Conception and validation of a protocol for reuse of non-irrigated electrophysiology catheters in a Brazilian teaching hospital.

PURPOSE: Since the Brazilian current legislation permits the reuse of single-use devices under a validated processing protocol, the main purpose of our study was to develop and validate a method for reusing non-irrigated electrophysiology catheter (EC). METHODS: Manual and mechanical processing by ultrasonic washer was associated with the use of enzymatic solution and hydrogen peroxide with a final rinse with filtered water. Validation of the cleaning process, as well as catheter integrity, was done by observing the ECs in stereoscopic microscope at ×60 magnification, followed by HemoCheck-S® (HCS) test to monitor the presence of residual blood on their surfaces. Ethylene oxide (EO) was used for sterilization, and the final validations of the processing were performed by assays of sterility, pyrogenicity, and EO residuals. Lastly, a cost-minimization study was performed. RESULTS: Cleaning process demonstrated absence of organic material detectable by HCS at the surfaces of the ECs. Assays for sterility were negative, and assays of EO residuals and endotoxins showed levels under established standards. The number of reuses was settled to a maximum of seven uses for the ECs with handle and ten uses for ECS without handle. The cost-minimization study showed an 84% savings, when considering seven reuses. CONCLUSIONS: Processing of ECs was validated at all stages. Therefore, reuse of ECs under the conditions that we designed was considered safe for patients and cost-effective for our institution.

A Comparison of Interventional Approaches for Increasing Power Take-off Shielding on New York Farms.

OBJECTIVE: Power take-off (PTO) driveline entanglements are a primary source of injury on US farms. As with many farm injury concerns, hazard control technology is widely available for mitigating the risk of these entanglements. Despite the availability of hazard control technology, PTO shields are damaged or missing on approximately 57% of PTO driveline implements in New York. Given the catastrophic nature of entanglements and the ready access to safety technology, a better understanding of what motivates farmers to install or replace PTO shields is warranted. METHODS: To examine this question, agricultural health and safety researchers in New York State conducted an initial comparison of PTO shield sales on farms receiving one of three different interventional approaches. These included PTO shield audits, a social marketing campaign, and on-farm safety services. PTO shield purchases were tracked from January 2011 through June 2016 on farms receiving these interventions and on other farms that were not exposed to interventional strategies. RESULTS: Results indicate that a significantly higher number of PTO shields were purchased on farms that requested and received on-farm safety services versus farms that were exposed to PTO shield audits, the social marketing campaign, or the control group. PTO shield sales were slightly elevated on farms receiving driveline audits, as compared with control farms (although these differences were not significant). CONCLUSIONS: No marked differences in sales were noted between control farms and farms exposed to the social marketing campaign. Only one of the three interventional strategies (on-farm safety services) approached the number of PTO shield sales necessary to prevent an entanglement.

A case study of machinery maintenance protocols and procedures within the UK utilities sector.

Failure to conduct periodic fixed-time-to (or scheduled) maintenance on off-highway plant and equipment represents a significant health and safety hazard and major litigation risk for utility contractors completing service excavation and reinstatement works on public highways. Mini-excavators are a ubiquitous mobile plant item used for such tasks and have recently been responsible for several major injuries and fatalities involving workers and members of the public in the United Kingdom (UK). The research utilises the method of triangulation to examine the maintenance practices of utility contractors in the UK. Findings from the research reveal that a combination of prevailing market forces and internal 'company' pressures have inadvertently removed knowledgeable and trained operators, site foremen and managerial supervisors from hands-on maintenance inspections. Rather, 'virtual' maintenance protocols and procedures are adopted by head office but rarely fully implemented on-site. The research concludes with pragmatic recommendations and direction for future research.

A Demonstration Project in New York and Virginia: Retrofitting Cost-Effective Roll-over Protective Structures (CROPS) on Tractors.

The NIOSH cost-effective roll-over protective structure (CROPS) demonstration project sought to determine whether three prototype roll-over protective structures (ROPS) designed to be retrofitted on Ford 8N, Ford 3000, Ford 4000, and Massey Ferguson 135 tractors could be installed in the field and whether they would be acceptable by the intended end users (farmers). There were a total of 50 CROPS. demonstrators (25 in New York and 25 in Virginia), with 45 observers attending the New York CROPS demonstrations and 36 observers attending the Virginia CROPS demonstrations, for a total of 70 participants in New York and 61 in Virginia. The oldest retrofitted tractors were 77 to 62 years old, while the newest retrofitted tractors were 40 to 37 years old. The most frequently retrofitted tractor in the CROPS demonstration project was a Ford 3000 series tractor (n = 19; 38%), followed by Ford 4000 (n = 11; 22%), Massey Ferguson 135 (n = 11; 22%), and Ford 8N (n = 9; 18%). A major issue of CROPS retrofitting was the rear wheel fenders. The effort involved in disassembling the fenders (removing the old bolts was often faster by cutting them with a torch), modifying the fender mounting brackets, and then reinstalling the fenders with the CROPS generally required the most time. In addition, various other semi-permanent equipment attachments, such as front-end loaders, required additional time and effort to fit with the CROPS. Demonstrators were asked to rank the reasons why they had not retrofitted their tractors with ROPS until they had enrolled in the CROPS demonstration program. ROPS "cost too much" was ranked as the primary reason for participants in both states (80% for New York and 88% for Virginia). The second highest ranked reasons were "ROPS wasn't available" for Virginia (80%) and "hassle to find ROPS" for New York (69%). The third highest ranked reasons were "not enough time to find ROPS" for New York (67%) and "hassle to find ROPS" for Virginia (79%). All demonstrators and observers indicated that they were glad to have participated in the CROPS project.

Integrating Cost-effective Rollover Protective Structure Installation in High School Agricultural Mechanics: A Feasibility Study.

This study with three Appalachian county agricultural education programs examined the feasibility, effectiveness, and impact of integrating a cost-effective rollover protective structure (CROPS) project into high school agricultural mechanics classes. The project aimed to (1) reduce the exposure to tractor overturn hazards in three rural counties through the installation of CROPS on seven tractors within the Cumberland Plateau in the east region; (2) increase awareness in the targeted rural communities of cost-effective ROPS designs developed by the National Institution for Occupational Safety and Health (NIOSH) to encourage ROPS installations that decrease the costs of a retrofit; (3) test the feasibility of integration of CROPS construction and installations procedures into the required agricultural mechanics classes in these agricultural education programs; and (4) explore barriers to the implementation of this project in high school agricultural education programs. Eighty-two rural students and three agricultural educators participated in assembly and installation instruction. Data included hazard exposure demographic data, knowledge and awareness of CROPS plans, and pre-post knowledge of construction and assessment of final CROPS installation. Findings demonstrated the feasibility and utility of a CROPS education program in a professionally supervised secondary educational setting. The project promoted farm safety and awareness of availability and interest in the NIOSH Cost-effective ROPS plans. Seven CROPS were constructed and installed. New curriculum and knowledge measures also resulted from the work. Lessons learned and recommendations for a phase 2 implementation and further research are included.

Pocket-size imaging device: effectiveness for ward-based transthoracic studies.

AIMS: Pocket-size imaging devices (PSID) are now available; their potential role in a hospital environment has been investigated but still remains undefined. METHODS AND RESULTS: We evaluated the effectiveness of PSID in 92 patients referred for bedside transthoracic echocardiogram (TTE). Patients were included where there was a focused clinical question: quantification of left ventricular function (LVF); presence of regional wall motion abnormalities (RWMA); evidence of pericardial effusion, exclusion of significant valve pathology. Each patient underwent an echocardiography evaluation using PSID and TTE. In 83 patients [k = 90%, 95% CI (82.2-95.4)], it was possible to answer the clinical question by PSID examination alone. There was agreement between the findings of PSID and TTE in 86 cases [79%; k = 47%, 95% CI (12.8-82.0)], in three cases, the clinical question was not answered by both modalities. When the clinical question was focused on LVF, the agreement was excellent [k = 96%, 95% CI (95.3-97.9)], as was the agreement in the detection of RWMA [k = 94.57%, 95% CI (82.4-95.1)]. There was also good concordance in the detection of valve pathology and pericardial effusion. Using PSID, the reduction in the scanning and reporting time was 66%. The cost-effectiveness analysis produced very favourable results: with PSE, we obtained an overall cost saving per scan of 76%, compared with TTE. CONCLUSION: This study demonstrates that PSID can provide a valuable alternative to TTE in the presence of focused clinical questions and can provide an efficient way of delivering a ward-based transthoracic echo service.

Prominent barriers and motivators to installing ROPS: an analysis of survey responses from Pennsylvania and Vermont.

Tractor overturns contribute significantly to the number of work-related deaths that occur every year on U.S. farms. Although the agriculture, forestry, and fishing industries have the highest fatality rates of any industries, researchers predict that the elimination of tractor overturn fatalities could result in a noticeable reduction in the farm fatality rate. Rollover protection structures (ROPS) are 99% effective in preventing overturn fatalities. However, roughly 50% of U.S. tractors do not have a ROPS. In order to identify prominent barriers and motivators to installing ROPS, a phone survey was conducted with a random sample of farmers (n = 327) in Vermont and Pennsylvania, two states interested in developing ROPS installation programs. Results indicated that cost and perceived need were the most frequently highly rated barriers to ROPS installation in both states, while working near hills or ditches and concerns regarding liability were the most frequently highly rated motivators for installing ROPS. Additionally, older farmers identified limited use of a tractor as a highly rated barrier.

Greening radiology.

PURPOSE: Reducing energy consumption has increased in importance with rising energy prices and funding cutbacks. With the introduction of electronic medical records on the rise in all fields of medicine, there will be a large jump in the number of computers in health care. Radiologist have the unique opportunity, as technological leaders, to direct energy efficiency measures as a means of cost savings and the reduction of airborne by-products from energy production to improve patients' lives. The aim of this study was to assess the many workstations and monitors throughout the authors' department to determine their electrical consumption and cost. METHODS: Equipment was monitored using an electricity meter during both active and standby states. Cost per kilowatt-hour was calculated at $0.11, not including taxes and fees. RESULTS: Any given monitor left on 24/7 would annually consume between 49.5 and 1,399.84 kWh, costing from $5.45 to $153.98. A single workstation left on 24/7 would use 455.65 to 2,358.72 kWh, costing from $59.91 to $259.46. In aggregate, all workstations and monitors would use approximately 137,759.54 kWh, costing $15,153.55. If all equipment were shut down after an 8-hour workday, the department would consume about 32,633.64 kWh, costing $3,589.70 thereby saving 83,866.6 kWh and $9,225.33. Although computers in the remainder of the hospital may use less energy than workstations, this serves as a predictive model for potential energy consumption and cost. CONCLUSIONS: With the increasing necessity of cost savings and energy reduction, this small and simple step, implemented hospital-wide, will lead to much larger cost savings across institutions.

Re-use of explanted osteosynthesis devices: a reliable and inexpensive reprocessing protocol.

INTRODUCTION: Orthopaedic surgical treatments emphasizing immobilization using open reduction and internal fixation with osteosynthesis devices are widely accepted for their efficacy in treating complex fractures and reducing permanent musculoskeletal deformity. However, such treatments are profoundly underutilized in low- and middle-income countries (LMIC), partially due to inadequate availability of the costly osteosynthesis devices. Orthopaedic surgeons in some LMIC regularly re-use osteosynthesis devices in an effort to meet treatment demands, even though such devices typically are regulated for single-use only. The purpose of this study is to report a reprocessing protocol applied to explanted osteosynthesis devices obtained at a leading trauma care hospital. METHODS: Explanted osteosynthesis devices were identified through a Register of Explanted Orthopaedic Prostheses. Guidelines to handle ethical issues were approved by the local Ethical Committee and informed patient consent was obtained at the time of explant surgery. Primary acceptance criteria were established and applied to osteosynthesis devices explanted between 2005 and 2008. A rigorous protocol for conducting decontamination and visual inspection based on specific screening criteria was implemented using simple equipment that is readily available in LMIC. RESULTS: A total of 2050 osteosynthesis devices, including a large variety of plates, screws and staples, were reprocessed using the decontamination and inspection protocols. The acceptance rate was 66%. Estimated labour time and implementation time of the protocol to reprocess a typical osteosynthesis unit (1 plate and 5 screws) was 25 min, with an estimated fixed cost (in Italy) of €10 per unit for implementing the protocol, plus an additional €5 for final sterilization at the end-user hospital site. DISCUSSION: This study was motivated by the treatment demands encountered by orthopaedic surgeons providing medical treatment in several different LMIC and their need for access to basic osteosynthesis devices. The rigorous decontamination protocol and generalized inspection criteria proved useful for efficiently screening a large volume of devices. Given that re-used osteosynthesis devices can yield satisfactory results, this study addresses potential complications of re-used devices and valid concerns that relate to patient safety. Implementing this defined reprocessing protocol into existing re-use practises in LMIC helps to limit the risks of inadequate sterilization and structural failure without adding additional risks to patients receiving re-used devices.

Recall alerts in implantable cardioverter-defibrillator recipients: implications for patients and physicians.

BACKGROUNDS: Implantable cardioverter-defibrillator (ICD) malfunctions sometimes need recall. Despite the increasing number of device implantation, ICD recalls and advisories' impacts have been little studied. The aim of this study was to determine the rate of ICD generator advisory in our center and to examine its clinical and financial implication. METHODS: We analyzed weekly Food and Drug Administration (FDA) Enforcement Reports issued between January 2000 and December 2008 to identify all advisories involving ICD generators and leads. We performed a retrospective analysis of all implanted patients affected by an advisory in our Cardiology department. RESULTS: During the 8 years of the study period, 13 advisories were issued for generators and one for leads, leading to a total number of 278 of 1,051 (26.4%) device with recall alerts, divided into 196 generator failures and 82 lead failures. Premature generator replacement was performed in 11 patients, whereas nine patients underwent lead replacement. There was no major complications attributable to advisory device replacement, and minor complications occurred only in one patient (lead extraction failure). Recalls accounted for 593 extra outpatient visits with a mean number of 2.20 ± 2.19 per patient. The total estimated cost of the device advisories in our population was 334,528 €. CONCLUSIONS: ICD recalls and safety alerts frequently occur in ICD recipients and tend to increase in number and rate. Although potentially serious, they do not appear to be associated with substantial complications. Financial implications are important.