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PubMed1994

Bacteriology of selective decontamination: efficacy and rebound colonization.

In earlier studies concerning the use of selective decontamination (SD) we recognized some patients to have an incomplete or failed decontamination which had negative consequences for their outcome. We also experienced patients to have a rebound colonization with potentially pathogenic microorganisms (PPM) after the withdrawal of SD medication, thereby endangering the hospital environment as sources of possibly resistant microorganisms. In a prospective observational cohort-study, we have studied 135 patients on a surgical ICU in a University hospital. On admission 51% of all patients harboured PPM, of which 64% and 79% were eliminated form the oropharynx and gut, respectively. A total of 49 episodes of SD (32%) had to be defined as ineffective, partly due to late or inadequate administration of medication. Rebound colonization with nosocomial aerobic PPM was seen in 20 of 90 successfully decontaminated episodes, but there were no infections. Eighty-four of 123 surveillance cultures (68%) revealed a complete recolonization with flora in a composition not different from the pre-admission flora. Withdrawal of SD medication 5 days after extubation proved satisfactory because no infections ensued. Surveillance cultures are obligatory to determine whether SD is effective as one third of patients receiving SD experienced bacterial colonization with PPM and therefore had no benefit from this prophylaxis. In addition, these results indicate that an intact and functional colonization resistance develops in patients after cessation of effective SD medication, but only when physiological defence mechanisms are presumably restored. In the seven years of experience with SD, increasing antibiotic resistance has not been in the study hospital.

Adolescent↗

PubMed1993

Betadine decontamination of donor globes.

Between May 1983 and December 1989, 2,921 donor eyes received by the Minnesota Lions Eye Bank underwent a decontamination protocol using 10% Betadine (1% povidone-iodine) solution. Positive pretreatment limbal cultures were obtained on 52.1% of donor eyes. Posttreatment limbal cultures demonstrated a 76.1% reduction in microbial growth, including an 85.7% reduction in Candida species. Streptococcus species were reduced by 76.7% and coagulase-negative Staphylococcus were reduced by 76.1%. In addition, of 250 donor rims obtained at the time of surgery, two had coagulase-negative. Staphylococcus present that were also present after the decontamination procedure. In no cases did endophthalmitis occur during this study. This study demonstrates that this protocol using 10% Betadine solution is extremely effective in decontaminating donor globes of aerobic bacteria and fungi. However, gentamicin-resistant organisms survived this protocol, emphasizing the need to develop storage media containing a broader-spectrum antibiotic agent then gentamicin.

Bacteria↗

PubMed1997

Selective intestinal decontamination in multiple trauma patients: prospective, controlled trial.

BACKGROUND: Reduction of potential pathogens by selective intestinal decontamination has been proposed to improve intensive care. Despite large scientific interest in this method, little is known about its benefit in homogeneous trauma populations. METHODS: In a prospective, controlled study, we enrolled non-infected trauma patients (age over 18 years, mechanical ventilation > or = 48 hours, intensive care for more than 3 days) who primarily were admitted to our university medical center. We randomized patients to be treated with two different topical regimens (polymyxin, tobramycin, and amphotericin (PTA) or polymyxin, ciprofloxin, amphotericin (PCA)) or the carrier only (placebo), administered four times daily both to the oropharynx and to the gastrointestinal tract. All patients received intravenous ciprofloxacin (200 mg, bd) for 4 days. FINDINGS: Of 357 enrolled patients, 310 (age 38.0 +/- 16.5 years, Injury Severity Score 35.2 +/- 12.7) met all inclusion criteria. Selective decontamination successfully reduced intestinal bacterial colonization. However, we did not identify significant differences between groups regarding pneumonia (PTA 47.5%, PCA 39.0%, placebo 45.3%), sepsis (PTA 47.5%, PCA 37.8%, placebo 42.6%), multiple organ failure (PTA 56.3%; PCA 52.4%, placebo 58.1%), and death (PTA 11.3%, PCA 12.2%, placebo 10.8%). Total costs per patient were highest with the PTA regimen. CONCLUSIONS: We found no benefit of selective decontamination in trauma patients. Apparently, bacterial overgrowth in the intestinal tract is not the sole link between trauma, sepsis, and organ failure.

Adult↗

PubMed2005

Effects of selective decontamination of digestive tract on mortality and antibiotic resistance in the intensive-care unit.

PURPOSE OF REVIEW: Since its introduction in 1984 several small trials have studied the infection prevention regimen of selective decontamination of the digestive tract (SDD) in intensive care patients. Although meta-analyses of these studies suggested that SDD could reduce mortality, it continued to be a highly controversial strategy. There were not only serious doubts about the methodological quality of the meta-analyses, fear also existed that SDD would lead to increased antibiotic resistance. Recently, two new large randomized trials have been published that studied the effects of SDD on mortality and resistance. In this article, we will review the concept on which SDD is based and the present knowledge of the effects of SDD on mortality and antibiotic resistance. RECENT FINDINGS: In accordance with earlier meta-analyses of small studies, two recent randomized trials have confirmed that selective decontamination of the digestive tract significantly lowers mortality and decreases the emergence of antibiotic resistance. Limitation of these studies is the fact that they were conducted in intensive-care units (ICUs) with a low prevalence of methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococcus (VRE). SUMMARY: There is convincing evidence that selective decontamination of the digestive tract (SDD) lowers mortality as well as resistance in circumstances with low prevalence of methicillin-resistant S. aureus (MRSA) and vancomycin-resistant enterococcus (VRE). SDD should still be considered experimental in area's where MRSA and VRE are endemic. However, given the important potential benefits of SDD, more studies are urgently needed to adapt SDD in a way that proves effective in those settings.

Antibiotic Prophylaxis↗

PubMed1994

Assessment of microwave-based clinical waste decontamination unit.

A clinical waste decontamination unit that used microwave-generated heat was assessed for operator safety and efficacy. Tests with loads artificially contaminated with aerosol-forming particles showed that no particles were detected outside the machine provided the seals and covers were correctly seated. Thermometric measurement of a self-generated steam decontamination cycle was used to determine the parameters needed to ensure heat disinfection of the waste reception hopper, prior to entry for maintenance or repair. Bacterial and thermometric test pieces were passed through the machine within a full load of clinical waste. These test pieces, designed to represent a worst case situation, were enclosed in aluminium foil to shield them from direct microwave energy. None of the 100 bacterial test pieces yielded growth on culture and all 100 thermal test pieces achieved temperatures in excess of 99 degrees C during their passage through the decontamination unit. It was concluded that this method may be used to render safe the bulk of of ward-generated clinical waste.

Aerosols↗

PubMed1992

Anaesthetic uptake and washout characteristics of patient circuit tubing with special regard to current decontamination techniques.

The amounts of halothane and isoflurane trapped after exposure for up to 3 h at 2 MAC in commonly used anaesthesia circuit tubing were quantitated by gas chromatography. The decontaminating effects of procedures such as flushing with oxygen, thermal disinfection and/or routine storage were assessed in a similar way. After halothane exposure, anaesthetic content was highest in silicone (398 +/- 55 mg 100 g-1). Lower quantities were found in all other tubings investigated (electrically conductive latex: 64 +/- 4, conductive rubber: 62 +/- 4, polyethylene-vinyl-acetate (PEVA): 293 +/- 10 and 149 +/- 17 for non-conductive corrugated and spiral tubes, respectively, polysulfone (Hytrel): 155 +/- 10 mg 100 g-1). The isoflurane contents were substantially lower (silicone: 278 +/- 23; others: 55 +/- 7, 61 +/- 6, 163 +/- 9 and 86 +/- 8, 74 +/- 4 mg 100 g-1). The tubings' content did not correlate with the material's partition coefficient as full saturation was not achieved during exposure. Decontamination procedures reduced the content of volatile anaesthetics to a variable extent. Conductive latex and rubber showed the highest residual content, even after thermal disinfection and subsequent storage. Twenty-minute flushing with oxygen (8 l min-1) decreased effluent gas concentrations below 5 p.p.m. in all tubings. With silicone, after 1 h flushing, halothane concentrations still exceeded 10 p.p.m. (isoflurane: 8 p.p.m.). It is concluded that urgent decontamination by a 20-min flush warrants the safe re-use of previously 'contaminated' conductive rubber and latex as well as polysulfone tubings in critical situations, e.g. in malignant hyperthermia patients if disposable tubing is not immediately available.(ABSTRACT TRUNCATED AT 250 WORDS)

Anesthesia, Inhalation↗

PubMedDate not supplied

Hand decontamination: what interventions improve compliance?

BACKGROUND: Haemodialysis units have traditionally been classified as high-risk areas in relation to infection control. Hand decontamination is the fundamental infection control practice, although this is not always performed optimally Deficiencies in the technique, frequency and appropriateness of this vital practice are frequently reported in health care journals. A literature search was carried out to determine what interventions improve compliance with hand decontamination practice. METHOD: A literature search was carried out of electronic databases from 1988-2000. Forty articles matched the key search words. When inclusion/exclusion criteria had been applied, seven primary research articles were found to be suitable. Appropriate tools were used to critically analyse the research. The findings were then synthesised into similar themes. FINDINGS: The interventions used in the seven articles utilised a combination of staff and patient education, feedback and motivational interventions to improve compliance. The evidence showed that these interventions met with different degrees of success. Multiple interventions were generally more successful than individual efforts. The improvement in hand decontamination practice often fell back to base line measurements after the intervention had ceased. IMPLICATIONS FOR PRACTICE: The findings can cautiously be used to improve practice. A combination of continuous, innovative education and motivation should improve and maintain this important skill.

Attitude of Health Personnel↗

PubMed1981

Bacteriological aspects of selective decontamination of the digestive tract as a method of infection prevention in granulocytopenic patients.

We describe the bacteriological results of a controlled clinical trial of selective decontamination of the digestive tract as a method of infection prevention in granulocytopenic patients. Selective elimination of Enterobacteriaceae and Pseudomonadaceae species was accomplished by the oral administration of nalidixic acid, co-trimoxazole, or polymyxin. Yeasts were eliminated selectively by amphotericin B or nystatin treatment. The drugs used in this study were chosen because of their capacities to selectively eliminate gram-negative rods and yeast without affecting the anaerobic part of the gut flora which is responsible for colonization resistance. Compared with the control group, the selectively decontaminated patients had significantly fewer (P less than 0.0005) gram-negative rods or yeasts or both in their throat swab cultures and in their feces. This reduction may explain the clinical effectiveness of selective decontamination.

Agranulocytosis↗

PubMed1990

Vapor-phase hydrogen peroxide as a surface decontaminant and sterilant.

The feasibility of utilizing vapor-phase hydrogen peroxide (VPHP) as a surface decontaminant and sterilant was evaluated in a centrifuge application. The prototype VPHP decontamination system, retrofitted into a Beckman L8-M ultracentrifuge, was designed to vaporize a 30% (wt/wt) solution of aqueous hydrogen peroxide continuously injecting and withdrawing VPHP in a deep-vacuum flow-through system. VPHP cycles of 4, 8, 16, and 32 min were examined for cidal activity against spores of Bacillus subtilis subsp. globigii and Bacillus stearothermophilus. Spore inocula (approximately 10(6)/coupon) were dried onto 0.5-in. (1.27-cm)-square stainless-steel coupons, and coupons were suspended in the centrifuge chamber, the space between the refrigeration can and the barrier ring (inner gap), and the space between the barrier ring and the vacuum ring (outer gap). At a chamber temperature of 4 degrees C, B. subtilis subsp. globigii spores were inactivated within 8 min, while inactivation of spores located in the outer gap at 27 degrees C required 32 min. The elevated temperature and high surface area/volume ratios in the outer gap may serve to decompose the gas more rapidly, thus reducing cidal efficacy. Of the two test spores, B. stearothermophilus was more resistant to VPHP. Nonetheless, VPHP was shown to possess significant sporicidal capability. For practical decontamination applications of the type described, VPHP shows promise as an effective and safer alternative to currently used ethylene oxide or formaldehyde vapors.

Bacillus subtilis↗

PubMed1987

Simplified acetylcysteine-alkali digestion-decontamination procedure for isolation of mycobacteria from clinical specimens.

During our attempts to reevaluate and improve mycobacteriology laboratory procedures, we found that isolation of mycobacteria from undecontaminated specimens through the use of selective media was unrewarding and that specimen decontamination was an essential step. A reevaluation of the N-acetyl-L-cysteine-sodium hydroxide (NALC-NaOH) decontamination procedure (G. P. Kubica, W. E. Dye, M. L. Cohn, and G. Middlebrook, Am. Rev. Respir. Dis. 87:775-779, 1963) indicated that this method could be simplified and shortened without affecting the isolation rate or growth and without increasing the contamination rate. The modified NALC-NaOH procedure effectively combines the decontamination step with the concentration step: specimens are mixed with the NALC-NaOH solution on a Vortex mixer and, without any waiting or addition of buffer or water to the digested specimens, centrifuged at 3,000 X g for 15 min, and the sediment is suspended in phosphate buffer (pH 5.3). The modified method is simpler, faster, and safer than the original procedure, and the reduced manipulation is also likely to minimize the chance for cross-contamination in sequential specimen processing. The total alkali exposure time in the modified NALC-NaOH method should be kept to a minimum; if necessary or feasible, the concentration of NaOH in the digestion solution may be reduced from the usual strength of 2% to about 1.5% to compensate for the longer alkali exposure time in the modified method to maintain the isolation rate or to improve it.

Acetylcysteine↗

PubMed1977

Partial antibiotic decontamination.

Partial antibiotic decontamination and reverse isolation were carried out in nine patients undergoing bone marrow transplantation. The aim of this approach was to eradicate the patient's endogenous potentially pathogenic bacteria while preserving the anaerobic flora of the gut, which help to prevent recolonisation. No exogenous infections developed, and only one patient developed an infection associated with endogenous recolonisation. Colonisation resistance seemed normal in patients during partial antibiotic decontamination. This form of decontamination deserves further study in patients with immunodepression.

Adolescent↗

PubMed2006

Effect of oral decontamination with chlorhexidine on the incidence of nosocomial pneumonia: a meta-analysis.

INTRODUCTION: Nosocomial pneumonia is a significant cause of in-hospital morbidity and mortality. Oral care interventions have great potential to reduce the occurrence of nosocomial pneumonia. Studies using topical antiseptic agents yielded mixed results. We hypothesized that the use of chlorhexidine for oral decontamination would reduce the incidence of nosocomial pneumonia in patients requiring mechanical ventilation. METHODS: This study is a meta-analysis of randomized controlled trials assessing the effect of chlorhexidine on the incidence of nosocomial pneumonia. Data sources were Medline, EMBASE, Cochrane library, citation review of relevant primary and review articles, and contact with expert informants. Out of 1,251 articles screened, 4 randomized, controlled trials were identified that included a total of 1,202 patients. Descriptive and outcome data were extracted by two reviewers independently. Main outcome measures were the incidence of nosocomial pneumonia, and mortality. A random effects model was used. RESULTS: The incidence of nosocomial pneumonia in the control group was 7% (41 out of 615) compared to 4% (24 out of 587) in the treatment group. Gram-negative bacteria accounted for 78% of the total isolates, with Pseudomonas aeruginosa being the most frequently isolated pathogen irrespective of the intervention provided. Duration of mechanical ventilation and intensive care unit length of stay were comparable between the two groups. Overall, the use of oral decontamination with chlorhexidine did not affect the incidence of nosocomial pneumonia (odds ratio of 0.42; 95% confidence interval 0.16-1.06) or the mortality rate (odds ratio 0.77, 95% confidence interval 0.28-2.11). CONCLUSION: The use of oral decontamination with chlorhexidine did not result in significant reduction in the incidence of nosocomial pneumonia in patients who received mechanical ventilation, nor altered the mortality rate. The lack of benefit may reflect the few studies conducted in this area. Future trials should focus on a combination strategy of mechanical and pharmacological interventions.

Administration, Oral↗

PubMed2002

Methyl parathion in residential properties: relocation and decontamination methodology.

In November 1994 methyl parathion (MP), a restricted agricultural pesticide, was discovered to have been illegally sprayed within hundreds of residences in Lorain County, Ohio. Surface levels and air concentrations of MP revealed detectable levels of the pesticide 3 years after spraying. Because of the high toxicity of MP (lethal dose to 50% of rats tested [LD50] = 15 mg/kg) and long half-life indoors, risk-based relocation and decontamination criteria were created. Relocation criteria were derived based on levels of p-nitrophenol in urine, a metabolic byproduct of MP exposure. In Ohio, concentrations of MP on surfaces and in the air were also used to trigger relocations. The criteria applied in Ohio underwent refinement as cases of MP misuse were found in Mississippi and then in several other states. The MP investigation (1994-1997) was the largest pesticide misuse case in the nation, ultimately involving the sampling of 9,000 residences and the decontamination of 1,000 properties. This article describes the methodology used for relocation of residents and decontamination of properties having MP.

Adolescent↗

PubMed1992

Decontamination of an HIV-contaminated CPR manikin.

There has been a concern that the number of persons engaging in cardiopulmonary resuscitation (CPR) training could decline because of questions about human immunodeficiency virus (HIV-1) transmission. We investigated the theoretical possibility that a CPR manikin might serve as a fomite for HIV-1 transmission. Decontamination protocols were tested by using elevated levels of virus and decreasing decontamination times. Even under these compromising conditions, however, decontamination was effective.

1-Propanol↗

PubMed2002

Effect of presilanization filler decontamination on aesthetics and degradation resistance of resin composites.

Filler-matrix coupling determines, to a large extent, the mechanical strength and clinical longevity of dental composites. The aim of this study was to examine how far a methodology to decontaminate filler prior to silanization may improve aesthetic performance in addition to physico-mechanical properties such as degradation resistance. It was reported that filler particles are surrounded and wrapped by a film that consists of multiple layers of silane molecules. X-ray photoelectron spectroscopy, however, revealed that silanization of filler particles largely depended upon siloxane bridge (Si-O-Si) formation between the silica surface and the silane molecule rather than on intermolecular bonding between adjacent silane molecules. In this study, we showed that filler decontamination resulted in a higher translucency, thereby providing a better aesthetic potential. In addition, experimental composites produced following presilanization decontamination of filler revealed a higher Vickers hardness value and a diametral tensile strength that was resistant to degradation by thermo-cycling.

Bisphenol A-Glycidyl Methacrylate↗

PubMed1998

Effect of several decontamination procedures on Listeria monocytogenes growing in biofilms.

Listeria monocytogenes is a pathogenic bacterium which has been implicated in several foodborne illnesses. This microorganism grows into biofilms attached to the surfaces in food-processing plants, increasing its resistance to antimicrobial agents. The present work was realized to investigate the attachment of L. monocytogenes isolates to glass surfaces and to find a decontamination procedure to remove these bacteria in biofilms. Three-day biofilms were prepared by growing L. monocytogenes isolates from food plant environments on glass surfaces. Sixteen decontamination treatments at different pHs, temperatures, and times of exposure were tested against L. monocytogenes biofilms. The most efficient treatments were those applied at 63 degrees C. Combinations of decontamination treatments applied at 55 degrees C for 30 min provided different results according to the other factors used. In general, L. monocytogenes biofilms were found to be not very susceptible to high osmolarity (10.5% NaCl), and the interaction of sodium chloride and acid did not seem to have important effects in inactivating these bacteria (from a 1.3-to a 1.9-log-CFU/cm2 reduction). The combination of NaOH (pH 10.5; 100 mM) and acetic acid (pH 5.4; 76.7 mM) applied sequentially at 55 degrees C for even 5 min was shown to be the most effective treatment to remove L. monocytogenes from biofilms (at least a 4.5-to 5.0-log-CFU/cm2 decline).

Acetic Acid↗

PubMed2000

Microbial populations on animal hides and beef carcasses at different stages of slaughter in plants employing multiple-sequential interventions for decontamination.

Multiple-sequential interventions were applied commercially to reduce beef carcass contamination in eight packing plants. The study evaluated microbial populations on animal hides and changes in carcass microbial populations at various stages in the slaughtering process. Sponge swab samples yielded mean (log CFU/100 cm2) total plate counts (TPC), total coliform counts (TCC), and Escherichia coli counts (ECC) on the exterior hide in the ranges of 8.2 to 12.5, 6.0 to 7.9, and 5.5 to 7.5, respectively, while corresponding contamination levels on carcass surfaces, after hide removal but before application of any decontamination intervention, were in the ranges of 6.1 to 9.1, 3.0 to 6.0, and 2.6 to 5.3, respectively. Following the slaughtering process and application of multiple-sequential decontamination interventions that included steam vacuuming, pre-evisceration carcass washing, pre-evisceration organic acid solution rinsing, hot water carcass washing, postevisceration final carcass washing, and postevisceration organic acid solution rinsing, mean TPC, TCC, and ECC on carcass surfaces were 3.8 to 7.1, 1.5 to 3.7, and 1.0 to 3.0, respectively, while corresponding populations following a 24 to 36 h chilling period were 2.3 to 5.3, 0.9 to 1.3, and 0.9, respectively. The results support the concept of using sequential decontamination processes in beef packing plants as a means of improving the microbiological quality of beef carcasses.

Abattoirs↗

PubMed1992

Prevention of infection in critically ill patients by selective decontamination of the digestive tract.

OBJECTIVE: To determine whether selective decontamination of the digestive tract using oral and nonabsorbable antimicrobial agents and parenteral cefotaxime prevents infection in critically ill patients. DESIGN: Randomized, controlled trial without blinding. SETTING: Surgical trauma and medical intensive care units in a tertiary referral hospital. PATIENTS: One hundred fifty patients admitted to surgical trauma and medical intensive care units during a 3-year interval, whose condition suggested a prolonged stay (greater than 3 days). INTERVENTION: Patients were randomly allocated to an experimental group (n = 75) that received cefotaxime, 1 g intravenously every 8 hours for the first 3 days only, and oral, nonabsorbable antibiotics (gentamicin, polymyxin, and nystatin by oral paste and oral liquid) for the entire stay in the intensive care unit. Control patients (n = 75) received usual care. MEASUREMENTS: The number of infections, total hospital days, and deaths, as well as the number of days in intensive care unit, were recorded. RESULTS: Control patients experienced more infections (36 compared with 12, P = 0.04), including bacteremias (14 compared with 4, P = 0.05) and pulmonary infections (14 compared with 4, P = 0.03). Although total hospital days, days in intensive care, and the overall death rate all were lower in the treatment group, these differences were not statistically significant. Clinically important complications of selective decontamination of the digestive tract were not encountered. CONCLUSIONS: Selective decontamination of the digestive tract decreases subsequent infection rates, especially by gram-negative bacilli, in selected patients during long-term stays in the intensive care unit.

Administration, Oral↗