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Biologic monitoring of dental office sterilizers in Mexico

AMERICAN JOURNAL OF INFECTION CONTROL 2002年第3期30卷 153-157页

作者： Acosta-Gío, AE Mata-Portuguez, VH Herrero-Farias, A Pérez, LS Univ Nacl Autonoma Mexico Sch Dent Postgrad Div Microbiol & Infect Control Lab Mexico City DF Mexico Metropolitan Autonomous Univ Xochimilco Hlth Attent Dept Mexico City DF Mexico

Background, Biologic indicators (BIs) are the quality control applicable to sterilization cycles, but their use was not previously taught in Mexican dental schools or recommended by professional associations. A Mexican official standard, the Mexican Official Norm, published by health authorities in 1999 makes it compulsory for dentists to biologically verify sterilization cycles, However, only a few dentists comply because the use of BIs is largely unknown and the standard is not being enforced. Objective: To evaluate the incidence of sterilization failures in a convenience sample of dental offices in Mexico. Methods: Spore strips were distributed to dentists interested in using this service. The dentists mailed the processed BIs to the laboratory for culture. Results. In 6 years, 3277 tests were submitted from 82 dental offices. Thirty-four offices (41%) submitted 1 to 12 tests, 22 (27%) sent 14 to 48 tests, 18 (22%)mailed 49 to 96 tests, and 8(10%) sent >97 tests. The sterilization methods were steam (74.4%), dry heat (20%), and chemical vapor (5.6%). A total of 242 sterilization failures (7.4% of all cycles) were detected. Convection dry heat failed with a greater frequency with chi(2) analysis (chi(2)=13.71, P=.0175). Conclusions: Sterilization failures occurred in instrument loads used in patient treatment. Steam and chemical vapor under pressure failed less often than convection dry heat. When corrective action is taken, routine use of BIs increases patient safety.

关键词：卡方分布牙科设备/标准牙科诊室牙医师/标准环境监测设备污染/统计学和数值数据指示剂和试剂感染控制/方法感染控制/标准感染控制/统计学和数值数据墨西哥质量控制灭菌/仪器和设备灭菌/方法灭菌/标准人类

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Paenibacillus macerans pseudobacteremia resulting from contaminated blood culture bottles in a neonatal intensive care unit

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AMERICAN JOURNAL OF INFECTION CONTROL 2001年第2期29卷 126-129页

作者： Noskin, GA Suriano, T Collins, S Sesler, S Peterson, LR Northwestern Univ Sch Med Dept Med Div Infect Dis & Pathol Chicago IL 60611 USA Northwestern Univ Sch Med Div Clin Microbiol Chicago IL USA Northwestern Mem Hosp Dept Infect Control & Prevent Chicago IL USA Northwestern Mem Hosp Dept Clin Microbiol Chicago IL USA

Paenibacillus species are gram-positive, rod-shaped, spore-forming aerobes that are abundant in nature and closely related to Bacillus. Between June 24 and June 30, 1999, 8 neonates in our neonatal intensive care unit had positive blood cultures for Paenibacillus macerans . This cluster of positive blood cultures with an unusual pathogen suggested a pseudoepidemic. investigation revealed that the most likely etiology of the pseudobacteremia was environmental contamination of the rubber stoppers in blood culture bottles. This was confirmed by environmental sampling and simulated inoculation studies. This pseudobacteremia outbreak highlights the importance of adhering to well-established methods for blood culture collection ongoing infection control surveillance.

关键词：芽孢杆菌科感染/血液芽孢杆菌科感染/诊断芽孢杆菌科感染/病因学芽孢杆菌科感染/预防和控制芽孢杆菌属菌血症/血液菌血症/诊断菌血症/病因学菌血症/预防和控制血样采集/仪器和设备血样采集/标准芝加哥交叉感染/血液交叉感染/诊断交叉感染/病因学交叉感染/预防和控制误诊疾病暴发流行/预防和控制疾病暴发流行/统计学和数值数据环境监测/方法设备污染/统计学和数值数据感染控制/方法感染控制/标准重症监护病房新生儿人类婴儿新生

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Computer keyboards and faucet handles as reservoirs of nosocomial pathogens in the intensive care unit

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AMERICAN JOURNAL OF INFECTION CONTROL 2000年第6期28卷 465-471页

作者： Bures, S Fishbain, JT Uyehara, CFT Parker, JM Berg, BW Tripler Army Med Ctr Dept Med Honolulu HI 96859 USA

Purpose: We postulate that computer keyboards and faucet handles are significant reservoirs of nosocomial pathogens in the intensive care unit (ICU) setting. Methods: Sterile swab samples were obtained from 10 keyboards and 8 pairs of faucet handles in the medical ICU at Tripler Army Medical Center during a period of 2 months. Methicillin-resistant Staphylococcus aureus (MRSA) obtained from the environmental and patient specimens were sent for DNA identification by using pulsed-field gel electrophoresis. Results: A total of 144 samples were obtained (80 keyboards and 64 faucet handles), yielding 33 isolates. The colonization rate for keyboards was 24% for all rooms and 26% in occupied rooms. Rates for faucet handles in all rooms and occupied rooms were 11% and 15%, respectively. The environmental isolates and their prevalence were: MRSA, 49%;Enterococcus, 18%;Enterobacter;12%;and all other gram-negative rods, 21%. Fourteen individual patient isolates were recorded: MRSA, 43%;Enterobacter;21%;other gram-negative rods, 36%;and Enterococcus, 0%. By using pulsed-field gel electrophoresis, an indistinguishable strain of MRSA was identified in two patients, the keyboards and faucet handles in their respective rooms, and on other keyboards throughout the ICU, including the doctors' station. Conclusions: The colonization rate for keyboards and faucet handles, novel and unrecognized fomites, is greater than that of other well-studied ICU surfaces in rooms with patients positive for MRSA. Our findings suggest an associated pattern of environmental contamination and patient infection, not limited to the patient's room. Pulsed-field gel electrophoresis results have documented an indistinguishable strain of MRSA present as an environmental contaminant on these two fomites and in two patients with clinical infections patients during the same period. We believe these findings add evidence to support the hypothesis that these particular surfaces may serve as reservoirs of nosocomia

关键词：交叉感染/微生物学交叉感染/预防和控制交叉感染/传播疾病贮主/统计学和数值数据电泳凝胶脉冲场肠杆菌科感染/微生物学肠杆菌科感染/预防和控制肠杆菌科感染/传播肠球菌属环境监测/方法设备污染/预防和控制设备污染/统计学和数值数据革兰氏阳性菌感染/微生物学革兰氏阳性菌感染/预防和控制革兰氏阳性菌感染/传播夏威夷/流行病学医院军队感染控制/方法重症监护病房甲氧西林抗药性微型计算机患病率危险因素卫生工程/仪器和设备血清分型葡萄球菌感染/微生物学葡萄球菌感染/预防和控制葡萄球菌感染/传播葡萄球菌金黄色人类

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Worst-case soiling levels for patient-used flexible endoscopes before and after cleaning

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AMERICAN JOURNAL OF INFECTION CONTROL 1999年第5期27卷 392-401页

作者： Alfa, MJ Degagne, P Olson, N Univ Manitoba St Boniface Res Ctr Winnipeg MB R3T 2N2 Canada

Background: The soiling levels of patient-used narrow-lumened flexible endoscopes were assessed for bronchoscopes, duodenoscopes, and colonoscopes. The effect of cleaning on the soil composition and concentration was evaluated. Design: Suction channels from 10 each of bronchoscopes, duodenoscopes used for endoscopic retrograde cholangiopancreatography, and colonoscopes were assessed immediately after patient use for the levels of bilirubin, hemoglobin, protein, sodium ion, carbohydrate, endotoxin, and viable bacteria. Another 10 suction channels of each type of endoscope were evaluated for the same components after routine cleaning hut before processing by high-level disinfection or sterilization for subsequent clinical use. Results: Recognizing that only soluble components could be quantified, the worst-cast soil levels in the suction channels (the average surface area of these channels was 45.6 cm(2), 149.8 cm(2), and 192.0 cm(2) for bronchoscopes, duodenoscopes, and colonoscopes, respectively) were protein 115 mu g/cm(2), sodium ion 7.4 mu mol/cm(2), hemoglobin 85 mu g/cm(2), bilirubin 299 nmol/cm(2), carbohydrate 29.1 mu g/cm(2), endotoxin 9852 endotoxin units/cm(2), and bacteria 7.1 (log(10)) colony-forming units (CFU)/cm(2). Colonoscopes had 4 to 5 times greater soiling on average compared with the other endoscope types. Routine cleaning reduced the levels of bilirubin to below the limits of detection for all endoscopes evaluated (limits of detection were <1 nmol/mL). After cleaning, residual hemoglobin was detectable in bronchoscopes only After cleaning, the levels of protein, endotoxin, and sodium ion all were reduced fivefold to tenfold for all types of endoscopes. Carbohydrate was reduced to lower than the limit of detection for all endoscopes after cleaning, except the duodenoscopes. The average load of viable bacteria was reduced from 3 log(10) to 5 log(10) CFU/cm(2) (which represents 5.9-9.5 log(10) CFU/endoscope channel) after patient use to approximat

关键词：支气管镜结肠镜消毒十二指肠镜设备污染/统计学和数值数据设备重复使用线性模型灭菌抽吸人类

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Medical records contaminated with dried blood: A quality issue

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AMERICAN JOURNAL OF INFECTION CONTROL 1999年第5期27卷 438-443页

作者： Fishman, M Mikolich, DJ Fort, GG Cataldo, DT Our Lady Fatima Hosp Dept Nosocomial Infect N Providence RI USA

A routine chart review over 23 months in a 256-bed community hospital revealed 246 medical records contaminated with apparent blood. Sixty percent of the records were nursing and anesthesiology records. Analysis of systematically selected records confirmed blood as the visible contaminant in 27% of the cases (8/30). Total quality improvement methodology reduced the incidents by 75%. Actions included policy development, in-service education, and changes in work practices. Although bloodborne pathogen transmission is statistically improbable, we should improve work practices to eliminate blood contamination of charts.

关键词：血液设备污染/预防和控制设备污染/统计学和数值数据医院社区病案质量控制人类

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