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Salmonella, Campylobacter and Escherichia coli O157:H7 decontamination techniques for the future.

Raw meat, particularly poultry meat, remains an important, and probably the major source of human infection with campylobacters and salmonellas. In spite of decades of effort it has so far proved extremely difficult to raise food animals free of these pathogens. For the foreseeable future, therefore, the most effective approach must be to decontaminate the final raw product. In this way numbers of these pathogens entering kitchens and commercial food processing premises will be reduced substantially, and hence opportunities for cross-contamination onto ready-to-eat foods or for survival during cooking or other processes will be much lower. The ideal method of decontamination will have the following attributes: it will not change appearance, smell, taste or nutritional properties; it will leave no residues; it will pose no threat to the environment; it will encounter no objections from consumers or legislators; it will be cheap and convenient to apply; it will improve the shelf life by inactivating spoilage organisms as well as pathogens. Various techniques will be listed and their potential assessed (see Table 1).

Acids↗

Selective intestinal decontamination in the prevention of bacterial infection in patients with acute liver failure.

To investigate whether selective intestinal decontamination from oral administration of poorly absorbable antibiotics is effective in preventing bacterial infection in patients with acute liver failure, the incidence of nosocomial infection in 34 patients consecutively admitted to hospital between 1985-1990 and treated with either neomycin + colistin + nystatin or norfloxacin + nystatin (group I) was compared to the incidence of infection in 57 patients who did not receive oral, poorly absorbable antibiotics and who were consecutively admitted between 1972-1984 (group II). Patients from groups I and II had similar clinical and laboratory data at hospital admission. Twelve patients from group I and 33 from group II developed bacterial infection during the study period. The probability of infection was significantly different (p = 0.0083) in the two groups: 19% vs. 39% at the 3rd day of admission, 33% vs. 74% at the 7th day, and 48% vs. 78% at the 14th day, respectively. This difference was due to a different rate of infection from enterobacteria. Enterobacteria caused one infectious episode in group I and 24 in group II (p less than 0.001). The incidence of infections caused by other organisms, however, was similar in both groups (15 and 19 episodes, respectively). These results suggest that selective intestinal decontamination is useful in reducing the risk of infection from enterobacteria in patients with acute liver failure.

Adult↗

An in-use evaluation of decontamination of polypropylene versus steel bedpans.

A prospective cross-over study in three different wards has demonstrated the lack of effect of two disinfectants compared with a detergent when added to the washing cycle of automatic bedpan washers that employ hot water centrally supplied at 60 degrees C. An unexpected and potentially important finding was that polypropylene pans were much more effectively cleaned and decontaminated than their stainless steel counterparts. The role, if any, of bedpans in the epidemiology of nosocomial infections remains a mystery. The continued absence of information clearly incriminating these ubiquitous devices in the transmission of potential pathogens, or of genes encoding antibacterial drug resistance, raises questions as to whether extensive efforts to achieve a high degree of decontamination of bedpans are necessary at all.

Cross Infection↗

Audit of decontamination procedures for specialist ophthalmic equipment.

A survey of ophthalmic decontamination protocols in eight district hospitals was undertaken. Procedures differed widely. A literature search revealed only four publications on the subject, all of which dealt with tonometer head disinfection only. After discussion with several manufacturers, whose advice was restricted largely to acrylic lens disinfection and which varied considerably, a local policy for ophthalmic decontamination was established. Nationally agreed disinfection guidelines for high risk ophthalmic instruments are needed.

Contact Lenses↗

Alteration of wound colonization by selective intestinal decontamination in thermally injured mice.

The effects of selective intestinal decontamination on the bacterial colonization of burn wounds were investigated in experimentally burned mice. Prior to scalding pathogen-free mice were pretreated with bacitracin to induce intestinal overgrowth of Enterobacteriaceae. Mice treated for 20 days postburn with oral aztreonam had significantly reduced enterobacterial wound colonization compared to untreated controls. This study indicates that burn wound colonization is altered by selective decontamination of the intestinal tract.

Animals↗

Reduction in Staphylococcus aureus wound colonization using nasal mupirocin and selective decontamination of the digestive tract in extensive burns.

Following the introduction in 1988 of a regimen of selective decontamination of the digestive tract (SDD) for extensively injured patients in our burns centre, colonization rates with Gram-negative organisms declined significantly, but colonization with Staphylococcus aureus was unaffected. In an effort to reduce staphylococcal colonization, the SDD regimen has been supplemented with intranasal mupirocin since 1991. In this paper, 33 consecutive patients with burns of > 30 per cent TBSA who were treated with the supplemental regimen (SDD + M) in 1991 and 1992, were compared with 34 consecutive patients admitted in the previous 2 years who were treated with SDD only. Staph. aureus colonization of wounds, sputum and gastric aspirates was significantly reduced in the SDD + M group. Gram-negative colonization rates and the incidence of clinical infections remained low in both groups. Our experience suggests that decontamination of endogenous bacterial reservoirs, in combination with isolation measures to prevent exogenous colonization, effectively prevents infectious complications in patients with severe burns.

Administration, Intranasal↗

Comparison of three methods of gut decontamination in tricyclic antidepressant overdose.

The purpose of this study was to prospectively compare the effectiveness of three different gut decontamination methods in 51 patients presenting to an emergency department with tricyclic antidepressant overdose. Patients were randomized to three treatments; Group 1 received activated charcoal, Group 2 received saline lavage followed by activated charcoal, and Group 3 received activated charcoal followed by saline lavage followed by activated charcoal. Baseline characteristics of the three groups did not differ, including Glasgow Coma Scores, age, and mean tricyclic antidepressant levels. Average length of stay in admitted patients was 93.3 hours in Group 1, 107.2 hours in Group 2, and 66.7 hours in Group 3. Of those admitted to an ICU, average ICU time was 66.9 hours in Group 1, 54.1 hours in Group 2, and 34.4 hours in Group 3. Average duration of sinus tachycardia was 20.8 hours in Group 1, 30.8 hours in Group 2, and 32.2 hours in Group 3. Of those requiring mechanical ventilation, average ventilator time was 43.4 hours in Group 1, 24.1 hours in Group 2, and 17.8 hours in Group 3. No statistically significant difference could be shown with respect to the clinical endpoints noted. There were no deaths in any of the groups. All three methods of gut decontamination had similar clinical outcomes.

Adult↗

[Selective digestive decontamination: the light as changed from red to green].

OBJECTIVES: To study the efficacy of selective digestive decontamination (SDD) for the prevention of nosocomial infections, particularly pneumonia, as well as its impact on the emergence of multiresistant bacteria. DATA SOURCES: Data collected from the Pubmed: original articles, review articles and editorial published on SDD. The keywords were: selective digestive decontamination, pneumonia, intensive care unit, infection. DATA SELECTION: Ten randomized clinical trials performed since 1995 in mechanically ventilated adult patients hospitalized in intensive care unit. RESULTS: The rationale for the use of SDD consists on the parenteral administration of a short course of antibiotic associated with the topical use of non-absorbable antibiotics directed against Gram negative bacteria. Five randomized studies described a reduction in the incidence of pneumonia associated with SDD. Only one study has showed a decrease in mortality rate. The other five studies, which present some methodological limitations, concluded the lack of efficacy of SDD. Regarding the emergence of multiresistant bacteria, the literature underlines the role of environment. The use of SDD seems to trigger the resistance in endemic areas, while these are softened in the units with a good control of their ecology. CONCLUSION: The data from the literature provide arguments to use SDD in targeted patient populations like multiple traumas in intensive care units, which have a low rate of multiresistant bacteria.

Anti-Bacterial Agents↗

Prosopis juliflora--a green solution to decontaminate heavy metal (Cu and Cd) contaminated soils.

Soil and plant samples (root and shoot) of Prosopis juliflora were collected in the vicinity of metal based foundry units in Coimbatore and assessed for their heavy metal content (Cu and Cd) to ascertain the use of P. juliflora as a green solution to decontaminate soils contaminated with Cu and Cd. The results showed that Cu and Cd content was much higher in plant components compared to their extractable level in the soil. Furthermore, there exist a strong correlation between the distance of the sources of industrial units and accumulation of heavy metals in plants. Accumulation of Cd in roots is comparatively higher than that of shoots. However, in case of Cu no such clear trend is seen. Considering the accumulation efficiency and tolerance of P. juliflora to Cd and Cu, this plant can be explored further for the decontamination of metal polluted soils. On the other hand, in view of heavy metal accumulate the practice of providing foliage and pods as fodder for live stock should be avoided.

Biodegradation, Environmental↗

Development of predictive modelling approaches for surface temperature and associated microbiological inactivation during hot dry air decontamination.

This research deals with the development of predictive modelling approaches in the field of heat transfer and microbial inactivation. Upon making some backstage microbiological considerations, surface temperature predictions during hot dry air decontaminations are incorporated in a microbial inactivation model, in order to describe inactivation kinetics under realistic (time-varying) temperature conditions. In the present study, the following parts are presented. (i) First, a one-dimensional heat transfer model is developed taking into account exchanges by convection, radiation and evaporation. The model is subsequently validated on a laboratory setup and on a test rig, assuming no water activity changes. This test rig is developed for studying-at a later stage-surface pasteurisation treatment on food products with the use of hot dry air. (ii) Isothermal inactivation data of Escherichia coli K12 MG1655 have been collected and inactivation parameters are accurately estimated by using a primary and a secondary model in a global modelling approach. (iii) Microbiological considerations such as microbial growth effects during come-up times, initial temperature of inactivation, and heat resistance effects, based on experimental observations and on literature studies, are formulated in order to evaluate possible microbial effects arising under the dynamic temperature conditions modelled in step (i). (iv) Microbial inactivation simulations with the incorporation of surface temperature predictions are presented. (v) Finally, the level of the microbial decontamination in an example based on the design of an industrial installation is presented, outlining the importance of the combination of surface temperature and microbial inactivation modelling approaches.

Escherichia coli↗

Bioremediation of 60Co from simulated spent decontamination solutions.

Bioremediation of 60Co from simulated spent decontamination solutions by utilizing different biomass of (Neurospora crassa, Trichoderma viridae, Mucor recemosus, Rhizopus chinensis, Penicillium citrinum, Aspergillus niger and, Aspergillus flavus) fungi is reported. Various fungal species were screened to evaluate their potential for removing cobalt from very low concentrations (0.03-0.16 microM) in presence of a high background of iron (9.33 mM) and nickel (0.93 mM) complexed with EDTA (10.3 mM). The different fungal isolates employed in this study showed a pickup of cobalt in the range 8-500 ng/g of dry biomass. The [Fe]/[Co] and [Ni]/[Co] ratios in the solutions before and after exposure to the fungi were also determined. At micromolar level the cobalt pickup by many fungi especially the mutants of N. crassa is seen to be proportional to the initial cobalt concentration taken in the solution. However, R. chinensis exhibits a low but iron concentration dependent cobalt pickup. Prior saturating the fungi with excess of iron during their growth showed the presence of selective cobalt pickup sites. The existence of cobalt specific sorption sites is shown by a model experiment with R. chinensis wherein at a constant cobalt concentration (0.034 microM) and varying iron concentrations so as to yield [Fe/Co]initial ratios in solution of 10, 100, 1000 and 287000 have all yielded a definite Co pickup capacity in the range 8-47 ng/g. The presence of Cr(III)EDTA (3 mM) in solution along with complexed Fe and Ni has not influenced the cobalt removal. The significant feature of this study is that even when cobalt is present in trace level (sub-micromolar) in a matrix of high concentration (millimolar levels) of iron, nickel and chromium, a situation typically encountered in spent decontamination solutions arising from stainless steel based primary systems of nuclear reactors, a number of fungi studied in this work showed a good sensitivity for cobalt pickup.

Biodegradation, Environmental↗

Selective bowel decontamination in hospitalized patients awaiting liver transplantation.

BACKGROUND: Infection remains a major contributor to morbidity and mortality following orthotopic liver transplantation (OLT). Selective bowel decontamination (SBD) in hospitalized patients is one strategy for prophylaxis. METHODS: A retrospective case-control study was performed using 18 consecutive hospitalized patients receiving SBD prior to OLT during the period September 1995 to September 1996. Eighteen consecutive hospitalized patients without SBD transplanted during the period March 1995 to September 1995 served as a historical control group. RESULTS: Selective bowel decontamination was associated with a significantly decreased prevalence of positive cultures for gram-negative bacteria and fungi and reduced overall hospital charges. CONCLUSION: In hospitalized patients awaiting OLT, SBD is an effective prophylactic measure against infectious morbidity associated with gram-negative bacteria and fungi.

Adult↗

Gastrointestinal decontamination for acute poisoning.

Gastric decontamination remains an important element in the therapy of pediatric poisoning; however, several issues remain unresolved. Additional studies, particularly in the clinical setting, are necessary to establish optimal therapeutic recommendations. Based on the data presented in this review, the following general recommendations can be made for gastric decontamination in children: If it is necessary to remove an ingested toxin, ipecac syrup is the preferred method if contraindications to its use are not present. The dose should be 30 ml in children older than 1 year of age and 10 ml in children 6 to 12 months of age. Pending further studies, the use of emetics in children younger than 6 months of age cannot be generally recommended, particularly in the home setting. Gastric lavage should be considered to be of very limited use in pediatric patients. Lavage using small nasogastric tubes, except under special circumstances, is nonproductive and cannot be advocated. If it must be used, a large-bore orogastric hose should be used. Administration of activated charcoal prior to lavage should be considered. In situations in which prompt induction of emesis is not possible or contraindications to emesis exist, activated charcoal followed by, or mixed with, a cathartic (preferably sorbitol) should be used as an alternative to removal of gastric contents. Patients with significant symptoms from ingestion requiring hospitalization should receive repeat doses of charcoal and cathartic until symptoms resolve. Activated charcoal should be given in conjunction with other appropriate therapies. Although the data to substantiate this recommendation are limited, particularly in pediatric patients, it is a benign therapy that holds promise of increasing drug elimination.

Absorption↗

Control of Aeromonas on minimally processed vegetables by decontamination with lactic acid, chlorinated water, or thyme essential oil solution.

Aeromonas is an opportunistic pathogen, which, although in low numbers, may be present on minimally processed vegetables. Although the intrinsic and extrinsic factors of minimally processed prepacked vegetable mixes are not inhibitory to the growth of Aeromonas species, multiplication to high numbers during processing and storage of naturally contaminated grated carrots, mixed lettuce, and chopped bell peppers was not observed. Aeromonas was shown to be resistant towards chlorination of water, but was susceptible to 1% and 2% lactic acid and 0.5% and 1.0% thyme essential oil treatment, although the latter provoked adverse sensory properties when applied for decontamination of chopped bell peppers. Integration of a decontamination step with 2% lactic acid in the processing line of grated carrots was shown to have the potential to control the overall microbial quality of the grated carrots and was particularly effective towards Aeromonas.

Aeromonas↗

Investigation of gaseous ozone for MRSA decontamination of hospital side-rooms.

A domestic, gaseous ozone generator was investigated for use in the decontamination of hospital side-rooms that have housed patients colonized with methicillin-resistant Staphylococcus aureus (MRSA). Three models of bacterial contamination were used. These were exposed to ozone generation in a standard hospital side-room for 4 and 7 h. A methicillin-sensitive and a methicillin-resistant strain of S. aureus were compared. Ozone concentrations of 0.14 ppm were reached, levels which are sufficient to cause mild pulmonary toxicity. Bacterial counts were reduced in the vicinity of the gas generator in most instances, but the effect elsewhere in the room was, at best, limited. MRSA appeared more resistant to the effects of ozone than methicillin-sensitive S. aureus. We conclude that the device tested would be inadequate for the decontamination of such hospital side-rooms.

Cross Infection↗

Selective decontamination of the digestive tract in severely burned pediatric patients.

Infection is still one of the leading causes of morbidity and mortality in severely burned patients. Evidence suggests that many of the responsible organisms are endogenous. Systemic antibiotic prophylaxis is not effective, and produces resistant strains of microorganisms. SDD has been postulated to be beneficial for controlling and decreasing infections in critically ill patients. Its efficacy in severely burned patients, however, remains controversial. In order to analyze the efficacy of selective decontamination of the digestive (SDD) tract, to decrease the bacterial colonization of the aerodigestive tract and burn wounds, and the incidence of septic complications in severely burned children, 23 pediatric patients affected of severe burns were prospectively randomized in a double-blinded study. Eleven patients received SDD (Polymyxin E, Tobramycin, and Amphotericin B), and 12 placebo. Demographics, hospital course, microbiology results, complications, infectious episodes, and serum levels of IL-1beta, IL-6, IL-10, and TNF-alpha were compared to determine the efficacy of SDD. Colonization rates to the wound, sputum, nasogastric aspirates, and feces were similar. Pneumonia, sepsis and other complications had similar incidence in both groups. Serum levels of all cytokines studied were also comparable, suggesting a similar inflammatory status in all patients, regardless of the treatment received. Patients in the SDD group, however, had a significantly higher incidence of diarrhea (P=0.003). We can conclude that selective decontamination of the digestive tract with Polymixin E, Tobramycin and Amphotericin B is not effective to decrease bacterial colonization and infectious episodes in severely burned pediatric patients.

Amphotericin B↗

Prehospital gastrointestinal decontamination of toxic ingestions: a missed opportunity.

The purpose of this study was to determine if emergency medical services (EMS) providers routinely initiate field gastrointestinal decontamination of adult drug overdose patients transported to the emergency department (ED). A retrospective prehospital chart review was performed on adult patients identified as drug overdose who were transported by EMS. ED charts on patients transported to a university hospital were reviewed for follow-up data. Prehospital care records showed that gastrointestinal decontamination was initiated in only 6 of 361 (2%) patients, all of whom received ipecac. No patient received activated charcoal. The median transport time was 25 minutes (range, 5 to 66 minutes). Follow-up data on patients transported to the university hospital revealed that 30 of 43 (70%) patients who might have been suitable candidates for prehospital activated charcoal actually received activated charcoal in the ED. Median time to activated charcoal in the ED was 82 minutes (range, 32 to 329 min). Use of activated charcoal in the field appears to be deferred despite its known loss of efficacy over time. The failure to start activated charcoal in the field contributes to the delay in initiating activated charcoal therapy.

Administration, Oral↗

Decontamination of uranium-contaminated steel surfaces by hydroxycarboxylic acid with uranium recovery.

We developed a simple, safe method to remove uranium from contaminated metallic surfaces so that the materials can be recycled or disposed of as low-level radioactive or nonradioactive waste. Surface analysis of rusted uranium-contaminated plain carbon-steel coupons by X-ray photoelectron spectroscopy and Rutherford backscattering spectroscopy showed that uranium was predominantly associated with ferrihydrite, lepidocrocite, and magnetite, or occluded in the matrix of the corrosion product as uranyl hydroxide and schoepite (UO3 x 2H2O). Citric acid formulations, consisting of oxalic acid-hydrogen peroxidecitric acid (OPC) or citric acid-hydrogen peroxidecitric acid (CPC), were used to remove uranium from the coupons. The efficiency of uranium removal varied from 68% to 94% depending on the extent of corrosion, the association of uranium with the iron oxide matrix, and the accessibility of the occluded contaminant. Decontaminated coupons clearly showed evidence of the extensive removal of rust and uranium. The waste solutions containing uranium and iron from decontamination by OPC and CPC were treated first by subjecting them to biodegradation followed by photodegradation. Biodegradation of a CPC solution by Pseudomonas fluorescens resulted in the degradation of the citric acid with concomitant precipitation of Fe (>96%), whereas U that remained in solution was recovered (>99%) by photodegradation as schoepite. In contrast, in an OPC solution citric acid was biodegraded but not oxalic acid, and both Fe and U remained in solution. Photodegradation of this OPC solution resulted in the precipitation of iron as ferrihydrite and uranium as uranyl hydroxide.

Biodegradation, Environmental↗