Cleaning Of Medical Equipment Research Articles

Waterborne Pseudomonas aeruginosa transmission in a hematology unit?

Pseudomonas aeruginosa is an important nosocomial pathogen that commonly colonizes hospital water supplies, including in taps and sinks. We report the transmission of P. aeruginosa from water to patients in a clinical hematology setting. P. aeruginosa from water samples were compared to clinical isolates from hematology ward patients, via molecular typing (pulsed field gel electrophoresis). P. aeruginosa cultured from blood cultures from 3 patients was indistinguishable from water strains, by molecular typing. Based on infection control inspections, the transmission event was surmised to be due to cleaning of equipment, specifically an infusion therapy procedure tray used to transport intravenous drugs to patients, with water from an outlet colonized by P. aeruginosa. We show the importance of holistic factors, such as disposal of patient waste water, cleaning of tap outlets, and cleaning of medical equipment, in the transmission of P. aeruginosa, and demonstrate that the role of waterborne transmission of this organism in a hematology setting cannot be overlooked. We suggest that appropriate management of water, including both holistic and engineering interventions, is needed to stop transmission of P. aeruginosa from water to patients.

Characterization and rapid control of a vancomycin-resistant Enterococcus faecium (VREF) outbreak in a renal transplant unit in Spain: The environment matters

ObjectiveTo describe a clonal outbreak due to vancomycin-resistant Enterococcus faecium (VREF) in the nephrology and renal transplant unit of a tertiary teaching hospital in Barcelona, Spain, and to highlight how active patient and environment surveillance cultures, as well as prompt and directed intervention strategies, mainly environmental, helped to successfully bring it under control. Patients and methodsA study was conducted on patients admitted to the nephrology ward with any culture positive for VREF over a 6-month period (August 2012–January 2013). Based on the identification of a clonal link between the isolates, weekly rectal screening using swabs was implemented for all patients, as well as environmental cultures and cleaning of medical equipment and the ward. VREF isolates were identified by MicroScan and confirmed by Etest. Bacterial identification was confirmed by MALDI-TOF MS. The presence of van genes, and esp and hyl virulence genes was determined using PCR. The clonal relationship between the isolates was studied first with DiversiLab (bioMérieux), and then by PFGE-Smal and MLST. A two-tier sequence of infection control measures was implemented. ResultsDuring the study period, VREF was isolated from 13 patients. All cases were colonized with no criteria for infection. VREF isolates were also extensively recovered from the environment and medical equipment. Isolates carried the vanA gene, and were multidrug-resistant, including high-level resistance (MIC >16mg/L) to vancomycin and teicoplanin. Molecular analysis showed that all VREF isolates belonged to sequence type 17 (ST17) carrying hyl virulence genes. After implementing infection control measures in a two-tier sequence, and reinforcing particularly environmental and medical equipment cleaning, no further cases were detected in the follow-up year. ConclusionA clonal outbreak of VREF-ST17 involving only colonization is reported. The prompt implementation of aggressive infection control measures in patients and the environment was effective in controlling the outbreak and avoided the potential emergence of infection among patients.

Characterization and rapid control of a vancomycin-resistant Enterococcus faecium (VREF) outbreak in a renal transplant unit in Spain: The environment matters

ObjectiveTo describe a clonal outbreak due to vancomycin-resistant Enterococcus faecium (VREF) in the nephrology and renal transplant unit of a tertiary teaching hospital in Barcelona, Spain, and to highlight how active patient and environment surveillance cultures, as well as prompt and directed intervention strategies, mainly environmental, helped to successfully bring it under control. Patients and methodsA study was conducted on patients admitted to the nephrology ward with any culture positive for VREF over a 6-month period (August 2012–January 2013). Based on the identification of a clonal link between the isolates, weekly rectal screening using swabs was implemented for all patients, as well as environmental cultures and cleaning of medical equipment and the ward. VREF isolates were identified by MicroScan and confirmed by Etest. Bacterial identification was confirmed by MALDI-TOF MS. The presence of van genes, and esp and hyl virulence genes was determined using PCR. The clonal relationship between the isolates was studied first with DiversiLab (bioMérieux), and then by PFGE-Smal and MLST. A two-tier sequence of infection control measures was implemented. ResultsDuring the study period, VREF was isolated from 13 patients. All cases were colonized with no criteria for infection. VREF isolates were also extensively recovered from the environment and medical equipment. Isolates carried the vanA gene, and were multidrug-resistant, including high-level resistance (MIC >16mg/L) to vancomycin and teicoplanin. Molecular analysis showed that all VREF isolates belonged to sequence type 17 (ST17) carrying hyl virulence genes. After implementing infection control measures in a two-tier sequence, and reinforcing particularly environmental and medical equipment cleaning, no further cases were detected in the follow-up year. ConclusionA clonal outbreak of VREF-ST17 involving only colonization is reported. The prompt implementation of aggressive infection control measures in patients and the environment was effective in controlling the outbreak and avoided the potential emergence of infection among patients.

Effect comparison between multiple enzymes cleaning fluid and alkaline cleaning fluid in the cleaning of moisturizing medical equipment

Objective To explore the cleaning effect of moisturizing through multiple enzymes cleaning fluid or alkaline cleaning fluid in the cleaning of medical equipment .Methods One thousand and two hundred surgical instruments used by cesarean delivery and recycled immediately from June 2013 to September 2013 were chosen and divided into the Ⅰ,Ⅱ,Ⅲ,Ⅳgroup according to the random number table , each with 300 .the ⅠandⅡgroup received the cleaning 2, 12 h after the moisturizing through the multiple enzymes cleaning fluid , respectively;and Ⅲ and Ⅳ group received the cleaning 2, 12 h after the moisturizing through the alkaline cleaning fluid , respectively .The qualification rates of cleaning were compared among the groups .Results No differences were found in the qualification rates of cleaning through the visual , microscopically and test paper detection between Ⅰ and Ⅲ groups （ P 〉0.05 ）.The qualification rates of cleaning through the visual , microscopically and test paper detection were respectively 97.33% （292/300）,96.33% （289/300） and 97.00%（291/300） in Ⅳ group, and were higher than 87.00% （261/300）,86.33% （259/300） and 86.33%（259/300） in Ⅱ group, and the differences were statistically significant （χ2 =18.690,18.950, 14.592, respectively;P〈0.01）.The qualification rates of cleaning through the visual , microscopically and test paper detection were respectively 98.67% （296/300）,98.00% （294/300） and 98.33% （295/300） in Ⅰgroup, and were higher than those of Ⅱgroup, and the differences were statistically significant （χ2 =30.688, 22.017,30.513, respectively;P 〈0.01）.No differences were found in the qualification rates of cleaning betweenⅢandⅣgroups （P〉0.05）.Conclusions The surgical instruments after the normal use should be cleaned within 2 hours, and the moisturizing through multiple enzymes cleaning fluid or alkaline cleaning fluid can all ensure the cleaning quality .The surgical instruments after the use can not be cleaned within 2 hours, and should be firstly moisturized through the alkaline cleaning fluid and secondly cleaned through the machine so as to improve the cleaning quality of instruments . Key words: Surgical instruments; Cleaning; Multiple enzyme cleaning fluid; Alkaline cleaning fluid

Epidemiological characteristics of hospital-acquired Clostridium difficile-associated diarrhea

Clostridium difficile is an anaerobic bacterium which produces spores that can survive for a long time in the environment. The disease spectrum caused by Clostridium difficile ranges from diarrhea to toxic megacolon and collectively they are all called Clostridium difficileassociated disease (CDAD). Since 2000, this pathogen has demonstrated an increased propensity to cause more frequent and virulent illness that is often refractory to treatment. Clostridium difficile-associated disease is usually diagnosed following the demonstration of toxins A and/or B in stool samples. The most important risk factors are: age over 65 years, broad-spectrum antibiotics, severe underlying illness, nasogastric intubation, gastrointestinal surgery, and longer hospital stay. The measures of prevention and control of Clostridium difficile in the health care settings include the appropriate use of isolation precautions, hand hygiene, protective clothing, environmental cleaning and cleaning of medical equipment, good antibiotic stewardship, and specific measures during outbreaks.

Inactivation of influenza A virus H1N1 by disinfection process

Because any patient, health care worker, or visitor is capable of transmitting influenza to susceptible persons within hospitals, hospital-acquired influenza has been a clinical concern. Disinfection and cleaning of medical equipment, surgical instruments, and hospital environment are important measures to prevent transmission of influenza virus from hospitals to individuals. This study was conducted to evaluate the efficacy of disinfection processes, which can be easily operated at hospitals, in inactivating influenza A virus H1N1 (H1N1). The effects of 0.1 mol/L NaOH, 70% ethanol, 70% 1-propanol, solvent/detergent (S/D) using 0.3% tri (n-butyl)-phosphate and 1.0% Triton X-100, heat, and ethylene oxide (EO) treatments in inactivating H1N1 were determined. Inactivation of H1N1 was kinetically determined by the treatment of disinfectants to virus solution. Also, a surface test method, which involved drying an amount of virus on a surface and then applying the inactivation methods for 1 minute of contact time, was used to determine the virucidal activity. H1N1 was completely inactivated to undetectable levels in 1 minute of 70% ethanol, 70% 1-propanol, and solvent/detergent treatments in the surface tests as well as in the suspension tests. H1N1 was completely inactivated in 1 minute of 0.1 mol/L NaOH treatment in the suspension tests and also effectively inactivated in the surface tests with the log reduction factor of 3.7. H1N1 was inactivated to undetectable levels within 5 minutes, 2.5 minutes, and 1 minute of heat treatment at 70, 80, and 90 degrees C, respectively in the suspension tests. Also, H1N1 was completely inactivated by EO treatment in the surface tests. Common disinfectants, heat, and EO tested in this study were effective at inactivating H1N1. These results would be helpful in implementing effective disinfecting measures to prevent hospital-acquired infections.

Infection control measures to limit the spread of Clostridium difficile

Clostridium difficile-associated diarrhoea (CDAD) presents mainly as a nosocomial infection, usually after antimicrobial therapy. Many outbreaks have been attributed to C. difficile, some due to a new hyper-virulent strain that may cause more severe disease and a worse patient outcome. As a result of CDAD, large numbers of C. difficile spores may be excreted by affected patients. Spores then survive for months in the environment; they cannot be destroyed by standard alcohol-based hand disinfection, and persist despite usual environmental cleaning agents. All these factors increase the risk of C. difficile transmission. Once CDAD is diagnosed in a patient, immediate implementation of appropriate infection control measures is mandatory in order to prevent further spread within the hospital. The quality and quantity of antibiotic prescribing should be reviewed to minimise the selective pressure for CDAD. This article provides a review of the literature that can be used for evidence-based guidelines to limit the spread of C. difficile. These include early diagnosis of CDAD, surveillance of CDAD cases, education of staff, appropriate use of isolation precautions, hand hygiene, protective clothing, environmental cleaning and cleaning of medical equipment, good antibiotic stewardship, and specific measures during outbreaks. Existing local protocols and practices for the control of C. difficile should be carefully reviewed and modified if necessary.

Efficacy of Glutaraldehyde Disinfectant Against Cryptosporidium parvum in the Presence of Various Organic Soils

The opportunistic protozoan Cryptosporidium parvum is highly resistant to disinfectants, including those specifically used for processing reused medical equipment in hospitals. C. parvum oocysts were dried onto glass and steel grooved penicylinders and challenged with 2.5% glutaraldehyde solution in the presence of 3 types of soil with exposures at 10 min, 90 min, and 10 h. The influence of organic soils on disinfection was measured with 5% fetal bovine serum (FBS), 10% FBS, and 5 mg mucin/mL. An in vitro excystation procedure and cell culture infection assay were used to determine survivability of oocysts after the germicide challenge. In the presence of organic soil, all oocysts removed from carriers excysted and infected cell monolayers after all germicide contact times. However, excystation was observed only from oocysts that received no protection from organic soil after 10 h exposure. In these samples, no infection was observed in the cell monolayers. The results of this research demonstrate the importance of thorough cleaning of medical equipment before disinfection.