Allergic reaction to ortho‐phthalaldehyde following flexible laryngoscopy

Atiyeh, Kimberly; Chitkara, Ajay; Achlatis, Stratos; Branski, Ryan C.; Amin, Milan R.

doi:10.1002/lary.25421

Cited by 11 publications

(14 citation statements)

References 5 publications

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“…25 However, recent research has raised new toxicity concerns for ortho-phthalaldehyde as a substitute, 26 because its adhesive nature has led to reports of anaphylactic shock from residual on endoscopes. 27 The micellized nature of Microbide's products eliminates adhesion, and thus, demonstrates clear advantages for infection control. Microbide-O outperformed Cidex ® OPA at both temperatures by successfully disinfecting more carriers overall and failing just one test compared to Cidex ® OPA, which failed three tests ( Table 3).…”

Section: Discussionmentioning

confidence: 99%

New disinfectants for inactivation and disinfection of Pseudomonas aeruginosa: comparison with market leaders

Gedge¹,

Hollingsworth²,

Suchmann³

2019

JBMOA

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Background Pseudomonas aeruginosa is a clinically relevant opportunistic pathogen that is a major cause of nosocomial infections worldwide. The bacterium's ubiquitous nature predominantly affects those with compromised host or mucosal immunity with a wide range of presentations including pneumonia, endocarditis, peritonitis, meningitis, bacteremia, and overwhelming septicemia. Routes of transmission in healthcare settings include water sources such as medical tubing 1 or cross-infection through contaminated medical diagnostic or surgical devices, such as endoscopic equipment. 2-5 In the US, an estimated 51,000 healthcare-associated P. aeruginosa infections occur per year with more than 6,000 multidrug-resistant cases causing approximately 400 deaths. 6 The bacterium habitually adopts a sessile biofilm lifestyle that is resistant to antimicrobial management. 7 Surveillance of these infections has shown trends in increasing antimicrobial resistance due to a combination of the bacterium's inherent resistance to many drug classes, its ability to acquire resistance via mutations to new treatments, its high prevalence, and its recurrent role in severe infections. 8 Therefore, prevention of P. aeruginosa infection by disinfection interventions that eradicate bacteria is essential to interrupt the pathogen's spread. The Centers for Disease Control and Prevention (CDC) formulated Guidelines for Disinfection and Sterilization in Healthcare Facilities. 9 Both the CDC and the Environmental Protection Agency (EPA) recommend using disinfectant products that comply with these guidelines. However, some of these require a full twelve minutes of contact time to for full disinfection. 10 This long contact time is often difficult to achieve in a healthcare environment due to time pressure. For practical usage, disinfectants should cause a significant reduction in pathogen viability on environmental surfaces (fomites) following a reasonably short contact time under ambient conditions. It is widely accepted that efficacy testing of disinfectants is best performed in carrier studies rather than in suspension studies. 11,12 The gold standard for testing the antimicrobial efficacy of liquid disinfectants on fomites is the Use-Dilution test designed by the Association of Official Analytical Chemists (AOAC). 13 This test is specified by the U.S. EPA as the required method for validating a hospital disinfectant claim. 14 The Use-Dilution method is conducted by soaking stainless steel carriers in P. aeruginosa bacteria, treating the carriers with the disinfectant, and then placing the carriers in growth broth containing neutralizer to establish whether any surviving bacteria remain.

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Section: Discussionmentioning

confidence: 99%

New disinfectants for inactivation and disinfection of Pseudomonas aeruginosa: comparison with market leaders

Gedge¹,

Hollingsworth²,

Suchmann³

2019

JBMOA

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“…Specific to otolaryngology, three cases of OPA‐induced anaphylaxis have been reported in the literature from patients undergoing serial laryngoscopy for head and neck cancer surveillance . Three additional cases recently were reported, and a literature review identified 17 reactions in nine patients across surgical specialties . Although quite rare, an allergic reaction to the sterilant likely is underrecognized and may well increase with growing awareness of this possibility.…”

Section: Discussionmentioning

confidence: 99%

“…11 Three additional cases recently were reported, and a literature review identified 17 reactions in nine patients across surgical specialties. 12 Although quite rare, an allergic reaction to the sterilant likely is underrecognized and may well increase with growing awareness of this possibility. The Medicine and Healthcare products Regulatory Agency in the United Kingdom has gone so far as to recommend the use of a validated alternative to OPA due to the difficulty in rinsing and the risk of anaphylaxis.…”

Section: Discussionmentioning

confidence: 99%

The cost of being clean: A cost analysis of nasopharyngoscope reprocessing techniques

Sowerby

Rudmik

2017

The Laryngoscope

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Objective Nasopharyngoscopes are an essential instrument to otolaryngologists; reprocessing them in a high‐value manner is paramount. Although several different techniques for reprocessing exist, all methods yield similar effectiveness. Given equivalent effectiveness outcomes, a cost analysis of four nasopharyngoscope reprocessing techniques was performed. Study Design Cost‐minimization analysis. Methods Four techniques were evaluated: 1) an automated reprocessor using peracetic acid (Steris System 1; Steris Canada Inc., Mississauga, Canada), 2) an automated reprocessor using ortho‐phthalaldehyde (OPA) (Cidex OPA; Advanced Sterilization Products, Johnson and Johnson Inc., Markham, Canada), 3) a manually performed accelerated hydrogen peroxide bath (Revital‐Ox; Steris Canada Inc.), and 4) a chlorine dioxide wipe (Tristel Trio Wipes System; Tristel plc, Cambridgeshire, U.K.). The costing perspective was a third‐party payer that was adjusted to 2014 Canadian dollars. The base‐case scenario used an annual volume of 4,153 reprocessing events in a tertiary care setting, and a scenario analysis assessed the impact of volume and capital expense. Results The cost per reprocessing event for the Steris (Steris Canada Inc.) automated endoscope reprocessing, Cidex OPA (Advanced Sterilization Products), Revital‐Ox (Steris Canada Inc.), and Tristel Trio Wipes (Tristel plc) were $20.58, $14.20, $9.57, and $13.14, respectively. Scenario analysis demonstrated the Tristel Trio Wipes System (Tristel plc) was the least expensive method in practices with low reprocessing volumes (a threshold of less than 6 events per day, or 22 per week), whereas the Revital‐Ox (Steris Canada Inc.) system was least expensive at higher volumes and became substantially more so as volumes increased. Conclusion A manual accelerated hydrogen peroxide bath offers the least costly approach to nasopharyngoscope reprocessing. The convenience and portability of the Tristel Trio (Tristel plc) system may be a good alternative for low reprocessing volumes, or when rapid turnaround is necessary. Level of Evidence NA. Laryngoscope, 128:64–71, 2018

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“…Immediate-type hypersensitivity reactions during cystoscopy and laryngoscopy with orthophthaldehyde have been reported. 82 , 83 , 84…”

Section: Antiseptics Disinfectants and Sterilizing Agentsmentioning

confidence: 99%

Update on perioperative hypersensitivity reactions: joint document from the Brazilian Society of Anesthesiology (SBA) and Brazilian Association of Allergy and Immunology (ASBAI) - Part II: etiology and diagnosis

Solé

Spindola

Aun

et al. 2020

Brazilian Journal of Anesthesiology (English Edition)

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Allergic reaction to ortho‐phthalaldehyde following flexible laryngoscopy

Cited by 11 publications

References 5 publications

New disinfectants for inactivation and disinfection of Pseudomonas aeruginosa: comparison with market leaders

New disinfectants for inactivation and disinfection of Pseudomonas aeruginosa: comparison with market leaders

The cost of being clean: A cost analysis of nasopharyngoscope reprocessing techniques

Update on perioperative hypersensitivity reactions: joint document from the Brazilian Society of Anesthesiology (SBA) and Brazilian Association of Allergy and Immunology (ASBAI) - Part II: etiology and diagnosis

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