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PubMed2003

Selective digestive decontamination should not be routinely employed.

There is a general consensus that antimicrobial resistance in the hospital setting has emerged as an important variable influencing patient outcome and resource utilization. Hospitals worldwide are faced with increasingly rapid emergence and spread of antibiotic-resistant bacteria. Both antibiotic-resistant Gram-negative bacilli and Gram-positive bacteria are reported as important causes of hospital-acquired infections. Few antimicrobial agents are available for effective treatment. Selective digestive decontamination (SDD) is a technique aimed at selectively eliminating aerobic Gram-negative bacilli and yeast from the mouth and stomach to reduce the occurrence of hospital-acquired infections, including ventilator-associated pneumonia. Unfortunately, the application of SDD has been associated with emergence of antibiotic-resistant bacterial strains, limiting its overall utility.

Critical Care↗
PubMed2003

In vitro evaluation of different chemical agents for the decontamination of gutta-percha cones.

This study evaluated the effectiveness of three disinfectants used in Dentistry for decontamination of gutta-percha cones. Sixty gutta-percha cones were contaminated with standardized pure cultures of five species of microorganisms (Enterococcus faecalis ATCC 29212, Staphylococcus aureus ATCC 25923, Candida albicans ATCC CBS-ICB/USP 562, Bacillus subtilis spores ATCC 6633 and Streptococcus mutans ATCC 25175). The cones were treated with 10% polyvinylpyrrolidone-iodine aqueous solution (PVP-I; Groups 1 and 2), 5.25% aqueous sodium hypochlorite (Groups 3 and 4) and paraformaldehyde tablets (Group 5). All chemical agents were efficient for the cold sterilization of gutta-percha cones in short time periods.

Anti-Infective Agents, Local↗
PubMed1978

A method of decontamination of ultrasonic scalers and high speed handpieces.

The use of contaminated water in high speed handpieces and ultrasonic handpieces presents potential hazards to both dentist and patient. This study has shown that after waterline sterilization, the use of a sterile, disposable membrane filter can eliminate the microflora from the water of an ultrasonic scaler for up to 48 hours. Similarly, the water from a high speed handpiece can remain bacteria free for up to 72 hours when a 0.45 micrometer pore size membrane filter is installed into the waterline. This system of decontamination by filtration may present a workable approach to the problem of contaminated water and merits further research and development. Commercial materials and equipment are identified in this report to specify the investigative procedures. Such identification does not simply recommendation or endorsement or that the materials and equipment are necessarily the best available for the purpose. Furthermore, the opinions expressed herein are those of the authors and are not to be construed as those of the Army Medical Department.

Bacteria↗
PubMed2003

Alfalfa seed decontamination in a Salmonella outbreak.

Based on in vitro data, the U.S. Food and Drug Administration recommends chemical disinfection of raw sprout seeds to reduce enteric pathogens contaminating the seed coats. However, little is known about the effectiveness of decontamination at preventing human disease. In 1999, an outbreak of Salmonella enterica serotype Mbandaka occurred in Oregon, Washington, Idaho, and California. Based on epidemiologic and pulsed-field gel electrophoresis evidence from 87 confirmed cases, the outbreak was linked to contaminated alfalfa seeds grown in California's Imperial Valley. Trace-back and trace-forward investigations identified a single lot of seeds used by five sprout growers during the outbreak period. Cases of salmonellosis were linked with two sprout growers who had not employed chemical disinfection; no cases were linked to three sprout growers who used disinfection. This natural experiment provides empiric evidence that chemical disinfection can reduce the human risk for disease posed by contaminated seed sprouts.

Adolescent↗
PubMed2006

Results of gastroscope bacterial decontamination by enzymatic detergent compared to chlorhexidine.

AIM: To compare the efficacy of enzymatic detergent with chlorhexidine for gastroscope bacterial decontamination. METHODS: A prospective randomized controlled study was undertaken to evaluate the ability of these 2 agents to achieve high level disinfection in a gastroscope. A total of 260 samples were collected from 5 different gastroscopes. Manual cleaning was done for 10 min with these 2 agents separately (n = 130 each). Then all specimens underwent 2% glutaraldehyde soaking for 20 min. After 70% alcohol was rinsed, sterile normal saline was flushed into each gastroscope channel and 40 mL of sample was collected. The sample was sent for aerobic bacterial culture after membrane was filtered. A colony count greater than 200 cfu/mL was considered significant. RESULTS: The positive culture rate was 4.6% in the enzymatic detergent arm and 3.1% in the chlorhexidine arm. Pseudomonas species were the main organism detected from both groups (60%). Multiple organisms were found from 4 specimens (enzymatic detergent arm = 1, chlorhexidine arm = 3). CONCLUSION: The contamination rate of both types of cleaning solution is equivalent.

Acinetobacter baumannii↗
PubMed2002

Vesicants and nerve agents in chemical warfare. Decontamination and treatment strategies for a changed world.

Vesicants and nerve agents have been used in chemical warfare for ages. They remain a threat in today's altered political climate because they are relatively simple to produce, transport, and deploy. Vesicants, such as mustard and lewisite, can affect the skin, eyes, respiratory system, and gastrointestinal system. They leave affected persons at risk for long-term effects. Nerve agents, such as tabun, sarin, soman, and VX, hyperstimulate the muscarinic and nicotinic receptors of the nervous system. Physicians need to familiarize themselves with the clinical findings of such exposures and the decontamination and treatment strategies necessary to minimize injuries and deaths.

Antidotes↗
PubMed1998

Rheological properties and lipid oxidation of rice decontaminated with low-energy electrons.

Microbial load and quality of rice grains which were exposed to electrons at different acceleration voltages of 170 to 200 kV were examined to evaluate the efficacy of decontaminating rice with low-energy electrons. Electrons at any acceleration voltage between 170 and 200 kV reduced microbial loads of brown rice grains to levels lower than 10 colony-forming units (CFU)/g. Higher acceleration voltages resulted in a lower viscosity and a higher thiobarbituric acid value (TBA). Milling at a yield of 90 or 88% after electron treatment made the viscosity and TBA of rice treated with electrons at 170 kV almost the same as untreated rice. Low and high compression analyses of rice grains which were exposed to electrons at 170 to 180 kV and milled at a yield of 90% followed by cooking showed almost the same hardness and stickiness as untreated grains which were milled at 90%. The results indicate that milling at a yield of 90% or lower removes the portion of rice exposed to electrons at 170 kV and that treatment of brown rice with low-energy electrons enables the preparation of milled rice with extremely low levels of microbial load and little quality deterioration.

Decontamination↗
PubMed1994

Creutzfeldt-Jacob disease decontamination of tissues and contaminated materials.

Although CJD is certainly infectious, like other unconventional viruses (slow viruses) it demonstrates a low potential for transmissibility to humans who are exposed accidentally to infected material. This may be due to a low dose of prion exposure or to reasons which are unknown at this point. When effective decontamination techniques are available, the processing of tissue from a suspected or confirmed case of CJD can be handled with confidence. Careful application of techniques makes the possibility of acquiring the disease remote, while not interfering with the diagnosis and care of patients.

Canada↗
PubMedDate not supplied

Decontamination.

The soil encountered in the cleaning and decontamination process is protein in nature and relatively difficult to remove, especially if the protein has been allowed to dry on the surface. However, removal of this soil prior to sterilization is necessary in order to achieve satisfactory results--the lower the bioburden, the greater the probability of actually achieving sterilization. Therefore, when cleaning is done thoroughly and properly, visible soil and film and most microorganisms and pyrogens will be removed from the surface of the item. By providing instruments and other patient care equipment that are safe to handle or that have been adequately prepared for sterilization, you can be confident that you have made a major contribution to the provision of quality patient care in your hospital.

Central Supply, Hospital↗
PubMed1999

[Selective decontamination of the digestive tract reduces mortality in intensive care patients].

Selective decontamination of the digestive tract (SDD) is a strategy designed to prevent or minimize the impact of infections by potentially pathogenic micro-organisms in critically ill patients requiring long-term mechanical ventilation. SDD is a four-component protocol to control the three types of infections occurring in intensive care patients: (a) a parenteral antibiotic, cefotaxime, for a few days to prevent primary endogenous infections that generally occur 'early'; (b) the topical antimicrobial drugs colistine (polymyxin E), tobramycin and amphotericin B (together: PTA) used throughout the stay in the intensive care unit (ICU) to prevent secondary endogenous infections developing in general 'late'; (c) a high standard of hygiene to prevent exogenous infections that may occur throughout the ICU stay; (d) surveillance samples of throat and rectum to distinguish between the three types of infection, to monitor compliance and efficacy of treatment and to detect emergence of resistance at an early stage. The most recent and rigorous meta-analysis examined 33 randomized SDD trials involving 5727 patients. It shows significant reductions, in overall mortality by 20% and in the incidence of lower airway infections by 65%. It failed to detect any report on the emergence of resistance and associated superinfections and/or out-breaks in the 33 studies covering a period of more than 10 years. Using the criterion of cost-per-survivor, four recent randomised trials showed that it is cheaper to produce a survivor using SDD than with the traditional approach.

Amphotericin B↗
PubMedDate not supplied

[The use of the natural mineral saponite for water decontamination].

Sorption properties were studied of natural and activated specimens of saponite with respect to poliomyelitis virus, Coxsackie B 1 and B 6 viruses as well as to Enterobacteriaceae group bacteria. With the purpose of comparing the processes of sorption of microorganisms, other minerals were also used, such as bentonite, alunite, glauconite, ceolite. The natural saponite adsorptive properties were found out to undergo changes during the process of thermoactivation. Mechanisms are discussed of a decontaminating effect of thermoactivated saponite in water.

Adsorption↗
PubMedDate not supplied

Selective decontamination of the digestive tract helps prevent bacterial infections in the early postoperative period after liver transplant.

UNLABELLED: In liver transplant (LTx) recipients, gut-associated bacterial and fungal organisms produce significant postoperative morbidity and mortality. We sought to assess the role of selective digestive decontamination (SDD) in preventing postoperative infections in a large single-center cohort of liver recipients transplanted under two non-simultaneous protocols. In 212 consecutive patients transplanted between 1/1/91 and 7/31/92, SDD (gentamicin 80 mg, polymyxin B 100 mg, nystatin suspension 10 mL) was employed, starting after induction of anesthesia and continued until POD 21 (SDD Group). In 157 consecutive patients transplanted between 1/1/93 and 12/31/93, SDD was not used (non-SDD Group). Both groups received IV vancomycin and cefotaxime prophylaxis. All culture-positive infections within the first 30 days post-LTx were recorded and classified as bacterial or fungal. Infection-related mortality (patients who died of infectious complications without any technical complication) was recorded. Groups did not differ in patient demographics, United Network for Organ Sharing (UNOS) status, use of veno-venous bypass, total/warm ischemia, or length of ICU stay. Infections developed in fewer SDD patients (56/212; 26%) than non-SDD patients (69/157; 44%) (p<0.001). The incidence of gram-negative infection was less in the SDD group (11% vs. 26%, p<0. 001) as was gram-positive infection (16% vs. 26%, p<0.001). Among patients who developed infection, there was no difference between groups in infections per patient. Primary graft non-function (PNF) developed in 20 SDD patients (7/20 had infections) and 8 non-SDD patients (6/8 had infections) (p=0.06). There were no differences in incidence of fungal infections or of infection-related mortality between groups. In the SDD group, there were fewer abdominal (p<0. 001), lung (p<0.001), wound (p<0.01), and urinary tract infections (p<0.05). CONCLUSION: Use of SDD in liver recipients early after transplant was associated with significantly fewer infections in the early postoperative period.

Adolescent↗
PubMed2000

Fenbendazole treatment without environmental decontamination eradicates Syphacia muris from all rats in a large, complex research institution.

Syphacia muris parasitism was eliminated from rats and voles by feeding fenbendazole-medicated chow (150 ppm) for five 7-day periods; treatment periods were separated by 7-day periods of feeding non-medicated chow, yielding atotal treatment course of 9 weeks. No other manipulations to facilitate eradication, including the use of filter tops, autoclaved cages, environmental decontamination, colony depopulation, breeding cessation, and research restriction, were done. The examination of 3143 cellophane-tape impressions of the anus and 160 cecal examinations from euthanized rats and voles during the treatment period and for 7 months afterwards confirmed the efficacy of treatment. Treatment was rapidly effective in voles. In rats, pinworm eggs persisted at high levels for 2 weeks after the start of treatment, but no eggs were found after 22 days.

Anal Canal↗
PubMed2001

Selective decontamination of the digestive tract as infection prevention in the critically ill. Does it lead to resistance?

Several meta-analysis showed the efficacy of selective decontamination of the digestive tract (SDD) in the reduction of infections in critically ill patients, particularly for ventilator associated pneumonia and bloodstream infections, thereby reducing mortality and morbidity. The principle of SDD is that by means of application of non-absorbable antibiotics in the intestinal canal and oropharyngeal cavity, potentially pathogenic microorganisms are eliminated, thereby reducing the incidence of organ site infections. The endogenous anaerobic flora is preserved as a factor contributing to defence against colonization. The potential induction of antibiotic resistance (AR) due to SDD is a major concern in ICU. This review evaluates the onset of clinically relevant AR after SDD. The results of a recent meta-analysis and of several studies, which confirmed the virtual absence of any reported AR with SDD and that did not find AR after stopping SDD, are presented. The eradication of the reservoir of abnormal bacteria located in the gut by topical non-absorbable antibiotics appears to significantly reduce morbidity, mortality and resistance. Using only systemic antibiotics in ICU may contribute to maintain an abnormal population of bacteria among which AR is encouraged.

Acute Disease↗
PubMed2001

[Gastrointestinal decontamination. Use in non-drug poisoning].

AIM: To assess whether Danish doctors use gastrointestinal decontamination (GID) in non-drug poisoning in accordance with recommendations for restricted application. METHOD: Doctors telephoning the Danish Poisons Information Centre about non-drug exposures were surveyed prospectively. The doctor's intention to treat, the age and sex of the patient, and information about poison, amount and time since exposure, were assessed. RESULTS: Of the 138 telephone calls, 64% concerned children below 5 years of age and 24% patients above 15 years of age. The risk was estimated as insignificant in 63%, minor in 30%, significant in 6% and severe in only 1%. The insignificant risk was found mainly in children and the severe risk solely in those above 15 years of age. GID was proposed in 33% with the highest frequency in children with minor or insignificant risks, and the time since exposure did not influence the frequency of GID. Charcoal was not proposed. CONCLUSION: It is clear from this small sample that Danish doctors tend to use GID more often than is recommended. Activated charcoal was apparently not used. GID was in most cases used in children with insignificant and minor risks, where it is likely to do more harm than good.

Adult↗
PubMed2002

[Effect of selective digestive decontamination on the nosocomial infection and multiresistant microorganisms incidence in critically ill patients].

BACKGROUND: Ventilator-associated pneumonia (VAP) is a common complication in mechanically ventilated patients. Other infections related to the use of invasive devices, such urinary tract infections (UTI) and central venous catheter-related bloodstream infections are found in patients admitted in intensive care units (ICU). Selective digestive decontamination (SDD) is a set of manoeuvres (hygiene, topic digestive antimicrobials and short course of systemic antibiotics) aimed at decreasing the incidence of nosocomial infections, mainly VAP, in ICU. The objective of this study was to describe the impact of SDD in the rates of nosocomial infections in an 18-bed medical-surgical ICU. PATIENTS AND METHOD: All patients admitted in the ICU from October 1998 to September 1999 with expected mechanical ventilation for at least 72 h or with an illness where SDD has proven to be efficacious. The infection rates during this period were compared with the infection rates of the period without SDD (October 1997 to September 1998). RESULTS: VAP rates decreased from 12.38 to 3.64 per 1000 days of mechanical ventilation (RR 0.3; CI 95%: 0.16 to 0.53). Urinary tract infection rates decreased form 7.70 to 4.51 per 1000 bladder-catheter days (RR 0.6. CI 95%: 0.37 to 0.93). Central venous catheter related bloodstream infections decreased from 5.92 to 2.73 per 1000 catheter days (RR: 0.5. CI 95%: 0.24 to 0.90). There was no emergence of resistant microorganims when SDD was used. CONCLUSIONS: SDD reduces infection rates in ICU without any significant adverse events.

Cross Infection↗
PubMed2002

Considerations for selecting personal protective equipment for hazardous materials decontamination.

PPE is necessary to protect staff and to deliver rapid and efficient care to patients contaminated with HAZMAT chemicals. Planning for HAZMAT cases includes learning about the common chemicals in the area, what resources are available to care for victims, identifying a decontamination area, and providing PPE to protect employees and other patients. A customized service can be used to meet OSHA standards and reduce costs. Ongoing training will be an important part of any HAZMAT program.

Air↗