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Kremer T, Rowan NJ, McDonnell G. A proposed cleaning classification system for reusable medical devices to complement the Spaulding classification. J Hosp Infect 2024; 145:88-98. [PMID: 38103694 DOI: 10.1016/j.jhin.2023.11.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 11/17/2023] [Accepted: 11/22/2023] [Indexed: 12/19/2023]
Abstract
A central tenet in infection prevention is application of the Spaulding classification system for the safe use of medical devices. Initially defined in the 1950s, this system defines devices and surfaces as being critical, semi-critical or non-critical depending on how they will be used on a patient. Different levels of antimicrobial treatment, defined as various levels of disinfection or sterilization, are deemed appropriate to reduce patient risk of infection. However, a focus on microbial inactivation is insufficient to address this concern, which has been particularly highlighted in routine healthcare facility practices, emphasizing the underappreciated importance of cleaning and achieving acceptable levels of cleanliness. A deeper understanding of microbiology has evolved since the 1950s, which has led to re-evaluation of the Spaulding classification along with a commensurate emphasis on achieving appropriate cleaning. Albeit underappreciated, cleaning has always been important as the presence of residual materials on surfaces can interfere with the efficacy of the antimicrobial process to inactivate micro-organisms, as well as other risks to patients including device damage, malfunction and biocompatibility concerns. Unfortunately, this continues to be relevant, as attested by reports in the literature on the occurrence of device-related infections and outbreaks due to failures in processing expectations. This reflects, in part, increasing sophistication in device features and reuse, along with commensurate manufacturer's instructions for use. Consequently, this constitutes the first description and recommendation of a new cleaning classification system to complement use of the traditional Spaulding definitions to help address these modern-day technical and patient risk challenges. This quantitative risk-based classification system highlights the challenge of efficient cleaning based on the complexity of device features present, as an isolated variable impacting cleaning. This cleaning classification can be used in combination with the Spaulding classification to improve communication of cleaning risk of a reusable medical device between manufacturers and healthcare facilities, and improve established cleaning practices. This new cleaning classification system will also inform future creation, design thinking and commensurate innovations for the sustainable safe reuse of important medical devices.
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Affiliation(s)
- T Kremer
- Centre for Sustainable Disinfection and Sterilization, Bioscience Research Institute, Technological University of the Shannon Midlands Midwest, Athlone, Ireland; Microbiological Quality and Sterility Assurance, Johnson & Johnson, Raritan, NJ, USA.
| | - N J Rowan
- Centre for Sustainable Disinfection and Sterilization, Bioscience Research Institute, Technological University of the Shannon Midlands Midwest, Athlone, Ireland; Department of Nursing and Healthcare, Technological University of the Shannon Midwest Mideast, Athlone, Ireland; SFI-funded CURAM Centre for Medical Device Research, University of Galway, Galway, Ireland
| | - G McDonnell
- Microbiological Quality and Sterility Assurance, Johnson & Johnson, Raritan, NJ, USA
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Clymo J, Bickerton R, McBrinn S, Rollin M. Disinfection of flexible fibre-optic endoscopes out-of-hours: confidential telephone survey of ENT units in England - 20 years on. J Laryngol Otol 2024:1-6. [PMID: 38343197 DOI: 10.1017/s0022215124000240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/17/2024]
Abstract
BACKGROUND Flexible upper aerodigestive endoscopy is often performed in the emergency setting. To prevent nosocomial infection on-call clinicians must have access to decontaminated endoscopes. METHODS A telephone survey of 104 ENT units in England replicated previous cycles conducted 10 and 20 years ago. The on-call clinician was asked about decontamination practices, training and cross-cover. RESULTS Seventy-one clinicians participated of which 68 had an endoscope available out-of-hours. Twenty-five (36.8 per cent) used single-use endoscopes. Twenty-three (51.1 per cent) of the 45 clinicians using re-usable endoscopes decontaminated them themselves, an increase from 43.3 per cent in 2013 and from 35.1 per cent in 2002. Overall 91.2 per cent had safe practices, up from 68.7 per cent in 2013 and 48 per cent in 2002. One hundred per cent had been trained in decontamination, compared to 37.3 per cent in 2013 and 12.1 per cent in 2002. On-call clinicians from the ENT department increased to 91.5 per cent, compared to 63 per cent in 2013. CONCLUSION There has been a dramatic increase in patient safety, underpinned by the introduction of single-use endoscopes, increased training and reduced cross-cover.
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Affiliation(s)
- Jonathon Clymo
- Department of Ear Nose and Throat Surgery, Imperial College Healthcare NHS Trust, London, UK
| | - Robert Bickerton
- Department of Ear Nose and Throat Surgery, Imperial College Healthcare NHS Trust, London, UK
| | - Sarah McBrinn
- Department of Ear Nose and Throat Surgery, Imperial College Healthcare NHS Trust, London, UK
| | - Matthew Rollin
- Department of Ear Nose and Throat Surgery, Imperial College Healthcare NHS Trust, London, UK
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Reynier T, Berahou M, Albaladejo P, Beloeil H. Moving towards green anaesthesia: Are patient safety and environmentally friendly practices compatible? A focus on single-use devices. Anaesth Crit Care Pain Med 2021; 40:100907. [PMID: 34153533 DOI: 10.1016/j.accpm.2021.100907] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 04/07/2021] [Accepted: 04/09/2021] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Discuss if the use of disposable or reusable medical devices leads to a difference in terms of hospital-acquired infection or bacterial contamination. Determine which solution is less expensive and has less environmental impact in terms of carbon footprint, energy and water consumption and amount of waste. METHODS We carried out a narrative review. Articles published in English and French from January 2000 to April 2020 were identified from PubMed. RESULTS We retrieved 81 articles, including 12 randomised controlled trial, 21 literature reviews, 13 descriptive studies, 6 experimental studies, 9 life-cycle studies, 6 cohort studies, 2 meta-analysis, 4 case reports and 8 other studies. It appears that pathogen transmission in the anaesthesia work area is mainly due to the lack of hand hygiene among the anaesthesia team. The benefit of single-use devices on infectious risk is based on weak scientific arguments, while reusable devices have benefits in terms of costs, water consumption, energy consumption, waste, and reducing greenhouse gas emissions. CONCLUSION Disposable medical devices and attire in the operating theatre do not mitigate the infectious risk to the patients but have a greater environmental, financial and social impact than the reusable ones. This study is the first step towards recommendations for more environmental-friendly practices in the operating theatre.
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Affiliation(s)
- Thibault Reynier
- Grenoble-Alpes University Hospital, Department of Anaesthesia and Intensive Care Medicine, F-38000 Grenoble, France
| | - Mathilde Berahou
- University of Rennes, CHU Rennes, Inserm, CIC 1414, COSS U1242, Anaesthesia and Intensive Care Medicine, F-35000 Rennes, France
| | - Pierre Albaladejo
- Grenoble-Alpes University Hospital, Department of Anaesthesia and Intensive Care Medicine, F-38000 Grenoble, France.
| | - Hélène Beloeil
- University of Rennes, CHU Rennes, Inserm, CIC 1414, COSS U1242, Anaesthesia and Intensive Care Medicine, F-35000 Rennes, France
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Rohrmeier C, Schneider-Brachert W, Kühnel T, Hitzenbichler F, Holzmann T, Bohr C. [Hygiene in ENT examination: Fluorescence study with overview of current recommendations]. Laryngorhinootologie 2021; 100:434-442. [PMID: 33851374 DOI: 10.1055/a-1408-7046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Increasing normative demands on patient safety and quality assurance measures, but also the problem of multi-resistant germs and pathogens with a high potential for infection, increase the need for hygienically correct work.In this study, hygienically relevant potential sources of contamination in ENT examinations were to be identified and possible improvement strategies examined.A complete ENT examination was performed by 5 examiners with different professional experience, whose gloves were wetted with fluorescent lotion prior to the examination. Contaminations especially on the examination unit and on the instruments were identified. The potential risk of transmission of pathogens to subsequent patients was assessed using a specially developed score. Various strategies to reduce identified contamination possibilities were developed and thought through.The score of the investigators was very high with an average of 87.4 points (±3.6). The implementation of individual hygiene measures during the examination process would lead to a significant reduction of the score and thus to an improvement in hygiene: No shaking of hands (81.8), additional disinfection of patient's chair (79.8), disinfection of important surfaces (69.8), provision of standard instruments (60.2) or all instruments (32.2), disinfection of all relevant surfaces and provision of all instruments (7.4).The results show very clearly that an ENT examination is a complex procedure from the point of view of hygiene. For reliable protection against possible transmission events, a structured bundling of hygiene measures is therefore necessary.
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Affiliation(s)
- Christian Rohrmeier
- XXXX PRIVATADRESSE XXXX, Straubing.,Fakultät für Medizin, Universität Regensburg, Regensburg.,HNO-Praxis, Straubing
| | - Wulf Schneider-Brachert
- Abteilung für Krankenhaushygiene und Infektiologie, Universitätsklinikum Regensburg, Regensburg
| | - Thomas Kühnel
- Klinik für Hals-Nasen-Ohrenheilkunde, Universität Regensburg, Regensburg
| | - Florian Hitzenbichler
- Abteilung für Krankenhaushygiene und Infektiologie, Universitätsklinikum Regensburg, Regensburg
| | - Thomas Holzmann
- Abteilung für Krankenhaushygiene und Infektiologie, Universitätsklinikum Regensburg, Regensburg
| | - Christopher Bohr
- Klinik für Hals-Nasen-Ohrenheilkunde, Universität Regensburg, Regensburg
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Bowdle A, Jelacic S, Shishido S, Munoz-Price LS. Infection Prevention Precautions for Routine Anesthesia Care During the SARS-CoV-2 Pandemic. Anesth Analg 2020; 131:1342-1354. [DOI: 10.1213/ane.0000000000005169] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Bowdle A, Munoz-Price LS. Preventing Infection of Patients and Healthcare Workers Should Be the New Normal in the Era of Novel Coronavirus Epidemics. Anesthesiology 2020; 132:1292-1295. [PMID: 32195701 PMCID: PMC7155906 DOI: 10.1097/aln.0000000000003295] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2020] [Indexed: 02/06/2023]
Affiliation(s)
- Andrew Bowdle
- From the Department of Anesthesiology, University of Washington, Seattle, Washington (A.B.) Department of Medicine, Division of Infectious Diseases, Medical College of Wisconsin, Milwaukee, Wisconsin (L.S.M.-P.)
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Abstract
Semicritical medical devices are defined as items that come into contact with mucous membranes or nonintact skin (eg, gastrointestinal endoscopes, endocavitary probes). Such medical devices require minimally high-level disinfection. As many of these items are temperature sensitive, low-temperature chemical methods must be used rather than steam sterilization. Strict adherence to current guidelines is required as more outbreaks have been linked to inadequately cleaned or disinfected endoscopes and other semicritical items than any other reusable medical devices.
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8
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Infection prevention in the operating room anesthesia work area. Infect Control Hosp Epidemiol 2018; 40:1-17. [DOI: 10.1017/ice.2018.303] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Surface contamination in the operating room: use of adenosine triphosphate monitoring. J Anesth 2018; 33:85-89. [PMID: 30539274 DOI: 10.1007/s00540-018-2590-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2018] [Accepted: 11/20/2018] [Indexed: 10/27/2022]
Abstract
PURPOSE We prospectively investigated contamination of high-contact surfaces in the operating room (OR) using adenosine triphosphate (ATP) monitoring. We tested whether contamination would increase from morning (AM) to afternoon (PM), despite cleaning between cases. Second, we compared the degree of OR contamination to non-OR control sites. METHODS ORs with high case volumes were selected for the study. Ten sites in each OR were swabbed using the AccuPoint® HC ATP Sanitation Monitoring device, which provided a numerical measure of contamination (relative light units, RLUs). According to the manufacturer, surfaces are considered clean at ≤ 400 RLUs. AM measurements were taken before the start of surgical cases and PM measurements were taken after cases were completed. RESULTS Eighty morning and 70 afternoon samples were obtained from 8 ORs. Apart from the OR floor, laryngoscope handles had the highest level of morning contamination (1204 RLUs, interquartile range 345, 2603), with 75% of AM samples and 100% of PM samples exceeding 400 RLUs. This contamination was comparable to hospital toilet seats (87% of samples exceeding 400 RLUs). No sites showed statistically significant increases in contamination from AM to PM. CONCLUSION Apart from the OR floors, laryngoscope handles emerged as a key OR site where improved cleaning practices may reduce cross-contamination risk. While some sites showed increased contamination over the course of the day, none of these met statistical significance thereby offering tentative evidence that current cleaning practices during case turnover are effective for most sites.
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Tash RME, Wegdan AA, Amer FA, Bassyouni RHA, Botros JM. Pattern of anaesthetic equipment contamination and infection prevention in anaesthesia practice at university hospitals. Indian J Anaesth 2018; 62:786-792. [PMID: 30443062 PMCID: PMC6190425 DOI: 10.4103/ija.ija_41_18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND AND AIMS Infection control is essential in anaesthetic practice for both personnel and equipment used. This study aims to evaluate knowledge of anaesthesiologists about infection control practices and to detect the pattern of anaesthetic devices contamination. METHODS Cross-sectional observational study at two university hospitals was done. Self-administered questionnaires were distributed to 80 anaesthesiologists and 90 nursing staff. Forty-four samples were taken from rigid laryngoscopes (22 pairs from handle and blade) for detection of bacterial or fungal contamination. Same laryngoscopes were tested for occult blood. RESULTS The response rate among the physicians was 72% while for nurses 94.4%. The responses were variable reflecting lack of adequate knowledge and unsatisfactory compliance to infection control practices. Tested samples showed no fungal growth. Fourteen (31.8%) samples were negative for bacteriological contamination and 5/44 (11.4%) showed gram-positive bacilli; gram-positive cocci were isolated from 12 samples (27.3%) where Staphylococcus epidermidis and Staphylococcus aureus, respectively, shared 18.2% and 9.1% of the total samples. Gram-negative bacilli were isolated from 13 samples (29.5%), of which Klebsiella spp. were most frequent (11.4%). Both Pseudomonas aeruginosa and Acinetobacter baumannii were isolated from 6.8% each. Citerobacter spp. was isolated from 4.5%. Occult blood was found in 45.5% of samples. CONCLUSION The current study showed contamination of ready-to-use laryngoscopes in operative theatres and ICUs.
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Affiliation(s)
- Rehab M Elsaid Tash
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Ahmed A Wegdan
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Fayoum University, Fayoum, Egypt
| | - Fatma A Amer
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Rasha H A Bassyouni
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Fayoum University, Fayoum, Egypt
| | - Joseph M Botros
- Department of Anaesthesia, Faculty of Medicine, Fayoum University, Fayoum, Egypt
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11
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Choi JH, Cho YS, Lee JW, Shin HB, Lee IK. Bacterial Contamination and Disinfection Status of Laryngoscopes Stored in Emergency Crash Carts. J Prev Med Public Health 2018; 50:158-164. [PMID: 28605891 PMCID: PMC5495683 DOI: 10.3961/jpmph.17.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Accepted: 03/14/2017] [Indexed: 12/14/2022] Open
Abstract
Objectives To identify bacterial contamination rates of laryngoscope blades and handles stored in emergency crash carts by hospital and area according to the frequency of intubation attempts. Methods One hundred forty-eight handles and 71 blades deemed ready for patient use from two tertiary hospitals were sampled with sterile swabs using a standardized rolling technique. Samples were considered negative (not contaminated) if no colonies were present on the blood agar plate after an 18-hour incubation period. Samples were stratified by hospital and according to the frequency of intubation attempts (10 attempts per year) using the χ2-test and Fisher exact test. Results One or more species of bacteria were isolated from 4 (5.6%) handle tops, 20 (28.2%) handles with knurled surfaces, and 27 (18.2%) blades. No significant differences were found in microbial contamination levels on the handle tops and blades between the two hospitals and two areas according to the frequency of intubation attempts. However, significant differences were found between the two hospitals and two areas in the level of microbial contamination on the handles with knurled surfaces (p<0.05). Conclusions Protocols and policies must be reviewed to standardize procedures to clean and disinfect laryngoscope blades and handles; handles should be re-designed to eliminate points of contact with the blade; and single-use, one-piece laryngoscopes should be introduced.
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Affiliation(s)
- Jae Hyung Choi
- Department of Emergency Medicine, Soonchunhyang University College of Medicine, Cheonan, Korea
| | - Young Soon Cho
- Department of Emergency Medicine, Soonchunhyang University College of Medicine, Cheonan, Korea
| | - Jung Won Lee
- Department of Emergency Medicine, Soonchunhyang University College of Medicine, Cheonan, Korea
| | - Hee Bong Shin
- Department of Emergency Medicine, Soonchunhyang University College of Medicine, Cheonan, Korea
| | - In Kyung Lee
- Department of Emergency Medicine, Soonchunhyang University College of Medicine, Cheonan, Korea
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Alipour N, Karagoz A, Taner A, Gaeini N, Alipour N, Zeytin H, Yildiz F, Durmaz R. Outbreak of Hospital Infection from Biofilm-embedded Pan Drug-resistant Pseudomonas aeroginosa, Due to a Contaminated Bronchoscope. ACTA ACUST UNITED AC 2017; 2. [PMID: 29225413 DOI: 10.21767/2572-5483.100014] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Background Colistin-resistant Pseudomonas aeruginosa (P. aeruginosa) has been defined as pandrug-resistant (PDR) strain. Outbreaks of PDR P. aeruginosa especially in pulmonary tract infections due to contaminated bronchoscopes have rarely been reported. The emergence of pandrug-resistant strains in both CF (Cystic Fibrosis) and non-CF clinical isolates over recent years remains of a great concern. Hospital wards contaminated with PDR P. aeruginosa infection, must be shot down until their eradication. Health Authorities must be informed immediately and infection control strategies must be implemented. Aim To report such an outbreak and modify the infection control strategy in an academic hospital in Ankara Turkey. Methods From October to December 2013, PDR-Pseudomonas aerogionsa were identified from bronchial cultures of 15 patients who had undergone bronchoscopy prior to the infection. Three batches of surveillance cultures were obtained from the environmental objects and healthcare workers related to the procedures. Pulsed-field gel electrophoresis (PFGE) was used for bacterial typing. Antimicrobial susceptibility was assessed by disc diffusion and E-test methods. Findings A total of 70 specimens were obtained during the first surveillance operation. One Colistin-resistant P. aeroginosa was isolated from a bronchoscope. Although the disinfection protocols for bronchoscope were revised and implemented, seven additional bronchial cases were identified thereafter. The pathogen was identified from two subsequent surveillance cultures and was not eliminated until Ethylene oxide sterilization was added to the disinfection protocol. PFGE revealed that all 15 isolates from the patients and the three isolates from the bronchoscope shared a common pattern with minor variance. XbaI restriction enzyme turned out better than SpeI in interpreting bacterial pulse types with BioNumerics 6.0. The most suitable cut off value for SpeI was above 80% Dice similarity while for XbaI above 95%Dice similarity with BioNumerics 6.0. Conclusion The outbreak of "Colistin" pan drug-resistant Pseudomonas aeroginosa was caused by a contaminated bronchoscope and was terminated by the implementation of a revised disinfection protocol for bronchoscope.
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Affiliation(s)
- Nader Alipour
- Department of Microbiology & Biotechnology, Metu, Ankara, Turkey
| | - Alper Karagoz
- Department of Molecular Microbiology, Rafik Saydam Hifzi saha, Ankara, Turkey
| | - Abbas Taner
- Department of Medical Microbiology, Kuru Hospital, Ankara, Turkey
| | - Nasrin Gaeini
- Department of Radiology, SİFA Medical Center, Gebze, Kocaeli, Turkey
| | | | - Hassan Zeytin
- Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Fatih Yildiz
- Department of Microbiology & Biotechnology, Metu, Ankara, Turkey
| | - Riza Durmaz
- Department of Molecular Microbiology, Rafik Saydam Hifzi saha, Ankara, Turkey
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Rutala WA, Weber DJ. Disinfection and Sterilization in Health Care Facilities: An Overview and Current Issues. Infect Dis Clin North Am 2016; 30:609-37. [PMID: 27515140 PMCID: PMC7134755 DOI: 10.1016/j.idc.2016.04.002] [Citation(s) in RCA: 77] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
When properly used, disinfection and sterilization can ensure the safe use of invasive and noninvasive medical devices. The method of disinfection and sterilization depends on the intended use of the medical device: critical items (contact sterile tissue) must be sterilized before use; semicritical items (contact mucous membranes or nonintact skin) must be high-level disinfected; and noncritical items (contact intact skin) should receive low-level disinfection. Cleaning should always precede high-level disinfection and sterilization. Current disinfection and sterilization guidelines must be strictly followed.
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Affiliation(s)
- William A Rutala
- Hospital Epidemiology, University of North Carolina Health Care System, Chapel Hill, NC 27514, USA; Division of Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, NC 27599-7030, USA.
| | - David J Weber
- Hospital Epidemiology, University of North Carolina Health Care System, Chapel Hill, NC 27514, USA; Division of Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, NC 27599-7030, USA
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Reprocessing semicritical items: Current issues and new technologies. Am J Infect Control 2016; 44:e53-62. [PMID: 27131136 DOI: 10.1016/j.ajic.2015.12.029] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Accepted: 12/14/2015] [Indexed: 11/23/2022]
Abstract
Semicritical medical devices are defined as items that come into contact with mucous membranes or nonintact skin (eg, gastrointestinal endoscopes, endocavitary probes). Such medical devices minimally require high-level disinfection. Because many of these items are temperature sensitive, low-temperature chemical methods are usually used rather than steam sterilization. Strict adherence to current guidelines is required because more outbreaks have been linked to inadequately cleaned or disinfected endoscopes and other semicritical items undergoing high-level disinfection than any other reusable medical device.
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15
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Winckworth LC, McLaren E, Lingeswaran A, Kelsey M. Neonatal resuscitation equipment: A hidden risk for our babies? J Paediatr Child Health 2016; 52:518-22. [PMID: 27329905 DOI: 10.1111/jpc.13150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Revised: 11/01/2015] [Accepted: 12/21/2015] [Indexed: 11/30/2022]
Abstract
AIM Neonatal infections carry a heavy burden of morbidity and mortality. Poor practice can result in unintentional colonisation of medical equipment with potentially pathogenic organisms. This study will determine the prevalence and type of bacterial contamination on exposed neonatal resuscitation equipment in different clinical settings and explore simple measures to reduce contamination risk. METHODS A survey determined the rates of resuscitation equipment usage. All environmentally exposed items were identified on resuscitaires hospital-wide and swabbed for bacterial contamination. A new cleaning and storage policy was implemented and the prevalence of environmentally exposed equipment re-measured post-intervention. RESULTS Resuscitation equipment was used in 28% of neonatal deliveries. Bacterial colony forming units were present on 44% of the 236 exposed equipment pieces swabbed. There was no significant difference in contamination rates between equipment types. Coagulase negative staphylococcus was the most prevalent species (59 pieces, 25%) followed by Escherichia coli and Enterobacter cloacae (20 pieces, 9% each). Opened items stored inside plastic remained sterile, whilst those in low-use areas had significantly less contamination than those in high-use areas (22% vs. 51%, P < 0.05). Implementing a simple educational programme led to a significant reduction in environmentally exposed equipment (79% reduction, P < 0.01). CONCLUSIONS Pathogenic bacteria can colonise commonly used pieces of neonatal resuscitation equipment. Whilst the clinical significance remains uncertain, equipment should be kept packaged until required and discarded once open, even if unused. Standardising cleaning policies results in rapid and significant improvements in equipment storage conditions, reducing microbial colonisation opportunities.
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Affiliation(s)
| | - Emma McLaren
- Centre for IH&D, UCL Institute of Child Health, London, UK
| | | | - Michael Kelsey
- Microbiology Department, The Whittington Hospital, London, UK
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16
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Buescher DL, Möllers M, Falkenberg MK, Amler S, Kipp F, Burdach J, Klockenbusch W, Schmitz R. Disinfection of transvaginal ultrasound probes in a clinical setting: comparative performance of automated and manual reprocessing methods. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2016; 47:646-651. [PMID: 26426683 DOI: 10.1002/uog.15771] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Revised: 09/17/2015] [Accepted: 09/26/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVES Transvaginal and intracavitary ultrasound probes are a possible source of cross-contamination with microorganisms and thus a risk to patients' health. Therefore appropriate methods for reprocessing are needed. This study was designed to compare the standard disinfection method for transvaginal ultrasound probes in Germany with an automated disinfection method in a clinical setting. METHODS This was a prospective randomized controlled clinical study of two groups. In each group, 120 microbial samples were collected from ultrasound transducers before and after disinfection with either an automated method (Trophon EPR®) or a manual method (Mikrozid Sensitive® wipes). Samples were then analyzed for microbial growth and isolates were identified to species level. RESULTS Automated disinfection had a statistically significantly higher success rate of 91.4% (106/116) compared with 78.8% (89/113) for manual disinfection (P = 0.009). The risk of contamination was increased by 2.9-fold when disinfection was performed manually (odds ratio, 2.9 (95% CI, 1.3-6.3)). Before disinfection, bacterial contamination was observed on 98.8% of probes. Microbial analysis revealed 36 different species of bacteria, including skin and environmental bacteria as well as pathogenic bacteria such as Staphylococcus aureus, enterobacteriaceae and Pseudomonas spp. CONCLUSIONS Considering the high number of contaminated probes and bacterial species found, disinfection of the ultrasound probe's body and handle should be performed after each use to decrease the risk of cross-contamination. This study favored automated disinfection owing to its significantly higher efficacy compared with a manual method. Copyright © 2015 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- D L Buescher
- Department of Obstetrics and Gynecology, University Hospital Muenster, Muenster, Germany
| | - M Möllers
- Department of Obstetrics and Gynecology, University Hospital Muenster, Muenster, Germany
| | - M K Falkenberg
- Department of Obstetrics and Gynecology, University Hospital Muenster, Muenster, Germany
| | - S Amler
- Institute of Biostatistics and Clinical Research, University of Muenster, Muenster, Germany
| | - F Kipp
- Institute of Hygiene, University of Muenster, Muenster, Germany
| | - J Burdach
- Catalyst Consultants, Sydney, Australia
| | - W Klockenbusch
- Department of Obstetrics and Gynecology, University Hospital Muenster, Muenster, Germany
| | - R Schmitz
- Department of Obstetrics and Gynecology, University Hospital Muenster, Muenster, Germany
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Chawla R, Gupta A, Gupta A, Kumar M. Laryngoscope decontamination techniques: A survey. J Anaesthesiol Clin Pharmacol 2016; 32:99-102. [PMID: 27006551 PMCID: PMC4784224 DOI: 10.4103/0970-9185.175706] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background and Aims: India is a vast country with variable, nonuniform healthcare practices. A laryngoscope is an important tool during general anesthesia and resuscitation. The study aimed to determine the current practices of laryngoscope decontamination in India. Material and Methods: An online survey was conducted amongst 100 anesthesiologists to determine the common methods of laryngoscope decontamination adopted in their settings. The survey was done over 6 months after validating the questionnaire. Results: A total of 73 responses were received out of 100. The result of the survey revealed that there is no uniform technique of laryngoscope decontamination. There is marked variability in techniques followed not only among different institutions, but also within the same institution. Conclusion: There are no fixed protocols adopted for laryngoscope decontamination. Thus, there is a need to develop definitive guidelines on this subject, which can be implemented in India.
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Affiliation(s)
- Rajiv Chawla
- Department of Anaesthesia, G. B. Pant Hospital, New Delhi, India
| | - Akhilesh Gupta
- Department of Anaesthesia, PGIMER, Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | - Anshu Gupta
- Department of Anaesthesia, Lady Hardinge Medical College, New Delhi, India
| | - Mritunjay Kumar
- Ex-Department of Anaesthesia, G. B. Pant Hospital, New Delhi, India
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Laryngoscopes: Evaluation of microbial load of blades. Am J Infect Control 2016; 44:294-8. [PMID: 26775934 DOI: 10.1016/j.ajic.2015.10.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Revised: 10/14/2015] [Accepted: 10/16/2015] [Indexed: 11/22/2022]
Abstract
BACKGROUND Laryngoscope blades were analyzed, and the presence of blood, bodily fluids, and microorganisms was verified, indicating their potential as a source of cross contamination during clinical usage. The way in which the blades are cleaned and disinfected in daily practice may place the patient and health care team at risk. The aim of this study was to determine the bacterial and fungal load on this equipment. METHODS Descriptive cross-sectional study. A total of 83 laryngoscope blades, ready for use, were analyzed for their bacterial and fungal load at 2 university hospitals. RESULTS The microbiologic analysis revealed the presence of microorganisms in 76.2% of cases at institution 1 and 92.7% of cases at institution 2, with microbial loads >10(1) colony forming units in 31.2% and 44.7% of cases, respectively. At both institutions, potentially pathogenic microorganisms were found, including Candida sp, Staphylococcus aureus, Enterococcus faecalis, Streptococcus agalactiae, extended-spectrum β-lactamase-producing Klebsiella pneumoniae, multiresistant Acinetobacter baumannii, Pantoea sp, Enterobacter gergoviae, Escherichia coli, and Proteus mirabilis. CONCLUSIONS These results indicate that the use of laryngoscope blades at these 2 institutions present a potential risk. Based on these findings, action needs to be taken so a higher level of safety can be offered to patients and health care professionals who have direct contact with this equipment.
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Birnbach DJ, Rosen LF, Fitzpatrick M, Carling P, Arheart KL, Munoz-Price LS. A New Approach to Pathogen Containment in the Operating Room: Sheathing the Laryngoscope After Intubation. Anesth Analg 2016. [PMID: 26214550 DOI: 10.1213/ane.0000000000000854] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Anesthesiologists may contribute to postoperative infections by means of the transmission of blood and pathogens to the patient and the environment in the operating room (OR). Our primary aims were to determine whether contamination of the IV hub, the anesthesia work area, and the patient could be reduced after induction of anesthesia by removing the risk associated with contaminants on the laryngoscope handle and blade. Therefore, we conducted a study in a simulated OR where some of the participants sheathed the laryngoscope handle and blade in a glove immediately after it was used to perform an endotracheal intubation. METHODS Forty-five anesthesiology residents (postgraduate year 2-4) were enrolled in a study consisting of identical simulation sessions. On entry to the simulated OR, the residents were asked to perform an anesthetic, including induction and endotracheal intubation timed to approximately 6 minutes. Of the 45 simulation sessions, 15 were with a control group conducted with the intubating resident wearing single gloves, 15 with the intubating resident using double gloves with the outer pair removed and discarded after verified intubation, and 15 wearing double gloves and sheathing the laryngoscope in one of the outer gloves after intubation. Before the start of the scenario, the lips and inside of the mouth of the mannequin were coated with a fluorescent marking gel. After each of the 45 simulations, an observer examined the OR using an ultraviolet light to determine the presence of fluorescence on 25 sites: 7 on the patient and 18 in the anesthesia environment. RESULTS Of the 7 sites on the patient, ultraviolet light detected contamination on an average of 5.7 (95% confidence interval, 4.4-7.2) sites under the single-glove condition, 2.1 (1.5-3.1) sites with double gloves, and 0.4 (0.2-1.0) sites with double gloves with sheathing. All 3 conditions were significantly different from one another at P < 0.001. Of the 18 environmental sites, ultraviolet light detected fluorescence on an average of 13.2 (95% confidence interval, 11.3-15.6) sites under the single-glove condition, 3.5 (2.6-4.7) with double gloves, and 0.5 (0.2-1.0) with double gloves with sheathing. Again, all 3 conditions were significantly different from one another at P < 0.001. CONCLUSIONS The results of this study suggest that when an anesthesiologist in a simulated OR sheaths the laryngoscope immediately after endotracheal intubation, contamination of the IV hub, patient, and intraoperative environment is significantly reduced.
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Affiliation(s)
- David J Birnbach
- From the *Department of Anesthesiology, University of Miami - Jackson Memorial Hospital Center for Patient Safety, University of Miami Miller School of Medicine, Miami, Florida; †Department of Medicine Infectious Diseases, Boston Medical Center, Boston, Massachusetts; ‡Department of Public Health Science, University of Miami Miller School of Medicine, Miami, Florida; and §Institute for Health and Society, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
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Rohrmeier C, Strutz J, Schneider-Brachert W. [Disinfection and recontamination of rigid endoscopes: improved safety using an immersion quiver system]. HNO 2015; 62:746-51. [PMID: 24867489 DOI: 10.1007/s00106-014-2873-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND In Otorhinolaryngology, rigid endoscopes are used daily at a high frequency. There is no consensus for reprocessing these medical instruments. Often immersion disinfection procedures are used. The present study examined the possible risk of recontamination by this disinfection method and investigated the possibility of avoiding this risk by using a new immersion quiver system. METHODS Using coloured markers, a possible contact of the endoscope with the top edges of quivers of different diameters during endoscope removal was tested for. In addition, it was evaluated whether Staphylococcus aureus transfer is possible via this route. The same methodology was applied to a new immersion quiver system. RESULTS Whenever removing the rigid endoscopes from the conventional quiver, these touched the top of the quiver, regardless of its diameter. A transfer of Staphylococcus aureus from the quiver to the endoscope via this route could be detected in five out of eight attempts. During endoscope removal from the new immersion quiver system, no contact of the endoscope with the outer quiver occurred in 20 passes. In none of eight trials was a transfer of Staphylococcus aureus from previously contaminated immersion quivers to the endoscope shown; all immersion quivers were sterile after disinfection. DISCUSSION After conventional immersion disinfection, recontamination of rigid endoscopes by a contaminated quiver edge is possible. An immersion quiver system can resolve this risk of recontamination easily, by decontaminating not only the endoscope, but also the immersion quiver (inner quiver) itself in the disinfectant solution.
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Affiliation(s)
- C Rohrmeier
- Klinik für Hals-Nasen-Ohren-Heilkunde, Universität Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Deutschland,
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Kaye AD, Kaye AM, Urman RD. Disinfection Agents and Antiseptics. ESSENTIALS OF PHARMACOLOGY FOR ANESTHESIA, PAIN MEDICINE, AND CRITICAL CARE 2015. [PMCID: PMC7120559 DOI: 10.1007/978-1-4614-8948-1_35] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Germicidal agents are nonspecific antimicrobial agents that are too toxic to be administered internally but are safe and effective when used topically. When applied to living tissue (e.g., the skin), they are termed antiseptics. When applied to inanimate objects (e.g., environmental surfaces or instruments used to perform medical procedures), they are termed disinfectants. All of these agents work at least by damaging microbial surfaces, often by alkylation, oxidation, or reaction with proteins. Products capable of destroying all forms of microbial life, including bacterial spores, are termed sterilizing agents.
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Affiliation(s)
- Alan David Kaye
- Departments of Anesthesiology and Pharmacology, LSU Health Sciences Center, New Orleans, Louisiana USA
| | - Adam M. Kaye
- Department of Pharmacy Practice, Thomas J. Long School of Pharmacy and Health Sciences, Stockton, California USA
| | - Richard D. Urman
- Center for Perioperative Management and Medical Informatics, Brigham and Women’s Hospital, Boston, Massachusetts USA
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Sakles JC, Patanwala AE, Mosier J, Dicken J, Holman N. Comparison of the reusable standard GlideScope® video laryngoscope and the disposable cobalt GlideScope® video laryngoscope for tracheal intubation in an academic emergency department: a retrospective review. Acad Emerg Med 2014; 21:408-15. [PMID: 24730403 DOI: 10.1111/acem.12351] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2013] [Revised: 10/01/2013] [Accepted: 11/01/2013] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The objective was to compare the first-pass success and clinical performance characteristics of the reusable standard GlideScope® video laryngoscope (sGVL) and the disposable Cobalt GlideScope® video laryngoscope (cGVL). METHODS This was a retrospective analysis of prospectively collected data recorded into a continuous quality improvement database at an urban academic emergency department (ED). The intent of the database is to evaluate operator performance and to track practice patterns used for intubation in the ED. Between July 1, 2007, and June 30, 2013, operators recorded all consecutive intubations performed in the ED. The database included patient demographics and detailed information about each intubation, such as device(s) used, reason for device selection, method of intubation, difficult airway characteristics, number of intubation attempts, and outcome of each attempt. The operator also evaluated the presence of lens fogging and extent of lens contamination. The primary outcome measure was first-pass success. Secondary outcome measures were ultimate success, Cormack-Lehane (CL) view of the airway, presence of lens fogging, and extent of lens contamination. Only adult patients age 18 years or older intubated with the sGVL or cGVL using a stylet, and who had data forms completed at the time of intubation, were included in this study. RESULTS A total of 583 intubations were included in the study, 504 with the sGVL and 79 with cGVL. First pass success was achieved in 81.0% (95% confidence interval [CI]=77.3% to 84.3%) of patients in the sGVL group and in 58.2% (95% CI=46.6% to 69.2%) of patients in the cGVL group. In a multivariate logistic regression analysis, the sGVL was associated with a higher first pass success than the cGVL (odds ratio [OR]=3.3, 95% CI=1.9 to 5.8). The ultimate success of the sGVL was 92.1% (95% CI=89.4% to 94.3%) and the cGVL was 72.2% (95% CI=60.9% to 81.7%). A CL grade I or II view was obtained in 93.2% (95% CI=90.7% to 95.3%) in the sGVL group and 86.1% (95% CI=76.5% to 92.8%) in the cGVL group. Lens fogging occurred in 33.3% (95% CI=29.2% to 37.6%) of the cases in the sGVL group and 59.5% (95% CI=47.9% to 70.4%) of the cases in the cGVL group. Significant lens contamination occurred in 5.0% (95% CI=3.2% to 7.2%) of the sGVL group and 21.5% (95% CI=13.1% to 32.2%) of the cGVL group. CONCLUSIONS In this observational study, the sGVL had higher first pass and overall success than the disposable cGVL. The cGVL had significantly higher incidence of lens fogging and contamination, which may partially account for its lower success. A prospective randomized trial is needed to confirm these findings.
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Affiliation(s)
| | - Asad E. Patanwala
- The Department of Pharmacy Practice and Science; University of Arizona College of Pharmacy; Tucson AZ
| | - Jarrod Mosier
- The Department of Emergency Medicine; Tucson AZ
- The Department of Medicine; Section of Pulmonary; Critical Care; Allergy and Sleep; University of Arizona College of Medicine; Tucson AZ
| | - John Dicken
- The University of Arizona College of Medicine; Tucson AZ
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Chang CL, Su LH, Lu CM, Tai FT, Huang YC, Chang KK. Outbreak of ertapenem-resistant Enterobacter cloacae urinary tract infections due to a contaminated ureteroscope. J Hosp Infect 2013; 85:118-24. [PMID: 23954065 DOI: 10.1016/j.jhin.2013.06.010] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2013] [Accepted: 06/24/2013] [Indexed: 11/30/2022]
Abstract
BACKGROUND Outbreaks of urinary tract infections (UTIs) due to contaminated ureteroscopes have been rarely reported. AIM To report such an outbreak at a regional teaching hospital in southern Taiwan. METHODS From October to December 2010, ertapenem-resistant Enterobacter cloacae were identified from urine cultures of 15 patients who had undergone ureteroscopy prior to the infection. Three batches of surveillance cultures were obtained from the environmental objects and healthcare workers related to the procedures. Pulsed-field gel electrophoresis (PFGE) was used for bacterial typing. Antimicrobial susceptibility was assessed by disc diffusion and E-test methods. Polymerase chain reaction and sequencing were used to analyse β-lactamase genes. FINDINGS A total of 70 specimens were obtained during the first surveillance operation. One ertapenem-resistant E. cloacae was isolated from a ureteroscope. Although the disinfection protocols for ureteroscopes were revised and implemented, seven additional UTI cases were identified thereafter. The pathogen was identified from two subsequent surveillance cultures and was not eliminated until ethylene oxide sterilization was added to the disinfection protocol. PFGE revealed that all 15 isolates from the patients and the three isolates from the ureteroscope shared a common pattern with minor variance. Most isolates were resistant to gentamicin, levofloxacin, ceftriaxone, ceftazidime, and ertapenem. All isolates were susceptible to amikacin, imipenem, and meropenem. SHV-12 and IMP-8 genes were simultaneously identified in 16 of the 18 isolates. CONCLUSION The outbreak of ertapenem-resistant E. cloacae was caused by a contaminated ureteroscope and was terminated by the implementation of a revised disinfection protocol for ureteroscopes.
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Affiliation(s)
- C-L Chang
- Committee of Infection Control, Tainan Municipal Hospital, Tainan, Taiwan
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Rutala WA, Weber DJ. New developments in reprocessing semicritical items. Am J Infect Control 2013; 41:S60-6. [PMID: 23622752 DOI: 10.1016/j.ajic.2012.09.028] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2012] [Revised: 09/07/2012] [Accepted: 09/10/2012] [Indexed: 10/26/2022]
Abstract
Semicritical medical devices are defined as items that come into contact with mucous membranes or nonintact skin (eg, gastrointestinal endoscopes). Such medical devices require minimally high-level disinfection. Because many of these items are temperature sensitive, low-temperature chemical methods must be used rather than steam sterilization. Strict adherence to current guidelines is required because more outbreaks have been linked to inadequately cleaned or disinfected endoscopes undergoing high-level disinfection than any other medical device.
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Laryngoscope blades and handles as sources of cross-infection: an integrative review. J Hosp Infect 2013; 83:269-75. [DOI: 10.1016/j.jhin.2012.10.015] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2012] [Accepted: 10/24/2012] [Indexed: 12/20/2022]
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Baker PA, Flanagan BT, Greenland KB, Morris R, Owen H, Riley RH, Runciman WB, Scott DA, Segal R, Smithies WJ, Merry AF. Equipment to manage a difficult airway during anaesthesia. Anaesth Intensive Care 2011; 39:16-34. [PMID: 21375086 DOI: 10.1177/0310057x1103900104] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Airway complications are a leading cause of morbidity and mortality in anaesthesia. Effective management of a difficult airway requires the timely availability of suitable airway equipment. The Australian and New Zealand College of Anaesthetists has recently developed guidelines for the minimum set of equipment needed for the effective management of an unexpected difficult airway (TG4 [2010] www.anzca.edu.au/resources/professionaldocuments). TG4 [2010] is based on expert consensus, underpinned by wide consultation and an extensive review of the available evidence, which is summarised in a Background Paper (TG4 BP [2010] www.anzca.edu.au/ resources/professional-documents). TG4 [2010] will be reviewed at the end of one year and thereafter every five years or more frequently if necessary. The current paper is reproduced directly from the Background Paper (TG4 BP [2010]).
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Affiliation(s)
- P A Baker
- Australian and New Zealand College of Anaesthetists, Melbourne, Victoria, Australia
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Jabre P, Galinski M, Ricard-Hibon A, Devaud ML, Ruscev M, Kulstad E, Vicaut E, Adnet F, Margenet A, Marty J, Combes X. Out-of-hospital tracheal intubation with single-use versus reusable metal laryngoscope blades: a multicenter randomized controlled trial. Ann Emerg Med 2010; 57:225-31. [PMID: 21129822 DOI: 10.1016/j.annemergmed.2010.10.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2010] [Revised: 09/24/2010] [Accepted: 10/25/2010] [Indexed: 11/19/2022]
Abstract
STUDY OBJECTIVE Emergency tracheal intubation is reported to be more difficult with single-use plastic than with reusable metal laryngoscope blades in both inhospital and out-of-hospital settings. Single-use metal blades have been developed but have not been compared with conventional metal blades. This controlled trial compares the efficacy and safety of single-use metal blades with reusable metal blades in out-of-hospital emergency tracheal intubation. METHODS This randomized controlled trial was carried out in France with out-of-hospital emergency medical units (Services de Médecine d'Urgence et de Réanimation). This was a multicenter prospective noninferiority randomized controlled trial in adult out-of-hospital patients requiring emergency tracheal intubation. Patients were randomly assigned to either single-use or reusable metal laryngoscope blades and intubated by a senior physician or a nurse anesthetist. The primary outcome was first-pass intubation success. Secondary outcomes were incidence of difficult intubation, need for alternate airway devices, and early intubation-related complications (esophageal intubation, mainstem intubation, vomiting, pulmonary aspiration, dental trauma, bronchospasm or laryngospasm, ventricular tachycardia, arterial desaturation, hypotension, or cardiac arrest). RESULTS The study included 817 patients, including 409 intubated with single-use blades and 408 with a reusable blade. First-pass intubation success was similar in both groups: 292 (71.4%) for single-use blades, 290 (71.1%) for reusable blades. The 95% confidence interval (CI) for the difference in treatments (0.3%; 95% CI -5.9% to 6.5%) did not include the prespecified inferiority margin of -7%. There was no difference in rate of difficult intubation (difference 3%; 95% CI -7% to 2%), need for alternate airway (difference 4%; 95% CI -8% to 1%), or early complication rate (difference 3%; 95% CI -3% to 8%). CONCLUSION First-pass out-of-hospital tracheal intubation success with single-use metal laryngoscopy blades was noninferior to first-pass success with reusable metal laryngoscope blades.
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Affiliation(s)
- Patricia Jabre
- Institut National de la santé et de la Recherche Médicale, U970 (Cardiovascular Research Centre), Paris, France
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Evaluation of the Risk of Transmission of Bacterial Biofilms and Clostridium difficile During Gastrointestinal Endoscopy. Gastroenterol Nurs 2010; 33:28-35. [DOI: 10.1097/sga.0b013e3181cd199f] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
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Call TR, Auerbach FJ, Riddell SW, Kiska DL, Thongrod SC, Tham SW, Nussmeier NA. Nosocomial contamination of laryngoscope handles: challenging current guidelines. Anesth Analg 2009; 109:479-83. [PMID: 19608822 DOI: 10.1213/ane.0b013e3181ac1080] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Laryngoscope blades are often cleaned between cases according to well-defined protocols. However, despite evidence that laryngoscope handles could be a source of nosocomial infection, neither our institution nor the American Society of Anesthesiologists has any specific guidelines for handle disinfection. We hypothesized that laryngoscope handles may be sufficiently contaminated with bacteria and viruses to justify the implementation of new handle-cleaning protocols. METHODS Sixty laryngoscope handles from the adult operating rooms were sampled with premoistened sterile swabs. Collection was performed between cases, in operating rooms hosting a broad variety of subspecialty procedures, after the room and equipment had been thoroughly cleaned for the subsequent case. Samples from 40 handles were sent for aerobic bacterial culture, and antimicrobial susceptibility testing was performed for significant isolates. Samples from 20 handles were examined for viral contamination using a polymerase chain reaction assay that detects 17 respiratory viruses. RESULTS Of the 40 samples sent for culture, 30 (75%) were positive for bacterial contamination. Of these positive cultures, 25 (62.5%) yielded coagulase-negative staphylococci, seven (17.5%) Bacillusspp. not anthracis, three (7.5%) alpha-hemolytic Streptococcusspp., and one each (2.5%) of Enterococcusspp., Staphylococcus aureus(S. aureus), and Corynebacteriumspp. No vancomycin-resistant enterococci, methicillin-resistant S. aureus, or Gram-negative rods were detected. All viral tests were negative. CONCLUSION We found a high incidence of bacterial contamination of laryngoscope handles despite low-level disinfection. However, no vancomycin-resistant enterococci, methicillin-resistant S. aureus, Gram-negative rods, or respiratory viruses were detected. Our results support adoption of guidelines that include, at a minimum, mandatory low-level disinfection of laryngoscope handles after each patient use.
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Affiliation(s)
- Tyler R Call
- Department of Anesthesiology, College of Medicine, State University of NY Upstate Medical University, Syracuse, New York 13210, USA
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Abstract
PURPOSE OF REVIEW Recent outbreaks of nosocomial infection and pseudoinfection have been linked to contaminated endoscopes. This review summarizes the recent literature, analyzes the latest published information related to the epidemiology, examines potential causes for the outbreaks, and discusses current alternatives for preventing infection. RECENT FINDINGS A systematic follow-up of patients revealed that the risk of infection attributed to inadequate endoscope reprocessing was very low. Nevertheless, inadequate reprocessing practices are still considered the main culprit underlying contamination from endoscopy procedures. Moreover, standards of care are difficult to maintain given the numerous inconsistencies that exist among reprocessing guidelines and manufacturer's recommended practices. Exposure to contaminated equipment could be prevented through better reprocessing practices and adherence to decontamination guidelines. Recent literature reinforces the need for endoscopy drying after each reprocessing cycle, endoscope reprocessing after short periods of disuse, surveillance, and for a coordinated approach to handle postcontamination responses. Additional analyses such as health technology assessment and cost analysis are needed to identify control alternatives that are most effective. SUMMARY Although the risk of endoscopy-related infection is very low, continued efforts are needed to ensure that quality is maintained during endoscope reprocessing to reduce the incidence of endoscopy-related infections.
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