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Inadequacy of manual cleaning for reprocessing single-use, triple-lumen sphinctertomes: Simulated-use testing comparing manual with automated cleaning methods

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AMERICAN JOURNAL OF INFECTION CONTROL 2003年第4期31卷 193-207页

作者： Alfa, MJ Nemes, R Wayne State Univ Dept Clin Lab Sci Detroit MI 48202 USA

Background and Aims: Despite widespread reuse of single-use sphinctertomes, publications regarding the adequacy of reprocessing are conflicting and the cautery wire channel is seldom evaluated. Our objective was to use thickened artificial test soil containing microorganisms to perform simulated-use tests combined with in-situ and destructive testing to evaluate cleaning efficacy and ethylene oxide sterilization of single-use triple lumen sphinctertomes. Methods: New triple-lumen sphinctertomes were soiled with thickened artificial test soil containing 6 log(10) per milliliter of Enterococcus faecalis and Bacillus stearothermophilus by inoculation through the distal end and dried for I hour, 24 hours, or 7 days before cleaning. The efficacy of manual cleaning was compared with that of automated cleaning with the Medisafe SI-Auto narrow-lumen cleaner After cleaning, Bradford's reagent was injected into the channels as a direct method of detecting residual protein. Destructive testing was done to determine the levels of residual protein, carbohydrate, hemoglobin, endotoxin, and viable bacteria in the cleaned device. Destructive sterility testing of the devices also was performed after ethylene oxide sterilization. Results: Both in-situ and destructive testing demonstrated that manual cleaning and automated washers connected via the luer ports did not remove soil or organisms from the cautery wire channel. Only retro-flushing in the SI-Auto provided adequate cleaning of all 3 channels. If reprocessing was delayed for more than 24 hours, retro-flush cleaning was no longer effective. Ethylene oxide sterilization failure was detected only for devices held for 7 days before cleaning and sterilization. In-use testing showed that patient secretions gained access to the cautery wire channel. Conclusions: Only retro-flushing done within 24 hours of use provided adequate cleaning for multi-lumen, single-use sphinctertomes. Our data validate the efficacy of reprocessing sphincte

关键词：交叉感染/预防和控制净化/方法净化/标准一次性设备设备污染设备重复使用环氧乙烷/药理学灭菌/方法外科器械/微生物学人类

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Investigation of single-use versus reusable infectious waste containers as potential sources of microbial contamination

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AMERICAN JOURNAL OF INFECTION CONTROL 2003年第1期31卷 13-17页

作者： Neely, AN Maley, MP Taylor, GL Shriners Burns Hosp Cincinnati OH 45229 USA

Background: Laws require that infectious waste be segregated from noninfectious waste. Companies certified to dispose of infectious waste offer both reusable and single-use containers. The focus of this study was to determine if there would be a microbiologic advantage to the use of one type of container over another in a burn hospital. Methods: Monthly swab cultures were taken from the tops of > 250 infectious waste containers during 2 years. Bacteria and fungi were identified. in a substudy swab cultures were taken from an area of reusable tops before and after cleaning to evaluate the efficacy of cleaning on both the number and type of microbes present. Infection rates for acute patients were compared before and after control measures were instituted to decrease microbial transfer from infectious waste containers to patients. Results: Cultures taken from reusable boxes when received from the container company showed that > 99% were contaminated with bacteria or fungi;most were normal environmental or skin flora, but some cultures showed microorganisms that can be potentially harmful to patients with compromised immunity. Wiping the lids with a phenolic disinfectant decreased both the total microbial load (P < .001) and the variety of microbes present (P < .001). In contrast, only 10% of the incoming single-use boxes showed any contamination. Infection rates dropped from 5.8 to 3.2 per 100 burn patients (P < .05) after the institution of cleaning and other changes made to decrease the possibility of microbial transfer from the infectious waste boxes to the patients. Conclusions: Upon delivery, significantly fewer single-use infectious waste boxes were contaminated than reusable ones (P < .001). Extra infection control measures were needed when reusable infectious waste boxes were used in areas housing patients with compromised immunity Facilities need be aware of the possible contamination of reusable infectious waste containers with microorganisms capable of caus

关键词：烧伤病房交叉感染/流行病学交叉感染/病因学交叉感染/预防和控制消毒/方法一次性设备设备污染/预防和控制设备重复使用感染控制/方法医用废弃物处理/方法美国人类

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Cluster of tuberculosis cases in North Carolina: Possible association with atomizer reuse

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AMERICAN JOURNAL OF INFECTION CONTROL 2001年第1期29卷 1-6页

作者： Southwick, KL Hoffmann, K Ferree, K Matthews, J Salfinger, A N Carolina Dept Hlth & Human Serv Gen Commun Dis Control Sect Atlanta GA USA Ctr Dis Control & Prevent Epidemiol Program Off Atlanta GA USA Univ N Carolina Sch Med Chapel Hill NC USA Moore Reg Hosp Pinehurst NC USA New York State Dept Hlth Wadsworth Ctr Albany NY USA

Background: Three patients with identical strains of M tuberculosis (TB) underwent bronchoscopy on the same day at hospital A. Methods: We reviewed each patient's clinical history, hospital A's infection control practices for bronchoscopies, and specimen and isolate handling at each of 3 laboratories involved. We searched for possible community links between patients. Restriction fragment length polymorphism was performed on TB isolates. Results: The first patient who underwent bronchoscopy had biopsy-confirmed granulomatous pulmonary TB. A sputum sample collected from the third patient 6 weeks after the bronchoscopy produced an isolate with an identical restriction fragment length polymorphism pattern to isolates collected during the bronchoscopies. No evidence existed for community transmission or laboratory contamination;the only common link was the bronchoscopy. Different bronchoscopes were used for each patient. Hospital ventilation and wall-suctioning were functioning well. Respiratory technicians reported sometimes reusing the nozzles of atomizers on more than one patient. A possible mechanism for transmission was contamination from the first patient of the atomizer ii it was used to apply lidocaine to the pharynx and nasal passages of other patients. Conclusions: A contaminated atomizer may have caused TB transmission during bronchoscopy. Hospital A changed to single-use atomizers after this investigation.

关键词：支气管镜/微生物学支气管镜检查交叉感染/流行病学交叉感染/微生物学交叉感染/传播疾病暴发流行设备污染设备重复使用感染控制分枝杆菌结核/遗传学分枝杆菌结核/分离和提纯雾化器和汽化器/微生物学北卡罗来纳/流行病学多态性限制性片段长度痰/微生物学结核/流行病学结核/微生物学结核/传播老年人老年人 80以上女(雌)性人类男(雄)性中年人

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Effects of recycling on the mechanical properties and the surface topography of nickel-titanium alloy wires

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AMERICAN JOURNAL OF ORTHODONTICS AND DENTOFACIAL ORTHOPEDICS 2001年第6期120卷 654-663页

作者： Lee, SH Chang, YI Seoul Natl Univ Coll Dent Dept Orthodont Seoul 110749 South Korea

The purpose of this study was to investigate the changes in mechanical properties, surface topography, and frictional forces of various nickel-titanium wires after recycling. Three types of nickel-titanium wires were separated into 3 groups: as-received condition (T0, control group), treated in artificial saliva for 4 weeks (T1), and treated in artificial saliva and autoclaved (T2). Strength changes were observed by tensile testing, and surface topography was assessed by scanning electron microscope and 3-D profilogram. Frictional coefficients were tested by friction test, and fatigue by bending fatigue test, Our findings showed that there were no statistically significant differences between the wires in maximum tensile strength, elongation rate, modulus of elasticity, and bending fatigue. Two wires demonstrated increased pitting and corrosion after recycling. The same 2 wires also demonstrated significantly greater surface roughness and maximum frictional coefficients compared with the control wires (P < .05), but the third wire showed no significant difference. However, surface roughness and frictional coefficient of the 2 wires after recycling were not greater than those of the third wire before treatment. Recycling increased the surface roughness and friction coefficients, but these seemed to have limited clinical significance.

关键词： Dental Alloys Equipment Reuse Nickel Orthodontic Wires Titanium 牙科合金设备重复使用镍正畸金属丝钛 Surface roughness Orthodontic Wires Mechanical properties coefficient of friction nickel-titanium alloy dental alloy Sea Surface Topography titanium wire Equipment Reuse Nickel bending fatigue Artificial Saliva

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A review of single-use and reusable gowns and drapes in health care

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INFECTION CONTROL AND HOSPITAL EPIDEMIOLOGY 2001年第4期22卷 248-257页

作者： Rutala, WA Weber, DJ Univ N Carolina Sch Med Div Infect Dis Chapel Hill NC 28599 USA Univ N Carolina Hlth Care Syst Dept Hosp Epidemiol Chapel Hill NC USA

Gowns and drapes are used widely in healthcare facilities. Gowns have been used to minimize the risk of disease acquisition by healthcare providers, to reduce the risk of patient-to-patient transmission, and during invasive procedures to aid in maintaining a sterile field. Drapes have been used during invasive procedures to maintain the sterility of environmental surfaces, equipment, and patients. This article reviews the use of gowns and drapes in healthcare facilities, including the characteristics, costs, benefits, and barrier effectiveness of single-use and reusable products. Currently, gowns protect healthcare personnel performing invasive procedures from contact with bloodborne pathogens. Although gowns have been recommended to prevent patient-to-patient transmission in certain settings leg, neonatal intensive care unit) and for certain patients leg, those infected with vancomycin-resistant enterococci), scientific studies have produced mixed results of their efficacy. While appropriate use of drapes during invasive procedures is recommended widely as an aid in minimizing contamination of the operative field, the efficacy of this practice in reducing surgical-site infections has not been assessed by scientific studies. Based on an evaluation of the functional requirements, environmental impact, and economics of gowns and drapes, clear superiority of either reusable or single-use gowns and drapes cannot be demonstrated. The selection of particular gowns and drapes by individual healthcare facilities requires an assessment of the facility's requirements, available products, and costs and should be based on the desired characteristics of an ideal gown or drape as defined in this paper.

关键词： Blood-Borne Pathogens Cross Infection Disposable Equipment Equipment Reuse 血传病原体交叉感染一次性设备设备重复使用感染控制职业暴露防护服 invasive procedure Health Care Disposable Equipment Equipment Reuse Cross Infection Reusable Drapery burka Blood-Borne Pathogens gowning

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Decontaminated single-use devices: An oxymoron that may be placing patients at risk for cross-contamination

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INFECTION CONTROL AND HOSPITAL EPIDEMIOLOGY 2001年第9期22卷 542-549页

作者： Heeg, P Roth, K Reichl, R Cogdill, CP Bond, WW Univ Tubingen Dept Hosp Infect Control D-72076 Tubingen Germany Univ Tubingen Ctr Testing Med Devices D-72076 Tubingen Germany Univ Tubingen Steinbeis Transfer Ctr Minimally Invas Surg D-72076 Tubingen Germany Univ Tubingen Nat & Med Sci Inst Reutlingen Germany Boston Sci Corp Corp Sterilizat & Microbiol Natick MA USA Res Consulting Serv Associates Inc Lawrenceville GA USA

OBJECTIVE: To determine whether reprocessed single-use devices would meet regulatory standards for sterility and meet the same materials standards as a new device. \ DESIGN: The study included single-use and reusable biopsy forceps and papillotomes and a reusable stone retrieval basket. The suitability of these devices for cleaning and disinfection or sterilization was examined. METHODS: Testing of cleanability was conducted on devices contaminated with technetium 99-radiolabeled human blood. Instruments were cleaned using hospital recommended practices for manual cleaning. Gamma counts per second were determined before and after cleaning to localize contaminants, which were additionally visualized using light and scanning electron microscopy. X-ray photoelectron spectroscopy was used to quantify contamination elements on the materials tested. Residual bioburden testing on instruments contaminated with microorganisms suspended in coagulable sheep blood was carried out to establish the efficacy of disinfection and sterilization. RESULTS: All devices remained contaminated after cleaning, but single-use devices and the stone basket tended to be more heavily contaminated than reusable forceps and papillotomes. Cleaning procedures facilitated distribution of contaminants further into the lumens of the disposable forceps. Decreased concentrations of silicon and increased concentrations of carbon and nitrogen suggested that layers of silicon lubricant had been removed and contaminants were organic material. Reusable devices were effectively disinfected, but single-use devices were not. Sterilization could not eliminate the challenge microorganisms completely. CONCLUSIONS: None of the reprocessed single-use instruments were effectively cleaned, disinfected, or sterilized. This condition may provide an opportunity for the viability of nonresistant or nosocomial organisms and viruses. Additionally, reprocessing procedures may result in material destruction of fragile devices.

关键词： Cross Infection Disposable Equipment Equipment Contamination Equipment Reuse 交叉感染一次性设备设备污染设备重复使用灭菌 cross contamination reprocessing Device Labeled for Single Use Disposable Equipment Equipment Reuse Cross Infection Reusable Equipment Contamination Sterilization Pollutant

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Infectious waste surveys in a Saudi Arabian hospital: An important quality improvement tool

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AMERICAN JOURNAL OF INFECTION CONTROL 2001年第3期29卷 198-202页

作者： Hagen, DL Al-Humaidi, F Blake, MA Saudi Aramco Med Serv Org Dhahran Hlth Ctr Saudi Arabian Oil Co Environm Compliance ServPrevent Med Serv Div Dhahran 31311 Saudi Arabia Saudi Aramco Med Serv Org Dhahran Hlth Ctr Saudi Arabian Oil Co Med Housekeeping Serv Unit Dhahran 31311 Saudi Arabia Saudi Aramco Med Serv Org Dhahran Hlth Ctr Saudi Arabian Oil Co Med Plant Serv DivMed Support Serv Dept Dhahran 31311 Saudi Arabia

Objectives: To analyze the composition by weight of the infectious waste stream, better segregate waste, reduce disposal costs, reduce the load on the hospital incinerator, identify inappropriate items having signficant cost or safety implications, and provide a safer work environment for housekeepers, Methods: Four infectious waste surveys were conducted between 1991 and 1999 that involved opening a total of 7364 bags of infectious waste. The contents of each infectious waste bag were separated into 20 different components and weighed. Inappropriately discarded items were removed and tagged with the date and hospital unit of origin. Setting: Dhahran Health Center, a 410-bed hospital operated by the Saudi Arabian Oil Company (Saudi Aramco) in Dhahran, Saudi Arabia. Results: The surveys show a continuing trend in a higher percentage of plastics and a decrease in paper due to increased use of disposables. Much of the infectious waste consisted of plastic intravenous bottles, intravenous lines, and paper wrappers for sterile instrument sets that were not infectious. Dhahran Health Center was producing a total of 1163 kg of infectious waste per day before the first survey. This was reduced to 407 kg per day after implementation of a waste segregation program in 1991 (a reduction of 65%). Incineration operation was reduced from daily to 3 days per week, with a corresponding reduction in incinerator emissions. Infectious waste from inpatient, surgical, and obstetric areas was reduced by a total of 70% between 1991 and 1999, from 2.8 kg (6.1 lb) to 0.85 kg (1.9 lb) per patient per day. This is in the rang of 2 to 4 lb per patient per day that is generally reported. Numerous inappropriately discarded items were discovered during the surveys with cost or safety implications. Each survey, including the latest one of November-December 1999, has shown that further improvements are possible in the hospital's waste management program. Specific educational efforts and changes in p

关键词：数据收集/方法设备重复使用医院医用废弃物处理/方法医用废弃物处理/标准质量保证卫生保健/方法沙特阿拉伯人类

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A reusable and specific protein A-coated piezoelectric biosensor for flow injection immunoassay

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BIOTECHNOLOGY PROGRESS 2000年第1期16卷 116-124页

作者： Lu, HC Chen, HM Lin, YS Lin, JW Natl Taiwan Univ Sci & Technol Dept Chem Engn Taipei 106 Taiwan Chang Gung Univ Dept Chem Engn Tao Yuan 333 Taiwan

A hydrophilic matrix of periodate-oxidized dextran was used as a double-sided linker to covalently immobilize Staphylococcus aureus protein A (SpA) molecules onto a poly-L-lysine-modified piezoelectric crystal surface to improve their stability, activity, and binding specificity with human immunoglobulin G (IgG) in flow injection assays. The prepared sensing crystals displayed best sensitivity and reusability at a flow rate of 140 mu L/min. A human IgG concentration as low as 0.3 nM can be detected by this system. Up to 19 successive assay repetitions were achieved without significant loss of sensitivity using the same crystal. The analysis of adsorption kinetics indicates that such a preparation can greatly increase the amount of available active human IgG binding sites on immobilized SpA. Hardly any response arising from unspecific binding was detected. In addition, the sensing crystal prepared by this method was found to retain activity better than one prepared via direct deposition when stored in either wet or dry states. Finally, the prepared SpA-coated crystals were applied to the affinity immobilization of polyclonal goat anti-Schistosoma japonicum glutathione-S-transferase (GST) and were able to subsequently detect GST and its genetically engineered mutant either in a purified form or in the crude cell lysate.

关键词：抗体蠕虫生物传感技术生物技术设备重复使用大肠杆菌/遗传学流动注射分析/方法谷胱甘肽转移酶/分析谷胱甘肽转移酶/遗传学谷胱甘肽转移酶/免疫学免疫测定/方法免疫球蛋白G/分析免疫吸附技术重组蛋白质类/分析重组蛋白质类/遗传学重组蛋白质类/免疫学血吸虫日本/酶学血吸虫日本/遗传学血吸虫日本/免疫学葡萄球菌蛋白质A 动物人类

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Cooperative oligonucleotides in purification of cycle sequencing products

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BIOTECHNIQUES 2000年第2期29卷 352-+页

作者： Blomstergren, A O'Meara, D Lukacs, M Uhlén, M Lundeberg, J Royal Inst Technol KTH Dept Biochem SE-10044 Stockholm Sweden Dynal AS Oslo Norway

Nucleic acid hybridization is an essential component in many of today's standard molecular biology techniques. In a recent study, we investigated whether nucleic acid capture could be improved by taking advantage of stacking hybridization, which refers to the stabilizing effect that exists between oligonucleotides when they hybridize in a contiguous tandem fashion. Here, we describe a specific approach for purification of sequencing products using cooperative probes that hybridize to single-strand targets where one of the probes has been coupled to a magnetic bead. This approach has been developed for standard sequencing primers and has been applied to shotgun plasmid libraries. The cooperative probes have been designed to anneal within the common vector sequence and to avoid copurification of non extended sequencing primers and misprimed sequencing products. The reuse of magnetic beads, together with salt independent elution, makes the approach suitable for high-capacity capillary electrophoresis instruments.

关键词：碱基序列着色剂 DNA 细菌/分离和提纯 DNA 细菌/代谢 DNA 重组/分离和提纯 DNA 重组/代谢设备重复使用免疫磁化分离微球体分子序列数据霉菌样支原体/遗传学核酸杂交/方法寡脱氧核糖核苷酸类/分离和提纯寡脱氧核糖核苷酸类/代谢质粒/遗传学聚合酶链反应/方法序列分析 DNA/方法温度模板遗传

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Trace contamination following reuse of anion-exchange DNA purification resins

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BIOTECHNIQUES 2000年第2期28卷 299-+页

作者： Fogel, BL McNally, MT Med Coll Wisconsin Dept Microbiol & Mol Genet Milwaukee WI 53226 USA

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