Overcoming limitations in the availability of swabs systems used for SARS-CoV-2 laboratory diagnostics.

The diagnosis of COVID-19 relies on the direct detection of SARS-CoV-2 RNA in respiratory specimens by RT-PCR. The pandemic spread of the disease caused an imbalance between demand and supply of materials and reagents needed for diagnostic purposes including swab sets. In a comparative effectiveness study, we conducted serial follow-up swabs in hospitalized laboratory-confirmed COVID-19 patients. We assessed the diagnostic performance of an in-house system developed according to recommendations by the US CDC. In a total of 96 serial swabs, we found significant differences in the accuracy of the different swab systems to generate a positive result in SARS-CoV-2 RT-PCR, ranging from around 50 to 80%. Of note, an in-house swab system was superior to most commercially available sets as reflected by significantly lower Ct values of viral genes. Thus, a simple combination of broadly available materials may enable diagnostic laboratories to bypass global limitations in the supply of swab sets.

Environmental Sustainability in Canadian Critical Care: A Nationwide Survey Study on Medical Waste Management.

BACKGROUND: To date, the literature surrounding healthcare sustainability has focused largely on operating rooms, energy efficiency and biohazardous waste management. Few studies have looked at the sustainability within intensive care units (ICUs). OBJECTIVE: Our study sought to capture the array of sustainability initiatives undertaken by Canadian ICUs and gain a better understanding of current practices with regard to the management of single-use equipment waste. METHODS: We conducted a nationwide e-mail survey through the Canadian Critical Care Network. RESULTS: We received responses from a total of 81 hospital sites representing all 10 Canadian provinces and approximately 28.3% of all Canadian ICUs. The vast majority of responses came from ICU managers or nursing leadership. Our study identified variable waste management practices across the country and showcased successful initiatives undertaken by Canadian ICUs toward increased environmental sustainability.

A comparison of health care worker-collected foam and polyester nasal swabs in convalescent COVID-19 patients.

Both polyester and foam nasal swabs were collected from convalescent COVID-19 patients at a single visit and stored in viral transport media (VTM), saline or dry. Sensitivity of each swab material and media combination were estimated, three by three tables were constructed to measure polyester and foam concordance, and cycle threshold (Ct) values were compared. 126 visits had polyester and foam swabs stored in viral transport media (VTM), 51 had swabs stored in saline, and 63 had a foam swab in VTM and a polyester swab stored in a dry tube. Polyester and foam swabs had an estimated sensitivity of 87.3% and 94.5% respectively in VTM, 87.5% and 93.8% respectively in saline, and 75.0% and 90.6% respectively for dry polyester and foam VTM. Polyester and foam Ct values were correlated, but polyester showed decreased performance for cases with a viral load near the detection threshold and higher Ct values on average.

Cotton-Tipped Plastic Swabs for SARS-CoV-2 RT-qPCR Diagnosis to Prevent Supply Shortages.

CDC and WHO guidelines for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) diagnosis only recommend synthetic fiber swabs for nasopharyngeal (NP) sampling. We show that cotton-tipped plastic swabs do not inhibit PCR and have equivalent performance to rayon swabs. Cotton-tipped plastic swabs are massively produced worldwide and would prevent swab supply shortages under the current high SARS-CoV-2 testing demands, particularly in developing countries.

3D-Printing to Address COVID-19 Testing Supply Shortages.

The recent SARS-CoV-2 outbreak has placed immense pressure on supply chains, including shortages in nasopharyngeal (NP) swabs. Here, we report our experience of using 3D-printing to rapidly develop and deploy custom-made NP swabs to address supply shortages at our healthcare institution.

[Application Study of Medical Consumables Supply Chain Reengineering in Hospitals Based on SPD].

The supply chain management of medical consumables in hospitals is an important guarantee for the improvement of clinical diagnosis and treatment. It requires continuous re-engineering and optimization on procurement and supplier management, costs and efficiency of daily operation. Based on the practical case of Shanghai Yueyang Integrated Traditional Chinese Medicine and Western Medicine Hospital, the study discusses the practical path and key points as well as improvement results in hospital medical consumables supply chain re-engineering via SPD model. Also, the research can provide references on medical consumables supply chain management to large and medium-size hospitals.

A Device to Predict Short-Term Healing Outcome of Chronic Wounds.

Objective: While myriads of studies have suggested that a survey of wound pH environment could indicate wound healing activities, it is not clear whether wound alkalinity can be used as a prognostic indicator of nonhealing wounds. Currently available systems cannot reliably assess the pH environment across wounds, which is the objective of this study. Approach: A disposable device, DETEC® pH, was developed and characterized on its ability to map wound alkalinity by pressing a freshly recovered wound dressing against its test surface. By comparing the wound's alkalinity and size reduction rates (∼7 days) following pH measurement, we assessed the capability of wound alkalinity to prognosticate subsequent short-term wound size reduction rates. Results: The device had high accuracy and specificity in determining the alkalinity of simulated wound fluids soaked onto wound dressing. The type of wound dressing type had an insignificant effect on its detection sensitivity. Upon testing discarded wound dressings from human patients, the device quickly determined alkaline and acidic wounds. Finally, statistical analyses of wound size reduction rates in wounds with various alkalinities confirmed that wound alkalinity has a strong influence on, at least, short-term wound healing activity. Innovation: Without directly contacting the patient, this device provides a quick assessment of wound alkalinity to prognosticate immediate and short-term wound healing activities. Conclusion: DETEC® pH may serve as a prognosis device for wound care specialists during routine wound assessment to predict wound healing progress. This information can assist the decision-making process in a clinical setting and augur well for chronic wound treatment. DETEC® pH can also be used as an aid for home health care nurses or health care providers to screen nonhealing wounds outside clinics.

Application Study of Medical Consumables Supply Chain Reengineering in Hospitals Based on SPD / 中国医疗器械杂志

The supply chain management of medical consumables in hospitals is an important guarantee for the improvement of clinical diagnosis and treatment. It requires continuous re-engineering and optimization on procurement and supplier management, costs and efficiency of daily operation. Based on the practical case of Shanghai Yueyang Integrated Traditional Chinese Medicine and Western Medicine Hospital, the study discusses the practical path and key points as well as improvement results in hospital medical consumables supply chain re-engineering via SPD model. Also, the research can provide references on medical consumables supply chain management to large and medium-size hospitals.

Source of Education, Source of Care, Access to Glucometers, and Independent Correlates of Diabetes Knowledge in Ethiopian Adults with Diabetes.

BACKGROUND: Knowledge, self-care and access to diabetes-related resources is critical to diabetes management. However, there is paucity of data on source of education, source of care, and access to diabetes-related resources in the developing world, including Ethiopia. OBJECTIVE: To examine source of education, source of care, access to diabetes-related resources, and correlates of diabetes knowledge in a random sample of adults with diabetes in Ethiopia. METHODS: A sample of 337 subjects was selected using systematic random sampling. Validated questionnaires were used to obtain data on source of education, source of care, access to diabetes-related resources, and diabetes knowledge. Multiple logistic and linear models were used to assess independent correlates of owning a glucometer and good diabetes knowledge. RESULTS: Response rate was 91.1%. Correlates of access to glucometer were being ≥55 years of age (OR = 2.6 95% CI 1.0 to 6.73), having high school (OR = 3.5; 95% CI: 1.17 to 10.41) and college education (OR = 5.2; 95% CI: 1.67 to 16.27), higher income (OR = 3.3; 95% CI: 1.19 to 9.19), and receiving DM care in private hospital/clinics (OR = 9.4; 95% CI: 2.24 to 39.31). Independent correlates of poor diabetes knowledge were being age 40-54, being single, lack of education, lower monthly income (0-499 birr or $0 - $18.11), getting DM care from public hospitals, treatment with oral medications, and not owning a glucometer. CONCLUSIONS: This study provides new insights on source of education, source of care, access to diabetes-related resources (e.g. glucometers, test strips), and correlates of diabetes knowledge in developing countries like Ethiopia that are experiencing an increasing prevalence of diabetes.

Hats Off: A Study of Different Operating Room Headgear Assessed by Environmental Quality Indicators.

BACKGROUND: The effectiveness of operating room headgear in preventing airborne contamination has been called into question. We hypothesized that bouffant style hats would be as effective in preventing bacterial and particulate contamination in the operating room compared with disposable or cloth skull caps, and bouffant style hats would have similar permeability, particle penetration, and porosity compared with skull caps. STUDY DESIGN: Disposable bouffant and skull cap hats and newly laundered cloth skull caps were tested. A mock surgical procedure was used in a dynamic operating room environment. Airborne particulate and microbial contaminants were sampled. Hat fabric was tested for permeability, particle transmission, and pore sizes. RESULTS: No significant differences were observed between disposable bouffant and disposable skull caps with regard to particle or actively sampled microbial contamination. However, when compared with disposable skull caps, disposable bouffant hats did have significantly higher microbial shed at the sterile field, as measured by passive settle plate analysis (p < 0.05). When compared with cloth skull caps, disposable bouffants yielded higher levels of 0.5 µm and 1.0 µm particles and significantly higher microbial shed detected with passive analysis. Fabric assessment determined that disposable bouffant hats had larger average and maximum pore sizes compared with cloth skull caps, and were significantly more permeable than either disposable or cloth skull caps. CONCLUSIONS: Disposable bouffant hats had greater permeability, penetration, and greater microbial shed, as assessed by passive microbial analysis compared with disposable skull caps. When compared with cloth skull caps, disposable bouffants yielded greater permeability, greater particulate contamination, and greater passive microbial shed. Disposable style bouffant hats should not be considered superior to skull caps in preventing airborne contamination in the operating room.

Physician Engagement in Improving Operative Supply Chain Efficiency Through Review of Surgeon Preference Cards.

STUDY OBJECTIVE: To reduce operative costs involved in the purchase, packing, and transport of unnecessary supplies by improving the accuracy of surgeon preference cards. STUDY DESIGN: Quality improvement study (Canadian Task Force classification II-3). SETTING: Gynecologic surgery suite of an academic medical center. PARTICIPANTS: Twenty-one specialized and generalist gynecologic surgeons. INTERVENTIONS: The preference cards of up to the 5 most frequently performed procedures per surgeon were selected. A total of 81 cards were distributed to 21 surgeons for review. Changes to the cards were communicated to the operating room charge nurse and finalized. MEASUREMENTS AND MAIN RESULTS: Fourteen surgeons returned a total of 48 reviewed cards, 39 of which had changes. A total of 109 disposable supplies were removed from these cards, at a total cost savings of $767.67. The cost per card was reduced by $16 on average for disposables alone. Three reusable instrument trays were also eliminated from the cards, resulting in savings of approximately $925 in processing costs over a 3-month period. Twenty-two items were requested by surgeons to be available on request but were not routinely placed in the room at the start of each case, at a total cost of $6,293.54. The rate of return of unused instruments to storage decreased after our intervention, from 10.1 to 9.6 instruments per case. CONCLUSIONS: Surgeon preference cards serve as the basis for economic decision making regarding the purchase, storing, packing, and transport of operative instruments and supplies. A one-time surgeon review of cards resulted in a decrease in the number of disposable and reusable instruments that must be stocked, transported, counted in the operating room, or returned, potentially translating into cost savings. Surgeon involvement in preference card management may reduce waste and provide ongoing cost savings.

Do recycled spectacles meet the refractive needs of a developing country?

PURPOSE: The aim was to compare the power of spectacles donated to a recycled spectacle program to the custom-made spectacle refractive prescriptions dispensed in a developing country. METHODS: Two hundred consecutive prescriptions were audited in an optical dispensary in Timor-Leste, a developing nation. These refractions were compared against measurements of 2,075 wearable donated spectacles. We determined how many of the 200 prescriptions could be matched to a donated spectacle measurement, how many donated spectacles could be tried for each prescription and how long it would take to find the matched spectacles. RESULTS: There were 1,854 donated spectacles identified as being suitable for comparison with the 200 refractive prescriptions. Twenty-nine out of 200 prescriptions (14.5 per cent) were matched to at least one pair of donated spectacles. CONCLUSION: Recycling all spectacles is not cost-effective in a developing country that has the ability to make custom-made spectacles and dispense ready-made spectacles.

[Application of supply chain integration management of medical consumables].

This paper introduces the background, the content, the information management system of material supply chain integration management and the consumables management process. The system helps to expand the selection of hospital supplies varieties, to reduce consumables management costs, to improve the efficiency of supplies, to ensure supplies safety, reliability and traceability.

Pilot statewide study of pediatric emergency department alignment with national guidelines.

BACKGROUND: The American Academy of Pediatrics, American College of Emergency Physicians, and Emergency Nursing Association have developed consensus guidelines for pediatric emergency department policies, procedures, supplies, and equipment. Kentucky received funding from the Health Resources and Services Administration through the Emergency Medical Services for Children program to pilot test the guidelines with the state's hospitals. In addition to providing baseline data regarding institutional alignment with the guidelines, the survey supported development of grant funding to procure missing items. METHODS: Survey administration was undertaken by staff and members of the Kentucky Board of Emergency Medical Services Emergency Medical Services for Children work group and faculty and staff of the University of Kentucky College of Public Health and the University of Louisville School of Medicine. Responses were solicited primarily online with repeated reminders and offers of assistance. RESULTS: Seventy respondents completed the survey section on supplies and equipment either online or by fax. Results identified items unavailable at 20% or more of responding facilities, primarily the smallest sizes of equipment. The survey section addressing policy and procedure received only 16 responses. CONCLUSIONS: Kentucky facilities were reasonably well equipped by national standards, but rural facilities and small hospitals did not stock the smallest equipment sizes because of low reported volume of pediatric emergency department cases. Thus, a centralized procurement process that gives them access to an adequate range of pediatric supplies and equipment would support capacity building for the care of children across the entire state. Grant proposals were received from 28 facilities in the first 3 months of funding availability.

Improved accessibility of emergency obstetrics and newborn care (EmONC) services for maternal and newborn health: a community based project.

BACKGROUND: Every year an estimated three million neonates die globally and two hundred thousand of these deaths occur in Pakistan. Majority of these neonates die in rural areas of underdeveloped countries from preventable causes (infections, complications related to low birth weight and prematurity). Similarly about three hundred thousand mother died in 2010 and Pakistan is among ten countries where sixty percent burden of these deaths is concentrated. Maternal and neonatal mortality remain to be unacceptably high in Pakistan especially in rural areas where more than half of births occur. METHOD/DESIGN: This community based cluster randomized controlled trial will evaluate the impact of an Emergency Obstetric and Newborn Care (EmONC) package in the intervention arm compared to standard of care in control arm. Perinatal and neonatal mortality are primary outcome measure for this trial. The trial will be implemented in 20 clusters (Union councils) of District Rahimyar Khan, Pakistan. The EmONC package consists of provision of maternal and neonatal health pack (clean delivery kit, emollient, chlorhexidine) for safe motherhood and newborn wellbeing and training of community level and facility based health care providers with emphasis on referral of complicated cases to nearest public health facilities and community mobilization. DISCUSSION: Even though there is substantial evidence in support of effectiveness of various health interventions for improving maternal, neonatal and child health. Reduction in perinatal and neonatal mortality remains a big challenge in resource constrained and diverse countries like Pakistan and achieving MDG 4 and 5 appears to be a distant reality. A comprehensive package of community based low cost interventions along the continuum of care tailored according to the socio cultural environment coupled with existing health force capacity building may result in improving the maternal and neonatal outcomes. The findings of this proposed community based trial will provide sufficient evidence on feasibility, acceptability and effectiveness to the policy makers for replicating and scaling up the interventions within the health system.

Reducing waste in the critical care setting.

BACKGROUND: The ICU at London Health Sciences Centre-University Hospital (LHSC-UH) is a 40-bed critical care unit that contains two separate supply rooms that carry all the essential materials necessary for patient care. However, considering the patient acuity in critical care, it is vital that this equipment is made more accessible for practitioners at the bedside. Therefore, nurse servers or bedside supply cabinets are present in each of the patient rooms. While these servers provide timely access to the supplies essential for nursing care, they are also a huge source of waste. When patients who are identified as having antibiotic-resistant organisms (AROs) are discharged, numerous unused items are discarded for infection control purposes. AIMS AND OBJECTIVES: Project objectives were to curtail waste by minimizing stocked supplies at the bedside, exploring alternative stocking options and increasing awareness of this issue with practitioners. METHODS: An interprofessional team was formed consisting of registered nurses, support service workers, environmental service workers, infection control practitioners and critical care leadership. A cost analysis of discarded supplies was undertaken, and results were communicated to all staff. Infection control practitioners developed guidelines specific to use of the nurse servers and linen supply areas. The stocking process and contents of the servers were reviewed; surplus was removed and relocated to a close central area outside patient rooms. Following agreement on new server contents, lists and photos were created and posted in each supply room. New stocking guidelines were phased in gradually and were adapted according to user feedback. RESULTS: Over a two-week period, a pilot cost analysis identified that supplies valued at $2,327.25 had been discarded from five bedsides. Future long-term cost savings will enable management to redirect such resources and therefore improve other essential care services in the ICU. CONCLUSION: Increasing awareness of wasteful stocking practices facilitated the engagement of this CQI project. New stocking practices have greatly reduced waste and increased service efficiencies while maintaining the integrity of optimal patient care.

Analysis of the environmental impact of insulin infusion sets based on loss of resources with waste.

Insulin pump therapy [continuous subcutaneous insulin infusion (CSII)] requires regular change of infusion sets every 2-3 days in order to minimize the risk of skin irritations or other adverse events. This has been discussed to be a potential burden to the environment. The purpose of this analysis was to perform an environmental assessment of insulin pump infusion sets based on loss of resources occurring during incineration of the discarded products and by means of a lifecycle concept used to weight a material in relation to its rareness on earth and its consumption. In addition to five infusion sets (Inset30, InsetII, Comfort, Quick-set, and Cleo), a patch pump (Omnipod) was also included in this analysis. The annual loss in waste of the so called "person reserve" of 3 days of catheter use was compared with daily consumption of a cup of coffee in a disposable paper cup and to a soft drink in an aluminum can. The weight-based loss in resources through waste for the infusion sets (except for Cleo) corresponded to 70-200% of the loss of resources for a coffee cup (Cleo, 320%; Omnipod, 1,821,600%) and to 1-3% of the loss from an aluminum soft drink can (Cleo, 5%; Omnipod, 31,200%). The loss or resources by use of infusion sets used in insulin pump therapy appears to be low and is similar to the burden induced by the uptake of one cup of coffee per day. The loss or resources with regular CSII is considerably lower than the loss or resources induced by patch pumps.