Safety issue of re-sterilization of polyurethane electrophysiology catheters: a cytotoxicity study

Terminal sterilization of medical devices using vaporized hydrogen peroxide: a review of current methods and emerging opportunities

Medical devices are an important and growing aspect of healthcare provision and are increasing in complexity to meet established and emerging patient needs. Terminal sterilization plays a vital role in the provision of safe medical devices. While terminal sterilization technologies for medical devices include multiple radiation options, ethylene oxide remains the predominant nonthermal gaseous option, sterilizing c. 50% of all manufactured devices. Vaporized hydrogen peroxide (abbreviated VH2O2 by the International Organization for Standardization) is currently deployed for clinical sterilization applications, where its performance characteristics appear aligned to requirements, constituting a viable alternative low-temperature process for terminal processing of medical devices. However, VH2O2 has operational limitations that create technical challenges for industrial-scale adoption. This timely review provides a succinct overview of VH2O2 in gaseous sterilization and addresses its applicability for terminal sterilization of medical devices. It also describes underappreciated factors such as the occurrence of nonlinear microbial inactivation kinetic plots that may dictate a need to develop a new standard approach to validate VH2O2 for terminal sterilization of medical devices.

Thermomechanical properties, collapse pressure, and expansion of shape memory polymer neurovascular stent prototypes

Shape memory polymer stent prototypes were fabricated from thermoplastic polyurethane. Commercial stents are generally made of stainless steel or other alloys. These alloys are too stiff and prevent most stent designs from being able to navigate small and tortuous vessels to reach intracranial lesions. A solid tubular model and a high flexibility laser etched model are presented. The stents were tested for collapse in a pressure chamber. At 37 degrees C, the full collapse pressure was comparable to that of commercially available stents, and higher than the estimated maximum pressure exerted by intracranial arteries. However, there is a potential for onset of collapse, which needs further study. The stents were crimped and expanded, the laser-etched stent showed full recovery with an expansion ratio of 2.7 and a 1% axial shortening.

Scanning CO2laser bacterial inactivation systems

AIMS

The performance of three scanning CO(2) laser inactivation systems was assessed and included: a gantry system, a rapidly rotating mirror and a low-power hybrid system combining an oscillating mirror and rotary motion of the sample.

METHODS AND RESULTS

Escherichia coli and Staphylococcus aureus were the target organisms on stainless steel, nutrient agar or moist collagen film and the laser power was varied from 2 to 1060 W (two laser sources). In general, a threshold energy density was identified, above which no inactivation was observed because the scanning velocity was too high (10 cm s(-1) for stainless steel, 660 W). Reducing the velocity increased the inactivation process until complete inactivation was observed at 1.3 cm s(-1) (E. coli, approximately 10(6) CFU per sample) and 0.82 cm s(-1) (S. aureus, approximately 10(8) CFU per sample); consequently, S. aureus organisms showed a greater resistance to laser irradiation. For the nutrient agar and collagen samples, the averages of the width of clearing were measured as a function of the translation velocity and the rates of inactivation (I(R), cm(2) s(-1)) were found; an optimum velocity was observed that produced the maximum rate of inactivation. At a laser power of 1060 W, the maximum value of I(R) was 140 cm(2) s(-1) ( approximately 10(7) CFU cm(-2)) for S. aureus on collagen and slightly less on nutrient agar (114 cm(2) s(-1), estimated from a best-fit polynomial, r(2) = 0.98).

CONCLUSIONS

A comparison of the low- and high-power lasers produced values of 0.09 cm(2) s(-1) W(-1) (i.e. I(R) per Watt delivered) for S. aureus on nutrient agar with the low-power laser at 13 W and on collagen 0.13 cm(2) s(-1) W(-1) for 1060 W. The rate of inactivation was found to be a function of the laser power, translation velocity and properties of the substrate media. The three laser inactivation systems successfully demonstrated the potential speed, efficiency and application of such systems.

SIGNIFICANCE AND IMPACT OF THE STUDY

Laser scanning systems offer the potential for rapid and efficient inactivation of surfaces, eliminating the need for chemical treatment.

Catheter interventions for congenital heart disease in third world countries

The term "Third World" loosely encompasses a group of middle- and low-income countries. Considerable differences exist in health care delivery and health indices among these countries. The vast majority of children in the Third World do not have health insurance for congential heart disease (CHD). Catheter interventions for CHD are expensive because of installation costs of expensive biplane equipment, the requirement of dedicated personnel, and the need to stock a large inventory of expensive hardware. As a result, many catheter intervention procedures are beyond the reach of the average patient in the developing world. The following cost-effective strategies have evolved in selected institutions that have attempted to perform catheter interventions for CHD at an affordable cost: sharing of space, equipment, and support personnel with a busy adult cardiology program; use of single plane equipment; the development of sedation protocols to reduce the need for anesthesiologists; strategies to reduce procedure time; reuse of hardware through ethylene oxide sterilization; improvisations to use adult hardware items for CHD interventions; judicious case selection; and improvised alternatives to occlusive devices. These strategies may help reduce costs and allow a larger proportion of patients in developing countries with CHD to undergo interventions. However, the safety of these strategies and the cost savings need to be carefully evaluated prospectively.