Eventos adversos e incidentes notificados em um centro de materiais e esterilização / Adverse events and incidents reported in a materials and sterilization center

Objetivo: Caracterizar as notificações dos incidentes e eventos adversos do Centro de Material e Esterilização (CME) de um hospital de ensino. Método: Estudo retrospectivo, documental, descritivo e quantitativo em um CME classe II, em que foram analisadas as notificações contidas no banco de dados do Núcleo do Sistema de Gestão da Qualidade e Segurança do paciente, entre 2016 e 2020. Como técnica de análise dos dados coletados, utilizou-se o diagrama de causa e efeito, e a descrição das notificações foram agrupadas conforme o diagrama de 6M: método; material; mão de obra; máquina; medida; e meio ambiente. Resultados: Entre as notificações realizadas, as variáveis matéria-prima e método foram as que mais geraram incidentes durante todo o período, representando 28,54 e 26,44%, respectivamente. Além disso, o Centro Cirúrgico foi o que mais notificou e foi notificado pelo CME. Conclusão: Foi possível conhecer os incidentes que mais predominam no CME da instuição, e as variáveis materiais e método, com o centro cirúrgico, foram as variáveis e setor que mais geraram notificações no período pesquisado (AU)

Percentual de utilização de instrumentais em procedimentos cirúrgicos / Percentage of use of instruments in surgical procedures / Porcentaje de uso de instrumentos en procedimientos quirúrgicos

Objetivo: analisar o percentual de instrumentais cirúrgicos que compõem a caixa de laparotomia exploradora e não são utilizados durante as cirurgias. Método: estudo descritivo, transversal com abordagem quantitativa, que contabilizou instrumentais constituintes da caixa de laparotomia exploradora utilizados e não utilizados durante 13 cirurgias realizadas em um período de 17 dias, em um hospital do interior paulista. Resultados: nas 13 cirurgias analisadas, obteve-se um total de 1300 (100%) pinças presentes nas caixas, onde 832 (64%) não foram utilizadas e 468 (36%) foram utilizadas. Nos tempos cirúrgicos, o maior número de uso foi de 166 (35,5%) artigos, para preensão e afastadores. Conclusão: houve 64% de instrumentais não utilizados nas cirurgias analisadas. Há necessidade de implementar estratégias gerenciais que reduzam os números encontrados e, consequentemente, reduzam gastos, para gerar menor desperdício e reduzir falhas no gerenciamento de recursos materiais.

Objective: to analyze the percentage of surgical instruments that make up the operating laparotomy box and are not used during surgeries. Method: descriptive, cross-sectional study with quantitative approach, which counted instrumental constituents of the exploratory laparotomy box used and not used during 13 surgeries performed in a period of 17 days, in a hospital in the interior of São Paulo. Results: in the 13 surgeries analyzed, a total of 1300 (100%) tweezers were obtained in the boxes, where 832 (64%) were not used and 468 (36%) were used. In surgical times, the highest number of use was 166 (35.5%) articles, for seizures and reparators. Conclusion: there were 64% of instruments not used in the analyzed surgeries. There is a need to implement management strategies that reduce the numbers found and, consequently, reduce expenses, to generate less waste and reduce failures in the management of material resources.

Objetivo: analizar el porcentaje de instrumentos quirúrgicos que componen la caja de laparotomía quirúrgica y no se utilizan durante las cirugías. Método: estudio descriptivo, transversal con enfoque cuantitativo, que contó constituyentes instrumentales de la caja de laparotomía exploratoria utilizada y no utilizada durante 13 cirugías realizadas en un período de 17 días, en un hospital del interior de São Paulo. Resultados: en las 13 cirugías analizadas, se obtuvieron un total de 1300 (100%) pinzas en las cajas, donde no se utilizaron 832 (64%) y 468 (36%). En tiempos quirúrgicos, el mayor número de uso fue de 166 (35,5%) artículos, para convulsiones y reparadores. Conclusión: hubieran 64% de instrumentos no utilizados en las quirurgias analizadas. Es necesario implementar estrategias de gestión que reduzcan los números encontrados y, en consecuencia, reduzcan los gastos, para generar menos residuos y reducir las fallas en la gestión de los recursos materiales.

Particle Filtration Efficiency Testing of Sterilization Wrap Masks.

OBJECTIVES: Non-traditional materials are used for mask construction to address personal protective equipment shortages during the coronavirus disease 2019 (COVID-19) pandemic. Reusable masks made from surgical sterilization wrap represent such an innovative approach with social media frequently referring to them as "N95 alternatives." This material was tested for particle filtration efficiency and breathability to clarify what role they might have in infection prevention and control. METHODS: A heavyweight, double layer sterilization wrap was tested when new and after 2, 4, 6, and 10 autoclave sterilizing cycles and compared with an approved N95 respirator and a surgical mask via testing procedures using a sodium chloride aerosol for N95 efficiency testing similar to 42 CFR 84.181. Pressure testing to indicate breathability was also conducted. RESULTS: The particle filtration efficiency for the sterilization wrap ranged between 58% to 66%, with similar performance when new and after sterilizing cycles. The N95 respirator and surgical mask performed at 95% and 68% respectively. Pressure drops for the sterilization wrap, N95 and surgical mask were 10.4 mmH2O, 5.9 mmH2O, and 5.1 mmH2O, respectively, well below the National Institute for Occupational Safety and Health limits of 35 mmH2O during initial inhalation and 25 mmH2O during initial exhalation. CONCLUSIONS: The sterilization wrap's particle filtration efficiency is much lower than a N95 respirator, but falls within the range of a surgical mask, with acceptable breathability. Performance testing of non-traditional mask materials is crucial to determine potential protection efficacy and for correcting misinterpretation propagated through popular media.

[Factors associated with the quality of sterilization of surgical drapes at the National Hospital University Hubert Koutoukou Maga of Cotonou]. / Facteurs associés à la qualité de la stérilisation du linge opératoire au Centre National Hospitalier Universitaire Hubert Koutoukou MAGA de Cotonou.

INTRODUCTION: The sterilization of surgical drapes plays an important role in preventing infections associated with treatments. At the CNHU-HKM, sterilization procedure for drapes encounters problems. The purpose of this study was to examine the factors associated with the quality of sterilization of surgical drapes at the CNHU-HKM. METHODS: We conducted a cross-sectional, descriptive and analytical study focusing on 20 sterile surgical drapes, 41 agents were involved in the management of drapes and 55 members of the surgical team. The probabilistic method was used for sterile surgical drapes, the non-probabilistic method for the others. Pearson's Chi-square Test and logistic regression were used to find the association, with a significant threshold and a p<0.05. RESULTS: Eighty six point forty six percent of subjects were males with an average age of 42 years. The quality of the process of sterilization of the operative drapes was not good in the two departments responsible for processing the drapes. Bacteriological analysis showed that, out of 20 sterile surgical drapes, 9 had Acinetobacter spp. a multidrug-resistant germ causing nosocomial infections. Multivariate analysis showed that professional experience (p=0.015) and quality control of the procedure (p=0.034) were statistically associated with the quality of sterilization. CONCLUSION: The presence of Acinetobacter spp. on the sterilized drapes demonstrates that sterilization of drapes at the CNHU-HKM is of poor quality. Measures strengthening the skills of providers are necessary to improve the quality of sterilization procedures.

Obstetric Violence in Mexico: Results From a 2016 National Household Survey.

Obstetric violence has not received the same amount of interest as other forms of violence against women (VAW). We assess the prevalence and factors associated with experiences of obstetric violence (obstetric abuse and violence, and nonconsensual care) among women between 15 and 49 years of age in their latest childbirth within the last 5 years by using the 2016 National Survey on Household Relationship Dynamics. (N = 24,126 women). A total of 33.3% of Mexican women experienced obstetrical violence in their last childbirth: 23.6% experienced obstetric abuse and violence and 17.1% nonconsensual care. Gender interacts with other social stratification variables. Obstetric violence is an extended practice in health care services. It is a human rights problem that must be prevented and eradicated.

Medical injection and access to sterile injection equipment in low- and middle-income countries: a meta-analysis of Demographic and Health Surveys (2010-2017).

BACKGROUND: Unsafe injection practices contribute to increased risks of blood-borne infections, including human immunodeficiency virus, hepatitis B and hepatitis C viruses. The aim of this study was to estimate the prevalence of medical injections as well as assess the level of access to sterile injection equipment by demographic factors in low- and middle-income countries (LMICs). METHODS: We carried out a meta-analysis of nationally representative Demographic and Health Surveys (DHSs) conducted between 2010 and 2017 in 39 LMICs. Random effects meta-analysis was used in estimating pooled and disaggregated prevalence. All analyses were conducted using Stata version 14 and Microsoft Excel 2016. RESULTS: The pooled 12-month prevalence estimate of medical injection was 32.4% (95% confidence interval 29.3-35.6). Pakistan, Rwanda and Myanmar had the highest prevalence of medical injection: 59.1%, 56.4% and 53.0%, respectively. Regionally, the prevalence of medical injection ranged from 13.5% in west Asia to 42.7% in south and southeast Asia. The pooled prevalence of access to sterile injection equipment was 96.5%, with Pakistan, Comoros and Afghanistan having comparatively less prevalence: 86.0%, 90.3% and 90.9%, respectively. CONCLUSIONS: Overuse of medical injection and potentially unsafe injection practices remain a considerable challenge in LMICs. To stem the tides of these challenges, national governments of LMICs need to initiate appropriate interventions, including education of stakeholders, and equity in access to quality healthcare services.

Sterilization and Biologic Monitoring in Private Dental Clinics in Lebanon.

AIM: The aim of the present study was to evaluate sterilization practices and effectiveness in the Lebanese private dental sector and identify potential factors contributing to sterilization failure. MATERIALS AND METHODS: A 13-item questionnaire consisting of four demographic/professional questions and nine questions related to sterilization practices along with self-contained biologic indicators (SCBIs) were delivered to a representative sample of Lebanese private offices. Univariate statistics and bivariate analyses were performed to compare sterilization failure rates according to demographic, professional, and sterilization-related conditions. RESULTS: Out of the 560 dentists contacted, 205 dentists returned the completed questionnaires and undamaged processed SCBIs. The tested autoclaves (n = 134) were mostly dynamic air removal (69.4%) and had a mean age of 10.5 ± 6.9 years. The dry heat ovens (n = 71) were all static air and had 12.9 ± 8.1 years. The dental assistants performed the routine sterilization procedures in nearly 62% of the practices and sterilization cycles were run 4 to 6 times per week in 75% of the offices. Correct temperature/time ratios were applied in 97% of the autoclaves and 80.3% of the ovens. Few dental practices reported having preventive maintenance (17.9% for the autoclaves and 14.1% for the ovens). Routine monitoring of sterilizer efficacy was infrequently performed and was mostly conducted using physical indicators. Sterilization failure rate was higher for the ovens (16.9%) than for the autoclaves (7.5%). Incorrect temperature/time ratio was the main significant factor associated with sterilization failures. CONCLUSION: The present study demonstrated a relatively high rate of sterilization failures in the Lebanese private dental sector and identified the human error in setting sterilization cycle parameters as the predominant cause of failure. These findings should prompt actions toward increasing knowledge of the sterilization processes and their monitoring among dental professionals and improving the quality control of sterilization through collaborative efforts among health authorities, dental schools, and associations. CLINICAL SIGNIFICANCE: This study presents the first published data relative to sterilization practices and effectiveness in private Lebanese dental offices and provides a rationale to implement biologic monitoring protocols in Lebanon as long practiced in developed countries.

How reliable are health registers? Registration of induced abortions and sterilizations in Finland.

Finland's population-based health registers are widely used in health-monitoring and research. We assessed the quality of the Finnish Register on Induced Abortions and Sterilisations and compared it to the Hospital Discharge Register. Ten hospitals out of 67 public hospitals performing induced abortions and sterilizations and three randomly selected months in 2011 were included. This data was compared to the data in the Register on Induced Abortions and Sterilisations. The sample presented 43.1% of all induced abortions and sterilizations during the study months. The coverage on data on induced abortions was excellent: 97.0% of induced abortions were found in the register. Coverage on data on sterilizations was good: 89.4% of sterilizations performed were found in the register. More detailed comparisons of the variable data showed good to very good validity. The coverage of the Hospital Discharge Register was found also to be good. The validity of Finland's Register on Induced Abortions and Sterilisations makes it a good base for research and health-monitoring. The Hospital Discharge Register was a good source in measuring volumes of hospital use as well as the main diagnoses or procedures, but the registration of single diagnoses or procedures may be less ideal for research.

Evaluation of the presence of Leishmania infantum in bone stored in glycerol or sterilized by autoclave for cortical bone grafting / Avaliação da presença de Leishmania infantum em ossos armazenados em glycerol ou esterilizados em autoclave para enxertia óssea cortical

This study was performed to evaluate the effects of autoclaving and storage in 85% glycerol on cortical bone from dogs infected with Leishmania sp. We used 42 cadavers with leishmaniasis. The dogs were evaluated for the presence of Leishmania sp. in culture of bone marrow and by culturing cortical bone. From the infected animals, we harvested 42 diaphysis of the right femur for culture of cortical bone before and after autoclaving or storage in glycerol. There was no significant difference in growth of the parasite in culture of bone marrow or cortical bone. There was no growth of Leishmania sp. in culture of samples after autoclaving or storage in glycerol. Both treatments were effective in preventing the growth of the parasite in vitro, so it was considered viable for grafting.(AU)

Este estudo teve por objetivo avaliar os efeitos da esterilização em autoclave e do armazenamento em glicerol a 85% no osso cortical de cães infectados por Leishmania sp. Foram utilizados 42 cadáveres de cães com leishmaniose. Os cães foram avaliados para a presença de Leishmania sp. em cultura de medula óssea e de osso cortical. Foram coletadas 42 diáfises do fêmur direito para cultura do osso cortical antes e após a esterilização e o armazenamento em glicerol. Não houve diferença significativa no crescimento do parasito em cultura utilizando-se medula óssea ou osso cortical. Não houve crescimento de Leishmania sp. em cultura de amostras de osso cortical após a autoclavagem ou o armazenamento em glicerol. Ambos os tratamentos foram eficazes na prevenção do crescimento do parasita in vitro, de modo que foram considerados viáveis para enxerto.(AU)

A invisibilidade do trabalho de enfermagem no Centro de Material e Esterilização / The invisibility of nursing work in the Central Sterile Supply Department

Objeto de estudo: A invisibilidade do trabalho de enfermagem no Centro de Material e Esterilização (CME). Objetivos: Descrever a percepção do profissional de enfermagem do CME acerca da invisibilidade do trabalho no Centro de Material e Esterilização; Analisar, na percepção dos trabalhadores de enfermagem de um Centro de Material e Esterilização, fatores que interferem na visibilidade do trabalho executado no CME e implicações para a sua saúde; Discutir intervenções para a construção da visibilidade do trabalho a partir das perspectivas dos trabalhadores de enfermagem do CME. Metodologia: estudo com abordagem qualitativa, descritiva, utilizando o delineamento da Pesquisa Convergente Assistencial (PCA). Realizado em um Hospital Universitário do município do Rio de Janeiro, com 52 participantes enfermeiros, técnicos em enfermagem e auxiliares de enfermagem. O projeto foi aprovado por Comitê de Ética em Pesquisa sob o número 1.514.800. Para a coleta de dados sociodemográficos, laboral e de condições de saúde, utilizou-se um questionário e, para os dados da invisibilidade do trabalho no CME, a entrevista individual e discussão em grupo. Os dados das entrevistas foram submetidos à análise de conteúdo temática. Resultados: A análise dos depoimentos resultou em seis categorias de análise: Lotação no Centro de Material e Esterilização; Valorização do trabalho realizado no Centro de Material e Esterilização; A capacitação do profissional do CME; A invisibilidade do trabalho no CME; A desconstrução da invisibilidade do trabalho no CME e O trabalho no CME e a saúde do trabalhador. Os resultados mostraram que, na percepção dos trabalhadores do CME, as limitações laborais eram motivos cruciais para a lotação, e revelaram o desconhecimento das práticas dessa unidade pelos demais profissionais do hospital e a falta de capacitação profissional como causas para a sua invisibilidade. Os agravos à saúde do trabalhador mais presentes foram DORT, LER e varizes. Os resultados também evidenciaram ações na desconstrução da invisibilidade do CME com enfoque sobre a educação permanente. Contudo, percepção e a reflexão dos participantes por si só não garantem a implementação das ações propostas pelo grupo. As propostas de ações foram definidas a curto, médio e longo prazo, com potencial para a desconstrução da invisibilidade do trabalho no CME. Nas ações em curto prazo, foram criados material informativo e um folder sobre o processo de trabalho no CME às unidades consumidoras, como forma de disseminar e contribuir para a visibilidade e a valorização do trabalho realizado. Conclusão: É importante e necessário que as ações propostas a médio e longo prazo envolvam os gestores e a Coordenação de Educação Permanente, garantindo que as intervenções sejam implementadas, pois a participação ativa na construção dos processos de trabalho possibilita o aprendizado de forma coletiva.(AU)

'Unfit for human consumption': a study of the contamination of formula milk fed to young children in East Java, Indonesia.

OBJECTIVES: To examine levels of bacterial contamination in formula feeding bottles in Sidoarjo, East Java, and to assess the preparation practices that may have been responsible. METHODS: A cross-sectional study was conducted among 92 randomly selected households with children under the age of two who were bottle-fed formula. In each household, we carried out video observation of mothers/caregivers preparing bottles, and examined samples of formula for coliform bacteria and Escherichia coli (E. coli). In-depth interviews were conducted with a subsample of 20 mothers. RESULTS: A total of 88% of the formula feeds were contaminated with total coliforms at a level >10 MPN/ml, and 45% contained E. coli. These feeds were defined as 'unfit for human consumption'. In the video observations, none of the mothers complied with all five WHO-recommended measures of hygienic formula feed preparation. Only two mothers washed their hands with soap prior to formula preparation. Most mothers also failed to clean or sterilise the bottle and clean the preparation area. In-depth interviews confirmed that such suboptimal hygiene practices were common. CONCLUSION: The high levels of contamination found highlight that bottles are an important faecal-oral exposure pathway resulting from poor hygiene practices during bottle preparation.

A Bayesian Approach to Determination of F, D, and Z Values Used in Steam Sterilization Validation.

For manufacturers of sterile drug products, steam sterilization is a common method used to provide assurance of the sterility of manufacturing equipment and products. The validation of sterilization processes is a regulatory requirement and relies upon the estimation of key resistance parameters of microorganisms. Traditional methods have relied upon point estimates for the resistance parameters. In this paper, we propose a Bayesian method for estimation of the well-known DT , z, and Fo values that are used in the development and validation of sterilization processes. A Bayesian approach allows the uncertainty about these values to be modeled using probability distributions, thereby providing a fully risk-based approach to measures of sterility assurance. An example is given using the survivor curve and fraction negative methods for estimation of resistance parameters, and we present a means by which a probabilistic conclusion can be made regarding the ability of a process to achieve a specified sterility criterion.LAY ABSTRACT: For manufacturers of sterile drug products, steam sterilization is a common method used to provide assurance of the sterility of manufacturing equipment and products. The validation of sterilization processes is a regulatory requirement and relies upon the estimation of key resistance parameters of microorganisms. Traditional methods have relied upon point estimates for the resistance parameters. In this paper, we propose a Bayesian method for estimation of the critical process parameters that are evaluated in the development and validation of sterilization processes. A Bayesian approach allows the uncertainty about these parameters to be modeled using probability distributions, thereby providing a fully risk-based approach to measures of sterility assurance. An example is given using the survivor curve and fraction negative methods for estimation of resistance parameters, and we present a means by which a probabilistic conclusion can be made regarding the ability of a process to achieve a specified sterility criterion.

Towards safe injection practices for prevention of hepatitis C transmission in South Asia: Challenges and progress.

AIM: To summarize the available information about injection use and its determinants in the South Asian region. METHODS: We searched published and unpublished literature on injection safety in South Asia published during 1995-2016 using the keywords "injection" "unsafe injection" and "immunization injection" and combined these with each of the countries and/or their respective states or provinces in South Asia. We used a standardized questionnaire to abstract the following data from the articles: the annual number of injections per capita, the proportion of injections administered with a reused syringe or needle, the distribution of injections with respect to prescribers and providers and determinants of injection use. RESULTS: Although information is very limited for certain countries (i.e., Bhutan, Maldives and Sri Lanka), healthcare injection use is very common across South Asia, with cross-country rates ranging from 2.4 to 13.6 injections/person/year. Furthermore, recent studies show that 5% to 50% of these injections are provided with reused syringes, thus creating potential to transmission of blood-borne pathogens. Qualified and unqualified practitioners, especially in the private sector, are the major drivers behind injection use, but patients also prefer injections, especially among the rural, poor or uneducated in certain countries. According to available data, Pakistan and India have recently taken steps towards achieving safe injection. Potential interventions include the introduction of reuse prevention devices, and patient-, community- and patient/community and provider-centered interventions to change population and practitioner behavior. CONCLUSION: Injection use is common in South Asian countries. Multilevel interventions aiming at patients, providers and the healthcare system are needed to reduce injection use and reuse.

Moments for hand hygiene in Material and Sterilization Center. / Momentos para higienizar as mãos em Centro de Material e Esterilização.

OBJECTIVE: to characterize the moments when there is a need for hand hygiene (HH) by employees who work in Material and Sterilization Center (MSC). METHOD: we conducted a descriptive cross-sectional study in the MSC of a large hospital, from July to November 2012, in Goiânia, state of Goiás, Brazil. Data obtained through observation of workers, following a previously evaluated and tested checklist. RESULTS: to the dirty area, standardized moments of HH were enough. In the clean area, "Extra moments with indication" for HH, resulting from the work process, such as: after disinfecting benches, after verification and inventory of consigned products, before assembling boxes/trays, before loading and unloading the autoclave, before handling and distributing health care products, among others, were necessary. CONCLUSION: the moments of HH in the dirty area coincide with indications of the clinical practice; and, in the clean area, characteristic moments of the work process were captured.

Momentos para higienizar as mãos em Centro de Material e Esterilização / Momentos para higienizar las manos en el Centro de Material y Esterilización / Moments for hand hygiene in Material and Sterilization Center

RESUMO Objetivo: caracterizar os momentos nos quais há necessidade de higienização das mãos (HM) por trabalhadores que atuam em Centro de Material e Esterilização (CME). Método: foi realizado um estudo transversal, descritivo, no CME de um hospital de grande porte, de julho a novembro de 2012, em Goiânia - GO. Dados obtidos por observação dos trabalhadores, seguindo check list, previamente avaliado e testado. Resultados: para a área suja, momentos de HM padronizados foram suficientes. Na área limpa, foram necessários "Momentos adicionais com indicação" para HM, apreendidos do processo de trabalho como: após desinfecção de bancadas, após conferência e registro de material consignado, antes de montar caixas/bandejas, antes de carregar e descarregar a autoclave, antes de manusear e distribuir os produtos para saúde, entre outros. Conclusão: os momentos de HM na área suja coincidem com indicações da prática clínica; e, na área limpa, apreenderam-se momentos característicos do processo de trabalho.

RESUMEN Objetivo: caracterizar los momentos en los cuales los trabajadores del Centro de Material y Esterilización (CME) necesitan higienizar las manos (HM). Método: se llevó a cabo un estudio transversal, descriptivo, en el CME de un hospital de gran porte, de julio hasta noviembre de 2012, en la ciudad de Goiânia, Brasil. Se obtuvieron los datos por observación de los trabajadores, siguiendo una lista de control, previamente evaluada y probada. Resultados: para el área sucia, fueron suficientes los momentos de HM estandarizados. En el área limpia fueron necesarios "Momentos adicionales con indicación" para HM, aprehendidos del proceso de trabajo: tras la desinfección de las mesas de trabajo, tras la conferencia y el registro de material consignado, antes de montar las cajas/bandejas, antes de la carga y descarga del autoclave, antes de manipular y de distribuir los productos para salud, entre otros. Conclusión: los momentos de HM en el área sucia coincidieron con las indicaciones de la práctica clínica, y en el área limpia se aprehendieron momentos característicos del proceso de trabajo.

ABSTRACT Objective: to characterize the moments when there is a need for hand hygiene (HH) by employees who work in Material and Sterilization Center (MSC). Method: we conducted a descriptive cross-sectional study in the MSC of a large hospital, from July to November 2012, in Goiânia, state of Goiás, Brazil. Data obtained through observation of workers, following a previously evaluated and tested checklist. Results: to the dirty area, standardized moments of HH were enough. In the clean area, "Extra moments with indication" for HH, resulting from the work process, such as: after disinfecting benches, after verification and inventory of consigned products, before assembling boxes/trays, before loading and unloading the autoclave, before handling and distributing health care products, among others, were necessary. Conclusion: the moments of HH in the dirty area coincide with indications of the clinical practice; and, in the clean area, characteristic moments of the work process were captured.

Declining rates of sterilization procedures in Western Australian women from 1990 to 2008: the relationship with age, hospital type, and government policy changes.

OBJECTIVE: To describe trends in age-specific incidence rates of female sterilization (FS) procedures in Western Australia and to evaluate the effects of the introduction of government-subsidized contraceptive methods and the implementation of the Australian government's baby bonus policy on FS rates. DESIGN: Population-based retrospective descriptive study. SETTING: Not applicable. PATIENT(S): All women ages 15-49 undergoing an FS procedure during the period January 1, 1990, to December 31, 2008 (n = 47,360 procedures). INTERVENTION(S): Records from statutory statewide data collections of hospitals separations and births were extracted and linked. MAIN OUTCOME MEASURE(S): Trends in FS procedures and the influence on these trends of the introduction of government policies: subsidization of long-acting reversible contraceptives (Implanon and Mirena) and the Australian baby bonus initiative. RESULT(S): The annual incidence rate of FS procedures declined from 756.9 per 100,000 women in 1990 to 155.2 per 100,000 women in 2008. Compared with the period 1990-1994, women ages 30-39 years were 47% less likely (rate ratio [RR] = 0.53; 95% confidence interval [CI], 0.39-0.72) to undergo sterilization during the period 2005-2008. Adjusting for overall trend, there were significant decreases in FS rates after government subsidization of Implanon (RR = 0.89; 95% CI, 0.82-0.97) and Mirena (RR = 0.81; 95% CI, 0.73-0.91) and the introduction of the baby bonus (RR = 0.70; 95% CI, 0.61-0.81). CONCLUSION(S): Rates of female sterilization procedures in Western Australia have declined substantially across all age groups in the last two decades. Women's decisions to undergo sterilization procedures may be influenced by government interventions that increase access to long-term reversible contraceptives or encourage childbirth.

Effect of two viscosity models on lethality estimation in sterilization of liquid canned foods.

A numerical study on 2D natural convection in cylindrical cavities during the sterilization of liquid foods was performed. The mathematical model was established on momentum and energy balances and predicts both the heating dynamics of the slowest heating zone (SHZ) and the lethal rate achieved in homogeneous liquid canned foods. Two sophistication levels were proposed in viscosity modelling: 1) considering average viscosity and 2) using an Arrhenius-type model to include the effect of temperature on viscosity. The remaining thermodynamic properties were kept constant. The governing equations were spatially discretized via orthogonal collocation (OC) with mesh size of 25 × 25. Computational simulations were performed using proximate and thermodynamic data for carrot-orange soup, broccoli-cheddar soup, tomato puree, and cream-style corn. Flow patterns, isothermals, heating dynamics of the SHZ, and the sterilization rate achieved for the cases studied were compared for both viscosity models. The dynamics of coldest point and the lethal rate F0 in all food fluids studied were approximately equal in both cases, although the second sophistication level is closer to physical behavior. The model accuracy was compared favorably with reported sterilization time for cream-style corn packed at 303 × 406 can size, predicting 66 min versus an experimental time of 68 min at retort temperature of 121.1 ℃.