Reprocessing capabilities of newly approved devices for use in surgery

INTRODUCTION

Single-use medical devices used in surgery can create environmental waste and increased costs. Reprocessed medical devices may reduce cost and environmental impact. This study investigated the reprocessing capabilities of newly FDA-approved devices in surgery.

METHODS

Devices were identified using the publicly-available FDA Releasable 510(k) Database from 2018 to 2023 using the instrument product codes for laparoscope, general, and plastic surgery (GCJ); and electrosurgical (GEI) devices. GCJ and GEI devices were categorized based on usage, and the number of devices (total, single, and reprocessed) were extracted. Costs were obtained from public websites.

RESULTS

There were 658,510(k) applications for surgical devices, representing 3.8 % (658/16723) of total applications. Reprocessing capabilities existed for 29 % of GCJ devices and 14 % of GEI devices. Among GCJ devices, 5 (56 %) laparoscopy and 16 (38 %) camera devices had reprocessing capabilities. For GEI devices, 7 (50 %) laparoscopic and 5 (50 %) cable devices had reprocessing capabilities. Only one (6 %) tissue ablation device had reprocessing capabilities. The average cost of GCJ and GEI single-use devices ($11314; $8554, respectively) was less than reprocessed counterparts ($17206; $16134, respectively).

CONCLUSION

Reprocessing capabilities for newly approved surgical devices are variable and overall limited. To enhance adoption of reprocessing in surgical practice, future efforts will likely be needed to expand the reprocessing potential of new surgical devices.

Influence of drying time on the removal of blood from medical devices

BACKGROUND

When processing surgical instruments after use, the safe, residue-free removal of blood and blood-containing soiling is one of the most important tasks. There are recommendations from various working groups regarding the ideal timeframe for cleaning used instruments in order to ensure safe disinfection and sterilization and avoid adverse effects. These are generally based primarily on practical experience and there is little systematic work on this topic.

AIM

In the present study, cleaning experiments with test specimens previously contaminated with sheep's blood were performed, and in this way the effects of the drying time of whole blood on the results of the subsequent cleaning were examined.

METHODS

Reflecting practice, both visual and spectroscopic methods were used to quantify residual protein. The experimental results were evaluated both as a function of the drying time and the residual moisture of the blood.

FINDINGS

Drying blood was particularly difficult to remove within the first 1-2 h. In this phase, in which the blood is coagulated but not yet completely dried, considerably more protein residues remained on the test specimens after cleaning than after longer standing times.

CONCLUSION

There is a timeframe for the removal of blood residues in which optimum cleaning results can be expected. As a consequence, there are also standing times that are disadvantageous for reprocessing. Based on the experimental data, it was deduced that this optimum time is either directly after contamination or in the range of >3 h and <24 h after soiling.

Microbiological evaluation of ultraviolet C light-emitting diodes for disinfection of medical instruments

Background

Despite the many guidelines for reprocessing of medical instruments, challenges persist such as microbial resistance to biocides, corrosive effects on materials, and time-consuming reprocessing procedures. Ultraviolet (UV) C light-emitting diode (LED) chambers might provide a solution but the integration in healthcare is still in its infancy. Here, we evaluated the efficacy of a novel ZAPARAY™ UVC LED chamber as a time and energy-efficient alternative for reprocessing of medical instruments for which current disinfection protocols exhibit limitations.

Methods

We verified the disinfection efficacy of the UVC LED chamber on a Petri dish and contaminated several medical devices with Staphylococcus aureus ATCC 25923. The bacterial reduction was assessed after 5 min of UVC LED exposure. Additionally, we investigated the impact of rinsing before UVC exposure.

Results

We demonstrated a bacterial reduction of 9 log10 on a Petri dish. Non-rinsed dental tools exhibited varied reduction levels ranging from a 3.23 log10 to a 6.25 log10 reduction. Rinsing alone yielded an average reduction of 2.7 log10 and additional UVC exposure further reduced the bacterial load by an average of 3.65 log10. We showed an average 4.90 log10 reduction on thermistors, 2 log10 or less on orthodontic pliers, and no reduction on handpieces.

Conclusions

This study demonstrates that UVC LED chambers may be used as a standardized substitute for specific (manual) disinfection procedures of certain medical devices, offering a time-efficient and more sustainable alternative. However, its use should be preceded by efficacy testing for each specific type of instrument.

Efficacy of spray flushing in the reprocessing of flexible endoscopes: A randomized controlled trial

BACKGROUND

Commonly used cleaning brushes in the reprocessing of flexible endoscopes often cause damage within the working channels.

AIM

To develop a spray flushing system to achieving effective cleaning of the working channels while minimizing damage.

METHODS

This prospective study included 60 used endoscopes and 60 Teflon tubes randomly divided into a control group (n = 30) and an experimental group (n = 30). The material of Teflon tubes was the same as that of the endoscope working channel. Endoscopes in the control group were manually cleaned using traditional cleaning brushes, while those in the experimental group were cleaned using the newly developed spray flushing system. ATP levels, cleanliness, and microbiological testing of the working channels were measured. Additionally, Teflon tubes in the control group underwent 500 passes with a cleaning brush, while those in the experimental group were subjected to the spray flushing system, and channel damage was evaluated.

RESULTS

The ATP levels (RLU) in the two groups were 32.5 (13-66) and 26 (16-40), respectively (P > 0.05). Cleanliness scores were 1.5 (1-2) and 1 (1-2), respectively (P > 0.05). Debris was found in 73.3% of the control group, which was significantly higher than 46.7% in the experimental group (P < 0.05). Microbiological tests for both groups yielded negative results. Teflon tube damage in the control group was rated at 4 (4-5.25), which was significantly higher than in the experimental group 4 (3-4) (P < 0.01).

CONCLUSION

The spray flushing system demonstrated superior efficacy in removing debris and resulted in less damage to the endoscope working channels compared with traditional cleaning brushes.

Evaluation of the practice of reprocessing ORs in German hospitals from an infection prevention and control perspective

BACKGROUND

The aim of this study was to analyze the cleaning and disinfection of operating rooms (ORs) status quo focusing on hygiene plans in German hospitals.

METHODS

In 2016, a structured online survey was sent to infection prevention and control (IPC) specialists at the cost calculation hospitals of the Institute for the Hospital Remuneration System (InEK) and all university hospitals in Germany (n = 365).

RESULTS

With a response rate of 27.4%, 78% stated that written hygiene plans were available. After cleaning and disinfecting an OR with a "septic" patient, 55% waited until surfaces were dry before reusing in accordance with national recommendations, 27% waited > 30 min. Additionally, 28% of hospitals had ORs only for "septic" patients. In 56% "septic" patients were only operated on at the end of the program. Postoperative monitoring of patients with bacteria with special IPC requirements took place in the post anesthesia care unit (PACU) (29%), operating room (OR) (52%), intensive care unit (ICU) (53%), and in the intermediate care unit (IMC) (19%).

DISCUSSION AND CONCLUSIONS

Despite written hygiene plans in place the partly long duration of OR nonuse time following IPC measures, the consistent continued use of stratification for "septic" patients and the postoperative follow-up care of patients with colonizing/infecting bacteria with special IPC requirements in the OR and high care areas represent relevant potential for improvement.

Non-isocyanate Synthesis of Covalent Adaptable Networks Based on Dynamic Hindered Urea Bonds: Sequential Polymerization and Chemical Recycling

The development of environmentally sustainable processes for polymer recycling is of paramount importance in the polymer industry. In particular, the implementation of chemical recycling for thermoset polymers via covalent adaptable networks (CANs), particularly those based on the dynamic hindered urea bond (HUB), has garnered intensive attention from both the academic and industrial sectors. This interest stems from its straightforward chemical structure and reaction mechanism, which are well-suited for commercial polyurethane and polyurea applications. However, a substantial drawback of these CANs is the requisite use of toxic isocyanate curing agents for their synthesis. Herein, we propose a new HUB synthesis pathway involving thiazolidin-2-one and a hindered amine. This ring-opening reaction facilitates the isocyanate-free formation of a HUB and enables sequential reactions with acrylate and epoxide monomers via thiol-Michael and thiol-epoxy click chemistry. The CANs synthesized using this methodology exhibit superior reprocessability, chemical recyclability, and reutilizability, facilitated by specific catalytic and solvent conditions, through the reversible HUB, thiol-Michael addition, and transesterification processes.

Cold Sintering Enables the Reprocessing of LLZO-Based Composites

All-solid-state batteries have the potential for enhanced safety and capacity over conventional lithium ion batteries, and are anticipated to dominate the energy storage industry. As such, strategies to enable recycling of the individual components are crucial to minimize waste and prevent health and environmental harm. Here, we use cold sintering to reprocess solid-state composite electrolytes, specifically Mg and Sr doped Li7La3Zr2O12 with polypropylene carbonate (PPC) and lithium perchlorate (LLZO-PPC-LiClO4). The low sintering temperature allows co-sintering of ceramics, polymers and lithium salts, leading to re-densification of the composite structures with reprocessing. Reprocessed LLZO-PPC-LiClO4 exhibits densified microstructures with ionic conductivities exceeding 10-4 S/cm at room temperature after 5 recycling cycles. All-solid-state lithium batteries fabricated with reprocessed electrolytes exhibit a high discharge capacity of 168 mA h g-1 at 0.1 C, and retention of performance at 0.2 C for over 100 cycles. Life cycle assessment (LCA) suggests that recycled electrolytes outperforms the pristine electrolyte process in all environmental impact categories, highlighting cold sintering as a promising technology for recycling electrolytes.

Integrated procurement and reprocessing planning for reusable medical devices with a limited shelf life

We present a new model formulation for a multiproduct dynamic order quantity problem with product returns and a reprocessing option. The optimization considers the limited shelf life of sterile medical devices as well as the capacity constraints of reprocessing and sterilization resources. The time-varying demand is known in advance and must be satisfied by purchasing new medical devices or by reprocessing used and expired devices. The objective is to determine a feasible procurement and reprocessing plan that minimizes the incurred costs. The problem is solved in a heuristic manner in two steps. First, we use a Dantzig-Wolfe reformulation of the underlying problem, and a column generation approach is applied to tighten the lower bound. In the next step, the obtained lower bound is transformed into a feasible solution using CPLEX. Our numerical results illustrate the high solution quality of this approach. The comparison with a simulation based on the first-come-first-served principle shows the advantage of integrated planning.

Position paper on sustainability in cardiac pacing and electrophysiology from the Working Group of Cardiac Pacing and Electrophysiology of the French Society of Cardiology

Sustainability in healthcare, particularly within the domain of cardiac electrophysiology, assumes paramount importance for the near future. The escalating environmental constraints encountered necessitate a proactive approach. This position paper aims to raise awareness among physicians, spark critical inquiry and identify potential solutions to enhance the sustainability of our practice. Reprocessing of single-use medical devices has emerged as a potential solution to mitigate the environmental impact of electrophysiology procedures, while also offering economic advantages. However, reprocessing remains unauthorized in certain countries. In regions where it is possible, stringent regulatory standards must be adhered to, to ensure patient safety. It is essential that healthcare professionals, policymakers and manufacturers collaborate to drive innovation, explore sustainable practices and ensure that patient care remains uncompromised in the face of environmental challenges. Ambitious national/international programmes of disease prevention should be the cornerstone of the strategy. It is equally vital to implement immediate actions, as delineated in this position paper, to bring about tangible change quickly.

Decontamination of a robot used to reprocess reusable surgical instruments

BACKGROUND

Using robots to handle medical devices in the decontamination area of the Central Sterile Supply Department (CSSD) can reduce risks and address staff shortages. The gripper design must allow reliable cleaning using standard CSSD procedures to avoid build-up of biofilms and possible cross-contamination between different instrument trays and the gripper's functionality. This study explores the design of the robot's gripper regarding cleanability, aiming to determine whether successful cleaning can be achieved even after prolonged drying for a working shift of 8 h.

METHODS

We optimized a gripper for cleanability and used it to assess the spread of different test soils depending on different forms of motion. Subsequently, we analysed the cleanability using sheep's blood as test soil, reprocessing the gripper in different assembly configurations after 4 and 8 h of drying, and measuring residual protein.

FINDINGS

Based on our investigations, we documented the spread of contamination depending on the type of motion of the gripper's components. Sheep's blood exhibited the highest dispersion among the test soils, permeating through thin crevices. Importantly, all samples displayed residual protein levels below the warning threshold, irrespective of drying time and gripper disassembly or cleaning position. Cleaning in a device-specific optimized position achieved results comparable to cleaning the disassembled individual components.

CONCLUSIONS

These findings indicate that cleaning even after one working shift of 8 h and without the labour-intensive disassembly of the gripper is feasible, supporting the future use of robots to handle contaminated medical devices in the CSSD decontamination area.

Reprocessed precise science orbits and gravity field recovery for the entire GOCE mission

ESA's Gravity field and steady-state Ocean Circulation Explorer (GOCE) orbited the Earth between 2009 and 2013 for the determination of the static part of Earth's gravity field. The GPS-derived precise science orbits (PSOs) were operationally generated by the Astronomical Institute of the University of Bern (AIUB). Due to a significantly improved understanding of remaining artifacts after the end of the GOCE mission (especially in the GOCE gradiometry data), ESA initiated a reprocessing of the entire GOCE Level 1b data in 2018. In this framework, AIUB was commissioned to recompute the GOCE reduced-dynamic and kinematic PSOs. In this paper, we report on the employed precise orbit determination methods, with a focus on measures undertaken to mitigate ionosphere-induced artifacts in the kinematic orbits and thereof derived gravity field models. With respect to the PSOs computed during the operational phase of GOCE, the reprocessed PSOs show in average a 8-9% better consistency with GPS data, 31% smaller 3-dimensional reduced-dynamic orbit overlaps, an 8% better 3-dimensional consistency between reduced-dynamic and kinematic orbits, and a 3-7% reduction of satellite laser ranging residuals. In the second part of the paper, we present results from GPS-based gravity field determinations that highlight the strong benefit of the GOCE reprocessed kinematic PSOs. Due to the applied data weighting strategy, a substantially improved quality of gravity field coefficients between degree 10 and 40 is achieved, corresponding to a remarkable reduction of ionosphere-induced artifacts along the geomagnetic equator. For a static gravity field solution covering the entire mission period, geoid height differences with respect to a superior inter-satellite ranging solution are markedly reduced (43% in terms of global RMS, compared to previous GOCE GPS-based gravity fields). Furthermore, we demonstrate that the reprocessed GOCE PSOs allow to recover long-wavelength time-variable gravity field signals (up to degree 10), comparable to information derived from GPS data of dedicated satellite missions. To this end, it is essential to take into account the GOCE common-mode accelerometer data in the gravity field recovery.

Environmentally friendly strategy to access self-healable, reprocessable and recyclable chitin, chitosan, and sodium alginate based polysaccharide-vitrimer hybrid materials

Natural polysaccharides show enviable advantages for preparation of sustainable hybrid materials. However, in most cases, complex chemical modifications of natural polysaccharides are required, which not only causes changes of the inherent properties of polysaccharides, but also increases the manufacturing costs of the final materials. Therefore, it is highly desired to develop efficient and low-cost ways to access polysaccharides-containing hybrid materials. In this work, we report the environmentally friendly preparation of a new kind of polysaccharide-based materials, called polysaccharide-vitrimer hybrid materials, for the first time. The vitrimer synthesis and hybridization with polysaccharides can be achieved via a convenient one-pot method in absence of solvent and catalyst. In addition, time-consuming and labor-intensive physical/chemical modifications of natural polysaccharides are completely avoided. The resultant hybrid materials show good mechanical performance (tensile toughness is up to 13.7 MJ/m³), high thermal stability (T_d,max is up to 457 °C), fast self-healing ability (self-healing efficiency is up to 99 % within 20s at 80 °C) and excellent reprocessability and recyclability (at least three cycles). Especially, conductive polysaccharide-vitrimer hybrid materials could be readily prepared from the resultant materials, exhibiting novel applications as flexible sensors and electromagnetic shielding materials (the EMI SE is up to 24.93 dB).

Treatment of tributyl phosphate by fenton oxidation: Optimization of parameter, degradation kinetics and pathway

In nuclear industry, tributyl phosphate (TBP) is used as organic extracting solvent to separate uranium and plutonium. The spent TBP is finally discarded as the radioactive organic waste, which should be treated due to its potential risk. In this study, TBP degradation by Fenton oxidation was investigated in detail, including the optimization of operational conditions, degradation kinetics and degradation products. The optimal conditions for TBP degradation (per 10 ml) by Fenton oxidation was: 95 °C, pH 2, 150 ml 30% H₂O₂, and 105 ml 0.2 M Fe(II). H₂O₂ was continuously added with the flow rate of 0.5 ml/min, Fe(II) was intermittently added with the flow rate of 3 ml/10 min. The oil phase volume decreased with time and completely disappeared at the third hour. In contrast, the COD in water phase increased firstly and then decreased. At the end of the experiments, the COD achieved 23.8 g/L. The detection of phosphorus in water phase further confirmed the decomposition of TBP. Mono-butyl phosphate and di-butyl phosphate were identified as the intermediate products of TBP degradation. In addition, other four degradation products with the same m/z of 154 were identified, which may be derived from the hydroxylation of mono-butyl phosphate and di-butyl phosphate. Based on the degradation products, the degradation pathway of TBP was proposed. This study could provide an insight into the TBP degradation by Fenton oxidation, and an potential strategy for treating the spent radioactive organic solvent.

Cost minimization analysis of nasopharyngoscope reprocessing in community practice

BACKGROUND

Reprocessing of nasopharyngoscopes represents a large financial burden to community physicians. The aim of this study was to perform a cost analysis of nasopharyngoscope reprocessing methods at the community level.

METHODS

Electronic surveys were distributed by email to community otolaryngologists. Surveys were comprised of 14 questions assessing clinic size, nasopharyngoscope volume, scope reprocessing method and maintenance. Four manual techniques were evaluated: (1) soak with ortho-phthalaldehyde solution (Cidex-OPA; Advanced Sterilization Products, Johnson and Johnson Inc., Markham, Canada), (2) soak with accelerated hydrogen peroxide solution (Revital-Ox; Steris Canada Inc., Mississauga, Canada), (3) disinfection with chlorine dioxide wipe (Tristel Trio Wipes System; Tristel plc., Cambridgeshire, UK), (4) UV-C light system (UV Smart, Delft, The Netherlands). All costs are reported in CAD, and consumable and capital costs for reprocessing methods were obtained from reported vendor prices. Time costs were derived from manufacturer recommendations, the Ontario Medical Association Physician's Guide to Uninsured Services, and the Ontario Nurses Association Collective Agreement. Cost analyses determined the most cost-effective reprocessing method in the community setting. Sensitivity analyses assessed the impact of reprocessing volume and labour costs.

RESULTS

Thirty-six (86%) otolaryngologists responded and answered the survey. The cost per reprocessing event for Cidex-OPA, Revital-Ox, Tristel and UV system were $38.59, $26.47, $30.53, and $22.74 respectively when physicians reprocessed their endoscopes themselves. Sensitivity analyses demonstrated that Revital-Ox was the least costly option in a low volume, however, the UV system remained the most cost effective in higher volumes. The cost per reprocessing event when done by clinic staff was $5.51, $4.42, $11.23 and $6.21 for Cidex-OPA, Revital-Ox, Tristel and the UV system.

CONCLUSIONS

The UV light system appears to be the most cost-effective method in high volumes of reprocessing, and Revital-Ox is cheaper in lower volumes and when performed by clinic staff rather than physicians. It is important to consider the anticipated work volume, shared clinic space and number of co-workers prior to choosing a reprocessing method.

Solvent-free synthesis of high-performance polyurethane elastomer based on low-molecular-weight alkali lignin

Using cheap and green lignin as a partial substitute for petroleum-based polyols is highly attractive for sustainable development of polyurethane elastomers (LPUes). However, the traditional synthesis process of LPUes inevitably uses toxic solvents that are difficult to remove or carcinogenic. Here, we reported a solvent-free synthesis method to prepare lignin-containing polyurethane elastomers (SF-LPUes) with high strength, high toughness and high elasticity. Most of the hydroxyl groups of lignin reacted with isocyanates to form a strong chemical cross-linking network, while the unreacted ones formed a dynamic hydrogen bond network with polyurethane matrix, contributing to the in-situ formation of lignin nanoparticles to build a nano-micro phase separation structure. Consequently, a dual-crosslinking network structure was formed and endowed SF-LPUes with excellent mechanical properties. Especially, the SF-LPUes prepared from low molecular alkali lignin possessed a tensile strength as high as 38.2 MPa, a maximum elongation at break of 1108 %, and an elastic recovery ratio of up to 98.7 %. Moreover, SF-LPUes showed impressing reprocessing performance and aging resistance. This work provides an industrial application prospect for the synthesis of lignin-containing polyurethane elastomers via a solvent-free synthesis process.

Electron beam technology for Re-processing of personal protective equipment

Beginning with the outbreak of COVID-19 at the dawn of 2020, the continuing spread of the pandemic has challenged the healthcare market and the supply chain of Personal Protective Equipment (PPE) around the world. Moreover, the emergence of the variants of COVID-19 occurring in waves threatens the sufficient supply of PPE. Among the various types of PPE, N95 Respirators, surgical masks, and medical gowns are the most consumed and thus have a high potential for a serious shortage during such emergencies. Considering the unanticipated demand for PPE during a pandemic, re-processing of used PPE is one approach to continue to protect the health of first responders and healthcare personnel. This paper evaluates the viability and efficacy of using FDA-approved electron beam (eBeam) sterilization technology (ISO 11137) to re-process used PPE. PPEs including 3M N95 Respirators, Proxima Sirus gowns, and face shields were eBeam irradiated in different media (air, argon) over a dose range of 0-200 kGy. Several tests were then performed to examine surface properties, mechanical properties, functionality performance, discoloration phenomenon, and liquid barrier performance. The results show a reduction of filtration efficiency to about 63.6% in the N95 Respirator; however, charge regeneration may improve the re-processed efficiency. Additionally, mechanical degradation was observed in Proxima Sirus gown with increasing dose up to 100 kGy. However, no mechanical degradation was observed in the face shields after 10 times donning and doffing. Apart from the face shield, N95 Respirators and Proxima Sirus gown both show significant mechanical degradation with ebeam dose over sterilization doses (>25 kGy), indicating that eBeam technology is not appropriate for the re-processing these PPEs.

The reuse of circular external fixator components: an assessment of safety and potential savings

PURPOSE

Cost-saving strategies are important, especially in a resource-constrained environment. One such strategy well supported in the literature is the reuse of temporary monolateral external fixator components, a strategy we utilize at our institution. The aim of the study was to determine the safety and cost saving associated with the reuse of definitive circular external fixator components in a resource-constrained environment.

METHOD

We performed a retrospective review of all adult patients who were treated with either new or reused circular external fixators from a single manufacturer between January and December 2017. Reused circular external fixator components, excluding half pins and wires, were subjected to an in-house reprocessing protocol. Cost savings were calculated as the difference between the price of a completely new frame and the amount invoiced for new components only in a reused frame.

RESULTS

Thirty-three patients were included in the study with an average age of 31.9 years. The mean duration of treatment with a circular external fixator was 5.8 months. No mechanical failure events were recorded during the study period. Our institution saved approximately 52% (R717 503.89) and 63% (R136 568.19) of expected total cost for hexapod and Ilizarov frames, respectively.

CONCLUSION

The strategy of reusing circular external fixator components is unconventional, and this study was conducted to evaluate the safety and potential savings in a resource-constrained environment. We demonstrated this practice to be reasonably safe and to result in significant cost savings which might be relevant in low-and-middle-income countries.

[Environmentally friendly absorption of anesthetic gases : First experiences with a commercial anesthetic gas capture system]

Anesthetic gases are potent greenhouse gases, which are currently released into the atmosphere where they remain for many years. Strategies to reduce the carbon footprint in anesthesiology without compromising patient safety are urgently needed. Since 2020 several departments of anesthesiology have installed anesthetic gas capture systems with which anesthetic gases can be collected. This article aims to describe the anesthetic gas capture system CONTRAfluran™ and to give an overview of the first experiences in four departments of anesthesiology working with the new device in the daily clinical routine. The CONTRAfluran™ system presents a new concept in the surgical setting that has the potential to reduce the carbon footprint in anesthesiology; however, in order to accurately estimate CO₂ equivalent savings, more information concerning the reprocessing and data on the pharmacokinetics of anesthetic gases are needed. Application of the CONTRAfluran™ system in daily clinical routine is feasible when anesthesiologists are aware of specific issues. In order to minimize the carbon footprint, it remains essential to implement the specific recommendations in the position paper of the German Society of Anaesthesiology and Intensive Care medicine (DGAI) and the Professional Association of German Anaesthesiologists (BDA) on ecological sustainability in anesthesiology and intensive care medicine and to support further research.

Current practices and expectations to reduce environmental impact of electrophysiology catheters: results from an EHRA/LIRYC European physician survey

The healthcare sector accounts for nearly 5% of global greenhouse gas emissions (GHG) and is a significant contributor to complex waste. Reducing the environmental impact of technology-heavy medical fields such as cardiac electrophysiology (EP) is a priority. The aim of this survey was to investigate the practice and expectations in European centres on EP catheters environmental sustainability. A 24-item online questionnaire on EP catheters sustainability was disseminated by the EHRA Scientific Initiatives Committee in collaboration with the Lyric Institute. A total of 278 physicians from 42 centres were polled; 62% were motivated to reduce the environmental impact of EP procedures. It was reported that 50% of mapping catheters and 53% of ablation catheters are usually discarded to medical waste, and only 20% and 14% of mapping and ablation catheters re-used. Yet, re-use of catheters was the most commonly cited potential sustainability solution (60% and 57% of physicians for mapping and ablation catheters, respectively). The majority of 69% currently discarded packaging. Reduced (42%) and reusable (39%) packaging also featured prominently as potential sustainable solutions. Lack of engagement from host institutions was the most commonly cited barrier to sustainable practices (59%). Complexity of the process and challenges to behavioral change were other commonly cited barriers (48% and 47%, respectively). The most commonly cited solutions towards more sustainable practices were regulatory changes (31%), education (19%), and product after-use recommendations (19%). In conclusion, EP physicians demonstrate high motivation towards sustainable practices. However, significant engagement and behavioural change, at local institution, regulatory and industry level is required before sustainable practices can be embedded into routine care.

Leaching of rare earth elements from phosphogypsum

High amounts of phosphogypsum (PG) are generated in the production of phosphoric acid. Previous literature demonstrates that obtaining rare earth elements (REE) from PG is a promising alternative to managing this waste. However, the reported leaching efficiencies are low in most cases, or drastic leaching conditions are required. Therefore, this work aimed to study the leaching conditions of REE from PG to obtain high leaching efficiency values. Initially, a 2⁴ factorial experimental design investigated the factors that affect the conventional acid leaching of REE from PG (leaching acid (citric and sulfuric acid), solid/liquid ratio, acid concentration, and temperature). Better leaching efficiency values of the sum of all REE (62.0% and 89.7% for citric and sulfuric acid, respectively) were obtained using an acid concentration of 3 mol L^-1, solid/liquid ratio of 1/20 g mL^-1, and temperature of 80 °C. Subsequently, the experiments optimization, performed through a central composite rotational design, indicated that the maximum leaching efficiency was achieved using a sulfuric acid concentration of 2.9 mol L^-1, solid/liquid ratio of 1.7/20 g mL^-1, and 55 °C. Under these conditions, the leaching efficiency of the sum of all REE was 90.0%. Leaching kinetics results showed that the equilibrium was reached in about 20 min for most REE. The mechanism investigation suggested that surface chemical reaction and diffusion through the boundary layer controlled the leaching.

Single-use duodenoscopes for the prevention of endoscopic retrograde cholangiopancreatography -related cross-infection – from bench studies to clinical evidence

BACKGROUND

Several strategies have been implemented to reduce or abolish the life-threatening risk of endoscopic retrograde cholangiopancreatography (ERCP)-related multidrug-resistant infections due to duodenoscopes contaminations; among those strategies, serial microbiologic tests, thorough reprocessing schedules, and use of removable scope cap have been adopted, but the potential cross-infection risk was not eliminated.

AIM

To review available evidence in the field of single-use duodenoscopes (SUD) use for ERCP.

METHODS

An overview on ongoing clinical studies was also performed to delineate which data will become available in the next future.

RESULTS

One bench comparative study and four clinical trials performed with EXALT model-D (Boston Scientific Corp., United States) have been identified. Of them, one is a randomized controlled trial, while the other three studies are prospective single-arm, cross-over studies. Pooled technical success rate (4 studies, 368 patients) was 92.9% [95% confidence interval (CI): 89.9-95.5; I²: 11.8%]. Pooled serious adverse event (4 studies, 381 patients) rate was 5.9% [3.7%-8.5%; I²: 0.0%].

CONCLUSION

Although few clinical trials are available, evidence is concordant in identifying an absolute feasibility and safety and feasibility for SUD use for ERCP. The expertise and quality of evidence in this field are going to be improved by further large clinical trials; data on cost-effectiveness and environmental impact will be needed for a worldwide spread of SUD use for ERCP.

Droplet dispersal in decontamination areas of instrument reprocessing suites

BACKGROUND

Personnel working in sterile processing or endoscope reprocessing departments are at high risk of exposure to tissue, blood, and patient fluids when decontaminating reusable medical instruments and equipment. The effectiveness of protective measures for reprocessing personnel has not yet been systematically evaluated in real-world settings.

OBJECTIVE

This pilot project aimed to identify reprocessing activities that generate splashes, determine how far droplets can travel in decontamination areas, and assess personal protective equipment exposure during routine activities.

METHODS

Moisture-detection paper was affixed to environmental surfaces and personal protective equipment in a sterile processing department. Droplet dispersal was assessed after personnel simulated performance of routine reprocessing tasks.

RESULTS

Visible droplets were generated during every reprocessing activity except running the sonication sink. Droplets traveled at least 3 feet when filling a sink, brushing a ureteroscope, and using a power sprayer to rinse a basin. Some activities dispersed droplets up to 5 feet from the sink. Personal protective equipment was splashed during most activities and did not prevent skin exposure even when properly donned and doffed.

CONCLUSION

This hypothesis-generating pilot project found that routine reprocessing activities generated substantial splashing, and currently recommended personal protective equipment did not adequately protect sterile processing personnel from exposure.

Healthcare worker feedback on duodenoscope reprocessing workflow and ergonomics

BACKGROUND

The objectives of this survey study were to assess duodenoscope precleaning and manual cleaning times, identify human factors issues in duodenoscope reprocessing workflow or ergonomics, and ascertain any best practices in duodenoscope reprocessing.

METHODS

Researchers developed the confidential, qualitative, online Duodenoscope Reprocessing Workflow and Ergonomic Design Human Factors Survey with an intended audience of healthcare workers (HCWs) who routinely perform duodenoscope precleaning or manual cleaning. The unrestricted survey link was distributed to target HCW email addresses in December 2020; the survey closed in January 2021.

RESULTS

Three hundred and forty-one individuals completed the survey. Most respondents complete duodenoscope precleaning in 10 minutes or less and manual cleaning in 16-to-30 minutes. Most respondents' facilities use fixed distal endcap duodenoscopes. Most respondents experience pressure to work faster when cleaning duodenoscopes and reported that cleaning duodenoscopes caused fatigue or discomfort in at least one body part. Mentoring HCWs and retaining experienced staff were 2 primary duodenoscope reprocessing best practices identified by respondents.

DISCUSSION AND CONCLUSIONS

To enhance duodenoscope cleaning, facilities should provide ample reprocessing work spaces with incorporated height-adjustable work surfaces, train HCWs on validated duodenoscope reprocessing instructions, provide step-by-step instructions for HCWs when duodenoscope cleaning is performed, mentor reprocessing HCWs, and retain experienced staff.

Validating cleanability of dental rotary diamond instruments soiled with 2 clinically relevant dental test soil components

BACKGROUND

The aim of this study was to produce a dental test soil, with 2 clinically relevant soil components, to be quantified for cleaning process validation. Another goal was to soil diamond instruments with the 2 soil components and validate the efficacy of cleaning instructions, developed and detailed in this study, using both qualitative and quantitative techniques.

METHODS

To simulate worst-case clinical use conditions, the authors used each soiled instrument to prepare a 9-millimeter-deep access cavity on a noncarious extracted molar. Afterward, the authors applied a mixture of pooled human saliva and blood test soil to each instrument and air-dried it for 30 minutes. The authors cleaned each instrument using documented multistep cleaning instructions, which were then validated via both qualitative and quantitative assessment of protein and enamel-dentin residues using spectrophotometric analysis and microscopy images.

RESULTS

After thorough cleaning, neither protein nor enamel-dentin residues were found at quantifiable levels (spectrophotometric analysis) on the soiled and cleaned diamond instruments, which was qualitatively verified (microscopy images).

CONCLUSIONS

The results of this study show the successful development of a dental test soil with 2 clinically relevant soil components. Furthermore, using these soil components as test markers, the authors found that when the established cleaning instructions are properly followed, a soiled diamond instrument can be cleaned in a quantifiable manner.

PRACTICAL IMPLICATIONS

Thorough cleaning is a critical step in reprocessing multiuse dental instruments. In accordance with US Food and Drug Administration guidance, the described process for quantification of soil components, using 2 clinically relevant soil markers, on cleaned diamond instruments can be helpful to dental instrument manufacturers in the development and validation of cleaning instructions for their reusable instruments.