[Principles of antisepsis, disinfection and sterilization]

Green Dentistry: State of the Art and Possible Development Proposals

Objectives: The objective of this narrative literature review was to highlight all dental procedures attributable to sectoral waste and to consider possible alternatives in line with the concept of sustainable development. Methods: An extensive search of electronic databases, including the Cochrane Oral Health Group Specialized Register, Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science, PubMed, EMBASE, and Google Scholar. Search words included 'Green Dentistry', 'Dental Pollution', 'Pollutants and Dentistry', 'Disinfectants and Dentistry', and 'High-tech Dentistry'. All of them allowed an assessment of the impact of dental practice on the external environment, and new frontiers currently applied or possibly applicable for green dentistry were included in the study. Non-full-text papers, animal studies, studies in languages other than English, and studies not related to the topic under consideration were excluded. Results: According to the inclusion criteria, 76 papers were selected for the study. The topics analyzed were the impact of dental practice on the outdoor environment, currently applied and potentially applicable principles of green dentistry, and the 'Four Rs' model (Rethink, Reduce, Reuse, and Recycle). Conclusions: With the limitations of the present study, the concept of green dentistry could be applicable provided that the measures already taken to reduce indoor and outdoor risk factors are continued and improved.

Emerging biofilm formation and disinfectant susceptibility of ESBL-producing Klebsiella pneumoniae

Klebsiella pneumoniae is an opportunistic pathogen responsible for various infections in humans and animals. It is known for its resistance to multiple antibiotics, particularly through the production of Extended-Spectrum Beta-Lactamases (ESBLs), and its ability to form biofilms that further complicate treatment. This study aimed to isolate and identify K. pneumoniae from animal and environmental samples and assess commercial disinfectants' effectiveness against K. pneumoniae isolates exhibiting ESBL-mediated resistance and biofilm-forming ability in poultry and equine farms in Giza Governorate, Egypt. A total of 320 samples, including nasal swabs from equine (n = 60) and broiler chickens (n = 90), environmental samples (n = 140), and human hand swabs (n = 30), were collected. K. pneumoniae was isolated using lactose broth enrichment and MacConkey agar, with molecular confirmation via PCR targeting the gyrA and magA genes. PCR also identified ESBL genes (blaTEM, blaSHV, blaCTX-M, blaOXA-1) and biofilm genes (luxS, Uge, mrkD). Antimicrobial susceptibility was assessed, and the efficacy of five commercial disinfectants was evaluated by measuring inhibition zones. Klebsiella pneumoniae was isolated from poultry (13.3%), equine (8.3%), wild birds (15%), water (10%), feed (2%), and human hand swabs (6.6%). ESBL and biofilm genes were detected in the majority of the isolates, with significant phenotypic resistance to multiple antibiotics. The disinfectants containing peracetic acid and hydrogen peroxide were the most effective, producing the largest inhibition zones, while disinfectants based on sodium hypochlorite and isopropanol showed lower efficacy. Statistical analysis revealed significant differences in the effectiveness of disinfectants against K. pneumoniae isolates across various sample origins (P < 0.05). The presence of K. pneumoniae in animal and environmental sources, along with the high prevalence of ESBL-mediated resistance and biofilm-associated virulence genes, underscores the zoonotic potential of this pathogen. The study demonstrated that disinfectants containing peracetic acid and hydrogen peroxide are highly effective against ESBL-producing K. pneumoniae. Implementing appropriate biosecurity measures, including the use of effective disinfectants, is essential for controlling the spread of resistant pathogens in farm environments.

Effective of different industrial disinfection in subzero cold-chain environment

Effective disinfection methods are crucial in the cold chain transportation process of food due to the specificity of temperature and the diversity of contaminated flora. The objective of this study was to investigate the sanitizing effect of different disinfectants on various fungi at - 20 °C to achieve accurate disinfection of diverse bacterial populations. Peracetic acid, hydrogen peroxide, and potassium bisulfate were selected as low-temperature disinfectants and were combined with antifreeze. The sanitizing effect of these cryogenic disinfectants on pathogens such as Bacillus subtilis black variant spores (ATCC9372), Staphylococcus aureus (ATCC 6538), Candida albicans (ATCC 10231), Escherichia coli (8099), and poliovirus (PV-1) was sequentially verified by bactericidal and virus inactivation experiments. After a specified time of disinfection, a neutralizing agent was used to halt the sanitizing process. The study demonstrates that different disinfectants exhibit selective effects during the low-temperature disinfection process. Peracetic acid, hydrogen peroxide, and potassium monopersulfate are suitable for the low-temperature environmental disinfection of bacterial propagules, viruses, and fungal contaminants. However, for microorganisms with strong resistance to spores, a low-temperature disinfectant based on peracetic acid should be chosen for effective disinfection treatment. Our results provide a valuable reference for selecting appropriate disinfectants to sanitize various potential pathogens in the future.

Biocides in the Hospital Environment: Application and Tolerance Development

Hospital-acquired infections are a rising problem with consequences for patients, hospitals, and health care workers. Biocides can be employed to prevent these infections, contributing to eliminate or reduce microorganisms' concentrations at the hospital environment. These antimicrobials belong to several groups, each with distinct characteristics that need to be taken into account in their selection for specific applications. Moreover, their activity is influenced by many factors, such as compound concentration and the presence of organic matter. This article aims to review some of the chemical biocides available for hospital infection control, as well as the main factors that influence their efficacy and promote susceptibility decreases, with the purpose to contribute for reducing misusage and consequently for preventing the development of resistance to these antimicrobials.

Global neurosurgery: Reflections on myelomeningocele in the Zanzibar archipelago (Tanzania)

Objective

Our main goal was to describe the general characteristics and demographic data of myelomeningocele (MMC) patients at Mnazi Mmoja Surgical NED Institute (MMSNI) in Zanzibar and to assess the clinical characteristics and medium-term result-impact of the implemented health care measures.

Methods

This is a retrospective study on 41 MMC patients treated at the MMSNI in Zanzibar (Tanzania) from September 2016 to September 2018. Patient demographics, prenatal care, clinical and radiographic characteristics, surgical management and nursing care, and clinical outcomes were abstracted.

Results

The mean age of the patients was 6.1 ± 4.6 days, and 53.7% were males. A total of 51.2% came from Zanzibar, 39% to Pemba, and 9.8% from mainland Tanzania. Maternal ultrasound checkups revealed hydrocephalus in 18.7% of the cases. 85.4% of the newborns were operated on. Surgical wound infection was the most frequent complication (28.6%). A significantly higher risk of complications was observed in children from Pemba Island (p = 0.046) and those born by vaginal delivery (p = 0.694), particularly infections. During follow-up, 48.57% of the patients presented with infantile hydrocephalus and in the majority of them, a ventriculoperitoneal shunt was inserted.

Conclusions

Proper prenatal care with early diagnosis, together with the neurosurgical and nursing standard of care in a specialized institution, are all essential to increase the chances of successful treatment of newborns harboring MMC and is one of the main goals pursued in the MMSNI, as the only referral public health center with locally trained health personnel in Zanzibar archipelago.

Analysis of the Application Effect of PDCA Cycle Management Combined With Risk Factor Management Nursing for Reducing Infection Rate in Operating Room

Purpose

To explore the application effect of plan-do-check-action (PDCA) cycle management combined with risk factor management nursing in an operating room.

Methods

A total of 150 surgical patients in our hospital from November 2020 to February 2021 were selected as the conventional group, and 150 surgical patients in our hospital from March 2021 to June 2021 were selected as the research group. The conventional group implemented routine infection management, and the research group implemented PDCA cycle management combined with risk factor management. Detection of pathogenic bacteria, incidence of incision infection, infection control, occurrence of irregular events, and nursing quality in the operating room were observed in the two groups.

Results

The detection rate of Gram-negative bacillus and Gram-positive cocci, infection rate of incision, and total incidence of irregular events in the research group were lower than those in the conventional group (P < 0.05). The qualified rate of disinfection of object surface, hands of medical staff and air, and nursing quality scores in the research group were higher than those in the conventional group (P < 0.05).

Conclusion

Plan-do-check-action (PDCA) cycle management combined with risk factor management nursing can reduce the detection rate of pathogenic bacteria and infection rate of incision in the operating room, reduce the incidence of irregular events, improve the qualified rate of disinfection, and greatly improve the quality of nursing, which can be considered to be widely used in clinical practice.

Adaptation and validation of a method for evaluating the bactericidal activity of ethyl alcohol in gel format 70% (w/w)

Ethyl alcohol 70% (w/w) is a broad-spectrum bactericidal agent that is mandatorily marketed as a gel in Brazil since 2002. However, there is no method described for the microbiological quality control of surface disinfectants in the form of gel, which makes it impossible to monitor the effectiveness of these products by the Health Surveillance. Thus, the present study aimed to adapt an analytical method and validate it so that it is possible to evaluate the bactericidal activity of ethyl alcohol-based disinfectants at 70% (w/w) in gel form. The proposed analytical method is an adaptation of a method developed by the Association of Official Analytical Chemists (AOAC), which is currently used to evaluate the bacterial activity of disinfectants in the form of spray and aerosol. The method consisted of challenging the disinfectant by putting it in contact with 60 carriers - previously contaminated with the test microorganism - during the contact time established by the manufacturer. The bacteria used in this work were Staphylococcus aureus CBRVS 00039 ATCC 6538, Salmonella enterica CBRVS 00028 ATCC 10708, and Pseudomonas aeruginosa CBRVS 00025 ATCC 15442. The parameters chosen for the validation of the method were: matrix effect, robustness, and repeatability. The experiments performed with a disinfectant matrix showed that there is no interference of the gel on the effectiveness of alcohol. Satisfactory results regarding the evaluation of bactericidal activity were obtained for the three microorganisms tested when the volume of 100 μL of disinfectant was applied. The method also showed good repeatability, as it proved to be robust with modification of incubation times, equipment and analysts. The development and validation of this method were extremely important for the quality monitoring of these products, besides being the first method described for the evaluation of gel disinfectants.

Specific Hygiene Procedures and Practices Assessment: A Cross-Sectional Study in Fresh Fishery Product Retailers of Lisbon's Traditional Food Markets

This study aimed to assess the compliance of specific hand hygiene and food contact surfaces hygiene in fresh fishery product retailers (FFPR) and its relation to socio-demographic characteristics that might influence the observed procedures and practices. A cross-sectional study was conducted in traditional food markets’ FFPRs (N = 74) using interviews and audits for data collection purposes. Results revealed that women were overrepresented among FFPR managers; most were over 50 years of age and had a long working experience in fish retail activities, despite a low educational level. The majority had attended training courses in food hygiene, safety, and Hazard Analysis and Critical Control Points-based procedures. Both documental assessment and hand hygiene procedures and practices verification revealed a low level of compliance. Many documents supporting hygiene practices were lacking. Several non-conforming requisites were identified related to the handwashing procedure and equipment and to glove wearing practices. A higher level of compliance was obtained in food contact surfaces hygiene procedures and practices verification, with complete hygiene procedures applied and proper cleaning of utensils and chemical products management in several cases. These findings reflect an ambiguous understanding and misconceptions related to hygiene procedures and practices, suggesting the need to improve and update FFPR food handler training regarding basic food hygiene and safety.

Evaluation of a Biocide Used in the Biological Isolation and Containment Unit of a Veterinary Teaching Hospital

Hospital-acquired infections (HAIs) are a rising problem worldwide, and the best way of coping with them is through infection tracking and surveillance systems, combined with prevention strategies, namely efficient disinfection protocols, that employ various biocides. However, increasing reports about reductions in biocide susceptibility and the development of cross-resistance to antimicrobials emphasize the need for identifying the factors influencing biocide efficiency. In this study, 29 bacterial isolates (n = 3 E. coli, n = 2 Pseudomonas spp., n = 23 Enterococcus spp., and n = 1 Staphylococcus pseudintermedius), obtained from environmental samples collected from the Biological Isolation and Containment Unit (BICU), of the Veterinary Teaching Hospital of the Faculty of Veterinary Medicine, University of Lisbon, were tested in order to determine their antimicrobial susceptibility to various antibiotics. Thirteen of these isolates were further selected in order to determine their antimicrobial susceptibility to Virkon™ S, with and without the presence of organic matter. Afterward, seven of these isolates were incubated in the presence of sub-lethal concentrations of this formulation and, subsequently, new susceptibility profiles were determined. Fourteen of the 29 isolates (48.3%) were classified as multidrug resistant, all previously identified as enterococci. Concerning Virkon™ S's susceptibility, the Minimal Bactericidal Concentration (MBC) of this biocide regarding all isolates was at least eight times lower than the concentration regularly used, when no organic matter was present. However, when organic matter was added, MBC values rose up to 23 times. After exposure to sub-lethal concentrations of Virkon™ S, four enterococci presented a phenotypical change regarding antimicrobial susceptibility towards gentamicin. Virkon™ S also resulted in higher MBC values, up to 1.5 times, in the presence of low concentrations of organic matter, but no rise in these values was observed in assays without interfering substance. Virkon™ S seemed to be an efficient formulation in eliminating all bacteria isolates isolated from the BICU. However, organic matter could represent a hindrance to this ability, which emphasizes the importance of sanitization before disinfection procedures. The changes seen in antimicrobial susceptibility could be explained by a general stress-induced response promoted by the sub-lethal levels of Virkon™ S. Additionally, when no organic matter was present, a decrease in susceptibility to this biocide seemed to be non-existent.

Difficulties and Countermeasures in Hospital Emergency Management for Fast-Lane Treatment of Acute Stroke During the COVID-19 Epidemic Prevention and Control

Background: Coronavirus disease 2019 (COVID-19) has a long incubation period and a high degree of infectivity. Patients may not show specific signs or symptoms of upper respiratory tract infection, and the age of onset is similar to that of stroke. Furthermore, an increase in neurological conditions, specifically acute cerebrovascular disease, has been detected. Providing emergency treatment for acute stroke in accordance with the strict epidemic control measures is currently one of the main challenges, as acute stroke is rapid onset and a major cause of death and disability globally. We aimed to evaluate the emergency treatment system for acute stroke during the epidemic control period to provide a reference and basis for informing government and medical institutions on improving patient treatment rates during this period. Methods: Difficulties faced in providing emergency treatment for stroke during an epidemic were investigated and combined with medical educational resources and clinical management experiences to construct an emergency treatment framework for acute stroke during the epidemic. Findings: Currently, emergency treatment measures for acute stroke during the epidemic control period are limited because the main focus is on identifying COVID-19 comorbidities during the critical period. Establishing standards for patients in the neurological outpatient consultation rooms and emergency observation and resuscitation zones; implementing a fast-lane system for the emergency treatment of patients with acute stroke, and strengthening ward management and medicine popularization, can improve the treatment efficiency for stroke patients during the epidemic and provide a reference for peers in clinical practice. Interpretation: Emergency treatment for acute stroke during COVID-19 epidemic control period requires a joint promotion of clinical, popularization, and teaching resources.

Thermal disinfection in hemodialysis using the A0 concept as dispenser

Patients with chronic kidney disease in the hemodialysis program are exposed to large amounts of water, as this constitutes about 96% of the dialysis fluid. It is known that the use of better quality water decreases the state of chronic inflammation in dialysis patients. Disinfection as part of water treatment plays an important role in meeting the established quality standards; currently, heat disinfection is highly recommended, however its dose is not clearly established in the literature. The objective of this review is to know what is available in the literature on the dose of heat disinfection that should be used in hemodialysis and to present our experience with this method at a set dose of 12.000 A₀.

Basics concepts about asepsis and antiseptics

During health care, the patient is exposed to a wide variety of microorganisms. Maximum hygiene in all care activities is therefore essential in order to reduce the cross-transmission of preventable infectious diseases. The 3 key mechanisms for the prevention of infection in health centers are cleaning, disinfection and sterilization. The scientific and rational use of disinfectants and antiseptics, and the correct application of aseptic techniques in the care of patients and in the handling and supply of materials are the fundamental considerations for the prevention of healthcare related infections. Adequate knowledge of the concepts and standards of use of antiseptics and disinfectants offers healthcare workers the essential tool needed to avoid the spread of infectious agents, while also establishing the scientific basis for their rational use. This article is part of a supplement entitled "Antisepsis in the critical patient", which is sponsored by Becton Dickinson.