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PubMed2005

Are sterile water and brushes necessary for hand washing before surgery in Japan?

PURPOSE: To examine whether sterile water and brushes are necessary for hand washing before surgery. METHOD: Twenty-two operating room nurses were randomly divided into two groups as follows: 11 nurses who used 7.5% povidone iodine (PVI group) and another 11 nurses who used 4% chlorhexidine gluconate (CHG group) to wash their hands using the rubbing method. All the nurses were examined for bacterial contamination of their hands before and after surgical hand rubbing. We used tap water to wash the hands at the sink used for washing surgical instruments in the operating room and non sterilized plastic brushes. RESULTS: No bacteria were detected in the tap water. Before washing the hands, the number of bacteria detected was 5.0 x 10(3) cfu/H in the PVI group and 4.0 x 10(3) cfu/H in the CHG group, which were similar in both groups. After washing the hands, the median value of the bacteria decreased to 8.7 x 10(2) cfu/H in the PVI group and 0 cfu/H in the CHG group. CONCLUSIONS: Sterile water and brushes are not necessary for preoperative scrubbing up. When using tap water for surgical hand washing, 1) the hand-rubbing method should be used; 2) a quick-alcohol-based disinfectant scrub should be used; 3) the concentration of free chloride in the water should be maintained at over 0.1 PPM; 4) the bacterial contamination of the water should be checked; and 5) the faucet should be routinely cleaned and sterilized.

Anti-Infective Agents, Local↗

PubMed1985

Microwave sterilization.

This study has shown that representative fungi, viruses, and aerobic and anaerobic bacteria, including spore formers, can easily be killed in a conventional microwave oven with proper modifications. Metal instruments, including air turbine handpieces and burs, and acrylic dentures can be sterilized in short periods. Consistent sterilization can be accomplished only if the items to be sterilized are rotated in a three-dimensional manner throughout the microwave cavity. Arcing back to the magnetron and damage to the microwave oven are prevented by placing a radar absorbent material within the oven and with proper insulation of the item to be sterilized.

Bacteriological Techniques↗

PubMed2001

Serum total renin after tubal sterilization.

The effect of laparoscopic tubal sterilization by Hulka or Filshie clips on serum total renin levels was evaluated in 33 healthy, regularly menstruating women. Serum total renin levels were measured in the follicular (days 3 to 7) and in the luteal (days 20 to 24) phase during the cycle immediately preceeding the sterilization and 12 months after the procedure. The total renin secreted did not change after the sterilization. The follicular phase levels were lower (160 +/- 113 and 170 +/- 93 ng/l, respectively) than luteal phase levels (230 +/- 124 and 228 +/- 83 ng/l, respectively) in both cycles studied (p=0.0001 for both). The length of the menstrual cycle was not affected, either. Laparoscopic tubal sterilization caused no measurable changes in total renin secretion during one year follow-up.

Adult↗

PubMed2000

[An investigation on ethylene oxide sterilization management in medical institutions].

The present study describes an investigation on the use and management of ethylene oxide (EO) which is used mainly as a sterilant in medical institutions in a Cabinet-order designated city. Information was obtained from a self-administered questionnaire on safety and health matters related to sterilization with EO gas. The questionnaire was sent to 189 medical institutions including major hospitals and randomly selected clinics. 127 questionnaire were returned and the analysis was carried out for 120 respondents, excluding seven respondents whose answers were found to be inappropriate. The proportion of medical institutions, employing more than 50 workers, in which an occupational health physician and/or health supervisor was appointed was 70% and was lower than for other industries. 1.6% of the employees engaged in EO sterilization activities in the hospitals, whereas in clinics the percentage was as high as 20%. Several problems were found both in the management and work methods with EO: operations were not isolated in 46%; gas leaks and back-streaming of exhaust gas were found in 59% and 41%, respectively; and personal protective clothing was not used in 69%. Improvement was found only for three items among the institutions where an occupational health physician was appointed. These results suggest that good workplace controls and practices are essential for medical institutions using hazardous materials including EO for sterilization.

Disinfectants↗

PubMed2005

Currently available devices for female sterilization.

Sterilization is now the method of family planning most commonly used in the world. Over the last 150 years, research has evolved in the search for the ideal method of female sterilization. The procedure should ideally have high efficacy, be readily accessible and be personally and culturally acceptable. The method should be simple, quick, easily learned and be able to be performed in an outpatient setting without general anesthesia. The most common and effective method for sterilization has, thus far, been via the laparoscopic route. Hysteroscopic sterilization, however, potentially fulfills many of these ideal criteria, but until recently has remained more of a concept than a reality.

Cautery↗

PubMedDate not supplied

[Items sterilized in humid heat: validation of the storage system].

We aimed at identifying the period of validity of the sterilization of items by humid heat, taking into account the conditions of sterilization and storage. The validation was carried out by means of microbiological tests performed with instruments in the same load and evaluated in 0, 7, 10, 15, and 25 days. 30% of the instruments in each package were analysed and put in a Mueller Hinton solution and incubated at 37 degrees C for 72 hours. The reading was accomplished taking into consideration how dark the solution was. Out of the samples evaluated in nine loads, none showed microbiological growth. It was concluded that, although sterilization and storage conditions of the material were not fully in accordance with parameters recommended by the literature, the sterilization happened and was maintained for a period of 25 days.

Hot Temperature↗

PubMed1982

Effects of sterilization on periodontal instruments.

The sharpness of surgical instruments is of particular importance to the periodontist. In order to study the effects of sterilization on the cutting edges of periodontal curets and scalers, new sharpened instruments were sterilized 10 cycles with saturated steam, formalin-alcohol vapor or dry heat. The instruments were evaluated before and after sterilization with a scanning electron microscope. No visual damage to the cutting edges of stainless steel instruments was evident after sterilization by saturated steam at 250 degrees F, formalin-alcohol vapor at 270 degrees F or dry heat up to 340 degrees F. Carbon steel instruments were not damaged by formalin-alcohol vapor at 270 degrees F or dry heat up to 340 degrees F. Saturated steam caused oxidation and dulling of carbon steel instruments.

Carbon↗

PubMed2002

Rapid polyethylene failure of unicondylar tibial components sterilized with gamma irradiation in air and implanted after a long shelf life.

BACKGROUND: The mechanical toughness of polyethylene that has been sterilized by gamma irradiation in air decreases after a long shelf life. The purpose of the present study is to report the high failure rate after unicondylar knee replacements performed with polyethylene bearings that had been sterilized with gamma irradiation in air and implanted after a shelf life of < or = 4.4 years. METHODS: Between December 1997 and January 2000, seventy-five unicondylar knee replacements were performed in sixty-two patients. All patients were followed both clinically and radiographically. A revision operation was offered when the patient had pain, swelling, and radiographic evidence of rapid polyethylene wear. The effect of aging of the polyethylene during storage was evaluated by dividing the knees into three groups on the basis of shelf life and comparing them with regard to the rate of revision and the observed wear of the polyethylene. Four retrieved components were examined for the presence of oxidation. RESULTS: At a mean of eighteen months after the arthroplasty, thirty knees had been revised and seven were scheduled for revision. The rate of polyethylene wear increased as the shelf life increased. There was a significant inverse linear correlation between the shelf life of the polyethylene and the time to revision (p < 0.01, r (2) = 0.64). All retrieved components had greater-than-expected wear with pitting and delamination of the surface. Seven components had fractured, and ten had both fractured and fragmented. Analysis of four components confirmed severe oxidation of the polyethylene. CONCLUSION: The present study demonstrated early, severe wear of tibial polyethylene bearings that had been sterilized by gamma irradiation in air and stored for < or = 4.4 years. This risk can be minimized by ensuring that implants have not been sterilized with gamma irradiation in air and stored for several years.

Arthroplasty, Replacement, Knee↗

PubMed2005

In vivo degradation of polyethylene liners after gamma sterilization in air.

BACKGROUND: Ultra-high molecular weight polyethylene degrades during storage in air following gamma sterilization, but the extent of in vivo degradation remains unclear. The purpose of this study was to quantify the extent to which the mechanical properties and oxidation of conventional polyethylene acetabular liners treated with gamma sterilization in air change in vivo. METHODS: Fourteen modular cementless acetabular liners were revised at an average of 10.3 years (range, 5.9 to 13.5 years) after implantation. All liners, which had been machined from GUR 415 resin, had been gamma-sterilized in air; the average shelf life was 0.3 year (range, 0.0 to 0.8 year). After removal, the components were expeditiously frozen to minimize ex vivo changes to the polyethylene prior to characterization. The average duration between freezing and testing was 0.6 year. Mechanical properties and oxidation were measured with use of the small-punch test and Fourier transform infrared spectroscopy, respectively, in the loaded and unloaded regions of the liners. RESULTS: There was substantial regional variation in the mechanical properties and oxidation of the retrieved liners. The ultimate load was observed to vary by >90% near the surface. On the average, the rim and the unloaded bearing showed evidence of severe oxidation near the surface after long-term in vivo aging, but these trends were not typically observed on the loaded bearing surface or near the backside of the liners. CONCLUSIONS: The mechanical properties of polyethylene that has been gamma-sterilized in air may decrease substantially in vivo, depending on the location in the liner. The most severe oxidation was observed at the rim, suggesting that the femoral head inhibits access of oxygen-containing body fluids to the bearing surface. This is perhaps why in vivo oxidation has not been associated with clinical performance to date.

Acetabulum↗

PubMed2005

Osteolysis after total knee arthroplasty: influence of tibial baseplate surface finish and sterilization of polyethylene insert. Findings at five to ten years postoperatively.

BACKGROUND: Debris displaced from the articular and backside surfaces of the polyethylene inserts of modular tibial components is considered a chief cause of osteolysis at the sites of total knee arthroplasties. One design of total knee replacement featured changes, over time, in the proximal surface roughness of the tibial baseplate and the method of sterilization of the polyethylene insert. We hypothesized that polishing the baseplate surface and sterilizing the insert with means other than gamma radiation in air had reduced the prevalence of osteolysis. METHODS: Three hundred and sixty-five posterior cruciate ligament-retaining Anatomic Modular Knee primary total knee arthroplasties were performed in 300 patients from 1987 to 1998. Anteroposterior and lateral radiographs of the knees were made within a five to ten-year postoperative interval. Two arthroplasty specialists independently examined the radiographs for evidence of osteolysis (defined as any nonlinear region of cancellous bone loss with delineable margins). RESULTS: Osteolysis was identified in 34% (eighty-two) of 242 knees treated with an insert that had been gamma-irradiated in air and affixed to a rough baseplate surface, and it was identified in 9% (nine) of ninety-eight knees treated with an insert that had been gamma-irradiated in an inert gas, or had not been irradiated, and joined to a polished surface. Osteolysis was associated with six factors, including one related to the patient (male gender), one related to the tibial baseplate (the proximal surface finish), three related to the polyethylene insert (the material from which it was machined, the sterilization method, and the shelf age), and one related to the technique (hyperextension of the femoral component relative to the tibial component). CONCLUSIONS: In this design of a total knee prosthesis, polishing the tibial baseplate counterface and implementing a more contemporary sterilization practice (as opposed to gamma radiation in air) noticeably diminished but did not eliminate osteolysis.

Aged↗

PubMed1993

Property variations of stone casts following high-temperature sterilization.

The effects of high-temperature sterilization methods (boiling, dry-heating, autoclaving and chemiclaving) on the properties of four types of stone cast were determined. SEM observations were made of the cast surface before and after sterilization. High-temperature sterilization affected the properties of the stone casts. Boiling, dry-heating and autoclaving were considered to be unacceptable methods for sterilizing stone casts before making prosthetic restorations.

Calcium Sulfate↗

PubMed1991

Selection of a sterilization method for the study of cereal grain digestion.

Experiments were initiated to select a sterilization method(s) that minimizes alterations in the digestive properties of cereal grains and, thus, would be suitable for the study of cereal grain digestion by pure cultures of ruminal bacteria. The following five treatments were examined: unsterilized (U), autoclaving with buffer (AB), autoclaving without buffer (AD), ethylene oxide (E), and gamma irradiation (I). Solubility of DM, starch, and CP was determined by soaking grain in buffer for 1 h followed by filtration through Whatman #54 filter paper. Ground corn and wheat from each treatment were placed in vials with a 1:1 mixture of Bryant's medium and ruminal inoculum. Vials were incubated for 4, 8, 12, 24, and 48 h and analyzed for starch content. Bacterial growth was not evident in sterilized, uninoculated samples. The AD treatment decreased the disappearance of CP in wheat and corn, whereas AB caused an increase in the disappearance of DM, CP, and starch in wheat (P less than .001) compared with U. Rates of microbial starch digestion for corn were 1.3, 1.5, 3.3, 14.7, and 3.5%/h and for wheat were 1.3, 3.4, 4.6, 17.1, and 4.6%/h for AD, E, I, AB, and U, respectively. Contrasts indicated that AD and AB differed (P less than .001) from U for both corn and wheat. It is likely that gelatinization of cereal starch enhanced microbial starch digestion in AB and the formation of Maillard products reduced starch digestion in AD. Corn and wheat sterilized with E or I had digestive properties that closely resembled those of U grain, and either sterilization method was suitable for studying cereal grain digestion.

Animals↗

PubMed1983

Steam sterilization of air turbine dental handpieces.

The efficacy of autoclaving high-speed dental handpieces was tested in two types of downward displacement steam sterilizers (instrument autoclaves), commonly used in the dentist's office. Eight series of experiments were performed with various sterilization schedules. Lubrication oils with or without antimicrobial agent were used in four of the series. Each handpiece was inoculated with 1 ml of a suspension containing equal amounts of saliva and spores of Bacillus stearothermophilus (approx. 10(6) spores/ml). Neither sterilization at 120-124 degrees C for 20 min nor at 134-136 degrees C for 10 min resulted in complete inactivation of the spores in series in which the instruments were tested without oil or with oil containing no antimicrobial agent. However, when the handpieces were lubricated with oil containing isopropanol and formaldehyde and the schedule 134-136 degrees C/10 min was used, no growth was observed. The results indicate that instrument autoclaves with built-in programs of 120-124 degrees C/20 min and 134-136 degrees C/10 min could have insufficient capacity to sterilize lubricated or unlubricated dental handpieces. The use of oils containing an antimicrobial agent can overcome this problem.

Dental High-Speed Equipment↗

PubMed1980

Effects of small concentrations of Mucor miehei protease on stability of sterile milk-based dietetic foods.

Four commercial sterile milk-based dietetic products were inoculated aseptically with small concentrations of a commericial milk clotting enzyme derived from Mucor miehei and incubated at 30 C for 32 wk. One of the products, Sustacal, exhibited no observable changes in body and texture during storage. Enzyme concentrations of 1 x 10(-4) chymosin units per milliliter or higher induced undesirable changes in the body of the other three products, Enfamil Ready-to-Use, Enfamil Concentrate, and Metrecal Shape. None of the products was affected visibly by enzyme concentrations of 1 x 10(-5) chymosin units per milliliter or less. In-can sterilization of Enfamil Ready-to-Use at 126.1 C for 4.5 min and Enfamil Concentrate at 126.7 C for 4.23 min completely destroyed all measurable enzyme activity at concentrations (up to 5.5 x 10(-2) chymosin units per milliliter) in these experiments. However, 1 to 3 h between formulation and sterilization allowed time for the enzyme at concentrations of 1 x 10(-2) chymosin units per milliliter or more to cause coagulation during heat sterilization.

Dairy Products↗

PubMedDate not supplied

New disinfection and sterilization methods.

New disinfection methods include a persistent antimicrobial coating that can be applied to inanimate and animate objects (Surfacine), a high-level disinfectant with reduced exposure time (ortho-phthalaldehyde), and an antimicrobial agent that can be applied to animate and inanimate objects (superoxidized water). New sterilization methods include a chemical sterilization process for endoscopes that integrates cleaning (Endoclens), a rapid (4-hour) readout biological indicator for ethylene oxide sterilization (Attest), and a hydrogen peroxide plasma sterilizer that has a shorter cycle time and improved efficacy (Sterrad 50).

Disinfectants↗

PubMed1999

Sterilization of contaminated bone-tendon autografts using 10% povidone-iodine solution.

This study evaluates methods of sterilizing contaminated bone-tendon autografts using 10% povidone-iodine solution. Sterile grafts were prepared from human cadavers. Grafts were immersed in a suspension of either Staphylococcus aureus or Pseudomonas aeruginosa, and three sets of sterilization experiments were performed in 10% povidone-iodine for 30 minutes: one each with S. aureus and P. aeruginosa by static soaking and a third with S. aureus by serial washing with agitation. Of grafts inoculated with S. aureus, six of six grew the test organism after soaking at room temperature, as did five of six after soaking at 36 degrees C and also eight of nine after washing with agitation. Of grafts inoculated with P. aeruginosa, five of six grew the test strain after soaking at room temperature, as did six of six after soaking at 36 degrees C. Thirty minutes of exposure to aqueous 10% povidone-iodine does not adequately sterilize an inoculated graft.

Anti-Infective Agents, Local↗

PubMed2003

Effect of microorganism characteristics on leak size critical to predicting package sterility.

The effects of microorganism size and motility on the leak size critical to the sterility of a package, along with the imposed pressure required to initiate liquid flow for the critical leak size, were measured. Pseudomonas fragi Lacy-1052, Bacillus atrophaeus ATCC 49337, and Enterobacter aerogenes ATCC 29007 were employed to assess package sterility. One hundred twenty-six 7-mm-long microtubes with interior diameters of 5, 10, and 20 microm were used to simulate package defects. Forty-two solid microtubes were used as controls. No significant differences were found between sizes or motility statuses of test organisms with respect to loss of sterility as a result of microbial ingress into test cells with microtube interior diameters of 5, 10, and 20 microm (P > 0.05). Interactions between the initiation of liquid flow as a result of applied threshold pressures and sterility loss for test cells were significant (P < 0.05).

Bacillus↗

PubMed1987

Delayed ectopic pregnancies after sterilization.

Female sterilization as an interval, postabortal or postpartum procedure, is one of the most widely employed contraceptive techniques on a global basis. The short-term complications of sterilization, which include intra- and extrauterine pregnancies, are well researched and documented. The figures for long-term complications, including ectopic pregnancy, are much less reliable as the follow-up rates diminish as time passes after sterilization. Three cases of tubal pregnancy that occurred long after interval sterilization are presented as a warning against the assumption that long-term complications cannot occur.

Adult↗