Caracterização clínica e económica das úlceras por pressão em ambiente hospitalar : contributos para a melhoria da segurança do doente e da qualidade dos cuidados

RESUMO - Prestar cuidados a um doente que além da patologia de base apresenta úlceras por pressão (UPP) implica um esforço acrescido por parte da Instituição de saúde e equipa multidisciplinar, custos acrescidos no tratamento e reactualizações frequentes, para que se prestem cuidados que primem pela excelência. OBJETIVOS: caracterizar o impacto clinico e económico das UPP e relacioná-los com as temáticas da Segurança do Doente e Qualidade em Saúde. METODOLOGIA: estudo observacional retrospetivo longitudinal, com uma população do estudo constituída por 164 adultos que estiveram internados entre 1 de janeiro a 31 de dezembro de 2012 no CHMT e que desenvolveram UPP durante o internamento. RESULTADOS: com uma população do estudo maioritariamente masculina (57,3%), e uma média de idades de 81 anos, a taxa de incidência de UPP foi de 1,4%. A maior parte de UPP desenvolvidas durante o internamento foram as de categoria II e a localização anatómica mais frequente os membros inferiores. Em termos de impacto económico, 842.609 euros foi o montante estimado correspondente aos custos totais associados às UPP. CONCLUSÃO: o contínuo investimento na Segurança do Doente e na Qualidade em Saúde e, em especial, na prevenção das UPP devem ser mantidos para que se continuem a mobilizar esforços que minimizem a frequência da ocorrência das últimas. Mais do que tratar pretende-se prevenir tendo em conta que as consequências, quer para a díade doente-família como para as Instituições de saúde, são significativas.

Estimated Financial Impact of Trypanosoma vivax on the Brazilian Pantanal and Bolivian Lowlands

The financial impact of the first outbreak of Trypanosoma vivax in the Brazilian Pantanal wetland is estimated. Results are extended to include outbreaks in the Bolivian lowlands providing a notion of the potential influence of the disease and an analytical basis. More than 11 million head of cattle, valued at more than US$3 billion are found in the Brazilian Pantanal and Bolivian lowlands. The total estimated cost of the 1995 outbreak of T. vivax is the sum of the present values of mortality, abortion, and productivity losses and treatment costs, or about 4% of total brood cow value on affected ranches. Had the outbreak gone untreated, the estimated losses would have exceeded 17% of total brood cow value.

Alveolar echinococcosis: from a deadly disease to a well-controlled infection. Relative survival and economic analysis in Switzerland over the last 35 years.

BACKGROUND/AIMS: Alveolar echinococcosis (AE) is a serious liver disease. The aim of this study was to explore the long-term prognosis of AE patients, the burden of this disease in Switzerland and the cost-effectiveness of treatment. METHODS: Relative survival analysis was undertaken using a national database with 329 patient records. 155 representative cases had sufficient details regarding treatment costs and patient outcome to estimate the financial implications and treatment costs of AE. RESULTS: For an average 54-year-old patient diagnosed with AE in 1970 the life expectancy was estimated to be reduced by 18.2 and 21.3 years for men and women, respectively. By 2005 this was reduced to approximately 3.5 and 2.6 years, respectively. Patients undergoing radical surgery had a better outcome, whereas the older patients had a poorer prognosis than the younger patients. Costs amount to approximately Euro108,762 per patient. Assuming the improved life expectancy of AE patients is due to modern treatment the cost per disability-adjusted life years (DALY) saved is approximately Euro6,032. CONCLUSIONS: Current treatments have substantially improved the prognosis of AE patients compared to the 1970s. The cost per DALY saved is low compared to the average national annual income. Hence, AE treatment is highly cost-effective in Switzerland.

Implications of Objective vs Subjective Delirium Assessment in Surgical Intensive Care Patients.

Background Delirium is an independent predictor of increased length of stay, mortality, and treatment costs in critical care patients. Its incidence may be underestimated or overestimated if delirium is assessed by using subjective clinical impression alone rather than an objective instrument. Objectives To determine frequency of discrepancies between subjective and objective delirium monitoring. Methods An observational cohort study was performed in a surgical-cardiosurgical 31-bed intensive care unit of a university hospital. Patients' delirium status was rated daily by bedside nurses on the basis of subjective individual clinical impressions and by medical students on the basis of scores on the objective Confusion Assessment Method for the Intensive Care Unit. Results Of 160 patients suitable for analysis, 38.8% (n = 62) had delirium according to objective criteria at some time during their stay in the intensive care unit. A total of 436 paired observations were analyzed. Delirium was diagnosed in 26.1% of observations (n = 114) with the objective method. This percentage included 6.4% (n = 28) in whom delirium was not recognized via subjective criteria. According to subjective criteria, delirium was present in 29.4% of paired observations (n = 128), including 9.6% (n = 42) with no objective indications of delirium. A total of 8 patients with no evidence of delirium according to the objective criteria were prescribed haloperidol and lorazepam because the subjective method indicated they had delirium. Conclusions Use of objective criteria helped detect delirium in more patients and also identified patients mistakenly thought to have delirium who actually did not meet objective criteria for diagnosis of the condition.

Cost effectiveness of a new combined immunosuppressive and antiviral regimen on the one-year follow-up of kidney transplant patients.

Background: Medical prescription after organ transplant must prevent both rejection and infectious complications. We assessed the 1-year effectiveness and cost of introducing a new combined regimen in kidney transplantation. Methods: Patients transplanted from January 2000 to March 2003 (Period 1) were compared to patients transplanted from April 2003 to July 2005 (Period 2). In period 1, patients were treated with Basiliximab, Cyclosporin, steroids and Mycophenolate (MMF) or Azathioprine. Prophylaxis with Valacyclovir was prescribed only in CMV D+/R- patients. In period 2, immunosuppressive drugs were Basiliximab, Tacrolimus, steroids and MMF. A 3-month universal CMV prophylaxis with Valganciclovir was used. Medical charts of outpatient visits allowed identifying drug, laboratory and radiological tests use, and hospital information system causes of hospitalisation and length of stay (LOS) over the first year after transplant. Patients with incomplete costs data were excluded. Results: 53 patients were analysed in period 1, and 60 in period 2. CMV serostatus patterns were not significantly different between the 2 periods. Over 12 months, acute rejection decreased from 22 patients (42%) in period 1 to 4 patients (7%) in period 2 (p<0.001), and CMV infection from 25 patients (47%) to 9 patients (15%, p<0.001). Average total rehospitalisation LOS decreased from 28±19 to 20±11 days (p<0.007). Average outpatient visits decreased from 49±10 to 39±8 (p<0.001). Average immunosuppression and CMV prophylaxis costs increased from US$ 18,362±6,546 to 24,637±5,457 (p<0.001), while average graft rejection costs decreased form US$ 4,135±9,164 to 585±2,850 (p=0.005), and average CMV treatment costs from US$ 2,043±5,545 to 91±293 (p=0.008). Average outpatient visits costs decreased from US$ 7,619±1,549 to 6,074±1,043 (p<0.001), and other hospital costs from US$ 3,801±6,519 to 1,196±3,146 (p=0.007). Altogether, average 1-year treatment costs decreased from US$ 35,961±14,916 to 32,584±6,211 (p=0.115). Cost-effectiveness ratios to avoid graft rejection and CMV infection decreased from US$ 61,482±9,292 to 34,911± 1,639 (p=0.006) and US$ 68,070±11,122 to 39,899±2,650 (p=0.015), respectively. Conclusion: The new combined regimen administered in period 2 was significantly more effective. Its additional cost was more than offset by savings linked with complications avoidance.

In Vitro Activity of Gentamicin-Loaded Bioabsorbable Beads against Different Microorganisms

Abstract: Osteomyelitis is responsible for high treatment costs, long hospital stays, and results in substantial morbidity. Treatment with surgical debridement and antibiotic-impregnated Polymethylmetacrylate (PMMA) beads is the standard of care, providing high local but low serum antibiotic concentrations, thereby avoiding systemic toxicity. However, for several reasons, the beads require surgical removal. Alternative antibiotic delivery systems should improve the treatment of bone infection, actively encourage bone healing and require no additional surgery for removal. We investigated the activity of gentamicin-loaded bioabsorbable beads against different microorganisms (Staphylococcus epidermidis, S. aureus, Escherichia coli, Enterococcus faecalis, Candida albicans) commonly causing surgical site bone infection, by microcalorimetry. Calcium sulphate beads containing gentamicin were incubated in microcalorimetry ampoules containing different concentrations of the corresponding microorganism. Growth medium with each germ and unloaded beads was used as positive control, growth medium with loaded beads alone as negative control. Bacterial growth-related heat production at 37 °C was measured for 24 h. Cultures without gentamicin-loaded beads produced heat-flow peaks corresponding to the exponential growth of the corresponding microorganisms in nutrient-rich medium. In contrast, cultures with gentamicin-loaded beads completely suppressed heat production during 24 h, demonstrating their antibiotic activity. Gentamicin-loaded beads effectively inhibited growth of susceptible microorganisms, under the described in vitro conditions.

The economic burden of alcohol dependence in europe.

AIMS: To determine the economic burden pertaining to alcohol dependence in Europe. METHODS: Database searching was combined with grey literature searching to identify costs and resource use in Europe relating to alcohol dependence as defined by the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) or the World Health Organisation's International Classification of Diseases (ICD-10). Searches combined MeSH headings for both economic terms and terms pertaining to alcohol dependence. Relevant outcomes included direct healthcare costs and indirect societal costs. Main resource use outcomes included hospitalization and drug costs. RESULTS: Compared with the number of studies of the burden of alcohol use disorders in general, relatively few focussed specifically on alcohol dependence. Twenty-two studies of variable quality were eligible for inclusion. The direct costs of alcohol dependence in Europe were substantial, the treatment costs for a single alcohol-dependent patient lying within the range euro1591-euro7702 per hospitalization and the annual total direct costs accounting for 0.04-0.31% of an individual country's gross domestic product (GDP). These costs were driven primarily by hospitalization; in contrast, the annual drug costs for alcohol dependence were low. The indirect costs were more substantial than the direct costs, accounting for up to 0.64% of GDP per country annually. Alcohol dependence may be more costly in terms of health costs per patient than alcohol abuse. CONCLUSIONS: This review confirms that alcohol dependence represents a significant burden for European healthcare systems and society. Difficulties in comparing across cost-of-illness studies in this disease area, however, prevent specific estimation of the economic burden.

Lipase Improvement: Goals and strategies

Lipases have received great attention as industrial biocatalysts in areas like oils and fats processing, detergents, baking, cheese making, surface cleaning, or fine chemistry . They can catalyse reactions of insoluble substrates at the lipid-water interface, preserving their catalytic activity in organic solvents. This makes of lipases powerful tools for catalysing not only hydrolysis, but also various reverse reactions such as esterification, transesterification, aminolysis, or thiotransesterifications in anhydrous organic solvents. Moreover, lipases catalyse reactions with high specificity, regio and enantioselectivity, becoming the most used enzymes in synthetic organic chemistry. Therefore, they display important advantages over classical catalysts, as they can catalyse reactions with reduced side products, lowered waste treatment costs, and under mild temperature and pressure conditions. Accordingly, the use of lipases holds a great promise for green and economical process chemistry.

09012-009 Little River Lake Watershed Final Report

Little River Lake watershed is a 13,305 acre subwatershed of Little River. The 788 acre lake was listed as a 303d impaired water body in 2008 due to elevated turbidity and algae levels. The Decatur SWCD has prioritized water quality protection efforts within the Little River Lake watershed because 1) portions of this watershed has been identified as the primary contributor of sediment and nutrients to Little River Lake, which provides an essential source of drinking water for Decatur County and the Southern Iowa Rural Water Association; 2) the watershed provides exemplary education and project interpretation opportunities due to its proximity to Little River Lake Recreation Area, and 3) by using targeted and proven soil conservation practices to address water quality deficiencies the probability of successfully attenuating soil erosion and ameliorating water quality impairments is enhanced. The specific goals of this proposal are to: 1. reduce annual sediment, and phosphorous delivery to the lake by 11,280 tons and 14,664 lbs., respectively, via applications of conservation practices on targeted agricultural land; 2. delist the lake as an EPA 303d impaired water body via water quality enhancement; 3. obtain a “Full Support” status for the lake’s aquatic life and recreational use; 4. reduce potable water treatment costs (minimum 50% cost reduction) associated with high suspended solid levels; and 5. restore a viable sport-fish population, thereby bolstering tourism and the economy. To achieve timely project implementation the Decatur SWCD has cooperated with the IDNR Watershed Improvement Section, Fisheries Bureau, and IDALS-DSC to assess extant water quality and watershed conditions, coalesced a diverse team of committed partners and secured matching funding from multiple sources.

1231-014 Twelve Mile Lake Watershed Final Report

Twelve Mile Creek Lake is a 660 acre, Significant Publicly Owned Lake with a watershed of 14,820 acres for a ratio of 21:3. The watershed is predominately privately owned agricultural land that originates in Adair County and drains into the lake which serves as the primary source water for the City of Creston, Union County and the seven counties served by the Southern Iowa Rural Water Association. In recent years, frequent algae blooms and recurrent spikes in suspended solid concentrations have been inflating water treatment expenses for the Creston Municipal Utilities (CMU). Declining trends in water quality spurred CMU to enlist the Union Soil and Water Conservation District (SWCD) to assist in evaluating watershed conditions for potential upland improvements. Significant gully erosion issues that had been previously underestimated were discovered during this watershed assessment process. Newly acquired LiDAR elevation data readily revealed this concern which was previously obscured from view by the dense tree canopy. A Watershed Development and Planning Assistance Grant Application was approved and funded by the Iowa Department of Ag and Land Stewardship- Division of Soil Conservation. Throughout the planning process, project partners innovatively evaluated and prioritized a number of resource concerns throughout the watershed. The implementation plan presented will thwart these threats which left unaided will continue to diminish the overall health of the system, reduce the appeal of the lake to recreational users, and contribute to higher water treatment costs.

Cost-effectiveness of a new combined immunosuppressive and anti-infectious regimen in kidney transplantation.

OBJECTIVES: The aims of this study were to assess the 1-year cost-effectiveness of a new combined immunosuppressive and anti-infectious regimen in kidney transplantation to prevent both rejection and infectious complications. METHODS: Patients (pts) transplanted from January 2000 to March 2003 (Group A) and treated with a conventional protocol were compared with pts submitted to a combined regimen including universal cytomegalovirus (CMV) prophylaxis between April 2003 and July 2005 (Group B). Costs were computed from the hospital accounting system for hospital stays, and official tariffs for outpatient visits. Patients with incomplete costs data were excluded from analysis. RESULTS: Fifty-three patients were analyzed in Group A, and 60 in Group B. Baseline characteristics including CMV serostatus were not significantly different between the two groups. Over 12 months after transplantation, acute rejections decreased from 41.5 percent in Group A to 6.7 percent in Group B (p &lt; .001), and CMV infections from 47 percent to 15 percent (p &lt; .001). Overall, readmissions decreased from 68 percent to 55 percent (p = .160), and average hospital days from 28 +/- 19 to 20 +/- 11 days (p &lt; .007). The average number of outpatient visits decreased from 49 +/- 10 to 39 +/- 8 (p &lt; .001). Average 1-year immunosuppressive and CMV prophylaxis costs (per patient) increased from CHF20,402 +/- 7,273 to 27,375 +/- 6,063 (p &lt; .001), graft rejection costs decreased from CHF4,595 +/- 10,182 to 650 +/- 3,167 (p = .005), CMV treatment costs from CHF2,270 +/- 6,161 to 101 +/- 326 (p = .008), and outpatient visits costs from CHF8,466 +/- 1'721 to 6,749 +/- 1,159 (p &lt; .001). Altogether, 1-year treatment costs decreased from CHF39'957 +/- 16,573 to 36,204 +/- 6,901 (p = .115). CONCLUSIONS: The new combined regimen administered in Group B was significantly more effective, and its additional costs were more than offset by savings associated with complications avoidance.

Öljyvahinkojätteiden käsittely alusonnettomuuden jälkeen Kymenlaakson alueen näkökulmasta

Työn tavoitteena oli selvittää Suomenlahden rannalta merkittävän suuruisen alusöljyvahingon jälkeen kerättävän öljyisen jätteen käsittelymahdollisuudet ja -kapasiteetit sekä loppusijoitusmahdollisuudet ja -kapasiteetit Kymenlaakson alueen näkökulmasta. Tarkoituksena oli selvittää, missä jätteiden käsittely voidaan toteuttaa sekä, miten öljyisiä jätteitä voidaan esikäsitellä välivarastoinnin aikana puhdistuksen ja loppusijoituksen tehostamiseksi. Tutkimuksen kohteena oli sekä rannalta kerättävät kiinteät öljyiset ainekset että öljyinen merivesi. Työn alussa on perehdytty jätehuoltovastuuseen, eli kenen vastuulla öljyalusonnettomuuksissa syntyvät öljyiset jätteet ovat. Työssä on esitelty lyhyesti öljyvahinkojätteille teknisesti soveltuvien käsittelymenetelmien periaatteet ja menetelmien rajoituksia käsitellä öljyvahinkojätetteitä. Työssä on myös mainittu aiemmin Suomea koskettaneiden tai maailmalla tapahtuneiden alusöljyvahinkojen jätemääriä ja tapauksissa käytettyjä jätteiden käsittelymenetelmiä. Työ painottuu esittelemään Kymenlaakson alueen laitosten, Riihimäen Ekokem Oy Ab:n ja siirrettävien laitteistojen mahdollisuuksia käsitellä öljyisiä jätteitä. Lisäksi on esitelty öljyisen meriveden käsittelyyn soveltuvia laitoksia Kymenlaakson alueen näkökulmasta. Tietoja on kerätty puhelimitse ja sähköpostitse yritysten edustajilta vuoden 2007 aikana. Kymenlaakson alueella voidaan polttaa voimalaitosten leijupedeissä puhtaaseen polttoaineeseen sekoitettuja öljyisiä orgaanisia aineksia ja murskautuvia puhdistustyössä käytettyjä varusteita noin 10 000 t/a, homogenoitua öljyistä orgaanista ainesta voidaan polttaa Leca-soratehtaan rumpu-uunissa noin 1 200 t/a. Alueen polttokapasiteetti kasvaa, kun työn aikana rakenteilla oleva jätteenpolttolaitos valmistuu ja jätettä voidaan polttaa laitoksen arinalla. Haihtuvilla öljy-yhdisteillä pilaantuneita maa-aineksia voidaan alipainekäsitellä, jos yhdisteet eivät ole haihtuneet jo merellä. Erityisesti öljyiset maaainekset voidaan käsitellä alhaisilla öljypitoisuuksilla (öljypitoisuus noin alle 1-2 %) bitumistabiloimalla, aumakompostoimalla tai pesemällä siirrettävällä pesulaitteistolla. Kymenlaakson alueelle voidaan tuoda myös alueen ulkopuolelta siirrettäviä laitteistoja. Siirrettävät termodesorptiolaitteistot on tehty pilaantuneen maa-aineksen ensisijaiseen käsittelyyn, mutta samalla voidaan käsitellä myös muita jätejakeita, joilla on pieni partikkelikoko (alle 5-10 cm). Savaterra Oy:n siirrettävän termodesorptiolaitteiston kapasiteettiarvio on 100 000 t/a. Myös Niska & Nyyssönen Oy:llä on siirrettävä termodesorptiolaitteisto. Doranova Oy:n siirrettävän pesulaitteiston kapasiteettiarvio on 30 000- 50 000 t/a öljyistä maa-ainesta. Tutkimuksessa on ollut mukana myös Riihimäen Ekokem Oy Ab:n jätevoimala, jonka kapasiteettiarvio on 40 000-45 000 t/a erityisesti öljyisille orgaanisille aineksille, varusteille ja kuolleille eläimille. Riihimäen Ekokem Oy Ab:n ongelmajätelaitoksen rumpuuuneissa voidaan käsitellä arviolta 80 000-100 000 t/a öljyisiä maa-aineksia eli kiinteitä jätteitä, joiden partikkelikoko on suunnilleen alle 10 cm, ja 20 000 t/a nestemäisiä öljyisiä jätteitä. Työn loppupuolella on esitelty myös öljyisen meriveden käsittelyyn soveltuvia laitoksia ja niiden rajoituksia käsitellä kyseistä jätettä. Kyseisten laitosten kapasiteetit selviävät usein vasta onnettomuuden sattuessa. Kaikkiin annettuihin kapasiteettiarvioihin vaikuttaa merkittävästi jätteen koostumus. Raportin lopussa on esitelty alustava toimintasuunnitelma öljyvahinkojätteen käsittelemiseksi. Suunnitelmaan sisältyvät eri jätejakeille laaditut kaaviot, joista voi nähdä muun muassa eri jätekoostumuksille teknisesti soveltuvat käsittelymenetelmät ja käsittelymenetelmiä suorittavat yritykset. Öljyalusonnettomuuden sattuessa soveltuviin yrityksiin tulee ottaa yhteyttä ja selvittää kyseisellä hetkellä vapaana oleva käsittelykapasiteetti. Raportissa on myös esitelty käsittelykustannuksiin vaikuttavia tekijöitä ja arvioitu aiheutuvia kuljetuskustannuksia. Saadut tutkimustulokset ovat hyödynnettävissä erityisesti Kymenlaakson alueella. Tiedot käsittelymenetelmistä ja niiden rajoitteista ovat hyödynnettävissä valtakunnallisesti.

Lipase Improvement: Goals and strategies

Lipases have received great attention as industrial biocatalysts in areas like oils and fats processing, detergents, baking, cheese making, surface cleaning, or fine chemistry . They can catalyse reactions of insoluble substrates at the lipid-water interface, preserving their catalytic activity in organic solvents. This makes of lipases powerful tools for catalysing not only hydrolysis, but also various reverse reactions such as esterification, transesterification, aminolysis, or thiotransesterifications in anhydrous organic solvents. Moreover, lipases catalyse reactions with high specificity, regio and enantioselectivity, becoming the most used enzymes in synthetic organic chemistry. Therefore, they display important advantages over classical catalysts, as they can catalyse reactions with reduced side products, lowered waste treatment costs, and under mild temperature and pressure conditions. Accordingly, the use of lipases holds a great promise for green and economical process chemistry.

Prevenció en lesions musculars en el futbol

Les lesions musculars són molt freqüents en el futbol, superant el 30% de totes les lesions; provocant una interrupció en la pràctica esportiva normal del jugador durant dies o setmanes. Així doncs, la prevenció és un factor molt important. L’objectiu d’aquest estudi és el disseny d’un pla integral preventiu de fisioteràpia englobant diferent àmbits: nutrició, salut muscular i preparació física, sempre dins la perspectiva de la salut; per poder amb l’avaluació d’aquest pla disminuir la incidència de lesions musculars en el futbol amateur. Aquesta pràctica de prevenció es durà a terme a un dels dos equips sèniors masculins de futbol aficionat que formaran part de l’estudi (grup d’intervenció), mentre que l’altre equip de característiques el més similars possibles seguirà la seva preparació habitual (grup control). Després d’una temporada es compararà la incidència de lesions musculars entre els dos equips. Si les dades demostren evidències, aquest pla es facilitarà al servei interessat corresponent, perquè el puguin distribuir als equips associats, podent disminuir el número de lesions i així reduir els costos en tractaments.

Alusöljyvahingossa kuolleiden eläinten turvallinen käsittely

Diplomityö on osa Kymenlaakson ammattikorkeakoulun SÖKÖ II-hanketta, missä tehdään toimintamalli suuren öljyntorjuntaoperaation koordinointiin rannikon öljytorjunnasta vastaaville viranomaisille. Työn tavoitteena oli selvittää alusöljyvahingossa kuolleiden eläinten sekä eläinten keräilystä ja hoidosta syntyvien jätteiden käsittelymenetelmät ja soveltuvat käsittelylaitokset. Lisäksi tavoitteena oli selvittää kuolleiden eläinten välivarastointialueen tekniset vaatimukset ja öljyiselle eläinjätteelle soveltuva kuljetuskalusto. Työn teoriaosuudet toteutettiin kirjallisten lähteiden ja asiantuntijahaastatteluiden avulla. Tärkeäksi osaksi työtä muodostui kustannuslaskelma, missä laskettiin kuolleiden eläinten keräilystä aina loppukäsittelyyn asti muodostuvat kustannukset. Työn teoriaosuudet loivat pohjan kustannuslaskelmalle. Kuolleiden eläinten loppukäsittelyyn valittiin kolme eri laitosta ja kolme eri käsittelytekniikkaa, mitkä ovat: rumpu-uuni, siirrettävä termodesorptio ja renderöinti. Kuolleet eläimet kannattaa keskitetysti kerätä ja kuljettaa yhdelle alueelle, missä suoritetaan kuolleiden eläinten välivarastointi kylmäkonteissa ja tilastointi sekä elävien eläinten pesu ja hoito. Kustannuslaskelman perusteella siirrettävä termodesorptiolaitos on halvin käsittelyvaihtoehto, mutta kustannuserot muihin laitoksiin ovat pienet. Koko kuolleiden eläinten turvallisen käsittelyn kustannukset ovat alle promillen koko suuren öljyvahingon kustannuksista. Loppukäsittelylaitosta valittaessa on käsittelykustannuksia tärkeämpää selvittää laitoksen sen hetkinen jätteenkäsittelytilanne ja vapaa käsittelykapasiteetti kuolleille eläimille.