Cleaning Of Instruments Research Articles

Fungal contamination of wind instruments: Immunological and clinical consequences for musicians

IntroductionPlaying a wind instrument is an increasingly reported cause of hypersensitivity pneumonitis. However, current knowledge about contamination of wind instruments by fungi and specific fungal sensitization is scarce. Therefore, we aimed: (i) to assess the current prevalence and type of fungal contamination of wind instruments, (ii) to identify potential risk factors associated with instrument contamination, and (iii) to evaluate the prevalence of sensitization to these fungi among musicians. Material and methodsMusicians from music schools in eastern France and who played a wind instrument were prospectively recruited (NCT01487850). The mouthpiece and the reed of their instrument were sampled to quantify the magnitude and type of fungi. Each subject had a physical examination, a mycological analysis of saliva and a blood sample in search of serum precipitins against the most frequent fungi isolated from instruments. The results were compared with those of 40 healthy non-exposed controls. ResultsForty musicians playing a wind instrument (bassoon, clarinet, oboe, saxophone) were included. (i) 95% of wind instruments were colonized by fungi, mainly with Phoma spp., Penicillium spp. and Rhodotorula mucilaginosa; (ii) absence of systematic drying of the instrument was a main contributing factor; (iii) serum precipitins were significantly more present in the musicians' sera than in control sera and were consistent with the fungi present in their instrument. ConclusionThis study reveals a constant and specific fungal contamination among wind reed instruments with a significant sensitization among musicians, pleading in favour of regular instrument cleaning. Physicians should be aware of this possible source of antigenic exposure.

Dangerous Decontamination: The Unnecessary Perils of Instrument Cleaning.

Dangerous Decontamination: The Unnecessary Perils of Instrument Cleaning.

Observance of Sterilization Protocol Guideline Procedures of Critical Instruments for Preventing Iatrogenic Transmission of Creutzfeldt-Jakob Disease in Dental Practice in France, 2017.

Effective sterilization of reusable instruments contaminated by Creutzfeldt–Jakob disease in dental care is a crucial issue for public health. The present cross-sectional study investigated how the recommended procedures for sterilization were implemented by French dental practices in real-world settings. A sample of dental practices was selected in the French Rhône-Alpes region. Data were collected by a self-questionnaire in 2016. Sterilization procedures (n = 33) were classified into 4 groups: (1) Pre-sterilization cleaning of reusable instruments; (2) Biological verification of sterilization cycles—Monitoring steam sterilization procedures; (3) Autoclave performance and practitioner knowledge of autoclave use; (4) Monitoring and documentation of sterilization procedures—Tracking and tracing the instrumentation. Answers were provided per procedure, along with the global implementation of procedures within a group (over 80% correctly performed). Then it was verified how adherence to procedure groups varied with the size of the dental practice and the proportion of dental assistants within the team. Among the 179 questionnaires available for the analyses, adherence to the recommended procedures of sterilization noticeably varied between practices, from 20.7% to 82.6%. The median percentages of procedures correctly implemented per practice were 58.1%, 50.9%, 69.2% and 58.2%, in Groups 1, 2, 3 and 4, respectively (corresponding percentages for performing over 80% of the procedures in the group: 23.4%, 6.6%, 46.6% and 38.6%). Dental practices ≥ 3 dental units performed significantly better (>80%) procedures of Groups 2 and 4 (p = 0.01 and p = 0.002, respectively), while no other significant associations emerged. As a rule, practices complied poorly with the recommended procedures, despite partially improved results in bigger practices. Specific training regarding sterilization procedures and a better understanding of the reasons leading to their non-compliance are needed.

Reducing the risk of iatrogenic Creutzfeldt–Jakob disease by improving the cleaning of neurosurgical instruments

In all, there have been 178 variant Creutzfeldt-Jakob disease (vCJD) patients diagnosed in the UK, with an estimated maximum 1:2000 carriage rate based on archived appendix and tonsil tissue, implying that infection may be rare but carriage relatively frequent. Previous workers have identified that maintenance of surgical instruments in a humid atmosphere after use and prior to cleaning assists cleaning efficacy. Recently the Department of Health/Advisory Committee on Dangerous Pathogens UK have recommended a surgical instrument cleanliness threshold post cleaning of <5μg protein per instrument side. To quantify cleanliness of neurosurgical instruments and to investigate cost-effective measures for improved cleaning. Two instrument protein quantification methods were used: one based on the International Standard (15883 series) using sodium dodecyl sulphate elution and ortho-phthalaldehyde reaction, and a second in-situ protein fluorescence detection system (ProReveal) providing results per instrument side. In-vitro investigation of the efficacy of some commercial and in-house pre-clean wetting agents was undertaken using artificial test soil and stainless steel discs under standard conditions. In-vivo evaluation of best-performing in-vitro agents was undertaken on craniotomy sets. ProReveal technology demonstrated that 163 out of 187 (87%) neurosurgical instruments had <5μg residual protein per instrument side. The use of proprietary National Health Service plastic bags and sterile water-soaked wound pads were equivalent in efficacy to commercial pre-cleaning wetting products and significantly less expensive. Although we demonstrate low in-situ protein levels on neurosurgical instruments and the beneficial effects of keeping instruments moist, other cleaning critical-control points such as instrument loading patterns should also be monitored.

Biosafety conducts adopted by orthodontists.

ABSTRACTObjective: This cross-sectional observational study was designed to assess the biosafety conducts adopted by orthodontists, and possible differences regarding training time. Methods: Both the application of methods for sterilization/disinfection of instruments and materials, and the use of personal protective equipment (PPE) were collected through questionnaires via e-mail. Results: The questionnaires were answered by 90 orthodontists with a mean age of 37.19 ± 9.08 years and mean training time of 13.52 ± 6.84 years. Regarding orthodontic pliers, 63.23% use an autoclave, except 1 who does not perform any procedure. All participants use autoclave to sterilize instruments, and 95.6% of respondents perform cleaning with chemicals prior to sterilization. Most of them (65.56%) use an autoclave to sterilize orthodontic bands, with some still associating disinfection methods, while few (18.89%) do nothing at all. There was a high incidence of the answer “nothing” for the methods used for elastic, accessories, bandages, metal springs, and arches. All respondents use mask and gloves in attendance, 78.92% use aprons, 58.92% use protective goggles, and 50.01% use cap. Training time significantly influenced (p = 0.003) only the use of glutaraldehyde for sterilization/disinfection of pliers. Conclusions: The sterilization and cleaning of pliers, instruments, and bands, besides the use of PPE, received more uniform and positive responses, while other items suggest disagreements and possible failures. Only orthodontists trained for more than 13 years choose using glutaraldehyde for pliers sterilization/disinfection, the only adopted method with a significant difference in relation to training time.

Application effect analysis of details management on endoscope management in operating room

Objective To study the details management measures of endoscope management in operating room to analyze the management method and effect of reducing endoscope damage. Methods A total of 1 200 operations implemented in the operating room of our hospital from January to March, 2015 were selected as observation group, and details management was conducted to the endoscope instruments of operating room. 1200 operations from October to December, 2014 were selected as the control group. The aspects of instrument cleaning and disinfection acceptability, instrument perfectness rate and the occurrence rate of instrument preparation error of operations in observation group were compared with 1200 operations before details management was conducted. Meanwhile, the satisfaction of surgeon to the implementation of details management was observed. Results After details management was implemented, the instrument cleaning and disinfection acceptability, instrument perfectness rate and the occurrence rate of instrument preparation error of operations in two groups had significant difference. The observation group was obviously superior to control group (P<0.05), and the difference was statistically significant. Conclusions The effective details management conducted to operation endoscope in operating room can significantly improve the nursing quality. Moreover, the perfectness rate of surgical cavity mirror instruments and acceptability of instrument cleaning and disinfection can be improved. In addition, the occurrence of instrument preparation error will be reduced effectively and the satisfaction of surgeon to the operation nursing will be increased significantly. Therefore, the implementation of details management in operating room is of great significance. Key words: Operating room; Endoscopic management; Detail management

RISK FACTORS AFFECTING OCCUPATIONAL EXPOSURE TO BLOOD AND BODY FLUIDS AMONG DENTAL STUDENTS: A CROSS-SECTIONAL STUDY IN A BRAZILIAN FEDERAL UNIVERSITY

Introduction: Dental students are often exposed to bloodborne pathogens during dental training. Several factors are involved in increased risk of human deficiency, hepatitis B and hepatitis C virus (HIV, HBV, and HCV) infection. However, there are few studies that address the risks and forms of prevention among dental students in Brazil. Methods: A cross-sectional study of occupational exposure to blood or body fluids among dental students of Universidade Federal do Rio Grande do Sul, Brazil, was performed. These students were referred to the Occupational Medicine Department of Hospital de Clinicas de Porto Alegre from January 2007 to April 2015. Analyzed data included type of exposure (needlestick injury, mucosal exposure, and exposure to non-intact skin); source patient status for HBV, HIV and HCV infection, accident during dental training, procedure performed, biological material involved, type of accident, and hepatitis B vaccination and serological protection status. The objective was to know the incidence rate and others characteristics of accidents in order to prevent them. Results: There were 312 accidents during the study period of 8 years and 4 months, an estimated incidence rate of Incidence rate was 87,42 exposures per 1000 students-year. Source patient was known in 297 of the cases (95.2%), of which 3 were HBsAg reagent, 12 were HIV reagent, and 17 were HCV reagent. The majority of accidents occurred during procedure, but nearly as high as 40% occurred after procedure, of which 63% occurred during instrument cleaning, disinfecting or sterilizing. Most involved sharp instruments were anesthetic syringe needle and curette. Only 48% of dental students knew their anti-HBs was > 10 mIU/mL. Conclusions: Dental students should be tested for hepatitis B immune status at the beginning of training, and vaccination should be available to all dental students before they start clinical practice. Work practice controls on sharp devices should be addressed at the beginning and strengthened during dental training. Dental training institutions should review instrumental cleaning process to minimize handling of loose contaminated instruments. Keywords: Dental students; occupational exposure; bloodborne pathogens; sharp injury; needlestick injury.

Work assignments, delegation of tasks and job satisfaction among Danish dental hygienists.

Recent legislation in Denmark has made it possible for dentists to delegate their tasks to dental hygienists. Previous studies have shown that Danish dental hygienists primarily were performing assignments within their own work field. These assignments include prophylaxis or instructing patients in oral health care. However, studies have also shown that Danish dental hygienists performed dental nurse assignments such as chair-side assistance, unit cleaning and disinfection of instruments. The objectives of this study were to investigate (i) the range of work assignments performed by Danish dental hygienists, (ii) the types of dentist tasks performed by Danish dental hygienists and (iii) job satisfaction among Danish dental hygienists. Dental hygienists graduating in 2004-2007 were invited to participate in this study. Participants answered an email-distributed questionnaire. The questionnaire consisted of questions regarding job satisfaction, assignments performed, postgraduate course attendance, receiving assistance from a dental nurse and which work assignments Danish dental hygienists wish to perform in the future. The results of this study showed that 90% of Danish dental hygienists were satisfied with their job and 52% were performing dentists' tasks. Among dentists' tasks performed by Danish dental hygienists, invasive caries therapy was the most frequently performed task. The type of assignments performed by Danish dental hygienists today appears to be changing compared to previous studies. From initially performing prophylaxis and chair-side assistance for the dentist, Danish dental hygienists today are performing a wider range of tasks which includes dentists' tasks.

The Role of Protease as Detergents and Disinfectants in Instrument Cleaning and Reprocessing

The Role of Protease as Detergents and Disinfectants in Instrument Cleaning and Reprocessing

Control of the efficiency of instrument-cleaning using real-time Polymerase Chain Reaction

Inefficiently cleaned surgical instruments may cause the transfer of infections. The control of the efficieny of medical cleaning of reusable instruments is a challenge in every medical facility. Various control-methods have been developed over time. Here we present the use of the Polymerase Chain Reaction (PCR) to evaluate the success of cleaning efforts of surgical instruments.

Single-Use Energy Sources and Operating Room Time for Laparoscopic Hysterectomy: A Randomized Controlled Trial

Study ObjectivesTo compare the intraoperative direct costs of a single-use energy device with reusable energy devices during laparoscopic hysterectomy. DesignA randomized controlled trial (Canadian Task Force Classification I). SettingAn academic hospital. PatientsForty-six women who underwent laparoscopic hysterectomy from March 2013 to September 2013. InterventionsEach patient served as her own control. One side of the uterine attachments was desiccated and transected with the single-use device (Ligasure 5-mm Blunt Tip LF1537 with the Force Triad generator). The other side was desiccated and transected with reusable bipolar forceps (RoBi 5 mm), and transected with monopolar scissors using the same Covidien Force Triad generator. The instrument approach used was randomized to the attending physician who was always on the patient's left side. Resident physicians always operated on the patient's right side and used the converse instruments of the attending physician. Measurements and Main ResultsStart time was recorded at the utero-ovarian pedicle and end time was recorded after transection of the uterine artery on the same side. Costs included the single-use device; amortized costs of the generator, reusable instruments, and cords; cleaning and packaging of reusable instruments; and disposal of the single-use device. Operating room time was $94.14/min. We estimated that our single use-device cost $630.14 and had a total time savings of 6.7 min per case, or 3.35 min per side, which could justify the expense of the device. The single-use energy device had significant median time savings (−4.7 min per side, p < .001) and total intraoperative direct cost savings ($254.16 per case). ConclusionsA single-use energy device that both desiccates and cuts significantly reduced operating room time to justify its own cost, and it also reduced total intraoperative direct costs during laparoscopic hysterectomy in our institution. Operating room cost per minute varies between institutions and must be considered before generalizing our results.

Infection Prevention: The Surgical Care Continuum

Lack of careful attention to the increasing complexity of surgical procedures, instrument cleaning and processing, and the transition of surgical and other invasive procedures from the OR to areas outside the traditional hospital OR can contribute to surgical site infection (SSI) risk. Regardless of the location of an intervention, when basic infection prevention measures are applied reliably, even low infection rates can be reduced. To address infection prevention challenges, infection preventionists (IPs) must be well informed regarding infection risk and prevention during surgical and other invasive procedures and the effect a facility type may have on patients’ infection risk. The IP must have a solid understanding of surgical asepsis, instrument disinfection, and sterilization to educate and support clinical teams in identifying opportunities for improvement relative to infection prevention.

Guideline Implementation: Surgical Instrument Cleaning

Cleaning, decontaminating, and handling instructions for instruments vary widely based on the type of instrument and the manufacturer. Processing instruments in accordance with the manufacturer’s instructions can help prevent damage and keep devices in good working order. Most importantly, proper cleaning and disinfection may prevent transmission of pathogenic organisms from a contaminated device to a patient or health care worker. The updated AORN “Guideline for cleaning and care of surgical instruments” provides guidance on cleaning, decontaminating, transporting, inspecting, and storing instruments. This article focuses on key points of the guideline to help perioperative personnel implement appropriate instrument care protocols in their practice settings. The key points address timely cleaning and decontamination of instruments after use; appropriate heating, ventilation, and air conditioning parameters for the decontamination area; processing of ophthalmic instruments and laryngoscopes; and precautions to take with instruments used in cases of suspected prion disease. Perioperative RNs should review the complete guideline for additional information and for guidance when writing and updating policies and procedures.

Cleaning ophthalmology microscopic instruments and making a series of maps for nurse training

Objective The study aimed to explore the instructive effect of ophthalmology microsurgical instrument map on nurse training of ophthalmology microsurgical instrument cleaning. Methods 40 nurses were randomly divided into the experimental group and the control group by lottery. The ophthalmology microsurgical instrument map was used in the experimental group for training nurses how to cleaning microsurgi-cal instruments, and oral training method was adopted in the control group. The corresponding testing was carried out after training and the results were scored. Results The training time was less (t=3.181), the testing results were better (t=3.071) and the damage rate was lower (χ2=6.847) in the experimental group than those in the control group. Conclusions Using ophthalmology microsurgical instru ment map for training nurses can shorten the training time, improve score of assessment, reduce instrument damage rate, which proved to be an effective method. Key words: Pictorial works; Nurses; Inservice training; Microsurgical instruments

Barcoding of live human peripheral blood mononuclear cells for multiplexed mass cytometry.

Mass cytometry is developing as a means of multiparametric single-cell analysis. In this study, we present an approach to barcoding separate live human PBMC samples for combined preparation and acquisition on a cytometry by time of flight instrument. Using six different anti-CD45 Ab conjugates labeled with Pd104, Pd106, Pd108, Pd110, In113, and In115, respectively, we barcoded up to 20 samples with unique combinations of exactly three different CD45 Ab tags. Cell events carrying more than or less than three different tags were excluded from analyses during Boolean data deconvolution, allowing for precise sample assignment and the electronic removal of cell aggregates. Data from barcoded samples matched data from corresponding individually stained and acquired samples, at cell event recoveries similar to individual sample analyses. The approach greatly reduced technical noise and minimizes unwanted cell doublet events in mass cytometry data, and it reduces wet work and Ab consumption. It also eliminates sample-to-sample carryover and the requirement of instrument cleaning between samples, thereby effectively reducing overall instrument runtime. Hence, CD45 barcoding facilitates accuracy of mass cytometric immunophenotyping studies, thus supporting biomarker discovery efforts, and it should be applicable to fluorescence flow cytometry as well.

Process of instrument sterilization in shops with manicure and pedicure services

OBJECTIVE: Understanding the sterilization process of critical items used in commercial establishments that offer the services of manicures and pedicure to the public.METHODS: Cross-sectional study with 90 employees exercising the function of manicure and pedicure in commercial establishments. The research instrument was a questionnaire with open and closed questions about the knowledge and procedures related to disinfection and sterilization of instruments.RESULTS: The mean age was 33.8 years, 72 % had taken vocational courses and had professional experience of more than five years. The use of hot air oven was prevalent in 84.3 % of establishments and 65.7 % reported opening the oven during sterilization. The relation between the higher cost of the service and the use of autoclave was statistically significant (p &lt; 0.001).CONCLUSION: The sterilization process of the instruments used in the studied commercial establishments that offer services of manicures and pedicure to the public have significant deficiencies related to cleaning and sterilization of instruments.

Use of Synthetic Single-Stranded Oligonucleotides as Artificial Test Soiling for Validation of Surgical Instrument Cleaning Processes

Surgical instruments are often strongly contaminated with patients' blood and tissues, possibly containing pathogens. The reuse of contaminated instruments without adequate cleaning and sterilization can cause postoperative inflammation and the transmission of infectious diseases from one patient to another. Thus, based on the stringent sterility requirements, the development of highly efficient, validated cleaning processes is necessary. Here, we use for the first time synthetic single-stranded DNA (ssDNA_ODN), which does not appear in nature, as a test soiling to evaluate the cleaning efficiency of routine washing processes. Stainless steel test objects were coated with a certain amount of ssDNA_ODN. After cleaning, the amount of residual ssDNA_ODN on the test objects was determined using quantitative real-time PCR. The established method is highly specific and sensitive, with a detection limit of 20 fg, and enables the determination of the cleaning efficiency of medical cleaning processes under different conditions to obtain optimal settings for the effective cleaning and sterilization of instruments. The use of this highly sensitive method for the validation of cleaning processes can prevent, to a significant extent, the insufficient cleaning of surgical instruments and thus the transmission of pathogens to patients.

Top 10 Essentials for Effective Instrument Cleaning

Top 10 Essentials for Effective Instrument Cleaning

&lt;b&gt;Evaluation of simplified oral hygiene index of the elementary school students before fluoride mouthwash&lt;/b&gt; - doi: 10.4025/actascihealthsci.v35i2.13205

The State Program of fluoride mouthwashes for caries control was established in 1980 in elementary schools of Paraná State covering children 7-11 years old. Knowing the importance of removing bacterial plaque to reach the maximum desired effect of prevention, this study aimed to evaluate the Simplified Oral Hygiene Index, before applying the solution of Sodium Fluoride (NaF; 0.2%) in children from an elementary school in the city of Nova Aurora, Paraná State, by using disclosing dental plaque. This is a quantitative research, descriptive and exploratory whose data were obtained through a specific form, with 61 children and analyzed using descriptive statistics with distribution of absolute and percentage frequencies. Most children (60%) showed the worst results - regular and bad - with presence of plaque and risk of dental caries. Therefore, we should establish a prevention program in oral health that must involve parents and students. This program should be developed by health professionals inside the school, explaining about the etiologic factors, causes and consequences of plaque, the techniques of cleaning and maintenance of hygiene instruments, and the risks of the lack of proper hygiene in the oral cavity.

Otitis externa following aural irrigation linked to instruments contaminated with Pseudomonas aeruginosa

The incidence of acute otitis externa, an infection of the external auditory canal, in general practitioners' (GP) practices in The Netherlands is about 14 per 1000 patients per year. In early 2010, one of the authors noted that some of the otitis externa patients in his GP practice had undergone cerumen removal by ear syringing a few weeks earlier. Bacterial cultures of samples taken from the instruments used showed contamination of an ear syringe by Pseudomonas aeruginosa. From then on, P.aeruginosa isolates from patients' ears were stored in the laboratory. It was assessed whether cross-contamination with P.aeruginosa between patients in the same GP practice could occur through the use of contaminated ear lavage instruments. From 17 GP practices, the otolaryngology Outpatient Department and the Out-of-Hours GP Service, instruments used for examining and cleaning the outer ear were swabbed. Strains of P.aeruginosa cultured from the instruments were genotyped together with isolates of patients registered in the same practice. In four practices where contaminated instruments were found, genotyping showed similarity between P.aeruginosa strains isolated from a patient and the ear syringe, and/or between strains of different patients in the same practice. Transmission of P.aeruginosa from ear lavage instruments to patients appears to occur with otitis externa as a result. Together with the Infection Control Unit of our hospital we have formulated recommendations for the appropriate cleaning, disinfection and storage of re-usable ear lavage instruments for the GP practices to implement.