Evaluation of the effectiveness of UV-C dose for photoinactivation of SARS-CoV-2 in contaminated N95 respirator, surgical and cotton fabric masks.

As part of efforts to combat the Covid-19 pandemic and decrease the high transmissibility of the new coronavirus, SARS-CoV-2, effective inactivation strategies, such as UV-C decontamination technologies, can be reliably disseminated and well-studied. The present study investigated the susceptibility of a high viral load of SARS-CoV-2 in filtering facepiece respirators (FFR) N95, surgical mask, cotton fabric mask and N95 straps under three different doses of UV-C, applying both real-time PCR (qPCR) and plaque formation assays to quantify viral load reduction and virus infectivity, respectively. The results show that more than 95% of the amount of SARS-CoV-2 RNA could be reduced after 10 min of UV-C exposure (0.93 J cm-2 per side) in FFR N95 and surgical masks and, after 5 min of UV-C treatment (0.46 J cm-2 per side) in fabric masks. Furthermore, the analysis of viable coronaviruses after these different UV-C treatments demonstrated that the lowest applied dose is sufficient to decontaminate all masks ([Formula: see text] 3-log10 reduction of the infective viral load, > 99.9% reduction). However, for the elastic strap of N95 respirators, a UV-C dose three times greater than that used in masks (1.4 J cm-2 per side) is required. The findings suggest that the complete decontamination of masks can be performed effectively and safely in well-planned protocols for pandemic crises or as strategies to reduce the high consumption and safe disposal of these materials in the environment.

The Economic Implications of a Reusable Flexible Digital Ureteroscope: A Cost-Benefit Analysis.

PURPOSE: Questions remain regarding the durability and longevity of flexible ureteroscopes. The objective of this study was to estimate the potential economic benefits of single use, flexible digital ureteroscopes compared to our recent experience with reusable flexible digital ureteroscopes using cost-benefit analysis. MATERIALS AND METHODS: Ureteroscopic procedures were prospectively recorded over the 12-month period of February 2014 to February 2015. All flexible ureteroscopies were performed using Flex XC digital ureteroscopes (Karl Storz Endoscopy-America, El Segundo, California). Cost assessment was based on the original purchasing cost and repair-exchange fees divided by the number of cases. An algorithm was created to include per case reprocessing costs and calculate the benefit-to-cost ratio. This cost was compared to potential costs of the LithoVue™, a single use digital ureteroscope. RESULTS: In 160 cases a flexible reusable ureteroscope was used. There was damage to 11 ureteroscopes during this time with an average of 12.5 cases to failure. Excluding original purchasing costs, the cost analysis revealed an amortized cost of $848.10 per use. After 99 ureteroscope cases the cost-benefit analysis favored reusable ureteroscopes compared to disposable ureteroscopes. CONCLUSIONS: Digital ureteroscopes are the latest trend in the evolution of endourology. It appears that a disposable ureteroscope may be cost beneficial at centers with a lower case volume per year. However, institutions with a high volume of cases may find reusable ureteroscopes cost beneficial.

Lithotripsy Performance of Specially Designed Laser Fiber Tips.

PURPOSE: We evaluated and compared a standard laser lithotripsy fiber to laser fibers claimed to have lithotripsy performance enhancing features. MATERIALS AND METHODS: A special AccuMax™ 200 polished tip fiber and an AccuTrac™ ball-shaped tip fiber, each with an approximately 240 µm core, were compared to a standard 272 µm core fiber (Rocamed™). The polished and ball-shaped tip fibers were used and reused without preparation. The standard fiber was stripped and cleaved according to manufacturer instructions after each experiment. An automated laser fragmentation testing system was used to perform multiple 30-second laser lithotripsy experiments. To mimic most typical lithotripsy conditions soft and hard stone materials were used with high frequency, low pulse energy (20 Hz and 0.5 J) or with low frequency, high pulse energy (5 Hz and 2.0 J) lithotripter settings. Ablation volumes and laser fiber tip photographs before and after lithotripsy were compared. RESULTS: The standard and ball-shaped tip fibers did not differ in ablation volume (p = 0.72) but they ablated 174% and 188% more stone, respectively, than the polished tip fiber (p <0.0001). The ball-shaped tip showed remarkable fiber tip degradation after short-term use at low frequency, high pulse energy settings. When high pulse energy settings were applied first even for short-term use, the ablation volume achieved by the polished and ball-shaped tip fibers at high frequency, low pulse energy settings decreased more than 20%. CONCLUSIONS: The standard laser fiber was as good as and sometimes better than the specially designed fibers. Rapid degradation of the specially designed laser fiber tips strongly limits their general usefulness but ball-shaped tip fibers may be useful in specific situations.

Beyond equipment distribution in Needle and Syringe Programmes: an exploratory analysis of blood-borne virus risk and other measures of client need.

BACKGROUND: Despite high levels of equipment distribution through Needle and Syringe Programmes (NSPs) in Australia, the levels of reuse of equipment among people who inject drugs remain concerning. This paper used an exploratory analysis to examine the needs of NSP client that could be addressed by NSPs to enhance service impact and blood-borne virus risk practices. METHODS: People who inject drugs were recruited from six NSP sites in Sydney, Australia, to undertake a self-completed survey. RESULTS: Using the responses of 236 NSP client participants, three factors were identified in an exploratory factor analysis: recent risky injection (Eigenvalue 3.63, 20.2 % of variance); disadvantage and disability (Eigenvalue 2.26, 12.5 % of variance); and drug use milieu (Eigenvalue 1.50, 8.4 % of variance). To understand the distribution of these factors, the standardised factor scores were dichotomised to explore those participants with 'above average' vulnerability on each factor. A small group of NSP clients reported a cluster of vulnerability measures. Most participants (55.5 %) reported vulnerability on none or only one factor, indicating that 45.5 % could be considered as having double (35.6 %) or triple (8.9 %) vulnerability. CONCLUSIONS: These results challenge NSPs to understand the heterogeneity among their client group and develop programmes that respond to their clients' range of needs beyond those immediately associated with blood-borne virus (BBV) risk. This paper contributes to the growing evidence base regarding the need for BBV prevention efforts to examine strategies beyond equipment distribution.

Are we all doing it wrong? Influence of stripping and cleaving methods of laser fibers on laser lithotripsy performance.

PURPOSE: We assessed whether stripping and cleaving the laser fiber tip with specialized tools, namely laser fiber strippers, or ceramic or metal scissors, would influence lithotripsy performance. MATERIALS AND METHODS: Laser fiber tips were stripped with a specialized laser fiber stripper or remained coated. The tips were then cleaved with metal or ceramic scissors. Laser lithotripsy experiments were performed with the 4 fiber tip combinations using an automated laser fragmentation testing system with artificial stones made of plaster of Paris or BegoStone Plus (Bego, Lincoln, Rhode Island). High frequency-low pulse energy (20 Hz and 0.5 J) and low frequency-high pulse energy (5 Hz and 2.0 J) settings were used for 30 seconds. Fissure width, depth and volume, and laser fiber tip photos were analyzed. RESULTS: Coated laser fiber tips always achieved significantly higher ablation volumes (sometimes greater than 50%) than stripped laser fiber tips (p <0.00001) regardless of cleaving scissor type, stone material or lithotripter setting. Coated fiber tips cleaved with metal scissors ablated as well as those cleaved with ceramic scissors (p = 0.16). However, stripped fibers were much less ablative when they were cut with metal scissors compared to ceramic scissors (p <0.00001). Harder stone material decreased ablation volume (p <0.00001). Low frequency-high pulse energy settings were an average of 3 times more ablative than high frequency-low pulse energy settings (p <0.00001). Stripping the fibers, a harder stone material and low frequency-high pulse energy settings were associated with increased fiber tip degradation. CONCLUSIONS: Coated laser fibers provided better lithotripsy performance and metal scissors were as good as ceramic scissors to cleave coated fibers. This knowledge may improve and simplify the way that laser lithotripsy procedures are done worldwide.

A comparison of four decontamination procedures in Reusing healing abutments: An in vitro study.

Objectives: This study aimed to compare the effect of four decontamination methods on the level of residual contaminants in the re-usage of dental healing abutments. Materials and methods: In this experimental study, 50 used healing abutments were divided into five groups of ten as follows: 1. Control group: healing abutments were submerged in the ultrasonic device then autoclaved at 121 °C for 15 min; 2. Hypochlorite group: Same procedure as the control group, but the healing abutments were additionally immersed in 3 % hypochlorite for 20 min; 3. Chlorhexidine group: Same procedure as the control group, but the healing abutments were additionally treated with 12 % chlorhexidine; 4. Air polishing group: Same procedure as the control group, but the healing abutments were subjected to air polishing; 5. Hydrogen peroxide group: Same procedure as the control group, but the healing abutments were additionally exposed to 3 % hydrogen peroxide. Then, all healing abutments were stained with a protein-specific stain, Phloxine B. Five photographs were taken of each healing abutment, with four capturing the body (shank)and one capturing the top. All images were analysed, to measure the stained (contaminated) areas of each sample. The obtained data were analysed using statistical software (significance set at p < 0.05). Results: The one-way ANOVA test indicated that the average percentage of contamination residues on the occlusal surface did not show a significant difference among the five groups: control: 5.5 ± 2.8, sodium hypochlorite: 4.9 ± 2.5, Chlorhexidine: 5.3 ± 2.5, air polisher: 3.1 ± 1.8 and Hydrogen peroxide: 4.8 ± 3.1. (p = 0.26). The average percentage of residual contamination on the body surfaces (shank part) was significantly lower in the air polisher (1.7 ± 1.1) and sodium hypochlorite (2.4 ± 1.1) groups compared to the other three groups (Control: 6.1 ± 2.3, Hydrogen peroxide: 4.6 ± 0.7, Chlorhexidine: 5.4 ± 2.4) (p < 0.05). Conclusion: The results of this study showed that the use of sodium hypochlorite and air polishing, alongside autoclaving and ultrasonic cleaning, effectively reduced residual contamination on the body surfaces of healing abutments.

Effect of hydrochloric acid, sodium hypochlorite, and autoclave sterilization on the force characteristics of orthodontic NiTi-closed coils.

Background: This study presented a cleaning method for orthodontic NiTi-closed coils and evaluated its effect on the force characteristics of these coils. Materials and Methods: In this in vitro study, 160 orthodontic NiTi-closed coils, 160 orthodontic NiTi-closed coils (9 mm) from two brands G and H and DB, randomly assigned into four groups. Group 1: Three times of immersion in the 10% hydrochloric acid (HCI) solution for 1 min followed by the immersion in 5.25% sodium hypochlorite solution for 5 min. Group 2: Three times autoclave sterilization. Group 3: Three times of immersion in 10% HCI solution for 1 min, followed by the immersion in 5.25% sodium hypochlorite solution for 5 min and autoclave sterilization. Group 4: No immersion and no sterilization. The forces of coils were measured at 25, 23, 21, 19, and 17 mm extension. To measure the force characteristics of coils, an electromechanical universal testing machine was used. For the statistical analysis, Kolmogorov-Smirnov, Kruskal-Wallis, and Mann-Whitney U-tests were used at 0.05 significance level. Results: In G and H coils, no significant differences between the mean forces of different groups were found in any extensions. In DB coils, only in 25 mm extension, there were no significant differences between the groups (P = 0.144). In 17-, 19-, and 21-mm extensions, significant differences (P < 0.001) were found like in 23 mm extension (P = 0.05). In both brands, more extension makes significant more forces statistically (P < 0.01). In all extensions, G and H coils have significant less forces (P < 0.001). Conclusion: Immersion in HCl, 10% for 1 min followed by the immersion in NaOCl, 5.25% for 5 min followed by autoclave sterilization, even three times repeating of this process, did not result in significant changes in the force characteristics of A-NiTi-closed coils.

Disposable versus reusable fibre-optic nasendoscopes: a national survey of UK ENT surgical trainees and a single-centre cost-analysis.

BACKGROUND: This study primarily assessed ENT surgical trainees' preferences for the qualities of disposable and reusable fibre-optic nasendoscopes. Secondary aims included eliciting trainees' views on ENT surgery and climate change, and creating a single-centre per-use cost analysis for disposable and reusable fibre-optic nasendoscopes. METHODS: A cross-sectional study was formulated. An online survey consisting of multiple-choice and Likert-scale questions was distributed nationally. Cost analysis was performed using 2021-2022 data from the host institution. RESULTS: Twenty-four trainees responded. Data on disposable fibre-optic nasendoscopes showed no difference in overall satisfaction (p = 0.244). Reusable fibre-optic nasendoscopes had a lower cost per use compared with disposable nasendoscopes at 5 years (4.7 per cent reduction) and 10 years (7.1 per cent reduction). Of the trainees, 79.2 per cent were supportive of climate-friendly initiatives within ENT surgery, and 25 per cent felt supported by their departments. CONCLUSION: Trainees' satisfaction with disposable and reusable fibre-optic nasendoscopes is similar. Cost analysis favours reusable fibre-optic nasendoscopes in the long term at the host institution. Empowering departments and trainees to pursue climate-friendly initiatives should be encouraged.

Comparative Life Cycle Assessment Between Single-Use and Reprocessed IPC Sleeves.

Purpose: Healthcare has a large environmental footprint, not least due to the wide use of single-use supplies. Reprocessing of medical devices is a well-established, regulated process, and can reduce its environmental impact. This life cycle assessment (LCA) compares the environmental footprint of a single-use and a reprocessed version of otherwise identical intermittent pneumatic compression (IPC) sleeves. Materials and Methods: The LCA was performed in accordance with the international standard ISO 14044 using the Environmental Footprint 3.0 (EF) method for the assessment. Data were obtained in cooperation with IPC sleeve manufacturers. Where no primary data were available, ecoinvent database records were used. The functional unit is five hospital treatments applying IPC. The robustness of the results was interrogated in sensitivity analyses of the energy mix, the ethylene oxide emissions during reprocessing, and the transport distances. The impact of waste reduction on hospital disposal costs was calculated. Results: The environmental footprint of reprocessed IPC sleeves was found to be reduced in all categories compared to single-use devices, leading to a weighted normalized reduction of 43% across all categories. In a breakdown of the LCA results, reprocessed IPC sleeves were found to reduce the carbon footprint by 40%, with the treatment of five patients with single-use IPC sleeves creating 7 kg CO2eq, compared to 4.2 kg CO2eq from reprocessed sleeves. Waste disposal costs were also reduced by 90%. Conclusion: Reprocessing of IPC sleeves provides an environmental and economic benefit in comparison to single-use devices.

The carbon footprint of the operating room related to infection prevention measures: a scoping review.

BACKGROUND: Infection prevention measures are widely used in operating rooms (ORs). However, the extent to which they are at odds with ambitions to reduce the health sector's carbon footprint remains unclear. AIM: To synthesize the evidence base for the carbon footprint of commonly used infection prevention measures in the OR, namely medical devices and instruments, surgical attire and air treatment systems. METHODS: A scoping review of the international scientific literature was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. The search was performed in PubMed and Google Scholar. Articles published between 2010 and June 2021 on infection prevention measures, their impact on the health sector's carbon footprint, and risk for surgical site infections (SSIs) were included. FINDINGS: Although hospitals strive to reduce their carbon footprint, many infection prevention measures result in increased emissions. Evidence suggests that the use of disposable items instead of reusable items generally increases the carbon footprint, depending on sources of electricity. Controversy exists regarding the correlation between air treatment systems, contamination and the incidence of SSIs. The literature indicates that new air treatment systems consume more energy and do not necessarily reduce SSIs compared with conventional systems. CONCLUSION: Infection prevention measures in ORs can be at odds with sustainability. The use of new air treatment systems and disposable items generally leads to significant greenhouse gas emissions, and does not necessarily reduce the incidence of SSIs. Alternative infection prevention measures with less environmental impact are available. Implementation could be facilitated by embracing environmental impact as an additional dimension of quality of care, which should change current risk-based approaches for the prevention of SSIs.

Mask decontamination methods (model N95) for respiratory protection: a rapid review.

BACKGROUND: N95 respiratory protection masks are used by healthcare professionals to prevent contamination from infectious microorganisms transmitted by droplets or aerosols. METHODS: We conducted a rapid review of the literature analyzing the effectiveness of decontamination methods for mask reuse. The database searches were carried out up to September 2020. The systematic review was conducted in a way which simplified the stages of a complete systematic review, due to the worldwide necessity for reliable fast evidences on this matter. RESULTS: A total of 563 articles were retrieved of which 48 laboratory-based studies were selected. Fifteen decontamination methods were included in the studies. A total of 19 laboratory studies used hydrogen peroxide, 21 studies used ultraviolet germicidal irradiation, 4 studies used ethylene oxide, 11 studies used dry heat, 9 studies used moist heat, 5 studies used ethanol, two studies used isopropanol solution, 11 studies used microwave oven, 10 studies used sodium hypochlorite, 7 studies used autoclave, 3 studies used an electric rice cooker, 1 study used cleaning wipes, 1 study used bar soap, 1 study used water, 1 study used multi-purpose high-level disinfection cabinet, and another 1 study used chlorine dioxide. Five methods that are promising are as follows: hydrogen peroxide vapor, ultraviolet irradiation, dry heat, wet heat/pasteurization, and microwave ovens. CONCLUSIONS: We have presented the best available evidence on mask decontamination; nevertheless, its applicability is limited due to few studies on the topic and the lack of studies on real environments.

[Limited Reuse and Extended Use of Filtering Facepiece Respirators]. / Reutilización limitada y uso extendido de mascarillas de media-alta filtración.

AIM: Personal protective equipment (PPE), including respirators, is essential in a pandemic like COVID-19, which has required, on many occasions, the reuse of material due to its shortage. The aim of this review is to summarize available evidence on the reuse and extended use of filtering facepiece respirator. METHOD: Scoping review. Search through natural language in PUBMED and Centers, Agencies and Organizations for Disease Control. Limited to articles published between 2010-2020 in English and Spanish. RESULTS: 83 articles were located, 14 were selected, plus 5 recommendations. The topics included in this study are classified in 7 sections: expiration, extended use and reuse of masks, handling techniques, sealing, physical-psychological effects and compliance, contamination and decontamination of respirators. CONCLUSIONS: The reuse of masks is not recommended by official organizations or manufacturers, and is only accepted in extraordinary cases, such as pandemics. The studies are characterized by having small samples, using different models of respirators adjusting their recommendation to the model.

Safety in the practice of decontaminating filtering facepiece respirators: A systematic review.

BACKGROUND: Considering the new SARS-CoV-2 pandemic and the potential scarcity of material resources, the reuse of personal protective equipment such as filtering facepiece respirators (FFRs) for N95 filtering or higher is being discussed, mainly regarding the effectiveness and safety of cleaning, disinfection and sterilization processes. AIM: To analyze the available evidence in the literature on the safety in processing FFRs. METHODS: A systematic review conducted by searching for studies in the following databases: PubMed, CINAHL, LILACS, CENTRAL, EMBASE, Web of Science, and Scopus. RESULTS: Forty studies were included in this review. The disinfectant/sterilizing agents most frequently tested at different concentrations and exposure periods were ultraviolet irradiation, vaporized hydrogen peroxide and steam sterilization. Microbial reduction was assessed in 21 (52.5%) studies. The only disinfectants/sterilizers that did not caused degradation of the material-integrity were alcohol, electric cooker, ethylene oxide, and peracetic acid fogging. Exposure to ultraviolet irradiation or microwave generated-steam resulted in a nonsignificant reduction in filter performance. CONCLUSION: There is a complex relationship between the FFR raw materials and the cycle conditions of the decontamination methods, evidencing the need for validating FFRs by models and manufacturers, as well as the process. Some methods may require additional tests to demonstrate the safety of FFRs for use due to toxicity.

Reuse of pacemakers and implantable cardioverter-defibrillators: systematic review, meta-analysis and quality assessment of the body of evidence.

BACKGROUND: Pacemakers (PMs) and implantable cardioverter-defibrillators (ICDs) have reduced mortality and improved the quality of life of cardiac patients. However, the high cost of these devices prevents their large-scale incorporation, particularly in low-income countries, where reusing explanted PMs/ICDs has become an alternative. METHODS: A systematic review and meta-analysis were conducted of studies that compare infection rates, device-related deaths, malfunction and premature battery depletion in patients with reused PM and ICD implants and those with new devices. The quality of the body of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework. RESULTS: The meta-analysis demonstrated no significant intergroup differences in infection rates (OR 0.98; 95% CI 0.60-1.60), device malfunction (OR 1.58; 95% CI 0.56-4.48) or premature battery depletion (OR 1.96; 95% CI 0.81-4.72) and no device-related deaths. Based on GRADE assessment, confidence in estimates for the outcomes infection rate and device-related death was rated as moderate. CONCLUSION: The results of this analysis enabled us to conclude that PMs and ICDs can be safely and effectively reused. As such, every effort should be made to overcome regulatory, technical and ethical barriers to ensure implantation.

Decontamination and reuse of N95 filtering facemask respirators: A systematic review of the literature.

INTRODUCTION: As has happened in other emerging respiratory pandemics, demand for N95 filtering facemask respirators (FFRs) has far exceeded their manufacturing production and availability in the context of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic. One of the proposed strategies for mitigating the massive demand for N95 FFRs is their reuse after a process of decontamination that allows the inactivation of any potentially infectious material on their surfaces. This article aims to summarize all of the available evidence on the different decontamination methods that might allow disposable N95 FFRs to be reused, with emphasis on decontamination from SARS-CoV-2. METHODS: We performed a systematic review of the literature in order to identify studies reporting outcomes of at least 1 decontamination method for inactivating or removing any potentially infectious material from the surface of N95 FFRs, specifically addressing issues related to reduction of the microbial threat (including SARS-CoV-2 when available), maintaining the function of N95 FFRs and a lack of residual toxicity. RESULTS: We identified a total of 15 studies reporting on the different decontamination methods that might allow disposable N95 FFRs to be reused, including small-scale energetic methods and disinfecting solutions/spray/wipes. Among these decontamination methods, ultraviolet germicidal irradiation and vaporized hydrogen peroxide seem to be the most promising decontamination methods for N95 FFRs, based on their biocidal efficacy, filtration performance, fitting characteristics, and residual chemical toxicity, as well as other practical aspects such as the equipment required for their implementation and the maximum number of decontamination cycles. CONCLUSIONS: Although all the methods for the decontamination and reuse of N95 FFRs have advantages and disadvantages, ultraviolet germicidal irradiation and vaporized hydrogen peroxide seem to be the most promising methods.

Investigation of Desulfurization Activity, Reusability, and Viability of Magnetite Coated Bacterial Cells.

BACKGROUND: Magnetic separation using magnetic nanoparticles can be used as a simple method to isolate desulfurizing bacteria from a biphasic oil/water system. OBJECTIVES: Magnetite nanoparticles were applied to coat the surface of Rhodococcus erythropolis IGTS8 and Rhodococcus erythropolis FMF desulfurizing bacterial cells, and the viability and reusability of magnetite-coated bacteria evaluated by using various methods. MATERIAL AND METHODS: Magnetite nanoparticles were synthesized through a reverse co-precipitation method. Glycine was added during and after the synthesis of magnetite nanoparticles to modify their surface and to stabilize the dispersion of the nanoparticles. The glycine-modified magnetite nanoparticles were immobilized on the surface of both oil-desulfurizing bacterial strains. Reusability of magnetite-coated bacterial cells was evaluated via assessing the desulfurization activity of bacteria via spectrophotometry using Gibb's assay, after the separation of bacterial cells from 96h-cultures with the application of external magnetic field. In addition, CFU and fluorescence imaging were used to investigate the viability of magnetite-coated and free bacterial cells. RESULTS: TEM micrographs showed that magnetite nanoparticles have the size approximately 5.35±1.13 nm. Reusability results showed that both magnetite-coated bacterial strains maintain their activity even after 5 × 96h-cycles. The viability results revealed glycine-modified magnetite nanoparticles did not negatively affect the viability of two bacterial strains R. erythropolis IGTS8 and R. erythropolis FMF. CONCLUSIONS: In conclusion, the glycine-modified magnetite nanoparticles have great capacity for immobilization and separation of desulfurizing bacteria from suspension.

Durability of Flexible Ureteroscopes: A Prospective Evaluation of Longevity, the Factors that Affect it, and Damage Mechanisms.

BACKGROUND: Flexible ureteroscopy is an established treatment modality for evaluating and treating abnormalities in the upper urinary tract. Reusable ureteroscope (USC) durability is a significant concern. OBJECTIVE: To evaluate the durability of the latest generation of digital and fiber optic reusable flexible USCs and the factors affecting it. DESIGN, SETTING, PARTICIPANTS: Six new flexible USCs from Olympus and Karl Storz were included. The primary endpoint for each USC was its first repair. Data on patient and treatment characteristics, accessory device use, ureteroscopy time, image quality, USC handling, disinfection cycles, type of damage, and deflection loss were collected prospectively. INTERVENTION: Ureteroscopy. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: USC durability was measured as the total number of uses and ureteroscopy time before repair. USC handling and image quality were scored. After every procedure, maximal ventral and dorsal USC deflection were documented on digital images. RESULTS AND LIMITATIONS: A total of 198 procedures were performed. The median number of procedures was 27 (IQR 16-48; 14h) for the six USCs overall, 27 (IQR 20-56; 14h) for the digital USCs, and 24 (range 10-37; 14h) for the fiber optic USCs. Image quality remained high throughout the study for all six USCs. USC handling and the range of deflection remained good under incremental use. Damage to the distal part of the shaft and shaft coating was the most frequent reason for repair, and was related to intraoperative manual forcing. A limitation of this study is its single-center design. CONCLUSIONS: The durability of the latest reusable flexible USCs in the current study was limited to 27 uses (14h). Damage to the flexible shaft was the most important limitation to the durability of the USCs evaluated. Prevention of intraoperative manual forcing of flexible USCs maximizes their overall durability. PATIENT SUMMARY: Current flexible ureteroscopes proved to be durable. Shaft vulnerability was the most important limiting factor affecting durability.

Bundles for the central sterile supply department.

BACKGROUND: Traditional resources, such as bundles, can help experts define essential steps of health product processing to prevent infections. The present study developed bundle content construction and validation criteria for central sterile supply departments (CSSDs). METHODS: The present study employed a Delphi technique modified for content evaluation. Eleven professionals with at least 4 years of experience in sterilization were enlisted. Participants discussed main stages of the process virtually and compiled a list of items based on scientific references justified by law and/or logical reasoning. Agreement, disagreement, and/or suggestions on each step resulted in bundles for a CSSD. Items were then reassessed by experts using a Likert scale with a 90% approval criterion. RESULTS: Six bundles were developed: cleaning, inspection, preparation and packaging, sterilization, and storage resulting from 384 responses and 373 agreements (Interassessor coefficient = 97%). DISCUSSIONS: Items obtained from the criteria assessment received majority agreement from the first document. CONCLUSIONS: Agreement among varying professionals was achieved, and bundles were successfully developed to evaluate the processing of goods in CSSDs.

Reuse of N95/PFF2 masks in clinical practice: morphological and structural analysis / Reutilización de mascarillas N95/PFF2 en la práctica clínica: análisis morfológico y estructural / Reutilização das máscaras N95/PFF2 na prática clínica: análise morfológica e estrutural

Objective: to analyze the integrity of N95/PFF2 masks in relation to fiber morphology, porosity, cracks and micro holes, as well as identify visible damage to their structure and components, after seven- and fifteen-day reuse protocols. Method: cross-sectional study. Structural and morphological characteristics of a new N95/PFF2 mask were analyzed in comparison with N95/PFF2 masks (n=10) used in seven- and fifteen-day protocols, through visual inspection and scanning electron microscopy. Results: upon visual inspection, following the seven-day protocol, 40% and 60% of the N95/PFF2 masks showed, respectively, personal identification marks and external and internal dirt. Additionally, 20% exhibited loosening and/or tearing of the straps, while 100% showed some type of damage to the nose clips. In the fifteen-day protocol, all N95/PFF2 masks had dirt, loose straps and damaged nose clips, and 80% had folds. Electronic microscopy revealed an increase in pores and loosening in the weaves from seven days onwards, extending up to fifteen days, with the presence of micro holes and residues. Conclusion: the reuse of N95/PFF2 masks affects their structural and morphological integrity. It is crucial to carry out tests to measure the impact of this practice on the safety of health professionals.

Objetivo: analizar la integridad de mascarillas N95/PFF2 con relación a la morfología de las fibras, porosidad, grietas y microagujeros, así como identificar daños visibles en su estructura y componentes, luego de protocolos de reutilización de siete y quince días. Método: estudio transversal. Se analizaron las características estructurales y morfológicas de una mascarilla N95/PFF2 nueva en comparación con las mascarillas N95/PFF2 (n=10) utilizadas en protocolos de siete y quince días, mediante inspección visual y microscopía electrónica de barrido. Resultados: tras la inspección visual, siguiendo el protocolo de siete días, el 40% y el 60% de las mascarillas N95/PFF2 mostraron, respectivamente, marcas de identificación personal y suciedad externa e interna. Además, el 20% presentó aflojamiento y/o desgarro de las correas de sujeción, mientras que el 100% presentó algún tipo de daño en los clips nasales. En el protocolo de quince días, todas las mascarillas N95/PFF2 tenían suciedad, correas de sujeción sueltas y clips nasales dañados, y el 80% tenía pliegues. La microscopía electrónica reveló un aumento de poros y aflojamiento en las tramas a partir de los siete días, extendiéndose hasta los quince días, con presencia de microagujeros y residuos. Conclusión: la reutilización de las mascarillas N95/PFF2 compromete su integridad estructural y morfológica. Es crucial realizar pruebas para medir el impacto de esta práctica en la seguridad de los profesionales de la salud.

Objetivo: analisar a integridade das máscaras N95/PFF2 em relação à morfologia das fibras, porosidade, fissuras e micro furos, bem como identificar danos visíveis em sua estrutura e componentes, após protocolos de reutilização de sete e quinze dias. Método: estudo transversal. Características estruturais e morfológicas de uma máscara N95/PFF2 nova foram analisadas em comparação com máscaras N95/PFF2 (n=10) utilizadas em protocolos de sete e quinze dias, por meio da inspeção visual e microscopia eletrônica de varredura. Resultados: na inspeção visual, seguindo o protocolo de sete dias, 40% e 60% das máscaras N95/PFF2 apresentaram, respectivamente, marcas de identificação pessoal e sujidades externas e internas. Além disso, 20% exibiram afrouxamento e/ou rompimento das tiras de fixação, enquanto 100% mostraram algum tipo de dano nos clipes nasais. No protocolo de quinze dias, todas as máscaras N95/PFF2 apresentavam sujidade, tiras de fixação frouxas e clipes nasais comprometidos; 80% possuíam dobras. A microscopia eletrônica revelou aumento dos poros e afrouxamento nas tramas a partir de sete dias, ampliando-se até quinze dias, com presença de micro furos e detritos. Conclusão: a reutilização das máscaras N95/PFF2 compromete a integridade estrutural e morfológica. É crucial realizar testes para mensurar o impacto dessa prática na segurança dos profissionais de saúde.

Single-Use Devices in Argentina: Cost Comparison Analysis of a "Re-Use" versus a "Single-Use" Policy for Trocars, Endocutters, Linear Cutters, and Harmonic Scalpels.

BACKGROUND: Re-use of medical devices labeled and marketed for single use only is a current practice around the world. OBJECTIVES: To estimate the average difference per surgery in device-related costs (DRCs) when performed with single-use devices under a single-use policy (SUP) instead of a re-use policy (RP) from the perspective of the private health sector of Argentina. METHODS: An analytical model was developed in Microsoft Excel and populated with data from a literature review, a Delphi-like panel, and local cost estimations. Four single-use devices were selected for analysis: plastic trocars, endocutters, linear cutters, and harmonic scalpels. DRCs were expressed in 2012 US dollars and divided into four cost categories: devices, adverse events, device failure, and surgical time extension. Outputs were expressed as DRCs per surgery under a SUP, under a RP, the difference between them expressed in US dollars (Diff_$), and the difference between them expressed as a percentage of surgery costs (Diff_%S). Deterministic and probabilistic sensitivity analyses were performed to analyze the impact of uncertainty on results. RESULTS: Expected DRCs per surgery were as follows: for trocars: SUP, US $424.6; RP, US $244.2; Diff_$, US $-180.4; and Diff_%S, -3.8%; for endocutters: SUP, US $1667.4; RP, US $1102.3; Diff_$, US $-565.1; and Diff_%S, -11.1%; for linear cutters: SUP, US $1228.1; RP, US $1045.9; Diff_$, US $-182.2; and Diff_%S, -3.4%; and for harmonic scalpels: SUP, US $1040.9; RP, US $292.4; Diff_$, US $-748.5; and Diff_%S, -14.8%. Sensitivity analyses showed results to be robust. CONCLUSIONS: RP was shown to be less costly in all devices and scenarios considered. Nevertheless, the real frequency of adverse events and their cost implications are still uncertain. More research is needed to assess the effectiveness and safety of these off-label policies.