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Noh MS, Jung SH, Kwon O, Lee SI, Yang SJ, Hahm E, Jun BH. Evaluation of Sterilization Performance for Vaporized-Hydrogen-Peroxide-Based Sterilizer with Diverse Controlled Parameters. ACS OMEGA 2020; 5:29382-29387. [PMID: 33225169 PMCID: PMC7676334 DOI: 10.1021/acsomega.0c04208] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Accepted: 10/12/2020] [Indexed: 06/11/2023]
Abstract
Hydrogen-peroxide-based low-temperature sterilization is a new sterilization technology for temperature-dependent medical devices. The effect of the process parameters of hydrogen-peroxide-based sterilizer on the sterilization performance of process challenge devices (PCDs) needs to be investigated. Sterilant amount, operating temperature, vacuum pressure, diffusion time, and chamber loading of the sterilizer on the sterilization performance of PCDs were adjusted. Seven PCDs with various morphologies and material containing biological indicators (BI) (EZTest, Geobacillus stearothermophilus) were used to evaluate the sterilization performance. The sterilization success rates of PCDs were 86, 71, and 57% with controlled temperature and pressure, diffusion time, and sterilant volume injection, respectively. The PCD material and structure also obviously affected sterilization performance. The sterilization of PCD A is the least successful for all parameters. Meanwhile, the sterilization of PCD B was influenced by the diffusion time and the sterilant injection volume. PCD B and PCD C were successfully sterilized by controlling the temperature and pressure. The weights and volume of the sterilization loading chamber resulted in a different sterilization performance. Sterilization performances of PCD 1, PCD 2, and PCD 3 were <70, <90, and 100%, respectively. Sterilant volume, sterilant diffusion time, pressure, temperature, PCD types, and chamber loading were proven to be important process parameters of sterilizer that affect the sterilization performance of vaporized-hydrogen-peroxide-based sterilizers.
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Affiliation(s)
- Mi Suk Noh
- Medical
Device & Bio-research Team, Bio-medical
& Environ-chemical Division, Korea Testing Certification, Gunpo 15809, Gyeonggi-do, Republic of Korea
| | - Suk Hee Jung
- Medical
Device & Bio-research Team, Bio-medical
& Environ-chemical Division, Korea Testing Certification, Gunpo 15809, Gyeonggi-do, Republic of Korea
| | - Ohryun Kwon
- Bio-Health
Center, Bio-medical & Environ-chemical Division, Korea Testing Certification, Ochang-eup 28115, Chungcheongbuk-do, Republic of
Korea
| | - Sang-Il Lee
- LOWTEM
Co., Ltd., Gunpo 15850, Gyeonggi-do, Republic of Korea
| | - Sung-Jin Yang
- Research
Institute, CMTECH Co., Ltd., Dong-Gu, Daegu-City, Republic of Korea
| | - Eunil Hahm
- Department
of Bioscience and Biotechnology, Konkuk
University, Seoul 05029, Republic of Korea
| | - Bong-Hyun Jun
- Department
of Bioscience and Biotechnology, Konkuk
University, Seoul 05029, Republic of Korea
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Parikh KP, Jain RJ, Parikh AK. Is plasma sterilization the modality of choice of sterilization today for endourological procedures such as ureterorenoscopy and retrograde intrarenal surgery? A single-center retrospective evaluation of 198 patients. Urol Ann 2020; 12:122-127. [PMID: 32565648 PMCID: PMC7292435 DOI: 10.4103/ua.ua_61_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Accepted: 11/12/2019] [Indexed: 11/17/2022] Open
Abstract
Introduction: The prevalence of infective complications among patients undergoing Retrograde Intrarenal Surgery (RIRS) for renal stone is 1.7%-18%, including fever, Systemic Inflammatory Response Syndrome (SIRS) and sepsis. The infectious complications of RIRS can be minimised by strict aseptic precautions and plasma sterilization. The Sterrad Next Generation (Sterrad NX) System, a low-temperature sterilizer represents the next generation of low-temperature hydrogen peroxide gas plasma sterilizers. This study was conducted to evaluate the efficacy of plasma sterilization among patients undergoing ureterorenoscopy (URS) and RIRS. The primary endpoint of this study was incidence of septicemia or related complications. Till date, there is no study on the incidence of infection rate in RIRS in relation to a specific mode of sterilization. Material and Methods: This is a retrospective study comprising of 198 patients undergoing URS and/or RIRS. The parameters studied were incidence of post-operative fever, Systemic Inflammatory Response Syndrome (SIRS), pyelonephritis or septicemic shock. Results: Out of 198 patients, incidence of post-operative fever was 3.5%, SIRS was 1.7%, pyelonephritis was 0.7% and septicemic shock was 0%. This is statistically significantly low septicemia rate among patients undergoing URS and /or RIRS as compared to the available literature. No health hazards of plasma sterilization were noted. No damage to the endoscopes or instruments was noted. Conclusion: Sterrad NX based on hydrogen peroxide gas plasma (HPGP) technology is highly efficacious, safe and the modality for sterilization of instruments, including heat labile instruments such as semi rigid, flexible and chip on the tip endoscopes and other EndoUrology armamentarium.
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Affiliation(s)
- Kandarp Priyakant Parikh
- Department of Genito Urinary Surgery, Minimal Access Surgery Training Institute, Shyam Urosurgical Hospital, Ahmedabad, Gujarat, India
| | - Ravi Jineshkumar Jain
- Department of Genito Urinary Surgery, Minimal Access Surgery Training Institute, Shyam Urosurgical Hospital, Ahmedabad, Gujarat, India
| | - Aditya K Parikh
- Department of Genito Urinary Surgery, Minimal Access Surgery Training Institute, Shyam Urosurgical Hospital, Ahmedabad, Gujarat, India
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Shea GKH, Wu KLK, Li IWS, Leung MF, Ko ALP, Tse L, Pang SSY, Kwan KYH, Wong TM, Leung FKL, Fang CX. A review of the manufacturing process and infection rate of 3D-printed models and guides sterilized by hydrogen peroxide plasma and utilized intra-operatively. 3D Print Med 2020; 6:7. [PMID: 32232596 PMCID: PMC7106677 DOI: 10.1186/s41205-020-00061-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 03/10/2020] [Indexed: 01/08/2023] Open
Abstract
3D printing in the context of medical application can allow for visualization of patient-specific anatomy to facilitate surgical planning and execution. Intra-operative usage of models and guides allows for real time feedback but ensuring sterility is essential to prevent infection. The additive manufacturing process restricts options for sterilisation owing to temperature sensitivity of thermoplastics utilised for fabrication. Here, we review one of the largest single cohorts of 3D models and guides constructed from Acrylonitrile butadiene styrene (ABS) and utilized intra-operatively, following terminal sterilization with hydrogen peroxide plasma. We describe our work flow from initial software rendering to printing, sterilization, and on-table application with the objective of demonstrating that our process is safe and can be implemented elsewhere. Overall, 7% (8/114 patients) of patients developed a surgical site infection, which was not elevated in comparison to related studies utilizing traditional surgical methods. Prolonged operation time with an associated increase in surgical complexity was identified to be a risk factor for infection. Low temperature plasma-based sterilization depends upon sufficient permeation and contact with surfaces which are a particular challenge when our 3D-printouts contain diffusion-restricted luminal spaces as well as hollows. Application of printouts as guides for power tools may further expose these regions to sterile bodily tissues and result in generation of debris. With each printout being a bespoke medical device, it is important that the multidisciplinary team involved in production and application understand potential pitfalls to ensuring sterility as to minimize infection risk.
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Affiliation(s)
- Graham Ka-Hon Shea
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong, Hong Kong.
| | - Kenneth Lap-Kei Wu
- School of Biomedical Sciences, The University of Hong Kong, Hong Kong, Hong Kong
| | - Iris Wai-Sum Li
- School of Public Health, The University of Hong Kong, Hong Kong, Hong Kong
| | - Man-Fai Leung
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong, Hong Kong
| | - Ada Lai-Ping Ko
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong, Hong Kong
| | - Lane Tse
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong, Hong Kong
| | | | - Kenny Yat-Hong Kwan
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong, Hong Kong
| | - Tak-Man Wong
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong, Hong Kong
| | - Frankie Ka-Li Leung
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong, Hong Kong
| | - Christian Xinshuo Fang
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong, Hong Kong.,Tam Shiu Foundation Anatomical Modelling Laboratory, Hong Kong, Hong Kong
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Severe anaphylactic shock due to ethylene oxide in a patient with myelomeningocele: successful exposure prevention and pretreatment with omalizumab. ACTA ACUST UNITED AC 2015; 2:3-6. [PMID: 25612258 DOI: 10.1097/acc.0b013e3182a08ff1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Ethylene oxide (EO) is a highly reactive gas widely used for sterilization of medical devices, for example, plastic materials and ventriculoperitoneal shunts. Allergic reactions to EO are rare and have been observed mainly in patients during hemodialysis and myelomeningocele patients. We describe severe anaphylaxis to EO in a patient with myelomeningocele during general anesthesia. A detailed description is provided about the prevention measures aimed at reducing exposure to EO including a novel approach by resterilization with plasma. Also, pretreatment with omalizumab was implemented for the first time in such a case. With these measures, further surgeries in our patient were uneventful.
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O'Connor N, Cahill O, Daniels S, Galvin S, Humphreys H. Cold atmospheric pressure plasma and decontamination. Can it contribute to preventing hospital-acquired infections? J Hosp Infect 2014; 88:59-65. [PMID: 25146226 DOI: 10.1016/j.jhin.2014.06.015] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2013] [Accepted: 06/27/2014] [Indexed: 11/28/2022]
Abstract
Healthcare-associated infections (HCAIs) affect ∼4.5 million patients in Europe alone annually. With the ever-increasing number of 'multi-resistant' micro-organisms, alternative and more effective methods of environmental decontamination are being sought as an important component of infection prevention and control. One of these is the use of cold atmospheric pressure plasma (CAPP) systems with clinical applications in healthcare facilities. CAPPs have been shown to demonstrate antimicrobial, antifungal and antiviral properties and have been adopted for other uses in clinical medicine over the past decade. CAPPs vary in their physical and chemical nature depending on the plasma-generating mechanism (e.g. plasma jet, dielectric barrier discharge, etc.). CAPP systems produce a 'cocktail' of species including positive and negative ions, reactive atoms and molecules (e.g. atomic oxygen, ozone, superoxide and oxides of nitrogen), intense electric fields, and ultraviolet radiation (UV). The effects of these ions have been studied on micro-organisms, skin, blood, and DNA; thus, a range of possible applications of CAPPs has been identified, including surface decontamination, wound healing, biofilm removal, and even cancer therapy. Here we evaluate plasma devices, their applications, mode of action and their potential role specifically in combating HCAIs on clinical surfaces.
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Affiliation(s)
- N O'Connor
- National Centre for Plasma Science and Technology, Dublin, Ireland; School of Electronic Engineering, Dublin City University, Dublin, Ireland
| | - O Cahill
- National Centre for Plasma Science and Technology, Dublin, Ireland.
| | - S Daniels
- National Centre for Plasma Science and Technology, Dublin, Ireland; School of Electronic Engineering, Dublin City University, Dublin, Ireland
| | - S Galvin
- Department of Clinical Microbiology, Education and Research Centre, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - H Humphreys
- Department of Clinical Microbiology, Education and Research Centre, Royal College of Surgeons in Ireland, Dublin, Ireland; Department of Microbiology, Beaumont Hospital, Dublin, Ireland
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