[50% of "cleaned" equipment contaminated by fecal germs. Infection caused by the endoscope? (Interview)].
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Cross Infection↗
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An audit into the efficacy of single use bacterial/viral filters for the prevention of equipment contamination during lung function assessment.
Lung function testing has been suggested to provide a potential risk regarding cross-infection between patients. About 155 patients (86 infectious, 69 non-infectious) used a single use bacterial/viral filter when performing routine lung function tests. Swabs from the patient side of the filter (Proximal) and the equipment side (Distal), and two sections of the filter itself were cultured. About 33/155 samples showed bacterial growth on the Proximal compared with 2/155 on the Distal side (P<0.01). Growth was obtained from the filter in 125/155 (80.6%) of cases. Pathogenic micro-organisms such as Pseudomonas aeruginosa (4 cases) and Staphylococcus aureus (5 cases) were isolated. Appropriate infection control measures should be used when performing lung function tests.
Bacterial Infections↗
An efficacy evaluation of a synergized glutaraldehyde-phenate solution in disinfecting respiratory therapy equipment contaminated during patient use.
Reusable, corrugated, expiratory limb ventilator tubing that had been in use for 24 hours, were randomly allocated to one of three groups: no treatment (N = 36); detergent wash (N = 83); or a detergent wash followed by a 10 minute immersion in a 1:16 dilution of synergized glutaraldehyde-phenate solution which was reused for 30 days. (Between 10 and 22 tubes were tested in each five day interval during this 30-day period.) Tubes were quantitatively and qualitatively cultured. There were significant differences in both the percent of contaminated tubes (no treatment = 92%, detergent wash = 72%, glutaraldehyde-phenate = 0 to 20%) and numbers of microorganisms per tube (no treatment = 3.2 x 10(6), detergent wash = 1.3 x 10(4), glutaraldehyde-phenate = 0 to 182) between groups. There was no apparent decrease in glutaraldehyde-phenate's efficacy throughout the 30-day reuse period, and in the final five days of the reuse period it was completely effective.
Aldehydes↗
HAZARDS OF EQUIPMENT CONTAMINATED WITH PARATHION.
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Parathion↗
Evaluation of cross-contamination on automatic viscera removal equipment.
Contamination of poultry carcasses by fecal or ingested material is a major problem in the processing of poultry products. It was determined that the automatic equipment used to process uncontaminated carcasses could be used to clean and reprocess contaminated carcasses and significantly reduce the manual labor required to reprocess these carcasses. The potential for cross-contamination of the automatic viscera removal equipment was tested by microbiological evaluation, and it was determined that cross-contamination by this equipment was not a problem.
Animals↗
An outbreak of Pseudomonas aeruginosa infection associated with contaminated urodynamic equipment.
Seven patients developed Pseudomonas aeruginosa urinary tract infections following urodynamic studies, over a two-month period. One patient developed septicaemia and meningitis and died following rupture of a berry aneurysm. Two others required hospital admission for intravenous antibiotic treatment. Pseudomonas aeruginosa was isolated from a pressure dome which covered the pressure transducer of the urodynamic system used for assessing bladder pressure. The device packaging carried the symbol designating this as a 'single use' product, but as an economy measure, a local decision had been taken to change the device monthly.
Cross Infection↗
Delhi hospital lambasted for use of contaminated surgical equipment.
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Cross Infection↗
[Investigation on HBV contamination of equipment].
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DNA, Viral↗
Domiciliary metaproterenol nebulization: a bacteriologic survey.
We wanted to determine whether domiciliary jet nebulization (DJN) leads to contamination of the equipment with fungi or aerobic bacteria and, eventually, to respiratory colonization or pneumonia in daily users of the equipment. We surveyed from this standpoint 23 veterans 65 +/- 10.1 years of age, present or former smokers, treated with steroids more than 7 months in the year preceding the survey, and with FEV1/FVC of 42 +/- 11%; they all were daily users of the equipment, diluting the metaproterenol solution with nonbacteriostatic saline dispensed in multiple-dose bottles of 500 to 1000 ml (protocol 1 [P1]). After this protocol was completed, the large saline bottles were replaced by 20 cc vials; 11/23 completed 1 year of this treatment (protocol 2 [P2]). Equipment contamination was checked in all initial 23 patients after one-time nebulization in the laboratory with fresh material (protocol 3 [P3]). We found that DJN leads to equipment contamination in 20/23 subjects of P1 and 3/11 subjects of p2; saline bottles and the nebulizer were the most frequently contaminated items (32/41 equipment items in P1 and 10/55 in P2). The contamination was predominantly bacterial with oropharyngeal saprophytes (19 in p1, O in P2) or gram-negative bacilli (47 in P1, 8 in P2). Bacterial growth was heavier in P1 than in P2. During P3, three equipment items became contaminated in 3/23 subjects; the flora was oropharyngeal. No patient developed respiratory colonization or developed pneumonia during 9000 patient days of DJN.(ABSTRACT TRUNCATED AT 250 WORDS)
Aged↗
Cross-infection from contaminated anaesthetic equipment. A real hazard?
A definite relationship between the use of contaminated anaesthetic equipment and subsequent pulmonary infection remains to be established. There is however indirect and circumstantial evidence suggesting that cross-infection may occur, and further an increased susceptibility of surgical patients to pulmonary infections has been demonstrated. Decontamination should be recommended before the equipment is re-used. Pasteurisation may prove sufficient and this can be obtained employing a specially designed dish-washing machine.
Anesthesia, Inhalation↗
Occupational biohazards affecting clinical engineers & BMETs. Part III: Blood and other body fluids.
Results of a previously reported survey of BMETs and CEs indicated a need for further education of these professionals concerning work-related biohazards. In this third article of a five-part series, the dangers of disease transmission by blood and other body fluids are discussed. Susceptibility factors are cited to indicate those persons at greatest risk of infection, and recommendations are provided to assist BMETs and CEs in effectively protecting both themselves and other clinical and nonclinical personnel from infection. The recommendations presented include suggested disinfection procedures for contaminated equipment. Persons interested in further information are advised to contact the infection control officer at their facility, or the Centers for Disease Control.
Acquired Immunodeficiency Syndrome↗
The microbiological contamination of equipment processed by the HSDU.
The microbiological hazard to staff of used instruments and equipment when returned to the HSDU appears to be small providing reasonable precautions are taken (Parsons et al, 1985). Nevertheless, little evidence is available on the contamination of used equipment or the efficiency of cleaning and disinfection methods.
Central Supply, Hospital↗
Microbiological evaluation of various parameters in ophthalmic operating rooms. The need to establish guidelines.
PURPOSE: Postoperative infections can be caused by a contaminated environment, unsterile equipment, contaminated surfaces, and infected personnel as well as contaminated disinfectants. In order to establish guidelines for microbiological monitoring, a detailed microbiological surveillance was carried out in an ophthalmic hospital. METHOD: Over a period of 21 months, we assessed environmental Bacteria Carrying Particle(BCP) load and surface samples weekly (n = 276); the autoclaving system once a month and repeated whenever the process failed (n = 24); the air conditioning filters for fungal growth once in four months (n = 15), and the disinfectant solution for contamination once in two months (n = 10). Additionally, the personnel involved directly in surgery were screened for potential pathogens such as Staphylococcus aureus and beta haemolytic streptococci. RESULT: On 14 (5.07%) occasions the environment in the operating rooms had a significant risk of airborne infections. Sterilisation of instruments in the autoclaves was unsatisfactory on 4 (16.66%) occasions. Samples from the filters of the air-conditioning units yielded potentially pathogenic fungi on 3 (20%) occasions. Personnel sampling revealed that 5 (8.77%) individuals harboured beta haemolytic Streptococci in the throat and 4 (7.01%) harboured S. aureus in the nasal cavity. The samples of disinfectant in use were not contaminated. CONCLUSION: There is a need to standardise microbiological evaluation protocols for operating rooms.
Disinfection↗
Contaminated oral intubation equipment associated with an outbreak of carbapenem-resistant Pseudomonas in an intensive care unit.
Twenty intensive care patients were diagnosed as infected or colonized by Pseudomonas aeruginosa within a one-month period; a rate three to four times higher than the typical background frequency of this infection in the intensive care unit (ICU). Patients with positive respiratory specimens were mechanically ventilated, which included re-used disinfected bite blocks during intubation. Fourteen specimens from 20 positive patients originated in the respiratory tract. Seven clonal variants were isolated and identified as originating from the same strain by pulsed-field analysis. These isolates were also matched to the strain detected on the re-used bite blocks, which had been disinfected with 140ppm sodium hydrochloride. Notably, Staphylococcus aureus was also detected on bite blocks sterilized with ethylene dioxide, indicating incomplete disinfection. In immunocompromised patients, re-use of bite blocks during intubation must be prohibited. Single-use kits or intubation without the use of bite blocks is recommended.
Carbapenems↗
An outbreak of Pseudomonas aeruginosa related to contaminated urodynamic equipment.
Investigation of an outbreak of multiresistant Pseudomonas aeruginosa urinary tract infections within our hospital identified the urodynamic laboratory as the point source. Disinfection procedures were inadequate, and transducers designated for single-patient use were used repeatedly and subsequently became contaminated. These improper procedures were part of a cost-containment effort.
Cross Infection↗
An outbreak of methicillin resistant Staphylococcus aureus on a burn unit: potential role of contaminated hydrotherapy equipment.
OBJECTIVE: To report a multi-institution outbreak caused by a single strain of methicillin-resistant Staphylococcus aureus (MRSA). OUTBREAK: Between September 19 and November 20, 1996 an index case and five secondary cases of nosocomial MRSA occurred on a 26 bed adult plastic surgery/burn unit (PSBU) at a tertiary care teaching hospital. Between November 11 and December 23, 1996, six additional cases were identified at a community hospital. One of the community hospital cases was transferred from the PSBU. All strains were identical by pulsed-field gel electrophoresis. MRSA may have contributed to skin graft breakdown in one case, and delayed wound healing in others. Patients required 2 to 226 isolation days. CONTROL MEASURES: A hand held shower and stretcher for showering in the hydrotherapy room of the PSBU were culture positive for the outbreak strain, and the presumed means of transmission. Replacement of stretcher showering with bedside sterile burn wound compresses terminated the outbreak. The PSBU was closed to new admissions and transfers out for 11 days during the investigation. Seven of 12 patients had effective decolonization therapy. CONCLUSION: Environmental contamination is a potential source of nosocomial MRSA transmission on a burn unit. Notification among institutions and community care providers of shared patients infected or colonized with an antimicrobial resistant microorganism is necessary.
Adult↗
Scanning electron microscopy of dairy equipment surfaces contaminated by two milk-borne micro-organisms.
Ethanol dehydration followed by argon replacement induced drying (ARID) was found to be a suitable method for the preparation of glass, stainless steel and rubber surfaces which had been in contact with inoculated milk and which were to be examined using scanning electron microscopy (SEM). This technique was used to examine samples of all three materials which had been subjected to both single and repeated inoculation with whole milk containing a Pseudomonas sp. or a Micrococcus sp. and incubated for various periods. Some samples were also prepared for SEM using a cryofixation technique. The Pseudomonas sp. was found to proliferate on glass and stainless steel surfaces but not on rubber. Due to the clumping tendency of the Micrococcus sp. proliferation of this organism was more difficult to assess accurately. In general there was no difference in results obtained between single and repeated inoculation. Various factors which may have aided attachment of micro-organisms to surfaces were identified viz., surface channels present in stainless steel, milk deposits and the production of extracellular material. The value of using both the cryofixation and chemical preparatory techniques for the identification of artifacts is discussed.
Animals↗
Critical care unit outbreak of Serratia liquefaciens from contaminated pressure monitoring equipment.
Between October and December 1999, Serratia liquefaciens was isolated from 11 patients in an adult critical care unit. One patient was infected on two separate occasions. In total, there were 10 positive blood cultures and five positive intravascular catheter tips. Eight cases were clinically infected, three were possibly infected and one was not. All patients with clinical isolates received appropriate empirical antibiotic treatment and responded well. Environmental investigation revealed S. liquefaciens in syringes and connector tubing used to calibrate the intravascular line pressure monitoring equipment of eight patients. Three of these patients also had clinical isolates of S. liquefaciens. Analysis by pulsed-field gel electrophoresis found clinical and environmental isolates to be of the same strain. The most likely mode of transmission was a non-sterile sphygmomanometer tip used daily for calibration. Inadequate microbiological sampling methods may have limited detection of S. liquefaciens. Several other examples of poor infection control techniques were identified during the outbreak, notably lapses in hand hygiene during intravascular pressure monitoring. It was also observed that unlabelled multidose heparin and insulin vials were shared between patients and personal hand creams were used by staff. However, these were not directly implicated in the outbreak. The outbreak ended when poor infection control practices were corrected. Calibration syringes and connector tubing were discarded after a single use. The sphygmomanometer was replaced by a pneumatic pressure transducer tester with connector tube and the frequency of calibration reduced to a single test following line insertion only. The non-disposable tube was disinfected with alcohol wipes between patients.
Adult↗