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One method of preventing surgical-site infection is lowering intraoperative environmental contamination. The authors sought to evaluate their hospital's operating room (OR) contamination rate and compare it with the remainder of the hospital. They tested environmental contamination in preoperative, intraoperative, and postoperative settings for a total joint arthroplasty patient. A total of 190 air settle plates composed of trypsin soy agar were placed in 19 settings within the hospital. Locations included the OR with light and heavy traffic, with and without masks, jackets, and shoe covers; the substerile room; OR hallways; the sterile equipment processing center; preoperative areas; post-anesthesia care units; orthopedic floors; the emergency department; OR locker rooms and restrooms; a resident's home; and controls. The trypsin soy agar plates were incubated at 36 °C for 48 hours. Colony counts were performed for each plate. Average colony-forming units (CFUs) were calculated in each setting. The highest CFUs were in the OR locker room, at 28 CFUs per plate per hour. Preoperative and post-anesthesia care unit holding areas were 7.4 CFUs and 9.6 CFUs, respectively. The main orthopedic surgical ward had 10.0 CFUs per plate per hour, whereas the VIP hospital ward had 17.0 CFUs per plate per hour. All OR environments had low CFUs. A live OR had slightly higher CFUs than settings without OR personnel. In comparison with the local community household, the OR locker room, restrooms, hospital orthopedic wards, emergency department, preoperative holding, post-anesthesia care unit, and OR hallway all had higher airborne contamination. On the basis of these results, the authors recommend environmental sampling as a simple, fast, inexpensive tool for monitoring airborne contamination. [ Orthopedics . 2021;44(3):e414-e416.].

Markers for preoperative skin marking are used several times and bear a risk of transmitting bacteria. Bacterial contamination was assessed by sonication and culture. Antimicrobial susceptibility testing (AST) was performed for facultative pathogens to assess multi-drug resistance (MDR). An accelerated failure time model was applied to assess the statistical relationship between the bacterial contamination and the filling status of markers. Of 45 markers, 13 had a colony count <10 cfu/mL and 32 had counts from 10 to 12,500 cfu/mL. Three markers were colonized by Staphylococcus aureus. No MDR bacteria were found. We recommend single use of markers to reduce transmission risk., (Copyright © 2020 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Background: Medical equipment can transmit pathogenic bacteria to patients. This single-institution point prevalence study aimed to characterise the types and relative amount of bacteria found on surgical loupes, headlights and their battery packs., Method: Surgical loupes, headlights and battery packs of 16 otolaryngology staff and residents were sampled, cultured and quantified. Plate scores were summed for each equipment type, and the total was divided by the number of users to generate mean bacterial burden scores. Residents completed a questionnaire regarding their equipment cleaning practices., Results: The contamination rates of loupes, headlights and battery packs were 68.75 per cent, 100 per cent and 75 per cent, respectively. Battery packs cultured more bacteria (1.58 per swab ± 1.00) than loupes (0.75 per swab ± 0.66; p = 0.024). Headlights had non-significantly greater growth (1.50 per swab ± 0.71) than loupes (p = 0.052). Bacterial growth was significantly higher from inner surfaces of loupes (p = 0.035) and headlights (p = 0.037). Potentially pathogenic bacteria were cultured from the equipment of five participants, including: Pantoea agglomerans, Acinetobacter radioresistens, Staphylococcus aureus, Acinetobacter calcoaceticus baumannii complex and Moraxella osloensis., Conclusion: This study demonstrates that surgical loupes and headlights used in otolaryngology harbour non-pathogenic skin flora and potentially pathogenic bacteria.

Several complications may be encountered after rotator cuff (RC) repair. A thorough knowledge of surgical interventions, normal postoperative findings, and postoperative complications is crucial to provide a timely diagnosis, improving the clinical outcome of patients. Postoperative complications may involve RC, implanted device, osteochondral tissue, surgical-site infection, peripheral nerves, soft tissues, and vascular structures. In this review, we discuss the usual and unusual complications detectable after RC repair.

level and improve surgical outcomes. Recently, some institutions have approved the use of Press'n Seal cling film (CF; Glad Products, Oakland, CA) as a practical, cost-effective alternative to sterile drapes for rodent surgeries. The purpose of this study was to evaluate the sterility of CF by using ATP and replicate organism detection and counting (RODAC) plates. We tested 10 boxes of CF at days 0, 14, and 28 after opening the box and compared the results with traditional packaged sterile drapes. Our data indicated that CF ATP bioluminescence remained at or below 10 relative light units for 28 d after opening the box. In addition, RODAC plates had no growth for 70% of CF boxes at day 0, 100% at day 14, and 90% at day 28. The mean growth for the positive plates was 0.024 cfu/cm² sampled after contacting locations on the front and back of the CF. The results of this study support the use of CF as an acceptable alternative to traditional sterile drapes during rodent aseptic surgery.

Competing Interests: All authors have completed and submitted the ICMJE form for disclosure of potential conflicts of interest. No potential conflicts of interest were disclosed.

A global outbreak of invasive Mycobacterium chimaera infections has been associated with exposure to certain heater-cooler devices (HCDs) used during cardiopulmonary bypass. Outbreak investigations have shown that these HCDs harbor M. chimaera in water circuits and generate bio-aerosols in the operating room, leading to airborne transmission to patients during surgery. Whole genome sequencing data support a common-source outbreak originating at an HCD manufacturing facility. Most clinical infections are associated with implanted devices, diagnosis is often delayed, and treatment requires device removal and prolonged antibiotic therapy. Because it is nearly impossible to eradicate M. chimaera from HCDs using existing disinfection approaches, strict separation of HCD exhaust from operating room air is necessary to prevent patient exposure. Lessons learned from this outbreak include: 1) medical device risks are difficult to predict, requiring improved expert review before approval, and 2) advances in genomics provide powerful tools for outbreak investigation and public health surveillance., Competing Interests: Potential Conflicts of Interest: None disclosed.

Background: While there are various techniques to create the gastrojejunostomy during a laparoscopic Roux-en-Y gastric bypass (LRYGB), many surgeons prefer using a circular stapler. One drawback of this method, however, is the higher incidence of surgical site infections (SSIs). To investigate the effect of a dual ring wound protector on SSIs during LRYGB., Methods: In April 2016, our bariatric surgical group implemented an intervention whereby a dual ring wound protector in conjunction with a conical EEA stapler introducer was used when creating the gastrojejunostomy. SSIs from pre- and post-intervention were compared using Fisher's exact test. Only LRYGBs performed with a circular stapler were included in our analysis. Student's t test and χ2 were used to compare pre- and post-intervention groups with respect to demographics and co-morbidities., Results: Between April 2015 and January 31st, 2017, our surgeons performed 158 LRYGBs using a circular stapler for the gastrojejunostomy. There were 84 patients (53%) in the pre-intervention group and 74 (47%) in the post-intervention group. The pre- and post-intervention groups were not statistically different. The SSI rate for the pre-intervention group was 9.5% while the SSI rate was 1.35% in the post-intervention group (p = 0.0371). The use of a dual ring wound protector for LRYGBs with circular stapled gastrojejunostomy was associated with an 86% relative risk reduction in SSIs., Conclusion: Using a dual ring wound protector in conjunction with a conical EEA introducer for LRYGBs with circular stapled gastrojejunostomy significantly decreased SSIs.

Excessive rainfall and dam failures resulted in floodwater contaminating our public water supply. The endotoxin risk in the contaminated water created challenges in recovery of sterile processing for our surgical equipment. Recovery plans should include a potable water source and a method to connect it to the required location. We share our solution of plumbing our sterile processing equipment to tanker-transported potable water sources. (Disaster Med Public Health Preparedness. 2018; 12: 415-418).

Background: Nosocomial infections are a major setback in the healthcare delivery system especially in developing countries due to the limited resources. The roles played by medical care equipment and work surfaces in the transmission of such organisms have inevitably contributed to the elevated mortality, morbidity and antibiotic resistances., Methods: A total 138 samples were collected during the study from Kawolo general hospital. Swab samples were collected from various work surfaces and fomites which consisted of; beds, sink taps, infusion stands, switches, work tables and scissors. Cultures were done and the susceptibility patterns of the isolates were determined using Kirby Bauer disc diffusion method. Data was analyzed using Stata 13 and Microsoft Excel 2013 packages., Results: A total of 44.2% (61/138) of the collected swab specimens represented the overall bacterial contamination of the sampled articles. Staphylococcus aureus and Klebsiella pneumoniae accounted for the highest bacterial contaminants constituting of 75.4% (46/61) and 11.5% (7/61) respectively. Infusion stands and patient beds were found to have the highest bacterial contamination levels both constituting 19.67% (12/61). The highest degree of transmission of organisms to patients was found to be statistically significant for patient beds with OR: 20.1 and P-value 8X10 - 4 . Vancomycin, ceftriaxone and ciprofloxacin were the most effective antibiotics with 100%, 80% and 80% sensitivity patterns among the isolates respectively. Multi-drug resistant (MDR) Staphylococcus aureus accounted for 52% (24/46) with 4% (1/24) classified as a possible extensively drug resistant (XDR) whereas Gram negative isolates had 27% (4/15) MDR strains out of which 50%(2/4) were classified as possible pan-drug resistant (PDR)., Conclusion: The high prevalence of bacterial contaminants in the hospital work environment is an indicator of poor or ineffective decontamination. The study findings reiterate the necessity to formulate drug usage policies and re-examine effectiveness of decontamination and sterilization practices within Kawolo general hospital. We also recommend installation of a sound Microbiology unit at the hospital to take on susceptibility testing to check on the empirical use of antibiotics as a way of reducing the rampant elevations in drug resistances.

Background: Silver nanoparticles (AgNPs) are believed to be emerging tool against various infectious diseases including multi-drug resistant (MDR) bacteria. In the present study, in vitro synthesis of AgNPs was optimized using 1:50 ratio of macerozyme (25 μg/μl) and 1 mM AgNO 3 incubated at 80 °C for 8 h. AgNPs were characterized by UV-Visible spectroscopy, dynamic light scattering (DLS), scanning electron microscopy, energy-dispersive X-ray spectroscopy, transmission electron microscopy (TEM) and X-ray diffraction (XRD)., Results: Characterization studies suggest the synthesis of elliptical, stable and crystalline AgNPs with an average size of 38.26 ± 0.4 nm calculated using TEM. The XRD pattern revealed the face-centered-cubic (fcc) form of metallic silver. Good shape integrity and dispersion of AgNPs after 1 year of incubation confirmed their stability. AgNPs were exibited the antimicrobial property against ten pathogenic bacteria, three molds and one yeast. The AgNPs also revealed remarkable antimicrobial activity against three MDR strains i.e. Extended spectrum beta-lactamase positive Escherichia coli, Staphylococcus aureus (MRSA) and Teicoplanin resistant Streptococcus Pneumoniae. The AgNPs coated surgical threads (suture) were revealed the remarkble antibacterial activity against three MDR strains. This is the first report to synthesize antimicrobial elliptical AgNPs using enzymes., Conclusion: The results suggest the possibilities to develop the nanoparticles coated antimicrobial medical fabric to combat against MDR infection.

Objective: To evaluate the utility of endotracheal aspirate microscopy, culture and endotracheal tube tip culture for early diagnosis of ventilator-associated pneumonia in neonates., Methods: Inborn ventilated neonates were followed-up for ventilator-associated pneumonia using Center for Disease Control and Prevention (CDC) criteria. Endotracheal aspirate microscopy, culture and endotracheal tube tip cultures were performed., Results: Ventilator-associated pneumonia occurred in 28/68 (41%) neonates as per CDC criteria. Endotracheal aspirate microscopy (≥5 polymorphonuclear cells per high power field) and endotracheal aspirate culture had 78.6% and 75% sensitivity, 87.5% and 90% specificity, positive predictive value of 81.5% and 84%, and negative predictive value of 85.4% and 83.72%, respectively. Mean (SD) time of result of microscopy and endotracheal aspirate culture was 55.7 (4.3) h and 108.3 (19.7) h, respectively in comparison to diagnosis made at 143.5 (23.3) h, as per CDC criteria., Conclusion: Endotracheal aspirate microscopic examination and culture can be supportive in objective diagnosis of ventilator-associated pneumonia with an added advantage of earlier prediction.

Background: An urgent UK investigation was launched to assess risk of invasive Mycobacterium chimaera infection in cardiothoracic surgery and a possible association with cardiopulmonary bypass heater-cooler units following alerts in Switzerland and The Netherlands., Methods: Parallel investigations were pursued: (1) identification of cardiopulmonary bypass-associated M. chimaera infection through national laboratory and hospital admissions data linkage; (2) cohort study to assess patient risk; (3) microbiological and aerobiological investigations of heater-coolers in situ and under controlled laboratory conditions; and (4) whole-genome sequencing of clinical and environmental isolates., Results: Eighteen probable cases of cardiopulmonary bypass-associated M. chimaera infection were identified; all except one occurred in adults. Patients had undergone valve replacement in 11 hospitals between 2007 and 2015, a median of 19 months prior to onset (range, 3 months to 5 years). Risk to patients increased after 2010 from <0.2 to 1.65 per 10000 person-years in 2013, a 9-fold rise for infections within 2 years of surgery (rate ratio, 9.08 [95% CI, 1.81-87.76]). Endocarditis was the most common presentation (n = 11). To date, 9 patients have died. Investigations identified aerosol release through breaches in heater-cooler tanks. Mycobacterium chimaera and other pathogens were recovered from water and air samples. Phylogenetic analysis found close clustering of strains from probable cases., Conclusions: We identified low but escalating risk of severe M. chimaera infection associated with heater-coolers with cases in a quarter of cardiothoracic centers. Our investigations strengthen etiological evidence for the role of heater-coolers in transmission and raise the possibility of an ongoing, international point-source outbreak. Active management of heater-coolers and heightened clinical awareness are imperative given the consequences of infection., (© Crown copyright 2016.)

In the spring of 2015, investigators in Switzerland reported a cluster of six patients with invasive infection with Mycobacterium chimaera, a species of nontuberculous mycobacterium ubiquitous in soil and water. The infected patients had undergone open-heart surgery that used contaminated heater-cooler devices during extracorporeal circulation (1). In July 2015, a Pennsylvania hospital also identified a cluster of invasive nontuberculous mycobacterial infections among open-heart surgery patients. Similar to the Swiss report, a field investigation by the Pennsylvania Department of Health, with assistance from CDC, used both epidemiologic and laboratory evidence to identify an association between invasive Mycobacterium avium complex, including M. chimaera, infections and exposure to contaminated Stöckert 3T heater-cooler devices, all manufactured by LivaNova PLC (formerly Sorin Group Deutschland GmbH) (2). M. chimaera was described as a distinct species of M. avium complex in 2004 (3). The results of the field investigation prompted notification of approximately 1,300 potentially exposed patients.* Although heater-cooler devices are used to regulate patients' blood temperature during cardiopulmonary bypass through water circuits that are closed, these reports suggest that aerosolized M. chimaera from the devices resulted in the invasive infections (1,2). The Food and Drug Administration (FDA) and CDC have issued alerts regarding the need to follow updated manufacturer's instructions for use of the devices, evaluate the devices for contamination, remain vigilant for new infections, and continue to monitor reports from the United States and overseas (2).

Background: Sterilized packaging systems are designed to maintain the sterility of surgical instruments and devices from the time of sterilization until use. This study evaluated the effectiveness of rigid containers versus wrapped instrument trays, sterilized using North American sterilization protocols, to maintain a sterile internal environment poststerilization when challenged with aerosolized bacteria under dynamic environmental conditions., Methods: Using a custom aerosol chamber, 111 rigid containers of various durations of use (unused, used <5 years, used 5-9 years) and 161 wrapped trays using 3 grades of sterilization wrap were challenged with ~10(2) colony-forming units per liter of air containing aerosolized Micrococcus luteus with a count median particle size of 1 μm, while simultaneously experiencing air volume exchanges due to vacuum cycles-two 1-psi cycles, three 0.7-psi cycles, and three 0.4-psi cycles-to simulate air exchange events occurring during the sterilization, transportation, and storage of sterilized instrument trays in health care facilities., Results: Of 111 rigid containers tested, 97 (87%) demonstrated bacterial ingress into the container. Of 161 wrapped trays, 0 (0%) demonstrated bacterial ingress into the tray. Contamination rates of rigid containers increased significantly with increasing duration of use., Conclusions: In this study using a dynamic bacterial aerosol challenge, sterilized wrapped trays demonstrated significantly greater protection than sterilized rigid containers against the ingress of airborne bacteria., (Copyright © 2015. Published by Elsevier Inc.)

Following a patient complaint, the Health Department carried out a hygiene inspection of a urological practice in Braunschweig in February 2013. The topic of the complaint was that a patient assumed having acquired a resistant pathogen in the practice. In the subsequent visit, significant hygiene defects were found, particularly with regard to the processing of medical devices. This led to a decision to commit all urological practices in Braunschweig to hygiene inspections as part of a priority project. In retrospect, the hygiene surveys were justified. Deficiencies included inadequate preparation of medical products, procedures in practice inconsistent with hygiene plans, poor knowledge of hygiene procedures among assistant staff and doctors, lack of expertise of assistant staff and lack of hygiene risk awareness by doctors. Positive experiences were: open communication in a good atmosphere with the Practice managers, willingness to change, good cooperation between the Health Authority and the Labor Inspectorate and Physicians' Association. The claimed deficits were corrected by spring 2014 by the practice operators. The consulting expertise of the health authorities was made use of continuously., (© Georg Thieme Verlag KG Stuttgart · New York.)

Digital dermatitis (DD) is an infectious foot disease causing severe lameness in dairy cattle (worldwide) and sheep (UK). This study investigated whether DD Treponema phylogroups can be present on equipment used to trim ruminant hooves and, therefore, consider this trimming equipment as a possible vector for the transmission of DD. Equipment was tested after being used to trim DD symptomatic and asymptomatic cattle and sheep hooves, and subsequently after disinfection of equipment. After trimming, 'Treponema medium/Treponema vincentii-like', 'Treponema phagedenis-like' and 'Treponema denticola/T putidum-like' DD spirochaetes, were shown to be present on 23/37 (62%), 21/37 (57%) and 20/37 (54%) of knives, respectively. After disinfection, detection rates for the DD treponemes were 9/37 (24%), 6/37 (16%) and 3/37 (8%), respectively. Following culture of a swab, an isolate belonging to the T phagedenis-like spirochaetes was identified from a knife sample after trimming a DD positive cow. No isolates were obtained from knife samples after disinfection. This new data has, for the first time, identified treponemes in the farm environment, and highlighted disinfection of hoof trimming equipment between animals and between farms, as a logical precaution to limit the spread of DD., (British Veterinary Association.)

Few studies have investigated the potential contamination of splash basins and they have shown very divergent results: contamination ranging from 2.13% to 74% has been reported. This study set out to examine if splash basins used in a laminar air flow (LAF) environment during elective knee and hip arthroplasty constitute an unnecessary risk. Of the 49 cases sampled two cultures were positive (4%; 95% confidence interval = 0.49-13.9). We conclude that splash basins do get contaminated even in an LAF environment. Further studies with larger populations are needed to validate our findings.

Objective: To determine the integrity of microscope covers and bacterial contamination at the end of lumbar spinal decompressive surgery., Materials and Methods: A prospective study of 25 consecutive lumbar spinal decompressions with the use of a surgical microscope was performed. For detection of perforations, the microscope covers were filled with water at the end of surgery and the presence of water leakage in 3 zones (objective, ocular and control panel) was examined. For detection of bacterial contamination, swabs were taken from the covers at the same locations before and after surgery., Results: Among the 25 covers, 1 (4%) perforation was observed and no association between perforation and bacterial contamination was seen; 3 (4%) of 75 smears from the 25 covers showed post-operative bacterial contamination, i.e. 2 in the ocular zone and 1 in the optical zone, without a cover perforation., Conclusions: The incidence of microscope cover perforation was very low and was not shown to be associated with bacterial contamination. External sources of bacterial contamination seem to outweigh the problem of contamination due to failure of cover integrity., (© 2014 S. Karger AG, Basel.)

Any hospital or facility in which surgery and other invasive procedures are performed should have accommodations for cleaning, decontaminating, disinfecting, and sterilizing instruments, equipment, and other essential supplies that are used for patient procedures. Sterilization is essential to reducing or preventing the risk of surgical site infections. This is a collaborative process and should include all health care providers who handle these instruments, including perioperative nurses. The revised AORN "Recommended practices for sterilization," which became effective June 15, 2012, includes updates on sterilizing single-use items, inspecting critical items before sterilization, using low-temperature hydrogen peroxide vapor sterilization methods, and immediate use steam sterilization. This RP document is the first AORN document to be evidence rated and accepted for inclusion in the Agency for Healthcare Research and Quality National Guideline Clearinghouse., (Copyright © 2013 AORN, Inc. Published by Elsevier Inc. All rights reserved.)

In hospitals and clinics worldwide, medical device surfaces have become a rapidly growing source of nosocomial infections. In particular, patients requiring mechanical ventilation (and, thus, intubation with an endotracheal tube) for extended lengths of time are faced with a high probability of contracting ventilator-associated pneumonia. Once inserted into the body, the endotracheal tube provides a surface to which bacteria can adhere and form a biofilm (a robust, sticky matrix that provides protection against the host immune system and antibiotic treatment). Adding to the severity of this problem is the spread of bacterial genetic tolerance to antibiotics, in part demonstrated by the recent and significant increase in the prevalence of methicillin-resistant Staphylococcus aureus. To combat these trends, different techniques in biomaterial design must be explored. Recent research has shown that nanomaterials (materials with at least one dimension less than 100 nm) may have the potential to prevent or disrupt bacterial processes that lead to infections. In this study, polyvinyl chloride (PVC) taken from a conventional endotracheal tube was embedded with varying concentrations of zinc oxide (ZnO) nanoparticles. S. aureus biofilms were then grown on these nanocomposite surfaces during a 24-hour culture. Following this, biofilms were removed from the surfaces and the number of colony forming units present was assessed. Bacterial proliferation on the samples embedded with the highest concentration of ZnO nanoparticles was 87% less when compared to the control, indicating that this technique is effective at reducing biofilm formation on PVC surfaces without the use of antibiotics.

Study Design: Prospective study., Objective: Assess the contamination rates of sterile microscope drapes after spine surgery., Summary of Background Data: The use of the operating microscope has become more prevalent in certain spine procedures, providing superior magnification, visualization, and illumination of the operative field. However, it may represent an additional source of bacterial contamination and increase the risk of developing a postoperative infection., Methods: This study included 25 surgical spine cases performed by a single spine surgeon that required the use of the operative microscope. Sterile culture swabs were used to obtain samples from 7 defined locations on the microscope drape after its use during the operation. The undraped technician's console was sampled in each case as a positive control, and an additional 25 microscope drapes were swabbed immediately after they were applied to the microscope to obtain negative controls. Swab samples were assessed for bacterial growth on 5% sheep blood Columbia agar plates using a semiquantitative technique., Results: No growth was observed on any of the 25 negative control drapes. In contrast, 100% of preoperative and 96% of postoperative positive controls demonstrated obvious contamination. In the postoperative group, all 7 sites of evaluation were found to be contaminated with rates of 12% to 44%. Four of the 7 evaluated locations were found to have significant contamination rates compared with negative controls, including the shafts of the optic eyepieces on the main surgeon side (24%, P = 0.022), "forehead" portion on both the main surgeon (24%, P = 0.022) and assistant sides (28%, P = 0.010), and "overhead" portion of the drape (44%, P = 0.0002)., Conclusion: Bacterial contamination of the operative microscope was found to be significant after spine surgery. Contamination was more common around the optic eyepieces, likely due to inadvertent touching of unsterile portions. Similarly, all regions above the eyepieces also have a propensity for contamination because of unknown contact with unsterile parts of the surgeon. Therefore, we believe that changing gloves after making adjustments to the optic eyepieces and avoid handling any portion of the drape above the eyepieces may decrease the risks of intraoperative contamination and possibly postoperative infection as well.

Ventilator-associated pneumonia (VAP) is a serious and costly clinical problem. Specifically, receiving mechanical ventilation for over 24 hours increases the risk of VAP and is associated with high morbidity, mortality, and medical costs. Cost-effective endotracheal tubes (ETTs) that are resistant to bacterial infections could help prevent this problem. The objective of this study was to determine differences in the growth of Staphylococcus aureus on nanomodified and unmodified polyvinyl chloride (PVC) ETTs under dynamic airway conditions simulating a ventilated patient. PVC ETTs were modified to have nanometer surface features by soaking them in Rhizopus arrhisus, a fungal lipase. Twenty-four-hour experiments (supported by computational models) showed that airflow conditions within the ETT influenced both the location and the concentration of bacterial growth on the ETTs, especially within areas of tube curvature. More importantly, experiments revealed a 1.5 log reduction in the total number of S. aureus on the novel nanomodified ETTs compared with the conventional ETTs after 24 hours of airflow. This dynamic study showed that lipase etching can create nanorough surface features on PVC ETTs that suppress S. aureus growth, and thus may provide clinicians with an effective and inexpensive tool to combat VAP.

Background: Nosocomial infection constitute over 25% of infection rates in the hospital setting causing significant morbidity and mortality especially in developing countries. The aim of this study is to establish the possible presence of known bacteria pathogens on fomites in the operating theatre and evaluate their antibiotic susceptibility pattern., Methods: Various items in the operating theatre rooms such as forceps, scissors, floor, walls, suction tube, sink, theatre bed covers etc. were screened for the presence of bacterial and fungal pathogens from Murtala Mohammed Specialist Hospital, Kano between Jan - Aug 2009. One thousand eight hundred (1,800) samples were processed. Bacterial and fungal isolates were identified by standard microbiological procedures. Antibiotic susceptibility testing was carried out by disc diffusion method., Results: A total of eight bacteria genera and four fungal species were observed. The following bacterial pathogens were isolated; Escherichia coli (10.0%), Proteus Mirabilis (8.33%), Proteus vulgaris (6.70%), Pseudomonas aeruginosa (23.3%), Staphylococcus aureus (0.83%), Streptococcus spp. (18.3%), E. faecalis (3.33%), Coagulase negative staph (28.3%) and Salmonella choleraesius (0.83%). Ofloxacin and ceftriaxone showed encouraging results against the isolates., Conclusion: Fomites should be regarded as a possible source of nosocomial infection since bacteria from them can be carried from the hands of theatre personnel to the patient undergoing surgery or through redispersed bacteria from surfaces during surgery.

Background: Intra-operative photography provides valuable information for photo-documentation. In order to improve quality of photographs and avoid additional contamination, we applied a sterilised waterproof case to adapt a digital camera that allowed the operating surgeon himself to obtain his own ideal images. A prospective study was designed to investigate the efficacy and safety of this technique., Materials and Methods: A total of 46 patients were enrolled in this study. The Fujifilm FinePix F30 digital camera encased in Fuji WP-FXF30 waterproof case was used in this study. Microbiological swabs were taken from the case's surface immediately after sealing the digital camera and at the end of surgery. In addition, intra-operative wound swabs were taken for correlation. The patients were followed up to record the possibility of any additional wound infections., Results: None of the swab results on the waterproof case were positive before use. Overall, 11 patients had positive results of bacteria growth from intra-operative wound cultures. Eight of them also revealed positive microorganisms cultured from the case surface after use, in which the bacteria strains were correlated with the intra-operative wound cultures. However, no additional bacteria growth was noted from the culture of case surface., Conclusion: A digital camera encased in a sterilised waterproof case met the strict requirements for sterility in our series and demonstrated no added increase in infection rate. Safe use of this technique for obtaining intra-operative photographs with high image quality can be achieved., (Copyright © 2011 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.)

Splash basins are used in arthroplasty cases to wash instruments. Several studies in the literature have shown these basins being a potential source of bacterial infection. This study assesses the risk of contamination of intraoperative splash basins used to wash and store instruments. A total of 46 random clean primary arthroplasty cases (32 hips, 13 knees, and 1 unicondylar knee) were studied by taking cultures of sterile splash basins as soon as they are opened (controls) and again at wound closure after instruments and debris have come into contact with the sterile water. All cultures were taken with sterile culture swabs and sent to the laboratory for aerobic, anaerobic, and fungal culture. Outcome measured was any positive culture. A total of 92 cultures from 46 cases were tested. Only 1 (2.17%) control culture, which grew Streptococcus viridans, was positive for bacterial growth. One of 46 samples (2.17%) taken at wound closure was positive for coagulase-negative Staphylococcus. Mean time between basin opening and wound closure was 180±45 minutes. For the 1 infected sample taken at the conclusion of the case, it was 240 minutes. Previous studies show contamination rates as high as 74% for splash basins used intraoperatively. Our study contradicts the belief that splash basins are a high source of infection, with only 2.17% of basins showing contamination. Splash basins can be a potential source of contamination, but the risk is not as high as previously cited in the orthopedic literature., (Copyright 2011, SLACK Incorporated.)

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.

Candida albicans can develop biofilms on medical devices and these biofilms are most often nourished by a continuous flow of body fluids and subjected to shear stress forces. While many C. albicans biofilm studies have been carried out using in vitro static models, more limited information is available for biofilms developed under conditions of flow. We have previously described a simple flow biofilm model (SFB) for the development of C. albicans biofilms under conditions of continuous media flow. Here, we recount in detail from a methodological perspective, this model that can be assembled easily using materials commonly available in most microbiological laboratories. The entire procedure takes approximately two days to complete. Biofilms developed using this system are robust, and particularly suitable for studies requiring large amounts of biofilm cells for downstream analyses. This methodology simplifies biofilm formation under continuous replenishment of nutrients. Moreover, this technique mimics in vivo flow conditions, thereby making it physiologically more relevant than the currently dominant static models.

The initial contamination of femoral head, femoral stem and femoral component producted by seven factories in Beijing is tested, all of the initial contamination values are 580 in total. Then these data is analyzed on statistics. The result indicates that the initial contamination values of three kinds of products according with normal distribution; The initial contamination values have not significant difference between femoral head and femoral component of the same factory; and the season has not significant effect on initial contamination in Beijing. According to the experimental data, the level of initial contamination is undulatory, so the factories should control the initial contamination and maintain the stability of initial contamination.

Background: There are no clear guidelines for how long a sterile operating-room tray can be exposed to the open environment before the contamination risk becomes unacceptable. The purpose of this study was to determine the time until first contamination and the rate of time-dependent contamination of sterile trays that had been opened in a controlled operating-room environment. We also examined the effect of operating-room traffic on the contamination rate., Methods: Forty-five sterile trays were opened in a positive-air-flow operating room. The trays were randomly assigned to three groups. All trays were opened with use of sterile technique and were exposed for four hours. Culture specimens were obtained immediately after opening and every thirty minutes thereafter during the study period. Group 1 consisted of fifteen trays that were opened and left uncovered in a locked operating room (i.e., one with no traffic). Group 2 was identical to Group 1 with the addition of single-person traffic flowing in and out of the operating room from a nonsterile corridor every ten minutes. Group 3 included fifteen trays that were opened, immediately covered with a sterile surgical towel, and then left uncovered in a locked operating room (i.e., one with no traffic)., Results: Three of the thirty uncovered trays (one left in the operating room with traffic and two left in the room with no traffic) were found to be contaminated immediately after opening. After those three trays were eliminated, the contamination rates recorded for the twenty-seven uncovered trays were 4% (one tray) at thirty minutes, 15% (four) at one hour, 22% (six) at two hours, 26% (seven) at three hours, and 30% (eight) at four hours. There was no difference in survival time (p = 0.47) or contamination rate (p = 0.69) between the uncovered trays in the room with traffic and those in the room without traffic. The covered trays were not contaminated during the testing period. The survival time for those trays was significantly longer (p = 0.03) and the contamination rate was significantly lower (p = 0.02) than those for the uncovered trays., Conclusions: Culture positivity correlated directly with the duration of open exposure of the uncovered operating-room trays. Light traffic in the operating room appeared to have no impact on the contamination risk. Coverage of surgical trays with a sterile towel significantly reduced the contamination risk.

Bacterial biofilms have recently been shown to be important in neurosurgical device-related infections. Because the concept of biofilms is novel to most practitioners, it is important to understand that both traditional pharmaceutical therapies and host defense mechanisms that are aimed at treating or overcoming free-swimming bacteria are largely ineffective against the sessile bacteria in a biofilm. Bacterial biofilms are complex surface-attached structures that are composed of an extruded extracellular matrix in which the individual bacteria are embedded. Superimposed on this physical architecture is a complex system of intercellular signaling, termed quorum sensing. These complex organizational features endow biofilms with numerous microenvironments and a concomitant number of distinct bacterial phenotypes. Each of the bacterial phenotypes within the biofilm displays a unique gene expression pattern tied to nutrient availability and waste transport. Such diversity provides the biofilm as a whole with an enormous survival advantage when compared to the individual component bacterial cells. Thus, it is appropriate to view the biofilm as a multicellular organism, akin to metazoan eukaryotic life. Bacterial biofilms are much hardier than free floating or planktonic bacteria and are primarily responsible for device-related infections. Now that basic research has demonstrated that the vast majority of bacteria exist in biofilms, the paradigm of biofilm-associated chronic infections is spreading to the clinical world. Understanding how these biofilm infections affect patients with neurosurgical devices is a prerequisite to developing strategies for their treatment and prevention.

A prospective study was conducted during a 2-year period to evaluate the effectiveness of event-related outdating. Hospital-prepared sterilized items (n = 152) were shelved in wards and every 3 months, several articles were retrieved and microbiologically tested. During the 2-year period, all of the items tested were sterile.

Even drinking water is contaminated with pathogenic microorganisms. This does not necessarily pose a risk for healthy individuals, but it may result in serious consequences in people with impaired immune systems. This is particularly valid if drinking water is used for medical purposes. The heater-cooler unit (HCU) connected to heat exchangers or blankets by tubing, the connection is closed water circuit that contains microorganisms and algae. While connecting the tubing to the heat exchanger, spilling of water cannot be avoided. Microbiological examinations showed that germs and particles pollute the units. Exposure to the patient and the OR equipment has the potential to increase the risk of infection should the HCU water come in contact with the patient. As a result of the high incidence of particle and algae in the HCU, malfunction occurs. Sampling shows >1000/mL CFU (colony forming units) at 36 degrees C and 55/mL CFU at 20 degrees C on average. The specific findings include Pseudomonas and Legionella. Disinfecting HCU is very difficult. Often HCUs do not provide any technology to reduce bacterial or other contamination. The instructions for use of oxygenators often exclude the use of disinfectants. Maintenance instructions for the HCU advocate the use of disinfectants that carry the risk of oxygenator damage and of heat exchanger leakage. The effect of chemical disinfectants and heat exchanger membranes have not been examined, they may impair heat exchanger permeability and function. As an alternative to chemical and thermal disinfection, we used the alternative method of filtration. Using a membrane filter element, we noticed a decreasing number of CFUs from 55 to sterile conditions at 20 degrees C and from >1000 CFUs to 100 CFUs at 36 degrees C (Figure 1). In addition, we noticed a removal of other particles and algae. In conclusion, we have demonstrated a technique that is simple to implement and effectively reduces the microbiological load of the water in the heater-cooler unit.

Health care providers today often can choose between reprocessed single-use devices (SUDs) or SUDs from original equipment manufacturers. The concern about whether reprocessing is safe and should continue was reflected in the US Food and Drug Administration's draft regulations regarding reprocessing and reuse of SUDs; the Government Accounting Office study on SUDs; legislation introduced at both the federal and state levels; and Congressional hearings by the US House of Representatives and the US Senate. This article offers a review of these activities.

Sterilisation is a critical and integral stage in the manufacture of a sterile device. It should, therefore, be recognised at the design stage of the device if the desired confidence in the end product and potential benefits of sterilisation options are to be achieved. This article highlights some of the issues to consider when selecting the most appropriate sterilisation method.

The paper describes a Monte Carlo study for planning the irradiation of test samples for microbiological validation of distinct products in the Portuguese Gamma Irradiation Facility. Three different irradiation geometries have been used. Simulated and experimental results are compared and good agreement is observed. It is shown that Monte Carlo simulation improves process understanding, predicts absorbed dose distributions and calculates dose uniformity in different products. Based on these results, irradiation planning of the product can be performed.

Purpose: Contamination of automated surgical equipment is a potential source of postoperative endophthalmitis. The effect of disinfecting the unsterile vacuum control manifold (VCM) on contamination of the aspiration fluid was studied., Design: Comparative prospective microbiologic contamination study. SPECIMENS AND CONTROLS: The 37 aspiration fluid specimens studied or examined consisted of 25 from three automated evacuation systems equipped with an internal VCM (experimental groups) and 12 from one system equipped with a modified external VCM (control group). In addition, the tubings of two internal VCMs were investigated., Methods: We investigated aspiration fluid specimens from routine cataract and vitrectomy operations performed with automated evacuation systems. After tracing the source of contamination to the internal VCM, the system was modified, creating an external VCM with the possibility for disinfection, and the study was continued. Whereas no sterilizing rinsing procedures were applied to the hidden internal VCM, the modified external VCM was regularly rinsed and filled overnight with 70% isopropanol. All samples were collected under sterile conditions, centrifuged, and cultured for bacterial growth on blood agar and MacConkey agar for 24 to 48 hours at 37 degrees C. The samples of the two internal VCMs were cultured for fungi as well., Main Outcome Measures: Bacterial growth was quantified, and bacteria and fungi were isolated and identified according to standard microbiologic procedures., Results: In all aspiration fluid specimens from internal VCM-systems, 2+ to 4+ bacterial growth was found. Pseudomonas-related genera (Stenotrophomonas maltophilia, 17x; Comamonas acidovorans, 8x; Chryseomonas spp., 3x), Agrobacterium radiobacter (1 3x), Flavobacterium spp. (3x), and Micrococcus luteus (7x) were found most frequently. The tubing of the two VCMs contained biofilms exhibiting several of these bacteria and fungi. All specimens from the modified external VCM-system remained sterile. There was a significant difference with regard to the frequency of contamination of the aspiration fluid between the experimental and control groups (chi-square: P = 0.0001)., Conclusions: The technical modification described herein allows facile hygienic measures, by which contamination of aspiration fluid by the VCM can be eliminated, which otherwise can be a significant source of contamination.