Manejo de aerossóis durante a pandemia da COVID-19 / Aerosol management during the COVID-19 pandemic / Manejo de aerosol durante la pandemia COVID-19

Objetivo: Descrever o processo de prototipação de um dispositivo de filtragem para manejo de aerossóis em procedimentos laparoscópicos durante a pandemia do coronavírus SARS-CoV-2. Método: Estudo descritivo, tipo relato de experiência sobre o protótipo de dispositivo de filtragem para manejo de aerossóis em laparoscopia durante a pandemia de COVID-19 pelo SARS-CoV-2, com base nos processos de imersão, ideação e prototipação do design thinking. Resultados: Os processos de imersão preliminar e profunda permitiram a abordagem do problema. A utilização do mapa mental proporcionou a identificação dos fatores relacionados às suspensões de cirurgias em decorrência do SARS-CoV-2. Pelas medidas do aspirador das salas cirúrgicas, idealizaram-se os recursos materiais necessários: extensor de aspiração, filtro bacteriológico e viral, conector e ponteira. Conclusão: O dispositivo para filtragem do dióxido de carbono do pneumoperitônio obteve boa aceitação da equipe cirúrgica e foi incorporado à rotina do setor durante a realização de cirurgias laparoscópicas.

Objective: To describe the prototyping process of a filtration device for aerosol management in laparoscopic procedures during the SARSCoV-2 coronavirus pandemic. Method: Descriptive study with the report of experience on the prototype filter device for aerosol management in laparoscopy during the SARS-CoV-2 COVID-19 pandemic, based on immersion, ideation and design thinking prototyping processes. Results: Preliminary and deep immersion processes allowed the problem to be addressed. The use of a mental map helped to identify factors related to surgery suspensions due to the SARS-CoV-2. Based on the measurements of the operating room aspirator, the necessary material resources were idealized: suction extender, bacteriological and viral filter, connector and tip. Conclusion: The device for filtering carbon dioxide from the pneumoperitoneum was well accepted by the surgical team and incorporated into the sector's routine for laparoscopic surgeries.

Objetivo: Describir el proceso de prototipado de un dispositivo de filtración para el manejo de aerosol en procedimientos laparoscópicos durante la pandemia de Coronavirus SARS-CoV-2. Método: Estudio descriptivo, un relato de experiencia sobre el prototipo de dispositivo de filtrado para el manejo de aerosol en laparoscopia durante la pandemia de COVID-19 por SARS-CoV-2, a partir de los procesos de inmersión, ideación y prototipado del Design Thinking. Resultados: Los procesos de inmersión profunda y preliminar permitieron abordar el problema. El uso del Mapa Mental permitió identificar los factores relacionados con la suspensión de cirugías debido al SARS-CoV-2. A partir de las mediciones del aspirador de las salas quirúrgicas, se idearon los recursos materiales necesarios: extensor de aspiración, filtro bacteriológico y viral, conector y férula. Conclusión: El dispositivo para filtrar dióxido de carbono del neumoperitoneo obtuvo buena aceptación por parte del equipo quirúrgico y fue incorporado a la rutina del sector durante las cirugías laparoscópicas.

Research on Self-perception and Active Warning Model of Medical Equipment Operation and Maintenance Status Based on Machine Learning Algorithm / 中国医疗器械杂志

The panoramic perception of medical equipment operation and maintenance status is the basic guarantee for the implementation of smart medical care, the machine learning algorithm-based autonomous perception and active early warning model of medical equipment operation and maintenance status is proposed. Introduce deep learning multi-dimensional perception of medical equipment multi-source heterogeneous fault data training sample characteristics to realize autonomous perception of medical equipment operation and maintenance status, introduce reinforcement learning to realize autonomous decision-making of test sample fault characteristics, and build the active early warning mechanism for medical equipment faults. Taking the equipment department of hospital as the carrier of model effectiveness verification, the effectiveness simulation of the model was carried out, the results show that the model has the advantages of comprehensive fault information perception, strong compatibility of medical equipment, high efficiency of active early warning.

Implementação e uso diário da lista de verificação de segurança cirúrgica em hospitais / Implementation and daily use of the surgical safety checklist in hospitals / Implementación y uso diario de la lista de control de seguridad quirúrgica en hospitales

Objetivo: Identificar o processo de implementação e o uso diário da lista de verificação de segurança cirúrgica, segundo relato de enfermeiros que atuavam no centro cirúrgico de hospitais. Método: Estudo descritivo-exploratório, com amostra de 77 enfermeiros. A coleta de dados ocorreu durante seis meses, no ano de 2016, por meio da aplicação de instrumento elaborado e submetido à validação de face e conteúdo. Na análise dos dados, adotou-se a estatística descritiva. Resultados: A realização de programa educacional foi essencial no processo de implementação da lista de verificação de segurança cirúrgica. O circulante era o responsável pela checagem diária da ferramenta na sala cirúrgica. A maioria dos enfermeiros relatou adesão parcial no uso do checklist pela equipe cirúrgica; houve diferença de adesão entre as etapas de checagem (entrada, pausa e saída) e entre as categorias profissionais. Conclusão: O conhecimento produzido oferece subsídios para a implementação da ferramenta e o uso de estratégias que podem auxiliar no cotidiano da prática clínica.

Objective: To identify the implementation process and the daily use of the surgical safety checklist, according to the report of nurses who worked in the surgical center of hospitals. Method: Descriptive-exploratory study, with a sample of 77 nurses. Data collection took place over six months in 2016, with the application of an instrument prepared and submitted to face and content validation. In the data analysis, descriptive statistics was adopted. Results: The realization of an educational program was essential in the process of implementing the surgical safety checklist. The circulator nurse was responsible for checking the instrument daily in the operating room. Most nurses reported partial adherence to the use of the checklist by the surgical team; there was difference in adherence between the checking stages (sign in, time out, and sign out) and between professional categories. Conclusion: The knowledge produced offers subsidies for the implementation of the instrument and the use of strategies that can assist in daily clinical practice.

Objetivo: Identificar el proceso de implementación y uso diario de la lista de verificación de seguridad quirúrgica, según el informe de enfermeras que laboraron en el centro quirúrgico de los hospitales. Método: Estudio descriptivo-exploratorio, con una muestra de 77 enfermeros. La recolección de datos se llevó a cabo durante seis meses, en 2016, mediante la aplicación de un instrumento elaborado y sometido a validación facial y de contenido. En el análisis de los datos se adoptó estadística descriptiva. Resultados: La realización de un programa educativo fue fundamental en el proceso de implementación de la lista de verificación de seguridad quirúrgica. El circulador se encargaba de revisar la herramienta diariamente en el quirófano. La mayoría de las enfermeras informaron un cumplimiento parcial del uso de la lista de verificación por parte del equipo quirúrgico; hubo una diferencia en la adherencia entre los pasos de verificación (entrada, pausa y salida) y entre categorías profesionales. Conclusión: El conocimiento producido ofrece subsidios para la implementación de la herramienta y el uso de estrategias que pueden ayudar en la práctica clínica diaria.

Reconstrucción nasal con colgajo frontal paramediano. Estudio restrospectivo / Nasal reconstruction with forehead flap. A retrospective study

RESUMENIntroducción y objetivo: Los defectos nasales pueden ocurrir por varias causas, siendo las más comunes neoplasias malignas cutáneas y trauma. Se considera la región frontal como un sitio donador ideal para reconstrucción nasal debido a la calidad, tamaño y vascularidad de la piel. El objetivo de la reconstrucción nasal es la restauración de su contorno lo más normal posible, evitando cualquier distorsión de su apariencia. Pacientes y Método: En un periodo de 5 años, desde junio del 2011 hasta abril del 2016, se realizaron 28 reconstrucciones nasales con colgajo frontal en pacientes con defectos nasales oncológicos. Se realizó la recolección de datos de las historias clínicas de todos los pacientes obteniendo el tipo de patología, el sexo, la edad, el tipo de reconstrucción y las complicaciones. Resultados: Veinte y ocho pacientes con edades comprendidas entre 29 a 86 años, con una edad media de 67.9 años, fueron tratados mediante este colgajo. Un 57.1% (16 pacientes) requirió injertos cartilaginosos y reconstrucción de la cobertura nasal interna. Existieron pocas complicaciones, la más frecuente fue necrosis parcial de borde distal (7.1%). Los resultados finales estéticos como funcionales fueron considerados por el equipo quirúrgico como buenos o excelentes en la mayoría de los casos. Conclusion: El empleo del colgajo frontal paramediano es una excelente alternativa en la reconstrucción de defectos nasales mayores a 1.5 cm, debido a que brinda una cobertura cutánea amplia de características similares al color y textura de la piel nasal. Por la gran vascularidad de este colgajo se disminuye el riesgo de complica-ciones permitiendo obtener muy buenos resultados estéticos y funcionales.Palabras claves: Colgajo Perforante; Reconstrucción nasal; Nariz; Procedimientos Quirúrgicos Reconstructivos; Trasplantes

ABSTRACTBackground and objective: Nasal defects can be caused by several causes, the most common of which are malignant cutaneous neo-plasms and trauma. The frontal region is considered as an ideal donor site for nasal reconstruction due to the quality, size and vascular-ization of the skin. The goal of nasal reconstruction is to restore its contour as normal as possible, avoiding distortion of nasal appearance.Patients and Method: In a 5-year period, from june 2011 to april 2016, twenty-eight nasal reconstructions were performed in patients with oncological defects using forehead flap. We reviewed the medical records of all patients obtaining data such as the type of pathology, sex, age, type of reconstruction and complications. Results: Twenty-eight patients aged 29-86 years (mean age of 67.9 years) were treated using this flap. In 57.1% (16 patients) required cartilage grafts and reconstruction of the internal nasal layer. There were few complications, the most frequent being partial necrosis of the distal border (7.1%). The final aesthetic and functional results were considered by the sur-gical team as good or excellent in most cases. Conclusions. The use of forehead flap is an excellent alternative in the reconstruction of nasal defects larger than 1.5 cm, because it provides a broad skin cover of similar characteristics to the color and texture of the nasal skin. Because of the great vascularization of this flap, the risk of complications is reduced allowing very good esthetic and functional results.Keywords: Colgajo Perforante; Reconstrucción nasal; Nariz; Procedimientos Quirúrgicos Reconstructivos; Trasplantes

Development of MyCheckTime® software for perioperative safety based on Toyota's Lean Methodology / Desarrollo del software MyCheckTime® para seguridad perioperatoria con base en la metodología Lean de Toyota

Abstract Introduction: In the age of healthcare safety, compliance with checklists and time tracking in surgery continue to be a gray zone in care processes. The technology applied to approach this issue and other scenarios, may contribute to solve a problem that impacts welfare and the healthcare sector economics. Objective: To introduce the design and construction of the MyCheckTime® software that incorporates Toyota's Lean methodology under the concept of Bundles. Materials and methods: Using a conceptual map, 5 measures were incorporated into the bundle; the MyCheckTime® platform was built based on a software code developed in Java8, PHP, Javascript, HTML5, Angular4, MongoDB-MySQL databases, and Docker, Ionic, VertX, Laravel-implemented technologies. Results: A software (MyCheckTime®) was constructed based on an App available for tablets and IOS and Android system-based mobile devices; a web-based platform and a database. The software captures the patient's circuit in the surgical area in real time, and records the times in which the checklists were conducted. Conclusion: MyCheckTime® is a Lean Methodology-based software that potentially enables the surgical team to deliver more efficient, safer, and timely care, allowing real time recording of the patient's circuit in the surgery area.

Resumen Introducción: En la era de la seguridad en la atención en salud, la de atención. La tecnología aplicada a esta problemática, al igual que adherencia a las listas de verificación y el seguimiento de tiempos otros escenarios, podrá contribuir a solucionar un problema que en el área de cirugía, continúan siendo puntos grises en los procesos de atención. La tecnología aplicada a esta problemática, al igual que otros escenarios, podrá contribuir a solucionar un problema que impacta el bienestar y la economía en el sector salud. Objetivo: Presentar el diseño y construcción del software MyCheckTime® que incorpora la metodología Lean de Toyota, bajo el concepto Bundles. Materiales y métodos: Mediante un mapa conceptual se incorporaron cinco medidas al paquete y se construyó una plataforma llamada MyCheckTime® con un código de software desarrollado en Java8, PHP, Javascript, HTML5, Angular4, bases de datos MongoDB-MySQL y tecnologías implementadas Docker, Ionic, VertX, Laravel. Resultados: Se construyó un software (MyCheckTime® ), compuesto por una App disponible para tabletas y móviles con sistema IOS o Android; una plataforma en la web y una base de datos. El software captura en tiempo real el circuito del paciente en el área de cirugía y registra los momentos en que se realizaron las listas de verificación. Conclusión: MyCheckTime® es un software basado en la Metodología Lean que potencialmente permitirá al equipo quirúrgico brindar una atención más eficiente, segura, y oportuna, permitiendo el registro en tiempo real del circuito que el paciente hace en el área de cirugía.

Validação da limpeza de produtos para saúde no cotidiano do centro de material e esterilização / Validation of daily medical device cleaning in the sterile processing department / Validación de la limpieza de productos de salud en todos los días del centro de material y esterilización

Objetivo: Discutir os aspectos que devem ser considerados na validação concorrente da limpeza no Centro de Materiais e Esterilização (CME). Método: Revisão narrativa da literatura científica, legislação e normatização pertinentes. Resultados: A validação da limpeza na rotina deve considerar: o design dos produtos, a definição e a exequibilidade dos procedimentos operacionais padrão, além da estrutura do CME, dimensionamento, seleção e treinamento de pessoal, registro e interpretação dos resultados obtidos pelos testes químicos na rotina. Conclusão: A validação concorrente da limpeza dos produtos para saúde no CME imprime a cultura da valorização dessa etapa do processamento entre todos os colaboradores do setor, de tal forma que a limpeza passa a ser, de fato, o núcleo central do processamento

Objective: To discuss the aspects that should be considered in the concurrent cleaning validation at Sterile Processing Department (SPD). Method: Narrative review of scientific literature, legislation, and pertinent normalizations. Results: The routine cleaning validation should consider the product design, definition, and feasibility of standard operating procedures (SOP); SPD structure; staff sizing; selection and training; and the recording and interpretation of results obtained by routine chemical tests. Conclusion: The concurrent cleaning validation of health products at SPD points out the value of this stage to all employees in the sector such that cleaning becomes a core function of health service product processing.

Objetivo: Discutir los aspectos que deben considerarse en la validación concurrente de limpieza en el Centro de Materiales y Esterilización (CME). Método: revisión narrativa de la literatura científica relevante, legislación y normas. Resultados: La validación de la limpieza en la rutina debe considerar: el diseño de los productos, la definición y la viabilidad de los procedimientos operativos estándar, además de la estructura del CME, dimensionamiento, selección y capacitación del personal, registro e interpretación de los resultados obtenidos por las pruebas químicas en el rutina Conclusión: La validación concurrente de la limpieza de productos de salud en CME impresiona la cultura de valorar esta etapa de procesamiento entre todos los empleados del sector, de tal manera que la limpieza se convierta, de hecho, en el núcleo central del procesamiento

La cirugía como una sinfonía. Un proyecto para el trabajo en equipo y coordinado / Surgery as a symphony. A project for team and coordinated work

La seguridad del paciente es uno de los aspectos de mayor relevancia en la atención en un quirófano. El trabajo en equipo y coordinado, sumado al liderazgo, permite que los errores sean menos. Mantener un equipo estable en el quirófano, que conozca bien los procedimientos, y donde cada participante sabe el rol que juega, es uno de los factores más importantes para lograr un trabajo eficiente, con disminución de las complicaciones y del tiempo quirúrgico. Comparar el trabajo en el quirófano con una orquesta sinfónica, nos ayuda a entender la importancia del trabajo coordinado

Patient safety is one of the most important aspects of care in an operating room. Coordinated teamwork, coupled with leadership, allows mistakes to be fewer. Maintaining a stable team in the operating room, who knows the procedures well, and where each participant knows the role they play, is one of the most important factors to achieve efficient work, with a reduction in complications and surgical time. Comparing work in the operating room with a symphony orchestra helps us understand the importance of coordinated work

Exploration and Minging of Large Medical Equipment Operation Data under Internet of Things / 中国医疗器械杂志

With the technology development in Internet of Things (IoT) area, it is good to try to use IoT and cloud computing technologies to improve the efficiency of medical equipment management. This article described using CT as sample to do the data capture and data analysis with the IoT technology. The positive result got shows the benefit of the exploring.

La laparoscopía el nuevo estándar de oro para el tratamiento de quistes renales simples sintomáticos / Laparoscopy the new gold standard for the treatment simple symptomatic renal cysts

más frecuentes del riñón. Su tratamiento consiste en la exploración quirúrgica y marsupialización. La cirugía laparoscópica permite una mejor disección, exploración e identificación de la anatomía con trauma mínimo del paciente. OBJETIVO. Mostrar la experiencia en el tratamiento quirúrgico laparoscópico mínimamente invasivo del quiste renal simple sintomático. MATERIALES Y MÉTODOS. Estudio retrospectivo del tratamiento laparoscópico transperitoneal, se evaluó la seguridad de la técnica, complicaciones perioperatorias y resultados clínicos en el transcurso de un año. Se estudió 8 pacientes: 4 mujeres y 4 hombres, con diagnóstico de quistes renales simples sintomáticos, atendidos por el Servicio de Urología del Hospital de Especialidades Carlos Andrade Marín de Quito, Ecuador. CASOS CLÍNICOS. Se registró edad, sexo, antecedentes patológicos personales, comorbilidades, historia familiar, examen físico completo, exámenes de imagen y de laboratorio. RESULTADOS. La media de la edad fue de 57 años con un intervalo entre 39 y 77 años. La indicación de cirugía fue dolor en región lumbar ipsilateral, que no respondieron a los analgésicos convencionales. El tamaño de los quistes osciló entre 7-10 cm de diámetro. El tiempo operatorio medio fue de 71 minutos sin requerir conversión a cirugía abierta. Los pacientes fueron dados de alta en los primeros cinco días del postoperatorio y los drenajes extraídos dentro del primer día. CONCLUSIÓN. El tratamiento laparoscópico de quistes renales simples sintomáticos por vía transperitoneal fue exitoso en todos los casos. El abordaje permitió la extirpación de los quistes, con menor morbilidad, y con un mejor confort postoperatorio para los pacientes.

kidney. Its treatment consists of surgical exploration and marsupialization. Laparoscopic surgery allows a better dissection, exploration and identification of the anatomy with minimal patient trauma. OBJECTIVE. To show the experience in the minimally invasive laparoscopic surgical treatment of the symptomatic simple renal cyst. MATERIALS AND METHODS. Retrospective study of transperitoneal laparoscopic treatment, the safety of the technique, perioperative complications and clinical results over the course of a year were evaluated. 8 patients were studied: 4 women and 4 men, with diagnosis of symptomatic simple renal cysts, attended by the Urology Service of the Carlos Andrade Marín Specialty Hospital of Quito, Ecuador. CLINICAL CASES. Age, sex, personal pathological history, comorbidities, family history, complete physical examination, image and laboratory tests were recorded. RESULTS. The mean age was 57 years with an interval between 39 and 77 years. The indication for surgery was pain in the ipsilateral lumbar region, which did not respond to conventional analgesics. The size of the cysts ranged between 7-10 cm in diameter. The mean operative time was 71 minutes without requiring conversion to open surgery. The patients were discharged in the first five days of the postoperative period and the drains extracted within the first day. CONCLUSION. The laparoscopic treatment of simple symptomatic renal cysts by the transperitoneal route was successful in all cases. The approach allowed the removal of the cysts, with less morbidity, and with a better postoperative comfort for the patients.

Reprocessamento de produtos: estado da arte à luz dos estudos de Kazuko Uchikawa Graziano / Reprocessing of products: state of the art in the light of the studies of Kazuko Uchikawa Graziano / Reprocesamiento de productos: estado del arte a la luz de los estudios de Kazuko Uchikawa Graziano

Objetivo: Revisar o estado da arte sobre reprocessamento de produtos à luz dos estudos da Professora Kazuko Graziano. Método: Revisão integrativa de literatura, tendo como descritor o nome da autora e com a seleção de 34 artigos. Resultados: Os estudos são abrangentes, majoritariamente experimentais e perpassaram pelos processos de limpeza e enxágue, desinfecção, esterilização e acondicionamento de artigos processados e em áreas emblemáticas para o reúso de materiais como ortopedia, oftalmologia, endoscopia e cirurgias videoassistidas. Conclusão: As evidências científicas desses estudos são valorosas para o campo do reúso de produtos e para a qualidade e a segurança da prática assistencial na medida em que clarificam dúvidas e subsidiam mudanças de atitudesprocessos de trabalho. Esses estudos contribuem, também, para o controle sanitário de serviços de saúde ao subsidiar as Vigilâncias Sanitárias com aportes teóricos sobre risco em reprocessamento de produtos e a Agência Nacional de Vigilância Sanitária (ANVISA) na atualização da política nacional de reúso de produtos para saúde (PPS) do país

Objective: To review the state of the art reprocessing of products in the light of Professor Kazuko Graziano's studies. Method: Integrative literature review, with the name of the author as a descriptor and the selection of 34 articles. Results: The studies are comprehensive, mainly experimental and outline processes of cleaning and rinsing, disinfection, sterilization and packaging of processed articles and in emblematic areas for the reuse of materials such as orthopedics, ophthalmology, endoscopy and video-assisted surgeries. Conclusion: The scientific evidence of these studies is valuable for the field of product reuse and the quality and safety of health care practice insofar as they clarify doubts and support changes in attitudes related to work processes. These studies also contribute to the control of health services by supporting Sanitary Vigilance with theoretical contributions on the risks of product reprocessing, and the Brazilian Health Surveillance Agency (ANVISA) by updating the national policy for the reuse of health products (HP)

Objetivo: Revisar el estado del arte sobre reprocesamiento de productos a la luz de los estudios de la Profesora Kazuko Graziano. Método: Revisión integrativa de literatura, teniendo como descriptor el nombre de la autora y con la selección de 34 artículos. Resultados: Los estudios son abarcadores, mayoritariamente experimentales y pasaron por los procesos de limpieza y enjuague, desinfección, esterilización y acondicionamiento de artículos procesados y en áreas emblemáticas para el reúso de materiales como ortopedia, oftalmología, endoscopía y cirugías video-asistidas. Conclusión: Las evidencias científicas de esos estudios son valerosas para el campo del reúso de productos y para la calidad y la seguridad de la práctica asistencial en la medida en que clarifican dudas y subsidian cambios de actitudes-procesos de trabajo. Esos estudios contribuyen, también, para el control sanitario de servicios de salud al subsidiar las Vigilancias Sanitarias con aportes teóricos sobre riesgo en reprocesamiento de productos y la Agencia Nacional de Vigilancia Sanitaria (ANVISA) en la actualización de la política nacional de reúso de productos para salud (PPS) del país

Implicações na qualidade do atendimento cirúrgico diante da não manutenção dos equipamentos hospitalares / Implications for the quality of surgical care through the non-maintenance of hospital equipment / Implicaciones para la calidad de la atención quirúrgica por medio del no mantenimiento de los equipos hospitalarios

Objetivo: Identificar as implicações da não manutenção dos equipamentos hospitalares na qualidade do atendimento cirúrgico. Método: Trata-se de uma pesquisa quantitativa, exploratória, descritiva, observacional, realizada em um hospital filantrópico do interior de Minas Gerais. Aplicou-se a técnica de observação direta e a avaliação de registros de manutenção preventiva e corretiva dos equipamentos cirúrgicos. Resultados: Durante o período de observação, verificou-se que os equipamentos que mais apresentaram falhas durante a cirurgia foram: bisturi elétrico, intensificador e foco cirúrgico. Os dados de funcionalidade e manutenção dos equipamentos foram comparados com recomendações do fabricante e com a literatura científica. Conclusão: A não manutenção dos equipamentos cirúrgicos pode prolongar a recuperação pós-operatória, aumentar a morbidade e a mortalidade e levar a um impacto financeiro desnecessário para a instituição. Espera-se que os resultados deste estudo possam motivar a equipe multiprofissional à realização da manutenção preventiva dos equipamentos antes das cirurgias.

Objective: To identify the implications of non-maintenance of hospital equipment for the quality of surgical care. Method: This is a quantitative, exploratory, descriptive, observational study carried out at a philanthropic hospital in the countryside of Minas Gerais. The technique of direct observation was applied, as well as the evaluation of records related to preventive and corrective maintenance of surgical equipment. Results: During the observation period, the equipment presenting most failures during surgical procedures were: electric scalpel, intensifier, and surgical focus. Equipment functionality and maintenance data were compared with manufacturers' recommendations and the scientific literature. Conclusion: Failure in surgical equipment maintenance can prolong patients' postoperative recovery, increase morbidity and mortality, and lead to unnecessary financial impact for the institution. It is hoped that the results of this study motivate the multiprofessional team to perform preventive maintenance of equipment before surgeries.

Objetivo: Identificar las implicaciones del no mantenimiento de los equipos hospitalarios en la calidad de la atención quirúrgica. Método: Se trata de un estudio observacional, descriptivo, exploratorio y cuantitativo realizado en un hospital filantrópico del interior de Minas Gerais. Se aplicó la técnica de observación directa y la evaluación de registros de mantenimiento preventivo y correctivo de los equipos quirúrgicos. Resultados: Durante el período de observación, se verificó que los equipos que presentaron el mayor número de fallas durante la cirugía fueron: bisturí eléctrico, intensificador y foco quirúrgico. La funcionalidad del equipo y los datos de mantenimiento se compararon con las recomendaciones del fabricante y la literatura científica. Conclusión: La falta de mantenimiento del equipo quirúrgico puede prolongar la recuperación postoperatoria, aumentar la morbilidad y la mortalidad y generar un impacto financiero innecesario para la institución. Se espera que los resultados de este estudio motiven al equipo multiprofesional a realizar el mantenimiento preventivo del equipo antes de las cirugías

Requirements for Cerebrovascular Surgery in Comprehensive Stroke Centers in South Korea

OBJECTIVE: Cerebrovascular disease (CVD) was the third most common cause of death in South Korea in 2014. Evidence from abroad suggests that comprehensive stroke centers play an important role in improving the mortality rate of stroke. However, surgical treatment for CVD is currently slightly neglected by national policy, and there is still regional imbalance in this regard. For this reason, we conducted a survey on the necessity of, and the requirements for, establishing regional comprehensive cerebrovascular surgery centers (CCVSCs).METHODS: This investigation was performed using the questionnaire survey method. The questionnaire was consisted with two sections. The first concerned the respondent’s opinion regarding the current status of demand and the regional imbalance of cerebrovascular surgery in South Korea. The second section asked about the requirements for establishing regional CCVSCs. We sent the questionnaire to 100 board members of the Korean Society of Cerebrovascular Surgeons.RESULTS: Most experts agreed that cerebrovascular surgery patients were concentrated in large hospitals in the capital area, and 83.6% of respondents agreed that it was necessary to alleviate the regional imbalance of cerebrovascular surgery. With regards to personnel, over 90% of respondents answered that at least two neuro-vascular surgeons and two neuro-interventionists are necessary to establish a CCVSC. Regarding facilities, almost all respondents stated that each CCVSC would require a neuro-intensive care unit and hybrid operating room. The survey asked the respondents about 13 specific neurovascular surgical procedures and whether they were necessary for a regional CCVSC. In the questions about the necessity of cerebrovascular surgical equipment, all seven pieces of equipment were considered essential by all respondents. A further five pieces of equipment were considered necessary on site: computed tomographic angiography, magnetic resonance angiography, conventional angiography, surgical microscope, and surgical navigation. Our results may provide a basis for future policy regarding treatment of cerebrovascular disease, including surgery.CONCLUSION: Raising the comprehensiveness of treatment at a regional level would lower the national disease burden. Policies should be drafted regarding comprehensive treatment including surgery for cerebrovascular disease, and related support plans should be implemented.

Requirements for Cerebrovascular Surgery in Comprehensive Stroke Centers in South Korea

OBJECTIVE: Cerebrovascular disease (CVD) was the third most common cause of death in South Korea in 2014. Evidence from abroad suggests that comprehensive stroke centers play an important role in improving the mortality rate of stroke. However, surgical treatment for CVD is currently slightly neglected by national policy, and there is still regional imbalance in this regard. For this reason, we conducted a survey on the necessity of, and the requirements for, establishing regional comprehensive cerebrovascular surgery centers (CCVSCs). METHODS: This investigation was performed using the questionnaire survey method. The questionnaire was consisted with two sections. The first concerned the respondent’s opinion regarding the current status of demand and the regional imbalance of cerebrovascular surgery in South Korea. The second section asked about the requirements for establishing regional CCVSCs. We sent the questionnaire to 100 board members of the Korean Society of Cerebrovascular Surgeons. RESULTS: Most experts agreed that cerebrovascular surgery patients were concentrated in large hospitals in the capital area, and 83.6% of respondents agreed that it was necessary to alleviate the regional imbalance of cerebrovascular surgery. With regards to personnel, over 90% of respondents answered that at least two neuro-vascular surgeons and two neuro-interventionists are necessary to establish a CCVSC. Regarding facilities, almost all respondents stated that each CCVSC would require a neuro-intensive care unit and hybrid operating room. The survey asked the respondents about 13 specific neurovascular surgical procedures and whether they were necessary for a regional CCVSC. In the questions about the necessity of cerebrovascular surgical equipment, all seven pieces of equipment were considered essential by all respondents. A further five pieces of equipment were considered necessary on site: computed tomographic angiography, magnetic resonance angiography, conventional angiography, surgical microscope, and surgical navigation. Our results may provide a basis for future policy regarding treatment of cerebrovascular disease, including surgery. CONCLUSION: Raising the comprehensiveness of treatment at a regional level would lower the national disease burden. Policies should be drafted regarding comprehensive treatment including surgery for cerebrovascular disease, and related support plans should be implemented.

Armazenar tubos de silicone antes do empacotamento impede a esterilização? / ¿Almacenar tubos de silicona antes del empaque impide la esterilización? / Does storage of silicone tubes prior to packaging prevent sterilization?

Resumo Objetivo: Determinar a carga microbiana de tubos de silicone imediatamente após a limpeza e em diferentes intervalos de armazenamento. Métodos: Estudo experimental que analisou tubos de silicone oriundos da assistência ao paciente cirúrgico. Foi conduzido após aprovação do Comitê de Ética (protocolo n° 1.277.077), no período de setembro a novembro de 2015, com tubos oriundos do Centro de Material e Esterilização (CME) de um hospital geral de grande porte da região Centro-Oeste do Brasil. Os tubos foram segmentados: extremidade 01, 02 e meio e novamente segmentados, conforme intervalos de tempo preestabelecidos em zero, 12 e 24 horas. Os fragmentos foram preenchidos com água estéril, vedados e submetidos a cinco minutos de sonicação. A água foi filtrada em Millipore 0,45 µm e as membranas incubadas a 35°C por 24 horas em ágar nutriente. As membranas foram removidas e dispostas em tubos de ensaio, contendo 1mL de solução salina, que foram agitadas por cinco minutos e submetidos a técnica de alça calibrada. Resultados: Houve aumento da carga microbiana na ordem de uma grandeza na escala logarítmica a cada 12 horas (p<0,05), nas condições de limpeza e armazenamento proporcionados pela instituição, nos grupos experimental e controle positivo, e não houve diferença quando comparados o meio e extremidades dos tubos de silicone (p>0,05) nos períodos zero, 12 e 24 horas. Conclusão: A depender da carga microbiana inicial, o aumento da ordem uma grandeza pode resultar no insucesso da esterilização, achados que ratificam a não permanência de PPS na área limpa aguardando o processamento.

Resumen Objetivo: Determinar la carga microbiana de tubos de silicona inmediatamente después de su limpieza e en diferentes intervalos de almacenamiento. Métodos: Estudio experimental en el que se analizaron tubos de silicona propios de la asistencia al paciente quirúrgico, en el período de septiembre a noviembre de 2015. Los tubos provenían del Centro de Material y Esterilización (CME) de un hospital general de gran tamaño de la región Centro-Oeste de Brasil. Los tubos fueron segmentados así: extremo 01, 02 y medio y nuevamente segmentados según intervalos de tiempo preestablecidos en cero, 12 y 24 horas. Los fragmentos se llenaron con agua estéril, fueron sellados y sometidos a cinco minutos de sonicación. El agua fue filtrada en Millipore 0,45 μm y las membranas incubadas a 35°C por 24 horas en agar nutriente. Las membranas fueron removidas y dispuestas en tubos de ensayo que contenían 1mL de solución salina, fueron agitados durante cinco minutos y sometidos a técnica de alza calibrada Resultados: Se observó un aumento de la carga microbiana en el orden de una magnitud en la escala logarítmica cada 12 horas (p <0,05), en las condiciones de limpieza y almacenamiento proporcionadas por la institución, en los grupos experimental y de control positivo. No hubo diferencia cuando se compararon el medio y los extremos de los tubos de silicona (p> 0,05) en los períodos cero, 12 y 24 horas. Conclusión: Dependiendo de la carga microbiana inicial, el aumento del orden de una magnitud puede resultar en el fracaso de la esterilización. Estos hallazgos ratifican la no permanencia de PPS en el área limpia mientras se aguarda el procesamiento.

Abstract Objective: To determine the microbial load of silicone tubes, immediately after cleaning, and at different storage intervals. Methods: Experimental study that analyzed silicone tubes from surgical patient care, conducted after approval by the Ethics Committee (protocol no. 1,277,077), from September to November of 2015, with tubes from the Central Processing Department (CPD) of a large general hospital in the West Central region of Brazil. The tubes were segmented (end 1 and 2, and the middle) and were then segmented again, according to established time intervals (zero, 12, and 24 hours). The fragments were filled with sterile water, sealed, and exposed to five minutes of sonication. The water was filtered via 0.45μm Millipore, and the membranes were incubated at 35°C for 24 hours, on nutrient agar. The membranes were removed and placed in test tubes containing 1mL of saline, which were mixed for five minutes, and subjected to a calibrated loop technique. Results: An increase in microbial load was identified, in the order of a logarithmic magnitude every 12 hours (p<0.05), in the cleaning and storage conditions provided by the institution, in the experimental and positive control groups, and no difference was identified when comparing the middle and ends of the silicone tubes (p> 0.05) at periods zero, 12, and 24 hours. Conclusion: Depending on the initial microbial load, an increase in the order of magnitude can result in sterilization failure, which corroborates the need to not maintain healthcare products in the storage place while awaiting processing.

Avaliação e controle de instrumentais utilizados em sala operatória durante cirurgias torácicas / Assessment and control of instruments utilized in operating room during thoracic surgeries / Evaluación y control de instrumentales utilizados en quirófano durante cirugías torácicas

Objetivo: Avaliar o número de instrumentais cirúrgicos não utilizados durante as cirurgias torácicas realizadas em um hospital universitário. Métodos: Trata-se de um estudo exploratório, descritivo, transversal com abordagem quantitativa, realizado a partir do levantamento de dados sobre a utilização ou não de instrumentais cirúrgicos presentes nas caixas cirúrgicas. Resultados: Foram observadas 30 cirurgias torácicas, sendo a média de instrumentais utilizados por cirurgia de 84,53% e a média de instrumentais não utilizados de 15,48%. Conclusão: São necessárias reformulações na composição das caixas cirúrgicas dessa especialidade a fim de otimizar a utilização e o processamento dos instrumentais.

Objective: To assess the number of unused surgical instruments during thoracic surgeries performed at a university hospital. Methods: An exploratory, descriptive, cross-sectional study with a quantitative approach, conducted by gathering data on the use or lack of use of surgical instruments present in the surgical box. Results: A total of thirty thoracic surgeries were observed, with a mean of 84.53% of instruments utilized for surgery and a mean of 15.48% of instruments left unused. Conclusion: A reconfiguration of the surgical boxes for this specialty is needed in order to optimize the utilization and the process of these instruments.

Objetivo: Evaluar el número de instrumentales quirúrgicos no utilizados durante las cirugías torácicas realizadas en un hospital universitario. Métodos: Se trata de un estudio exploratorio, descriptivo, transversal con abordaje cuantitativo, realizado a partir del levantamiento de datos sobre a utilización o no de instrumentales quirúrgicos presentes en las cajas quirúrgicas. Resultados: Fueron observadas 30 cirugías torácicas, siendo el promedio de instrumentales utilizados por cirugía del 84,53% y el promedio de instrumentales no utilizados del 15,48%. Conclusión: Son necesarias reformulaciones en la composición de las cajas quirúrgicas de esa especialidad a fin de optimizar la utilización y el procesamiento de los instrumentales.

Drug-Eluting Sinus Stent for Chronic Rhinosinusitis / 대한이비인후과학회지

Chronic rhinosinusitis is one of the most common surgical disease in otorhinolaryngology field. Since the introduction of functional endoscopic sinus surgery in Korea in the early 1990s, the development of surgical equipments and techniques has led to a dramatic improvement in surgical outcomes. However, achieving good surgical outcomes with sinus surgery depends on postoperative care for avoiding local complications, such as scar formation, lateralization of middle turbinate, formation of synechia, stenosis of ostium, and mucosal polypoid change. Various medications and methods have been used to address these problems. Several types of drug-eluting stents have been used since the early 2000s to address these problems. There were a lot of researches on off-label local drug releasing system combining nasal packing material, topical medication, and ethmoid sinus was a main target lesion. The combination of steroids such as dexamethasone, triamcinolone and absorbable nasal packing material have been reported. Since 2010, products have been developed that are capable of sustained and constant drug outflow and are being used in clinical practice. There are still some problems to be solved, such as stent migration, not enough volume of drug in stents, and the high price of device, but if these problems are solved in the future, they may be more widely used in clinical practice.

Cleft Lip and Palate Repair Using a Surgical Microscope

BACKGROUND: Cleft lip and palate repair requires a deep and small surgical field and is usually performed by surgeons wearing surgical loupes. Surgeons with loupes can obtain a wider surgical view, although headlights are required for the deepest procedures. Surgical microscopes offer comfort and a clear and magnification-adjustable surgical site that can be shared with the whole team, including observers, and easily recorded to further the education of junior surgeons. Magnification adjustments are convenient for precise procedures such as muscle dissection of the soft palate. METHODS: We performed a comparative investigation of 18 cleft operations that utilized either surgical loupes or microscopy. Paper-based questionnaires were completed by staff nurses to evaluate what went well and what could be improved in each procedure. The operating time, complication rate, and scores of the questionnaire responses were statistically analyzed. RESULTS: The operating time when microscopy was used was not significantly longer than when surgical loupes were utilized. The surgical field was clearly shared with surgical assistants, nurses, anesthesiologists, and students via microscope-linked monitors. Passing surgical equipment was easier when sharing the surgical view, and preoperative microscope preparation did not interfere with the duties of the staff nurses. CONCLUSIONS: Surgical microscopy was demonstrated to be useful during cleft operations.

Cleft Lip and Palate Repair Using a Surgical Microscope

BACKGROUND: Cleft lip and palate repair requires a deep and small surgical field and is usually performed by surgeons wearing surgical loupes. Surgeons with loupes can obtain a wider surgical view, although headlights are required for the deepest procedures. Surgical microscopes offer comfort and a clear and magnification-adjustable surgical site that can be shared with the whole team, including observers, and easily recorded to further the education of junior surgeons. Magnification adjustments are convenient for precise procedures such as muscle dissection of the soft palate. METHODS: We performed a comparative investigation of 18 cleft operations that utilized either surgical loupes or microscopy. Paper-based questionnaires were completed by staff nurses to evaluate what went well and what could be improved in each procedure. The operating time, complication rate, and scores of the questionnaire responses were statistically analyzed. RESULTS: The operating time when microscopy was used was not significantly longer than when surgical loupes were utilized. The surgical field was clearly shared with surgical assistants, nurses, anesthesiologists, and students via microscope-linked monitors. Passing surgical equipment was easier when sharing the surgical view, and preoperative microscope preparation did not interfere with the duties of the staff nurses. CONCLUSIONS: Surgical microscopy was demonstrated to be useful during cleft operations.