Decontaminating N95 Respirators for Reuse in a Hospital Setting.

With the global outbreak of the COVID-19 pandemic, hospitals in Canada and around the world have been forced to consider conservation strategies to ensure continued availability of personal protective equipment (PPE) for healthcare providers. To mitigate critical PPE shortages, Sinai Health System (Sinai Health), a large academic healthcare institution in Canada, has developed and operationalized a standard operating procedure for the collection, decontamination and reuse of N95 respirators and other single-use PPE using a vaporized hydrogen peroxide decontamination method. Sinai Health has incorporated stringent quality assurance steps to ensure that the N95 respirators are successfully decontaminated without deformation and are safe to use.

Safety, Feasibility, and Effectiveness of Weighted Blankets in the Care of Infants With Neonatal Abstinence Syndrome: A Crossover Randomized Controlled Trial.

BACKGROUND: Nurses are caring for increasing numbers of infants diagnosed with neonatal abstinence syndrome (NAS). The recommended initial line of treatment to alleviate NAS symptoms includes nonpharmacologic interventions; however, there is little rigorous evidence on the effectiveness of nonpharmacologic interventions. PURPOSE: The purpose of this study was to assess the safety, feasibility, and effectiveness of weighted blankets in the care of NAS infants. METHODS: This pilot study was a crossover randomized nonblinded controlled trial conducted at a level III neonatal intensive care unit. Infants' care included 30-minute sessions utilizing either a nonweighted or weighted blanket, with infants serving as their own controls. RESULTS: A total of 16 patients were enrolled for a total of 67 weighted blanket sessions. To address safety, no adverse events were observed, the weighted blankets were never removed due to infant distress, and infants experienced no significant temperature change. To address feasibility, 94% of approached mothers were receptive to the use of weighted blankets and staff reported no obstacles to using the blanket. Finally, to assess effectiveness, there was a significant decrease in the infant's heart rate and Finnegan score when a weighted blanket was used. There was no significant change in respiratory rate with the use of a weighted blanket. IMPLICATIONS FOR PRACTICE: Weighted blankets may be safe, feasible, and effective in decreasing NAS symptoms. IMPLICATIONS FOR RESEARCH: Larger studies are needed to thoroughly study the use of weighted blankets in this population and examine additional outcomes, such as need for pharmacologic intervention, length of hospital stay, and cost of hospital stay.

Bioaerosol concentrations generated from toilet flushing in a hospital-based patient care setting.

Background: In the United States, 1.7 million immunocompromised patients contract a healthcare-associated infection, annually. These infections increase morbidity, mortality and costs of care. A relatively unexplored route of transmission is the generation of bioaerosols during patient care. Transmission of pathogenic microorganisms may result from inhalation or surface contamination of bioaerosols. The toilet flushing of patient fecal waste may be a source of bioaerosols. To date, no study has investigated bioaerosol concentrations from flushing fecal wastes during patient care. Methods: Particle and bioaerosol concentrations were measured in hospital bathrooms across three sampling conditions; no waste no flush, no waste with flush, and fecal waste with flush. Particle and bioaerosol concentrations were measured with a particle counter bioaerosol sampler both before after a toilet flushing event at distances of 0.15, 0.5, and 1 m from the toilet for 5, 10, 15 min. Results: Particle concentrations measured before and after the flush were found to be significantly different (0.3-10 µm). Bioaerosol concentrations when flushing fecal waste were found to be significantly greater than background concentrations (p-value = 0.005). However, the bioaerosol concentrations were not different across time (p-value = 0.977) or distance (p-value = 0.911) from the toilet, suggesting that aerosols generated may remain for longer than 30 min post flush. Toilets produce aerosol particles when flushed, with the majority of the particles being 0.3 µm in diameter. The particles aerosolized include microorganisms remaining from previous use or from fecal wastes. Differences in bioaerosol concentrations across conditions also suggest that toilet flushing is a source of bioaerosols that may result in transmission of pathogenic microorganisms. Conclusions: This study is the first to quantify particles and bioaerosols produced from flushing a hospital toilet during routine patient care. Future studies are needed targeting pathogens associated with gastrointestinal illness and evaluating aerosol exposure reduction interventions.

Quantitative assessment of interactions between hospitalized patients and portable medical equipment and other fomites.

In an observational study, we demonstrated that hospitalized patients frequently had direct or indirect interactions with medical equipment and other fomites that are shared among patients, and these items were often contaminated with health care-associated pathogens. There is a need for protocols to ensure routine cleaning of shared portable equipment.

Eventos adversos relacionados ao uso de equipamentos e materiais na assistência de enfermagem a pacientes hospitalizados / Adverse events related to the use of equipment and materials in nursing care to hospitalized patients

O uso de equipamentos e materiais na assistência à saúde contribui para a segurança do paciente e para o bom desempenho dos profissionais, porém não se pode desconsiderar o potencial de riscos trazido pela utilização destes e a possibilidade de ocorrências de eventos adversos (EA). O objetivo geral dessa investigação foi analisar o uso de equipamentos e materiais na assistência de enfermagem e sua relação com a ocorrência de EA. Trata-se de um estudo quantitativo, descritivo, com delineamento de pesquisa não-experimental, dividido em três etapas: 1ª) Revisão integrativa da literatura com busca nas bases de dados PubMed, CINAHL e LILACS; 2ª) Consulta às fichas informatizadas de notificação de EA de um hospital privado acreditado, registradas no período de 01/01/2011 a 30/06/2015, com vistas à seleção e análise dos eventos ocasionados pelo uso de equipamentos e materiais; 3ª) Elaboração, validação e aplicação de um instrumento de coleta para investigar os EA relacionados aos equipamentos e materiais e as estratégias utilizadas para propiciar o uso seguro desses dispositivos. Os principais resultados encontrados foram: 1ª) Seleção e análise de sete artigos, agrupados nas categorias: "Métodos de registro, taxas de ocorrência e tipos de EA" e "EA ocorridos no transporte de pacientes críticos" (ambos relacionados a equipamentos e materiais); 2ª) Constatado a notificação de 1.065 EA, sendo 180 (16,9% do total) relacionados ao uso de equipamentos e materiais na assistência de enfermagem: perda de sonda de alimentação (SNE, SNG, SOG e gastrostomia) (45,0%), perda de cateter venoso central (15,5%), lesão de pele (10,5%), extubação acidental (10,0%), perda de sonda vesical de demora (4,4%), erros de administração de medicamentos (bomba de infusão) (3,9%), perda de dreno (2,8%), tecnovigilância (2,8%), obstrução de cânula de traqueostomia (1,7%), perda de cateter de pressão arterial invasiva (1,7%), quedas (1,1%) e perda de cateter de analgesia (0,5%); 3ª) O instrumento foi elaborado, validado por cinco juízes e aplicado a 22 enfermeiros, apresentando as seguintes respostas: a) sobre o funcionamento inadequado ou o não funcionamento dos equipamentos, os mais citados foram bomba de infusão, cama elétrica, esfigmomanômetro, monitor multiparamêtrico, oxímetro de pulso e ventilador pulmonar mecânico; b) os EA provocados pela utilização inadequada ou incorreta de materiais foram lesão de pele, perda de sonda de alimentação, perda de cateter venoso central, perda de drenos, extubação acidental, perda de cateter de pressão arterial invasiva e perda de cateter de pressão intra-craniana; c) os EA ocorreram durante mudança de decúbito, administração de medicamentos, higiene corporal, transporte intra-hospitalar, atendimento de Urgências/Emergências e troca da fixação de cateteres e sondas; d) as estratégias preventivas prioritárias foram capacitação dos profissionais de enfermagem (na admissão e na aquisição de um novo equipamento ou material), utilização de protocolos assistenciais de enfermagem e manutenção preventiva / teste de qualidade prévio dos dispositivos. A aquisição de aparatos tecnológicos modernos se torna nula se não for acompanhada do investimento em capacitação dos profissionais de enfermagem das instituições de saúde e da preocupação em prevenir e minimizar a ocorrência de EA relacionados ao uso de equipamentos e materiais na assistência ao paciente

The use of equipment and materials in health care contributes to patient safety and to the good performance of professionals, but the potential for risks brought by the use of them and the possibility of adverse event (AE) occurrences cannot be ignored. This study aimed to analyze the use of equipment and materials in nursing care and its relationship to the AE occurrence. This is a quantitative, descriptive, non-experimental research design study, divided into three stages: 1) Integrative review with search in the databases PubMed, CINAHL and LILACS; 2) Consultation in computerized records of AE notification in an accredited private hospital, which were registered from January 1, 2011 to June 30, 2015, in order to select and to analyze events caused by the use of equipment and materials; 3) Development, validation and application of a data collection tool to investigate the AE related to equipment and materials and the strategies used to promote the safe use of these devices. The main results were: 1) Selection and analysis of seven articles, grouped into the following categories: "Registration methods, occurrence rates and types of AE" and "AE occurred in the transport of critically ill patients" (both related to equipment and materials); 2) After verifying the notification of 1,065 AE, and 180 (16.9% of the total) related to the use of equipment and materials in nursing care: feeding tube loss (SNE, SNG, SOG and gastrostomy) (45,0%), central venous catheter loss (15.5%), skin lesions (10.5%), accidental extubation (10.0%), bladder catheter loss (4.4%), medication administration errors (infusion pump) (3.9%), surgical drain loss (2.8%), technical surveillance (2.8%), tracheostomy tube obstruction (1.7%), invasive arterial pressure catheter loss (1,7%), falls (1.1%) and analgesia catheter loss (0.5%); 3) The instrument was developed, validated by five judges and applied to 22 nurses, with the following answers: a) about the improper functioning or non-functioning of equipment, the most common were infusion pump, electric bed, sphygmomanometer, multiparameter monitor , pulse oximeter and mechanical pulmonary ventilator; b) the AE caused by improper or incorrect use of materials were skin lesions, feeding tube loss, central venous catheters loss, surgical drain loss, accidental extubation, invasive arterial pressure catheter loss and intracranial pressure catheter loss; c) the EA occurred during change of decubitus, medication administration, personal hygiene, intra-hospital transport, Urgency/Emergency care and exchange of fixation of catheters and probes; d) priority preventive strategies were training of nursing professionals (on admission and in the purchase of new equipment or materials), use of nursing care protocols and preventive maintenance/quality prior testing of the devices. The acquisition of modern technological devices becomes invalid if it is not accompanied by investment in training of nursing professionals in health institutions and concerned to prevent and minimize the occurrence of adverse events related to the use of equipment and materials in patient care

[Prevention of medical device-related adverse events in hospitals: Specifying the recommendations of the German Coalition for Patient Safety (APS) for users and operators of anaesthesia equipment]. / Prävention Medizintechnik-assoziierter Risiken im Krankenhaus: Spezifizierung der APS-Empfehlungen für Anwender und Betreiber von Anästhesiegeräten.

BACKGROUND: The use and organisation of medical technology has an important role to play for patient and user safety in anaesthesia. OBJECTIVES: Specification of the recommendations of the German Coalition for Patient Safety (APS) for users and operators of anaesthesia equipment, explore opportunities and challenges for the safe use and organisation of anaesthesia devices. METHODS: We conducted a literature search in Medline/PubMed for studies dealing with the APS recommendations for the prevention of medical device-related risks in the context of anaesthesia. In addition, we performed an internet search for reports and recommendations focusing on the use and organisation of medical devices in anaesthesia. Identified studies were grouped and assigned to the recommendations. The division into users and operators was maintained. RESULTS: Instruction and training in anaesthesia machines is sometimes of minor importance. Failure to perform functional testing seems to be a common cause of critical incidents in anaesthesia. There is a potential for reporting to the federal authority. Starting points for the safe operation of anaesthetic devices can be identified, in particular, at the interface of staff, organisation, and (anaesthesia) technology. CONCLUSIONS: The APS recommendations provide valuable information on promoting the safe use of medical devices and organisation in anaesthesia. The focus will be on risks relating to the application as well as on principles and materials for the safe operation of anaesthesia equipment.

[HEALTH INCIDENT MANAGEMENT MATERIAL]. / Gestión de incidencias de material sanitario. COMISIÓN DE RECURSOS MATERIALES. HOSPITAL CLÍNIC (BARCELONA).

INTRODUCTION: The problems encountered with medical device increase patient morbidity, affect safety professionals and in crease health spending. The Material Resources Committee a the Hospital Clinic of Barcelona decided to understand the im plications associated with these products through a system o incident reporting from October2011 to June2013. METHODOLOGY: A descriptive retrospective study. No probabi listic statements consecutive occurrences sampling. Variable studied: type of material, type and time resolution and degre, of impact. For statistical analysis SPSS version 20 software wa used. RESULTS: 103 incident statements of 68 items, of which 83.8% were medical supplies and 16.2% for non-health were collected. The medical supplies impacted more frequently and severely in patients compared to non-health (p = 0.026). According to the family of the material, the incidents were related: 30.9%, to "infusión"; 17.6 %, to "cover material"; 13.2 %, to "cures" and 11.8 %, to "ventilation". Families of infusion and ventilation items got more serious problems in patients (p = 0.001). Incidences sanitary items were resolved in an average of 18.0 ± 28.0 days and non-health at an average of 8 4 ± 6.6 days (p = 0.03). CONCLUSIONS: The medical equipment is the one with most incidents, severely impacting on patient safety. These incidents ar resolved over a long period of time that could be imoroved.

Reuso y sustitución del material y equipo desechable de inhaloterapia / Reuse and replacement of disposable materials and equipment for inhalotherapy", "_i": "

Los profesionales de la salud utilizan diariamente para el cuidado de las personas enfermas diversos artefactos llamados dispositivos médicos, que generalmente son de un solo uso; sin embargo, el aumento de los costos en salud, la necesidad de reducir los gastos en la adquisición de dispositivos médicos, el pago del procesamiento de residuos hospitalarios y el cuidado del medio ambiente, son factores que han llevado a una práctica de reuso en el material rotulado como desechable; para ello se debe contar con disposición técnica, personal capacitado, características físicas y funcionales del área de reprocesamiento, procesos normatizados y validados, controles estrictos de seguridad que garanticen la funcionalidad e integridad de los dispositivos médicos, que eliminen el riesgo de infecciones o de reacciones endotóxicas; así mismo, que avalen la seguridad del personal, todo esto bajo un marco legal y ético. Uno de los principales problemas que se enfrenta con el reuso de los dispositivos médicos es la falta de estándares centrados en el proceso que nos direccione a conocer ¿cómo? y ¿cuántas? veces es viable realizarlo, por lo que los esfuerzos deben encaminarse a desarrollar estrategias de mejora para promover la estandarización del proceso y mantener un estricto control del número de reusos y con ello garantizar la integridad y esterilidad del material. La presente información se sustenta con el análisis de riesgos y validación del proceso de limpieza, desinfección y esterilización que requieren los dispositivos desechables reusados en el servicio de inhaloterapia.

Health professionals use every day to care for sick persons, several artifacts called medical devices, which are generally single use; however, rising health costs, the need to reduce costs in the acquisition of medical devices, payment for processing medical waste and environmental care, are factors that have led to the practice of reuse in the material labeled as disposable; to do this, there must be technical provisions, trained personnel, physical and functional characteristics in the reprocessing area, normed and validated processes, strict safety controls to guarantee the functionality and integrity of the medical devices, that eliminate the risk of infections or endotoxic reactions; while supporting the safety of staff, all this under a legal and ethical framework. One of the main problems that faces the reuse of medical devices is the lack of standards focused on the process that addresses us to know how and how many times it is feasible to reuse them, so efforts should be directed towards developing improvement strategies to promote standardization of the process and maintain strict control on the number of reuses and thereby ensure the integrity and sterility of the material. This information is supported with risk analysis and validation of the cleaning, disinfection and sterilization processes required by the reused disposable inhalation therapy devices.

Nursing perception of the impact of medication carts on patient safety and ergonomics in a teaching health care center.

OBJECTIVES: In our Quebec (Canada) University Hospital Center, 68 medication carts have been implemented as part of a nationally funded project on drug distribution technologies. There are limited data published about the impact of medication carts in point-of-care units. Our main objective was to assess nursing staff's perception and satisfaction of medication carts on patient safety and ergonomics. METHOD: Quantitative and qualitative cross-sectional study. Data were gathered from a printed questionnaire administered to nurses and an organized focus group composed of nurses and pharmacists. RESULTS: A total of 195 nurses completed the questionnaire. Eighty percent of the nurses agreed that medication carts made health care staff's work easier and 64% agreed that it helped to reduce medication incidents/accidents. Only 27% and 43% agreed that carts' location reduces the risk of patients' interruptions and colleagues' interruptions, respectively. A total of 17 suggestions were extracted from the focus group (n = 7 nurses; n = 3 pharmacist) and will be implemented in the next year. CONCLUSIONS: This descriptive study confirms the positive perception and satisfaction of nurses exposed to medication carts. However, interruptions are a major concern and source of dissatisfaction. The focus group has revealed many issues which will be improved.

A review of alternatives to di (2-ethylhexyl) phthalate-containing medical devices in the neonatal intensive care unit.

OBJECTIVE: To conduct an extensive literature and toxicological database review on substitute compounds and available alternative medical products to replace polyvinyl chloride (PVC) and/or di(2-ethylhexyl) phthalate (DEHP), and conduct a DEHP-medical inventory analysis at a large metropolitan neonatal intensive care unit (NICU). STUDY DESIGN: A systematic search for DEHP-free alternative products was performed using online databases. An informal audit of a large metropolitan NICU was undertaken in 2005 and 2006; 21 products were identified that could potentially contain DEHP. Availability of DEHP-free alternatives was determined through company websites and phone interviews. RESULT: Two alternative approaches are available for replacing DEHP in NICU medical products: (1) replacement by DEHP-free plasticizers; and (2) replacement of PVC entirely through the use of other polymers. Both approaches seem to provide less harmful substitutes to DEHP, but support PVC-free polymers as the preferred alternative. However, significant data gaps exist, particularly for the alternative polymers. In all, 10 out of 21 (48%) products in the NICU audit were DEHP-free; six consisted of alternative polymers and four of alternative plasticizers. Of the remaining 11 products, only three were available without DEHP at the time of the audit. CONCLUSION: Because of significant data gaps, systematic toxicological testing of DEHP-free alternatives is imperative. Continued development of alternative products is also needed.

Avaliação do ambiente eletromagnético em estabelecimentos assistenciais de saúde / Electromagnetic environment assessment in health care facilities

A crescente inserção de tecnologia eletroeletrônica em estabelecimentos assistenciais de saúde (EAS), seja como equipamentos terapêuticos, de diagnóstico ou até mesmo suporte vital, tem sido vista pela comunidade científica como a grande responsável pelo aumento dos níveis de energia eletromagnética emitidos ao ambiente hospitalar. Dessa forma, quando a energia eletromagnética presente no ambiente atinge um determinado nível crítico, fica estabelecida uma situação que é propícia ao aparecimento de dois fenômenos indesejados: a interferência eletromagnética (EMI) em equipamentos médicos, e os riscos biológicos (RBL) em seres vivos. Um importante recurso para gerenciar a compatibilidade eletromagnética e evitar o aparecimento destes fenômenos é o conhecimento das características eletromagnéticas presentes nestes ambientes. O objetivo deste trabalho é diagnosticar o comportamento eletromagnético estabelecido em ambientes de grande concentração de fontes emissoras como, por exemplo, o encontrado em centros cirúrgicos, através de uma série de medições in situ das grandezas eletromagnéticas envolvidas nestes meios (campos elétricos, campos magnéticos, ruídos conduzidos). Com base nestas medidas é realizada uma avaliação crítica de modo a comparar a situação estabelecida nos EAS e os limites de segurança preconizados por organismos competentes, tanto para EMI quanto para RBL. Como resultado desta análise, começa a existir maior discernimento quanto à real situação do ambiente eletromagnético encontrado em EAS nacionais, subsidiando informações para a definição de diretrizes mais eficientes para implementação de programas de gestão tecnológica que são direcionados às necessidades específicas destes hospitais.

Advances in technology and the increased use of electro-medical equipment (EME) to support medical procedures such as monitoring, diagnosis, therapeutic or even life support are considered as greatly responsible for the increase of electromagnetic energy within health care facilities (HCF) environments. In such circumstances, when electromagnetic energy reaches a certain critical level, a dangerous situation is established and two undesirable phenomena can take place, both electromagnetic interference (EMI) in medical equipment, and biological risks (BLR) in living beings. The knowledge of electromagneticcharacteristics shown by these environments can represent an important tool in order to promote electromagnetic compatibility and avoid the appearance of undesirable phenomena. Therefore, this work aims to diagnose the electromagnetic profile established in critical areas, such as operating rooms, through a number of “in situ” measurements concerning electromagnetic quantities present in this environment (electric field, magnetic field, conducted noise). Moreover, a critical evaluation follows in order to compare the establishedsituation within HCF and the safety levels prescribed by regulatory organizations regarding EMI and BLR. As a result of this assessment, a better understanding on the actual situation concerning the electromagnetic environment in HCF can be achieved, allowing clinical engineers to define better directives in order to implement an adequate management programs in these hospitals.

Heights of occupied patient beds: a possible risk factor for inpatient falls.

AIMS: The aim of this study was to ascertain the average height of occupied patient beds in a general medical ward and to investigate the relationship between staff working-height for patient beds, time and whether the patient was on fall precaution. BACKGROUND: The height of occupied patient beds can be an overlooked contributor to inpatient falls. Better physical design of hospital equipment such as patient beds may reduce patient falls and injuries. METHODS: This study took place in an acute medical ward of a Michigan medical center. One researcher collected all the data and used the same metric for all the measurements. Univariate analyses were performed. RESULTS: The average staff working-height measurement taken at the weekend was significantly higher than that taken on weekdays. The average height of patient beds on fall precaution was significantly higher than of those not on fall precaution. CONCLUSIONS: A higher patient/nurse ratio at weekends than on weekdays may result in fewer bedside nursing hours and nurses being less conscientious about keeping beds in the low position after treatments. In an effort to prevent high-fall-risk patients from falling, nurses may have consciously or unconsciously kept their beds in higher positions. Relevance to clinical practice. If the patient bed can be manually or automatically adjusted, nurses must lower the height of the bed to the lowest position after completing treatments or tasks. This after-procedure activity should be enforced and monitored regularly as part of a hospital's patient fall prevention programme. Low beds should be used for patients at high risk of falling. Future research should investigate patients' and staff's views on hospital equipment to provide evidence-based information for policy-makers determining the design-regulation standard for hospital bedframes.

Multiple chemical sensitivity in the clinical setting.

Multiple chemical sensitivity (MCS) is a condition in which people experience a broad array of symptoms in reaction to exposure to trace amounts of common chemicals. Symptoms are most often triggered by odors, typically affect many systems, and can range from a runny nose to difficulty breathing and heart palpitations. The cause of this condition is unclear and there is no universal consensus on how to diagnose or treat it. MCS afflicts millions of Americans, although its prevalence is difficult to establish reliably. Theories of causation include both the physical and the psychogenic. This article begins with a case study, describes the current research on MCS, and offers recommendations to guide nurses when treating these patients in the hospital.