Minimising the risk of Mycobacterium chimaera infection during cardiopulmonary bypass by the removal of heater-cooler units from the operating room

Perfusion ◽  
2017 ◽  
Vol 33 (4) ◽  
pp. 264-269 ◽  
Author(s):  
Thomas A. Barker ◽  
Uday Dandekar ◽  
Nina Fraser ◽  
Lincoln Dawkin ◽  
Paul Sweeney ◽  
...  
Keyword(s):  
Cardiopulmonary Bypass ◽  
Operating Room ◽  
Low Cost ◽  
Airborne Bacteria ◽  
Contaminated Water ◽  
Dual Purpose ◽  
Standard Operating ◽  
Life Threatening ◽  
Surgical Field ◽  
Circuit Function

Introduction: Mycobacterium chimaera ( M. chimaera) is a recently characterised bacterium that can cause life-threatening infections in small numbers of patients who undergo cardiopulmonary bypass during cardiac surgery. The likely mode of transmission is thought to occur through aerosolisation from contaminated water reservoirs. The airborne bacteria then contaminate the surgical field, leading to an infection months or even years later. The preferred practical solution to disrupt the transmission of these airborne bacteria to the patient is to remove the heater-cooler units (HCUs) from the operating room (OR). We describe a process of achieving this in order to provide information to guide other institutions who wish to do a similar thing. Methods: A multidisciplinary team was assembled to work on the project. The planning phase involved trialling different OR layouts and simulating the alterations in the HCU circuit function. The changes to the OR were made over a weekend to minimise disruption to the operating schedule. Results: The HCU was moved to the dirty utility room adjacent to the OR. Standard operating procedures (SOP) and risk assessments were made to enable this to be used for a dual purpose. One of the ORs was reconfigured to allow the cardiopulmonary bypass machine to be located close to the HCU in the dirty utility room. The total cost of the alterations was £6,158. Although we have provided a physical barrier to interrupt patient exposure to aerosolised M. chimaera from HCUs, we continue to perform cultures and decontamination as per the national recommendations. The SOP was designed to be auditable to ensure compliance with the protocols. Conclusions: We show a method by which the HCU can be removed from the OR in a relatively low-cost, straightforward and practical manner.

Parameters Affecting Dye Adsorption - Using Graphene Coated Sand (GSC)

2018 ◽  
Vol 4 (02) ◽  
Author(s):  
Seroor Atalah Khaleefa Alia ◽  
Dr. Mohammed Ibrahimb ◽  
Hussein Ali Hussein
Keyword(s):  
Heavy Metals ◽  
Contact Time ◽  
Organic Dyes ◽  
Low Cost ◽  
Dye Adsorption ◽  
Contaminated Water ◽  
Maximum Adsorption Capacity ◽  
Engineering Designs ◽  
Heavy Metals Ions ◽  
Coated Sand

Adsorption is most commonly applied process for the removal of pollutants such as dyes and heavy metals ions from wastewater. The present work talks about preparing graphenic material attached sand grains called graphene sand composite (GSC) by using ordinary sugar as a carbon source. Physical morphology and chemical composition of GSC was examined by using (FTIR, SEM, EDAX and XRD). Efficiency of GSC in the adsorption of organic dyes from water was investigated using reactive green dye with different parameters such as (ph, temperature, contact time and dose). Adsorption isotherm was also studied and the results showed that the maximum adsorption capacity of dye is 28.98 mg/g. This fast, low-cost process can be used to manufacture commercial filters to treat contaminated water using appropriate engineering designs.

scholarly journals A Paradigm Shift in Critical Care Infrastructure in Complex Settings: Evaluating an Ultraportable Operating Room to Improve Field Surgical Safety

2021 ◽  
Vol 186 (Supplement_1) ◽  
pp. 295-299
Author(s):  
Debbie L Teodorescu ◽  
Stephen Okajima ◽  
Asad Moten ◽  
Mike H M Teodorescu ◽  
Majed El Hechi ◽  
...  
Keyword(s):  
Operating Room ◽  
In Silico ◽  
Environmental Control ◽  
External Environment ◽  
Control Unit ◽  
Mortality And Morbidity ◽  
Particle Count ◽  
Surgical Safety ◽  
Surgical Field ◽  
Complex Settings

ABSTRACT Introduction Scarcity of operating rooms and personal protective equipment in far-forward field settings make surgical infections a potential concern for combat mortality and morbidity. Surgical and transport personnel also face infectious risks from bodily fluid exposures. Our study aimed to describe the serial, proof-of-concept testing of the SurgiBox technology: an inflatable sterile environment that addresses the aforementioned problems, fits on gurneys and backpacks, and drapes over incisions. Materials and Methods The SurgiBox environmental control unit and inflatable enclosure were optimized over five generations based on iterative feedback from stakeholders experienced in surgery in austere settings. The airflow system was developed by analytic modeling, verified through in silico modeling in SOLIDWORKS, and confirmed with prototype smoke-trail checking. Particulate counts evaluated the enclosure’s ability to control and mitigate users’ exposures to potentially infectious contaminants from the surgical field in various settings. SurgiBox enclosures were setup over a mannequin’s torso, in a configuration and position for either thoracic or abdominal surgery. A particle counter was serially positioned in sternotomy and laparotomy positions, as well as bilateral flank positions. This setup was repeated with open ports exposing the enclosure to the external environment. To simulate stress scenarios, sampling was repeated with enclosure measurements during an increase in external particulate concentration. Results The airflow technology effectively kept contaminants away from the incision and maintained a pressure differential to reduce particle entry. Benchtop testing demonstrated that even when ports were opened or the external environment had high contaminant burden, the enclosed surgical field consistently registered 0 particle count in all positions. Time from kit opening to incision averaged 54.5 seconds, with the rate-limiting step being connecting the environmental control unit to the enclosure. The portable kit weighted 5.9 lbs. Conclusions Analytic, in silico, and mechanical airflow modeling and benchtop testing have helped to quantify the SurgiBox system’s reliability in creating and maintaining an operating room-quality surgical field within the enclosure as well as protecting the surgical team outside the enclosure. More recent and ongoing work has focused on specifying optimal use settings in the casualty chain of care, expanding support for circumferential procedures, automating airflow control, and accelerating system setup. SurgiBox’s ultimate goal is to take timely, safe surgery to patients in even the most austere of settings.

scholarly journals Promising medium-term results of anterior approach with an anatomical short stem in primary hip arthroplasty

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Fabrizio Rivera ◽  
Alessandro Bardelli ◽  
Andrea Giolitti
Keyword(s):  
Operating Room ◽  
Anterior Approach ◽  
Direct Anterior Approach ◽  
Short Stem ◽  
Medium Term ◽  
Operating Room Table ◽  
Sf 36 ◽  
Standard Operating ◽  
The Mean

Abstract Background In the last decade, the increase in the use of the direct anterior approach to the hip has contributed to the diffusion of the use of short stems in orthopedic surgery. The aim of the study is to verify the medium-term clinical and radiographic results of a cementless anatomic short stem in the anterior approach to the hip. We also want to verify whether the use of the standard operating room table or the leg positioner can affect the incidence of pre- and postoperative complications. Materials and methods All total hip arthroplasty patients with a 1-year minimum follow-up who were operated using the MiniMAX stem between January 2010 and December 2019 were included in this study. Clinical evaluation included the Harris Hip Score (HHS), Western Ontario and McMaster Universities Hip Outcome Assessment (WOMAC) Score, and Short Form-36 (SF-36) questionnaires. Bone resorption and remodeling, radiolucency, osteolysis, and cortical hypertrophy were analyzed in the postoperative radiograph and were related to the final follow-up radiographic results. Complications due to the use of the standard operating room table or the leg positioner were evaluated. Results A total of 227 patients (238 hips) were included in the study. Average age at time of surgery was 62 years (range 38–77 years). Mean follow-up time was 67.7 months (range 12–120 months). Kaplan–Meier survivorship analysis after 10 years revealed 98.2% survival rate with revision for loosening as endpoint. The mean preoperative and postoperative HHS were 38.35 and 94.2, respectively. The mean preoperative and postoperative WOMAC Scores were 82.4 and 16.8, respectively. SF-36 physical and mental scores averaged 36.8 and 42.4, respectively, before surgery and 72.4 and 76.2, respectively, at final follow-up. The radiographic change around the stem showed bone hypertrophy in 55 cases (23%) at zone 3. In total, 183 surgeries were performed via the direct anterior approach (DAA) on a standard operating room table, and 44 surgeries were performed on the AMIS mobile leg positioner. Comparison between the two patient groups did not reveal significant differences. Conclusion In conclusion, a short, anatomic, cementless femoral stem provided stable metaphyseal fixation in younger patients. Our clinical and radiographic results support the use of this short stem in the direct anterior approach. Level of evidence IV.

scholarly journals Eggshell Powder as an Adsorbent for Removal of Fluoride from Aqueous Solution: Equilibrium, Kinetic and Thermodynamic Studies

2012 ◽  
Vol 9 (3) ◽  
pp. 1457-1480 ◽  
Author(s):  
R. Bhaumik ◽  
N. K. Mondal ◽  
B. Das ◽  
P. Roy ◽  
K. C. Pal ◽  
...  
Keyword(s):  
Aqueous Solution ◽  
Adsorption Process ◽  
Low Cost ◽  
Fluoride Removal ◽  
Contaminated Water ◽  
Fluoride Adsorption ◽  
Langmuir Isotherm Model ◽  
Pseudo Second Order ◽  
Kinetic And Thermodynamic Studies ◽  
Maximum Removal

A new medium, eggshell powder has been developed for fluoride removal from aqueous solution. Fluoride adsorption was studied in a batch system where adsorption was found to be pH dependent with maximum removal efficiency at 6.0. The experimental data was more satisfactorily fitted with Langmuir isotherm model. The kinetics and the factor controlling adsorption process fully accepted by pseudo-second-order model were also discussed. Eawas found to be 45.98 kJmol-1by using Arrhenius equation, indicating chemisorption nature of fluoride onto eggshell powder. Thermodynamic study showed spontaneous nature and feasibility of the adsorption process with negative enthalpy (∆H0) value also supported the exothermic nature. Batch experiments were performed to study the applicability of the adsorbent by using fluoride contaminated water collected from affected areas. These results indicate that eggshell powder can be used as an effective, low-cost adsorbent to remove fluoride from aqueous solution as well as groundwater.

Highly Efficient and Low‐cost Clay‐based Adsorbent for Glyphosate Removal from Contaminated Water

2021 ◽  
Author(s):  
Farzana Nargis ◽  
Ann Duong ◽  
Erwin Rehl ◽  
Charles Bradshaw ◽  
Hossein Kazemian
Keyword(s):  
Low Cost ◽  
Contaminated Water ◽  
Highly Efficient

Biomaterial development for cardiopulmonary bypass

Perfusion ◽  
2001 ◽  
Vol 16 (5) ◽  
pp. 381-390 ◽  
Author(s):  
T Gourlay
Keyword(s):  
Cardiopulmonary Bypass ◽  
Inflammatory Response ◽  
Polyvinyl Chloride ◽  
Surface Coating ◽  
Host Defence ◽  
New Materials ◽  
Pharmacological Interventions ◽  
Defence Mechanisms ◽  
Life Threatening

Cardiopulmonary bypass (CPB) is dependent on materials foreign to the patient for its successful application. When blood comes into contact with these so-called biomaterials, an inappropriate inflammatory response, which can be life-threatening in some patients, may develop. The reason for this inappropriate activation of host defence mechanisms is not entirely clear, however a number of strategies have evolved over the years to minimize this unwanted sequelae of CPB. These strategies include surface coating of the materials of the circuit, using new materials thought to improve biocompatibility, and using a number of pharmacological interventions designed to suppress the inflammatory response. Recently, there has been some evidence which indicates that the plasticizer employed in the polyvinyl chloride (PVC) tubing of the CPB circuit may play a part in the development of the inflammatory response. The work described in this paper tends to support this thesis. These studies showed that by washing the plasticizer from the surface of the PVC tubing, the biocompatibility, as reflected in the upregulation of CD11b on the surface of neutrophils, was enhanced. Furthermore, the use of non-plasticized substitutes for PVC had a similar effect. The benefit from removing the plasticizer was similar to that gained from surface coating with heparin, one of the conventional approaches to reducing the inflammatory response to CPB.

scholarly journals Removal of Cyanide-Contaminated Water by Vetiver Grasses

2015 ◽  
Vol 9 (13) ◽  
pp. 252 ◽  
Author(s):  
Piyada Wachirawongsakorn ◽  
Tongsai Jamnongkan ◽  
Mohd Talib Latif
Keyword(s):  
Growth Rate ◽  
Survival Rate ◽  
Sri Lanka ◽  
Removal Efficiency ◽  
Water Samples ◽  
Low Cost ◽  
Contaminated Water ◽  
Vetiver Grass ◽  
Vetiveria Zizanioides ◽  
Concentration Levels

<p>Vetiver grass and it usages have been widely investigated in many researches as the preferred plant species due to its known efficiency, low cost, the ease of availability and spread. This research aimed to use four different vetiver grass (<em>Vetiveria zizanioides</em>) ecotypes to remove cyanide (CN<sup>-</sup>)-contaminated water for improve its quality. Growth capability, tolerance and removal efficiency were evaluated. The results showed that the vetiver grass had a 100% survival rate for one month after planting. Songkhlar3 had the longest leaves, followed by Surat-Thani, Sri Lanka and Monto, respectively. Root lengths of all ecotypes showed no significant differences (p ≤ 0.05). All vetiver grass ecotypes could potentially purify CN<sup>-</sup>-contaminated water at lower concentrations of ≤ 35 mg CN<sup>-</sup>/L. The Monto ecotype had the highest CN<sup>-</sup> removal efficiency at all CN<sup>-</sup> concentration levels, showing 100% CN<sup>-</sup> removal from the 5-45 mg CN<sup>-</sup>/L contaminated water samples within 2-5 weeks growth. The tolerance of vetiver grass to CN<sup>-</sup> was a more important factor than growth rate when selecting a vetiver grass ecotype for CN<sup>-</sup> phytoremediation.</p>

Fibrinogen measurement in cardiac surgery with cardiopulmonary bypass: Analysis of repeatability and agreement of Clauss method within and between six different laboratories

2014 ◽  
Vol 112 (07) ◽  
pp. 109-117 ◽  
Author(s):  
Ekaterina Baryshnikova ◽  
Armando Tripodi ◽  
Christoph J. Schlimp ◽  
Herbert Schöchl ◽  
Janne Cadamuro ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Plasma Fibrinogen ◽  
Detection Methods ◽  
Fibrinogen Concentration ◽  
Plasma Samples ◽  
Limits Of Agreement ◽  
Study Objective ◽  
Standard Operating ◽  
Mean Differences

SummaryPlasma fibrinogen concentration is important for coagulopathy assessment, and is most commonly measured using the Clauss method. Several factors, including device type and reagent, have been shown to affect results. The study objective was to evaluate performance and repeatability of the Clauss method and to assess differences between measurements performed during and after cardiopulmonary bypass (CPB), by testing plasma samples from patients undergoing cardiac surgery with CPB. Samples were collected from 30 patients before surgery, approximately 20 minutes before weaning from CPB, and 5 minutes after CPB and protamine. Fibrinogen concentration was determined using the Clauss method at six quality-controlled specialised laboratories, according to accredited standard operating procedures. Regarding within-centre agreement for Clauss measurement, mean differences between duplicate measurements were between 0.00 g/l and 0.15 g/l, with intervals for 95% limits of agreement for mean Bland-Altman differences up to 1.3 g/l. Regarding between-centre agreement, some mean differences between pairs of centres were above 0.5 g/l. Differences of up to ∼2 g/l were observed with individual samples. Increased variability was observed between centres, with inter-class correlation values below 0.5 suggesting only fair agreement. There were no significant differences in fibrinogen concentration before weaning from CPB and after CPB for most centres and methods. In conclusion, considerable differences exist between Clauss-based plasma fibrinogen measured using different detection methods. Nevertheless, the similarity between measurements shortly before weaning from CPB and after CPB within centres suggests that on-pump measurements could provide an early estimation of fibrinogen deficit after CPB and thus guidance for haemostatic therapy.

scholarly journals A review on bioflocculation using microalgae for nutrient removal from waste water.

2021 ◽  
Vol 10 (1) ◽  
pp. 1-10
Author(s):  
Swathy Krishna
Keyword(s):  
Waste Water ◽  
Water Treatment ◽  
Surface Water ◽  
Nutrient Removal ◽  
Environmental Concern ◽  
Low Cost ◽  
Waste Water Treatment ◽  
Dual Purpose ◽  
Excellent Candidate ◽  
Conventional Methods

In recent decades, the eutrophication of surface water has become a major environmental concern. Increased concentration of nutrients such as nitrogen and phosphorous lead to eutrophication condition which highlights the demand for effective and economical methods of removing nitrogen and phosphorous from waste water. Bio flocculation using microalgae is an excellent candidate for satisfying the dual purpose of nutrient removal and waste water treatment. It has so many advantages over conventional methods such as toxic free, no chemical is needed, low cost etc. In this review the bio flocculation of microalgae, its mechanisms, applications and harvesting methods are discussed. Keywords: Bio flocculation, microalgae, nutrient removal, waste water treatment  

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