Risk-assessment-based approach to patients exposed to endoscopes contaminated with Pseudomonas spp.

Patients exposed to bronchoscopes contaminated with Pseudomonas aeruginosa are at increased risk of pseudomonal infection. The optimal methods for management and mitigation of risk following exposure are controversial. This article describes a two-phase risk assessment following pseudomonal contamination of a family of 75 endoscopes, detected through routine surveillance and attributed to one endoscope washer-disinfector. An initial risk assessment identified 18 endoscopes as high risk, based on the presence of lumens used for irrigation or biopsy. Exposure was communicated to the patients' clinical teams and a further clinical risk assessment of the exposed patients was performed. No patients developed complications due to pseudomonal infection.

ECETOC Florence workshop on risk assessment of endocrine substances, including the potency concept.

The European regulation on plant protection products (1107/2009) and the Biocidal Products Regulation (EC Regulation 528/2012) only support the marketing and use of chemicals if they do not cause endocrine disruption in humans or wildlife species. Also, substances with endocrine properties are subject to authorization under the European regulation on the registration, evaluation, authorization and restriction of chemicals (REACH; 1907/2006). Therefore, the regulatory consequences of identifying a substance as an endocrine disrupting chemical are severe. In contrast to that, basic scientific criteria, necessary to define endocrine disrupting properties, are not described in any of these legislative documents. Thus, the European Center for Ecotoxicology and Toxicology of Chemicals (ECETOC) established a task force to provide scientific criteria for the identification and assessment of chemicals with endocrine disrupting properties that may be used within the context of these three legislative texts (ECETOC, 2009a). In 2009, ECETOC introduced a scientific framework as a possible concept for identifying endocrine disrupting properties within a regulatory context (ECETOC, 2009b; Bars et al., 2011a,b). The proposed scientific criteria integrated, in a weight of evidence approach, information from regulatory (eco)toxicity studies and mechanistic/screening studies by combining evidence for adverse effects detected in apical whole-organism studies with an understanding of the mode of action (MoA) of endocrine toxicity. However, since not all chemicals with endocrine disrupting properties are of equal hazard, an adequate concept should also be able to differentiate between chemicals with endocrine properties of low concern from those of higher concern (for regulatory purposes). For this purpose, the task force refined this part of their concept. Following an investigation of the key factors at a second workshop of invited regulatory, academic and industry scientists, the guidance was advanced further. For human health assessments it is based on the relevance to humans of the endocrine mechanism of toxicity, the specificity of the endocrine effects with respect to other toxic effects, the potency of the chemical to induce endocrine toxicity and consideration of exposure levels.

Development and assessment of disinfectant efficacy test methods for regulatory purposes.

The United States Environmental Protection Agency regulates pesticidal products, including products with antimicrobial activity. Test guidelines have been established to inform manufacturers of which methodology is appropriate to support a specific efficacy claim. This paper highlights efforts designed to improve current methods and the development and assessment of new test methods.

Molecular epidemiology of a Pseudomonas aeruginosa hospital outbreak driven by a contaminated disinfectant-soap dispenser.

BACKGROUND AND OBJECTIVE: Pseudomonas aeruginosa infection represents a main cause of morbidity and mortality among immunocompromised patients. This study describes a fatal epidemic of P. aeruginosa that occurred in a hematology unit in Italy. METHODS: Retrospective cohort study, prospective surveillance, auditing, extensive testing on healthcare workers and environmental investigation were performed to define the dynamics and potential causes of transmission. RAPD, macrorestriction analyses and sequence typing were used to define relationships between P. aeruginosa isolates. RESULTS: Eighteen cases of infection were identified in the different phases of the investigation. Of these, five constitute a significant molecular cluster of infection. A P. aeruginosa strain with the same genetic fingerprint and sequence type (ST175) as clinical isolates strain was also isolated from a heavily contaminated triclosan soap dispenser. DISCUSSION AND CONCLUSIONS: Our results are consistent with the hypothesis that patients became indirectly infected, e.g., during central venous catheter handling through contaminated items, and that the triclosan soap dispenser acted as a common continuous source of P. aeruginosa infection. Since P. aeruginosa is intrinsically unsusceptible to triclosan, the use of triclosan-based disinfectant formulations should be avoided in those healthcare settings hosting patients at high risk of P. aeruginosa infection.

Considerations on Directive 98/8 of the European Commission - the biocide directive.

Nowadays, versatile human activity requires the development of technologies in the chemical and biological industries that ultimately enable an increase in human activity, and help create the living conditions in the domain of human civilization. Increasing this activity very frequently requires the implementation of new technologies concerning the active elimination of numerous threats and obstacles which are found in the human and natural environment. The concept of so-called biocidal products has been introduced into the European legislation as long as ten years ago, defining them as various types of 'chemical substances or microorganisms which can deter, render harmless, or exert a controlling eff ect on any harmful organism, by chemical or biological means'. They can be added to other materials (typically liquids) to protect them against biological infestation and growth. Biocidal products - due to their specificity, toxicity and composition - create a serious risk for human and animal life and health, as well as for the natural environment, it is therefore fully justified to have legal regulations concerning such biocides. Because biocidal products are intended to kill living organisms, and as such, many biocidal products pose a significant risk to human health and welfare, and have significant adverse eff ects on the natural environment. Great care is required when handling biocides and appropriate protective clothing and equipment should be used. Currently, Directive 98/8/EC is a comprehensive set of legal regulations concerning biocidal products, their specificity, principles relating to their placing on the market, and guidelines for their control. It is worth emphasizing that Directive 98/8/EC implements the clampdown on poisoning cases with biocides, the duty of which was passed to the so-called Centres of Consultation and Toxicological Information. These centres provide round-the-clock (24-hour) medical consultation and assistance in cases of poisonings with these products. The presented study constitutes an in-depth presentation and analysis of the European law concerning biocides and the current regulations applying to them.

Assessment of disinfectants cleaning against bacterial biofilm of house hold water tanks.

UNLABELLED: The purpose of this study was to compare the efficacy, in terms of bacterial biofilm penetration and killing, of some chemical disinfectants against E. coli and P. aeruginosa. This study was undertaken to examine the efficacy of some disinfectants including sodium hypochlorite, povidine and tryad detergent against E. coli biofilms and the efficacy of sodium hypochlorite and tryad detergents against P. aeruginosa. Two species biofilm of E. coli and P. aeruginosa were grown by flowing a dilute tryptic soy broth medium over an inclined cement, polyethylene, fiberglass and galvanized steel slides, 2.25 x 2.25 cm2 for 15 days. Biofilm formation was evaluated by scanning electron microscopy (SEM) and standard plate counts procedures through selective media for both E. coli and P. aeruginosa. In addition, some disinfectants were selected through disk diffusion susceptibility test. The disinfectants which gave higher zone of inhibitions, were applied to remove of E. coli and P. aeruginosa biofilms from cement, fiberglass, polyethylene and galvanized steel slide surfaces. Results showed that all disinfectants tested gave high inhibition of biofilm adhesion to tank surfaces with some being significant. CONCLUSION: polyethylene and galvanized steel are strongly recommended as alternative drinking house holds water tanks in Saudi Arabia. The choice of disinfectants or cleaning agents along with optimum concentrations and the time of action is very important when destroying microbes. It is also important that resistance of microbes to some disinfectants and cleaning agents is take into consideration when planning the cleaning process.

[Methodology for evaluation of disinfectants on the basis of system analysis]. / Metodologiia kompleksnoi otsenki dezinfitsiruiushchikh sredstv na osnove sistemnogo analiza.

The paper proposes a methodology based on the operation study theory, which can compare disinfectants by a combination of all their properties, which is integrated in the cost of tackling a disinfectological task rather than by the presence or magnitude of these or those useful properties.

Technical-regulatory aspects of antiseptics and disinfectants in Italy.

The authors analyze Italian laws, in light of changes introduced with Legislative Act n. 178/91, which regulate products with antiseptic and disinfectant action. A new reclassification of medicinal, cosmetic and health products is considered and proposed. Particular attention is given to marketing criteria adopted by various producers with regard to the form of product presentation.

[Procedures for health monitoring in a breeding facility for specific pathogen free mice and rats]. / Vorgehen bei der Hygiene-Uberwachung in einer Zuchtanlage für spezifiziert pathogen freie Mäuse und Ratten.

Causes of variation in animal experiments include differences in the genotype of the animals as well as a number of environmental factors. Through standardisation of the physical, chemical and biological components of the environment the quality of the results of the experiments can be improved, which in turn leads to a reduction of the number of animals used. One of the means to achieve this goal is the use of specified pathogen free (SPF) animals. To assure the microbiological quality of these animals the population and its environment needs to be screened thoroughly on a routine basis. This publication describes the necessary quality assurance procedures. These include bacteriological, parasitological, virological and histological examinations of the animals themselves, as well as environmental screens such as microbiological examinations of feed, control of water quality or the testing of the efficacy of disinfectants.

Addressing blood and body fluid spills: conserving time and resources during surface disinfecting.

As new issues and areas of concern arise in the health care industry, such as the potential transmission of HIV and HBV, adaptive measures will continue to be developed to assist health care professionals in their mission to provide expert medical care for patients and safe environments in which to practice. Health care institutions must commit to exploration of the advances in infection control that employ improved measures to manage the cleaning and disinfecting of spill incidents involving blood and/or body fluids and the disinfecting of contaminated surfaces. Together, product manufacturers and health care workers will discover new ways to save time, money, and resources. The goal for health care administrators should be to focus on products that stress simplicity, efficiency, cost containment, and, most important, the safety of staff and patients.

Sporicidin responds to the recall of its products.

In the January 1992 edition of HHMM, we reported on the seizure and recall of Sporicidin International's sterilant and disinfectant products by a joint action of FDA, EPA, and, indirectly, the Federal Trade Commission (FTC). This month, we provide Sporicidin's perspectives on the government action and its aftermath.