Sue Crow

Peracetic acid sterilization: a timely development for a busy healthcare industry.

Peracetic acid is a component of an equilibrium mixture that includes acetic acid, hydrogen peroxide, and water. Although it was first reported in 1902, not until years later did Greenspan and MacKellar find it to be bactericidal at 0.001%, fungicidal at 0.003%, and sporicidal at 0.30%.’ There are no specific data explaining how peracetic acid actually destroys the cell; it has been speculated that it functions like other peroxides and oxidizing agents. Block suggests that it destroys the chemosmotic function of the lipoprotein cytoplasmic membrane through dislocation or rupture of the cell wall. Peracetic acid is sporicidal at low temperatures, and it remains effective in the presence of some organic material. Sprossig stated that peracetic acid has advantages for disinfection and sterilization not found in any other agent. Block states that, “It would be desirable to have a chemical with the attributes of hydrogen peroxide-effective germicidal and sterilizing capabilities, no harmful decomposition products, and infinite water solubility-but with greater lipid solubility and freedom from deactivation by catalases and peroxidases. Such a compound exists. It is peracetic acid.” Fraser adds that, “A prime advantage of peracetic acid is that it is a nonfoaming, water-soluble liquid that is fast acting and nonderivatising, as well as environmentally accepted.”

Microbial Contamination of Arterial Infusions Used for Hemodynamic Monitoring: A Randomized Trial of Contamination with Sampling Through Conventional Stopcocks versus a Novel Closed System

Arterial catheters are now commonly used to monitor blood pressure and obtain blood samples for arterial blood gas and other laboratory determinations. Stopcocks inserted into the pressure monitoring circuit have been the primary means of obtaining blood from arterial catheters. However, these stopcock systems have been associated with nosocomial contamination and bacteremias. Because of the problems of bacterial contamination and blood wasting with the stopcock sampling systems, we compared the frequency and extent of contamination of external sampling ports and the monitoring tubing fluid in stopcocks with that of a novel closed needle-sampling system (Lab-Site, Migada Ltd, Rehovot, Israel), incorporated into pressure monitoring tubing (Abbott Laboratories Inc., North Chicago, Illinois). We found that use of the novel sampling system resulted in significantly fewer episodes of internal bacterial contamination of the arterial monitoring line (7%) than did the use of a stopcock system (61%). External contamination of the sampling port was also lower in the novel system (8%) than in the stopcock system (37%). This suggests that the closed system may reduce the risk of nosocomial infections in patients requiring arterial pressure monitoring.

Gas plasma sterilization--application of space-age technology.

Gas plasma sterilization is new to the healthcare field. The first such sterilizer has been manufactured by Advanced Sterilization Products (J&J, Irvine, CA). The system uses hydrogen peroxide as the substrate gas and radio frequency emissions to generate plasma. This system is a low-temperature, quick-acting process with no toxic residues. It appears that this sterilizer system holds promise in the healthcare field and could help to reduce the use of ethylene oxide.

Steam sterilizers: an evolution in design.

The basic design of steam sterilizers has remained virtually unchanged for more than forty years. Facelifts have improved the machines external appearance, and microprocessor controls have simplified the wiring. However, the sterilization process--the essence of sterilization-has remained the same. Steam sterilization, although relatively simple in theory when compared with other methods of sterilization, can be applied improperly, resulting in unsterile products. Most sterilization experts indicate that inadequate air removal is the most common cause of ineffective sterilization in steam sterilizers.1 Air prevents adequate steam penetration, which prevents materials in the sterilizer from reaching proper temperature and thereby impairs the sterilization process. There are numerous sources of air leaks in the most commonly used prevacuum steam sterilizers, including door seal gaskets, valve seats, pipe fittings, and fatigued or corroded pressure components. The healthcare industry spends

Nurses' compliance with aseptic technique

20 million annually for indicators that assure proper performance of steam sterilizers.2 Indicators typically used include Bowie Dick tests, biological indicators, chemical indicators, and more recently, integrating chemical indicators. A considerable safety factor is built into sterilizers to assure sterilization occurs. Recommended exposure time and temperature are significantly greater than needed to actually sterilize materials.1 The safety factors are based on a history of ineffective air removal. Extended exposure times help compensate for slow heating when trace quantities of air remain in the process and retard heat penetration; however, extended times only provide limited compensation for air in the system.1 The main evolution in the design of steam sterilizers has centered on developing methods to remove air from the sterilizing chamber more effectively. Most of the design improvements have been related to changes in the preconditioning phase of the sterilization cycles because air is supposed to be removed from the load and the sterilizing chamber during preconditioning. After the preconditioning phase, the other aspects of the sterilization processes remain substantially unchanged.

Training of Personnel for Infection Control

Operating room team members are responsible for providing and maintaining a safe operating room environment. By applying the basic principles of aseptic technique and understanding the infectious disease process, OR personnel isolate the operative site, create a sterile field, and prevent exogenous wound contamination. Do operating room teams comply with these principles of surgical asepsis? To answer this question, we designed a

Washer-Decontaminator-An Evaluation

The overall objectives for implementing an infection control program are to make hospital personnel aware of nosocomial infections and to educate these persons in their role in decreasing the risk of these infections. The infection control practitioner (ICP) implements these objectives by performing surveillance to determine problem areas and by developing policies and procedures that prevent and control nosocomial infections. Appropriate qualities for an ICP include initiative, leadership, communication skills, commitment, and charisma. Expertise in patient care practices, aseptic principles, sterilization practices, education, research, epidemiology, microbiology, infectious diseases, and psychology are acquired skills. Local, state, and national organizations, as well as universities, are responsible for ICP training, In the US the Centers for Disease Control have established a training program for the beginning ICP and the Association of Practitioners in Infection Control (APIC) has developed a study guide for developing infection control skills. The ultimate responsibility for education is an individual obligation, however. Certification of the ICP would insure a minimum level of knowledge, thereby standardizing and upgrading the practice of infection control.

Dissolving the problem of infectious medical waste

Experience with washer-sterilizers has shown that when an instrument is heavily soiled, the machine not only fails to clean the item thoroughly but also actually bakes the organic material onto the instrument, causing difficulty in removing the material. One answer to this problem is to hand clean the instrument before using the washer-sterilizer. This means that someone, who is usually at the bottom of the organizational chart, has to clean the items mechanically. Even though properly attired with gown, gloves, mask, goggles, and hair covering, this person is still at risk for contamination by puncturing himor herself with a sharp, contaminated instrument. Protective apparel is no protection from this sort of accident. Consequently, because of the need for prewashing, this machine is not the preferred method of cleaning.

The Lone Ranger Rides Again, This Time Followed by a Federal Posse

Decisions in purchasing healthcare products are based on fiscal responsibility, employee safety, regulatory agency guidelines, and environmental conservation. One of todays major dilemmas in health care is that of disposing of medical waste. The Isolyser Company of Norcross, Georgia, is one of the first to develop a biocycle system to reduce the problem of contaminated waste. A description of the system is provided, along with its advantages and disadvantages.

Nursing Care of the Immunosuppressed Patient

The Centers for Disease Control and Prevention proposed guidelines regarding the high-efficiency particulate air-filtered respirator have raised many questions that the healthcare worker has found difficult to answer. This product commentary addresses questions related to material that the respiratory protection program should include; provides information related to the physical exam before the use of the respirator; and explains the types of respirators. Cost issues also are discussed.