Evaluation of stainless steel surgical instruments subjected to multiple use/processing

Costa, Dayane de Melo; Lopes, Lillian Kelly de Oliveira; Tipple, Anaclara Ferreira Veiga; Johani, Khalid; Hu, Honghua; Deva, Anand K.; Watanabe, Evandro; Vickery, Karen

doi:10.1016/j.idh.2017.08.004

Cited by 30 publications

(19 citation statements)

References 24 publications

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“…A handful of studies evaluating reprocessed SUDs have illustrated the retention of biological soils despite cleaning procedures. In a study that examined surgical scissors, forceps, rasps, and drill bits, complex device features were found to harbor protein, and biofilm encapsulated bacteria [ 23 ]. Stainless steel surgical instruments intended for multiple use have also proven to harbor organic material despite reprocessing procedures [ 24 ].…”

Section: Discussionmentioning

confidence: 99%

“…There was evidence of a hydrophobic surface based on beading of the water-based Luminol solution. We hypothesize that the heat generated during device use and the reprocessing process may have bonded the biological material to the plastic jaw, which is supported by studies evaluating a series of stainless steel surgical instruments that had undergone several sterilization cycles [ 23 , 24 ]. Future work is needed to confirm bonding and effectively solubilize film samples to enable identification and quantification of the remnant material.…”

Section: Discussionmentioning

confidence: 99%

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Assessing organic material on single-use vessel sealing devices: a comparative study of reprocessed and new LigaSure™ devices

2020

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Background Reprocessed devices must be thoroughly cleaned prior to sterilization to ensure efficacy of sterilization agents. Many single-use devices are not designed to be thoroughly cleaned. Interlocking design features inherent to LigaSure™ vessel sealing devices may prevent thorough cleaning and promote accumulation of human tissue that cannot be removed. Thus, the aim of this study was to compare industry reprocessed and new LigaSure™ vessel sealing devices for organic material. Methods A total of 168, 84 new and 84 reprocessed, vessel sealing devices were disassembled and inspected for the presence of residual organic matter using visual, microscopic, and chemical analysis. Devices were randomized and test conductors blinded to group membership. Devices were aseptically disassembled and sent through visual inspection. Next, devices were either examined using light microscopy, scanning electron microscopy (SEM) or exposed to a solution that luminesces in the presence of hemoglobin. Additionally, 165 reprocessed devices were sent to a 3rd party lab for sterility testing via direct immersion culture for 14 days. Results Significant amounts of remnant organic material (C, N, O, S, Na, P) were observed with 81/84 reprocessed and 0/84 new devices failing inspection protocols. When tested for the presence of hemoglobin, only 1/12 reprocessed devices passed inspection. SEM of reprocessed devices revealed residues with liquid patterns and diffuse soiling with foreign material. Sterility testing of reprocessed devices revealed a sterility level < 6–3. Conclusions The abundance of material resembling human tissue observed on reprocessed VSDs suggests inadequate cleaning prior to sterilization. Atomic and morphological analyses of the remnant materials suggest that bacterial biofilms could also be present. Additionally, surface degradation and release of reinforcing glass fibers from the device were observed. Devices designed for single use can harbor significant amounts of remnant material that likely interfere with the sterilization process.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Assessing organic material on single-use vessel sealing devices: a comparative study of reprocessed and new LigaSure™ devices

2020

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“…The design of the surgical instrument can act by making it difficult to remove dirt during the cleaning stage (24) . In health products containing joints, serrations, lumen or with irregular surface processed several times during their useful life, analyzed after sterilization, the presence of proteins was verified in levels up to 100 times higher than recommended, besides the presence of biofilms (25) . Therefore, in addition to accumulating a greater bacterial load, these areas present an even greater challenge to their removal during processing.…”

Section: Discussionmentioning

confidence: 97%

Impact of the contamination time by Escherichia coli on biofilm formation in surgical instruments

2021

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Objectives: to evaluate the microbial load and adherence of Escherichia coli in different areas of the surgical instrument surface exposed to experimental contamination over time. Methods: experimental study in which fragments of crile forceps (serrated, rod and rack) were contaminated by immersion in Tryptic Soy Broth, containing 106 CFU/mL of E. coli, for 1, 2, 4, 6, 8, 12 and 24 hours. Microbial load and bacterial adherence were evaluated using microbiological culture and scanning electron microscopy, respectively. Results: there was an increase in the microbial load on the surgical instrument, proportional to the contamination interval, ranging from 102 after 1 hour to 105 CFU/cm2 in 24 hours. The presence of exopolysaccharide was detected after two hours of contamination. Conclusions: microbial load and adhesion of E. coli increased over time, reaching 105 CFU/cm2 after 24 hours of contamination, starting biofilm formation after two hours.

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“…This phenomenon has demonstrated to be effective at removing contamination from hands 37 , skin 38 , proteins from stainless steel and tissue from bone grafts 39 , dental biofilms 39 , 40 , marine biofouling 41 and contaiminant from railtracks 42 . Bjerknes forces 43 aid the scrubbing bubbles in efficiently removing contaminants from microscopic crevices, such as those found on worn surgical instruments 44 , that are traditionally difficult to clean by brushes, wiping, or by chemical means that rely on passive diffusion for reagents to penetrate deep into the crevice 45 . The efficient removal of contamination from crevices using a UAS system has been demonstrated previously 40 .…”

Section: Introductionmentioning

confidence: 99%

A cold water, ultrasonically activated stream efficiently removes proteins and prion-associated amyloid from surgical stainless steel

Secker

Leighton

Offin

et al. 2020

Journal of Hospital Infection

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Evaluation of stainless steel surgical instruments subjected to multiple use/processing

Cited by 30 publications

References 24 publications

Assessing organic material on single-use vessel sealing devices: a comparative study of reprocessed and new LigaSure™ devices

Assessing organic material on single-use vessel sealing devices: a comparative study of reprocessed and new LigaSure™ devices

Impact of the contamination time by Escherichia coli on biofilm formation in surgical instruments

A cold water, ultrasonically activated stream efficiently removes proteins and prion-associated amyloid from surgical stainless steel

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