Additive Manufacturing Interventions during the COVID-19 Pandemic: South Africa

Additive manufacturing (AM), also known as 3D printing, is considered a renaissance of the manufacturing industry. Its unique capability of manufacturing 3D objects with intricate geometrical configurations has been used to produce hospital equipment and personal protective equipment (PPE) in an attempt to curb the spread of the COVID-19 pandemic in South Africa. The technology has been used by different research units to produce ventilators, respirator face masks, oscillating respiratory devices, oxygen connectors, oxygen splitters, non-invasive ventilation helmets, reusable clinician PPE, visor frames for face shields, etc. Despite the efforts of the AM community in South Africa, COVID-19 infections have continued to increase in the country. It came to light that technological interventions (including AM) alone cannot prevent the spread of the virus without the corresponding adaptive behavioural changes, such as adhering to COVID-19 prevention protocols (washing of hands, social distancing, etc.). It could be postulated that the spread of COVID-19 can only be prevented by inter-marrying the technological interventions (AM) with adaptive behavioural changes.

Cybersecurity risks and gaps in hospital clinical care: Summary review (for the non-cyber professional) (Preprint)

BACKGROUND Healthcare is facing a growing threat of cyberattacks. Myriad data sources illustrate the same trends that healthcare is one of the industries with the highest risk of cyber infiltration and is seeing the rate of security incidents surge within just a few years. The circumstances thus begged the question: are US hospitals prepared for the risks that accompany clinical medicine in cyberspace? OBJECTIVE This study aimed to identify the major topics and concerns present in today’s hospital cybersecurity field, intended for the non-cyber professionals audience in hospital settings. METHODS Via a structured literature search of the National Institutes of Health’s PubMed database (including the MEDLINE database) and Tel Aviv University’s DaTa database, 35 journal articles were identified to form the core of the study. 86 additional sources were examined to inform the study findings RESULTS The literature review revealed a basic landscape of hospital cybersecurity, including the top ten methods of attack, the primary reasons hospitals are frequent targets, and the consequences hospitals face following attacks. The cyber technologies common in clinical medicine, as well as their risks, were also examined, with the major categories highlighted being medical devices, telemedicine software, and electronic data. By infiltrating any of these three components of clinical care, cyber attackers can access a trove of valuable information and manipulate, steal, ransom, or otherwise compromise the records, or can use the access to catapult themselves to access other parts of a hospital’s network. Multiple secondary issues that can increase the cyber risks associated with devices, telemedicine, and electronic data were also identified. Finally, strategies that hospitals tend to employ to combat the cyber risks were explored and found to be subpar. There exist within hospitals’ cybersecurity measures serious vulnerabilities and gaps that many of today’s hospitals fail to address. The COVID-19 pandemic was used to further illustrate this issue. CONCLUSIONS Comparison of the risks, strategies, and gaps revealed that many hospitals in the US are unprepared for cybersecurity risks. The focus of their efforts are misdirected, with external - often governmental - efforts negligible. Policy changes, such as training employees in cyber protocols, adding advanced technical protections, and collaborating with a variety of experts, are necessary. Overall, hospitals must recognize that, in cyber incidents, the real victims are the patients. They are the ones at risk, physically and in information confidentiality, when medical devices, hospital equipment, or treatments are compromised.

Hospitalisation and mortality from COVID-19 in Mexican indigenous people: a cross-sectional observational study

BackgroundDespite having a large indigenous population, little is known about the differences in COVID-19-related health outcomes between indigenous and non-indigenous patients in Mexico. The aim of this study is to analyse the variation in hospitalisation and death between indigenous and non-indigenous patients with COVID-19 to guide future policies and clinical practice.MethodsWe used data from the Mexican Ministry of Health (MoH) to study the hospitalisation and death of adults with laboratory-confirmed SARS-CoV-2 in MoH facilities between 1 March 2020 and 28 February 2021. Predicted probabilities of hospitalisation and death were adjusted for sociodemographic and presentation to care characteristics as well as municipal social deprivation index and health jurisdiction-level index of human resource and hospital equipment availability.ResultsOf 465 676 hospitalised adults with COVID-19, 5873 (1.3%) were identified as indigenous. Indigenous patients had higher odds of hospitalisation (adjusted OR (aOR)=1.9, 95% CI 1.8 to 2.0), death (aOR=1.3, 95% CI 1.1 to 1. 3) and early mortality (aOR=1.2, 95% CI 1.0 to 1.4), compared with non-indigenous patients. Living in municipalities with high social deprivation was associated with a higher risk of hospitalisation and early death. Living in areas with low healthcare resources was associated with a higher risk of hospitalisation but not death. Being male, aged 51 years or older, having diabetes, hypertension and obesity were associated with an incremental probability of hospitalisation and death among indigenous patients.ConclusionsIndigenous patients with COVID-19 in Mexico have a higher risk of hospitalisation and death than non-indigenous individuals. Our findings can guide future efforts to protect this population from SARS-CoV-2 infection and associated outcomes.

Outbreaks of healthcare-associated infections linked to water-containing hospital equipment: a literature review

Background Healthcare-associated infections (HAIs) are a significant cause of morbidity and mortality in hospitalized patients. Water in the environment can be a source of infection linked to outbreaks and environmental transmission in hospitals. Water safety in hospitals remains a challenge. This article has summarized available scientific literature to obtain an overview of outbreaks linked to water-containing hospital equipment and strategies to prevent such outbreaks. Methods We made a list of water-containing hospital equipment and devices in which water is being used in a semi-closed circuit. A literature search was performed in PubMed with a search strategy containing the names of these medical devices and one or more of the following words: outbreak, environmental contamination, transmission, infection. For each medical device, we summarized the following information: the function of the medical device, causes of contamination, the described outbreaks and possible prevention strategies. Results The following water-containing medical equipment or devices were identified: heater-cooler units, hemodialysis equipment, neonatal incubators, dental unit waterlines, fluid warmers, nebulizers, water traps, water baths, blanketrol, scalp cooling, and thermic stimulators. Of the latter three, no literature could be found. Of all other devices, one or more outbreaks associated with these devices were reported in the literature. Conclusions The water reservoirs in water-containing medical devices can be a source of microbial growth and transmissions to patients, despite the semi-closed water circuit. Proper handling and proper cleaning and disinfection can help to reduce the microbial burden and, consequently, transmission to patients. However, these devices are often difficult to clean and disinfect because they cannot be adequately opened or disassembled, and the manufacturer’s cleaning guidelines are often not feasible to execute. The development of equipment without water or fluid containers should be stimulated. Precise cleaning and disinfection guidelines and instructions are essential for instructing healthcare workers and hospital cleaning staff to prevent potential transmission to patients.

On the design of Remote Health Monitoring System

With improvement in technology and miniaturization of sensors, there have been attempts to utilize the new technology in various areas to improve the quality of human life. One main area of research that has seen adoption of the technology is the healthcare sector. The people in need of healthcare services find it very expensive, this is particularly true in developing countries. With improvement in technology previously expensive hospital equipment have been redesigned using current technology. The developments have seen a trend known as remote healthcare or previously known as Telemedicine. As a result, this paper is an attempt to solve a healthcare problem facing the society. The main objective of the paper is to design a remote healthcare system. It is comprised of three main parts. The first part being detection of a fall, second being detection of electrocardiogram commonly referred to as ECG or EKG( heartbeat detection) and the last part is providing the detected data for remote viewing. Remote viewing of the data enables a doctor or health specialist to monitor a patient’s health progress away from hospital premises.

Feasibility of a One Degree-of-Freedom Linear Robot for Bed-Bound Stroke Rehabilitation

A 1DOF lower limb rehabilitation robot is presented for delivering leg extension therapy to bed-bound stroke patients. Such a compact and minimal system may be beneficial in terms of compatibility with pre-existing hospital equipment, ease-of-use, safety, and cost. A set of design criteria was created based on the literature and on previous field work at a local hospital. The device uses admittance control to apply assistive or resistive forces, and can also use haptic feedback to increase user engagement. A pilot study on six healthy participants was used to determine the feasibility of such a minimal system in administering assistance or resistance through the leg extension exercise. Results indicate that a single DOF is capable of decreasing trajectory error with assistance and increasing user effort with resistance. Observations confirm that the minimal system is effective; however, extending the robot with additional DOFs so that it can target multiple bed-bound exercises may help to increase therapy duration.

Strategi Mitigasi Risiko Produktivitas Pada Proses Assembly Hospital Equipment

The rapid development of technology and industrialization demands an increasing need for strategic planning. One of the strategies needed for a company to remain competitive in the industrialized world is to increase productivity. However, practically several companies still experience difficulties in making efforts to increase productivity so that the productivity achieved is not optimal. The same thing happened at PT. Mega Andalan Kalasan, especially on the Assembly Unit of the Hospital Equipment. Where the productivity achieved cannot be categorized as optimal because it can be seen from the number of non-value added activities that occur in assembly process. Among the products produced, it is known that the Operating Table Manual product has the highest percentage of non-value added activity, which is 30% of the total cycle time. This study aims to identify risks using the Failure Mode and Effect Analysis (FMEA) method and design a mitigation strategy as an initial effort to improve productivity by minimizing non-value added activities. The identification results show that there are 22 risks with moderate severity but high occurrence. Recommendations in the form of implementing better quality control on incoming materials are one of the strategies which capable of mitigating 40% of the risk of existing non value added activities. Adanya perkembangan teknologi dan industrialisasi yang semakin pesat menuntut kebutuhan akan perencanaan strategi semakin meningkat. Salah satu strategi yang dibutuhkan agar sebuah perusahaan dapat tetap bersaing di dunia perindustrian adalah dengan meningkatkan produktivitas. Namun pada penerapannya, beberapa perusahaan masih mengalami kesulitan dalam melakukan upaya peningkatan produktivitas sehingga produktivitas yang dicapai belum optimal. Hal yang serupa terjadi di PT. Mega Andalan Kalasan, khususnya pada lantai kerja Assembly unit Hospital Equipment. Dimana produktivitas yang dicapai belum bisa dikatakan optimal karena terlihat dari banyaknya non value added activity yang terjadi pada proses assembly. Diantara sejumlah produk yang dihasilkan, diketahui bahwa pengerjaan produk Operating Table Manual memiliki persentase non value added activity yang tertinggi yaitu sebanyak 30% dari total waktu siklusnya. Penelitian ini bertujuan untuk mengidentifikasi risiko dengan menggunakan metode Failure Mode and Effect Analysis (FMEA) dan merancang strategi mitigasi sebagai upaya awal untuk memperbaiki produktivitas dengan meminimalisir aktivitas non value added. Hasil identifikasi menunjukkan terdapat 22 risiko dengan tingkat severity sedang namun memiliki occurence yang tinggi. Rekomendasi berupa penerapan quality control yang lebih baik terhadap incoming material menjadi salah satu strategi yang mampu memitigasi 40% risiko aktivitas non value added yang ada.

THE ANALYSIS OF WASTE ACTIVITIES IN SUPRAMAK BED PRODUCTION BY USING VALUE STREAM MAPPING AND VALSAT APPROACHES

X Ltd. is a company which is producing hospital equipment with one of its products is supramak bed (patient’s bed). From the observation at the production floor of X Ltd, several non-value added activities are identified, which are components accumulation, reworking a number of products which do not meet the standards, idling operators, and waiting in working process. Based on the results of VSM Current State Map is obtained that total time for value added activities are 96816 seconds and for non-value added activities are 80869 seconds. Based on WAM analysis, the highest waste occurs during waiting time with an index of 19.09%. Based on VALSAT analysis, the proposed input from researchers are as follows: giving the mandates to the warehouse department, monitoring product flow, creating and enforcing SOP, increasing the number of forklifts, and analyzing transportation effectiveness

PROTÓTIPO DE UMA CAMARA DE RADIAÇÃO UV-C PARA DESINFECÇÃO DE OBJETOS

Hospitals use germicidal lamps at ultraviolet wavelengths (UV-C -254 nm) to sterilize equipment, water and the environment in operating rooms. The food and medicine industries use them to disinfect various types of products, containers and packaging. Thistechnology is currently being used to disinfect environments, medical and hospital equipment and protective equipment in common use in the face of the current COVID-19 pandemic. In view of the UV-C applications to perform sterilization of environments andobjects, this project involves the development of a prototype using a hardware electronic prototyping platform of a chamber with portable UV lamps for disinfecting objectives. This prototype consists of a hardware module and a software module. In the hardware module, the necessary components for the assembly of the physical system were evaluated, as well as its basic functions, such as the activation of lamps and safety devices, while in the software module, the timing system, the activation and shutdown control were developed. of the lamps, the user interface and security, the exposure to radiation through a magnetic reed switch sensor to check the state of the door.