مخاطر ابتلاع أدوات الأسنان

المرضى الذين يبتلعون أدوات طب الأسنان معرضون للخطر وقد يحتاجون إلى الإحالة إلى المستشفى لإجراء مزيد من التقييم ، كما تقول منظمة الدفاع عن الأسنان على مستوى المملكة المتحدة. يجب على جميع الممارسين أن يدركوا أن التقييم الطبي في حالات الطوارئ مطلوب عند استنشاق أي شيء ، لكن ابتلاع أداة يمكن أن يكون ضارًا للمريض. تقول كلير رينتون ، مستشارة طب الأسنان في MDDUS: "قد يؤدي ابتلاع التاج أو الملغم إلى تقليل المخاطر على المريض ، ولكن بالنسبة للأدوات اللبية مثل ملفات اليد أو النصائح المكسورة لأدوات طب الأسنان مثل أدوات القياس ، يجب إحالة المرضى إلى المستشفى على الفور للتقييم". (في الصورة). تعاملت MDDUS مع الحالات التي ابتلع فيها المرضى أداة اللبية أو النهاية الحادة المكسورة من قشور الموجات فوق الصوتية أثناء مقياس وتلميع وحتى أجزاء من القبضات المعيبة. في حين أن جميع المهنيين يجب أن يكونوا على دراية بخطورة استنشاق الأشياء ، يعتقد البعض أنه لا توجد حاجة لإحالة المريض الذي يبتلع أداة طب الأسنان. ومع ذلك ، في هذه الحالات ، يجب على الممارس أن يشرح للمريض أنه يحتاج إلى فحص وتقييم في المستشفى كإجراء احترازي. "في حين أن ابتلاع جسم ما قد يشكل خطرًا أقل ، يجب أن يكون الممارس الطبي هو الشخص الذي يصدر الحكم ، وبالتالي يجب إحالة المريض إلى أ &E ، كاملة مع رسالة تحتوي على تاريخ الأسنان. قد يكون من المفيد تقديم كائن مماثل لمساعدة الطبيب في تقييمهم. هذا يعطي الطبيب معلومات كافية للحكم على ما إذا كان يمكن تبني نهج "المراقبة والطريق" أو إذا كانت الجراحة مطلوبة لاسترداد الكائن قبل أن يضر بالأمعاء. يجب على الممارسين توضيح الحادث في سجلات المريض ، وتحديد العلاج المقدم وما إذا كان قد تم إجراء إحالة.'

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Finding the Best Dental Surgical Instrument Manufacturer in US
Finding the Best Dental Surgical Instrument Manufacturer in US
Buying products from a dental surgical instrument manufacturer is the best choice for sure, but how do you take a step? Here are some quick tips to find the right option. For any dental clinic and facility, one of the major investments is dental equipment and instruments. Apart from spending on the latest equipment, there are some basic requirements, such as extraction kits, endodontic, crown instruments, orthodontics, elevators and periodontal instruments. The quality of service offered by any dental clinic is based on the expertise of the dental experts and surgeons and also on the effectiveness of treatment, for which the dental instruments are essential. In this post, we will talk of how you can procure quality instruments at the best prices. Deciding between sellers, dealers and manufacturers: Typically, most clinics and dentists reach out to regular dealers and retailers for their needs, which isnt a bad idea, except for the pricing. If you are concerned over the quality of goods and pricing, you should be looking for a dental surgical instrument manufacturer that you can trust. Most manufacturers work through dealers, but some of them have their own websites, where you can check their goods they manufacturer and its pricing. Sometimes, emails and phone calls may be needed to get customa quotes, but it is always a good idea to actually check with a manufacturer first. Make a list: Before you look for quotes, start by making a list of the instruments and equipment that you need. This can be anything from the basic dental instruments to specific kits and products related to cosmetic dental care. With a concrete order in place, you should be able to locate the right sellers who can deal with entire order. Taking a quote will help you in understanding the pricing, although just the price shouldnt be the only factor for placing an order. There are some other aspects that need equal attention, as discussed below. Check for standards: No matter whether it is about general or dental surgical instrument, precision, quality and accuracy is the key, and since you wont be investing in instruments every year, durability and overall performance does matter. If you are checking with US manufacturers, ask them about the standards they follow. Ideally, a reputed manufacturer will never shy away from offering information on their products. As a buyer, you have every right to ask about their manufacturing plant and the clients they work with. Experienced companies that have been in business for more than a couple of decades should be an ideal choice, because it is easier to trust a renowned name. If you can get a few references, make sure that you check for the same. Since dentists and dental clinics need new tools and equipment from time to time, it makes sense to take some time in finding a genuine supplier. Also, if you have any concerns shipping, returns, warranty and exchange, make sure that you discuss the same. A clear quote from the manufacturer should ideally discuss all these aspects, but in case you have questions , always email and get clear the possible doubts. Get started with an online search right now.
Mad Cow Bug Linked to Dentists' Equipment
Mad Cow Bug Linked to Dentists' Equipment
A COMMITTEE of experts charged with monitoring the threat of mad cow disease in humans is to discuss new warnings about a possible risk of contracting the fatal infection from dental instruments.Dr Michael Farrell, a neurologist at Beaumont Hospital and a member of the CJD Surveillance Committee said yesterday they will consider the development at next month's meeting.He was responding to reports that Prof Peter Smith, chairman of the British government's advisory committee on the illness, said there is a theoretical risk'' of the new variant of the disease being passed on from patient to patient in dental surgeries.However, Dr Farrell said the public should be reminded that the risk of getting the disease, linked to eating BSE-infected beef, is infinitesimal. He pointed to the estimated 70 cases which have come to light in Britain in the last six years despite the huge population.When this is broken down further the theoretical'' risk of contracting the disease from dental instruments would be extremely small, he explained.To date only one person, a young mother, has been diagnosed with the new variant CJD in the Republic. The woman underwent an internal procedure in St Vincent's Hospital and other patients treated with the same instruments were notified and informed of the tiny risk.Dr Farrell revealed that a bar code system for surgical instruments is being devised which would indicate which patients they have been used on. This would mean they would be easily traced back if a potential risk came to light. The average age of those contracting new variant CJD is 29 years, compared to older age groups for classic CJD.Prof Smith stressed the need for thorough cleaning and sterilisation practices as the infective agent in the new form of the disease is known to survive normal sterilisation procedures. He advised dentists to follow recommended procedures for sterilisation which includes washing as well as autoclaving the risks of infection are increased if any human tissue is left on the instruments before they go into the autoclave.The committee is also looking at the more general issue of switching to disposable instruments for surgery.Other areas, besides the mouth, which may involve a risk of contamination include the eyes, central nervous system, tonsils and appendix. Health officials here have decided against banning blood donations from people who were in the UK in the 1980s.
Evaluation of the Effectiveness of Decontamination of Dental Syringes
Evaluation of the Effectiveness of Decontamination of Dental Syringes
Aim Steam autoclaving is the gold standard for decontaminating dental instruments, but worldwide disinfection is still widely employed. We have evaluated a range of procedures for their ability to inactivate duck hepatitis B virus contaminating dental syringes.Methods Residual infectivity of virus suspensions following 2% glutaraldehyde treatment, ultrasonication or steam sterilisation at 121° or 134° was assayed by injecting day-old ducklings and examining their livers for viral DNA 2.5 weeks later. Dental syringes were contaminated with DHBV positive blood, then treated by the same methods. An anaesthetic cartridge containing water was loaded into the syringe and 400μl aliquots used to inject day-old ducklings. Used dental syringes were examined by Scanning Electron Microscopy.Results Suspension test:- ultrasonic treatment failed to inactivate DHBV in suspension, but complete inactivation was achieved by 2% glutaraldehyde and autoclaving. Syringe test:- neither ultrasonic treatment nor glutaraldehyde inactivated DHBV. Autoclaving at 134° (3 minutes) permitted transmission to 1/16 ducklings but steam sterilisation at 121° (15 minutes) was effective. Electronmicroscopy demonstrated organic debris (biofilm) in the lumen of used syringes.Conclusion Short autoclaving cycles, albeit at raised temperatures, may fail to inactivate the virus because of poor steam penetration, inadequate heat transfer and the accumulation of protective biofilm.Infection control practices have come under increasing public scrutiny over the last decade in the light of significant medical problems associated with the acquisition of blood borne pathogens following both medical and dental procedures.Successive revisions of official guidelines have made progressively more stringent recommendations for decontamination of instruments in office practice, to bring them into line with current 'best practice' procedures in hospitals. The National Health and Medical Research Council of Australia (NHMRC) recommends that all instruments, materials and medications introduced into sterile tissue must be sterile. For instruments and equipment, this should be achieved by using single-use items only, or, if the items are designed for multi-use, they must be scrupulously cleaned and adequately sterilised.The level of risk for invasive surgical, including dental procedures is ranked by Spaulding's classification scheme as 'critical' and therefore all instruments used must be sterile. Items that come in contact with intact mucous membranes however are classified as semi-critical and must be subjected to high-level disinfection with an approved disinfectant such as glutaraldehyde. In contrast to Spaulding's classification The British Dental Association (BDA) Advisory Service recommends sterilisation of all instruments that become contaminated with oral and other body fluids. Sterility can be achieved by: autoclaving (steam sterilisation under pressure at 121° to 134°C), or by dry heat at 160°C. Large scale systems of radiation, ethylene-oxide, or chemical treatment are also effective. Autoclaving is generally accepted as the method of choice to render contaminated instruments safe for reuse. Currently steam sterilisation using portable autoclaves is recommended for sterilising dental instruments for use in critical sites but it has been reported that some practitioners are still utilising high-grade disinfection such as buffered alkaline glutaraldehyde although this is now recommended for use in semi-critical areas only. This lack of compliance may arise because there is only limited direct scientific evidence about the effectiveness of various disinfection/sterilisation methods in the dental practice.Blood borne viruses are of major concern in the health care setting. Hepatitis B virus (HBV) is the most resistant blood borne virus in the environment and can persist for extended periods on contaminated surfaces or under the fingernails of providers. It is also present in high concentration in the blood and saliva and currently there are many more carriers of HBV in the community than there are carriers of HIV. Therefore, the effective elimination of HBV is the most critical indicator for assessing efficacy of infection control procedures.Unfortunately the lack of suitable infectivity models for HBV, such as tissue culture or animal inoculation, makes assessment of disinfectant efficacy difficult. The polymerase chain reaction (PCR) is a sensitive and specific test for the detection of viral nucleic acids and has been successfully employed to trace the fate of viruses in the environment. However, since nucleic acids survive treatments with heat, solvents and fixatives known to destroy microbial infectivity, PCR results obtained from disinfected or sterilised instruments may be misleading.Resistance to chemical and physical agents is very similar for members of each virus family, and this similarity is very useful when selecting test organisms for evaluation of disinfection and sterilisation procedures. Studies of the duck hepatitis B virus (DHBV) in particular have revealed similar biological and structural characteristics as HBV. The DHBV model also appears to have similar disinfectant inactivation kinetics to those reported in the very limited chimpanzee transmission studies of HBV. DHBV reaches high titre >10 ID/ml (10 times the amount of virus required to infect half of the experimental animals is present in each ml of blood) in the blood of infected ducks, and day-old ducklings are exquisitely sensitive to infection. These advantages have led to adoption of DHBV as a model for disinfectant and antiviral testing by the worlds regulatory bodies.Education of the dental health care professionals about the parameters that influence disinfectant efficacy is of paramount importance in gaining informed compliance with regulatory guidelines. It is also important that the guidelines are built on firm scientific evidence that takes into account the multiple parameters such as shape of instrument, amount and type of biological contaminant which influence efficacy in the field as opposed to results obtained using artificial test protocols. With this in mind we have used DHBV to determine inactivation efficacy of autoclaving and glutaraldehyde disinfection of blood soiled dental syringes.
'Dodgy' Dentist Who Sparked the Biggest NHS Recall When 22,000 Patients Were Offered Precautionary B
'Dodgy' Dentist Who Sparked the Biggest NHS Recall When 22,000 Patients Were Offered Precautionary B
A dentist who sparked an NHS recall of 22,000 patients because of poor hygiene at his practice has refused to attend a disciplinary hearing.The case against Desmond D'Mello, who faces more than 50 allegations of misconduct for poor hygiene after he was secretly filmed by a whistleblower In August 2014, will now go ahead in his absence.The 62-year-old was filmed failing to change his surgical gloves between patients and did not clean dental instruments through out appointments at the Daybrook Dental Surgery in Nottinghamshire.Following the leak of the video more than 100 of his patients accused D'Mello of putting their lives at risk from HIV and other diseases by failing to sterilise equipment and are still threatening to sue.NHS bosses urged 22,000 patients who had been treated by D'Mello in his 30-year career to get a blood test for diseases including HIV and Hepatitis C, with more than 4,000 taking up the offer.Today at the General Dental Council a professional practice committee decided the millionaire's misconduct hearing should be heard in his absence after he failed to attend and did not send any legal representation. David Bradly, representing the GDC, said: 'The council's submission is that he has chosen not to attend the proceedings at all.'While of course he may be disadvantaged by not being present, the difficulty for him is to be balanced against the the public interest in proceeding.'He pointed out there would be not appropriate for the committee to adjourn the proceedings as it is unlikely D'Mello would attended a re-listed hearing.Mr Bradly said: 'In the public interest the council applies to your committee to proceed with this hearing in Mr D'Mello's absence.'He showed the committee a letter from the solicitors Branbers, which had previously represented D'Mello from November 10, 2015.In it they said: 'For the reasons set out, we confirm our client does not intend to participate in the ongoing fitness to practice proceedings.'The hearing was also shown a letter from D'Mello dated December 8, 2015, in which he said: 'I do not wish to engage in this process.'Earlier this year in at a preliminary hearing D'Mello wrote to the GDC and said: 'I would like to confirm that I will not be attending or be represented at the hearing on 6th May 2016 as I repeat I have applied for voluntary erasure from the GDC register and have no intention of ever practising dentistry again.'The committee found D'Mello had been given enough prior notice of the hearing and agreed to proceed in his absence.Also facing allegations along side him is his dental assistant Caroline Surgey who faced four charges, with 23 sub-charges, including failing to change her gloves after blowing her nose into a tissue and failing to decontaminate equipment.At today's hearing Malcolm Fortune, representing Surgey, said: 'She faces four charges and all of these are admitted by me on her behalf.'The dentist faces five charges, with more than 50 sub-charges including failure to change surgical gloves and failure to wear a surgical mask.He is also accused of failing to maintain adequate infection control by using instruments which had not been decontaminated before use.D'Mello also faces allegations of managing patients in an inadequate manner including in the way he issued prescriptions.The hearing, which is scheduled to run until September 2, continues.
Washer Disinfector - Why Get One
Washer Disinfector - Why Get One
Washer disinfectors are the latest in the disinfectants that you can see in dental instruments. There are a large number of these available in the market and are also easily available online and you can purchase these as well. They are really useful while disinfecting dental instruments and this is something that is of a lot of importance when you are dealing with dental instruments and dental requirements. These include ultrasonic, disinfectors, pasteurizers and sterilizer and washers and all of these are best suited to help you with your dental disinfectant needs.The best part of these is that they come with a large number of very useful features like ease of use and a very high quality of hygiene. This helps you offer the best health care that is available in the industry. If you are in the dental industry it is of the utmost importance that you provide your patients with the best available hygiene levels. This is a very important factor when you are dealing with a patient.These disinfectants use the highest standards of cleaning that are available and they use the best decontamination equipment available in the market. Washer disinfectors help decontaminate these dental equipments using normal jet water cleaning processes and they then make use of heat treatment where they treat the equipment to very high heat levels.The spray of water that is used in these disinfectants is spread all over the equipment and is also sprayed in such a way that it covers all the equipment that is present. This makes sure that everything gets disinfected in an equal manner and nothing is missed out. There are many factors that you need to consider while using these like the water flow pressure and the temperature should be lower than 45 degrees. It has been observed that this may cause protein coagulation and this affects further cleaning.
Improving the Inspection and Manual Cleaning of Dental Instruments in a Dental Hospital
Improving the Inspection and Manual Cleaning of Dental Instruments in a Dental Hospital
AbstractWithin the dental hospital setting, it is a frequent occurrence to find residual cement contaminating instruments in a newly opened kit having undergone the decontamination cycle. Any instrument found to be contaminated then cannot be used, as the area underneath the cement is not sterile. This in itself has several repercussions. These include: cross-contamination, since there is a chance that the cement will be removed and the contaminated instrument used; cost, as each new kit that will be opened due to contaminated instruments will incur decontamination costs; and finally time, which most importantly has an impact on patient experience. Our baseline data recording focussed on finding out the severity of the problem, which instruments were most affected, and how this affected patient treatment, using a questionnaire. Within the paediatric department, 27% of examination kits contained a contaminated instrument, almost one third of all kits used. This quality improvement project utilized a poster and team huddle discussions to raise awareness of the problem and successfully reduced the number of contaminated instrument kits to 7% over a period of four weeks.ProblemWithin the dental hospital setting, it is a frequent occurrence to find residual cement contaminating instruments in a newly opened kit having undergone the decontamination cycle. Any instrument found to be contaminated then cannot be used, as the area underneath the cement is not sterile. This presents a problem as the instrument must be replaced in order to be used on a patient, thus requiring a new kit to be opened. This in itself has several repercussions. These include: cross-contamination, since there is a chance that the cement will be removed and the contaminated instrument used; cost, as each new kit that will be opened due to contaminated instruments will incur decontamination costs; and finally time, which most importantly has an impact on patient experience.BackgroundDuring our time treating patients in the dental school, we noticed that this recurring problem of contaminated instruments with residual cement was found to exist throughout all departments. We decided therefore that this would be a good opportunity to improve the quality of care, whilst also reducing unnecessary costs for the dental hospital.Approaching our mentor, we discovered that this problem was identified around ten years ago. Since then, attempts have been made to improve this issue, but none with great success or sustainability. Within the contract between the dental hospital and central sterile services department (CSSD), visual inspection is not included, so instruments often go through the decontamination process while contaminated with residual cement. This highlights the need for an intervention within the dental hospital prior to sending the instruments to CSSD. The problem lies with the fact that manual cleaning of instruments at chairside is not occurring prior to sending the instruments for sterilisation. A paper published in the British Dental Journal in 2007 titled "Pre-sterilisation cleaning of re-usable instruments in general dental practice" investigates this claim, proposing that effective cleaning prior to sterilisation is vital in the prevention of cross-infection. It states that "the cleaning of re-usable dental instruments is [also] important to ensure device longevity and functionality, removal of chemical residues and compliance with medico-legal directives." It then highlights that "effective cleaning is also vital to ensure microbial inactivation since retention of organic or inorganic debris may compromise subsequent disinfection or sterilization processes." Although this paper investigates the sterilisation of instruments in general practice setting, where decontamination is carried out at a local level as opposed to a centralised sterilisation department as utilized by the dental hospital, it demonstrates that this problem is not limited to our working environment, but has been recognised on a national level.The Scottish Dental Clinical Effectiveness Programme has released guidance on the cleaning of dental instruments, which was updated in October 2014. These guidelines come as part of the wider guidance on decontamination, and again explain that effective cleaning prior to sterilisation is required for reliable decontamination of instruments. It states that "any organic material or adherent dental materials left on instruments can inhibit these processes [disinfection and sterilisation]. This can also cause corrosion of instruments or impair their function, and might lead to transmission of infection from one patient to another."We were able to study existing data collected within the children's department of the dental hospital by Dr Daffyd Evans, showing that 36.7% of all instrument kits opened were not free from cement contamination. The study also showed the instruments most likely to be contaminated with cement. These included: flat plastic, excavator, burnishers, and thymosin probe. However these were not the only instruments shown to have contamination, therefore there is a risk to all instruments of being contaminated.From our search we are unaware of any other improvement projects tackling this issue.See supplementary file: ds4034.pdf - "Audit of Hand Instrument Kits RESULT"Baseline measurementTo collect our baseline data, we used the three key phases of baseline measurement: develop, collect, analyse. Our main objective for this project was to investigate whether contamination of instruments is a significant problem, and to what extent. Our first process measure that we assessed was the number of kits that were contaminated on opening. The second process measure was to look at which instruments were affected. The outcome measure was whether the contaminated instruments affected patient care.In order to collect the data, we had to decide on a universal definition of contamination. We defined a contaminated instrument as one with any amount of visible cement and explained this to our colleagues who assisted in collecting the data, during a clinical session in the children's department of the dental hospital. We decided to collect our data using a short questionnaire (attached below) which was our first PDSA cycle.PDSA 1 - A Questionnaire to Investigate the ProblemP- Prepare a questionnaire, which would highlight whether contaminated instruments were a problem, and which instruments were commonly affected. The questionnaire should be simple, and not time-consuming, to encourage students and staff to participate in our improvement project.D- During a clinical session in the children's department of the dental school, every student treating a patient was asked to examine their kit on opening and identify any contaminated instruments. We asked the students to specify which instrument(s) was/were contaminated and if this affected patient care.S- The students found the questionnaire easy to understand and every student who treated a patient completed a questionnaire. The feedback also highlighted that they were simple and quick to complete which encouraged participation. Of the six kits that were opened on the afternoon clinic, four were free from cement contamination, while two kits were not free from cement. Of these two kits, one had a contaminated flat plastic and treatment was not affected. The other contaminated kit contained a contaminated excavator, which did affect treatment and compromise patient care.We realized from this first cycle that we did not have all of the information we required. We knew that the contamination affected patient care, but we did not know why.A- We decided to update the questionnaire to include how the care of the patient was affected, and carry out a second PDSA cycle.PDSA 2 - A Questionnaire to Assess How our Problem Impacts upon Patient CareOn carrying out our second PDSA cycle with the updated questionnaire, we received nine returned forms, of which two students had reported contaminated instruments, whilst the other seven found no residual cement in their kits. Although we anticipated more detailed results in this second cycle with regards to how the contaminated instruments affected patient care, our responses stated that there was in fact no effect on patient care in this clinical session. The feedback we received from our colleagues regarding this was that the instruments that were contaminated were not required for that particular treatment, therefore had no impact. However, if another procedure was to be carried out that required these instruments, then an impact on patient care would have been reported. In the first case the contaminated instrument was reported as the flat plastic, and in the second case, the excavator was contaminated. This highlights that these instruments are the most commonly affected and that an intervention is required.The results that we collected during our baseline data collection, demonstrated that our results correlated with the previous data collected within the Paediatric department at 27% of examination kits containing a contaminated instrument, almost one third of all kits used.See supplementary file: ds3675.docx - "QI Project Tool Version 1"DesignOur first step in tackling the problem was to assign responsibility to the person using the instrument kit, so that our intervention was targeted to this individual. We had several discussions with our senior clinician, head dental nurse, and patient safety lead to ensure that our intervention would be viable. One suggestion which arose at these meetings was the idea of introducing single use instruments, which would eliminate the problem. However, we were intent on avoiding this approach as we felt that although it was financially viable, the constant disposal of instruments would be detrimental to the environment. Although the single use instruments may seem to be cost effective on the surface, we also anticipated there would be hidden costs involved, such as having to increase the quantity of sharps bins for their safe disposal.Therefore we came to our second approach, which would be to safely manually clean the instruments that we already have. This raised concerns in terms of sharps injury risk, and risk of damaging the surface of metal instruments. It became clear that we would have to devise a safe procedure for doing so, which involved working closely with the infection control team to gain approval. Taking advice from our senior clinician and our patient safety lead, we concluded that the safest and most cost-effective process would be to utilise detergent wipes and wooden spatulas as required, in order to remove contaminants from instruments prior to sterilisation. This is a process that had not been trialled in NHS Tayside so far; the NHS Tayside Infection Prevention and Control Policy states that the decontamination for dental instruments should take place at CSSD, or otherwise in an appropriate LDU, no mention of manual cleaning is provided. Once this process had been approved, we deduced that the most effective way to explain this process to our colleagues would be to present it as a poster. Included in our poster, we realised it should have a clear flow diagram as to how the process should be carried out, and also briefly explain the logic behind our intervention. Please see attached poster.We created a process map tracking an instrument kit's journey following use, to not only explain our intervention to other stakeholders, but also to illustrate where our intervention would fit in on this journey, and have the most effect. Please see attached process map.On reflecting on previous unsuccessful attempts within the department to tackle this problem, we were aware from our quality improvement knowledge that education alone may not obtain the desired result. Therefore to increase motivation to comply, we devised a method of tracing individual kits back to the user, therefore improving accountability of practice. This method involved recording the date, time, student number/staff name, and the bar code number of the kit used. We decided that this would not be a long term component of our intervention, but a tool to aid us in implementing it and help to establish the process as part of every day practice.StrategyOur first step aimed to test the effectiveness of our designed poster, and assess whether it was clear enough to explain the process of manual cleaning effectively. This would be essential to allow us to meet our main aim of every dental student/staff member being compliant with the manual inspection and cleaning of instruments within the paediatric department of the dental school within four weeks.PDSA 3 - Designing our Intervention PosterOur third PDSA cycle involved testing the poster with one student and asking them for feedback as to how easy the process was to follow. We expected that the student would find the poster informative and self explanatory. However, the findings of this test showed that some additional verbal information was required. This allowed us to modify how we planned to deliver the intervention, ensuring that the poster was explained verbally at each team huddle at the beginning of clinic, as well as being displayed throughout the clinic to be viewed easily by all students and staff working in the area. This would be the basis of our next test, to assess whether this approach would achieve full understanding. Another useful outcome of this PDSA cycle, was feedback from the student recommended specific locations in the clinic that they felt would be most noticeable and effective. Through the discussions of this test, we decided that the posters would be placed on the wall over the 'dirty instrument' trolley to serve as a reminder, centrally within the clinical area, and within the tutorial room so that it would be easily accessed by students to read up on the process.PDSA 4 - Testing our InterventionThe fourth PDSA cycle was carried out on a morning clinic within the department. At the team huddle at the beginning of clinic (at which all members of the team were present, including students, staff, and nurses) the intervention was described by displaying the poster and supplementing this with verbal information to further explain the problem and our intervention. Feedback from the group highlighted that this was a more effective method, and full understanding of what was expected was demonstrated. We decided that our intervention was now ready to be spread within the department, and PDSA 5 would involve carrying out this process at morning and afternoon clinics for two weeks.PDSA 5 - Implementing our InterventionPDSA 5 involved utilizing the information we had collected in the previous tests, displaying the poster around the clinic in key areas, explaining the process at the team huddles, and ensuring that all students/staff using examination kits were carrying out inspection and manual cleaning as necessary, before returning the kit to the "dirty" trolley. Accountability of practice was introduced by recording the clinical session, barcode of kit used, and student number/staff name. This meant that when the instrument kits were examined for a second time by a dental nurse before sending to CSSD, if a contaminated instrument was present, this could be traced back to the individual. Please see attached flow diagram which depicts the journey of an examination kit through this process.See supplementary file: ds5597.docx - "Intervention Poster"Post-measurementAs our intervention was tested, implemented, and spread, we collected data to prove its reliability. After the planned two weeks of implementing our intervention, our results showed that every examination kit had been through the process at least once, and all were free from contaminants. We were able to ensure this using the method of placing a sticker on the outer packaging following delivery of the sterilised kits from CSSD. The method of having the examination kits double-checked before sterilisation and the bar-code traceability is what proved that we did not have any contaminated kits, as no bar codes required following up during the two week process. This highlighted that awareness of the problem had increased and staff and students were complying with the inspection and manual cleaning.In the following two weeks, we used an almost identical data collection method to our baseline data collection. Throughout these two weeks, the recording of bar codes was stopped. This was due to the fact that we felt too much paperwork was causing resentment towards the project, and that at this stage it would be more beneficial to collect physical data as we had during our baseline data collection. This was in the form of a simple questionnaire that asked whether or not any instruments in the newly-opened kit were contaminated, and if so, which instruments and whether this had an impact on patient care. (See attached.)Our data collection targeted the same group as our baseline collection, which was any member of staff or student who had used an examination kit. Over the period of two weeks, we received 28 completed questionnaires. This number was lower than we expected, however this could be due to the fact that we were not present for one of the weeks so were not encouraging or reminding people to fill them out. It may also be down to failed appointments which is a regular occurrence in the paediatric department, therefore reducing the number of patients seen and so the number of kits used. This is especially true as one week coincided with school holidays so less appointments were booked/attended on this week.However, of the 28 questionnaires we received, only two reported a contaminated instrument. Both of these claimed to have an impact on patient treatment. We found that 7.1% of our kits were contaminated, this being an improvement from our baseline measurement which was 27% of examination kits having a contaminated instrument. Although we have achieved a reduction, it has to be questioned why the number is still at 7%, as in our first two weeks of the intervention, we had reduced it to zero. This puts into question the sustainability of the intervention and what needs to be improved so that we can continue to solve the problem without our presence on clinic being necessary.See supplementary file: ds6576.pdf - "Exam kit journey & run chart"Lessons and limitationsThere were a few limitations that we encountered when carrying out this project, all of which stem from the fact that dentistry is a demanding course in itself which does not leave much time for carrying out an improvement project on top of studies and clinical practice. Due to our need for gaining experience in all clinical areas, we have only a set amount of time in each specific department. Therefore we could not always be present in the Paediatric department to take part in the running of the intervention due to other clinical commitments. This made organising the intervention more difficult, and also made sustainability more of a challenge. This has made us realise how important team-working is in quality improvement, especially delegating tasks to other members of the team. For example, this project could not have been possible without the input and cooperation of the dental nurses, who allowed the intervention to run in our absence. It is therefore our hope that the intervention will be continued as we move into our final year when our time in the dental school is minimal.Another limitation was the lack of awareness of quality improvement within the dental school. This is something that will only increase with time and development of more quality improvement projects by the students. We would hope that with increasing awareness, students will realise the impact they can have on improving patient care and engage more fully in the projects of fellow students.Furthermore, similar to the above limitation of lack of awareness, we also lacked the presence of a clear tutor within the dental school with knowledge of quality improvement to guide us throughout the improvement project. Although we had a great deal of help from the senior clinician in the paediatric department, his retiral occurred before the intervention had begun. However, during the implementation of our intervention we received a great deal of support from the head dental nurse, whose input was invaluable.ConclusionAs our first experience of quality improvement, we are pleased as to how the project has run, and have learned a great deal from the experience. We are proud of the success we have achieved, not only in terms of reducing the number of contaminated instruments but also raising awareness of the problem. We feel that at this point, the intervention is not sustainable, but as the process becomes habit and new generations of students come through the system, we feel that it has the potential to be. At present, the department are trialling the use of disposable instruments as an alternative to our intervention. This removes the problem of dependency on students and staff carrying out the inspection and manual cleaning process.We also feel that by piloting the first quality improvement project within the dental school, we have taken the first step in raising awareness of quality improvement itself, both with staff and students.References1 Bagg J, Smith AJ, Hurrell D, McHugh S, Irvine G. Pre-sterilisation cleaning of re-usable instruments in general dental practice. British Dental Journal 2007; 202(): . (accessed 24 June 2015).2 Scottish Dental Clinical Effectiveness Programme. Decontamination. Dundee Dental Education Centre, Frankland Building, Small's Wynd, Dundee DD1 4HN: ; 2014. www.sdcep.co.uk (accessed 24 June 2015).3 Data collected by Daffyd Evans, Honorary Senior Lecturer in Paediatric Dentistry, Dundee Dental Hospital & School.4 Infection Control Team. NHS Tayside Infection Prevention and Control Policy. (accessed 24/11/15).Declaration of interestsNothing to declare.AcknowledgementsVicki Tully, Wendy Roud, Daffyd Evans, Marilla HunterEthical approvalEthics not required as this project was undertaken as a service improvement.
10 Weird and Unusual Things to Do and See in Maryland
10 Weird and Unusual Things to Do and See in Maryland
Baltimore is one of the most unusual and outright wacky cities in the United States to begin with, so writing a collection of ten unusual things to do in the state of Maryland, it was hard not to make the whole list just about the attractions in that one city. Still, the rest of Maryland has its share of offbeat and weird attractions that deserve to be on this list. These are my ten favorites of the interesting attractions there are to see and do in Maryland. There are of course many other things to see and do in that state but these are for those of us with offbeat and unusual tastes. Hopefully they will provide you with entertainment if you were to find yourself in that New England state.CAFE HONMost famous for its giant pink flamingo statue, Cafe Hon is a restaurant in the Hampden area of Baltimore made famous by the films of John Waters. Any fan of Waters film will want to visit this part of town and to visit the Cafe Hon. The place is pretty popular with Baltimore residents for the food as well as the style and is located at 1002 West 36th Street. GEPPI'S ENTERTAINMENT MUSEUMOwned by the CEO of Diamond Comics distributors, this unique museum is dedicated mostly to the medium of comic books but also including exhibits that deal with other forms of pop culture. It would be a good place to visit for families with kids and for nerds of all ages. It is located at 301 W. Camden Street in Baltimore, Maryland.NATIONAL CRYPTOLOGIC MUSEUMSpeaking of things that might appeal to nerds, Maryland is also home of the National Cryptologic Museum. Associated with the NSA, this museum presents a history of intelligence work in the United States. As a note, those that love this place might also want to visit the International Spy Museum in Washington DC, which isn't terribly far away, The Cryptologic Museum is located at 8290 Colony Seven Road in Annapolis Junction, Maryland. NATIONAL GREAT BLACKS IN WAX MUSEUMWax museums have a quirky vibe in general but this is the only wax museum in the country that is dedicated completely to African Americans. This one is also in Baltimore and is located at 1601 East North Avenue. the Museum has a large number of black historical figures and also portrays events, such as the struggle for voting rights. NATIONAL MUSEUM OF DENTISTRYThe National Museum of Dentistry is a fun place to take the whole family. A number of dental instruments from history, games and exhibits like George Washington's dentures can be found here. This is yet another Museum on display in Baltimore and can be found at 21 South Greene Street.NATIONAL MUSEUM OF HEALTH AND MEDICINEThere are a lot of wacky medical museums throughout the United States but this one manages to be just as fascinating as any of them. The museum has a number of medical artifacts going all the way back to the Civil War. The most fascinating have to do with Abraham Lincoln and his assassination by John Wilkes Booth. It is located at 2500 Linden Lane in Silver Spring, Maryland.NATIONAL VIGILANCE PARKNear Ft. Meade is another place for people who love espionage and military history. The park is a display of reconnaissance airplanes and has associations with the National Cryptologic Museum. The park is just one block west of the museum and it is easy to visit them both at once. NOAH'S ARK RECONSTRUCTIONGod's Ark of Safety Church in Maryland has given us one of the most interesting religious attractions in the country. The church is constructing a rebuilding of Noah's Ark. Supposedly this is inspired by a dream that the church's pastor had and is a huge 450 feet long, 75 feet wide and 45 feet tall structure. It is located at 18600 Cherry Lane SW, Frostburg, MD. OCEAN CITY Ocean City is a resort town in Maryland and would make a great vacation destination for a number of reasons, but if you are going there you might want to look for these quirky attractions. Check out the miniature golf course at 13903 Coastal Hwy, Ocean City, MD with its quirky look and design. On the corner of Coastal Hwy and 18th St. check out Paddock's Nightclub with its giant martini glass. And be sure to check out the Ocean Gallery on 2nd Street. STAR WARS TOYS MUSEUM The Star Wars Toys Museum in Linthicum Heights, Maryland is another place that nerds of all ages can enjoy. The museum features a collection of virtually every Star Wars toy ever made and includes a blog and online videos on the website.
'Vets Continue to Die':  Phoenix Hospital at Center of VA Scandal Ranked Among Nation's Worst
'Vets Continue to Die': Phoenix Hospital at Center of VA Scandal Ranked Among Nation's Worst
Three years after at least 35 veterans died waiting for care at the Veterans Affairs hospital in Phoenix, sparking a firestorm of demands for reform across the nation, the facility has been ranked one of the nation's worst -- and whistle-blowers are frustrated.Some 89,000 veterans are directed to seek medical care through the Phoenix VA, but the care the government facility provides was awarded the lowest rating, just 1 of 5 points, in a recent internal VA administration evaluation. The annual "Strategic Analytics for Improvement and Learning" report compared all VA medical centers to each other and its own previous performance."This is ground zero here in Phoenix, Ariz. It is a cesspool. It's the worst example of VA health care in the United States -- period," said Brandon Coleman about problems at the VA in Phoenix. Coleman was one of the original whistle-blowers in the scandal, but he no longer works there. "After the scandal hit in 2014, money poured into this place like there was no tomorrow. The annual budget was increased more than $100 million per year and yet wait times continue to get worse. Veterans continue to die," he said.In January, The U.S. Office of Special Counsel sent its own investigative findings to the White House and Congress, saying the Phoenix VA continues to struggle with significant patient wait times."In one case, the VA found that a veteran who died of cardiovascular disease did not receive a cardiology exam his VA physician ordered. The VA determined that had he received the exam in a timely fashion, further testing and interventions could have prevented his death," the report said.The report also found that during a week in October 2015, 3,900 appointments were canceled, and 12 patients "may have experienced harm that could have been prevented without the delay in care."Other concerns: On average, the Phoenix VA has 1,100 patients waiting longer than 30 days for appointments; the most overwhelmed is the psychotherapy division, with patients waiting an average of 75 days.Rima Nelson, the current director, is the seventh person to head the Phoenix VA since the scandal broke in 2014 - exposing a consistent and chronic pattern of long wait times, canceled appointments and fraudulent record-keeping. Dozens of veterans died waiting for care that never came. While Nelson has been tasked with reform, her history within the administration has been extremely controversial, and her critics aren't sure she can handle the monumental undertaking.When Nelson headed the St. Louis VA from 2009 to 2013, the VA was forced to notify 1,800 patients that they potentially were exposed to Hepatitis and HIV because dental instruments weren't properly sanitized. A short time later, the facility closed down its operating rooms for the same reason.Following the St. Louis fiasco, Nelson was sent to the Philippines for three years to head the VA hospital there and then was reassigned to Phoenix."We've had seven directors in 2 ½ years, each with more baggage than the last," Coleman said.Nelson, in an interview with Fox News, said being reassigned to the Philippines was her choice. She says that she took action after finding out about the problems in St. Louis and said she can understand why people would question her time there if they only read the headlines. She also struggled to say what rating she'd give to the facility in Phoenix right now."I wasn't here in 2014, so I don't have all the details. I know what happened with the access issue was in 2014, but I'm going to stay away from a rating because I don't have all the information," Nelson said.Kuauhtemoc Rodriguez, a whistle-blower thanked by the U.S. Office of Special Counsel in January for his help in providing critical information about problems at the Phoenix VA, said the problems are far worse than the report indicates."Anyone who has ever served in the military knows that you never leave somebody behind and the Phoenix VA has left veterans behind and I'm not going to stand for it," Rodriguez said. "I say, personally, that it's gotten worse than when it first got disclosed in 2014 that they were manipulating data because the people who were manipulating data then are still in charge today. They only changed the upper heads and the executive leadership."For speaking out, Rodriguez says he's now being retaliated against. "It's been a living hell," Rodriguez said.Nelson could not explain why Rodriguez' duties have been curtailed."I can't give you a specific response because I don't know of any specific connection that would address that directly," Nelson said, maintaining that if she knew of retaliation, she would do something about it.While Nelson said she has an open-door policy, Rodriguez said Nelson has never asked to meet with him even after his allegations were made public.Several veterans who spoke with Fox News are looking to the new administration to turn things around.One concern they have: President Trump's VA secretary nominee was an appointee of then-President Obama and a big supporter of Nelson.Last October, David Shulkin, then Undersecretary of Health for the Department of Veterans Affairs, introduced Nelson at the Phoenix VA and was pressed about her time in St. Louis."We looked at these issues, we actually saw a leader who was decisive, acting with veterans interests and capable of managing this type of complex organization," Shulkin said.Coleman said he hopes the new administration is up to the task."We need a bulldog in there somewhere," he said. "We need someone who is going to get the accountability going that's going to hold these corrupt administrators accountable."
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