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PubMed1991

Selective decontamination of the digestive tract in cardiac surgical patients.

OBJECTIVE: To test the hypothesis that selective decontamination of the digestive tract improves outcome in cardiac surgical patients. DESIGN: Prospective, consecutive, controlled trial over two 4-month periods. SETTING: Eight-bed, open-plan postcardiac surgery ICU. PATIENTS: All patients undergoing cardiac bypass surgery were eligible. Patients requiring endotracheal intubation for greater than 4 days were included in the analysis. In the initial 4 months, 12 (8.5%) of 141 patients required greater than 4 days of intubation. These 12 patients were not treated with selective decontamination of the digestive tract. We therefore used these patients as the control group. In the second 4-month period, 12 (6.6%) of 180 patients were treated with selective decontamination of the digestive tract and formed the study group. MAIN OUTCOME MEASURES: The primary measure was mortality. Secondary measures included oropharyngeal decontamination and the presence of lower airway infection. INTERVENTIONS: Cephradine prophylaxis. The study group received every 6 hrs 4 mL orally and 20 mL intragastrically a suspension of antimicrobial agents (tobramycin 80 mg, polymyxin E 100 mg, amphotericin B 500 mg), starting on postoperative day 1. The control group did not receive any oral antimicrobial agents. RESULTS: Mortality rate was significantly (p less than .05) reduced from eight (66%) of 12 patients in the control group to two (16.7%) of 12 patients in the selective decontamination of the digestive tract group. No differences in oropharyngeal decontamination or lower airway infection rates between the two groups were found. CONCLUSIONS: There is a reduced mortality rate in patients receiving selective decontamination of the digestive tract. However, the reader should recognize the small sample size studied. A simple suspension of the antimicrobial agents failed to rid the oropharynx of bacteria.

Administration, Oral↗

PubMed1995

Long-term effects of selective decontamination on antimicrobial resistance.

OBJECTIVE: To determine whether selective decontamination of the digestive tract exerts any long-term effects on antimicrobial resistance patterns. DESIGN: A surveillance and interventional study comparing the antimicrobial sensitivity patterns of clinically important bacterial isolates the year before a 2-yr, double-blind, randomized, controlled study of selective decontamination of the digestive tract, and for the year thereafter when no use of the regimen was made. SETTING: A ten-bed respiratory intensive care unit (ICU) in a 1,200-bed teaching hospital. PATIENTS: All 1,528 patients admitted to the ICU over the 4-yr study period were included. There were 406 patients admitted in the year before the study of decontamination of the digestive tract (65% medical, 23% surgical, and 12% trauma), of whom 76% required mechanical ventilation. There were 719 patients admitted during the 2-yr study of selective decontamination (55% medical, 28% surgical, and 17% trauma), of whom 79.6% required mechanical ventilation. There were 403 patients admitted in the subsequent year (61% medical, 25% surgical, and 14% trauma), of whom 76.9% required mechanical ventilation. INTERVENTIONS: We performed daily clinical monitoring to detect nosocomial infection, with microbiological investigation when clinically indicated, as well as twice-weekly routine microbiological surveillance sampling. Antimicrobial susceptibility testing using standard laboratory methods was also performed. Selective decontamination of the digestive tract included parenteral cefotaxime and oral and enteral polymyxin E, amphotericin B, and tobramycin. MEASUREMENTS AND MAIN RESULTS: The occurrence rate of nosocomial infection was 20.6%, 16.6%, and 25.3%, respectively, in the three study periods. In the year after selective decontamination, there was an increase in the occurrence rate of infection (p = .005), with an-associated increase in infections caused by the Enterobacteriaceae, while a reduction in the level of resistance to the third-generation cephalosporins were found (p = .07). There was a progressive increase in the occurrence rate of infections caused by Acinetobacter species (p = .05). Only 11 infections over the 4 yrs were caused by Enterococcus species. Staphylococcal infections were uncommon (5.7% of admissions), and the level of methicillin resistance did not change. No increase in aminoglycoside resistance occurred. CONCLUSION: No long-term effects on antimicrobial resistance or the spectrum of nosocomial pathogens could be attributed to the use of selective decontamination of the digestive tract over a 2-yr period in a respiratory ICU admitting all categories of patients.

APACHE↗

PubMed2003

[Decontamination of ocular globes--comparison of three methods].

PURPOSE: Determination of the success degree of the three decontamination methods for the purpose of choosing the decontamination method before the prelevation of the cornea for its best preservation. MATERIAL AND METHOD: The studied decontamination methods were: 1. Immersion of the ocular globe in Betadina (polividon--iod) 2. Immersion of the ocular globe in Silver Nitrate 3. Washing of the ocular globe with Gentamicina. 30 animal eyes (pig) were used, 10 for each method. A bacteriological sample was prelevated from each ocular globe, before and after the decontamination. Afterwards the cornea was immersed in solution of Inosol type, following the indicator of the Inosol for 10 days. RESULTS: In each conjunctival the microbial population was present before the decontamination. Positive samples existed after the decontamination for every method, microbial concentration being however greatly reduced in the first 2 samples. The contamination of the conservation environment occurred for a cornea in the case of Betadine, for 2 cornea in the case of Silver Nitrate and for 7 corneas in the case of Gentamicin. CONCLUSIONS: 1. Decontamination with Gentamicin 33 mg/ml solution is inefficient. 2. The efficacy of Silver Nitrate and Betadine solution is similarly. 3. The best option is immersion of the globe in Betadine solution.

Animals↗

PubMed1995

Decontamination procedures for drugs of abuse in hair: are they sufficient?

This paper reviews the methods for decontaminating hair exposed to external solutions of drugs of abuse. Exposure of hair to cocaine at 1 microgram/ml for 5 min is sufficient to contaminate hair, yet decontamination is a very slow process. Using externally contaminated hair, a number of decontamination procedures were attempted, and none removed all the contamination. The percentage of external contamination removed depended on the hair type, with thick black hair being the most resistant to decontamination. Hair treated by dying incorporated externally applied drugs differently, depending on the hair type. Thick black hair became more absorbent whereas thin brown hair became less absorbent. Kinetic wash criteria are evaluated for their ability/inability to determine if hair has been contaminated from external sources. A theoretical framework for the incorporation and removal of drugs from hair is discussed, and the hypothesis that inaccessible domains exist in hair which trap drugs is critically examined. The results presented in this paper strongly suggest that much more information on the decontamination of hair and the differentiation of exogenously and endogenously incorporated drugs is needed before hair analysis can be employed in most forensic applications. We propose that the radioactive tracer methods discussed herein are well suited for evaluating any new decontamination or extraction technique.

Decontamination↗

PubMed2005

Decontamination of rooms, medical equipment and ambulances using an aerosol of hydrogen peroxide disinfectant.

A programmable device (Sterinis, Gloster Sante Europe) providing a dry fume of 5% hydrogen peroxide (H(2)O(2)) disinfectant was tested for decontamination of rooms, ambulances and different types of medical equipment. Pre-set concentrations were used according to the volumes of the rooms and garages. Three cycles were performed with increasing contact times. Repetitive experiments were performed using Bacillus atrophaeus (formerly Bacillus subtilis) Raven 1162282 spores to control the effect of decontamination; after a sampling plan, spore strips were placed in various positions in rooms, ambulances, and inside and outside the items of medical equipment. Decontamination was effective in 87% of 146 spore tests in closed test rooms and in 100% of 48 tests in a surgical department when using three cycles. One or two cycles had no effect. The sporicidal effect on internal parts of the medical equipment was only 62.3% (220 tests). When the devices were run and ventilated during decontamination, 100% (57/57) of spore strips placed inside were decontaminated. In the ambulances, the penetration of H(2)O(2) into equipment, devices, glove boxes, under mattresses, and the drivers' cabins was 100% (60/60 tests) when using three cycles, but was less effective when using one or two cycles. In conclusion, an H(2)O(2) dry fumigation system, run in three cycles, seemed to have a good sporicidal effect when used in rooms, ambulances, and external and internal parts of ventilated equipment. Further studies need to be performed concerning concentration, contact time and the number of cycles of H(2)O(2). This is especially important for inner parts of medical equipment that cannot be ventilated during the decontamination process.

Aerosols↗

PubMed2005

Comparison of NaOH-N-acetyl cysteine and sulfuric acid decontamination methods for recovery of mycobacteria from clinical specimens.

We compared the NaOH-N-acetyl cysteine (NaOH-NALC) and the sulfuric acid decontamination procedure in the detection of mycobacteria using the Mycobacteria Growth Indicator Tube (MGIT). In total 219 sputum specimens were collected from 142 Zambian patients and subjected to mycobacterial culture. One half of the specimen was decontaminated with NaOH-NALC and the other half was decontaminated with sulfuric acid. From the 438 samples a total of 261 (60%) cultures yielded growth of mycobacteria, consisting of 22 different species. The sulfuric acid method was more successful than the NaOH-NALC method in recovering mycobacteria in MGITs (146 versus 115 respectively, p = 0.001). Of the 146 positive mycobacterial cultures recovered after sulfuric acid decontamination 28 were Mycobacterium tuberculosis, 84 nontuberculous mycobacteria (NTM) and 34 acid fast bacterial isolates which could not be identified to the species level. The 115 mycobacteria recovered by the NaOH-NALC method consisted of 34 M. tuberculosis strains, 55 NTM and 26 acid fast bacteria that could not be identified. The most frequently isolated NTM were Mycobacterium lentiflavum and Mycobacterium intracellulare. Comparing the two decontamination methods the recovery of NTM in the sulfuric acid group was significant higher than in the NaOH-NALC group (p = 0.001). In contrast, no significant difference was found for the recovery of M. tuberculosis. These results show that the decontamination method used affects the recovery of nontuberculous mycobacteria in particular.

Acetylcysteine↗

PubMed1991

Techniques for radioactive decontamination in nuclear medicine.

Working with unsealed radioactive sources in nuclear medicine carries the potential risk of contamination. Careful design of a department and its operational procedures will minimize but never completely eliminate the possibility of such incidents occurring. Contingency planning forms as important a part of handling such incidents as the procedures to reduce the hazard once an incident has occurred. It should include anticipating where such incidents are likely to occur, training and exercising staff in the appropriate procedures to deal with these incidents, providing a comprehensive decontamination kit, and implementing a routine contamination monitoring survey. Assessing the magnitude of the radiation hazard and the effect of decontamination efforts, containing the spread of contamination, minimizing the radiation dose to individuals, and continuing to decontaminate to the lowest level possible are principles to follow in managing any incident. Nuclear medicine staff should be familiar with techniques for decontaminating different anatomical sites on the body; for eliminating or reducing the uptake of radioactivity absorbed into the body; and for decontaminating dry and wet surfaces, equipment, clothing, and bedding. Radiopharmaceutical dispensing procedures, ventilation scanning, and decontaminating 131I treatment areas are identified as the most likely causes of body surface and internal contamination of nuclear medicine staff.

Decontamination↗

PubMed1995

Simulated exposure of hospital emergency personnel to solvent vapors and respirable dust during decontamination of chemically exposed patients.

STUDY OBJECTIVE: To ascertain the breathing-zone level of organic solvents and respirable particulates in a simulated hospital patient decontamination. DESIGN: An adult-sized, clothed plastic mannequin was contaminated with a solvent or particulate, then decontaminated. Rescuers were exposed to acetone, p-xylene, iron oxide, or zinc oxide during decontamination. We performed breathing-zone air sampling on the two rescuers. Five trials were run with each chemical. PARTICIPANTS: Two physicians performed the decontamination. RESULTS: Measured breathing-zone concentrations for the chemicals tested were significantly lower than their respective short-term breathing-zone limits (P = .042, .043, .001, and .001 for acetone, p-xylene, iron, and zinc oxide, respectively). CONCLUSION: The chemicals tested during simulated hospital decontamination did not pose a respiratory health risk to rescuers. This model may be useful in the extrapolation of breathing-zone exposure to more toxic chemicals. Because ours are preliminary data, the use of respiratory protective equipment during decontamination must be recommended.

Decontamination↗

PubMed1989

Cutaneous absorption and decontamination of [3H]T-2 toxin in the rat model.

Cutaneous absorption and decontamination of [3H]T-2 mycotoxin using various treatment modalities incorporating water, detergent, sprays, and scrubbing of application sites were examined in the rat model at 5, 30, 60, and 1440 min (24 h) postexposure. Rats were killed immediately after treatment and radiolabeled T-2 remaining in full-thickness skin samples were determined. Absorption and decontamination were followed over time, and decontaminating treatment modalities were evaluated for efficacy. Less than 1% of the applied dose was absorbed in 5 min, and 50% was absorbed in 24 h. At 5 min, 99.5 +/- 0.05% of nonabsorbed (residual) [3H]T-2 was removed, and 58 +/- 5.2% of residual toxin was removed at 24 h with a 2.5% detergent/water spray. When treatment modalities were evaluated at 60 min, a 2.5% detergent/water scrub followed by a detergent/water spray produced optimal decontamination by removing 81 +/- 2.2% of residual toxin. All treatment modalities using detergent and/or water removed significant amounts of toxin (p less than or equal to .0001); a dry scrub was not efficacious. Treatment should be initiated as soon as possible after exposure for best results. However, the stratum corneum acts as a reservoir for the toxin, and decontamination should be carried out even if delayed several hours or days after exposure. Dermal absorption pharmacokinetics found in these studies are similar to those described for other low-molecular-weight compounds, and the decontamination results from T-2 toxin should be applicable to other, similar toxic substances.

Animals↗

PubMed2005

Change in tensile properties of neoprene and nitrile gloves after repeated exposures to acetone and thermal decontamination.

This study investigated the change in tensile properties of neoprene and nitrile gloves after repeated cycles of exposure to acetone, followed by thermal decontamination. The glove was exposed to acetone (outer surface in contact with chemical), subjected to thermal decontamination, and tested for the tensile strength and the ultimate elongation. Thermal decontamination was carried out inside an oven for 16 hours at 100 degrees C. The exposure/decontamination procedure was repeated for a maximum of 10 cycles. For neoprene versus acetone, the mean tensile strength consistently decreased after each exposure/decontamination cycle. Multiple comparisons indicated that the mean tensile strengths between the new swatches and each exposure/decontamination group were significantly different (p < 0.05). The loss of either tensile strength or ultimate elongation was less than 23% compared with new swatches after four exposure/decontamination cycles. Swatches with out acetone exposure were then cycled through the oven in the same manner. It was found that both the heat used for thermal decontamination and acetone exposure significantly affected the tensile strength and ultimate elongation. For nitrile gloves exposed to acetone, the mean tensile strength remained virtually unchanged (p > 0.05). The mean tensile strength for the new swatches was 37.1 MPa and the mean tensile strength after nine exposure/decontamination cycles was 36.0 MPa, with a loss less than 3%. The largest single cycle loss for ultimate elongation occurred during the first exposure/decontamination cycle for both glove materials. In our previous study, decisions regarding the effectiveness of the decontamination process were based on having no discernible change in the breakthrough time and steady-state permeation rate. The results of this study indicate that the effectiveness of the decontamination process cannot be based on permeation parameters alone but must also take into account the change in physical properties.

Acetone↗

PubMed1997

The prevention of anastomotic leakage after total gastrectomy with local decontamination. A prospective, randomized, double-blind, placebo-controlled multicenter trial.

OBJECTIVE: A prospective, randomized, double-blind, placebo controlled multicenter trial was undertaken in 205 patients treated with total gastrectomy for gastric malignancies to evaluate whether local antimicrobial measures reduce the incidence of esophagojejunal anastomotic leakage. SUMMARY BACKGROUND DATA: Anastomotic leakage of the esophagojejunostomy is always a septic complication of total gastrectomy for gastric malignancies, but it never has been attempted to prevent this complication with the administration of topical antimicrobial agents during the critical phase of anastomotic wound healing. METHODS: To evaluate the efficacy and safety of topical decontamination, the study was carried out as a prospective, randomized, double-blind and placebo-controlled clinical multicenter trial in patients with total gastrectomy for gastric cancer. Patients received either placebo or decontamination with polymyxin B (100 mg), tobramycin (80 mg), vancomycin (125 mg), and amphotericin B (500 mg) four times per day orally from the day before the operation until the seventh postoperative day. All patients received a perioperative intravenous prophylaxis with cefotaxime 2 x 2 g. Other interventions including the administration of antibiotics and fluids, were not affected by the study protocol. RESULTS: Of 260 patients who were randomized, total gastrectomy was not carried out in 55 patients. They dropped out of the study. Patients receiving an esophagojejunostomy were observed until day 42, when they were discharged from the clinic or died. An intention-to-treat analysis of the data was carried out. Among the 103 recipients of placebo, there were 11 (10.6%) with an anastomotic leakage of the esophagojejunostomy, and among the 102 recipients of decontamination, there were 3 (2.9%) with an anastomotic leakage of the esophagojejunostomy (p = 0.0492). Pulmonary infections were observed in 23 patients (22.3%) receiving placebo and in 9 patients (8.8%) who were decontaminated (p = 0.02). There were 11 deaths (10.6%) among the recipients of placebo and 5 deaths (4.9%) among the recipients of decontamination (p = 0.1). CONCLUSIONS: Decontamination with polymyxin, tobramycin, vancomycin, and amphotericin B during anastomotic wound healing is safe and effective in the prevention of esophagojejunal anastomotic leakage after total gastrectomy.

Aged↗

PubMed1993

Can selective digestive decontamination avoid the endotoxemia and cytokine activation promoted by cardiopulmonary bypass?

OBJECTIVE: To evaluate the effect of selective digestive decontamination on endotoxemia and cytokine activation during the ischemic phase of cardiopulmonary bypass surgery. DESIGN: Prospective, open, randomized, controlled trial. SETTING: Two multidisciplinary intensive care units in tertiary care hospitals. PATIENTS: Eighty consecutive patients randomly allocated to two groups: selective digestive decontamination (group 1, n = 40) and controls (group 2, n = 40). INTERVENTIONS: Preoperative administration of oral antibiotics (polymyxin E, tobramycin, and amphotericin B) vs. untreated controls. MEASUREMENTS AND MAIN RESULTS: Assessment of decontamination by bacteriologic evaluation of rectal swabs (colony-forming units [cfu]/mL) were made in each group, along with circulating endotoxin, tumor necrosis factor and interleukin-6 (IL-6) determinations before surgery, during ischemic and reperfusion phases of bypass, and at 4 hrs and at 24 hrs after surgery. Group 1 patients showed that rectal bacteria decreased ten-fold after treatment for 24 hrs, thousand-fold after 48 hrs, and registered 0 cfu/mL after digestive decontamination was administered for > 72 hrs. Endotoxin and IL-6 assays showed significantly lower values in this latter group vs. those circulating concentrations of control patients. On the other hand, both endotoxin and IL-6 concentrations correlated positively with the duration of surgical ischemia. CONCLUSIONS: Selective digestive decontamination reduces the gut content of enterobacteria, with complete elimination after 3 days of treatment. This fact could explain the lower endotoxin and cytokine concentrations found in the blood samples of patients who had been fully decontaminated. Duration of aortic cross-clamping is an important factor in generating endotoxemia and in the activation of cytokines.

Adult↗

PubMed1997

Randomized, controlled trial of selective digestive decontamination in 600 mechanically ventilated patients in a multidisciplinary intensive care unit.

OBJECTIVE: To evaluate the efficacy of two regimens of selective decontamination of the digestive tract in mechanically ventilated patients. DESIGN: Prospective, randomized, concurrent trial. SETTING: Multidisciplinary intensive care unit (ICU) in a 1,800-bed university hospital. PATIENTS: Consecutive patients (n = 660) who were likely to require mechanical ventilation for at least 48 hrs were randomized to one of three groups: conventional antibiotic regimen (control group A); oral and enteral ofloxacin-amphotericin B (group B); and oral and enteral polymyxin E-tobramycin-amphotericin B (group C). Both treatment groups received systemic antibiotics for 4 days (ofloxacin in group B and cefotaxime in group C). INTERVENTIONS: Patients were randomized to receive standard treatment (control group A, n = 220), selective decontamination regimen B (group B, n = 220), and selective decontamination regimen C (group C, n = 220). After early deaths and exclusions from the study, 185 controls (group A) and 193 (group B)/200 (group C) selective decontamination regimen patients were available for analysis. MEASUREMENTS AND MAIN RESULTS: Measurements included colonization and primary/secondary infection rate, ICU mortality rate, emergence of antibiotic resistance, length of ICU stay, and antimicrobial agent costs. The study duration was 19 months. The patient groups were fully comparable for age, diagnostic category, and severity of illness. One third of patients in each group suffered a nosocomial infection at the time of admission. There was a significant difference between treatment group B and control group A in the number of infected patients (odds ratio of 0.42, 95% confidence interval of 0.27 to 0.64), secondary lower respiratory tract infection (odds ratio of 0.47, 95% confidence interval of 0.26 to 0.82), and urinary tract infection (odds ratio of 0.47, 95% confidence interval of 0.27 to 0.81). Significantly more Gram-positive bacteremias occurred in treatment group C vs. group A (odds ratio of 1.22, 95% confidence interval 0.72 to 2.08). Infection at the time of admission proved to be the most significant risk factor for subsequent infection in control and both treatment groups. ICU mortality rate was almost identical (group A 16.8%, group B 17.6%, and group C 15.5%) and was not significantly related to primary or secondary infection. Increased antimicrobial resistance was recorded in both treatment groups: tobramycin-resistant enterobacteriaceae (group C 48% vs. group A 14%, p < .01), ofloxacin-resistant enterobacteriaceae (group B 50% vs. group A 11%, p < .02), ofloxacin-resistant nonfermenters (group B 81% vs. group A 52%, p < .02), and methicillin-resistant Staphylococcus aureus (group C 83% vs. group A 55%, p < .05). Antimicrobial agent costs were comparable in control and group C patients; one third less was spent for group B patients. CONCLUSIONS: In cases of high colonization and infection rates at the time of ICU admission, the preventive benefit of selective decontamination is highly debatable. Emergence of multiple antibiotic-resistant microorganisms creates a clinical problem and a definite change in the ecology of environmental, colonizing, and infecting bacteria. The selection of multiple antibiotic-resistant Gram-positive cocci is particularly hazardous. No beneficial effect on survival is observed. Moreover, selective decontamination adds substantially to the cost of ICU care.

Adult↗

PubMed1991

Decontamination of aqueous solutions of biological stains.

Aqueous solutions of a number of biological stains were completely decontaminated to the limit of detection using Amberlite resins. Amberlite XAD-16 was the most generally applicable resin but Amberlite XAD-2, Amberlite XAD-4, and Amberlite XAD-7 could be used to decontaminate some solutions. Solutions of acridine orange, alcian blue 8GX, alizarin red S, azure A, azure B, Congo red, cresyl violet acetate, crystal violet, eosin B, erythrosin B, ethidium bromide, Janus green B, methylene blue, neutral red, nigrosin, orcein, propidium iodide, rose Bengal, safranine O, toluidine blue O, and trypan blue could be completely decontaminated to the limit of detection and solutions of eosin Y and Giemsa stain were decontaminated to very low levels (less than 0.02 ppm) using Amberlite XAD-16. Reaction times varied from 10 min to 18 hr. Up to 500 ml of a 100 micrograms/ml solution could be decontaminated per gram of Amberlite XAD-16. Fourteen of the 23 stains tested were found to be mutagenic to Salmonella typhimurium. None of the completely decontaminated solutions were found to be mutagenic.

Acrylic Resins↗

PubMed2003

Hand decontamination practices in paediatric wards.

The purpose of this study was to determine and describe hand decontamination practices of health care professionals in the paediatric wards of an academic hospital in Johannesburg. The purpose was addressed within a survey design and through the use of descriptive and comparative methods. Data were collected through direct observation conducted with the use of a researcher-administered checklist. A sample of sixty-six health professionals was obtained through convenience sampling. Results indicated that significantly fewer health professionals did not decontaminate their hands on entering the ward (16.6%), prior to making patient contact (34.8%) and prior to donning gloves (9.1%). Significantly more health professionals did decontaminate their hands following contact with the patient (63.6%) and following removal of gloves (77.8%). More health professional did not wash their hands after leaving the ward (51.5%). More than half (57.6%) of the health professionals who decontaminate their hands used the correct hand washing technique. Compliance with standard hand decontamination practices of health professionals was found to be poor with only 83.4% of health professionals decontaminating their hands at the start of work.

Child↗

PubMed1992

Washer-sterilizers vs. indexed washer-decontaminators: a cost comparison.

Washer-sterilizers are the most common type of automated decontamination equipment in hospitals today, but from a cost standpoint, installing an indexed washer-decontaminator makes more sense for hospitals with active decontamination areas. An indexed washer-decontaminator is a highly productive and efficient machine that results in streamlined workflow in decontamination. Even in hospitals that own washer-sterilizers, the economics can be so compelling that they might want to consider replacing them with indexed washer-decontaminators.

Costs and Cost Analysis↗

PubMedDate not supplied

[Radioprotective agents in the decontamination of rats poisoned with percutaneously administered mustard gas].

The efficacy of rat skin decontamination by radioprotective agents AET and cystamine were tested. Results were compared to standard decontaminants-alcoholate, clay and fuller's earth. It was found that all the animals decontaminated with standard decontaminants had survived 4 LD50 of poison for 21 days. All the animals poisoned by 6 LD50 had survived for 1 day except for those decontaminated with alcoholate where 50% survived throughout the observation period. Alcoholate and clay protected all, and fuller's earth 70% of animals poisoned by 12 LD50, but no longer than 24 h. AET and cystamine protected all rats from 1.7 LD50 for 3 days, from 1 LD50 for 2 days, and from 2 LD50 for 1 day. When higher doses of poison were used (1.7-6.8 LD50) only partial protection was achieved. Our results support the conclusion that radioprotective agents could be convenient means for improvised decontamination of persons poisoned by sulfur mustard, so additional investigations are necessary.

Animals↗

PubMedDate not supplied

[Survey of methods of cleaning, decontamination, disinfection and sterilization in dental health services in tropical areas].

The International Aid for Ontology (IAO) carried out this survey of hygiene in the dental health services of 5 French-speaking African countries in 1994, in association with the Faculty of Pharmaceutical and Biological Sciences of Paris. This study received support from the World Health Organization (WHO), the French Ministry for Cooperation and the European Community and the Ivory Coast Oral and Dental Hygiene and Health Committee (CIHSBD). Twenty-nine dental services from Benin (3), Burkina Faso (6), Ivory Coast (12), Mali (5), Niger (3) participated in this survey which gives an insight into the daily hygiene routines of these services. The cleaning, decontamination, disinfection and sterilization procedures for premises, dental equipment, instruments, hands and disposable items were investigated. No individual protocols are reported. Bench tops were cleaned or disinfected daily in 73% of centers and floors were cleaned or disinfected daily in 59% of centers. Walls were cleaned once per week in 44% of the centers. Hands were always washed between patients, with 68% of dental surgeons using only solid or liquid cleansing soaps and the others using antiseptic or disinfectant solutions. The dentist's chair was cleaned or disinfected daily in 68% of centers, mostly with soap (43%) or diluted bleach (23%). Vacuum equipment was cleaned with soap (50%) or diluted bleach (57%), with some surgeries using a combination of the two. Hand pieces and turbines were cleaned and disinfected after each use with alcohol (35%) or diluted bleach (26%) and were sterilized in 9% of centers. Instruments were sterilized with a Poupinel (63%), unspecified sterilizer (26%), autoclave (7%) or low temperature disinfection procedure (4%). Instruments were regularly sterilized in all centers. Single-use disposable items were often reused: 88% of centers reused gloves, 64% anesthetic cartridges and 32% disposable needles. This survey demonstrates that dentists do attempt to achieve appropriate hygiene standards despite difficult practice conditions, exacerbated by supply problems. In all applications, hygiene involves a succession of closely-related, logical steps, which form an asepsis chain aimed at preventing the transmission of infection. Our survey shows that fundamental elements of hygiene require attention to achieve this aim. The cleaning, disinfection and sterilizing of floor surfaces and equipment should be improved and more widespread use made of disposable items. It is important to define the hygiene level required for particular treatments, taking into account the oral and dental micro flora and whether the equipment has been decontaminated, disinfected or sterilized. A piece of equipment is decontaminated if it has been mechanically cleaned and decontaminated. It is disinfected if these steps are followed by rinsing with sterile water, drying and conditioning. An item is described as sterilized if it is cleaned, decontaminated, rinsed, dried, conditioned and then sterilized. We found that a wide variety of chemicals were used to clean hands, surfaces and equipment. The nature and appropriate methods of use of these chemicals were not widely known. Understanding the chemical composition of these chemicals makes it possible to classify them into cleaning agents, detergents, decontaminating agents and disinfectants. The definition, choice and use of antiseptics and disinfectants should be strictly controlled. It is also vital that single-use disposable items are used only once and are never reused. Hygiene in the dental surgery is a chain of processes aimed at protecting the patient and the medical staff. There are many links in the chain, involving floor and surface hygiene, hand washing by dentists and dental assistants, washing of surgery linen and treatment of equipment. Dental practitioners should continually focus on ensuring that the chain of hygiene procedures is not broken, in their own interests as well as in those of their patients.

Benin↗