[Enthalpies: Evidence and theory applied to sterilization practice]. / Base de données Enthalpies : évidence et théorie appliquée à la pratique en stérilisation.

OBJECTIVES: In order to share their knowledge, sterilization unit managers publish the results of their work in journals or at scientific conferences. The aim of Enthalpies is to list all such work in a single database. The work presented describes the construction of this database and the assessment of its feasibility for the washing step. METHODS: The first step was to carry out a literature review. Only articles published over 10years (2013-2023) in connection with the ten-year washing stage were included. Then, each publication was categorized, coded, graded and summarized by a pharmacist-internal pair. All this data was collated in an Excel® spreadsheet, and from the data categorization a tree structure was created, enabling the interface between the user and the platform hosting Enthalpies to be understood. RESULTS: Eighty-one publications were identified. These were categorized into 6 themes and 27 sub-themes. A reading grid was drawn up for each publication. Genially®, an online platform, was chosen to host our database. CONCLUSION: Enthalpies was not designed to issue recommendations for best practice. However, by collating published scientific data, this tool can be used to assist decision-making. It represents an innovative solution for providing a literature review in the field of hospital sterilization.

[Knowledge and practices of the steps prior to the sterilization of heat-resistant medical devices: Study at University Hospital Centre of Sahloul, Sousse-Tunisia - 2022]. / Connaissances et pratiques des étapes préalables à la stérilisation des dispositifs médicaux thermorésistants : étude au centre hospitalo-universitaire Sahloul, Sousse-Tunisie ­ 2022.

OBJECTIVES: The standard process of central sterilization is crucial for the optimal functioning of the operating room. The outcome of this process is closely linked to the steps preceding the steps prior to the sterilization step itself. These steps include pre-disinfection carried out in the operating rooms and other stages, namely washing, drying and packaging, which must be performed in the central sterilization unit. In this context, this study aimed to describe the knowledge of the staff in the operating rooms and the central sterilization unit at Sahloul University Hospital in Sousse (Tunisia) in 2022, regarding the steps prior to the sterilization of reusable thermoresistant medical devices and to describe their practices in terms of compliance with these steps. METHOD: A descriptive study was conducted from January 2022 to June 2022 with the aforementioned staff, using a self-administered questionnaire to assess their knowledge of the pre-sterilization steps and a direct observation audit of their practices with regard to these steps. Both measurement instruments were pre-tested. RESULTS: Out of 102 self-administered questionnaires (knowledge assessment) distributed to the staff concerned, only 80 were returned and correctly filled out, giving a response rate of 78.4%. Participants' responses regarding the order of steps prior to the sterilization were incorrect in 64% of cases. With regard to the evaluation of professional practices, 224 observations were made in the study area (practice audit). In 82% of these observations, the pre-disinfection step was confused with the washing step. The use of Betadine brushes and scrubbing pads for device washing was noted in 89.3%, along with the absence of swabbing of the canals and hollow parts in 9.4% of cases and the absence of drying of the canals with compressed air. CONCLUSION: Mastery of the steps prior to sterilisation of reusable thermoresistant medical devices was insufficient in our institution, suggesting the importance of reinforcing the implementation of the procedure through a continuous training program followed by action plans.

Effectiveness of filtering or decontaminating air to reduce or prevent respiratory infections: A systematic review.

Installation of technologies to remove or deactivate respiratory pathogens from indoor air is a plausible non-pharmaceutical infectious disease control strategy. OBJECTIVE: We undertook a systematic review of worldwide observational and experimental studies, published 1970-2022, to synthesise evidence about the effectiveness of suitable indoor air treatment technologies to prevent respiratory or gastrointestinal infections. METHODS: We searched for data about infection and symptom outcomes for persons who spent minimum 20 h/week in shared indoor spaces subjected to air treatment strategies hypothesised to change risk of respiratory or gastrointestinal infections or symptoms. RESULTS: Pooled data from 32 included studies suggested no net benefits of air treatment technologies for symptom severity or symptom presence, in absence of confirmed infection. Infection incidence was lower in three cohort studies for persons exposed to high efficiency particulate air filtration (RR 0.4, 95%CI 0.28-0.58, p < 0.001) and in one cohort study that combined ionisers with electrostatic nano filtration (RR 0.08, 95%CI 0.01-0.60, p = 0.01); other types of air treatment technologies and air treatment in other study designs were not strongly linked to fewer infections. The infection outcome data exhibited strong publication bias. CONCLUSIONS: Although environmental and surface samples are reduced after air treatment by several air treatment strategies, especially germicidal lights and high efficiency particulate air filtration, robust evidence has yet to emerge that these technologies are effective at reducing respiratory or gastrointestinal infections in real world settings. Data from several randomised trials have yet to report and will be welcome to the evidence base.

Evaluation of hernia surgical meshes sterilised with ethylene oxide for adoption under UK regulations.

BACKGROUND: Low-cost meshes (LCM) have been successfully used in low-income countries (LIC) over the past decades, demonstrating comparable surgical outcomes to commercial meshes at a fraction of the cost. However, LIC sterilisation standards (autoclave sterilisation at 121 °C) do not meet UK regulations for medical devices, which require either ethylene oxide (EO) sterilisation or steam sterilisation at 134 °C. Therefore, the aim of this study was to sterilise UK LCM and characterise their mechanical properties and in vitro biocompatibility to verify whether EO sterilisation causes changes in the mechanical properties and biocompatibility of LCM. METHODS: EO sterilised LCM were used. Uniaxial tensile tests were performed to measure mechanical properties. Biocompatibility was measured through viability and morphology of Human Dermal Fibroblasts (HDFs) cultured in mesh-conditioned media, and by calculating the metabolic activity and proliferation of HDFs attached on the meshes, with alamarBlue assay. RESULTS: Break stress of LCM1 was significantly higher than LCM2 (p < 0.0001), while Young's modulus of LCM1 was significantly lower than LCM2 (p < 0.05) and there was no significant difference in break strain. Viability and morphology showed no significant difference between LCM and control. Attachment and proliferation of HDFs on LCM showed a better proliferation on LCM2 than LCM1, with values similar to the control at the final time point. CONCLUSIONS: We demonstrated that EO sterilisation affects LCM mechanical properties, but they still have values closer to the native tissues than the commercially available ones. We also showed that in vitro biocompatibility of LCM2 is not affected by EO sterilisation, as HDFs attached and proliferated on the mesh, while EO affected attachment on LCM1. A more detailed cost analysis of the potential savings for healthcare systems around the world needs to be performed to strengthen the cost-effectiveness of this frugal innovation.

From preventive eugenics to slippery eugenics: Population control and contemporary sterilisations targeted to indigenous peoples in Mexico.

Eugenic ideas in Mexico were popularised after the Mexican Revolution (1910-1920) as a way of 'modernising' and 'civilising' the nation. As a result, eugenic ideas were able to linger and be maintained through different departments, institutions, and individuals from all disciplines. After eugenics was considered a pseudoscience, its practices and ideas continued through population control measures that targeted indigenous populations for sterilisation, a trend that still prevails. The purpose of this article is to explore the legacies of eugenics in current sterilizations procedures mostly targeted at indigenous communities in Mexico. I offer the term 'slippery eugenics' to account for the legacies of eugenics in Mexico which, in this specific case, resurface in the systematic forced and coerced sterilisation procedures targeted at indigenous communities.

Female sterilisation in India: Examining the role of women's own decision making and information given to client.

India has a very high prevalence of female sterilisation compared to other countries in the world, with a prevailing situation of very low level of information about contraceptive options given to women. It is well established in demographic research that, there exists a strong association between knowledge of contraceptive methods and type of contraception chosen. Present study uses data from 3 consecutive rounds of National Family Health Survey (3, 4 & 5). The sample contains currently married women who started using the current method 5 years prior to each round of survey. Multilevel Logistic Regression and Fairlie Decomposition Model are used to analyse the effect of information given to respondents and decision-making power regarding contraceptive methods on choice of female sterilisation. Women, who are informed about available methods, have lower chance (45.8%, 37.5% & 40% for NFHS 3, 4 & 5 respectively) to opt for sterilisation after controlling all other factors. If woman is the sole decision maker for contraceptive choice, the chance of sterilisation reduces than cases where decision is taken only by husband or jointly. Information about other methods also contributes towards reducing the chance of female sterilisation over the time. Information about contraceptive methods is found to be a major factor in controlling choice of temporary or permanent method. Thus, major focus for the policy makers should be to make information regarding contraceptives more accessible for women.

Trends in female sterilisations in New South Wales, 2010-2019.

BACKGROUND: Female sterilisation remains a common contraceptive method in many countries. AIMS: The aim is to analyse the recent changes in the incidence of female sterilisation in New South Wales (NSW). METHODS: Data were obtained from the NSW Admitted Patients Data Collection for all female patients who had undergone one of the five sterilisation procedures in a public or private hospitals in NSW during 2010 and 2019. Denominators for calculating sterilisation rates were estimated using census and other population data. RESULTS: The number of sterilisation cases dropped from 3407 in 2010 to 2561 in 2019, and the sterilisation rate declined from 22.6 per 10 000 females aged 20-49 in 2010 to 15.4 in 2019. Incidence was at its peak in the 35-39 age group in both years. Indigenous females had higher sterilisation rates than non-Indigenous females born in Australia or overseas. While some foreign-born females had higher sterilisation rates than for those who were in Australia or overseas on average their rates were lower than those who were born in Australia or overseas. There was a clear socio-economic gradient such that females living in the most disadvantaged areas had much higher sterilisation rates than those living in the least disadvantaged areas. The Indigenous, ethnic and socio-economic differences in sterilisation rates persisted in both years of this study. CONCLUSION: Although fertility rates in NSW changed little over the 10-year interval a steady decline in sterilisation occurred, consistent with other forms of contraception (particularly long-acting reversible types) increasing concurrently in popularity.

[Individual traceability to the instrument: Evolution of laser and micropercussion markings over the sterilisation cycles]. / Traçabilité individuelle à l'instrument : évolution des marquages laser et micropercussion au fil des cycles de stérilisation.

In order to implement individual instrument traceability, the evolution of laser and micropercussion markings was evaluated over 250 sterilisation cycles. A datamatrix associated with its alphanumeric code was applied on three types of instruments by laser or micropercussion. All instruments had a unique identifier affixed by the manufacturer. The sterilisation cycles corresponded to the usual cycles performed in our sterilisation unit. The laser markings had very good visibility but were quickly affected by corrosion: 12% of the markings were corroded after the 5th sterilisation cycle. Similar results were observed for unique identifiers applied by the manufacturer but with visibility attenuated by sterilisation cycles: 33% of identifiers were poorly visible after the 125th sterilisation cycle. Finally, micropercussion markings were less susceptible to corrosion but initially showed poorer contrast.

[Qualification of low temperature vaporized hydrogen peroxide sterilization: Towards greater harmonization of practices?] / Qualification de stérilisateurs à basse température au peroxyde d'hydrogène : vers une meilleure harmonisation des pratiques ?

OBJECTIVES: Comparing performance qualification procedures for low temperature vaporized hydrogen peroxide sterilization. Assessing conformity with draft standard ISO/DIS 22441. METHODS: Qualification reports from several providers have been compared according to specific criteria: choices of cycles, loads, sterile barrier systems, probes, biological and chemical indicators; checking of packaging integrity and exposure to sterilizing agent. RESULTS: Six out of 8 reports based on 4 distinct sterilizers have been performed by third-party providers. Routine and process challenge devices are respectively used in 6 and 3 of these reports. Sizes and masses are never mentioned whereas load configuration is always specified. All reports use at least one biological indicator and 50% of them use one chemical indicator at a minimum. Most frequent wrapping materials are Ultra® and Tyvek® bags (respectively 50% and 37.5% of reports). Each qualification monitors per process pression and temperature, and 37.5% of them also quantify hydrogen peroxide concentration. Packaging integrity and environmental exposure are checked in respectively 50% and 12.5% of all reports. All reports have received providers approval. CONCLUSION: Qualification procedure is based on steam sterilization NF EN 14937 standard, which seems unsuitable for low temperature process. The lack of autonomy, the heterogeneity of loads and measurement choices reveal a low harmonization of practices. New standard should dispel the doubts about this heterogeneity.

The Voluntary Sterilisation Act: Best Interests, Caregivers, and Disability Rights.

How can caregivers' interests be balanced with disability rights in decisions about whether to sterilise an intellectually disabled person? This question is considered in the context of Singapore, a commonwealth country that lacks a test case. Singapore has a lesser-known history of eugenics, and has struck an uneasy compromise between communitarian values and obligations under the United Nations Convention on the Rights of Persons with Disabilities (CRPD) in recent years. This article provides an overview of Singaporean law under the Voluntary Sterilisation Act 1974 and the Mental Capacity Act 2008, and compares this with the law in Canada, England and Wales, and Australia. This article also situates the CRPD in the context of Singapore's dualist view of international law and communitarian approach to disability policy. It argues that CRPD rights to bodily integrity can be presumptively upheld in best interests determinations on sterilisation, while caregivers' interests can be accommodated in a relational understanding of best interests. A decisional framework along these lines is proposed.

[Recommendations of the Committee of Andrology and Sexual Medicine of the AFU concerning the management of Vasectomy]. / Recommandations du Comité d'Andrologie et de Médecine Sexuelle de l'AFU concernant la prise en charge de la vasectomie.

OBJECTIVES: To answer the main clinical questions asked by practitioners and men consulting for a vasectomy request. METHOD: The CPR method was used. The clinical questions were formulated according to the PICO methodology. A Pubmed literature search for the period 1984-2021 identified 508 references, of which 79 were selected and analyzed with the GRADE grid. RECOMMENDATIONS: Vasectomy is a permanent, potentially reversible contraception. It is a safe procedure. A second vasectomy is necessary in only 1 % of cases. Surgical complications (hematoma, infection, pain, etc.) are rare. The frequency of prolonged scrotal pain after vasectomy is about 5 %, and less than 2 % describe a negative impact of this pain on their quality of life. Vasectomy does not have negative consequences on sexuality. The only contraindication to vasectomy is the minor patient. Patients at increased risk of remorse are single, divorced or separated men under the age of 30. Sperm storage may be particularly appropriate for them. Whatever the reason, the law allows the surgeon to refuse to perform the vasectomy. He must inform the patient of this at the first consultation. The choice of the type of anesthesia is left to the discretion of the surgeon and the patient. It must be decided during the preoperative consultation. Local anesthesia should be considered first. General anesthesia should be particularly considered in cases of anxiety or intense sensitivity of the patient to palpation of the vas deferens, difficulty palpating the vas deferens, or a history of scrotal surgery that would make the procedure more complex. Concerning the vasectomy technique, 2 points seem to improve the efficiency of the vasectomy: coagulation of the deferential mucosa and interposition of fascia. Leaving the proximal end of the vas deferens free seems to reduce the risk of post-vasectomy syndrome without increasing the risk of failure or complications. No-scalpel vasectomy is associated with a lower risk of postoperative complications than conventional vasectomy. Regarding follow-up, it is recommended to perform a spermogram at 3 months post-vasectomy and after 30 ejaculations. If there are still a few non-motile spermatozoa at 3 months, it is recommended that a check-up be performed at 6 months post-vasectomy. In case of motile spermatozoa or more than 100,000 immobile spermatozoa/mL at 6 months (defining failure), a new vasectomy should be considered. Contraception must be maintained until the effectiveness of the vasectomy is confirmed.

Calcium chloride diluted in ethanol 95% as female sterilizing agent: effect of transcutaneous delivery in rats.

BACKGROUND: Different fertility control methods are investigated as a tool for population control of free-roaming animals. Chemical castration using calcium chloride has been widely studied over the years in males, but there are few studies related to its use in females. Therefore, we aimed to evaluate the local effects, as a potential chemosterilant, of two concentrations of calcium chloride diluted in 95% ethanol when administered by transcutaneous ultrasound-guided intraovarian injection in rats. In this study, 30 female Wistar rats were randomly divided into three treatment groups, which consisted of transcutaneous ultrasound-guided intraovarian injection of: 0.9% sodium chloride solution (GC); 10% calcium chloride diluted in 95% ethanol (G10); 20% calcium chloride diluted in 95% ethanol (G20). The animals were subdivided into two evaluation times, 15 days (n = 5 of each group) and 30 days (n = 5 of each group) after the intraovarian injection. The ovarian diameter was measured using ultrasound image prior and immediately after the injection and after the treatment period. Furthermore, animals' clinical evaluation, estrous cycles assessment, macroscopic examination of the abdominal cavity and histological evaluation of the ovaries were performed. RESULTS: Ovarian ultrasound measurement revealed changes (p < 0.05) between ovarian diameters before and immediately after the injection in all treatments. Three animals in G20 had a small focal skin lesion at the injection site that evolved to total healing. Extended and abnormal estrous cycles were observed in G10 and G20. At gross examination, adhesions and ovarian cysts were noticed in both groups, G10 and G20. Also, the histopathology analysis revealed changes in ovarian architecture and vessel congestion in G10 and G20, but ovarian tissue damage was greater in the ovaries treated with the highest concentration (G20). CONCLUSIONS: The results indicate that 20% calcium chloride diluted in 95% ethanol may be a potential agent for inducing sterilization in females and was possible to be minimally invasively delivered.

Time and time again: the reincarnations of coerced sterilisation.

The recently reported cases of coerced sterilisation of women at a privately operated immigration detention facility in the USA are egregious in their disregard for human dignity and professional ethics, but sadly not surprising. These abuses represent a continuation of efforts to control the reproductive capacity of women, fueled by racist and xenophobic motives. Physicians helped create and legitimise the pseudoscientific framework for the eugenics movement, which would implement forceful sterilisation as its tool of choice to eliminate undesirable traits that were thought to be biologically inherited and predominant among racial and ethnic minorities. Although state-endorsed forcible sterilisation programs have ended, incarcerated women have remained particularly vulnerable to sterilisation abuse. The intersectional vulnerabilities of racism, xenophobia and carcerality must be addressed to prevent such abuses from recurring.

Voluntary sterilisation of young childless women: not so fast.

An increasing number of bioethicists are raising concerns that young childless women requesting sterilisation as means of birth control are facing unfair obstacles. It is argued that these obstacles are inconsistent, paternalistic, that they reflect pronatalist bias and that men seem to face fewer obstacles. It is commonly recommended that physicians should change their approach to this type of patient. In contrast, I argue that physicians' reluctance to eagerly follow an unusual request is understandable and that whatever obstacles result from this reluctance serve as a useful filter for women who are not seriously committed to their expressed requests for sterilisation. As women already disproportionally bear the birth control burden, less resistance that men might be getting in terms of voluntary sterilisation works to women's advantage, providing a much needed balance. Societal attitudes towards women and motherhood should not be confused with individual physicians' reasonable reluctance to jump at a serious elective procedure at fairly mild expression of interest.

Efficacy of single pass UVC air treatment for the inactivation of coronavirus, MS2 coliphage and Staphylococcus aureus bioaerosols.

There is strong evidence that SARS-CoV-2 is spread predominantly by airborne transmission, with high viral loads released into the air as respiratory droplets and aerosols from the infected subject. The spread and persistence of SARS-CoV-2 in diverse indoor environments reinforces the urgent need to supplement distancing and PPE based approaches with effective engineering measures for microbial decontamination - thereby addressing the significant risk posed by aerosols. We hypothesized that a portable, single-pass UVC air treatment device (air flow 1254 L/min) could effectively inactivate bioaerosols containing bacterial and viral indicator organisms, and coronavirus without reliance on filtration technology, at reasonable scale. Robust experiments demonstrated UVC dose dependent inactivation of Staphylococcus aureus (UV rate constant (k) = 0.098 m2/J) and bacteriophage MS2, with up to 6-log MS2 reduction achieved in a single pass through the system (k = 0.119 m2/J). The inclusion of a PTFE diffuse reflector increased the effective UVC dose by up to 34% in comparison to a standard Al foil reflector (with identical lamp output), resulting in significant additional pathogen inactivation (1-log S. aureus and MS2, p < 0.001). Complete inactivation of bovine coronavirus bioaerosols was demonstrated through tissue culture infectivity (2.4-log reduction) and RT-qPCR analysis - confirming single pass UVC treatment to effectively deactivate coronavirus to the limit of detection of the culture-based method. Scenario-based modelling was used to investigate the reduction in risk of airborne person-to-person transmission based upon a single infected subject within the small room. Use of the system providing 5 air changes per hour was shown to significantly reduce airborne viral load and maintain low numbers of RNA copies when the infected subject remained in the room, reducing the risk of airborne pathogen transmission to other room users. We conclude that the application of single-pass UVC systems (without reliance on HEPA filtration) could play a critical role in reducing the risk of airborne pathogen transfer, including SARS-CoV2, in locations where adequate fresh air ventilation cannot be implemented.

FSFI score and timing of tubal ligation in patients: preliminary results of an online survey.

INTRODUCTION: Tubal ligation is the most common contraceptive method worldwide. Apart from a very low pearl index and anxiety relief, other benefits are not commonly recognised. In young patients, there is the post-operative risk of regretting the decision with the need for In-Vitro-Fertilisation or refertilising surgery. Positive side effects have not been widely published. In our study we investigated the change in the female sexual function index score after tubal ligation. MATERIAL AND METHOD: In this survey the FSFI score of participants around the time of the tubal ligation was compared with the FSFI score of intermediate and long-term time distance to the ligation. RESULTS: The data indicate an increase in younger women seeking information on permanent contraception and whilst the FSFI score of the early group indicates a risk of female sexual dysfunction, the intermediate and long-term FSFI scores are comparable to published control groups. DISCUSSION: Besides the obvious benefit of a low pearl index, tubal ligation may contribute to reduce the risk of female sexual dysfunction in the mid and long term. Informed consent is essential for the surgeon and patient to weigh up the risks and benefits individually including possible future perspectives on family planning.

A retrospective cohort study of tubal occlusion or salpingectomy for permanent contraception in Australia.

BACKGROUND: Laparoscopic permanent contraception was previously accomplished most commonly using tubal occlusion procedures. Bilateral salpingectomy (BS) has recently been introduced as an alternative due to possibly superior contraception and greater protection against ovarian cancer. AIMS: The aim of this study is to assess uptake, feasibility and perioperative outcomes of laparoscopic BS as an alternative to tubal occlusion in Australia. MATERIALS AND METHODS: A retrospective review of permanent female contraception at two Australian hospitals from January 2014 through December 2020 was performed. The primary outcome was the uptake of BS. Secondary outcomes were feasibility, procedure length, number of ports, perioperative complications and admission length. RESULTS: A total of 414 women were included; 92 (22.2%) underwent BS and 322 (77.8%) underwent tubal occlusion. There was a slow uptake of BS from 2014 to 2016 (0-3.2%), with a steep uptake from 2017 to 2020 (30-72%) (P = 0.001). Procedure feasibility was 96.8% (62/64) and 99.3% (282/284) for BS and tubal occlusion group, respectively (P = 0.64). BS procedure time was longer by 23 min (P < 0.001). Three or more surgical ports were used in all cases of BS compared to 4.5% of the tubal occlusion group (P < 0.001). There were no intraoperative complications. There were nine and six postoperative complications in the tubal occlusion versus BS group, respectively (P = 0.10). The median admission length was 7.1 (tubal occlusion) versus 7.3 (BS) h (P = 0.10), with five unintended overnight admissions. CONCLUSION: BS is an increasing choice for permanent contraception. It appears equally feasible as tubal occlusion but typically requires a longer procedure time and a minimum of three surgical ports.

Efficacy and safety of sterilisation procedures to reduce the risk of epithelial ovarian cancer: a systematic review comparing salpingectomy with tubal ligation.

PURPOSE: The objective of this systematic review is to evaluate current literature comparing salpingectomy for sterilisation with tubal ligation, regarding the effectiveness and safety, and assess the certainty of evidence. MATERIALS AND METHODS: PubMed, Cochrane, and Embase databases were searched. Randomised (RCT) and observational studies were included. Articles were quality assessed and data extracted by two independent authors. Certainty of evidence was assessed using GRADE. RESULTS: Of 2020 articles, 17 were included. No study investigated the risk of EOC. No difference in anti-Müllerian hormone was reported in one RCT at caesarean section (CS). Two cohort studies evaluated ovarian function with surrogate measures and found no difference at caesarean section. Complications did not differ but were inconsistently reported. Laparoscopic tubal ligation was 7 min faster (95% CI 3.8-10.5). Operative time at caesarean section was dependent on the use of surgical devices. Certainty of evidence was low or very low for all estimates, indicating knowledge gaps. Reliable safety data on salpingectomy for sterilisation is lacking, and there is no effectiveness data. Presently, women cannot be properly counselled regarding salpingectomy for sterilisation.

[ISO 9001 quality approach in Sterilization Unit and developing the skills of agents: Contribution of a multi-support, transdisciplinary and multi-professional training plan]. / Démarche qualité ISO 9001 en stérilisation et développement des compétences des agents : apports d'un plan de formation multi-support, transdisciplinaire et pluri-professionnel.

OBJECTIVES: The Sterilization Unit of the Narbonne Hospital Center (France) has decided to embark on a process of NF EN ISO 9001: 2015 certification. The objective is to describe how the working group has appropriated the provisions relating to staff training in order to build a skills development plan for its Sterilization agents. METHODS: A multi-professional working group has been set up. After a preliminary inventory, an inventory of skills needs, expectations of the agents, available means, and a bibliographical research, the group drew up a training plan with the support of a quality engineer from the Hospital Centre. The training plan was validated by a review of the management of the establishment. RESULTS: Several teaching aids were chosen: a serious game developed by the working group, the planning of instrumentation sessions, quality meetings and feedback committees. The principle of transdisciplinarity and recourse to multi-professional exchanges is the common thread in the elaboration of the training plan. CONCLUSION: The use of the selected materials is formalised in the form of a skills development plan indexed in the institution's quality management system. The application of the requirements of the ISO 9001 standard in terms of training in our Sterilization quality management system enables risk control and continuous improvement of the training plan to comply with technical and regulatory changes in the profession.

An innovative procedure: Laparoscopic sterilisation of liver hydatid cyst cavities with Foley catheter method.

Sterilisation of the liver hydatid cyst cavities is a significant step in the surgical treatment of these cysts. We previously performed a study addressing the Foley catheter method in sterilisation of the cyst cavities with open surgery. Recently, we have been laparoscopically using Foley catheters for sterilisation of the cyst cavities. We tried laparoscopically in five cases with six cysts. A Foley catheter can be used in the sterilisation of hydatid cysts cavity both in laparoscopic and open interventions. We think that this procedure can reach cysts at all locations of liver and be applied to multiple liver cysts, too. From laparoscopic point of view, the method we presented is innovative procedure. To date, we have not seen any morbidity including recurrence and mortality in cases we applied this procedure.