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1.
Endosc Int Open ; 7(2): E268-E273, 2019 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-30705961

RESUMEN

Background and study aims Prevention of infection transmission from contaminated endoscopes would benefit from a rapid test that could detect low levels of viable bacteria after high level disinfection. The aim of this study was to evaluate the rapid NOW! (RN) test's ability to detect endoscope contamination. Materials and methods The RN test kit and the accompanying fluorometer were evaluated. The manufacturer states that a fluorometer signal > 300 units is indicative of viable Gram-negative bacteria. Suspension testing of varying concentrations of Escherichia coli, Pseudomonas aeruginosa and Enterococcus faecalis were used to determine the RN test limit of detection. Simulated-use testing was done using a duodenoscope inoculated with 10 % blood containing approximately 35 CFU E. coli per channel. Samples were extracted from the duodenoscope instrument channel and tested using the manufacturer's instructions. Results The RN test could consistently detect 10 CFU of E. coli and P. aeruginosa (fluorescent signal of 9,000 to 11,000 units) but not E. faecalis. Sensitivity and specificity for Gram-negative bacteria were 93 % and 90 %, respectively, using all of the suspensions in the study. Extraction of E. coli from an inoculated duodenoscope instrument channel repeatedly provided a positive signal (i. e. > 2,000 units). Conclusions The RN test can reliably detect low levels of Gram-negative bacteria in suspension as well as from samples extracted from endoscope channels. These preliminary findings are encouraging but further assessment of extraction efficacy, impact of organic residuals and clinical workflow are still needed.

2.
Gastrointest Endosc ; 88(2): 292-302, 2018 08.
Artículo en Inglés | MEDLINE | ID: mdl-29476844

RESUMEN

BACKGROUND AND AIMS: We aimed to determine whether monitoring of duodenoscope cleaning by rapid adenosine triphosphate (ATP) combined with channel-purge storage could eliminate high-concern microorganisms. METHODS: In a simulated-use study, suction channels, as well as lever recesses, from 2 duodenoscopes models and the unsealed elevator guidewire (EGW) channel from 1 of these 2 duodenoscopes (the other model has a sealed EGW) were perfused with ATS2015 containing approximately 8 Log10 colony-forming units (CFU)/mL of both Enterococcus faecalis and Escherichia coli. Pump-assisted cleaning was monitored by rapid ATP testing. Duodenoscopes exceeding 200 relative light units (RLUs) were recleaned. Clean duodenoscopes were processed through an automated endoscope reprocessor and then stored in a channel-purge storage cabinet for 1 to 3 days. Cultures of EGW channel and instrument channel combined with the lever recess (IC-LR) were taken after storage. The impacts of extended cleaning and alcohol flush were evaluated. RESULTS: E coli was reliably eliminated in IC-LR and EGW channels of 119 duodenoscope tests (59 with sealed EGW and 60 with nonsealed EGW). However, actionable levels of E faecalis and environmental bacteria persisted. Neither alcohol flush nor extended cleaning resulted in a reduction of actionable levels for these organisms. Identification of isolates indicated that residual organisms in duodenoscope channels were hardy Gram-positive bacteria (often spore formers) that likely originated from environmental sources. CONCLUSIONS: These data indicate that high-concern Gram-negative bacteria but not E faecalis or environmental bacteria can be reliably eliminated by use of the manufacturer's instructions for reprocessing with ATP monitoring of cleaning and channel-purge storage conditions.


Asunto(s)
Desinfección/métodos , Desinfección/normas , Duodenoscopios/microbiología , Control de Calidad , Adenosina Trifosfato/análisis , Enterococcus faecalis/aislamiento & purificación , Contaminación de Equipos , Escherichia coli/aislamiento & purificación
3.
Clin Nutr ; 37(3): 797-807, 2018 06.
Artículo en Inglés | MEDLINE | ID: mdl-28410921

RESUMEN

BACKGROUND: The elderly often have a diet lacking resistant starch (RS) which is thought to lead to gut microbiome dysbiosis that may result in deterioration of gut colonocytes. OBJECTIVE: The primary objective was to assess if elderly (ELD; ≥ 70 years age) had microbiome dysbiosis compared to mid-age (MID; 30-50 years age) adults and then determine the impact of daily consumption of MSPrebiotic® (a RS) or placebo over 3 months on gut microbiome composition. Secondary objectives included assessment of stool short-chain fatty acids (SCFA) and inflammatory markers in ELD and MID Canadian adults. DESIGN: This was a prospective, placebo controlled, randomized, double-blinded study. Stool was collected at enrollment and 6, 10 and 14 weeks after randomization to placebo or MSPrebiotic®. Microbiome analysis was done using 16S rRNA sequencing of DNA extracted from stool. SCFA analysis of stool was performed using gas chromatography. RESULTS: There were 42 ELD and 42 MID participants randomized to either placebo or MSPrebiotic® who completed the study. There was significantly higher abundance of Proteobacteria (Escherichia coli/Shigella) in ELD compared to MID at enrollment (p < 0.001) that was not observed after 12 weeks of MSPrebiotic® consumption. There was a significant increase in Bifidobacterium in both ELD and MID compared to placebo (p = 0.047 and 0.006, respectively). There was a small but significant increase in the stool SCFA butyrate levels in the ELD on MSPrebiotic® versus placebo. CONCLUSIONS: The study data demonstrated that MSPrebiotic® meets the criteria of a prebiotic and can stimulate an increased abundance of endogenous Bifidobacteria in both ELD and MID without additional probiotic supplementation. MSPrebiotic® consumption also eliminated the dysbiosis of gut Proteobacteria observed in ELD at baseline. CLINICAL TRIAL REGISTRY NUMBER: NCT01977183 listed on NIH website: ClinicalTrials.gov. The full trial protocol is available on request from the corresponding author. NUCLEOTIDE SEQUENCE ACCESSION NUMBERS: The 16S rRNA sequencing data and metadata generated in this study have been submitted to the NCBI Sequence Read Archive (SRA: http://www.ncbi.nlm.nih.gov/bioproject/381931).


Asunto(s)
Dieta , Disbiosis/epidemiología , Microbioma Gastrointestinal/efectos de los fármacos , Prebióticos/administración & dosificación , Almidón/administración & dosificación , Adulto , Anciano , Envejecimiento , Bacterias/clasificación , Bacterias/aislamiento & purificación , Biomarcadores/sangre , Butiratos/análisis , Canadá/epidemiología , Digestión , Método Doble Ciego , Disbiosis/etiología , Ácidos Grasos Volátiles/análisis , Heces/química , Heces/microbiología , Microbioma Gastrointestinal/fisiología , Humanos , Inflamación/sangre , Persona de Mediana Edad , Placebos , Estudios Prospectivos , Almidón/química , Almidón/metabolismo
4.
Am J Infect Control ; 46(1): 73-75, 2018 01.
Artículo en Inglés | MEDLINE | ID: mdl-28918989

RESUMEN

BACKGROUND: Some outbreaks associated with contaminated duodenoscopes have been attributed to biofilm formation. The objective of this study was to determine whether bacteria within an organic matrix could survive if the elevator lever was improperly positioned in the automated endoscope reprocessor (AER) after 1 round of reprocessing. METHODS: Duodenoscope lever cavities with an open or sealed elevator wire channel were inoculated with 6-7 Log10 of both Escherichia coli and Enterococcus faecalis in ATS2015 (Healthmark Industries, Fraser, MI) and dried for 2 hours. The duodenoscopes with the lever in the horizontal position were processed through 2 makes of AERs. The cavity was sampled using a flush-brush-flush method to determine the quantity of surviving bacteria. RESULTS: E faecalis (range, 21-6 Log10 CFU) and E coli (range, 0-3 Log10 CFU) survived disinfection of sealed or unsealed elevator wire channel duodenoscopes in 2 different AERs with and without cleaning cycles. CONCLUSION: If bacteria in organic residue are under the improperly positioned lever, then just 1 round of use is sufficient for bacteria to survive both liquid chemical sterilization and liquid chemical HLD regardless of whether or not the AER had a cleaning cycle.


Asunto(s)
Desinfección/métodos , Duodenoscopios/microbiología , Contaminación de Equipos/prevención & control , Automatización , Bacterias , Equipo Reutilizado
5.
Infect Control Hosp Epidemiol ; 38(11): 1284-1290, 2017 11.
Artículo en Inglés | MEDLINE | ID: mdl-29039290

RESUMEN

OBJECTIVE Biofilm has been implicated in bacterial persistence and survival after endoscope reprocessing. In this study, we assessed the impact of different methods of reprocessing on organic residues and viable bacteria after repeated rounds of biofilm formation when each was followed by full reprocessing. METHODS ATS-2015, an artificial test soil containing 5-8 Log10 colony-forming units (CFU) of Enterococcus faecalis and Pseudomonas aeruginosa, was used to form biofilm in polytetrafluroethylene channels overnight on 5 successive days. Each successive day, full pump-assisted cleaning using bristle brushes or pull-through devices in combination with enzymatic or nonenzymatic detergents followed by fully automated endoscope reprocessor disinfection using peracetic acid was performed. Residuals were visualized by scanning electron microscopy (SEM). Destructive testing was used to assess expected cutoffs for adenosine triphosphate (ATP; <200 relative light units), protein (<2 µg/cm2), and viable bacteria count (0 CFU). RESULTS Protein residuals were above 2 µg/cm2, but ATP residuals were <200 relative light units for all methods tested. Only when enzymatic cleaner was used for cleaning were there no viable bacteria detected after disinfection irrespective of whether bristle brushes or pull-through devices were used. SEM revealed that some residual debris remained after all reprocessing methods, but more residuals were detected when a nonenzymatic detergent was used. CONCLUSIONS Surviving E. faecalis and P. aeruginosa were only detected when the non-enzymatic detergent was used, emphasizing the importance of the detergent used for endoscope channel reprocessing. Preventing biofilm formation is critical because not all current reprocessing methods can reliably eliminate viable bacteria within the biofilm matrix. Infect Control Hosp Epidemiol 2017;38:1284-1290.


Asunto(s)
Biopelículas , Politetrafluoroetileno/química , Desinfección/métodos , Enterococcus faecalis , Contaminación de Equipos , Microscopía Electrónica de Rastreo , Pseudomonas aeruginosa
6.
Gastrointest Endosc ; 86(3): 442-451.e1, 2017 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-28551023

RESUMEN

BACKGROUND AND AIMS: Clinical studies have shown variable culture results from flexible endoscope channels possibly because of low levels of bacteria that are difficult to extract. The aim of this study was to develop a simulated-use buildup biofilm (BBF) model that mimics low levels of viable bacteria after repeated rounds of aldehyde fixation and accumulation. METHODS: New endoscope channels were exposed to 8 days of repeated rounds of biofilm formation using ATS2015 containing Enterococcus faecalis and Pseudomonas aeruginosa, rinsing, fixation with glutaraldehyde, and rinsing. Viable count and scanning electron microscopy and borescope examination were used to compare the impact of dry storage over 26 weeks on the level of culturable bacteria and to compare the Centers for Disease Control and Prevention flush method of channel harvesting with a flush-brush-flush method. RESULTS: E faecalis (log10 6.6) and P aeruginosa (log10 8.6) accumulated over 8 days of cyclic biofilm formation and partial glutaraldehyde fixation, but after a final exposure to 2.6% glutaraldehyde the level of culturable bacteria was less than 2 log10. The Centers for Disease Control and Prevention channel harvesting method appeared by borescope to be inferior to a flush-brush-flush sample collection method for detection of viable bacteria. P aeruginosa increased up to 7 log10 after 26 weeks of dry storage, indicating there were viable but nonculturable bacteria present initially that recovered during storage. CONCLUSIONS: Viable but nonculturable P aeruginosa within the BBF model are able to recover, and this phenomenon may explain the variability of culture in patient-used endoscopes. Our data also indicated that friction may be a critical part of sample collection from endoscope channels.


Asunto(s)
Biopelículas , Desinfectantes , Desinfección/métodos , Endoscopios Gastrointestinales/microbiología , Enterococcus faecalis/crecimiento & desarrollo , Glutaral , Politetrafluoroetileno , Pseudomonas aeruginosa/crecimiento & desarrollo , Recuento de Colonia Microbiana , Endoscopios , Enterococcus faecalis/aislamiento & purificación , Contaminación de Equipos , Humanos , Viabilidad Microbiana , Microscopía Electrónica de Rastreo , Modelos Biológicos , Pseudomonas aeruginosa/aislamiento & purificación
7.
Front Med (Lausanne) ; 4: 260, 2017.
Artículo en Inglés | MEDLINE | ID: mdl-29410955

RESUMEN

INTRODUCTION: Type 2 diabetes (T2D) has reached epidemic proportions in North America. Recent evidence suggests that prebiotics can modulate the gut microbiome, which then plays an important role in regulating lipid metabolism, blood glucose, and insulin sensitivity. As such, prebiotics are appealing potential therapeutic strategies for prediabetes and T2D. The key objectives of this study were to determine the tolerability as well as the glucose and insulin modulating ability of MSPrebiotic® digestion resistant starch (DRS) in healthy mid-age (MID) and elderly (ELD) adults. MATERIALS AND METHODS: This was a prospective, blinded, placebo-controlled study. Prediabetes and diabetes were among the exclusion factors. ELD (>70 years) and MID (30-50 years) Canadian adults were recruited and, after 2 weeks of consuming placebo, they were randomized to consume 30 g of either MSPrebiotic® or placebo per day for 12 weeks. In total, 42 ELD and 42 MID participants completed the study. Blood samples were collected over the 14-week study and analyzed for glucose, lipid profile, and CRP, lipid particles, TNF-α, IL-10, insulin, and insulin resistance (IR). RESULTS: At baseline, the ELD population had a significantly higher percentage (p < 0.01) with elevated glucose and significantly higher TNF-α (p < 0.01) compared to MID adults. MSPrebiotic® DRS was well tolerated in both MID and ELD adults. There was a significant difference over time in blood glucose (p = 0.0301) and insulin levels (p = 0.009), as well as IR (HOMA-IR; p = 0.009) in ELD adults who consumed MSPrebiotic® compared to placebo. No significant changes were found in MID adults. CONCLUSION: Our results suggest that dietary supplementation with prebiotics such as MSPrebiotic® may be part of an effective strategy to reduce IR, a major risk factor for developing T2D, in the ELD. CLINICAL TRIAL REGISTRATION: NCT01977183 listed on NIH website: ClinicalTrials.gov, The metadata generated in this study have been submitted to the NCBI Sequence Read Archive (http://www.ncbi.nlm.nih.gov/bioproject/381931).

8.
J Clin Microbiol ; 53(1): 105-12, 2015 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-25355764

RESUMEN

An efficient workflow to screen for and confirm the presence of carbapenemase-producing Gram-negative bacilli was developed by evaluating five chromogenic screening agar media and two confirmatory assays, the Rapid Carb screen test (Rosco Diagnostica A/S, Taastrup, Denmark) and the modified Hodge test. A panel of 150 isolates was used, including 49 carbapenemase-producing isolates representing a variety of ß-lactamase enzyme classes. An evaluation of analytical performance, assay cost, and turnaround time indicated that the preferred workflow (screening test followed by confirmatory testing) was the chromID Carba agar medium (bioMérieux, Marcy l'Étoile, France), followed by the Rapid Carb screen test, yielding a combined sensitivity of 89.8% and a specificity of 100%. As an optional component of the workflow, a determination of carbapenemase gene class via molecular means could be performed subsequent to confirmatory testing.


Asunto(s)
Antibacterianos/farmacología , Proteínas Bacterianas/genética , Bacterias Gramnegativas/efectos de los fármacos , Bacterias Gramnegativas/genética , Infecciones por Bacterias Gramnegativas/microbiología , Pruebas de Sensibilidad Microbiana/métodos , Juego de Reactivos para Diagnóstico , beta-Lactamasas/genética , Medios de Cultivo , Bacterias Gramnegativas/clasificación , Infecciones por Bacterias Gramnegativas/diagnóstico , Humanos , Reacción en Cadena de la Polimerasa Multiplex , Reproducibilidad de los Resultados , Flujo de Trabajo
9.
Am J Infect Control ; 40(9): 860-5, 2012 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-22317858

RESUMEN

BACKGROUND: Cleaning of flexible endoscopes is most commonly performed using manual methods that are often performed inadequately. The aim of this study was to validate the sample collection protocol and the Rapid Use Scope Test (RUST) and then assess its usefulness in clinical use. METHODS: The benchmarks for adequate cleaning were protein <6.4 µg/cm(2), hemoglobin <2.2 µg/cm(2), and carbohydrate <1.2 µg/cm(2). Sample collection consisted of flushing 10 mL of sterile reverse osmosis water through the suction-biopsy port to the distal end. Validation of the RUST audit tool included simulated-use and in-use testing in 43 endoscopy clinics across Canada. RESULTS: Simulated-use testing validated that improperly cleaned endoscopes that exceeded the cleaning benchmarks would be flagged by the RUST test. The clinical-use study indicated that 96.6% of 1,489 scope channels tested were RUST negative; however, 19% and 12% of elevator guide-wire channels and endoscopic retrograde colangiopancreatography channels, respectively, exceeded the benchmarks. The survey indicated that reprocessing personnel valued a rapid audit tool for assessing compliance with manual cleaning. CONCLUSION: The validated RUST test provides health care users with a rapid audit tool for manual cleaning that can be integrated into the quality program in endoscopy.


Asunto(s)
Carbohidratos/análisis , Descontaminación/métodos , Endoscopios , Proteínas/análisis , Canadá , Humanos
10.
Diagn Microbiol Infect Dis ; 69(2): 130-6, 2011 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-21251555

RESUMEN

This study was undertaken to evaluate the UF-1000i™ (UF) flow cytometer to count urine constituents including bacteria. The objective was to screen urine samples and determine what white blood cell (WBC) and/or bacteria screening criteria would minimize the number of specimens cultured yet ensuring that all true positives were cultured. UF screening and culture on CHROMagar™ Orientation (CO) medium were performed on 2496 specimens. Various combinations of WBC/bacterial counts were assessed as screening criteria and correlated with significant growth on CO medium. A bacterial count of ≥20 from UF gave an overall screening sensitivity of 92.6%, allowing 35% of specimens to be screened out and not cultured. The sensitivity was 99.2% and 85.0% for Gram-negative and Gram-positive organisms, respectively, using the same bacterial count. Our study indicated that UF was a simple, rapid, and reliable method for urine screening when the bacterial count of ≥20 was used as the sole screening criterion.


Asunto(s)
Infecciones Bacterianas/diagnóstico , Citometría de Flujo , Urinálisis/métodos , Infecciones Urinarias/diagnóstico , Adolescente , Adulto , Anciano , Bacterias/crecimiento & desarrollo , Bacterias/aislamiento & purificación , Infecciones Bacterianas/microbiología , Infecciones Bacterianas/orina , Carga Bacteriana , Humanos , Recuento de Leucocitos , Tamizaje Masivo/métodos , Persona de Mediana Edad , Sensibilidad y Especificidad , Infecciones Urinarias/microbiología , Infecciones Urinarias/orina , Orina/citología , Orina/microbiología , Adulto Joven
11.
BMC Infect Dis ; 10: 268, 2010 Sep 15.
Artículo en Inglés | MEDLINE | ID: mdl-20843348

RESUMEN

BACKGROUND: C. difficle spores in the environment of patients with C. difficile associated disease (CDAD) are difficult to eliminate. Bleach (5000 ppm) has been advocated as an effective disinfectant for the environmental surfaces of patients with CDAD. Few alternatives to bleach for non-outbreak conditions have been evaluated in controlled healthcare studies. METHODS: This study was a prospective clinical comparison during non-outbreak conditions of the efficacy of an accelerated hydrogen peroxide cleaner (0.5% AHP) to the currently used stabilized hydrogen peroxide cleaner (0.05% SHP at manufacturer recommended use-dilution) with respect to spore removal from toilets in a tertiary care facility. The toilets used by patients who had diarrhea with and without C. difficile associated disease (CDAD) were cultured for C. difficile and were monitored using an ultraviolet mark (UVM) to assess cleaning compliance on a daily basis 5 days per week. A total of 243 patients and 714 samples were analysed. The culture results were included in the analysis only if the UVM audit from the same day confirmed that the toilet had been cleaned. RESULTS: Our data demonstrated that the efficacy of spore killing is formulation specific and cannot be generalized. The OxivirTB AHP formulation resulted in statistically significantly (p = 0.0023) lower levels of toxigenic C. difficile spores in toilets of patients with CDAD compared to the SHP formulation that was routinely being used (28% vs 45% culture positive). The background level of toxigenic C. difficile spores was 10% in toilets of patients with diarrhea not due to CDAD. The UVM audit indicated that despite the enhanced twice-daily cleaning protocol for CDAD patients cleaning was not achieved on approximately 30 - 40% of the days tested. CONCLUSION: Our data indicate that the AHP formulation evaluated that has some sporicidal activity was significantly better than the currently used SHP formulation. This AHP formulation provides a one-step process that significantly lowers the C. difficile spore level in toilets during non-outbreak conditions without the workplace safety concerns associated with 5000 ppm bleach.


Asunto(s)
Clostridioides difficile/efectos de los fármacos , Desinfectantes/farmacología , Desinfección/métodos , Microbiología Ambiental , Peróxido de Hidrógeno/farmacología , Esporas Bacterianas/efectos de los fármacos , Cuartos de Baño , Clostridioides difficile/aislamiento & purificación , Recuento de Colonia Microbiana , Humanos , Viabilidad Microbiana/efectos de los fármacos , Estudios Prospectivos , Esporas Bacterianas/aislamiento & purificación
12.
BMC Infect Dis ; 10: 200, 2010 Jul 09.
Artículo en Inglés | MEDLINE | ID: mdl-20618935

RESUMEN

BACKGROUND: The objective of this study was to perform simulated-use testing as well as a clinical study to assess the efficacy of the EVOTECH Endoscope Cleaner and Reprocessor (ECR) cleaning for flexible colonoscopes, duodenoscopes, gastroscopes and bronchoscopes. The main aim was to determine if the cleaning achieved using the ECR was at least equivalent to that achieved using optimal manual cleaning. METHODS: Simulated-use testing consisted of inoculating all scope channels and two surface sites with Artificial Test Soil (ATS) containing 108 cfu/mL of Enterococcus faecalis, Pseudomonas aeruginosa and Candida albicans. Duodenoscopes, colonoscopes, and bronchoscopes (all Olympus endoscopes) were included in the simulated use testing. Each endoscope type was tested in triplicate and all channels and two surface sites were sampled for each scope. The clinical study evaluated patient-used duodenoscopes, bronchoscopes, colonoscopes, and gastroscopes (scopes used for emergency procedures were excluded) that had only a bedside flush prior to being processed in the ECR (i.e. no manual cleaning). There were 10 to 15 endoscopes evaluated post-cleaning and to ensure the entire ECR cycle was effective, 5 endoscopes were evaluated post-cleaning and post-high level disinfection. All channels and two external surface locations were sampled to evaluate the residual organic and microbial load. Effective cleaning of endoscope surfaces and channels was deemed to have been achieved if there was < 6.4 microg/cm2 of residual protein, < 1.8 microg/cm2 of residual hemoglobin and < 4 Log10 viable bacteria/cm2. Published data indicate that routine manual cleaning can achieve these endpoints so the ECR cleaning efficacy must meet or exceed these to establish that the ECR cleaning cycle could replace manual cleaning RESULTS: In the clinical study 75 patient-used scopes were evaluated post cleaning and 98.8% of surfaces and 99.7% of lumens met or surpassed the cleaning endpoints set for protein, hemoglobin and bioburden residuals. In the simulated-use study 100% of the Olympus colonoscopes, duodenoscopes and bronchoscopes evaluated met or surpassed the cleaning endpoints set for protein, and bioburden residuals (hemoglobin was not evaluated). CONCLUSIONS: The ECR cleaning cycle provides an effective automated approach that ensures surfaces and channels of flexible endoscopes are adequately cleaned after having only a bedside flush but no manual cleaning. It is crucial to note that endoscopes used for emergency procedures or where reprocessing is delayed for more than one hour MUST still be manually cleaned prior to placing them in the ECR.


Asunto(s)
Automatización/métodos , Candida albicans/aislamiento & purificación , Descontaminación/métodos , Endoscopios/microbiología , Enterococcus faecalis/aislamiento & purificación , Pseudomonas aeruginosa/aislamiento & purificación , Recuento de Colonia Microbiana , Humanos
13.
BMC Infect Dis ; 8: 64, 2008 May 12.
Artículo en Inglés | MEDLINE | ID: mdl-18474086

RESUMEN

BACKGROUND: An ultraviolet visible marker (UVM) was used to assess the cleaning compliance of housekeeping staff for toilets in a tertiary healthcare setting. METHODS: The UVM was applied to the toilets of patients who were on isolation precautions due to Clostridium difficile-associated diarrhea (CDAD) as well as for patients who were not on isolation precautions. Cleaning was visually scored using a numeric system where 0, 1, 2, and 3 represented; no, light, moderate or heavy residual UVM. Rodac plates containing CDMN selective agar were used to test for the presence of C. difficile on the surfaces of patient's toilets. RESULTS: Despite twice daily cleaning for the toilets of patients who were on CDAD isolation precautions, the average cleaning score was 1.23 whereas the average cleaning score for toilets of patients not on isolation precautions was 0.9. Even with optimal cleaning (UVM score of 0) C. difficile was detected from 33% of the samples taken from toilets of patients with CDAD (4% detection in toilet samples from patients who had diarrhea not due to CDAD). CONCLUSION: Our data demonstrated the value of UVM for monitoring the compliance of housekeeping staff with the facility's toilet cleaning protocol. In addition to providing good physical cleaning action, agents with some sporicidal activity against C. difficile may be needed to effectively reduce the environmental reservoir.


Asunto(s)
Clostridioides difficile/aislamiento & purificación , Diarrea/microbiología , Servicio de Limpieza en Hospital/normas , Esporas Bacterianas/aislamiento & purificación , Cuartos de Baño/normas , Rayos Ultravioleta , Antiinfecciosos Locales/farmacología , Clostridioides difficile/fisiología , Infección Hospitalaria/prevención & control , Medios de Cultivo , Desinfección/métodos , Humanos , Peróxido de Hidrógeno/farmacología , Control de Infecciones , Aislamiento de Pacientes , Esporas Bacterianas/fisiología
14.
Am J Infect Control ; 34(9): 561-70, 2006 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-17097450

RESUMEN

BACKGROUND: Manual cleaning of flexible endoscopes is prone to error. To date, attempts to automate this process have been unsuccessful. The aim of this project was to compare the efficacy of the washing phase in the new Reliance EPS (STERIS Corp, Mentor, OH) with that of optimal manual cleaning. METHODS: Using simulated-use testing, all channels in 3 different flexible endoscopes, including a bronchoscope (Pentax, Pentax Medical Company, Miami, FL), a side-viewing duodenoscope (Olympus, Olympus Corporation), and a colonoscope (Fujinon, Fujinon Corporation, Wayne, NJ) were evaluated. All of the channels in the flexible endoscope were soiled with artificial test soil (ATS) (test soil that mimics the worst case levels of hemoglobin, protein, carbohydrate, and endotoxin from patient-used flexible endoscopes) containing 10(8) cfu/mL of Enterococcus faecalis and Pseudomonas aeruginosa The soiled scopes were allowed to dry for 1 hour prior to processing. Hemoglobin, protein, and viable organism counts for the flexible endoscopes were determined before and after cleaning. RESULTS: Both the Reliance EPS washing phase and optimal manual cleaning achieved >90% reduction of hemoglobin and protein, resulting in <6.4 microg/cm2 after the cleaning cycle. The reduction factor for viable organisms was not significantly different between the 2 methods, which ranged from 2.06 to 6.21 for manual cleaning and from 2.1 to 5.93 for the Reliance EPS washing phase. The mean reduction factor (all tests) was 4.32 +/- 1.03 for manual cleaning compared with 4.24 +/- 1.11 for Reliance EPS washing phase. CONCLUSION: The efficacy of the Reliance EPS washing phase for flexible endoscopes was equivalent to optimal manual cleaning for all the makes and models of flexible endoscopes tested.


Asunto(s)
Broncoscopios/microbiología , Desinfección/instrumentación , Endoscopios Gastrointestinales/microbiología , Contaminación de Equipos/prevención & control , Control de Infecciones/instrumentación , Recuento de Colonia Microbiana , Desinfección/métodos , Enterococcus faecalis/efectos de los fármacos , Equipo Reutilizado , Hemoglobinas/análisis , Humanos , Pseudomonas aeruginosa/efectos de los fármacos
15.
Infect Control Hosp Epidemiol ; 23(7): 388-92, 2002 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-12138978

RESUMEN

OBJECTIVE: The primary objective of this study was to evaluate fluorescent readout results of Attest 1291 Biological Indicators (BIs) (3M Health Care, St. Paul, MN) and Attest 1296 BI test packs (containing Attest 1292 BIs) using full and fractional cycles compared with the growth data when prolonged incubation (7 days) was included. Gravity displacement and vacuum-assisted steam sterilization cycles were evaluated. A secondary objective of this study was to evaluate the new automated rapid fluorescent reader (Attest 290 Auto Reader). DESIGN: The rapid readout BIs for gravity displacement and vacuum-assisted steam autoclave cycles at 132 degrees C were processed using full (4 minutes) and four fractional cycles that provided 30% to 80% positive results for growth after 24 hours of incubation (48 hours of incubation for Attest 1292 BIs from the Attest 1296 test packs). Sixty of each type of BI were tested for each cycle (300 of each BI type in total). RESULTS: For all full steam sterilization cycles, results of the rapid fluorescent readout and the 24-hour, 48-hour, and 7-day growth tests were negative for all Attest 1291 and 1292 BIs tested. For all fractional cycles, the 24- and 48-hour growth results for the Attest 1291 and 1292 BIs, respectively, were the same as the 7-day growth results. The fractional cycle data indicated that fluorescent rapid readout was a more sensitive indicator than growth. There were rare (0.9%) false-negative results for BIs under fractional cycle conditions and these all correlated with short fractional cycle exposure times. CONCLUSIONS: The fluorescent rapid readout results of the 1291 BIs and 1296 BI test packs reliably predict both 24- and 48-hour and 7-day growth. These data support the value of rapid readout BIs for sterilizer monitoring for both the vacuum-assisted and the gravity displacement steam sterilization cycles. The new automated reader requires less manipulation of the BI and makes monitoring user friendly and less prone to user errors.


Asunto(s)
Contaminación de Equipos/prevención & control , Esterilización/métodos , Esterilización/normas , Biomarcadores , Equipo Reutilizado/normas , Fluorometría , Geobacillus stearothermophilus/crecimiento & desarrollo , Vapor , Esterilización/instrumentación , Factores de Tiempo , Vacio
16.
Infect Control Hosp Epidemiol ; 23(4): 198-206, 2002 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-12002234

RESUMEN

OBJECTIVES: To obtain information about current reprocessing practices and to obtain samples from the biopsy channel to quantitate soil levels and bioburden in patient-ready flexible duodenoscopes used for endoscopic retrograde choliangiopancreatography (ERCP). DESIGN: Participating centers were sent a questionnaire and a kit for on-site collection of samples from the biopsy channel of the duodenoscope. SETTING: Thirty-seven hospitals from across Canada participated. The only criterion was that they currently used and reprocessed flexible duodenoscopes for ERCP procedures. METHODS: The questionnaire obtained information on reprocessing practices. The kit included a detailed instruction booklet outlining sample collection and all of the tubes, sterile water, and brushes needed for it. Samples were collected on-site from all ERCP scopes in each center on Monday morning and shipped by overnight courier on ice to the research center. Each sample was assayed by routine microbiologic methods for total viable count and protein, blood, carbohydrate, and endotoxin levels. RESULTS: Microbial overgrowth was present in 7% of 119 scope samples. Cleaning appeared to be reasonably well done in most of the centers, and 43% of the centers were in total compliance with basic national guidelines. The data from the scope samples indicated that there was significantly greater buildup of protein, carbohydrate, and endotoxin associated with ERCP scopes from centers using glutaraldehyde, compared with those using peracetic acid. Carbohydrate was the soil component detected most frequently and in the highest concentration in scope channels. CONCLUSIONS: Although cleaning was generally well done, areas for improvement included ensuring the availability of written reprocessing protocols, immersion of scopes during manual cleaning, use of adequate fluid volume for rinsing, adequate drying of scopes prior to storage, and the separation of ERCP valves from scopes during storage.


Asunto(s)
Colangiopancreatografia Retrógrada Endoscópica/instrumentación , Desinfección/normas , Duodenoscopios/microbiología , Contaminación de Equipos/estadística & datos numéricos , Canadá , Recolección de Datos , Adhesión a Directriz , Investigación sobre Servicios de Salud , Hospitales Públicos , Humanos , Control de Calidad
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