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Kinetics of the reduction of Creutzfeldt-Jakob disease prion seeding activity by steam sterilization support the use of validated 134°C programmes. J Hosp Infect 2023; 132:125-132. [PMID: 36216171 DOI: 10.1016/j.jhin.2022.08.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 08/09/2022] [Accepted: 08/13/2022] [Indexed: 11/12/2022]
Abstract
BACKGROUND Prions are renowned for their distinct resistance to chemical or physical inactivation, including steam sterilization. Impaired efficacy of inactivation poses a risk to patients for iatrogenic transmission of Creutzfeldt-Jakob disease (CJD) via contaminated surgical instruments. AIMS Most established prion inactivation methods were validated against scrapie agents, although those were found to be generally less thermostable than human prions. Thus, knowledge gaps regarding steam-sterilization kinetics of CJD prions should be filled and current guidelines reviewed accordingly. METHODS Prion inactivation through widely recommended steam sterilization at 134°C was assessed for several holding times by analysing the residual prion seeding activity using protein misfolding cyclic amplification (PMCA). FINDINGS Scrapie 263K was found to be the least thermoresistant prion strain showing no seeding activity after 1.5 min at 134°C, while variant CJD was the most stable one demonstrating some seeding activity even after 18 min of steam sterilization. Sporadic CJD subtype VV2 exhibited residual seeding activity after 3 min, but no detectable activity after 5 min at 134°C. CONCLUSION Validated steam sterilization for 5 min at 134°C as previously recommended for the routine reprocessing of surgical instruments in contact with high-risk tissues is able to substantially reduce the seeding activity of CJD agents, provided that no fixating chemical disinfection has been performed prior to sterilization and that thorough cleaning has reduced the protein load on the surface to less than 100 μg per instrument.
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Zeng F, Wang X, Gao Y, Hu L. Influence of Fine Management Combined With PDCA Cycle Method on Disinfection Qualified Rate and Performance Grade of Ophthalmic Precision Instruments. Front Surg 2022; 9:856312. [PMID: 35372479 PMCID: PMC8964488 DOI: 10.3389/fsurg.2022.856312] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 02/08/2022] [Indexed: 12/02/2022] Open
Abstract
Objective The aim of this study is to explore the influence of fine management combined with the plan-do-check-action (PDCA) cycle method on the management of ophthalmic precision instruments. Methods The ophthalmic precision instruments centralized in the disinfection supply room of our hospital were selected as the research objects and divided into groups A and B. Traditional instrument management method was adopted in group A, and fine management combined with the PDCA cycle method based on the group A was adopted in group B. The instrument management risk scores, the qualified rate of disinfection, instrument performance grade, and incidence of toxic anterior segment syndrome (TASS) of the two groups were compared. Results The risk scores of instrument management and incidence of TASS in group B were lower than those in group A (p < 0.05). The qualified rate of disinfection and instrument performance grades in group B were higher than those in group A (p < 0.05). Conclusion Fine management combined with the PDCA cycle method can improve the qualified rate of disinfection of ophthalmic precision instruments, optimize the performance of instruments, reduce the risk of instrument management, and reduce the incidence of TASS.
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Affiliation(s)
- Fanli Zeng
- Department of Anesthesiology, Chongqing General Hospital, Chongqing, China
| | - Xiuling Wang
- Department of Ophthalmology, Chongqing Banan District People's Hospital, Chongqing, China
| | - Yan Gao
- Central Sterile Supply Department, Chongqing General Hospital, Chongqing, China
| | - Ling Hu
- Central Sterile Supply Department, Chongqing Hospital of Traditional Chinese Medicine, Chongqing, China
- *Correspondence: Ling Hu
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Masia MD, Dettori M, Deriu GM, Bellu S, Arcadu L, Azara A, Piana A, Palmieri A, Arghittu A, Castiglia P. ATP Bioluminescence for Assessing the Efficacy of the Manual Cleaning Procedure during the Reprocessing of Reusable Surgical Instruments. Healthcare (Basel) 2021; 9:352. [PMID: 33808731 PMCID: PMC8003443 DOI: 10.3390/healthcare9030352] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 02/26/2021] [Accepted: 03/16/2021] [Indexed: 11/16/2022] Open
Abstract
Achieving sterilization by adopting proper practices is essential to ensure that surgical instruments do not transmit microorganisms to patients. As the effectiveness of sterilization mandates effective cleaning, it is necessary to verify the success of cleaning procedures. In this study, we used the adenosine triphosphate (ATP) bioluminescence method for assessing the efficacy of the manual cleaning procedure during the reprocessing of reusable surgical instruments. The ATP bioluminescence assay was performed on 140 surgical instruments of 12 different types, both before being cleaned (baseline) and after each of the cleaning procedures (i.e., decontamination, manual washing, drying, and visual inspection). For each instrument, two swabs were used as follows: one to sample the entire surface (test point 1) and the other to sample the most difficult part of the surface to clean (test point 2). Overall, for each type of instrument, there was a decrease in contamination ranging from 99.6 to >99.9% (log reduction from 2.40 to 3.76). Thus, in order to standardize the assessment of cleanliness, it may be useful to introduce the bioluminescence method into the daily routine or, at least, at regular time intervals as a complementary check combined with visual inspection. This would allow real-time verification of the achievement of an adequate level of cleanliness.
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Affiliation(s)
- Maria Dolores Masia
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, 07100 Sassari, Italy; (M.D.M.); (L.A.); (A.A.); (A.P.); (A.P.); (P.C.)
| | - Marco Dettori
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, 07100 Sassari, Italy; (M.D.M.); (L.A.); (A.A.); (A.P.); (A.P.); (P.C.)
| | - Grazia Maria Deriu
- University Hospital of Sassari, 07100 Sassari, Italy; (G.M.D.); (S.B.); (A.A.)
| | - Sabina Bellu
- University Hospital of Sassari, 07100 Sassari, Italy; (G.M.D.); (S.B.); (A.A.)
| | - Lisa Arcadu
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, 07100 Sassari, Italy; (M.D.M.); (L.A.); (A.A.); (A.P.); (A.P.); (P.C.)
| | - Antonio Azara
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, 07100 Sassari, Italy; (M.D.M.); (L.A.); (A.A.); (A.P.); (A.P.); (P.C.)
| | - Andrea Piana
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, 07100 Sassari, Italy; (M.D.M.); (L.A.); (A.A.); (A.P.); (A.P.); (P.C.)
| | - Alessandra Palmieri
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, 07100 Sassari, Italy; (M.D.M.); (L.A.); (A.A.); (A.P.); (A.P.); (P.C.)
| | - Antonella Arghittu
- University Hospital of Sassari, 07100 Sassari, Italy; (G.M.D.); (S.B.); (A.A.)
- Department of Biomedical Sciences, University of Sassari, 07100 Sassari, Italy
| | - Paolo Castiglia
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, 07100 Sassari, Italy; (M.D.M.); (L.A.); (A.A.); (A.P.); (A.P.); (P.C.)
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Inactivation of Prions by Low-Temperature Sterilization Technology Using Vaporized Gas Derived from a Hydrogen Peroxide-Peracetic Acid Mixture. Pathogens 2020; 10:pathogens10010024. [PMID: 33396428 PMCID: PMC7824636 DOI: 10.3390/pathogens10010024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 12/28/2020] [Accepted: 12/28/2020] [Indexed: 02/03/2023] Open
Abstract
Prion diseases are proteopathies that cause neurodegenerative disorders in humans and animals. Prion is highly resistant to both chemical and physical inactivation. Here, vaporized gas derived from a hydrogen peroxide–peracetic acid mixture (VHPPA) was evaluated for its ability to inactivate prion using a STERIACE 100 instrument (Saraya Co., Ltd.). Brain homogenates of scrapie (Chandler strain) prion-infected mice were placed on a cover glass, air-dried, sealed in a Tyvek package, and subjected to VHPPA treatment at 50–55 °C using 8% hydrogen peroxide and <10% peracetic acid for 47 min (standard mode, SD) or 30 min (quick mode, QC). Untreated control samples were prepared in the same way but without VHPPA. The resulting samples were treated with proteinase K (PK) to separate PK-resistant prion protein (PrPres), as a marker of the abnormal isoform (PrPSc). Immunoblotting showed that PrPres was reduced by both SD and QC VHPPA treatments. PrPres bands were detected after protein misfolding cyclic amplification of control but not VHPPA-treated samples. In mice injected with prion samples, VHPPA treatment of prion significantly prolonged survival relative to untreated samples, suggesting that it decreases prion infectivity. Taken together, the results show that VHPPA inactivates prions and might be applied to the sterilization of contaminated heat-sensitive medical devices.
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Sakudo A, Yamashiro R, Harata C. Effect of Non-Concentrated and Concentrated Vaporized Hydrogen Peroxide on Scrapie Prions. Pathogens 2020; 9:pathogens9110947. [PMID: 33202870 PMCID: PMC7696461 DOI: 10.3390/pathogens9110947] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 11/10/2020] [Accepted: 11/11/2020] [Indexed: 11/16/2022] Open
Abstract
To date, there have been no studies on the sterilization of prions by non-concentrated and concentrated vaporized hydrogen peroxide (VHP) applied by the same instrument. Here, the effect of the two types of VHP applied using an ES-700 sterilizer on prions was investigated. Brain homogenate from scrapie (Chandler) prion-infected mice was spotted on a cover glass and subjected to ES-700 treatment in soft (non-concentrated VHP from 59% hydrogen peroxide) or standard (concentrated VHP from 80% hydrogen peroxide) mode. Proteinase K-resistant prion protein (PrPres), an indicator of the abnormal isoform of prion protein (PrPSc), was reduced by ES-700 treatment under several conditions: SFT1/4 (soft mode, quarter cycle), SFT1/2 (soft mode, half cycle), SFT1 (soft mode, full cycle), and STD1/2 (standard mode, half cycle). PrPres was detected after the first and second rounds of protein misfolding cyclic amplification (PMCA) of untreated samples, but was undetectable in SFT1/4, SFT1/2, SFT1, and STD1/2 treated samples. In a mouse bioassay, SFT1/2 and STD1/2 treatment of prions significantly prolonged survival time, suggesting that prion infectivity is reduced after ES-700 treatment. In summary, both non-concentrated and concentrated VHP inactivate prions and may be useful for the low-temperature sterilization of prion-contaminated medical devices.
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Affiliation(s)
- Akikazu Sakudo
- School of Veterinary Medicine, Okayama University of Science, Imabari, Ehime 794-8555, Japan
- Laboratory of Biometabolic Chemistry, School of Health Sciences, University of the Ryukyus, Nishihara, Okinawa 903-0215, Japan;
- Correspondence:
| | - Risa Yamashiro
- Laboratory of Biometabolic Chemistry, School of Health Sciences, University of the Ryukyus, Nishihara, Okinawa 903-0215, Japan;
| | - Chihiro Harata
- Canon Lifecare Solutions Inc., Minato-ku, Tokyo 108-0075, Japan;
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Secker TJ, Leighton TG, Offin DG, Birkin PR, Hervé RC, Keevil CW. A cold water, ultrasonically activated stream efficiently removes proteins and prion-associated amyloid from surgical stainless steel. J Hosp Infect 2020; 106:649-656. [PMID: 32956784 PMCID: PMC7501313 DOI: 10.1016/j.jhin.2020.09.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 09/11/2020] [Accepted: 09/11/2020] [Indexed: 11/30/2022]
Abstract
Background Sterile service department decontamination procedures for surgical instruments struggle to demonstrate efficient removal of the hardiest infectious contaminants, such as prion proteins. A recently designed novel system, which uses a low pressure ultrasonically activated, cold water stream, has previously demonstrated efficient hard surface cleaning of several biological contaminants. Aim To test the efficacy of an ultrasonically activated stream for the removal of tissue proteins, including prion-associated amyloid, from surgical stainless steel surfaces. Methods Test surfaces were contaminated with 22L, ME7 or 263K prion-infected brain homogenates. The surfaces were treated with the ultrasonically activated water stream for contact times of 5 and 10 s. Residual proteinaceous and amyloid contamination were quantified using sensitive microscopic analysis, and immunoblotting was used to characterize the eluted prion residues before and after treatment with the ultrasonically activated stream. Findings Efficient removal of the different prion strains from the surgical stainless steel surfaces was observed, and reduced levels of protease-susceptible and -resistant prion protein was detected in recovered supernatant. Conclusion This study demonstrated that an ultrasonically activated stream has the potential to be a cost-effective solution to improve current decontamination practices and has the potential to reduce hospital-acquired infections.
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Affiliation(s)
- T J Secker
- Environmental Healthcare Unit, School of Biological Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK.
| | - T G Leighton
- Institute of Sound and Vibration Research, Faculty of Engineering and Environment, University of Southampton, Southampton, UK; Sloan Water Technology Ltd, Chilworth, Southampton, UK
| | - D G Offin
- Chemistry, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
| | - P R Birkin
- Chemistry, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
| | - R C Hervé
- Environmental Healthcare Unit, School of Biological Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
| | - C W Keevil
- Environmental Healthcare Unit, School of Biological Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
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Uttley L, Carroll C, Wong R, Hilton DA, Stevenson M. Creutzfeldt-Jakob disease: a systematic review of global incidence, prevalence, infectivity, and incubation. THE LANCET. INFECTIOUS DISEASES 2020; 20:e2-e10. [PMID: 31876504 DOI: 10.1016/s1473-3099(19)30615-2] [Citation(s) in RCA: 96] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 09/13/2019] [Accepted: 10/15/2019] [Indexed: 12/15/2022]
Abstract
Creutzfeldt-Jakob disease (CJD) is a fatal disease presenting with rapidly progressive dementia, and most patients die within a year of clinical onset. CJD poses a potential risk of iatrogenic transmission, as it can incubate asymptomatically in humans for decades before becoming clinically apparent. In this Review, we sought evidence to understand the current iatrogenic risk of CJD to public health by examining global evidence on all forms of CJD, including clinical incidence and prevalence of subclinical disease. We found that although CJD, particularly iatrogenic CJD, is rare, the incidence of sporadic CJD is increasing. Incubation periods as long as 40 years have been observed, and all genotypes have now been shown to be susceptible to CJD. Clinicians and surveillance programmes should maintain awareness of CJD to mitigate future incidences of its transmission. Awareness is particularly relevant for sporadic CJD, which occurs in older people in whom clinical presentation could resemble rapidly developing dementia.
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Affiliation(s)
- Lesley Uttley
- School of Health and Related Research, University of Sheffield, Sheffield, UK.
| | - Christopher Carroll
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Ruth Wong
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - David A Hilton
- Department of Neuropathology, University Hospitals Plymouth National Health Service Trust, Plymouth, UK
| | - Matt Stevenson
- School of Health and Related Research, University of Sheffield, Sheffield, UK
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Stevenson M, Uttley L, Oakley JE, Carroll C, Chick SE, Wong R. Interventions to reduce the risk of surgically transmitted Creutzfeldt-Jakob disease: a cost-effective modelling review. Health Technol Assess 2020; 24:1-150. [PMID: 32122460 PMCID: PMC7103914 DOI: 10.3310/hta24110] [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] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Creutzfeldt-Jakob disease is a fatal neurological disease caused by abnormal infectious proteins called prions. Prions that are present on surgical instruments cannot be completely deactivated; therefore, patients who are subsequently operated on using these instruments may become infected. This can result in surgically transmitted Creutzfeldt-Jakob disease. OBJECTIVE To update literature reviews, consultation with experts and economic modelling published in 2006, and to provide the cost-effectiveness of strategies to reduce the risk of surgically transmitted Creutzfeldt-Jakob disease. METHODS Eight systematic reviews were undertaken for clinical parameters. One review of cost-effectiveness was undertaken. Electronic databases including MEDLINE and EMBASE were searched from 2005 to 2017. Expert elicitation sessions were undertaken. An advisory committee, convened by the National Institute for Health and Care Excellence to produce guidance, provided an additional source of information. A mathematical model was updated focusing on brain and posterior eye surgery and neuroendoscopy. The model simulated both patients and instrument sets. Assuming that there were potentially 15 cases of surgically transmitted Creutzfeldt-Jakob disease between 2005 and 2018, approximate Bayesian computation was used to obtain samples from the posterior distribution of the model parameters to generate results. Heuristics were used to improve computational efficiency. The modelling conformed to the National Institute for Health and Care Excellence reference case. The strategies evaluated included neither keeping instruments moist nor prohibiting set migration; ensuring that instruments were kept moist; prohibiting instrument migration between sets; and employing single-use instruments. Threshold analyses were undertaken to establish prices at which single-use sets or completely effective decontamination solutions would be cost-effective. RESULTS A total of 169 papers were identified for the clinical review. The evidence from published literature was not deemed sufficiently strong to take precedence over the distributions obtained from expert elicitation. Forty-eight papers were identified in the review of cost-effectiveness. The previous modelling structure was revised to add the possibility of misclassifying surgically transmitted Creutzfeldt-Jakob disease as another neurodegenerative disease, and assuming that all patients were susceptible to infection. Keeping instruments moist was estimated to reduce the risk of surgically transmitted Creutzfeldt-Jakob disease cases and associated costs. Based on probabilistic sensitivity analyses, keeping instruments moist was estimated to on average result in 2.36 (range 0-47) surgically transmitted Creutzfeldt-Jakob disease cases (across England) caused by infection occurring between 2019 and 2023. Prohibiting set migration or employing single-use instruments reduced the estimated risk of surgically transmitted Creutzfeldt-Jakob disease cases further, but at considerable cost. The estimated costs per quality-adjusted life-year gained of these strategies in addition to keeping instruments moist were in excess of £1M. It was estimated that single-use instrument sets (currently £350-500) or completely effective cleaning solutions would need to cost approximately £12 per patient to be cost-effective using a £30,000 per quality-adjusted life-year gained value. LIMITATIONS As no direct published evidence to implicate surgery as a cause of Creutzfeldt-Jakob disease has been found since 2005, the estimations of potential cases from elicitation are still speculative. A particular source of uncertainty was in the number of potential surgically transmitted Creutzfeldt-Jakob disease cases that may have occurred between 2005 and 2018. CONCLUSIONS Keeping instruments moist is estimated to reduce the risk of surgically transmitted Creutzfeldt-Jakob disease cases and associated costs. Further surgical management strategies can reduce the risks of surgically transmitted Creutzfeldt-Jakob disease but have considerable associated costs. STUDY REGISTRATION This study is registered as PROSPERO CRD42017071807. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 11. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Matt Stevenson
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Lesley Uttley
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Jeremy E Oakley
- School of Mathematics and Statistics, University of Sheffield, Sheffield, UK
| | - Christopher Carroll
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | | | - Ruth Wong
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
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Silva DF, Toledo Neto JL, Machado MF, Bochnia JR, Garcez AS, Foggiato AA. Effect of photodynamic therapy potentiated by ultrasonic chamber on decontamination of acrylic and titanium surfaces. Photodiagnosis Photodyn Ther 2019; 27:345-353. [PMID: 31279916 DOI: 10.1016/j.pdpdt.2019.06.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 06/07/2019] [Accepted: 06/14/2019] [Indexed: 01/19/2023]
Abstract
Photodynamic Therapy (PDT) is an alternative to surface decontamination that is based on the interaction between a non-toxic photosensitizer (PS) and a light source to allow for the formation of reactive oxygen species. The objective of this study was to test a new patented device - the "Ultrasonic Photodynamic Inactivation Device" (UPID) under the patent deposit MU-BR 20.2018.00.9356-3 - for the photodynamic inactivation on contaminated acrylic plates and titanium disk. This new low cost device contains light emitting diodes (LEDs) and was built in a stainless-steel container for better light distribution. In addition, 28 waterproof red LEDs plates, with a wavelength of 660 nm were used, containing three irradiators in each plate, for which the irradiation distribution and the spectral irradiance on all 6 internal faces of this device were calculated. The effect of red LED irradiation (660 nm) methylene blue (MB) (100 μmol/L) diluted in water or 70% alcohol on three types of microorganisms: Candida albicans ATCC 10231, Staphylococcus aureus ATCC 25923 and Escherichia coli ATCC 25922. In order to estimate the effects of PDI, acrylic plates and Titanium disks were contaminated by bacterial suspensions (3 × 108 CFU/mL), then treated with a solution of MB for 30 min, followed by irradiation for 30 min (0.45 J/cm2). Microbial inhibition was evaluated by counting the number of colony forming units (CFU), compared to the control group. The results showed that the UPID promoted significant reduction (p < 0.001) of the microorganism when compared with the positive control. The new device promoted an effective microbial inhibition on the surfaces tested and, thus, makes possible new studies. The perspective is that this new device may be a low-cost and non-toxic alternative to the disinfection of biomedical devices, non-critical instruments and also for use in the food industry.
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Affiliation(s)
- Douglas Fernandes Silva
- Health Science Center - Dentistry, Paraná Northern State University - UENP, Jacarezinho, PR, Brazil; Medical and Dental Institute of Phototherapy Foggiato, Jacarezinho, PR, Brazil.
| | - João Lopes Toledo Neto
- Health Science Center - Dentistry, Paraná Northern State University - UENP, Jacarezinho, PR, Brazil.
| | - Milena Ferreira Machado
- Health Science Center - Dentistry, Paraná Northern State University - UENP, Jacarezinho, PR, Brazil.
| | - Jetter Ribeiro Bochnia
- Department of Prosthodontics and Dental Materials, School of Dentistry, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil.
| | | | - Augusto Alberto Foggiato
- Health Science Center - Dentistry, Paraná Northern State University - UENP, Jacarezinho, PR, Brazil; Medical and Dental Institute of Phototherapy Foggiato, Jacarezinho, PR, Brazil.
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Smith A, Winter S, Lappin D, Sherriff A, McIvor I, Philp P, Suttner N, Holmes S, Stewart A. Reducing the risk of iatrogenic Creutzfeldt–Jakob disease by improving the cleaning of neurosurgical instruments. J Hosp Infect 2018. [DOI: 10.1016/j.jhin.2018.03.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Veiga-Malta I. Preventing Healthcare-Associated Infections by Monitoring the Cleanliness of Medical Devices and Other Critical Points in a Sterilization Service. Biomed Instrum Technol 2018; 50 Suppl 3:45-52. [PMID: 27100075 DOI: 10.2345/0899-8205-50.s3.45] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
It is well known that the common goal of all central sterile supply departments (CSSDs) is to prevent healthcare-associated infections. Such infections entail high costs to society, not only economic but also social. Therefore, delivering safe medical devices and guaranteeing a positive contribution to the control of healthcare-associated infections form the main responsibilities of a CSSD. The monitoring of the effectiveness of medical device cleaning processes is highly recommended. However, ensuring a flawless environment for the preparation, assembly, and packaging of medical devices and clean handling of sterilized items is crucial to achieving the goal of safe medical devices. This study analyzed not only the cleanliness of surgical instruments but also two critical aspects of the surrounding environment: the cleanliness of work surfaces and the cleanliness of workers' hands. To evaluate the cleanliness of surgical instruments, two methods were used: the adenosine triphosphate (ATP) detection method and a residual protein test. It was not the intention of this work to make an exhaustive comparison of these methods. The ATP bioluminescence method was also used for monitoring the cleanliness of work surfaces and workers' hands. The aims of this study were to establish the most suitable method of evaluating the cleanliness of reusable medical devices in the CSSD and to assess the quality of the environment. Assessing the surgical instruments, work surfaces, and staff hands for cleanliness allowed the identification of possible contamination sources and to correct them by improving cleaning/disinfection protocols. Furthermore, the use of ATP monitoring tests of workers' hands highlighted the importance of staff compliance with good practice guidelines. Thus, these results have a positive impact on the CSSD quality system and, consequently, on patient safety.
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Langsteiner A, Loncaric I, Henkel-Odwody AM, Tichy A, Licka TF. Initial adhesion of methicillin-sensitive and methicillin-resistant Staphylococcus aureus strains to untreated and electropolished surgical steel drill bits. Res Vet Sci 2017; 114:474-481. [PMID: 28946121 DOI: 10.1016/j.rvsc.2017.09.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Revised: 05/22/2017] [Accepted: 09/14/2017] [Indexed: 11/26/2022]
Abstract
Electropolishing of stainless steel has been thoroughly investigated as a prophylactic measure to prevent bacterial colonization of orthopaedic implants and infection. Initial bacterial adhesion onto surgical drill bits as a possible factor for orthopaedic surgical site infections has not yet been documented. The present study investigated the influence of electropolishing on initial staphylococcal adhesion onto AISI 440A stainless steel drill bits. Specifically, one methicillin-susceptible standard laboratory Staphylococcus aureus type strain (DSM 20231T), one methicillin-resistant S. aureus reference strain (DSM 46320) and one methicillin-resistant clinical isolate from an infected orthopaedic implant were used. After standard sterilization, drill bits were immersed in the respective bacterial suspension; bacteria adherent to surface were harvested by vortexing the drill bits in phosphate-buffered saline and viable counts of bacteria transferred from the suspension were made (transferred to log10 for further analysis). Electropolishing significantly reduced adhesion of the clinical S. aureus strain and the S. aureus DSM 20231T. However, electropolishing significantly increased adhesion of the S. aureus DSM 46320. These results show that electropolishing significantly influences initial adhesion of S. aureus strains to surgical drill bits and that the nature of this influence depends on the S. aureus strain examined. For a general recommendation of electropolishing drill bits and guidelines for their handling during surgery, further studies with more strains isolated from infected wounds are suggested.
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Affiliation(s)
- Annemarie Langsteiner
- Department for Companion Animals and Horses, Equine University Clinic, University of Veterinary Medicine, Veterinärplatz 1, 1210 Vienna, Austria
| | - Igor Loncaric
- Department for Pathobiology, Institute of Microbiology, University of Veterinary Medicine, Veterinärplatz 1, 1210 Vienna, Austria.
| | - Anna-Maria Henkel-Odwody
- Department for Companion Animals and Horses, Equine University Clinic, University of Veterinary Medicine, Veterinärplatz 1, 1210 Vienna, Austria
| | - Alexander Tichy
- Department of Biomedical Sciences, Bioinformatics and Biostatistics Platform, University of Veterinary Medicine, Veterinärplatz 1, 1210 Vienna, Austria.
| | - Theresia F Licka
- Department for Companion Animals and Horses, Equine University Clinic, University of Veterinary Medicine, Veterinärplatz 1, 1210 Vienna, Austria; Department of Veterinary Clinical Studies, Royal (Dick) School of Veterinary Studies, University of Edinburgh, Easter Bush Campus, EH25 9RG Edinburgh, United Kingdom.
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Infektionsschutz und spezielle Hygienemaßnahmen in klinischen Disziplinen. KRANKENHAUS- UND PRAXISHYGIENE 2016. [PMCID: PMC7152143 DOI: 10.1016/b978-3-437-22312-9.00005-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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14
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Bruna CQDM, Souza RQD, Massaia IFS, Cruz ÁS, Graziano KU. The impact of the use of different types of gloves and bare hands for preparation of clean surgical instruments. Rev Lat Am Enfermagem 2016; 24:e2805. [PMID: 27737375 PMCID: PMC5068903 DOI: 10.1590/1518-8345.1127.2805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Accepted: 05/16/2016] [Indexed: 11/22/2022] Open
Abstract
Objectives: to determine if there are differences on the safety of the preparation of clean
surgical instruments using different types of gloves and bare hands and evaluate
the microbiological load of these preparations without gloves. Method: laboratory procedure with a pragmatic approach, in which the samples were handled
with different types of gloves and bare hands. In addition, cytotoxicity assays
were carried out by means of the agar diffusion method. Further samples were
subjected to microbiological analysis after being handled without gloves. Results: none of the samples showed cytotoxic effect. All microbiological cultures showed
growth of microorganisms, but no microorganism has been recovered after
autoclaving. Conclusion: there were no differences in the cytotoxic responses regarding the use of
different types of gloves and bare hands in the handling of clean surgical
instruments, which could entail iatrogenic risk. It is noteworthy that the use of
gloves involves increase in the costs of process and waste generation, and the
potential allergenic risk to latex.
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15
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16
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Secker TJ, Pinchin HE, Hervé RC, Keevil CW. Efficacy of humidity retention bags for the reduced adsorption and improved cleaning of tissue proteins including prion-associated amyloid to surgical stainless steel surfaces. BIOFOULING 2015; 31:535-541. [PMID: 26263927 DOI: 10.1080/08927014.2015.1067686] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Increasing drying time adversely affects attachment of tissue proteins and prion-associated amyloid to surgical stainless steel, and reduces the efficacy of commercial cleaning chemistries. This study tested the efficacy of commercial humidity retention bags to reduce biofouling on surgical stainless steel and to improve subsequent cleaning. Surgical stainless steel surfaces were contaminated with ME7-infected brain homogenates and left to dry for 15 to 1,440 min either in air, in dry polythene bags or within humidity retention bags. Residual contamination pre/post cleaning was analysed using Thioflavin T/SYPRO Ruby dual staining and microscope analysis. An increase in biofouling was observed with increased drying time in air or in sealed dry bags. Humidity retention bags kept both protein and prion-associated amyloid minimal across the drying times both pre- and post-cleaning. Therefore, humidity bags demonstrate a cheap, easy to implement solution to improve surgical instrument reprocessing and to potentially reduce associated hospital acquired infections.
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Affiliation(s)
- T J Secker
- a Environmental Healthcare Unit, Centre for Biological Sciences , University of Southampton , Southampton , UK
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17
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Birkin PR, Offin DG, Vian CJB, Howlin RP, Dawson JI, Secker TJ, Hervé RC, Stoodley P, Oreffo ROC, Keevil CW, Leighton TG. Cold water cleaning of brain proteins, biofilm and bone – harnessing an ultrasonically activated stream. Phys Chem Chem Phys 2015. [DOI: 10.1039/c5cp02406d] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The ability of acoustically active bubbles to remove a range of biological contaminants is demonstrated in an ultrasonically activated stream.
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Affiliation(s)
| | | | | | - R. P. Howlin
- National Centre for Advanced Tribology at Southampton
- University of Southampton
- UK
| | - J. I. Dawson
- Centre for Human Development
- Stem Cells and Regeneration
- Medicine
- University of Southampton
- UK
| | - T. J. Secker
- Centre for Biological Sciences
- University of Southampton
- UK
| | - R. C. Hervé
- Centre for Biological Sciences
- University of Southampton
- UK
| | - P. Stoodley
- National Centre for Advanced Tribology at Southampton
- University of Southampton
- UK
| | - R. O. C. Oreffo
- Centre for Human Development
- Stem Cells and Regeneration
- Medicine
- University of Southampton
- UK
| | - C. W. Keevil
- Centre for Biological Sciences
- University of Southampton
- UK
| | - T. G. Leighton
- Institute of Sound and Vibration Research
- University of Southampton
- UK
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18
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Birkin PR, Offin DG, Vian CJB, Leighton TG. Electrochemical ‘bubble swarm’ enhancement of ultrasonic surface cleaning. Phys Chem Chem Phys 2015; 17:21709-15. [DOI: 10.1039/c5cp02933c] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Control and excitation of electrochemical bubble swarms enhances surface cleaning within an ultrasonically activated stream.
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Affiliation(s)
- P. R. Birkin
- Chemistry
- Natural and Environmental Sciences
- University of Southampton
- Southampton
- UK
| | - D. G. Offin
- Chemistry
- Natural and Environmental Sciences
- University of Southampton
- Southampton
- UK
| | - C. J. B. Vian
- Chemistry
- Natural and Environmental Sciences
- University of Southampton
- Southampton
- UK
| | - T. G. Leighton
- Institute of Sound and Vibration Research
- Engineering and the Environment
- University of Southampton
- Southampton
- UK
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19
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Smith A, Smith G, Lappin DF, Baxter HC, Jones A, Baxter RL. Dental handpiece contamination: a proteomics and surface analysis approach. BIOFOULING 2014; 30:29-39. [PMID: 24138163 DOI: 10.1080/08927014.2013.839782] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Dental handpieces (DHPs) become biofouled internally with patient derived material that is difficult to access for removal and inactivation. This study undertook a quantitative and qualitative investigation of protein contamination of internal components from three different types of DHP: the turbine, slow speed contra-angle and surgical. Eluates from the high speed turbine, low speed spray channels and surgical gear were assayed for protein using an orthophthaldehyde assay. Eluates concentrated by Amicon ultrafiltration were also analysed by SDS-PAGE, mass spectroscopy, Western blotting and ELISA. The surfaces of handpiece components were also investigated by SEM, EFSCAN and EDAX microscopy. Surgical gears contained highest levels of protein (403 μg), followed by low speed spray channels (17.7 μg) and the high speed turbine (<5 μg). Mass spectroscopy of surgical gears demonstrated mostly serum derived proteins. Decontamination of the DHPs using an automated washer disinfector and handpiece irrigator showed a significant reduction in residual protein levels.
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Affiliation(s)
- Andrew Smith
- a Institute of Infection and Immunity, College of Medical, Veterinary & Life Sciences, Glasgow Dental Hospital & School, University of Glasgow , Glasgow , UK
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20
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Thiede B, Kramer A. Evaluation of reprocessing medical devices in 14 German regional hospitals and at 27 medical practitioners' offices within the European context - consequences for European harmonization. GMS HYGIENE AND INFECTION CONTROL 2013; 8:Doc20. [PMID: 24327946 PMCID: PMC3857276 DOI: 10.3205/dgkh000220] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Safe reprocessing of medical devices through cleaning, disinfection, and sterilization is essential for the prevention of health care associated infections (HAI) and to guarantee patient safety. Several studies detected residual contamination and even severe infections of patients, despite carrying out reprocessing. To develop appropriate solutions, the existing situation in Germany and selected European countries was analyzed. Additionally, in 27 medical practitioners' offices and 14 hospitals, the true practice of reprocessing was analyzed using a questionnaire, a checklist, and inspection on site. A structured analysis of potential alternatives to the internal reprocessing was conducted within the German and European context. The results indicate that the conditions for the execution of the reprocessing process in the analyzed health facilities in southern Hesse (Germany) do not satisfy legal requirements. The detected deficiencies were consistent with other reports from Germany and Europe. The analysis gave insight into several reasons for the detected deficiencies. The three main reasons were the high costs for proper implementation, the subjective value assigned to the reprocessing unit in health care facilities, and deficits in monitoring by the health authority. Throughout the European Union, a similar regulatory framework for the performance of the reprocessing process exists, while the environment, structures of the health systems and administrative supervision vary significantly. The German states as well as selected European countries are currently discussing the challenges of increased quality-assured execution of the reprocessing process. For instance, the same supervisory system for hospitals and medical practitioners should be established at an equal standard. Alternatives such as the use of single-use medical devices, outsourcing the decontamination processes, or the cooperation of health facilities may be considered. This paper also discusses economic and ecological aspects. Finally, different options are recommended to ensure the exclusive use of reliable medical devices for surgical procedures that guarantee an adequate standard of patient safety within economic constraints.
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Affiliation(s)
| | - Axel Kramer
- Institute of Hygiene and Environmental Medicine, University Medicine Greifswald, Germany
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21
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Critical evaluation of ninhydrin for monitoring surgical instrument decontamination. J Hosp Infect 2013; 84:97-102. [DOI: 10.1016/j.jhin.2012.11.029] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2012] [Accepted: 11/16/2012] [Indexed: 11/24/2022]
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22
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Secker TJ, Hervé R, Zhao Q, Borisenko KB, Abel EW, Keevil CW. Doped diamond-like carbon coatings for surgical instruments reduce protein and prion-amyloid biofouling and improve subsequent cleaning. BIOFOULING 2012; 28:563-569. [PMID: 22694725 DOI: 10.1080/08927014.2012.698387] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Doped diamond-like carbon (DLC) coatings offer potential antifouling surfaces against microbial and protein attachment. In particular, stainless steel surgical instruments are subject to tissue protein and resilient prion protein attachment, making decontamination methods used in sterile service departments ineffective, potentially increasing the risk of iatrogenic Creutzfeldt-Jakob disease during surgical procedures. This study examined the adsorption of proteins and prion-associated amyloid to doped DLC surfaces and the efficacy of commercial cleaning chemistries applied to these spiked surfaces, compared to titanium nitride coating and stainless steel. Surfaces inoculated with ME7-infected brain homogenate were visualised using SYPRO Ruby/Thioflavin T staining and modified epi-fluorescence microscopy before and after cleaning. Reduced protein and prion amyloid contamination was observed on the modified surfaces and subsequent decontamination efficacy improved. This highlights the potential for a new generation of coatings for surgical instruments to reduce the risk of iatrogenic CJD infection.
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Affiliation(s)
- T J Secker
- Environmental Healthcare Unit, Centre for Biological Sciences, University of Southampton, Southampton, SO17 1BJ, UK.
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23
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Smith GWG, Smith AJ. Evaluation of residual protein on unprocessed and decontaminated dental extraction forceps. BIOFOULING 2012; 28:921-927. [PMID: 22963078 DOI: 10.1080/08927014.2012.722207] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Research into protein contamination of surgical instruments has received increasing attention and has focused on a quantitative analysis, without subsequent identification of these proteins. This study aimed to validate methods for the isolation and identification of instrument protein contamination using extraction forceps as a model. The working ends of used, unclean and decontaminated forceps were boiled in 1% (v/v) SDS and samples precipitated using StrataClean™ resin and Amicon® filtration. Proteins were visualised using SDS-PAGE and identified by mass spectrometry and Western blot. A total of 17 proteins were identified from used, unclean forceps, including blood and bacterial proteins and 2 protein bands from decontaminated forceps samples which could not be accurately identified. The methods described, when used in conjunction with quantitative and surface analysis of instruments, can aid development of cleaning processes by identifying contaminants on used devices that have been removed following cleaning.
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Affiliation(s)
- Gordon W G Smith
- Institute of Infection and Immunity, College of Medical, Veterinary & Life Sciences, Glasgow Dental Hospital & School, University of Glasgow, 378 Sauchiehall Street, Glasgow, G2 3JZ, Scotland, UK
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24
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Martinsen TC, Benestad SL, Moldal T, Waldum HL. Inhibitors of gastric acid secretion increase the risk of prion infection in mice. Scand J Gastroenterol 2011; 46:1418-22. [PMID: 21936725 DOI: 10.3109/00365521.2011.619277] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
UNLABELLED Gastric juice is a unique combination of hydrochloric acid and the proteolytic enzyme pepsin. Its main function is to inactivate ingested microorganisms. Prions cause fatal transmissible degenerative encephalopathies in animals and man. These diseases have attracted attention due to the proposed link between bovine spongiform encephalopathy in cattle and the occurrence of a new variant Creutzfeldt-Jakob disease in humans where the most probable route of transmission is via contaminated food. The role of gastric juice in the protection against these agents is not settled. OBJECTIVE The aim of this study was to examine if drug-induced gastric hypoacidity increases the susceptibility of prion infection transmitted by the oral route. MATERIAL AND METHODS Forty-six mice (tg338) were given brain homogenates contaminated with scrapie by gastric intubation. Twenty-two of these animals were concomitantly dosed with omeprazole increasing the median gastric pH from 1.2 to 5.3. After 381 days, the animals were sacrificed and all the brains were examined for detection of pathogenic prion proteins by enzyme-linked immunosorbent assay and western blot. RESULTS Drug-induced decrease in gastric acidity more than doubled the rate (59% vs. 25%, p < 0.035) of brain infection compared to controls with normal gastric acidity at the time of inoculation. CONCLUSIONS Our results demonstrate that the normal gastric juice constitutes a significant defense against prion disease in mice. Thus, gastric hypochlorhydria would be expected to enhance the susceptibility to prion infection by the oral route. This finding may have relevance to the pathogenesis of the new variant Creutzfeldt-Jakob disease and prion diseases in general.
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Affiliation(s)
- Tom C Martinsen
- Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway.
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25
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Fernie K, Hamilton S, Somerville RA. Limited efficacy of steam sterilization to inactivate vCJD infectivity. J Hosp Infect 2011; 80:46-51. [PMID: 22099953 DOI: 10.1016/j.jhin.2011.09.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2011] [Accepted: 09/16/2011] [Indexed: 10/15/2022]
Abstract
BACKGROUND The transmission of bovine spongiform encephalopathy (BSE) to humans as variant Creutzfeldt-Jakob Disease (vCJD) raised concerns about potential secondary transmissions due to the resistance of the agents causing transmissible spongiform encephalopathies (TSEs), sometimes known as prions, to commonly used methods of sterilization, notably steam sterilization (or autoclaving). It has been suggested that surgical instruments and other medical devices might retain sufficient infected tissue debris after cleaning and steam sterilization to infect patients on whom they are subsequently used. AIM To determine whether concerns about the lack of efficacy of steam sterilization of vCJD were justified. METHODS The reduction in infectivity of brain macerates of vCJD brain after steam sterilization using the standard temperatures and time recommended for autoclaving in UK hospitals (134-137°C for 3 min) was measured. FINDINGS Reductions in titre of 10(2.3) to >10(3.6) ID(50) were found. In three of four samples, infectivity was recovered after steam sterilization. CONCLUSION As noted previously, TSE strains derived from BSE sources appear to be more resistant to steam sterilization and other forms of heat inactivation than other TSE sources.
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Affiliation(s)
- K Fernie
- Neurobiology Division, The Roslin Institute and R(D)SVS, University of Edinburgh, Easter Bush, Midlothian, UK
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26
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Vassey M, Budge C, Poolman T, Jones P, Perrett D, Nayuni N, Bennett P, Groves P, Smith A, Fulford M, Marsh PD, Walker JT, Sutton JM, Raven NDH. A quantitative assessment of residual protein levels on dental instruments reprocessed by manual, ultrasonic and automated cleaning methods. Br Dent J 2011; 210:E14. [DOI: 10.1038/sj.bdj.2011.144] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/28/2010] [Indexed: 11/09/2022]
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Smith GW, Goldie F, Long S, Lappin DF, Ramage G, Smith AJ. Quantitative analysis of residual protein contamination of podiatry instruments reprocessed through local and central decontamination units. J Foot Ankle Res 2011; 4:2. [PMID: 21219613 PMCID: PMC3023740 DOI: 10.1186/1757-1146-4-2] [Citation(s) in RCA: 7] [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: 10/19/2010] [Accepted: 01/10/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The cleaning stage of the instrument decontamination process has come under increased scrutiny due to the increasing complexity of surgical instruments and the adverse affects of residual protein contamination on surgical instruments. Instruments used in the podiatry field have a complex surface topography and are exposed to a wide range of biological contamination. Currently, podiatry instruments are reprocessed locally within surgeries while national strategies are favouring a move toward reprocessing in central facilities. The aim of this study was to determine the efficacy of local and central reprocessing on podiatry instruments by measuring residual protein contamination of instruments reprocessed by both methods. METHODS The residual protein of 189 instruments reprocessed centrally and 189 instruments reprocessed locally was determined using a fluorescent assay based on the reaction of proteins with o-phthaldialdehyde/sodium 2-mercaptoethanesulfonate. RESULTS Residual protein was detected on 72% (n = 136) of instruments reprocessed centrally and 90% (n = 170) of instruments reprocessed locally. Significantly less protein (p < 0.001) was recovered from instruments reprocessed centrally (median 20.62 μg, range 0 - 5705 μg) than local reprocessing (median 111.9 μg, range 0 - 6344 μg). CONCLUSIONS Overall, the results show the superiority of central reprocessing for complex podiatry instruments when protein contamination is considered, though no significant difference was found in residual protein between local decontamination unit and central decontamination unit processes for Blacks files. Further research is needed to undertake qualitative identification of protein contamination to identify any cross contamination risks and a standard for acceptable residual protein contamination applicable to different instruments and specialities should be considered as a matter of urgency.
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Affiliation(s)
- Gordon Wg Smith
- Institute of Infection, Immunity and Inflammation, Glasgow Dental School, College of Medicine, Veterinary and Life Sciences University of Glasgow, Glasgow, G2 3JZ, UK
| | - Frank Goldie
- Central Decontamination Unit Cowlairs Industrial Estate 24 Finlas Street, Glasgow, G22 5DT, UK
| | - Steven Long
- Podiatry Lead (North Acute) Department of Podiatry, Glasgow Royal Infirmary, Alexandra Parade, Glasgow G31 2ER, UK
| | - David F Lappin
- Institute of Infection, Immunity and Inflammation, Glasgow Dental School, College of Medicine, Veterinary and Life Sciences University of Glasgow, Glasgow, G2 3JZ, UK
| | - Gordon Ramage
- Institute of Infection, Immunity and Inflammation, Glasgow Dental School, College of Medicine, Veterinary and Life Sciences University of Glasgow, Glasgow, G2 3JZ, UK
| | - Andrew J Smith
- Institute of Infection, Immunity and Inflammation, Glasgow Dental School, College of Medicine, Veterinary and Life Sciences University of Glasgow, Glasgow, G2 3JZ, UK
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Edgeworth JA, Sicilia A, Linehan J, Brandner S, Jackson GS, Collinge J. A standardized comparison of commercially available prion decontamination reagents using the Standard Steel-Binding Assay. J Gen Virol 2010; 92:718-26. [PMID: 21084494 PMCID: PMC3081234 DOI: 10.1099/vir.0.027201-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Prions are comprised principally of aggregates of a misfolded host protein and cause fatal transmissible neurodegenerative disorders of mammals, such as variant Creutzfeldt-Jakob disease in humans and bovine spongiform encephalopathy in cattle. Prions pose significant public health concerns through contamination of blood products and surgical instruments, and can resist conventional hospital sterilization methods. Prion infectivity binds avidly to surgical steel and can efficiently transfer infectivity to a suitable host, and much research has been performed to achieve effective prion decontamination of metal surfaces. Here, we exploit the highly sensitive Standard Steel-Binding Assay (SSBA) to perform a direct comparison of a variety of commercially available decontamination reagents marketed for the removal of prions, alongside conventional sterilization methods. We demonstrate that the efficacy of marketed prion decontamination reagents is highly variable and that the SSBA is able to rapidly evaluate current and future decontamination reagents.
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Affiliation(s)
- Julie Ann Edgeworth
- MRC Prion Unit, Department of Neurodegenerative Disease, UCL Institute of Neurology, Queen Square, London WC1N 3BG, UK
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Rauscher H, Kylián O, Benedikt J, von Keudell A, Rossi F. Elimination of biological contaminations from surfaces by plasma discharges: chemical sputtering. Chemphyschem 2010; 11:1382-9. [PMID: 19967733 DOI: 10.1002/cphc.200900757] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Plasma treatment of surfaces as a sterilisation or decontamination method is a promising approach to overcome limitations of conventional techniques. The precise characterisation of the employed plasma discharges, the application of sensitive surface diagnostic methods and targeted experiments to separate the effects of different agents, have led to rapid progress in the understanding of different relevant elementary processes. This contribution provides an overview of the most relevant and recent results, which reveal the importance of chemical sputtering as one of the most important processes for the elimination of biological residuals. Selected studies on the interaction of plasmas with bacteria, proteins and polypeptides are highlighted, and investigations employing beams of atoms and ions confirming the prominent role of chemical sputtering are presented. With this knowledge, it is possible to optimize the plasma treatment for decontamination/sterilisation purposes in terms of discharge composition, density of active species and UV radiation intensity.
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Affiliation(s)
- Hubert Rauscher
- Institute for Health and Consumer Protection, European Commission-Joint Research Centre, V. Fermi, 21027 Ispra, Italy.
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30
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The cleaning of photographic retractors; a survey, clinical and laboratory study. Br Dent J 2010; 208:E14; discussion 306-7. [PMID: 20357820 DOI: 10.1038/sj.bdj.2010.310] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/24/2009] [Indexed: 11/09/2022]
Abstract
OBJECTIVES To determine the methods currently being used to decontaminate photographic retractors in specialist orthodontic practice and to investigate the effectiveness of the cleaning methods. DESIGN The study was carried out in two parts: I - a postal self-report questionnaire, and II - a cross-sectional clinical and laboratory investigation. SETTING The Orthodontic Department of the Charles Clifford Dental Hospital. SUBJECTS AND MATERIALS I - The questionnaire was sent to 278 specialist UK orthodontists. II - One hundred and twenty pairs of photographic retractors were collected following use. One retractor from each pair was randomly chosen to be the unwashed control and immediately placed in 20 ml of PBS-Tween for elution. The other was subjected to the one of four cleaning procedures: alcohol wipe, handwashing, ultrasonic bath or washer-disinfector, before being placed in PBS-Tween. Aliquots were taken for assay. MAIN OUTCOME MEASURES Antibody capture (ELISA) for amylase, to detect the presence of saliva, and for albumin, to detect the presence of serum. RESULTS I - The questionnaire response rate was 65% and the majority of respondents (87.2%) were routinely taking clinical photographs. A wide variety of techniques were being used to decontaminate photographic retractors. II - All unwashed controls had detectable levels of amylase and albumin. All the retractors that were cleaned using an alcohol wipe had residual detectable levels of amylase and 80% had detectable levels of albumin. Only one retractor had detectable amylase and one had detectable albumin following cleaning using the washer-disinfector. There was a highly significant statistical difference between the techniques in the proportional reduction in both amylase and albumin detected from the unwashed control and cleaned experimental retractors (p <0.001). The infective risk from inadequate cleaning of photographic retractors is discussed. CONCLUSIONS The washer-disinfector is the most effective method of cleaning photographic retractors, but no method was found to be 100% successful at removing amylase and albumin.
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Rutala WA, Weber DJ. Guideline for disinfection and sterilization of prion-contaminated medical instruments. Infect Control Hosp Epidemiol 2010; 31:107-17. [PMID: 20055640 DOI: 10.1086/650197] [Citation(s) in RCA: 117] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- William A Rutala
- Hospital Epidemiology, University of North Carolina School of Medicine, Chapel Hill, 27599-7030, USA.
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32
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Ungurs M, Hesp J, Poolman T, McLuckie G, O'Brien S, Murdoch H, Wells P, Raven N, Walker J, Sutton J. Quantitative measurement of the efficacy of protein removal by cleaning formulations; comparative evaluation of prion-directed cleaning chemistries. J Hosp Infect 2010; 74:144-51. [DOI: 10.1016/j.jhin.2009.07.023] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2009] [Accepted: 07/24/2009] [Indexed: 12/22/2022]
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33
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Biofilm removal by medical device cleaners: comparison of two bioreactor detection assays. J Hosp Infect 2010; 74:160-7. [DOI: 10.1016/j.jhin.2009.10.023] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2009] [Accepted: 10/09/2009] [Indexed: 11/20/2022]
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34
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Hesp J, Poolman T, Budge C, Batten L, Alexander F, McLuckie G, O'Brien S, Wells P, Raven N, Sutton J. Thermostable adenylate kinase technology: a new process indicator and its use as a validation tool for the reprocessing of surgical instruments. J Hosp Infect 2010; 74:137-43. [DOI: 10.1016/j.jhin.2009.07.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2009] [Accepted: 07/24/2009] [Indexed: 11/27/2022]
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Heathcote R, Stadelmann B. Measuring of ATP bioluminescence as a means of assessing washer disinfector performance and potentially as a means of validating the decontamination process. ACTA ACUST UNITED AC 2009. [DOI: 10.1071/hi09019] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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37
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38
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Howlin RP, Harrison J, Secker T, Keevil CW. Acquisition of proteinaceous contamination through the handling of surgical instruments by hospital staff in sterile service departments. J Infect Prev 2009. [DOI: 10.1177/1757177409105073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Using Episcopic Differential Interference Contrast (EDIC) microscopy, this study has investigated the potential reapplication of prote ina ceouscontami napotential reapplication of proteinaceous contamination onto surgical instruments following a washer-disinfector cycle through the handling of staff within the clean room. The deposition of 0.51 ng/mm2 of protein onto surgical grade stainless steel by one finger print alone has been demonstrated. Moreover, using a previously described contamination index, a 5 to 10-fold increase in protein present on surgical instruments was noted following handling by clean-room staff under current departmental practices, relative to instruments handled by staff wearing gloves. While unlikely to pose a direct risk to patient health, subsequent sterilisation will fix protein to an instrument surface thereby decreasing the effectiveness of further decontamination cycles. Current guidelines make no recommendations surrounding the use of gloves by staff working within the clean room. However it is clear that this matter must be reviewed to limit the unnecessary transference of protein to surgical instruments.
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Affiliation(s)
- RP Howlin
- Environmental Healthcare Unit, School of Biological Sciences, University of Southampton, UK,
| | - J. Harrison
- Basingstoke & North Hampshire Hospital, Aldermaston Road, Basingstoke. UK
| | - T. Secker
- Environmental Healthcare Unit, School of Biological Sciences, University of Southampton, UK
| | - CW Keevil
- Environmental Healthcare Unit, School of Biological Sciences, University of Southampton, UK
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Lappalainen SK, Gomatam SV, Hitchins VM. Residual total protein and total organic carbon levels on reprocessed gastrointestinal (GI) biopsy forceps. J Biomed Mater Res B Appl Biomater 2009; 89:172-6. [DOI: 10.1002/jbm.b.31202] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Hall NJ, Kufeji D, Keshtgar A. Out with the old and in with the new: a comparison of rectal suction biopsies with traditional and modern biopsy forceps. J Pediatr Surg 2009; 44:395-8. [PMID: 19231542 DOI: 10.1016/j.jpedsurg.2008.10.093] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2008] [Accepted: 10/23/2008] [Indexed: 11/18/2022]
Abstract
AIMS Rectal suction biopsy, the gold standard for the diagnosis of Hirschsprung disease, has been associated with a varying incidence of complications and inadequate biopsy. The rbi2 is a modern alternative to the 'Noblett' biopsy forceps and has recently become available. The aim of this study was to compare the performance of this novel tool with the Noblett forceps. METHODS Single-center retrospective study of all infants (<1 year) undergoing rectal suction biopsy from January 2004 to December 2007. During the study period, 2 different biopsy forceps were used--the Noblett forceps (first 2.5 years) and the rbi2 (last 1.5 years). A specimen was defined as inadequate if it was too small or contained inadequate submucosa for histological diagnosis. Fisher's Exact test and Mann-Whitney U test were used as appropriate. RESULTS During the study period, 238 specimens were obtained from 88 infants in 102 biopsy episodes. Overall, 13 episodes were inadequate. There were no demographic differences between the 2 groups, and no serious complications (hemorrhage requiring transfusion, rectal perforation, pelvic sepsis) occurred in any infant. A significantly higher proportion of specimens taken with the Noblett forceps were inadequate compared with the rbi2 (Noblett 30/153 [20%] vs rbi2 6/85 [7%]; Relative risk (RR) = 2.8; 95% confidence interval, 1.2-6.3; P = .01). There was a nonsignificantly higher incidence of inadequate biopsy episode with the Noblett forceps compared with the rbi2 (Noblett 10/63 [16%] vs rbi2 3/40 [7%]; RR = 2.2; 95% confidence interval, 0.6-7.3; P = .24). The rbi2 carries a small cost premium for each biopsy episode compared with the Noblett forceps, but this is low when compared with the cost of repeat biopsy. CONCLUSIONS Rectal suction biopsy is a safe procedure with a low incidence of complications. The rbi2 offers superior efficacy over the Noblett forceps, and its use is likely to be more cost-effective.
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Affiliation(s)
- Nigel J Hall
- Department of Paediatric Surgery, University Hospital Lewisham, London, UK.
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Cleanability of dental instruments – implications of residual protein and risks from Creutzfeldt-Jakob disease. Br Dent J 2007; 203:395-401. [DOI: 10.1038/bdj.2007.893] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/15/2007] [Indexed: 11/08/2022]
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Enzymatic detergent use for gastroscope cleaning; surgical hand disinfectants; instrument decontamination; residual protein levels. AORN J 2006. [DOI: 10.1016/s0001-2092(06)63973-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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