Biomedical Instrumentation & Technology

Upon drying, physical changes of the characteristics of proteins are observed by coagulation, but the nature and chronology of these changes have not been well studied. Coagulation changes the structure of protein from liquid to a solid or a thicker liquid by heat, mechanical action, or acids. Changes may have implications regarding the cleanability of reusable medical devices; therefore, an understanding of the chemical phenomena associated with drying of proteins is essential to ensuring adequate cleaning and mitigation of retained surgical soils...

In the healthcare environment, delays can occur that prevent reusable devices from being processed within the specified time outlined in manufacturers' instructions for use. It has been suggested in the literature and industry standards that residual soil components, such as proteins, may undergo a chemical change when they are exposed to heat or experience prolonged drying times under ambient conditions. However, little experimental data are available in the literature to document this change or how is may be addressed for cleaning efficacy...

Background: Cleaning is essential to ensuring the safe processing of reusable medical devices, and most manufacturers' instructions for use (IFUs) specify that clinical soil should not be allowed to dry on devices. If soil is allowed to dry, the cleaning challenge could be increased due to change in soil solubility. As a result, an additional step could be needed to reverse the chemical changes and return a device to a state where cleaning instructions are appropriate. Methods: Using a solubility test method and surrogate medical devices, the experiment described in this article challenged eight remediation conditions to which a reusable medical device might be exposed if soil is dried on a device...

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Studies of healthcare providers doffing personal protective equipment, especially gloves, indicate that self-contamination does occur. Although generally this is not hazardous, working with particularly pathogenic organisms, such as Ebola virus and Clostridium difficile, can present a serious health risk. Decontaminating medical gloves before removal can reduce self-contamination and mitigate the spread of these types of pathogens. Also, in cases of extreme shortage, the Centers for Disease Control and Prevention (CDC) has specific recommendations for decontaminating gloves for extended use...

Background: Ongoing management of monitor alarms is important for reducing alarm fatigue among clinicians (e.g., nurses, physicians). Strategies to enhance clinician engagement in active alarm management in pediatric acute care have not been well explored. Access to alarm summary metrics may enhance clinician engagement. Objective: To lay the foundation for intervention development, we sought to identify functional specifications for formulating, packaging, and delivering alarm metrics to clinicians. Methods: Our team of clinician scientists and human factors engineers conducted focus groups with clinicians from medical-surgical inpatient units in a children's hospital...

Objectives: To ensure effectiveness in the endoscope channel cleaning process, using functional brushes that are in good condition is necessary. This study sought to identify the criteria for acquiring, using, and disposing of cleaning brushes at endoscopy facilities in Brazil. We further sought to evaluate the conditions of the cleaning brushes in use in the facilities. Methods: This cross-sectional study was conducted between July 2021 and January 2022. Personnel responsible for processing endoscopes were interviewed regarding the use, processing, and disposal of flexible endoscope cleaning brushes...

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OBJECTIVE: To detect unusual infusion alerting patterns using machine learning (ML) algorithms as a first step to advance safer inpatient intravenous administration of high-alert medications. MATERIALS AND METHODS: We used one year of detailed propofol infusion data from a hospital. Interpretable and clinically relevant variables were feature engineered, and data points were aggregated per calendar day. A univariate (maximum times-limit) moving range (mr) control chart was used to simulate clinicians' common approach to identifying unusual infusion alerting patterns...

Manufacturers could improve the pulse tones emitted by pulse oximeters to support more accurate identification of a patient's peripheral oxygen saturation (SpO2) range. In this article, we outline the strengths and limitations of the variable-pitch tone that represents SpO2 of each detected pulse, and we argue that enhancements to the tone to demarcate clinically relevant ranges are feasible and desirable. The variable-pitch tone is an appreciated and trusted feature of the pulse oximeter's user interface. However, studies show that it supports relative judgments of SpO2 trends over time and is less effective at supporting absolute judgments about the SpO2 number or conveying when SpO2 moves into clinically important ranges...

Database migration involves the transferring of data from one system to another system and typically is associated with information systems, database administration, relational databases, analytics, and business intelligence. Database migration requires careful planning and poses many challenges related to data assessment and cleansing, migration, testing, and managing risks throughout the project. This article describes the database migration activities associated with Penn Medicine's initiative to insource the clinical engineering department at Princeton Health into the health system's corporate information services department...

Fluid-warming systems are crucial in surgical and trauma settings because of their key role in preventing or treating hypothermia and enabling proper resuscitation of blood products that are stored cold. Recently, several manufacturers have issued warnings of the possibility of aluminum leaching from their fluid warmers and cautioned about the potential for aluminum toxicity in patients who underwent fluid resuscitation with these devices. Studies suggest that one of the main factors affecting aluminum leaching in this setting is the coating of the aluminum plate itself...

The surface finish of reusable medical devices often is a consideration during design, with attention paid to utility, aesthetics, and cost. To study the cleanability of metal surfaces of varying roughness and finish, soil made of bovine blood and egg yolk was placed on nickel alloy surface of varying average roughness (Ra) values (nominal values of 2-500 μin) and finishes (lapped, ground, milled, profiled, and shape turned). A commercially available wipe consisting of quaternary ammonium compound and less than 20% alcohol was applied for a total of eight wipe cycles to remove the soil...