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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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Rutala WA, Weber DJ. Reprocessing semicritical items: An overview and an update on the shift from HLD to sterilization for endoscopes. Am J Infect Control 2023; 51:A96-A106. [PMID: 37890958 DOI: 10.1016/j.ajic.2023.01.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 01/04/2023] [Indexed: 10/29/2023]
Abstract
BACKGROUND Semicritical medical devices are defined as items that come into contact with mucous membranes or nonintact skin (e.g., gastrointestinal endoscopes, endocavitary probes). Such medical devices require minimally high-level disinfection. METHODS Analyze the methods used to reprocess semicritical medical devices and identify methods and new technologies to reduce the risk of infection. RESULTS The reprocessing methods for semicritical medical devices is described as well as a shift from high-level disinfection to sterilization for lumened endoscopes. CONCLUSIONS Strict adherence to current guidelines and transition to sterilization for endoscopes is required as more outbreaks have been linked to inadequately disinfected endoscopes and other semicritical items than any other reusable medical devices.
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Affiliation(s)
- William A Rutala
- Statewide Program for Infection Control and Epidemiology, University of North Carolina Hospitals, Chapel Hill, NC; Division of Infectious Diseases, UNC School of Medicine, Chapel Hill, NC.
| | - David J Weber
- Statewide Program for Infection Control and Epidemiology, University of North Carolina Hospitals, Chapel Hill, NC; Division of Infectious Diseases, UNC School of Medicine, Chapel Hill, NC; Department of Infection Prevention, Hospital Epidemiology, University of North Carolina Hospitals, Chapel Hill, NC
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Guidelines for infection control and prevention in anaesthesia in South Africa. SOUTHERN AFRICAN JOURNAL OF ANAESTHESIA AND ANALGESIA 2021. [DOI: 10.36303/sajaa.2021.27.4.s1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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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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Nielsen SW, Stevens JR, Stevens GJ, Patel J, Eller RL. Mandated wrapping of airway cart instruments: Limited access without the intended safety benefits. Laryngoscope 2018; 129:715-719. [PMID: 30549057 DOI: 10.1002/lary.27503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/16/2018] [Indexed: 11/07/2022]
Abstract
OBJECTIVES/HYPOTHESIS Isolated case studies have shown improper sterilization or contamination of equipment from anesthesia carts can lead to transmission of disease and even death. Citing this literature, national accrediting agencies mandated all instruments in the otolaryngology airway carts at San Antonio Military Medical Center be packaged to prevent contamination. This study sought to determine the infection and safety implications of packaged airway cart instruments. STUDY DESIGN Retrospective chart review. METHODS A review of upper aerodigestive tract procedures, some of which penetrated mucosa, was performed by analyzing 100 patient records during the unpackaged period and 100 during the packaged period. A comparison of infections, deaths, and length of stay in the hospital was included in the analysis. Additionally, a timed simulation to setup a simple group of instruments for an emergency airway situation from both the unpackaged and packaged airway carts was performed using a total of 11 surgical technologists and nurses. RESULTS Each group had a total of four airway infections and neither had any deaths. The average length of hospital stay was 0.36 days for the unpackaged period and 0.44 days from the packaged period. None of these variables reached statistical significance. The average time to find and set out the correct instruments for the two groups was 46.6 and 95.5 seconds for the unpackaged and packaged airway carts, respectively (P = .004). CONCLUSIONS This study suggests individually packaging of instruments used for emergency airway cases may put lives at risk when time matters and fails to decrease the risk of infection. LEVEL OF EVIDENCE 3 Laryngoscope, 129:715-719, 2019.
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Affiliation(s)
- Skyler W Nielsen
- Department of Otolaryngology, Tripler Army Medical Center, 1 Jarrett White Rd, HI, 96859
| | - Jayne R Stevens
- San Antonio Uniformed Services Health Education Consortium, Fort Sam Houston, Texas.,Department of Head and Neck Oncological Surgery, Madigan Army Medical Center, Department of Otolaryngology, 9040 Jackson Ave, Tacoma, WA 98431, University of Michigan, Ann Arbor, Michigan
| | - Gregory J Stevens
- Department of Otolaryngology, Tripler Army Medical Center, 1 Jarrett White Rd, HI, 96859
| | - Jagatkumar Patel
- Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Robert L Eller
- Greenville Voice Center, Greenville ENT Associates, Greenville Health System, Greenville, South Carolina, U.S.A
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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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Sherman JD, Hopf HW. Balancing Infection Control and Environmental Protection as a Matter of Patient Safety. Anesth Analg 2018; 127:576-579. [DOI: 10.1213/ane.0000000000002759] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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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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Shah SB, Bhargava AK. Recent advances in low temperature sterilization - Moving ahead from Cidex™/ETO to OPA/Ozone: An update. Indian J Anaesth 2017; 61:855-857. [PMID: 29242666 PMCID: PMC5664899 DOI: 10.4103/ija.ija_281_17] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Karnik PP, Dave NM, Nataraj G, Gupta R, Garasia M. Comparison of efficacy and cost-effectiveness of 0.55% ortho-phthalaldehyde and 2% glutaraldehyde for disinfection of laryngoscopes: A prospective pilot study. Indian J Anaesth 2017; 61:490-493. [PMID: 28655955 PMCID: PMC5474918 DOI: 10.4103/ija.ija_22_17] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND AND AIMS The laryngoscope is a potential source of cross-infection as it involves contact with the mucous membrane, saliva and occasionally blood. This study compared efficacy and cost-effectiveness of two Centre for Disease Control approved agents for disinfection of laryngoscope blades. METHODS One hundred and sixty patients requiring laryngoscopy and intubation for general anaesthesia were randomly allocated into two groups. After tracheal intubation, used laryngoscope blades were cleaned with tap water. The blades were then immersed in either 2% w/v glutaraldehyde for a contact time of 20 min or 0.55% w/v ortho-phthalaldehyde (OPA) for 10 min. The handles were wiped with 0.5% w/v chlorhexidine wipes. Samples were collected using sterile cotton swabs from the tip, flange and light bulb area of the laryngoscope blade and one from the handle. They were cultured aerobically on blood and McConkey agar. RESULTS In 2% glutaraldehyde group, of 240 samples sent from the blades, 2 (0.8%) showed the growth of methicillin-resistant coagulase-negative staphylococci (MRCONS) and Enterobacter. In OPA group, of 240 samples, 2 (0.8%) showed growth of MRCONS. Thus, 2% glutaraldehyde and 0.55% OPA were comparable in terms of efficacy of disinfection. Growth was seen on 4 out of 160 handles. CONCLUSIONS We suggest OPA for high-level disinfection of laryngoscope blades as it is equally efficacious as compared to glutaraldehyde, with a shorter contact time and available as a ready to use formulation.
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Affiliation(s)
- Priyanka Pradeep Karnik
- Department of Anesthesiology, Seth G. S. Medical College, K.E.M. Hospital, Mumbai, Maharashtra, India
| | - Nandini Malay Dave
- Department of Anesthesiology, Seth G. S. Medical College, K.E.M. Hospital, Mumbai, Maharashtra, India
| | - Gita Nataraj
- Department of Microbiology, Seth G. S. Medical College, K.E.M. Hospital, Mumbai, Maharashtra, India
| | - Rajarshi Gupta
- Department of Microbiology, Seth G. S. Medical College, K.E.M. Hospital, Mumbai, Maharashtra, India
| | - Madhu Garasia
- Department of Anesthesiology, Seth G. S. Medical College, K.E.M. Hospital, Mumbai, Maharashtra, India
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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: 80] [Impact Index Per Article: 10.0] [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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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: 13] [Impact Index Per Article: 1.6] [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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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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Birnbach DJ, Rosen LF, Fitzpatrick M, Carling P, Arheart KL, Munoz-Price LS. Double gloves: a randomized trial to evaluate a simple strategy to reduce contamination in the operating room. Anesth Analg 2015; 120:848-52. [PMID: 24836472 DOI: 10.1213/ane.0000000000000230] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Oral flora, blood-borne pathogens, and bacterial contamination pose a direct risk of infection to patients and health care workers. We conducted a study in a simulated operating room using a newly validated technology to determine whether the use of 2 sets of gloves, with the outer set removed immediately after endotracheal intubation, may reduce this risk. METHODS Forty-one anesthesiology residents (PGY 2-4) were enrolled in a study consisting of individual or group simulation sessions. On entry to the simulated operating room, the residents were asked to perform an anesthetic induction and tracheal intubation timed to approximately 6 minutes; they were unaware of the study design. Of the 22 simulation sessions, 11 were conducted with the intubating resident wearing single gloves, and 11 with the intubating resident using double gloves with the outer pair removed after verified intubation. Before the start of the scenario, we coated the lips and inside of the mouth of the mannequin with a fluorescent marking gel as a surrogate pathogen. After the simulation, an observer examined 40 different sites using a handheld ultraviolet light in the operating room to determine the transfer of surrogate pathogens to the patient and the patient's environment. Residents who wore double gloves were instructed by a confederate nurse to remove the outer set immediately after completion of the intubation. Forty sites of potential intraoperative pathogen spread were identified and assigned a score. RESULTS The difference in the rate of contamination between anesthesiology residents who wore single gloves versus those with double gloves was clinically and statistically significant. The number of sites that were contaminated in the operating room when the intubating resident wore single gloves was 20.3 ± 1.4 (mean ± SE); the number of contaminated sites when residents wore double gloves was 5.0 ± 0.7 (P < 0.001). CONCLUSIONS The results of this study suggest that when an anesthesiologist wears 2 sets of gloves during laryngoscopy and intubation and then removes the outer set immediately after intubation, the contamination of the intraoperative environment is dramatically reduced.
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Affiliation(s)
- David J Birnbach
- From the *Department of Anesthesiology, UM-JMH Center for Patient Safety, and the †Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, Florida; and ‡Department of Medicine Infectious Diseases, Boston Medical Center, Boston, Massachusetts
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Cowperthwaite L, Holm RL. Guideline Implementation: Surgical Instrument Cleaning. AORN J 2015; 101:542-9; quiz 550-2. [DOI: 10.1016/j.aorn.2015.03.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Accepted: 03/17/2015] [Indexed: 10/23/2022]
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Chlorhexidine to maintain cleanliness of laryngoscope handles: an audit and laboratory study. Eur J Anaesthesiol 2014; 30:216-21. [PMID: 23511956 DOI: 10.1097/eja.0b013e3283607827] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
CONTEXT Laryngoscope handles are a potential vector for infection transmission and require adequate decontamination. OBJECTIVE To establish an effective cleaning regimen for laryngoscope handles. DESIGN Three laboratory studies and an audit cycle. SETTING The Queen Elizabeth Hospital, King's Lynn, UK. MATERIALS Twenty Heine laryngoscope handles. INTERVENTIONS Twenty laryngoscope handles were contaminated with microbial broth and then disinfected with chemical wipes, either using Sani-Cloth CHG 2% (chlorhexidine 2%/alcohol 70%) or Tuffie 5 wipes. This was repeated with an interval of 24 h between cleaning and contamination. A further experiment repeatedly re-contaminated the handles at varying time intervals after cleaning. The audit established the current level of contamination of laryngoscope handles within the hospital, and this was repeated following a change in cleaning protocol. MAIN OUTCOME MEASURES Bacterial growth on agar plates was counted as the number of colony forming units. RESULTS Both Sani-Cloth CHG 2% and Tuffie 5 wipes were effective against microorganisms, including methicillin-resistant Staphylococcus aureus, immediately following wiping (P = 0.002). However, the chlorhexidine wipes also had a residual effect such that after wiping, the handle remained sterile following further contamination and this effect persisted for 24 h. Audit following the introduction of this practice showed significant improvements in the incidence and extent of contamination compared with the previous disinfection practice (P<0.002). CONCLUSION Decontamination with Sani-Cloth CHG 2% wipes confers additional advantages over routine autoclaving or handle disposal, due to a residual effect. Autoclaving handles may be desirable on a scheduled basis and if Clostridium difficile is encountered.
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Samuel RA, Gopalan PD, Coovadia Y, Samuel R. Infection control in anaesthesia in regional, tertiary and central hospitals in KwaZulu-Natal. Part 3: Decontamination practices. SOUTHERN AFRICAN JOURNAL OF ANAESTHESIA AND ANALGESIA 2014. [DOI: 10.1080/22201173.2013.10872925] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- RA Samuel
- Department of Anaesthesiology, King Edward VIII Hospital; Nelson R Mandela School of Medicine, University of KwaZulu-Natal
| | - PD Gopalan
- Department of Anaesthesiology, Nelson R Mandela School of Medicine, University of KwaZulu-Natal
| | | | - R Samuel
- Inkosi Albert Luthuli Central Hospital
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Samuel RA, Gopalan PD, Coovadia Y, Samuel R. Infection control in anaesthesia in regional, tertiary and central hospitals in KwaZulu-Natal. Part 2: Equipment contamination. SOUTHERN AFRICAN JOURNAL OF ANAESTHESIA AND ANALGESIA 2014. [DOI: 10.1080/22201173.2013.10872914] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- RA Samuel
- Department of Anaesthesiology King Edward VIII Hospital; Nelson R Mandela School of Medicine, University of KwaZulu-Natal
| | - PD Gopalan
- Department of Anaesthesiology, Nelson R Mandela School of Medicine, University of KwaZulu-Natal
| | | | - R Samuel
- Inkosi Albert Luthuli Central Hospital
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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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Use of a systematic review to inform the infection risk for biomedical engineers and technicians servicing biomedical devices. AUSTRALASIAN PHYSICAL & ENGINEERING SCIENCES IN MEDICINE 2011; 34:431-40. [DOI: 10.1007/s13246-011-0103-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2010] [Accepted: 09/05/2011] [Indexed: 10/16/2022]
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