Impact of artificial accelerated ageing of PVC surfaces and surface degradation on disinfectant efficacy.

BACKGROUND: Standardized efficacy surface tests for disinfectants are performed on pristine surfaces. There is a growing interest in understanding the impact of surface ageing on disinfectant activity, owing for example to the increased usage of ultraviolet (UV) radiation and oxidative chemistries for surface decontamination. This acknowledges that general surface 'wear and tear' following UV radiation and oxidative biocide exposure may impact biocidal product efficacy. METHODS: PVC surfaces were aged through thermal and UV-A radiation (340 nm wavelength) following the use of standard ageing surface protocols to simulate natural surface degradation. Surface roughness, contact angle and scanning electron microscopy were performed to evaluate physical changes in PVC surfaces before and after artificial ageing. The efficacy of five pre-impregnated disinfectant wipes were evaluated using the ASTM E2967-15 on stainless-steel (control) and PVC surfaces (aged and non-aged). RESULTS: The type of formulation and the organism tested remained the most significant factors impacting disinfectant efficacy, compared with surface type. Both thermal ageing and UV-A exposure of PVC surfaces clearly showed signs of surface degradation, notably an increase in surface roughness. Physical changes were observed in the roughness of PVC after artificial ageing. A difference in disinfectant efficacy dependent on aged PVC surfaces was observed for some, but not all formulations. CONCLUSION: We showed that surface type and surface ageing can affect biocidal product efficacy, although in a non-predictable manner. More research is needed in this field to ascertain whether surface types and aged surfaces should be used in standardized efficacy testing.

The effects of pen ink and surface disinfectants on red blood cells stored in plasticized polyvinylchloride transfusion bags.

BACKGROUND: Each unit of red blood cells (RBCs) produced represents a significant cost to the healthcare system. Unnecessary blood wastage should be minimized. In clinical settings, alterations to blood component bags after issue from the protected setting of the blood bank include pen markings, and those that are exposed to an infectious environment require surface disinfecting. These units may be discarded due to unclear effects on RBC quality. In this study, we investigate whether pen markings or surface disinfection negatively affects the quality of packed RBCs and whether pen ink diffuses through the blood bag. STUDY DESIGN AND METHODS: RBC bags were marked with pens (water, oil, or alcohol-based) or subjected to surface disinfection (ethanol, hydrogen peroxide [Preempt wipes], or benzalkonium chloride-based wipes [CaviWipes]) and sampled 24 h after applying the treatment and at day 42 post collection (n = 3 for each condition). The samples were analyzed for RBC in vitro quality markers. The presence of any ink in the RBC bags was investigated using mass spectrometry (n = 2). RESULTS: Data from 24 h and day 42 time points indicated no differences in RBC count, mean corpuscular volume, morphology, deformability, potassium content, or hemolysis for either pen markings or disinfectants when compared with their untreated controls (p > .05). No trace of ink was detected inside the bag. CONCLUSION: RBC units marked with ballpoint, gel, or Sharpie pens do not suffer a loss of in vitro quality, nor do RBC units which have been surface disinfected with 70% ethanol, Preempt wipes or CaviWipes.

Endocrine-disruptor endpoints in the ovary and thyroid of adult female rats exposed to realistic doses of di-(2-ethylhexyl) phthalate.

Di-(2-ethylhexyl) phthalate (DEHP) is the world's most widely used polyvinyl chloride (PVC) plasticizer and is used in virtually every category of flexible PVC. In fact, DEHP is extensively used in food cosmetics and medical packaging. It has become a serious problem in recent years. DEHP can be absorbed into the human body through the air, food, water, and skin. The current study involved intraperitoneal injection of DEHP dissolved in corn oil once daily for 21 consecutive days to investigate the effects of DEHP on the thyroid and the reproductive system in female rats. Results show that ovarian hormones (progesterone and estrogen) decreased significantly in the rats treated with DEHP compared to control. This result is supported by the alteration of folliculogenesis, the decrease of the follicles viability, and the apoptosis of the granulosa cells observed on histological sections of ovary and thyroid in female rats exposed to low doses of DEHP. Histopathological study revealed that DEHP could damage thyroid tissue and disrupt these functions. We also observed cellular damage, particularly in the liver cells, and a significant increase in biochemical parameters such as alanine aminotransferase (ALT) and aspartate aminotransferase (AST) compared to the control group.

Low-energy X-ray irradiation effectively inactivates major foodborne pathogen biofilms on various food contact surfaces.

Human pathogens can develop biofilm structures on different artificial substrates common in the food industry. In this study, we investigated the inactivation efficacy of low-energy X-ray irradiation on Escherichia coli O157:H7, Salmonella Typhimurium, and Listeria monocytogenes biofilms on food contact surfaces, including polyvinyl chloride (PVC), stainless steel with finish 2B (STS 2B), and Teflon. The numbers of viable cells in biofilms on all test coupons were significantly (p < 0.05) reduced as the X-ray dose increased. Interestingly, different biofilm inactivation levels were observed relative to various material surfaces. Teflon showed the lowest D5d (dose required for a 5-log reduction in cell count) values among three groups of coupons, whereas PVC exhibited higher D5d values than the other two coupons. The mechanism of the X-ray antibiofilm effect was identified through the measurement of extracellular polymeric substances (EPS) in biofilms. X-ray irradiation could remove exopolysaccharides, which are major component of EPS and the removal rate increased with increasing irradiation dose. The analyses also confirmed that the disintegration of EPS was strongly related to the trends of biofilm inactivation on different coupon surfaces. This study is the first to demonstrate that X-ray irradiation effectively inactivates major foodborne pathogen biofilms on various food contact surfaces and to evaluate its antibiofilm mechanisms to enhance safety in the food processing industries.

Acute toxicity of bioplastic leachates to Paracentrotus lividus sea urchin larvae.

In an attempt to ensure that bioplastics, progressively replacing petrochemical-derived plastics, do not release any harmful compound to the environment, the study assessed the toxic effects of three innovative bioplastic products: polyhydroxybutyrate resin (PHB), polylactic acid cups (PLA) and a polylactic acid/polyhydroxyalkanoate 3D printing filament (PLA/PHA), together with a synthetic polyvinyl chloride (PVC) toy in Paracentrotus lividus sea urchin larvae. PVC toy was the most toxic material, likely due to the added plasticizers; remarkably, even if PHB is conceived as a nontoxic polymer, it showed a slight toxicity and Gas Chromatography-Mass Spectometry analysis (GC-MS) revealed the presence of a wide range of additives. Conversely, PLA cups and PLA/PHA filament were innocuous for the larvae, a positive outcome for these renewable solutions. Proven that additives are also used in some bioplastic formulations, they should be carefully addressed to ensure that they are as safe as regarded.

Histopathological damage and stress- and immune-related genes' expression in the intestine of common carp, Cyprinus carpio exposed to copper and polyvinyl chloride microparticle.

The present study aimed at assessing the singular and combined effects of water copper and polyvinyl chloride microplastic (MPVC) on intestinal copper accumulation, histopathological damage, and stress-/immune-related genes' expression in common carp, Cyprinus carpio. Four groups of fish were maintained in triplicate: control (kept in clean water), Cu (exposed to 0.25 mg/L of copper), MPVC (exposed to 0.5 mg/L of MPVC), and Cu-MPVC (exposed to 0.25 mg/L of copper + 0.5 mg/L of MPVC). After 14-day exposure, the fish of Cu and Cu-MPVC treatments exhibited significantly higher intestinal copper contents, compared to the fish of control and MPVC treatments. In this regard, the Cu-MPVC fish had significantly higher copper content than the Cu fish. Exposure to copper and/or MPVC significantly upregulated the intestinal heat shock protein 70 (hsp70), cytochrome P450 family 1 subfamily A member 1 (cyp1a1), lysozyme (lys), defensin (def), mucin 2 (muc2), and mucin 5 (muc5) expression. The highest expression of hsp70, cyp1a1, lys, and def was related to Cu-MPVC treatment; whereas, the highest expression of muc2 and muc5 was observed in Cu and MPVC treatments. Exposure to copper and/or MPVC induced intestinal damage, which Cu-MPVC fish exhibited the highest severity. The present study revealed that exposure to copper and/or MPVC causes intestinal histopathological damage and upregulation in stress- and immune-related genes' expression. The most serious effects were observed in Cu-MPVC treatment that might be due to additive effects of copper and MPVC and/or higher copper accumulation in this treatment.

Riboflavin Surface Modification of Poly(vinyl chloride) for Light-Triggered Control of Bacterial Biofilm and Virus Inactivation.

Poly(vinyl chloride) (PVC) is the most used biomedical polymer worldwide. PVC is a stable and chemically inert polymer. However, microorganisms can colonize PVC producing biomedical device-associated infections. While surface modifications of PVC can help improve the antimicrobial and antiviral properties, the chemically inert nature of PVC makes those modifications challenging and potentially toxic. In this work, we modified the PVC surface using a derivative riboflavin molecule that was chemically tethered to a plasma-treated PVC surface. Upon a low dosage of blue light, the riboflavin tethered to the PVC surface became photochemically activated, allowing for Pseudomonas aeruginosa bacterial biofilm and lentiviral in situ eradication.

Comparison of Genotoxicity and Cytotoxicity of Polyvinyl Chloride and Poly(methyl methacrylate) Nanoparticles on Normal Human Lung Cell Lines.

High concentrations of micro- and nanoparticles of common plastic materials present in the environment are causing an adverse health impact on living organisms. As a model study, here we report the synthesis and characterization of luminescent polyvinyl chloride (PVC) and poly(methyl methacrylate) (PMMA) nanoparticles and investigate the interaction with normal human lung fibroblast cells (IMR 90) to understand the uptake, translocation, and toxicity of PVC and PMMA nanoparticles. The synthesized particles are in the size range of 120-140 nm with a negative surface potential. The colocalization and uptake efficiency of the nanoparticles were analyzed, and the cytotoxicity assay shows significant reduction in cell viability. Cellular internalization was investigated using colocalization and dynasore inhibitor tests, which showed that the PVC and PMMA nanoparticles enter into the cell via endocytosis. The polymer nanoparticles induced a reduction in viability, decrease in adenosine triphosphate, and increase in reactive oxygen species and lactate dehydrogenase concentrations. In addition, the polymer nanoparticles caused cell cycle arrest at sub-G1, G0/G1, and G2/M phases, followed by apoptotic cell death. Our results reported here are important to the emerging data on understanding the impact of common polymer particles on human health.

PVC Does Not Influence Cadmium Uptake or Effects in the Mussel (Mytilus edulis).

Microplastics have become a global concern in recent years. In this study, we studied (i) whether the presence of polyvinyl chloride (PVC) microparticles may affect cadmium (Cd) uptake in mussel (Mytilus edulis); and (ii) the biological effects of PVC microparticles exposure alone or in combination with Cd. Significant Cd uptake in digestive gland was observed following Cd exposure. However, PVC did not significantly increase Cd uptake compared with Cd alone treatment. In terms of biological impacts, significantly lower neutral red retention (NRR) time and elevated expression of Metallothionein isoform 20-IV (MT-20) were observed in mussels exposed to Cd alone, or combined with microplastics, yet there was no significant difference between them. catalase (CAT) expression only showed a significant increase in mussels exposed to Cd alone. This work provides an insight into the relationship on resulting biological impacts between these two contaminants.

Sampling and inactivation of wet disseminated spores from flooring materials, using commercially available robotic vacuum cleaners.

AIMS: Four commercially available robotic vacuum cleaners were assessed for sampling efficiency of wet disseminated Bacillus atrophaeus spores on carpet, polyvinyl chloride (PVC) and laminate flooring. Furthermore, their operability was evaluated and decontamination efficiency of one robot was assessed, using a sodium hypochlorite solution. METHODS AND RESULTS: In an environmental chamber, robots self-navigated around 4 m2 of flooring containing a single contaminated 0·25 m2 tile (c. 104 spores per cm2 ). Contamination levels at predetermined locations were assessed by macrofoam swabs (PVC and laminate) or water soluble tape (carpet), before and after sampling. Robots were dismantled postsampling and spore recoveries assessed. Aerosol contamination was also measured during sampling. Robot sampling efficiencies were variable, however, robots recovered most spores from laminate (up to 17·1%), then PVC and lastly the carpet. All robots spread contamination from the 'hotspot' (all robots spread <0·6% of the contamination to other areas) and became surface contaminated. Spores were detected at low levels during air sampling (<5·6 spores per litre). Liquid decontamination inactivated 99·1% of spores from PVC. CONCLUSIONS: Robotic vacuum cleaners show promise for both sampling and initial decontamination of indoor flooring. SIGNIFICANCE AND IMPACT OF THE STUDY: In the event of a bioterror incident, e.g. deliberate release of Bacillus anthracis spores, areas require sampling to determine the magnitude and extent of contamination, and to establish decontamination efficacy. In this study, we investigate robotic sampling methods against high concentrations of bacterial spores applied by wet deposition to different floorings, contamination spread to other areas, potential transfer of spores to the operators and assessment of a wet vacuum robot for spore inactivation. The robots' usability was evaluated and how they can be employed in real life scenarios. This will help to reduce the economic cost of sampling and the risk to sampling/decontamination teams.

Modulating Surface Potential by Controlling the ß Phase Content in Poly(vinylidene fluoridetrifluoroethylene) Membranes Enhances Bone Regeneration.

Bioelectricity plays a vital role in living organisms. Although electrical stimulation is introduced in the field of bone regeneration, the concept of a dose-response relationship between surface potential and osteogenesis is not thoroughly studied. To optimize the osteogenic properties of different surface potentials, a flexible piezoelectric membrane, poly(vinylidene fluoridetrifluoroethylene) [P(VDF-TrFE)], is fabricated by annealing treatment to control its ß phases. The surface potential and piezoelectric coefficients (d33 ) of the membranes can be regulated by increasing ß phase contents. Compared with d33  = 20 pC N-1 (surface potential = -78 mV) and unpolarized membranes, bone marrow mesenchymal stem cells (BM-MSCs) cultured on the d33  = 10 pC N-1 (surface potential = -53 mV) membranes have better osteogenic properties. In vivo, d33  = 10 pC N-1 membranes result in rapid bone regeneration and complete mature bone-structure formation. BM-MSCs on d33  = 10 pC N-1 membranes have the lowest reactive oxygen species level and the highest mitochondrial membrane electric potential, implying that these membranes provide the best electrical qunantity for BM-MSCs' proliferation and energy metabolism. This study establishes an effective method to control the surface potential of P(VDF-Trfe) membranes and highlights the importance of optimized electrical stimulation in bone regeneration.

Alternative plasticizer, 4-cyclohexene-1,2-dicarboxylic acid dinonyl ester, for blood containers with protective effects on red blood cells and improved cold resistance.

Di (2-ethylhexyl) phthalate (DEHP), a typical plasticizer used for polyvinyl chloride (PVC), is eluted from PVC-made blood containers and protects against red blood cell (RBC) hemolysis. However, concerns have arisen regarding the reproductive and developmental risks of DEHP in humans, and the use of alternative plasticizers for medical devices has been recommended worldwide. In this study, we propose that the use of a novel plasticizer, 4-cyclohexene-1,2-dicarboxylic acid dinonyl ester (DL9TH), could help produce more useful and safe blood containers. PVC sheet containing DL9TH and di (2-ethylhexyl) 4-cyclohexene-1,2-dicarboxylate (DOTH) provides comparable or superior protective effects to RBCs relative to PVC sheet containing DEHP or di-isononyl-cyclohexane-1,2-dicarboxylate (DINCH® , an alternative plasticizer that has been used in PVC sheets for blood containers). The total amount of plasticizer eluted from DOTH/DL9TH-PVC sheets is nearly the same as that eluted from DEHP-PVC sheets. In addition, DOTH/DL9TH-PVC has better cold resistance than DEHP- and DINCH® -PVC sheets. In vitro and in vivo tests for biological safety based on International Organization for Standardization guidelines (10993 series) suggest that the DOTH/DL9TH-PVC sheet can be used safely. Subchronic toxicity testing of DL9TH in male rats in accordance with the principles of Organisation for Economic Co-operation and Development Test Guideline 408 showed that DL9TH did not induce adverse effects up to the highest dose level tested (717 mg/kg body weight/day). There were no effects on testicular histopathology and sperm counts, and no indications of endocrine effects: testosterone, thyroid-stimulating hormone, follicle-stimulating hormone, and 17ß-estradiol were unchanged by the treatment, compared with the control group. © 2017 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 106B: 1052-1063, 2018.

The purified vepoloxamer prevents haemolysis in 42-day stored, DEHP/PVC-free red blood cell units.

BACKGROUND: Use of the plasticiser di(2-ethylhexyl) phthalate (DEHP) in polyvinyl chloride (PVC) blood bags poses a potential dilemma. The presence of DEHP in blood bags has been shown to be beneficial to red blood cells during storage by diminishing haemolysis. However, DEHP use in PVC may be carcinogenic or estrogenising. Vepoloxamer is a poloxamer with rheological and cytoprotective rheological properties and a favourable toxicity profile in clinical trials. We hypothesised that vepoloxamer may be sufficient to replace the plasticiser DEHP to prevent elevated haemolysis while conserving the biochemical and redox potential++ in RBCs stored for up to 42 days. MATERIALS AND METHODS: Paired analyses of aliquots from pooled RBC suspensions of ABO identical donors were aseptically split into test storage containers (DEHP/PVC or DEHP-free/ethylene vinyl acetate [EVA]) supplemented with or without vepoloxamer (at concentrations of 0.1, 1, 5 or 7.89 mg/mL) and cold stored for up to 42 days. RESULTS: Vepoloxamer significantly prevented the increased haemolysis induced by the absence of DEHP in EVA bags in a dose-dependent manner by days 28 and 42 of storage (approx. 50% reduction of the maximum concentration of vepoloxamer; p<0.001). There was an inverse correlation between the concentration of vepoloxamer used and the haemolysis rate (r2=0.27, p<0.001) and a direct correlation between haemolysis and phosphatidylserine (PS) exposure (r2=0.42; p<0.01). Increased osmotic fragility and shear induced deformability of 42-day stored RBC in EVA bags was significantly corrected by the addition of vepoloxamer. DISCUSSION: Vepoloxamer, in a concentration-dependent fashion, is able to partly rescue the increased haemolysis and PS exposure induced by the absence of the commonly used plasticiser DEHP. These results provide initial but strong evidence to support vepoloxamer use to replace DEHP in long-term storage of RBC.

Lipase degradation of plasticized polyvinyl chloride endotracheal tube surfaces to create nanoscale features.

Polyvinyl chloride (PVC) endotracheal tubes (ETTs) nanoetched with a fungal lipase have been shown to reduce bacterial growth and biofilm formation and could be an inexpensive solution to the complex problem of ventilator-associated pneumonia (VAP). Although bacterial growth and colonization on these nanoetched materials have been well characterized, little is known about the mechanism by which the fungal lipase degrades the PVC and, thus, alters its properties to minimize bacteria functions. This study used X-ray photoelectron spectroscopy (XPS) and attenuated total reflectance Fourier transform infrared spectroscopy (ATR-FTIR) to better describe the surface chemistry of both unetched and lipase nanoetched PVC ETT. ATR-FTIR analysis of the unetched and treated surfaces showed a similar presence of a plasticizer. This was confirmed by XPS analysis, which showed an increase of carbon and the presence of oxygen on both unetched and nanoetched surfaces. A quantitative comparison of the FTIR spectra revealed significant correlations (Pearson's correlation, R=0.997 [R2=0.994, P<0.001]) between the unetched and nanomodified PVC ETT spectra, demonstrating similar surface chemistry. This analysis showed no shifting or widening of the bands in the spectra and no significant changes in the intensity of the infrared peaks due to the degradation of the plasticizer by the fungal lipase. In contrast, results from this study did demonstrate significantly increased nanoscale surface features on the lipase etched compared to non-etched PVC ETTs. This led to a change in surface energetics, which altered ion adsorption to the ETTs. Thus, these results showed that PVC surfaces nanoetched with a 0.1% lipase solution for 48 hours have no significant change on surface chemistry but do significantly increase nanoscale surface roughness and alters ion adsorption, which suggests that the unique properties of these materials, including their previously reported ability to decrease bacterial adhesion and growth, are due to the changes in the degree of the nanoscale roughness, not changes in their surface chemistry.

Factors Influencing the Accurate Administration of Peristaltic Finger Infusion Pumps Attached to Polyvinylchloride Infusion Sets Containing Tris(2-ethylhexyl) trimellitate.

An accurate continuous intravenous injection via a peristaltic finger infusion pump has been utilized at outpatient clinics recently. An infusion element designed for this pump is necessary for the accurate handling of the pump, and for proper use of this equipment, we need accurate information. Our experiments have shown that medication administration has occasionally been incomplete at the calculated input time when a peristaltic finger infusion pump has been used. In this paper, we have investigated the cause of the delay in the administration time and the effect of the attachment procedure using a combination of features from three kinds of such infusion pumps and five kinds of exclusive polyvinyl chloride (PVC) infusion sets, under various conditions. Our results suggest that the time required for complete administration was correlated to the input time when five kinds of PVC tubing without stretching were attached to three kinds of peristaltic finger infusion pumps (R(2)=0.9998-1.0000). However, when the PVC tubing was stretched 1-3 cm and was attached to the pump, the time required for complete administration of the solution was prolonged compared to the recommended listed input time (p<0.01-0.05, ANOVA, Tukey-Kramer multiple comparison). Therefore, we suggest that the procedure technique used by the medical staff and involving the infusion pump adversely prolonged the time required for completion of the administration of medication. In our opinion, pharmacists must provide information concerning not only the drugs, but also the medical devices used to the physicians and nurses.

Physicochemical analysis of initial adhesion and biofilm formation of Methanosarcina barkeri on polymer support material.

The retention of selective biofilms of Methanosarcina species within anaerobic digesters could reduce start-up times and enhance the efficiency of the process in treating high-strength domestic sewage. The objective of the study was to examine the effect of the surface characteristics of six common polymer support materials on the initial adhesion of the model methanogen, Methanosarcina barkeri, and to assess the potential of these support materials as selective biofilm carriers. Results from both the initial adhesion tests and extended DLVO (xDLVO) model correlated with each other, with PVC (12% surface coverage/mm(2)), PTFE (6% surface coverage/mm(2)), and PP (6% surface coverage/mm(2)), shown to be the better performing support materials for initial adhesion, as well as subsequent biofilm formation by M. barkeri after 72h. Experimental results of these three support materials showed that the type of material strongly influenced the extent of adhesion from M. barkeri (p<0.0001), and the xDLVO model was able to explain the results in these environmental conditions. Therefore, DLVO physicochemical forces were found to be influential on the initial adhesion of M. barkeri. Scanning electron microscopy suggested that production of extracellular polymeric substances (EPS) from M. barkeri could facilitate further biofilm development. This study highlights the potential of using the xDLVO model to rapidly identify suitable materials for the selective adhesion of M. barkeri, which could be beneficial in both the start-up and long-term phases of anaerobic digestion.

I-TiO2/PVC film with highly photocatalytic antibacterial activity under visible light.

Iodine-modified TiO2(I-TiO2) film were coated on medical-grade PVC material by impregnation-deposition method and subsequently characterized by XRD, SEM, TEM, AFM, DRS and XPS. The photocatalytic anti-bacterial activity of I-TiO2/PVC was investigated both by in vitro anti-bacterial experiments and by clinical study. The results revealed that I-TiO2/PVC exhibit excellent photocatalytic antibacterial activity, which can destroy the propagation of the Escherichia coli and cause the deactivation and death of most E. coli bacteria within 30min visible light illumination. Clinical study on animals showed that I-TiO2 coated on PVC decrease the formation of biofilm on PVC surface in the mechanical ventilation. Furthermore, I-TiO2/PVC can effectively reduce inflammation of tracheal tissue of bam suckling pig and prevents the occurrence of VAP.

Adhesion behaviors of Escherichia coli on hydroxyapatite.

Optimum design of support materials for microorganisms is required for the construction of bioreactors. However, the effects of support materials on microorganisms are still unclear. In this study, we investigated the adhesion behavior of Escherichia coli (E. coli) on hydroxyapatite (HA), polyurethane (PU), poly(vinyl chloride) (PVC), and carbon (Carbon) to obtain basic knowledge for the design of support materials. The total metabolic activity and number of E. coli adhering on the samples followed the order of HA ≈ Carbon>PVC>PU. On the other hand, the water contact angle of the pellet surfaces followed the order of HA

An investigation of red blood cell concentrate quality during storage in paediatric-sized polyvinylchloride bags plasticized with alternatives to di-2-ethylhexyl phthalate (DEHP).

BACKGROUND AND OBJECTIVES: Di-2-ethylhexyl phthalate (DEHP) is a blood bag plasticizer. It is also a toxin, raising concerns for vulnerable populations, for example, neonates and infants. Here, the in vitro quality of red cell concentrates (RCC) stored in paediatric bags formulated with alternative plasticizers to DEHP was compared. MATERIALS AND METHODS: RCC were pooled and split into polyvinylchloride (PVC)/DEHP, PVC/1,2-cyclohexanedicarboxylic acid diisononyl ester (DINCH) or PVC/butyryl trihexyl citrate (BTHC) bags. Quality was assessed on storage days 5, 21, 35 and 43. RESULTS: Metabolism differed among the bags: pCO2 levels were lowest and pO2 were highest in BTHC bags. Glucose consumption and lactate production suggested higher metabolic rates in BTHC bags. ATP levels were best maintained in DINCH bags (day 43 mean level: 2·86 ± 0·29 µmol/g Hb). RCC in BTHC bags had the greatest potassium release (54·6 ± 3·0 mm on day 43). From day 21, haemolysis was higher in BTHC bags (P < 0·01) and by day 43 had exceeded 0·8% (0·85 ± 0·10%). RCC in BTHC bags showed more microparticle formation than RCC in DEHP or DINCH bags. CONCLUSION: The results suggest that the BTHC formulation used was detrimental to RBC quality. DINCH bags could be a viable alternative to DEHP: they outperformed DEHP bags energetically, with better maintenance of ATP levels.