Disinfection Recommendations Research Articles

Efficacy of Disinfectants for Monkeypox Virus Inactivation on High Touch Surface Materials in Low-Resource Settings.

Disinfection efficacy tests were conducted on surface carriers inoculated with the monkeypox virus (MPXV) by applying six disinfectant solutions (and three controls) on six surfaces common in low-resource settings: four nonporous surfaces (stainless steel, glass, plastic, and latex) and two porous surfaces (ceramic and wood). Disinfectants were wiped on carriers in triplicate, with a 1 min contact time: 0.05 and 0.5% sodium hypochlorite, 70% ethanol, two quaternary ammonium compound (QAC)-based disinfectants, and 1.4% hydrogen peroxide. MPXV was then quantified, and log10 removal values were calculated. Sodium hypochlorite (0.05 and 0.5%) and ethanol (70%) removed MPXV to below detection level, ≥ 99.97% reduction for nonporous surfaces, and ≥99.40% for wood, QAC-based disinfectants were efficacious on nonporous surfaces (≥99.97% inactivation) but had diminished efficacy on wood, a porous surface, and 1.4% H2O2 had limited efficacy across all tested surfaces. Results varied by disinfectant type and surface type. Based on our results, we recommend using 0.05% sodium hypochlorite or 70% ethanol with 1 min contact time to inactive MPXV on clean nonporous and porous surfaces. As MPXV is evolving, future research with additional disinfectants, application methods, and environmental conditions and research to understand adsorption, disinfection efficacy, and transmission risk on porous surfaces are needed to develop practical disinfection recommendations.

Is platelet-rich plasma as safe as we think?: a case report

BackgroundPlatelet-rich plasma (PRP) is an autologous plasma product in which the concentration of platelets is several times higher than the physiologic level in peripheral blood and is a kind of concentrated form of platelet growth factor. It is widely used in dentistry, sports medicine, dermatology and cosmetology, gynecology and reproductive medicine, and ophthalmology. It has also been used in neurology for pain alleviation and regeneration of neurons. Herein, a 4-year-old patient, who was diagnosed with acute disseminated encephalomyelitis and received PRP subcutaneous injection was presented.Case presentationA 4-year-old patient, who was diagnosed with acute disseminated encephalomyelitis at the age of 3 years old and recovered with severe neurological sequelae despite treatment, received PRP subcutaneous injection in a private center to provide neuronal regeneration. The patient was admitted to our hospital 5 days after PRP with fever, refusal to feed, and decreased urine output. He was intubated due to respiratory distress. Inotropic treatments were initiated when hypotension and circulatory disturbance did not improve despite appropriate intravenous fluid administration. Staphylococcus epidermidis bacteremia was detected. Unfortunately, the patient died despite all interventions.ConclusionIn this case, it should not be ignored that the PRP procedure, which can be performed easily and quickly for various indications in many health institutions today, may be associated with serious side effects that may result in death. PRP injection must be performed in competent hands, following disinfection recommendations.

Ultrasound transducer disinfection for percutaneous procedures: A review of the evidence supporting guideline recommendations

AbstractIntroduction/PurposeThere are varying international recommendations regarding the minimum level of disinfection required for ultrasound transducers used in percutaneous procedures. While some guidelines recommend high‐level disinfection (HLD), others question the additional benefit this delivers over low‐level disinfection (LLD).MethodsThis narrative review identifies current guidelines and evaluates the evidence used to support disinfection recommendations for ultrasound transducers used in percutaneous procedures. Thirteen guidelines were identified using a search encompassing PubMed, Embase, Scopus and Google from 1st January 2013 to 31st January 2024.ResultsNo guidelines were supported by high‐quality evidence, instead, guidelines relied upon: expert opinion through the application of national standards and infection control principles; consideration of recommendations from other published guidelines; and the incidence of infection from retrospective studies. Guidelines were uniformly supportive of using ultrasound transducer covers and sterile ultrasound gel during ultrasound‐guided percutaneous procedures. However, the minimum recommended disinfection level was varied with seven guidelines recommending HLD, four LLD and two not specifying a level. Spaulding's classification was commonly used to support disinfection recommendations, however, the resultant wide variation in classification and subsequent recommendations suggest that its utility in accurately determining the minimum level of disinfection in this specific context is low.ConclusionWithout high‐level evidence, using a risk‐based assessment will likely remain fundamental to future guideline recommendations in determining the minimum disinfection level for an ultrasound transducer used in percutaneous procedures. This risk assessment must include the highest level of evidence available in addition to acknowledging the contribution of all steps taken to prevent infection during ultrasound‐guided percutaneous procedures.

Assessment of the legal regulation of forensic medical bureau activities in the field of anti-epidemic measures

Introduction. The staff of the Bureau of Forensic Medicine (BFM) experience a high microbial load in the performance of their professional duties, which poses a serious health hazard. Cases of infectious diseases continue to be recorded among the medical personnel of the BFM, which requires the prevention of infection during professional activities. The process of legal regulation of BFM activities in terms of compliance with sanitary and hygienic measures ensuring the safety of BFM employees from infectious contamination and improving the quality of expertise is becoming highly relevant.The purpose of the study is to propose measures to improve the regulation of relevant procedures based on the analysis of the legal regulation of BFM activities in matters of infectious safety.Materials and methods. We studied laws and bylaws at the federal and departmental levels. The regulatory framework was evaluated at the following conditional stages of forensic medical examination: processing of the sectional table; processing of instruments used for autopsy; personnel hand hygiene; current and general cleaning in the sectional rooms of the BFM.Results It was noted that there are no recommendations for disinfection after each dissection when processing the sectional table, the disagreements in the documents regulating the processing and disinfection of sectional instruments were revealed, the necessity of processing the instruments by mechanized method with the help of ultrasonic washers was shown. The points requiring attention with respect to the use of personal protective equipment, treatment of experts’ hands and other antiepidemic measures in the light of the new regulatory documents that have come into force are listed: Sanitary Rules and Regulations 3.3686-21 and Sanitary Rules 2.1.3678-20.Discussion The identified contradictions in the issues determining the actions of the expert at each of the stages indicate that the sanitary and hygienic measures are covered insufficiently and require more detailed elaboration.Conclusion Changes are required at the legislative, subordinate, and regulatory levels. Standard operating procedures must be implemented for BSMSE staff, which must be carried out in compliance with the requirements of the legislation regulating the activities of BFM, as well as precautions to ensure the infectious safety of employees.

AIUM Official Statement: Guidelines for Cleaning and Preparing External- and Internal-Use Ultrasound Transducers and Equipment Between Patients as Well as Safe Handling and Use of Ultrasound Coupling Gel.

AIUM Official Statement: Guidelines for Cleaning and Preparing External- and Internal-Use Ultrasound Transducers and Equipment Between Patients as Well as Safe Handling and Use of Ultrasound Coupling Gel.

Get Me a Mask! The Challenge of Equipment Supply Chains.

Get Me a Mask! The Challenge of Equipment Supply Chains.

Household Disinfection Interventions to Prevent Cholera Transmission: Facilitators, Barriers, Training, and Evidence Needs.

ABSTRACT.There are two common household disinfection interventions to prevent interhousehold transmission of cholera: household spraying, whereby a team disinfects cholera patients’ households, and household disinfection kits (HDKs), whereby cleaning materials are provided to cholera patients’ family members. Currently, both interventions lack evidence, and international agencies recommend HDK distribution; however, household spraying remains widely implemented. To understand this disconnect, we conducted 14 key informant interviews with international and national responders and a study in Haiti assessing HDK efficacy using two training modules including 20 household surveys and 327 surfaces samples before and after cleaning. During interviews, 80% of the international-level informants discussed evidence gaps for both interventions, and 60% preferred HDKs. Conversely, no national-level informants knew what an HDK was; therefore, they all preferred spraying. Informants discussed behavior changes, bleach perceptions, and implementation as facilitators and/or barriers to implementing both interventions. In households, training with demonstrations regarding the use of HDK led to increased reductions of Escherichia coli (P < 0.001) and Vibrio spp. (P < 0.001) on surfaces after participants cleaned the household compared with a hygiene promotion session only. These results emphasize the gap between the current international-level policy and the realities of cholera response programs, highlight the need for evidence to align household disinfection recommendations, and underscore the importance of the dissemination and training of responders and affected populations regarding methods to prevent intrahousehold cholera transmission.

Disinfection of Ultrasound Transducers Used for Percutaneous Procedures: Intersocietal Position Statement.

Disinfection of Ultrasound Transducers Used for Percutaneous Procedures: Intersocietal Position Statement.

Review of Hygiene and Disinfection Recommendations for Outpatient Glaucoma Care: A COVID Era Update.

This review focuses on best practices and recommendations for hygiene and disinfection to limit exposure and transmission of infection in outpatient glaucoma clinics during the current COVID-19 pandemic.

Evaluation of High-level Disinfection Processes for Linear Endoscopic Ultrasound Scopes Following New Delhi Metallo-beta-lactamase Carbapenem-resistant Enterobacteriaceae bacteremia

BACKGROUND A patient with New Delhi metallo-beta-lactamase (NDM) carbapenem-resistant Enterobacteriaceae (CRE) bacteremia was readmitted four days following a procedure with a linear endoscopic ultrasound scope (EUS) and duodenoscope. Prior outbreaks of CRE have been linked to the elevator mechanism in duodenoscopes. An elevator mechanism is also present in linear EUS and contributes to the complexity of cleaning and disinfection. However, EUS are not included in the FDA supplemental measures for duodenoscope reprocessing. This study aims to evaluate need for standardized cleaning and disinfection recommendations for all endoscopes with an elevator mechanism. METHODS High level disinfection (HLD) processes were evaluated via direct observation and culturing endoscopes used on the index patient. The EUS and duodenoscope were sequestered following the isolation of CRE and reprocessed prior to culture. FDA guidance for duodenoscope surveillance culturing was followed. Cultures were processed by a certified environmental testing laboratory. RESULTS Direct observation revealed differences in reprocessing frequency between duodenoscopes and EUS. Duodenoscopes underwent manual cleaning and HLD both immediately after and prior to patient use. EUS were reprocessed after use, but not immediately prior to next use. Culture results revealed no growth for the duodenoscope. The EUS grew 48 colony forming units (CFUs) of Neisseria species and 113 CFU of Rothia aeria. The EUS was reprocessed and resampled, which resulted in 1 CFU of Pseudomonas stutzeri. The EUS scope was submitted to the manufacturer for evaluation. To date, no additional case of NDM-CRE has been identified. CONCLUSIONS The elevator mechanism in linear EUS may be a source of bacterial contamination and recent EUS use should be evaluated when investigating CRE. This study demonstrates the need for standardized HLD processes for all endoscopes with elevator mechanisms. Collaboration between Gastroenterology departments and Infection Prevention is crucial to patient safety.

Determining the Efficacy, Safety and Suitability of Disinfectants to Prevent Emerging Infectious Disease Transmission

The scale of the 2014–2017 West African Ebola Virus Disease outbreak overwhelmed the international response capacity. This has led to inconsistencies in international guidance documents, particularly around chlorine disinfection of surfaces and hands to prevent transmission. To provide evidence for the disinfection recommendations, three research strands were conducted: (1) impacts of chlorine chemistry; (2) efficacy of surface cleaning recommendations; and (3) safety and efficacy of handwashing recommendations. Strand 1 research found that the compound chemistry of the chlorine source has an impact on the chlorine solution shelf-life (&lt;1 day–30 days), with testing of chlorine solutions recommended to ensure accuracy. Strand 2 research found that surface cleaning with 0.5% chlorine solutions with a 15-min exposure time is efficacious in reducing transmission risk. Strand 3 research found that community handwashing with chlorine solutions is as safe and efficacious as handwashing with soap and water or sanitizer, which offers a benefit of reducing pathogens in the rinsing water. Using calcium hypochlorite as the chlorine source compound provided a particularly good performance in chemistry and handwashing studies. The research was successful at providing information to align with the inconsistent international guidelines. Further research is needed to proactively establish the efficacy, safety and suitability of disinfection for the seven viral pathogens that are considered likely to cause severe outbreaks with few/no medical countermeasures.

Dialysis Station Disinfection Improvement Project- Implementing Cdc's Environmental Surface Disinfection Recommendations In Six Outpatient Centers

Dialysis Station Disinfection Improvement Project- Implementing Cdc's Environmental Surface Disinfection Recommendations In Six Outpatient Centers

EMS Provider Compliance with Infection Control Recommendations Is Suboptimal

Introduction. Standard precautions are disease transmission prevention strategies recommended by both the World Health Organization (WHO) and by the Centers for Disease Control and Prevention (CDC). Emergency medical services (EMS) personnel are expected to utilize standard precautions. Methods. This was a prospective observational study of the use of standard precautions by EMS providers arriving at a large urban emergency department (ED). Research assistants (RAs) observed EMS crews throughout their arrival and delivery of patients and recorded data related to the use of gloves, hand hygiene, and equipment disinfection. Results. A total of 423 EMS deliveries were observed, allowing for observation of 899 EMS providers. Only 512 (56.9%) EMS providers arrived wearing gloves. Hand washing was observed in 250 (27.8%) of providers. Reusable equipment disinfection was noted in only 31.6% of opportunities. The most commonly disinfected item was the stretcher (55%). Conclusion. EMS provider compliance with standard precautions and equipment disinfection recommendations is suboptimal. Strategies must be developed to improve EMS provider compliance with internationally recognized infection control guidelines. Key words: Emergency medical services, hand washing, hygiene, disinfection, disease prevention

Iatrogenic Creutzfeldt-Jakob disease via surgical instruments

Creutzfeldt-Jakob disease (CJD) is a neurodegenerative prion disease that can spread via contaminated neurosurgical instruments previously used on an infected patient. We examine current guidelines on how to recognize, handle, and prevent instrument-related iatrogenic CJD. Despite only four reported patients worldwide implicating contaminated neurosurgical instruments, and none in the past 30years, the public health consequences of potential instrument-related iatrogenic CJD can be far-reaching. Conventional sterilization and disinfection methods are inadequate in reducing prion infectivity of contaminated instruments, and World Health Organization recommendations for disinfection using bleach or sodium hydroxide are often impractical for routine decontamination. Recently, possible CJD exposure via infected surgical instruments was suspected at a large teaching hospital. Although CJD was later disproven, the intervening investigation exposed the difficulty in tracking infected surgical instruments and in protecting subsequent surgical patients from prion infection. To identify patients at risk for iatrogenic CJD, infectivity of instruments after this index patient is estimated using simple scenario modeling, assuming a certain log reduction of infectivity for each cleansing cycle. Scenario modeling predicts that after six cycles of instrument use with conventional cleansing following an index patient, other patients are highly unlikely to be at risk for iatrogenic CJD. Despite its rarity, the threat of iatrogenic CJD transmission via contaminated instruments poses tremendous challenges to neurosurgeons. Basic prevention strategies should be employed for patients with suspected CJD, including use of disposable instruments where possible and quarantining non-disposable instruments until the diagnosis is ascertained, or using special instrument reprocessing methods if CJD is suspected.

Staying up to Date on Disinfection and Sterilization Techniques

Preventing infection in surgical patients begins with cleaning, disinfecting, and sterilizing the medical instruments used during surgical and nonsurgical procedures. An estimated 71.9 million procedures are performed each year in the United States, so processing the instruments correctly is essential to minimize infection risk. The Joint Commission considers the following as infection prevention and control activities: Cleaning and performing low-level disinfection of medical supplies and devices and performing intermediate- and high-level disinfection and sterilization of medical equipment, devices, and supplies. Ongoing education about disinfection and sterilization techniques will improve your understanding of the implications of improper instrument handling. This article reviews the AORN practice recommendations for disinfection and sterilization so that you can better care for your patients during the perioperative and intraoperative periods.

Pre-operative skin preparation practices: results of the 2007 French national assessment

Pre-operative skin preparation, aimed at reducing the endogenous microbial flora, is one of the main preventive measures employed to decrease the likelihood of surgical site infection. National recommendations on pre-operative management of infection risks were issued in France in 2004. To assess compliance with the French national guidelines for pre-operative skin preparation in 2007. A prospective audit was undertaken in French hospitals through interviews with patients and staff, and observation of professional practice. Compliance with five major criteria selected from the guidelines was studied: patient information, pre-operative showering, pre-operative hair removal, surgical site disinfection and documentation of these procedures. Data for 41,188 patients from all specialties at 609 facilities were analysed. Patients were issued with information about pre-operative showering in 88.2% of cases [95% confidence interval (CI) 87.9-88.5]. The recommended procedure for pre-operative showering, including hairwashing, with an antiseptic skin wash solution was followed by 70.3% of patients (95% CI 69.9-70.8); this percentage was higher when patients had received appropriate information (P<0.001). Compliance with hair removal procedures was observed in 91.5% of cases (95% CI 91.2-91.8), and compliance with surgical site disinfection recommendations was observed in 25,529 cases (62.0%, 95% CI 61.5-62.5). The following documentary evidence was found: information given to patient, 35.6% of cases; pre-operative surgical hygiene, 82.3% of cases; and pre-operative site disinfection, 71.7% of cases. The essential content of the French guidelines seems to be understood, but reminders need to be issued. Some recommendations may need to be adapted for certain specialties.

Re-evaluation of current A0 value recommendations for thermal disinfection of reusable human waste containers based on new experimental data

Issues over the correct cleaning and disinfection of reusable medical devices are of great concern for local infection control teams. We investigated the heat resistance of two important micro-organisms implicated in nosocomial infections, Enterococcus spp. and spores of Bacillus subtilis (a surrogate for Clostridium difficile). Disinfection with moist heat, based on the A(0) concept (EN ISO 15883-1), is the most common method for disinfection of human waste containers in the hospital setting. The aim of this study was to scrutinise the A(0) concept regarding the inactivation of the above-mentioned micro-organisms and to look for possible interferences. Experiments were carried out in phosphate-buffered saline, artificial soil in suspension (ASS) and dried artificial soil (AS). Artificial soil was used to simulate insufficient cleaning of bedpans. Micro-organisms were treated at different temperatures and time periods. It was shown that soil protected the micro-organisms against heat and that dried soil enhanced this effect, probably as a result of thermal insulation. The results of the current study do not support the general recommendation to use an A(0) of 60 for the disinfection of bedpans but warrant differential strategies depending on the expected microbial load. We generally recommend for disinfection processes aimed at vegetative bacteria an A(0) of >or=180. Furthermore we want to emphasise the utmost importance of not allowing freshly contaminated bedpans to dry for longer time periods, as the significance of thorough cleaning of contaminated human waste containers before being exposed to heat treatment for their disinfection was clearly demonstrated.

Infection control during GI endoscopy

This is one of a series of statements discussing the use of GI endoscopy in common clinical situations. The Standards of Practice Committee of the American Society for Gastrointestinal Endoscopy (ASGE) prepared this text. In preparing this guideline, a search of the medical literature was performed by using PubMed, supplemented by accessing the "related articles" feature of PubMed. Additional references were obtained from the bibliographies of the identified articles and from recommendations of expert consultants. When little or no data exist from well-designed prospective trials, emphasis is given to results from large series and reports from recognized experts. Guidelines for appropriate use of endoscopy are based on a critical review of the available data and expert consensus at the time the guidelines are drafted. Further controlled clinical studies may be needed to clarify aspects of this guideline. This guideline may be revised as necessary to account for changes in technology, new data, or other aspects of clinical practice. The recommendations were based on reviewed studies and were graded on the strength of the supporting evidence (Table 1). This guideline is intended to be an educational device to provide information that may assist endoscopists in providing care to patients. This guideline is not a rule and should not be construed as establishing a legal standard of care or as encouraging, advocating, requiring, or discouraging any particular treatment. Clinical decisions in any particular case involve a complex analysis of the patient's condition and available courses of action. Therefore, clinical considerations may lead an endoscopist to take a course of action that varies from these guidelines.

Hygiène du matériel de nébulisation : enjeux, difficultés et propositions d’amélioration

Nebulization may transport with the drug some small particles containing microbes. These microbes may be present in all parts of the nebulizer, including the drug solution itself. Depending on the studies, contamination of the nebulizers may reach up to 55% of the devices in patients with cystic fibrosis. That's why using one nebulizer for one patient, using drug sterile ampoules, and having a good hygiene during and after the nebulization are so important. The national disinfection recommendations, usually depending on the type of the nebulizer, are variable from one to another country and are not very well validated. Moreover, the repetitive use of these disinfection techniques on the performances of the nebulizer are neither studied. In daily life, the patients respect these disinfection recommendations in 3 to 98% of the cases. We propose a standardized methodology for evaluating the microbial and functional effects of all disinfectants on the nebulizers. A simple, quick, efficacious, cheap, and without effect on nebulizer performances disinfectant is still waiting.

Infection control guidelines for optometrists 2007

Information from peer‐reviewed articles, guidelines from professional societies and manufacturers’ instructions were considered to determine the risk factors in optometric practice and to make recommendations for disinfection, sterilisation and reprocessing of instrumentation and other equipment used in practice and measures for personal protection.Wherever possible, all practitioners should adopt measures to decrease the risk of transmission of infection, such as single use instruments/equipment, appropriate methods of reprocessing where items are reused, routine employment of standard infection control precautions and application of more rigorous procedures for infected or immuno‐suppressed individuals.