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Lawaczeck L, Rudolph J, Norz V, Tsaur I, Rausch S. The role of planetary health in urologic oncology. Expert Rev Anticancer Ther 2024; 24:513-523. [PMID: 38709157 DOI: 10.1080/14737140.2024.2350631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 04/29/2024] [Indexed: 05/07/2024]
Abstract
INTRODUCTION Climate change and global warming are an omnipresent topic in our daily lives. Planetary health and oncology represent two critical domains within the broader spectrum of healthcare, each addressing distinct yet interconnected aspects of human well-being. We are encouraged to do our part in saving our planet. This should include the decisions we make in our professional life, especially in uro-oncology, as the healthcare sector significantly contributes to environmental pollution. AREAS COVERED There are many aspects that can be addressed in the healthcare sector in general, as there are structural problems in terms of energy consumption, water waste, therapeutic techniques, transportation and drug manufacturing, as well as in uro-oncology specific areas. For example, the use of different surgical techniques, forms of anesthesia and the use of disposable or reusable instruments, each has a different impact on our environment. The literature search was carried out using PubMed, a medical database. EXPERT OPINION We are used to making decisions based on the best outcome for patients without considering the impact that each decision can have on the environment. In the present article, we outline options and choices for a more climate-friendly approach in urologic oncology.
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Affiliation(s)
- Laura Lawaczeck
- Department of Urology, Eberhard-Karls-University, Tübingen, Germany
| | - Julia Rudolph
- Department of Urology, Eberhard-Karls-University, Tübingen, Germany
| | - Valentina Norz
- Department of Urology, Eberhard-Karls-University, Tübingen, Germany
| | - Igor Tsaur
- Department of Urology, Eberhard-Karls-University, Tübingen, Germany
| | - Steffen Rausch
- Department of Urology, Eberhard-Karls-University, Tübingen, Germany
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Ramai D, Ofosu A, Siadappa P, Chandan S, Barakat MT. Advanced trainee perceptions of disposable duodenoscopes and disposable endcaps: results of a nationwide survey. Surg Endosc 2024; 38:3361-3367. [PMID: 38710887 DOI: 10.1007/s00464-024-10855-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 04/10/2024] [Indexed: 05/08/2024]
Abstract
INTRODUCTION Disposable duodenoscopes and duodenoscopes with disposable endcaps are being used in clinical practice to reduce or eliminate the risk of transmitting infections. The study aim was to assess perceptions and experiences regarding the use of these duodenoscopes among advanced endoscopy fellows in a nationally representative sample. METHODS A 17-item electronic survey was sent to 74 advanced endoscopy training programs. The survey was completed by 50 participants and their responses were included for analysis. RESULTS Most participants were from academic training programs (82.7%) and identified as being in their 7th year of post graduate training (92%; PGY-7). Participants performed an average of 414 ERCPs. 29% reported difficulty with cannulation using disposable duodenoscopes versus 15.7% with duodenoscopes with disposable endcaps (vs. standard duodenoscope). 96% of trainees perceived disposable duodenoscopes as not cost effective and 92% stated they would not use this device during independent practice. 100% of trainees stated that they would use duodenoscopes with disposable endcaps during independent practice. For their most challenging cases, 90% of trainees preferred using standard reprocessable duodenoscopes while no trainee indicated they would prefer using a disposable duodenoscope in this scenario. 82% of participants stated that disposable duodenoscopes and disposable endcaps should be used exclusively or preferentially for high-risk patients citing cost, functionality, and concerns regarding environmental impact. DISCUSSION Advanced endoscopy fellows perceive disposable duodenoscopes as impacting technical maneuverability. Concerns about functionality, cost effectiveness and environmental impact are barriers to adoption.
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Affiliation(s)
- Daryl Ramai
- Division of Gastroenterology & Hepatology, University of Utah Health, Salt Lake City, UT, USA
| | - Andrew Ofosu
- Division of Digestive Diseases, University of Cincinnati, Cincinnati, OH, USA
| | - Pradeep Siadappa
- Division of Gastroenterology, Stanford University Medical Center, Stanford, CA, USA
| | - Saurabh Chandan
- Division of Gastroenterology & Hepatology, CHI Health Creighton University Medical Center, Omaha, NE, USA
| | - Monique T Barakat
- Divisions of Adult and Pediatric Gastroenterology & Hepatology, Stanford University Medical Center, 300 Pasteur Drive, Mail Code #5244, Stanford, CA, USA.
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Oderda M, Amato A, de la Rosette J, Doizi S, Estrade V, Falcone M, Grey B, Knudsen B, Olsburgh J, Pietropaolo A, Rukin N, Sedigh O, Saeed A, Somani BK, Gontero P. The impact of single-use digital flexible cystoscope for double J removal on hospital costs and work organization: A multicentric evaluation. Urologia 2023; 90:670-677. [PMID: 37154464 DOI: 10.1177/03915603231172543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
BACKGROUND Isiris-α® is a single-use digital flexible cystoscope with an integrated grasper designed for double J (DJ) stent removal. Aim of this study was to conduct a multicentric evaluation of the costs and criticalities of stent removals performed with Isiris®-α in different hospitals and health systems, as compared to other DJ removal procedures. METHODS After gathering 10 institutions worldwide with experience on Isiris-α®, we performed an analysis of the reported costs of DJ removal with Isiris-α®, as compared to the traditional reusable equipment used in each institution. The cost evaluation included instrument purchase, Endoscopic Room (EnR)/ Operatory Room (OR) occupancy, medical staff, instrument disposal, maintenance, repairs, decontamination or sterilization of reusable devices. RESULTS The main factor affecting the costs of the procedure was OR/EnR occupancy. Decontamination and sterilization accounted for a less important part of total costs. Isiris-α® was more profitable in institutions where DJ removal is usually performed in the EnR/OR, allowing to transfer the procedure to outpatient clinic, with a significant cost saving and EnR/OR time saving to be allocated to other activities. In the only institution where DJ removal was already performed in outpatient clinics, there is a slight cost difference in favor of reusable instruments in high-volume institutions, given a sufficient number to guarantee the turnover. CONCLUSION Isiris-α® leads to significant cost benefit in the institutions where DJ removal is routinely performed in EnR/OR, and brings significant improvement in organization, cost impact and turnover.
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Affiliation(s)
- Marco Oderda
- Dept. of Surgical Sciences, Division of Urology, Città della Salute e della Scienza di Torino - Molinette Hospital, University of Torino, Torino, Italy
| | - Antonio Amato
- Dept of Renal Transplantation, Civico Hospital, Palermo, Italy
| | | | - Steve Doizi
- Dept of Urology, Tenon Hospital, Paris, France
| | | | - Marco Falcone
- Dept. of Surgical Sciences, Division of Urology, Città della Salute e della Scienza di Torino - Molinette Hospital, University of Torino, Torino, Italy
| | - Ben Grey
- Dept of Urology, Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Bodo Knudsen
- Dept of Urology, Ohio State University Wexner Medical Center, Columbus, OH, USA
| | | | | | - Nick Rukin
- Dept of Urology, Redcliffe Hospital, Redcliffe, QLD, Australia
| | - Omidreza Sedigh
- Dept. of Surgical Sciences, Division of Urology, Città della Salute e della Scienza di Torino - Molinette Hospital, University of Torino, Torino, Italy
| | - Alhamri Saeed
- Dept. of Urology, Dept. of Surgery, King Abdulaziz Medical City, National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Bhaskar K Somani
- Dept of Urology, University Hospital Southampton, Southampton, UK
| | - Paolo Gontero
- Dept. of Surgical Sciences, Division of Urology, Città della Salute e della Scienza di Torino - Molinette Hospital, University of Torino, Torino, Italy
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Rutala WA, Weber DJ. Reprocessing semicritical items: An overview and an update on the shift from HLD to sterilization for endoscopes. Am J Infect Control 2023; 51:A96-A106. [PMID: 37890958 DOI: 10.1016/j.ajic.2023.01.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 01/04/2023] [Indexed: 10/29/2023]
Abstract
BACKGROUND Semicritical medical devices are defined as items that come into contact with mucous membranes or nonintact skin (e.g., gastrointestinal endoscopes, endocavitary probes). Such medical devices require minimally high-level disinfection. METHODS Analyze the methods used to reprocess semicritical medical devices and identify methods and new technologies to reduce the risk of infection. RESULTS The reprocessing methods for semicritical medical devices is described as well as a shift from high-level disinfection to sterilization for lumened endoscopes. CONCLUSIONS Strict adherence to current guidelines and transition to sterilization for endoscopes is required as more outbreaks have been linked to inadequately disinfected endoscopes and other semicritical items than any other reusable medical devices.
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Affiliation(s)
- William A Rutala
- Statewide Program for Infection Control and Epidemiology, University of North Carolina Hospitals, Chapel Hill, NC; Division of Infectious Diseases, UNC School of Medicine, Chapel Hill, NC.
| | - David J Weber
- Statewide Program for Infection Control and Epidemiology, University of North Carolina Hospitals, Chapel Hill, NC; Division of Infectious Diseases, UNC School of Medicine, Chapel Hill, NC; Department of Infection Prevention, Hospital Epidemiology, University of North Carolina Hospitals, Chapel Hill, NC
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Rutala WA, Boyce JM, Weber DJ. Disinfection, sterilization and antisepsis: An overview. Am J Infect Control 2023; 51:A3-A12. [PMID: 37890951 DOI: 10.1016/j.ajic.2023.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 01/05/2023] [Indexed: 10/29/2023]
Abstract
BACKGROUND Each year in the United States there are approximately 100,000,000 outpatient/inpatient surgical procedures. Each of these procedures involves contact by a medical device or surgical instrument with a patient's sterile tissue and/or mucous membrane. A major risk of all such procedures is the introduction of infection. METHODS We searched published literature for articles on the use and effectiveness of disinfectants, sterilization methods and antiseptics. RESULTS The level of disinfection is dependent on the intended use of the object: critical (items that contact sterile tissue such as surgical instruments), semicritical (items that contact mucous membrane such as endoscopes), and noncritical (devices that contact only intact skin such as stethoscopes) items require sterilization, high-level disinfection and low-level disinfection, respectively. Cleaning must always precede high-level disinfection and sterilization. Antiseptics are essential to infection prevention as part of a hand hygiene program as well as other uses such as surgical hand antisepsis and pre-operative patient skin preparation. CONCLUSIONS When properly used, disinfection and sterilization can ensure the safe use of invasive and non-invasive medical devices. Cleaning should always precede high-level disinfection and sterilization. Strict adherence to current disinfection and sterilization guidelines is essential to prevent patient infections and exposures to infectious agents.
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Affiliation(s)
- William A Rutala
- Statewide Program for Infection Control and Epidemiology, UNC School of Medicine, Chapel Hill, NC; Division of Infectious Diseases, UNC School of Medicine, Chapel Hill, NC.
| | - John M Boyce
- J.M. Boyce Consulting, Boyce Consulting, LLC, Middletown, CT
| | - David J Weber
- Statewide Program for Infection Control and Epidemiology, UNC School of Medicine, Chapel Hill, NC; Division of Infectious Diseases, UNC School of Medicine, Chapel Hill, NC; Infection Prevention, University of North Carolina Medical Center, Chapel Hill, NC
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Yazigi C, Chaar MS, Busch R, Kern M. The Effect of Sterilization on the Accuracy and Fit of 3D-Printed Surgical Guides. MATERIALS (BASEL, SWITZERLAND) 2023; 16:5305. [PMID: 37570008 PMCID: PMC10419648 DOI: 10.3390/ma16155305] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 07/23/2023] [Accepted: 07/26/2023] [Indexed: 08/13/2023]
Abstract
This study was conducted to evaluate the accuracy of 3D-printed surgical guides before and after sterilization in a steam sterilizer. A test-model incorporating three implant replicas was customized. A total of forty guides were printed from five printable resins. A group made from a self-curing composite served as control group. The guides were checked for fit. Vertical discrepancies between the model and guides were measured at standardized points at a load of 500 g (P1). The guides were connected to implant replicas and scanned, and their angles were digitally measured. The specimens were sterilized in a steam sterilizer at 121 °C for 20 min at 2 bar pressure. Vertical discrepancies (P2) and angulations were remeasured. Additionally, the specimens were repositioned with an increased load, and measurements were repeated (P3). All specimens were repositionable after sterilization. The smallest variation in discrepancy at a 500 g load was 428 µm, whereas the greatest was 1487 µm. Under an increased force, the smallest change was 94 µm, while the greatest was 260 µm. The level of significance α = 0.05 (95% confidence interval) was set for all tests. The variation in the measured angles was not statistically significant (Kruskal-Wallis's test, p > 0.05). The accuracy was affected by the material and sterilization, but it was clinically acceptable when an increased load was applied during repositioning.
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Affiliation(s)
- Christine Yazigi
- Department of Prosthodontics, Propaedeutics and Dental Materials, School of Dentistry, Christian-Albrechts University, 24105 Kiel, Germany; (M.S.C.); (R.B.); (M.K.)
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Barakat MT. In the era of duodenoscopes with single-use endcaps, what is the role for single-use duodenoscopes? Gastrointest Endosc 2023; 98:119-121. [PMID: 37004813 DOI: 10.1016/j.gie.2023.03.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 03/18/2023] [Accepted: 03/20/2023] [Indexed: 04/04/2023]
Affiliation(s)
- Monique T Barakat
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Stanford University School of Medicine, Division of Pediatric Gastroenterology, Hepatology & Nutrition, Department of Pediatrics, Lucile Packard Children's Hospital at Stanford, Stanford, California, USA
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Barakat MT, Ghosh S, Banerjee S. Cost utility analysis of strategies for minimizing risk of duodenoscope-related infections. Gastrointest Endosc 2022; 95:929-938.e2. [PMID: 35026281 DOI: 10.1016/j.gie.2022.01.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 01/03/2022] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Transmission of multidrug-resistant organisms by duodenoscopes during ERCP is problematical. The U.S. Food and Drug Administration recently recommended transitioning away from reusable fixed-endcap duodenoscopes to those with innovative device designs that make reprocessing easier, more effective, or unnecessary. Partially disposable (PD) duodenoscopes with disposable endcaps and fully disposable (FD) duodenoscopes are now available. We assessed the relative cost of approaches to minimizing infection transmission, taking into account duodenoscope-transmitted infection cost. METHODS We developed a Monte Carlo analysis model in R (R Foundation for Statistical Computing, Vienna, Austria) with a multistate trial framework to assess the cost utility of various approaches: single high-level disinfection (HLD), double HLD, ethylene oxide (EtO) sterilization, culture and hold, PD duodenoscopes, and FD duodenoscopes. We simulated quality-adjusted life years (QALYs) lost by duodenoscope-transmitted infection and factored this into the average cost for each approach. RESULTS At infection transmission rates <1%, PD duodenoscopes were most favorable from a cost utility standpoint in our base model. The FD duodenoscope minimizes the potential for infection transmission and is more favorable from a cost utility standpoint than use of reprocessable duodenoscopes after single or double HLD at all infection rates, EtO sterilization for infection rates >.32%, and culture and hold for infection rates >.56%. Accounting for alternate scenarios of variation in hospital volume, QALY value, post-ERCP lifespan, and environmental cost shifted cost utility profiles. CONCLUSIONS Our model indicates that PD duodenoscopes represent the most favorable option from a cost utility standpoint for ERCP, with anticipated very low infection transmission rates and a low-cost disposable element. These data underscore the importance of cost calculations that account for the potential for infection transmission and associated patient morbidity/mortality.
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Affiliation(s)
- Monique T Barakat
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, California, USA
| | - Swarnadip Ghosh
- Department of Statistics, Stanford University, Stanford, California, USA
| | - Subhas Banerjee
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, California, USA
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Guidelines for infection control and prevention in anaesthesia in South Africa. SOUTHERN AFRICAN JOURNAL OF ANAESTHESIA AND ANALGESIA 2021. [DOI: 10.36303/sajaa.2021.27.4.s1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Alfred M, Catchpole K, Huffer E, Fredendall L, Taaffe KM. Work systems analysis of sterile processing: assembly. BMJ Qual Saf 2020; 30:271-282. [PMID: 33077512 DOI: 10.1136/bmjqs-2019-010740] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 08/31/2020] [Accepted: 09/17/2020] [Indexed: 11/04/2022]
Abstract
BACKGROUND Sterile processing departments (SPDs) play a crucial role in surgical safety and efficiency. SPDs clean instruments to remove contaminants (decontamination), inspect and reorganise instruments into their correct trays (assembly), then sterilise and store instruments for future use (sterilisation and storage). However, broken, missing or inappropriately cleaned instruments are a frequent problem for surgical teams. These issues should be identified and corrected during the assembly phase. OBJECTIVE A work systems analysis, framed within the Systems Engineering Initiative for Patient Safety (SEIPS) model, was used to develop a comprehensive understanding of the assembly stage of reprocessing, identify the range of work challenges and uncover the inter-relationship among system components influencing reliable instrument reprocessing. METHODS The study was conducted at a 700-bed academic hospital in the Southeastern United States with two reprocessing facilities from October 2017 to October 2018. Fifty-six hours of direct observations, 36 interviews were used to iteratively develop the work systems analysis. This included the process map and task analysis developed to describe the assembly system, the abstraction hierarchy developed to identify the possible performance shaping factors (based on SEIPS) and a variance matrix developed to illustrate the relationship among the tasks, performance shaping factors, failures and outcomes. Operating room (OR) reported tray defect data from July 2016 to December 2017 were analysed to identify the percentage and types of defects across reprocessing phases the most common assembly defects. RESULTS The majority of the 3900 tray defects occurred during the assembly phase; impacting 5% of surgical cases (n=41 799). Missing instruments, which could result in OR delays and increased surgical duration, were the most commonly reported assembly defect (17.6%, n=700). High variability was observed in the reassembling of trays with failures including adding incorrect instruments, omitting instruments and failing to remove damaged instrument. These failures were precipitated by technological shortcomings, production pressures, tray composition, unstandardised instrument nomenclature and inadequate SPD staff training. CONCLUSIONS Supporting patient safety, minimising tray defects and OR delays and improving overall reliability of instrument reprocessing require a well-designed instrument tracking system, standardised nomenclature, effective coordination of reprocessing tasks between SPD and the OR and well-trained sterile processing technicians.
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Affiliation(s)
- Myrtede Alfred
- Department of Anesthesia and Perioperative Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Ken Catchpole
- Department of Anesthesia and Perioperative Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Emily Huffer
- Department of Industrial Engineering, Clemson University, Clemson, South Carolina, USA
| | - Larry Fredendall
- Department of Management, Clemson University, Clemson, South Carolina, USA
| | - Kevin M Taaffe
- Department of Industrial Engineering, Clemson University, Clemson, South Carolina, USA
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Abstract
Elevator-based endoscope-related infections from patient cross-contamination is a multifactorial problem related to device design, maintenance, and function, with additional risk incurred from a high-level disinfection process that lacks quality controls. This article reviews the historical context for these outbreaks, technical aspects of scope design contributing to this risk, and innovations in endoscope technology that have the potential to overcome these shortcomings. Also reviewed are interim solutions and the data that support use of some of these interventions. Still needed are a validated manufacturer-recommended schedule for routine duodenoscope and echoendoscope maintenance with reprocessing protocols that can be implemented in endoscopy units.
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Affiliation(s)
- Jennifer T Higa
- Division of Gastroenterology, Fox Chase Cancer Center, 333 Cottman Avenue, P3179, Philadelphia, PA 19111, USA.
| | - Andrew S Ross
- Division of Gastroenterology, Virginia Mason Medical Center, 1100 Ninth Avenue, C3GAS, Seattle, WA 98101, USA
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Costello C, Basseal JM, Yang Y, Anstey J, Yastrebov K. Prevention of pathogen transmission during ultrasound use in the Intensive Care Unit: Recommendations from the College of Intensive Care Medicine Ultrasound Special Interest Group (USIG). Australas J Ultrasound Med 2020; 23:103-110. [PMID: 34760589 PMCID: PMC8411769 DOI: 10.1002/ajum.12205] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
ICU ultrasonography constitutes important part of modern car patient care. Current standards and practice of infection control and prevention are inadequate. This purpose of this document is to adapt and expand the 2017 Australasian Society for Ultrasound in Medicine (ASUM) and the Australasian College for Infection Prevention Control (ACIPC) guidelines on minimum standards for reprocessing/cleaning of ultrasound transducers to the specifics of intensive care medicine and provide advice to the ICU practitioners and health care administrators. It considers the medical, administrative, financial and practical controversies surrounding implementation, and addresses emerging issues of care for patients with confirmed or suspected Corona Virus Disease 2019 (COVID-19).
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Affiliation(s)
| | - Jocelyne M Basseal
- Discipline of Infectious Diseases & ImmunologyFaculty of Health and MedicineThe University of SydneySydneyNew South WalesAustralia
| | - Yang Yang
- Department of SurgeryUniversity of MelbourneAustralia Monash UniversityEastern Clinical SchoolMelbourneVictoriaAustralia
| | - James Anstey
- Royal Melbourne HospitalParkvilleVictoriaAustralia
| | - Konstantin Yastrebov
- St George HospitalPrince of Wales HospitalUniversity of New South WalesSydneyNew South WalesAustralia
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STANDARD OF INFECTION PREVENTION IN THE GASTROENTEROLOGY SETTING. Gastroenterol Nurs 2020; 43:E84-E97. [PMID: 32251230 DOI: 10.1097/sga.0000000000000519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Ofstead CL, Hopkins KM, Buro BL, Eiland JE, Wetzler HP. Challenges in achieving effective high-level disinfection in endoscope reprocessing. Am J Infect Control 2020; 48:309-315. [PMID: 31677925 DOI: 10.1016/j.ajic.2019.09.013] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 09/18/2019] [Accepted: 09/19/2019] [Indexed: 01/15/2023]
Abstract
Endoscope reprocessing is often ineffective, and microbes frequently remain on endoscopes after the use of high-level disinfectants (HLDs). Several factors impact reprocessing effectiveness, including non-adherence to guidelines, use of damaged endoscopes, use of insoluble products during endoscopy, insufficient cleaning, contaminated rinse water, and inadequate drying before storage. Our team suspected that issues with HLD chemistries and monitoring could also contribute to reprocessing failures. We conducted a mixed-methods analysis of published literature, our interviews with frontline personnel, and evidence from our previous studies. The evidence showed that reusable HLDs commonly failed tests for minimum effective concentration (MEC) before their maximum usage periods. MEC tests also detected failures associated with single-use HLDs that did not fully deploy. These failures were due to product issues, process complexities, and personnel non-adherence with guidelines and manufacturer instructions. HLDs will likely continue to be used for the foreseeable future. More research is needed to assess real-world practice patterns related to the high-level disinfection step and MEC testing and to establish more realistic usage periods for reusable HLD chemistries. Manufacturers and researchers should evaluate the ability of technological solutions and engineered safeguards to overcome human error. Recognition of the need for quality improvement is growing, and infection preventionists should take action to build on this momentum and collaborate with manufacturers, endoscopists, and reprocessing personnel to improve the effectiveness of high-level disinfection.
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Török G, Gombocz P, Bognár E, Nagy P, Dinya E, Kispélyi B, Hermann P. Effects of disinfection and sterilization on the dimensional changes and mechanical properties of 3D printed surgical guides for implant therapy - pilot study. BMC Oral Health 2020; 20:19. [PMID: 31973705 PMCID: PMC6979289 DOI: 10.1186/s12903-020-1005-0] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Accepted: 01/13/2020] [Indexed: 11/26/2022] Open
Abstract
Background The purpose of this research was to investigate the effects of disinfection and three different sterilization methods on the dimensional changes and mechanical properties of three-dimensional (3D) printed surgical guide for implant therapy. The objective was to assess the effects of sterilization procedures in 3D printed drill guide templates with destructive and non-destructive material testing. Methods Fifteen identical drill guide templates were produced using a 3D printer. The surgical guides were classified into five groups: three controls, three disinfected (4% Gigasept®, 60 min), three plasma sterilized, three autoclave sterilized (+ 1 bar, 121 °C, 20 min), and three autoclave sterilized (+ 2 bar, 134 °C, 10 min). The templates were digitalized with a Steinbichler SCAN ST 3D scanner. Length was measured under an SZX16 stereomicroscope. A scanning electron microscope was used to study the surface morphology of the drill templates. The hardness, and flexural and compressive strength were measured to assess any changes in the physical characteristics of the material caused by sterilization. The drill guide templates were also examined with a Dage XiDAT 6600 X-ray. During the X-ray examinations, the following parameters were used: 100 kV voltage, 128 AVG averaging, 0.8 W power. One-way analysis of variance (ANOVA) was used to detect the difference between groups. Results Evaluation of the hardness measurements of the various specimens shows that the hardness of the material was not changed by the plasma sterilization (p = 0.0680), steam sterilization on 121 °C (p = 0.6033) or disinfection process (p = 0.1399). The statistical analysis revealed significant difference in hardness strength of the autoclave sterilized (134 °C) specimens (p = 0.0002). There was no significant difference between the goups regarding the scanning electron microscopic and stereomicroscopic examinations. There was no significant difference regarding the X-ray visibility of the templates to the effect of the disinfection (p = 0.7844), plasma sterilization (p = 0.4091) and steam sterilization on 121 °C (p = 0.9277) and steam sterilization on 131 °C (p = 0.093). The effect of the sterilization was the same in case of both flexural and compressive strength of the material. Conclusions Our findings indicate that plasma sterilization and steam sterilization at 121 °C were both suitable for sterilizing the tested 3D printed surgical guides.
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Affiliation(s)
- Gréta Török
- Department of Prosthodontics, Faculty of Dentistry, Semmelweis University, Szentkirályi Street 47, Budapest, H-1088, Hungary.
| | - Péter Gombocz
- Department of Prosthodontics, Faculty of Dentistry, Semmelweis University, Szentkirályi Street 47, Budapest, H-1088, Hungary
| | - Eszter Bognár
- Department of Materials Science and Engineering, Faculty of Mechanical Engineering, Budapest University of Technology and Economics, Bertalan Lajos Street 7, Budapest, H-1111, Hungary.,Budapest and MTA-BME Research Group for Composite Science and Technology, Műegyetem rkp. 3, Budapest, H-1111, Hungary
| | - Péter Nagy
- Department of Materials Science and Engineering, Faculty of Mechanical Engineering, Budapest University of Technology and Economics, Bertalan Lajos Street 7, Budapest, H-1111, Hungary
| | - Elek Dinya
- Institute of Digital Health Sciences, Semmelweis University, Ferenc Square 15., Budapest, H-1094, Hungary
| | - Barbara Kispélyi
- Department of Prosthodontics, Faculty of Dentistry, Semmelweis University, Szentkirályi Street 47, Budapest, H-1088, Hungary
| | - Péter Hermann
- Department of Prosthodontics, Faculty of Dentistry, Semmelweis University, Szentkirályi Street 47, Budapest, H-1088, Hungary
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Alfred M, Catchpole K, Huffer E, Fredendall L, Taaffe KM. Work systems analysis of sterile processing: decontamination. BMJ Qual Saf 2019; 29:320-328. [PMID: 31723018 DOI: 10.1136/bmjqs-2019-009422] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 10/24/2019] [Accepted: 11/04/2019] [Indexed: 12/23/2022]
Abstract
BACKGROUND Few studies have explored the work of sterile processing departments (SPD) from a systems perspective. Effective decontamination is critical for removing organic matter and reducing microbial levels from used surgical instruments prior to disinfection or sterilisation and is delivered through a combination of human work and supporting technologies and processes. OBJECTIVE In this paper we report the results of a work systems analysis that sought to identify the complex multilevel interdependencies that create performance variation in decontamination and identify potential improvement interventions. METHODS The research was conducted at a 700-bed academic hospital with two reprocessing facilities decontaminating approximately 23 000 units each month. Mixed methods, including 56 hours of observations of work as done, formal and informal interviews with relevant stakeholders and analysis of data collected about the system, were used to iteratively develop a process map, task analysis, abstraction hierarchy and a variance matrix. RESULTS We identified 21 different performance shaping factors, 30 potential failures, 16 types of process variance, and 10 outcome variances in decontamination. Approximately 2% of trays were returned to decontamination from assembly, while decontamination problems were found in about 1% of surgical cases. Staff knowledge, production pressures, instrument design, tray composition and workstation design contributed to outcomes such as reduced throughput, tray defects, staff injuries, increased inventory and equipment costs, and patient injuries. CONCLUSIONS Ensuring patients and technicians' safety and efficient SPD operation requires improved design of instruments and the decontamination area, skilled staff, proper equipment maintenance and effective coordination of reprocessing tasks.
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Affiliation(s)
- Myrtede Alfred
- Department of Anesthesia and Perioperative Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Ken Catchpole
- Department of Anesthesia and Perioperative Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Emily Huffer
- Department of Industrial Engineering, Clemson University, Clemson, South Carolina, USA
| | - Larry Fredendall
- Department of Management, Clemson University, Clemson, South Carolina, USA
| | - Kevin M Taaffe
- Department of Industrial Engineering, Clemson University, Clemson, South Carolina, USA
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17
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Rauwers AW, Kwakman JA, Vos MC, Bruno MJ. Endoscope-associated infections: A brief summary of the current state and views toward the future. TECHNIQUES IN GASTROINTESTINAL ENDOSCOPY 2019. [DOI: 10.1016/j.tgie.2019.04.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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18
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Yagnik KJ, Kalyatanda G, Cannella AP, Archibald LK. Outbreak of Acinetobacter baumannii associated with extrinsic contamination of ultrasound gel in a tertiary centre burn unit. Infect Prev Pract 2019; 1:100009. [PMID: 34368675 PMCID: PMC8336045 DOI: 10.1016/j.infpip.2019.100009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 06/20/2019] [Indexed: 11/28/2022] Open
Abstract
Background During 2011 and 2012, an increase in occurrence of multidrug-resistant Acinetobacter baumannii infections was recorded in the Shands Hospital Burn Intensive Care Unit (BICU). An epidemic curve together with strain typing was consistent with an intermittent common source outbreak. An investigation was therefore initiated. Aim To identify risk factors for A. baumannii infection, characterize the source of the pathogen, implement control measures to terminate the outbreak, and institute preventive measures. Methods We conducted a retrospective case-control study; reviewed BICU infection control policies, practices and procedures, and patient exposure to healthcare workers (HCWs), and obtained epidemiologically-directed environmental cultures. Findings Eleven patients met the case definition. On multivariate analysis, case-patients were more likely to have undergone an ultrasound procedure in the BICU (adjusted odds ratio [AOR]: 19.5; confidence interval [CI]: 2.4-435) or have a FlexiSeal™ device (AOR: 11.9, CI:1.3-276). Epidemiologically-directed cultures of the environment, ultrasound equipment, and ultrasound gel from opened containers on the ultrasound trolley and in the Ultrasound Department were negative for the outbreak pathogen. Culture of an open ultrasound gel dispenser stored in the Ultrasound Department yielded an A. baumannii strain with DNA banding patterns identical to the outbreak strain. Conclusions Based on data from our epidemiologic, microbiologic, and observational studies, we believe that inadvertent extrinsic contamination of the gel dispenser occurred in the Ultrasound Department. Contaminated gel was then dispensed into multiuse vials of gel stored on the mobile carts. The outbreak was stemmed by instituting changes in practices in the Ultrasound Department, including introduction of single-use ultrasound vials and storage of ultrasound gel.
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Affiliation(s)
- Kruti J Yagnik
- University of Florida College of Medicine, Department of Medicine, Gainesville, FL, USA
| | - Gautam Kalyatanda
- University of Florida College of Medicine, Department of Medicine, Division of Infectious Diseases & Global Medicine, Gainesville, FL, USA
| | - Anthony P Cannella
- University of Florida College of Medicine, Department of Medicine, Division of Infectious Diseases & Global Medicine, Gainesville, FL, USA.,Malcolm Randall Veterans Health Administration Medical Centre, Gainesville, FL, USA.,University of Florida College of Medicine, Department of Molecular Genetics & Microbiology, Gainesville, FL, USA.,University of Florida College of Medicine, Emerging Pathogens Institute, Gainesville, FL, USA
| | - Lennox K Archibald
- University of Florida College of Medicine, Department of Medicine, Division of Infectious Diseases & Global Medicine, Gainesville, FL, USA.,Malcolm Randall Veterans Health Administration Medical Centre, Gainesville, FL, USA
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Ofstead CL, Hopkins KM, Eiland JE, Wetzler HP. Widespread clinical use of simethicone, insoluble lubricants, and tissue glue during endoscopy: A call to action for infection preventionists. Am J Infect Control 2019; 47:666-670. [PMID: 30922624 DOI: 10.1016/j.ajic.2019.02.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 02/10/2019] [Accepted: 02/11/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND Current methods for reprocessing flexible endoscopes do not consistently eliminate organic soil. The off-label use of simethicone as a defoaming agent may contribute to reprocessing failures, and endoscope manufacturers have cautioned against its use. METHODS We sought evidence of simethicone use by interviewing hospital personnel, conducting audits, inspecting endoscopes, and conducting tests. RESULTS Researchers examined 69 fully reprocessed endoscopes in 4 hospitals. Microbial cultures were positive for ≥50% of endoscopes. Researchers observed cloudy, shimmery fluid resembling simethicone inside channels and under a duodenoscope elevator mechanism. Crystallized white fragments were observed protruding from a gastroscope water jet outlet. Oily, sticky residue was found on endoscopes, and a 3-dimensional mass was found inside an endoscopic ultrasound endoscope. Hospital personnel reported the use of simethicone, cooking oil and silicone sprays, and tissue glue during endoscopy. DISCUSSION The off-label use of defoaming agents, lubricants, and tissue glue is common and many endoscopists consider these products essential. Our findings suggest these substances are not removed during reprocessing and may impact reprocessing effectiveness. CONCLUSIONS Infection preventionists should determine whether these products are used in their institutions and evaluate methods for removing them. New policies may be needed to support procedural success and effective endoscope reprocessing.
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Abstract
Semicritical medical devices are defined as items that come into contact with mucous membranes or nonintact skin (eg, gastrointestinal endoscopes, endocavitary probes). Such medical devices require minimally high-level disinfection. As many of these items are temperature sensitive, low-temperature chemical methods must be used rather than steam sterilization. Strict adherence to current guidelines is required as more outbreaks have been linked to inadequately cleaned or disinfected endoscopes and other semicritical items than any other reusable medical devices.
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Abstract
All invasive procedures involve contact by a medical device or surgical instrument with a patient's sterile tissue or mucous membranes. The level of disinfection or sterilization is dependent on the intended use of the object. Critical (items that contact sterile tissue, such as surgical instruments), semicritical (items that contact mucous membranes, such as endoscopes), and noncritical (devices that contact only intact skin, such as stethoscopes) items require sterilization, high-level disinfection, and low-level disinfection, respectively. Cleaning must always precede high-level disinfection and sterilization. Antiseptics are essential to infection prevention as part of a hand hygiene program, as well as other uses, such as surgical hand antisepsis and preoperative skin preparation.
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22
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Bhatt S, Mehta P, Chen C, Schneider CL, White LN, Chen HL, Kong MG. Efficacy of low-temperature plasma-activated gas disinfection against biofilm on contaminated GI endoscope channels. Gastrointest Endosc 2019; 89:105-114. [PMID: 30120959 DOI: 10.1016/j.gie.2018.08.009] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 08/02/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS It has been increasingly recognized that the safety of GI endoscopes needs to be improved by addressing the small margin of safety of high-level disinfectants (HLDs) and the failure of HLDs to clear multidrug-resistant organisms and biofilms. There is also an unmet need for effective low-temperature sterilization techniques that have a clear pathway for U.S. Food and Drug Administration clearance. Here, we report the results of our investigation of a novel argon plasma-activated gas (PAG) for disinfection and potentially sterilization of biofilm-contaminated endoscopic channels. METHODS Test polytetrafluoroethylene channel segments were contaminated with 4-, 24- and 48-hour luminal biofilms of methicillin-resistant Staphylococcus aureus, Pseudomonas aeruginosa, or Escherichia coli and were treated by PAG flowing for up to 9 minutes. After PAG treatment, inactivation and dispersal of luminal bacterial biofilms and their regrowth in 48 hours were evaluated. Reactive species induced by PAG were measured with colorimetric probes and electron spin resonance spectrometry. Surface morphology and elemental composition of PAG-treated channel material were analyzed with scanning electron microscopy. RESULTS PAG treatment for 9 minutes led to more than 8 log reduction of viable cells and dispersal of 24- and 48-hour luminal biofilms of all 3 bacteria and to suppression of their regrowth, whereas it resulted in little morphologic abnormalities in channel material. Ozone concentration of PAG fell to below .01 ppm within 30 seconds of switching off the plasma. PAG-treated deionized water was acidified with numerous types of reactive species, each with a concentration some 3 orders of magnitude or more below its bacterial inhibition concentration. CONCLUSIONS PAG is capable of effectively and rapidly disinfecting luminal bacterial biofilms and offers an alternative to the step of HLDs and/or ethylene oxide in the endoscope reprocessing procedure with safety to personnel and environment.
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Affiliation(s)
- Sudhir Bhatt
- Center for Bioelectrics, Old Dominion University, Norfolk, Virginia, USA
| | - Poonam Mehta
- Center for Bioelectrics, Old Dominion University, Norfolk, Virginia, USA
| | - Chen Chen
- State Key Lab of Electrical Insulation and Power Equipment, Center for Plasma Biomedicine, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | | | - Lauren N White
- Center for Bioelectrics, Old Dominion University, Norfolk, Virginia, USA
| | - Hai-Lan Chen
- Center for Bioelectrics, Old Dominion University, Norfolk, Virginia, USA
| | - Michael G Kong
- Center for Bioelectrics, Old Dominion University, Norfolk, Virginia, USA; Department of Electrical and Computer Engineering, Norfolk, Virginia, USA
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Grein JD, Murthy RK. New Developments in the Prevention of Gastrointestinal Scope-Related Infections. Infect Dis Clin North Am 2018; 32:899-913. [PMID: 30241713 DOI: 10.1016/j.idc.2018.06.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Gastrointestinal endoscopes are used for diagnostic and therapeutic purposes and are the most common medical device implicated in health care-associated outbreaks. Infections can be divided into endogenous or exogenous. Exogenous infections were associated with lapses in reprocessing. Recent outbreaks have occurred despite compliance with reprocessing guidelines and highlight the challenges with clearance of all organisms from the duodenoscopes and the potential role of biofilms in hindering adequate reprocessing. This review provides an overview of recent developments and the current understanding of the key contributing factors related to gastrointestinal endoscope-related infections and current approaches to identify and prevent these complications.
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Affiliation(s)
- Jonathan D Grein
- Department of Hospital Epidemiology, Division of Infectious Diseases, Cedars-Sinai Medical Center, 8635 W 3rd Street, Suite 1150W, Los Angeles, CA, USA
| | - Rekha K Murthy
- Department of Hospital Epidemiology, Division of Infectious Diseases, Cedars-Sinai Medical Center, 8635 W 3rd Street, Suite 1150W, Los Angeles, CA, USA; Department of Medical Affairs, Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Suite 2211, Los Angeles, CA 90048, USA.
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Kanamori H, Rutala WA, Weber DJ. The Role of Patient Care Items as a Fomite in Healthcare-Associated Outbreaks and Infection Prevention. Clin Infect Dis 2018; 65:1412-1419. [PMID: 28520859 DOI: 10.1093/cid/cix462] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Accepted: 05/11/2017] [Indexed: 01/28/2023] Open
Abstract
Patient-care items can serve as a source or reservoir for healthcare-associated pathogens in hospitals. We reviewed healthcare- associated outbreaks from medical equipment and provide infection prevention recommendations. Multiple healthcare-associated outbreaks via a contaminated patient-care item were identified, including infections with multidrug-resistant organisms. The type of patient care items implicated as a fomite causing healthcare-associated infections (HAIs) has changed over time. Patient populations at risk were most commonly critically ill patients in adult and neonatal intensive care units. Most fomite related healthcare-associated outbreaks were due to inappropriate disinfection practices. Repeated healthcare-associated outbreaks via medical equipment highlight the need for infectious disease professionals to understand that fomites/medical devices may be a source of HAIs. The introduction of new and more complex medical devices will likely increase the risk that such devices serve as a source of HAIs. Assuring appropriate cleaning and disinfection or sterilization of medical equipment is necessary to prevent future fomite-associated outbreaks.
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Affiliation(s)
- Hajime Kanamori
- Division of Infectious Diseases, University of North Carolina School of Medicine, North Carolina.,Hospital Epidemiology, University of North Carolina Health Care, Chapel Hill, North Carolina
| | - William A Rutala
- Division of Infectious Diseases, University of North Carolina School of Medicine, North Carolina.,Hospital Epidemiology, University of North Carolina Health Care, Chapel Hill, North Carolina
| | - David J Weber
- Division of Infectious Diseases, University of North Carolina School of Medicine, North Carolina.,Hospital Epidemiology, University of North Carolina Health Care, Chapel Hill, North Carolina
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Emiliani E, Mercadé A, Millan F, Sánchez-Martín F, Konstantinidis CA, Angerri O. First clinical evaluation of the new single-use flexible and semirigid Pusen ureteroscopes. Cent European J Urol 2018; 71:208-213. [PMID: 30038812 PMCID: PMC6051369 DOI: 10.5173/ceju.2018.1620] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2017] [Revised: 03/03/2018] [Accepted: 04/02/2018] [Indexed: 12/23/2022] Open
Abstract
Introduction The purpose of the present study was to clinically evaluate two new single-use Pusen ureteroscopes, one semirigid with a flexible tip (srURS) and one flexible (fURS). Materials and methods During ten consecutive procedures (five srURS and five fURS), we subjectively evaluated on a scale from 0 (poor) to 10 (excellent), the scope's deflection, image quality, and maneuverability prior to, during and after the surgery. Patient demographics, complications with the devices, and troubleshooting were recorded. Results There were a total of ten patients, five of which were female while the other five were male. Mean age was 58.9 years. Seven patients had a single kidney stone with mean size of 9.6 mm (1.6-20 mm). Half of the patients were pre-stented. For the fURS, the preoperative image quality rating was 8.4 (8-10), compared with 6.8 (4-9) during surgery. The preoperative deflection rating was 9.6+ 0.9 (8-10), while during surgery this decreased to 8.0 (6-10) and to 6.0 (4-8) when using a laser fiber. The srURS had a preoperative image quality rating of 9.2 (8-10), which decreased to 7.6 (6-9) while using the scope. The deflection rating decreased from 9.4 (7-10) preoperatively to 7.0 (1-10) postoperatively, and a similar reduction was observed in the maneuverability rating, from 9.6 (8-10) to 7.4 (1-10). Ureteroscopy was considered as a standard in four of the fURS and three of the srURS procedures. The mean overall satisfaction rating was 6. Conclusions The two new single-use ureteroscopes, one flexible and one semirigid, were considered to have allowed standard ureteroscopy in four and three out of the five procedures for each scope, respectively. The image quality, deflection, and maneuverability ratings decreased during the procedure for both scopes.
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Affiliation(s)
- Esteban Emiliani
- Department of Urology, Fundació Puigvert, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Asier Mercadé
- Department of Urology, Fundació Puigvert, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Félix Millan
- Department of Urology, Fundació Puigvert, Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | | | - Oriol Angerri
- Department of Urology, Fundació Puigvert, Universitat Autònoma de Barcelona, Barcelona, Spain
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Abstract
PURPOSE OF REVIEW Flexible ureteroscopy has been widely developed in the last decade been nowadays one of the first line treatment options for urolithiasis and conservative management for upper tract urothelial tumors. Even though some unfavorable features of the reusable flexible scopes can limit the surgical procedure such as their availability, lack of sterilization or costly repairs. Disposable scopes have been developed with the intention of improving such problems. RECENT FINDINGS To our knowledge, seven devices have been developed. Of the scopes features, size, deflection, image quality and ergonomic handling have to be at least as good as reusable ones as they are expected to be noninferior. Three devices match all the features of reusable scopes, although only one has been properly studied. SUMMARY Not all the available disposable devices have been properly studied or compared with standard scopes. Although some devices are promising more studies are needed to proof their benefits.
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Valeriani F, Agodi A, Casini B, Cristina ML, D'Errico MM, Gianfranceschi G, Liguori G, Liguori R, Mucci N, Mura I, Pasquarella C, Piana A, Sotgiu G, Privitera G, Protano C, Quattrocchi A, Ripabelli G, Rossini A, Spagnolo AM, Tamburro M, Tardivo S, Veronesi L, Vitali M, Romano Spica V. Potential testing of reprocessing procedures by real-time polymerase chain reaction: A multicenter study of colonoscopy devices. Am J Infect Control 2018; 46:159-164. [PMID: 28958445 DOI: 10.1016/j.ajic.2017.08.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Revised: 08/07/2017] [Accepted: 08/08/2017] [Indexed: 12/27/2022]
Abstract
BACKGROUND Reprocessing of endoscopes is key to preventing cross-infection after colonoscopy. Culture-based methods are recommended for monitoring, but alternative and rapid approaches are needed to improve surveillance and reduce turnover times. A molecular strategy based on detection of residual traces from gut microbiota was developed and tested using a multicenter survey. METHODS A simplified sampling and DNA extraction protocol using nylon-tipped flocked swabs was optimized. A multiplex real-time polymerase chain reaction (PCR) test was developed that targeted 6 bacteria genes that were amplified in 3 mixes. The method was validated by interlaboratory tests involving 5 reference laboratories. Colonoscopy devices (n = 111) were sampled in 10 Italian hospitals. Culture-based microbiology and metagenomic tests were performed to verify PCR data. RESULTS The sampling method was easily applied in all 10 endoscopy units and the optimized DNA extraction and amplification protocol was successfully performed by all of the involved laboratories. This PCR-based method allowed identification of both contaminated (n = 59) and fully reprocessed endoscopes (n = 52) with high sensibility (98%) and specificity (98%), within 3-4 hours, in contrast to the 24-72 hours needed for a classic microbiology test. Results were confirmed by next-generation sequencing and classic microbiology. CONCLUSIONS A novel approach for monitoring reprocessing of colonoscopy devices was developed and successfully applied in a multicenter survey. The general principle of tracing biological fluids through microflora DNA amplification was successfully applied and may represent a promising approach for hospital hygiene.
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Affiliation(s)
- Federica Valeriani
- Department of Movement, Human and Health Science, University of Rome "Foro Italico", Rome, Italy
| | - Antonella Agodi
- Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia," University of Catania, Catania, Italy
| | - Beatrice Casini
- Department of Translational Research and New Technologies in Medicine and Surgery, Pisa University, Pisa, Italy
| | | | - Marcello Mario D'Errico
- Department of Biomedical Sciences and Public Health, Politechnic University of Marche, Ancona, Italy
| | - Gianluca Gianfranceschi
- Department of Movement, Human and Health Science, University of Rome "Foro Italico", Rome, Italy
| | - Giorgio Liguori
- Department of Movement and Health Sciences, University "Parthenope," Napoli, Italy
| | - Renato Liguori
- Department of Movement and Health Sciences, University "Parthenope," Napoli, Italy
| | - Nicolina Mucci
- Department of Technological Innovations and Safety of Plants, Products and Anthropic Settlements, National Institute for Insurance against Accidents at Work, INAIL, Rome, Italy
| | - Ida Mura
- Department of Biomedical Science-Hygiene Section, University of Sassari, Sassari, Italy
| | | | - Andrea Piana
- Department of Biomedical Science-Hygiene Section, University of Sassari, Sassari, Italy
| | - Giovanni Sotgiu
- Department of Biomedical Science-Hygiene Section, University of Sassari, Sassari, Italy
| | - Gaetano Privitera
- Department of Translational Research and New Technologies in Medicine and Surgery, Pisa University, Pisa, Italy
| | - Carmela Protano
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Annalisa Quattrocchi
- Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia," University of Catania, Catania, Italy
| | - Giancarlo Ripabelli
- Department of Medicine and Health Sciences "Vincenzo Tiberio," University of Molise, Campobasso, Italy
| | - Angelo Rossini
- Fondazione Santa Lucia Institute for Research and Health Care, IRCCS, Rome, Italy
| | | | - Manuela Tamburro
- Department of Medicine and Health Sciences "Vincenzo Tiberio," University of Molise, Campobasso, Italy
| | - Stefano Tardivo
- Department of Public Health and Community Medicine, University of Verona, Verona, Italy
| | - Licia Veronesi
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Matteo Vitali
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Vincenzo Romano Spica
- Department of Movement, Human and Health Science, University of Rome "Foro Italico", Rome, Italy.
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Nyhsen CM, Humphreys H, Koerner RJ, Grenier N, Brady A, Sidhu P, Nicolau C, Mostbeck G, D’Onofrio M, Gangi A, Claudon M. Infection prevention and control in ultrasound - best practice recommendations from the European Society of Radiology Ultrasound Working Group. Insights Imaging 2017; 8:523-535. [PMID: 29181694 PMCID: PMC5707224 DOI: 10.1007/s13244-017-0580-3] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Revised: 10/03/2017] [Accepted: 10/05/2017] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVES The objective of these recommendations is to highlight the importance of infection prevention and control in ultrasound (US), including diagnostic and interventional settings. METHODS Review of available publications and discussion within a multidisciplinary group consistent of radiologists and microbiologists, in consultation with European patient and industry representatives. RECOMMENDATIONS Good basic hygiene standards are essential. All US equipment must be approved prior to first use, including hand held devices. Any equipment in direct patient contact must be cleaned and disinfected prior to first use and after every examination. Regular deep cleaning of the entire US machine and environment should be undertaken. Faulty transducers should not be used. As outlined in presented flowcharts, low level disinfection is sufficient for standard US on intact skin. For all other minor and major interventional procedures as well as all endo-cavity US, high level disinfection is mandatory. Dedicated transducer covers must be used when transducers are in contact with mucous membranes or body fluids and sterile gel should be used inside and outside covers. CONCLUSIONS Good standards of basic hygiene and thorough decontamination of all US equipment as well as appropriate use of US gel and transducer covers are essential to keep patients safe. MAIN MESSAGES • Transducers must be cleaned/disinfected before first use and after every examination. • Low level disinfection is sufficient for standard US on intact skin. • High level disinfection is mandatory for endo-cavity US and all interventions. • Dedicated transducer covers must be used for endo-cavity US and all interventions. • Sterile gel should be used for all endo-cavity US and all interventions.
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Affiliation(s)
- Christiane M. Nyhsen
- Radiology Department, City Hospitals Sunderland, Kayll Road, Sunderland, SR4 7TP UK
| | - Hilary Humphreys
- Department of Clinical Microbiology, The Royal College of Surgeons in Ireland, Dublin, Ireland
- Department of Microbiology, Beaumont Hospital, Dublin, Ireland
| | - Roland J. Koerner
- Infection Prevention and Control Department, Department of Microbiology, City Hospitals Sunderland, Kayll Road, Sunderland, SR4 7TP UK
| | - Nicolas Grenier
- Service d’Imagerie Diagnostique et Interventionnelle de l’Adulte Groupe Hospitalier, Pellegrin Place Amelie Raba-Leon, 33076 Bordeaux, Cedex France
| | - Adrian Brady
- Department of Radiology, Mercy University Hospital, Grenville Place, Cork, T12 WE28 Ireland
| | - Paul Sidhu
- King’s College Hospital, Denmark Hill, London, SE5 9RS UK
| | | | | | - Mirko D’Onofrio
- Radiology, Policlinico G.B. Rossi, VERONA, piazzale LA SCURO 10, 37134 Verona, Italy
| | - Afshin Gangi
- NHC, 1, Place de l’Hôpital, 67091 Strasbourg, France
| | - Michel Claudon
- Children Hospital, University Hospital - Nancy Brabois, Rue du Morvan, 54511 Vandoeuvre Les Nancy, Cedex France
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Barenghi L, Di Blasio A. Orthodontic instruments and supplies: Are they semicritical or critical items? Am J Infect Control 2017; 45:210-211. [PMID: 27856075 DOI: 10.1016/j.ajic.2016.09.028] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2016] [Accepted: 09/12/2016] [Indexed: 11/19/2022]
Affiliation(s)
| | - Alberto Di Blasio
- Department of Orthodontics, Parma University, Parma, Italy; Department of Biomedical, Biotechnological, and Translational Sciences, Parma University, Parma, Italy
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Rutala WA, Weber DJ. Disinfection and Sterilization in Health Care Facilities: An Overview and Current Issues. Infect Dis Clin North Am 2016; 30:609-37. [PMID: 27515140 PMCID: PMC7134755 DOI: 10.1016/j.idc.2016.04.002] [Citation(s) in RCA: 77] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
When properly used, disinfection and sterilization can ensure the safe use of invasive and noninvasive medical devices. The method of disinfection and sterilization depends on the intended use of the medical device: critical items (contact sterile tissue) must be sterilized before use; semicritical items (contact mucous membranes or nonintact skin) must be high-level disinfected; and noncritical items (contact intact skin) should receive low-level disinfection. Cleaning should always precede high-level disinfection and sterilization. Current disinfection and sterilization guidelines must be strictly followed.
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Affiliation(s)
- William A Rutala
- Hospital Epidemiology, University of North Carolina Health Care System, Chapel Hill, NC 27514, USA; Division of Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, NC 27599-7030, USA.
| | - David J Weber
- Hospital Epidemiology, University of North Carolina Health Care System, Chapel Hill, NC 27514, USA; Division of Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, NC 27599-7030, USA
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Butticè S, Sener TE, Netsch C, Emiliani E, Pappalardo R, Magno C. LithoVue™: A new single-use digital flexible ureteroscope. Cent European J Urol 2016; 69:302-305. [PMID: 27730000 PMCID: PMC5057057 DOI: 10.5173/ceju.2016.872] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Revised: 07/22/2016] [Accepted: 08/09/2016] [Indexed: 11/30/2022] Open
Affiliation(s)
- Salvatore Butticè
- Department of Human Pathology, Unit of Urology, University of Messina, Italy; The authors equally contributed to this article
| | - Tarik Emre Sener
- Department of Urology, Marmara University, School of Medicine, Istanbul, Turkey; The authors equally contributed to this article
| | | | | | - Rosa Pappalardo
- Department of Human Pathology, Unit of Urology, University of Messina, Italy
| | - Carlo Magno
- Department of Human Pathology, Unit of Urology, University of Messina, Italy
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Rutala WA, Weber DJ. Disinfection, sterilization, and antisepsis: An overview. Am J Infect Control 2016; 44:e1-6. [PMID: 27131128 DOI: 10.1016/j.ajic.2015.10.038] [Citation(s) in RCA: 75] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2015] [Accepted: 10/28/2015] [Indexed: 11/29/2022]
Abstract
All invasive procedures involve contact by a medical device or surgical instrument with a patient's sterile tissue or mucous membranes. The level of disinfection or sterilization is dependent on the intended use of the object: critical (items that contact sterile tissue such as surgical instruments), semicritical (items that contact mucous membrane such as endoscopes), and noncritical (devices that contact only intact skin such as stethoscopes) items require sterilization, high-level disinfection and low-level disinfection, respectively. Cleaning must always precede high-level disinfection and sterilization. Antiseptics are essential to infection prevention as part of a hand hygiene program as well as several other uses such as surgical hand antisepsis and pre-operative skin preparation.
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Affiliation(s)
- William A Rutala
- Hospital Epidemiology, University of North Carolina Health Care, Chapel Hill, NC; Division of Infectious Diseases, UNC School of Medicine, Chapel Hill, NC.
| | - David J Weber
- Hospital Epidemiology, University of North Carolina Health Care, Chapel Hill, NC; Division of Infectious Diseases, UNC School of Medicine, Chapel Hill, NC
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