In the absence of sufficient cleaning of medical instruments, contamination and infection can result in serious consequences for the health sector and remains a significant unmet challenge. In this paper we describe a novel cleaning system reliant on cavitation action created in a free flowing fluid stream where ultrasonic transmission to a surface, through the stream, is achieved using careful design and control of the device architecture, sound field and the materials employed. Cleaning was achieved with purified water at room temperature, moderate fluid flow rates and without the need for chemical additives or the high power consumption associated with conventional strategies. This study illustrates the potential in harnessing an ultrasonically activated stream to remove biological contamination including brain tissue from surgical stainless steel substrates, S. epidermidis biofilms from glass, and fat/soft tissue matter from bone structures with considerable basic and clinical applications.

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The accumulation of marine organisms on a range of manmade surfaces, termed biofouling, has proven to be the Achilles' heel of the shipping industry. Current antifouling coatings, such as foul release coatings (FRCs), only partially inhibit biofouling, since biofilms remain a major issue. Mechanical ship hull cleaning is commonly employed to remove biofilms, but these methods tend to damage the antifouling coating and often do not result in full removal. Here, we report the effectiveness of biofilm removal from FRCs through a novel cleaning device that uses an ultrasonically activated stream (UAS). In this device, ultrasound enhances the cleaning properties of microbubbles in a freely flowing stream of water. The UAS was applied on two types of commercial FRCs which were covered with biofilm growth following twelve days immersion in the marine environment. Biofilm removal was quantified in terms of reduction in biovolume and surface roughness, both measured using an optical profilometer, which were then compared with similar measurements after cleaning with a non-ultrasonically activated water stream. It was found that the UAS significantly improves the cleaning capabilities of a water flow, up to the point where no detectable biofilm remained on the coating surfaces. Overall biofilm surface coverage was significantly lower on the FRC coatings cleaned with the UAS system when compared to the coatings cleaned with water or not cleaned at all. When biofilm biomass removal was investigated, the UAS system resulted in significantly lower biovolume values even when compared to the water cleaning treatment with biovolume values close to zero. Remarkably, the surface roughness of the coatings after cleaning with the UAS was found to be comparable to that of the blank, non-immersed coatings, illustrating that the UAS did not damage the coatings in the process.

Doped diamond-like carbon (DLC) coatings offer potential antifouling surfaces against microbial and protein attachment. In particular, stainless steel surgical instruments are subject to tissue protein and resilient prion protein attachment, making decontamination methods used in sterile service departments ineffective, potentially increasing the risk of iatrogenic Creutzfeldt-Jakob disease during surgical procedures. This study examined the adsorption of proteins and prion-associated amyloid to doped DLC surfaces and the efficacy of commercial cleaning chemistries applied to these spiked surfaces, compared to titanium nitride coating and stainless steel. Surfaces inoculated with ME7-infected brain homogenate were visualised using SYPRO Ruby/Thioflavin T staining and modified epi-fluorescence microscopy before and after cleaning. Reduced protein and prion amyloid contamination was observed on the modified surfaces and subsequent decontamination efficacy improved. This highlights the potential for a new generation of coatings for surgical instruments to reduce the risk of iatrogenic CJD infection.

Increasing drying time adversely affects attachment of tissue proteins and prion-associated amyloid to surgical stainless steel, and reduces the efficacy of commercial cleaning chemistries. This study tested the efficacy of commercial humidity retention bags to reduce biofouling on surgical stainless steel and to improve subsequent cleaning. Surgical stainless steel surfaces were contaminated with ME7-infected brain homogenates and left to dry for 15 to 1,440 min either in air, in dry polythene bags or within humidity retention bags. Residual contamination pre/post cleaning was analysed using Thioflavin T/SYPRO Ruby dual staining and microscope analysis. An increase in biofouling was observed with increased drying time in air or in sealed dry bags. Humidity retention bags kept both protein and prion-associated amyloid minimal across the drying times both pre- and post-cleaning. Therefore, humidity bags demonstrate a cheap, easy to implement solution to improve surgical instrument reprocessing and to potentially reduce associated hospital acquired infections.

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