Perception of neonatology staff regarding the availability of equipment and supplies for the care of patients in need of nCPAP.

BACKGROUND: Respiratory distress syndrome (RDS) is Mexico's second leading cause of neonatal mortality. The 75% reduction in mortality due to RDS has been attributed to the use of nasal continuous positive airway pressure (nCPAP). A survey was conducted to determine the perception of the medical staff regarding the availability of nCPAP equipment and supplies in Mexican hospitals with neonatal intensive care units (NICUs). METHODS: We sent a survey via e-mail to several neonatologists in each state of the country, requesting only one response per hospital. We performed statistical analysis with SPSS software. RESULTS: We received 195 surveys from private (HPri) and public (HPub) hospitals with NICUs nationwide: 100% of HPri and 39% of HPub. More than 75% of the nursing and medical staff had received formal training in nCPAP in 11% of HPri and 5% of HPub. The perceived availability of CPAP equipment was 83.7% vs. 52.1%; nasal cannula supply, 75.5% vs. 36.3%; air/oxygen blender availability, 51.0% vs. 32.9%, in HPri and HPub, respectively. The observed differences were statistically significant. Significant differences were also found among healthcare institutions. CONCLUSIONS: The availability of CPAP equipment and consumables between HPub and HPri is unbalanced and is lower in public institutions. Bubble CPAP is not included essential equipment in the national catalog of instruments and equipment for public hospitals, and its request is complicated. The training of CPAP staff and the availability of bubble CPAP and supplies in public hospitals should be improved.

INTRODUCCIÓN: El síndrome de dificultad respiratoria (SDR) es la segunda causa de mortalidad neonatal en México. La reducción del 75% de la mortalidad por SDR se le ha atribuido al uso de la presión positiva nasal continua de las vías respiratorias (nCPAP). Se realizó una encuesta con el objetivo de conocer la percepción del personal médico acerca de la disponibilidad del equipo e insumos para nCPAP en hospitales de México que cuenten con unidades de cuidados intensivos neonatales (UCIN). MÉTODOS: La encuesta se envió por correo electrónico a varios neonatólogos de cada estado del país y se solicitó una sola respuesta por cada hospital. El análisis estadístico se realizó con el software SPSS. RESULTADOS: Se recibieron 195 encuestas respondidas tanto de hospitales privados (HPri) como públicos (HPub) que cuentan con UCIN a escala nacional: el 100% de HPri y el 39% de HPub. Más del 75% del personal de enfermería y médico recibió una capacitación formal en nCPAP en el 11% de HPri y el 5% de HPub. La percepción de disponibilidad de equipos de presión positiva continua de las vías respiratorias (CPAP) fue del 83.7% vs. el 52.1%; el abasto de cánulas nasales, del 75.5% vs. el 36.3%; la disponibilidad del mezclador aire/oxígeno, del 51.0 % vs. el 32.9%, en HPri y HPub, respectivamente. Las diferencias fueron estadísticamente significativas. También se encontraron diferencias significativas entre las instituciones de salud. CONCLUSIONES: La disponibilidad de equipo y material de consumo para CPAP entre HPub y HPri es desequilibrada, y es menor en las instituciones públicas. El CPAP burbuja no se encuentra incluido en el cuadro básico de equipo médico y se dificulta su solicitud. Debe mejorarse la capacitación del personal en CPAP y la disponibilidad de CPAP burbuja e insumos en los hospitales públicos.

Perception of neonatology staff regarding the availability of equipment and supplies for the care of patients in need of nCPAP / Percepción del personal de neonatología sobre la disponibilidad de equipo e insumos para la atención de pacientes con necesidad de nCPAP

Abstract Background: Respiratory distress syndrome (RDS) is Mexico's second leading cause of neonatal mortality. The 75% reduction in mortality due to RDS has been attributed to the use of nasal continuous positive airway pressure (nCPAP). A survey was conducted to determine the perception of the medical staff regarding the availability of nCPAP equipment and supplies in Mexican hospitals with neonatal intensive care units (NICUs). Methods: We sent a survey via e-mail to several neonatologists in each state of the country, requesting only one response per hospital. We performed statistical analysis with SPSS software. Results: We received 195 surveys from private (HPri) and public (HPub) hospitals with NICUs nationwide: 100% of HPri and 39% of HPub. More than 75% of the nursing and medical staff had received formal training in nCPAP in 11% of HPri and 5% of HPub. The perceived availability of CPAP equipment was 83.7% vs. 52.1%; nasal cannula supply, 75.5% vs. 36.3%; air/oxygen blender availability, 51.0% vs. 32.9%, in HPri and HPub, respectively. The observed differences were statistically significant. Significant differences were also found among healthcare institutions. Conclusions: The availability of CPAP equipment and consumables between HPub and HPri is unbalanced and is lower in public institutions. Bubble CPAP is not included essential equipment in the national catalog of instruments and equipment for public hospitals, and its request is complicated. The training of CPAP staff and the availability of bubble CPAP and supplies in public hospitals should be improved.

Resumen Introducción: El síndrome de dificultad respiratoria (SDR) es la segunda causa de mortalidad neonatal en México. La reducción del 75% de la mortalidad por SDR se le ha atribuido al uso de la presión positiva nasal continua de las vías respiratorias (nCPAP). Se realizó una encuesta con el objetivo de conocer la percepción del personal médico acerca de la disponibilidad del equipo e insumos para nCPAP en hospitales de México que cuenten con unidades de cuidados intensivos neonatales (UCIN). Métodos: La encuesta se envió por correo electrónico a varios neonatólogos de cada estado del país y se solicitó una sola respuesta por cada hospital. El análisis estadístico se realizó con el software SPSS. Resultados: Se recibieron 195 encuestas respondidas tanto de hospitales privados (HPri) como públicos (HPub) que cuentan con UCIN a escala nacional: el 100% de HPri y el 39% de HPub. Más del 75% del personal de enfermería y médico recibió una capacitación formal en nCPAP en el 11% de HPri y el 5% de HPub. La percepción de disponibilidad de equipos de presión positiva continua de las vías respiratorias (CPAP) fue del 83.7% vs. el 52.1%; el abasto de cánulas nasales, del 75.5% vs. el 36.3%; la disponibilidad del mezclador aire/oxígeno, del 51.0 % vs. el 32.9%, en HPri y HPub, respectivamente. Las diferencias fueron estadísticamente significativas. También se encontraron diferencias significativas entre las instituciones de salud. Conclusiones: La disponibilidad de equipo y material de consumo para CPAP entre HPub y HPri es desequilibrada, y es menor en las instituciones públicas. El CPAP burbuja no se encuentra incluido en el cuadro básico de equipo médico y se dificulta su solicitud. Debe mejorarse la capacitación del personal en CPAP y la disponibilidad de CPAP burbuja e insumos en los hospitales públicos.

Titration of Parameters in Shared Ventilation With a Portable Ventilator.

BACKGROUND: Dual-patient, single-ventilator protocols (ie, protocols to ventilate 2 patients with a single conventional ventilator) may be required in times of crisis. This study demonstrates a means to titrate peak inspiratory pressure (PIP), PEEP, and [Formula: see text] for test lungs ventilated via a dual-patient, single-ventilator circuit. METHODS: This prospective observational study was conducted using a ventilator connected to 2 test lungs. Changes in PIP, PEEP, and [Formula: see text] were made to the experimental lung, while no changes were made to the control lung. Measurements were obtained simultaneously from each test lung. PIP was titrated using 3D-printed resistors added to the inspiratory circuit. PEEP was titrated using expiratory circuit tubing with an attached manual PEEP valve. [Formula: see text] was titrated by using a splitter added to the ventilator tubing. RESULTS: PIP, PEEP, and [Formula: see text] were reliably and incrementally titratable in the experimental lung, with some notable but manageable changes in pressure and [Formula: see text] documented in the control lung during these titrations. Similar results were measured in lungs with identical and different compliances. CONCLUSIONS: Pressures and [Formula: see text] can be reliably adjusted when utilizing a dual-patient, single-ventilator circuit with simple, low-cost modifications to the circuit. This innovation could potentially be lifesaving in a resource-limited or crisis setting. Understanding the interactions of these circuits is imperative for making their use safer.

Decontamination of stainless-steel bowls with 80% (w/v) alcohol for 30 s and 60 s: randomized experimental study / Descontaminação de bacias inoxidáveis com álcool 80% (p/v) por 30 s e 60 s: estudo experimental randomizado / Descontaminación de palanganas de acero inoxidable con alcohol al 80% (p/v) durante 30 s y 60 s: estudio experimental aleatorizado

Objective: to compare the efficacy of 80% (w/v) alcohol, rubbed for 30 and 60 seconds, in the manual processing of stainless-steel wash bowls, after cleaning with running water and neutral detergent. Method: experimental study conducted in a hospital in the state of São Paulo, Brazil, on 50 bowls randomly divided into two groups of 25 bowls each for interventions of 30 and 60 seconds of rubbing with 80% (w/v) alcohol. Results: based on the microbiological analyses collected, before and after the interventions for both groups, partial efficacy of the disinfectant was observed even when extending rubbing time. In both groups, there was a higher prevalence of survival of Pseudomonas aeruginosa, with 14 strains that were resistant to carbapenems, being, specifically, 11 to imipenem and three to meropenem. Conclusion: stainless-steel bed wash bowls decontaminated for reuse by 80% (w/v) alcohol, after cleaning with running water and neutral detergent, showed to be reservoirs of hospital pathogens. The use of bed wash bowls for patients with intact skin would not have worrying consequences, but considering those with non-intact skin and the contamination of professionals' hands, the results in this study justify the search for other decontamination methods or the adoption of disposable bed baths.

Objetivo: comparar a eficácia do álcool 80% (p/v), friccionado por 30 e 60 segundos, no processamento manual de bacias de banho em aço inoxidável, após limpeza com água corrente e detergente neutro. Método: estudo experimental realizado em hospital do estado de São Paulo, Brasil, com 50 bacias randomicamente distribuídas em dois grupos de 25, para as intervenções de 30 e 60 segundos de fricção com álcool 80% (p/v). Resultados: das análises microbiológicas coletadas, antes e após as intervenções para os dois grupos, verificou-se eficácia parcial do desinfetante, mesmo ampliando o tempo de fricção. Em ambos os grupos, observou-se maior prevalência de sobrevida de Pseudomonas aeruginosa, 14 cepas resistentes a carbapenens, especificamente, 11 ao imipenen e três ao meropenen. Conclusão: bacias de banho no leito em aço inoxidável, descontaminadas para reuso com álcool 80% (p/v), após limpeza com água corrente e detergente neutro, apresentam-se como reservatórios de patógenos hospitalares. O uso das bacias de banho no leito para pacientes com pele íntegra não teria consequências preocupantes, mas para aqueles com pele não íntegra e pensando na contaminação das mãos dos profissionais, os resultados dessa pesquisa justificam a busca de outros métodos de descontaminação ou a adoção de banho de leito descartável.

Objetivo: comparar la eficacia del alcohol al 80% (p/v), frotado durante 30 y 60 segundos, en el proceso de descontaminación manual de palanganas de baño de acero inoxidable, después de lavarlas con agua corriente y detergente neutro. Método: estudio experimental realizado en un hospital del estado de São Paulo, Brasil, con 50 palanganas divididas aleatoriamente en dos grupos de 25, para intervenciones de 30 y 60 segundos de frotamiento con alcohol al 80% (p/v). Resultados: los análisis microbiológicos recolectados, antes y después de las intervenciones para ambos grupos, demostraron efectividad parcial del desinfectante, incluso cuando se extendió el tiempo de fricción. En ambos grupos, se observó una mayor prevalencia de supervivencia de Pseudomonas aeruginosa, 14 cepas resistentes a carbapenemas, específicamente 11 a imipenem y tres a meropenem. Conclusión: las palanganas de baño de cama de acero inoxidable, descontaminadas para su reutilización con alcohol al 80% (p/v), después del lavado con agua corriente y detergente neutro, actúan como reservorios de patógenos hospitalarios. El uso de las palanganas de baño de cama no tendría consecuencias preocupantes para pacientes con la piel íntegra, pero para aquellos cuya piel no conserva su integridad y pensando en la contaminación de las manos de los profesionales, los resultados de esta investigación justifican la búsqueda de otros métodos de descontaminación o la adopción del baño de cama desechable.

Analysis of Shared Services Center Deployment at a University Hospital (CENTROMED) in Natal, Brazil: A Study on Availability and Capacity.

PURPOSE: The hospital is an organization that has its own characteristics that differentiate it from other institutions. It is characterized as a company providing services of social purpose, with a great operational complexity, due to the diversity of services provided. These organizations are dependent on technology to play the role of assisting society. Technology is onerous: it is up to the aforementioned institutions to adopt management tools to control these costs. The present study explains the process of implementing a shared service centre (CENTROMED) for the management of hospital medical equipment (HME) at the Hospital Universitário Onofre Lopes (HUOL) in the city of Natal, RN. PATIENTS AND METHODS: In order to achieve a successful implementation, four key steps were taken: process modelling; determination of key performance indicators, organization of physical arrangement; and adequate training and development of human resources. The work followed an action research approach focusing on three main methodological steps: identification of HUOL clinical engineering team's demands, definition of the process for providing the equipment service, and definition of the supply items that will be managed. RESULTS: The preliminary results of this research indicate that the centralization of the management of the HME contributed to the optimization of the processes, the reduction of the costs and the availability of the equipment, thus providing a powerful management tool to support the hospital operational management. CONCLUSION: The utilization of the shared service center for the management of hospital medical equipment is ultimately linked to the patient's well-being as it contributes to the agility in hospital procedures and provides support in maintaining the capacity of attendance of the assistance teams.

Emergency management of nursing human resources and supplies to respond to coronavirus disease 2019 epidemic.

OBJECTIVE: To introduce the emergency management of nursing human resources and supplies of a large general hospital when facing the outbreak of coronavirus disease 2019(COVID-19). METHOD: The Nursing Department of the hospital fully executed its functional authority to establish a three-level echelon of sustainable support, allocate human recourses dynamically, organize pre-service training, supervise the key working steps, formulate positive incentive methods, and deploy medical supplies scientifically. RESULT: By taking these strategies, the hospital effectively improved the coping capacity of the nursing team and played a positive role in the prevention and treatment of COVID-19. CONCLUSION: The emergency management of nursing human resources and material resources for COVID-19 of the hospital is successful. But several deficiencies were identified as well, which indicated that the hospital needs to establish an efficient emergency management system, and pay attention to the practice of nursing emergency plans to enhance coping capacities in public health emergencies.

Determinación de stock de medicamentos y productos médicos para tratamiento inicial en desastres utilizando la tecnica DELPHI en un Hospital del interior de la Provincia de Córdoba (Argentina) / Drugs and medical products stock determination for initial treatment in disaster situations using delphi technique in a hospital in the interior of the province of Cordoba (Argentina) / Determinação do estoque de medicamentos eprodutos médicos para tratamento inicial emdesastres empregando a técnica delphi em umhospital do interior da província de Córdoba (Argentina)

El objetivo de este trabajo fue determinar el stock de medicamentos y productos médicos para el tratamiento inicial de víctimas en masa en un hospital de la provincia de Córdoba (Argentina).Se utilizó la Técnica Delphi como método de consenso. Se solicitó la participación de 13 profesionales entre médicos y enfermeras del Hospital Dr. Arturo U. Illia de la ciudad de Alta Gracia, coordinados por una farmacéutica. Se realizaron 3 cuestionarios por medio de los cuales se arribó a la selección de los insumos necesarios para la atención de víctimas en masa para un plazo de 48 horas.Se determinaron dos listados finales con 25 medicamentos y 25 productos médicos, respectivamente.La utilización de esta técnica en la mencionada selección, agilizó el consenso en la toma de decisiones respecto a la inclusión de los insumos en cuestión.

The objective of this work was to determine the stock of drugs and medical products for the initial treatment of mass casualties at a hospital in the province of Córdoba (Argentina). Delphi Technique was used as the consensus method. Thirteen practitioners including physicians and nurses from Dr. Arturo U. Illia Hospital, in the city of Alta Gracia, were requested to participate, coordinated by a pharmacist. Three questionnaires were produced to come to a selection of the necessary products for mass casualty management during a 48-hour period. Two final lists were made with 25 drugs and 25 medical products, respectively. The use of this technique for the above mentioned selection accelerated consensus in decision making regarding the inclusion of the items in question

Determinación de stock de medicamentos y productos médicos para tratamiento inicial en desastres utilizando la tecnica DELPHI en un Hospital del interior de la Provincia de Córdoba (Argentina) / Drugs and medical products stock determination for initial treatment in disaster situations using delphi technique in a hospital in the interior of the province of Cordoba (Argentina) / DeterminaþÒo do estoque de medicamentos eprodutos médicos para tratamento inicial emdesastres empregando a técnica delphi em umhospital do interior da província de Córdoba (Argentina)

El objetivo de este trabajo fue determinar el stock de medicamentos y productos médicos para el tratamiento inicial de víctimas en masa en un hospital de la provincia de Córdoba (Argentina).Se utilizó la Técnica Delphi como método de consenso. Se solicitó la participación de 13 profesionales entre médicos y enfermeras del Hospital Dr. Arturo U. Illia de la ciudad de Alta Gracia, coordinados por una farmacéutica. Se realizaron 3 cuestionarios por medio de los cuales se arribó a la selección de los insumos necesarios para la atención de víctimas en masa para un plazo de 48 horas.Se determinaron dos listados finales con 25 medicamentos y 25 productos médicos, respectivamente.La utilización de esta técnica en la mencionada selección, agilizó el consenso en la toma de decisiones respecto a la inclusión de los insumos en cuestión.(AU)

The objective of this work was to determine the stock of drugs and medical products for the initial treatment of mass casualties at a hospital in the province of Córdoba (Argentina). Delphi Technique was used as the consensus method. Thirteen practitioners including physicians and nurses from Dr. Arturo U. Illia Hospital, in the city of Alta Gracia, were requested to participate, coordinated by a pharmacist. Three questionnaires were produced to come to a selection of the necessary products for mass casualty management during a 48-hour period. Two final lists were made with 25 drugs and 25 medical products, respectively. The use of this technique for the above mentioned selection accelerated consensus in decision making regarding the inclusion of the items in question(AU)