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The problem of bacterial antibiotic resistance has attracted considerable research attention, and the effects of water treatment on antibiotic resistant bacteria (ARB) and antibiotic resistance genes (ARGs) are being increasingly investigated. As an indispensable part of the water treatment process, disinfection plays an important role in controlling antibiotic resistance. At present, there were many studies on the effects of conventional and new sterilization methods on ARB and ARGs. However, there is a lack of literature relating to the limitations of conventional methods and analysis of new techniques. Therefore, this review focuses on analyzing the deficiencies of conventional disinfection and the development of new methods for antibiotic resistance control to guide future research. Firstly, we analyzed the effects and drawbacks of conventional disinfection methods, such as chlorine (Cl), ultraviolet (UV) and ozone on antibiotic resistance control. Secondly, we discuss the research progress and shortcomings of new sterilization methods in antibiotic resistance. Finally, we propose suggestions for future research directions. There is an urgent need for new effective and low-cost sterilization methods. Disinfection via UV and chlorine in combination, UV/chlorine showed greater potential for controlling ARGs., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Establishing and maintaining a sterile field to help prevent surgical site infections requires specific knowledge and skills and is among the most important responsibilities of the perioperative RN. Perioperative RNs should remain vigilant in monitoring the sterile field, communicate when a break in sterile technique occurs, and collaborate with other surgical team members to correct the break in technique. The AORN "Guideline for sterile technique" provides guidance to perioperative personnel on the principles and processes of sterile technique. This article elaborates on key takeaways from the guideline, including using sterile technique when donning sterile gowns and gloves, delivering sterile items to the sterile field, using drapes to establish a sterile field, and maintaining the sterile field. Perioperative RNs should review the complete guideline for additional information and for guidance when writing and updating policies and procedures., (© AORN, Inc, 2019.)

Millions of gastrointestinal endoscopes are performed each year in the United States. Gastrointestinal endoscopes become highly contaminated during use (ie, internal channels contain 7-10-log 10 enteric microorganisms). Currently, endoscopes (eg, bronchoscopes and gastrointestinal endoscopes) are classified as semicritical items because they contact intact mucous membranes and most commonly undergo cleaning followed by high-level disinfection, which may result in as little as a 6-log 10 reduction of microorganisms. Therefore, and not surprisingly, in recent years there have been multiple reports that have documented that endoscopes, especially duodenoscopes, frequently remain contaminated with bacterial pathogens after proper cleaning and disinfection. Multiple outbreaks of multidrug-resistant organisms from contaminated duodenoscopes have resulted in substantial death and morbidity. Because duodenoscopes commonly contact nonintact mucous membranes and sterile tissue, such endoscopes should be considered critical items. We propose that to ensure patient safety, we follow the Spaulding scheme and move from high-level disinfection to sterilization of reusable endoscopes or use an alternative diagnostic/therapeutic method (eg, disposable sterile endoscopes)., (Copyright © 2019. Published by Elsevier Inc.)

Background: The efficacy of widely used povidone-iodine applicators for skin sterilization in abdominal surgery is unclear. The aim of this trial was to evaluate whether sterilization with a povidone-iodine applicator was not inferior to a conventional sterilization method., Methods: Patients undergoing elective abdominal surgery were assigned randomly to receive single sterilization with the applicator or conventional sterilization. The primary endpoint was wound infection rate. Secondary endpoints were rate of organ/space surgical-site infection (SSI), adverse effects of povidone-iodine, amount of povidone-iodine used and total cost of sterilization., Results: Of 498 patients eligible for the study between April 2015 and September 2017, 240 were assigned and analysed in the applicator group and 246 in the conventional group. Wound infection was detected in 16 patients (6·7 per cent) in the applicator group and 16 (6·5 per cent) in the conventional group (absolute difference 0·0016 (90 per cent c.i. -0·037 to 0·040) per cent; P  = 0·014 for non-inferiority). There was no difference between the groups in the organ/space SSI rate (11 patients (4·6 per cent) in the applicator group and 16 (6·5 per cent) in the conventional group. Both the amount of povidone-iodine used and the total cost of sterilization were higher in the conventional group than in the applicator group (median 76·7 versus 25 ml respectively, P  < 0·001; median €7·0 versus €6·4, P  < 0·001). Skin irritation was detected in three patients in the conventional group., Conclusion: In abdominal surgery, this povidone-iodine applicator was not inferior to conventional sterilization in terms of the wound infection rate, and it is cheaper. Registration number: UMIN000018231 (http://www.umin.ac.jp/ctr/).

Objective: To describe trends in age-specific incidence rates of female sterilization (FS) procedures in Western Australia and to evaluate the effects of the introduction of government-subsidized contraceptive methods and the implementation of the Australian government's baby bonus policy on FS rates., Design: Population-based retrospective descriptive study., Setting: Not applicable., Patient(s): All women ages 15-49 undergoing an FS procedure during the period January 1, 1990, to December 31, 2008 (n = 47,360 procedures)., Intervention(s): Records from statutory statewide data collections of hospitals separations and births were extracted and linked., Main Outcome Measure(s): Trends in FS procedures and the influence on these trends of the introduction of government policies: subsidization of long-acting reversible contraceptives (Implanon and Mirena) and the Australian baby bonus initiative., Result(s): The annual incidence rate of FS procedures declined from 756.9 per 100,000 women in 1990 to 155.2 per 100,000 women in 2008. Compared with the period 1990-1994, women ages 30-39 years were 47% less likely (rate ratio [RR] = 0.53; 95% confidence interval [CI], 0.39-0.72) to undergo sterilization during the period 2005-2008. Adjusting for overall trend, there were significant decreases in FS rates after government subsidization of Implanon (RR = 0.89; 95% CI, 0.82-0.97) and Mirena (RR = 0.81; 95% CI, 0.73-0.91) and the introduction of the baby bonus (RR = 0.70; 95% CI, 0.61-0.81)., Conclusion(s): Rates of female sterilization procedures in Western Australia have declined substantially across all age groups in the last two decades. Women's decisions to undergo sterilization procedures may be influenced by government interventions that increase access to long-term reversible contraceptives or encourage childbirth., (Copyright © 2016 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.)

A review of regulatory clearances for selected new sterilization and disinfection products for the period January 2012-June 2015 indicates continued leverage of established technologies for steam and low-temperature sterilization, and high-level disinfection. New products in these areas were typically modified and improved versions of existing products, with the exception of a new combination hydrogen peroxide/ozone sterilizer. Development of new low-temperature sterilization technologies to address continued evolution of complex medical devices is expected to continue., (Copyright © 2016 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.)

Operative sterility is a critical factor with regard to infection in the postoperative period. In recent years, techniques and devices have been developed to reduce the potential for exposure to pathogens. This brief review details the SteriCup, a unique product that has the potential to reduce the risk of healthcare-acquired infections. The SteriCup provides a designated sterile area to store suction catheters and removed endotracheal tubes and allows for their simple and safe disposal. Devices such as the SteriCup have the potential to improve operating room systems and minimize potential for operative infection.

The comparative characteristic of the accepted methods of low-temperature sterilization of medical equipment is given. Special attention is devoted to the surgical infection prophylaxis. The efficacy, expediency and safety of gas sterilization with ethilenoxide is proved. Plasmic methods of sterilization is recommended for use together with other methods of low-temperature sterilization.

Bacillus species are a spoilage and safety challenge to the food industry due to their extremely resistant endospores. To interfere with (out)growth of spores and vegetative cells, weak organic acids are suitable preservatives. To ensure their continued use while optimally preserving product quality, knowledge of resistance development is important. In Bacilli stress responses induced by weak organic acids include intracellular membrane and pH homeostasis and detoxification of reactive oxygen species. Targeted identification of inhibitors and formulation of milder antimicrobial combinations, as desired by consumers, is thereby facilitated. In addition to being food spoilers, probiotic Bacilli are known and utilized. Knowledge of weak organic acid stress resistance may be used to develop enhanced strain robustness facilitating their permanence in the gastrointestinal tract., (Copyright 2010 Elsevier Ltd. All rights reserved.)

Sterile processing department (SPD) staff members have the difficult task of processing complicated instrumentation, containing costs, and managing limited resources; and how they face these challenges has a direct effect on patient care. Recent technological advances require SPD staff members to be more knowledgeable about what instrument trays are used together and the conditions in which they are used to help prevent costly delays in processing. This article explores how one health care system was successful in facing these challenges by implementing a solid orientation and education program.

How many times have procedures in your operating rooms been delayed because the instruments needed were still in the sterilizer? As Perioperative nurses you are likely to be quite familiar with the constant pressure to ensure that scarce instrumentation is available when needed. In 2003, a Canadian company developed a unique sterilization process employing ozone as the sterilizing agent. This technology is a safe, rapid and economical alternative to other low temperature sterilization modalities and may relieve some of the pressure experienced when instruments in short supply are in high demand. This article will discuss the principles of the sterilizer and the cycle and will explore the advantages of using this sterilization technology.

Plasma-derived intravenous immunoglobulin (IVIG) preparations have been successfully applied for the prophylactic prevention of infectious diseases in immunodeficient patients. In addition to its replacement therapy of primary and secondary antibody deficiencies, IVIG has found increased use in autoimmune and inflammatory diseases. IVIG has become the major plasma product on the global blood product market. The world wide consumption nearly tripled between 1992 and 2003, from 19.4 to 52.6 tons. Classical manufacturing processes of IVIG, but also new strategies for purification are discussed with respect to practicability and yield. Ethanol fractionation is still the basis for most IVIG processes, although isolation and purification of immunoglobulin G (IgG) by chromatography has gained ground. The efficiency of virus inactivation methods and virus removal techniques in terms of logarithmic reduction factors are analyzed, but also the IgG losses are taken into consideration. Some of these methods also have the ability to separate prions. High pathogen safety and high yields have become the dominant goals of the plasma fractionation industry.

Prion diseases, also called transmissible spongiform encephalopathies (TSEs), are a family of neurodegenerative disorders affecting both humans and animals. They are caused by the accumulation of an abnormal form of a protein known as prion that results in neuronal death and a characteristic spongiform appearance of the brain tissue. Human prion diseases can be sporadic, acquired or hereditary. Acquired prion diseases have been linked to entering contaminated food into the human food chain, failure to completely disinfect or sterilize contaminated surgical instruments, patients receiving tissues and organs from infected donors, recipients of blood and other biological contaminated products, and potentially to cross infection in dental procedures. At present, there is unfortunately no efficient therapy that can be administered to clinically infected patients with prion diseases. Moreover, there are no simple diagnostic tests that can be used to show the agent of transmissible spongiform encephalopathy during the preclinical phase of the disease. Therefore, to prevent the spread of this emerging infectious agent it is necessary to implement several health control strategies and maintain surveillance for subclinical infections.

The use of CO(2) under pressure (dense CO(2)) is one of the most promising techniques to achieve cold pasteurization and/or sterilization of liquid and solid materials, and is likely to replace or partially substitute currently and widely applied thermal processes. Although the ability of CO(2) to inactivate microorganisms has been known since the 1950's, only within the last 15 years it has received special attention, and the scientific and economic interest towards practical applications is presently growing more and more. Here we collect and discuss the relevant current knowledge about the potentials of dense CO(2) as a non-thermal technology in the field of microbial inactivation. We summarize the state of the art, including definitions, description of the equipment, relevant applications, in both simple suspensions and complex media, for the treatment of a wide range of microorganisms in both liquid and solid substrates. Finally, we also summarize and discuss the different hypotheses about the mechanisms of inactivation., (Copyright 2003 Wiley Periodicals, Inc.)

High-purity porcine factor VIII (pFVIII) (Hyate:C, Ipsen, UK), with a specific activity of > 125 U mg(-1) protein, has been shown to be effective in up to 90% of bleeds in patients with FVIII inhibitors. These inhibitors have been shown to have a median 15% cross-reactivity to pFVIII, and even less cross-reactivity in patients with acquired haemophilia. Its use is sometimes associated with a transient fall in platelet count and with transfusion reactions. Furthermore, it is not virally attenuated. Although pFVIII has not been shown to transmit any viral illness to its human recipients, it is extensively screened for porcine viruses using a 4-cell line general screen. The source plasma is also screened for porcine parvovirus. To satisfy the demand for ever-improved side-effect profile and viral safety a third-generation pFVIII is under consideration by Ipsen. This product will be purified from porcine plasma screened for porcine parvovirus, using immuno-purification, ion-exchange chromatography and washing. Spiking experiments using human FVIIIC (hFVIIIC) suggest that these purification steps may be associated with a 6-log viral reduction. The product is also virally attenuated using the solvent-detergent method. This should yield an ultra-pure concentrate, lacking porcine von Willebrand factor, with a specific activity of approximately 5000 U mg(-1) protein which does not require added albumin as stabilizer and which may be stored at 2-4 degrees. One would anticipate that this product should be clinically effective and should be associated with enhanced viral safety and an improved side-effect profile. It should not affect the platelet count and should be associated with a much reduced risk of transfusion reactions. Clinical trials are planned.

Driven by economic and time constraints, some medical centers and third parties are resterilizing single-use devices (SUDs) for reuse. The steam autoclave is quick, but most plastics used in SUDs cannot survive the temperature. Thus, a number of new methods of cleaning, disinfecting, and sterilizing these complex devices are being introduced on the market. The present study investigated the effects of a range of methods on the tensile strength of latex rubber, silicone elastomer, 2 different formulations of polyurethane, nylon, and high-density polyethylene (HDPE) specimens. The methods used were sodium hypochlorite bleach (Clorox), peracetic acid + hydrogen peroxide (Steris), formaldehyde gas (Chemiclave), low-temperature peracetic acid and gas plasma (Plazlyte), and low-temperature hydrogen peroxide gas plasma (Sterrad). The results showed that silicone elastomer was minimally affected, whereas the strengths of nylon, polyethylene, and latex were reduced by some of the methods. Depending on the formulation, the strength of polyurethane either increased or decreased. The data demonstrated that disinfection and sterilization can affect the tensile strength of certain materials used in medical devices.

In a survey of 140 electrophysiologic laboratories in the USA, 49% reuse catheters to some extent. Catheter reuse is associated with significant reductions in cost but is not conducted in a standardized fashion.

The latest generation of electron-beam technology, which includes higher power accelerators fitted with X-ray conversion, is offering manufacturers a broader range of sterilizing options and driving market share for this method of sterilization.

Despite many predictions about the demise of ethylene oxide as a sterilization method, it continues to be used for increasing volumes of medical devices. This article examines why this has happened and what the future holds.

Some recent events have suggested that the best days of steels have gone and that disposable plastics would be better for many applications. Although it cannot be denied that plastics have taken over many of the roles of steel during the last few decades and will, quite rightly, continue to do so in certain areas, this article argues the case for proper consideration for steels in other areas, where their properties are still of the greatest relevance.

The repeated use of semicritical and critical medical instruments in clinical procedures carries an inherent risk of subsequent patient infection, necessitating "high-level" disinfection or sterilization. However, residual bio-organic contamination may hinder the ability of such processes to efficiently destroy infectious microbes. In this study, the inner surfaces of three clinically used expanded polytetrafluoroethylene endoscope tubes treated with glutaraldehyde disinfectant solutions were analyzed to quantify the efficacy of a buffered peracetic acid sterilization procedure, the STERIS PROCESS, in removing this contamination. Samples of the flexible distal biopsy channel of colonoscope tubes were examined before and after a variable number of STERIS processing cycles by three complementary surface characterization techniques: Fourier transform infrared spectroscopy (FTIR), electron spectroscopy for chemical analysis (ESCA), and atomic force microscopy (AFM). Glutaraldehyde fixed protein deposits identified on the tubing surface decreased with increased STERIS cycles. After 20 STERIS cycles, FTIR data indicated that approximately 30% of the contamination was removed, whereas ESCA indicated that 50% of the contamination was removed. AFM images showed considerable variation between control and processed samples, including evidence for cracks in the residual contamination layer. Clinical glutaraldehyde treatment and subsequent device drying are suggested to be two majors factors that limit effective cleaning of endoscopic tubing.

Two tasks must be accomplished to provide planetary protection for Mars return missions: (1) sterilization of the scientific module to be landed on Mars and (2) reliable sterilization of all material returned to Earth, while ensuring the scientific integrity of martian samples. This paper examines similarity and differences between these two tasks, and includes a discussion of technological implementation conditions and the nature of terrestrial and hypothesized martian microflora. The feasibility of a number of chemical and physical (ultraviolet and ionizing radiation and heating) methods of sterilization for use on the ground and onboard are discussed and compared. A combination of different methods will probably be selected as the most appropriate for ensuring planetary protection on the return mission.

The 1993 Medical Device Technology survey on sterilization is the second in a series of annual surveys that examines the use of sterilization techniques within the European medical device industry. By conducting this study each year, a database will be established and maintained on the various ways in which the sterilization of medical devices is achieved. In the longer term this will indicate changes in the market for sterilization equipment and services and will identify future trends in this very important segment of the medical device industry. Such information will be passed on to the readers of Medical Device Technology in forthcoming issues of the magazine.

A number of plasma-based techniques for sterilizing heat-sensitive medical equipment at low temperatures are being developed worldwide as alternatives to existing chemical and gaseous sterilization methods. The techniques involve the use of plasmas in controlled sterilization processes that increase operator safety and offer medical device manufacturers the option of using materials they cannot currently consider because of the incompatability of those materials with existing sterilization technologies. In this article, the author discusses three development programmes that are under way and assesses the potential applications of the technique as an alternative to ethylene oxide sterilization. The potential of the technique to meet in-house sterilization requirements of medical product manufacturers is also discussed.

Processing of instruments has become complex. OR nurses are sometimes assigned this responsibility without having proper knowledge and understanding of processing procedures. Formal continuing education programs and continuous quality reviews must be carried out to ensure appropriate processing of OR equipment.

Hospitals can continue to operate their 12/88 sterilizers, knowing that an environmentally improved mix that meets the requirements of the Clean Air Act is available now in small quantities and will be widely available in 1994. Moreover, a long-term environmentally acceptable mix, also called for by the Clean Air Act for the next century, is now being tested. Both new mixes are formulated for use without change to existing equipment.