Proper Decontamination Research Articles

Redefining infection management in implant-based breast reconstruction: Insights and innovations from an 11-year retrospective analysis

BackgroundInfection associated with implant-based breast reconstructive surgery is a nightmare for both patients and surgeons, often implying high recurrence rate, long treatments (both medical and surgical management), multiple invasive procedures, delay of the end-result and, in some cases, even reconstruction failure. Early diagnosis is crucial but not always easy to achieve. Different treatment options are available and have been described in literature, with no clear winning strategy. Recent improvements in microbiological and therapeutic tools have led the authors to question what would be considered the best plan for reconstruction salvage approach. MethodsAll patients undergoing implant-based breast reconstruction between 2012 and 2023 were enrolled. Clinical records regarding infections and treatment were retrospectively analyzed. ResultsAmong a total of 506 patients, 26 (5.14%) developed implant-associated infection. Discussing the results, we realized that previous protocol was old-fashioned and in need of improvements. Through a multidisciplinary approach, a new prevention and treatment algorithm was derived. Firstly, microbiological screening through nasal and rectal swab allows for proper decontamination prior to intervention. However, the keystone improvement consists in the use of molecular biology analysis, thus minimizing diagnosis timing and allowing targeted antibiotic therapy shortly after the removal of the infected implant. In addition, a fundamental role is played using instillation negative pressure wound therapy as a temporary spacer to ensure the maintenance of the peri-prosthetic pocket. ConclusionsFollowing precise steps, in case of implant-associated infection, the treatment can be optimized to reduce duration of both therapy and hospitalization, giving the patient a reconstruction in a relative short time. Level of EvidenceIV

Contact with Wet Cement-A Preventable Cause of Chemical Burn: Case Report and Discussion.

To review the management of a patient with a chemical burn from wet cement. This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and registered nurses with an interest in skin and wound care. After participating in this educational activity, the participant will:1. Recognize the clinical presentation of a patient with a chemical burn from contact with wet cement.2. Describe features related to the pathophysiology of alkali burns from wet cement.3. Select the proper decontamination procedure after exposure to wet cement.4. Identify steps in the treatment of a patient with a chemical burn from contact with wet cement.

Evaluating the Protective Effectiveness of Rubber Glove Materials Against Organic Solvents Upon Repeated Exposure and Decontamination

BackgroundGlove reuse poses risks, as chemicals can persist even after cleaning. Decontamination methods like thermal aeration, recommended by US OSHA, vary in effectiveness. Some studies show promising results, while others emphasize the importance of considering both permeation and tensile strength changes. This research advocates for informed glove reuse, emphasizing optimal thermal aeration temperatures and providing evidence to guide users in maintaining protection efficiency. MethodsThe investigation evaluated Neoprene and Nitrile gloves (22 mils). Permeation tests with toluene and acetone adhered to American Society for Testing Materials (ASTM) F739 standards. Decontamination optimization involved aeration at various temperatures. The experiment proceeded with a maximum of 22 re-exposure cycles. Tensile strength and elongation were assessed following ASTM D 412 protocols. Breakthrough time differences were statistically analyzed using t-test and ANOVA. ResultsAt room temperature, glove residuals decreased, and standardized breakthrough time (SBT)2 was significantly lower than SBT1, indicating reduced protection. Higher temperature decontamination accelerated residual removal, with ΔSBT (SBT2/SBT1) exceeding 100%, signifying restored protection. Tensile tests showed stable neoprene properties postdecontamination. Results underscore thermal aeration's efficacy for gloves reuse, emphasizing temperature's pivotal role. Findings recommend meticulous management strategies, especially post-breakthrough, to uphold glove-protective performance. ConclusionsThermal aeration at 100°C for 1 hour proves effective, restoring protection without compromising glove strength. The study, covering twenty cycles, suggests safe glove reuse with proper decontamination, reducing costs significantly. However, limitations in chemical-glove combinations and exclusive focus on specific gloves caution against broad generalization. The absence of regulatory directives on glove reuse highlight the importance of informed selection and rigorous decontamination validation for workplace safety practices.

Bacterial and fungal characterization of pancreatic adenocarcinoma from Endoscopic Ultrasound-guided biopsies.

The tumor microbiome (TM) has been linked to pancreatic cancer prognosis. Specific microbes can confer tumor resistance to therapies. Early knowledge of the TM at time of diagnosis would be clinically relevant for precision therapy based on microbial composition. However, it is difficult to define the TM prior to surgical resection. In this pilot feasibility study, patients underwent Endoscopic Ultrasound-Fine Needle Aspiration (EUS-FNA) biopsy of pancreatic adenocarcinoma. These samples were analyzed using 16S rRNA and internal transcribed spacer (ITS) sequencing for characterization of the tumor bacteria and fungi. After in silico decontamination and comparison to non-matched tumor, we were able to characterize the TM in biopsies, which was comparable to the TM from surgical specimens. EUS-FNA biopsy may represent a feasible modality to characterize the pancreatic TM prior to surgical resection with proper decontamination strategies and improvements in matched controls.

The Role of Technology Advancement in Improving the Current Practice of Ambulance Decontamination in Malaysia: A Scoping Review

Abstract
 In Malaysia, the current methodology for decontaminating ambulances is by manually cleaning surfaces with Environmental Protection Agency (EPA) approved disinfecting solutions as contrast to previous practice using water and soap. The solutions used are registered with National Pharmaceutical Regulatory Agency (NPRA) Ministry of Health Malaysia (NPRA) to ensure adherence to international standard of practice. The manual decontamination practices are effective if strictly conducted following guidelines. However, the proper cleaning and decontamination of an ambulance is an important task that frequently overlooked. It creates a risk to healthcare providers and their patients for subsequent ambulance trip. To ensure the patient compartment is absent from multitudes of infectious pathogen especially Covid-19, is not only an escalating challenge for healthcare providers as it is an unseen, but also poses a real threat to them and their patient. The healthcare managers should consider technologies that can provide a safer, effective and more efficient cleaning and decontamination of an ambulances. We proposed to adapt a new approach of decontamination by using a vapour based disinfection method coupled with germicidal enhancement using ultra violet. It utilizes an EPA-approved hospital disinfectant to decontaminate surfaces in the patient care compartment after every patient transport. A nozzle, placed inside the patient care compartment, disperses a mist of disinfectant solution that designed to meet standard requirement. The enhancement of germicidal effect using an ultra violet ray will disinfect and ensure a free patient compartment from an infectious organism. This decontamination system directly integrated into a new or existing ambulance. It is convenient, timesaving, hands-off solution for decontaminating of an ambulance and importantly creates a safer practice.
 Keywords: Ambulance service, decontamination, Vapour-based, safe practice.

Ozone – A versatile therapy in implant dentistry

Oral cavity is an open ecosystem for many microorganisms making the oral environment more prone to bacterial colonization. Several studies have indicated that accumulation of bacteria on implant surface is a primary etiology for inflammatory conditions around implants, apparently leading to peri-implant diseases. Peri-implantitis is an inflammatory process that affects the tissues around an osseointegrated implant in function, resulting in the loss of the supporting bone. Hence, proper decontamination and disinfection may aid in successful osseointegration of dental implants. Ozone (O3) is a triatomic molecule, consisting of three oxygen atoms with a wide range of valuable properties which have been proven to be effective for applications in dentistry. O3 is a powerful oxidative agent with bactericidal, virucidal, and fungicidal properties. It can be used in gaseous, liquid (water/soil), or nanoparticle form as an adjunctive therapy in the management of peri-implant diseases and to decontaminate the implant surfaces. The application of ozone therapy is a novel approach in implant dentistry with limited literature. Therefore, the objective of the present review is to assess the impact of ozone therapy on the dental implant procedures and peri-implant diseases.

Identification, antimicrobial susceptibility screening and ESBL-status of Gram-negative bacteria from healthy humans and livestock waste by VITEK-2 Automated System

Bacteria in healthy body sites of humans and livestock waste may harbour antibiotic resistance and cause community-based opportunistic and resistant infections. The study profiled the antibiotic susceptibilities of resident bacteria in healthy humans and livestock waste. Gram-negative bacteria were isolated from 23 specimens including skin swabs (6), nasal swabs (4), urine (6), stool (3), chicken droppings (2) and cattle droppings (2). VITEK® 2 Automated System was used for identification, antimicrobial susceptibility and extended-spectrum β-lactamase (ESBL) production test of the isolates. Nineteen (19) Gram-negative bacteria belonging to five genera and six species were identified, including Escherichia coli (n=9) 47.4%, Klebsiella pneumoniae ssp pneumoniae (n=1) 11.1%, Enterobacter cloacae ssp dissolvens (n=1) 11.1%, Acinetobacter baumannii (n=3) 15.8%, Acinetobacter haemolyticus (n=1) 11.1%, and Providentia stuartii (n=4) 21.1%. The isolates showed highest resistances to Ampicillin (78.6%) and Piperacillin (63.2%) and high susceptibilities to Ertapenem, Amikacin, Ciprofloxacin and Levofloxacin (100%); Ceftazidime, Cefepime, Meropenem (94.7%); Cefoxitin (93.3%); Gentamicin and Tobramycin (73.7%). Multiple Antibiotic Resistance (MAR) index values above the critical limit of 0.2 were shown by 100% (4/4) of Providentia stuartii isolates, 75% (3/4) of Acinetobacter isolates and 33.3% (3/9) of E. coli isolates. All the isolates tested negative for ESBL production. The public health implication is that resident bacteria from healthy individuals harbouring antibiotic resistance may transmit these to other bacteria or cause resistant opportunistic infections difficult to treat. Resistant bacteria from livestock can be transmitted to humans through the food chain. Proper disposal or decontamination of human body secretions and livestock waste is necessary.

Novel pulsed infrared radiation: Effect on microbial, chemical and sensory properties of saffron (Crocus sativus L.).

In this study, the effect of pulsed infrared (PIR) irradiation on saffron microbial, chemical and sensory properties were evaluated. The PIR power (250, 350 and 450 W), the distance of sample with irradiation source (10, 20 and 30 cm), irradiation time (0-20 min) and PIR pulse (1, 2 and 3 pulse/s) were investigated. Decontamination of total bacteria and total mould and yeast flora and microbial inactivation kinetics were determined. Saffron quality by FTIR and HPLC and sensory attributes were also measured. The highest reduction of the total bacterial count (2.203 log10 CFU per g) and total mould and yeast counts (2.194 log10 CFU per g) were obtained in Sargol Negin saffron at 350 W PIR power, 10cm distance, 1.5min treatment time and 3 pulse/s. The Double Weibull model is the best-fit model for the prediction of the microbial population. Until now, there have been no reports of application for PIR in food processing and decontamination. According to the results, it can be concluded that PIR can be used as a safe method of saffron processing. Utilization of a proper decontamination method for spices especially saffron as the most expensive agricultural product is challengeable. It is recommended to use the PIR method for food processing because due to the reduction of microbial population, it can maintain foodstuff quality at an acceptable level.

A study to assess the knowledge, attitude, and practice on occupational blood and body fluid spill management awareness among nursing students in a tertiary care hospital in Chennai, Tamil Nadu

Background: Nurses form a major taskforce of healthcare providers in hospitals and are hence at a great risk of such exposure. Occupational exposure in the context of this study is the exposure of skin to blood and body fluids. Transmission of these infections puts healthcare providers at major risk. Proper decontamination and taking measures to prevent occupational exposure to blood, mercury and body fluids is a primary method of prevention of disease in a healthcare setup. Aims and Objectives: To estimate, the level of knowledge, attitude& practice of nursing students regarding the management of blood and body fluid spill. Methodology: A Cross sectional –KAP among Second and third years from Nursing school, Chennai. Result: Among 98 nursing students, second year nursing 40%, 61%, 40 % shows knowledge, attitude and practice respectively. Third year students shows better than second year which was 57%, 71%, 71 % shows knowledge, attitude and practice respectively. The studied participants had a median (IQR) percentage KAP score of 8(7-9) and 11 (10-13) for second and third year students respectively. Comparison KAP score of the excellent and fair among second and third year students showed the significant p-value (<0.001*) by the Mann- Whitney U test. Conclusion: Majority of third year nursing students showed better KAP than second year students hence we recommend more mock training classes to improve the knowledge and practice.

Efficiency of marketable decontamination agent and graphene oxide on 99mTc and 131I spillages in nuclear medicine department

Dealing with open sources of radioactive substances in nuclear medicine is a daily task since contamination due to radioactive spills may happen frequently. Proper and safe decontamination management is a vital procedure. However, regular purchase of decontamination agents incurs high costs and might be toxic due to their chemical properties. The purpose of this study is to compare graphene oxide, which is an environmentally friendly carbon-based material and marketable decontamination agent, in decontaminating radioactive spillage. Samples of pure 99mTc and 131I from the laboratory were spilled on a petri dish. The spill was immediately decontaminated with a marketable decontamination agent swab and varying concentrations of graphene oxide swab. The initial radioactivity of each swab containing 99mTc and 131I was measured using a dose calibrator. The absorbance spectra of each sample were analysed using an ultraviolet-visible spectrophotometer. The morphology image of graphene oxide was observed under field emission scanning electron microscope. For decontamination using a marketable decontamination agent, the radioactivity of 131I was slightly higher, whereas that of 99mTc was slightly lower than the high concentration of graphene oxide. The absorbance spectra of 99mTc and 131I that had been decontaminated using graphene oxide were observed at a range of 200 nm to 250 nm due ???* to the transition.

Hospital liquid waste contaminated with multidrug-resistant bacteria raises a public health hazard alert in Brazil.

The spread of multidrug-resistant bacteria (MDR) is a global concern because it poses a serious threat to public health. The inadequate handling of Health Services Waste (HSW) and, therefore, the incorrect disposal of infected liquids can cause contamination of the environment, the emergence of diseases caused by MDR bacteria, and the loss of the population's quality of life. The present study aimed to survey the bacteria and their antimicrobial resistance profiles, present in the liquid residues from infected surgeries performed in fiveyears, often discharged into the sewage network of a large tertiary hospital located in the city of Uberlândia, which is considered one of the main economic and demographic centers of Brazil. A systematic and retrospective survey of the medical records of patients who underwent infected surgeries from January 2015 to December 2019 was carried out at the referred hospital. The bacterial species were previously identified and characterized for the antimicrobial susceptibility profile by the VITEK 2 automated system (bioMérieux, Brazil). In the evaluated period, 1658 infected surgeries were performed and the results showed 661 bacterial strains distributed in 48 different species, being Staphylococcus aureus the most prevalent species. The vast majority (85.6%) showed some type of antimicrobial resistance among these strains, with more than half (54.6%) being MDR. The results of this work raise an alert and concern for the risks to the environment and public health by dumping these infected liquid wastes directly into the sewage system without proper prior decontamination.

VeriMask

The US CDC has recognized moist-heat as one of the most effective and accessible methods of decontaminating N95 masks for reuse in response to the persistent N95 mask shortages caused by the COVID-19 pandemic. However, it is challenging to reliably deploy this technique in healthcare settings due to a lack of smart technologies capable of ensuring proper decontamination conditions of hundreds of masks simultaneously. To tackle these challenges, we developed an open-source wireless sensor platform---VeriMask1 ---that facilitates per-mask verification of the moist-heat decontamination process. VeriMask is capable of monitoring hundreds of masks simultaneously in commercially available heating systems and provides a novel throughput-maximization functionality to help operators optimize the decontamination settings. We evaluate VeriMask in laboratory and real-scenario clinical settings and find that it effectively detects decontamination failures and operator errors in multiple settings and increases the mask decontamination throughput. Our easy-to-use, low-power, low-cost, scalable platform integrates with existing hospital protocols and equipment, and can be broadly deployed in under-resourced facilities to protect front-line healthcare workers by lowering their risk of infection from reused N95 masks. We also memorialize the design challenges, guidelines, and lessons learned from developing and deploying VeriMask during the COVID-19 Pandemic. Our hope is that by reflecting and reporting on this design experience, technologists and front-line health workers will be better prepared to collaborate for future pandemics, regarding mask decontamination, but also other forms of crisis tech.

Measures Against Disposable Masks: A Potential Source of Environmental and Biological Pollution

Contaminated disposable masks are potential hazards to the hygiene and environment. There is increased demand, and in turn, the production of PPEs and masks has also scaled up. But due to the lack of awareness and integrated strategy for the proper disposal of these masks they might be a cause of rising health and environmental issues in the upcoming time. People lack awareness regarding the number of times each mask can be used, how to sanitize and reuse the mask, and the proper disposal of a contaminated mask. In addition, the concerned authorities lack efficient strategies to diminish the use of non-biodegradable material to minimize plastic waste, creating awareness among people to dispose of the masks properly and design efficient strategies to cope with the plastic waste. Due to which these COVID-19 masks can be a potential source of the spread of the virus and increase of plastic waste. This is a review article pertaining to details from the recent researches and articles in regards to the prevalent issues and solutions in respect of the current pandemic. The best approach is to educate the masses to reduce contaminated waste along with proper decontamination and disposal of dreg.

Different processing additives is efficacious on microbial loads and antibiotics sensitivity pattern of giant African land snail (Archachatina marginata)

Snails are harvested for food in many parts of the world but are susceptible to environmental contaminations and pollutants due to the continuous ingesting of bacteria from the soil and the environment which they are found. Thus, the study has been designed to investigate the distribution and prevalence of micro-organisms in snails in humid tropics of Nigeria. Fifteen samples of Archachatina marginata were collected from Melege village, Ose local government area, Ondo State, Nigeria. The foot and head were analyzed microbiologically for bacterial loads before and after processing with five cleansing reagents: lime, alum, vinegar, salt and ash. Lime proved most effective reagent for decontaminating snail meats as it had the highest reduction of microbial load after processing (57.1%), followed by salt (44%) and the least was alum (20%). The mean microbial load on the head ranged between 9-22cfu/cm2 before and 4-12cfu/cm2 after processing, while foot ranged between 13-19cfu/cm2 before and 8-14cfu/cm2 after processing. Eight isolates belonging to nine genera including Micrococcus luteus [10(21.31%)] most predominant, followed by Escherichia coli [8(13.11%)], Proteus vulgaris [8(13.11%)], Klebsiella spp [6(16.39%)], Bacillus spp [6(9.84%)], Aeromonas spp [5(11.48%)], Streptococcus pyogenes [6(8.2%)], and least was Enterobacter spp [4(6.56%)] respectively. Results showed different pathogenic bacteria in snails. The presence of higher number of pathogenic Klebsiella spp and Escherichia coli among others, encountered in Archachatina marginata is an indication of public health hazard and also a warning signal for possible occurrence of food borne. The result showed lime as the most effective reagent in processing snail meat. The antibiotic susceptibility patterns of the bacterial isolates showed that all the bacteria isolated were susceptible to Gentamicin (GEN), only Proteus vulgaris and Bacillus spp were susceptible to Ceftazidime (CAZ) and Cloxacillin (CXC) respectively and all the were resistant to Ampicillin (AMP). The presence of these microorganisms showed that snail's samples harbor some potential pathogenic bacteria of medical importance and washing with some cleansing additives, especially lime is recommended for proper decontamination. The resistance of the organisms to some of the drugs portrayed the global increased concern over the continuous use of antibiotics in human and veterinary medicine and the resultant effects.

THERMODYNAMICS OF HEAVY METALS (Hg2+, Cd2+, Fe2+AND Ni2+) ADSORPTION USING BOILER FLY ASH

The effect of temperature on the adsorption of heavy metals, Hg 2+ , Cd 2+ , Fe 2+ and Ni 2+ using unactivated boiler fly ash (an agricultural waste) was investigated. The results showed that Hg 2+ and Cd 2+ ions were mostly affected by increase in temperature because their sorption rate decreased at high temperature. At the temperature of 273 K and 383 K, the amount of Hg 2+ adsorbed (mg/g) by the unactivated boiler fly ash was 49.890 mg/g and 49.653 mg/g respectively. For Cd 2+ ion, the amount adsorbed were 49.671 mg/g and 48.962 mg/g at temperatures of 273 K and 383 K respectively. The sorption of Fe 2+ and Ni 2+ fluctuated as temperature was increased. However; more of Fe 2+ was removed from its aqueous solution followed by Ni 2+ ion. The enthalpy of adsorption of Hg 2+ and Fe 2+ were found to be endothermic while that of Cd 2+ and Ni 2+ ions were exothermic. More so, Δ S θ for all the metal ions were greater than zero (> 0) and ∆G o were all negative which showed that the adsorption process was spontaneous, irreversible and feasible. Furthermore, lower temperatures favoured the removal of Hg 2+ and Ni 2+ ions from their solutions. Therefore, effect of temperature is a very important parameter to be investigated for proper decontamination of metal ions from wastewater. Key words: Adsorption, Boiler fly ash, Heavy metals, Temperature, Unactivated.

Inactivation of Adeno-Associated Viral Vectors by Oxidant-Based Disinfectants.

Adeno-associated viral (AAV) vectors are becoming increasingly popular in basic research as well as in clinical gene therapy. Due to its exceptional resistance against physical and chemical stress, however, the increasing use of AAV in laboratories and clinics around the globe raises safety concerns. Proper decontamination of tools and surfaces based on reliable AAV inactivation is crucial to prevent uncontrolled vector dissemination. Although recommended for AAV decontamination, sodium hypochlorite is not compatible with all surfaces found in the laboratory or clinical environment due to its corrosive nature. We, therefore, compared 0.5% sodium hypochlorite to 0.25% peracetic acid (PAA), a second substance declared effective, and to three less aggressive, commonly available alternative disinfectants 70% ethanol, 1.5% hydrogen peroxide, and 0.45% potassium peroxymonosulfate. The impact of all five disinfectants on virus capsid integrity, viral genome integrity, and infectivity upon different exposure times was tested on AAV2 and AAV5, two serotypes with highly different thermostability. While sodium hypochlorite, potassium peroxymonosulfate, and PAA successfully inactivated AAV2 after 1, 5, and 30 min, respectively, ethanol and hydrogen peroxide did not show significant effects on AAV2 even after exposure for 30 min. For AAV5, only sodium hypochlorite and potassium peroxymonosulfate proved efficient capsid and genome denaturation after incubation for 1 and 30 min, respectively. Consequently, ethanol or hydrogen peroxide should not be considered for routine laboratory or clinical use, while 0.45% potassium peroxymonosulfate and 0.5% sodium hypochlorite represent suitable and broadly effective disinfectants for AAV inactivation.

UVC Germicidal Units: Determination of Dose Received and Parameters to be Considered for N95 Respirator Decontamination and Reuse.

The COVID‐19 pandemic has resulted in an international shortage of personal protective equipment including N95 filtering facepiece respirators (FFRs), resulting in many institutions using ultraviolet germicidal irradiation (UVGI) technology for N95 FFR decontamination. To ensure proper decontamination, it is crucial to determine the dose received by various parts of the FFR in this process. Recently, our group customized a UVGI unit for N95 decontamination. With experimental and theoretical approach, this manuscript discusses the minimum dose received by various parts of the N95 respirator after one complete decontamination cycle with this UVGI unit. The results demonstrate that all parts of the N95 FFR received at least 1 J cm−2 after one complete decontamination cycle with this unit. As there are a variety of UVGI devices and different types of FFRs, this study provides a model by which UVC dose received by different areas of the FFRs can be accurately assessed to ensure proper decontamination for the safety of healthcare providers.

Chemical and Physical Analysis of a Petroleum Hydrocarbon Contamination on a Soil Sample to Determine Its Natural Degradation Feasibility

Crude oil is the world’s leading fuel source and is the lifeblood of the industrialized nations as it is vital to produce many everyday essentials. This dependency on fossil fuels has resulted in serious environmental issues in recent times. Petroleum contaminated soils must be treated to ensure that human health and the environment remain protected. The restoration of petroleum-polluted soil is a complex project because once petroleum hydrocarbon enters the environment, the individual constituents will partition to various environmental compartments in accordance with their own physical–chemical properties; therefore, the composition and inherent biodegradability of the petroleum hydrocarbon pollutant determines the suitability of a remediation approach. The objective of this study was to assess the prospective of bioremediation as a feasible technique for practical application to the treatment of petroleum hydrocarbon-contaminated soils, by trending the changes in the properties of the petroleum due to biodegradation. Each polluted soil has particularities, thus, the bioremediation approach for each contaminated site is unique. Therefore, hydrocarbon-contaminated sites that have remained polluted for decades due to lack of proper decontamination treatments present in this part of the world would benefit from cost effective treatments. Most bioremediation case studies are usually based on hypothetical assumptions rather than technical or experimental data; providing data that show the capabilities of biodegradation of indigenous microbes on specific oil composition can lead to the creation of strategies to accelerate the biological breakdown of hydrocarbons in soil.

Incidence and Outcome of Aluminium Phosphide Poisoning Cases Admitted to the Egyptian National Poisoning Centre

Aluminium Phosphide (ALP) poisoning is one of the major causes of suicidal deaths. It is one of the fatal pesticides. It liberates lethal phosphine gas when it comes in contact either with atmospheric moisture or with hydrochloric acid in the stomach. It causes cellular hypoxia, inhibition of cytochrome c oxidase and formation of highly reactive hydroxyl radicals. The aim of this work was to investigate ALP poisoning-related deaths in the National Egyptian Center of Environmental and Toxicological Research (NECTR), to arouse attention to its use in committing suicide due to its easy availability through the objective data from a sample of acutely poisoned patients admitted to NECTR in Cairo. Management of cases is mainly supportive as there is no specific antidote, causing high mortality rate. Early arrival and proper decontamination, resuscitation, intensive monitoring and supportive therapy may result in good outcome.

Building of a gene therapy facility: a Singapore experience

Background & Aim In recent years, using gene-modified cell therapy products for treatment of diseases has gained traction. This is largely due to the improved safety profile of the newer generation of viral vectors and several of such therapies have already obtained marketing authorisation. With time, the number of available treatment and demand are likely to increase. As these products can only be produced ex-vivo using patients’ cells, there is a need for a production site within Singapore that can meet both biosafety and good manufacturing practice (GMP) requirements. Methods, Results & Conclusion The Cell Therapy Facility at Health Sciences Authority, Singapore houses two independent clean room facilities. The older of the two was constructed in 2006 and it was used to prepare cell therapy products intended for haematopoietic transplantation and immunotherapy. Operations were relocated to a bigger facility in 2011 to accommodate an increasing demand for such products. This facility had since obtained GMP compliance status from the local regulatory body and JACIE accreditation. With current advances in the gene therapy field, it is timely that the older facility can be put into better use by converting it into a separate Gene Therapy Facility for viral vector related cell manufacturing. However, as compared to building a new facility from scratch, modification of an existing facility comes with a different set of challenges. The design and layout of the Gene therapy Facility has to comply to GMP regulations while navigating the constraints of an existing pre-defined space and retaining most of the original infrastructure such as the air control and mechanical ventilation systems. After much consideration, the space is reconfigured to include one large negative-pressured grade B room for cell processing (bubble air-lock design for bio-containment). Additional adjacent grade B and C rooms are carved out for a two-stage gowning process prior to entry into the processing suite and for a unidirectional personnel flow through a different exit. Numerous pass-through windows are installed for proper movement of cell therapy products, supplies and waste. There is one limitation for this design whereby only a single product can be processed at a time. Handling of multiple products has to be managed with proper process controls such as time segregation, proper decontamination and changeover procedures.