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Sacher F, Bacquelin R, Bessiere F, Ditac G, Duchateau J, Ait-Said M, Boveda S, Extramiana F, Delsarte L, Fauchier L, Gandjbakhch E, Garcia R, Klug D, Lellouche N, Marijon E, Martins R, Maury P, Mette C, Piot O, Taieb J, Defaye P. Position paper on sustainability in cardiac pacing and electrophysiology from the Working Group of Cardiac Pacing and Electrophysiology of the French Society of Cardiology. Arch Cardiovasc Dis 2024; 117:224-231. [PMID: 38302391 DOI: 10.1016/j.acvd.2023.11.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 11/19/2023] [Accepted: 11/20/2023] [Indexed: 02/03/2024]
Abstract
Sustainability in healthcare, particularly within the domain of cardiac electrophysiology, assumes paramount importance for the near future. The escalating environmental constraints encountered necessitate a proactive approach. This position paper aims to raise awareness among physicians, spark critical inquiry and identify potential solutions to enhance the sustainability of our practice. Reprocessing of single-use medical devices has emerged as a potential solution to mitigate the environmental impact of electrophysiology procedures, while also offering economic advantages. However, reprocessing remains unauthorized in certain countries. In regions where it is possible, stringent regulatory standards must be adhered to, to ensure patient safety. It is essential that healthcare professionals, policymakers and manufacturers collaborate to drive innovation, explore sustainable practices and ensure that patient care remains uncompromised in the face of environmental challenges. Ambitious national/international programmes of disease prevention should be the cornerstone of the strategy. It is equally vital to implement immediate actions, as delineated in this position paper, to bring about tangible change quickly.
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Affiliation(s)
- Frédéric Sacher
- Cardiac Arrhythmia Department, Bordeaux University Hospital, 33000 Bordeaux, France; Inserm U 1045, IHU Liryc, CRCTB, université de Bordeaux, 33000 Bordeaux, France.
| | | | - Francis Bessiere
- Hospices civils de Lyon, hôpital cardiovasculaire Louis-Pradel, 69500 Bron, France; Inserm, LabTau U1032, université Claude-Bernard Lyon 1, 69003 Lyon, France
| | - Geoffroy Ditac
- Hospices civils de Lyon, hôpital cardiovasculaire Louis-Pradel, 69500 Bron, France
| | - Josselin Duchateau
- Cardiac Arrhythmia Department, Bordeaux University Hospital, 33000 Bordeaux, France; Inserm U 1045, IHU Liryc, CRCTB, université de Bordeaux, 33000 Bordeaux, France
| | | | - Serge Boveda
- Heart Rhythm Management Department, clinique Pasteur, 31076 Toulouse, France; Vrije Universiteit Brussel (VUB), 1090 Jette, Brussels, Belgium; Inserm U970, 75908 Paris, France
| | - Fabrice Extramiana
- Cardiologie, université Paris Cité, hôpital Bichat, AP-HP, 75018 Paris, France
| | - Laura Delsarte
- Service de cardiologie, CHU de Montpellier, 34295 Montpellier, France
| | - Laurent Fauchier
- Service de cardiologie, CHU de Trousseau, 37170 Chambray-lès-Tours, France; Faculté de médecine, université François-Rabelais, 37032 Tours, France
| | - Estelle Gandjbakhch
- Cardiology Department, ICAN, Sorbonne université, Pitié-Salpêtrière University Hospital, AP-HP, 75013 Paris, France
| | - Rodrigue Garcia
- Cardiology Department, entre d'investigation CIC14-02, CHU de Poitiers, 86000 Poitiers, France
| | - Didier Klug
- Service de cardiologie, CHU de Lille, 59000 Lille, France
| | - Nicolas Lellouche
- Service de cardiologie, hôpital Henri-Mondor, AP-HP, 94000 Créteil, France
| | - Eloi Marijon
- Service de cardiologie, hôpital européen Georges-Pompidou, 75015 Paris, France
| | - Raphael Martins
- Inserm, LTSI - UMR 1099, CHU de Rennes, université de Rennes, 35000 Rennes, France
| | - Philipe Maury
- Unité Inserm U 1048, Department of Cardiology, University Hospital Rangueil, 31400 Toulouse, France
| | - Carole Mette
- Centre cardiologique du Nord Saint-Denis, 93207 Saint-Denis, France
| | - Olivier Piot
- Centre cardiologique du Nord Saint-Denis, 93207 Saint-Denis, France
| | - Jerome Taieb
- Service de cardiologie, centre hospitalier du Pays d'Aix, 13100 Aix-en-Provence, France
| | - Pascal Defaye
- Cardiology Department, Grenoble-Alpes University, University Hospital, 38043 Grenoble, France
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Lan YC, Ghasemi M, Hall SL, Fair RA, Maranas C, Shi R, Gomez ED. Cold Sintering Enables the Reprocessing of LLZO-Based Composites. ChemSusChem 2024:e202301920. [PMID: 38400831 DOI: 10.1002/cssc.202301920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 01/30/2024] [Accepted: 02/19/2024] [Indexed: 02/26/2024]
Abstract
All-solid-state batteries have the potential for enhanced safety and capacity over conventional lithium ion batteries, and are anticipated to dominate the energy storage industry. As such, strategies to enable recycling of the individual components are crucial to minimize waste and prevent health and environmental harm. Here, we use cold sintering to reprocess solid-state composite electrolytes, specifically Mg and Sr doped Li7 La3 Zr2 O12 with polypropylene carbonate (PPC) and lithium perchlorate (LLZO-PPC-LiClO4 ). The low sintering temperature allows co-sintering of ceramics, polymers and lithium salts, leading to re-densification of the composite structures with reprocessing. Reprocessed LLZO-PPC-LiClO4 exhibits densified microstructures with ionic conductivities exceeding 10-4 S/cm at room temperature after 5 recycling cycles. All-solid-state lithium batteries fabricated with reprocessed electrolytes exhibit a high discharge capacity of 168 mA h g-1 at 0.1 C, and retention of performance at 0.2 C for over 100 cycles. Life cycle assessment (LCA) suggests that recycled electrolytes outperforms the pristine electrolyte process in all environmental impact categories, highlighting cold sintering as a promising technology for recycling electrolytes.
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Affiliation(s)
- Yi-Chen Lan
- Department of Chemical Engineering, The Pennsylvania State University, University Park, PA 16802, USA
| | - Masoud Ghasemi
- Department of Chemical Engineering, The Pennsylvania State University, University Park, PA 16802, USA
| | - Shelby L Hall
- Department of Chemical Engineering, The Pennsylvania State University, University Park, PA 16802, USA
| | - Ryan A Fair
- Department of Materials Science, The Pennsylvania State University, University Park, PA 16802, USA
| | - Christina Maranas
- Department of Materials Science, The Pennsylvania State University, University Park, PA 16802, USA
| | - Rui Shi
- Department of Chemical Engineering, The Pennsylvania State University, University Park, PA 16802, USA
| | - Enrique D Gomez
- Department of Chemical Engineering, The Pennsylvania State University, University Park, PA 16802, USA
- Department of Materials Science, The Pennsylvania State University, University Park, PA 16802, USA
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Rickers S, Sahling F. Integrated procurement and reprocessing planning for reusable medical devices with a limited shelf life. Health Care Manag Sci 2024:10.1007/s10729-024-09664-9. [PMID: 38270704 DOI: 10.1007/s10729-024-09664-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 01/03/2024] [Indexed: 01/26/2024]
Abstract
We present a new model formulation for a multiproduct dynamic order quantity problem with product returns and a reprocessing option. The optimization considers the limited shelf life of sterile medical devices as well as the capacity constraints of reprocessing and sterilization resources. The time-varying demand is known in advance and must be satisfied by purchasing new medical devices or by reprocessing used and expired devices. The objective is to determine a feasible procurement and reprocessing plan that minimizes the incurred costs. The problem is solved in a heuristic manner in two steps. First, we use a Dantzig-Wolfe reformulation of the underlying problem, and a column generation approach is applied to tighten the lower bound. In the next step, the obtained lower bound is transformed into a feasible solution using CPLEX. Our numerical results illustrate the high solution quality of this approach. The comparison with a simulation based on the first-come-first-served principle shows the advantage of integrated planning.
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Affiliation(s)
- Steffen Rickers
- Department of Production Management, Leibniz Universität Hannover, Königsworther Platz 1, Hannover, 30167, Germany
| | - Florian Sahling
- RPTU School of Management and Economics, Chair of Production Management, University of Kaiserslautern-Landau (RPTU), Gottlieb-Daimler-Straße, Kaiserslautern, 67663, Germany.
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Heibeyn J, Witte M, Radermacher K. Decontamination of a robot used to reprocess reusable surgical instruments. J Hosp Infect 2024; 143:1-7. [PMID: 38529779 DOI: 10.1016/j.jhin.2023.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 10/05/2023] [Accepted: 10/14/2023] [Indexed: 03/27/2024]
Abstract
BACKGROUND Using robots to handle medical devices in the decontamination area of the Central Sterile Supply Department (CSSD) can reduce risks and address staff shortages. The gripper design must allow reliable cleaning using standard CSSD procedures to avoid build-up of biofilms and possible cross-contamination between different instrument trays and the gripper's functionality. This study explores the design of the robot's gripper regarding cleanability, aiming to determine whether successful cleaning can be achieved even after prolonged drying for a working shift of 8 h. METHODS We optimized a gripper for cleanability and used it to assess the spread of different test soils depending on different forms of motion. Subsequently, we analysed the cleanability using sheep's blood as test soil, reprocessing the gripper in different assembly configurations after 4 and 8 h of drying, and measuring residual protein. FINDINGS Based on our investigations, we documented the spread of contamination depending on the type of motion of the gripper's components. Sheep's blood exhibited the highest dispersion among the test soils, permeating through thin crevices. Importantly, all samples displayed residual protein levels below the warning threshold, irrespective of drying time and gripper disassembly or cleaning position. Cleaning in a device-specific optimized position achieved results comparable to cleaning the disassembled individual components. CONCLUSIONS These findings indicate that cleaning even after one working shift of 8 h and without the labour-intensive disassembly of the gripper is feasible, supporting the future use of robots to handle contaminated medical devices in the CSSD decontamination area.
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Affiliation(s)
- J Heibeyn
- Department of Medical Engineering, RWTH Aachen University, Aachen, Germany.
| | - M Witte
- Department of Medical Engineering, RWTH Aachen University, Aachen, Germany
| | - K Radermacher
- Department of Medical Engineering, RWTH Aachen University, Aachen, Germany
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Arnold D, Grombein T, Schreiter L, Sterken V, Jäggi A. Reprocessed precise science orbits and gravity field recovery for the entire GOCE mission. J Geod 2023; 97:67. [PMID: 37396058 PMCID: PMC10313854 DOI: 10.1007/s00190-023-01752-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 05/24/2023] [Indexed: 07/04/2023]
Abstract
ESA's Gravity field and steady-state Ocean Circulation Explorer (GOCE) orbited the Earth between 2009 and 2013 for the determination of the static part of Earth's gravity field. The GPS-derived precise science orbits (PSOs) were operationally generated by the Astronomical Institute of the University of Bern (AIUB). Due to a significantly improved understanding of remaining artifacts after the end of the GOCE mission (especially in the GOCE gradiometry data), ESA initiated a reprocessing of the entire GOCE Level 1b data in 2018. In this framework, AIUB was commissioned to recompute the GOCE reduced-dynamic and kinematic PSOs. In this paper, we report on the employed precise orbit determination methods, with a focus on measures undertaken to mitigate ionosphere-induced artifacts in the kinematic orbits and thereof derived gravity field models. With respect to the PSOs computed during the operational phase of GOCE, the reprocessed PSOs show in average a 8-9% better consistency with GPS data, 31% smaller 3-dimensional reduced-dynamic orbit overlaps, an 8% better 3-dimensional consistency between reduced-dynamic and kinematic orbits, and a 3-7% reduction of satellite laser ranging residuals. In the second part of the paper, we present results from GPS-based gravity field determinations that highlight the strong benefit of the GOCE reprocessed kinematic PSOs. Due to the applied data weighting strategy, a substantially improved quality of gravity field coefficients between degree 10 and 40 is achieved, corresponding to a remarkable reduction of ionosphere-induced artifacts along the geomagnetic equator. For a static gravity field solution covering the entire mission period, geoid height differences with respect to a superior inter-satellite ranging solution are markedly reduced (43% in terms of global RMS, compared to previous GOCE GPS-based gravity fields). Furthermore, we demonstrate that the reprocessed GOCE PSOs allow to recover long-wavelength time-variable gravity field signals (up to degree 10), comparable to information derived from GPS data of dedicated satellite missions. To this end, it is essential to take into account the GOCE common-mode accelerometer data in the gravity field recovery.
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Affiliation(s)
- Daniel Arnold
- Astronomical Institute, University of Bern, Sidlerstrasse 5, 3012 Bern, Switzerland
| | - Thomas Grombein
- Astronomical Institute, University of Bern, Sidlerstrasse 5, 3012 Bern, Switzerland
- Present Address: Geodetic Institute, Karlsruhe Institute of Technology (KIT), Karlsruhe, Germany
| | - Lucas Schreiter
- Astronomical Institute, University of Bern, Sidlerstrasse 5, 3012 Bern, Switzerland
- Present Address: GFZ German Research Centre for Geosciences, Potsdam, Germany
| | - Veerle Sterken
- Astronomical Institute, University of Bern, Sidlerstrasse 5, 3012 Bern, Switzerland
- Present Address: Department of Physics, Institute for Particle Physics and Astrophysics, ETH Zürich, Zürich, Switzerland
| | - Adrian Jäggi
- Astronomical Institute, University of Bern, Sidlerstrasse 5, 3012 Bern, Switzerland
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Feng Z, Zhao W, Jin L, Zhang J, Xue B, Ni Y. Environmentally friendly strategy to access self-healable, reprocessable and recyclable chitin, chitosan, and sodium alginate based polysaccharide-vitrimer hybrid materials. Int J Biol Macromol 2023; 240:124531. [PMID: 37085067 DOI: 10.1016/j.ijbiomac.2023.124531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Revised: 04/13/2023] [Accepted: 04/16/2023] [Indexed: 04/23/2023]
Abstract
Natural polysaccharides show enviable advantages for preparation of sustainable hybrid materials. However, in most cases, complex chemical modifications of natural polysaccharides are required, which not only causes changes of the inherent properties of polysaccharides, but also increases the manufacturing costs of the final materials. Therefore, it is highly desired to develop efficient and low-cost ways to access polysaccharides-containing hybrid materials. In this work, we report the environmentally friendly preparation of a new kind of polysaccharide-based materials, called polysaccharide-vitrimer hybrid materials, for the first time. The vitrimer synthesis and hybridization with polysaccharides can be achieved via a convenient one-pot method in absence of solvent and catalyst. In addition, time-consuming and labor-intensive physical/chemical modifications of natural polysaccharides are completely avoided. The resultant hybrid materials show good mechanical performance (tensile toughness is up to 13.7 MJ/m3), high thermal stability (Td,max is up to 457 °C), fast self-healing ability (self-healing efficiency is up to 99 % within 20s at 80 °C) and excellent reprocessability and recyclability (at least three cycles). Especially, conductive polysaccharide-vitrimer hybrid materials could be readily prepared from the resultant materials, exhibiting novel applications as flexible sensors and electromagnetic shielding materials (the EMI SE is up to 24.93 dB).
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Affiliation(s)
- Zihao Feng
- College of Bioresources Chemical and Materials Engineering, Shaanxi University of Science and Technology, Xi'an 710021, PR China; Key Laboratory of Paper Based Functional Materials, China National Light Industry, Xi'an 710021, PR China; Shaanxi Provincial Key Laboratory of Papermaking Technology and Specialty Paper Development, Xi'an 710021, PR China
| | - Wei Zhao
- College of Bioresources Chemical and Materials Engineering, Shaanxi University of Science and Technology, Xi'an 710021, PR China; Key Laboratory of Paper Based Functional Materials, China National Light Industry, Xi'an 710021, PR China; Shaanxi Provincial Key Laboratory of Papermaking Technology and Specialty Paper Development, Xi'an 710021, PR China.
| | - Liuping Jin
- College of Bioresources Chemical and Materials Engineering, Shaanxi University of Science and Technology, Xi'an 710021, PR China; Key Laboratory of Paper Based Functional Materials, China National Light Industry, Xi'an 710021, PR China; Shaanxi Provincial Key Laboratory of Papermaking Technology and Specialty Paper Development, Xi'an 710021, PR China
| | - Jiarong Zhang
- College of Bioresources Chemical and Materials Engineering, Shaanxi University of Science and Technology, Xi'an 710021, PR China
| | - Bailiang Xue
- College of Bioresources Chemical and Materials Engineering, Shaanxi University of Science and Technology, Xi'an 710021, PR China; Key Laboratory of Paper Based Functional Materials, China National Light Industry, Xi'an 710021, PR China; Shaanxi Provincial Key Laboratory of Papermaking Technology and Specialty Paper Development, Xi'an 710021, PR China
| | - Yonghao Ni
- Department of Chemical Engineering, University of New Brunswick, Fredericton E3B 5A3, New Brunswick, Canada; Department of Chemical and biomedical Engineering, University of Maine, Orono, ME 04469, USA
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Wang S, Yu G, Wang J. Treatment of tributyl phosphate by fenton oxidation: Optimization of parameter, degradation kinetics and pathway. Chemosphere 2023; 317:137889. [PMID: 36657574 DOI: 10.1016/j.chemosphere.2023.137889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 01/14/2023] [Accepted: 01/15/2023] [Indexed: 06/17/2023]
Abstract
In nuclear industry, tributyl phosphate (TBP) is used as organic extracting solvent to separate uranium and plutonium. The spent TBP is finally discarded as the radioactive organic waste, which should be treated due to its potential risk. In this study, TBP degradation by Fenton oxidation was investigated in detail, including the optimization of operational conditions, degradation kinetics and degradation products. The optimal conditions for TBP degradation (per 10 ml) by Fenton oxidation was: 95 °C, pH 2, 150 ml 30% H2O2, and 105 ml 0.2 M Fe(II). H2O2 was continuously added with the flow rate of 0.5 ml/min, Fe(II) was intermittently added with the flow rate of 3 ml/10 min. The oil phase volume decreased with time and completely disappeared at the third hour. In contrast, the COD in water phase increased firstly and then decreased. At the end of the experiments, the COD achieved 23.8 g/L. The detection of phosphorus in water phase further confirmed the decomposition of TBP. Mono-butyl phosphate and di-butyl phosphate were identified as the intermediate products of TBP degradation. In addition, other four degradation products with the same m/z of 154 were identified, which may be derived from the hydroxylation of mono-butyl phosphate and di-butyl phosphate. Based on the degradation products, the degradation pathway of TBP was proposed. This study could provide an insight into the TBP degradation by Fenton oxidation, and an potential strategy for treating the spent radioactive organic solvent.
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Affiliation(s)
- Shizong Wang
- Laboratory of Environmental Technology, INET, Tsinghua University, Beijing, 100084, China; Energy Science Building, INET, Tsinghua University, Beijing, 100084, China.
| | - Guoce Yu
- Laboratory of Environmental Technology, INET, Tsinghua University, Beijing, 100084, China; Energy Science Building, INET, Tsinghua University, Beijing, 100084, China.
| | - Jianlong Wang
- Laboratory of Environmental Technology, INET, Tsinghua University, Beijing, 100084, China; Beijing Key Laboratory of Radioactive Wastes Treatment, Tsinghua University, Beijing, 100084, China.
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Biadsee A, Crosby L, Chow W, Sowerby LJ. Cost minimization analysis of nasopharyngoscope reprocessing in community practice. J Otolaryngol Head Neck Surg 2023; 52:8. [PMID: 36750881 PMCID: PMC9906939 DOI: 10.1186/s40463-022-00610-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 11/16/2022] [Indexed: 02/09/2023] Open
Abstract
BACKGROUND Reprocessing of nasopharyngoscopes represents a large financial burden to community physicians. The aim of this study was to perform a cost analysis of nasopharyngoscope reprocessing methods at the community level. METHODS Electronic surveys were distributed by email to community otolaryngologists. Surveys were comprised of 14 questions assessing clinic size, nasopharyngoscope volume, scope reprocessing method and maintenance. Four manual techniques were evaluated: (1) soak with ortho-phthalaldehyde solution (Cidex-OPA; Advanced Sterilization Products, Johnson and Johnson Inc., Markham, Canada), (2) soak with accelerated hydrogen peroxide solution (Revital-Ox; Steris Canada Inc., Mississauga, Canada), (3) disinfection with chlorine dioxide wipe (Tristel Trio Wipes System; Tristel plc., Cambridgeshire, UK), (4) UV-C light system (UV Smart, Delft, The Netherlands). All costs are reported in CAD, and consumable and capital costs for reprocessing methods were obtained from reported vendor prices. Time costs were derived from manufacturer recommendations, the Ontario Medical Association Physician's Guide to Uninsured Services, and the Ontario Nurses Association Collective Agreement. Cost analyses determined the most cost-effective reprocessing method in the community setting. Sensitivity analyses assessed the impact of reprocessing volume and labour costs. RESULTS Thirty-six (86%) otolaryngologists responded and answered the survey. The cost per reprocessing event for Cidex-OPA, Revital-Ox, Tristel and UV system were $38.59, $26.47, $30.53, and $22.74 respectively when physicians reprocessed their endoscopes themselves. Sensitivity analyses demonstrated that Revital-Ox was the least costly option in a low volume, however, the UV system remained the most cost effective in higher volumes. The cost per reprocessing event when done by clinic staff was $5.51, $4.42, $11.23 and $6.21 for Cidex-OPA, Revital-Ox, Tristel and the UV system. CONCLUSIONS The UV light system appears to be the most cost-effective method in high volumes of reprocessing, and Revital-Ox is cheaper in lower volumes and when performed by clinic staff rather than physicians. It is important to consider the anticipated work volume, shared clinic space and number of co-workers prior to choosing a reprocessing method.
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Affiliation(s)
- Ameen Biadsee
- grid.39381.300000 0004 1936 8884Department of Otolaryngology- Head and Neck Surgery, Western University, 268 Grosvenor Street, London, ON N6A 4V2 Canada ,grid.415250.70000 0001 0325 0791Department of Otolaryngology- Head and Neck Surgery, Meir Medical Center, Kfar Saba, Israel ,grid.12136.370000 0004 1937 0546Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Lauren Crosby
- grid.22072.350000 0004 1936 7697Department of Anesthesiology, Perioperative and Pain Medicine, Foothills Medical Centre, University of Calgary, Calgary, Canada
| | - Winsion Chow
- grid.28046.380000 0001 2182 2255Deptartment of Otolaryngology- Head and Neck Surgery, University of Ottawa, Ottawa, ON Canada
| | - Leigh J Sowerby
- Department of Otolaryngology- Head and Neck Surgery, Western University, 268 Grosvenor Street, London, ON, N6A 4V2, Canada.
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Huang J, Wang H, Liu W, Huang J, Yang D, Qiu X, Zhao L, Hu F, Feng Y. Solvent-free synthesis of high-performance polyurethane elastomer based on low-molecular-weight alkali lignin. Int J Biol Macromol 2023; 225:1505-1516. [PMID: 36435459 DOI: 10.1016/j.ijbiomac.2022.11.207] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 10/09/2022] [Accepted: 11/20/2022] [Indexed: 11/25/2022]
Abstract
Using cheap and green lignin as a partial substitute for petroleum-based polyols is highly attractive for sustainable development of polyurethane elastomers (LPUes). However, the traditional synthesis process of LPUes inevitably uses toxic solvents that are difficult to remove or carcinogenic. Here, we reported a solvent-free synthesis method to prepare lignin-containing polyurethane elastomers (SF-LPUes) with high strength, high toughness and high elasticity. Most of the hydroxyl groups of lignin reacted with isocyanates to form a strong chemical cross-linking network, while the unreacted ones formed a dynamic hydrogen bond network with polyurethane matrix, contributing to the in-situ formation of lignin nanoparticles to build a nano-micro phase separation structure. Consequently, a dual-crosslinking network structure was formed and endowed SF-LPUes with excellent mechanical properties. Especially, the SF-LPUes prepared from low molecular alkali lignin possessed a tensile strength as high as 38.2 MPa, a maximum elongation at break of 1108 %, and an elastic recovery ratio of up to 98.7 %. Moreover, SF-LPUes showed impressing reprocessing performance and aging resistance. This work provides an industrial application prospect for the synthesis of lignin-containing polyurethane elastomers via a solvent-free synthesis process.
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Affiliation(s)
- Jianhua Huang
- School of Chemistry and Chemical Engineering, Guangdong Provincial Key Lab of Green Chemical Product Technology, South China University of Technology, Wushan Road 381, Guangzhou, Guangdong 510640, PR China
| | - Haixu Wang
- School of Chemistry and Chemical Engineering, Guangdong Provincial Key Lab of Green Chemical Product Technology, South China University of Technology, Wushan Road 381, Guangzhou, Guangdong 510640, PR China
| | - Weifeng Liu
- School of Chemistry and Chemical Engineering, Guangdong Provincial Key Lab of Green Chemical Product Technology, South China University of Technology, Wushan Road 381, Guangzhou, Guangdong 510640, PR China; State Key Laboratory of Pulp and Paper Engineering, South China University of Technology, Wushan Road 381, Guangzhou 510640, PR China.
| | - Jinhao Huang
- School of Chemistry and Chemical Engineering, Guangdong Provincial Key Lab of Green Chemical Product Technology, South China University of Technology, Wushan Road 381, Guangzhou, Guangdong 510640, PR China
| | - Dongjie Yang
- School of Chemistry and Chemical Engineering, Guangdong Provincial Key Lab of Green Chemical Product Technology, South China University of Technology, Wushan Road 381, Guangzhou, Guangdong 510640, PR China
| | - Xueqing Qiu
- School of Chemical Engineering and Light Industry, Guangdong University of Technology, Waihuan Xi Road 100, Guangzhou, Guangdong 510006, PR China
| | - Liang Zhao
- BASF Advanced Chemicals Co. Ltd., 333 Jiangxinsha Road, Pudong District, Shanghai, China
| | - Fengchao Hu
- BASF Advanced Chemicals Co. Ltd., 333 Jiangxinsha Road, Pudong District, Shanghai, China
| | - Yuexia Feng
- BASF Advanced Chemicals Co. Ltd., 333 Jiangxinsha Road, Pudong District, Shanghai, China
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Chironga K, Swanepoel S, Dey R, Graham SM, Held M, Laubscher M. The reuse of circular external fixator components: an assessment of safety and potential savings. Eur J Orthop Surg Traumatol 2023; 33:119-124. [PMID: 34817660 DOI: 10.1007/s00590-021-03169-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 11/15/2021] [Indexed: 01/07/2023]
Abstract
PURPOSE Cost-saving strategies are important, especially in a resource-constrained environment. One such strategy well supported in the literature is the reuse of temporary monolateral external fixator components, a strategy we utilize at our institution. The aim of the study was to determine the safety and cost saving associated with the reuse of definitive circular external fixator components in a resource-constrained environment. METHOD We performed a retrospective review of all adult patients who were treated with either new or reused circular external fixators from a single manufacturer between January and December 2017. Reused circular external fixator components, excluding half pins and wires, were subjected to an in-house reprocessing protocol. Cost savings were calculated as the difference between the price of a completely new frame and the amount invoiced for new components only in a reused frame. RESULTS Thirty-three patients were included in the study with an average age of 31.9 years. The mean duration of treatment with a circular external fixator was 5.8 months. No mechanical failure events were recorded during the study period. Our institution saved approximately 52% (R717 503.89) and 63% (R136 568.19) of expected total cost for hexapod and Ilizarov frames, respectively. CONCLUSION The strategy of reusing circular external fixator components is unconventional, and this study was conducted to evaluate the safety and potential savings in a resource-constrained environment. We demonstrated this practice to be reasonably safe and to result in significant cost savings which might be relevant in low-and-middle-income countries.
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Affiliation(s)
- Kudzai Chironga
- Orthopaedic Research Unit, University of Cape Town, Cape Town, South Africa.
| | - Stefan Swanepoel
- Orthopaedic Research Unit, University of Cape Town, Cape Town, South Africa
| | - Roopam Dey
- Orthopaedic Research Unit, University of Cape Town, Cape Town, South Africa
| | - Simon Matthew Graham
- Orthopaedic Research Unit, University of Cape Town, Cape Town, South Africa
- Institute of Population Health Sciences, University of Liverpool, Liverpool, UK
- Department of Orthopaedic and Trauma Surgery, Liverpool University Teaching Hospital Trust, Liverpool, UK
| | - Michael Held
- Orthopaedic Research Unit, University of Cape Town, Cape Town, South Africa
| | - Maritz Laubscher
- Orthopaedic Research Unit, University of Cape Town, Cape Town, South Africa
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11
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Kochendörfer IM, Kienbaum P, Großart W, Rossaint R, Snyder-Ramos S, Grüßer L. [Environmentally friendly absorption of anesthetic gases : First experiences with a commercial anesthetic gas capture system]. Anaesthesiologie 2022; 71:824-833. [PMID: 36301310 DOI: 10.1007/s00101-022-01210-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/09/2022] [Indexed: 06/16/2023]
Abstract
Anesthetic gases are potent greenhouse gases, which are currently released into the atmosphere where they remain for many years. Strategies to reduce the carbon footprint in anesthesiology without compromising patient safety are urgently needed. Since 2020 several departments of anesthesiology have installed anesthetic gas capture systems with which anesthetic gases can be collected. This article aims to describe the anesthetic gas capture system CONTRAfluran™ and to give an overview of the first experiences in four departments of anesthesiology working with the new device in the daily clinical routine. The CONTRAfluran™ system presents a new concept in the surgical setting that has the potential to reduce the carbon footprint in anesthesiology; however, in order to accurately estimate CO2 equivalent savings, more information concerning the reprocessing and data on the pharmacokinetics of anesthetic gases are needed. Application of the CONTRAfluran™ system in daily clinical routine is feasible when anesthesiologists are aware of specific issues. In order to minimize the carbon footprint, it remains essential to implement the specific recommendations in the position paper of the German Society of Anaesthesiology and Intensive Care medicine (DGAI) and the Professional Association of German Anaesthesiologists (BDA) on ecological sustainability in anesthesiology and intensive care medicine and to support further research.
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Affiliation(s)
| | - Peter Kienbaum
- Klinik für Anästhesiologie, Universitätsklinikum Düsseldorf, Düsseldorf, Deutschland
| | - Wolfgang Großart
- Klinik für Anästhesiologie, interdisziplinäre Intensivmedizin und Notfallmedizin, KRH Klinikum Großburgwedel, Großburgwedel, Deutschland
| | - Rolf Rossaint
- Klinik für Anästhesiologie, Universitätsklinikum RWTH Aachen, Aachen, Deutschland
| | - Stephanie Snyder-Ramos
- Abteilung für Anästhesie und Intensivmedizin, Krankenhaus Salem, Evangelische Stadtmission Heidelberg, Heidelberg, Deutschland
| | - Linda Grüßer
- Klinik für Anästhesiologie, Universitätsklinikum RWTH Aachen, Aachen, Deutschland.
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12
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Huang M, Hasan MK, Pillai SD, Pharr M, Staack D. Electron beam technology for Re-processing of personal protective equipment. Radiat Phys Chem Oxf Engl 1993 2022; 202:110557. [PMID: 36189446 PMCID: PMC9516357 DOI: 10.1016/j.radphyschem.2022.110557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 09/01/2022] [Accepted: 09/18/2022] [Indexed: 11/26/2022]
Abstract
Beginning with the outbreak of COVID-19 at the dawn of 2020, the continuing spread of the pandemic has challenged the healthcare market and the supply chain of Personal Protective Equipment (PPE) around the world. Moreover, the emergence of the variants of COVID-19 occurring in waves threatens the sufficient supply of PPE. Among the various types of PPE, N95 Respirators, surgical masks, and medical gowns are the most consumed and thus have a high potential for a serious shortage during such emergencies. Considering the unanticipated demand for PPE during a pandemic, re-processing of used PPE is one approach to continue to protect the health of first responders and healthcare personnel. This paper evaluates the viability and efficacy of using FDA-approved electron beam (eBeam) sterilization technology (ISO 11137) to re-process used PPE. PPEs including 3M N95 Respirators, Proxima Sirus gowns, and face shields were eBeam irradiated in different media (air, argon) over a dose range of 0-200 kGy. Several tests were then performed to examine surface properties, mechanical properties, functionality performance, discoloration phenomenon, and liquid barrier performance. The results show a reduction of filtration efficiency to about 63.6% in the N95 Respirator; however, charge regeneration may improve the re-processed efficiency. Additionally, mechanical degradation was observed in Proxima Sirus gown with increasing dose up to 100 kGy. However, no mechanical degradation was observed in the face shields after 10 times donning and doffing. Apart from the face shield, N95 Respirators and Proxima Sirus gown both show significant mechanical degradation with ebeam dose over sterilization doses (>25 kGy), indicating that eBeam technology is not appropriate for the re-processing these PPEs.
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Affiliation(s)
- Min Huang
- Department of Mechanical Engineering, Texas A&M University, 3123 Spence St, College Station, TX, 77840, USA
| | - Md Kamrul Hasan
- Department of Mechanical Engineering, Texas A&M University, 3123 Spence St, College Station, TX, 77840, USA
| | - Suresh D Pillai
- National Center for Electron Beam Research, Texas A&M University, College Station, TX, 77840, USA
| | - Matt Pharr
- Department of Mechanical Engineering, Texas A&M University, 3123 Spence St, College Station, TX, 77840, USA
| | - David Staack
- Department of Mechanical Engineering, Texas A&M University, 3123 Spence St, College Station, TX, 77840, USA
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13
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Boussuge-Roze J, Boveda S, Mahida S, Anic A, Conte G, Chun JKR, Marijon E, Sacher F, Jais P. Current practices and expectations to reduce environmental impact of electrophysiology catheters: results from an EHRA/LIRYC European physician survey. Europace 2022; 24:1300-1306. [PMID: 35943366 DOI: 10.1093/europace/euac085] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 05/13/2022] [Indexed: 01/13/2023] Open
Abstract
The healthcare sector accounts for nearly 5% of global greenhouse gas emissions (GHG) and is a significant contributor to complex waste. Reducing the environmental impact of technology-heavy medical fields such as cardiac electrophysiology (EP) is a priority. The aim of this survey was to investigate the practice and expectations in European centres on EP catheters environmental sustainability. A 24-item online questionnaire on EP catheters sustainability was disseminated by the EHRA Scientific Initiatives Committee in collaboration with the Lyric Institute. A total of 278 physicians from 42 centres were polled; 62% were motivated to reduce the environmental impact of EP procedures. It was reported that 50% of mapping catheters and 53% of ablation catheters are usually discarded to medical waste, and only 20% and 14% of mapping and ablation catheters re-used. Yet, re-use of catheters was the most commonly cited potential sustainability solution (60% and 57% of physicians for mapping and ablation catheters, respectively). The majority of 69% currently discarded packaging. Reduced (42%) and reusable (39%) packaging also featured prominently as potential sustainable solutions. Lack of engagement from host institutions was the most commonly cited barrier to sustainable practices (59%). Complexity of the process and challenges to behavioral change were other commonly cited barriers (48% and 47%, respectively). The most commonly cited solutions towards more sustainable practices were regulatory changes (31%), education (19%), and product after-use recommendations (19%). In conclusion, EP physicians demonstrate high motivation towards sustainable practices. However, significant engagement and behavioural change, at local institution, regulatory and industry level is required before sustainable practices can be embedded into routine care.
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Affiliation(s)
- Julie Boussuge-Roze
- Electrophysiology and Heart Modelling institute, IHU Liryc, Univ. Bordeaux, INSERM, CRCTB, U 1045, Campus Xavier Arnozan - Avenue du Haut-Leveque, F-33600 Pessac, France
- CHU de Bordeaux, Department of Electrophysiology and Cardiac Stimulation, F-33000 Bordeaux, France
| | - Serge Boveda
- Clinique Pasteur, Heart Rhythm Department, Toulouse, France
- Universiteit Ziekenhuis Brussel - VUB, Brussels, Belgium
| | - Saagar Mahida
- Electrophysiology and Heart Modelling institute, IHU Liryc, Univ. Bordeaux, INSERM, CRCTB, U 1045, Campus Xavier Arnozan - Avenue du Haut-Leveque, F-33600 Pessac, France
- Department of Cardiac Electrophysiology, Liverpool Heart and Chest Hospital, NHS Trust, UK
| | - Ante Anic
- University Hospital Centre Split, Department for Cardiovascular diseases, Split, Croatia
| | - Giulio Conte
- Cardiology Department, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Julian K R Chun
- CCB, Cardiology, Med. Klinik III, Markuskrankenhaus, Frankfurt, Germany
| | - Eloi Marijon
- European Georges Pompidou Hospital and Paris City University, Cardiology Department, Paris, France
| | - Frederic Sacher
- Electrophysiology and Heart Modelling institute, IHU Liryc, Univ. Bordeaux, INSERM, CRCTB, U 1045, Campus Xavier Arnozan - Avenue du Haut-Leveque, F-33600 Pessac, France
- CHU de Bordeaux, Department of Electrophysiology and Cardiac Stimulation, F-33000 Bordeaux, France
| | - Pierre Jais
- Electrophysiology and Heart Modelling institute, IHU Liryc, Univ. Bordeaux, INSERM, CRCTB, U 1045, Campus Xavier Arnozan - Avenue du Haut-Leveque, F-33600 Pessac, France
- CHU de Bordeaux, Department of Electrophysiology and Cardiac Stimulation, F-33000 Bordeaux, France
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14
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Lütke SF, Oliveira MLS, Waechter SR, Silva LFO, Cadaval TRS, Duarte FA, Dotto GL. Leaching of rare earth elements from phosphogypsum. Chemosphere 2022; 301:134661. [PMID: 35452647 DOI: 10.1016/j.chemosphere.2022.134661] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 03/31/2022] [Accepted: 04/16/2022] [Indexed: 06/14/2023]
Abstract
High amounts of phosphogypsum (PG) are generated in the production of phosphoric acid. Previous literature demonstrates that obtaining rare earth elements (REE) from PG is a promising alternative to managing this waste. However, the reported leaching efficiencies are low in most cases, or drastic leaching conditions are required. Therefore, this work aimed to study the leaching conditions of REE from PG to obtain high leaching efficiency values. Initially, a 24 factorial experimental design investigated the factors that affect the conventional acid leaching of REE from PG (leaching acid (citric and sulfuric acid), solid/liquid ratio, acid concentration, and temperature). Better leaching efficiency values of the sum of all REE (62.0% and 89.7% for citric and sulfuric acid, respectively) were obtained using an acid concentration of 3 mol L-1, solid/liquid ratio of 1/20 g mL-1, and temperature of 80 °C. Subsequently, the experiments optimization, performed through a central composite rotational design, indicated that the maximum leaching efficiency was achieved using a sulfuric acid concentration of 2.9 mol L-1, solid/liquid ratio of 1.7/20 g mL-1, and 55 °C. Under these conditions, the leaching efficiency of the sum of all REE was 90.0%. Leaching kinetics results showed that the equilibrium was reached in about 20 min for most REE. The mechanism investigation suggested that surface chemical reaction and diffusion through the boundary layer controlled the leaching.
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Affiliation(s)
- Sabrina F Lütke
- Research Group on Adsorptive and Catalytic Process Engineering (ENGEPAC), Federal University of Santa Maria, Av. Roraima, 1000-7, 97105-900, Santa Maria, RS, Brazil; Department of Chemistry, Federal University of Santa Maria-UFSM, 1000 Roraima Avenue, 97105-900, Santa Maria, RS, Brazil
| | - Marcos L S Oliveira
- Department of Civil and Environmental, Universidad de La Costa, CUC, Calle 58 # 55-66, Barranquilla, Atlántico, Colombia; Department of Sanitary and Environmental Engineering, Federal University of Santa Catarina, Florianópolis 88040-900, Santa Catarina, Brazil
| | - Samuel R Waechter
- Department of Chemistry, Federal University of Santa Maria-UFSM, 1000 Roraima Avenue, 97105-900, Santa Maria, RS, Brazil
| | - Luis F O Silva
- Department of Civil and Environmental, Universidad de La Costa, CUC, Calle 58 # 55-66, Barranquilla, Atlántico, Colombia.
| | - Tito R S Cadaval
- School of Chemistry and Food, Federal University of Rio Grande-FURG, Km 8 Italia Avenue, 96203-900, Rio Grande, RS, Brazil
| | - Fabio A Duarte
- Department of Chemistry, Federal University of Santa Maria-UFSM, 1000 Roraima Avenue, 97105-900, Santa Maria, RS, Brazil
| | - Guilherme L Dotto
- Research Group on Adsorptive and Catalytic Process Engineering (ENGEPAC), Federal University of Santa Maria, Av. Roraima, 1000-7, 97105-900, Santa Maria, RS, Brazil.
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15
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Lisotti A, Fusaroli P, Napoleon B, Cominardi A, Zagari RM. Single-use duodenoscopes for the prevention of endoscopic retrograde cholangiopancreatography -related cross-infection – from bench studies to clinical evidence. World J Methodol 2022; 12:122-131. [PMID: 35721249 PMCID: PMC9157629 DOI: 10.5662/wjm.v12.i3.122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 01/16/2022] [Accepted: 03/17/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Several strategies have been implemented to reduce or abolish the life-threatening risk of endoscopic retrograde cholangiopancreatography (ERCP)-related multidrug-resistant infections due to duodenoscopes contaminations; among those strategies, serial microbiologic tests, thorough reprocessing schedules, and use of removable scope cap have been adopted, but the potential cross-infection risk was not eliminated.
AIM To review available evidence in the field of single-use duodenoscopes (SUD) use for ERCP.
METHODS An overview on ongoing clinical studies was also performed to delineate which data will become available in the next future.
RESULTS One bench comparative study and four clinical trials performed with EXALT model-D (Boston Scientific Corp., United States) have been identified. Of them, one is a randomized controlled trial, while the other three studies are prospective single-arm, cross-over studies. Pooled technical success rate (4 studies, 368 patients) was 92.9% [95% confidence interval (CI): 89.9-95.5; I2: 11.8%]. Pooled serious adverse event (4 studies, 381 patients) rate was 5.9% [3.7%-8.5%; I2: 0.0%].
CONCLUSION Although few clinical trials are available, evidence is concordant in identifying an absolute feasibility and safety and feasibility for SUD use for ERCP. The expertise and quality of evidence in this field are going to be improved by further large clinical trials; data on cost-effectiveness and environmental impact will be needed for a worldwide spread of SUD use for ERCP.
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Affiliation(s)
- Andrea Lisotti
- Gastroenterology Unit, Hospital of Imola, University of Bologna, Imola 40026, BO, Italy
| | - Pietro Fusaroli
- Gastroenterology Unit, Hospital of Imola, University of Bologna, Imola 40026, BO, Italy
| | - Bertrand Napoleon
- Gastroenterology Unit, Hôpital privé Jean Mermoz - Ramsay Générale de Santé, Lyon 69008, FR, France
| | - Anna Cominardi
- Gastroenterology Unit, Hospital of Imola, University of Bologna, Imola 40026, BO, Italy
| | - Rocco Maurizio Zagari
- Dipertimento Di Scienze Mediche e Chirurgiche, Università di Bologna, Policlinico San Orsola Malpighi, Bologna 40138, Italy
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16
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Lisotti A, Zagari RM, Fusaroli P, Napoléon B. Optimal safety and pooled technical success rate for ERCP performed with single-use duodenoscopes. Dig Liver Dis 2022; 54:291-292. [PMID: 34838478 DOI: 10.1016/j.dld.2021.11.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 10/27/2021] [Accepted: 11/01/2021] [Indexed: 12/11/2022]
Affiliation(s)
- Andrea Lisotti
- Gastroenterology Unit, Hospital of Imola, University of Bologna, Imola, Italy; Endoscopy Unit, Hopital Privé Jean Mermoz, Ramsay Générale de Santé, Lyon, France
| | - Rocco Maurizio Zagari
- Department of Medical and Surgical Sciences - DIMEC, University of Bologna, Bologna, Italy
| | - Pietro Fusaroli
- Gastroenterology Unit, Hospital of Imola, University of Bologna, Imola, Italy
| | - Bertrand Napoléon
- Endoscopy Unit, Hopital Privé Jean Mermoz, Ramsay Générale de Santé, Lyon, France.
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17
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Ofstead CL, Hopkins KM, Smart AG, Brewer MK. Droplet dispersal in decontamination areas of instrument reprocessing suites. Am J Infect Control 2022; 50:126-132. [PMID: 34865859 DOI: 10.1016/j.ajic.2021.10.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 10/14/2021] [Accepted: 10/16/2021] [Indexed: 12/23/2022]
Abstract
BACKGROUND Personnel working in sterile processing or endoscope reprocessing departments are at high risk of exposure to tissue, blood, and patient fluids when decontaminating reusable medical instruments and equipment. The effectiveness of protective measures for reprocessing personnel has not yet been systematically evaluated in real-world settings. OBJECTIVE This pilot project aimed to identify reprocessing activities that generate splashes, determine how far droplets can travel in decontamination areas, and assess personal protective equipment exposure during routine activities. METHODS Moisture-detection paper was affixed to environmental surfaces and personal protective equipment in a sterile processing department. Droplet dispersal was assessed after personnel simulated performance of routine reprocessing tasks. RESULTS Visible droplets were generated during every reprocessing activity except running the sonication sink. Droplets traveled at least 3 feet when filling a sink, brushing a ureteroscope, and using a power sprayer to rinse a basin. Some activities dispersed droplets up to 5 feet from the sink. Personal protective equipment was splashed during most activities and did not prevent skin exposure even when properly donned and doffed. CONCLUSION This hypothesis-generating pilot project found that routine reprocessing activities generated substantial splashing, and currently recommended personal protective equipment did not adequately protect sterile processing personnel from exposure.
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18
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Sivek AD, Davis J, Tremoulet P, Smith M, Lavanchy C, Sparnon E, Kommala D. Healthcare worker feedback on duodenoscope reprocessing workflow and ergonomics. Am J Infect Control 2022; 50:1038-1048. [PMID: 35108583 DOI: 10.1016/j.ajic.2022.01.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 01/11/2022] [Accepted: 01/12/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND The objectives of this survey study were to assess duodenoscope precleaning and manual cleaning times, identify human factors issues in duodenoscope reprocessing workflow or ergonomics, and ascertain any best practices in duodenoscope reprocessing. METHODS Researchers developed the confidential, qualitative, online Duodenoscope Reprocessing Workflow and Ergonomic Design Human Factors Survey with an intended audience of healthcare workers (HCWs) who routinely perform duodenoscope precleaning or manual cleaning. The unrestricted survey link was distributed to target HCW email addresses in December 2020; the survey closed in January 2021. RESULTS Three hundred and forty-one individuals completed the survey. Most respondents complete duodenoscope precleaning in 10 minutes or less and manual cleaning in 16-to-30 minutes. Most respondents' facilities use fixed distal endcap duodenoscopes. Most respondents experience pressure to work faster when cleaning duodenoscopes and reported that cleaning duodenoscopes caused fatigue or discomfort in at least one body part. Mentoring HCWs and retaining experienced staff were 2 primary duodenoscope reprocessing best practices identified by respondents. DISCUSSION AND CONCLUSIONS To enhance duodenoscope cleaning, facilities should provide ample reprocessing work spaces with incorporated height-adjustable work surfaces, train HCWs on validated duodenoscope reprocessing instructions, provide step-by-step instructions for HCWs when duodenoscope cleaning is performed, mentor reprocessing HCWs, and retain experienced staff.
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Affiliation(s)
| | | | - Patrice Tremoulet
- ECRI, Plymouth Meeting, PA; Department of Psychology, Rowan University, Glassboro, NJ
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19
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Gopal P, Claussen E, Azzolin K, Megremis S. Validating cleanability of dental rotary diamond instruments soiled with 2 clinically relevant dental test soil components. J Am Dent Assoc 2022; 153:221-232.e1. [PMID: 35000746 DOI: 10.1016/j.adaj.2021.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 07/23/2021] [Accepted: 08/05/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND The aim of this study was to produce a dental test soil, with 2 clinically relevant soil components, to be quantified for cleaning process validation. Another goal was to soil diamond instruments with the 2 soil components and validate the efficacy of cleaning instructions, developed and detailed in this study, using both qualitative and quantitative techniques. METHODS To simulate worst-case clinical use conditions, the authors used each soiled instrument to prepare a 9-millimeter-deep access cavity on a noncarious extracted molar. Afterward, the authors applied a mixture of pooled human saliva and blood test soil to each instrument and air-dried it for 30 minutes. The authors cleaned each instrument using documented multistep cleaning instructions, which were then validated via both qualitative and quantitative assessment of protein and enamel-dentin residues using spectrophotometric analysis and microscopy images. RESULTS After thorough cleaning, neither protein nor enamel-dentin residues were found at quantifiable levels (spectrophotometric analysis) on the soiled and cleaned diamond instruments, which was qualitatively verified (microscopy images). CONCLUSIONS The results of this study show the successful development of a dental test soil with 2 clinically relevant soil components. Furthermore, using these soil components as test markers, the authors found that when the established cleaning instructions are properly followed, a soiled diamond instrument can be cleaned in a quantifiable manner. PRACTICAL IMPLICATIONS Thorough cleaning is a critical step in reprocessing multiuse dental instruments. In accordance with US Food and Drug Administration guidance, the described process for quantification of soil components, using 2 clinically relevant soil markers, on cleaned diamond instruments can be helpful to dental instrument manufacturers in the development and validation of cleaning instructions for their reusable instruments.
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Heuvelmans M, Wunderink HF, van der Mei HC, Monkelbaan JF. A narrative review on current duodenoscope reprocessing techniques and novel developments. Antimicrob Resist Infect Control 2021; 10:171. [PMID: 34949217 PMCID: PMC8697464 DOI: 10.1186/s13756-021-01037-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 11/19/2021] [Indexed: 11/10/2022] Open
Abstract
Duodenoscopy-associated infections occur worldwide despite strict adherence to reprocessing standards. The exact scope of the problem remains unknown because a standardized sampling protocol and uniform sampling techniques are lacking. The currently available multi-society protocol for microbial culturing by the Centers for Disease Control and Prevention, the United States Food and Drug Administration (FDA) and the American Society for Microbiology, published in 2018 is too laborious for broad clinical implementation. A more practical sampling protocol would result in increased accessibility and widespread implementation. This will aid to reduce the prevalence of duodenoscope contamination. To reduce the risk of duodenoscopy-associated pathogen transmission the FDA advised four supplemental reprocessing measures. These measures include double high-level disinfection, microbiological culturing and quarantine, ethylene oxide gas sterilization and liquid chemical sterilization. When the supplemental measures were advised in 2015 data evaluating their efficacy were sparse. Over the past five years data regarding the supplemental measures have become available that place the efficacy of the supplemental measures into context. As expected the advised supplemental measures have resulted in increased costs and reprocessing time. Unfortunately, it has also become clear that the efficacy of the supplemental measures falls short and that duodenoscope contamination remains a problem. There is a lot of research into new reprocessing methods and technical applications trying to solve the problem of duodenoscope contamination. Several promising developments such as single-use duodenoscopes, electrolyzed acidic water, and vaporized hydrogen peroxide plasma are already applied in a clinical setting.
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Affiliation(s)
- Maarten Heuvelmans
- Department of Medical Microbiology, University Medical Center Utrecht, G04.643, PO box 85500, 3508GA, Utrecht, The Netherlands.
| | - Herman F Wunderink
- Department of Medical Microbiology, University Medical Center Utrecht, G04.643, PO box 85500, 3508GA, Utrecht, The Netherlands
| | - Henny C van der Mei
- Department of Biomedical Engineering, University of Groningen and University Medical Center Groningen, Groningen, The Netherlands
| | - Jan F Monkelbaan
- Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands
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21
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Avasarala SK, Muscarella LF, Mehta AC. Sans Standardization: Effective Endoscope Reprocessing. Respiration 2021; 100:1208-1217. [PMID: 34488219 DOI: 10.1159/000517335] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 05/14/2021] [Indexed: 01/10/2023] Open
Abstract
Bronchoscopy is a commonly performed procedure within thoracic and critical care medicine. Modern bronchoscopes are technologically advanced tools made of fragile electronic components. Their design is catered to allow maximum maneuverability within the semi-rigid tracheobronchial tree. Effective cleaning and reprocessing of these tools can be a challenge. Although highly functional, the design poses several challenges when it comes to reprocessing. It is a very important step, and lapses in the procedure have been tied to nosocomial infections. The process lacks universal standardization; several organizations have developed their own recommendations. Data have shown that key stakeholders are not fully versed in the essentials of endoscope reprocessing. A significant knowledge gap exists between those performing bronchoscopy and those who are stewards of effective endoscope reprocessing. To service as a resource for bronchoscopists, this study summarizes the steps of effective reprocessing, details the important elements within a health-care facility that houses this process, and reviews some of the current data regarding the use of disposable endoscopes.
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Affiliation(s)
- Sameer K Avasarala
- Division of Allergy, Pulmonary, and Critical Care, Vanderbilt University Medical Center, Nashville, Tennessee, USA,
| | | | - Atul C Mehta
- Respiratory Institute, Cleveland Clinic, Cleveland, Ohio, USA
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Casini B, Pan A, Guarini A, Rivara C, Zullo A, Monica F, Cimbro M, Casarano S, Inglese A, Vaghi A, Schiffino L, Capezzuto E, Da Massa Carrara P, Pasquale L. Multisocieties position paper: Microbiological surveillance on flexible endoscopes. Dig Liver Dis 2021; 53:1105-1111. [PMID: 34266792 DOI: 10.1016/j.dld.2021.06.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 06/14/2021] [Accepted: 06/15/2021] [Indexed: 12/11/2022]
Abstract
Transmission with endoscopes, particularly duodenoscope, of potential lethal infections prompted different scientific societies to deliver recommendations aimed reducing this risk. Some International societies extended recommendations on microbial surveillance to all the endoscopes and devices used in the reprocessing procedure. Considering the relevance of the topic, 8 Italian scientific societies of physicians, nurses and technical operators prepared a concerted document taking into account Institutional advisories and facilities in Italy. The rules for a correct microbial surveillance on endoscopes were detailed in term of what, how and when to perform the procedure, also suggesting behaviors in case of contamination.
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Affiliation(s)
- Beatrice Casini
- Dipartimento di Ricerca Traslazionale e Nuove Tecnologie in Medicina e Chirurgia Università di Pisa, Pisa.
| | | | | | - Cinzia Rivara
- Gastroenterologia, S.C. ASL TO4 Ciriè-Chivasso-Cuorgnè, Torino
| | - Angelo Zullo
- Gastroenterologia, Ospedale Nuovo Regina Margherita, Roma
| | - Fabio Monica
- Gastroenterologia, Azienda Ospedaliera Universitaria Cattinara, Trieste
| | | | | | | | - Adriano Vaghi
- Pneumologia, Ospedale Generale di Garbagnate Milanese, Milano
| | | | | | | | - Luigi Pasquale
- Gastroenterologia, S. O. Ospedale Frangipane, Ariano Irpino, Avellino
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23
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Duncker D, Svetlosak M, Guerra F, Nagy KV, Vanduynhoven P, Mikhaylov EN, Kosiuk J. Reprocessing of electrophysiology material in EHRA countries: an EHRA Young EP survey. Europace 2021; 23:479-485. [PMID: 33083819 DOI: 10.1093/europace/euaa250] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 07/20/2020] [Indexed: 11/12/2022] Open
Abstract
Data on reprocessing of electrophysiology (EP) materials are sparse. Reprocessing of catheters and other materials in daily routine varies through countries and may depend on specific material characteristics, supplier, or federal law. The aim of this study was to collect data on reprocessing usage through EHRA countries. An online survey consisting of 27 questions was distributed to EHRA Young EP members and members of national EP working groups. Two hundred and two participants from 34 EHRA countries completed the survey. One hundred and seven respondents (53.0%) reported having used and using reprocessed EP material, 30 (14.9%) respondents have used reprocessed EP material in the past but not at the time of the survey, 65 (32.2%) had never used reprocessed EP material. The most reprocessed EP materials include cables (70%), diagnostic EP catheters with deflectable (64%) or fixed curve (63%), non-irrigated ablation catheters (51%), and other conventional diagnostic catheters (41%). The most durable material was diagnostic EP catheters with a fixed curve (61%), the most sensitive material was ablation catheters with contact force sensors (21%). Important benefits were seen in reducing costs for the providing hospital (65%) and the healthcare provider (42%) and making EP procedures available for a greater number of patients (42%). Main concerns were on quality aspects (58%), contamination (52%), and loss of precision (47%). Reprocessing of EP materials is heterogeneously managed among EHRA countries. The present survey shows that European electrophysiologists consider the use of reprocessed EP material as generally safe and cost-effective.
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Affiliation(s)
- David Duncker
- Hannover Heart Rhythm Center, Department of Cardiology and Angiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Martin Svetlosak
- Department for Arrhythmias and Cardiostimulation, National Institute for Cardiovascular Diseases, Pod Krásnou hôrkou 1, 83348 Bratislava, Slovakia
| | - Federico Guerra
- Cardiology and Arrhythmology Clinic, University Hospital 'Ospedali Riuniti Umberto I- Lancisi - Salesi', Marche Polytechnic University, via Conca 71, 60126 Ancona, Italy
| | | | | | - Evgeny N Mikhaylov
- Arrhythmia Department, Neuromodulation Laboratory, Almazov National Medical Research Centre, Saint Petersburg, Russian Federation.,Department of Bioengineering Systems, Saint-Petersburg Electrotechnical University 'LETI', Saint Petersburg, Russian Federation
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24
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Umadevi K, Mandal D. Performance of radio-iodine discharge control methods of nuclear reprocessing plants. J Environ Radioact 2021; 234:106623. [PMID: 34004408 DOI: 10.1016/j.jenvrad.2021.106623] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 04/10/2021] [Accepted: 04/10/2021] [Indexed: 06/12/2023]
Abstract
It is imperative to control radio-iodine discharges to atmosphere from nuclear reprocessing plants. Inhalation and ingestion of radio-iodine cause its concentration in the thyroid gland leading to risk of thyroid cancer in humans. Two isotopes of iodine viz. iodine-131 (131I) and iodine-129 (129I) are generated in considerable quantities in the nuclear fuel as fission products in the nuclear reactors. From nuclear reactors, no iodine is released to the atmosphere during normal operations, whereas from spent fuel reprocessing plants, during normal operation, iodine is discharged to the atmosphere, mainly through gaseous discharges. Shortly after the initial periods of reprocessing in 1944, iodine emission control methods were incorporated in the design of reprocessing plants. At the time of spent fuel discharge from reactor, quantity of 131I is high and can contribute radiation dose to humans during reprocessing operations. A delay or cooling period of spent fuel, before reprocessing for a definite number of days can reduce the quantities to below the permissible limits of discharge due to its short half-life of 8 days. 129I has a very long half-life, and is only significant for reprocessing plants of large throughput and high fuel burn-ups. Minimum required de-contamination factor (DF) for iodine for a reprocessing plant can be estimated from the limits of discharge of iodine stipulated by regulatory authority of each country. Though many processes were developed and demonstrated extensively in lab and pilot scale, only a few of these processes were found to be suitable for commercial deployment. This paper reviews systematically the operation experiences and performance characteristics of iodine control methods implemented so far. The review also focus on the effect of integrating various iodine control methods on the main reprocessing operations and thereby facilitate selection of the optimum iodine control method.
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Affiliation(s)
- K Umadevi
- Nuclear Recycle Board, Bhabha Atomic Research Centre, Mumbai, 400085, India; Homi Bhabha National Institute, Mumbai, 400094, India.
| | - D Mandal
- Homi Bhabha National Institute, Mumbai, 400094, India; Alkali Material and Metal Division, Bhabha Atomic Research Centre, Mumbai, 400085, India.
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25
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Eichel VM, Jabs JM, Unser S, Mutters NT, Scherrer M. Does the Reprocessing of Endoscopes Have to Take Place Immediately after Pre-Cleaning? A First Evaluation. Clin Endosc 2021; 54:526-533. [PMID: 34256556 PMCID: PMC8357578 DOI: 10.5946/ce.2020.238] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 01/10/2021] [Indexed: 01/17/2023] Open
Abstract
Background/Aims The recommendations on the time interval between pre-cleaning and reprocessing of endoscopes differ in international guidelines, with a low level of evidence. The aim of this study was to investigate the influence of postponing reprocessing on the reprocessing quality after pre-cleaning the flexible endoscopes.
Methods We reprocessed 124 standardized test tubes simulating endoscope channels after soiling and contamination and determined the reprocessing performance. In addition, we examined contaminated gastroscopes, colonoscopes, and bronchoscopes. The duration of interim storage after pre-cleaning was 16 h for 100 test tubes and up to 24 h for 18 endoscopes. We determined the residual protein content and germ load as markers for cleaning and disinfection performance. In addition, we determined biofilm formation by photometry of crystal violet staining.
Results All test tubes and flexible endoscopes showed residual protein content and germ load significantly below legally prescribed threshold values, independent of the interval between pre-cleaning and reprocessing.
Conclusions Our findings indicate that flexible endoscopes could be stored overnight after pre-cleaning without any influence on the quality of reprocessing. While ensuring patient safety, this could simplify logistical processes and enable cost savings.
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Affiliation(s)
- Vanessa M Eichel
- Section for Hospital Hygiene and Environmental Health, Center for Infectious Diseases, Heidelberg University Hospital, Im Neuenheimer Feld 324, Heidelberg, Germany
| | - Jonas M Jabs
- Section for Hospital Hygiene and Environmental Health, Center for Infectious Diseases, Heidelberg University Hospital, Im Neuenheimer Feld 324, Heidelberg, Germany.,Institute of Hygiene and Public Health, University Hospital Bonn, Venusberg-Campus 1, Bonn, Germany
| | - Samy Unser
- Section for Hospital Hygiene and Environmental Health, Center for Infectious Diseases, Heidelberg University Hospital, Im Neuenheimer Feld 324, Heidelberg, Germany
| | - Nico T Mutters
- Section for Hospital Hygiene and Environmental Health, Center for Infectious Diseases, Heidelberg University Hospital, Im Neuenheimer Feld 324, Heidelberg, Germany.,Institute of Hygiene and Public Health, University Hospital Bonn, Venusberg-Campus 1, Bonn, Germany
| | - Martin Scherrer
- Infection Control Engineering, Center for Infectious Diseases, Heidelberg University Hospital, Im Neuenheimer Feld 324, Heidelberg, Germany
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Suresh S, Pande M, Patel K, Mahometano LD, Romero LG, Barringer D, Sealock RJ, Raju GS. Education, training, and knowledge of infection control among endoscopy technicians and nurses. Am J Infect Control 2021; 49:836-839. [PMID: 33485921 DOI: 10.1016/j.ajic.2021.01.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 01/14/2021] [Accepted: 01/15/2021] [Indexed: 11/28/2022]
Abstract
Our survey of 88 endoscopy technicians and nurses to determine their experience, training, and knowledge of infection control found that few personnel (<15%) received formal training in endoscope reprocessing or infection prevention before or after joining an endoscopy unit. While self-reported confidence in endoscope reprocessing was high (9 out of 10), knowledge of best practices in this regard lagged (average assessment score of 62%).
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Affiliation(s)
- Sanjivini Suresh
- Department of Gastroenterology, Hepatology, & Nutrition, The University of Texas MD Anderson Cancer Center, Houston, TX.
| | - Mala Pande
- Department of Gastroenterology, Hepatology, & Nutrition, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Kalpesh Patel
- Department of Gastroenterology and Hepatology, Baylor College of Medicine, Houston, TX
| | - Liben D Mahometano
- Department of Gastroenterology, Hepatology, & Nutrition, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Laura G Romero
- Department of Gastroenterology, Hepatology, & Nutrition, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Denise Barringer
- Department of Gastroenterology, Hepatology, & Nutrition, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Robert J Sealock
- Department of Gastroenterology and Hepatology, Baylor College of Medicine, Houston, TX
| | - Gottumukkala S Raju
- Department of Gastroenterology, Hepatology, & Nutrition, The University of Texas MD Anderson Cancer Center, Houston, TX
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Antonopoulos I, Faraca G, Tonini D. Recycling of post-consumer plastic packaging waste in the EU: Recovery rates, material flows, and barriers. Waste Manag 2021; 126:694-705. [PMID: 33887695 PMCID: PMC8162419 DOI: 10.1016/j.wasman.2021.04.002] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 01/13/2021] [Accepted: 04/01/2021] [Indexed: 05/15/2023]
Abstract
Increasing plastic waste recycling is a milestone of European environmental policy to reduce environmental impacts and dependency on foreign resources. This is particularly challenging for plastic packaging waste, consisting of very heterogeneous fractions and typically rather contaminated. In this study, we collected primary data from plants sorting and recycling plastic packaging waste to illustrate process efficiencies, material flows, and barriers. We observed that significant losses of target materials occurred both at sorting and recycling stages. These were higher for polymers such as films, polypropylene and polystyrene, and lower for polyethylene terephthalate and high-density polyethylene. Applying material flow analysis, we estimated an overall end-of-life recycling rate for post-consumer plastic packaging waste in EU27 in 2017 of 14% (not considering waste exported as recycled; 25% otherwise). An improved scenario for 2030 showed that achieving an overall end-of-life recycling rate of about 49% was possible when best available practices and technologies were implemented. To fulfil the ambitious recycling targets set at EU27 level (55% overall recycling rate), substantial improvements are necessary at the plants, product design, collection system, and market level. Our findings further indicate that films and other problematic contaminants in the input-waste considerably hamper the recovery rates, thus the improvement of the efficiency of the collection systems is imperative. In parallel, the development of markets for lower value fractions, e.g. polypropylene, could be a way forward to increase recycling, while improvements in the product design will considerably reduce the presence of impurities and contaminants in the input-waste.
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Affiliation(s)
- Ioannis Antonopoulos
- European Commission Joint Research Centre, Calle Inca Garcilaso 3, 41092 Sevilla, Spain.
| | - Giorgia Faraca
- European Commission Joint Research Centre, Calle Inca Garcilaso 3, 41092 Sevilla, Spain
| | - Davide Tonini
- European Commission Joint Research Centre, Calle Inca Garcilaso 3, 41092 Sevilla, Spain
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28
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Lieu A, Mah J, Zanichelli V, Exantus RC, Longtin Y. Impact of extended use and decontamination with vaporized hydrogen peroxide on N95 respirator fit. Am J Infect Control 2020; 48:1457-1461. [PMID: 32805321 PMCID: PMC7428459 DOI: 10.1016/j.ajic.2020.08.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 08/05/2020] [Accepted: 08/06/2020] [Indexed: 11/09/2022]
Abstract
Background To address the shortage of N95 respirators in the wake of the COVID-19 pandemic, some organizations have recommended the decontamination of respirators using vaporized hydrogen peroxide (VHP) sterilizer for up to 10 times. However, these recommendations are based on studies that did not take into account the extended use of respirators, which can degrade respirator fit. Methods We investigated the impact of extended use and decontamination with VHP on N95 Respirator Fit. We performed a prospective cohort study to determine the number of times respirators can be decontaminated before respirator fit test failure. The primary outcome was the overall number of cycles required for half of the respirators to fail (either mechanical failure or fit test failure). Results Thirty-six participants completed 360 hours of respirator usage across 90 cycles. The median number of cycles completed by participants before respirator failure was 2. The overall number of cycles required for half of respirators to fail was 1, 3, 5, and 4 for the 3M 1860(S), 3M 1870+, Moldex 151X and ProGear 88020 respirators, respectively. Conclusions The combination of prolonged usage and VHP decontamination was associated with early failure. Decontamination and prolonged usage of respirators must be done cautiously.
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29
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Aljabo A, Mueller E, Abdul-Azeez D, Hoare T, Jain A. Gravity steam reprocessing in healthcare facilities for the reuse of N95 respirators. J Hosp Infect 2020; 106:698-708. [PMID: 33017616 PMCID: PMC7530561 DOI: 10.1016/j.jhin.2020.09.032] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 09/17/2020] [Accepted: 09/27/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) has significantly impacted the health of millions of people around the world. The shortage of personal protective equipment, including N95 respirators, in hospital facilities has put frontline healthcare professionals at high risk for contracting this virus. AIM To develop a reproducible and safe N95 respirator reprocessing method that satisfies all presented regulatory standards and that can be directly implemented by hospitals using existing available equipment. METHODS A non-toxic gravity steam reprocessing method has been developed for the reuse of N95 respirators consisting of 30 min of steam treatment at 121°C followed by 30 min of heat drying. Samples of model number 1860, 1860s, 1870+, and 9105 N95 respirators were either collected from hospitals (for microbiology testing) or purchased new (for functionality testing), with all functionality tests (i.e. filter efficiency, fit evaluation, and strap integrity) performed at the Centers for Disease Control and Prevention using standard procedures established by the National Institute for Occupational Safety and Health. FINDINGS All tested models passed the minimum filter efficiency of 95% after three cycles of gravity steam reprocessing. The 1870+ N95 respirator model is the most promising model for reprocessing based on its efficient bacterial inactivation coupled with the maintenance of all other key functional respirator properties after multiple reprocessing steps. CONCLUSIONS The gravity steam method can effectively reprocess N95 respirators over at least three reprocessing cycles without negatively impacting the functionality requirements set out by regulators. Enabling the reuse of N95 respirators is a crucial tool for managing both the current pandemic and future healthcare crises.
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Affiliation(s)
- A Aljabo
- SteriPro Canada, Inc., Mississauga, Ontario, Canada.
| | - E Mueller
- Department of Chemical Engineering, McMaster University, Hamilton, Ontario, Canada
| | - D Abdul-Azeez
- Department of Chemical Engineering, McMaster University, Hamilton, Ontario, Canada
| | - T Hoare
- Department of Chemical Engineering, McMaster University, Hamilton, Ontario, Canada
| | - A Jain
- SteriPro Canada, Inc., Mississauga, Ontario, Canada
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30
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Pinder P, Thomzig A, Schulz-Schaeffer WJ, Beekes M. Alpha-synuclein seeds of Parkinson's disease show high prion-exceeding resistance to steam sterilization. J Hosp Infect 2020; 108:25-32. [PMID: 33137444 DOI: 10.1016/j.jhin.2020.10.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 10/22/2020] [Accepted: 10/26/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Cerebral deposition of abnormally misfolded and aggregated alpha-synuclein (αSyn) is a neuropathological hallmark of Parkinson's disease (PD). Pathologically aggregated αSyn species of PD (αSynPD) can act, in a 'prion-like' manner, as proteinaceous nuclei ('seeds') which are capable of self-templated propagation. This has raised concerns that αSynPD seeds transmitted iatrogenically between humans may stimulate αSyn pathologies or clinically harmful effects in the recipients. Effective decontamination when reprocessing medical devices could significantly counteract such risks. Steam sterilization at 134°C is recommended as an essential pathogen inactivation step in many reprocessing guidelines for medical devices, and also shows effectiveness against prions, the self-propagating biological agents long thought to exhibit the highest resistance to steam sterilization. METHODS This study examined the reduction in αSynPD seeding activity in brain tissue homogenates from patients with PD after steam sterilization at 134°C using a specifically adapted real-time quaking induced conversion assay. FINDINGS Titres of approximately 1010 50% seeding doses per gram were detected in non-steam-sterilized caudate nucleus tissue of patients with PD by endpoint titration. Five minutes of steam sterilization reduced this titre by only 2.25 ± 0.15 decadic-logarithmic units, with an extension of the sterilization time to 90 min not causing additional inactivation. These findings reveal that αSynPD species are disease-associated biological agents with seeding activity that has higher resistance to steam sterilization than prions. CONCLUSION The remarkable heat resistance of αSynPD seeds calls for thoroughly validated cleaning and disinfection methods that reliably remove or inactivate possible contaminations of seeding-active αSyn aggregates when reprocessing medical devices.
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Affiliation(s)
- P Pinder
- Prion and Prionoid Research Unit, ZBS 6 - Proteomics and Spectroscopy, ZBS - Centre for Biological Threads and Special Pathogens, Robert Koch Institute, Berlin, Germany
| | - A Thomzig
- Prion and Prionoid Research Unit, ZBS 6 - Proteomics and Spectroscopy, ZBS - Centre for Biological Threads and Special Pathogens, Robert Koch Institute, Berlin, Germany
| | - W J Schulz-Schaeffer
- Institute of Neuropathology, Saarland University Medical Centre, Homburg, Germany
| | - M Beekes
- Prion and Prionoid Research Unit, ZBS 6 - Proteomics and Spectroscopy, ZBS - Centre for Biological Threads and Special Pathogens, Robert Koch Institute, Berlin, Germany.
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31
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Panta G, Richardson AK, Shaw IC, Coope PA. Compliance of primary and secondary care public hospitals with standard practices for reprocessing and steam sterilization of reusable medical devices in Nepal: findings from nation-wide multicenter clustered audits. BMC Health Serv Res 2020; 20:923. [PMID: 33028325 PMCID: PMC7542764 DOI: 10.1186/s12913-020-05788-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Accepted: 09/30/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Reusable medical devices in healthcare facilities are decontaminated and reprocessed following standard practices before each clinical procedure. Reprocessing of critical medical devices (those used for invasive clinical procedures) comprises several processes including sterilization, which provides the highest level of decontamination. Steam sterilization is the most used sterilization procedure across the globe. Noncompliance with standards addressing reprocessing of medical devices may lead to inadequate sterilization and thus increase the risk of person-to-person or environmental transmission of pathogens in healthcare facilities. We conducted nationwide multicenter clustered audits to understand the compliance of primary- and secondary-care public hospitals in Nepal with the standard practices for medical device reprocessing, including steam sterilization. METHODS We developed an audit tool to assess compliance of hospitals with the standard practices for medical device reprocessing including steam sterilization. Altogether, 189 medical device reprocessing cycles which included steam sterilization were assessed in 13 primary and secondary care public hospitals in Nepal using the audit tool. Percentage compliance was calculated for each standard practice. Mean percentage compliances were obtained for overall primary and secondary care hospitals and for each hospital type, specific hospital and process involved. RESULTS For all primary and secondary care hospitals in Nepal, the mean percentage compliance with the standard practices for medical device reprocessing including steam sterilization was 25.9% (95% CI 21.0-30.8%). The lower the level of care provided by the hospitals, the lower was the mean percentage compliance, and the difference in the means across the hospital types was statistically significant (p < 0.01). The mean percentage compliance of individual hospitals ranged from 14.7 to 46.0%. The hospitals had better compliance with the practices for cleaning of used devices and transport and storage of sterilized devices compared with the practices for other processes of the medical device reprocessing cycle. CONCLUSION The primary and secondary care hospitals in Nepal had poor compliance with the standard practices for steam sterilization and reprocessing of medical devices. Interventions to improve compliance of the hospitals are immediately required to minimize the risks of person-to-person or environmental transmission of pathogens through inadequately reprocessed medical devices.
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Affiliation(s)
| | - Ann K Richardson
- School of Health Sciences, University of Canterbury, Christchurch, New Zealand
| | - Ian C Shaw
- School of Physical and Chemical Sciences, University of Canterbury, Christchurch, New Zealand
| | - Patricia A Coope
- College of Education, Health and Human Development, University of Canterbury, Christchurch, New Zealand
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Haugen SP, Ferriter A, Connell J, Min LJ, Wiyor HD, Cole S. Recent Actions by the US Food and Drug Administration: Reducing the Risk of Infection from Reprocessed Duodenoscopes. Gastrointest Endosc Clin N Am 2020; 30:711-721. [PMID: 32891227 DOI: 10.1016/j.giec.2020.06.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
In addition to technological advancements, engagement and collaboration among the wider community of stakeholders will be beneficial toward reducing the risk of infection from reprocessed duodenoscopes. Such a community can raise awareness of the importance of duodenoscope cleaning, work to improve reprocessing training, identify the most pressing unanswered questions that merit further research, and develop tools that can be used by health care facilities to improve the quality of reprocessing at their sites. The Food and Drug Administration looks forward to working with the community to further reduce the risk of infections from reprocessed duodenoscopes.
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Affiliation(s)
- Shanil P Haugen
- United States Food and Drug Administration, Office of Medical Products and Tobacco, Center for Devices and Radiological Health, Office of Health Technology 3, 10903 New Hampshire Avenue, Silver Spring, MD 20993-0002, USA.
| | - Ann Ferriter
- United States Food and Drug Administration, Office of Medical Products and Tobacco, Center for Devices and Radiological Health, Office of Health Technology 3, 10903 New Hampshire Avenue, Silver Spring, MD 20993-0002, USA
| | - Jian Connell
- United States Food and Drug Administration, Office of Medical Products and Tobacco, Center for Devices and Radiological Health, Office of Health Technology 3, 10903 New Hampshire Avenue, Silver Spring, MD 20993-0002, USA
| | - Lauren J Min
- United States Food and Drug Administration, Office of Medical Products and Tobacco, Center for Devices and Radiological Health, Office of Health Technology 3, 10903 New Hampshire Avenue, Silver Spring, MD 20993-0002, USA
| | - Hanniebey D Wiyor
- United States Food and Drug Administration, Office of Medical Products and Tobacco, Center for Devices and Radiological Health, Office of Health Technology 3, 10903 New Hampshire Avenue, Silver Spring, MD 20993-0002, USA
| | - Stephanie Cole
- United States Food and Drug Administration, Office of Medical Products and Tobacco, Center for Devices and Radiological Health, Office of Health Technology 3, 10903 New Hampshire Avenue, Silver Spring, MD 20993-0002, USA
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Vitale DS, Kwok KK, Liu QY. Society Guidelines-Where Is the Consensus? Gastrointest Endosc Clin N Am 2020; 30:763-779. [PMID: 32891231 DOI: 10.1016/j.giec.2020.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
With reports of ongoing duodenoscope contamination and pathogen transmission despite strict adherence to manufacturer reprocessing instructions, professional societies continue to release updated recommendations. Despite general guideline similarities, there are differences. Although adherence to guidelines does not entirely eliminate pathogen contamination or transmission, it is critical to strictly adhere to updated guidelines for maximum risk reduction. In the United States, the Food and Drug Administration and Centers for Disease Control and Prevention continue to offer updates regarding improved duodenoscope reprocessing techniques and endoscope design. This article critically analyzes currently available national and international duodenoscope reprocessing guidelines.
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Affiliation(s)
- David S Vitale
- Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH, 45229; Department of Pediatrics, University of Cincinnati College of Medicine, 3230 Eden Avenue, Cincinnati, OH, 45267, USA
| | - Karl K Kwok
- Southern California Kaiser Permanente Medical Group, 1526 North Edgemont Street, 7th floor, Los Angeles, CA 90027, USA. https://twitter.com/GI_Guy
| | - Quin Y Liu
- Department of Medicine and Pediatrics, Digestive Disease Center, Cedars-Sinai Medical Center/David Geffen School of Medicine at UCLA, 8700 Beverly Blvd, Suite 7700, South Tower, Los Angeles, CA 90048, USA.
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Gilbertson J, Quintanar-Solares M, Liland F, Niermeyer S. High-level disinfection of re-usable neonatal resuscitation equipment through boiling and steaming. J Hosp Infect 2020; 106:721-5. [PMID: 32956788 DOI: 10.1016/j.jhin.2020.09.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Accepted: 09/10/2020] [Indexed: 11/21/2022]
Abstract
Infection and asphyxia are two major causes of neonatal death globally. Where single-use resuscitation devices or sterilization of re-usable devices are unavailable, there is a need for effective, low-cost methods of high-level disinfection. Laboratory validation examined the efficacy of boiling and enclosed steaming (without pressure) as methods for attaining high-level disinfection of re-usable neonatal resuscitation equipment. The microbial load extracted and measured for each test article met internationally accepted standards for high-level disinfection. Boiling and steaming are low-cost, effective methods for reprocessing re-usable neonatal resuscitation devices in low- and middle-income countries.
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Chivukula SR, Lammers S, Wagner J. Assessing organic material on single-use vessel sealing devices: a comparative study of reprocessed and new LigaSure™ devices. Surg Endosc 2020; 35:4539-4549. [PMID: 32909208 PMCID: PMC8263541 DOI: 10.1007/s00464-020-07969-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 08/27/2020] [Indexed: 11/29/2022]
Abstract
Background Reprocessed devices must be thoroughly cleaned prior to sterilization to ensure efficacy of sterilization agents. Many single-use devices are not designed to be thoroughly cleaned. Interlocking design features inherent to LigaSure™ vessel sealing devices may prevent thorough cleaning and promote accumulation of human tissue that cannot be removed. Thus, the aim of this study was to compare industry reprocessed and new LigaSure™ vessel sealing devices for organic material. Methods A total of 168, 84 new and 84 reprocessed, vessel sealing devices were disassembled and inspected for the presence of residual organic matter using visual, microscopic, and chemical analysis. Devices were randomized and test conductors blinded to group membership. Devices were aseptically disassembled and sent through visual inspection. Next, devices were either examined using light microscopy, scanning electron microscopy (SEM) or exposed to a solution that luminesces in the presence of hemoglobin. Additionally, 165 reprocessed devices were sent to a 3rd party lab for sterility testing via direct immersion culture for 14 days. Results Significant amounts of remnant organic material (C, N, O, S, Na, P) were observed with 81/84 reprocessed and 0/84 new devices failing inspection protocols. When tested for the presence of hemoglobin, only 1/12 reprocessed devices passed inspection. SEM of reprocessed devices revealed residues with liquid patterns and diffuse soiling with foreign material. Sterility testing of reprocessed devices revealed a sterility level < 6–3. Conclusions The abundance of material resembling human tissue observed on reprocessed VSDs suggests inadequate cleaning prior to sterilization. Atomic and morphological analyses of the remnant materials suggest that bacterial biofilms could also be present. Additionally, surface degradation and release of reinforcing glass fibers from the device were observed. Devices designed for single use can harbor significant amounts of remnant material that likely interfere with the sterilization process.
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Affiliation(s)
- Swathi Ramesh Chivukula
- Department of Bioengineering, University of Colorado Denver
- Anschutz Medical Campus, 12705 E. Montview Blvd., Ste. 100, Mail Stop 8607, Aurora, CO, 80045, USA
| | - Steven Lammers
- Department of Bioengineering, University of Colorado Denver
- Anschutz Medical Campus, 12705 E. Montview Blvd., Ste. 100, Mail Stop 8607, Aurora, CO, 80045, USA
| | - Jennifer Wagner
- Department of Bioengineering, University of Colorado Denver
- Anschutz Medical Campus, 12705 E. Montview Blvd., Ste. 100, Mail Stop 8607, Aurora, CO, 80045, USA.
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Pascoe MJ, Robertson A, Crayford A, Durand E, Steer J, Castelli A, Wesgate R, Evans SL, Porch A, Maillard JY. Dry heat and microwave-generated steam protocols for the rapid decontamination of respiratory personal protective equipment in response to COVID-19-related shortages. J Hosp Infect 2020; 106:10-19. [PMID: 32652212 PMCID: PMC7343662 DOI: 10.1016/j.jhin.2020.07.008] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 07/06/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND In the wake of the SARS-CoV-2 pandemic and unprecedented global demand, clinicians are struggling to source adequate access to personal protective equipment. Respirators can be in short supply, though are necessary to protect workers from SARS-CoV-2 exposure. Rapid decontamination and reuse of respirators may provide relief for the strained procurement situation. METHOD In this study, we investigated the suitability of 70°C dry heat and microwave-generated steam (MGS) for reprocessing of FFP2/N95-type respirators, and Type-II surgical face masks. Staphylococcus aureus was used as a surrogate as it is less susceptible than enveloped viruses to chemical and physical processes. RESULTS We observed >4 log10 reductions in the viability of dry S. aureus treated by dry heat for 90 min at 70°C and >6 log10 reductions by MGS for 90 s. After 3 reprocessing cycles, neither process was found to negatively impact the bacterial or NaCl filtration efficiency of the respirators that were tested. However, MGS was incompatible with Type-II surgical masks tested, as we confirmed that bacterial filtration capacity was completely lost following reprocessing. MGS was observed to be incompatible with some respirator types due to arcing observed around some types of metal nose clips and by loss of adhesion of clips to the mask. CONCLUSION Considering the advantages and disadvantages of each approach, we propose a reprocessing personal protective equipment/face mask workflow for use in medical areas.
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Affiliation(s)
- M J Pascoe
- Cardiff School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Cardiff, Wales, UK
| | - A Robertson
- Cardiff School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Cardiff, Wales, UK
| | - A Crayford
- Cardiff School of Engineering, Cardiff University, Cardiff, Wales, UK
| | - E Durand
- Cardiff School of Engineering, Cardiff University, Cardiff, Wales, UK
| | - J Steer
- Cardiff School of Engineering, Cardiff University, Cardiff, Wales, UK
| | - A Castelli
- Cardiff School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Cardiff, Wales, UK; Cardiff School of Engineering, Cardiff University, Cardiff, Wales, UK
| | - R Wesgate
- Cardiff School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Cardiff, Wales, UK
| | - S L Evans
- Cardiff School of Engineering, Cardiff University, Cardiff, Wales, UK
| | - A Porch
- Cardiff School of Engineering, Cardiff University, Cardiff, Wales, UK
| | - J-Y Maillard
- Cardiff School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Cardiff, Wales, UK.
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Oliveira DC, Bonfim F, Vinhas M, Silva I, Teixeira M, Galembeck A. Catheter Reprocessing for Coronary Angiography: It is Not Safe. Cardiol Res 2020; 11:342-347. [PMID: 32849970 PMCID: PMC7430894 DOI: 10.14740/cr1134] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 07/28/2020] [Indexed: 11/24/2022] Open
Abstract
Background Coronary angiography and percutaneous coronary intervention are frequently and increasingly performed worldwide. Although catheters for coronary angiography are considered as single-use devices, some people still question this decision. This study evaluated the structural characteristics and thermal stability of new and reprocessed catheters. Methods Five catheters (Judkins left) of the same brand and manufacturer were selected for each analysis. We evaluated: new catheters, catheters reprocessed once (first), twice (second), thrice (third), and seven times (seventh). The optical analyses of the proximal, middle and distal parts of the catheters were performed by magnifying glass. Besides, thermogravimetric analyses were done. Results After reprocessing, the crushing, color changes, folds, dents, deformations, and lumen narrowing were observed; the stainless-steel framework, the external tortuosity, the interlaced mesh of stainless-steel wires and loss of polymeric material were visualized. Thermogravimetric analysis showed lost of mass of the catheters. Conclusions This study demonstrated that the structural integrity and mass of catheters are lost with reprocessing. These findings may be caused by several steps of reprocessing; however, regardless of which step or steps were responsible, the presence of structural integrity loss leads to the recommendation of not reusing this type of device.
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Affiliation(s)
| | - Flavia Bonfim
- Federal University of Pernambuco (UFPE), Recife-PE, Brazil
| | - Maria Vinhas
- Federal University of Pernambuco (UFPE), Recife-PE, Brazil
| | - Ivan Silva
- Federal University of Pernambuco (UFPE), Recife-PE, Brazil
| | - Magno Teixeira
- Federal University of Pernambuco (UFPE), Recife-PE, Brazil
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Ridtitid W, Pakvisal P, Chatsuwan T, Kerr SJ, Piyachaturawat P, Luangsukrerk T, Kongkam P, Rerknimitr R. Performance characteristics and optimal cut-off value of triple adenylate nucleotides test versus adenosine triphosphate test as point-of-care testing for predicting inadequacy of duodenoscope reprocessing. J Hosp Infect 2020; 106:348-356. [PMID: 32768608 DOI: 10.1016/j.jhin.2020.07.038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Accepted: 07/31/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Adenosine triphosphate (ATP) test based on one nucleotide has been applied as point-of-care testing (POCT) for bacterial contamination in the medical and food industries. Hypothetically, testing three adenylate nucleotides (A3) may provide better detection of duodenoscope bacterial contamination than ATP test. AIM To evaluate performance characteristics and optimal cut-off value of A3 and ATP tests in predicting bacterial contamination of duodenoscopes. METHODS Four hundred duodenoscope samples obtained after 100 endoscopic retrograde cholangiopancreatography procedures were randomized into group A (A3 test) or B (ATP test). Samples were collected from the elevator at the four-step cleaning process of duodenoscope. We defined the new cut-off value of the test for reaching 100% negative predictive value (NPV) from our receiver operating characteristic (ROC). FINDINGS Using the cultures from the four-step cleaning process as the reference, the areas under ROC (AUROC) were 0.83 and 0.84 for group A (N = 200) and group B (N = 200), respectively. Using the cultures from post-high-level disinfection (HLD) as the reference, the AUROC were 0.35 and 0.74 for group A (N = 50) and group B (N = 50), respectively. We investigated ATP as a POCT after HLD with a new cut-off value of 40 RLU. However, this threshold did not allow detection of low numbers of bacteria. CONCLUSION A3 and ATP tests provide good performances in predicting bacterial contamination of duodenoscopes for the four-step cleaning process. The ATP <40 RLU is helpful as a POCT after HLD; however, the limitation of this cut-off value is its inability to detect low numbers of bacteria.
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Affiliation(s)
- W Ridtitid
- Division of Gastroenterology, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand; Center of Excellence for Innovation and Endoscopy in Gastrointestinal Oncology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - P Pakvisal
- Division of Gastroenterology, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - T Chatsuwan
- Department of Microbiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand; Antimicrobial Resistance and Stewardship Research Unit, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - S J Kerr
- Biostatistics Excellence Centre, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - P Piyachaturawat
- Division of Gastroenterology, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - T Luangsukrerk
- Division of Gastroenterology, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - P Kongkam
- Division of Gastroenterology, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand; Center of Excellence for Innovation and Endoscopy in Gastrointestinal Oncology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - R Rerknimitr
- Division of Gastroenterology, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand; Center of Excellence for Innovation and Endoscopy in Gastrointestinal Oncology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
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Muthusamy VR, Bruno MJ, Kozarek RA, Petersen BT, Pleskow DK, Sejpal DV, Slivka A, Peetermans JA, Rousseau MJ, Tirrell GP, Ross AS. Clinical Evaluation of a Single-Use Duodenoscope for Endoscopic Retrograde Cholangiopancreatography. Clin Gastroenterol Hepatol 2020; 18:2108-2117.e3. [PMID: 31706060 DOI: 10.1016/j.cgh.2019.10.052] [Citation(s) in RCA: 59] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Accepted: 10/11/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Disposable, single-use duodenoscopes might reduce outbreaks of infections associated with endoscope reuse. We tested the feasibility, preliminary safety, and performance of a new single-use duodenoscope in patients undergoing endoscopic retrograde cholangiopancreatography (ERCP). METHODS We conducted a case-series study of the outcomes of ERCP with a single-use duodenoscope from April through May 2019 at 6 academic medical centers. We screened consecutive patients (18 years and older) without alterations in pancreaticobiliary anatomy and enrolled 73 patients into the study. Seven expert endoscopists performed roll-in maneuvers (duodenoscope navigation and visualization of duodenal papilla only) in 13 patients and then ERCPs in the 60 other patients. Outcomes analyzed included completion of ERCP for the intended clinical indication, crossover from a single-use duodenoscope to a reusable duodenoscope, endoscopist performance ratings of the device, and serious adverse events (assessed at 72 hours and 7 days). RESULTS Thirteen (100%) roll-in maneuver cases were completed using the single-use duodenoscope. ERCPs were of American Society for Gastrointestinal Endoscopy procedural complexity grade 1 (least complex; 7 patients [11.7%]), grade 2 (26 patients [43.3%]), grade 3 (26 patients [43.3%]), and grade 4 (most complex; 1 patient [1.7%]). Fifty-eight ERCPs (96.7%) were completed using the single-use duodenoscope only and 2 ERCPs (3.3%) were completed using the single-use duodenoscope followed by crossover to a reusable duodenoscope. Median overall satisfaction was 9 out of 10. Three patients developed post-ERCP pancreatitis, 1 patient had post-sphincterotomy bleeding, and 1 patient had worsening of a preexisting infection and required rehospitalization. CONCLUSIONS In a case-series study, we found that expert endoscopists can complete ERCPs of a wide range of complexity using a single-use duodenoscope for nearly all cases. This alternative might decrease ERCP-related risk of infection. Clinicaltrials.gov no: NCT03701958.
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Affiliation(s)
- V Raman Muthusamy
- Vatche and Tamar Manoukian Division of Digestive Diseases, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California.
| | - Marco J Bruno
- Department of Gastroenterology and Hepatology; Erasmus Medical Center, University Medical Center, Rotterdam, The Netherlands
| | - Richard A Kozarek
- Department of Gastroenterology, Digestive Disease Institute, Virginia Mason Medical Center, Seattle, Washington
| | - Bret T Petersen
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
| | - Douglas K Pleskow
- Center for Advanced Endoscopy, Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Divyesh V Sejpal
- Division of Gastroenterology, Zucker School of Medicine at Hofstra/Northwell, North Shore University Hospital, Manhasset, New York
| | - Adam Slivka
- Department of Gastroenterology, Hepatology, and Nutrition, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Joyce A Peetermans
- Endoscopy Division, Boston Scientific Corporation, Marlborough, Massachusetts
| | - Matthew J Rousseau
- Endoscopy Division, Boston Scientific Corporation, Marlborough, Massachusetts
| | - Gregory P Tirrell
- Endoscopy Division, Boston Scientific Corporation, Marlborough, Massachusetts
| | - Andrew S Ross
- Department of Gastroenterology, Digestive Disease Institute, Virginia Mason Medical Center, Seattle, Washington
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Liu TC, Peng CL, Wang HP, Huang HH, Chang WK. SpyGlass application for duodenoscope working channel inspection: Impact on the microbiological surveillance. World J Gastroenterol 2020; 26:3767-3779. [PMID: 32774056 PMCID: PMC7383844 DOI: 10.3748/wjg.v26.i26.3767] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 05/28/2020] [Accepted: 06/23/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Patient-ready duodenoscopes were designed with an assumed contamination rate of less than 0.4%; however, it has been reported that 5.4% of clinically used duodenoscopes remain contaminated with viable high-concern organisms despite following the manufacturer’s instructions. Visual inspection of working channels has been proposed as a quality control measure for endoscope reprocessing. There are few studies related to this issue.
AIM To investigate the types, severity rate, and locations of abnormal visual inspection findings inside patient-ready duodenoscopes and their microbiological significance.
METHODS Visual inspections of channels were performed in 19 patient-ready duodenoscopes using the SpyGlass visualization system in two endoscopy units of tertiary care teaching hospitals (Tri-Service General Hospital and National Taiwan University Hospital) in Taiwan. Inspections were recorded and reviewed to evaluate the presence of channel scratches, buckling, stains, debris, and fluids. These findings were used to analyze the relevance of microbiological surveillance.
RESULTS Seventy-two abnormal visual inspection findings in the 19 duodenoscopes were found, including scratches (n = 10, 52.6%), buckling (n = 15, 78.9%), stains (n = 14, 73.7%), debris (n = 14, 73.7%), and fluids (n = 6, 31.6%). Duodenoscopes > 12 mo old had a significantly higher number of abnormal visual inspection findings than those ≤ 12 mo old (46 findings vs 26 findings, P < 0.001). Multivariable regression analyses demonstrated that the bending section had a significantly higher risk of being scratched, buckled, and stained, and accumulating debris than the insertion tube. Debris and fluids showed a significant positive correlation with microbiological contamination (P < 0.05). There was no significant positive Spearman’s correlation coefficient between negative bacterial cultures and debris, between that and fluids, and the concomitance of debris and fluids. This result demonstrated that the presence of fluid and debris was associated with positive cultures, but not negative cultures. Further multivariate analysis demonstrated that fluids, but not debris, is an independent factor for bacterial culture positivity.
CONCLUSION In patient-ready duodenoscopes, scratches, buckling, stains, debris, and fluids inside the working channel are common, which increase the microbiological contamination susceptibility. The SpyGlass visualization system may be recommended to identify suboptimal reprocessing.
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Affiliation(s)
- Tao-Chieh Liu
- Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan
| | - Chen-Ling Peng
- Department of Integrated Diagnostics & Therapeutics, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei 10002, Taiwan
| | - Hsiu-Po Wang
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei 114, Taiwan
| | - Hsin-Hung Huang
- Division of Gastroenterology, Cheng Hsin General Hospital, National Defense Medical Center, Taipei 114, Taiwan
| | - Wei-Kuo Chang
- Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan
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Widmer AF, Richner G. Proposal for a EN 149 acceptable reprocessing method for FFP2 respirators in times of severe shortage. Antimicrob Resist Infect Control 2020; 9:88. [PMID: 32552867 PMCID: PMC7298450 DOI: 10.1186/s13756-020-00744-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 05/29/2020] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Transmission of SARS-CoV-2 to health care workers (HCW) poses a major burden in the current COVID-19 pandemic. Unprotected exposure to a COVID-19 patient is a key risk factor for HCWs. Transmission mainly occurs by droplet transmission, or by aerosol generating procedures. Respirators such as filtering face piece masks (FFP2), also called respirators, are required to prevent transmission during aerosol generating procedures, as part of the personal protective equipment (PPE) for HCWs. However, many HCW were infected due to lack of PPE, or failure to use them. Therefore, the worldwide shortage of respirators triggered the development of reprocessing used FFP2 respirators or N95 respirators as standard in the US. Our proposal with H2O2 plasma sterilization for decontamination allows to reprocess FFP2, while they still meet the filtration efficiency required by EN 149. The protocol is simple, uses available resources in hospitals and can be rapidly implemented to decrease the shortage of respirators during this crisis. The goal of the study was the evaluate if respirators can be reprocessed and still fulfill the requirements for filtration efficiency outlined by EN 149. METHODS Used FFP2 respirators - Model 3 M Aura™ 1862+ - were sterilized using a low temperature process hydrogen peroxide (H2O2), V-PRO® maX Low Temperature, a FDA (Food and Drug Administration) approved method to decontaminate FFP2 respirators. Decontaminated respirators were further checked for residual peroxide by a single-gas detector for H2O2. The total inward leakage of the protective respirators was quantitatively tested with 10 test persons in an atmosphere charged with paraffin aerosol according to the European Standard EN 149. The fit factor was calculated as the inverse of the total inward leakage. RESULTS Ten new and ten decontaminated FFP2 respirators were tested for filtration efficiency. None of the respirators exceeded the maximum acceptable concentration of peroxide. More than 4000 respirators have been reprocessed so far, at cost of approximately 0.3 Euro/piece. CONCLUSIONS FFP2 respirators can be safely reprocessed once after decontamination with plasma peroxide sterilization, whereafter they still fulfill EN 149 requirements. This allows to almost double the current number of available FFP2 respirators.
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Affiliation(s)
- Andreas F Widmer
- University of Basel Hospitals, Division of infectious Diseases & Hospital Epidemiology and University of Basel, 4031, Basel, Switzerland.
| | - Gilles Richner
- Federal Office for Civil Protection FOCP, Spiez Laboratory, Spiez, Switzerland
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Rudhart SA, Günther F, Dapper L, Thangavelu K, Gehrt F, Stankovic P, Wilhelm T, Guenzel T, Stuck BA, Hoch S. UV light-based decontamination: an effective and fast way for disinfection of endoscopes in otorhinolaryngology? Eur Arch Otorhinolaryngol 2020; 277:2363-9. [PMID: 32358650 DOI: 10.1007/s00405-020-05978-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 04/10/2020] [Indexed: 12/28/2022]
Abstract
Background Reprocessing of endoscopes becomes increasingly complex, due to rising demands of hygiene. Established methods are often expensive/time-consuming. Recent studies suggest beneficial aspects of disinfection by UV light. In this study we analyzed the efficiency of UV light disinfection of rigid otorhinolaryngological endoscopes. Materials and methods After mechanical pre-cleaning, the endoscopes were decontaminated for 25 s in the D25 using Impelux™ UV C light technology (UV Smart B.V., Delft, The Netherlands). First, the surface contact samples were taken from 50 used endoscopes to evaluate the bacterial load. Additionally, surface contact samples were taken from further 50 used endoscopes after reprocessing with the D25. Another 50 endoscopes were tested on protein residuals. Furthermore, the absolute effectiveness of the D25 was tested on 50 test bodies (RAMS) with a standardized contamination of 107 colony-forming units (CFU) of Enterococcus faecium. Results The used endoscopes showed a high bacterial contamination with an average value of 66.908 (± 239.215) CFU. After reprocessing, only a minimal contamination on 10% (n = 5) of the endoscopes with a mean value of 0.12 CFU (± 0.39) was found, resulting in a log-5 reduction in a clinical environment. The documented bacteria were components of the normal skin flora. All tested endoscopes were practically protein-free (< 1 μg). Furthermore, the average absolute germ reduction of the D25 was about 106 CFU on the tested RAMS. Conclusion The D25 UV light system seems to be an effective device for the reprocessing of rigid ORL endoscopes, and therefore, might be suitable for the usage in clinical practice on site.
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Tofanelli M, Capriotti V, Saraniti C, Marcuzzo AV, Boscolo-Rizzo P, Tirelli G. Disposable chlorine dioxide wipes for high-level disinfection in the ENT department: A systematic review. Am J Otolaryngol 2020; 41:102415. [PMID: 32059828 DOI: 10.1016/j.amjoto.2020.102415] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 02/02/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Nasopharyngoscope reprocessing methods should be effective, rapid and reproducible with moderate cost. Tristel Trio Wipes system (TTWS) is a manual reprocessing method based on chlorine dioxide that has lately emerged in ENT department. This review aims to collect evidence on this system. METHODS The PubMed, Web of Science and Cochrane Library databases were searched for all the studies on TTWS or one of its components. Data were grouped according to the study type. RESULTS Ten articles were included in the review. TTWS ensured high-level disinfection in laboratory and clinical setting. Although the limitations of the manual systems, TTWS proved to be faster than automated endoscope reprocessing (AER) and safe for patients and health-care workers. TTWS represented cheaper system than AER or sheaths in low- and medium-volume centers. CONCLUSION TTWS could be a valid, safe and fast HLD method for nasopharyngoscopes, with reasonable costs for medium-low reprocessing volumes.
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Affiliation(s)
- Margherita Tofanelli
- Department of Otorhinolaryngology and Head and Neck Surgery, University of Trieste, Cattinara Hospital, Strada di Fiume 447, 34149 Trieste, Italy
| | - Vincenzo Capriotti
- Department of Otorhinolaryngology and Head and Neck Surgery, University of Trieste, Cattinara Hospital, Strada di Fiume 447, 34149 Trieste, Italy.
| | - Carmelo Saraniti
- Department of Otorhinolaryngology and Head and Neck Surgery, University of Palermo, P. Giaccone Hospital, Via del Vespro 129, 90127 Palermo, Italy
| | - Alberto Vito Marcuzzo
- Department of Otorhinolaryngology and Head and Neck Surgery, University of Trieste, Cattinara Hospital, Strada di Fiume 447, 34149 Trieste, Italy
| | - Paolo Boscolo-Rizzo
- Department of Neurosciences, Section of Otolaryngology and Regional Centre for Head and Neck Cancer, University of Padova, Piazzale dell'Ospedale, 1, 31100 Treviso, TV, Italy
| | - Giancarlo Tirelli
- Department of Otorhinolaryngology and Head and Neck Surgery, University of Trieste, Cattinara Hospital, Strada di Fiume 447, 34149 Trieste, Italy
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Dinis MDL, Fiúza A, Futuro A, Leite A, Martins D, Figueiredo J, Góis J, Vila MC. Characterization of a mine legacy site: an approach for environmental management and metals recovery. Environ Sci Pollut Res Int 2020; 27:10103-10114. [PMID: 31975010 PMCID: PMC7089905 DOI: 10.1007/s11356-019-06987-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 11/06/2019] [Indexed: 06/10/2023]
Abstract
The characterization of historical mine tailings provides important information for land-management decisions, in particular when considering potential reprocessing activities or the development of an environmental protection program. In addition, outcomes from such characterization may define the scope for a more detailed investigation. The present work describes the characterization of the waste material from the Cabeço do Pião tailings impoundment performed within the project ReMinE: Improve Resource Efficiency and Minimize Environmental Footprint. The purpose of the work was to investigate alternative mine waste management options such as the extraction of valuable resources from an environmental liability. The study involved the collection of 41 samples at different locations at two different depths, physical and chemical characterization of the wastes, natural leaching tests, and potential for acid generation. The results showed that, apart from the potential instability of the dyke (with an average slope of 35°), the drained solutions flowing by percolation contain very small particles with high arsenic contents that are being incorporated into the river sediments. In addition, these very fine-grained materials are available for the transport by the wind creating secondary sources of environmental contamination. This data is fundamental for economic and environmental assessment of the two main alternatives, reprocessing or removal.
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Affiliation(s)
- Maria de Lurdes Dinis
- Center for Natural Resources and the Environment (CERENA-FEUP), Faculty of Engineering, University of Porto, R. Dr. Roberto Frias, 4200-465, Porto, Portugal.
- Faculty of Engineering, University of Porto, R. Dr. Roberto Frias, 4200-465, Porto, Portugal.
| | - António Fiúza
- Center for Natural Resources and the Environment (CERENA-FEUP), Faculty of Engineering, University of Porto, R. Dr. Roberto Frias, 4200-465, Porto, Portugal
- Faculty of Engineering, University of Porto, R. Dr. Roberto Frias, 4200-465, Porto, Portugal
| | - Aurora Futuro
- Center for Natural Resources and the Environment (CERENA-FEUP), Faculty of Engineering, University of Porto, R. Dr. Roberto Frias, 4200-465, Porto, Portugal
- Faculty of Engineering, University of Porto, R. Dr. Roberto Frias, 4200-465, Porto, Portugal
| | - Alexandre Leite
- Center for Natural Resources and the Environment (CERENA-FEUP), Faculty of Engineering, University of Porto, R. Dr. Roberto Frias, 4200-465, Porto, Portugal
- Faculty of Engineering, University of Porto, R. Dr. Roberto Frias, 4200-465, Porto, Portugal
| | - Diogo Martins
- Faculty of Engineering, University of Porto, R. Dr. Roberto Frias, 4200-465, Porto, Portugal
| | - Janine Figueiredo
- Center for Natural Resources and the Environment (CERENA-FEUP), Faculty of Engineering, University of Porto, R. Dr. Roberto Frias, 4200-465, Porto, Portugal
- Faculty of Engineering, University of Porto, R. Dr. Roberto Frias, 4200-465, Porto, Portugal
| | - Joaquim Góis
- Center for Natural Resources and the Environment (CERENA-FEUP), Faculty of Engineering, University of Porto, R. Dr. Roberto Frias, 4200-465, Porto, Portugal
- Faculty of Engineering, University of Porto, R. Dr. Roberto Frias, 4200-465, Porto, Portugal
| | - Maria Cristina Vila
- Center for Natural Resources and the Environment (CERENA-FEUP), Faculty of Engineering, University of Porto, R. Dr. Roberto Frias, 4200-465, Porto, Portugal
- Faculty of Engineering, University of Porto, R. Dr. Roberto Frias, 4200-465, Porto, Portugal
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Balan GG, Sfarti CV, Chiriac SA, Stanciu C, Trifan A. Duodenoscope-associated infections: a review. Eur J Clin Microbiol Infect Dis 2019; 38:2205-2213. [PMID: 31482418 DOI: 10.1007/s10096-019-03671-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 08/05/2019] [Indexed: 02/08/2023]
Abstract
Flexible digestive endoscopes are used for the management of various conditions with hundreds of thousands of therapeutic procedures performed worldwide each year. Duodenoscopes are indispensable tools for the delivery of minimally invasive vital care of numerous pancreaticobiliary disorders. Despite the fact that nosocomial infections after endoscopic retrograde cholangiopancreatography (ERCP) have always been among the most frequently cited postprocedural complications, recent emergence of duodenoscope-transmitted multiple drug-resistant bacterial infections has led to intense research and debate yet with no clearly delineated solution. Duodenoscope-transmitted nosocomial infections have become one of the most visible topics in the recent literature. Hundreds of high-impact articles have therefore been published in the last decade. This review article discusses how such infections were seen in the past and what is the current situation in both research and practice and thus tries to solve some of the unanswered questions for the future. With the persistence of nosocomial infections despite strict adherence to both manufacturer-issued reprocessing protocols and international guidelines and regulations, an urgent and proper microbiologically driven common action is needed for controlling such nosocomial worldwide threat.
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Affiliation(s)
- Gheorghe G Balan
- Grigore T. Popa, University of Medicine and Pharmacy of Iași, Iași, Romania
| | | | | | - Carol Stanciu
- Institute of Gastroenterology and Hepatology, St. Spiridon Emergency Hospital of Iași, Iași, Romania
| | - Anca Trifan
- Grigore T. Popa, University of Medicine and Pharmacy of Iași, Iași, Romania
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Chang WK, Liu TC, Liu TL, Peng CL, Wang HP. Enhanced manual cleaning efficacy of duodenoscope in endoscopy units: Results of a multicenter comprehensive quality control program. Am J Infect Control 2019; 47:1233-9. [PMID: 31126624 DOI: 10.1016/j.ajic.2019.03.029] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Revised: 03/21/2019] [Accepted: 03/21/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND Multiple outbreaks from contaminated duodenoscopes have been reported since 2008. This study assessed results of a multicenter comprehensive quality control (QC) program to enhance manual cleaning efficacy of duodenoscopes in endoscopy units. METHODS Digestive Endoscopy Society of Taiwan implemented a QC program with adenosine triphosphate (ATP) testing of patient-used duodenoscopes in 2 rounds of on-site audit in endoscopy units. ATP samples were obtained from 5 different locations of the duodenoscope after manual cleaning. Duodenoscope exceeding ATP benchmark of 200 relative light units indicated inadequate manual cleaning. RESULTS During the first round on-site audit, 12 hospitals and 27 patient-used duodenoscopes were analyzed. Distal end outer surface (29.6%), elevator mechanism (51.9%), distal attachment cap (59.3%), elevator wire channel (37.0%), and suction biopsy channel (37.0%) were inadequately cleaned. Overall, 19 (70.4%) duodenoscopes had inadequate manual cleaning, ranging widely from 0%-100% among endoscopy units. During the follow-up on-site audit, 32 patient-used duodenoscopes were analyzed, and 6 (18.8%) had inadequate manual cleaning. CONCLUSIONS ATP tests may provide real-time feedback on the cleaning efficacy of patient-used duodenoscopes. Implementing a comprehensive QC program could enhance the efficacy of manual cleaning in endoscopy units.
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Kampf G, Jung M, Suchomel M, Saliou P, Griffiths H, Vos MC. Prion disease and recommended procedures for flexible endoscope reprocessing - a review of policies worldwide and proposal for a simplified approach. J Hosp Infect 2019; 104:92-110. [PMID: 31408691 DOI: 10.1016/j.jhin.2019.08.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Accepted: 08/05/2019] [Indexed: 10/26/2022]
Abstract
Several guidelines recommend specific treatments for endoscopes, procedures of quarantine for endoscopes, or additional treatments for the endoscope washer disinfector (EWD) in suspected or confirmed cases of Creutzfeldt-Jakob disease (CJD) or variant CJD (vCJD) but vary in many details. This study therefore reviewed guidelines on reprocessing flexible endoscopes after use in patients with suspected or confirmed prion disease. In addition, a literature search was performed in Medline on prion, CJD, vCJD, chemical inactivation, transmission healthcare, epidemiology healthcare, concentration tissue human and endoscope. Thus far, no case of CJD or vCJD transmitted by flexible endoscope has been reported. In animals it has been shown that oral uptake of 0.1-5 g of bovine spongiform encephalopathy (BSE)-infected brain homogenate is necessary for transmission. The maximum prion concentration in other tissues (e.g., terminal ileum) is at least 100-fold lower. Automated cleaning of endoscopes alone results in very low total residual protein ≤5.6 mg per duodenoscopes. Recommendations vary between countries, sometimes with additional cleaning, use of alkaline cleaners, no use of cleaners with fixative properties, use of disinfectants without fixative properties or single-use disinfectants. Sodium hydroxide (1 M) and sodium hypochlorite (10,000 and 25,000 mg/L) are very effective in preventing transmission via contaminated wires implanted into animal brains, but their relevance for endoscopes is questionable. Based on circumstantial evidence, it is proposed to consider validated reprocessing as appropriate in the case of delayed suspected prion disease when immediate bedside cleaning, routine use of alkaline cleaners, no fixative agents anywhere prior to disinfection and single use brushes and cleaning solutions can be assured.
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Affiliation(s)
- G Kampf
- University Medicine Greifswald, Institute for Hygiene and Environmental Medicine, Greifswald, Germany.
| | - M Jung
- University Hospital Frankfurt, Medical Department 1, Endoscopy, Frankfurt, Germany
| | - M Suchomel
- Medical University of Vienna, Institute for Hygiene and Applied Immunology, Vienna, Austria
| | - P Saliou
- Brest Teaching Hospital, Infection Control Unit, Brest, France
| | - H Griffiths
- Brecon War Memorial Hospital, Brecon, Powys, UK
| | - M C Vos
- Erasmus University Medical Center, Department of Medical Microbiology and Infectious Diseases, Rotterdam, The Netherlands; ESCMID Study Group on Nosocomial Infections
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Ofstead CL, Hopkins KM, Eiland JE, Wetzler HP. Widespread clinical use of simethicone, insoluble lubricants, and tissue glue during endoscopy: A call to action for infection preventionists. Am J Infect Control 2019; 47:666-670. [PMID: 30922624 DOI: 10.1016/j.ajic.2019.02.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 02/10/2019] [Accepted: 02/11/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND Current methods for reprocessing flexible endoscopes do not consistently eliminate organic soil. The off-label use of simethicone as a defoaming agent may contribute to reprocessing failures, and endoscope manufacturers have cautioned against its use. METHODS We sought evidence of simethicone use by interviewing hospital personnel, conducting audits, inspecting endoscopes, and conducting tests. RESULTS Researchers examined 69 fully reprocessed endoscopes in 4 hospitals. Microbial cultures were positive for ≥50% of endoscopes. Researchers observed cloudy, shimmery fluid resembling simethicone inside channels and under a duodenoscope elevator mechanism. Crystallized white fragments were observed protruding from a gastroscope water jet outlet. Oily, sticky residue was found on endoscopes, and a 3-dimensional mass was found inside an endoscopic ultrasound endoscope. Hospital personnel reported the use of simethicone, cooking oil and silicone sprays, and tissue glue during endoscopy. DISCUSSION The off-label use of defoaming agents, lubricants, and tissue glue is common and many endoscopists consider these products essential. Our findings suggest these substances are not removed during reprocessing and may impact reprocessing effectiveness. CONCLUSIONS Infection preventionists should determine whether these products are used in their institutions and evaluate methods for removing them. New policies may be needed to support procedural success and effective endoscope reprocessing.
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Abstract
Background In China, reprocessing and reuse of single-use medical devices (SUDs) are banned. However, the actual situation has not been reported so far. The study aims to clarify the perceptions and concerns of various sectors of the community on the reuse of SUDs, and whether such practice exists. In addition, we are also wondering how acceptable the respondents are on this matter. Methods A cross-sectional study based on a national survey which was conducted on the professional online questionnaire survey platform (www.wjx.cn) from July 26 to August 4, 2015. We analyzed the data according to the work fields, sex, age, education level, professional background and participants’ answers to 49 other questions. Results Five hundred forty-four nationwide respondents belong to nine different work fields. In general, participants had positive attitudes towards the reprocessing and reuse of SUDs. However, many respondents doubted the hygienic and functional safety of the reprocessed SUDs. They also tended to think that the reuse of SUDs should have lower prices and more technical training as well as patient advocacy. Further analysis demonstrated the work fields, education level and professional background of respondents were statistically associated with their responses to certain questions. Conclusions The research indicated that although the reuse of SUDs is prohibited legally in China, there were extensive reprocessing and reuse in hospitals. Most responses tended to accept reprocessed SUDs if safety and low prices were guaranteed. These existing contradictions and the lack of relevant research led to policy makers in China will confront numerous challenges in building and improving this use system of medical devices to meet escalating demands of social sectors. Electronic supplementary material The online version of this article (10.1186/s12889-019-6835-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Duojin Wang
- Shanghai Engineering Research Center of Assistive Devices/School of Medical Instrument and Food Engineering, University of Shanghai for Science and Technology, Jungong Road 516, Shanghai, 200093, China
| | - Jing Wu
- School of Economics & Management, Tongji University, Siping Road 1500, Shanghai, 200092, China.
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Kenters N, Tartari E, Hopman J, El-Sokkary RH, Nagao M, Marimuthu K, Vos MC, Huijskens EGW, Voss A. Worldwide practices on flexible endoscope reprocessing. Antimicrob Resist Infect Control 2018; 7:153. [PMID: 30564309 PMCID: PMC6296091 DOI: 10.1186/s13756-018-0446-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Accepted: 12/04/2018] [Indexed: 12/21/2022] Open
Abstract
Background Endoscopy related infections represent an important threat for healthcare systems worldwide. Recent outbreaks of infections with multidrug resistant micro-organisms have highlighted the problems of contaminated endoscopes. Endoscopes at highest risk for contamination have intricate mechanisms, multiple internal channels and narrow lumens that are especially problematic to clean. In light of raised awareness about the necessity for meticulous reprocessing of all types of endoscopes, a call for international collaboration is needed. An overview is presented on current practices for endoscope reprocessing in facilities worldwide. Method An electronic survey was developed and disseminated by the International Society for Antimicrobials and Chemotherapy. The survey consisted of 50 questions aimed at assessing the reprocessing of flexible endoscopes internationally. It covered three core elements: stakeholder involvement, assessment of perceived risks, and reprocessing process. Results The survey received a total of 165 completed responses from 39 countries. It is evident that most facilities, 82% (n = 136), have a standard operating procedure. There is, however a lot of variation within the flexible endoscope reprocessing practices observed. The need for regular training and education of reprocessing practitioners were identified by 50% (n = 83) of the respondents as main concerns that need to be addressed in order to increase patient safety in endoscope reprocessing procedures. Conclusion This international survey on current flexible endoscope reprocessing identified a large variation for reprocessing practices among different health care facilities/countries. A standardised education and training programme with a competency assessment is essential to prevent reprocessing lapses and improve patient safety. Electronic supplementary material The online version of this article (10.1186/s13756-018-0446-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- N Kenters
- 1Department of Medical Microbiology, Radboud University Medical Centre, Radboudumc, Nijmegen, the Netherlands
| | - E Tartari
- 2Infection Control Programme & WHO collaborating Centre of Patient, Safety, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland.,3Faculty of Health Sciences, University of Malta, Msida, Malta
| | - J Hopman
- 1Department of Medical Microbiology, Radboud University Medical Centre, Radboudumc, Nijmegen, the Netherlands
| | - Rehab H El-Sokkary
- 4Department of Medical Microbiology and Immunology, Faculty of Medicine, Zagazig University, Zagazig, Arab Republic of Egypt
| | - M Nagao
- 5Department of Infection and Prevention, Kyoto University Hospital, Kyoto, Japan
| | - K Marimuthu
- 6Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore, Republic of Singapore.,National Centre for Infectious Diseases, Singapore, Republic of Singapore
| | - M C Vos
- 8Department of Medical Microbiology and Infectious Diseases, Erasmus MC, Rotterdam, the Netherlands
| | | | - E G W Huijskens
- 10Department of Medical Microbiology, Albert Schweitzer hospital, Dordrecht, the Netherlands
| | - Andreas Voss
- 1Department of Medical Microbiology, Radboud University Medical Centre, Radboudumc, Nijmegen, the Netherlands.,11Department of Medical Microbiology, Canisius Wilhelmina Hospital, Nijmegen, the Netherlands
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