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PubMed1984

Selective decontamination and the anaerobic faecal flora.

Selective decontamination with non-absorbable antibiotics of the gastrointestinal tract of patients with impaired host defense is increasingly applied to prevent infections with gram-negative facultatively anaerobic rods. In vivo experiments on the effect of antibiotics on the human intestinal flora were performed with (ex-germ-free) mice. The experiments have shown that the human obligately anaerobic flora did not change during selective decontamination with polymyxin B, but Enterobacteriaceae were eliminated. The magnitude of differences between the sensitivity to antibiotics of the human obligately anaerobic flora and the Enterobacteriaceae in vitro may be used as an index for the usefulness of the antibiotic for selective decontamination. Binding of the antibiotics to intestinal contents has been found to be important for the estimation of the daily dose. The release of the bound antibiotic could contribute to the maintenance of equable concentrations in the intestine.

Anaerobiosis↗

PubMed2002

Improved decontamination method for recovering mycobacteria from patients with cystic fibrosis.

In order to improve the recovery of mycobacteria from patients with cystic fibrosis, the present study evaluated a two-step decontamination procedure for clinical specimens. A total of 920 specimens obtained from 239 patients with cystic fibrosis were treated initially with N-acetyl-L-cysteine/sodium hydroxide. Of these specimens, 31 (3.3%) showed mycobacterial growth and 415 (45.1%) remained contaminated. Contaminated specimens were then subjected to a second round of decontamination, using a combination of N-acetyl-L-cysteine/sodium hydroxide and oxalic acid. Following this second decontamination, the number of specimens overgrown by microorganisms other than mycobacteria was reduced to 7.3%, and an additional 10 specimens positive for mycobacteria were found. The results suggest this two-step protocol could improve the recovery of mycobacteria from heavily contaminated specimens.

Acetylcysteine↗

PubMed1991

Selective intestinal decontamination prevents spontaneous bacterial peritonitis.

In a prospective randomized study, selective intestinal decontamination with norfloxacin was performed during hospitalization in 32 cirrhotic patients with low ascitic fluid total protein levels. The incidence of infections was compared with that in a control group of 31 nontreated cirrhotic patients of similar characteristics. We found a significantly lower incidence of infections [1/32 (3.1%) vs. 13/31 (41.9%); P less than 0.005] and spontaneous bacterial peritonitis [0/32 (0%) vs. 7/31 (22.5%); P less than 0.05] in patients receiving norfloxacin. The lower incidence of extraperitoneal infections [1/32 (3.1%) vs. 7/31 (22.5%); P = 0.052] in the treated group did not reach statistical significance. The incidence of infections [1/28 (3.6%) vs. 9/22 (40.9%); P less than 0.01] and spontaneous bacterial peritonitis [0/28 (0%) vs. 5/22 (22.7%); P less than 0.05] in cirrhotic patients admitted because of ascites was also significantly lower in the treated group. The decrease in the rate of mortality observed in the group undergoing selective intestinal decontamination did not reach statistical significance. These data show that selective intestinal decontamination is useful to prevent spontaneous bacterial peritonitis and extraperitoneal infections in hospitalized cirrhotic patients with low ascitic fluid total protein levels.

Aged↗

PubMed2005

Real-time monitoring in managing the decontamination of flexible gastrointestinal endoscopes.

OBJECTIVES: To evaluate the efficacy of endoscope reprocessing using bacteriologic methods and adenosine triphosphate (ATP) bioluminescence and to evaluate the potential benefits of the latter in managing the process. SETTING: An endoscopy unit in each of 2 acute district general hospitals in the United Kingdom. METHODS: Following visual observation, 8 locations important in the decontamination of gastrointestinal (GI) endoscopes were monitored during reprocessing by bacteriologic sampling (paddle method) and ATP bioluminescence. RESULTS: Endoscope reprocessing was conducted in accordance with British Society of Gastroenterology guidelines. Bacteriologic tests required 24 hours for results to be obtained; ATP tests were completed within 2 minutes. Of the 504 sites tested throughout the decontamination process, bacterial growth was recorded on 32 occasions, 3 from the end product. Throughout the decontamination process, ATP tests obtained 95 results above benchmark values and 1 from the end product. CONCLUSIONS: The bacteriologic results after terminal disinfection indicated that the reprocessing was carried out effectively overall. ATP results prior to disinfection indicated that manual cleaning might not have always been performed adequately and that this could have impaired the disinfection process. ATP provided a rapid means of assessing the efficacy of cleaning steps prior to terminal disinfection.

Adenosine Triphosphate↗

PubMed2005

Screening of nitrogen mustards and their degradation products in water and decontamination solution by liquid chromatography-mass spectrometry.

Analysing nitrogen mustards and their degradation products in decontamination emulsions posed a significant challenge due to the different phases present in such matrices. Extensive sample preparation may be required to isolate target analytes. Furthermore, numerous reaction products are formed in the decontamination emulsion. A fast and effective qualitative screening procedure was developed for these compounds, using liquid chromatography-mass spectrometry (LC-MS). This eliminated the need for additional sample handling and derivatisation that are required for gas chromatographic-mass spectrometric (GC-MS) analysis. A liquid chromatograph with mixed mode column and isocratic elution gave good chromatography. The feasibility of applying this technique for detecting these compounds in spiked water and decontamination emulsion was demonstrated. Detailed characterisation of the degradation products in these two matrices was carried out. The results demonstrated that N-methyldiethanolamine (MDEA), N-ethyldiethanolamine (EDEA) and triethanolamine (TEA) are not the major degradation products of their respective nitrogen mustards. Degradation profiles of nitrogen mustards in water were also established. In verification analysis, it is important not only to develop methods for the identification of the actual chemical agents; the methods must also encompass degradation products of the chemical agents as well so as to exclude false negatives. This study demonstrated the increasingly pivotal role that LC-MS play in verification analysis.

Chromatography, Liquid↗

PubMed2005

Intense light pulses decontamination of minimally processed vegetables and their shelf-life.

Intense light pulses (ILP) is a new method intended for decontamination of food surfaces by killing microorganisms using short time high frequency pulses of an intense broad spectrum, rich in UV-C light. This work studied in a first step the effect of food components on the killing efficiency of ILP. In a second step, the decontamination of eight minimally processed (MP) vegetables by ILP was evaluated, and thirdly, the effect of this treatment on the shelf-life of MP cabbage and lettuce stored at 7 degrees C in equilibrium modified atmosphere packages was assessed by monitoring headspace gas concentrations, microbial populations and sensory attributes. Proteins and oil decreased the decontamination effect of ILP, whilst carbohydrates and water showed variable results depending on the microorganism. For this reason, high protein and fat containing food products have little potential to be efficiently treated by ILP. Vegetables, on the other hand, do not contain high concentrations of both compounds and could therefore be suitable for ILP treatment. For the eight tested MP vegetables, log reductions up to 2.04 were achieved on aerobic mesophilic counts. For the shelf-life studies, respiration rates at 3% O2 and 7 degrees C were 14.63, 17.89, 9.17 and 16.83 ml O2/h kg produce for control and treated cabbage, and control and treated lettuce respectively; used packaging configurations prevented anoxic conditions during the storage times. Log reductions of 0.54 and 0.46 for aerobic psychrothrophic count (APC) were achieved after flashing MP cabbage and lettuce respectively. APC of treated cabbage became equal than that from control at day 2, and higher at day 7, when the tolerance limit (8 log) was reached and the panel detected the presence of unacceptable levels of off-odours. Control never reached 8 log in APC and were sensory acceptable until the end of the experiment (9 days). In MP lettuce, APC of controls reached rejectable levels at day 2, whilst that of treated samples did after 3 days. Both samples were sensory unacceptable at day 3, controls because of bad overall visual quality (OVQ), off-odour and leaf edge browning and treated samples due to bad OVQ; browning inhibitors might be proposed to preserve OVQ. Yeasts and lactic acid bacteria counts were low in all the samples. It seems that ILP treatment alone under the conditions used in this work does not increase MP vegetables shelf-life in spite of the reduction in the initial microbial load.

Bacteria↗

PubMed2006

Gastrointestinal endoscopy decontamination failure and the risk of transmission of blood-borne viruses: a review.

The risk of blood-borne virus transmission with an inadequately decontaminated endoscope during gastrointestinal endoscopy remains unclear, although it is likely to be low. A systematic review of the literature was undertaken to determine previous episodes of blood-borne virus transmission in these circumstances. In total, 31 articles were included in this review. No articles relating to possible transmission of human immunodeficiency virus were identified. The articles included were generally case series or case reports and were written prior to the comprehensive endoscope decontamination guidelines in use today. The results suggest that hepatitis B and hepatitis C transmission are low during endoscopy with an inadequately decontaminated endoscope.

Blood-Borne Pathogens↗

PubMed2005

Gastrointestinal decontamination.

Overall, no conclusive data support the use of gastric decontamination in the routine management of the poisoned patient. Studies of asymptomatic patients suggest that no treatment is required, and, given the complications that have been reported, this may be a reasonable approach to' most patients. Even in symptomatic patients, the only demonstrable benefit was found in a post-hoc subgroup analysis and involved an outcome of questionable clinical importance. Given these data, it would be easy to conclude that GI decontamination has no role in the management of the poisoned patient. This conclusion is valid when considering poisoned patients as a group, but all poisoned patients are not the same. Patients with trivial ingestion do well without treatment, and their greatest risk is an iatrogenic complication. Even patients with more serious ingestions usually have good outcomes with supportive care alone. It is no longer sufficient to justify GL or forced administration of AC with the supposition that "the patient could have taken something bad." However,there are some overdoses where limiting the systemic absorption of the poison may limit the toxic effects and prevent serious toxicity. After careful consideration of the risks, GI decontamination should be targeted at patients who, in the opinion of the treating physician, have a potentially life-threatening exposure.

Charcoal↗

PubMed2004

[Efficacy and safety of gut decontamination in patients with acute therapeutic drug overdose].

BACKGROUND AND OBJECTIVE: Gut decontamination (GD) may be used as a treatment for acute therapeutic drug overdose (ATDO) to reduce the absorption of the drug and thereby avoid the presence or worsening of signs and symptoms of intoxication. The objective of this study was to assess the efficacy and safety of GD in ATDO patients. PATIENTS AND METHOD: A 4-month prospective observational study was designed to include all patients admitted to the emergency department due to an ATDO. On admission, epidemiological data, vital signs and physical examination results were all recorded and a blood sample was taken for toxicological analysis. An algorithm was used to determine the GD method to be applied. A clinical reassessment was made at 3-6 hours and a further sample was taken for toxicological analysis. Patients were followed until hospital discharge, with all possible adverse events due to GD being recorded. RESULTS: Ninety-four patients were included. GD was indicated in 60 patients (63.8%): 3.3% received ipecacuana syrup, 8.3% gastric lavage, 21.6% gastric lavage followed by activated charcoal and 71.6% oral activated charcoal alone. The clinical state worsened in 19.1% of patients, usually on the basis of a diminished consciousness. Adverse events attributable to GD were observed in 8.3% of patients. A toxicological analysis was made in 50 patients and in 42% of them, drug concentrations were higher at 3 or 6 hours than on admission. An analysis of the method of decontamination used showed that the procedure recommended by the algorithm was applied in 70 patients (group A) while in the remaining 24 (group B) another decontamination technique was used. Clinical deterioration was seen in 14.3% of patients in group A and 33.3% in group B (p = 0.041). There was a favourable evolution of the analytic curve in 63.9% patients in group A and 42.9% in group B (p = NS); severe adverse events attributable to GD were suffered by 2.4% patients in group A and 11.1% in group B (p = NS). CONCLUSIONS: The efficacy and safety of GD in ATDO increases in patients in whom the decision-making algorithm is applied. However, this does not prevent clinical deterioration or continued drug absorption in all cases and may be accompanied by adverse events.

Adult↗

PubMed2002

Oxidative decontamination of chemical and biological warfare agents using L-Gel.

A decontamination method has been developed using a single reagent that is effective both against chemical warfare (CW) and biological warfare (BW) agents. The new reagent, "L-Gel", consists of an aqueous solution of a mild commercial oxidizer, Oxone, together with a commercial fumed silica gelling agent, Cab-O-Sil EH-5. L-Gel is non-toxic, environmentally friendly, relatively non-corrosive, maximizes contact time because of its thixotropic nature, clings to walls and ceilings, and does not harm carpets or painted surfaces. The new reagent also addresses the most demanding requirements for decontamination in the civilian sector, including availability, low maintenance, ease of application and deployment by a variety of dispersal mechanisms, minimal training and acceptable expense. Experiments to test the effectiveness of L-Gel were conducted at Lawrence Livermore National Laboratory and independently at four other locations. L-Gel was tested against all classes of chemical warfare agents and against various biological warfare agent surrogates, including spore-forming bacteria and non-virulent strains of real biological agents. Testing showed that L-Gel is as effective against chemical agents and biological materials, including spores, as the best military decontaminants.

Biological Warfare↗

PubMed2003

The effect of decontamination protocols on the numbers of sheep strain Mycobacterium avium subsp. paratuberculosis isolated from tissues and faeces.

The effect of decontamination protocols on the numbers of sheep strain Mycobacterium avium subsp. paratuberculosis isolated in BACTEC cultures from clinical samples was assessed by spiking tissues and faeces at various points during the decontamination procedure. Routine protocols in the laboratory were shown to decrease the number of organisms isolated per sample by about 2.7 log(10) and 3.1 log(10) for faeces and tissues, respectively. These findings are important for the interpretation of negative culture results and may be useful in epidemiological studies. Addition of a centrifugation step to the tissue protocol increased the recovery by about 1 log, but resulted in increased contamination of BACTEC cultures. These studies may also facilitate future improvements to decontamination procedures.

Animals↗

PubMed1997

Inhaled vancomycin-induced allergic reaction in decontamination of respiratory tracts for allogeneic bone marrow transplantation.

A 34-year-old male suffered from an allergic reaction after inhalation of decontaminating drugs for BMT. Clinical challenge tests were undertaken to determine the causal drug. It was found that vancomycin hydrochloride (VCM) repeatedly induced dyspnea, fever, hypoxia, eosinophilia, and elevation of CRP. Therefore, clindamycin (CLDM) was used instead of VCM for decontamination of patient respiratory tract. Although complete decontamination of the respiratory tract was not achieved during the leukocytopenic period, BMT was successful, and there were no life-threatening infectious complications. Although inhaled VCM-induced allergic reaction may be a very rare complication in the BMT setting, careful clinical attention should be paid to such patients.

Administration, Inhalation↗

PubMed1998

The survival and growth of acid-adapted mesophilic pathogens that contaminate meat after lactic acid decontamination.

Lactic acid decontamination (LAD) may adapt pathogens to lactic acid. Such organisms may have an increased resistance to acid and can contaminate meat after LAD. The survival and growth of acid adapted Campylobacter jejuni, Salmonella typhimurium. Escherichia coli O157:H7 and Staphylococcus aureus inoculated on skin surface of still warm pork belly cuts 2 h after LAD was examined during chilled (4 degrees C) storage and refrigeration abuse equivalent to 12.5 degrees C. Lactic acid decontamination included dipping in 1, 2 or 5% lactic acid solutions at 55 degrees C for 120 s. Lactic acid decontamination brought sharp reductions in meat surface pH, but these recovered with time after LAD at approximately 1-1.5 pH units below that of water-treated controls. A sharp decrease in the number of cfu of pathogens occurred on chilled 2-5% lactic acid treated pork belly cuts when the skin surface was less than pH 4.8-5.2. The reductions ranged from 0.1-0.3 log10 cfu cm-2 for E. coli O157:H7 to over 1.7-2.4 log10 cfu cm-2 for Camp. jejuni, respectively. Increase in storage temperature from 4 to 12.5 degrees C reduced delayed decrease in numbers of all pathogens except Camp. jejuni by a factor of two. Deaths in Camp. jejuni at 12.5 degrees C slightly exceeded those at 4 degrees C. After the initial sharp decline, the number of cfu of mesophilic pathogens decreased gradually at a rate similar to that on water-treated controls. Growth of all mesophilic pathogens except Camp. jejuni on 2-5% LAD meat occurred during storage at 12.5 degrees C when the meat surface pH exceeded 4.8-5.2, and was slower than on water-treated controls. Low temperature and acid-adapted E. coli O157:H7, Salm. typhimurium and Staph. aureus, and acid adapted Camp. jejuni that contaminate skin surface after hot 2-5% LAD, did not cause an increased health hazard, although microbiota and intrinsic parameters (lactic acid content, pH) were created that could advantage their survival and growth.

Animals↗

PubMed1984

Safe decontamination of hospital autopsy rooms and ventilation system by formaldehyde generation.

Space decontamination was required prior to the onset of a remodeling project in the autopsy suite of a large university-hospital complex. The National Institutes of Health procedure using formaldehyde gas as a disinfectant was modified to decontaminate not only the three autopsy rooms but also the exhaust ductwork and the three associated air incinerators. Modifications included an automated formaldehyde gas generator, a smoke test procedure for leaks, and an exhausting technique. This procedure proved to be successful and has the advantage of including the safety features necessary to conduct such a potentially hazardous decontamination in an occupied hospital.

Autopsy↗

PubMed2006

Selective digestive tract decontamination--will it prevent infection with multidrug-resistant gram-negative pathogens but still be applicable in institutions where methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococci are endemic?

The purposes of selective decontamination of the digestive tract are to treat infections that may be incubating at the time a patient is admitted to an intensive care unit (ICU), by intravenous administration of antibiotics during the first days of a stay in the ICU, and to prevent ICU-acquired infections, by topical application of antibiotics in the oropharynx and the gastrointestinal tract. Despite multiple trials in which a considerable reduction in the incidence of ventilator-associated pneumonia was demonstrated, major objections against the routine use of selective decontamination of the digestive tract have included a lack of demonstrated reductions in mortality rates and in length of stay (in individual trials), a lack of cost-efficacy data, and the threat of selection of multidrug-resistant bacteria. Recently, 2 controlled, randomized studies reported significant reductions in mortality rates among patients in ICUs who underwent selective decontamination of the digestive tract in combination with reduced selection of antibiotic-resistant pathogens. However, those studies were performed in settings where levels of antibiotic resistance are low, and some methodological issues remain unresolved. If these beneficial results are confirmed, the question of how to balance these benefits against the expected enhanced selection of methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci, and, possibly, multidrug-resistant gram-negative bacteria will emerge.

Anti-Bacterial Agents↗

PubMedDate not supplied

Selective decontamination of the digestive tract with oral aztreonam and temocillin.

Selective decontamination of the digestive tract by antimicrobial drugs with limited spectra of antibacterial activity has been reported to reduce the risk of superinfection and cross-infection in immunocompromised hosts by leaving the flora responsible for colonization resistance (largely anaerobic) intact. Aztreonam, a monobactam, and temocillin, a beta-lactam antibiotic, are possible candidates for use in selective decontamination of the digestive tract because of their specific activity against gram-negative bacteria. When these drugs were administered orally to mice, low dosages (0.016-1.13 mg per day) did not significantly affect colonization resistance. In volunteers, the indigenous flora either was not affected or was only minimally affected by orally administered aztreonam (20 mg and 100 mg every 8 hr). Intramuscular temocillin also was effective. However, in a small number of subjects inactivation (most likely enzymatic) of these antibiotics occurred in the bowel. Both drugs can be considered serious candidates for use in the selective decontamination of the digestive tract in granulocytopenic patients.

Animals↗

PubMed2006

The efficiency of magnetic-activated cell sorting and fluorescence-activated cell sorting in the decontamination of testicular cell suspensions in cancer patients.

BACKGROUND: Before clinical application, the feasibility and safety of autologous testicular stem cell transplantation should be explored. Apart from limitations in their numbers, spermatogonial stem cells may also be contaminated by malignant cells. Therefore, both enrichment and decontamination before transplantation may be necessary. This study aimed at evaluating the decontaminating potential of magnetic-activated cell sorting (MACS) and/or fluorescence-activated cell sorting (FACS) for both murine and human testicular cell suspensions. In the mouse, the effectiveness of the transplantation technique after cell sorting was also assessed. METHODS: Murine testicular cells were contaminated with 5% EL4 cells. Fresh and frozen-thawed suspensions were sorted using MACS (CD49f (+)) and FACS (CD49f(+), H-2Kb(-)) and evaluated by FACS, cell culture and transplantation into W/W(v) mice. Human testicular cells were contaminated with 5 or 0.05% CCRF-SB (SB) cells. Frozen-thawed suspensions were sorted using FACS (HLA class I(-)) and evaluated by FACS, cell culture and PCR for the B-cell receptor. RESULTS: In the mouse, the sorted fractions contained 0.39% H-2K(b)-positive and 76.55% CD49f-positive cells. After transplantation, 1 in 20 recipient mice developed a malignancy. In the human experiments, an average of 0.58% SB cells was detected after sorting. In only 1 of 11 samples, there were no SB cells observed. CONCLUSION: MACS and/or FACS are insufficient for completely depleting testicular tissue of malignant cells. Although more research on alternative decontamination techniques is necessary, developing a reliable method to screen a priori testicular tissue for malignant cells may be equally important.

Animals↗

PubMed1988

Gut decontamination by oral ofloxacin and ciprofloxacin in healthy volunteers.

The selectivity of enterobacterial decontamination during oral ofloxacin and ciprofloxacin was studied in 15 volunteers. Dilution studies of 294 faecal samples were made to monitor concentrations of enterobacteria, yeasts and enterococci. Detection of beta-aspartylglycine content was used for evaluation of interaction with the indigenous (mostly anaerobic) flora. Inactivation of ofloxacin and ciprofloxacin by faeces was studied to explain the effects of gut decontamination. Escherichia coli was successfully eliminated from the gut in all volunteers during treatment. Decontamination was found to be more or less selective with both quinolones, although yeast overgrowth and decrease of enterococci was significantly higher with ciprofloxacin. This may be explained by the higher intrinsic activity of ciprofloxacin against anaerobic flora, the inactivation by faeces being low for both agents. Ofloxacin and ciprofloxacin are two new quinolones of value in the therapy of infections between 'waist and knee' (e.g. cystitis, enteritis, prostatitis) because of the elimination of the infection focus combined with the eradication of the source.

Adult↗