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PubMed1975

Laparoscopic sterilization immediately after term delivery: a preliminary report.

To evaluate the feasibility and safety of performing laparoscopic sterilization immediately after a normal delivery, 46 patients were studied. All sterilizations were performed within 48 hours of delivery, using a single puncture technique with cautery and separation of the uterine tubes, under a neuroleptanalgesic. A description of the technique, the technical difficulties encountered in performing the procedures and the incidence of complications are presented. The technique, when performed during the early puerperium, is practicable since technical difficulties and the severity and incidence of complications are clinically acceptable. The sterilization procedure did not significantly increase the duration of hospitalization after delivery. Most patients were discharged from the hospital 1 to 2 days after the sterilization.

Adult↗
PubMed2002

Bilateral tubal pregnancies after tubal sterilization in a human immunodeficiency virus seropositive woman.

Bilateral tubal ectopic pregnancies are rare occurrences. Bilateral tubal ectopic pregnancy in a patient who had undergone tubal sterilization is also very rare. The authors report a case of a 32-year-old, gravida 2, parity 1, human immunodeficiency virus seropositive who had previously undergone tubal sterilization. She presented with abdominal distention and vaginal bleeding after 12 weeks of amenorrhea. Pre-operative diagnosis was ruptured ectopic pregnancy. Emergency exploratory laparotomy and bilateral salpingectomy were performed. The pathology report confirmed bilateral tubal pregnancies. She was well at the fifth day of discharge and four-week follow-up. Ectopic pregnancy should always be suspected in reproductive-age patients presenting with amenorrhea even if they have undergone tubal sterilization. To the authors' knowledge, there has been no report of bilateral tubal pregnancy in a patient with human immunodeficiency virus seropositive after tubal sterilization.

Adult↗
PubMedDate not supplied

Incubation time in sterility tests for pharmaceutical products.

Throughout the evolution of sterility test methodology, different periods of incubation were adopted depending on both the type of microorganism to be detected and the employed inoculation methodology. Some official compendiums, such as Brazilian and Mexican pharmacopoeias, recommend different incubation periods, according to the inoculation methodology employed for the sterility test, whereas the United States Pharmacopeia, in its last edition, started to adopt an incubation period of 14 days, independently from the methodology employed. The aim of this work was the evaluation of the influence of the incubation time on the efficiency of different methodologies for sterility test, as well as the benefits that could be achieved with the incubation time extension. The experiments led to the conclusion that an incubation period of 14 days is enough for the detection of microbiological contaminants in pharmaceutical products submitted to sterility tests, independently from the methodology employed, what values the alteration introduced in the USP XXIV, to the detriment of other pharmacopoeias which maintain different periods of time in accordance with the inoculation method employed.

Bacteria↗
PubMedDate not supplied

Qualification of a rapid readout biological indicator with moist heat sterilization.

Biological indicators are recognized as an important component in the validation and routine monitoring of moist heat (steam) sterilization processes. Due to the need to allow for the recovery and outgrowth of test organisms that may have been sub-lethally injured, between 2-5 days of incubation are typically required before the outcome of sterilization processing can be reliably interpreted. Rapid readout biological indicators that incorporate the response of a heat resistant enzyme provide a means for assessing the efficacy of moist heat sterilization within hours of processing. This study describes the qualification of the 3M Attest 1292 Rapid Readout Biological Indicator with moist heat sterilization according to the procedures described in the PDA Technical Report No. 33, "Evaluation, Validation and Implementation of New Microbiological Testing Methods".

Geobacillus stearothermophilus↗
PubMed2003

Sterilizer monitoring: a vital component for infection control.

Because instrument sterilization is such a vital component to an effective infection control program, improper sterilizer operation can result in serious consequences. Weekly biological monitoring of sterilizer function offers confidence to dentists, staff, and patients that sterilization procedures provide protection from infectious diseases.

Dental Instruments↗
PubMedDate not supplied

Comparison between sterile saline and tap water for the cleaning of acute traumatic soft tissue wounds.

OBJECTIVE: To find out if there were any differences in infection rates if acute traumatic soft tissue wounds were cleaned with tap water instead of sterile saline. DESIGN: Randomised study. SETTING: Emergency department at one city hospital. SUBJECTS: 705 consecutive patient with soft tissue wounds less than six hours old that did not penetrate a viscus, cavity, or joint and could be treated by primary suture. INTERVENTIONS: Randomly allocated to have the wound cleaned with either sterile saline or tap water in addition to debridement. MAIN OUTCOME MEASURE: Rate of wound infection, the presence of which was indicated by pus in the wound and prolonged healing. RESULTS: The infection rate in wounds cleaned with sterile saline was 10.3% compared with 5.4% in wounds cleaned with tap water (p less than 0.05). Infected wounds were significantly larger than uninfected ones (p less than 0.05) and more likely to be located on a lower extremity (p less than 0.05). There were no microbiological differences between the two groups, and no bacterial species grown from tap water was subsequently grown from an infected wound. CONCLUSION: Sterile saline should be replaced by tap water for the cleaning of acute traumatic superficial soft tissue wounds.

Acute Disease↗
PubMed1977

The safety of combined abortion-sterilization procedure.

To determine the safety of tubal sterilization performed at the time of induced abortion, we compared data on 616 women who underwent induced abortion and concurrent tubal ligation (Group 1) with 1,805 women who had induced abortion only (Group 2). These two groups of women were healthy, seven to 12 weeks pregnant, and between the ages of 16 and 44 years. The partly-standardized morbidity rates for Group 1 and Group 2 were 5.4 and 3.6%, respectively. Thus, the sterilization procedure added 1.8% to the complication rate of induced abortion only. The complication rate for women who had interval culdoscopic ligation under the same conditions in the same department was 2.4%. This is not significantly different from the complication rate of 1.8% attributable to sterilization procedures in women who had abortion and concurrent ligation. We conclude that these data support our present practice of performing tubal ligation at the time of induced abortion, rather than changing to the practice of abortion followed by interval sterilization six weeks later, with its many disadvantages to the patient as well as to those providing family-planning services.

Abortion, Induced↗
PubMedDate not supplied

Anaesthesia for minilaparotomy female sterilization in JUTH, Nigeria: a fourteen-year review.

This is a retrospective study aimed at evaluating the various anaesthetic methods used for minilaparotomy female sterilization. During the fourteen-year period, 2913 clients had minilaparotomy female sterilization. Their mean age was 36.35 +/- 4.19 years. Mean number of living children was 6.82 +/- 1.64. 74.87% of the clients did not have any formal education, but were aware of other contraceptive options. In all 98.42% of the clients were married and in a stable relationships. Local anaesthesia with 1% xylocaine (10-20 mls) was used in 83.69% of the cases. Local anaesthesia with sedation in 13.53% and general anaesthesia in only 2.78%. Above 93.55% (2725) of the sterilization was carried out as an interval procedure, while 6.45% (188) were done postpartum. Pomeroy's technique was used in 96.98% of the tubal ligation. There was no mortality. The morbidity was vomiting and hallucination and it occurred in 0.20% amongst the clients who had sedation or general anaesthesia. Minilaparotomy under local anaesthesia for female sterilization has been found to be safe an effective outpatient procedure, and it is currently and established family planning option in our institution. The use of local anaesthesia alone gradually rose from 1987 up to date. The successful outcome was attributable to psychological and emotional preparation of the clients who also had to learn abdominal breathing exercises (for easy access to the fallopian tubes) from the trained personnel before the procedure.

Adult↗
PubMed2003

Quinacrine sterilization: a retrospective.

OBJECTIVE: To trace development of quinacrine sterilization (QS). METHODS: Review of published reports. RESULTS: The high prevalence of septic abortion among high parity women in Santiago, Chile, motivated Zipper to find a safe, inexpensive method of non-surgical female sterilization. Various cytotoxic drugs were tried in rats. Because quinacrine was already accepted for intrapleural injection it was chosen for the first clinical trial. A slurry consisting of quinacrine and xylocaine was instilled into the uterine cavity with a transcervical syringe. Reasonable efficacy was noted and a limited scar of the intramural tube demonstrated. However, a side effect of cortical excitation and reports of 3 deaths ended this approach. Zipper and Wheeler hypothesized that the difficulty was due to rapid absorption of quinacrine under pressure and designed a pellet form that dissolves slowly and could be delivered transcervically using a modified IUD inserter. A standard protocol of 252 mg in seven 36 mg pellets placed at the uterine fundus on two occasions a month apart has now been widely used with considerable evidence for safety and efficacy. Indeed, protection is greater than 98% at 2 years of use. CONCLUSION: QS is ready for widespread use, especially where surgical sterilization is not safely available or when women are poor candidates for surgery or have such a fear of surgery that they will not seek surgical sterilization.

Animals↗
PubMed2003

25 years of quinacrine sterilization experience in Chile: review of 2,592 cases.

OBJECTIVES: To assess short-term side effects, long-term risks and efficacy of quinacrine sterilization (QS) in Chile. METHODS: Review experience of 2,592 cases sterilized with 2 or 3 transcervical insertions of 252 mg quinacrine as pellets since 1977; review the Chilean pre-clinical experience and epidemiological studies on cervical, endometrial and other cancers. RESULTS: Among 2,592 women who underwent QS, the total number of pregnancies was 119 (4.6%); 59 (49.5%) were carried to term with no birth defects related to QS. Nine cases were ectopic pregnancies. The ectopic pregnancy risk per 1,000 woman-years was 0.41, similar to that for surgical sterilization. The cumulative life-table pregnancy rates per 100 women at 10 years varied from 5.2 to 6.9. Mild and transient side effects were reported in 13.5% of quinacrine intrauterine insertions and pelvic inflammatory disease was diagnosed in 4 cases (0.15%). Long-term follow-up of quinacrine-sterilized patients shows no increased risk of cervical, endometrial or other cancer. CONCLUSIONS: QS efficacy at 10 years is comparable to widely accepted tubal clip and single point bipolar electrocoagulation laparoscopic procedures. QS has a low risk of serious, immediate side effects. No long-term risks have been identified after 25 years of use.

Adult↗
PubMed1992

[The effect of various sterilization procedures on the osteoinductive properties of demineralized bone matrix].

To minimize potential infection following the transplantation of allogeneic bone, extremely rigorous selection of donors and careful processing and storage of samples are required. Other major problems related to allogeneic transplants, such as reduced osteogenic properties and immunological reactions, led to the development of demineralized bone matrix (DBM). This osteoinductive bone extract is largely free of antigens and is easy to produce. However, to eliminate the potential risk of infection, DBM should be sterilized prior to implantation. The purpose of this study was to investigate the influence of different sterilization techniques on the osteoinductive properties of DBM. A series of 76 cortical defects (drill holes) 0.6 cm in diameter in the tibiae of 11 Merino sheep were filled with DBM in addition to autogeneic and allogeneic cancellous bone. Prior to implantation DBM was sterilized by autoclaving, gamma irradiation, or application of ethylene oxide or ethyl alcohol. A further 12 drill holes were left empty as controls. The formation of new bone was examined 3 and 6 weeks postoperatively, using histological, fluorescent-optical and microradiographical techniques. The amount of newly formed bone was also quantified. Apart from autoclaved DBM all matrix grafts showed excellent new bone formation following sterilization, by far exceeding the formation with allogeneic cancellous bone.

Animals↗
PubMed1992

Safe storage times for sterile instrument packs.

Military health care facilities are required to place expiration dates on sterile instrument packs. There are few scientific guidelines for determining these dates. This article reports the findings of two studies conducted at Wilford Hall USAF Medical Center, which investigated the potential shelf-life of three packaging materials for sterile instruments. The results of the studies indicate that sterility is maintained for at least 1 year with all three materials. The maximum storage times allowed for sterile instruments at most military facilities appear to be overly restrictive.

Culture Media↗
PubMed2004

Bacterial sterilization and intracellular protein release by a pulsed electric field.

Several biotechnological applications of high-voltage pulsed electric field (PEF) are introduced. Electrical breakdown or disruption of a biological membrane by PEF is understood to occur by electromechanical compression, which results in the formation of transmembrane pores. If the total area of induced pores is small in relation to the total surface area of the membrane, the pores are able to close again mainly through the diffusion of the lipid molecules and rearrangement of the proteins (reversible disruption). If the total area of the pores becomes unfavorably large, the membrane is no longer able to repair these perturbations (irreversible disruption), and that results in sterilization. We have investigated effective sterilization by using PEF-induced irreversible disruption of biological membranes. The treatment temperature or growth temperature was found to have a great effect on PEF sterilization. The shape of the treatment chamber also proved important for effective PEF sterilization. Therefore, a number of reactors having novel structures were developed. We have also verified that this PEF-induced reversible disruption could be utilized for the selective release of intracellular proteins from yeast and certain gene-engineered Escherichia coli. The secretion of periplasmic protein from E. coli was achieved during cultivation.

Bacteria↗
PubMed2004

Immediate complications of laparoscopic tubal sterilization: 11 years of experience.

OBJECTIVE: To evaluate the complications of laparoscopic tubal sterilization. METHOD: A retrospective study of laparoscopic tubal sterilization performed at Maharaj Nakorn Chiang Mai Hospital, Faculty of Medicine, Chiang Mai, Thailand was conducted. The details of the operation, including complications and operation time were collected from the operative and family planning registry. RESULTS: Between January 1987 and December 1997, 948 cases of laparoscopic tubal sterilization were performed as an outpatient setting. The combination of intravenous sedation and local anesthesia was employed in all cases. Minor intra-operative complications were found in 4.6% of cases. The most frequent complications were meso-salphingeal and meso-ovarian bleeding. No serious complication was found in this study. The mean operation time was 19.3 minutes (range 5-75 minutes). CONCLUSION: The present study suggested that out-patient laparoscopic tubal sterilization under the combination of intravenous sedation and local anesthesia is a convenient and relatively safe procedure.

Adolescent↗
PubMed2005

Effect of different sterile barrier precautions and central venous catheter dressing on the skin colonization around the insertion site.

AIM: The purpose of this prospective, randomized, controlled study was the comparison of maximal sterile barrier (consisting of mask, cap, sterile gloves, gown, large drape) vs control precautions (mask, cap, sterile gloves, small drape) and of transparent polyurethan film vs gauze dressing for use on central venous (CVC) nontunneled catheters, inserted via the jugular vein. Skin colonization at the insertion site (defined by quantitative skin cultures performed at the time of insertion and in days 2 and 5) was used as a primary endpoint. Catheter tip colonization was also assessed through qualitative culture and CVC related sepsis was defined by the isolation of the same organism from the catheter tip and the blood, with clinical sepsis of no other apparent source. METHODS: Eighty-two consecutive patients were enrolled, admitted to a mixed medical-surgical ICU, aged 72+/-12 years, 58% male, SAPS II 42+/-13. One-hundred and seven CVCs were studied (presenting 750 catheter in situ days); CVCs were in place for a mean period of 6.9+/-4.7 days and 5 episodes of central catheter-related bloodstream infection were detected (6.6 per 1000 catheter days). RESULTS: A multiple logistic regression detected an increased risk of skin colonization in male gender (OR=2.5) and control precautions (OR=3.4) and no difference with regard to age, dressing and diagnostic group. CONCLUSIONS: Maximal sterile barrier proved to be an effective and recommended practice. However surveillance skin cultures revealed the common and changing nature of colonization of skin at the insertion site.

Aged↗
PubMedDate not supplied

Permeation risks with peracetic acid and hydrogen peroxide sterilizing agent inside ambulatory pumps.

The sterilizing agent commonly used to sterilize materials for an isolator is a peracetic acid (PA) and hydrogen peroxide (HP) mixture. The permeation of this agent through ambulatory pumps should reveal a potential toxic risk for the patient and a stability modification of the drug by a pH change. Six wrapped and six unwrapped ambulatory pumps from each laboratory were introduced in the transfer chamber for the sterilizing process over 2 h 45 min. The presence of PA and HP were determined by using analytical strips. If the analytical strips of HP were positive, the level of HP was determined by using a specific spectrometric kit. No acid permeation was found in all wrapped pumps. Acid permeation was found in two samples of Ultraflow unwrapped series and in one unwrapped sample of Easypump series by the analytical strips. In other unwrapped samples, no acid permeation was detected. In four unwrapped ambulatory pumps (Accufuser, Infusor, Ultraflow, and Easypump), the analytical strips of HP were positive in the range of 0.5 to 25 mg/L, varying by laboratory. In only one sample (Surefuser), no detection of HP was found. The quantitative dosage of HP by spectrophotometry confirmed the permeation risk inside all pumps except the Surefuser. Our investigation shows that the permeation risk inside ambulatory pumps is real when pumps are unwrapped and exposed at high levels to PA and HP mixture. The results of our study recommend retaining the wrapping for the peracetic acid sterilization of the ambulatory pumps.

Hydrogen Peroxide↗
PubMed1992

Assessment of the effectiveness of dental sterilizers using biological monitors.

This study was undertaken to evaluate the effectiveness of steam, chemical vapor, and dry heat sterilizers, over a three-year period, in dental operatories subscribing to the University of British Columbia's sterilization monitoring service. A total of 4,579 sterilizer loads were tested. The results demonstrated an overall failure rate of 4.4 per cent. Individual failure rates for each type of sterilizer were: chemiclaves, 4.9 per cent; steam autoclaves, 2.3 per cent; and dry heat ovens, 7.9 per cent. In 38 per cent of these cases, the reasons for failure could be attributed to a definite cause.

Bacillus subtilis↗
PubMed2006

Sterilization of bacteria, yeast, and bacterial endospores by atmospheric-pressure cold plasma using helium and oxygen.

Atmospheric-pressure cold plasma (APCP) using helium/oxygen was developed and tested as a suitable sterilization method in a clinical environment. The sterilizing effect of this method is not due to UV light, which is known to be the major sterilization factor of APCP, but instead results from the action of reactive oxygen radicals. Escherichia coli, Staphylococcus aureus, and Saccharomyces cerevisiae deposited on a nitrocellulose filter membrane or Bacillus subtilis spores deposited on polypropylene plates were exposed to helium/oxygen plasma generated with AC input power at 10 kHz, 6 kV. After plasma treatment, nitrocellulose filter membranes were overlaid on fresh solid media and CFUs were counted after incubation overnight. D-values were 18 sec for E. coli, 19 sec for S. aureus, 1 min 55 sec for S. cerevisiae, and 14 min for B. subtilis spores. D-values of bacteria and yeast were dependent on the initial inoculation concentration, while the D-value of B. subtilis spores showed no correlation. When treated cells were observed with a scanning electron microscope, E. coli was more heavily damaged than S. aureus, S. cerevisiae exhibited peeling, and B. subtilis spores exhibited shrunken morphology. Results showed that APCP using helium/oxygen has many advantages as a sterilization method, especially in a clinical environment with conditions such as stable temperature, unlimited sample size, and no harmful gas production.

Atmospheric Pressure↗