Disinfection Research Articles

Decontamination of Surgical Instruments for Safe Wound Care Surgeries in Disasters: What are the Options? A Scoping Review.

International guidelines stipulate that autoclavation is necessary to sterilize surgical equipment. World Health Organization (WHO) guidelines for decontamination of medical devices require four levels of decontamination: cleaning, low- and high-level disinfection, as well as sterilization. Following disasters, there is a substantial need for wound care surgery. This requires prompt availability of a significant volume of instruments that are adequately decontaminated. Ideally, they should be sterilized using an autoclave, but due to the resource-limited field context, this may be impossible. The aim of this study was therefore to identify whether there are portable and less resource-demanding techniques to decontaminate surgical instruments for safe wound care surgery in disasters. A scoping review was chosen, and searches were performed in three scientific databases, grey literature, and included data from organizations and journals. Articles were scanned for decontamination techniques feasible for use in the resource-scarce disaster setting given that: they achieved at least high-level disinfected instruments, were portable, and did not require electricity. A total of 401 articles were reviewed, yielding 13 articles for inclusion. The study identified three techniques: pressure cooking, boiling, and liquid chemical immersion, all achieving either sterilized or high-level disinfected instruments. It was concluded that besides autoclaves, there are less resource-demanding decontamination techniques available for safe wound surgery in disasters. This study provides systematic information to guide optimal standard setting for sterilization of surgical material in resource-limited disaster settings.

Declining Effect of Precipitation on the Normalized Difference Vegetation Index of Grasslands in the Inner Mongolian Plateau, 1982–2010

Grasslands play an irreplaceable role in maintaining carbon balance and stabilizing the entire Earth’s ecosystem. Although the grasslands in Inner Mongolia are sensitive and vulnerable to climate change, a generalized effect of climate change on the grasslands is still unavailable. In this study, we analyzed the effects of annual mean precipitation and annual mean temperature on the normalized difference vegetation index from 1982 to 2010 on the Inner Mongolia Plateau. Our results indicated that the normalized difference vegetation index was mostly affected by precipitation, followed by temperature. Spatially, temperature and precipitation had greater effects on normalized difference vegetation index in dry regions than in wet ones. In time series, the effect of precipitation on normalized difference vegetation index had significantly decreased from 1982 to 2010 (R2 = 0.11, p > 0.05). However, the effect of temperature on normalized difference vegetation index remained stable. The high variation effect of precipitation on normalized difference vegetation index was due to the significant decrease in precipitation from 1980 to 2010. Thus, 35.47% and 0.56% of the dynamic of normalized difference vegetation index from 1982 to 2010 was accounted for by the precipitation and temperature, respectively. Our findings highlighted that grasslands are adaptable to the significant increase in temperature, but are sensitive to the decrease in precipitation on the Inner Mongolia Plateau.

Resistance of poliovirus 1 and enterovirus A71 against alcohol and other disinfectants

Poliovirus 1 (PV 1) is the standard virus used in tests to support claims of virucidal property in commercial hand sanitizers and disinfectants in China. Classified within the same genus as poliovirus, enterovirus A71 (EV A71), which causes hand-foot-mouth disease among children, has caused numerous outbreaks in China and other countries. Hand hygiene and surface cleaning are critical to prevent and control this disease and many other infectious diseases. This study compared the efficacies of 17 self-made alcohol-based hand sanitizers and 10 commercially available disinfectants (4 high-level, 4 intermediate-level, 2 low-level) against these two viruses.The results showed that by itself, ethanol needed to reach a concentration of 75 % to meet the inactivation requirement of 4-log reduction in average TCID50 against PV 1. Nine out of 13 laboratory-formulated alcohol-based hand sanitizers reached the 4-log inactivation requirement against PV 1 after 4.5 min, while the remaining four sanitizers did not. Unexpectedly, none of the tested ethanol-based sanitizers inactivated EV A71 by 4-log. For the commercially available disinfectants, all four high-level and one intermediate-level disinfectants passed the inactivation requirements against both PV 1 and EV A71, while two intermediate-level disinfectants met the inactivation requirement against PV 1 but failed against EV A71. The last intermediate-level and both low-level disinfectants did not meet the requirement for either PV 1 or EV A71. Therefore, PV 1 is more susceptible to inactivation by many common alcohol-based and non-alcohol-based disinfectants than EV A71. Therefore, the adoption of EV A71 as the standard test virus would elevate the disinfectant requirement standard and provide better protection for the public. Based on these results, seven new alcohol-based hand sanitizer recipes were formulated and found to be effective against both PV 1 and EV A71, with two candidates reaching the required 4-log virus reduction efficacy within 1 min.

Обґрунтування безпечного застосування дезінфекційного засобу «СТЕРІЗЕНТ»

diseases, especially a use of the disinfectants (DS), in particular, are of special relevance in order to break the mechanisms of the transmission of infectious agents. The variety of DS, presented at the modern market, allows us to choose the most appropriate ones for the purposes, conditions and methods of application. However, the effectiveness and safety of the DS both for humans and the environment are still the main choice criteria. In this regard, electrolysis preparations (anolytes) attract a special attention. Objective: We determined the bactericidal, virucidal and yeast activity of the STERISENT preparation (Israel) according to modern requirements and standards. Materials and methods: Studies of the specific activity of the DS "STERISENT" were carried out in accordance with the Order of the Ministry of Health of Ukraine No. 2024, 03.09.2020 and the European standards. The test cultures and culture media recommended by the Order No. 2024 and the standards EN 13727: 2012 + A2: 2015 [3] and DSTU EN 13624: 2019 (EN 13624: 2013, IDT) were used in the quantitative suspension method. Virucidal activity was studied in the intestinal bacteriophages T2 and MS2.Toxicological studies were carried out in the laboratory animals in accordance with modern standards. Results: A high bactericidal and yeast-killing activity of STERISENT preparation (Israel) in undiluted form was established for Escherichia coli K12 NCTC 10538 lg R >5.42, for Pseudomonas aeruginosa lg R >5.37; for Staphylococcus aureus lg R >5.34; for Candida albicans lg R >4.31at exposure of 30 s and 60 s. In the study in bacteriophages at an exposure of 30 s, the logarithms of the reduction were: T2 - >5.08, MS2 - >5.12. According to GOST 12.1.007-76,by the parameters of acute toxicity, STERIZENT preparation belongs to class 4 - low-hazardous substances when administered to the stomach and applied to the skin; at the inhalation application in saturated concentrations - to class 3. moderately dangerous substances. The preparation does not have a sensitizing effect in the recommended modes of application.

Economic burden of enhanced practices of duodenoscopes reprocessing and surveillance: balancing risk and cost containment.

Background and study aims Recent outbreaks attributed to contaminated duodenoscopes have led to the development of enhanced surveillance and reprocessing techniques (enhanced-SRT) aimed at minimizing cross-contamination. Common enhanced-SRT include double high-level disinfection (HLD), ethylene oxide (EtO) gas sterilization, and culture-based monitoring of reprocessed scopes. Adoption of these methods adds to the operational costs and we aimed to assess its economic impact to an institution. Methods We compared the estimated costs of three enhanced-SRT versus single-HLD using data from two institutions. We examined the cost of capital measured as scope inventory and frequency of scope use per unit time, the constituent reprocessing costs required on a per-cycle basis, and labor & staffing needs. The economic impact attributable to enhanced-SRT was defined as the difference between the total cost of enhanced-SRT and single HLD. Results Compared to single HLD, adoption of double HLD increased the costs approximately by 47 % ($80 vs $118). Similarly, culture and quarantine and EtO sterilization increased costs by 160 % and 270 %, respectively ($80 vs $208 and $296). Enhanced-SRT introduced significant scope downtime due to prolonged techniques, necessitating a 3.4-fold increase in the number of scopes needed to maintain procedural volume. The additional annual budget required to implement enhanced-SRT approached $406,000 per year in high-volume centers. Conclusions While enhanced-SRT may reduce patient risk of exposure to contaminated duodenoscopes, it significantly increases the cost of performing ERCP. Future innovation should focus on approaches that can ensure patient safety while maintaining the ability to perform ERCP in a cost-effective manner.

Opto-chemical treatment for enhanced high-level disinfection of mature bacterial biofilm in a Teflon-based endoscope model.

Medical societies and public health agencies rigorously emphasize the importance of adequate disinfection of flexible endoscopes. The aim of this work was to propose a novel opto-chemical disinfection treatment against Staphylococcus aureus grown in mature biofilm on Teflon-based endoscope channel models. Laser irradiation using near-infrared and blue wavelengths combined with a low concentration of chemical disinfectant induced both irreversible thermal denaturation and intercellular oxidative stress as a combined mechanism for an augmented antimicrobial effect. The opto-chemical method yielded a 6.7-log10 reduction of the mature Staphylococcus aureus biofilms (i.e., approximately 1.0-log10 higher than current requirement of standard treatment). The proposed technique may be a feasible disinfection method for mitigating the risk associated with infection transmission.

Mask decontamination methods (model N95) for respiratory protection: a rapid review

BackgroundN95 respiratory protection masks are used by healthcare professionals to prevent contamination from infectious microorganisms transmitted by droplets or aerosols.MethodsWe conducted a rapid review of the literature analyzing the effectiveness of decontamination methods for mask reuse. The database searches were carried out up to September 2020. The systematic review was conducted in a way which simplified the stages of a complete systematic review, due to the worldwide necessity for reliable fast evidences on this matter.ResultsA total of 563 articles were retrieved of which 48 laboratory-based studies were selected. Fifteen decontamination methods were included in the studies. A total of 19 laboratory studies used hydrogen peroxide, 21 studies used ultraviolet germicidal irradiation, 4 studies used ethylene oxide, 11 studies used dry heat, 9 studies used moist heat, 5 studies used ethanol, two studies used isopropanol solution, 11 studies used microwave oven, 10 studies used sodium hypochlorite, 7 studies used autoclave, 3 studies used an electric rice cooker, 1 study used cleaning wipes, 1 study used bar soap, 1 study used water, 1 study used multi-purpose high-level disinfection cabinet, and another 1 study used chlorine dioxide. Five methods that are promising are as follows: hydrogen peroxide vapor, ultraviolet irradiation, dry heat, wet heat/pasteurization, and microwave ovens.ConclusionsWe have presented the best available evidence on mask decontamination; nevertheless, its applicability is limited due to few studies on the topic and the lack of studies on real environments.

High-Level Disinfection in Ambulatory Care: Overcoming the Barriers of a Decentralized System through Auditing and Education

Background: High-level disinfection (HLD) of semicritical instruments in a multispecialty ambulatory care network has the potential for increased risk due to the decentralized instrument reprocessing and lack of a sterile processing department. Attention to HLD practices is an important part of device-borne outbreak prevention. Method: An HLD database was developed to identify specific departments and locations where HLD occurred across a 30-medical practice ambulatory care network in eastern Massachusetts, which included otolaryngology, urology, endoscopy, and obstetrics/gynecology departments. Based on qualitative feedback from managers and reprocessing staff, this database centralized information that included the supply inventory including manufacturer and model information, HLD methodology, standard work, and listing of competency evaluations. The infection control team then led audits to directly observe compliance with instrument reprocessing and a monthly-driven HLD calendar was developed to enforce annual competencies. Result: The results of the audits demonstrated variability across departments with gaps in precleaning, transportation of used instruments, the dilution of enzymatic cleaner, and maintenance of quality control logs. Given the uniqueness of shape and size of various ambulatory locations, proper storage and separation between clean and dirty spaces were common pitfalls. Auditing also revealed different levels of staff understanding of standard work and variable inventory management. Centralized education sessions held jointly by the infection control team and various manufacturers for the reprocessing staff helped to create and reinforce best practices. Conclusion: Decentralized HLD that occurs across multiple ambulatory care sites led to gaps in instrument reprocessing and unique challenges due to variable geography of sites, physical space constraints, and an independent approach to procuring medical supplies. Through the auditing and feedback of all areas that perform HLD, an effective and sustainable strategy was created to ensure practice improvement. Streamlining standard work, seeking direct input from frontline staff, and collective educational events were critical to our success in the ambulatory setting.Funding: NoDisclosures: None

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Disinfection of Neonatal Resuscitation Equipment in Low-Resource Settings: The Importance, the Reality, and Considerations for the Future.

Preventable neonatal deaths due to prematurity, perinatal events, and infections are the leading causes of under-five mortality. The vast majority of these deaths are in resource-limited areas. Deaths due to infection have been associated with lack of access to clean water, overcrowded nurseries, and improper disinfection (reprocessing) of equipment, including vital resuscitation equipment. Reprocessing has recently come to heightened attention, with the COVID-19 pandemic bringing this issue to the forefront across all economic levels; however, it is particularly challenging in low-resource settings. In 2015, Eslami et al. published a letter to the editor in Resuscitation, highlighting concerns about the disinfection of equipment being used to resuscitate newborns in Kenya. To address the issue of improper disinfection, the global health nongovernment organization PATH gathered a group of experts and, due to lack of best-practice evidence, published guidelines with recommendations for reprocessing of neonatal resuscitation equipment in low-resource areas. The guidelines follow the gold-standard principle of high-level disinfection; however, there is ongoing concern that the complexity of the guideline would make feasibility and sustainability difficult in the settings for which it was designed. Observations from hospitals in Kenya and Malawi reinforce this concern. The purpose of this review is to discuss why proper disinfection of equipment is important, why this is challenging in low-resource settings, and suggestions for solutions to move forward.

Monitoring COVID-19 pandemic through the lens of social media using natural language processing and machine learning.

PurposeIt has been over a year since the first known case of coronavirus disease (COVID-19) emerged, yet the pandemic is far from over. To date, the coronavirus pandemic has infected over eighty million people and has killed more than 1.78 million worldwide. This study aims to explore “how useful is Reddit social media platform to surveil COVID-19 pandemic?” and “how do people’s concerns/behaviors change over the course of COVID-19 pandemic in North Carolina?”. The purpose of this study was to compare people’s thoughts, behavior changes, discussion topics, and the number of confirmed cases and deaths by applying natural language processing (NLP) to COVID-19 related data.MethodsIn this study, we collected COVID-19 related data from 18 subreddits of North Carolina from March to August 2020. Next, we applied methods from natural language processing and machine learning to analyze collected Reddit posts using feature engineering, topic modeling, custom named-entity recognition (NER), and BERT-based (Bidirectional Encoder Representations from Transformers) sentence clustering. Using these methods, we were able to glean people’s responses and their concerns about COVID-19 pandemic in North Carolina.ResultsWe observed a positive change in attitudes towards masks for residents in North Carolina. The high-frequency words in all subreddit corpora for each of the COVID-19 mitigation strategy categories are: Distancing (DIST)—“social distance/distancing”, “lockdown”, and “work from home”; Disinfection (DIT)—“(hand) sanitizer/soap”, “hygiene”, and "wipe"; Personal Protective Equipment (PPE)—“mask/facemask(s)/face shield”, “n95(s)/kn95”, and “cloth/gown”; Symptoms (SYM)—“death”, “flu/influenza”, and “cough/coughed”; Testing (TEST)—“cases”, “(antibody) test”, and “test results (positive/negative)”.ConclusionThe findings in our study show that the use of Reddit data to monitor COVID-19 pandemic in North Carolina (NC) was effective. The study shows the utility of NLP methods (e.g. cosine similarity, Latent Dirichlet Allocation (LDA) topic modeling, custom NER and BERT-based sentence clustering) in discovering the change of the public's concerns/behaviors over the course of COVID-19 pandemic in NC using Reddit data. Moreover, the results show that social media data can be utilized to surveil the epidemic situation in a specific community.

Ingestion of Cyanogens from Cassava Generates Disinfectant Hypothiocyanite That May Decrease the Transmissibility of SARS-CoV-2

Ingestion of Cyanogens from Cassava Generates Disinfectant Hypothiocyanite That May Decrease the Transmissibility of SARS-CoV-2

Implementation of a Successful Sterilization and High-Level Disinfection Outpatient Program

Background To ensure that new acquired clinics perform sterilization and high-level disinfection (HLD) according to best practice guidelines, a comprehensive competency program was begun by our Infection Prevention (IP) Program. The competency program included a classroom session, reprocessing demonstration, and a subsequent competency checkoff. The program reviewed topics pertaining to point of care cleaning, cleaning, instrument inspection, preparation and packaging, autoclaving, logging, and biological indicators (for sterilization) and other quality control items. Methods IP specialists conducted a detailed inspection and comprehension assessment of the clinics’ sterilization and HLD practices that mirrored the competency program. Baseline IP surveys were completed between 2014-2016 and were compared to phase-one (2016-2017), phase-two (2017-2018) and phase-three surveys (2019-2020) to measure the competency programs impact on reprocessing practices. Only clinics that performed sterilization or HLD during all three surveys were included. For analysis, the sterilization scores were further divided into reprocessing area, point of care/cleaning, preparation/quality, and logging/storage subcategories. HLD scores were separated into reprocessing area, point of care/cleaning, preparation/quality, and after HLD/logging/storage subcategories. Kruskal-Wallis test was used to determine significance for the overall clinic average. Results A total of 38 clinics were included in the sterilization analysis, and 8 clinics in the HLD. The overall clinic scores for sterilization were baseline (65%), phase-one (93%), phase-two (94%) and phase-three (94%) (p-value: Conclusions The competency program improved sterilization and HLD reprocessing in every category assessed and it has sustained for the next five years validating the value of a comprehensive competency program with an education, demonstration, and evaluation component. To ensure that new acquired clinics perform sterilization and high-level disinfection (HLD) according to best practice guidelines, a comprehensive competency program was begun by our Infection Prevention (IP) Program. The competency program included a classroom session, reprocessing demonstration, and a subsequent competency checkoff. The program reviewed topics pertaining to point of care cleaning, cleaning, instrument inspection, preparation and packaging, autoclaving, logging, and biological indicators (for sterilization) and other quality control items. IP specialists conducted a detailed inspection and comprehension assessment of the clinics’ sterilization and HLD practices that mirrored the competency program. Baseline IP surveys were completed between 2014-2016 and were compared to phase-one (2016-2017), phase-two (2017-2018) and phase-three surveys (2019-2020) to measure the competency programs impact on reprocessing practices. Only clinics that performed sterilization or HLD during all three surveys were included. For analysis, the sterilization scores were further divided into reprocessing area, point of care/cleaning, preparation/quality, and logging/storage subcategories. HLD scores were separated into reprocessing area, point of care/cleaning, preparation/quality, and after HLD/logging/storage subcategories. Kruskal-Wallis test was used to determine significance for the overall clinic average. A total of 38 clinics were included in the sterilization analysis, and 8 clinics in the HLD. The overall clinic scores for sterilization were baseline (65%), phase-one (93%), phase-two (94%) and phase-three (94%) (p-value: The competency program improved sterilization and HLD reprocessing in every category assessed and it has sustained for the next five years validating the value of a comprehensive competency program with an education, demonstration, and evaluation component.

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Rates of Clostridioides difficile at an Urban Hospital During Initial COVID Pandemic Wave

BackgroundDuring the first three months of the COVID 19 pandemic, our facility cared for an influx of patients. At the peak, the daily census exceeded 200 patients with COVID 19. Surveillance for healthcare acquired infections (HAIs) continued throughout this time. Despite the acuity of the patients and the frequent use of antibiotics, the rates of Clostridioides difficile lab ID (CDI) events remained relatively stable. We sought to determine the validity of this rate.MethodsTo determine if cases of CDI were missed, we compared the 3-month rate per 10,000 patient days in 2020 to the same time-period in 2019 (March, April, and May). The number of tests ordered during the two periods was also compared. Additionally, the Doctor of Pharmacy from our antibiotic stewardship team reviewed all orders for oral Vancomycin to determine if empiric CDI treatment was initiated without confirmatory testing.ResultsThe CDI rate for the 3 months in 2019 was zero compared to 0.48 per 10,000 patient days during the peak of the pandemic. The number of tests increased in the 2020 period to 17.5 per 10,000 patient days versus 15.8 in the 2019 period. Three patients received oral Vancomycin, each of whom had valid indications.ConclusionsBased on this data, CDI cases were not underreported. We speculate that the lack of an increase in CDI rates may be attributed to: Increased hand hygiene by staff – compliance increased to 91 % in 2020 compared to 83 % in 2019,enhanced attention to cleaning and high level disinfection, and Improved adherence to use of personal protective equipment.

Preclinical evaluation of passive disinfection caps with a long-term catheter for the prevention of catheter-related bloodstream infection in pediatric cancer patients.

The use of passive disinfection devices (disinfection caps) may be a beneficial part of a maintenance care bundle, aiming at the prevention of catheter-related bloodstream infections in pediatric cancer patients. This preclinical in vitro investigation tested the visual and mechanical integrity of a Broviac™ catheter hub after simulation testing with 122 3M™ CurosTM Stopper Disinfection Caps for Open Female Luers repeatedly attached and removed over 6 months. We found that these catheter hubs were compatible, fully operational, and airtight with use of 3M Curos stopper caps after 6 months of use with 122 caps per catheter hub.

Occupational exposure to high-level disinfectants and risk of miscarriage among nurses

ObjectivesTo examine the association of occupational exposure to high-level disinfectants (HLDs) with risk of miscarriage among nurses.MethodsOur study included women who enrolled in the Nurses’ Health Study 3 (2010–2020) and...

ID: 3523254 A LARGE MULTICENTER STUDY OF DUODENOSCOPE CONTAMINATION RATES AFTER REPROCESSING

It is estimated that over 650,000 patients in the United States undergo Endoscopic Retrograde Cholangio-Pancreatography (ERCP) annually. Several outbreaks of infections associated with duodenoscopes have been reported in recent years. Following clinical procedures, duodenoscopes are reprocessed using manual cleaning, automated cleaning, and high-level disinfection, according to the manufacturer’s Instructions for Use (IFU). To date, the contamination rates of duodenoscopes following the reprocessing procedure has not been investigated in a large-scale, multicenter, real-world study. As part of this study, we have assessed the contamination rates of duodenoscopes following reprocessing, as part of the Post Market Surveillance (PMS) studies of the Olympus duodenoscopes, ordered by the US Food and Drug Administration (FDA).

Effect of Five Essential Oils as Green Disinfectants on Selected Photographic Prints: Experimental Study

Albumen, silver gelatin and chromogenic prints are found abundantly among photographic collections in Egypt. Due to the uncontrolled environment in archives and libraries, this precious visual heritage with its high protein and cellulose content provides the right culture medium required for fungal growth. Many essential oils have been proven to have antibacterial and antifungal properties. Essential oils offer a safe alternative to other common disinfection methods; however, their effect on the properties of photographs have not received much study. This paper studies the effect of vapors of anise, cinnamon, clove, lavender and thyme oils on albumen, silver gelatin and chromogenic prints, to find a proper disinfection method that is user-friendly and environmentally safe and respects the nature of photographic materials. Essential oils were provided by the National Research Center (NRC) in Cairo, Egypt. Artificially aged albumen prints, and naturally aged silver gelatin and chromogenic prints were exposed in desiccators to the selected essential oils in the vapor phase for a period of 5 days. All samples were artificially aged at a temperature of 80°C and 65% RH for a period of 5 days to study the long-term effects of the tested treatments. Treatments were evaluated using several techniques including visual inspection, microscopic inspection, colorimetric measurements, and attenuated total reflectance Fourier transform infrared spectroscopy. Results showed that all tested essential oils had a very slight effect on the tested photographic samples; however lavender oil was found to be the best option, specifically in terms of preserving the chemical properties of the photographic surfaces.