Microwave inactivation of Bacillus atrophaeus spores in healthcare waste

A study of the effect of testing for diversification of healthcare waste sterilization and crushing facilities

This study conducted sterilization testing under different conditions using different strains for sterilization and crushing, the intermediate healthcare waste treatment phase, and proposed strategies for diversifying corresponding facilities in addition to promoting their installation. Five indicator microorganisms were selected to test the sterilization efficiency of steam, microwave, and chemical methods. Steam sterilization testing was conducted in accordance with legal and technological standards, microwave testing was carried out according to the legal standard, and chemical sterilization employed three typical compounds. Steam and microwave sterilization achieved 99.9999 % inactivation rates for all five strains under both conditions used; whereas under the chemical sterilization analyses, sodium hypochlorite (1000 ppm) failed to meet the inactivation requirement of the fungal strain Candida albicans, requiring further investigation. Based on these findings, this study presents strategies for diversifying sterilization·crushing facilities and promoting their installation.

Assessment of the response of indigenous microflora and inoculated Bacillus licheniformis endospores in reconstituted skim milk to microwave and conventional heating systems by flow cytometry

Heat treatment is one of the most widely used processing technologies in the dairy industry. Its primary purpose is to destroy microorganisms, both pathogenic and spoilage, to ensure the product is safe and has a reasonable shelf life. In this study microwave volumetric heating (MVH) was compared with a conventional tubular heat exchanger (THE), in terms of the effects of each at a range of temperatures (75°C, 85°C, 95°C, 105°C, 115°C, and 125°C) on indigenous microflora viability and the germination of inoculated Bacillus licheniformis endospores in reconstituted skim milk. To assess the heat treatment-related effects on microbial viability, classical agar-based tests were applied to obtain the counts of 4 various microbiological groups including total bacterial, thermophilic bacterial, mesophilic aerobic bacterial endospore, and thermophilic aerobic bacterial endospore counts, and additional novel insights into cell permeability and spore germination profiles post-heat treatment were obtained using real-time flow cytometry (FC) methods. No significant differences in the plate counts of the indigenous microorganisms tested, the plate counts of the inoculated B. licheniformis, or the relative percentage of germinating endospores were observed between MVH- and THE-treated samples, at equal temperatures in the range specified above, indicating that both methods inactivated inoculated endospores to a similar degree (up to 70% as measured by FC and 5 log reduction as measured by plate counting for some treatments of inoculated endospores). Furthermore, increased cell permeability of indigenous microflora was observed by FC after MVH compared with THE treatment of uninoculated skim milk, which was reflected in lower total bacterial count at a treatment temperature of 105°C. This work demonstrates the utility of FC as a rapid method for assessing cell viability and spore inactivation for postthermal processing in dairy products and overall provides evidence that MVH is at least as effective at eliminating native microflora and inoculated B. licheniformis endospores as THE.

Review of Current Healthcare Waste Management Methods and Their Effect on Global Health

Healthcare is a rapidly growing industry as medical treatments become more sophisticated, more in demand due to increasing incidence of chronic disease and more widely available worldwide. This booming industry is also creating more waste than ever before and, as such, there is a growing need to treat and dispose of this waste. Healthcare waste (HCW) disposal includes a multitude of disposal methods, including incineration, landfilling and chemical treatments. These rudimentary methods and their growing use present their own problems that negatively impact both the environment and, in turn, damage public health, thus contributing to a global healthcare crisis. The aim of this review was to examine the current HCW disposal methods in place and the harmful effects they have on the environment and on public health. The findings accumulated in this review demonstrate a heavy reliance on basic, low tech HCW disposal techniques and uncovered the negative impacts of these methods. There is a notable lack of employment of "greener" HCW disposal methods on a largescale due to cost, access and feasibility. Despite innovations in HCW disposal, there is no scalable, global green solution at present. Further, the review highlights that global health consequences of HCW disposal methods often differ depending on how developed the country is.

Emergency response to the explosive growth of health care wastes during COVID-19 pandemic in Wuhan, China

During the Coronavirus Disease 2019 (COVID-19) as a worldwide pandemic, the security management of health care wastes (HCWs) has attracted increasing concern due to their high risk. In this paper, the integrated management of HCWs in Wuhan, the first COVID-19-outbreaking city with over ten millions of people completely locking down, was collected, investigated and analyzed. During the pandemic, municipal solid wastes (MSWs) from designated hospitals, Fangcang shelter hospitals, isolation locations and residential areas (e.g. face masks) were collected and categorized as HCWs due to the high infectiousness and strong survivability of COVID-19, and accordingly the average production of HCWs per 1000 persons in Wuhan explosively increased from 3.64 kg/d to 27.32 kg/d. Segregation, collection, storage, transportation and disposal of HCWs in Wuhan were discussed and outlined. Stationary facilities, mobile facilities, co-processing facilities (Incineration plants for MSWs) and nonlocal disposal were consecutively utilized to improve the disposal capacity, from 50 tons/d to 280.1 tons/d. Results indicated that stationary and co-processing facilities were preferential for HCWs disposal, while mobile facilities and nonlocal disposal acted as supplementary approaches. Overall, the improved system of HCWs management could meet the challenge of the explosive growth of HCWs production during COVID-19 pandemic in Wuhan. Furthermore, these practices could provide a reference for other densely populated metropolises.

The Use of UVC Irradiation to Sterilize Filtering Facepiece Masks Limiting Airborne Cross-Infection

In addition to looking for effective drugs and a vaccine, which are necessary to save and protect human health, it is also important to limit, or at least to slow, the spread of coronavirus. One important element in this action is the use of individual protective devices such as filtering facepiece masks. Currently, masks that use a mechanical filter, such as a HEPA (High Efficiency Particulate Air) filter, are often used. In some countries that do not have a well-developed healthcare system or in exceptional situations, there is a real and pressing need to restore filters for reuse. This article presents technical details for a very simple device for sterilization, including of HEPA polymer filters. The results of biological and microscopic tests confirming the effectiveness of the sterilization performed in the device are presented. The compact and portable design of the device also allows its use to disinfect other small surfaces, for example a small fragment of a floor, table, or bed.

Dynamic assessment of economic and environmental performance index and generation, composition, environmental and human health risks of hospital solid waste in developing countries; A state of the art of review

Many studies have been conducted on hospital solid waste management (HSWM) throughout the world, especially developing countries. This interdisciplinary study aims to summarize the available knowledge on the health and environmental risks of hospital solid waste (HSW) and also, develop a dynamic associational assessment among hospital solid waste generation rate (HSWGR), hospital solid waste composition (HSWC), gross domestic product (GDP) per capita, and environmental performance index (EPI) in some developing countries for the first time. The results of this study showed that researchers from India, China, Pakistan, Brazil, and Iran had found more evidence about the health, economic, and environmental issues in HSW than the other developing countries. The literature showed that the highest and lowest reported HSWGR (in national average level) belonged to Ethiopia (6.03) and India (0.24) kg bed ^-1 day^-1, respectively. It has also been shown that all studied countries except Serbia, have higher levels of hazardous waste in their HSWC, based on the WHO's standard. Furthermore, the quantity and quality of HSW in developing countries depend on the service provided by the hospital, type of hospital, HSWM system, and the level of regional economic and culture. The association analysis showed that the EPI and GDP per capita of developing countries were significantly (p-value <0.05) associated with HSWGR, non-hazardous HSW, and hazardous HSW by the Spearman coefficients equal to 0.389, 0.118, -0.118, and 0.122, 0.216, and -0.346, respectively. However, it can be concluded that GDP per capita and EPI have a weak correlation with hazardous HSW and non-hazardous HSW. Moreover, HSW has many hazardous health and environmental risks such as dioxin and furan, that must be controlled and managed through implementing programs and policies based on sustainable development. As a final point, we believed that the present study can be considered to be a guide for future studies on HSWM in developing countries.

Microwave Technologies: An Emerging Tool for Inactivation of Biohazardous Material in Developing Countries

Inappropriate treatment and disposal of waste containing biohazardous materials occurs especially in developing countries and can lead to adverse effects on public and occupational health and safety, as well as on the environment. For the treatment of biohazardous waste, microwave irradiation is an emerging tool. It is a misbelief that microwave devices cannot be used for inactivation of solid biohazardous waste; however, the inactivation process, and especially the moisture content, has to be strictly controlled, particularly if water is required to be added to the process. Appropriate control allows also inactivation of waste containing inhomogeneous compositions of material with low fluid/moisture content. Where appropriate, especially where control of transport of waste cannot be guaranteed, the waste should be inactivated directly at the place of generation, preferably with a closed waste collection system. In waste containing sufficient moisture, there are direct useful applications, for example the treatment of sewage sludge or human feces. A number of examples of microwave applications with impacts for developing countries are presented in this review. In respect to energy costs and environmental aspects, microwave devices have clear advantages in comparison to autoclaves.

Microwave as an emerging technology for the treatment of biohazardous waste: A mini-review

Microwave is an emerging technology to treat biohazardous waste, including material from healthcare facilities. A screen of the peer-reviewed literature shows that only limited information may be found in this area of work and, furthermore, analysis of the references reveals that sometimes not all necessary aspects for the appropriate use of the technology are considered. Very often conventional microwave technology is applied for the inactivation of pathogens, which might make sense for certain applications but, on the other hand, may lead to the misbelief that microwave systems cannot be used for the inactivation of a solid "dry" waste. However, conventional microwave units have no means to control the inactivation process, and especially moisture content. But there are a few sophisticated microwave technologies with appropriate measurements allowing a validated inactivation of biohazardous materials. These technologies are an effective tool for inactivation and some of them are commercially available. It must also be considered that the waste should be preferably inactivated either directly at the place where it is generated or biohazardous waste should be transported only in closed systems. Moreover, microwave technology presents a possibility to save energy costs in comparison to the more widely used autoclaves. This mini-review will discuss important aspects for the use of microwave technology for the treatment of biohazardous waste.

Inactivation of Clostridium difficile spores by microwave irradiation

Spores are a potent agent for Clostridium difficile transmission. Therefore, factors inhibiting spores have been of continued interest. In the present study, we investigated the influence of microwave irradiation in addition to conductive heating for C. difficile spore inactivation in aqueous suspension. The spores of 15 C. difficile isolates from different host origins were exposed to conductive heating and microwave irradiation. The complete inhibition of spore viability at 10(7) CFU/ml was encountered following microwave treatment at 800 W for 60 s, but was not observed in the conductive-heated spores at the same time-temperature exposure. The distinct patterns of ultrastructural alterations following microwave and conductive heat treatment were observed and the degree of damages by microwave was in the exposure time-dependent manner. Microwave would therefore be a simple and time-efficient tool to inactivate C. difficile spores, thus reducing the risk of C. difficile transmission.

Differences in Physical and Biochemical Properties of Thermus scotoductus SA-01 Cultured with Dielectric or Convection Heating

A thermophile, Thermus scotoductus SA-01, was cultured within a constant-temperature (65°C) microwave (MW) digester to determine if MW-specific effects influenced the growth and physiology of the organism. As a control, T. scotoductus cells were also cultured using convection heating at the same temperature as the MW studies. Cell growth was analyzed by optical density (OD) measurements, and cell morphologies were characterized using electron microscopy imaging (scanning electron microscopy [SEM] and transmission electron microscopy [TEM]), dynamic light scattering (DLS), and atomic force microscopy (AFM). Biophysical properties (i.e., turgor pressure) were also calculated with AFM, and biochemical compositions (i.e., proteins, nucleic acids, fatty acids) were analyzed by attenuated total reflectance-Fourier transform infrared (ATR-FTIR) spectroscopy. Gas chromatography-mass spectrometry (GC-MS) was used to analyze the fatty acid methyl esters extracted from cell membranes. Here we report successful cultivation of a thermophile with only dielectric heating. Under the MW conditions for growth, cell walls remained intact and there were no indications of membrane damage or cell leakage. Results from these studies also demonstrated that T. scotoductus cells grown with MW heating exhibited accelerated growth rates in addition to altered cell morphologies and biochemical compositions compared with oven-grown cells.

Inactivation of chemical and heat-resistant spores of Bacillus and Geobacillus by nitrogen cold atmospheric plasma evokes distinct changes in morphology and integrity of spores

Bacterial spores are resistant to severe conditions and form a challenge to eradicate from food or food packaging material. Cold atmospheric plasma (CAP) treatment is receiving more attention as potential sterilization method at relatively mild conditions but the exact mechanism of inactivation is still not fully understood. In this study, the biocidal effect by nitrogen CAP was determined for chemical (hypochlorite and hydrogen peroxide), physical (UV) and heat-resistant spores. The three different sporeformers used are Bacillus cereus a food-borne pathogen, and Bacillus atrophaeus and Geobacillus stearothermophilus that are used as biological indicators for validation of chemical sterilization and thermal processes, respectively. The different spores showed variation in their degree of inactivation by applied heat, hypochlorite, hydrogen peroxide, and UV treatments, whereas similar inactivation results were obtained with the different spores treated with nitrogen CAP. G. stearothermophilus spores displayed high resistance to heat, hypochlorite, hydrogen peroxide, while for UV treatment B. atrophaeus spores are most tolerant. Scanning electron microscopy analysis revealed distinct morphological changes for nitrogen CAP-treated B. cereus spores including etching effects and the appearance of rough spore surfaces, whereas morphology of spores treated with heat or disinfectants showed no such changes. Moreover, microscopy analysis revealed CAP-exposed B. cereus spores to turn phase grey conceivably because of water influx indicating damage of the spores, a phenomenon that was not observed for non-treated spores. In addition, data are supplied that exclude UV radiation as determinant of antimicrobial activity of nitrogen CAP. Overall, this study shows that nitrogen CAP treatment has a biocidal effect on selected Bacillus and Geobacillus spores associated with alterations in spore surface morphology and loss of spore integrity.

The differential susceptibility of spores from virulent and attenuated Bacillus anthracis strains to aldehyde- and hypochlorite-based disinfectants

This study compared the sensitivity of spores from virulent and attenuated Bacillus anthracis strains in suspension to inactivation by various chemical disinfectants. Spore suspensions from two virulent strains (A0256 and A0372) and two attenuated strains (Sterne and A0141) of B. anthracis were tested against two aldehyde-based disinfectants and one hypochlorite-based disinfectant. A novel statistical model was used to estimate 4-log₁₀ reduction times for each disinfectant/strain combination. Reduction times were compared statistically using approximate Z and χ² tests. Although there was no consistent correlation between virulence and increased sporicidal resistance across all three disinfectants, spores from the two virulent and two attenuated strains did display significantly different susceptibilities to different disinfectants. Significant disinfectant–strain interactions were observed for two of the three disinfectants evaluated. The comparative results suggest that the use of surrogate organisms to model the inactivation kinetics of virulent B. anthracis spores may be misleading. The accuracy of such extrapolations is disinfectant dependent and must be used with caution.

Glycerol-based sterilization bioindicator system from Bacillus atrophaeus: development, performance evaluation, and cost analysis

The development of new value-added applications for glycerol is of worldwide interest because of the environmental and economic problems that may be caused by an excess of glycerol generated from biodiesel production. A novel use of glycerol as a major substrate for production of a low-cost sterilization biological indicator system (BIS; spores on a carrier plus a recovery medium) was investigated. A sequential experimental design strategy was applied for product development and optimization. The proposed recovery medium enables germination and outgrowth of heat-damaged spores, promoting a D (160 °C) value of 6.6 ± 0.1 min. Bacillus atrophaeus spores production by solid-state fermentation reached a 2.3 ± 1.2 × 10(8) CFU/g dry matter. Sporulation kinetics results allowed this process to be restricted in 48 h. Germination kinetics demonstrated the visual identification of nonsterile BIS within 24 h. Performance evaluation of the proposed BIS against dry-heat and ethylene oxide sterilization showed compliance with the regulatory requirements. Cost breakdowns were from 41.8 (quality control) up to 72.8 % (feedstock). This is the first report on sterilization BIS production that uses glycerol as a sole carbon source, with significant cost reduction and the profitable use of a biodiesel byproduct.

Treatment of clinical solid waste using a steam autoclave as a possible alternative technology to incineration

A steam autoclave was used to sterilize bacteria in clinical solid waste in order to determine an alternative to incineration technology in clinical solid waste management. The influence of contact time (0, 5, 15, 30 and 60 min) and temperature (111 °C, 121 °C and 131 °C) at automated saturated steam pressure was investigated. Results showed that with increasing contact time and temperature, the number of surviving bacteria decreased. The optimum experimental conditions as measured by degree of inactivation of bacteria were 121 °C for 15 minutes (min) for Gram negative bacteria, 121 °C and 131 °C for 60 and 30 min for Gram positive bacteria, respectively. The re-growth of bacteria in sterilized waste was also evaluated in the present study. It was found that bacterial re-growth started two days after the inactivation. The present study recommends that the steam autoclave cannot be considered as an alternative technology to incineration in clinical solid waste management.

Development of a low-cost sterilization biological indicator using Bacillus atrophaeus by solid-state fermentation

The production of biological indicators involving bacterial sporulation and multi-step downstream processes has been described. The goal of the present work was to use fermented material as the final product in a biological indicator, thereby reducing processing steps and costs. The performance of three different inexpensive supports (vermiculite, sand, and sugarcane bagasse) was assessed by determining Bacillus atrophaeus sporulation during solid-state fermentation and by assessing the direct use of the fermentation products in the subsequent steps of the process. All three supports allowed spore production of between 10(7) and 10(9) CFU g(-1). Sand proved to be the best inert support enabling the direct use of the fermented product due to its easy homogenization, filling properties, and compatibility with recovery medium. Bacterial adhesion to the sand surface was supported by biofilm formation. The resistance to sterilization of the dried fermentation product was evaluated. For dry-heat resistance (160°C), the D value was 6.6 min, and for ethylene oxide resistance (650 mg/L), the D value was 6.5 min. The cost reduction of this process was at least 48%. No previous studies have been published on the application of sand as a support in solid-state fermentation for the production of biological indicators.