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Objectives: This study aimed to compare the effect of four decontamination methods on the level of residual contaminants in the re-usage of dental healing abutments. Materials and methods: In this experimental study, 50 used healing abutments were divided into five groups of ten as follows: 1. Control group: healing abutments were submerged in the ultrasonic device then autoclaved at 121 °C for 15 min; 2. Hypochlorite group: Same procedure as the control group, but the healing abutments were additionally immersed in 3 % hypochlorite for 20 min; 3. Chlorhexidine group: Same procedure as the control group, but the healing abutments were additionally treated with 12 % chlorhexidine; 4. Air polishing group: Same procedure as the control group, but the healing abutments were subjected to air polishing; 5. Hydrogen peroxide group: Same procedure as the control group, but the healing abutments were additionally exposed to 3 % hydrogen peroxide. Then, all healing abutments were stained with a protein-specific stain, Phloxine B. Five photographs were taken of each healing abutment, with four capturing the body (shank)and one capturing the top. All images were analysed, to measure the stained (contaminated) areas of each sample. The obtained data were analysed using statistical software (significance set at p < 0.05). Results: The one-way ANOVA test indicated that the average percentage of contamination residues on the occlusal surface did not show a significant difference among the five groups: control: 5.5 ± 2.8, sodium hypochlorite: 4.9 ± 2.5, Chlorhexidine: 5.3 ± 2.5, air polisher: 3.1 ± 1.8 and Hydrogen peroxide: 4.8 ± 3.1. (p = 0.26). The average percentage of residual contamination on the body surfaces (shank part) was significantly lower in the air polisher (1.7 ± 1.1) and sodium hypochlorite (2.4 ± 1.1) groups compared to the other three groups (Control: 6.1 ± 2.3, Hydrogen peroxide: 4.6 ± 0.7, Chlorhexidine: 5.4 ± 2.4) (p < 0.05). Conclusion: The results of this study showed that the use of sodium hypochlorite and air polishing, alongside autoclaving and ultrasonic cleaning, effectively reduced residual contamination on the body surfaces of healing abutments.

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Objective: to analyze the integrity of N95/PFF2 masks in relation to fiber morphology, porosity, cracks and micro holes, as well as identify visible damage to their structure and components, after seven- and fifteen-day reuse protocols. Method: cross-sectional study. Structural and morphological characteristics of a new N95/PFF2 mask were analyzed in comparison with N95/PFF2 masks (n=10) used in seven- and fifteen-day protocols, through visual inspection and scanning electron microscopy. Results: upon visual inspection, following the seven-day protocol, 40% and 60% of the N95/PFF2 masks showed, respectively, personal identification marks and external and internal dirt. Additionally, 20% exhibited loosening and/or tearing of the straps, while 100% showed some type of damage to the nose clips. In the fifteen-day protocol, all N95/PFF2 masks had dirt, loose straps and damaged nose clips, and 80% had folds. Electronic microscopy revealed an increase in pores and loosening in the weaves from seven days onwards, extending up to fifteen days, with the presence of micro holes and residues. Conclusion: the reuse of N95/PFF2 masks affects their structural and morphological integrity. It is crucial to carry out tests to measure the impact of this practice on the safety of health professionals.

Objetivo: analizar la integridad de mascarillas N95/PFF2 con relación a la morfología de las fibras, porosidad, grietas y microagujeros, así como identificar daños visibles en su estructura y componentes, luego de protocolos de reutilización de siete y quince días. Método: estudio transversal. Se analizaron las características estructurales y morfológicas de una mascarilla N95/PFF2 nueva en comparación con las mascarillas N95/PFF2 (n=10) utilizadas en protocolos de siete y quince días, mediante inspección visual y microscopía electrónica de barrido. Resultados: tras la inspección visual, siguiendo el protocolo de siete días, el 40% y el 60% de las mascarillas N95/PFF2 mostraron, respectivamente, marcas de identificación personal y suciedad externa e interna. Además, el 20% presentó aflojamiento y/o desgarro de las correas de sujeción, mientras que el 100% presentó algún tipo de daño en los clips nasales. En el protocolo de quince días, todas las mascarillas N95/PFF2 tenían suciedad, correas de sujeción sueltas y clips nasales dañados, y el 80% tenía pliegues. La microscopía electrónica reveló un aumento de poros y aflojamiento en las tramas a partir de los siete días, extendiéndose hasta los quince días, con presencia de microagujeros y residuos. Conclusión: la reutilización de las mascarillas N95/PFF2 compromete su integridad estructural y morfológica. Es crucial realizar pruebas para medir el impacto de esta práctica en la seguridad de los profesionales de la salud.

Objetivo: analisar a integridade das máscaras N95/PFF2 em relação à morfologia das fibras, porosidade, fissuras e micro furos, bem como identificar danos visíveis em sua estrutura e componentes, após protocolos de reutilização de sete e quinze dias. Método: estudo transversal. Características estruturais e morfológicas de uma máscara N95/PFF2 nova foram analisadas em comparação com máscaras N95/PFF2 (n=10) utilizadas em protocolos de sete e quinze dias, por meio da inspeção visual e microscopia eletrônica de varredura. Resultados: na inspeção visual, seguindo o protocolo de sete dias, 40% e 60% das máscaras N95/PFF2 apresentaram, respectivamente, marcas de identificação pessoal e sujidades externas e internas. Além disso, 20% exibiram afrouxamento e/ou rompimento das tiras de fixação, enquanto 100% mostraram algum tipo de dano nos clipes nasais. No protocolo de quinze dias, todas as máscaras N95/PFF2 apresentavam sujidade, tiras de fixação frouxas e clipes nasais comprometidos; 80% possuíam dobras. A microscopia eletrônica revelou aumento dos poros e afrouxamento nas tramas a partir de sete dias, ampliando-se até quinze dias, com presença de micro furos e detritos. Conclusão: a reutilização das máscaras N95/PFF2 compromete a integridade estrutural e morfológica. É crucial realizar testes para mensurar o impacto dessa prática na segurança dos profissionais de saúde.

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Purpose: Healthcare has a large environmental footprint, not least due to the wide use of single-use supplies. Reprocessing of medical devices is a well-established, regulated process, and can reduce its environmental impact. This life cycle assessment (LCA) compares the environmental footprint of a single-use and a reprocessed version of otherwise identical intermittent pneumatic compression (IPC) sleeves. Materials and Methods: The LCA was performed in accordance with the international standard ISO 14044 using the Environmental Footprint 3.0 (EF) method for the assessment. Data were obtained in cooperation with IPC sleeve manufacturers. Where no primary data were available, ecoinvent database records were used. The functional unit is five hospital treatments applying IPC. The robustness of the results was interrogated in sensitivity analyses of the energy mix, the ethylene oxide emissions during reprocessing, and the transport distances. The impact of waste reduction on hospital disposal costs was calculated. Results: The environmental footprint of reprocessed IPC sleeves was found to be reduced in all categories compared to single-use devices, leading to a weighted normalized reduction of 43% across all categories. In a breakdown of the LCA results, reprocessed IPC sleeves were found to reduce the carbon footprint by 40%, with the treatment of five patients with single-use IPC sleeves creating 7 kg CO2eq, compared to 4.2 kg CO2eq from reprocessed sleeves. Waste disposal costs were also reduced by 90%. Conclusion: Reprocessing of IPC sleeves provides an environmental and economic benefit in comparison to single-use devices.

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Background: This study presented a cleaning method for orthodontic NiTi-closed coils and evaluated its effect on the force characteristics of these coils. Materials and Methods: In this in vitro study, 160 orthodontic NiTi-closed coils, 160 orthodontic NiTi-closed coils (9 mm) from two brands G and H and DB, randomly assigned into four groups. Group 1: Three times of immersion in the 10% hydrochloric acid (HCI) solution for 1 min followed by the immersion in 5.25% sodium hypochlorite solution for 5 min. Group 2: Three times autoclave sterilization. Group 3: Three times of immersion in 10% HCI solution for 1 min, followed by the immersion in 5.25% sodium hypochlorite solution for 5 min and autoclave sterilization. Group 4: No immersion and no sterilization. The forces of coils were measured at 25, 23, 21, 19, and 17 mm extension. To measure the force characteristics of coils, an electromechanical universal testing machine was used. For the statistical analysis, Kolmogorov-Smirnov, Kruskal-Wallis, and Mann-Whitney U-tests were used at 0.05 significance level. Results: In G and H coils, no significant differences between the mean forces of different groups were found in any extensions. In DB coils, only in 25 mm extension, there were no significant differences between the groups (P = 0.144). In 17-, 19-, and 21-mm extensions, significant differences (P < 0.001) were found like in 23 mm extension (P = 0.05). In both brands, more extension makes significant more forces statistically (P < 0.01). In all extensions, G and H coils have significant less forces (P < 0.001). Conclusion: Immersion in HCl, 10% for 1 min followed by the immersion in NaOCl, 5.25% for 5 min followed by autoclave sterilization, even three times repeating of this process, did not result in significant changes in the force characteristics of A-NiTi-closed coils.

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BACKGROUND: This study primarily assessed ENT surgical trainees' preferences for the qualities of disposable and reusable fibre-optic nasendoscopes. Secondary aims included eliciting trainees' views on ENT surgery and climate change, and creating a single-centre per-use cost analysis for disposable and reusable fibre-optic nasendoscopes. METHODS: A cross-sectional study was formulated. An online survey consisting of multiple-choice and Likert-scale questions was distributed nationally. Cost analysis was performed using 2021-2022 data from the host institution. RESULTS: Twenty-four trainees responded. Data on disposable fibre-optic nasendoscopes showed no difference in overall satisfaction (p = 0.244). Reusable fibre-optic nasendoscopes had a lower cost per use compared with disposable nasendoscopes at 5 years (4.7 per cent reduction) and 10 years (7.1 per cent reduction). Of the trainees, 79.2 per cent were supportive of climate-friendly initiatives within ENT surgery, and 25 per cent felt supported by their departments. CONCLUSION: Trainees' satisfaction with disposable and reusable fibre-optic nasendoscopes is similar. Cost analysis favours reusable fibre-optic nasendoscopes in the long term at the host institution. Empowering departments and trainees to pursue climate-friendly initiatives should be encouraged.

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As part of efforts to combat the Covid-19 pandemic and decrease the high transmissibility of the new coronavirus, SARS-CoV-2, effective inactivation strategies, such as UV-C decontamination technologies, can be reliably disseminated and well-studied. The present study investigated the susceptibility of a high viral load of SARS-CoV-2 in filtering facepiece respirators (FFR) N95, surgical mask, cotton fabric mask and N95 straps under three different doses of UV-C, applying both real-time PCR (qPCR) and plaque formation assays to quantify viral load reduction and virus infectivity, respectively. The results show that more than 95% of the amount of SARS-CoV-2 RNA could be reduced after 10 min of UV-C exposure (0.93 J cm-2 per side) in FFR N95 and surgical masks and, after 5 min of UV-C treatment (0.46 J cm-2 per side) in fabric masks. Furthermore, the analysis of viable coronaviruses after these different UV-C treatments demonstrated that the lowest applied dose is sufficient to decontaminate all masks ([Formula: see text] 3-log10 reduction of the infective viral load, > 99.9% reduction). However, for the elastic strap of N95 respirators, a UV-C dose three times greater than that used in masks (1.4 J cm-2 per side) is required. The findings suggest that the complete decontamination of masks can be performed effectively and safely in well-planned protocols for pandemic crises or as strategies to reduce the high consumption and safe disposal of these materials in the environment.

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BACKGROUND: Infection prevention measures are widely used in operating rooms (ORs). However, the extent to which they are at odds with ambitions to reduce the health sector's carbon footprint remains unclear. AIM: To synthesize the evidence base for the carbon footprint of commonly used infection prevention measures in the OR, namely medical devices and instruments, surgical attire and air treatment systems. METHODS: A scoping review of the international scientific literature was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. The search was performed in PubMed and Google Scholar. Articles published between 2010 and June 2021 on infection prevention measures, their impact on the health sector's carbon footprint, and risk for surgical site infections (SSIs) were included. FINDINGS: Although hospitals strive to reduce their carbon footprint, many infection prevention measures result in increased emissions. Evidence suggests that the use of disposable items instead of reusable items generally increases the carbon footprint, depending on sources of electricity. Controversy exists regarding the correlation between air treatment systems, contamination and the incidence of SSIs. The literature indicates that new air treatment systems consume more energy and do not necessarily reduce SSIs compared with conventional systems. CONCLUSION: Infection prevention measures in ORs can be at odds with sustainability. The use of new air treatment systems and disposable items generally leads to significant greenhouse gas emissions, and does not necessarily reduce the incidence of SSIs. Alternative infection prevention measures with less environmental impact are available. Implementation could be facilitated by embracing environmental impact as an additional dimension of quality of care, which should change current risk-based approaches for the prevention of SSIs.

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Objetivo: describir el grado de conocimiento que poseen los usuarios de medicamentos inhalados, respecto al correcto reciclaje de los mismos, indagando cómo y por quién han recibido dicha información y su conocimiento sobre la importancia de los inhaladores recargables. Métodos: estudio epidemiológico, observacional, transversal y multicéntrico realizado en 22 farmacias comunitarias de la Comunidad Autónoma de Madrid. Se diseñó un cuestionario de conocimiento y actitudes sobre el uso y reciclado de inhaladores en pacientes mayores de edad en tratamiento con los mismos.Resultados: desde 22 farmacias comunitarias se incluyeron a 303 sujetos (edad media 57,5±19,9 años; 46,7 % varones; tiempo medio de uso de inhaladores 9,6±9,8 años; motivo de uso: asma: 46,2 %, EPOC: 25,7 %). El 66,2 % y el 67,5 % de los usuarios otorgan una elevada importancia al reciclado de inhaladores y a disponer del mismo inhalador recargable mensualmente cada 6 meses, respectivamente. En cuanto al reciclado, el 42,9 % de los usuarios lo hacía en el punto SIGRE de la farmacia. Solo el 33 % refería haber sido informado alguna vez sobre dónde depositar el inhalador y, en este caso, era el farmacéutico el que lo indicaba en la mayoría de las ocasiones (76,3 %).Conclusiones: a pesar de que la mayoría de los usuarios considera que es importante el reciclado de inhaladores, y de disponer de inhaladores recargables, sólo un tercio refiere haber sido informados sobre el sitio de depósito. Son necesarias campañas de información acerca de la importancia del reciclado de inhaladores y de cómo hacerlo. En este contexto, el farmacéutico comunitario jugaría un papel esencial. (AU)

Objectives: To ascertain where and how inhalers were removed after finalizing their use, and todetermine how the information about recycling was received, as well as the importance of having reusableinhalers.Methods: Epidemiological, observational, cross-sectional and multicenter study performed in thecommunity pharmacies of the Autonomous Community of Madrid, through the application of a voluntaryand anonymous questionnaire that analyzed the knowledge and attitudes regarding the recycling ofinhalers among adult users treated with inhalers.Results: From 22 community pharmacies, a total of 303 subjects (mean age 57.5±19.9 years; 46.7%men; mean time of inhalers` use 9.6±9.8 years; reason for use: asthma: 46.2%, COPD: 25.7%) were included.Overall, 66.2% and 67.5% of users gave a high importance to the recycling of inhalers and the availabilityof having a monthly rechargeable inhaler every 6 months, respectively. With regard to recycling, 42.9% ofusers recycled in the SIGRE point of the pharmacy. Only 33% of users had been informed about the placeof delivering the inhaler, and in this context, in most cases this was performed by the pharmacist (76.3%).Conclusions: Despite the majority of users consider that it is important the recycling of inhalersand the availability of re-usable inhalers, only one third refer having been informed about the place ofdelivering the inhaler. Information campaigns about the importance of recycling of inhalers and how to doit are warranted. In this setting, the community pharmacist could play a key role. (AU)

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ABSTRACT Objectives: to identify the safe storage time for the use of flexible gastrointestinal endoscopes after high-level disinfection, as well as the defining criteria for this time. Methods: an integrative literature review was carried out in the Virtual Health Library, PubMed, Scopus, and Web of Science, considering original articles published since 2000. Results: eleven articles were selected, whose storage times ranged from 1 to 56 days, with a predominance of one to seven days (73%). Several criteria were used to define this time, predominantly the premise of efficient processing (100%), use of alcohol flush (64%), use of drying cabinets (18%), among others. Conclusions: the criteria for determining the storage time did not show a consensus for clinical practice. Expanding the discussion of this theme with the definition of the minimum necessary conditions is of fundamental importance for the reduction of risks and safety of the procedure and the patient.

RESUMEN Objetivos: identificar el tiempo de almacenamiento seguro para utilización de endoscopios flexibles gastrointestinales después de la desinfección de alto nivel, así como los criterios definidores de ese tiempo. Métodos: realizado una revisión integrativa de la literatura en la Biblioteca Virtual en Salud, PubMed, Scopus y Web of Science, considerando artículos originales publicados desde 2000. Resultados: fueron seleccionados 11 artículos, cuyos tiempos de almacenamiento variaron entre 1 y 56 días, con predominio de uno a siete días (73%). Utilizados diversos criterios para definición de ese tiempo, siendo predominantes la premisa del procesamiento eficiente (100%), uso de flush de alcohol (64%), armarios de secado (18%), entre otros. Conclusiones: los criterios para determinación del tiempo de almacenamiento no evidenciaron un consenso para práctica clínica. Ampliar la discusión de esa temática con definición de las condiciones mínimas necesarias es de fundamental importancia para la reducción de riesgos y seguridad del procedimiento y del paciente.

RESUMO Objetivos: identificar o tempo de armazenamento seguro para utilização de endoscópios flexíveis gastrointestinais após a desinfecção de alto nível, bem como os critérios definidores desse tempo. Métodos: realizou-se uma revisão integrativa da literatura na Biblioteca Virtual em Saúde, PubMed, Scopus e Web of Science, considerando artigos originais publicados desde 2000. Resultados: foram selecionados 11 artigos, cujos tempos de armazenamento variaram entre 1 e 56 dias, com predomínio de um a sete dias (73%). Utilizaram-se diversos critérios para definição desse tempo, sendo predominantes a premissa do processamento eficiente (100%), uso de flush de álcool (64%), uso de armários de secagem (18%), entre outros. Conclusões: os critérios para determinação do tempo de armazenamento não evidenciaram um consenso para prática clínica. Ampliar a discussão dessa temática com definição das condições mínimas necessárias é de fundamental importância para a redução de riscos e segurança do procedimento e do paciente.

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INTRODUCTION: Climate change is a health problem and, at the same time, health systems are important contributors. Hospitals stand out due to their high rates of energy consumption, resources and waste generation. The purpose of the study is to know and identify the determinants of sanitary waste and the measures that can be implemented that allow reducing the production of hospital waste, seeking to achieve a general and updated appreciation of this phenomenon and taking into account hospital sustainability. METHOD: A bibliographic search was carried out in pubmed that included keywords related to the concepts of carbon footprint, recycling and hospital waste. The screening yielded a total of 37 articles and later 12 publications founded from references (or that were previously known by the authors) were added. RESULTS: The results are presented into 5 points known as the "5 Rs", named below. "Reduce" (through adequate segregation of waste, correct management of effluents and energy, significant reduction of excesses and automatic administration of anesthetic gases), "Reuse" (through device reprocessing, reusable material and donation), "Recycle", "Rethink" (with examples such as selection of less polluting gases, selective use of containers, staff education) and "Investigate" through different models. DISCUSSION: Several of the recognized measures could have an application in many hospital areas despite the fact that most of the available evidence refers to the operating room. The organization and education of the personnel is important in order to implement the measures found.

INTRODUCCIÓN: La estrategia de disposición y generación de residuos influye en el cambio climático y éste, al mismo tiempo, afecta la salud de las personas, incrementando la frecuencia de enfermedades cardiovasculares, respiratorias e infecciosas, entre otras. Los sistemas sanitarios son contribuyentes importantes, debido a sus altas tasas de consumo de energía, recursos y generación de desechos. Esta revisión de la literatura pretende obtener una apreciación general y actualizada de los determinantes de desechos sanitarios y las medidas implementables para disminuir la producción de residuos hospitalarios y nuestro impacto en el medio ambiente. MÉTODO: Se realizó una amplia búsqueda bibliográfica en la base de datos Medline que incluyó palabras clave relacionadas a huella de carbono, reciclaje y residuos hospitalarios. El cribado arrojó un total de 48 publicaciones. RESULTADOS: Se presentan los resultados organizados en 5 puntos, a los que se les conoce como las "5 R" y que corresponden a "Reducir" (a través de segregación adecuada de residuos, correcta gestión de efluentes, energía y disminución de excesos), "Reusar" (a través de reprocesamiento de dispositivos), "Reciclar" (transformación de residuos), "Repensar" (búsqueda de nuevas formas, innovadoras y sustentables, de las prácticas clínicas) e "Investigar" (Research, generar nuevo conocimiento). DISCUSIÓN: Numerosas estrategias pueden ser implementadas para contribuir a la sustentabilidad hospitalaria y podrían tener una aplicación en muchas áreas, a pesar de que la mayoría de la evidencia disponible hace referencia al sector quirúrgico. La investigación nos ofrece herramientas para desarrollar nuevas alternativas de gestión, donde la organización y educación del personal son esenciales.

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INTRODUCTION: Climate change is a health problem and, at the same time, health systems are important contributors. Hospitals stand out due to their high rates of energy consumption, resources and waste generation. The purpose of the study is to know and identify the determinants of sanitary waste and the measures that can be implemented that allow reducing the production of hospital waste, seeking to achieve a general and updated appreciation of this phenomenon and taking into account hospital sustainability. METHOD: A bibliographic search was carried out in pubmed that included keywords related to the concepts of carbon footprint, recycling and hospital waste. The screening yielded a total of 37 articles and later 12 publications founded from references (or that were previously known by the authors) were added. RESULTS: The results are presented into 5 points known as the "5 Rs", named below. "Reduce" (through adequate segregation of waste, correct management of effluents and energy, significant reduction of excesses and automatic administration of anesthetic gases), "Reuse" (through device reprocessing, reusable material and donation), "Recycle", "Rethink" (with examples such as selection of less polluting gases, selective use of containers, staff education) and "Investigate" through different models. DISCUSSION: Several of the recognized measures could have an application in many hospital areas despite the fact that most of the available evidence refers to the operating room. The organization and education of the personnel is important in order to implement the measures found.

INTRODUCCIÓN: La estrategia de disposición y generación de residuos influye en el cambio climático y éste, al mismo tiempo, afecta la salud de las personas, incrementando la frecuencia de enfermedades cardiovasculares, respiratorias e infecciosas entre otras. Los sistemas sanitarios son contribuyentes importantes, debido a sus altas tasas de consumo de energía, recursos y generación de desechos. Esta revisión de la literatura pretende obtener una apreciación general y actualizada de los determinantes de desechos sanitarios y las medidas implementables para disminuir la producción de residuos hospitalarios y nuestro impacto en el medio ambiente. MÉTODO: Se realizó una amplia búsqueda bibliográfica en la base de datos Medline que incluyó palabras clave relacionadas a huella de carbono, reciclaje y residuos hospitalarios. El cribado arrojó un total de 48 publicaciones. RESULTADOS: Se presentan los resultados organizados en 5 puntos, a los que se les conoce como las "5 R" y que corresponden a "Reducir" (a través de segregación adecuada de residuos, correcta gestión de efluentes, energía y disminución de excesos), "Reusar" (a través de reprocesamiento de dispositivos), "Reciclar" (transformación de residuos), "Repensar" (búsqueda de nuevas formas, innovadoras y sustentables, de las prácticas clínicas) e "Investigar" (Research, generar nuevo conocimiento). DISCUSIÓN: Numerosas estrategias pueden ser implementadas para contribuir a la sustentabilidad hospitalaria y podrían tener una aplicación en muchas áreas, a pesar de que la mayoría de la evidencia disponible hace referencia al sector quirúrgico. La investigación nos ofrece herramientas para desarrollar nuevas alternativas de gestión, donde la organización y educación del personal son esenciales.

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AIM: Personal protective equipment (PPE), including respirators, is essential in a pandemic like COVID-19, which has required, on many occasions, the reuse of material due to its shortage. The aim of this review is to summarize available evidence on the reuse and extended use of filtering facepiece respirator. METHOD: Scoping review. Search through natural language in PUBMED and Centers, Agencies and Organizations for Disease Control. Limited to articles published between 2010-2020 in English and Spanish. RESULTS: 83 articles were located, 14 were selected, plus 5 recommendations. The topics included in this study are classified in 7 sections: expiration, extended use and reuse of masks, handling techniques, sealing, physical-psychological effects and compliance, contamination and decontamination of respirators. CONCLUSIONS: The reuse of masks is not recommended by official organizations or manufacturers, and is only accepted in extraordinary cases, such as pandemics. The studies are characterized by having small samples, using different models of respirators adjusting their recommendation to the model.

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BACKGROUND: N95 respiratory protection masks are used by healthcare professionals to prevent contamination from infectious microorganisms transmitted by droplets or aerosols. METHODS: We conducted a rapid review of the literature analyzing the effectiveness of decontamination methods for mask reuse. The database searches were carried out up to September 2020. The systematic review was conducted in a way which simplified the stages of a complete systematic review, due to the worldwide necessity for reliable fast evidences on this matter. RESULTS: A total of 563 articles were retrieved of which 48 laboratory-based studies were selected. Fifteen decontamination methods were included in the studies. A total of 19 laboratory studies used hydrogen peroxide, 21 studies used ultraviolet germicidal irradiation, 4 studies used ethylene oxide, 11 studies used dry heat, 9 studies used moist heat, 5 studies used ethanol, two studies used isopropanol solution, 11 studies used microwave oven, 10 studies used sodium hypochlorite, 7 studies used autoclave, 3 studies used an electric rice cooker, 1 study used cleaning wipes, 1 study used bar soap, 1 study used water, 1 study used multi-purpose high-level disinfection cabinet, and another 1 study used chlorine dioxide. Five methods that are promising are as follows: hydrogen peroxide vapor, ultraviolet irradiation, dry heat, wet heat/pasteurization, and microwave ovens. CONCLUSIONS: We have presented the best available evidence on mask decontamination; nevertheless, its applicability is limited due to few studies on the topic and the lack of studies on real environments.

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BACKGROUND: Pacemakers (PMs) and implantable cardioverter-defibrillators (ICDs) have reduced mortality and improved the quality of life of cardiac patients. However, the high cost of these devices prevents their large-scale incorporation, particularly in low-income countries, where reusing explanted PMs/ICDs has become an alternative. METHODS: A systematic review and meta-analysis were conducted of studies that compare infection rates, device-related deaths, malfunction and premature battery depletion in patients with reused PM and ICD implants and those with new devices. The quality of the body of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework. RESULTS: The meta-analysis demonstrated no significant intergroup differences in infection rates (OR 0.98; 95% CI 0.60-1.60), device malfunction (OR 1.58; 95% CI 0.56-4.48) or premature battery depletion (OR 1.96; 95% CI 0.81-4.72) and no device-related deaths. Based on GRADE assessment, confidence in estimates for the outcomes infection rate and device-related death was rated as moderate. CONCLUSION: The results of this analysis enabled us to conclude that PMs and ICDs can be safely and effectively reused. As such, every effort should be made to overcome regulatory, technical and ethical barriers to ensure implantation.

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BACKGROUND: Considering the new SARS-CoV-2 pandemic and the potential scarcity of material resources, the reuse of personal protective equipment such as filtering facepiece respirators (FFRs) for N95 filtering or higher is being discussed, mainly regarding the effectiveness and safety of cleaning, disinfection and sterilization processes. AIM: To analyze the available evidence in the literature on the safety in processing FFRs. METHODS: A systematic review conducted by searching for studies in the following databases: PubMed, CINAHL, LILACS, CENTRAL, EMBASE, Web of Science, and Scopus. RESULTS: Forty studies were included in this review. The disinfectant/sterilizing agents most frequently tested at different concentrations and exposure periods were ultraviolet irradiation, vaporized hydrogen peroxide and steam sterilization. Microbial reduction was assessed in 21 (52.5%) studies. The only disinfectants/sterilizers that did not caused degradation of the material-integrity were alcohol, electric cooker, ethylene oxide, and peracetic acid fogging. Exposure to ultraviolet irradiation or microwave generated-steam resulted in a nonsignificant reduction in filter performance. CONCLUSION: There is a complex relationship between the FFR raw materials and the cycle conditions of the decontamination methods, evidencing the need for validating FFRs by models and manufacturers, as well as the process. Some methods may require additional tests to demonstrate the safety of FFRs for use due to toxicity.

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ABSTRACT Objectives: to evaluate the results of two methods of hospital bedpan reprocessing. Methods: cross-sectional study. Hospital bedpans containing a biological material contamination simulator or organic matter were submitted to manual cleaning followed by disinfection with 70% alcohol solution or thermodisinfection. Permanence of simulated contamination was evaluated by using the fluorescence technique and presence of organic matter was verified by carrying out the protein detection test. Results: the contamination simulator was found in bedpans submitted to both processes. The seat was dirtier after manual cleaning (p=0.044) in comparison with the result obtained with thermodisinfection. Automatized decontamination led to worse results when compared to the manual procedure for the scoop and external bottom (p=0.000). The protein detection test was positive in two items after thermodisinfection. Conclusions: manual cleaning followed by rubbing with 70% alcohol solution proved more effective than automatized cleaning in the reprocessing of hospital bedpans. There are relevant issues regarding reuse of hospital bedpans.

RESUMEN Objetivos: evaluar los resultados de dos métodos de reprocesamiento de chatas higiénicas. Métodos: estudio transversal. Chatas higiénicas conteniendo simulador de contaminación por material biológico o materia orgánica fueron sometidas a lavado manual/desinfección con alcohol al 70% o termodesinfección. La permanencia de contaminación simulada se evaluó por fluorescencia; la presencia de material orgánico, por prueba de detección de proteínas. Resultados: se constató presencia de simulador de contaminación en chatas sometidas a ambos procesos. El asiento resultó más contaminado luego de la limpieza manual (p=0,044. En la pala y el fondo externo, la descontaminación automatizada tuvo peor resultado comparada con la manual (p=0,000). La prueba de detección de proteínas fue positiva en dos chatas luego de la termodesinfección. Conclusiones: para reprocesar chatas higiénicas, la limpieza manual seguida por fricción con alcohol al 70% resultó más eficaz que la limpieza automatizada. Se plantean interrogantes respecto de reutilizar chatas higiénicas.

RESUMO Objetivos: avaliar os resultados de dois métodos de reprocessamento de comadres hospitalares. Métodos: estudo transversal. Comadres hospitalares contendo simulador de contaminação por material biológico ou matéria orgânica foram submetidas a limpeza manual/desinfecção com álcool a 70% ou termodesinfecção. A permanência de contaminação simulada foi avaliada por fluorescência e a presença de matéria orgânica pelo teste de detecção de proteína. Resultados: constatou-se a presença de simulador de contaminação nas comadres submetidas a ambos os processos. O assento se mostrou mais sujo após a limpeza manual (p=0,044). Nas áreas da pá e fundo externo, a descontaminação automatizada teve pior resultado quando comparada à manual (p=0,000). O teste de detecção de proteínas foi positivo em dois utensílios após a termodesinfecção. Conclusões: no reprocessamento de comadres hospitalares, a limpeza manual seguida de fricção com álcool a 70% mostrou-se mais eficaz que a limpeza automatizada. Há fragilidades relativas à reutilização de comadres hospitalares.

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INTRODUCTION: As has happened in other emerging respiratory pandemics, demand for N95 filtering facemask respirators (FFRs) has far exceeded their manufacturing production and availability in the context of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic. One of the proposed strategies for mitigating the massive demand for N95 FFRs is their reuse after a process of decontamination that allows the inactivation of any potentially infectious material on their surfaces. This article aims to summarize all of the available evidence on the different decontamination methods that might allow disposable N95 FFRs to be reused, with emphasis on decontamination from SARS-CoV-2. METHODS: We performed a systematic review of the literature in order to identify studies reporting outcomes of at least 1 decontamination method for inactivating or removing any potentially infectious material from the surface of N95 FFRs, specifically addressing issues related to reduction of the microbial threat (including SARS-CoV-2 when available), maintaining the function of N95 FFRs and a lack of residual toxicity. RESULTS: We identified a total of 15 studies reporting on the different decontamination methods that might allow disposable N95 FFRs to be reused, including small-scale energetic methods and disinfecting solutions/spray/wipes. Among these decontamination methods, ultraviolet germicidal irradiation and vaporized hydrogen peroxide seem to be the most promising decontamination methods for N95 FFRs, based on their biocidal efficacy, filtration performance, fitting characteristics, and residual chemical toxicity, as well as other practical aspects such as the equipment required for their implementation and the maximum number of decontamination cycles. CONCLUSIONS: Although all the methods for the decontamination and reuse of N95 FFRs have advantages and disadvantages, ultraviolet germicidal irradiation and vaporized hydrogen peroxide seem to be the most promising methods.

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Resumo Objetivos Comparar a reutilização do dialisador com o uso único deste material para marcadores bioquímicos, hematológicos, episódios de pirogenias e bacteremias. Métodos Estudo longitudinal com coleta de dados retrospectiva em prontuários de pacientes em hemodiálise, em hospital público universitário. A investigação foi conduzida seis meses com a reutilização do dialisador e seis meses com uso único. Os dados foram analisados no SPSS Versão 18.0. Para comparação das médias dos exames utilizou-se teste t pareado e Wilcoxon, episódios de pirogenia e bacteremia foram analisados pelo teste de Wilcoxon e Razão de Chances (RC) como medida de força de associação. Variáveis categóricas foram analisadas pelos testes de McNemar e Exato de Fisher. O estudo foi aprovado pelo Comitê de Ética e Pesquisa. Resultados Foram analisadas 5.508 sessões de hemodiálise de pacientes predominantemente masculinos 21(62%), média de idade 58(± 14) anos, hipertensos 14(41%), tempo médio de tratamento 6±3 anos. Durante uso único identificou-se redução da ureia pós diálise, creatinina, fósforo, ferritina, hematócrito e hemoglogina em relação ao reutilizado (p < 0,05) e 91% menos risco de pirogenia comparado a reutilização do dialisador (Razão de Chance= 0,091; IC 95%: 0,002-0,625). Não houve diferença significativa na ocorrência de bacteremias. Conclusão Os resultados sugerem maior remoção de biomarcadores bioquímicos e menos episódios de pirogenias quando o dialisador é uso único.ater removal of biochemical biomarkers and fewer pyrogenics episodes when the dialyzer is a single use.

Resumen Objetivos Comparar la reutilización del dializador con el uso único de este material en marcadores bioquímicos, hematológicos, episodios de reacciones pirógenas y bacteriemias. Métodos Estudio longitudinal con recolección de datos retrospectiva en historias clínicas de pacientes en hemodiálisis, en un hospital público universitario. La investigación fue conducida seis meses con la reutilización del dializador y seis meses con un único uso. Los datos fueron analizados en SPSS Versión 18.0. Para comparar los promedios de los análisis, se utilizó el Test-T pareado y prueba de Wilcoxon, los episodios de reacciones pirógenas y bacteriemia fueron analizados mediante la prueba de Wilcoxon y Razón de Momios (RM) como medida de fuerza de asociación. Las variables categóricas se analizaron con la prueba de McNemar y la prueba exacta de Fisher. El estudio fue aprobado por el Comité de Ética e Investigación. Resultados Se analizaron 5.508 sesiones de hemodiálisis de pacientes predominantemente masculinos 21 (62 %), promedio de edad 58 (±14) años, hipertensos 14 (41 %), tiempo promedio de tratamiento 6±3 años. Durante el uso único del dializador, se identificó una reducción de la urea posdiálisis, creatinina, fósforo, ferritina, hematocrito y hemoglobina respecto al dializador reutilizado (p < 0,05) y un 91 % menos de riesgo de reacción pirógena comparado con la reutilización del dializador (Razón de Momios = 0,091; IC 95 %: 0,002-0,625). No hubo diferencia significativa en episodios de bacteriemias. Conclusión Los resultados sugieren mayor eliminación de biomarcadores bioquímicos y menos episodios de reacciones pirógenas cuando el dializador se utiliza una única vez.

Abstract Objectives To compare dialyzer reuse with its single use for biochemical, hematological markers, pyrogenesis and bacteremia episodes. Methods A longitudinal study with retrospective data collection from medical records of patients on dialysis in a public university hospital. The investigation was conducted six months with dialyzer reuse and six months with single use. Data were analyzed using SPSS Version 18.0. To compare the tests means, paired t-test and Wilcoxon were used. Pyrogenesis and bacteremia episodes were analyzed using the Wilcoxon test and Odds Ratio (OR) as association strength measures. Categorical variables were analyzed using McNemar and Fisher's Exact tests. The study was approved by the hospital's Research Ethics Committee. Results Five thousand five hundred eight dialysis sessions of predominantly male patients were analyzed, 21 (62%), with mean age of 58 (± 14) years, hypertensive 14 (41%), with mean treatment time 6 ± 3 years. During single use, a reduction in urea after dialysis, creatinine, phosphorus, ferritin, hematocrit and hemoglogin was identified in relation to reuse (p<0.05) and 91% less risk of pyrogenesis compared to dialyzer reuse (Odds Ratio=0.091; 95% CI: 0.002-0.625). There was no significant difference in the occurrence of bacteremia. Conclusion The results suggest greater removal of biochemical biomarkers and fewer pyrogenics episodes when the dialyzer is a single use.

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BACKGROUND: Magnetic separation using magnetic nanoparticles can be used as a simple method to isolate desulfurizing bacteria from a biphasic oil/water system. OBJECTIVES: Magnetite nanoparticles were applied to coat the surface of Rhodococcus erythropolis IGTS8 and Rhodococcus erythropolis FMF desulfurizing bacterial cells, and the viability and reusability of magnetite-coated bacteria evaluated by using various methods. MATERIAL AND METHODS: Magnetite nanoparticles were synthesized through a reverse co-precipitation method. Glycine was added during and after the synthesis of magnetite nanoparticles to modify their surface and to stabilize the dispersion of the nanoparticles. The glycine-modified magnetite nanoparticles were immobilized on the surface of both oil-desulfurizing bacterial strains. Reusability of magnetite-coated bacterial cells was evaluated via assessing the desulfurization activity of bacteria via spectrophotometry using Gibb's assay, after the separation of bacterial cells from 96h-cultures with the application of external magnetic field. In addition, CFU and fluorescence imaging were used to investigate the viability of magnetite-coated and free bacterial cells. RESULTS: TEM micrographs showed that magnetite nanoparticles have the size approximately 5.35±1.13 nm. Reusability results showed that both magnetite-coated bacterial strains maintain their activity even after 5 × 96h-cycles. The viability results revealed glycine-modified magnetite nanoparticles did not negatively affect the viability of two bacterial strains R. erythropolis IGTS8 and R. erythropolis FMF. CONCLUSIONS: In conclusion, the glycine-modified magnetite nanoparticles have great capacity for immobilization and separation of desulfurizing bacteria from suspension.

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BACKGROUND: Traditional resources, such as bundles, can help experts define essential steps of health product processing to prevent infections. The present study developed bundle content construction and validation criteria for central sterile supply departments (CSSDs). METHODS: The present study employed a Delphi technique modified for content evaluation. Eleven professionals with at least 4 years of experience in sterilization were enlisted. Participants discussed main stages of the process virtually and compiled a list of items based on scientific references justified by law and/or logical reasoning. Agreement, disagreement, and/or suggestions on each step resulted in bundles for a CSSD. Items were then reassessed by experts using a Likert scale with a 90% approval criterion. RESULTS: Six bundles were developed: cleaning, inspection, preparation and packaging, sterilization, and storage resulting from 384 responses and 373 agreements (Interassessor coefficient = 97%). DISCUSSIONS: Items obtained from the criteria assessment received majority agreement from the first document. CONCLUSIONS: Agreement among varying professionals was achieved, and bundles were successfully developed to evaluate the processing of goods in CSSDs.

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