1
|
Adeghate JO, Yadav S, Kowalski RP, Juhász E, Kristóf K, Olsen KR, Bergren RL, Knickelbein JE, Chhablani J, Martel JN, Anetakis A, Dansingani KK, Rosin B, Gallagher DS, Prensky C, Eller AW, Friberg T, Sahel JA, Errera MH. Coagulase-negative staphylococcal endophthalmitis: clinical severity and outcomes based on speciation. CANADIAN JOURNAL OF OPHTHALMOLOGY 2024; 59:e371-e377. [PMID: 37321555 DOI: 10.1016/j.jcjo.2023.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 04/17/2023] [Accepted: 05/25/2023] [Indexed: 06/17/2023]
Abstract
OBJECTIVE To identify characteristics and visual outcomes of coagulase-negative staphylococcal (CoNS) endophthalmitis in the era after the Endophthalmitis Vitrectomy Study. DESIGN Single-centre retrospective analysis. PARTICIPANTS Forty-two samples from 40 patients with documented CoNS endophthalmitis. METHODS Visual acuity outcomes of CoNS endophthalmitis were assessed in relation to species and type of treatment instituted (i.e., pars plana vitrectomy [PPV] versus vitreous tap and injection of intravitreal antibiotics [T&I]) on 42 samples from 40 patients. RESULTS Staphylococcus epidermidis was the most prevalent CoNS in our study. Cataract surgery and intravitreal injections were the most common sources for acute CoNS endophthalmitis. Eyes presenting with hand motion or better vision had similar mean final vision after either intravitreal antibiotics or PPV, whereas those with light perception or worse vision at onset had better outcomes after PPV only. Subanalysis showed that patients with S. epidermidis endophthalmitis (n = 39 eyes) had similar visual outcomes with either intravitreal injections or PPV regardless of visual acuity. Hypopyon and vitritis are not always present. CONCLUSIONS Patients with S. epidermidis endophthalmitis may benefit similarly from either early vitrectomy or intravitreal antibiotic injections regardless of visual acuity. This finding may be a supplement to the complements the management standards set forth by the Endophthalmitis Vitrectomy Study.
Collapse
Affiliation(s)
- Jennifer O Adeghate
- Department of Ophthalmology, University of Pittsburgh, Pittsburgh, PA; Institute of Laboratory Medicine, Semmelweis University, Budapest, Hungary.
| | - Sanya Yadav
- Department of Ophthalmology, University of Pittsburgh, Pittsburgh, PA
| | - Regis P Kowalski
- Department of Ophthalmology, University of Pittsburgh, Pittsburgh, PA; Charles T. Campbell Microbiology Laboratory, University of Pittsburgh, Pittsburgh, PA
| | - Emese Juhász
- Institute of Laboratory Medicine, Semmelweis University, Budapest, Hungary
| | - Katalin Kristóf
- Institute of Laboratory Medicine, Semmelweis University, Budapest, Hungary
| | | | | | | | - Jay Chhablani
- Department of Ophthalmology, University of Pittsburgh, Pittsburgh, PA
| | - Joseph N Martel
- Department of Ophthalmology, University of Pittsburgh, Pittsburgh, PA
| | | | | | - Boris Rosin
- Department of Ophthalmology, University of Pittsburgh, Pittsburgh, PA
| | | | - Colin Prensky
- Department of Ophthalmology, University of Pittsburgh, Pittsburgh, PA
| | - Andrew W Eller
- Department of Ophthalmology, University of Pittsburgh, Pittsburgh, PA
| | - Thomas Friberg
- Department of Ophthalmology, University of Pittsburgh, Pittsburgh, PA
| | - José-Alain Sahel
- Department of Ophthalmology, University of Pittsburgh, Pittsburgh, PA
| | | |
Collapse
|
2
|
Hu R, Chen Y, Hu J, Yi L. Establishing Nursing-Sensitive Quality Indicators for the Central Sterile Supply Department: A Modified Delphi Study. Qual Manag Health Care 2024:00019514-990000000-00069. [PMID: 38427344 DOI: 10.1097/qmh.0000000000000418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
BACKGROUND AND OBJECTIVES Previous studies have shown that improving quality management in the central sterile supply department (CSSD) is an effective measure to control and decrease hospital-acquired infections. This study aimed to establish nursing-sensitive quality indicators for CSSD nursing in China. METHODS We drafted nursing-sensitive quality indicators on the basis of the Structure-Process-Outcome model, and then conducted 2 rounds of consultation with experts using a modified Delphi method to determine the indicators and scientific methods of measurement. RESULTS We identified five CSSD nursing-sensitive quality indicators. Recovery rates of the 2 rounds of valid questionnaires were 100%. Expert authority coefficients were 0.810 and 0.902, respectively. Kendall's coefficients of concordance were 0.168 and 0.210, respectively ( P < .05). CONCLUSION Evidence-based nursing-sensitive quality indicators for the CSSD were established.
Collapse
Affiliation(s)
- Ruixue Hu
- Author Affiliations: Department of Sterile processing Nursing, West China Second University Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, Sichuan, China; and Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
| | | | | | | |
Collapse
|
3
|
Fukuda A, Tominaga T, Matsumoto T, Nonaka T, Kosai K, Yanagihara K, Inoue T, Irie H, Miyoshi Y, Sugio T, Sakai T, Sakae E, Hamada M, Matsumoto K, Nagayasu T. Feasibility and efficacy of newly developed eco-friendly, automatic washer for endoscope using electrolyzed alkaline and acidic water. Asian J Endosc Surg 2024; 17:e13245. [PMID: 37724691 DOI: 10.1111/ases.13245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 08/29/2023] [Indexed: 09/21/2023]
Abstract
INTRODUCTION As well as preventing nosocomial and healthcare-associated infections, a reliable and eco-friendly washer for medical equipment would also be safe for the global environment. The aim of this study was to evaluate the efficacy of a newly developed automatic washing system (Nano-washer) that uses electrolyzed water and ultrasonication without detergent for washing endoscopes. METHODS Patients who underwent laparoscopic lobectomy or laparoscopic colectomy at Nagasaki University between 2018 and 2022 were included. A total of 60 cases of endoscope use were collected and classified according to endoscope washing method into the Nano-washer group (using no detergent) (n = 40) and the manual washing group (n = 20). Protein and bacterial residues were measured before and after washing, using absorbance spectrometry and 16S rRNA polymerase chain reaction. The effectiveness of protein and bacterial removal and endoscope surface damage after washing were compared under specular vision between the groups. RESULTS Nano-washer did not use detergent unlike manual washing. There was no difference in demographic or clinical characteristics between the groups except for the presence of comorbidities in the lobectomy group (Nano-washer, 85%; manual washing, 40%, P = .031). Compared with the manual washing group, residual protein levels in the Nano-washer group were significantly reduced after washing (lobectomy, 0.956 mg/mL vs 0.016 mg/mL, P < .001; colectomy, 0.144 mg/mL vs 0.002 mg/mL, P = .008). Nano-washer group showed a significant reduction in bacteria between before and after lobectomy (9437 copies/cm2 vs 4612 copies/cm2 , P = .024). CONCLUSION Nano-washer is a promising, effective, and eco-friendly automatic washing device that is safer and more efficient than manual washing.
Collapse
Affiliation(s)
- Akiko Fukuda
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Tetsuro Tominaga
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Takamune Matsumoto
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Takashi Nonaka
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Kosuke Kosai
- Department of Laboratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Katsunori Yanagihara
- Department of Laboratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Takumi Inoue
- Department of Materials, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Hiromi Irie
- Department of Materials, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | | | | | | | | | | | - Keitaro Matsumoto
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Takeshi Nagayasu
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| |
Collapse
|
4
|
McAleese T, Ó Doinn T, Broderick JM, Farrington R, Prior AR, Quinlan JF. Surgical helmet systems in total joint arthroplasty: assessment of hood sterility and donning technique. ARTHROPLASTY 2023; 5:53. [PMID: 37964378 PMCID: PMC10647130 DOI: 10.1186/s42836-023-00212-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Accepted: 09/05/2023] [Indexed: 11/16/2023] Open
Abstract
BACKGROUND The incidence of prosthetic joint infection (PJI) is increasing, coincident with the rising volume of joint arthroplasty being performed. With recent controversy regarding the efficacy of surgical helmet systems (SHS) in preventing infection, the focus has turned to the correct donning techniques and usage of surgical hoods. The aim of this study was to compare the bacterial contamination of the operating surgeon's gloves after two common donning techniques of SHS hoods. We also evaluated the baseline sterility of the SHS hoods at the beginning of the procedure. METHODS The bacterial contamination rate was quantified using colony-forming units (CFUs), with 50 trials performed per donning technique. Samples were cultured on 5% Columbia blood agar in ambient air at 37 °C for 48 h and all subsequent bacterial growth was identified using a MALDI-TOF mass spectrometer. In Group 1, the operating surgeon donned their colleague's hood. In Group 2, the operating surgeon had their hood applied by a non-scrubbed colleague. After each trial, the operating surgeon immediately inoculated their gloves onto an agar plate. The immediate sterility of 50 SHS hoods was assessed at two separate zones-the screen (Zone 1) and the neckline (Zone 2). RESULTS There was no significant difference in contamination rates between the two techniques (3% vs. 2%, P = 0.99) or between right and left glove contamination rates. Immediately after donning, 6/50 (12%) of SHS hoods cultured an organism. Contamination rates at both the face shield and neckline zones were equivalent. The majority of bacteria cultured were Bacillus species. DISCUSSION We found no significant difference in the operating surgeon's glove contamination using two common SHS hood-donning techniques when they were performed under laminar airflow with late fan activation. We suggest the SHS hood should not be assumed to be completely sterile and that gloves are changed if it is touched intraoperatively.
Collapse
Affiliation(s)
- Timothy McAleese
- RCSI University of Medicine and Health Sciences, Dublin, D02 YN77, Ireland.
- Department of Trauma and Orthopaedics, Tallaght University Hospital, Dublin, D24 NR04, Ireland.
| | - Tiarnán Ó Doinn
- Department of Trauma and Orthopaedics, Tallaght University Hospital, Dublin, D24 NR04, Ireland
| | - James M Broderick
- Department of Trauma and Orthopaedics, Tallaght University Hospital, Dublin, D24 NR04, Ireland
| | - Ross Farrington
- Department of Microbiology, Tallaght University Hospital, Dublin, D24 NR04, Ireland
| | - Anna-Rose Prior
- Department of Microbiology, Tallaght University Hospital, Dublin, D24 NR04, Ireland
| | - John F Quinlan
- Department of Trauma and Orthopaedics, Tallaght University Hospital, Dublin, D24 NR04, Ireland
| |
Collapse
|
5
|
Land V, Dickerson S, Goldman A, Shirley ED. The Surgical Instrument Sterilization Process: What Every Surgeon Should Know. JBJS Rev 2023; 11:01874474-202311000-00008. [PMID: 38015592 DOI: 10.2106/jbjs.rvw.23.00131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
» The phases of the sterilization process for surgical equipment are cleaning, disinfection, and sterilization.» Following manufacturer and regulatory guidelines will minimize contamination throughout the sterilization process.» Immediate use steam sterilization, when used appropriately, is a reasonably safe option to be used at the discretion of the operating surgeon.
Collapse
Affiliation(s)
- Vaughn Land
- Naval Medical Center Portsmouth, Portsmouth, Virginia
| | | | | | | |
Collapse
|
6
|
Rutala WA, Weber DJ. Risk of disease transmission to patients from "contaminated" surgical instruments and immediate use steam sterilization. Am J Infect Control 2023; 51:A72-A81. [PMID: 37890956 DOI: 10.1016/j.ajic.2023.01.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Accepted: 01/31/2023] [Indexed: 10/29/2023]
Abstract
BACKGROUND There are several sources of pathogens that cause surgical site infections (SSI) to include the patients endogenous microflora and exogenous sources (e.g., air, surfaces, staff, surgical equipment). METHODS We searched the published English literature (Google, Google Scholar, PubMed) for articles on reprocessing surgical instruments, effectiveness of sterilization methods, microbial load on surgical instruments, frequency of "contaminated" instruments, and the infection risk associated with "contaminated" surgical instruments and immediate use steam sterilization. RESULTS There is substantial redundancy in instrument reprocessing to include: even if a patient was exposed to a "contaminated" instrument, the decontamination and sterilization process would have removed and/or inactivated the contaminating pathogens due to the exceptional effectiveness of the manual and mechanical cleaning (i.e., washer-disinfector) and the remarkable robustness of sterilization technology; and the low-level of microorganisms on surgical instruments after use and before cleaning. CONCLUSIONS A critical review of the literature suggests that the risk of acquiring an SSI from instruments used in surgery is essentially zero if the sterilization cycle is validated.
Collapse
Affiliation(s)
- William A Rutala
- Statewide Program for Infection Control and Epidemiology, University of North Carolina (UNC) School of Medicine, Chapel Hill, NC; Division of Infectious Diseases, UNC School of Medicine, Chapel Hill, NC.
| | - David J Weber
- Statewide Program for Infection Control and Epidemiology, University of North Carolina (UNC) School of Medicine, Chapel Hill, NC; Division of Infectious Diseases, UNC School of Medicine, Chapel Hill, NC; Infection Prevention, University of North Carolina Medical Center, Chapel Hill, NC
| |
Collapse
|
7
|
Sowa PM, Fooken J, McGowan K, Birch S. Disposable and reusable instruments in dental health practice: A comparison of cost factors in a public provider organization in Queensland, Australia. Community Dent Oral Epidemiol 2023; 51:794-803. [PMID: 35661220 DOI: 10.1111/cdoe.12764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 03/12/2022] [Accepted: 05/19/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Choosing between reusable instruments (RIs) and disposable instruments (DIs) for dental care provision requires a careful consideration of costs and their contributing factors, alongside other choice criteria. This study aimed to assess the current use of instruments in the West Moreton Oral Health Service (WMOHS) in Queensland, Australia, with a broader goal of informing future practice in this and comparable organizations. METHODS A cost model was developed reflecting costs arising from procurement, reprocessing and disposal, depending on the RI and DI composition of instrumentation. The current practice in WMOHS was compared to modular (RI-only and DI-only) strategies by considering four standard instrument sets (examination, simple extraction, surgical extraction, restoration) and the annual use of instruments in the organization at large. The use of resources (water, electricity) and emissions (waste) were quantified for each strategy. The robustness of findings was explored across a range of scenarios that involved varying instrument prices, lifespans, factors impacting on the cost of reprocessing (labour, water, energy), the cost of waste disposal and couriering. RESULTS At the organization level, the current mix of instruments (A$1.28 m per year) was 4% more costly than the lower cost, RI-only alternative (A$1.23 m). However, with lower DI prices or higher labour costs current practice would become the lowest cost option. Results for specific instrument sets varied by service type. DI-only offered the lowest cost option for oral examinations (A$6.29), and the current practice of mixed instrumentation for simple extractions (A$16.56). RI-only sets were less costly in more resource intensive procedures such as surgical extractions (A$40.19) and restorations (A$43.83). In terms of environmental impacts, the use of instruments based on current practice required 37% of water and energy use of an RI-only alternative and generated 36% waste of the DI-only alternative. CONCLUSIONS Reusable instruments are generally less costly than DIs, but for specific instrument sets the outcome depends on the type of procedure. In some circumstances, mixed instrumentation can provide the lowest cost alternative. While the WMOHS instrument mix used in current practice does not minimize cost for the provider, it may be justified in light of operational risks, logistics and uncertainty regarding cost factors.
Collapse
Affiliation(s)
- P Marcin Sowa
- Centre for the Business and Economics of Health, The University of Queensland, St Lucia, Queensland, Australia
| | - Jonas Fooken
- Centre for the Business and Economics of Health, The University of Queensland, St Lucia, Queensland, Australia
| | - Kelly McGowan
- Oral Health Service, West Moreton Health, Ipswich, Queensland, Australia
- School of Dentistry, The University of Queensland, Herston, Queensland, Australia
| | - Stephen Birch
- Centre for the Business and Economics of Health, The University of Queensland, St Lucia, Queensland, Australia
- Centre for Health Economics, The University of Manchester, Manchester, UK
| |
Collapse
|
8
|
Farid Mojtahedi M, Sepidarkish M, Almukhtar M, Eslami Y, Mohammadianamiri F, Behzad Moghadam K, Rouholamin S, Razavi M, Jafari Tadi M, Fazlollahpour-Naghibi A, Rostami Z, Rostami A, Rezaeinejad M. Global incidence of surgical site infections following caesarean section: a systematic review and meta-analysis. J Hosp Infect 2023; 139:82-92. [PMID: 37308061 DOI: 10.1016/j.jhin.2023.05.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 05/27/2023] [Accepted: 05/30/2023] [Indexed: 06/14/2023]
Abstract
BACKGROUND Surgical site infection (SSI) is a health-threatening complication following caesarean section (CS); however, to the authors' knowledge, there is no worldwide estimate of the burden of post-CS SSIs. Therefore, this systematic review and meta-analysis aimed to estimate the global and regional incidence of post-CS SSIs and associated factors. METHODS International scientific databases were searched systematically for observational studies published from January 2000 to March 2023, without language or geographical restrictions. The pooled global incidence rate was estimated using a random-effects meta-analysis (REM), and then stratified by World-Health-Organization-defined regions as well as by sociodemographic and study characteristics. Causative pathogens and associated risk factors of SSIs were also analysed using REM. Heterogeneity was assessed with I2. RESULTS In total, 180 eligible studies (207 datasets) involving 2,188,242 participants from 58 countries were included in this review. The pooled global incidence of post-CS SSIs was 5.63% [95% confidence interval (CI) 5.18-6.11%]. The highest and lowest incidence rates for post-CS SSIs were estimated for the African (11.91%, 95% CI 9.67-14.34%) and North American (3.87%, 95% CI 3.02-4.83%) regions, respectively. The incidence was significantly higher in countries with lower income and human development index levels. The pooled incidence estimates have increased steadily over time, with the highest incidence rate during the coronavirus disease 2019 pandemic (2019-2023). Staphylococcus aureus and Escherichia coli were the most prevalent pathogens. Several risk factors were identified. CONCLUSION An increasing and substantial burden from post-CS SSIs was identified, especially in low-income countries. Further research, greater awareness and the development of effective prevention and management strategies are warranted to reduce post-CS SSIs.
Collapse
Affiliation(s)
- M Farid Mojtahedi
- Department of Obstetrics and Gynaecology, Arash Women's Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - M Sepidarkish
- Department of Biostatistics and Epidemiology, School of Public Health, Babol University of Medical Sciences, Babol, Iran
| | | | - Y Eslami
- Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - F Mohammadianamiri
- Infectious Diseases and Tropical Medicine Research Centre, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | | | - S Rouholamin
- Department of Obstetrics and Gynaecology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - M Razavi
- Department of Obstetrics and Gynaecology, School of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran
| | - M Jafari Tadi
- Department of Cell and Molecular Medicine, Rush University Medical Center, Chicago, IL, USA
| | - A Fazlollahpour-Naghibi
- Infectious Diseases and Tropical Medicine Research Centre, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Z Rostami
- Infectious Diseases and Tropical Medicine Research Centre, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - A Rostami
- Infectious Diseases and Tropical Medicine Research Centre, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - M Rezaeinejad
- Department of Obstetrics and Gynaecology, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran.
| |
Collapse
|
9
|
Rowan NJ, Kremer T, McDonnell G. A review of Spaulding's classification system for effective cleaning, disinfection and sterilization of reusable medical devices: Viewed through a modern-day lens that will inform and enable future sustainability. THE SCIENCE OF THE TOTAL ENVIRONMENT 2023; 878:162976. [PMID: 36963674 DOI: 10.1016/j.scitotenv.2023.162976] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Revised: 02/23/2023] [Accepted: 03/17/2023] [Indexed: 05/13/2023]
Abstract
Despite advances in medicine and innovations in many underpinning fields including disease prevention and control, the Spaulding classification system, originally proposed in 1957, remains widely used for defining the disinfection and sterilization of contaminated re-usable medical devices and surgical instruments. Screening PubMed and Scopus databases using a PRISMA guiding framework generated 272 relevant publications that were used in this review. Findings revealed that there is a need to evolve how medical devices are designed, and processed by cleaning, disinfection (and/or sterilization) to mitigate patient risks, including acquiring an infection. This Spaulding Classification remains in use as it is logical, easily applied and understood by users (microbiologists, epidemiologists, manufacturers, industry) and by regulators. However, substantial changes have occurred over the past 65 years that challenge interpretation and application of this system that includes inter alia emergence of new pathogens (viruses, mycobacteria, protozoa, fungi), a greater understanding of innate and adaptive microbial tolerance to disinfection, toxicity risks, increased number of vulnerable patients and associated patient procedures, and greater complexity in design and use of medical devices. Common cited examples include endoscopes that enable non- or minimal invasive procedures but are highly sophisticated with various types of materials (polymers, electronic components etc), long narrow channels, right angle and heat-sensitive components and various accessories (e.g., values) that can be contaminated with high levels of microbial bioburden and patient tissues after use. Contaminated flexible duodenoscopes have been a source of several significant infection outbreaks, where at least 9 reported cases were caused by multidrug resistant organisms [MDROs] with no obvious breach in processing detected. Despite this, there is evidence of the lack of attention to cleaning and maintenance of these devices and associated equipment. Over the last few decades there is increasing genomic evidence of innate and adaptive resistance to chemical disinfectant methods along with adaptive tolerance to environmental stresses. To reduce these risks, it has been proposed to elevate classification of higher-risk flexible endoscopes (such as duodenoscopes) from semi-critical [contact with mucous membrane and intact skin] to critical use [contact with sterile tissue and blood] that entails a transition to using low-temperature sterilization modalities instead of routinely using high-level disinfection; thus, increasing the margin of safety for endoscope processing. This timely review addresses important issues surrounding use of the Spaulding classification system to meet modern-day needs. It specifically addresses the need for automated, robust cleaning and drying methods combined with using real-time monitoring of device processing. There is a need to understand entire end-to-end processing of devices instead of adopting silo approaches that in the future will be informed by artificial intelligence and deep-learning/machine learning. For example, combinational solutions that address the formation of complex biofilms that harbour pathogenic and opportunistic microorganisms on the surfaces of processed devices. Emerging trends are addressed including future sustainability for the medical devices sector that can be enabled via a new Quintuple Helix Hub approach that combines academia, industry, healthcare, regulators, and society to unlock real world solutions.
Collapse
Affiliation(s)
- N J Rowan
- Centre for Sustainable Disinfection and Sterilization, Bioscience Research Institute, Technological University of the Shannon Midlands Midwest, Athlone Campus, Ireland; Department of Nursing and Healthcare, Technological University of the Shannon Midwest Mideast, Athlone Campus, Ireland; SFI-funded CURAM Centre for Medical Device Research, University of Galway, Ireland.
| | - T Kremer
- Centre for Sustainable Disinfection and Sterilization, Bioscience Research Institute, Technological University of the Shannon Midlands Midwest, Athlone Campus, Ireland; Microbiological Quality & Sterility Assurance, Johnson & Johnson, 1000 Route 202, South Raritan, NJ 08869, USA
| | - G McDonnell
- Microbiological Quality & Sterility Assurance, Johnson & Johnson, 1000 Route 202, South Raritan, NJ 08869, USA
| |
Collapse
|
10
|
Dreikausen L, Blender B, Trifunovic-Koenig M, Salm F, Bushuven S, Gerber B, Henke M. Analysis of microbial contamination during use and reprocessing of surgical instruments and sterile packaging systems. PLoS One 2023; 18:e0280595. [PMID: 36668667 PMCID: PMC9858816 DOI: 10.1371/journal.pone.0280595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 01/03/2023] [Indexed: 01/21/2023] Open
Abstract
A surgical site infection (SSI) is one of the most common surgical complications. This study analyzed different sources of microorganisms in the air, on reusable surgical instruments, and the outer surface of sterile packaging systems during the use and reprocessing of sterile goods (from the operating room (OR) to the Central Sterile Supply Department (CSSD)). The microbial load in the air was analyzed via active air sampling and settle plates. Furthermore, the airborne particle load was measured by a particle counter. Contact agar plates were used to determine the microbial load on surgical instruments and sterile packaging systems. The highest average microbial and particle load was measured in the air of the OR (active air sampling: max. 56 CFU/m3; settle plates: max. 9 CFU; ≥0.3 μm particles in size: 1,958,403 no./m3). However, no microbial load (0 CFU) was detected on surgical instruments sampled in the OR. The outer surface of stored sterile packaging systems showed a maximal microbial load of 64 CFU. The most common identified pathogen was coagulase-negative staphylococci. Compared to properly reprocessed reusable surgical instruments and sterile packaging systems, the air still seems to be the primary potential source of microbial contamination, especially within the OR.
Collapse
Affiliation(s)
- Lena Dreikausen
- Front End Innovation & Materials (FEIM), Aesculap AG, Tuttlingen, Germany
| | - Bernd Blender
- Front End Innovation & Materials (FEIM), Aesculap AG, Tuttlingen, Germany
| | - Milena Trifunovic-Koenig
- Institute for Infection Control and Infection Prevention, Health Care Association District of Constance, Konstanz, Germany
| | - Florian Salm
- Institute for Infection Control and Infection Prevention, Health Care Association District of Constance, Konstanz, Germany
| | - Stefan Bushuven
- Institute for Infection Control and Infection Prevention, Health Care Association District of Constance, Konstanz, Germany
| | - Bianka Gerber
- Institute for Anesthesiology, Intensive Care, Emergency Medicine and Pain Therapy, Hegau Bodensee Hospital Singen, Singen, Germany
| | - Matthias Henke
- Front End Innovation & Materials (FEIM), Aesculap AG, Tuttlingen, Germany
| |
Collapse
|
11
|
Avaliação do desempenho de detergentes para limpeza: validação de uma proposta. ACTA PAUL ENFERM 2023. [DOI: 10.37689/acta-ape/2023ao00301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
|
12
|
Owusu E, Asane FW, Bediako-Bowan AA, Afutu E. Bacterial Contamination of Surgical Instruments Used at the Surgery Department of a Major Teaching Hospital in a Resource-Limited Country: An Observational Study. Diseases 2022; 10:81. [PMID: 36278580 PMCID: PMC9589928 DOI: 10.3390/diseases10040081] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 09/25/2022] [Accepted: 09/30/2022] [Indexed: 11/20/2022] Open
Abstract
Surgical instruments, be they disposable or reusable, are essential in any surgical procedure. Reusable surgical instruments should be properly sterilized or disinfected before use. However, the protocols are not always followed accordingly. This results in sterilization and disinfection failures, leading to a possible increase in the incidence of surgical site infections. This observational study report on bacterial contaminants identified instruments used for surgical procedures in a major teaching hospital in a resource-limited country. In total, 207 pre-sterilized surgical instruments and instrument parts used at three units-the general surgical theater, and the gastrointestinal (GI) endoscopy and urology endoscopy (uro-endoscopy) units-within the surgical department were randomly sampled and examined for bacterial contamination. Bacteria isolates were identified, and their antimicrobial susceptibility patterns were determined. Bacteria isolates that were identified included Citrobacter spp., Citrobacter freundii, Bacillus cereus, Staphylococcus hominis, and Staphylococcus aureus. Bacillus cereus was the most predominant bacteria isolated (30/61, 49.1%), and Staphylococcus hominis the least (1/61, 1.6%). In terms of the number of isolates from the three units examined, the uro-endoscopy unit recorded the highest followed by the general surgical theater and the GI endoscopy. However, there was no association between the various units and bacteria isolated, and no significant difference between the number of isolates among the various units (p = 0.9467, χ2 = 0.1095). In this study, even though CFU per device or device part counted was less than 20, bacteria isolated from the instruments used for a surgical procedure is of great concern considering that the setting of the study is a major teaching hospital. Multi-drug resistance was observed in almost all the isolated bacteria. Sterilization processes should be strictly adhered to, taking into consideration the length and temperature in order to reduce the risk of using contaminated instruments in these environments. It is therefore recommended that similar studies should be carried out in surgical departments at different levels of hospitals to ascertain the extent of this problem.
Collapse
Affiliation(s)
- Enid Owusu
- Department of Medical Laboratory Sciences, School of Biomedical and Allied Health Sciences, University of Ghana, Accra 233, Ghana
| | - Francis W. Asane
- Department of Medical Laboratory Sciences, School of Biomedical and Allied Health Sciences, University of Ghana, Accra 233, Ghana
| | - Antoinette A. Bediako-Bowan
- Department of Surgery, University of Ghana Medical School, University of Ghana, Accra 233, Ghana
- Department of Surgery, Korle Bu Teaching Hospital, Accra 233, Ghana
| | - Emmanuel Afutu
- Department of Medical Microbiology, School of Biomedical and Allied Health Sciences, University of Ghana, Accra 233, Ghana
| |
Collapse
|
13
|
Muacevic A, Adler JR. The Impact of Sterile Instrument Set Wrapping Defects on Trauma and Orthopaedic Surgery Theatre Lists. Cureus 2022; 14:e29861. [PMID: 36337817 PMCID: PMC9628278 DOI: 10.7759/cureus.29861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/25/2022] [Indexed: 01/24/2023] Open
Abstract
Introduction Surgical site infections (SSIs) are a universally dreaded complication of any surgical procedure. The goal of this single-center study was to examine the issue of orthopaedic instrument wrapping defects with a focus on the importance of a high level of surveillance to enable identification of these defects in order to reduce the risk of instrument contamination. We also evaluated the impact on patient care, theatre staff, hospital finances and resource utilization during a defined study period in order to stimulate critical discussion and further research into potentially eliminating this problem via change in practice and advances in technology. To the best of our knowledge, this will be the first paper that looks at this problem from the above perspective within the United Kingdom National Health Service. Methods We conducted a prospective service evaluation project over a 30-week period from December 2021 to July 2022 across our three hospital sites within the United Kingdom National Health Service. We collated data on defects found in orthopaedic instrument wrappings as detected by visual inspection under ambient or theater lighting and the resulting surgical case cancellations. Defect types included in the study were all puncture holes, abrasions or tears visible to the naked eye irrespective of their size. Results A total of 601 orthopaedic sets were rejected during the study period due to defects identified in the sterile instrument wrappings. Of these, 437 were due to holes/tears in the wrapping, 129 were due to wet inner wrappings and 35 were due to insecure wrappings. This directly resulted in same-day cancellation of 13 surgical cases or 0.27% of booked cases with extra sets required for the other affected cases. These 13 cases could not proceed as they involved loan kits where no remedial action could be taken. Remedial action was required for the other 588 operation list cases affected by the sterile wrapping defects. The majority of the identified defects and resulting theatre case cancellations (61.5%) were in hip and knee arthroplasty surgery. The calculated potential financial loss due to these problems was £145,000 over the seven-month study period. This financial cost is equivalent to the best practice top-up tariff in England for treating approximately 108 hip fracture patients based on £1,335 per patient. Conclusion Our study identified defects in the sterile instrument wrappings affecting both the inner with or without involving the outer wrapping layer and resulting in cancellation of elective and trauma orthopaedic cases with resultant clinical and financial implications. There is a need to be more vigilant in identifying defects in drapes. Further research is warranted to improve ways of identifying defects in sterile wrappings and devise new protective mechanisms during sterilisation that can eliminate the use of sterile instrument wrappings.
Collapse
|
14
|
Wellington IJ, Schneider TJ, Hawthorne BC, McCarthy MB, Stelzer JW, Connors JP, Dorsey C, Williams V, Lindsay A, Solovyova O. Prevalence of Bacterial Burden on Macroscopic Contaminants of Orthopaedic Surgical Instruments Following Sterilization. J Hosp Infect 2022; 130:52-55. [PMID: 36087803 DOI: 10.1016/j.jhin.2022.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Revised: 08/23/2022] [Accepted: 08/30/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Macroscopic contamination of orthopaedic instruments with particulates, including cortical bone and polymethyl methacrylate (PMMA) cement, having previously undergone preoperative sterilization, is frequently encountered peri- or intraoperatively, calling into question the sterility of such instruments. AIM The purpose of this study is to determine if macroscopic contaminants of orthopaedic surgical instrumentation maintain a bacterial burden following sterile processing. Additionally, this manuscript looks to determine the most commonly contaminated instruments and what the most common contaminants are. METHODS At a single tertiary referral centre, we prospectively collected available macroscopic contaminants in orthopaedic instrument trays over a six month period from August 2021 to May 2022. When identified, these specimens were swabbed and plated on sheep blood agar. All specimens were incubated at 37°C for 14 days, and visually inspected for colony formation. When bacterial colony formation was identified, samples were sent for species identification. RESULTS A total of 33 contaminants were tested, with only one contaminant growing bacterial colonies which was found to be Corynebacterium. The items most commonly found to have macroscopic contamination were surgical trays (9) and cannulated drills. The identifiable contaminants were bone (10), PMMA bone cement (4), and hair (4). There were 11 macroscopic contaminants that were not identifiable. CONCLUSION This study found that 97% of macroscopic orthopaedic surgical instrument contaminants that underwent sterile processing did not possess a bacterial burden. Contaminants discovered during a procedure are likely to be sterile and do not pose a substantially increased risk of infection to a patient.
Collapse
Affiliation(s)
- Ian J Wellington
- University of Connecticut Department of Orthopedics, 120 Dowling Way, Farmington, CT, 06032.
| | - Thomas J Schneider
- University of Connecticut Department of Orthopedics, 120 Dowling Way, Farmington, CT, 06032
| | - Benjamin C Hawthorne
- University of Connecticut Department of Orthopedics, 120 Dowling Way, Farmington, CT, 06032
| | - Mary Beth McCarthy
- University of Connecticut Department of Orthopedics, 120 Dowling Way, Farmington, CT, 06032
| | - John W Stelzer
- University of Connecticut Department of Orthopedics, 120 Dowling Way, Farmington, CT, 06032
| | - John P Connors
- University of Connecticut Department of Orthopedics, 120 Dowling Way, Farmington, CT, 06032
| | - Caitlin Dorsey
- University of Connecticut Department of Orthopedics, 120 Dowling Way, Farmington, CT, 06032
| | - Vincent Williams
- University of Connecticut Department of Orthopedics, 120 Dowling Way, Farmington, CT, 06032
| | - Adam Lindsay
- University of Connecticut Department of Orthopedics, 120 Dowling Way, Farmington, CT, 06032
| | - Olga Solovyova
- University of Connecticut Department of Orthopedics, 120 Dowling Way, Farmington, CT, 06032
| |
Collapse
|
15
|
Park J, Popovic MM, Balas M, El-Defrawy SR, Alaei R, Kertes PJ. Clinical features of endophthalmitis clusters after cataract surgery and practical recommendations to mitigate risk: systematic review. J Cataract Refract Surg 2022; 48:100-112. [PMID: 34538777 DOI: 10.1097/j.jcrs.0000000000000756] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 06/20/2021] [Indexed: 11/26/2022]
Abstract
Intraocular transmission of exogenous pathogens in cataract surgery can lead to endophthalmitis. This review evaluates the features of endophthalmitis clusters secondary to pathogen transmission in cataract surgery. Articles reporting on pathogen transmission in cataract surgery were identified via searches of Ovid MEDLINE, EMBASE, and Cochrane CENTRAL, and a total of 268 eyes from 24 studies were included. The most common source of infectious transmission was attributed to a contaminated intraocular solution (ie, irrigation solution, viscoelastic, or diluted antibiotic; n = 10). Visual acuity at presentation with infectious features was 1.89 logMAR (range: 1.35 to 2.58; ∼counting fingers) and 1.33 logMAR (range: 0.04 to 3.00; Snellen: ∼20/430) at last follow-up. Patients with diabetes had worse outcomes compared with patients without diabetes. The most frequently isolated pathogen from the infectious sources was Pseudomonas sp. (50.0%). This review highlights the various routes of pathogen transmission during cataract surgery and summarizes recommendations for the detection, prevention, and management of endophthalmitis clusters.
Collapse
Affiliation(s)
- Jeff Park
- From the Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada (Park, Balas); Department of Ophthalmology & Vision Sciences, University of Toronto, Toronto, Ontario, Canada (Popovic, El-Defrawy, Kertes); Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada (Alaei); Kensington Eye Institute, Toronto, Ontario, Canada (El-Defrawy); John and Liz Tory Eye Centre, Sunnybrook Health Sciences Centre, Toronto, Canada (Kertes)
| | | | | | | | | | | |
Collapse
|
16
|
Zaman SU, Sadia I, Yasmin N, Islam KN, Rahman MM, Haq A, Mou TJ, Azmuda N, Haque M, Adnan N. Application of Rapid Biological Indicators Coupled With Auto-Reader for the Quality Assurance of Surgical Instruments After Sterilization at a Cardiac Hospital in Bangladesh. Cureus 2021; 13:e19428. [PMID: 34926019 PMCID: PMC8654048 DOI: 10.7759/cureus.19428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/10/2021] [Indexed: 12/02/2022] Open
Abstract
Background Sterilization failure is one of the main reasons for surgical site infections (SSIs). The biological indicator (BI) test is the most reliable test to check sterilization efficiencies. But 48 hours BI test result makes the monitoring process time-consuming. Rapid BI testing can be time demanding in this regard. Therefore, the objective is to determine the importance of rapid BI monitoring for the quality assurance of sterile surgical instruments. Methods This study was conducted in the Labaid Cardiac Hospital, Bangladesh from April 1, 2021, to July 8, 2021. A total of 100 steam and 100 ethylene oxide (EO) rapid BIs and an auto reader incubator were used to conduct this research. Quick BI of steam and EO were used once per day and tested by the auto reader. Later, all the tested BIs were incubated for 48 hours by a conventional incubator to confirm the auto reader's rapid BI test results. Result All the EO BI results were found negative, but the BI was found positive twice in steam sterilization. Surgical items of those two loads were re-sterilized. Again, after checking the BI result, the items were released. All BIs except positive steam rapid BIs were found with no growth after 48 hours of incubation for cross-checking of auto reader results. In positive rapid BI of steam, growth was found after 48 hours of incubation. Conclusion When sterilization failure occurred, process recall could not be possible at that time if rapid BI tests were not performed. So, integration of a rapid BI test with an auto reader can save the patient from critical SSI.
Collapse
Affiliation(s)
- Sifat U Zaman
- Department of Microbiology, Jahangirnagar University, Dhaka, BGD
- Division of Infection Prevention and Control, Medlife Healthcare Limited, Dhaka, BGD
| | - Israt Sadia
- Department of Infection Control, Labaid Cardiac Hospital, Dhaka, BGD
| | - Nawzia Yasmin
- Department of Public Health, State University of Bangladesh, Dhaka, BGD
| | | | | | - Ahsanul Haq
- Department of Statistics, Gonoshasthaya-RNA Molecular Diagnostic & Research Center, Dhaka, BGD
| | - Taslin Jahan Mou
- Department of Microbiology, Jahangirnagar University, Dhaka, BGD
| | - Nafisa Azmuda
- Department of Microbiology, Jahangirnagar University, Dhaka, BGD
| | - Mainul Haque
- Department of Pharmacology and Therapeutics, National Defence University of Malaysia, Kuala Lumpur, MYS
| | - Nihad Adnan
- Department of Microbiology, Jahangirnagar University, Dhaka, BGD
| |
Collapse
|
17
|
Momenzadeh K, Williams C, Czerwonka N, Kwon JY, Nazarian A, Miller CP. Contamination of the Mini C-Arm During Foot and Ankle Surgery. Foot Ankle Int 2021; 42:994-1001. [PMID: 33787360 DOI: 10.1177/10711007211001032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Many orthopedic surgeries utilize intraoperative fluoroscopy. The mini C-arm is an advantageous device as it can be easily used without the need for a dedicated radiology technician. However, there are concerns that the mini C-arm may represent a potential source of contamination and subsequent postoperative infection. Previous investigations of standard C-arm drapes have shown high rates of contamination. Similar contamination rates would be even more concerning for the mini C-arm as it requires physically maneuvering the machine. This study aimed to determine the rate of mini C-arm drape contamination and identify high-risk areas. METHODS Fifty foot and ankle surgeries requiring the use of mini C-arm fluoroscopy were included. Eight locations on the mini C-arm drape were sampled at the conclusion of each procedure. Culture Q-swabs were used for sampling defined locations. Swab samples were then assessed for bacterial growth on a 5% blood agar plate using a semiquantitative technique. RESULTS In 70% of surgical cases, contamination was observed in at least 1 location. Six of the 8 evaluated locations were found to have significantly higher contamination in comparison with their corresponding negative controls (Mann-Whitney U test, P < .05). The "outer portion of the upper arm" (location 1) exhibited bacteria growth in 26% (P < .0001) of cases. The "superior portion of the x-ray source" (location 2) exhibited growth in 30% (P < .0001) of cases. These were the highest-risk areas for contamination and were both significantly more likely to be involved than the "inferior portion of the x-ray source" and "superior portion of the beam receiver," locations 4 and 5, respectively. Fourteen percent (7/50) C-arm cases and 1.72% (1/58) Achilles tendon surgery control cases developed surgical site infection (P = .0234; OR, 9.27). CONCLUSION Bacterial contamination of the mini C-arm drape was found to be common after foot and ankle procedures. Contamination was more prevalent on the outer ring areas of the C-arm, both at the emitter and receiver. LEVEL OF EVIDENCE Level III, prospective cohort study.
Collapse
Affiliation(s)
- Kaveh Momenzadeh
- Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA.,Center for Advanced Orthopaedic Studies, Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - Caroline Williams
- Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA.,University of Miami Miller School of Medicine, Miami, FL
| | - Natalia Czerwonka
- Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - John Y Kwon
- Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - Ara Nazarian
- Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA.,Center for Advanced Orthopaedic Studies, Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA.,Department of Orthopaedic Surgery, Yerevan State Medical University, Yerevan, Armenia
| | - Christopher P Miller
- Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| |
Collapse
|
18
|
Zhou W, Ye C, Huang X, Zhang P, Zheng S, Qin L, Chen Y. Efficacy of Cleaning Methods for Ophthalmic Microscopic Instruments: A Comparison Study. AORN J 2021; 112:112-121. [PMID: 32716540 DOI: 10.1002/aorn.13105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 09/07/2019] [Accepted: 09/23/2019] [Indexed: 11/12/2022]
Abstract
The combination of silicone oil and blood is difficult to remove from ophthalmic surgical instruments during cleaning and decontamination processes. We sought to establish the most efficient cleaning procedure for this type of contaminated instrument. We uniformly contaminated microscopic instruments made of titanium alloy and stainless steel with either blood alone or blood and silicone oil. We randomly assigned each instrument to one of four types of cleaning procedures that involved combinations of water, a multi-enzyme detergent, or an alkaline detergent. After completing the designated cleaning procedure, a sterile processing technician used an adenosine triphosphate cleaning verification test to evaluate the cleaning efficacy. When cleaning blood- and silicone oil-contaminated titanium-alloy and stainless-steel instruments, the alkaline detergent immersion followed by a multi-enzyme detergent ultrasonic cleaning yielded the highest cleaning effectiveness score (92.5%), which indicates this was the most effective of the four cleaning procedures that we tested.
Collapse
|
19
|
Evangelista SDS, Santos SGD, Oliveira ACD. Impact of the contamination time by Escherichia coli on biofilm formation in surgical instruments. Rev Bras Enferm 2021; 74:e20200759. [PMID: 34287490 DOI: 10.1590/0034-7167-2020-0759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 11/16/2020] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES to evaluate the microbial load and adherence of Escherichia coli in different areas of the surgical instrument surface exposed to experimental contamination over time. METHODS experimental study in which fragments of crile forceps (serrated, rod and rack) were contaminated by immersion in Tryptic Soy Broth, containing 106 CFU/mL of E. coli, for 1, 2, 4, 6, 8, 12 and 24 hours. Microbial load and bacterial adherence were evaluated using microbiological culture and scanning electron microscopy, respectively. RESULTS there was an increase in the microbial load on the surgical instrument, proportional to the contamination interval, ranging from 102 after 1 hour to 105 CFU/cm2 in 24 hours. The presence of exopolysaccharide was detected after two hours of contamination. CONCLUSIONS microbial load and adhesion of E. coli increased over time, reaching 105 CFU/cm2 after 24 hours of contamination, starting biofilm formation after two hours.
Collapse
|
20
|
Carroll AM, Kim KG, Walters ET, Phillips BK, Singh B, Dekker PK, Steinberg JS, Attinger CE, Kim PJ, Evans KK. Glove and instrument changing to prevent bacterial contamination in infected wound debridement and closure procedures: A prospective observational study. Int Wound J 2021; 18:664-669. [PMID: 33955150 PMCID: PMC8450785 DOI: 10.1111/iwj.13568] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 01/29/2021] [Accepted: 01/31/2021] [Indexed: 11/28/2022] Open
Abstract
Many surgeons use a single table of instruments for both excisional debridement and coverage/closure of infected wounds. This study investigates the effectiveness of a two-table set-up of sterile instruments, in addition to glove exchange, to reduce instrument cross-contamination during these procedures. This is a prospective, single-site, institutional review board-approved observational study of surgical debridements of infected wounds over a 17-month period. Two separate sterile surgical tables were used for each case: Table A for initial wound debridement (debridement set-up) and Table B for wound coverage/closure (clean set-up). Swabs of each table and its respective instruments were taken after debridement but prior to coverage/closure. The primary outcome of interest was bacterial growth at 48 hours. There were 72 surgical cases included in this study. Culture results of Table A demonstrated bacterial growth in 23 of 72 (32%) cases at 48 hours compared with 5of 72 (7%) from Table B (P = .001). These data suggest that there is significant bacterial contamination of surgical instruments used for debridement of infected wounds. Use of a two-table set-up reduced instrument cross-contamination by 78%, suggesting avoidable re-contamination of the wound.
Collapse
Affiliation(s)
| | - Kevin G Kim
- Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, Washington, District of Columbia, USA
| | - Elliot T Walters
- Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, Washington, District of Columbia, USA
| | - Brian K Phillips
- Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, Washington, District of Columbia, USA
| | - Brinder Singh
- MedStar Georgetown University Hospital, Washington, District of Columbia, USA
| | - Paige K Dekker
- Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, Washington, District of Columbia, USA
| | - John S Steinberg
- Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, Washington, District of Columbia, USA
| | - Christopher E Attinger
- Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, Washington, District of Columbia, USA
| | - Paul J Kim
- Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, Washington, District of Columbia, USA
| | - Karen K Evans
- Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, Washington, District of Columbia, USA
| |
Collapse
|
21
|
Abstract
The instrumentation used in ophthalmic clinics can be a source of epidemics in health care set up. Contact tonometry with Schiotz or Applanation tonometer is associated with nosocomial epidemic keratoconjunctivitis outbreaks. Recently identified SARS-CoV-2 (COVID -19) spreads mainly via the respiratory route and fomites and can transmit through other body fluids, including tear film. Various ophthalmic instruments can become a common source of spreading cross infections. Chemical disinfection is one of the most common methods employed to decontaminate instruments and environmental surfaces and prevent transmission of infectious pathogens to patients through medical and surgical instruments. Various chemical disinfectants are available with a varied spectrum to work on a different group of organisms. In this article, we briefly cover commonly used chemical disinfectants in ophthalmic practice like Alcohol (Ethyl Alcohol, Isopropyl Alcohol), Chlorine-based solution (mainly Sodium Hypochlorite), Glutaraldehyde, Hydrogen Peroxide, Formaldehyde, Iodophors, and Quaternary Ammonium Compounds
Collapse
Affiliation(s)
- Shefali R Parikh
- Consultant, Shreeji Eye Clinic and Palak's Glaucoma Care Centre, Mumbai, Maharashtra, India
| | - Rajul S Parikh
- Consultant, Shreeji Eye Clinic and Palak's Glaucoma Care Centre, Mumbai, Maharashtra, India
| |
Collapse
|
22
|
Ali KM, Al-Jaff BM. Source and antibiotic susceptibility of gram-negative bacteria causing superficial incisional surgical site infections. INTERNATIONAL JOURNAL OF SURGERY OPEN 2021. [DOI: 10.1016/j.ijso.2021.01.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
|
23
|
Skowronek P, Wojciechowski A, Wypniewski K, Sibiński M, Polguj M, Maksymiuk-Kłos A, Piątkiewicz P. Time efficiency of direct anterior hip arthroplasty compared to postero-lateral approach in elderly patients. Arch Med Sci 2021; 17:106-112. [PMID: 33488862 PMCID: PMC7811311 DOI: 10.5114/aoms/86185] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 04/06/2018] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Primary arthroplasty of the hip joint is currently one of the most commonly performed procedures in orthopedics. In Poland we are observing significant changes in the age structure. With the prolonged life more and more elderly patients require musculoskeletal surgery to maintain comfortable and painless mobility. Reducing the duration of the procedure reduces the costs of anesthesiology, surgical and instrument teams, as well as the operating room technical team. The aim of the study was to compare the time required to perform hip joint arthroplasty by the direct anterior approach (DAA) with the postero-lateral approach (PLA) in our hospital. MATERIAL AND METHODS A retrospective analysis of 559 total and bipolar cemented and cementless hip replacement procedures based on two operative approaches - the minimally invasive DAA over the course of 2 years, and the standard PLA over the course of 3 years - was performed. RESULTS Statistically significant differences were observed between the approaches used for cementless total arthroplasty with regard to the mean treatment times: 51.9 min for the 272 DAA cases, and 78.3 min for the 190 PLA cases (p < 0.0001). For the cementless hemi-arthroplasty procedure, the mean treatment times were 46.9 min in 36 patients for DAA, and 48.2 min for 61 patients for PLA (p = 0.57). CONCLUSIONS Minimally invasive DAA significantly shortens the time of the procedure in elderly patients compared to PLA. Further study is needed to analyze other aspects of those two approaches.
Collapse
Affiliation(s)
- Paweł Skowronek
- Clinic of Orthopaedics and Traumatology WSZZ Kielce, Jan Kochanowski University, Kielce, Poland
| | - Artur Wojciechowski
- St. George’s University Hospitals NHS Foundation Trust, Radiology Department, Blackshaw Road Tooting, United Kingdom
| | - Krzysztof Wypniewski
- Clinic of Orthopaedics and Traumatology WSZZ Kielce, Jan Kochanowski University, Kielce, Poland
| | - Marcin Sibiński
- Clinic of Orthopaedics and Paediatric Orthopaedics, Medical University of Lodz, Lodz, Poland
| | - Michał Polguj
- Department of Angiology, Medical University of Lodz, Lodz, Poland
| | - Agnieszka Maksymiuk-Kłos
- Department of Internal Diseases, Diabetology and Endocrinology, Medical University of Warsaw, Warsaw, Poland
| | - Paweł Piątkiewicz
- Department of Internal Diseases, Diabetology and Endocrinology, Medical University of Warsaw, Warsaw, Poland
- Medical Department, Collegium Medicum, Cardinal Stefan Wyszynski University, Warsaw, Poland
| |
Collapse
|
24
|
Bocchi MB, Cianni L, Perna A, Vitiello R, Greco T, Maccauro G, Perisano C. A rare case of Bacillus megaterium soft tissues infection. ACTA BIO-MEDICA : ATENEI PARMENSIS 2020; 91:e2020013. [PMID: 33559642 PMCID: PMC7944702 DOI: 10.23750/abm.v91i14-s.10849] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Accepted: 11/23/2020] [Indexed: 12/20/2022]
Abstract
Background and aim of the work: To report the history and clinical presentation of a 60-year-old male who developed a rare soft tissue infection of the right leg caused by Bacillus megaterium and to perform a Literature review focusing on clinical manifestations and diagnostic difficulties of the aforementioned bacterium. Methods: Medical history and clinical presentation suggested the infectious etiology, which led to the surgical procedure of fistulectomy and to further histological and microbiological investigations with bacterial cultures. Results: The histological report tested negative for osteomyelitis. Bacterial cultures revealed Bacillus megaterium, which was sensitive to all antibiotics against which it was tested. The oral antibiotic therapy was set for 12 days with benefits. The patient has always been apyretic, inflammation indexes and white cells count have been within normal limits. Conclusions: This was a rare case of soft tissue infection caused by Bacillus megaterium known to be a “non-pathogenic” bacterium. The infection was likely acquired by the penetration through the injury wound. The combination of surgical and antibiotic therapy lead to complete skin healing and infection resolution at the 6-months follow up.
Collapse
Affiliation(s)
| | - Luigi Cianni
- Fondazione Policlinico Universitario Agostino Gemelli IRCSS, Rome.
| | - Andrea Perna
- Fondazione Policlinico Universitario Agostino Gemelli IRCSS, Rome.
| | | | - Tommaso Greco
- Fondazione Policlinico Universitario Agostino Gemelli IRCSS, Rome.
| | - Giulio Maccauro
- Fondazione Policlinico Universitario Agostino Gemelli IRCSS, Rome.
| | - Carlo Perisano
- Fondazione Policlinico Universitario Agostino Gemelli IRCSS, Rome.
| |
Collapse
|
25
|
Alfred M, Catchpole K, Huffer E, Fredendall L, Taaffe KM. Work systems analysis of sterile processing: assembly. BMJ Qual Saf 2020; 30:271-282. [PMID: 33077512 DOI: 10.1136/bmjqs-2019-010740] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 08/31/2020] [Accepted: 09/17/2020] [Indexed: 11/04/2022]
Abstract
BACKGROUND Sterile processing departments (SPDs) play a crucial role in surgical safety and efficiency. SPDs clean instruments to remove contaminants (decontamination), inspect and reorganise instruments into their correct trays (assembly), then sterilise and store instruments for future use (sterilisation and storage). However, broken, missing or inappropriately cleaned instruments are a frequent problem for surgical teams. These issues should be identified and corrected during the assembly phase. OBJECTIVE A work systems analysis, framed within the Systems Engineering Initiative for Patient Safety (SEIPS) model, was used to develop a comprehensive understanding of the assembly stage of reprocessing, identify the range of work challenges and uncover the inter-relationship among system components influencing reliable instrument reprocessing. METHODS The study was conducted at a 700-bed academic hospital in the Southeastern United States with two reprocessing facilities from October 2017 to October 2018. Fifty-six hours of direct observations, 36 interviews were used to iteratively develop the work systems analysis. This included the process map and task analysis developed to describe the assembly system, the abstraction hierarchy developed to identify the possible performance shaping factors (based on SEIPS) and a variance matrix developed to illustrate the relationship among the tasks, performance shaping factors, failures and outcomes. Operating room (OR) reported tray defect data from July 2016 to December 2017 were analysed to identify the percentage and types of defects across reprocessing phases the most common assembly defects. RESULTS The majority of the 3900 tray defects occurred during the assembly phase; impacting 5% of surgical cases (n=41 799). Missing instruments, which could result in OR delays and increased surgical duration, were the most commonly reported assembly defect (17.6%, n=700). High variability was observed in the reassembling of trays with failures including adding incorrect instruments, omitting instruments and failing to remove damaged instrument. These failures were precipitated by technological shortcomings, production pressures, tray composition, unstandardised instrument nomenclature and inadequate SPD staff training. CONCLUSIONS Supporting patient safety, minimising tray defects and OR delays and improving overall reliability of instrument reprocessing require a well-designed instrument tracking system, standardised nomenclature, effective coordination of reprocessing tasks between SPD and the OR and well-trained sterile processing technicians.
Collapse
Affiliation(s)
- Myrtede Alfred
- Department of Anesthesia and Perioperative Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Ken Catchpole
- Department of Anesthesia and Perioperative Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Emily Huffer
- Department of Industrial Engineering, Clemson University, Clemson, South Carolina, USA
| | - Larry Fredendall
- Department of Management, Clemson University, Clemson, South Carolina, USA
| | - Kevin M Taaffe
- Department of Industrial Engineering, Clemson University, Clemson, South Carolina, USA
| |
Collapse
|
26
|
Panta G, Richardson AK, Shaw IC, Coope PA. Compliance of primary and secondary care public hospitals with standard practices for reprocessing and steam sterilization of reusable medical devices in Nepal: findings from nation-wide multicenter clustered audits. BMC Health Serv Res 2020; 20:923. [PMID: 33028325 PMCID: PMC7542764 DOI: 10.1186/s12913-020-05788-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Accepted: 09/30/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Reusable medical devices in healthcare facilities are decontaminated and reprocessed following standard practices before each clinical procedure. Reprocessing of critical medical devices (those used for invasive clinical procedures) comprises several processes including sterilization, which provides the highest level of decontamination. Steam sterilization is the most used sterilization procedure across the globe. Noncompliance with standards addressing reprocessing of medical devices may lead to inadequate sterilization and thus increase the risk of person-to-person or environmental transmission of pathogens in healthcare facilities. We conducted nationwide multicenter clustered audits to understand the compliance of primary- and secondary-care public hospitals in Nepal with the standard practices for medical device reprocessing, including steam sterilization. METHODS We developed an audit tool to assess compliance of hospitals with the standard practices for medical device reprocessing including steam sterilization. Altogether, 189 medical device reprocessing cycles which included steam sterilization were assessed in 13 primary and secondary care public hospitals in Nepal using the audit tool. Percentage compliance was calculated for each standard practice. Mean percentage compliances were obtained for overall primary and secondary care hospitals and for each hospital type, specific hospital and process involved. RESULTS For all primary and secondary care hospitals in Nepal, the mean percentage compliance with the standard practices for medical device reprocessing including steam sterilization was 25.9% (95% CI 21.0-30.8%). The lower the level of care provided by the hospitals, the lower was the mean percentage compliance, and the difference in the means across the hospital types was statistically significant (p < 0.01). The mean percentage compliance of individual hospitals ranged from 14.7 to 46.0%. The hospitals had better compliance with the practices for cleaning of used devices and transport and storage of sterilized devices compared with the practices for other processes of the medical device reprocessing cycle. CONCLUSION The primary and secondary care hospitals in Nepal had poor compliance with the standard practices for steam sterilization and reprocessing of medical devices. Interventions to improve compliance of the hospitals are immediately required to minimize the risks of person-to-person or environmental transmission of pathogens through inadequately reprocessed medical devices.
Collapse
Affiliation(s)
| | - Ann K Richardson
- School of Health Sciences, University of Canterbury, Christchurch, New Zealand
| | - Ian C Shaw
- School of Physical and Chemical Sciences, University of Canterbury, Christchurch, New Zealand
| | - Patricia A Coope
- College of Education, Health and Human Development, University of Canterbury, Christchurch, New Zealand
| |
Collapse
|
27
|
Seeman K, Ogg MJ. Clinical Issues—July 2020. AORN J 2020; 112:73-80. [DOI: 10.1002/aorn.13090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
28
|
Du C, Wang C, Zhang T, Yi X, Liang J, Wang H. Reduced bacterial adhesion on zirconium-based bulk metallic glasses by femtosecond laser nanostructuring. Proc Inst Mech Eng H 2020; 234:387-397. [PMID: 31884888 DOI: 10.1177/0954411919898011] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
As high-performing materials, bulk metallic glasses have attracted widespread attention for biomedical applications. Herein, the bacterial adhesion properties of femtosecond laser-nanostructured surfaces of four types of zirconium-based bulk metallic glasses are assessed. Laser-induced periodical surface structures and nanoparticle structures were fabricated by femtosecond laser irradiation under different energy intensities (0.23 and 2.3 J/mm2). Surface topography, roughness, wettability, and surface energy were investigated after femtosecond laser irradiation and the surface bacterial adhesion properties were explored using Escherichia coli and Staphylococcus aureus as respective representatives of Gram-negative and Gram-positive bacteria. 4',6-Diamidino-2-phenylindole fluorescence staining was used to characterize and assess the bacterial surface coverage rate. The in vitro cytotoxicity of polished and laser-nanostructured surfaces was investigated using MC3T3-E cells. The obtained results demonstrate that femtosecond laser surface nanostructuring retained the amorphous structure of zirconium-based bulk metallic glasses and led to an obvious decrease in bacterial adhesion compared with polished surfaces. The inhibition of bacterial adhesion on laser-induced periodical surface structures was greater than on nanostructured surfaces after 24 h of bacterial incubation. In addition, femtosecond laser nanostructuring did not have an apparent effect on the cytotoxicity of zirconium-based bulk metallic glasses.
Collapse
Affiliation(s)
- Cezhi Du
- School of Electromechanical Engineering, Guangdong University of Technology, Guangzhou, China
| | - Chengyong Wang
- School of Electromechanical Engineering, Guangdong University of Technology, Guangzhou, China
| | - Tao Zhang
- School of Electromechanical Engineering, Guangdong University of Technology, Guangzhou, China
| | - Xin Yi
- School of Electromechanical Engineering, Guangdong University of Technology, Guangzhou, China
| | - Jianyi Liang
- School of Electromechanical Engineering, Guangdong University of Technology, Guangzhou, China
| | - Hongjian Wang
- School of Electromechanical Engineering, Guangdong University of Technology, Guangzhou, China
| |
Collapse
|
29
|
Rattanaprichavej P, Laoruengthana A, Galassi M, Weerakul S, Rasamimongkol S. Contamination Rate of Burnt Necrotic Tissue after Electrocoagulation in Total Knee Arthroplasty. Clin Orthop Surg 2020; 12:43-48. [PMID: 32117537 PMCID: PMC7031428 DOI: 10.4055/cios.2020.12.1.43] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 07/03/2019] [Indexed: 01/22/2023] Open
Abstract
Background Periprosthetic joint infection (PJI) is one of the commonly found catastrophic complications after total knee arthroplasty (TKA). Preoperative antibiotic prophylaxis, proper skin cleansing, shortened operative time, and sterility of surgical field and equipment are essential to minimize the risk of PJI. Although bacterial contamination of electrocautery tips has been reported, contamination of residual product of electrocoagulation, burnt necrotic tissue (BNT), is not well known. Therefore, we aimed to assess the contamination rate of BNT and association between contaminated BNT and PJI, and risk factors. Methods BNTs from 183 patients who had undergone unilateral primary TKA at our institution were retrospectively analyzed. In each patient, three to five specimens of BNT were routinely collected in the operative field of primary TKA. Collecting time was defined as the duration from start of using the electrocautery device to the first collection of BNT. Results Culture was positive in eight of 183 patients (4.4%; contaminated BNT group), and the most commonly isolated organism was coagulase-negative Staphylococcus (62.5%). The average operative time was 103.1 ± 44.2 minutes in the contaminated BNT group and 79.0 ± 16.7 minutes in the non-contaminated BNT group (p = 0.17), and collecting time was 48.0 ± 44.3 minutes and 29.7 ± 17.0 minutes (p = 0.28), respectively. None of the patients with contaminated BNT developed PJI, whereas four patients with culture-negative BNT developed PJI within 2 postoperative years. Conclusions BNT in surgical field can become a reservoir of contaminating bacteria. However, contamination of BNT was not associated with PJI. Therefore, routine removal of all BNTs may be unnecessary.
Collapse
Affiliation(s)
- Piti Rattanaprichavej
- Department of Orthopaedics, Faculty of Medicine, Naresuan University, Phitsanulok, Thailand
| | - Artit Laoruengthana
- Department of Orthopaedics, Faculty of Medicine, Naresuan University, Phitsanulok, Thailand
| | - Monton Galassi
- Department of Orthopaedics, Faculty of Medicine, Naresuan University, Phitsanulok, Thailand
| | - Santi Weerakul
- Department of Orthopaedics, Faculty of Medicine, Naresuan University, Phitsanulok, Thailand
| | - Supachok Rasamimongkol
- Department of Orthopaedics, Faculty of Medicine, Naresuan University, Phitsanulok, Thailand
| |
Collapse
|
30
|
Panta G, Richardson AK, Shaw IC, Chambers S, Coope PA. Effectiveness of steam sterilization of reusable medical devices in primary and secondary care public hospitals in Nepal and factors associated with ineffective sterilization: A nation-wide cross-sectional study. PLoS One 2019; 14:e0225595. [PMID: 31751421 PMCID: PMC6874085 DOI: 10.1371/journal.pone.0225595] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Accepted: 11/07/2019] [Indexed: 11/19/2022] Open
Abstract
Background Inadequate sterilization of reusable medical devices can lead to healthcare associated infections (HAIs) through person-to-person or environmental transmission of pathogens. Autoclaving (steam sterilization) is most commonly used for sterilizing medical devices in healthcare facilities. We conducted a nation-wide cross-sectional study to evaluate the effectiveness of steam sterilization practices in primary and secondary care public hospitals in Nepal and to identify factors associated with ineffective sterilization. Methods Using a stratified clustered random sampling, 13 primary- and secondary-care public hospitals in Nepal were selected. 189 steam sterilization cycles from these hospitals were evaluated for their effectiveness using self-contained biological indicators, class-5 chemical indicators, autoclave indicator tape and physical parameters. Information about the hospitals and the types of autoclaves being used was also collected. Data were analysed to estimate the proportion of ineffective steam sterilization cycles. Logistic regression was used to identify factors associated with ineffective sterilization. Findings In primary and secondary care public hospitals in Nepal, 71.0% (95% CI 46.8% - 87.2%) of the autoclave cycles were ineffective (i.e. showed positive results) when tested with biological indicators and 69.8% (95% CI 44.4% - 87.0%) showed ‘reject’ results with class 5 chemical indicators. There was no statistically significant difference in proportions showing positive or reject results by hospital types for either biological (p = 0.51) or class 5 chemical (p = 0.87) indicators. Autoclave type and pressure achieved during sterilization were statistically significantly associated with steam sterilization failures, adjusted for holding period, evenness of pressure and barrier system used. Conclusion Primary and secondary care hospitals in Nepal have a high proportion of steam sterilization failure, indicating a risk of person-to-person transmission of pathogens through reusable medical devices. There is an urgent need to improve steam sterilization processes in these hospitals.
Collapse
Affiliation(s)
- Gopal Panta
- School of Health Sciences, University of Canterbury, Christchurch, New Zealand
- * E-mail:
| | - Ann K. Richardson
- School of Health Sciences, University of Canterbury, Christchurch, New Zealand
| | - Ian C. Shaw
- School of Physical and Chemical Sciences, University of Canterbury, Christchurch, New Zealand
| | - Stephen Chambers
- Department of Pathology and Biomedical Science, University of Otago, Christchurch, New Zealand
| | - Patricia A. Coope
- College of Education, Health and Human Development, University of Canterbury, Christchurch, New Zealand
| |
Collapse
|
31
|
Hope D, Ampaire L, Oyet C, Muwanguzi E, Twizerimana H, Apecu RO. Antimicrobial resistance in pathogenic aerobic bacteria causing surgical site infections in Mbarara regional referral hospital, Southwestern Uganda. Sci Rep 2019; 9:17299. [PMID: 31754237 PMCID: PMC6872727 DOI: 10.1038/s41598-019-53712-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 11/05/2019] [Indexed: 11/09/2022] Open
Abstract
Surgical site infections (SSI) remain a common postoperative complication despite use of prophylactic antibiotics and other preventive measures, mainly due to increasing antimicrobial resistance. Here, we present antimicrobial resistance rate of bacteria isolated in clinical cases of SSI. A hospital based descriptive cross sectional study was conducted on 83 consented postoperative patients with clinical SSI. Data on patients was obtained using structured data collection form. Two swabs were collected aseptically from each patient. Bacteriological culture examination and identification was done following standard microbiological techniques. Antibiotic susceptibility test was done by Kirby-Bauer disc diffusion method. Gram negative bacteria (GNB) were predominant (65.59%) with the dominant being Klebsiella species (29.03%). Overall 86% of aerobic bacteria isolated were multidrug resistant (MDR) where 65.63% and 96.72% of Gram positive and Gram negative isolates were MDR respectively. All the isolates with exception of Enterococci species were resistant to ampicillin. GNB showed high resistance to ceftriaxone, sulfamethoxazole/trimethoprim and gentamicin. All the isolated Klebsiella spp were MDR. S. aureus were all resistant to oxacillin. The isolation rate was higher in emergency, males and dirty wounds in relation to nature of surgery, gender and class of surgical wound respectively. These findings necessitate judicious antibiotic use and calls for surveillance of SSIs periodically as well as strict adherence to good sanitation practice to reduce spread of drug-resistant pathogens.
Collapse
Affiliation(s)
- Derick Hope
- Department of Medical Microbiology, Mbarara University of Science and Technology, P.O. BOX 1410, Mbarara, Uganda.
| | - Lucas Ampaire
- Department of Medical Laboratory Sciences, Mbarara University of Science and Technology, P.O. BOX 1410, Mbarara, Uganda
| | - Caesar Oyet
- School of Allied Health, Clarke International University, P.O. BOX 7782, Kampala, Uganda
| | - Enoch Muwanguzi
- Department of Medical Laboratory Sciences, Mbarara University of Science and Technology, P.O. BOX 1410, Mbarara, Uganda
| | - Hillary Twizerimana
- Obstetrics and Gynecology Unit, Mbarara Regional Referral Hospital, P.O. BOX 40, Mbarara, Uganda
| | - Richard Onyuthi Apecu
- Department of Medical Laboratory Sciences, Mbarara University of Science and Technology, P.O. BOX 1410, Mbarara, Uganda
| |
Collapse
|
32
|
Alfred M, Catchpole K, Huffer E, Fredendall L, Taaffe KM. Work systems analysis of sterile processing: decontamination. BMJ Qual Saf 2019; 29:320-328. [PMID: 31723018 DOI: 10.1136/bmjqs-2019-009422] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 10/24/2019] [Accepted: 11/04/2019] [Indexed: 12/23/2022]
Abstract
BACKGROUND Few studies have explored the work of sterile processing departments (SPD) from a systems perspective. Effective decontamination is critical for removing organic matter and reducing microbial levels from used surgical instruments prior to disinfection or sterilisation and is delivered through a combination of human work and supporting technologies and processes. OBJECTIVE In this paper we report the results of a work systems analysis that sought to identify the complex multilevel interdependencies that create performance variation in decontamination and identify potential improvement interventions. METHODS The research was conducted at a 700-bed academic hospital with two reprocessing facilities decontaminating approximately 23 000 units each month. Mixed methods, including 56 hours of observations of work as done, formal and informal interviews with relevant stakeholders and analysis of data collected about the system, were used to iteratively develop a process map, task analysis, abstraction hierarchy and a variance matrix. RESULTS We identified 21 different performance shaping factors, 30 potential failures, 16 types of process variance, and 10 outcome variances in decontamination. Approximately 2% of trays were returned to decontamination from assembly, while decontamination problems were found in about 1% of surgical cases. Staff knowledge, production pressures, instrument design, tray composition and workstation design contributed to outcomes such as reduced throughput, tray defects, staff injuries, increased inventory and equipment costs, and patient injuries. CONCLUSIONS Ensuring patients and technicians' safety and efficient SPD operation requires improved design of instruments and the decontamination area, skilled staff, proper equipment maintenance and effective coordination of reprocessing tasks.
Collapse
Affiliation(s)
- Myrtede Alfred
- Department of Anesthesia and Perioperative Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Ken Catchpole
- Department of Anesthesia and Perioperative Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Emily Huffer
- Department of Industrial Engineering, Clemson University, Clemson, South Carolina, USA
| | - Larry Fredendall
- Department of Management, Clemson University, Clemson, South Carolina, USA
| | - Kevin M Taaffe
- Department of Industrial Engineering, Clemson University, Clemson, South Carolina, USA
| |
Collapse
|
33
|
Alfred M, Catchpole K, Huffer E, Taafe K, Fredendall L. A Work Systems Analysis of Sterile Processing: Sterilization and Case Cart Preparation. Adv Health Care Manag 2019; 18. [PMID: 32077655 DOI: 10.1108/s1474-823120190000018008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Achieving reliable instrument reprocessing requires finding the right balance among cost, productivity, and safety. However, there have been few attempts to comprehensively examine sterile processing department (SPD) work systems. We considered an SPD as an example of a socio-technical system - where people, tools, technologies, the work environment, and the organization mutually interact - and applied work systems analysis (WSA) to provide a framework for future intervention and improvement. The study was conducted at two SPD facilities at a 700-bed academic medical center servicing 56 onsite clinics, 31 operating rooms (ORs), and nine ambulatory centers. Process maps, task analyses, abstraction hierarchies, and variance matrices were developed through direct observations of reprocessing work and staff interviews and iteratively refined based on feedback from an expert group composed of eight staff from SPD, infection control, performance improvement, quality and safety, and perioperative services. Performance sampling conducted focused on specific challenges observed, interruptions during case cart preparation, and analysis of tray defect data from administrative databases. Across five main sterilization tasks (prepare load, perform double-checks, run sterilizers, place trays in cooling, and test the biological indicator), variance analysis identified 16 failures created by 21 performance shaping factors (PSFs), leading to nine different outcome variations. Case cart preparation involved three main tasks: storing trays, picking cases, and prioritizing trays. Variance analysis for case cart preparation identified 11 different failures, 16 different PSFs, and seven different outcomes. Approximately 1% of cases had a tray with a sterilization or case cart preparation defect and 13.5 interruptions per hour were noted during case cart preparation. While highly dependent upon the individual skills of the sterile processing technicians, making the sterilization process less complex and more visible, managing interruptions during case cart preparation, improving communication with the OR, and improving workspace and technology design could enhance performance in instrument reprocessing.
Collapse
|
34
|
Goldberg TD, Maltry JA, Ahuja M, Inzana JA. Logistical and Economic Advantages of Sterile-Packed, Single-Use Instruments for Total Knee Arthroplasty. J Arthroplasty 2019; 34:1876-1883.e2. [PMID: 31182409 DOI: 10.1016/j.arth.2019.03.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 02/25/2019] [Accepted: 03/04/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Total knee arthroplasty (TKA) is well established as a clinically successful and cost-effective procedure. The transition of the US healthcare system from a fee-for-service model to a value-based care model requires careful examination of patient care to ensure both quality and efficiency. Sterile-packed, single-use instruments have been introduced as a tool to help streamline the operating room (OR) logistics while reducing sterilization requirements. The aim of this study was to examine the potential logistic and economic benefits of single-use instruments compared to traditional, reusable instruments for TKA. METHODS Four variables related to TKA costs and logistics were modeled in this study: OR turnover time tray sterilization, tray management time, and 90-day infection rates. Model input data for traditional instruments and single-use instruments were based on peer-reviewed literature. A total of 200 sites and 500 cases per site were simulated using the Monte-Carlo-Technique. RESULTS The median total cost savings with single-use instruments was $994 per case. The largest driver for cost savings was tray sterilization. Sites with higher staff wages and sterilization costs had a larger probability of realizing greater cost savings with adoption of single-use instruments. In cases using single-use instruments, up to 51% of operating days could have accommodated an additional procedure due to the time savings in OR turnover. CONCLUSION This cost modeling study observed significant potential for logistical and economic improvements in TKA with single-use vs reusable instruments. Although few studies have been conducted to measure the impact of single-use instruments in practice, the results of these simulations motivate further investigation.
Collapse
Affiliation(s)
- Tyler D Goldberg
- Texas Orthopedics, Sports and Rehabilitation Associates, Austin, TX
| | | | | | | |
Collapse
|
35
|
Garcia DR, Deckey D, Haglin JM, Emanuel T, Mayfield C, Eltorai AE, Spake CS, Jarrell JD, Born CT. Commonly Encountered Skin Biome-Derived Pathogens after Orthopedic Surgery. Surg Infect (Larchmt) 2019; 20:341-350. [DOI: 10.1089/sur.2018.161] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Affiliation(s)
- Dioscaris R. Garcia
- Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - David Deckey
- Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Jack M. Haglin
- Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Toby Emanuel
- Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Cory Mayfield
- Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Adam E.M. Eltorai
- Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Carole Sl Spake
- Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - John D. Jarrell
- Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Christopher T. Born
- Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| |
Collapse
|
36
|
Brooks JV, Williams JAR, Gorbenko K. The work of sterile processing departments: An exploratory study using qualitative interviews and a quantitative process database. Am J Infect Control 2019; 47:816-821. [PMID: 30685129 DOI: 10.1016/j.ajic.2018.12.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 11/29/2018] [Accepted: 12/08/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND The sterile processing of surgical instruments and equipment is an essential part of surgical operations. Although clean instruments prevent infections, little is known about the departments that conduct this work. We sought to describe sterile processing departments (SPDs) and to identify factors impacting them. METHODS We analyzed data from 22 qualitative interviews of staff and managers and a quantitative benchmarking database. RESULTS Qualitative results indicated 4 primary factors impacting sterile processing work: (1) role and visibility, (2) relationships and communication with other departments and vendors, (3) staffing and management, and (4) technical problems and solutions. Quantitative analysis revealed significant differences in SPD responsibilities and scope. DISCUSSION Relationships with operating room staff were of paramount importance in the ability of the SPD to accomplish its job and in staff motivations and feelings. Differences in management practices, communication strategies, and problem-solving resources were also emphasized. Both quantitative and qualitative data showed concern for the role of the SPD in patient safety, particularly concerning practices such as the use of immediate-use steam sterilization. CONCLUSIONS To more completely address adverse patient events and surgical patient safety, we must move toward examining the entire surgical process, including the vital role of SPDs.
Collapse
Affiliation(s)
- Joanna Veazey Brooks
- Department of Health Policy and Management, University of Kansas School of Medicine, Kansas City, KS
| | - Jessica A R Williams
- Department of Health Policy and Management, University of Kansas School of Medicine, Kansas City, KS.
| | | |
Collapse
|
37
|
Medical instrument reprocessing: current issues with cleaning and cleaning monitoring. Am J Infect Control 2019; 47S:A10-A16. [PMID: 31146843 DOI: 10.1016/j.ajic.2019.02.029] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
The complexity of medical devices has increased over the past 10 years, and outbreaks of infections due to contaminated devices have focused attention on the need to adequately clean medical devices in order to ensure the adequacy of disinfection and sterilization. There has been a paradigm shift in reprocessing of medical devices, with increased emphasis on a quality management systems approach that requires validated cleaning instructions from manufacturers and ongoing monitoring by reprocessing personnel to ensure adequacy of cleaning. This article reviews the current issues related to medical device reprocessing and summarizes the approaches used for monitoring cleaning efficacy for surgical instruments and flexible endoscopes.
Collapse
|
38
|
Alfa MJ. Biofilms on instruments and environmental surfaces: Do they interfere with instrument reprocessing and surface disinfection? Review of the literature. Am J Infect Control 2019; 47S:A39-A45. [PMID: 31146849 DOI: 10.1016/j.ajic.2019.02.027] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
There is a growing appreciation for the role of biofilm-embedded microbes in many different aspects of infection transmission. The format of biofilm includes traditional hydrated biofilm, build-up biofilm, and dry surface biofilm. The objectives of this article are to discuss how traditional biofilm differs from build-up biofilm and dry surface biofilm, and to review the evidence supporting infection transmission from biofilm that accumulates in reprocessed instruments and from dry biofilm that forms environmental reservoirs.
Collapse
Affiliation(s)
- Michelle J Alfa
- Department of Medical Microbiology, University of Manitoba, Winnipeg, Manitoba, Canada.
| |
Collapse
|
39
|
Feurhuber M, Magno M, Miranda M, Prieler R, Hochenauer C. CFD Investigation of Non‐Condensable Gases in Vacuum and Non‐Vacuum Steam Sterilizers. CHEM-ING-TECH 2019. [DOI: 10.1002/cite.201800088] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Manuel Feurhuber
- Graz University of TechnologyInstitute of Thermal Engineering Inffeldgasse 25/B 8010 Graz Austria
| | - Marino Magno
- W&H Sterilization Via Bolgara 2 24060 Brusaporto, Bergamo Italy
| | - Marco Miranda
- W&H Sterilization Via Bolgara 2 24060 Brusaporto, Bergamo Italy
| | - René Prieler
- Graz University of TechnologyInstitute of Thermal Engineering Inffeldgasse 25/B 8010 Graz Austria
| | - Christoph Hochenauer
- Graz University of TechnologyInstitute of Thermal Engineering Inffeldgasse 25/B 8010 Graz Austria
| |
Collapse
|
40
|
Banks KC, Stalla DE, Bunyak FE, White TA, Schultz LG, Giuliano EA. Comparison of two cleaning and sterilization protocols of diamond burr tips used in debridement for canine superficial chronic corneal epithelial defects. Vet Ophthalmol 2019; 22:614-622. [DOI: 10.1111/vop.12632] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 11/05/2018] [Accepted: 11/07/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Kayla C. Banks
- Department of Veterinary Medicine and Surgery, College of Veterinary Medicine University of Missouri Columbia Missouri
| | - David E. Stalla
- Electron Microscopy Core Facility University of Missouri Columbia Missouri
| | - Filiz E. Bunyak
- Department of Computer Science University of Missouri Columbia Missouri
| | - Tommi A. White
- Electron Microscopy Core Facility University of Missouri Columbia Missouri
| | - Loren G. Schultz
- Department of Veterinary Medicine and Surgery, College of Veterinary Medicine University of Missouri Columbia Missouri
| | - Elizabeth A. Giuliano
- Department of Veterinary Medicine and Surgery, College of Veterinary Medicine University of Missouri Columbia Missouri
| |
Collapse
|
41
|
Abouljoud MM, Alvand A, Boscainos P, Chen AF, Garcia GA, Gehrke T, Granger J, Kheir M, Kinov P, Malo M, Manrique J, Meek D, Meheux C, Middleton R, Montilla F, Reed M, Reisener MJ, van der Rijt A, Rossmann M, Spangehl M, Stocks G, Young P, Young S, Zahar A, Zhang X. Hip and Knee Section, Prevention, Operating Room Environment: Proceedings of International Consensus on Orthopedic Infections. J Arthroplasty 2019; 34:S293-S300. [PMID: 30343970 DOI: 10.1016/j.arth.2018.09.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
|
42
|
Alsadaan M, Alrumaih HA, Brown T, Burgo FJ, Cabo FJ, Fillingham Y, Gambhir A, Giori N, Goosen J, Goswami K, Hoekstra MCL, Ilyas I, Jahoda D, Nelissen R, Petrie MJ, Ravetti L, Saheed Y, Smailys A, Stucinskas J, Zeniauskas L. General Assembly, Prevention, Operating Room - Surgical Field: Proceedings of International Consensus on Orthopedic Infections. J Arthroplasty 2019; 34:S127-S130. [PMID: 30348577 DOI: 10.1016/j.arth.2018.09.062] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
|
43
|
Assessment and verification of commercially available pressure cookers for laboratory sterilization. PLoS One 2018; 13:e0208769. [PMID: 30533061 PMCID: PMC6289433 DOI: 10.1371/journal.pone.0208769] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Accepted: 11/21/2018] [Indexed: 11/19/2022] Open
Abstract
Laboratory science requires careful maintenance of sterile reagents and tools as well as the sterilization of waste prior to disposal. However, steam autoclaves typically used for this purpose may not be readily accessible to everyone in the scientific community, such as K-12 teachers, researchers in the field, students in under-funded laboratories, or persons in the developing world who lack funding and resources. This work examines the use of commercial electric pressure cookers as an alternative method for the sterilization of media, instruments, and waste. Four commonly available brands of pressure cooker were tested for their ability to sterilize microbiological media, a variety of metal instruments, and high-titer microbial cultures. All four pressure cookers were able to sterilize these starting materials as well as a range of microbial types, including Gram-positive bacteria, Gram-negative bacteria, filamentous fungi, unicellular fungi, and mixed environmental samples. Only the Instant Pot, however, was able to sterilize autoclave tester ampoules of Geobacillus stearothermophilus spores. These results suggest that, depending on the nature of the work undertaken, store-bought pressure cookers can be an appropriate substitute for commercial autoclaves. Their adoption may also help increase the accessibility of science to a broader range of investigators.
Collapse
|
44
|
Spruce L. Back to Basics: Packaging Systems. AORN J 2018; 107:602-610. [DOI: 10.1002/aorn.12119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
45
|
Matthaiou DK, Blot S, Koulenti D. Candida burn wound sepsis: The "holy trinity" of management. Intensive Crit Care Nurs 2018; 46:4-5. [PMID: 29548615 DOI: 10.1016/j.iccn.2018.02.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Dimitrios K Matthaiou
- Department of Critical Care Medicine, Attikon University Hospital, University of Athens, Medical School, Athens, Greece
| | - Stijn Blot
- Faculty of Medicine & Health Science, Ghent University, Ghent, Belgium.
| | - Despoina Koulenti
- Burns, Trauma and Critical Care Research Centre, University of Queensland Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| |
Collapse
|
46
|
Wanke TR, Brock JL, Basile R, Merk B, Azizi J. Residual bioburden after standard cleaning of the reusable orthopedic depth gauge. Am J Infect Control 2018; 46:362. [PMID: 29361360 DOI: 10.1016/j.ajic.2017.10.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Revised: 10/30/2017] [Accepted: 10/31/2017] [Indexed: 11/18/2022]
Affiliation(s)
- Tyler R Wanke
- Northwestern University Feinberg School of Medicine, Chicago IL.
| | - J Logan Brock
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | | | - Bradley Merk
- Department of Orthopaedics, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Jahan Azizi
- J&D Medical Devices Consulting, Inc., Brighton, MI
| |
Collapse
|
47
|
Sanchez ML, Silveira RSD, Figueiredo PPD, Mancia JR, Schwonke CRGB, Gonçalves NGDC. ESTRATÉGIAS QUE CONTRIBUEM PARA A VISIBILIDADE DO TRABALHO DO ENFERMEIRO NA CENTRAL DE MATERIAL E ESTERILIZAÇÃO. TEXTO & CONTEXTO ENFERMAGEM 2018. [DOI: 10.1590/0104-07072018006530015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
RESUMO Objetivo: identificar estratégias para promover o reconhecimento e a visibilidade do fazer do enfermeiro na Central de Material e Esterilização. Método: pesquisa qualitativa, descritiva, realizada com enfermeiros de um hospital do sul do Brasil, de outubro a novembro de 2014, totalizando 17 participantes, através de entrevista semiestruturada e análise textual discursiva. Resultados: dentre as estratégias, destacaram-se a troca de vivência entre os enfermeiros da Central de Material e Esterilização e os enfermeiros de outras unidades; seleção dos trabalhadores, a partir de critérios necessários para a atuação no local e Serviço de Educação Permanente, com temáticas voltadas ao setor. Estas estratégias suscitaram mudanças no modo de perceber uma área da enfermagem, ainda pouco visível, apesar de tão essencial para as atividades realizadas no hospital. A visibilidade do trabalho realizado na Central de Material e Esterilização ainda se apresenta distorcida, pois, apesar de o trabalho desenvolvido no setor ser considerado importante pelos profissionais externos, muitos não conheciam a diversidade de atividades realizadas nem possuíam o conhecimento específico exigido. Conclusão: a pesquisa evidenciou a necessidade de engajamento dos próprios enfermeiros da Central de Material e Esterilização para se fazerem perceber e modificarem a imagem do setor e a maneira como a administração das instituições de saúde vem lidando com os avanços do processamento dos artigos médico-cirúrgicos.
Collapse
|
48
|
Munakomi S, Shah R, Shrestha S. A pilot study comparing pattern of damage sustained among instruments from different surgical units in a tertiary care centre in Nepal - reappraising the role of instrument reprocessing in retaining their value. F1000Res 2018; 7:102. [PMID: 30345016 PMCID: PMC6171723 DOI: 10.12688/f1000research.13699.1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/16/2018] [Indexed: 11/20/2022] Open
Abstract
Background: The quality of instruments plays a pivotal role in governing safe operating room culture. The reprocessing system followed in the institution determines their durability thereby ensuring patient safety as well as minimizing health spending. Rigorous reprocessing in a centralized instrument reprocessing department by well trained staff following formulated guidelines helps to achieve the target of "safe surgery saves lives" as formulated by the World Health Organization. Methods: We sought to determine the patterns of wear and tear sustained among sets of surgical equipment from two surgical units that had been sent to the repair department within a year of their purchase. Analysis of similar changes in the joints of the instrument, as well as pattern of fractures sustained was performed. Results: All patterns of wear and tear were common in both the general surgical arm and neurosurgical counterpart, with the exception of fractures and mal-alignments. Similar study was performed examining changes in the joints. Stains were the most commonly observed change pattern in both sets of instruments. Fractures were most frequent in the working ends in both sets of instruments. Conclusion: There is an alarming incidence of wear and tear patterns in the instruments used in the surgical units, even within the first year of their use. This supports the strict implementation of reprocessing guidelines by well trained workers and their quality assessments via audit checks. The quality of the purchased instruments also plays a pivotal role.
Collapse
Affiliation(s)
- Sunil Munakomi
- Department of Neurosurgery, Nobel Hospital, Biratnagar, 0977, Nepal
| | - Roshan Shah
- Department of Neurosurgery, Nobel Hospital, Biratnagar, 0977, Nepal
| | - Sangam Shrestha
- Department of Pediatrics, Koshi Zonal Hospital, Biratnagar, 0977, Nepal
| |
Collapse
|
49
|
Spertus CB, Brown JM, Giuliano EA. Diamond burr debridement vs. grid keratotomy in canine SCCED with scanning electron microscopy diamond burr tip analysis. Vet Ophthalmol 2017; 20:505-513. [DOI: 10.1111/vop.12460] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Chloe B. Spertus
- Department of Veterinary Medicine and Surgery; College of Veterinary Medicine; University of Missouri; 900 East Campus Drive Columbia MO 65211 USA
| | - Josef M. Brown
- Electron Microscopy Core Facility; University of Missouri; W125 Veterinary Medicine Building, East Campus Drive Columbia MO 65211 USA
| | - Elizabeth A. Giuliano
- Department of Veterinary Medicine and Surgery; College of Veterinary Medicine; University of Missouri; 900 East Campus Drive Columbia MO 65211 USA
| |
Collapse
|
50
|
Challenging Residual Contamination of Instruments for Robotic Surgery in Japan. Infect Control Hosp Epidemiol 2016; 38:143-146. [DOI: 10.1017/ice.2016.249] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUNDRecently, robotic surgery has been introduced in many hospitals. The structure of robotic instruments is so complex that updating their cleaning methods is a challenge for healthcare professionals. However, there is limited information on the effectiveness of cleaning for instruments for robotic surgery.OBJECTIVETo determine the level of residual contamination of instruments for robotic surgery and to develop a method to evaluate the cleaning efficacy for complex surgical devices.METHODSSurgical instruments were collected immediately after operations and/or after in-house cleaning, and the level of residual protein was measured. Three serial measurements were performed on instruments after cleaning to determine the changes in the level of contamination and the total amount of residual protein. The study took place from September 1, 2013, through June 30, 2015, in Japan.RESULTSThe amount of protein released from robotic instruments declined exponentially. The amount after in-house cleaning was 650, 550, and 530 µg/instrument in the 3 serial measurements. The overall level of residual protein in each measurement was much higher for robotic instruments than for ordinary instruments (P<.0001).CONCLUSIONSOur data demonstrated that complete removal of residual protein from surgical instruments is virtually impossible. The pattern of decline differed depending on the instrument type, which reflected the complex structure of the instruments. It might be necessary to establish a new standard for cleaning using a novel classification according to the structural complexity of instruments, especially for those for robotic surgery.Infect Control Hosp Epidemiol 2017;38:143–146
Collapse
|