Method of Dialyzer Cleaning and Frequency of Reuse

Several methods exist for cleaning hollow fiber dialyzers for reuse. How important is the cleaning procedure in determining the number of times a dialyzer can be reused?     

Asthma symptoms in women employed in domestic cleaning: a community based study

BACKGROUND: Epidemiological studies have shown an association between cleaning work and asthma, but the risk factors are uncertain. The aim of this study was to assess the risk of asthma in women employed in domestic cleaning. METHODS: A cross sectional study was conducted in 4521 women aged 30 to 65 years. Information on respiratory symptoms and cleaning work history was obtained using a postal questionnaire with telephone follow up. Asthma was defined as reported symptoms in the last year or current use of drugs to treat asthma. Odds ratios (OR) with 95% confidence intervals (CI) for asthma in different cleaning groups were estimated using adjusted unconditional logistic regression models. RESULTS: 593 women (13%) were currently employed in domestic cleaning work. Asthma was more prevalent in this group than in women who had never worked in cleaning (OR 1.46 (95% CI, 1.10 to 1.92)). Former domestic cleaning work was reported by 1170 women (26%), and was strongly associated with asthma (OR 2.09 (1.70 to 2.57)). Current and former non-domestic cleaning work was not significantly associated with asthma. Consistent results were obtained for other respiratory symptoms. Twenty five per cent of the asthma cases in the study population were attributable to domestic cleaning work. CONCLUSIONS: Employment in domestic cleaning may induce or aggravate asthma. This study suggests that domestic cleaning work has an important public health impact, probably involving not only professional cleaners but also people undertaking cleaning tasks at home.     

机器人手术器械清洗管理研究进展

从机器人手术系统发展、手术器械清洗现状、器械管理等方面进行综述。提出应专人管理、专业培训、建立规范的清洗灭菌流程,以保障机器人手术器械的清洗质量,以期为机器人手术质量管理提供参考。     

Microbiological evaluation of UV disinfection effectiveness in a specialist cystic fibrosis clinic

The aim of the study was to evaluate the impact of manual cleaning and manual cleaning followed by Ultraviolet-C disinfection on the colony forming units of bacteria retrievable from equipment and surfaces within clinic rooms following a CF outpatient encounter. While UV disinfection has proven to be effective within general healthcare settings, it has not been evaluated in a CF centre.Microbiological sampling was performed following outpatient encounters involving 11 adult patients with CF and chronic infection with P.aeruginosa, MRSA or E. coli ESBL.The results of this study suggest that manual cleaning followed by UV-C disinfection is more effective than manual cleaning alone at reducing environmental contamination within a CF clinic and that UV-C isinfection is likely to reduce the risk of fomite transmission in the CF outpatient setting.     

腹部平片清洁灌肠方法的改进

目的 探讨改良清洁灌肠方法用于腹部平片检查患者的临床效果,以提高清洁灌肠的效果.方法 采用单盲法将140例疑为泌尿系结石需行腹部平片或静脉肾盂造影患者随机分成两组各70例.对照组采用传统清洁灌肠方法,观察组采用改良清洁灌肠方法,即采用右侧屈膝卧位,冲洗袋高度距肛门60～100 cm,置入肛管长度20～25 cm;评价灌...     

Residual particle free surfaces after shot peening in modular hip arthroplasty are feasible

INTRODUCTION: Shot peening with steel balls is used for introduction of compressive stress in the production of morse taper junctions of modular hip endoprostheses. After this procedure, significant contamination with residual particles can be detected, which may lead to increased corrosion and third body wear. Additionally, the European norm EN 12010 requires surfaces free of residual particles. The aim of this study is to evaluate the effects of several cleaning procedures with regard to complying with EN 12010. MATERIAL AND METHOD: The surfaces of 12 Ti6Al7Nb rods with a diameter of 15 mm was shot peened with steel balls (GS VERA, Fa. Würth, Bad Friedrichshall, Germany). A field emission scanning electron microscopy (SEM, LEO 1525) was used for the detection of residual particles on the surface of the rods with a backscattered electron detector. After SEM examination, one sample each was cleaned using shot peening with sugar or dry ice and 10 rods using a pH dependent cleaning procedure. After these cleaning procedures, the samples were again analysed with the SEM for residual particle contamination. RESULTS: The surface of all rods showed a considerable contamination with steel particles after shot-peening with steel balls. After the cleaning procedure with dry ice or sugar steel contamination was lower, however, only the pH dependent cleaning procedure was able to achieve surfaces free of residual particles. DISCUSSION: For smooth shot-peened surfaces in modular hip arthroplasty Euro Norm EN 12010 can be fulfilled using shot peening with steel balls followed by a pH dependent cleaning procedure.     

Potassium permanganate reduces protein contamination of reusable laryngeal mask airways

We tested the hypothesis that supplementary cleaning with potassium permanganate 2 mg/L eliminates protein deposits from reusable laryngeal mask airways (LMAs). Sixty previously used classic LMAs were hand-washed, machine-washed, dried, autoclaved, and then randomly allocated into two groups for supplementary cleaning. In Group A, the cuff was immersed in potassium permanganate 2 mg/L at 20 degrees C for 20 min. In Group B (control), the cuff was immersed in sterile water at 20 degrees C for 20 min. After supplementary cleaning, the LMAs were immersed in a protein staining solution and rinsed, and a high-resolution digital image was taken of the dorsal surface. The severity of staining was scored by an observer blinded to the type of supplementary cleaning. The severity of protein contamination was reduced after supplementary cleaning in potassium permanganate (P < 0.00001). Protein contamination was detected on 20% of LMAs after supplementary cleaning in potassium permanganate, compared with all LMAs in the control group. We conclude that supplementary cleaning with potassium permanganate 2 mg/L does not eliminate protein deposits from all LMAs, but it does reduce the number of devices contaminated from 100% to 20%.     

Reprocessing safety issues associated with complex-design orthopaedic loaned surgical instruments and implants

BackgroundThe acquisition of reusable surgical instruments (RSIs) through loaner system is a worldwide phenomenon, particularly in orthopaedic surgeries. Loaner sets contain high-complex design RSIs, which are very difficult to clean, and also include single use implants, such as screws, that remain in the surgical tray and are subjected to multiple reprocessing until they are implanted. Inadequate cleaning of SI and various exposures of single-use implants to physical, chemical and biological agents can compromise their quality/safety and promote biofilm formation. The difficulty in cleaning is compounded in middle and low-income countries where automated cleaning infrastructure at sterilizing service units is often unavailable, and thus manual cleaning only is performed. Thus, we aimed to determine the condition of orthopaedic loaned sets when delivered to the hospital, assess the quality of complex-design RSIs reprocessed by manual cleaning, and evaluate the effect of multiple reprocessing on single-use implant (screw).MethodsFlexible medullary reamers (FMRs), depth gauges and screws used for femur intramedullary nailing, in clinical use for >1 year, were obtained from three Brazilian loaner companies and assessed for residual ATP, protein, bacterial contamination, endotoxin and/or biofilm at delivery at the hospital, following cleaning and steam sterilisation.ResultsBefore cleaning, blood was visible on a RSIs tray, and RSIs/screws were contaminated with high amounts of ATP, protein and bacteria. Visible soil was released during brushing of a FMR lumen and, following cleaning, the inner layer of 34/40 were visible soiled, and over 5/8 were protein test positive. Following sterilisation, biofilm and soil, including fragments appearing to be bone, were detected by scanning electron microscopy on RSIs/screws. A sterilised FMR revealed visible soil on the inner layer. Endotoxin tests were negative.ConclusionThe contaminated condition of loaned-complex-designed RSIs/screws upon arrival at the hospital and after reprocessing points to the insufficiency of manual reprocessing and management practices related to this instruments/implants. A multidisciplinary approach involving expert in design/manufacture, regulating, managing, reprocessing and surgeons is suggested to improve RSIs manufacture that enables complete decontamination and maintain the surgical patient safety.     

Eliminating protein from reusable laryngeal mask airways. A study comparing routinely cleaned masks with three alternative cleaning methods

Laryngeal mask airways (LMAs) have the potential to act as a vector for the transmission of prion diseases. This study was undertaken to define the problem of protein contamination and to investigate three alternative cleaning methods. Forty-eight LMAs were allocated to one of four groups, stained with erythrosin and given a total stain score and a grid stain score in order to determine the degree of protein contamination. Eighteen randomly selected LMAs that had been routinely cleaned and sterilised (group 1) were compared with 12 LMAs that had been washed and scrubbed with the benefit of prior staining (group 2), 13 that had been washed and scrubbed without any visual guide (group 3) and 13 that had been cleaned using a Biosonic ultrasonic cleaning system (group 4). The results show that none of the cleaning methods achieved optimal results, as all methods left proteinaceous material on some masks. The study showed that: (i) staining as a guide to cleaning does not lead to more effective removal of proteinaceous material; (ii) systematic cleaning and scrubbing does lead to more effective removal of proteinaceous material from surfaces other than the grid area; and (iii) ultrasonic cleaning was more effective than other methods of cleaning for the removal of proteinaceous material from those areas of the mask most inaccessible, such as the grid.     

Hyperbolic Divergence Cleaning in Lattice Boltzmann Magnetohydrodynamics

Magnetohydrodynamics couples the Navier–Stokes and Maxwell’s equations to describe the flow of electrically conducting fluids in magnetic fields. Maxwell’s equations require the divergence of the magnetic field to vanish, but this condition is typically not preserved exactly by numerical algorithms. Solutions can develop artifacts because structural properties of the magnetohydrodynamic equations then fail to hold. Magnetohydrodynamics with hyperbolic divergence cleaning permits a nonzero divergence that evolves under a telegraph equation, designed to both damp the divergence, and propagate it away from any sources, such as poorly resolved regions with large spatial gradients, without significantly increasing the computational cost. We show that existing lattice Boltzmann algorithms for magnetohydrodynamics already incorporate hyperbolic divergence cleaning, though they typically use parameter values for which it reduces to parabolic divergence cleaning under a slowly-varying approximation. We recover hyperbolic divergence cleaning by adjusting the relaxation rate for the trace of the tensor that represents the electric field, and absorb the contribution from the symmetric-traceless part of this tensor using a change of variables. Numerical experiments confirm that the qualitative behaviour changes from parabolic to hyperbolic when the relaxation time for the trace of the electric field tensor is increased.     

Bacteria on stumps of amputees and the effect of antiseptics

Amputees get stump infections usually from the natural inhabitants of the healthy skin and probably due to the unnatural environment of tight fitting sockets. The aim of the present study was to investigate the natural stump bacteria and the effect of antiseptics as well as the amputees' evaluation of such treatment. Fifteen amputees using their prostheses all day were investigated. Bacterial samplings were taken by swab technique with respect to bacteria and fungi from the stumps in the morning before prosthetic application and in the evening after a whole day's prosthetic use without antiseptic cleaning; after antiseptic cleaning with a combination of Isopropanol 45%. N-propanol 30% and N-cetyl-pyridiniumchloride 0.2% for one day: after fourteen days continuous use. The patients were asked if they liked the antiseptic and if they would like to continue to use it. Two patients did not submit bacteriological samples after the cleaning period. Before cleaning S. epidermidis, S. aureus and alpha-hemolytic streptococci were commonly found. In two instances gram negative rods were found. After the cleaning period there was a reduction of bacteria in 11 out of 13 patients. All patients liked the antiseptic and the simplicity by which the stumps and the sockets could be kept clean. The authors feel that the use of antiseptics to increase stump and socket hygiene is justified.     

口腔器械清洗液及器械投放量的研究

目的探讨口腔器械清洗液的种类及器械投放量对清洗效果的影响.方法选择300件崭新口腔齿类器械在血库血中浸泡24 h、干燥1h后随机分为多酶组、健之素组、自来水组各100把,分别采用多酶清洗液、健之素清洗液及自来水浸泡、人工刷洗及冲洗,均采用目测法和杰力试纸法检测.对多酶组、健之素组清洗不合格器械按同等配比清洗液再分批超声...     

Evaluation of disinfection of flexible nasendoscopes using Tristel wipes: a prospective single blind study

INTRODUCTION

The otorhinoiaryngoiogy department at Northwick Park Hospital uses the Tristei wipes system for cleaning nasendoscopes in the outpatient clinics. This system uses chlorine dioxide as its only disinfectant. The manufacturer claims the system provides safe sterilisation of nasendoscopes. However, there appear to be no reports in the literature to date that evaluate the efficacy of this system in a clinical setting. The aim of this study was to evaluate the ‘in use’ efficacy of Tristei wipes in decontaminating nasendoscopes and to identify any significant contamination between cleaning and usage.

METHODS

A total of 31 cleaning episodes were performed. Each cleaning episode included two swabs after cleaning the scopes, one from the tip and the other from the handle. Another two swabs from the same areas were also taken before application to the patient. The microbiology unit evaluated all swabs for bacterial, fungal and mycobacterial growth.

RESULTS

Overall, 123 swabs from 31 cleaning episodes were tested. None of the swabs taken from the tips (n=31) or handles (n=31) after cleaning with Tristei wipes developed any organism growth. Furthermore, none of the swabs taken from the tip of the scopes before using on patients (n=31) developed any growth. Of the 31 swabs taken from the handle before use, 3 developed significant staphylococcal growth.

CONCLUSIONS

In our study, the ‘in use’ efficacy of Tristei wipes in cleaning the scopes of bacteria, fungi and mycobacteria was 100%. Attention to hand hygiene and the use of gloves should be considered when handling the cleaned scopes to minimise the risk of contamination between cleaning and application to patients.     

长龙清洗机清洗介质适用性研究

目的探讨长龙清洗机清洗再生器械清洗液的有效使用频数。方法采用目测、潜血实验及细菌培养法检测长龙清洗机相同规范化清洗流程清洗1～7筐器械合格率。结果目测、细菌培养检测第5、6、7筐与第1筐比较,潜血实验第6、7筐与第1筐比较,差异有统计学意义(均P<0.05)。结论采用长龙清洗机按规范化清洗流程清洗再生器械,清洗4筐器械就应更换水及清洗酶,才能保证清洗质量。     

The effect of high concentration potassium permanganate on protein contamination from metallic and synthetic rubber airway equipment

We tested the hypothesis that supplementary cleaning using potassium permanganate 8 mg.l(-1) eliminates protein deposits from the reusable metallic and synthetic rubber airway equipment. Twenty Macintosh laryngoscope blades (surgical steel), 20 pairs of Magill's forceps (surgical steel) and 20 Guedel airways (synthetic rubber) were allocated to two groups for supplementary cleaning. In group A, the device was immersed in potassium permanganate 8 mg.l(-1). In group B (controls), the device was immersed in sterile water. The devices were then immersed in a protein staining solution, rinsed and the severity of staining was scored. In addition, the devices were inspected for tissue and then tested for occult blood. Protein contamination was lower in the potassium permanganate group for all devices (each device: p < 0.0001). There was no staining detected in the permanganate group. In the permanganate group, dried tissue was detected in the teeth of one pair of forceps, which was not detected following supplementary cleaning. Additionally, occult blood was detected on two pairs of forceps and a laryngoscope blade, which was not detected following supplementary cleaning. In the control group, no tissue was detected but one pair of forceps and two laryngoscope blades tested positive for occult blood before and after supplementary cleaning. We conclude that supplementary cleaning using potassium permanganate 8 mg.l(-1) eliminates protein deposits from re-usable metallic and synthetic rubber airway equipment.     

Bacterial contamination of stethoscopes on the intensive care unit

We assessed how often bedside stethoscopes in our intensive care unit were cleaned and whether they became colonised with potentially pathogenic bacteria. On two separate days the 12 nurses attending the bedspaces were questioned about frequency of stethoscope cleaning on the unit and the bedside stethoscopes were swabbed before and after cleaning to identify colonising organisms. Twenty-two health care providers entering the unit were asked the same questions and had their personal stethoscopes swabbed. All 32 non-medical staff cleaned their stethoscopes at least every day; however only three out of the 12 medical staff cleaned this often. Out of 24 intensive care unit bedside stethoscopes tested, two diaphragms and five earpieces were colonised with pathogenic bacteria. MRSA cultured from one earpiece persisted after cleaning. Three out of the 22 personal stethoscope diaphragms and five earpieces were colonised with pathogens. After cleaning, two diaphragms and two earpieces were still colonised, demonstrating the importance of regular cleaning.     

Nebulizer cleaning and disinfection practices in families with cystic fibrosis: The relationship between attitudes,practice and microbe colonization

BackgroundThe daily burden of health maintenance for children and families with cystic fibrosis (CF) is immense with respect to time and complexity of care. Infection control practices, specifically nebulizer cleaning and disinfection, are a recommended component of home health care for CF families due to colonization of home respiratory equipment with lung pathogens. To better inform education interventions at our center, we were interested in studying how families' views on infection prevention and awareness of CF Foundation infection prevention and control (IP&C) guidelines correlate with actual home nebulizer care and the presence of microorganisms on their nebulizers.MethodsTwenty families who have children with CF were surveyed to better understand attitudes toward infection prevention, awareness of CFF IP&C guidelines and nebulizer cleaning and disinfection practices in the home. Their nebulizers were also cultured for microbes to correlate recovery with infection control behaviors.ResultsA subset of families recognizes the importance of germ avoidance but do not recognize nebulizer cleaning and disinfection as very important for infection control practices. Decreased frequency of disinfection, but not cleaning, was correlated with the recovery of organisms on the nebulizers.ConclusionsThe study questionnaire results identify a gap between recognizing the importance of infection prevention and consistently implementing CFF IP&C guidelines in the home. This demonstrates the need at our center for new educational interventions to promote cleaning and disinfection of home nebulizers after each use as recommended by the CFF.     

西沙比利用于结肠镜检前清洁肠道的研究

为观察西沙比利在结肠清洁中的效果，将２４０例接受结肠镜检的病人随机分为三组；（１）对照组５６例，采用常规用药。（２）实验１组９２例，采用常规用药加西沙比利１０ｍｇ口服；（３）实验２组９２例，采用常规用药加西沙比利２０ｍｇ口服。结果实验２组９７．８％的病人达到清洁肠道的目的。     

手术室保洁人员岗前培训管理

目的提高手术室保洁工作质量,有效预防医院感染。方法对42名保洁人员上岗前就公司培训项目、频率、体检防疫、自我防护、职业认识等进行问卷调查。经2周培训后进行综合考核,内容包括废弃物品的分类处理、消毒液的配制与应用等,并在其完成手术间工作后,监测物体表面菌落数,并进行质量评判。结果通过调查掌握了保洁人员岗前所获培训项目、职业技能及心理等基本情况;培训后合格率分别为:废弃物品的分类处理92.9%,感染手术间的处理流程95.2%,消毒液的配置与使用85.7%,空气消毒机的使用90.5%,利器损伤后的处理83.3%;手术间物品表面菌落数监测合格率分别为:无影灯92.9%,器械台面97.6%,手术床面90.5%。结论科学严谨的岗前培训管理是保证手术室保洁工作质量的关键。     

肠梗阻患者行肠镜检查前清洁灌肠方法的改进

目的提高肠梗阻患者清洁灌肠的效果。方法将71例肠梗阻行肠镜检查的患者随机分成实验组与对照组,实验组患者取膝胸卧位,采用14F吸痰管作为肛管,插入5~7 cm,进行清洁灌肠;对照组患者采用传统的清洁灌肠方法。结果实验组肠道清洁度有明显改善,灌肠次数、灌肠总液量较对照组减少(P<0.05)。结论肠梗阻患者膝胸卧位可有效提高清洁灌肠的效果。