Disinfection Of Medical Devices Research Articles

The main directions of prevention of occupational infection viral hepatitis with a contact transmission mechanism in hospitals in Saint-Petersburg

The high level of hepatitis B and C infection in the modern period in the general population increases the frequency of contact of hospital specialists with patients with this infectious pathology. A significant concentration of infection sources in medical organizations and violations in the implementation of disinfection and sterilization algorithms and requirements for hand hygiene of medical workers create conditions for the nosocomial spread of viral hepatitis pathogens with a contact transmission echanism.The aim. Substantiation of the main directions of prevention of occupational infection viral hepatitis with a contact transmission mechanism in hospitals of Saint Petersburg.Materials and methods. A retrospective epidemiological analysis of the annual reports of Saint-Petersburg hospitals was carried out, which contain information on the number of new cases chronic forms of viral hepatitis among specialists of medical organizations and on the number personnel under dispensary supervision for these infectious diseases, as well as on the number of injuries received by hospital staff while performing functional duties, as well as vaccination coverage against viral hepatitis B, measles and diphtheria for the period from 2009 to 2022. The assessment of the equipment of megapolis healthcare institutions modern washing-disinfecting and sterilization equipment was also carried out.Results and discussion. The realization of the possibility of infecting hospital specialists viral hepatitis with a contact transmission mechanism is predetermined by the high concentration of patients with this pathology in healthcare institutions; the presence of occupational injuries during the implementation of medical and diagnostic procedures and disinfection and sterilization measures.Conclusion. A set of measures for early detection of sources of infections with a contact transmission mechanism among patients and staff; disinfection of medical devices using modern disinfection and sterilization equipment; revaccination against hepatitis B and equipping workplaces of specialists with personal protective equipment in full remains relevant for the prevention of occupational infection of medical workers.

Penetration of a Pulsed Guided Streamer Discharge into Micrometer-Sized Capillary Tubes

The penetration and propagation of streamers in capillary tubes is critical for applications involving the plasma-enabled disinfection of medical devices like catheters and plasma catalysis. In this study, a guided streamer is generated in a pulsed plasma jet operating in helium and impinged downstream onto a capillary tube with an inner diameter between 75 and 500 µm. The threshold voltage required to start the penetration of the guided streamer into the capillary was determined for both positive and negative polarities, and we observed a time delay between the streamer striking the top of the capillary and its penetration, which was found to be larger for the positive than the negative streamer. The observed differences can be explained by the need to sustain an electric field large enough to generate a sufficient seed electron density in the capillary to launch the streamer. The reported results suggest that the electric field at the capillary inlet is likely reduced by the formation of strong surface ionization waves for positive streamers. Nonetheless, in the case of positive streamers, the formation of surface streamers along the outside of the capillary wall can enhance streamer penetration into the capillary and the streamer propagation speed.

Using the Manufacturer's Instructions for Use and Spaulding Classification System to Assess Disinfection Practices for Ultrasound Transducers in the Perioperative Setting.

Proper use and disinfection of medical devices and instruments is essential to preventing infection and providing safe patient care. Because of an increase in the complexity of medical devices and patient interventions, it has become more difficult for perioperative staff members to ensure that equipment is properly used and disinfected according to the manufacturer's instructions for use and the Spaulding classification system. One type of medical device that may have multiple clinical uses is the ultrasound transducer. In the perioperative setting, ultrasound transducers can be used for surface, percutaneous, and endocavitary procedures. They also may be used at multiple times before, during, and after a procedure, which may make it challenging for perioperative staff members to know the correct disinfection practice. They should use the device's instructions for use and the Spaulding classification system to guide their clinical practice.

Site-specific fabrication of a melanin-like pigment through spatially confined progressive assembly on an initiator-loaded template

Melanin-like nanomaterials have emerged in surface biofunctionalization in a material-independent manner due to their versatile adhesion arising from their catechol-rich structures. However, the unique adhesive properties of these materials ironically raise difficulties in their site-specific fabrication. Here, we report a method for site-specific fabrication and patterning of melanin-like pigments, using progressive assembly on an initiator-loaded template (PAINT), different from conventional lithographical methods. In this method, the local progressive assembly could be naturally induced on the given surface pretreated with initiators mediating oxidation of the catecholic precursor, as the intermediates generated from the precursors during the progressive assembly possess sufficient intrinsic underwater adhesion for localization without diffusion into solution. The pigment fabricated by PAINT showed efficient NIR-to-heat conversion properties, which can be useful in biomedical applications such as the disinfection of medical devices and cancer therapies.

White light thermoplasmonic activated gold nanorod arrays enable the photo-thermal disinfection of medical tools from bacterial contamination.

The outspread of bacterial pathogens causing severe infections and spreading rapidly, especially among hospitalized patients, is worrying and represents a global public health issue. Current disinfection techniques are becoming insufficient to counteract the spread of these pathogens because they carry multiple antibiotic-resistance genes. For this reason, a constant need exists for new technological solutions that rely on physical methods rather than chemicals. Nanotechnology support provides novel and unexplored opportunities to boost groundbreaking, next-gen solutions. With the help of plasmonic-assisted nanomaterials, we present and discuss our findings in innovative bacterial disinfection techniques. Gold nanorods (AuNRs) immobilized on rigid substrates are utilized as efficient white light-to-heat transducers (thermoplasmonic effect) for photo-thermal (PT) disinfection. The resulting AuNRs array shows a high sensitivity change in refractive index and an extraordinary capability in converting white light to heat, producing a temperature change greater than 50 °C in a few minute interval illumination time. Results were validated using a theoretical approach based on a diffusive heat transfer model. Experiments performed with a strain of Escherichia coli as a model microorganism confirm the excellent capability of the AuNRs array to reduce the bacteria viability upon white light illumination. Conversely, the E. coli cells remain viable without white light illumination, which also confirms the lack of intrinsic toxicity of the AuNRs array. The PT transduction capability of the AuNRs array is utilized to produce white light heating of medical tools used during surgical treatments, generating a temperature increase that can be controlled and is suitable for disinfection. Our findings are pioneering a new opportunity for healthcare facilities since the reported methodology allows non-hazardous disinfection of medical devices by simply employing a conventional white light lamp.

Exploration of oxygen-mediated disinfection of medical devices reveals a high sensitivity of Pseudomonas aeruginosa to elevated oxygen levels

The microbiological safety of medical devices is of paramount importance for patients and manufacturers alike. However, during usage medical devices will inevitably become contaminated with microorganisms, including opportunistic pathogens. This is a particular problem if these devices come in contact with body sites that carry high bacterial loads, such as the oral cavity. In the present study, we investigated whether high oxygen concentrations can be applied to disinfect surfaces contaminated with different Gram-positive and Gram-negative bacteria. We show that some opportunistic pathogens, exemplified by Pseudomonas aeruginosa, are particularly sensitive to oxygen concentrations above the atmospheric oxygen concentration of 21%. Our observations also show that high oxygen concentrations can be applied to reduce the load of P. aeruginosa on nebulizers that are used by cystic fibrosis patients, who are particularly susceptible to colonization and infection by this bacterium. We conclude that the efficacy of oxygen-mediated disinfection depends on the bacterial species, duration of oxygen exposure and the oxygen concentration. We consider these observations relevant, because gas mixtures with high oxygen content can be readily applied for microbial decontamination. However, the main challenge for oxygen-based disinfection approaches resides in a potentially incomplete elimination of microbial contaminants, which makes combined usage with other disinfectants like ethanol or hydrogen peroxide recommendable.

Evaluation of knowledge, attitude, and behaviour of ophthalmologists about adenoviral conjunctivitis transmission and treatment : An online survey for Turkish ophthalmologists.

To determine the prevalence of adenoviral conjunctivitis in Turkish ophthalmologists, to provide an overview of the treatment and prophylaxis of adenoviral conjunctivitis, and to analyze the data in the context of evidence-based treatment recommendations. An online questionnaire consisting of 20 multiple-choice questions about the characteristics of the respondents, the individual adenoviral conjunctivitis history of the ophthalmologists, their practice's approaches, and prescription preferences were emailed to Turkish ophthalmologists. The survey was emailed to 500 ophthalmologists; 45% of them returned the questionnaire. According to the responses, the history of adenoviral conjunctivitis infections was positive in 46.7% (n: 120), recurrent attack prevalence was 16.2% in ophthalmologists. Lubricants (67.6%) are the most preferred first-line treatment options for adenoviral conjunctivitis, followed by povidone-iodine (59.6%), topical antibiotics (51.1%), topical antivirals (29.3%), topical corticosteroids (26.7%), and topical nonsteroidal anti-inflammatory agents (19.6%). A total of 98.2% preferred to dismiss infected patients. The preferred prophylaxis options were frequent hand washing/use of gloves (97.8%), disinfection of medical devices (95.1%), isolation of infected patients (79.1%), hand hygiene with gemicides (58.7%). The percentage of single-dose eye drop selection was 46.2. The findings of this survey showed that most Turkish ophthalmologists generally follow international guidelines for the treatment of adenoviral conjunctivitis. The treatment algorithm is still controversial, so ophthalmologists should be aware of treatment guideline updates in line with evidence-based recommendations. Having sufficient knowledge of the basic characteristics of viruses is important to control the spread of the disease.

Detrimental Effect of Ozone on Pathogenic Bacteria.

(1) Background: Disinfection of medical devices designed for clinical use associated or not with the growing area of tissue engineering is an urgent need. However, traditional disinfection methods are not always suitable for some biomaterials, especially those sensitive to chemical, thermal, or radiation. Therefore, the objective of this study was to evaluate the minimal concentration of ozone gas (O3) necessary to control and kill a set of sensitive or multi-resistant Gram-positive and Gram-negative bacteria. The cell viability, membrane permeability, and the levels of reactive intracellular oxygen (ROS) species were also investigated; (2) Material and Methods: Four standard strains and a clinical MDR strain were exposed to low doses of ozone at different concentrations and times. Bacterial inactivation (cultivability, membrane damage) was investigated using colony counts, resazurin as a metabolic indicator, and propidium iodide (PI). A fluorescent probe (H2DCFDA) was used for the ROS analyses; (3) Results: No reduction in the count colony was detected after O3 exposure compared to the control group. However, the cell viability of E. coli (30%), P. aeruginosa (25%), and A. baumannii (15%) was reduced considerably. The bacterial membrane of all strains was not affected by O3 but presented a significant increase of ROS in E. coli (90 ± 14%), P. aeruginosa (62.5 ± 19%), and A. baumanni (52.6 ± 5%); (4) Conclusion: Low doses of ozone were able to interfere in the cell viability of most strains studied, and although it does not cause damage to the bacterial membrane, increased levels of reactive ROS are responsible for causing a detrimental effect in the lipids, proteins, and DNA metabolism.

An enzymatic based formulation for cleaning and disinfection of medical devices

An enzymatic based formulation for cleaning and disinfection of medical devices

Re-purposing of domestic steam disinfectors within the hospital-at-home setting.

BackgroundVulnerable patients being cared for in hospital-at-home settings require safe disinfection of their medical devices, including nebulisers and other respiratory equipment. The scale of patients now being cared for in hospital-at-home settings as a result of COVID19 places huge pressure on hospital central sterile services departments (CSSDs) to provide consumable items to safely support such patients’ care. This places new importance on the disinfection of mundane objects, including crockery, cutlery and frequently touched objects in the home environment. This study examined temperature performance of steam disinfectors and the consequences of potential operator misuse on the survival of 62 bacteria and yeast organisms.MethodsThermal performance of steam disinfectors was evaluated using calibrated thermocouple probes in multiple permutations of device usage with 62 test organisms.ResultsThermocouple data demonstrated disinfection A0 values of 6000 (upper layer) and 60 (lower layer). Steam disinfection of baby bottles had a thermal lethality of at least A0 = 600. Variation in disinfector temperatures were noted, depending on the geometric location of thermocouples. Additional notable temperature reductions occurred with device underfilling with suboptimal water volumes. Steam disinfection eradicated all 62 non-spore-forming Gram-positive, Gram-negative and yeast organisms tested and eradicated all organisms in the inner teat space of contaminated babies' dummies, rendering safe steam disinfection of babies’ dummies.ConclusionDomestic steam disinfection offers an inexpensive, simple, versatile and widely available technology for the elimination of common non-spore-forming nosocomial pathogens and safe disinfection of medical devices, fomites and other mundane objects within the hospital-at-home scenario, thereby enhancing patient safety.

Disinfecting noncritical medical equipment—Effectiveness of hydrogen peroxide dry mist as an adjunctive method

Manual disinfection of medical devices is prone to failure. Disinfection by aerosolized hydrogen peroxide might be a promising adjunctive method. We aimed to assess effectiveness of dry mist of hydrogen peroxide (HPDM) on noncritical medical equipment. One cycle of HPDM was applied on a convenience sample of 16 different types of "ready to use" noncritical medical devices in a closed, but nonsealed room. Of every object, 2 adjacent areas with assumed similar bacterial burden were swabbed before and after HPDM deployment, respectively. After culturing, colony forming units (CFU) were counted, and bacterial burden per cm2 calculated. Of 160 objects included in the study, 36 (23%) showed a CFU-count of zero both before and after HPDM use. A decrease from a median of 0.14 CFU/cm2 (range: 0.00-125.00/cm2) to a median of 0.00 CFU/cm2 (range: 0.00-4.00/cm2) (P < .001) was observed. The bacterial burden was reduced by more than 90% in 45% (95% CI: 37-53) of objects. No pathogenic bacteria were identified. HPDM reduced bacterial burden on noncritical medical items. Since cleanliness of the included "ready to use" objects was high and no pathogens were found before nebulization, the HPDM device did not increase patient safety in this setting. HPDM nebulization can be a useful nonmanual adjunctive disinfection method in high-risk settings.

Design and implementation of the infection prevention program into risk management: Managing high level disinfection and sterilization in the outpatient setting.

Reusable, invasive medical devices within the outpatient setting pose a risk for patient harm. Ineffective disinfection of medical devices can potentially lead to transmission of pathogens between patients; and improper handling can lead to patient injury. A risk assessment was conducted, and the results strongly supported the necessity to develop a robust infection prevention program within the risk management department. This exclusive program was a proactive approach to preventing patient exposure within our healthcare system. Designing and integrating an Infection Prevention program into the Risk Management Department presented challenges, especially with the magnitude of devices and lack of standardization throughout our 33 clinics. Key components of the program included: capturing an accurate inventory of devices throughout the system, hiring a sterile processing expert, engaging support from senior leadership, adhering to rigorous auditing processes, and establishing a staff competency training structure. Since the program was launched 2 years ago, outcomes include: identification of high-risk practices with immediate resolution, increase in average clinic compliance to device reprocessing standards from 88% to 99%, elimination of 71% of scope reprocessing and 39% of instrument sterilization by clinic staff with allocation to central sterile processing departments, and development of a staff competency training structure.

Recommendations for Cutaneous and Aesthetic Surgeries during COVID-19 Pandemic.

Background:Amid the coronavirus disease 2019 (COVID-19) pandemic, dermatologists must be prepared to restructure their practice of procedural dermatology and cutaneous aesthetic surgeries. The COVID-19 pandemic has presented several challenges and has ushered in several changes in practice such as teledermatology, with many physicians adopting virtual consultations and treatments. Performing procedures in the times of COVID-19 pandemic presents challenges such as risk of transmission to doctors and staff due to potential aerosolization, release of virus droplets during the procedures, and risk of virus transfer through the instruments both in the peri- and postoperative period. This can have several medical, administrative, and legal implications.Objectives:This document aimed to outline best practices that can be followed in this scenario to perform cutaneous surgeries and procedures to ensure safer skin surgery.Recommendations:Standard precautions include social distancing of at least 1 m, hand hygiene, appropriate use of personal protective equipment (PPE), safe injection practices, sterilization and disinfection of medical devices, environmental cleaning, and respiratory hygiene. It is generally advisable to see patients only by appointments. Each clinic should have a special area at entry for screening patients and providing sanitizers and masks. Procedures, which are of short duration, performed on nonfacial areas are considered as low risk and require donning surgical mask. Procedures involved with minimal invasiveness and bleeding, short duration procedures on the face such as injectables, chemical peels, and aerosol-generating procedures on nonfacial areas are considered moderate risk. These procedures need apron with head cover, N95 mask, face shield, double gloves, and smoke evacuator with high-efficiency particulate air (HEPA) or ultralow particulate air (ULPA) filter. Aerosol and plume-regenerating procedures (such as ablative lasers on the face), prolonged surgeries on head (such as hair transplantation), intraoral, and intranasal procedures are considered high risk. These procedures must be carried out with full body cover with surgical gown, head cover, N95 mask, face shield, double gloves, and smoke evacuator. Physicians should be aware of local epidemiological situation and adhere to the relevant guidelines issued by the relevant governmental agencies.

An UV to NIR-driven platform based on red phosphorus/graphene oxide film for rapid microbial inactivation

The problem of bacterial infection is getting worse. Photo-driven disinfection is an effective solution with the perspective of energy consumption. However, the current researches focus on expanding the utilization of light energy from ultraviolet to visible light, while the infrared portion of sunlight has not been considered. Thus, it is desirable to develop novel materials, with a broader solar spectrum utilization, for rapid microbial inactivation. Here we show a crystalline phosphorus film consist of irregular pyramids covered by graphene oxide with an enhanced photoelectrochemical performance. The metal-free film exhibits broad absorption throughout the solar spectrum with good photocatalytic and photothermal properties. With the synergy of photodynamic and photothermal effects, the composite exhibited inactivation of about 99.9% on Staphylococcus aureus and Escherichia coli within 20 min of simulated sunlight irradiation. Meanwhile, well disinfection were also exhibited under visible and 808 nm light. By the way, good biocompatibility, along with excellent biofilm removal under LED light, provided the film a prospect in disinfection of medical devices.

Use of Disinfectants, Registered in Russia, by the NBC Protection Troops in Biological Emergencies

Disinfection measures in the event of an outbreak of epidemics created by natural and artificial causes are connected with high consumption of disinfectants, especially in anthrax foci. This does not exclude the situation, when the stock of authorized disinfectants may turn out to be insufficient. So it will be necessary to use non-authorized disinfectants. The aim of this paper is to reveal among the disinfectants, registered in Russia, the most convenient to use by the NBC Protection Troops in epidemic emergencies. 770 such disinfectants have been analyzed. It is established, that the disinfectants of the group of cationic surfactants (CPAS) based on quaternary ammonium compounds, amines, polyguanidines and compositions of these active substances in various combinations have been introduced into practice of Russian medical institutions for almost two decades. The analysis of the scientific literature and the results of our own experiments show that the solutions of these disinfectants, recommended for high-level sterilization and disinfection of medical devices, do not have any sporicidal effect. Because of that, only disinfectants based on chlorine-containing and oxygen-containing active substances can be interesting for the NBC Protection Troops and may be used as non-authorized disinfectants. The solutions of such agents have a wide range of antimicrobial action and provide complete death of not only bacteria, viruses and fungi, but also spores of various bacilli, at temperatures below 0 oС as well. The most convenient in use by the NBC Protection Troops are the products in the form of instant tablets based on sodium dichloroisocyanuric acid, as well as in the form of liquid concentrates based on hydrogen peroxide or peracetic acid. Because of that the above mentioned agents should be used by the NBC Protection Troops in cases of biological emergencies according to the regimes of standard approved disinfectants

Znaczenie dezynfekcji wstępnej wyrobów medycznych dla procesu dekontaminacji

Znaczenie dezynfekcji wstępnej wyrobów medycznych dla procesu dekontaminacji

Inactivation Efficacy of Nonthermal Plasma-Activated Solutions against Newcastle Disease Virus.

ABSTRACTIn recent years, plasma-activated solutions (PASs) have made good progress in the disinfection of medical devices, tooth whitening, and fruit preservation. In this study, we investigated the inactivation efficacy of Newcastle disease virus by PASs. Water, 0.9% NaCl, and 0.3% H2O2 were excited by plasma to obtain the corresponding solutions PAS(H2O), PAS(NaCl), and PAS(H2O2). The complete inactivation of virus after PAS treatment for 30 min was confirmed by the embryo lethality assay (ELA) and hemagglutination (HA) test. Scanning electron microscopy (SEM) results showed that the morphology of the viral particle changed under PAS treatments. The total protein concentration of virus decreased as measured by a Bradford protein assay due to PAS treatment. The nucleic acid integrity assay demonstrated that viral RNA degraded into smaller fragments. Moreover, the physicochemical properties of PASs, including the oxidation-reduction potential (ORP), electrical conductivity, and H2O2 concentration, and electron spin resonance spectra analysis indicated that reactive oxygen and nitrogen species play a major role in the virus inactivation. Therefore, the application of PASs, as an environmentally friendly method, would be a promising alternative strategy in poultry industries.IMPORTANCE Newcastle disease (ND), as an infectious viral disease of avian species, caused significant economic losses to domestic animal and poultry industries. The traditional chemical sanitizers, such as chlorine-based products, are associated with risks of by-product formation with carcinogenic effects and environmental pollution. On the basis of this, plasma-activated water as a green disinfection product is a promising alternative for applications in stock farming and sterilization in hospitals and public places. In this study, we explored the inactivation efficacy of different plasma-activated solutions (PASs) against ND virus (NDV) and the possible underlying mechanisms. Our results demonstrated that reactive oxygen and nitrogen species detected in PASs, including short-lived OH˙ and NO˙ and long-lived H2O2, changed the morphology, destroyed the RNA structure, and degraded the protein of the virus, consequently resulting in virus inactivation. These lay a foundation for the application of PASs to resolve the issues of public health and environmental sanitation.

Synthesis and Complete Antimicrobial Characterization of CEOBACTER, an Ag-Based Nanocomposite.

The antimicrobial activity of silver nanoparticles (AgNPs) is currently used as an alternative disinfectant with diverse applications, ranging from decontamination of aquatic environments to disinfection of medical devices and instrumentation. However, incorporation of AgNPs to the environment causes collateral damage that should be avoided. In this work, a novel Ag-based nanocomposite (CEOBACTER) was successfully synthetized. It showed excellent antimicrobial properties without the spread of AgNPs into the environment. The complete CEOBACTER antimicrobial characterization protocol is presented herein. It is straightforward and reproducible and could be considered for the systematic characterization of antimicrobial nanomaterials. CEOBACTER showed minimal bactericidal concentration of 3 μg/ml, bactericidal action time of 2 hours and re-use capacity of at least five times against E. coli cultures. The bactericidal mechanism is the release of Ag ions. CEOBACTER displays potent bactericidal properties, long lifetime, high stability and re-use capacity, and it does not dissolve in the solution. These characteristics point to its potential use as a bactericidal agent for decontamination of aqueous environments.

Design of pectin-sodium alginate based films for potential healthcare application: Study of chemico-physical interactions between the components of films and assessment of their antimicrobial activity

In this study, pectin based films including different amounts of sodium alginate were prepared by casting method. All the films, with and without polyglycerol as plasticizer, were crosslinked with zinc ions in order to extend their potential functionality. The development of junction points, occurring during the crosslinking process with zinc ions, induced the increasing of free volume with following changing in chemico-physical properties of films. The inclusion of alginate in pectin based formulations improved the strength of zinc ions crosslinking network, whereas the addition of polyglycerol significantly improved mechanical performance. Finally, zinc-crosslinked films evidenced antimicrobial activity against the most common exploited pathogens: Staphylococcus Aureus, Escherichia Coli and Candida Albicans. These results suggest that zinc-crosslinked based films can be exploitable as novel bio-active biomaterials for protection and disinfection of medical devices.

Study of the Effectiveness against Test Strain Mycobacterium terrae DSM 43227 of Some Substances Containing Fragment of Phenolic

Relevance. Multi-drug-resistant Mycobacterium tuberculosis has been an important problem in public health around the world. However, development of effective methods and means of disinfection is now extremely urgent. Phenol is probably the oldest known disinfectant. Disinfectants based on substances containing phenolic practically used in almost every countries of the worldwide for the disinfection of medical devices, surfaces and hand hygiene. Goal. Comparative study of the activity of certain disinfectants containing phenol fragment against the test strain. Materials and methods. Multi-drug-resistant M. terrae, M. avium-intracellulara and M. tuberculosis have similar characteristics of resistance to chemical disinfectants, herefore M. terrae DSM 43227 used as the test strain. We studied five used in Russia for the production of disinfectants and antiseptics. substances containing a phenolic. Results. The disinfectant effect of substances with phenol compounds was detected in lower concentrations (from 0.02% for 2-benzil-4-chlorphenol to 1.0% for ortophenylphenol) than with substances containing glutaraldehyde or chloramine B compounds. Conclusions. Saving disinfecting effectiveness at low concentrations of the active substances in the working solutions can be recommended disinfectants based on phenolic compounds for disinfection measures in the complex of measures for prevention of occurrence and spread of tuberculosis.