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Pontes DO, Costa DDM, da Silva Pereira PP, Whiteley GS, Glasbey T, Tipple AFV. Adenosine triphosphate (ATP) sampling algorithm for monitoring the cleanliness of surgical instruments. PLoS One 2023; 18:e0284967. [PMID: 37582099 PMCID: PMC10426997 DOI: 10.1371/journal.pone.0284967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Accepted: 04/13/2023] [Indexed: 08/17/2023] Open
Abstract
BACKGROUND Timely detection of cleaning failure is critical for quality assurance within Sterilising Service Units (SSUs). Rapid Adenosine Triphosphate (ATP) testing provides a real time and quantitative indication of cellular contaminants, when used to measure surface or device cleanliness. The aim of this study was to investigate the use of an ATP algorithm and to whether it could be used as a routine quality assurance step, to monitor surgical instruments cleanliness in SSUs prior to sterilisation. METHODS Cleanliness monitoring using rapid ATP testing was undertaken in the SSUs of four hospitals located in the western (Amazonia) region of Brazil. ATP testing was conducted (Clean Trace, 3M) on 163 surgical instruments, following manual cleaning. A sampling algorithm using a duplicate swab approach was applied to indicate surgical instruments as (i) very clean, (ii) clean, (iii) equivocal or (iv) fail, based around a 'clean' cut-off of 250 Relative Light Units (RLU) and a 'very clean' <100 RLU. RESULTS The four cleanliness categories were significantly differentiated (P≤0.001). The worst performing locations (hospitals A & C) had failure rates of 39.2% and 32.4%, respectively, and were distinctly different from hospitals B & D (P≤0.001). The best performing hospitals (B & D) had failure rates of 7.7% and 2.8%, respectively. CONCLUSION The ATP testing algorithm provides a simple to use method within SSUs. The measurements are in real time, quantitative and useful for risk-based quality assurance monitoring, and the tool can be used for staff training. The four-tiered approach to the grading of surgical instrument cleanliness provides a nuanced approach for continuous quality improvement within SSU than does a simple pass/fail methodology.
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Affiliation(s)
- Daniela Oliveira Pontes
- Faculty of Nursing, Federal University of Goiás, Catalão, Brazil
- Nursing Department, Federal University of Rondônia, Porto Velho, Brazil
| | - Dayane de Melo Costa
- Faculty of Nursing, Federal University of Goiás, Catalão, Brazil
- Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia
| | | | - Greg S. Whiteley
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia
- School of Medicine, Western Sydney University, Penrith, Australia
- Whiteley Corporation, Kewdale, Australia
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Liu HC, Zhang LJ, Ping YJ, Wang L. Failure mode and effects analysis for proactive healthcare risk evaluation: A systematic literature review. J Eval Clin Pract 2020; 26:1320-1337. [PMID: 31849153 DOI: 10.1111/jep.13317] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 10/08/2019] [Accepted: 10/28/2019] [Indexed: 12/23/2022]
Abstract
RATIONALE, AIMS, AND OBJECTIVES Failure mode and effects analysis (FMEA) is a valuable reliability management tool that can preemptively identify the potential failures of a system and assess their causes and effects, thereby preventing them from occurring. The use of FMEA in the healthcare setting has become increasingly popular over the last decade, being applied to a multitude of different areas. The objective of this study is to review comprehensively the literature regarding the application of FMEA for healthcare risk analysis. METHODS An extensive search was carried out in the scholarly databases of Scopus and PubMed, and we only chose the academic articles which used the FMEA technique to solve healthcare risk analysis problems. Furthermore, a bibliometric analysis was performed based on the number of citations, publication year, appeared journals, authors, and country of origin. RESULTS A total of 158 journal papers published over the period of 1998 to 2018 were extracted and reviewed. These publications were classified into four categories (ie, healthcare process, hospital management, hospital informatization, and medical equipment and production) according to the healthcare issues to be solved, and analyzed regarding the application fields and the utilized FMEA methods. CONCLUSION FMEA has high practicality for healthcare quality improvement and error reduction and has been prevalently employed to improve healthcare processes in hospitals. This research supports academics and practitioners in effectively adopting the FMEA tool to proactively reduce healthcare risks and increase patient safety, and provides an insight into its state-of-the-art.
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Affiliation(s)
- Hu-Chen Liu
- School of Economics and Management, Tongji University, Shanghai, People's Republic of China.,College of Economics and Management, China Jiliang University, Hangzhou, People'sRepublic of China
| | - Li-Jun Zhang
- School of Management, Shanghai University, Shanghai, People's Republic of China
| | - Ye-Jia Ping
- School of Management, Shanghai University, Shanghai, People's Republic of China
| | - Liang Wang
- School of Management, Shanghai University, Shanghai, People's Republic of China
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Healthcare failure mode and effect analysis (HFMEA) for improving the qualification rate of disinfection quality monitoring process. J Infect Public Health 2020; 13:718-723. [PMID: 32253173 DOI: 10.1016/j.jiph.2020.02.040] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Revised: 02/03/2020] [Accepted: 02/20/2020] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND This study aimed to assess potential failure mode, implement countermeasures against risks and improve disinfection quality monitoring using healthcare failure mode and effect analysis (HFMEA). METHODS Between July 2017 and March 2018, a multidisciplinary team was formed to conduct HFMEA and implement improvement interventions. Fourteen monitoring departments and seven monitoring items were involved. The qualification rate of monitoring process was used to evaluate the influence of HFMEA on the standardization monitoring management of disinfection quality. RESULTS After HFMEA, the qualification rate of overall monitoring process of disinfection quality improved from 16.5% to 78.7% (P < 0.001), and the qualification rates of each monitoring step were all significantly improved. The qualification rate implemented by the clinical laboratory improved from 20.1% to 100.0% (P < 0.001). The qualification rate implemented by thirteen monitoring departments improved from 20.1% to 78.7% (P < 0.001), where seven reached 100%. Out of seven monitored items, three had the qualification rate of 100.0%, while the remaining four items showed significant rising in qualification rates (P < 0.001). CONCLUSION HFMEA were helpful in improving the qualification rate of disinfection effect monitoring process.
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Furlan MCR, Ferreira AM, Rigotti MA, Guerra OG, Frota OP, Sousa AFLD, Andrade DD. Correlação entre métodos de monitoramento de limpeza e desinfecção de superfícies ambulatoriais. ACTA PAUL ENFERM 2019. [DOI: 10.1590/1982-0194201900039] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Resumo Objetivo Avaliar a correlação entre cultura microbiológica, teste de ATP por bioluminescência e inspeção visual na monitorização da eficiência da limpeza e da desinfecção de superfícies de uma unidade ambulatorial e determinar o valor de corte de ATP-bioluminescência capaz de indicar superfície limpa em relação à avaliação microbiológica. Métodos Estudo exploratório, longitudinal e correlacional. Foram realizadas 720 avaliações em cinco superfícies antes e após a limpeza e a desinfecção. Nos resultados, foram realizadas análises de duas proporções, a correlação de Spearman e a curva ROC. Resultados Ocorreram proporções semelhantes (p≥0,05) entre as taxas de reprovação apenas entre ATP-bioluminescência e contagem de colônias aeróbias (CCA) quando somadas as avaliações de todas as superfícies antes e depois da limpeza e da desinfecção. Houve correlação significativa entre os métodos de quantificação de ATP e a contagem microbiana para o balcão da recepção e a maca. A análise ROC indicou que a quantificação de ATP apresentou resultado significativo na comparação com a CCA (p=0,044). Conclusão Embora discreta, houve correlação significativa entre os métodos de quantificação de ATP e contagem microbiana para duas superfícies. Sugere-se que superfícies que apresentam valores ≤49 unidades relativas de luz estão limpas.
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Elliott-Dawe C. Synergism in Perioperative Services. AORN J 2018; 107:726-736. [PMID: 29851043 DOI: 10.1002/aorn.12151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
This article presents an analysis of the concept of synergism in perioperative services. Perioperative services can account for a hospital's highest expenditures and net income or loss, and leaders must understand how to maximize outcomes by creating value above expectations. Using Walker and Avant's methodology, I examined the use of synergism in the literature across multiple databases. The concept has been used in business, information technology, psychology, engineering, and theology. In health care, it is used to explain the effects of combined medications, teamwork, biological systems, patient care, cleaning effectiveness, and health promotion partnerships. I identified two attributes: an emergent property and increased positivity. Optimized outcomes, increased patient and employee satisfaction, and high net revenue are evidence of perioperative synergism. Synergism in this context is dependent on team cohesion, communication, workplace adaptability, and the tactical allocation of resources to ensure unimpeded flow of the patient through the system.
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Intra G, Alteri A, Corti L, Rabellotti E, Papaleo E, Restelli L, Biondo S, Garancini MP, Candiani M, Viganò P. Application of failure mode and effect analysis in an assisted reproduction technology laboratory. Reprod Biomed Online 2016; 33:132-9. [DOI: 10.1016/j.rbmo.2016.05.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Revised: 05/13/2016] [Accepted: 05/17/2016] [Indexed: 10/21/2022]
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Whiteley GS, Knight JL, Derry CW, Jensen SO, Vickery K, Gosbell IB. Response to Russotto et al. Am J Infect Control 2016; 44:733-4. [PMID: 27020083 DOI: 10.1016/j.ajic.2016.01.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Accepted: 01/20/2016] [Indexed: 11/17/2022]
Affiliation(s)
- Greg S Whiteley
- School of Science and Health, University of Western Sydney, Richmond, NSW, Australia; Whiteley Corporation Pty Ltd, North Sydney, NSW, Australia.
| | - Jessica L Knight
- School of Medicine, University of Western Sydney, Campbelltown, NSW, Australia; Antibiotic Resistance and Mobile Elements Group, Molecular Medicine Research Group, Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia
| | - Chris W Derry
- School of Science and Health, University of Western Sydney, Richmond, NSW, Australia
| | - Slade O Jensen
- School of Medicine, University of Western Sydney, Campbelltown, NSW, Australia; Antibiotic Resistance and Mobile Elements Group, Molecular Medicine Research Group, Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia
| | - Karen Vickery
- Surgical Infection Research Group, Faculty of Medicine and Health Sciences, Macquarie University, North Ryde, NSW, Australia
| | - Iain B Gosbell
- School of Medicine, University of Western Sydney, Campbelltown, NSW, Australia; Antibiotic Resistance and Mobile Elements Group, Molecular Medicine Research Group, Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia; Department of Microbiology and Infectious Diseases, Sydney South West Pathology Service, Liverpool, NSW, Australia
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Whiteley GS, Knight JL, Derry CW, Jensen SO, Vickery K, Gosbell IB. A pilot study into locating the bad bugs in a busy intensive care unit. Am J Infect Control 2015; 43:1270-5. [PMID: 26654232 DOI: 10.1016/j.ajic.2015.07.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Revised: 07/03/2015] [Accepted: 07/07/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND The persistence of multidrug-resistant organisms (MDROs) within an intensive care unit (ICU) possibly contained within dry surface biofilms, remains a perplexing confounder and is a threat to patient safety. Identification of residential locations of MDRO within the ICU is an intervention for which new scientific approaches may assist in finding potential MDRO reservoirs. METHOD This study investigated a new approach to sampling using a more aggressive environmental swabbing technique of high-touch objects (HTOs) and surfaces, aided by 2 commercially available adenosine triphosphate (ATP) bioluminometers. RESULTS A total of 13 individual MDRO locations identified in this pilot study. The use of ATP bioluminometers was significantly associated with the identification of 12 of the 13 individual MDRO locations. The MDRO recovery and readings from the 2 ATP bioluminometers were not significantly correlated with distinct cutoffs for each ATP device, and there was no correlation between the 2 ATP devices. CONCLUSION The specific MDRO locations were not limited to the immediate patient surroundings or to any specific HTO or type of surface. The use of ATP testing helped rapidly identify the soiled locations for MDRO sampling. The greatest density of positive MDRO locations was around and within the clinical staff work station.
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McElroy LM, Khorzad R, Nannicelli AP, Brown AR, Ladner DP, Holl JL. Failure mode and effects analysis: a comparison of two common risk prioritisation methods. BMJ Qual Saf 2015; 25:329-36. [PMID: 26170336 DOI: 10.1136/bmjqs-2015-004130] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Accepted: 06/21/2015] [Indexed: 11/03/2022]
Abstract
BACKGROUND Failure mode and effects analysis (FMEA) is a method of risk assessment increasingly used in healthcare over the past decade. The traditional method, however, can require substantial time and training resources. The goal of this study is to compare a simplified scoring method with the traditional scoring method to determine the degree of congruence in identifying high-risk failures. METHODS An FMEA of the operating room (OR) to intensive care unit (ICU) handoff was conducted. Failures were scored and ranked using both the traditional risk priority number (RPN) and criticality-based method, and a simplified method, which designates failures as 'high', 'medium' or 'low' risk. The degree of congruence was determined by first identifying those failures determined to be critical by the traditional method (RPN≥300), and then calculating the per cent congruence with those failures designated critical by the simplified methods (high risk). RESULTS In total, 79 process failures among 37 individual steps in the OR to ICU handoff process were identified. The traditional method yielded Criticality Indices (CIs) ranging from 18 to 72 and RPNs ranging from 80 to 504. The simplified method ranked 11 failures as 'low risk', 30 as medium risk and 22 as high risk. The traditional method yielded 24 failures with an RPN ≥300, of which 22 were identified as high risk by the simplified method (92% agreement). The top 20% of CI (≥60) included 12 failures, of which six were designated as high risk by the simplified method (50% agreement). CONCLUSIONS These results suggest that the simplified method of scoring and ranking failures identified by an FMEA can be a useful tool for healthcare organisations with limited access to FMEA expertise. However, the simplified method does not result in the same degree of discrimination in the ranking of failures offered by the traditional method.
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Affiliation(s)
- Lisa M McElroy
- Center for Healthcare Studies, Institute for Public Health and Medicine, Northwestern University, Chicago, Illinois, USA Northwestern University Transplant Outcomes Research Collaborative, Northwestern University, Chicago, Illinois, USA
| | - Rebeca Khorzad
- Center for Healthcare Studies, Institute for Public Health and Medicine, Northwestern University, Chicago, Illinois, USA Northwestern University Transplant Outcomes Research Collaborative, Northwestern University, Chicago, Illinois, USA
| | - Anna P Nannicelli
- Center for Healthcare Studies, Institute for Public Health and Medicine, Northwestern University, Chicago, Illinois, USA
| | - Alexandra R Brown
- Center for Healthcare Studies, Institute for Public Health and Medicine, Northwestern University, Chicago, Illinois, USA
| | - Daniela P Ladner
- Center for Healthcare Studies, Institute for Public Health and Medicine, Northwestern University, Chicago, Illinois, USA Northwestern University Transplant Outcomes Research Collaborative, Northwestern University, Chicago, Illinois, USA
| | - Jane L Holl
- Center for Healthcare Studies, Institute for Public Health and Medicine, Northwestern University, Chicago, Illinois, USA Northwestern University Transplant Outcomes Research Collaborative, Northwestern University, Chicago, Illinois, USA
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The perennial problem of variability in adenosine triphosphate (ATP) tests for hygiene monitoring within healthcare settings. Infect Control Hosp Epidemiol 2015; 36:658-63. [PMID: 25732269 DOI: 10.1017/ice.2015.32] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To investigate the reliability of commercial ATP bioluminometers and to document precision and variability measurements using known and quantitated standard materials. METHODS Four commercially branded ATP bioluminometers and their consumables were subjected to a series of controlled studies with quantitated materials in multiple repetitions of dilution series. The individual dilutions were applied directly to ATP swabs. To assess precision and reproducibility, each dilution step was tested in triplicate or quadruplicate and the RLU reading from each test point was recorded. Results across the multiple dilution series were normalized using the coefficient of variation. RESULTS The results for pure ATP and bacterial ATP from suspensions of Staphylococcus epidermidis and Pseudomonas aeruginosa are presented graphically. The data indicate that precision and reproducibility are poor across all brands tested. Standard deviation was as high as 50% of the mean for all brands, and in the field users are not provided any indication of this level of imprecision. CONCLUSIONS The variability of commercial ATP bioluminometers and their consumables is unacceptably high with the current technical configuration. The advantage of speed of response is undermined by instrument imprecision expressed in the numerical scale of relative light units (RLU).
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