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At least 55 records · Page 3Linked to original sources

Cross-contamination control in prosthodontic practice.

Prosthodontic patients are generally a high-risk group relative to their potential to transmit infectious diseases as well as acquire them. There has been a recent increase in awareness of the need for cross-infection control measures to protect against possible routes of transmission frequently ignored in the past. This article is essentially a literature review of cross-infection control measures especially relevant to removable prosthodontic practice. Cross-contamination control measures are considered within the following categories: patient evaluation, personal protection, instrument and equipment contamination, clinical technique, impression handling, and laboratory asepsis.

Cross Infection↗

Microbial contamination of non-disposable instruments in otolaryngology out-patients.

Nosocomial infections are an important cause of morbidity and contaminated equipment may contribute to this. There has been little work concerning contamination of non-disposable equipment in Otolaryngology. This study investigates the efficacy of the cleaning regimen for non-disposable instruments in an Otolaryngology out-patients clinic. Instruments were swabbed before each clinic, when they had been autoclaved, then after use on patients, when they had been washed with detergent and chlorhexidine. Swabs of 86 instruments were cultured using standardized microbiological techniques. Fifteen instruments (17 per cent) were contaminated, most with coagulase negative staphylococci. Two specimens of Micrococcus luteus were cultured and one each of Pseudomonas aeruginosa, Acinetobacter lwoffii and Aureobacterium spp. Micrococcus luteus and coagulase negative staphylococci may represent skin contaminants, but Aureobacterium spp. and Acinetobacter lwoffii can be sources of nosocomial infection. Pseudomonas aeruginosa is a potentially serious pathogen and is implicated in the aetiology of otitis externa. These findings question the efficacy of the current cleaning techniques.

Cross Infection↗

Blood contamination of anesthesia equipment and monitoring equipment.

This study was conducted to determine the extent of blood contamination of anesthesia equipment and monitoring equipment in clinical use in operating rooms. The study employed a catalytic-test method, which is used in forensic medicine, to detect blood contamination of anesthesia equipment and monitoring equipment. Nineteen definable surfaces were sampled in 22 operating rooms. Thirty-three percent of surfaces were contaminated with blood. Contaminated equipment included surfaces that are in continuous contact with patients, e.g., blood pressure cuffs and pulse oximeter probes. Visual inspection was not a reliable means of detecting blood contamination. Whether this blood contamination represents an infection risk was not determined. Nevertheless, improved cleaning and disinfection procedures are probably needed. Equipment design needs to focus on reducing the potential for blood contamination and enhancing capability for cleaning and disinfection.

Anesthesia Department, Hospital↗

Laboratory procedures for detoxification of equipment and waste contaminated with brevetoxins PbTx-2 and PbTx-3.

Procedures are presented for the detoxification of laboratory equipment contaminated with brevetoxins PbTx-2 and PbTx-3. An in vivo bioassay using the Japanese madaka Oryzias latipes monitored toxin activity. Incubation for 10 min with 0.1N NaOH detoxified a lethal dose of either PbTx-2 or PbTx-3 to levels below the detection limit of the assay (less than 10 ng/mL). Decreasing the NaOH concentration required correspondingly longer incubation times. The potency of both toxins was also destroyed by incubation for 10-15 min at 500 degrees C. Steam autoclaving 30 min at 122 degrees C (18 psi) was not sufficient to detoxify brevetoxins. These results show that laboratory equipment will be decontaminated and rendered safe for normal handling by washing or soaking it in a dilute NaOH solution. Disposable waste can be either soaked in an NaOH solution prior to disposal or burned in an incinerator with a combustion chamber of at least 500 degrees C. Steam autoclaving, however, is not a viable method of decontamination.

Animals↗

Microorganisms in honey.

Knowledge of the moisture and temperature conditions influencing growth of microorganisms in honey has long been used to control the spoilage of honey. However, the need for additional microbiological data on honey will increase as new technologies for, and uses of honey develop. Microorganisms in honey may influence quality or safety. Due to the natural properties of honey and control measures in the honey industry, honey is a product with minimal types and levels of microbes. Microbes of concern in post-harvest handling are those that are commonly found in honey (i.e., yeasts and spore-forming bacteria), those that indicate the sanitary or commercial quality of honey (i.e., coliforms and yeasts), and those that under certain conditions could cause human illness. Primary sources of microbial contamination are likely to include pollen, the digestive tracts of honey bees, dust, air, earth and nectar, sources which are very difficult to control. The same secondary (after-harvest) sources that influence any food product are also sources of contamination for honey. These include air, food handlers, cross-contamination, equipment and buildings. Secondary sources of contamination are controlled by good manufacturing practices. The microbes of concern in honey are primarily yeasts and spore-forming bacteria. Total plate counts from honey samples can vary from zero to tens of thousands per gram for no apparent reason. Most samples of honey contain detectable levels of yeasts. Although yeast counts in many honey samples are below 100 colony forming units per gram (cfu/g), yeasts can grow in honey to very high numbers. Standard industry practices control yeast growth. Bacterial spores, particularly those in the Bacillus genus, are regularly found in honey. The spores of C. botulinum are found in a fraction of the honey samples tested-normally at low levels. No vegetative forms of disease-causing bacterial species have been found in honey. Bacteria do not replicate in honey and as such high numbers of vegetative bacteria could indicate recent contamination from a secondary source. Certain vegetative microbes can survive in honey, at cool temperatures, for several years. However, honey has anti-microbial properties that discourage the growth or persistence of many microorganisms. Typically, honey can be expected to contain low numbers and a limited variety of microbes. A routine microbiological examination of honey might include several different assays. A standard plate count provides general information. Specialized tests, such as a count of yeasts and an assay for bacterial spore-formers, may also be useful. An indicator of sanitary quality as provided by coliform counts might be included. Additional tests, to explain unusually high counts or address a certain problem, may be needed. The use of honey in products that receive no or limited heat treatment may require additional tests. More information on the source and control of microbes in honey is needed to answer the concerns currently facing the industry.

Anti-Bacterial Agents↗

Occurrence of 222Rn and progeny in natural gas processing plants in western Canada.

In Western Canada, there are many plants that process natural gas to remove impurities (CO2, H2S, H2O) and recover natural gas liquids (propane, butane, etc.). Trace quantities of 222Rn present in the inlet stream are concentrated in streams rich with propane. Potential hazards to plant operators include direct inhalation of 222Rn and progeny; exposure to gamma radiation from short-lived progeny deposited inside equipment; or inhalation of 210Pb when contaminated equipment is opened for repair. Twenty-four plants operated by seven companies cooperated to assess these potential hazards. The findings indicate a substantial flux of 222Rn and progeny passing through the plants, but little accumulation of radionuclides. In no case was there evidence of significant exposure of plant operators or maintenance personnel to ionizing radiation. Further investigation of pipeline operations, and chemical operations using natural gas liquids as feed stock, is recommended.

Bismuth↗

Pseudomonas aeruginosa outbreak in a haematology-oncology unit associated with contaminated surface cleaning equipment.

An outbreak of six cases of hospital-acquired Pseudomonas aeruginosa infections (two pneumonia two septicaemia, two skin/wound infection) occurred between August and September 2000 in an adult haematology-oncology unit at a tertiary-care centre. During the outbreak, hospital-acquired infection (HAI) incidence density rates rose from 29.4 to 62.3 (P < 0.05) infections per 1000 days at risk (i.e., neutropenic days). A systematic outbreak management system was actioned in accordance with a German draft guideline. Multiple samples from the patients' environment were tested for the presence of P. aeruginosa. A total of 4.5% of samples from sanitary equipment and 20.0% of samples from surface cleaning equipment were found to be contaminated with P. aeruginosa. Genotypic analysis by pulsed-field gel electrophoresis showed different patterns for all (N = 6) of the patient isolates, however, two of the patient isolates were identical in comparison with environmental isolates from cleaning equipment (four samples) and sanitary equipment (one sample). Our investigation revealed that the cleaning staff had used cleaning solution instead of disinfectants for decontamination of the patients' environment. The outbreak was terminated after re-adoption of surface disinfection, application of sterile filters on taps and shower heads, chemical disinfection of the washbasin drains, and appointment of a hospital hygiene nurse to a previously unfilled position. After institution of the control measures, HAI incidence densities decreased to pre-outbreak level. This investigation emphasizes the need to carefully evaluate cleaning and disinfection practices for patient care, particularly in neutropenic patients.

Adult↗

Operating room environment.

Sepsis after total joint replacement is related directly to environmental contamination. Therefore, to control the source of environmental contamination, and ultimately sepsis, it must be realized that the operating room personnel are the major source of the bacteria as evidence by the rise in the colony forming units per square foot per hour from 13 units in an operating room without people to greater than 400 units during actual surgery. The use of inclusive gowns, such as hooded body exhaust, is most helpful. However, all operating room personnel including anesthesia personnel, circulating nurses, visitors, and the operating room team must wear inclusive gowns. Face masks and head covers offer no environmental protection. Some type of an environmental control, such as laminar airflow or ultraviolet light, is the most helpful with greater than 90% reduction of airborne bacteria at the wound and 60% reduction of airborne bacteria in the operating room. Therefore, to reduce environmental bacteria contamination the number of personnel in the operating room and the length of time for the actual surgery should be reduced, because wound contamination occurs first by direct fall out from the environment and second by contaminated equipment and gloved hands that initially were contaminated by the environment.

Arthroplasty, Replacement↗

Application of multivirus spike approach for viral clearance evaluation.

Viral contamination is a common risk to continuous cell line-derived biologics. Viral validation is thus required for license applications. Viral validation for chromatography procedures is routinely performed by spiking a model virus into the load material and performing the chromatography procedures at small scale under conditions equivalent to the commercial scale. With traditional cell-based infectivity assays, one can only spike one model virus at one time. Quantitative PCR methods (TaqMan) make it possible to spike multiple model viruses for a chromatography procedure simultaneously. TaqMan assays can quantify multiple types of viruses and other types of nucleic acid in a single sample without cross interference because of its extremely high specificity. Therefore, a multivirus spike approach was evaluated and compared to a single virus spike approach. The study was further extended to the evaluation of host cell DNA clearance. The data shows highly comparable viral and host cell DNA clearance between the single and multiple virus spike approaches. Application of a multivirus spike approach provides significant time, manpower, and cost savings for new drug development.

Animals↗

Infection risk associated with a closed luer access device.

The potential for microbial contamination associated with a recently developed needleless closed luer access device (CLAD) (Q-Syte; Becton Dickinson, Sandy, UT, USA) was evaluated in vitro. Compression seals of 50 multiply activated Q-Syte devices were inoculated with Staphylococcus epidermidis NCTC 9865 in 25% (v/v) human blood and then disinfected with 70% (v/v) isopropyl alcohol followed by flushing with 0.9% (w/v) sterile saline. Forty-eight of 50 (96%) saline flushes passed through devices that had been activated up to a maximum of 70 times remained sterile. A further 25 Q-Syte CLADs that had undergone multiple activations were challenged with prefilled 0.9% (w/v) sterile saline syringes, the external luer tips of which had been inoculated with S. epidermidis NCTC 9865 prior to accessing the devices. None of the devices that had been accessed up to 70 times allowed passage of micro-organisms, despite challenge micro-organisms being detected on both the syringe tip after activation and the compression seals before decontamination. These findings suggest that the Q-Syte CLAD may be activated up to 70 times with no increased risk of microbial contamination within the fluid pathway. The device may also offer protection from the external surface of syringe tips contaminated with micro-organisms.

2-Propanol↗

Organic contamination in dialysis water: trichloroethylene as a model compound.

BACKGROUND: Routine water monitoring in a haemodialysis centre revealed high trichloroethylene (TCE) concentrations. The aim of this study is to describe the measures adopted after organic contamination of dialysis water in order to avoid the possibility of patient exposure. We also carried out in vitro experiments to evaluate the accumulation of TCE in various devices normally used in a dialysis water treatment system (DWTS). METHODS: In vivo and in vitro blood and water TCE levels were determined by means of solid phase microextraction-gas chromatography/mass spectrometer. RESULTS: High TCE concentrations were found throughout the DWTS; acceptably low levels were obtained only by replacing the activated charcoal, ionic-exchange resins, microfilters and PVC pipes. The adsorption and realising capacities of these devices were tested in vitro, and the elimination curves made it possible to calculate the total percentage of the previously absorbed TCE mass released into the water. Evidence of exposure was confirmed by the relatively high TCE levels in the patient blood samples taken 30 days after the last exposure even if the subjects were asymptomatic. In vivo experiments showed that the blood gain of TCE through the low flux membrane during the course of dialysis was about 77+/-10.4% of the amount carried by dialysis fluid as calculated on the basis of its partition coefficient value (K(b/w) 3.75). CONCLUSIONS: This study shows that, when present in dialysis water, the lipophilic TCE contaminant can accumulate in various devices, thus transforming them into possible sources of exposure. This highlights the importance of periodically monitoring dialysis water for organic substances that have a great affinity to the blood compartment, in order to prevent occasional or chronic patient exposure.

Aged↗

A device to prevent cross-contamination when directly applying liquid nitrogen.

A common method of liquid-nitrogen treatment is with the use of the cotton-tipped applicator. Cross-contamination is possible when the applicator is repeatedly dipped into the liquid nitrogen supply. Described is a sterilizable device to hold a small portion of nitrogen sufficient for treatment of a single patient.

Cross Infection↗

When good water goes bad: how it happens, clinical consequences and possible solutions.

Dialysis fluid produced by state-of-the-art water preparation and distribution is contaminated with gram-negative bacteria and cytokine-inducing substances (CIS) derived from these microorganisms. The presence of a biofilm increases the risk of continuous contamination of dialysis fluid. Depending on the type of dialyzer membrane (cellulosic vs. synthetic) and the mode of dialysis (low flux vs. high flux with backfiltration), CIS may penetrate intact dialyzer membranes, induce cytokine production in the patient's blood and contribute to chronic inflammation associated with long-term hemodialysis therapy. Measures to improve the microbiological quality of dialysis fluid are: (1) the awareness of the problem and regular testing of dialysate samples using adequate methods; (2) disinfection of the entire water preparation and distribution system on a regular basis, replacement of biofilm-containing tubings, and (3) installation of ultrafilters in the dialysate circuit in particular when high-flux hemodialysis modalities are performed.

Adsorption↗

Effect of 24-hour intravenous tubing set change on the sterility of repackaged fat emulsion in neonates.

BACKGROUND: Duration of intravenous fat emulsion (IVFE) infusions, precise method of administration (manufactured bottle vs repackaged syringe), and interval for administration set change continue to be debated. OBJECTIVE: To determine the contamination rate associated with replacing IVFE administration sets every 24 hours in newborn infants receiving fat emulsion repackaged into unit-of-use syringes. METHODS: This was a prospective, microbiologic study of 90 administration sets used in 19 neonates. IVFE samples were obtained from administration sets at the end of a 19- to 23-hour infusion and prior to daily tubing set change from infants who received repackaged IVFE. Samples of IVFE (1-3 mL) were aseptically removed at the catheter connection site proximal to the patient, transferred into BACTEC PEDSPlus culture media, and continuously monitored for 5 days to detect gram-positive and gram-negative organisms, as well as yeast. RESULTS: Two samples (2.27%) grew coagulase-negative Staphylococcus. Both samples were from the same asymptomatic patient and were obtained on consecutive days. A blood sample obtained through this infant's central catheter grew the same organism and suggested catheter hub colonization as the primary site of microbe origin. CONCLUSIONS: Microbial contamination of IVFE infusion sets changed at 24-hour intervals, using unit-of-use syringes in neonates, was low at 2.2%.

Drug Contamination↗

Cross-contamination between processing equipment and deli meats by Listeria monocytogenes.

Contamination of luncheon meats by Listeria monocytogenes has resulted in outbreaks of listeriosis and major product recalls. Listeriae can survive on processing equipment such as meat slicers which serve as a potential contamination source. This study was conducted to determine (i) the dynamics of cross-contamination of L. monocytogenes from a commercial slicer and associated equipment onto sliced meat products, (ii) the influence of sample size on the efficacy of the BAX-PCR and U.S. Department of Agriculture-Food Safety and Inspection Service enrichment culture assays to detect L. monocytogenes on deli meat, and (iii) the fate of L. monocytogenes on sliced deli meats of different types during refrigerated storage. Three types of deli meats, uncured oven-roasted turkey, salami, and bologna containing sodium diacetate and potassium lactate, were tested. A five-strain mixture of L. monocytogenes was inoculated at ca.10(3) CFU onto the blade of a commercial slicer. Five consecutive meat slices were packed per package, then vacuum sealed, stored at 4 degrees C, and sampled at 1 and 30 days postslicing. Two sample sizes, 25 g and contents of the entire package of meat, were assayed. Total numbers of L. monocytogenes-positive samples, including the two sample sizes and two sampling times, were 80, 9, and 3 for turkey, salami, and bologna, respectively. A higher percentage of turkey meat samples were L. monocytogenes positive when contents of the entire package were assayed than when the 25-g sample was assayed (12.5 and 7.5%, respectively). Lower inoculum populations of ca. 10(1) or 10(2) CFU of L. monocytogenes on the slicer blade were used for an additional evaluation of oven-roasted turkey using two additional sampling times of 60 and 90 days postslicing. L. monocytogenes-positive samples were not detected until 60 days postslicing, and more positive samples were detected at 90 days than at 60 days postslicing. When BAX-PCR and enrichment culture assays were compared, 12, 8, and 2 L. monocytogenes-positive samples were detected by both the enrichment culture and BAX-PCR, BAX-PCR only, and enrichment culture only assays, respectively. The number of L. monocytogenes-positive samples and L. monocytogenes counts increased during storage of turkey meat but decreased for salami and bologna. Significantly more turkey samples were L. monocytogenes positive when the contents of the entire package were sampled than when 25 g was sampled. Our results indicate that L. monocytogenes can be transferred from a contaminated slicer onto meats and can survive or grow better on uncured oven-roasted turkey than on salami or bologna with preservatives. Higher L. monocytogenes cell numbers inoculated on the slicer blade resulted in more L. monocytogenes-positive sliced meat samples. In addition, the BAX-PCR assay was better than the enrichment culture assay at detecting L. monocytogenes on turkey meat (P < 0.05).

Animals↗