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PubMed2000

[Pursuit of economic efficiency in the hospital laboratory--full automatic re-test system of clinical chemistry, hematology, immunology and cost control system].

Further business improvement is requested due to finance-based fluctuation and the influence of the revision in the medical treatment law. Therefore, new laboratories are needed. To achieving this in our hospital, economic efficiency is being pursued. The first issue is the use of space, the second issue is labor-saving. The third issue is the simplification of business procedures. There is individual quality control by the zonal verification method that we developed, as well as the quality control of the batch method using controlled substances. The four issue is cost control. By controlling the delivery and use of reagents and materials including the term of validity control, we made an effort to abolition defective stock. The fifth issue is correspondence to circulation style society. The disposal of laboratory garbage is a major issue. We controlled garbage that occurs unnecessarily. Furthermore, we are improving the demand for reagents that exceeds the specification and use reagent containers.

Automation↗

PubMed2005

A study for the production of containers used in the diagnosis and prevention of infection.

OBJECTIVES: 1. To study the need of containers used in the diagnosis and prevention of infection. 2. To produce the containers, 3. To test the practicability of the product. MATERIAL AND METHOD: - The study on the need of the containers was done by questionnaires answered by nurses and microbiology laboratory technicians in 56 hospitals. - The containers were produced by the researchers who later had them tested for their practicability by nurses and technicians in the same hospitals. - The study was done during 2002-2004. RESULTS: Fifty-six hospitals were enrolled by stratified random sampling. Questionnaires were responded by 424 nurses and 35 microbiology laboratory technicians. Sputum trap, body fluid and feces containers and needle disposal box were studied and the need for commercial products was 31.1%, 31.1%, 32.3% and 99.5% respectively. Sixteen percent to 58.5% of these containers were bought and 14.3% to 68.6% were home-made. Sputum trap, body fluid and feces containers, and needle disposal boxes were produced and tested by 400 nurses and 32 laboratory technicians. The products were evaluated as satisfactory in 59.4% to 80.0%. The lid of the needle disposal box designed as saw tooth was not convenient for use and was later modified to various slits. The costs of the containers produced were 1.3% to 29.8% of available commercial products. CONCLUSION: Sputum trap, body fluid and feces containers and needle disposal boxes of reasonable prices were needed in Thailand. These containers could be produced locally and were much cheaper than available commercial ones.

Containment of Biohazards↗

PubMed2004

Assessment of waste amalgam management in dental clinics in Ramallah and al-Bireh cities in Palestine.

The behavior of dental health personnel was examined with regard to the handling and proper disposal of wastes generated at common dental clinics, and some of the amounts of waste they produce were estimated. In January 2002, a random sample of 37 dental clinics was chosen in the cities of Ramallah and al-Bireh. The visited clinics were distributed between 31 private practices and six public/NGO dental clinics. The dentists were asked about the methods they follow in disposing and discarding of amalgam wastes. An average dentist is estimated to place two small, seven medium and nine large amalgam restorations releasing 22.6 grams of mercury each week. The majority of amalgam wastes ended up in trash or drain.

Dental Amalgam↗

PubMed2006

Safety practice and professional exposure to blood and blood-containing materials in serbian health care workers.

Safety practice is an important element of workplace safety and quality of health care. To investigate the safety practice and professional exposure to blood and blood-containing materials during a one-year period among Health Care Workers (HCWs) in Serbia. Cross-sectional study of 1559 Serbian HCWs using a self-administered questionnaire. Mantel-Haenszel statistics and multiple logistic regression analysis were used in statistical analysis. Fifty-nine percent (921) of HCWs had skin contact with patients blood, followed by 51% (791) with needle stick injuries, 38% (599) with cuts from sharp instruments, and 34% with contact of eye and other mucosa with patient's blood. Nurses reported professional exposure more often than others. Safety practices consisted of using appropriate barriers (gloves, mask, glasses) in all procedures with patients and were used by 58%, 23%, and 4% of HCWs, respectively. Doctors protected themselves more regularly than others. Hospital protocols for post exposure prophylaxis and safety disposal of medical waste are not common in Serbian health care settings. Safety practices in use were having hospital guidelines for safety practice in hospitals [odds ratio (OR)=1.58, 95% confidence interval (CI)=1.14-2.19], carrying out some form of intervention with risks of infection (OR=3.76, 95% CI=2.57-5.51), and HCWs aware of the professional risk of acquiring infection (OR=1.48, 95% CI=1.28-1.79). This study indicates that emphasis on work practice, attire, disposal systems and education strategies, should be employed to reduce professional exposure to blood and blood containing materials among HCWs in Serbia.

Adult↗

PubMed2003

Injection practices in southern part of India.

The World Health Organization defines 'a safe injection' as one that does not harm the recipient, does not expose the provider to any avoidable risk, and does not result in any waste that is dangerous to the community. Irrational and unsafe injection practices are rife in developing countries. The objective of the present study was to assess the injection practices in the state of Tamilnadu, India, using the Rapid assessment and response guide of the Safe Injection Global Network of the World Health Organization. Thirty-nine prescribers, 62 providers, and 175 members of the general public were interviewed. The areas were chosen out of convenience while at the same time adhering to the guidelines. The study was carried out between April and June 2001. The per capita injection rate was 2.4 per year. The ratio of therapeutic to immunization injections was 6.5:1, and the proportion of injections given with a disposable syringe and needle was 35.4%. Knowledge about diseases transmitted by unsafe injections, for example involving human immunodeficiency virus and hepatitis B virus, was greater among all the study groups. The annual incidence of needlestick injuries among providers was 23.6, which is extremely high. It is concluded that there are deficiencies in practice such as an excessive, unwarranted usage of injections, a sizeable prevalence of unsafe injection practices, the short supply of injection equipment leading to a high incidence of needlestick injuries, a low proportion of hepatitis B virus immunization among providers, and a lack of adequate sharps containers and disposal facilities in this part of India. It is suggested that immediate and long-term remedial measures, such as the education of prescribers to reduce the number of injections to a bare minimum, an adequate supply of injection equipment, provider protection with immunization for hepatitis B virus, the provision of adequate sharps containers with safe disposal facilities and, not least, community education, be undertaken to avoid the future epidemic of transmissible diseases.

Acquired Immunodeficiency Syndrome↗

PubMedDate not supplied

Enfuvirtide nursing guidelines: a report from the Association of Nurses in AIDS Care Expert Panel on Enfuvirtide.

Enfuvirtide is the first of a new class of antiretrovirals know as fusion inhibitors approved for the treatment of HIV infection. It is administered via a subcutaneous injection. The patient is responsible for reconstitution from a powder and self-injection. Nurses caring for patients using enfuvirtide need a solid knowledge base about enfuvirtide administration and side effects in order to effectively educate and manage patients taking enfuvirtide. Enfuvirtide's safety and efficacy reported from phase III trials are summarized. Nursing guidelines were developed by the Association of Nurses in AIDS Care Expert Panel on Enfuvirtide. The guidelines, including suggestions on assessment, education, and management of side effects are reviewed. Teaching tools and resources are offered to assist in patient management. In addition, suggestions for proper syringe disposal and traveling with enfuvirtide are offered.

Aftercare↗

PubMedDate not supplied

Sharps handling and disposal: a study.

The risks associated with handling sharps are well known but it is less clear why accidents occur. This study aimed to determine how often sharps are used by nurses, the usual procedures associated with disposal, the identification of unsafe practices and any factors such as heavy workload or lack of resources which could be associated with accidents. The results overall were encouraging although unsafe practices were witnessed that were totally unnecessary.

HIV Infections↗

PubMed2005

Disposal of injection material used for the treatment of hepatitis C: comparison with insulin-dependent diabetes and thromboembolism.

AIM: The survey conducted in the Provence-Alpes-Cote d'Azur region in France in 1999 showed that 38% of patients infected with the hepatitis C virus (HCV) receiving interferon injections in their home were aware of the recommendations concerning the disposal of injection material and that 41% of the needles were discarded with household waste after use. The purpose of our study conducted in the Centre region of France was to ascertain how injection material used by HCV-positive patients for interferon treatment are disposed of in comparison with material used by patients injecting insulin for insulin-dependent diabetes mellitus (IDDM) or low-molecular-weight heparin (LMWH) for thromboembolism. MATERIAL AND METHODS: A questionnaire to be completed by patients was proposed to HCV-positive patients attending hepatogastroenterology clinics in the Centre region hepatitis C network for therapeutic follow-up (N=113 patients) between October 2001-January 2002. The same questionnaire was proposed to patients attending follow-up consultations for insulin-dependent diabetes mellitus (N=85 patients) or thromboembolism (N=23 patients) between March-June 2002. RESULTS: Significantly more patients stated they were aware of recommendations for disposal of injection material in the HCV group (89%) than in the IDDM (67%) or LMWH (26%) groups (P<0.01). Injection material was discarded with household waste less often by patients in the HCV group (6%) than in the IDDM (32%) or LMWH (29%) groups (P<0.001) and more often collected in a safety box prior to incineration (73% in the HCV group versus 63% and 14% in the IDDM and LMWH groups respectively). The safety box was discarded with household garbage more often by patients in the IDDM (54%) or LMWH (50%) groups than in the HCV group (0%) (P<0.001). Equivalent proportions of the patients said they recapped the needle after use (HCV 83%; IDDM 93%; LMWH 84%). DISCUSSION: Information concerning use of safety boxes for disposal of injection material should be provided to patients in order to comply with regulatory recommendations on proper disposal of used injection material. Moreover, the habit of recapping needles (89% of all patients in this study) is still widespread.

Adolescent↗

PubMed1996

A program for reducing biomedical waste: the Wellesley Hospital experience.

As hospitals face severe financial constraints, the need to review programs to ensure cost-effectiveness is critical. Waste management practices have come under scrutiny because inappropriate waste disposal is very costly. The Wellesley Hospital in Toronto, Ontario conducted a waste audit in July 1993 and found that 18.5% of waste was being disposed of as biomedical waste. Because the hospital pays nine times more to dispose of biomedical waste than it does landfill waste, a goal was set to reduce biomedical waste to 8% of total waste. A program, which included redefining biomedical waste, reviewing waste practices throughout the hospital, educating staff and monitoring outcomes, resulted in biomedical waste levels decreasing to 7.9% of total waste within 18 months. Savings realized were approximately $67,000. This program is easily reproducible.

Cost-Benefit Analysis↗

PubMed1994

Managing biomedical waste in Ontario: a regional approach.

The lack of landfill space, public perceptions, the escalating costs of disposal, and other factors have created a controversial environment for the disposal of healthcare waste. In the province of Ontario, a proposal has been made that aims to make Ontario self-sufficient in its management of healthcare waste through the use of regional incineration facilities. This article examines this proposal as well as other available options for Ontario's healthcare facilities.

Evaluation Studies as Topic↗

PubMed2005

Hospital waste management in the teaching hospitals of Karachi.

OBJECTIVE: To evaluate the current practices of segregation approaches, storage arrangements, collection and disposal systems in the teaching hospitals of Karachi. METHODS: A cross-sectional survey was conducted in eight teaching hospitals of Karachi, using convenient sampling technique. The instrument of research was a self administered questionnaire, with four sections, relating to the general information of the institution, administrative information, information regarding Health Waste Management personnel and a check-list of Hospital Waste Management activities. RESULTS: Out of eight hospitals visited 2 (25%) were segregating sharps, pathological waste, chemical, infectious, pharmaceutical and pressurized containers at source. For handling potentially dangerous waste, two (25%) hospitals provided essential protective gears to its waste handlers. Only one (12.5%) hospital arranged training sessions for its waste handling staff regularly. Five (62.5%) hospitals had storage areas but mostly it was not protected from access of scavengers. Five (62.5%) hospitals disposed off their hazardous waste by burning in incinerators, two (25%) disposed off by municipal landfills and one (12.5%) was burning waste in open air without any specific treatment. No record of waste was generally maintained. Only two (25%) hospitals had well documented guidelines for waste management and a proper waste management team. CONCLUSION: There should be proper training and management regarding awareness and practices of waste disposal. Research must be undertaken to seal existing gaps in the knowledge about hospital waste management. The hospital waste management guidelines enacted on 7th June 2004 should be followed and regulated by law enforcement agencies rigorously.

Awareness↗

PubMedDate not supplied

Monitoring sharps injuries: EPINet surveillance results.

Sharps injuries are one of the main types of accident sustained by NHS staff. The RCN's Be Sharp Be Safe campaign was launched in 2001 with the aim of reducing sharps injuries and includes a surveillance project to describe the current pattern of sharps injuries being experienced in participating trusts. This article gives an overview of the results from the second year of the surveillance project and indicates how the data can be used to help improve practice. Nurses emerge as the staff group reporting the highest proportion of injuries recorded in the study period. The most common sharps injury scenario involves nurses giving injections in the patient's room or ward area. Aspects of poor disposal practice and incidents involving the recapping of needles continue to result in injuries and are worthy of further investigation. Analysis of the data by location can highlight specific tasks which could be reviewed to identify safer working practices.

Accidents, Occupational↗

PubMed2004

Composition and production rate of dental solid waste in Xanthi, Greece: variability among dentist groups.

The objective of this work was to determine the composition and production rate of dental solid waste, produced by dental practices in the Prefecture of Xanthi, a multicultural area in Northeast Greece with a population of 102,000. For the study, 22 private dental practices and 1 public dental practice were selected of the 48 private and 5 public dental practices in operation. The 22 private dental practices included 16 owned by Christian Greek-born dentists, 3 by Moslem dentists and 3 by Christian dentists repatriated from the former Soviet Union. Differentiation on the basis of religion is directly related to the countries from which dentists received their training, e.g., Greece-European Union, Turkey and former Soviet Union. Thus, including the one public dental practice, 4 study groups were considered. Waste collection took place for 22 working days, from 20 May to 27 June 2002. This period was considered to be a representative one for a semi-rural area, such as Xanthi. Dentists were instructed to collect the total amount of waste they produced. A total of 260 kg dental solid waste was collected during the study period and was manually separated. Dental solid waste was classified in three main categories: (1) Infectious and potentially infectious waste, accounting for 94.7% by weight. (2) Non-infectious waste accounting for 2.0%. (3) Domestic-type waste, accounting for 3.3% by weight. The category of infectious waste is classified as hazardous and includes components containing metal (8.51%), components without metal (91.18%) and amalgam (0.33%). Using the weight data, the production rate of dental solid waste for the study period in the Prefecture of Xanthi was determined to be 513 g/practice/day and of infectious and potentially infectious waste 486 g/practice/day. The latter includes the production rate of sharps (9.8 g/practice/day), non-sharps (31.6), infectious waste without metal (443) and amalgam (1.6 g/practice/day). Since dental solid waste is currently disposed of in landfills together with the municipal solid waste, the results of the study were used to suggest an appropriate management scheme. The results were also used to compare the composition and production rates of dental solid waste produced by the 4 study groups.

Data Collection↗

PubMed2000

What do the needles, syringes, lancets and reagent strips of diabetic patients become in the absence of a common attitude? About 1070 questionnaires in diabetic clinics.

The aim was to investigate the fate of injection and monitoring material after its use by diabetic patients in different countries (France, Belgium, Luxemburg, Switzeland and Tunisia). Some suitable containers are available for disposal but little is known about the attitudes of patients and physicians to them. 1 070 questionnaires were completed by patients (age: 50 +/- 18 years; diabetes duration: 15 +/- 11 years; 2.8 +/- 1.1 injections per day) visiting 109 doctors. Injections were done at home (72.6%), or both at home and at work (26.6%). At home: needles, syringes, lancets and reagent strips were thrown directly into the bin in 46.9%, 49.9%, 52.2% and 67.6% of cases, respectively; and in a closed plastic bottle in 29. 6%, 28.5%, 28.9% and 19.9% of cases, respectively. Specific containers were used in 8.6% and 6.3% of cases for needles and syringes, respectively. 62% of the bottles and containers were thrown directly into the bin, whereas 15.5% were returned to a pharmacy (4.5% taken to hospitals, 2.9% were burned). At work: 63% of the patients brought their needles and syringes home for disposal, 6.9% kept suitable containers at work and 30% threw their materials directly into local bins. We conclude that awareness should be increased and the organization of the collection of used material improved.

Adult↗

PubMed2006

Improving access to sterile syringes and safe syringe disposal for injection drug users in methadone maintenance treatment.

We evaluated a novel intervention designed to improve access to sterile syringes and safe syringe disposal for injection drug users (IDUs) newly enrolled in methadone maintenance, through interviews with two sequential cohorts of 100 recent entrants into a methadone program in the Bronx, NY. A substantial number of participants had injected in the previous 6 months, and most continued injecting during the early weeks of treatment. The intervention was associated with significant behavior changes among IDUs, including increased use of pharmacies as a primary source of syringes (11% vs. 37%, p < .05) and decreases in both purchasing of syringes on the street (51% vs. 27%, p < .05) and needle sharing (40% vs. 7%, p < .01). The intervention had no impact on the prevalence of injection or on syringe disposal practices. Our findings suggest that drug treatment programs can serve an important role in reducing injection-related risk behavior by facilitating access to sterile syringes.

Adult↗

PubMed2006

Overview of biomedical waste management in selected Governorates in Egypt: a pilot study.

Inadequate management of biomedical waste can be associated with risks to healthcare workers, patients, communities and their environment. This study was conducted to assess the handling and treatment of biomedical waste in different healthcare settings in Egypt. Five hospitals and ten primary healthcare settings were surveyed using a modified survey questionnaire for waste management. This questionnaire was obtained from the World Health Organization (WHO), with the aim of assessing the processing systems for biomedical waste disposal. Researchers found that biomedical waste is inadequately processed in hospitals and primary healthcare settings due to the absence of written policies and protocols. Accordingly, healthcare staff, patients, the community and the environment may be negatively affected by exposure to the hazards of biomedical waste. The development of waste management policies, plans, and protocols are strongly recommended, in addition to establishing training programs on proper waste management for all healthcare workers.

Egypt↗

PubMed1995

Percutaneous injury analysis: consistent categorization, effective reduction methods, and future strategies.

OBJECTIVE: To report the results of an 8-year analysis of percutaneous injuries (PI), to describe interventions to decrease these injuries, and to discuss future prevention strategies. DESIGN: Using consistent methods, 881 percutaneous injury reports were reviewed, categorized, and analyzed from 1986 through 1993. SETTING: A 620-bed acute-care county teaching hospital located in San Jose, California, that is affiliated with Stanford University Medical School, Palo Alto, California. PARTICIPANTS: Employees of Santa Clara Valley Medical Center who reported percutaneous injuries from 1986 through 1993. INTERVENTIONS: Placement of needle disposal containers in all patient care areas, 1987; education, 1987 to present; communication of percutaneous injury analyses to all departments, 1988 to present; and safety product evaluation and purchases, 1991 to present. RESULTS: The total number of PI decreased by 65% (P = .0007) from 1986 through 1993. Recapping injuries decreased from 1986 through 1993 by 88% (P < .0002); interventions that included convenient placement of needle disposal containers and consistent annual education may have contributed to this decrease. Injuries from manipulating intravenous lines or heparin locks decreased in 1992 (P < .03) after purchase of a needleless system for intravenous lines. Injuries from improper disposal or from abrupt patient movement did not decrease significantly over the 8-year period. CONCLUSIONS: This institution has conducted percutaneous injury analysis for 8 years, utilizing consistent reviewers and categorization methods. Successful interventions have reduced recapping injuries, injuries from manipulating intravenous lines/heparin locks, and the overall numbers of PI. The categories of "Improper Disposal" and "Patient Moved Abruptly" present challenges for future reductions, as well as the recently identified problem of staff not using available safety devices or using them improperly.

California↗

PubMedDate not supplied

Soft copy using image processing in place of hard copy for detection of subtle pulmonary lesions: is it actually cost-effective?

PURPOSE: To comparatively assess the interpretation performance of hard-copy versus soft-copy presentations for detecting subtle pulmonary lesions and to estimate soft-copy cost-effectiveness. METHODS: Computed radiography was used to obtain images with a 1,600x 1,200 matrix having 8 bits of gray-scale definition. The two separate image formats (hard and soft copy), which consisted of 60 chest radiograph combinations, were shown to five board-certified radiologists. The costs of hard copies, chemicals, waste disposal, and labor were calculated. RESULTS: The mean accuracies and Az values were 0.63 (hard) vs. 0.64 (soft) and 0.657 (hard) vs. 0.729 (soft), respectively. Reading one set of hard copies took on average 8.0 sec less than reading soft copies (30.3 vs. 38.3 sec). Estimated savings resulting from replacement of hard copy with soft were US$128,004 per year or US$6.20 per patient at our hospital. CONCLUSION: Conversion from hard copy to soft copy, using image processing, is feasible and cost-effective.

Adult↗