Baby bottle and other disinfection devices used during travel to low electrical voltage (110V) regions: A practical experiment with implications for baby, lactating mothers and patient safety.

BACKGROUND: Baby bottle steam disinfectors are important for the disinfection of devices used with baby nutrition, lactating mothers and respiratory patients (e.g. nebulisers). There have been no reports to date describing the effect of incorrect voltage on thermal performance. It was the aim of this study to evaluate thermal output, at low (110 V) voltage compared to 220 V. Such data will determine if variation in voltage, results in temperature differences, constituting a microbiological safety risk. METHODS: Thermal performance was evaluated by positioning calibrated thermocouple probes in multiple locations operating the device at 110 V and 220-240 V. RESULTS: Within the upper tray at 220-240 V, a maximum temperature (TempMAX) of 100 °C was achieved, with the unit remaining at 90 °C for 420 s (A0 = 3000), whereas at 110 V, TempMAX = 71.1 °C, remaining at >70 °C for 630 s. Most importantly, when the lower tray of the device was examined at 110 V, TempMAX = 48.6 °C at one location, remaining >40 °C for 1140 s, whereas at 220-240 V, the lowest temperature achieved was 86.1 °C, with an A0 equivalence of A0 = 60. CONCLUSIONS: This study showed that input voltage of 110 V to the baby bottle steam disinfector had an adverse effect on thermal performance, by not achieving intended time/temperature combinations, compared to 220-240 V. Parents of babies and infants need to be made aware of the microbiological safety risks of operating such devices outside the manufacturers' specification. For the safety of babies, infants, mothers and patients, users must ensure that such devices are always operated safely within manufacturer's specifications and instructions for use.

Re-purposing of domestic steam disinfectors within the hospital-at-home setting.

BACKGROUND: Vulnerable patients being cared for in hospital-at-home settings require safe disinfection of their medical devices, including nebulisers and other respiratory equipment. The scale of patients now being cared for in hospital-at-home settings as a result of COVID19 places huge pressure on hospital central sterile services departments (CSSDs) to provide consumable items to safely support such patients' care. This places new importance on the disinfection of mundane objects, including crockery, cutlery and frequently touched objects in the home environment. This study examined temperature performance of steam disinfectors and the consequences of potential operator misuse on the survival of 62 bacteria and yeast organisms. METHODS: Thermal performance of steam disinfectors was evaluated using calibrated thermocouple probes in multiple permutations of device usage with 62 test organisms. RESULTS: Thermocouple data demonstrated disinfection A0 values of 6000 (upper layer) and 60 (lower layer). Steam disinfection of baby bottles had a thermal lethality of at least A0 = 600. Variation in disinfector temperatures were noted, depending on the geometric location of thermocouples. Additional notable temperature reductions occurred with device underfilling with suboptimal water volumes. Steam disinfection eradicated all 62 non-spore-forming Gram-positive, Gram-negative and yeast organisms tested and eradicated all organisms in the inner teat space of contaminated babies' dummies, rendering safe steam disinfection of babies' dummies. CONCLUSION: Domestic steam disinfection offers an inexpensive, simple, versatile and widely available technology for the elimination of common non-spore-forming nosocomial pathogens and safe disinfection of medical devices, fomites and other mundane objects within the hospital-at-home scenario, thereby enhancing patient safety.

Steam disinfection of toothbrushes from patients with cystic fibrosis: Evidence-based recommendations.

BACKGROUND: Patients with cystic fibrosis have increased morbidity/mortality due to chronic respiratory infections, which primarily originate from the environment. Infection prevention and control emphasize the importance of cleaning and disinfection of respiratory devices, however, there is a paucity of guidance on toothbrush hygiene, which have been shown to be a source of cystic fibrosis (CF) pathogens. METHODS: This study examined steam disinfection of toothbrushes contaminated with clinically significant CF isolates (n = 80; Gram positive = 33; Gram negative = 32, and non-tuberculous mycobacteria = 6) and yeasts (n = 9), as well as oral streptococci (n = 26) and environmental Pseudomonas aeruginosa (n = 12). RESULTS: Steam disinfection eradicated all organisms tested, as well as all organisms in CF sputum applied to toothbrushes. CONCLUSIONS: Steam disinfection offers a relatively simple, cheap and available method of eliminating non-spore-forming CF pathogens on toothbrushes. Toothbrushes should be thoroughly rinsed after each use before steam disinfection, to remove plaque, epithelial cells, and residual toothpaste. Toothbrushes should be steam disinfected after each use employing a baby bottle steam disinfector, adhering to manufacturers' operating instructions and stored in the disinfector until next used within 12 to 24 hours. Toothbrushes should be replaced every 3 to 4 months, or sooner if the bristles look worn out, as well as every time a pulmonary exacerbation occurs or every time the patient is treated for a pulmonary/throat infection. Steam disinfection of toothbrushes is crucial when the patient is undergoing eradication regimes for P. aeruginosa and methicillin-resistant Staphylococcus aureus, so that the patient does not become reinfected from this source, thereby aiding eradication and enhancing patient safety.

Who's at The Door? - Surface Contamination of Door Frames in a Single-Bedded In-Patient Adult Cystic Fibrosis (CF) Unit.

The Gram-negative bacterium, Pseudomonas aeruginosa, is a major respiratory pathogen in patients with cystic fibrosis (CF), with an associated increase in morbidity and mortality. Consequently, infection prevention and control (IPC) plays an important role within health care in order to minimize the risk of cross-infection of this organism amongst patients and the hospital environment. It was the aim of this study to examine bacterial contamination of the health estate of CF in-patients' single-bedded rooms and related environments (n=40). Twelve bacterial genera were identified, six being Gram-positive (Brevibacterium, Dermacoccus, Micrococcus, Rothia, Staphylococcus and Streptococcus), and six being Gram-negative (Acinetobacter, Citrobacter, Klebsiella, Moraxella, Pantoea and Pseudoxanthomonas). None of the organisms identified were considered of particular clinical significance to CF patients. The CF lung and associated sputa may be important reservoirs of Pseudomonas aeruginosa, with potential for spill-over into the health care estate. In the aftermath of the Pseudomonas neonatal outbreak at Altnagelvin and the Royal Jubilee Maternity Hospitals, where there was heightened IPC awareness regarding the presence of this bacterium, it is encouraging to note its absence from the CF-health care estate examined.

Public Health Bacteriology of Commercially Composted Domestic Food and Garden Waste by the 11 Councils in Northern Ireland - Persistence Of Clostridium perfringens and Implications for Local Food Safety.

BACKGROUND: New legislation has been introduced in Northern Ireland from April 2017, requiring domestic households to recycle all domestic food waste items. The purpose of this study was to examine the bacteriology of compost derived from this source which is supplied free-of-charge to the public for horticultural use. METHODS: Municipal compost samples were compared microbiologically with commercial garden compost samples, examining total viable count and diversity of bacteria cultivated. RESULTS: The municipal compost had a mean Total Viable Count (TVC) of 1.53 × 108 colony forming units (cfu)/ g compost, whereas the commercial garden compost had a mean TVC of 4.5 × 107 cfu/g compost. Campylobacter, Salmonella and Listeria were not isolated from any compost. Twenty-three bacterial genera were represented amongst the 46 organisms recovered. Of these, Pseudomonas aeruginosa and Clostridium perfringens were the most clinically significant. DISCUSSION: The application of municipal compost to cultivate non-food plants, such as roses and flowers presents minimal risk, provided safe handling practices are adopted and hands are thoroughly washed and dried afterwards. However, if applied to soil growing food produce, it is important that municipal compost does not enter the food chain without an effective critical control point which would prevent germination of spores of Clostridium perfringens. Risk may be increased in products such as marinades, home canning, home bottling and associated products. These methods of food preparation are common in ethnic Eastern European populations in Northern Ireland, where awareness of risk needs to be increased.

Snow angels - the microbiology of freshly fallen snow: implications for immunocompromised patients.

The frequency of seasonal snowfall results in the transient covering of gardens/amenity sites/open public spaces, which encourages recreational interaction mainly with children. No data is available demonstrating the microbiological composition of such fallen snow and therefore a study was undertaken to examine the microbiology of snow from 37 sites, estimating (i) total viable count (TVC), (ii) identification of bacteria, and (iii) the presence of Pseudomonas aeruginosa. Mean TVC count of 8.3 colony-forming units (cfu)/ml snow melt water, 51.7 cfu/ml, 865 cfu/ml and 2,197 cfu/ml, was obtained for public amenity sites, domestic gardens, public open spaces and melting snow from public footpaths, respectively. No bacterial organisms (<10 cfu/ml) were detected in 5/14 (35.7%) open public spaces, 2/5 (40%) amenity sites and in 1/10 (10%) domestic gardens. Pseudomonas aeruginosa was not detected from any snow sample examined. Bacterial diversity consisted of 15 bacterial species (11 Gram-positive/four Gram-negative). The six Gram-positive genera identified from snow were Actinomyces, Bacillus, Brevibacillus, Micrococcus, Staphylococcus and Streptococcus. The four Gram-negative genera identified were Enterobacter, Pantoea, Pseudomonas and Xanthomonas. Bacillus licheniformis was the most commonly isolated organism from snow; it was isolated from every snow type. Snow may contain a diverse range of bacteria, many of which are capable of causing human infections.

Furukawa Agar - A novel bacteriological agar designed to inhibit fungal contamination when sampling organic compost.

A novel bacteriological agar, named Furukawa Agar, has been specifically designed to inhibit the growth of filamentous fungi during microbiological examination of bacteria from organic compost, thereby allowing complete analysis of the resulting bacterial organisms, without the overgrowth with filamentous fungi.

Zoonoses associated with petting farms and open zoos.

The popularity of open farms and petting zoos has increased markedly over the last 5 years, with most children in developed countries now having the opportunity to visit such a facility at some stage in their childhood, either through school or family visits. The open access policy of these establishments allows visitors to be in direct contact with animals such as sheep (lambs), goats, cats (kittens), dogs (puppies), and birds and to have the opportunity to feed such animals. This contact may lead to the transmission of microbial pathogens from animals to humans, e.g., Escherichia coli O157:H7, resulting in human disease. This review outlines the causal organisms associated with such zoonoses, a description of previous outbreaks at farms and zoos, as well as infection control measures to help prevent such zoonotic infections.