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PubMed2004

Oral decontamination is cost-saving in the prevention of ventilator-associated pneumonia in intensive care units.

OBJECTIVE: Although the development of ventilator-associated pneumonia (VAP) is assumed to increase costs of intensive care unit stay, it is unknown whether prevention of VAP by means of oropharyngeal decontamination is cost-effective. Because of wide ranges of individual patient costs, crude cost comparisons did not show significant cost reductions. DESIGN: Based on actual cost data of 181 individual patients included in a former randomized clinical trial, cost-effectiveness of prevention of VAP was determined using a decision model and univariate sensitivity analyses, and bootstrapping was used to assess the impact of variability in the various outcomes. DATA SOURCE: Published data on prevention of VAP by oropharyngeal decontamination, which resulted in a relative risk for VAP of 0.45, with a baseline rate of VAP of 29% among control patients. The mean costs of the intervention were 351 dollars per patient (32 dollars per patient per day). All other costs were derived from the hospital administrative database for all individual patients. RESULTS OF BASE-CASE ANALYSIS: Prevention of VAP led to mean total costs of 16,119 dollars and 18,268 dollars for patients without preventive measures administered. Thus, costs were saved and instances of VAP were prevented. Similar results were observed in terms of overall survival. RESULTS OF SENSITIVITY ANALYSIS: Prevention of VAP remains cost-saving if the relative risk for VAP because of intervention is <0.923, the costs of the intervention are less than 2,500 dollars, and the prevalence of VAP without intervention is >4%. Bootstrapping confirmed that, with about 80% certainty, oropharyngeal decontamination results in prevention of VAP and simultaneously saves costs. In terms of a survival benefit, the results are less evident; the results indicate that with only about 60% certainty can we confirm that oropharyngeal decontamination would result in a survival benefit and simultaneously save costs. CONCLUSIONS: This study provides strong evidence that prevention of VAP by means of oropharyngeal decontamination is cost-effective.

Antibiotic Prophylaxis↗

PubMed2005

Decontamination assessment of Bacillus anthracis, Bacillus subtilis, and Geobacillus stearothermophilus spores on indoor surfaces using a hydrogen peroxide gas generator.

AIMS: To evaluate the decontamination of Bacillus anthracis, Bacillus subtilis, and Geobacillus stearothermophilus spores on indoor surface materials using hydrogen peroxide gas. METHODS AND RESULTS: Bacillus anthracis, B. subtilis, and G. stearothermophilus spores were dried on seven types of indoor surfaces and exposed to > or =1000 ppm hydrogen peroxide gas for 20 min. Hydrogen peroxide exposure significantly decreased viable B. anthracis, B. subtilis, and G. stearothermophilus spores on all test materials except G. stearothermophilus on industrial carpet. Significant differences were observed when comparing the reduction in viable spores of B. anthracis with both surrogates. The effectiveness of gaseous hydrogen peroxide on the growth of biological indicators and spore strips was evaluated in parallel as a qualitative assessment of decontamination. At 1 and 7 days postexposure, decontaminated biological indicators and spore strips exhibited no growth, while the nondecontaminated samples displayed growth. CONCLUSIONS: Significant differences in decontamination efficacy of hydrogen peroxide gas on porous and nonporous surfaces were observed when comparing the mean log reduction in B. anthracis spores with B. subtilis and G. stearothermophilus spores. SIGNIFICANCE AND IMPACT OF THE STUDY: These results provide comparative information for the decontamination of B. anthracis spores with surrogates on indoor surfaces using hydrogen peroxide gas.

Bacillaceae↗

PubMed2006

Surface decontamination of beef inoculated with Salmonella Typhimurium DT104 or Escherichia coli O157:H7 using dry air in a novel heat treatment apparatus.

AIMS: To determine the effectiveness of a novel dry air decontamination apparatus in the deactivation of Salmonella serotype Typhimurium DT104 or Escherichia coli O157:H7 on beef surfaces. METHODS AND RESULTS: A laboratory scale dry air decontamination apparatus, capable of producing repeatable and known heating time-temperature cycles on food surfaces was used in decontamination trials. Beef samples were surface inoculated with 7-8 log10CFU cm(-2) of S. Typhimurium DT104 or E. coli O157:H7 and heated at 60, 75, 90 and 100 degrees C using fast and slow heating rates and subsequently held at these temperatures for up to 600 s. A substantial reduction in pathogen numbers was achieved at higher temperatures (90 and 100 degrees C, 4.18-6.06 log10CFU cm(-2)) using both heating rates, but cell survival at these temperatures was also observed. At the lower temperatures, deactivation was small at 60 degrees C in particular it was less than one log unit after 3 min heating. No significant differences were observed when total reductions in pathogen counts were compared for all the temperature/heat up time combinations tested. During slow heating at 90 degrees C, and both heating rates at 100 degrees C, the pattern of deactivation of S. Typhimurium DT104 or E. coli O157:H7 was triphasic. CONCLUSIONS: This study has shown that heating meat surfaces with dry air can achieve substantial reductions in S. Typhimurium DT104 or E. coli O157:H7. As surface decontamination of beef surfaces with dry air had a negative effect on beef colour and appearance, such a decontamination apparatus would be unsuitable for producing meat for retail sale but it could be used to produce safer meat for use in the catering trade. SIGNIFICANCE AND IMPACT OF THE STUDY: This study provides researchers and food processors with data on the dynamic changes in S. Typhimurium DT104 and E. coli O157:H7 counts on intact beef surfaces during heating with dry air under realistic (time-varying) temperature conditions.

Air↗

PubMed2002

Facilities for chemical decontamination in accident and emergency departments in the United Kingdom.

OBJECTIVE: To audit the facilities for chemical decontamination, with special reference to cyanide poisoning, in all major accident and emergency departments in the UK. METHOD: A simple postal questionnaire was used to audit planning, premises, equipment, protection for staff, and stocks of specific antidotes to cyanide poisoning. RESULTS: 227 questionnaires from 261 departments (87%) were returned and used in the survey. Of the 227 departments who responded, 151 (66%) had a written plan; 168 (74%) departments had premises for decontamination; 55 (24%) were judged to have satisfactory premises; 146 (64%) departments had a shower or hose for decontamination; 60 (26%) departments had a decontamination trolley suitable for "stretcher" patients; 203 (89%) had some protective equipment for staff but only 77 (34%) had complete protection--that is, goggles, chemical resistant clothing, and breathing apparatus. In the authors' opinion only seven (3%) departments had satisfactory premises and equipment to treat "stretcher" patients and full protection for staff. A further 11 (5%) departments were equipped to manage ambulant patients at a similar level. Some 205 (90%) departments stocked one or more antidotes to cyanide and 77 (34%) stocked all four antidotes. Thirty four (15%) departments held all four antidotes to cyanide and had full protection for staff. Only five (2%) departments had satisfactory premises and equipment to treat "stretcher" patients, full protection for staff, and at least three of four antidotes. CONCLUSIONS: Most departments had some equipment for chemical decontamination. However, there were major inconsistencies in the range of equipment held and these limited its usefulness. Only a small minority of departments was satisfactorily equipped to deal with a serious chemical incident.

Cyanides↗

PubMed2002

Comparison of different decontamination methods for reagents to detect low concentrations of bacterial 16S DNA by real-time-PCR.

Contamination of polymerase chain reaction (PCR) reagents continues to be a major problem when consensus primers are used for detection of low concentrations of bacterial DNA. We designed a real-time polymerase chain reaction (PCR) for quantification of bacterial DNA by using consensus primers that bind specifically to the 16S region of bacterial DNA. We have tested four different methods of decontamination of PCR reagents in a project aimed at detecting bacterial DNA at low concentrations: deoxyribonuclease (DNAse) treatment, restriction endonuclease digestion, UV irradiation, and 8-methoxypsoralen in combination with long-wave UV light to intercalate contaminating DNA into double-stranded DNA. All four methods result in inhibition of the PCR reaction, and most of the decontamination procedures failed to eliminate the contaminating bacterial DNA. Only the DNAse decontamination proved to be efficient in eliminating contaminating DNA while conserving PCR efficiency. All four decontamination methods are time consuming and have the possibility of carrying new contamination into the reaction mixture. However, decontamination with DNAse may help, together with the use of highly purified PCR reagents, in detecting small amounts of bacterial DNA in clinical specimens.

Artifacts↗

PubMed1994

Contaminated implant surfaces: an in vitro comparison of implant surface coating and treatment modalities for decontamination.

The relationship between implant surfaces and decontamination treatments was studied in vitro to determine which implant surfaces were most effectively decontaminated, and which treatment was most effective for treating a particular implant surface. The implants used in the study were press fit cylindrical titanium units with machined, plasma sprayed, and hydroxyapatite-coated surfaces. Radioactive endotoxin (125I-LPS) was prepared from Porphyromonas gingivalis (ATCC 33277). Implants were coated with 125I-LPS and treated by burnishing with a cotton pellet soaked in water, citric acid solution (CA), or 0.12% chlorhexidine (CHX); or treated with an air-powder abrasive (AIR). Radioactivity was determined after each of two treatment cycles. The results for each implant surface were analyzed using ANOVA to determine differences between treatments. The remaining 125I-LPS after two treatment cycles were: for machined implants AIR < CA, with AIR = water = CHX and water = CHX = CA; for plasma sprayed implants AIR < water = CHX = CA; for hydroxyapatite implants AIR = CA < water < CHX. In evaluating treatment modalities, it was found that machined implants were decontaminated more effectively than the other surfaces by all treatments; the exception was citric acid treatment which was equally effective on either machined or hydroxyapatite surfaces. These results indicate that machined implants (without surface coating) are most readily decontaminated by a variety of methods; this characteristic should be considered, since long-term success of implants may involve treating periimplantitis. Further, the results indicate that air abrasives are effective for decontaminating implant surface, with the exception that hydroxyapatite coated surfaces can be treated equally with air abrasives or citric acid.

Air↗

PubMed1988

Decontamination: a microbiologist's perspective.

The primary objective of decontamination is to protect healthcare workers who handle medical devices from infectious diseases that may be present on those devices. Ideally, the decontamination process should provide both cleaning and biocidal activity. A wide range of equipment, from automatic washer/sterilizers to semi-automated washer/sanitizers are commercially available to satisfy this need. The primary difference between these pieces of equipment, from a microbiology perspective, is in the level of safety they provide. A summary comparison of the decontamination methods is shown in Table 1. Without a doubt, steam sterilization as a method of decontamination provides a greater safety level than may be required. However, the question is, "Do disinfection and sanitization provide an adequate safety level?" Although items do not necessarily need to be sterile to be safe to handle, sterilization processes provide the greatest margin of safety because of the significant microbial lethality and the ability to effectively monitor the process via biological indicators. Sterilization effectively eliminates the concern regarding the nearly unanswerable question of bioburden. Unfortunately, not all items are capable of being processed through a washer/sterilizer. Therefore, consideration must be given to the process compatibility of each device. Disinfection processes provide the next level of safety. Unfortunately, there is no recognized or accepted method for quantitatively describing or monitoring a thermal disinfection process. As is the case with sterilization consideration must be given to the process compatibility of each device. Sanitization provides the lowest level of safety for the decontamination process.(ABSTRACT TRUNCATED AT 250 WORDS)

Central Supply, Hospital↗

PubMed1993

The efficacy of different decontaminants in rats and pigs percutaneously poisoned with organophosphates.

The efficacies of clay or alcoholate as decontaminants and a polyethylene glycol + oxime N-octylpyridium-4-aldoxime bromide (OPAB) protective ointment were evaluated in rats and pigs percutaneously poisoned with O-ethyl S-2-diisopropylaminoethyl methylphosphonothioate (VX) and soman (GD) nerve gases. The use of protective ointment per se or combined with the decontaminants protected all rats poisoned with GD, regardless of the experimental procedure. No poisoning or fatalities were observed in pigs decontaminated 2 min later with clay or alcoholate, while the protective ointment delayed the onset of poisoning and even prevented death. The application of protective ointment, with or without the use of decontaminants, significantly postponed the onset of poisoning in animals contaminated with VX. There was no significant difference between procedures. Decontamination was very satisfactory and dependent on the duration of exposure, being somewhat more efficient if performed by 30 min after exposure.

Administration, Cutaneous↗

PubMed1993

Chemical casualty decontamination by medical platoons in the 82d Airborne Division.

Chemical casualty decontamination must be carried out as far forward as possible to limit spread of agents and to render aid as quickly as possible. Traditionally, decontamination in the 82d Airborne Division has been provided by the Forward Support Medical Company. During Operation Desert Shield, the Division's Medical Platoons acquired the ability to decontaminate casualties for the first time. The author describes a detailed plan for casualty decontamination by Medical Platoons developed for this purpose. Dedicated rehearsal of decontamination and other aspects of chemical casualty care is essential.

Chemical Warfare↗

PubMedDate not supplied

Bacteriological data on a prospective multicenter study of the effect of two different regimens for selective decontamination in patients with acute leukaemia.

In this paper we described the results of bacteriological monitoring of oropharynx and stool samples from granulocytopenic patients with leukaemia who received oral infection prophylaxis with two different regimens for selective decontamination of the digestive tract. Patients were prospectively randomized either into a group receiving non-absorbable antimicrobial drugs for selective decontamination (polymyxin and neomycin: group A) or into a group receiving polymyxin and co-trimoxazole (group B). The oropharynx was, or became, free of gram-negative bacilli within one week of treatment in 94% and 90%, respectively, of the patients in group A and group B. The stool samples were, or became, negative after the same treatment interval in 91% and 80%, respectively, of the two patient groups. Antibiotic therapy during selective decontamination treatment significantly increased the incidence of positive cultures from the oropharynx and stools. The sensitivity of the gram-negative bacilli isolated during selective decontamination treatment to the drugs administered did not influence the average response to treatment. Both resistant and sensitive gram-negative bacteria appeared to disappear from the patients' samples, mostly within a week, without the need to adjust the selective decontamination treatment. Yeasts behaved in almost the same way as gram-negative bacilli. All patients received oral amphotericin B; some patients occasionally yielded oropharyngeal or faecal cultures which were positive for yeasts.

Acute Disease↗

PubMed1990

Intestinal decontamination in a polyvalent ICU. A double-blind study.

A double blind, placebo-controlled trial was performed to test the efficacy of prevention of nosocomial infections by selective digestive decontamination. Placebo or tobramycin (80 mg) and colistin (100 mg) was given four times daily via the gastric tube. Amphotericin B (500 mg/6 h) was administered to all patients. As our ICU is divided into two separate subunits, intestinal decontamination or placebo was administered alternatively to patients of the two subunits during two 3-month periods, separated by a 2-month period without prevention. The decontamination (n = 97) and placebo groups (n = 84) were similar with respect to age, sex, severity score and diagnostic categories on admission. Intestinal decontamination alone failed to significantly reduce the number of infected patients (26% vs 34.5%, p = 0.20), but was effective on ICU-acquired infections (0.33 vs 0.60, p = 0.02) especially gram-negative infection rates (0.17 vs 0.43, p = 0.01). The onset of the first ICU-acquired infection was delayed (9 vs 13 days, p less than 0.001) and incidence of pneumonia (2 vs 13 cases, p less than 0.01) including bacterial pneumonia (0 vs 8 cases, p less than 0.01) was significantly decreased. However, mean ICU stay and mortality were not significantly modified by intestinal decontamination.

Amphotericin B↗

PubMed2001

[Microbiological and clinical effects of selective bowel decontamination in transthoracic resection of carcinoma of the esophagus and cardia].

INTRODUCTION: Surgical therapy of carcinoma of the esophagus or cardia by transthoracic esophageal resection is associated with a high morbidity in which nosocomial infections have a great importance. This study investigates the influence of prophylactic selective bowel decontamination on the course and results of transthoracic resection of the esophagus. METHODS: Seventy patients with carcinoma of the esophagus and cardia were included in this prospective and partially randomized study at the University of Heidelberg. Twenty-five patients received prophylactically selective bowel decontamination with tobramycin, polymyxin B and amphotericin B. The treatment course was documented uniformly. In addition, microbiological screening was performed by swab examinations of nose, throat and anus, by urine and blood cultures, and the documentation of results of additional microbiological diagnostic studies. RESULTS: Bacteriological screening confirmed a reduction in infectious agents and a change of their spectrum in the respiratory and digestive tract without an increase in multiresistant bacteria. Patients who received selective bowel decontamination had a lower infection rate, a shorter artificial respiration period and a shorter intensive care stay without statistically significant differences. The mortality rate was 4% vs 9% in the control group (95% confidence interval -0.172-0.116). CONCLUSION: This study confirms the feasibility and microbiological effectiveness of selective bowel decontamination in the context of surgical therapy which is associated with a high nosocomial infection rate. The result of the clinical treatment seems slightly more favorable in the treatment group. Decisive are complications caused by surgery which fundamentally determine the clinical course and frequently cause infectious complications. The prophylactic use of selective bowel decontamination may be useful in patients with an increased risk of prolonged ventilation support or colon interposition but it is not to be generally recommended.

Aged↗

PubMed1996

Nurses' infection-control practice: hand decontamination, the use of gloves and sharp instruments.

Infection is an acknowledged hospital problem. Micro-organisms are disseminated mainly via hands but there is evidence that hand decontamination, the most important means of prevention, is performed too seldom, and not always after activities likely to result in heavy contamination. Nurses themselves are exposed to risks of infection, chiefly through contact with blood and body fluids, yet it has also been reported that gloves are not always worn during contact with patients' secretions and that the handling and disposal of sharp instruments may be performed unsafely. The study reported in this paper documents nursing behaviour in relation to hand decontamination, the use of gloves and sharps, taking into consideration a number of variables which could influence practice: availability of the expertise afforded by an infection-control nurse, clinical setting, nursing workload, knowledge and the resources available to control infection. Hands were decontaminated after 28.78% of patient contacts. Hands were decontaminated after 49.85% of activities likely to result in heavy contamination. Performance was related to nursing workload and the availability of hand decontaminating agents, especially when the nurses became busy. Use of gloves when they were available also proved good, with little evidence of wasteful use. The handling and disposal of sharps were commendable for most subjects but a few grossly unsafe incidents were nevertheless witnessed, apparently not associated with any of the variables examined.

Analysis of Variance↗

PubMed2002

A laboratory pilot study of thermal decontamination of soils polluted by PCBs. Comparison with thermogravimetric analysis.

Real soils contaminated with a mixture of polychlorinated biphenyls were thermally decontaminated in a laboratory scale thermal desorption apparatus, under different operating conditions including two operating pressures (P= 0.01 and 0.1 MPa), different sample masses (80-320 g), carrier gas flow rates (0-30-280 Nl h(-1)) and two initial contamination levels. A standard European soil artificially contaminated with 4-chlorobiphenyl was decontaminated using a thermogravimetric analyser (TGA). The same parametric study as cited earlier was performed. With both techniques, the extent of decontamination was studied as a function of temperature during the heating programs (2-3 degrees C min(-1) for the thermal desorption apparatus; 5 degrees C min(-1) for TGA). Only a few differences were noticed between the two techniques. The decontamination starts when the melting temperature of the contaminant is reached (30 degrees C) and is complete before 350 degrees C. Thermogravimetric analysis which does not necessitate any chemical analysis appears to be a very attractive technique to investigate the feasibility of a decontamination and to quickly determine the best operating conditions.

Environmental Monitoring↗

PubMed2004

Detection and decontamination of residual energetics from ordnance and explosives scrap.

Extensive manufacturing of explosives in the last century has resulted in widespread contamination of soils and waters. Decommissioning and cleanup of these materials has also led to concerns about the explosive hazards associated with residual energetics still present on the surfaces of ordnance and explosives scrap. Typically, open burning or detonation is used to decontaminate ordinance and explosive scrap. Here the use of an anaerobic microbiological system applied as a bioslurry to decontaminate energetics from the surfaces of metal scrap is described. Decontamination of model metal scrap artificially contaminated with 2,4,6-trinitrotoluene and of decommissioned mortar rounds still containing explosives residue was examined. A portable ion mobility spectrometer was employed for the detection of residual explosives residues on the surfaces of the scrap. The mixed microbial populations of the bioslurries effectively decontaminated both the scrap and the mortar rounds. Use of the ion mobility spectrometer was an extremely sensitive field screening method for assessing decontamination and is a method by which minimally trained personnel can declare scrap clean with a high level of certainty.

Anaerobiosis↗

PubMed2001

Comparative evaluation of four decontamination protocols for the isolation of Mycobacterium avium subsp. paratuberculosis from milk.

AIMS: Four chemical decontamination protocols for milk were compared with respect to mean percentage recovery of spiked Mycobacterium avium subsp. paratuberculosis, minimum detection limit and ease of application. METHODS AND RESULTS: Raw milk spiked with 106 cfu M.a. paratuberculosis was decontaminated prior to culture by: (1) treatment with 0.75% (w/v) hexadecylpyridinium chloride (HPC) for 5 h; (2) and (3) Cornell methods employing brain heart infusion broth containing 0.75% (w/v) and 0.9% (w/v) HPC, respectively; and (4) a C18-carboxypropylbetaine (CB-18) METHOD: The 0.75% HPC method yielded the highest mean percentage recovery of M.a. paratuberculosis (28.7%) and was capable of detecting the lowest number of cells (30 cfu/40 ml). CONCLUSION: Treatment of milk with 0.75% HPC for 5 h was shown to be superior to the other methods for decontaminating milk prior to culture for M.a. paratuberculosis. SIGNIFICANCE AND IMPACT OF STUDY: Certain chemical decontamination protocols are too harsh for application to milk. The "best" decontamination protocol only recovered a fraction of the M.a. paratuberculosis cells present in a milk sample.

Animals↗

PubMed2002

Healthcare personnel and hand decontamination in intensive care units: knowledge, attitudes, and behaviour in Italy.

The purpose of this study was to evaluate knowledge, attitudes, and behaviour regarding hand decontamination in personnel of intensive care units (ICUs) in Italy. All ICU physicians and nurses in 19 and five randomly selected hospitals in Campania and Calabria (Italy) were mailed a questionnaire focusing on demographics and practice characteristics; knowledge about prevention of hospital acquired infection; attitudes and behaviour with respect to hand decontamination; and use of gloves. A total of 413 questionnaires were returned giving a response rate of 66.6%. Overall, 53.2% agreed with the correct responses on knowledge related to infection control, and this knowledge was significantly higher in neonatal and medicine-surgery wards and in larger ICUs. A positive attitude was reported by the large majority who agreed that hand decontamination reduces the risk of infection in patients (96.8%) and personnel (86.2%), and the positive attitude was significantly higher among older and female personnel and in those with a higher level of knowledge. Only 60% always decontaminate hands at the start of a shift, and 72.5% before and after a patient contact. Higher compliance is reported for invasive manoeuvres, such as urinary catheters (96.5%) and intravenous lines (77.1%). Routine hand decontamination between each patient was significantly higher in females, and in neonatal and medicine-surgery ICUs. Our results suggest that interventions should not only be focused on predisposing factors (knowledge), but also on enabling (facilitating) and reinforcing (gratifying) factors.

Adult↗

PubMed1995

Determination of the optimum concentration of decontaminants for the primary isolation of Mycobacterium bovis.

The majority of tissue specimens submitted for the isolation of Mycobacterium bovis contain contaminating microorganisms and therefore require selective decontamination before bacteriological examination. The purpose of this study was to identify the preferred decontaminant amongst four commonly used reagents. The four decontaminants used in the study were 1-hexadecylpyridinium chloride, sodium hydroxide, benzalkonium chloride and oxalic acid. A comparison was made of the toxicity of the four decontaminants for M. bovis and their ability to control contamination. Used at the recommended concentrations, all reagents showed a significant degree of toxicity. The toxicity of the decontaminants for three field strains and one laboratory strain of M. bovis were similar, but a second laboratory strain, AN5, was more susceptible. It was also observed that as the concentration of each reagent decreased an abrupt change from control to lack of control of contaminating micro-organisms occurred. Hexadecylpyridinium chloride was found to be the best all-round reagent because at concentrations that effectively controlled contamination this reagent was the least toxic to M. bovis. A protocol for handling specimens based on an assessment of the risk of contamination is recommended.

Journal Article↗