Bacteriological validation of a new apparatus for disinfection of hospital waste at the point of disposal

More than just teddy bears: Unconventional transmission agents in the operating room

INTRODUCTION

Surgical site infection (SSI) following orthopedic surgery can have a substantial impact on patients and families. The rate remains high, ranging from 0.5% to 8.5% in pediatric spine surgery. It is common to allow children to bring a teddy bear (or similar toy) to the surgical ward to help reduce the stress of surgery. We hypothesize that despite their known benefits for children, teddies would increase the bacterial load in the surgical room.

METHODS

A blinded descriptive study was conducted from June 2015 to September 2016. The study included children entering the hospital through the emergency ward for a traumatic cause requiring surgery. Patients admitted for infectious problems and those who had been hospitalized less than 6 months before the inclusion date were excluded. A picture of the teddy was taken and stored in a blind fashion. The AFNOR (Association française de normalisation) standardized rules for bacteriological surface control and the ISO/DIS 14698 protocol were strictly followed. Two independent observers performed blind bacteriologic analyses of the teddy bears with bacteria identification and colony counts. Photos of the teddy bears were then analyzed by two blinded, independent observers: one doctor and one parent from outside the hospital. Cleanliness and fluffiness of the toy was evaluated using a numeric scale.

RESULTS

Bacteria were identified on 100% of the 53 teddies included. The mean number of bacteria was 182.5±49.8 CFU/25 cm². Eight teddies (15.1%) tested positive for potential pathogenic bacteria (two staphylococcus aureus, one acinetobacter ursingii, four acinetobacter baumannii, one pseudomonas stutzeri). Three teddies (5.7%) tested positive for fungi. The median cleanliness score was 2 (interquartile range (IQR)=1) if rated by the doctor and 2 (IQR=1) if rated by the parent. No statistical difference was found between these two values in the global teddy bear population. We found no any statistical link between the number of CFUs and the cleanliness scores given by the doctor. The median fluffiness score given by the parent was 2 (IQR=1). Looking at the correlative CFUs, we found a statistically significant difference between each stage of fluffiness with a higher stage showing higher CFU (P<0.0001).

CONCLUSION

Despite their documented benefits for the child, teddy bears are not appropriate in the surgical room.

Clinical waste generation from renal units: implications and solutions

The treatment of end-stage renal disease (ESRD) makes extensive use of presterilized disposable items which, after use, are contaminated by blood. The preferred route of disposal of such items is by incineration. Disposal costs have risen and this increase in costs has not been matched by waste management programs in renal units. Many of the waste items generated also contain polyvinyl chloride (PVC) whose incineration is environmentally sensitive. Furthermore blood tubing sets contain plasticizers such as di(2-ethylhexyl) phthalate (DEHP), which is known to pose health risks to specific groups of patients. The generation of clinical waste in a dialysis unit is analyzed, issues associated with disposal are discussed, and approaches toward a cost-effective, environmentally sustainable clinical waste management program are reviewed.