specific methodology for pelvic examination in chimpanzees. Previously, the University of Louisiana at Lafayette New Iberia Research Center used a 3-ml plastic syringe case as a vaginal speculum to accommodate requirements of an approved research protocol in African green monkeys (Chlorocebus aethiops). Similarly, a simple and effective disposable vaginal speculum was developed for the chimpanzee. The closed tip of a plastic syringe case of appropriate size (20 to 60 ml) was removed to provide an open tube; momentary heating smoothed the cut edge. This simple speculum allowed for sufficient visualization of the cervix for assessment and assistance in the insertion of the IUD. Variously sized speculums were prepared to accommodate differences in animal size. This simple and effective speculum was clean, disposable, and inexpensive.

Use of three infusion pumps for postoperative administration of buprenorphine or morphine in dogs.

Results of using an implantable osmotic pump, a preset disposable infusion pump, or a reusable programmable infusion pump for postoperative administration of buprenorphine or morphine in dogs undergoing abdominal surgery are described. Ten dogs underwent abdominal surgery for implantation of vascular access ports. Dogs were given buprenorphine s.c. by use of an implantable osmotic pump (4 dogs), morphine s.c. by use of a preset infusion pump (4), or buprenorphine intra-arterially by use of a programmable infusion pump (2). Dogs were monitored, and serum buprenorphine or morphine concentration was measured for 72 hours after surgery; pumps were removed 48 hours after surgery. Severity of pain was determined by assigning a pain score. The preset infusion pump and the programmable infusion pump resulted in comparable pain relief and sustained serum analgesic concentrations throughout the recovery period. However, the cost of the pumps and other associated factors may limit their use to dogs undergoing invasive surgical procedures expected to result in substantial postoperative pain. The level of analgesia obtained with the implantable osmotic pumps was inconsistent.

Wound infection rates in dogs and cats after use of cotton muslin or disposable impermeable fabric as barrier material: 720 cases (1983-1989).

A retrospective study involving 720 dogs and cats that underwent a variety of elective surgical procedures was done to compare the effectiveness of reusable cotton barrier materials with that of a commercially available disposable barrier system for prevention of wound infection. The overall wound infection rate, using cotton barrier materials, was 3.1% and for disposable materials, was 4.4%. The difference between groups was not significant.