Public knowledge of button battery ingestions: A social media based cross-sectional analysis.

INTRODUCTION: Button battery (BB) ingestion injuries are a devastating and preventable event within the pediatric population. Efforts to reduce the prevalence of esophageal button battery ingestion injuries include primary preventative measures. It is integral to assess the public's baseline knowledge about BB injuries to tailor future primary prevention efforts. METHODS: This is a crowdsourcing survey-based study. Participants were notified through our institution's Twitter and Instagram accounts. RESULTS: There were 930 completed survey responses from May to June 2022. The survey found that 87% (791/910) knew that swallowing a BB could cause injury and 71% knew that it could cause death (642/905). Eight-five percent of respondents did not know what signs and symptoms to look for after BB ingestion, only 30% (99/340) of healthcare professionals felt they would know. Only 10.1% (94/930) of participants knew to give children over 12 months old honey after suspected BB ingestion. Thirty-four percent (311/930) knew that complications could still occur even after BB were removed. Seventy-seven percent (719/930) knew that a dead BB could cause injury but only 17% knew the correct way to dispose of a dead button battery (158/930). Only 8% (72/930) of participants were knew that wrapping dead BB in tape could potentially prevent injury. CONCLUSION: The current study reveals gaps in the public's understanding of BB injury including: the presentation of BB injuries; the delayed harm of BB impactions; management and mitigation strategies, and BB disposal methods. This survey provided imperative insights to help guide future education and primary prevention initiatives.

Clinical Validation of Computer-Aided Diagnosis Software for Preventing Retained Surgical Sponges.

BACKGROUND: We previously reported the successful development of a computer-aided diagnosis (CAD) system for preventing retained surgical sponges with deep learning using training data, including composite and simulated radiographs. In this study, we evaluated the efficacy of the CAD system in a clinical setting. STUDY DESIGN: A total of 1,053 postoperative radiographs obtained from patients 20 years of age or older who underwent surgery were evaluated. We implemented a foreign object detection application software on the portable radiographic device used in the operating room to detect retained surgical sponges. The results of the CAD system diagnosis were prospectively collected. RESULTS: Among the 1,053 images, the CAD system detected possible retained surgical items in 150 images. Specificity was 85.8%, which is similar to the data obtained during the development of the software. CONCLUSIONS: The validation of a CAD system using deep learning in a clinical setting showed similar efficacy as during the development of the system. These results suggest that the CAD system can contribute to the establishment of a more effective protocol than the current standard practice for preventing the retention of surgical items.

Reducing Retained Foreign Objects in the Operating Room: A Quality Improvement Initiative.

BACKGROUND: Although the incidence of pediatric retained foreign objects (RFOs) during surgery is diminutive (1/32,000), RFOs are often the most common sentinel events reported. In 2021, our institution noted an increase in RFOs evidenced by a substantial decrease in days between events. We aimed to minimize the incidence of RFO which was measured as an increase of days between events at our institution by implementation of a Quality Improvement initiative. STUDY DESIGN: This effort was conducted across 4 surgical centers within a tertiary children's healthcare system in December 2021. Patients undergoing surgery within this healthcare system across all surgical specialties were included. The quality improvement initiative was developed by a multidisciplinary team and included 6 steps focusing on quiet time, minimizing interruptions, and closed-loop communication during final surgical count. Seven Plan-Do-Study-Act cycles were used to test, refine, and implement the protocol. Adherence to the final surgical count protocol was monitored throughout the study period. RESULTS: In 2021, before protocol implementation, average time between RFO events was 29 days. After implementation of our quality initiative, the final surgical count protocol, we improved to 451 days between RFO events by February 2023, exceeding the upper control limit (235 days). After implementation, the number of RFO events dropped from 7 in 2021 to 0 in 2022. Adherence to the final surgical count protocol implementation was 96.4% by the end of cycle 7. CONCLUSIONS: RFOs during pediatric surgical procedures can be successfully reduced using quality improvement methodology focusing on standardizing the procedure of the final surgical count.

Pediatric Magnet Ingestion, Diagnosis, Management, and Prevention: A European Society for Paediatric Gastroenterology Hepatology and Nutrition (ESPGHAN) Position Paper.

Magnet ingestion is a special category of foreign body ingestion associated with high levels of morbidity and mortality worldwide, particularly if it is associated with staggered ingestion of multiple magnets or with simultaneous ingestion of other metallic foreign bodies, especially button batteries. A special category of magnet ingestion is the ingestion of earth magnets, which have higher levels of magnetism and therefore, potentially, carries a worse outcome. Legislative bodies, scientific Societies and community-led initiatives have been implemented worldwide with the aim of mitigating the effects of this growing, yet avoidable potential medical emergency. A scoping literature review summarized epidemiology, diagnosis, management, and prevention, including an algorithm for the diagnosis and management of magnet ingestion is presented and compared to previously published reviews and position papers (North American Society of Pediatric Gastroenterology, Hepatology and Nutrition, National Poison Center, Royal College of Emergency Medicine). The main emphasis of the algorithm is on identification of staggered/multiple magnet ingestion, and early joint gastroenterology and surgical consultation and management.

The effectiveness of radiofrequency scanning technology in preventing retained surgical items: An integrative review.

AIMS AND OBJECTIVES: To synthesise evidence on the effectiveness of radiofrequency (RF) scanning technology as an adjunct to manual counting protocols in preventing retained surgical items (RSIs) in the operating room. BACKGROUND: Despite the implementation of rigorous manual counting protocols, RSIs remain one of the most common reported sentinel events in operating theatres that lead to adverse patient outcomes. DESIGN: An integrative review. METHODS: This review was guided by the Whittemore and Knafl (2005) framework. A literature search using CINAHL, MEDLINE, ProQuest, PubMed, and Scopus with key search terms related to RSIs and RF was applied to select English articles from January 2011 till August 2021. The Joanna Briggs Institute (JBI) Critical Appraisal Checklist was utilised for study quality assessment while reporting of review was guided using the PRISMA checklist. RESULTS: A total of 15 peer-reviewed articles were included, enabling the knowledge on the RF scanning technology to be grouped into four themes, namely: detection accuracy of RF scanning technology, real-time detection of surgical items using RF identification, the impact of the RF scanning technology for detecting RSIs on patient safety, and cost-analysis of integrating the RF scanning technology in operating theatres. CONCLUSION: Radiofrequency scanning technology is effective in preventing RSIs with significant cost-savings. Perioperative leaders should develop a multidisciplinary process to evaluate and select the most appropriate RF scanning technology as part of their patient safety programs. However, future studies with a larger sample size and robust research design, such as randomised controlled trial, should be considered to enhance the generalisability and rigour of evidence. RELEVANCE TO CLINICAL PRACTICE: This review contributes to perioperative personnel's education/training of staff on using RF scanning technology to prevent RSIs. The cost-effectiveness analysis enables the healthcare leaders to decide on the selection of appropriate RF technology.

Guidelines in Practice: Prevention of Unintentionally Retained Surgical Items.

Retained surgical items (RSIs) are adverse events that can affect patients, surgeons, and nurses. Interdisciplinary teams should work to standardize surgical item accounting processes and help all perioperative team members prevent RSIs. AORN recently revised the "Guideline for prevention of unintentionally retained surgical items," which provides background information on RSIs and ways to prevent them. The revised guideline describes the role of team communication coupled with specific nursing actions aimed at preventing RSIs. This article reviews key concepts from the guideline and discusses new or changed recommendations regarding a consistent interdisciplinary approach and standard counting procedure; accounting for soft goods, sharps and miscellaneous items, instruments, device fragments and explants, and foam pieces; reconciling count discrepancies; adjunct technology; and education. The article also provides a scenario related to implementing adjunct technology to prevent RSIs. Perioperative leaders and nurses should review the guideline in its entirety and apply the recommendations to prevent RSIs.

Risk Reduction Strategy to Decrease Incidence of Retained Surgical Items.

BACKGROUND: Retained surgical items (RSIs) are rare but serious events associated with significant morbidity and costs. We assessed the effectiveness of radiofrequency (RF) detection technology and Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) in reducing the incidence of RSIs. STUDY DESIGN: All RSIs reported to the New York Patient Occurrence Reporting and Tracking System at five large urban teaching hospitals from 2007 to 2017 were analyzed. In 2012, TeamSTEPPS training was provided to all perioperative staff at each site, and use of RF detection became required in all procedures. The incidence of events before and after the interventions were compared using odds ratios. RESULTS: A total of 997,237 operative procedures were analyzed. After the interventions, the incidence of RSIs decreased from 11.66 to 5.80 events per 100,000 operations (odds ratio [OR] [95% CI] = 0.50 [0.32 to 0.78]). The frequency of RSIs involving RF-detectable items decreased from 5.21 to 1.35 events per 100,000 operations (OR [95% CI] = 0.26 [0.11 to 0.60]). The difference in RSIs involving non-RF-detectable surgical items was not statistically significant. CONCLUSIONS: The incidence of RSIs was significantly lower during the time period after implementing RF detection technology and after TeamSTEPPS training, primarily driven by a decrease in retained RF-detectable items. RF detection technology may be worth pursuing for hospitals looking to decrease RSI frequency. The benefit of TeamSTEPPS training alone may not result in a reduction of RSIs.

Prevention of foreign bodies entering Children's respiratory tracts: The effect of the Caregiver's knowledge, behaviour and attitude.

OBJECTIVES: To explore the effect of the caregiver's knowledge, behaviour and attitude on the prevention of foreign bodies in children's respiratory tracts to provide a basis for publicity and education on foreign bodies in children's respiratory tracts. METHODS: A case-control method was used to investigate the knowledge, behaviour and attitude of the caregivers of 900 paediatric patients at Hunan Children's Hospital from June 2017 to February 2019. Caregivers of 300 children with foreign bodies removed by rigid bronchoscopy were selected as the case group. Caregivers of 600 children with other conditions were selected as the control group. The knowledge, behaviour and attitude of the caregivers towards foreign bodies in children's respiratory tracts and the demographic characteristics of the two groups were analyzed and compared. RESULTS: The results showed significant differences for the children in terms of their gender, age and living conditions between the two groups (all p < 0.05) and for the caregivers in terms of their age, educational level, relationship with the child and the number of children in the family (all p < 0.05). There were statistically significant differences in the caregivers' knowledge of foreign bodies in the respiratory tract between the two groups (p < 0.05). In addition, a significant difference was also found between the groups in the caregivers' understanding of the prevention of foreign bodies in the respiratory tract, such as whether they were aware of the specific first-aid measures needed to treat the condition (p < 0.05). CONCLUSION: The caregiver's relationship to the child, their age, their level of education and the number of children in the family affected the occurrence of the condition, while the caregiver's knowledge, behaviour and attitude regarding foreign bodies in the respiratory tract also had some influence. However, in the future, national multiple-centre courses could be extremely useful in educating caregivers.

Replacing plastic bread clips with cardboard will prevent bowel perforation.

Plastic bread clips cause significant morbidity and mortality if accidentally ingested. A review of all existing case reports published in medical literature was conducted in PubMed, MedLine and Google Scholar. Key words included but was not limited to; clip, tag, tab, closure, kwik lok, bread, bag, ingestion, bowel, obstruction, perforation, plastic and foreign body. References of all the articles were sought out to ensure completeness. Fifty-six cases between 1975 and 2020 were analysed to understand the complications and the characteristics of the bread clip that caused these. About 28% of case reports described bowel perforation, with 61% of these occurring in the small bowel. Plastic bread clips are firm in nature, long lasting, and are shaped to grasp onto bowel, thus leading to these complications. Commercially available alternatives are introduced in order to encourage replacing plastic bread clips worldwide.

Button battery taping prevents oesophageal injury.

AIM: Most button battery (BB) ingestions in children are unwitnessed leading to prolonged exposures and severe complications. One third of ingestions occur from free BB, that are stored or awaiting disposal. Recommendations have been made to cover the terminals of discarded BB with adhesive tape; however, it is unclear if this practice prevents injury. Our aim was to determine if tape could prevent oesophageal injury in a cadaveric porcine model. METHODS: Electrical, masking, packing and duct tape were compared. One BB was left untaped. Taped BBs were placed in a cadaveric porcine oesophagus controlled for temperature and humidification. Specimens were assessed at 0, 0.5, and hourly for 6 h by visual inspection, temperature and pH. BB voltage was measured before and after testing. All tests were repeated in triplicate. RESULTS: Oesophageal specimens demonstrated burn prevention in the packing and duct tape trials. Burns were seen in 2/3 trials with electrical tape and 3/3 trials with masking tape. pH remained neutral throughout the study for all packing and duct tape specimens. pH remained neutral initially for masking tape but increased rapidly to 12 by 2 h. There was no change in battery voltage for the packing tape and duct tape trials. There was a 16.3% reduction in voltage for masking tape which was similar to controls. CONCLUSIONS: Taping BB with packing tape and duct tape prevented oesophageal burns. This may provide a novel method of burn prevention for loose BB intended for disposal.

Button battery taping and disposal: Risk reduction strategies for the household setting.

OBJECTIVES: Pediatric esophageal button battery (BB) injury occurs rapidly and continues to be a significant source of morbidity and mortality. Unfortunately, a BB that no longer supplies power to a device can still have enough residual voltage to cause injury within the body. Development of additional prevention strategies for consumers may reduce esophageal injury risk. METHODS: In this study, 24 commercially available button batteries (BBs) were horizontally and vertically wrapped (2 layers, full circumferential coverage, 90° apart) with 6 different types of common household tapes (Scotch®/clear, Scotch®/Magic, masking tape, packing tape/clear, packing tape/brown, black electrical tape) and left at room temperature for 30 days. In addition, 6 of the CR2032 batteries covered with each type of tape were placed in a cadaveric piglet esophageal model for a 4-h period and then compared to controls without tape for tissue pH changes and visible tissue injury. RESULTS: None of the tape-wrapped batteries showed voltage changes nor presented any hazard stemming from BB ingestion. All 6 tape covered batteries placed in the cadaveric piglet esophageal tissue model demonstrated no visible tissue injury and no change in tissue pH in contrast to the controls. Review of BB packaging language from various brands of commercially available CR2032 batteries showed that none had specific disposal recommendations. CONCLUSION: Both BB and electronics manufacturers should consider instructing the use of common household tape options to cover these BB immediately after removal from a device for either recycling or disposal. Such precautions may help to reduce related ingestion injuries in children.

Avoiding Retained Surgical Items at an Academic Medical Center: Sustainability of a Surgical Quality Improvement Project.

Unintentionally retained surgical items (RSIs) are a serious complication representing a surgical "Never" event. The authors previously reported the process and significant improvement over a 3-year multiphased quality improvement RSI reduction effort that included sponge-counting technology. Herein, they report the sustainability of that effort over the decade following the formal quality improvement project conclusion. This retrospective analysis includes descriptive and qualitative data collected during RSI event root cause analysis. Between January 2009 and December 2019, 640 889 operations were performed with 24 RSIs reported. The resulting RSI rate of 1 per 26 704 operations represent a 486% performance improvement compared to the preintervention rate of 1 per 5500 operations. The interval, in days, between RSI events increased to 160 from 26 during the preintervention phase. Cotton sponges were the most retained RSI despite the use of sponge-counting technology. A significant and sustained reduction in RSI is possible after designing a sustainable comprehensive multidisciplinary effort.

Incorrect Surgical Counts: A Potential for Retained Surgical Items.

BACKGROUND: In the main operating rooms of a large academic hospital there was a report of 408 count discrepancies in 2015-2016 and 13 incidences of retained surgical items (RSIs). There was a lack of a consistent and standardized surgical count process among nurses. OBJECTIVES: To reduce count discrepancies by 25%, prevent RSIs, and improve the compliance of the perioperative nursing team regarding the surgical count process. METHODS: An evidence-based quality improvement project with a sample of 455 surgical procedures and 118 nurses. Data collection occurred over an eight-week period in 2018 using a Plan-Do-Study-Act (PDSA) methodology to study the effectiveness of the utilization of the Association of periOperative Registered Nurses (AORN) practice guidelines for the prevention of RSIs. RESULTS: The inclusion of risk reduction strategies such as the utilization of an AORN guideline whiteboard to record surgical items and the identification of high-risk items for retained device fragments or high-risk surgical items for RSIs resulted in the reduction of incorrect surgical counts by 71.43%, with no incidence of RSIs. Further, nurse compliance on surgical count practices improved significantly, F (5, 46) = 2.47, p = .046, PES = .21. CONCLUSION: The implementation of the AORN guidelines for perioperative surgical count practices by the perioperative nursing team provided an improved surgical count process. IMPLICATION FOR NURSING: A system approach to performance improvement is needed to prevent RSIs.