An armoured endotracheal tube obstruction in a child

The case of a child whose tracheal tube became obstructed intraoperatively 30 minutes after intubation is reported. It appears that this obstruction was related to the development of bubbles within the walls which expanded upon exposure to nitrous oxide and diffusion of that gas into the bubbles. The authors want to point out the risk of gas diffusion into the walls of the tube and the possibility that repeated sterilization may enhance the development of bubbles. Les auteurs rapportent l’observation d’un enfant de sept mois dont la sonde tracheale s’est obstruée 30 minutes après l’intubation. Cette obstruction était due à l’expansion de bulles incluses dans la paroi du tube après exposition au N₂O et diffusion de celui-ci à l’interieur des bulles. Ils accusent également la stérilisation répétée de la sonde armée (contre l’avis du constructeur) d’avoir favorisé le développement de ces inclusions bulleuses.     

Contraception and its ethical considerations

Access to appropriate contraception not only has direct benefits for women's health and wellbeing but also has a broader positive impact on society as a whole. Obstetricians and gynaecologists play a key role in counselling women. Decisions regarding contraceptive choices must take into account women's preferences, cultural and religious beliefs as well as any co-existing medical issues.This article outlines three commonly encountered scenarios and the ethical and legal issues that may affect the choice of contraceptive.     

Men's experiences of vasectomy: a grounded theory study

This paper presents a theoretical model derived from a grounded theory analysis of interviews with 19 men who had had a vasectomy three years previously. The aim was to track men's experience of vasectomy through decision making, surgery and adjustment and to develop a model to shed light on the process. Early studies of vasectomy had suggested that men adopt more stereotypically masculine behaviours after vasectomy and their authors had conjectured that these were compensatory for a diminished sense of masculinity. Interesting findings from the present study suggest that, for these participants at least, vasectomy often enhanced their sense of masculinity. Surgery was sometimes construed as a “bloodbath” heroically endured and part of the construction of a valued identity of a “family man”. Peer pressure, particularly in the workplace, appeared to be a powerful motivator when making the decision to be sterilized and the authors suggest that vasectomy can be a passport to membership of a socially valued group.     

A 10-year survey of compliance with recommended procedures for infection control by dentists in Beijing

Objectives: This study aimed to survey changes in practices of infection control (IC) procedures by dentists in Beijing between 2000 and 2010. Methods: Data were based on the feedback of 592 and 769 dentists surveyed in 2000 and 2010, respectively. Statistical analysis was conducted using Pearson’s chi‐squared test. Results: Response rates of 95% (2000) and 94% (2010) were achieved. The percentages of dentists who had received training in IC were 62.96% (2000) and 76.21% (2010). Improvements in practices in 2010 over those in 2000 included increases in: the percentage of vaccination for hepatitis B virus from 32.66% to 68.14%; the routine use of gloves from 73.31% to 99.73%; the use of face shields or eyewear as protection against splatter during dental treatment from 13.94% to 95.45%; the use of protective gowns from 14.51% to 54.23%; the use of high‐volume suction from 11.19% to 74.34%; routine changing of gloves between patients from 63.25% to 99.22%; pressured steam sterilisation of dental handpieces between patients from 41.24% to 96.10%, and the flushing of dental unit waterlines after each treatment from 42.01% to 73.49%. Conclusions: Although compliance with recommended IC practices by dentists in Beijing improved between 2000 and 2010, not all dentists are properly familiar with IC procedures. Education in IC in dental schools and in continuing training in hospitals, and mandatory regulations are needed to improve IC practices in dental health care settings.     

The effect of mechanical cleaning and thermal disinfection on light intensity provided by fibrelight Macintosh laryngoscopes

The increased use of thermal decontamination procedures for fibrelight laryngoscope blades, to comply with international guidelines, will have considerable economical effects. We evaluated the effect of mechanical cleaning plus thermal disinfection at 90 degrees C, with or without subsequent steam sterilisation at 134 degrees C, on light intensity provided by fibrelight laryngoscopes. After mounting the blades in a special frame with a built-in light source, light intensity was measured using radiometer/photometer. In total, 14 blades provided by 11 companies were tested. The majority of fibrelight laryngoscope blades were fairly resistant to the damaging effects of machine washing plus disinfection at 90 degrees C (mean [range] reduction in light intensity 34.6%[2.1-78.3%]). However, when exposed to an additional sterilisation procedure at 134 degrees C, the majority of blades were unable to withstand the combined treatment for 300 cycles (mean [range] reduction in light intensity 86.5%[32.0-98.7%]). This study stresses the need for fibrelight laryngoscope blades which are more resistant to thermal decontamination procedures than those available at present.     

Near-Infrared (NIR) Monitoring of H2O2 Vapor Concentration During Vapor Hydrogen Peroxide (VHP) Sterilisation

Purpose. There is an increasing use in the pharmaceutical industry of barrier systems such as transfer isolators, sterilisation tunnels and work station isolators. As Vapor Hydrogen Peroxide (VHP) sterilisation of isolators and lyophilizers becomes an important sterilisation method, there is an acute need for a VHP monitoring system to be used for in-process control and validation. In this study, near infrared (NIR) spectrofotometry was evaluated as a potential technique to monitor hydrogen peroxide. Additionally the H₂O₂ vapor permeability of different packaging materials, commonly used in steam and ethylene oxide sterilisation, was evaluated. Methods. NIR spectrofotometry, using a gas cell connected with optic fibres, was evaluated as a potential technique to monitor hydrogen peroxide vapor and water vapor during VHP sterilisation of an isolator. A NIR spectrum was taken every 30 s during VHP sterilisation of an isolator. The influence of injection rate, air flow rate, working temperature and gas distribution was investigated. The H₂O₂ vapor permeability of different packaging materials was determined by placing the gas cell in the sterilisation bags and sealing the bags hermetically. The sterilisation bag was then subjected to VHP sterilisation. Results. The NIR spectra taken at steady state sterilization conditions showed 4 absorption peaks: at 1364,1378 and 1400 nm attributed to water and at 1420 nm attributed to H₂O₂ vapor. By measuring the absorbance level at these wavelengths, the actual concentration of H₂O and H₂O₂ vapor in the isolator was calculated. The water vapor permeation of the sterilisation bags, measured with NIR, appeared to be equal for all materials tested. Whereas Tyvek^® was the most permeable material for hydrogen peroxide vapor (82.7% of the reference concentration outside the bag), only 30% was found in bags made of medical paper. Sterilisation bags consisting of laminate films and PVC sealed to medical paper showed intermediate permeability. Conclusions. Near-infrared (NIR) spectroscopy using a gascell with optic fibres is a useful technique to monitor VHP sterilisation cycles. There was a difference in H₂O₂ vapor permeability of different packaging materials, commonly used in steam and ethylene oxide sterilisation.     

The long-term effects of vasectomy on sexual behaviour

Two hundred soldiers of the Sri Lanka Army who had undergone vasectomy at least 4 years earlier were interviewed by a pretested questionnaire to determine the incidence and nature of any changes in sexual behaviour after the operation. Fifty-six percent reported some change in their sexual behaviour after vasectomy. A decreased frequency of intercourse being reported by 15%, a decreased sexual desire by 19% and changes in sexual behaviour during intercourse by 33%. Seven percent reported that their wives had noticed an alteration in sexual behaviour after operation. In spite of these changes in sexual behaviour after vasectomy the majority of men (92%) reported satisfaction with the operation, which is an indication that changes in sexual behaviour cannot be attributed directly to vasectomy.