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Hong P, Sun X, Yuan S, Wang Y, Gong S, Zhang Y, Sang P, Xiao B, Shu Y. Nitrogen removal intensification of biofilm through bioaugmentation with Methylobacterium gregans DC-1 during wastewater treatment. CHEMOSPHERE 2024; 352:141467. [PMID: 38387667 DOI: 10.1016/j.chemosphere.2024.141467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 01/24/2024] [Accepted: 02/14/2024] [Indexed: 02/24/2024]
Abstract
The increasing concern for environmental remediation has led to a search for effective methods to remove eutrophic nutrients. In this study, Methylobacterium gregans DC-1 was utilized to improve nitrogen removal in a sequencing batch biofilm reactor (SBBR) via aerobic denitrification. This bacterium has the extraordinary characteristics of strong auto-aggregation and a high ability to remove nitrogen efficiently, making it an ideal candidate for enhanced treatment of nitrogen-rich wastewater. This strain was used for the bioassessment of a test reactor (SBBRbio), which showed a shorter biofilm formation time compared to a control reactor (SBBRcon) without this strain inoculation. Moreover, the enhanced biofilm was enriched in TB-EPS and had a wider variety of protein secondary structures than SBBRcon. During the stabilization phase of SBBRbio, the EPS molecules showed the highest proportion of intermolecular hydrogen bonding. It is possible that bioaugmentation with this strain positively affects the structural stability of biofilm. At influent ammonia loadings of 100 and 150 mg. L-1, the average reduction of ammonia and nitrate-nitrogen was higher in the experimental system compared to the control system. Additionally, nitrite-N accumulation was lower and N2O production decreased compared to the control. Analysis of the microbial community structure demonstrated successful colonization in the bioreactor by a highly nitrogen-tolerant strain that efficiently removed inorganic nitrogen. These results illustrate the great potential of this type of denitrifying bacteria in the application of bioaugmentation systems.
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Affiliation(s)
- Pei Hong
- School of Ecology and Environment, College of Life Sciences, Collaborative Innovation Center of Recovery and Reconstruction of Degraded Ecosystem in Wanjiang Basin Co-founded by Anhui Province and Ministry of Education, Anhui Normal University, Wuhu 241002, China
| | - Xiaohui Sun
- School of Ecology and Environment, College of Life Sciences, Collaborative Innovation Center of Recovery and Reconstruction of Degraded Ecosystem in Wanjiang Basin Co-founded by Anhui Province and Ministry of Education, Anhui Normal University, Wuhu 241002, China
| | - Saibo Yuan
- Ecological Environment Monitoring and Scientific Research Center, Ecology and Environment Supervision and Administration Bureau of Yangtze Valley, Ministry of Ecology and Environment of the People's Republic of China, Wuhan 430014, China.
| | - Yu Wang
- School of Ecology and Environment, College of Life Sciences, Collaborative Innovation Center of Recovery and Reconstruction of Degraded Ecosystem in Wanjiang Basin Co-founded by Anhui Province and Ministry of Education, Anhui Normal University, Wuhu 241002, China
| | - Shihao Gong
- Department of Civil and Environmental Engineering, The Hong Kong Polytechnic University, 100872, Hong Kong
| | - Yancheng Zhang
- School of Ecology and Environment, College of Life Sciences, Collaborative Innovation Center of Recovery and Reconstruction of Degraded Ecosystem in Wanjiang Basin Co-founded by Anhui Province and Ministry of Education, Anhui Normal University, Wuhu 241002, China
| | - Pengcheng Sang
- School of Ecology and Environment, College of Life Sciences, Collaborative Innovation Center of Recovery and Reconstruction of Degraded Ecosystem in Wanjiang Basin Co-founded by Anhui Province and Ministry of Education, Anhui Normal University, Wuhu 241002, China
| | - Bangding Xiao
- Key Laboratory of Algal Biology of the Chinese Academy of Sciences, Institute of Hydrobiology, Chinese Academy of Sciences, Wuhan, 430072, China
| | - Yilin Shu
- School of Ecology and Environment, College of Life Sciences, Collaborative Innovation Center of Recovery and Reconstruction of Degraded Ecosystem in Wanjiang Basin Co-founded by Anhui Province and Ministry of Education, Anhui Normal University, Wuhu 241002, China.
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Wang YF, Wu Y, Liu XW, Li JG, Zhan YQ, Liu B, Fan WL, Peng ZH, Xiao JT, Li BB, He J, Yi J, Lu ZX. Effect of a disposable endoscope precleaning kit in the cleaning procedure of gastrointestinal endoscope: A multi-center observational study. World J Gastrointest Endosc 2023; 15:705-714. [PMID: 38187912 PMCID: PMC10768042 DOI: 10.4253/wjge.v15.i12.705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 10/20/2023] [Accepted: 11/08/2023] [Indexed: 12/15/2023] Open
Abstract
BACKGROUND Precleaning is a key step in endoscopic reprocessing.
AIM To develop an effective and economic endoscope cleaning method by using a disposable endoscope bedside precleaning kit.
METHODS Altogether, 228 used gastrointestinal endoscopes were selected from five high-volume endoscopy units and precleaned by a traditional precleaning bucket (group T) or a disposable endoscope bedside precleaning kit (group D). Each group was further subdivided based on the replacement frequency of the cleaning solution, which was replaced every time in subgroups T1 and D1 and every several times in subgroups Ts and Ds. The adenosine triphosphate (ATP) level and residual proteins were measured three times: Before and after precleaning and after manual cleaning.
RESULTS After precleaning, the precleaning kit significantly reduced the ATP levels (P = 0.034) and has a more stable ATP clearance rate than the traditional precleaning bucket. The precleaning kit also saved a quarter of the cost of enzymatic detergent used during the precleaning process. After manual cleaning, the ATP levels were also significantly lower in the precleaning kit group than in the traditional precleaning bucket group (P < 0.05). Meanwhile, the number of uses of the cleaning solution (up to four times) has no significant impact on the cleaning effect (P > 0.05).
CONCLUSION Considering its economic cost and cleaning effect, the use of a disposable endoscope bedside precleaning kit can be an optimal option in the precleaning stage with the cleaning solution being replaced several times in the manual cleaning stage.
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Affiliation(s)
- Yi-Fan Wang
- Department of Gastroenterology, Xiangya Hospital, Central South University, Changsha 410008, Hunan Province, China
| | - Yu Wu
- Department of Gastroenterology, Xiangya Hospital, Central South University, Changsha 410008, Hunan Province, China
- Department of Gastroenterology, Hunan International Scientific and Technological Cooperation Base of Artificial Intelligence Computer Aided Diagnosis and Treatment for Digestive Disease, Changsha 410008, Hunan Province, China
| | - Xiao-Wei Liu
- Department of Gastroenterology, Xiangya Hospital, Central South University, Changsha 410008, Hunan Province, China
- Department of Gastroenterology, Hunan International Scientific and Technological Cooperation Base of Artificial Intelligence Computer Aided Diagnosis and Treatment for Digestive Disease, Changsha 410008, Hunan Province, China
- Department of Gastroenterology, National Research Center of Geriatric Diseases, Xiangya Hospital, Central South University, Changsha 410008, Hunan Province, China
| | - Jian-Guo Li
- Department of Gastroenterology, The Fourth Hospital of Changsha, Changsha 410006, Hunan Province, China
| | - Yan-Qiong Zhan
- Department of Gastroenterology, Zhuzhou Hospital Affiliated to Xiangya School of Medicine, Central South University, Zhuzhou 412007, Hunan Province, China
| | - Bin Liu
- Department of Gastroenterology, Xiangtan Central Hospital, Xiangtan 411100, Hunan Province, China
| | - Wen-Ling Fan
- Department of Gastroenterology, The First Hospital of Changsha, Changsha 410005, Hunan Province, China
| | - Zi-Heng Peng
- Department of Gastroenterology, Xiangya Hospital, Central South University, Changsha 410008, Hunan Province, China
| | - Jin-Tao Xiao
- Department of Gastroenterology, Xiangya Hospital, Central South University, Changsha 410008, Hunan Province, China
| | - Bing-Bing Li
- Department of Gastroenterology, Xiangya Hospital, Central South University, Changsha 410008, Hunan Province, China
| | - Jian He
- Department of Gastroenterology, Xiangya Hospital, Central South University, Changsha 410008, Hunan Province, China
| | - Jun Yi
- Department of Gastroenterology, Xiangya Hospital, Central South University, Changsha 410008, Hunan Province, China
| | - Zhao-Xia Lu
- Department of Gastroenterology, Xiangya Hospital, Central South University, Changsha 410008, Hunan Province, China
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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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Pontes DO, Costa DDM, da Silva Pereira PP, Whiteley GS, Glasbey T, Tipple AFV. Adenosine triphosphate (ATP) sampling algorithm for monitoring the cleanliness of surgical instruments. PLoS One 2023; 18:e0284967. [PMID: 37582099 PMCID: PMC10426997 DOI: 10.1371/journal.pone.0284967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Accepted: 04/13/2023] [Indexed: 08/17/2023] Open
Abstract
BACKGROUND Timely detection of cleaning failure is critical for quality assurance within Sterilising Service Units (SSUs). Rapid Adenosine Triphosphate (ATP) testing provides a real time and quantitative indication of cellular contaminants, when used to measure surface or device cleanliness. The aim of this study was to investigate the use of an ATP algorithm and to whether it could be used as a routine quality assurance step, to monitor surgical instruments cleanliness in SSUs prior to sterilisation. METHODS Cleanliness monitoring using rapid ATP testing was undertaken in the SSUs of four hospitals located in the western (Amazonia) region of Brazil. ATP testing was conducted (Clean Trace, 3M) on 163 surgical instruments, following manual cleaning. A sampling algorithm using a duplicate swab approach was applied to indicate surgical instruments as (i) very clean, (ii) clean, (iii) equivocal or (iv) fail, based around a 'clean' cut-off of 250 Relative Light Units (RLU) and a 'very clean' <100 RLU. RESULTS The four cleanliness categories were significantly differentiated (P≤0.001). The worst performing locations (hospitals A & C) had failure rates of 39.2% and 32.4%, respectively, and were distinctly different from hospitals B & D (P≤0.001). The best performing hospitals (B & D) had failure rates of 7.7% and 2.8%, respectively. CONCLUSION The ATP testing algorithm provides a simple to use method within SSUs. The measurements are in real time, quantitative and useful for risk-based quality assurance monitoring, and the tool can be used for staff training. The four-tiered approach to the grading of surgical instrument cleanliness provides a nuanced approach for continuous quality improvement within SSU than does a simple pass/fail methodology.
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Affiliation(s)
- Daniela Oliveira Pontes
- Faculty of Nursing, Federal University of Goiás, Catalão, Brazil
- Nursing Department, Federal University of Rondônia, Porto Velho, Brazil
| | - Dayane de Melo Costa
- Faculty of Nursing, Federal University of Goiás, Catalão, Brazil
- Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia
| | | | - Greg S. Whiteley
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia
- School of Medicine, Western Sydney University, Penrith, Australia
- Whiteley Corporation, Kewdale, Australia
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Ji Y, Liu J, Wang C, Zhang F, Xu X, Zhu L. Stability improvement of aerobic granular sludge (AGS) based on Gibbs free energy change (∆G) of sludge-water interface: Abstract2. Materials and Methods. WATER RESEARCH 2023; 240:120059. [PMID: 37216787 DOI: 10.1016/j.watres.2023.120059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 10/20/2022] [Accepted: 05/08/2023] [Indexed: 05/24/2023]
Affiliation(s)
- Yatong Ji
- Institution of Environment Pollution Control and Treatment, Department of Environmental Engineering, Zhejiang University, Hangzhou 310058, China
| | - Jieyi Liu
- Institution of Environment Pollution Control and Treatment, Department of Environmental Engineering, Zhejiang University, Hangzhou 310058, China
| | - Chen Wang
- Institution of Environment Pollution Control and Treatment, Department of Environmental Engineering, Zhejiang University, Hangzhou 310058, China
| | - Fan Zhang
- Environmental Protection Bureau of Changxing County, Huzhou 313100, China
| | - Xiangyang Xu
- Institution of Environment Pollution Control and Treatment, Department of Environmental Engineering, Zhejiang University, Hangzhou 310058, China; Zhejiang Province Key Laboratory for Water Pollution Control and Environmental Safety, Hangzhou 310058, China; Zhejiang Provincial Engineering Laboratory of Water Pollution Control, 388 Yuhangtang Road, Hangzhou 310058, China
| | - Liang Zhu
- Institution of Environment Pollution Control and Treatment, Department of Environmental Engineering, Zhejiang University, Hangzhou 310058, China; Zhejiang Province Key Laboratory for Water Pollution Control and Environmental Safety, Hangzhou 310058, China; Zhejiang Provincial Engineering Laboratory of Water Pollution Control, 388 Yuhangtang Road, Hangzhou 310058, China.
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Kwakman JA, Vos MC, Bruno MJ. Higher yield in duodenoscope cultures collected with addition of neutralizing agent. J Hosp Infect 2023; 132:28-35. [PMID: 36414167 DOI: 10.1016/j.jhin.2022.11.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 10/21/2022] [Accepted: 11/12/2022] [Indexed: 11/21/2022]
Abstract
AIM Microbiological cultures are the gold standard in the monitoring of duodenoscope reprocessing. However, many different sampling and culturing techniques are used, making it difficult to compare results. The latest Centers for Disease Control and Prevention protocol advises the use of a neutralizer to deactivate any remaining disinfectants in the samples. This study compared culturing results of duodenoscope samples collected with and without addition of a neutralizer. METHODS Six duodenoscopes were soiled with gut bacteria in a non-clinical experimental setting and reprocessed afterwards. Samples of the tip and working channel were collected immediately after decontamination or after drying. Dey-Engley (DE) broth was added as a neutralizer to the samples of four duodenoscopes; samples for the other two duodenoscopes were collected without the addition of DE broth. RESULTS Post-decontamination cultures were significantly more likely to be positive for growth of the applied micro-organisms in the group of samples with DE broth (88.1% vs 20.2%; P<0.0001). Post-drying samples were significantly more likely to be positive in the group of samples without DE broth (75.7% vs 33.4%; P<0.001). CONCLUSION The addition of DE broth to samples collected from wet duodenoscopes increases the yield of those cultures. Remaining disinfectants in wet duodenoscopes can lead to false-negative results. This can be overcome by adding a neutralizer, such as DE broth, to the samples. The higher yield after drying in the group without neutralizer could be due to biofilm formation in these two duodenoscopes, but this was not investigated. Standardization of the sampling method can help to compare both clinical and study results regarding duodenoscope contamination.
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Affiliation(s)
- J A Kwakman
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Centre, Rotterdam, the Netherlands; Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Centre, Rotterdam, the Netherlands.
| | - M C Vos
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Centre, Rotterdam, the Netherlands
| | - M J Bruno
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Centre, Rotterdam, the Netherlands
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Kwakman JA, Rauwers AW, Buijs JG, de Groot W, Vos MC, Bruno MJ. No relation between adenosine triphosphate after manual cleaning and presence of microorganisms on endoscopes after automated high-level disinfection. Endosc Int Open 2022; 10:E1275-E1281. [PMID: 36118629 PMCID: PMC9473803 DOI: 10.1055/a-1897-5000] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 07/08/2022] [Indexed: 12/02/2022] Open
Abstract
Background and study aims Adenosine triphosphate (ATP) tests are increasingly used to detect biological material; however, their reliability to detect bacterial contamination in endoscopes is not proven. We investigated the predictive value of ATP tests after manual cleaning for presence or absence of microorganisms as shown by culture after automated high-level disinfection (HLD) in duodenoscopes and linear echoendoscopes (DLEs). Patients and methods After manual cleaning, ATP tests were performed on swab samples taken from the detachable cap and forceps elevator, and on flush samples of the DLE working channels. These results were compared to the growth of any microorganisms in cultures acquired after automated HLD. ATP tests with > 200 relative light units (RLU) were considered positive. Receiver operator characteristic (ROC) curves were used to compare the RLU levels with microbial presence in cultures. Results In total, 903 procedures were performed involving 26 distinct DLEs. Depending on sample site, 20.8 % (cap) to 63.8 % (channel brush) of the ATP negative samples were accompanied by positive post-HLD cultures. 54.4 % of the cap samples with a positive culture (growth of any kind of microorganism) and 91.8 % of the channel samples with a positive culture had a negative ATP test after manual cleaning. ROC curves per sample site, DLE type and microorganism type all had area under the curves below 0.6. Conclusions In our study, ATP tests performed after manual cleaning could not predict presence or absence of microorganisms after automated HLD as shown by culture. More than half of the positive cultures were preceded by a negative ATP test.
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Affiliation(s)
- Judith A. Kwakman
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, the Netherlands,Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Arjan W. Rauwers
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, the Netherlands,Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Jolanda G. Buijs
- Qualtity Assurance and Regulatory Affairs Office Medical Devices, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Woutrinus de Groot
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Margreet C. Vos
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Marco J. Bruno
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
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Rauwers AW, Voor In 't Holt AF, Buijs JG, Groot WD, Erler NS, Vos MC, Bruno MJ. Assessment of postmanual cleaning adenosine triphosphate tests to prevent the use of contaminated duodenoscopes and linear echoendoscopes: the DETECT study. Gastrointest Endosc 2022; 96:282-290.e5. [PMID: 35341715 DOI: 10.1016/j.gie.2022.03.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 03/17/2022] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS We investigated whether the use of postmanual cleaning adenosine triphosphate (ATP) tests lowers the number of duodenoscopes and linear echoendoscopes (DLEs) contaminated with gut flora. METHODS In this single-center before-and-after study, DLEs were ATP tested after cleaning. During the control period, participants were blinded to ATP results: ATP-positive DLEs were not recleaned. During the intervention period, ATP-positive DLEs were recleaned. DLEs underwent microbiologic sampling after high-level disinfection (HLD) with participants blinded to culture results. RESULTS Using 15 endoscopes of 5 different DLE types, we included 909 procedures (52% duodenoscopes, 48% linear echoendoscopes). During the intervention period, the absolute rate of contamination with gut flora was higher (16% vs 21%). The main analysis showed that contamination was less likely to occur in the intervention period (odds ratio, .32; 95% credible interval [CI], .12-.85). A secondary analysis showed that this effect was based on 1 particular duodenoscope type (estimated probability, 39% [95% CI, 18%-64%] vs 9% [95% CI, 2%-21%]), whereas no effect was seen in the other 4 DLE types. In detail, of the 4 duodenoscopes of this type, 2 had lower contamination rates (69% vs 39% and 36% vs 10%). During the control period, both these duodenoscopes had multiple episodes with ongoing contamination with the same microorganism that ended weeks before the start of the intervention period (ie, they were not terminated by ATP testing). CONCLUSIONS Postmanual cleaning ATP tests do not reduce post-HLD gut flora contamination rates of DLEs. Hence, postcleaning ATP tests are not suited as a means for quality control of endoscope reprocessing.
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Affiliation(s)
- Arjan W Rauwers
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Centre, Rotterdam, The Netherlands; Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
| | - Anne F Voor In 't Holt
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
| | - Jolanda G Buijs
- Staff Office Medical Devices, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
| | - Woutrinus de Groot
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
| | - Nicole S Erler
- Department of Biostatistics, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
| | - Margreet C Vos
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
| | - Marco J Bruno
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
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Zhao S, Li H, Guo J, Zhang Y, Zhao J, Song Y, Lu C, Han Y, Zhang D, Hou Y. Formation of anaerobic granular sludge (AnGS) to treat high-strength perchlorate wastewater via anaerobic baffled reactor (ABR) system: Electron transfer characteristic, bacterial community and positive feedback mechanism. THE SCIENCE OF THE TOTAL ENVIRONMENT 2022; 828:154531. [PMID: 35292321 DOI: 10.1016/j.scitotenv.2022.154531] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 03/08/2022] [Accepted: 03/08/2022] [Indexed: 06/14/2023]
Abstract
Anaerobic granular sludge (AnGS) was cultured to treat high-strength perchlorate (reaching to 4800 mg/L) wastewater by an anaerobic baffled reactor (ABR) system with five equal-volume compartments (C1-C5 compartments). Inoculated sludge completely granulated on day 104 with granule size of 0.50-0.75 mm and perchlorate removal efficiency reaching to 97% (influent perchlorate of 2000-4800 mg/L). The Cyclic voltammetry (CV) capacitance increased from 487.5, 465.8 and 407.8 μF to 576.5, 552.4, 549.6 μF in C1, C3 and C5 compartments of ABR system, respectively, suggesting the electron transfer capacity was enhanced under high-strength perchlorate stress. Meanwhile, adenosine triphosphate (ATP) value and electron transport system activity (ETSA) increased to 25.05, 22.87, 20.43 and 6.22, 4.87, 3.95 of C1, C3 and C5 compartments, respectively. The results suggested that high-strength perchlorate stress improved the microbial metabolic activity, which promoted secretion of extracellular polymeric substances (EPS). The more EPS could facilitate the formation and stability of AnGS under high-strength perchlorate stress. In addition, more reasonable metabolic division of labor in functional bacterial (Thauera and Comamonas) was beneficial to AnGS formation, which achieved high-strength perchlorate efficient removal. Finally, a positive feedback mechanism between AnGS formation and high-strength perchlorate removal was established through EPS, microbial metabolic activity and electron transfer characteristic in ABR system. However, excessive perchlorate (5800 mg/L) would exceed the treatment capacity of AnGS, which resulted in the deterioration of removal performance. This work provided an effective information for AnGS application to treat high-strength perchlorate wastewater.
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Affiliation(s)
- Shiqi Zhao
- Tianjin Key Laboratory of Aquatic Science and Technology, School of Environmental and Municipal Engineering, Tianjin Chengjian University, Jinjing Road 26, Tianjin 300384, China
| | - Haibo Li
- Tianjin Key Laboratory of Aquatic Science and Technology, School of Environmental and Municipal Engineering, Tianjin Chengjian University, Jinjing Road 26, Tianjin 300384, China.
| | - Jianbo Guo
- School of Civil Engineering and Architecture, Taizhou University, Taizhou 318000, China
| | - Yuxiang Zhang
- Jinzhou Electromechanical Engineering School, Tianshan Road 17, Jinzhou 121007, Liaoning, China
| | - Jianhai Zhao
- Tianjin Key Laboratory of Aquatic Science and Technology, School of Environmental and Municipal Engineering, Tianjin Chengjian University, Jinjing Road 26, Tianjin 300384, China
| | - Yuanyuan Song
- Tianjin Key Laboratory of Aquatic Science and Technology, School of Environmental and Municipal Engineering, Tianjin Chengjian University, Jinjing Road 26, Tianjin 300384, China
| | - Caicai Lu
- Tianjin Key Laboratory of Aquatic Science and Technology, School of Environmental and Municipal Engineering, Tianjin Chengjian University, Jinjing Road 26, Tianjin 300384, China
| | - Yi Han
- Tianjin Key Laboratory of Aquatic Science and Technology, School of Environmental and Municipal Engineering, Tianjin Chengjian University, Jinjing Road 26, Tianjin 300384, China
| | - Daohong Zhang
- Tianjin Key Laboratory of Aquatic Science and Technology, School of Environmental and Municipal Engineering, Tianjin Chengjian University, Jinjing Road 26, Tianjin 300384, China
| | - Yanan Hou
- Tianjin Key Laboratory of Aquatic Science and Technology, School of Environmental and Municipal Engineering, Tianjin Chengjian University, Jinjing Road 26, Tianjin 300384, China
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Taunk P, Shimpi R, Singh R, Collins J, Muthusamy VR, Day LW. GI endoscope reprocessing: a comparative review of organizational guidelines and guide for endoscopy units and regulatory agencies. Gastrointest Endosc 2022; 95:1048-1059.e2. [PMID: 35303991 DOI: 10.1016/j.gie.2021.09.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Accepted: 09/12/2021] [Indexed: 12/11/2022]
Affiliation(s)
- Pushpak Taunk
- Division of Gastroenterology, University of South Florida, Tampa, Florida, USA
| | - Rahul Shimpi
- Department of Gastroenterology, Duke University Medical Center, Durham, North Carolina, USA
| | - Ravi Singh
- Department of Gastroenterology, Great South Bay Endoscopy Center, LLC, East Patchogue, New York, USA
| | - James Collins
- Department of Digestive Diseases, Cleveland Clinic, Cleveland, Ohio, USA
| | | | - Lukejohn W Day
- Division of Gastroenterology and Hepatology, University of California San Francisco, San Francisco, California, USA
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11
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Gromski MA, Sherman S. Technological review: developments in innovative duodenoscopes. Gastrointest Endosc 2022; 95:42-50. [PMID: 34487777 DOI: 10.1016/j.gie.2021.08.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 08/23/2021] [Indexed: 12/11/2022]
Affiliation(s)
- Mark A Gromski
- Division of Gastroenterology and Hepatology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Stuart Sherman
- Division of Gastroenterology and Hepatology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
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Wang X, Yu D, Chen G, Liu C, Xu A, Tang Z. Effects of interactions between quorum sensing and quorum quenching on microbial aggregation characteristics in wastewater treatment: A review. WATER ENVIRONMENT RESEARCH : A RESEARCH PUBLICATION OF THE WATER ENVIRONMENT FEDERATION 2021; 93:2883-2902. [PMID: 34719836 DOI: 10.1002/wer.1657] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 10/14/2021] [Accepted: 10/26/2021] [Indexed: 06/13/2023]
Abstract
Due to the increasingly urgent demand for effective wastewater denitrification and dephosphorization systems, there is a need to improve the performance of existing biological treatment technologies. As a bacteria-level communication mechanism, quorum sensing (QS) synchronizes gene expression in a density-dependent manner and regulates bacterial physiological behavior. On this basis, the QS-based bacterial communication mechanism and environmental factors affecting QS are discussed. This paper reviews the influence of QS on sludge granulation, biofilm formation, emerging contaminants (ECs) removal, and horizontal gene transfer in sewage treatment system. Furthermore, the QS inhibition strategies are compared. Based on the coexistence and balance of QQ and QS in the long-term operation system, QQ, as an effective tool to regulate the growth density of microorganisms, provides a promising exogenous regulation strategy for residual sludge reduction and biofilm pollution control. This paper reviews the potential of improving wastewater treatment efficiency based on QS theory and points out the feasibility and prospect of exogenous regulation strategy. PRACTITIONER POINTS: The mechanism of bacterial communication based on QS and the environmental factors affecting QS were discussed. The application of QS and QQ in improving the sludge performance of biological treatment systems was described. The significance of QS and QQ coexistence in sewage treatment process was described.
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Affiliation(s)
- Xueping Wang
- School of Environmental Science and Engineering, Qingdao University, Qingdao, China
| | - Deshuang Yu
- School of Environmental Science and Engineering, Qingdao University, Qingdao, China
| | - Guanghui Chen
- School of Environmental Science and Engineering, Qingdao University, Qingdao, China
- National Engineering Laboratory for Advanced Municipal Wastewater Treatment and Reuse Technology, Beijing University of Technology, Beijing, China
| | - Chengju Liu
- School of Environmental Science and Engineering, Qingdao University, Qingdao, China
| | - Ao Xu
- School of Environmental Science and Engineering, Qingdao University, Qingdao, China
| | - Zhihao Tang
- School of Environmental Science and Engineering, Qingdao University, Qingdao, China
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Day LW, Muthusamy VR, Collins J, Kushnir VM, Sawhney MS, Thosani NC, Wani S. Multisociety guideline on reprocessing flexible GI endoscopes and accessories. Gastrointest Endosc 2021; 93:11-33.e6. [PMID: 33353611 DOI: 10.1016/j.gie.2020.09.048] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 09/30/2020] [Indexed: 02/07/2023]
Affiliation(s)
- Lukejohn W Day
- Division of Gastroenterology and Hepatology, University of California San Francisco, San Francisco, California, USA
| | | | - James Collins
- Department of Digestive Diseases, Cleveland Clinic, Cleveland, Ohio, USA
| | - Vladimir M Kushnir
- Division of Gastroenterology, Washington University, St Louis, Missouri, USA
| | - Mandeep S Sawhney
- Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Nirav C Thosani
- Division of Gastroenterology, Hepatology and Nutrition, McGovern Medical School, UTHealth, Houston, Texas, USA
| | - Sachin Wani
- Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
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Raphael KL, McNoble E, Goldbeck J, Stiles M, Miller LS, Trindade AJ. Remote video auditing in the endoscopy unit for evaluation of duodenoscope reprocessing in a tertiary care center. Endoscopy 2020; 52:864-870. [PMID: 32408362 DOI: 10.1055/a-1157-8861] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND : A significant proportion of duodenoscope-transmitted infections have resulted from errors related to reprocessing. Remote video auditing (RVA) is a tool that can monitor reprocessing compliance but it has not been previously evaluated in a tertiary care setting. The aims of this study were to evaluate: 1) RVA feasibility in a tertiary care setting (defined as the ability to audit every step of duodenoscope reprocessing without delaying the next procedure due to unavailability of duodenoscopes); and 2) the use of RVA as a compliance monitoring tool. METHODS : This was a prospective study at a tertiary care center. A video camera with offsite monitoring was installed in March 2018. Auditors delivered a compliance score after each procedure. The duodenoscope was not used until it passed the audit. Feasibility and compliance data were collected from April 2018 to August 2019 after a 1-month run-in phase. Both per-step compliance and overall 100 % compliance rates were measured. RESULTS : Of 743 duodenoscope reprocessing procedures, 32 666 individual steps were audited and 99.9 % of the steps were fully viewable. The mean time per audit was 38.3 minutes, the mean duodenoscope turnover time was 76.1 minutes, and there were no delays to the next procedure due to unavailability of duodenoscopes. The per-step compliance rate was 99.5 % but the overall 100 % compliance rate was 90.3 %. CONCLUSIONS : The use of RVA in duodenoscope reprocessing was feasible and promoted sustained high-level compliance in a tertiary care center.
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Affiliation(s)
- Kara L Raphael
- Division of Gastroenterology, Zucker School of Medicine at Hofstra/Northwell, Long Island Jewish Medical Center, Northwell Health System, New Hyde Park, New York, United States
| | - Ellen McNoble
- Perioperative Patient Care Services, Zucker School of Medicine at Hofstra/Northwell, Long Island Jewish Medical Center, Northwell Health System, New Hyde Park, New York, United States
| | - Jessica Goldbeck
- Hospital Administration, Zucker School of Medicine at Hofstra/Northwell, Long Island Jewish Medical Center, Northwell Health System, New Hyde Park, New York, United States
| | - Megan Stiles
- Hospital Administration, Zucker School of Medicine at Hofstra/Northwell, Long Island Jewish Medical Center, Northwell Health System, New Hyde Park, New York, United States
| | - Larry S Miller
- Division of Gastroenterology, Zucker School of Medicine at Hofstra/Northwell, Long Island Jewish Medical Center, Northwell Health System, New Hyde Park, New York, United States
| | - Arvind J Trindade
- Division of Gastroenterology, Zucker School of Medicine at Hofstra/Northwell, Long Island Jewish Medical Center, Northwell Health System, New Hyde Park, New York, United States
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Ridtitid W, Pakvisal P, Chatsuwan T, J Kerr S, Tiankanon K, Piyachaturawat P, Mekaroonkamol P, Kongkam P, Rerknimitr R. A newly designed duodenoscope with detachable distal cap significantly reduces organic residue contamination after reprocessing. Endoscopy 2020; 52:754-760. [PMID: 32299115 DOI: 10.1055/a-1145-3562] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND A newly designed duodenoscope with detachable distal cap may reduce bacterial contamination by allowing better access to the elevator. We compared bacterial contamination and organic residue evaluated by rapid adenosine triphosphate (ATP) test and culture from duodenoscopes with detachable vs. fixed distal caps after high-level disinfection (HLD). METHODS During December 2018-April 2019, 108 used newly designed duodenoscopes were enrolled. In group A (n = 54), the distal cap of the duodenoscope was detached before manual cleaning. In group B (n = 54), the distal cap was not detached. After HLD, samples were collected from the elevator, submitted for culture, and evaluated using the ATP test, using the cutoff value of 40 relative light units (RLUs). RESULTS After HLD, the proportion of potential bacterial contamination and organic residue in group A was significantly lower than in group B (37.0 % vs. 75.9 %; P < 0.001; relative risk 0.49, 95 % confidence interval 0.33-0.71), and also confirmed by median ATP values (45.2 vs. 141.0 RLU; P < 0.001). In group B, one sample culture was positive for nonpathogenic bacteria. Pathogenic bacteria were not found in any culture from either group. CONCLUSIONS The detachable distal cap was more effective at eliminating bacterial contamination and reducing organic residue than a fixed cap. Nonpathogenic bacteria were detected in the fixed cap group after reprocessing. The ATP test with 40 RLU cutoff is a practical method to ensure the cleanliness of duodenoscope reprocessing without the need to wait for bacterial culture results.
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Affiliation(s)
- Wiriyaporn Ridtitid
- Division of Gastroenterology, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand.,Center of Excellence for Innovation and Endoscopy in Gastrointestinal Oncology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Piyapoom Pakvisal
- Division of Gastroenterology, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Tanittha Chatsuwan
- Department of Microbiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Stephen J Kerr
- Biostatistics Excellence Center, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Kasenee Tiankanon
- Division of Gastroenterology, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Panida Piyachaturawat
- Division of Gastroenterology, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Parit Mekaroonkamol
- Division of Gastroenterology, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Pradermchai Kongkam
- Division of Gastroenterology, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand.,Center of Excellence for Innovation and Endoscopy in Gastrointestinal Oncology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Rungsun Rerknimitr
- Division of Gastroenterology, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand.,Center of Excellence for Innovation and Endoscopy in Gastrointestinal Oncology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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Ridtitid W, Pakvisal P, Chatsuwan T, Kerr SJ, Piyachaturawat P, Luangsukrerk T, Kongkam P, Rerknimitr R. Performance characteristics and optimal cut-off value of triple adenylate nucleotides test versus adenosine triphosphate test as point-of-care testing for predicting inadequacy of duodenoscope reprocessing. J Hosp Infect 2020; 106:348-356. [PMID: 32768608 DOI: 10.1016/j.jhin.2020.07.038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Accepted: 07/31/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Adenosine triphosphate (ATP) test based on one nucleotide has been applied as point-of-care testing (POCT) for bacterial contamination in the medical and food industries. Hypothetically, testing three adenylate nucleotides (A3) may provide better detection of duodenoscope bacterial contamination than ATP test. AIM To evaluate performance characteristics and optimal cut-off value of A3 and ATP tests in predicting bacterial contamination of duodenoscopes. METHODS Four hundred duodenoscope samples obtained after 100 endoscopic retrograde cholangiopancreatography procedures were randomized into group A (A3 test) or B (ATP test). Samples were collected from the elevator at the four-step cleaning process of duodenoscope. We defined the new cut-off value of the test for reaching 100% negative predictive value (NPV) from our receiver operating characteristic (ROC). FINDINGS Using the cultures from the four-step cleaning process as the reference, the areas under ROC (AUROC) were 0.83 and 0.84 for group A (N = 200) and group B (N = 200), respectively. Using the cultures from post-high-level disinfection (HLD) as the reference, the AUROC were 0.35 and 0.74 for group A (N = 50) and group B (N = 50), respectively. We investigated ATP as a POCT after HLD with a new cut-off value of 40 RLU. However, this threshold did not allow detection of low numbers of bacteria. CONCLUSION A3 and ATP tests provide good performances in predicting bacterial contamination of duodenoscopes for the four-step cleaning process. The ATP <40 RLU is helpful as a POCT after HLD; however, the limitation of this cut-off value is its inability to detect low numbers of bacteria.
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Affiliation(s)
- W Ridtitid
- Division of Gastroenterology, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand; Center of Excellence for Innovation and Endoscopy in Gastrointestinal Oncology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - P Pakvisal
- Division of Gastroenterology, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - T Chatsuwan
- Department of Microbiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand; Antimicrobial Resistance and Stewardship Research Unit, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - S J Kerr
- Biostatistics Excellence Centre, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - P Piyachaturawat
- Division of Gastroenterology, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - T Luangsukrerk
- Division of Gastroenterology, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - P Kongkam
- Division of Gastroenterology, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand; Center of Excellence for Innovation and Endoscopy in Gastrointestinal Oncology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - R Rerknimitr
- Division of Gastroenterology, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand; Center of Excellence for Innovation and Endoscopy in Gastrointestinal Oncology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
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Sohn SY, Alfa MJ, Lai R, Tabani Y, Labib ME. Turbulent fluid flow is a novel closed-system sample extraction method for flexible endoscope channels of various inner diameters. J Microbiol Methods 2020; 168:105782. [PMID: 31758953 PMCID: PMC6939870 DOI: 10.1016/j.mimet.2019.105782] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 11/19/2019] [Accepted: 11/19/2019] [Indexed: 12/22/2022]
Abstract
OVERVIEW Effective sample extraction from endoscope channels is crucial for monitoring manual cleaning adequacy as well as for ensuring optimal sensitivity for culture after disinfection. The objective of this study was to compare the efficacy of Turbulent Fluid Flow (TFF) to Flush (F) or Flush-Brush-Flush (FBF) methods. MATERIALS & METHODS Pseudomonas aeruginosa and Enterococcus faecalis in artificial test soil-2015 (ATS2015) were used as bacterial markers while protein and carbohydrate were the organic markers for biofilm formed inside 3.2-mm and 1.37-mm polytetrafluoroethylene (PTFE) channels. TFF was generated using compressed air and sterile water to provide friction for sample extraction. Extraction for biofilm coated PTFE channels as well as for colonoscope channels perfused with ATS2015 containing 108 CFU/mL P. aeruginosa, E. faecalis and Candida albicans was determined using TFF compared to FBF and F. RESULTS The extraction ratio for P. aeruginosa and E. faecalis from biofilm extracted by TFF compared to the positive control was significantly better than F for 1.37-mm channels (≥0.94 for both bacteria by TFF versus 0.69 to 0.72 by F for P. aeruginosa and E. faecalis, respectively) but not significantly different between TFF and FBF for 3.2-mm channels. F was also ineffective for extraction of protein and carbohydrate from 1.37-mm channels. Extraction efficacy by TFF from inoculated colonoscope channels was >98% for all test markers. CONCLUSIONS The novel TFF method for extraction of samples from colonoscope channels is a more effective method than the existing FBF and F methods.
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Affiliation(s)
| | - Michelle J Alfa
- Department of Medical Microbiology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Richard Lai
- NovaFlux Inc., 1 Wall Street Princeton, NJ, USA
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Getting to zero: Enhanced reprocessing and future directions. TECHNIQUES IN GASTROINTESTINAL ENDOSCOPY 2019. [DOI: 10.1016/j.tgie.2019.150626] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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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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Zhang Z, Cao R, Jin L, Zhu W, Ji Y, Xu X, Zhu L. The regulation of N-acyl-homoserine lactones (AHLs)-based quorum sensing on EPS secretion via ATP synthetic for the stability of aerobic granular sludge. THE SCIENCE OF THE TOTAL ENVIRONMENT 2019; 673:83-91. [PMID: 30986684 DOI: 10.1016/j.scitotenv.2019.04.052] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 03/13/2019] [Accepted: 04/04/2019] [Indexed: 06/09/2023]
Abstract
According to the relationship among microbial activity, quorum sensing (QS) and structural stability of aerobic granular sludge, the mechanism of QS regulation for microbial activity and granular stability was investigated in AGS process. Results showed that ATP content decreased sharply from 1.8 μmol/gVSS of stable granules to 0.8 μmol/gVSS of disintegrating granules, and the relative abundance of QS-activity microbes, Rhodobacter spp. and Xanthomonadaceae decreased in initially unstable granules compared with stable granules. The main AHLs were detected in this study, and C8-HSL, 3OHC8-HSL and 3OHC12-HSL decreased significantly when structure of granules changed from stability to disintegration. Accompanying with the decrease of AHLs level, the extracellular polymeric substances (EPS) content in initially unstable granules decreased sharply from 226.8 to 163.6 mg/gVSS with the ratio of extracellular protein to exopolysaccharide (PN/PS) decreasing from 3.6 to 2.2, despite EPS-secretion microbes enriched. The effect of QS on microbial activity was proved by AHL add-back study, results indicated that ATP and EPS content in sludge increased significantly (p < 0.05) with AHLs added, but EPS production was limited when ATP synthesis was disrupted. It was concluded that the AHLs-based QS favored the granular stability via the enhancement of ATP synthesis in microbes. This study provides a new perspective for QS regulation in aerobic granular sludge system, because the ATP regulated by QS could be the energy currency for cellular metabolism, such as nutrient removal, degradation of emerging pollutants, microbial growth and other aspects.
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Affiliation(s)
- Zhiming Zhang
- Institute of Environmental Pollution Control and Treatment, Zhejiang University, Hangzhou 310058, China
| | - Runjuan Cao
- Institute of Environmental Pollution Control and Treatment, Zhejiang University, Hangzhou 310058, China
| | - Luonan Jin
- Hangzhou Urban & Rural Construction Design Institute Co., LTD, Hangzhou 310058, China
| | - Weitang Zhu
- Environmental Protection Bureau of Changxing County, Huzhou 313100, China
| | - Yatong Ji
- Institute of Environmental Pollution Control and Treatment, Zhejiang University, Hangzhou 310058, China
| | - Xiangyang Xu
- Institute of Environmental Pollution Control and Treatment, Zhejiang University, Hangzhou 310058, China; Zhejiang Province Key Laboratory for Water Pollution Control and Environmental Safety, Hangzhou 310058, China; Zhejiang Provincial Engineering Laboratory of Water Pollution Control, 388 Yuhangtang Road, Hangzhou 310058, China
| | - Liang Zhu
- Institute of Environmental Pollution Control and Treatment, Zhejiang University, Hangzhou 310058, China; Zhejiang Province Key Laboratory for Water Pollution Control and Environmental Safety, Hangzhou 310058, China; Zhejiang Provincial Engineering Laboratory of Water Pollution Control, 388 Yuhangtang Road, Hangzhou 310058, China.
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Salerno R, Mezzina N, Ardizzone S. Endoscopic retrograde cholangiopancreatography, lights and shadows: Handle with care. World J Gastrointest Endosc 2019; 11:219-230. [PMID: 30918587 PMCID: PMC6425281 DOI: 10.4253/wjge.v11.i3.219] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 02/21/2019] [Accepted: 03/11/2019] [Indexed: 02/06/2023] Open
Abstract
The role of endoscopic retrograde cholangiopancreatography (ERCP) has dramatically changed in the last years, mainly into that of a therapeutic procedure. The treatment of benign biliary disease, like “difficult” choledocolithiasis, with endoscopic papillary large balloon dilation combined with endoscopic sphinterotomy has proven an effective and safe technique. Moreover, safety in ERCP has improved as well, with the prevention of post-ERCP pancreatitis and patient-to-patient transmission of infections. The advent of self-expandable metal stenting has radically changed the management of biliopancreatic malignant strictures, while the role for therapy of benign strictures is still controversial. In addition, cholangioscopy (though the direct visualization of the biliopancreatic ductal system) has allowed for characterization of indeterminate biliary strictures and facilitated rescue therapy of large biliary stones deemed removable. Encouraging data from tissue ablation techniques, such as photodynamic therapy and radiofrequency ablation, need to be confirmed by large sample size clinical controlled trials. On the other hand, we have no drug-coated stents yet available to implant and evidence for the use of biodegradable stents is still weak. The competency and privileging of ERCP and endoscopic ultrasonography have been analyzed longer but the switch between the two procedures, at the same time, is becoming ordinary; as such, the endoscopist interested in this field should undergo parallel edification through training plans. Finally, the American Society for Gastrointestinal Endoscopy’s statement on non-anesthesiologist administration of propofol for gastrointestinal endoscopy is not actually endorsed by the European Society of Anaesthesiology, having many medical-legal implications in some European countries.
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Affiliation(s)
- Raffaele Salerno
- Gastroenterology and Digestive Endoscopy Unit, ASST Fatebenefratelli Sacco, Milan 20121, Italy
| | - Nicolò Mezzina
- Gastrointestinal Unit, ASST Fatebenefratelli Sacco-Department of Biochemical and Clinical Sciences "L. Sacco", University of Milan, Milano 20100, Italy
| | - Sandro Ardizzone
- Gastrointestinal Unit, ASST Fatebenefratelli Sacco - Department of Biochemical and Clinical Sciences "L. Sacco", University of Milan, Milano 20100, Italy
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Molloy-Simard V, Lemyre JL, Martel K, Catalone BJ. Elevating the standard of endoscope processing: Terminal sterilization of duodenoscopes using a hydrogen peroxide-ozone sterilizer. Am J Infect Control 2019; 47:243-250. [PMID: 30442443 DOI: 10.1016/j.ajic.2018.09.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 09/07/2018] [Accepted: 09/08/2018] [Indexed: 01/21/2023]
Abstract
BACKGROUND The health care community is increasingly aware of the processing challenges and infection risks associated with duodenoscopes owing to published reports of outbreaks and regulatory recalls. Studies have demonstrated that the current practices are inadequate for consistently producing patient-ready endoscopes. Alternatively, terminal sterilization would offer a greater margin of safety and potentially reduce the risk of patient infection. The purpose of this study was to evaluate the efficacy of a hydrogen peroxide-ozone sterilizer with regulatory clearance for terminal sterilization of duodenoscopes. METHODS AND RESULTS Validation studies were performed under laboratory simulated-use and clinical in-use conditions. The overkill method study demonstrated a reduction of at least 6-log of Geobacillus stearothermophilus spores at half-cycle, providing a sterility assurance level of 10-6. In addition, the sterilizer achieved a 6-log reduction of G stearothermophilus in the presence of inorganic and organic soils in a simulated-use study. The clinical in-use study confirmed that the sterilizer achieved sterilization of patient-soiled duodenoscopes under actual use conditions. CONCLUSIONS Simulated-use and clinical in-use studies demonstrated the efficacy of a hydrogen peroxide-ozone sterilizer for terminal sterilization of duodenoscopes. This offers health care facilities a viable alternative for duodenoscope processing to enhance patient safety as part of a comprehensive infection control strategy.
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Barakat MT, Huang RJ, Banerjee S. Comparison of automated and manual drying in the elimination of residual endoscope working channel fluid after reprocessing (with video). Gastrointest Endosc 2019; 89:124-132.e2. [PMID: 30148992 PMCID: PMC6748329 DOI: 10.1016/j.gie.2018.08.033] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2018] [Accepted: 08/09/2018] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Residual fluid within endoscope working channels after reprocessing may promote growth of pathogens. Current reprocessing guidelines therefore recommend endoscope drying with administration of forced filtered air; however, the duration and modality of administered air are not specified. The new DriScope Aid device enables automated administration of filtered air at controlled pressure through all internal endoscope channels. We systematically compared, for the first time, the impact of manual drying and automated drying on retained working channel fluid and bioburden after reprocessing. METHODS We assessed for residual working channel fluid after reprocessing and/or drying by using the SteriCam borescope. Drying was performed either manually (forced filtered air) or was automated (DriScope Aid) for either 5 or 10 minutes. Adenosine triphosphate (ATP) bioluminescence testing was performed on working channel rinsates after drying, to evaluate for residual bioburden. RESULTS Significantly more fluid droplets were evident after manual drying (4.55 ± 6.14) than with automated device-facilitated drying for either 5 minutes (0.83 ± 1.29; P = .007) or 10 minutes (0 ± 0; P = .001). ATP bioluminescence values were higher for manual drying compared with automated drying at 48 hours (P = .001) and 72 hours (P = .014) after reprocessing. CONCLUSIONS We demonstrate significantly fewer water droplets and delayed ATP bioluminescence values within endoscope working channels after automated drying compared with manual drying. In particular, virtually no retained fluid was evident within endoscope working channels after automated drying for 10 minutes. These findings support recommendations for automation of as many reprocessing steps as possible. Automated drying may decrease the risk of transmission of infection related to endoscopy.
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