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Background: Unsafe injection practices pose significant risks to both patients and healthcare providers, constituting a critical issue in global healthcare ensuring the safety and appropriateness of injection practices is imperative. Aim & Objective: This study aimed to comprehensively assess the safety of injection practices across various healthcare facilities. Methodology: A Descriptive survey was conducted during March to December-2021. Non random Purposive sampling technique was adopted to select health care facilities. Total 26 healthcare facilities were selected from Government & private sectors. The study areas were OPDs and indoor wards. An observational checklist used to collect data. Data analysis was done using SPSS-28. Results: A comprehensive assessment revealed commendable adherence to injection safety practices. No deficiencies were found in the availability of resources and materials necessary for injection practices in hospitals. However, certain areas for improvement were identified. Interestingly, the practice of using a fresh pair of gloves for injections was unnoticed in 33% of government facilities and 45% of private facilities, suggesting a possible lapse in infection control protocols. Conclusion: While the healthcare facilities of Surat exhibit commendable adherences to certain aspects of injection safety, there remain opportunities for enhancement. Addressing implementing regular training programs for healthcare providers are crucial steps toward optimizing injection safety practices and ensuring the well-being of both patients and providers. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the feedback of CPR training given to parents of preterm babies discharged from the NICU. Methods: This was a retrospective study conducted using a questionnaire sent to parents of preterm neonates admitted to a neonatal intensive care unit (NICU) from January 2007 to May 2020. All parents of newborns under 30 weeks gestation who survived to discharge were considered eligible. Parents were given CPR training on a manikin by a Neonatal resuscitation provider (NRP) certified doctor. Babies less than 30 weeks were sent home with a disposable bag and mask after the training of the parents. The responses thus received were analysed. Results: We analysed data from 60 responses (48.3%). 85% of the parents were given one-on-one training, the rest as classroom training. 68.3% felt that the addition of video demonstrations would be beneficial. 95% of parents said that the training helped increase their confidence in taking care of their babies. 78% felt it did not add to unnecessary parental anxiety. 5 babies received CPR at home, and all were told that the home CPR was successful on assessment at the hospital after the episode. 65% felt a repeat training would be helpful. All the parents educated about CPR opined that this training is essential for discharge preparation. Conclusion: We conclude that parental CPR training backed by video demonstration prior to the instructor-led session and followed by repeat training after 3 months is desirable in the holistic care of preterm babies post-discharge. [ABSTRACT FROM AUTHOR]

Introduction: Intensive care unit (ICU) admission is required for approximately 25% of patients affected with coronavirus disease-19 (COVID-19) and imposes a high economic burden on patients in resource-limited settings. Method: We conducted a retrospective direct medical care cost analysis of COVID-19 patients requiring ICU admission after obtaining the Institutional Ethics Committee approval. Data were obtained from the records of patients admitted to the COVID-19 ICU of a tertiary care trust teaching hospital from June 2020 to December 2020. Direct costs were analyzed and correlated with various demographic variables and clinical outcomes. Results: A total of 176 patients were included (males--76%). The median direct medical cost for a median stay of 13 days was INR 202248.5 ($ 2742.91). Hospital drugs and disposables accounted for 20% of the total cost followed by bed charges (19%), equipment charges (17%), biosafety protective gear (15.5%), pathological and radiological tests (15%), clinical management (7.6%), and biomedical waste management (1.6%). Government schemes accounted for 79% of medical claims followed by directly paying patients (12.5%) and private insurance (8.5%). The cost was significantly higher in patients with diabetes mellitus and sepsis and in those requiring mechanical ventilation (MV) (p <0.05). Shorter lead time to hospital admission and lesser length of hospital stay were associated with significant lower direct cost. Conclusion: Direct medical care cost is substantial for COVID-19 patients requiring ICU admission. This cost is significantly associated with increased ICU and hospital stay, longer lead time to admission, diabetes mellitus, sepsis, and those who need high-flow nasal cannula (HFNC), noninvasive ventilation (NIV), and MV. [ABSTRACT FROM AUTHOR]

The coronavirus disease (COVID-19) pandemic has affected nearly all nations globally. The highly contagious nature of the disease puts the healthcare workers at high risk of acquiring infection, especially while handling airway and performing aerosol-generating procedures. The Indian Society of Critical Care Medicine, through this position paper, aims to provide guidance for safe airway management to all healthcare workers dealing with airway in COVID-19 patients. [ABSTRACT FROM AUTHOR]

To optimise surgical outcomes and minimise the risk of infections, effective communication and teamwork are essential in the operating theatre (OT). In this pilot study, we mapped the OT team dynamics and roles in infection and safety-related practices. Between November 2021 and February 2022, data were gathered from adult surgical teams at a tertiary hospital in India. Data included direct ethnographic observations of OT activities and interactions, sociograms of targeted infection and safety-related communication, measurement of OT traffic, and focus group discussions with teams. Qualitative data were coded and analysed using a grounded theory approach. Quantitative data were analysed using descriptive statistics. Data gathered from 51 hours of direct observations across ten surgical pathways include 16 sociograms and 15 traffic-flow maps. Team hierarchies and dynamics are directly influenced by the senior surgeon. The OT staff adhere to implicitly understood roles, creating a missed opportunity for infection-related interventions. Instances of non-verbal communication are common, especially for routine activities. While the surgical and anaesthetic residents and technicians lead most tasks during procedures, the scrub nurse acts as a mediator coordinating and activating tasks among role players across hierarchies. Despite this role, the plan of events is not always communicated to them ahead of the procedure resulting in multiple door openings to source equipment and disposables. Traffic flow, counted by the number of door openings reach up to 14-15 per five minutes, with implications for infection management. Communication around the WHO checklist was limited. While interventions exist to optimise care in the OT, implementation challenges remain. Assigning explicit roles and responsibilities for actioning, including the WHO checklist completion, to specific team members is critical. On reflexive feedback to teams, the visual methods utilised provided an effective means for team reflection and an awareness of practices that may compromise infection management and patient safety. [ABSTRACT FROM AUTHOR]

Although insulin delivery devices are widely used by the patients, there is a paucity of published guidelines to help professionals manage their patients in insulin therapies. To provide simple and easily implementable guidelines to health care physicians on the choice of insulin delivery devices in routine clinical practice, experts in diabetes gathered together and discussed the recommendations at the National insulin Summit 2018. An ideal insulin delivery device should accurately deliver the prescribed dose of insulin and be easy to use. Recommendations are: (1) insulin should be initiated by using an insulin device if the patient seems to discontinue insulin therapy. (2) Pen devices offer accurate dosing than a syringe and vial and are associated with cost savings in the long term. (3) Switching over from syringes and vial to disposable pen devices improves adherence. (4) FlexPen® offers better accuracy, and it requires lower dose force and injection force than SoloStar® and KwikPen® (5). Durable delivery pens such as NovoPen® 4 maintain accuracy and low dose force compared with vials and syringes. (6) One pen should be used by only one patient. (7) Regular counseling on the proper use of the pen device is required regularly. This consensus-based recommendation is a useful reference tool for health care practitioners to initiate insulin therapy in patients with diabetes by using the appropriate insulin pen device. [ABSTRACT FROM AUTHOR]

Disposable filtering face piece respirators (FFRs) are usually not approved for routine practice of decontamination and reuse. However, such practice of decontamination and reuse may be needed only as a crisis capacity strategy to ensure continued availability. The current severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) pandemic would help us enlighten about more effective and efficient ways of decontamination and reuse. Based on the limited research available, ultraviolet irradiation, vapors of hydrogen peroxide, and moist heat showed the most promising potential methods to decontaminate FFRs. This article summarizes available research about decontamination of FFRs before reuse. [ABSTRACT FROM AUTHOR]

Medical device reuse has been accepted worldwide. Reuse benefits are not only cost-saving but also have a positive effect on the environment. On the other hand, it is necessary to meet certain requirements for considering reprocess to be harmless and efficient. The technique of reprocessing single-use medical devices was simplified and well regulated in the United States and Japan. However, this pattern continues unhindered in India because of irregularity of regulations. This study covers the history of reuse policy, known activities in the Indian and foreign contexts and also discusses the social and monetary consequences of reprocessing. The triggers for recycling are limited resources, poor training of healthcare workers and patients' confidence in the efficacy of injections. Among developed countries, the reuse of single-use products is less common, but may require sophisticated technological equipment. Reuse is restricted in many nations (e.g., the U.S., Canada, and some European countries) requiring ethical and legal requirements, high standards of personnel reprocessing and preparation, risk evaluation, monitoring, and confirmation of reprocessing. Decisions on the reprocessing of single-use products should only be taken in developing and developed nations after serious consideration of their benefits and drawbacks. The present study highlights the importance of reprocessing, provides information about the regulatory requirements in emerging and developed countries, and emphasizes the necessity of reprocessing in India. [ABSTRACT FROM AUTHOR]

Background  Neurological patients who are ventilator-dependent occupy scarce beds in the hospitals for prolonged periods of time. Most, if not all, can be discharged on home mechanical ventilation (HMV). However, due to lack of insurance and state support, it remains prohibitively expensive for the vast majority of those who require it most. Materials and Methods  The authors discuss three patients admitted in the Department of Neurosurgery between January and August 2019, who were discharged on HMV after remaining on ventilator support for prolonged period in the hospital. Each patient was discharged with two units (one as standby) of AgVa home ventilator (AgVa Healthcare; New Delhi, India), one Ambu-bag, one pulse oximeter, and one backup power supply unit capable of supplying power to ventilator for a minimum of 24 hours. All the equipment were given free-of-cost through donations by hospital staffs and other donors. All patients were followed up telephonically from their homes and the incidence of complications, ventilator malfunction, and additional cost of HMV on the families were ascertained. Observation and Results  Of the three patients, two were male and one female. Age ranged from 12 to 17 years. The duration of in-hospital ventilator support prior to discharge on HMV varied from 1 to 5 years. There was no insurance cover available for any of the patients with all expenses being "out of pocket." The equipment cost Indian Rupees (INR) 115,700 (USD 1,615: two units of AgVa home ventilator costing INR 100,000 [USD 1,396], one Ambu-bag costing INR 1,100 [USD 15], one pulse oximeter costing INR 1,600 [USD 22], and one backup power supply unit costing INR 13,000 [USD 182]). Discharge on HMV was planned on specific request from patients' families and informed consent was taken from all. All patients had tracheostomies. Mode of HMV was pressure support ventilation in all. Telephonic follow-up ranged from 1 to 7 months. The cost of disposables was INR 100 per month (USD 0.7) for all the patients. No complications occurred in any patient. There was no incidence of ventilator-associated pneumonia (VAP) or ventilator malfunction. Conclusions  Availability of cost-effective indigenous ventilator like AgVa home has made HMV possible, even for poor patients with neurological diseases, and has the potential to improve quality of life, decrease VAP rates, and free up scarce ventilator beds in hospitals. Longer-term follow-up in larger number of patients will improve the data on safety and feasibility in developing countries like India. [ABSTRACT FROM AUTHOR]

The article focuses on the medical device regulation in India. Topics include soft tissue fillers are regulated as Class C medical devices, as the types of materials approved for soft tissue filler vary from biologic to synthetic materials; mentions that many dermatologists import surgical instruments, primarily through third‑party vendors; and also mentions the government of India has identified the medical device industry as a focus industry for its flagship "Make in India" program.

Abstract: Background: Disposable-syringe jet injectors (DSJIs) have the potential to deliver vaccines safely and affordably to millions of children around the world. We estimated the incremental costs of transitioning from needles and syringes to delivering childhood vaccines with DSJIs in Brazil, India, and South Africa. Methods: Two scenarios were assessed: (1) DSJI delivery of all vaccines at current dose and depth; (2) a change to intradermal (ID) delivery with DSJIs for hepatitis B and yellow fever vaccines, while the other vaccines are delivered by DSJIs at current dose and depth. The main advantage of ID delivery is that only a small fraction of the standard dose may be needed to obtain an immune response similar to that of subcutaneous or intramuscular injection. Cost categories included were vaccines, injection equipment, waste management, and vaccine transport. Some delivery cost items, such as training and personnel were excluded as were treatment cost savings caused by a reduction in diseases transmitted due to unsafe injections. Results: In the standard dose and depth scenario, the incremental costs of introducing DSJIs per fully vaccinated child amount to US$ 0.57 in Brazil, US$ 0.65 in India and US$ 1.24 in South Africa. In the ID scenario, there are cost savings of US$ 0.11 per child in Brazil, and added costs of US$ 0.45 and US$ 0.76 per child in India and South Africa, respectively. The most important incremental cost item is jet injector disposable syringes. Conclusion: The incremental costs should be evaluated against other vaccine delivery technologies that can deliver the same benefits to patients, health care workers, and the community. DSJIs deserve consideration by global and national decision-makers as a means to expand access to ID delivery and to enhance safety at marginal additional cost. [ABSTRACT FROM AUTHOR]

The article reports on the reuse of syringes and its implications in India. The World Health Organization (WHO) has estimated that 300,000 people die every year in the country due to dirty syringes. The "Assessment of Injection Practices in India -- An India-Clinical Epidemiology Network (CLEN) Program Evaluation Network Study" sponsored by the Indian Ministry of Health and the World Bank has indicated that 62% of all injections were unsafe and syringes and needles in hospitals and clinics in the country were improperly disposed. Information on the move of the government in dealing with issue is also discussed.

A letter to the editor is presented in response to the article "Gloves Reprocessing: Does It Really Save Money?" by P. Arora et al. which appeared in a 2015 issue.