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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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2
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Pino A, Lee JJ, Hashmi NK, Brucker A, Chow SC, Mahmood K. Prevention of contamination after endotracheal intubation using a dedicated sleeve. J Thorac Dis 2023; 15:4717-4724. [PMID: 37868844 PMCID: PMC10587003 DOI: 10.21037/jtd-22-1510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Accepted: 05/26/2023] [Indexed: 10/24/2023]
Abstract
Background Contamination of work surfaces by used laryngoscopes after endotracheal intubation is a serious infection control concern but no strategies are available to address it. We assessed if contamination of the surfaces after endotracheal intubation would be reduced when providers used a dedicated, self-erected, disposable plastic sleeve (BladePouch) to store the used laryngoscope as compared to using single gloves or double gloves and sheathing the laryngoscope with the outer gloves. Methods Twenty participants were recruited including attending physicians, trainees and allied health care professionals. They performed endotracheal intubation on a mannequin with oral cavity coated with a dye and stored the used laryngoscope blade using single gloves, double gloves or BladePouch. Each participant used both direct and video laryngoscopes. Following intubation, dye contamination of gloves, gown and work surface was evaluated. Results There was no difference in the contamination of gloves or gowns between the single gloves, double gloves or BladePouch groups. However, work surface contamination was significantly reduced when using BladePouch compared to single or double gloves (13% vs. 100% vs. 80% respectively, P<0.001). The odds of work surface contamination were significantly lower with BladePouch vs. single or double gloves, even when adjusted for intubation device, role and experience of participants with an adjusted odds ratio of 0.0054 (95% confidence interval: 0.0009-0.0314), P<0.001. Conclusions In conjunction with standard precautions, the use of a dedicated plastic sleeve to store contaminated laryngoscope blade after endotracheal intubation may reduce the work surface contamination, independent of intubation device, role and experience of providers.
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Affiliation(s)
- Alejandro Pino
- Division of Pulmonary, Critical Care and Allergy, Department of Medicine, Duke University, Durham, NC, USA
| | | | - Nazish K. Hashmi
- Department of Cardiothoracic Anesthesiology, Duke University, Durham, NC, USA
| | - Amanda Brucker
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC, USA
| | - Shein-Chung Chow
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC, USA
| | - Kamran Mahmood
- Division of Pulmonary, Critical Care and Allergy, Department of Medicine, Duke University, Durham, NC, USA
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3
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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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4
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Yeoh CB, Lee KJ, Coric V, Tollinche LE. Simple Green Changes for Anesthesia Practices to Make a Difference. EC CLINICAL AND MEDICAL CASE REPORTS 2020; 3:1-6. [PMID: 33458720 PMCID: PMC7808258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
The environmental debate on going green in the operating room (OR) has been a controversial topic for many years. Challengers of greening efforts cite various obstacles and arguments against these initiatives. However, ORs in the United States continue to generate a staggering amount of waste daily. In this article, we review major barriers to going green and highlight simple, yet effective greening strategies that anesthesia practices could adopt to reduce our carbon footprint.
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Affiliation(s)
- Cindy B Yeoh
- Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Kathleen J Lee
- Department of Anesthesiology, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Vanja Coric
- Department of Anesthesiology, University at Buffalo, Buffalo, NY, USA
| | - Luis E Tollinche
- Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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5
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Duan N, Gao W, Wang Q. Preparedness and disinfection of anesthetic equipment in COVID-19. J Clin Anesth 2020; 66:109924. [PMID: 32473502 PMCID: PMC7250755 DOI: 10.1016/j.jclinane.2020.109924] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 05/17/2020] [Accepted: 05/24/2020] [Indexed: 11/25/2022]
Abstract
Standards for perioperative supply and equipment precaution for COVID-19 have not been detailed. Systematically introduces sufficiently preoperative and postoperative equipment precaution The sterilization of disassembled anesthesia machine according to high-temperature resistance The disinfection of the breathing systems of nondetachable anesthesia machines The decontamination of video laryngoscopes, fiberoptic bronchoscopes, and lighted stylets
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Affiliation(s)
- Na Duan
- Department of Anesthesiology & Center for Brain Science, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Wei Gao
- Department of Anesthesiology & Center for Brain Science, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Qiang Wang
- Department of Anesthesiology & Center for Brain Science, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.
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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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7
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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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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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9
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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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A Simulation Study to Evaluate Improvements in Anesthesia Work Environment Contamination After Implementation of an Infection Prevention Bundle. Anesth Analg 2018; 127:662-670. [DOI: 10.1213/ane.0000000000002764] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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11
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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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12
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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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Jeanes A, Dick J, Coen P, Drey N, Gould DJ. Hand hygiene compliance monitoring in anaesthetics: Feasibility and validity. J Infect Prev 2018; 19:116-122. [DOI: 10.1177/1757177418755306] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Accepted: 12/10/2017] [Indexed: 11/17/2022] Open
Abstract
Background: Hand hygiene compliance scores in the anaesthetic department of an acute NHS hospital were persistently low. Aims: To determine the feasibility and validity of regular accurate measurement of HHC in anaesthetics and understand the context of care delivery, barriers and opportunities to improve compliance. Methods: The hand hygiene compliance of one anaesthetist was observed and noted by a senior infection control practitioner (ICP). This was compared to the World Health Organization five moments of hand hygiene and the organisation hand hygiene tool. Findings: In one sequence of 55 min, there were approximately 58 hand hygiene opportunities. The hand hygiene compliance rate was 16%. The frequency and speed of actions in certain periods of care delivery made compliance measurement difficult and potentially unreliable. During several activities, taking time to apply alcohol gel or wash hands would have put the patients at significant risk. Discussion: We concluded that hand hygiene compliance monitoring by direct observation was invalid and unreliable in this specialty. It is important that hand hygiene compliance is optimal in anaesthetics particularly before patient contact. Interventions which reduce environmental and patient contamination, such as cleaning the patient and environment, could ensure anaesthetists encounter fewer micro-organisms in this specialty.
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Affiliation(s)
- A Jeanes
- Infection Control Department, University College London Hospitals, London, UK
| | - J Dick
- University College Hospital, London, UK
| | - P Coen
- Infection Control Department, University College London Hospitals, London, UK
| | - N Drey
- City University London, London, UK
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Quintard H, l’Her E, Pottecher J, Adnet F, Constantin JM, De Jong A, Diemunsch P, Fesseau R, Freynet A, Girault C, Guitton C, Hamonic Y, Maury E, Mekontso-Dessap A, Michel F, Nolent P, Perbet S, Prat G, Roquilly A, Tazarourte K, Terzi N, Thille A, Alves M, Gayat E, Donetti L. Intubation and extubation of the ICU patient. Anaesth Crit Care Pain Med 2017; 36:327-341. [DOI: 10.1016/j.accpm.2017.09.001] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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15
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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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Chaskar VP, Dave NM, Dias R, Karnik P. Disinfection of laryngoscopes: A survey of practice. Indian J Anaesth 2017; 61:245-249. [PMID: 28405039 PMCID: PMC5372406 DOI: 10.4103/ija.ija_347_16] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background and Aims: The laryngoscope is a common piece of equipment used by anaesthesiologists. It has been identified as a potential source of cross infection. Although guidelines exist regarding appropriate disinfection practices, recent reviews suggest ineffectiveness of current methods of disinfection and poor compliance with the established protocols. We conducted a questionnaire-based survey to study the current disinfection practices being followed by a cross section of anaesthesiologists. Methods: A simple questionnaire containing 13 questions was distributed amongst anaesthesiologists in an anaesthesia conference. Data were analysed with percentage analysis. Results: Out of 250 delegates who attended the conference, 150 submitted the completed questionnaires. Residents constituted 41% and 46% were consultants. Eighteen (12%) used only tap water for cleaning and 132 (88%) used a chemical agent after rinsing with water. Out of 132, 76 (51%) used detergent/soap solution, 29 (19%) would wash and then soak in disinfectant or germicidal agents (glutaraldehyde, povidone iodine and chlorhexidine) and 18 (12%) would wipe the blade with an alcohol swab. With respect to disinfection of laryngoscope handles, 70% respondents said they used an alcohol swab, 18% did not use any method, 9% were not aware of the method being used, while 3% did not respond. Conclusion: Our results indicate wide variation in methods of decontamination of laryngoscopes. Awareness regarding laryngoscope as a potential source of infection was high. We need to standardise and implement guidelines on a national level and make available resources which will help to improve patient safety.
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Affiliation(s)
| | - Nandini Malay Dave
- Department of Anaesthesiology, Seth G. S. Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - Raylene Dias
- Department of Anaesthesiology, Seth G. S. Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - Priyanka Karnik
- Department of Anaesthesiology, Seth G. S. Medical College and KEM Hospital, Mumbai, Maharashtra, India
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Hopkins P, Patel S. Beware the Trojan Horse - a timely reality check about re-using single-use devices. Anaesthesia 2016; 72:8-12. [PMID: 27748514 DOI: 10.1111/anae.13523] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- P Hopkins
- King's Critical Care, King's College Hospital, London, UK
| | - S Patel
- King's Critical Care, King's College Hospital, London, UK
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18
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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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19
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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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20
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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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Infektionsschutz und spezielle Hygienemaßnahmen in klinischen Disziplinen. KRANKENHAUS- UND PRAXISHYGIENE 2016. [PMCID: PMC7152143 DOI: 10.1016/b978-3-437-22312-9.00005-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Kramer A, Kohnen W, Israel S, Ryll S, Hübner NO, Luckhaupt H, Hosemann W. Principles of infection prevention and reprocessing in ENT endoscopy. GMS CURRENT TOPICS IN OTORHINOLARYNGOLOGY, HEAD AND NECK SURGERY 2015; 14:Doc10. [PMID: 26770284 PMCID: PMC4702059 DOI: 10.3205/cto000125] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
This article gives an overview on the principles of reprocessing of rigid and flexible endoscopes used in ENT units including structural and spatial requirements based on general and ENT-specific risks of infection associated with diagnostic and therapeutic endoscopy. The underlying legal principles as well as recommendations from scientific societies will be exemplified in order to give a practical guidance to the otorhinolaryngologist. Preliminary results of a small nation-wide survey on infection control standards based on data of 29 ENT practices in Germany reveal current deficits of varying degree concerning infection control management including reprocessing of endoscopes. The presented review aims to give support to the establishment of a structured infection control management program including the evaluation of results by means of a prospective surveillance.
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Affiliation(s)
- Axel Kramer
- Institute for Hygiene and Environmental Medicine, University Medicine of Greifswald, Germany
| | | | - Susanne Israel
- Institute for Hygiene and Environmental Medicine, University Medicine of Greifswald, Germany
| | - Sylvia Ryll
- Institute for Hygiene and Environmental Medicine, University Medicine of Greifswald, Germany
| | - Nils-Olaf Hübner
- Institute for Hygiene and Environmental Medicine, University Medicine of Greifswald, Germany
- Institute for Medical Diagnostics, Greifswald, Germany
| | - Horst Luckhaupt
- Dept. of Otolaryngology, St. Johannes Hospital Dortmund, Germany
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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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Loftus RW, Koff MD, Birnbach DJ. The Dynamics and Implications of Bacterial Transmission Events Arising from the Anesthesia Work Area. Anesth Analg 2015; 120:853-60. [DOI: 10.1213/ane.0000000000000505] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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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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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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Milne AD, Brousseau PA, Brousseau CA. Effects of laryngoscope handle light source on the light intensity from disposable laryngoscope blades. Anaesthesia 2014; 69:1331-6. [DOI: 10.1111/anae.12790] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/01/2014] [Indexed: 11/28/2022]
Affiliation(s)
- A. D. Milne
- Department of Anesthesia; Pain Management and Perioperative Medicine, and School of Biomedical Engineering; Dalhousie University; Halifax Canada
| | - P. A. Brousseau
- Department of Anesthesia; QEII Health Centre; Halifax Canada
| | - C. A. Brousseau
- School of Health Sciences; Dalhousie University; Halifax Canada
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Abstract
The main purpose of this review article is to bring up what has been known (practiced) about decontamination, disinfection, and sterilisation of anaesthetic equipment. It also discusses how this evidence-based information on infection prevention and control impacts care of patient in routine anaesthesia practice. This review underscores the role played by us, anaesthetists in formulating guidelines, implementing the same, monitoring the outcome and training post-graduate trainees and coworkers in this regard. The article re-emphasises that certain guidelines when followed strictly will go a long way in reducing transmission of hospital acquired infection between patient and anaesthetist or between patients. Anaesthetists do not restrict their work to operating room but are involved in disaster management, interventional radiological procedures and in trauma care. They should ensure that the patients are cared for in clean and safe environment so as to reduce healthcare associated infections (HCAIs) simultaneously taking preventive measures against the various health hazards associated with clinical practice. They should ensure that the coworkers too adopt all the preventive measures while delivering their duties. For this review, we conducted literature searches in Medline (PubMed) and also searched for relevant abstracts and full texts of related articles that we came across. There is much to be learned from the western world where, health care organisations now have legal responsibility to implement changes in accordance with the newer technology to reduce health care associated infection. There is a need to develop evidence-based infection prevention and control programs and set national guidelines for disinfection and sterilisation of anaesthesia equipment which all the institutions should comply with.
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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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Elkaradawy SA, Helaly GF, Abdel Wahab MM. Effect of an infection control educational programme on anaesthetists’ attitude and anaesthetic field bacterial contamination. EGYPTIAN JOURNAL OF ANAESTHESIA 2012. [DOI: 10.1016/j.egja.2011.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
Affiliation(s)
| | - Ghada F. Helaly
- Medical Research Institute, University of Alexandria , Egypt
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Roy RC, Brull SJ, Eichhorn JH. Surgical site infections and the anesthesia professionals' microbiome: we've all been slimed! Now what are we going to do about it? Anesth Analg 2011; 112:4-7. [PMID: 21173203 DOI: 10.1213/ane.0b013e3181fe4942] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Keen JN, Austin M, Huang LS, Messing S, Wyatt JD. Efficacy of soaking in 70% isopropyl alcohol on aerobic bacterial decontamination of surgical instruments and gloves for serial mouse laparotomies. JOURNAL OF THE AMERICAN ASSOCIATION FOR LABORATORY ANIMAL SCIENCE : JAALAS 2010; 49:832-837. [PMID: 21205449 PMCID: PMC2994051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Received: 03/10/2010] [Revised: 05/05/2010] [Accepted: 05/17/2010] [Indexed: 05/30/2023]
Abstract
Rodent surgeries in biomedical research facilities are often performed in series. This practice presents many challenges to maintaining aseptic technique between animals. Here, we examined using soaking in 70% isopropyl alcohol for aerobic bacterial decontamination of surgical instruments and gloves used in a series of as many as 10 mouse laparotomy surgeries. These surgeries were performed on mice that were euthanized immediately prior to the procedure. Instruments and gloves were cultured before and after each procedure to determine the presence of aerobic bacterial contamination. To assess the efficacy of the decontamination protocol, culture results were grouped by procedure and then paired (before soak and after soak) for analysis using McNemar test at an α level of 0.05. In addition, by using the Fisher exact test, this modified aseptic method was compared with strict aseptic technique, for which autoclaved instruments and sterile surgical gloves were used for each procedure. In this study, we observed that the modified aseptic technique using 70% isopropyl alcohol soaks pre- vented aerobic bacterial contamination of instruments and gloves for as many as 5 mice.
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Affiliation(s)
- Jessica N Keen
- Department of Comparative Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA.
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