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Surface decontamination of
surgical instruments: an ongoing dilemma.
Murdoch H,
Taylor D,
Dickinson J,
Walker JT,
Perrett D,
Raven ND,
Sutton JM.
Centre for Emergency Preparedness and Response
(Laboratory A), Health Protection Agency, Porton Down,
Salisbury, UK.
The issues of cross-infection and the survival of
variant Creutzfeldt Jakob disease (vCJD) on surgical
instruments have highlighted the importance of
cleanliness of multiple-use surgical instruments. The
aim of this study was to assess the levels of total
protein contamination on a wide range of surgical
instruments as an indication of the effectiveness of
routine cleaning and disinfection in hospitals.
Anonymized trays of wrapped and autoclaved instruments
were supplied to two laboratories for analysis at the
stage where they would normally be returned to operating
theatres. Instruments were assessed for residual protein
and total organic matter. Laboratory A showed that 17%
(35/206) of instruments were above a threshold that
equated to 200 microg. The worst examples, a McIvor gag,
a Draffin rod (child) and a Yankaur sucker, had 1.028,
1.286 and 2.228 mg of extractable protein, respectively.
The median (25th, 75th percentiles) amount of protein
from instruments from different hospitals assessed in
Laboratory B ranged from 8 (3, 30)mug (Hospital C) to 91
(35, 213) mug (Hospital D) (P=0.044). The residual
matter washed from instruments varied from 0.62 (0.32,
0.81) mg (Hospital E) to 3.5 (3.5, 4.0) mg (Hospital A)
(P=0.0001). In one case, 45 mg of residual organic
matter was washed from an instrument (split stem). In
conclusion, this study demonstrated that a proportion of
instruments at the point of use show levels of protein
that could pose a direct cross-infection risk via prion
agents and other organic contamination that may reduce
the effectiveness of cleaning/disinfection strategies
targeted against either prions or traditional infectious
agents.
PMID: 16759745 [PubMed - in process]
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