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Involvement in evaluating and selecting products for patient care is an important function of the nurse. Invaluable aids in product evaluation are standards developed by the FDA or other standards-writing organizations, defining minimum levels of performance, labeling, and safety for specific devices. Compliance with a voluntary consensus standard, which has been approved by consensus of a committee of experts representing manufacturers and users, is recommended. Nurses should be aware of device standards and recommended practices now available or being developed for specific devices. Often the standards-writing group has developed for specific devices. Often the standards-writing group has considered or will consider specific problems troubling the nurse. Involvement in the process itself will help ensure that these problems are addressed.

The Hospital Experience Reporting System was a pilot study initiated at Robert Packer Hospital in 1980 and continued for 22 months to examine abnormal or unusual failures of medical devices and to evaluate an inhospital reporting system. Hospital employees were encouraged to report device failures or problems, and the hospital purchasing department pursued recompensation or replacement from the manufacturer. Device deficiencies were found to be fairly common, but until HERS was implemented, only a negligible number were reported to either the hospital or to the U.S. Pharmacopoeial Convention. Cost savings brought about by this voluntary, inhospital reporting system were substantial. The study established that such a system results in safer device use.

Steam sterilization is the simplest and most useful method of sterilization of thermostable materials. Sterilization depends upon three factors: time, temperature, and the presence of live steam. For the first time an instrument can be employed to monitor these three factors with immediate readout. This paper contrasts the advantages of this integrator with sterilizer controls, and biological and chemical indicators; and describes methods utilized in testing the integrator.

Standards appearing in the Federal Register are law and are mandatory. Voluntary guidelines only constrain an institution if the guidelines are incorporated into the hospital's rules. Hospitals are required to have rules and regulations; however, they apply only to each individual hospital.

In 1720, Heister successfully removed a massive tumor of the breast. The lesion was probably a massive cystosarcoma phylloides rather than infiltrating carcinoma of the duct. His thorough description reveals that patients and surgeons have changed little in two and one-half centuries.

Aseptic barriers are employed in the form of surgical gowns, drapes, and wrappers for sterile goods. They possess many of the attributes of textiles, but must also protect sterile zones from microbial invasion. Surgeons rely on them to resist penetration by liquids and other bacterial vehicles. A large variety of both woven and nonwoven materials are being produced for this purpose. The user is faced with difficult choices. The provider of the barrier materials must assure the surgeon of their barrier quality under the usual conditions of their use in operating rooms. Identical standards of quality can be and should be applicable whether these materials are created to be used once and discarded or are reusable.

Acute appendicitis at this medical center for 1984 was reviewed and compared with previous studies reporting 1944 and 1964. In 1984, the perforation rate was strikingly higher than the earlier years. It was zero in 1944, rose to 13.6 per cent in 1964, and to 31.4 per cent in 1984. One quarter of perforations in 1984 occurred during the first decade of life. In 1984, 14 per cent (10/70) of all patients with appendicitis were examined by a physician prior to eventual hospitalization; nine had perforated the appendix, representing 41 per cent of all perforations. Major factors responsible for the increase in perforations included (1) an increase in patients less than ten years old (a group at high risk for perforation), and (2) physician or patient delay in hospitalization. We suggest that physician and public education, which has proven effective in the past, should be reinstituted. Critical review of appendicitis should be carried out at individual institutions to identify, and thus, modify trends in this disease. Perforation increases morbidity and cost, yet is easily avoidable.

Laminar filtered airflow is a special air system not required by any code for use in any operating room. It is, however, a method of securing ultrasepsis when this is needed for a very particular hazardous circumstance. Although these circumstances could be answered by other means, laminar airflow is useful in situations where a patient is particularly and unusually liable to wound infection.