Application of a fluorescent dual stain to assess decontamination of tissue protein and prion amyloid from surgical stainless steel during simulated washer-disinfector cycles

Howlin, Robert P.; Khammo, N.; Secker, T.J.; McDonnell, Gerald; Keevil, C. W.

doi:10.1016/j.jhin.2009.12.023

Cited by 13 publications

(10 citation statements)

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“…Current practice in surgery allows contamination to dry onto the instruments at room temperature until the instruments are cleaned. Previous studies have highlighted the adverse effects of drying time on the initial adsorption of protein and prion-associated amyloid, and on subsequent cleaning attempts Howlin et al 2010;Ungurs et al 2010;Secker et al 2011). One of these studies highlighted how keeping instruments in a moist environment greatly reduced the residual bioburden adsorbed over extended periods before reprocessing (up to 1,440 min), thus aiding subsequent cleaning (Secker et al 2011).…”

Section: Discussionmentioning

confidence: 99%

“…Studies from the authors' group and others indicate that drying times longer than 15 min significantly reduce the efficacy of subsequent treatments to remove proteins, including prions. Keeping surgical instruments in a moist environment directly after use greatly reduces protein/amyloid attachment and improves decontamination efficacy Howlin et al 2010;Ungurs et al 2010;Secker et al 2011). The present study evaluated the use of commercial humidity retention bags consisting of two layers of highly absorbent material sandwiched within a thin film pocket, which once sealed creates a long lasting moisture-retaining pouch.…”

Section: Introductionmentioning

confidence: 99%

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Efficacy of humidity retention bags for the reduced adsorption and improved cleaning of tissue proteins including prion-associated amyloid to surgical stainless steel surfaces

et al. 2015

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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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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Efficacy of humidity retention bags for the reduced adsorption and improved cleaning of tissue proteins including prion-associated amyloid to surgical stainless steel surfaces

et al. 2015

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“…Eleven studies reported log-reductions of prion infectivity after various decontamination processes, principally enzymatic detergents that did not use autoclaving (Table 14). In terms of prion strain, seven studies used 10% or 20% brain homogenate of 263 K hamster scrapie, [174][175][176][179][180][181][182] three used vCJD, 177,179,180 two used ME7 183,184 and the following prion strains were investigated in only a single study: Rocky Mountain Laboratory (RML), 185 BSE 6PB1 and TGB1, 181 M1000 178 and 127S. 177 Nine studies used steel wires contaminated with the prion, one study used steel tokens 183 and one used steel sheets.…”

Section: Clinical Evidencementioning

confidence: 99%

Interventions to reduce the risk of surgically transmitted Creutzfeldt–Jakob disease: a cost-effective modelling review

Stevenson

Uttley

Oakley

et al. 2020

Health Technol Assess

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Background Creutzfeldt–Jakob disease is a fatal neurological disease caused by abnormal infectious proteins called prions. Prions that are present on surgical instruments cannot be completely deactivated; therefore, patients who are subsequently operated on using these instruments may become infected. This can result in surgically transmitted Creutzfeldt–Jakob disease. Objective To update literature reviews, consultation with experts and economic modelling published in 2006, and to provide the cost-effectiveness of strategies to reduce the risk of surgically transmitted Creutzfeldt–Jakob disease. Methods Eight systematic reviews were undertaken for clinical parameters. One review of cost-effectiveness was undertaken. Electronic databases including MEDLINE and EMBASE were searched from 2005 to 2017. Expert elicitation sessions were undertaken. An advisory committee, convened by the National Institute for Health and Care Excellence to produce guidance, provided an additional source of information. A mathematical model was updated focusing on brain and posterior eye surgery and neuroendoscopy. The model simulated both patients and instrument sets. Assuming that there were potentially 15 cases of surgically transmitted Creutzfeldt–Jakob disease between 2005 and 2018, approximate Bayesian computation was used to obtain samples from the posterior distribution of the model parameters to generate results. Heuristics were used to improve computational efficiency. The modelling conformed to the National Institute for Health and Care Excellence reference case. The strategies evaluated included neither keeping instruments moist nor prohibiting set migration; ensuring that instruments were kept moist; prohibiting instrument migration between sets; and employing single-use instruments. Threshold analyses were undertaken to establish prices at which single-use sets or completely effective decontamination solutions would be cost-effective. Results A total of 169 papers were identified for the clinical review. The evidence from published literature was not deemed sufficiently strong to take precedence over the distributions obtained from expert elicitation. Forty-eight papers were identified in the review of cost-effectiveness. The previous modelling structure was revised to add the possibility of misclassifying surgically transmitted Creutzfeldt–Jakob disease as another neurodegenerative disease, and assuming that all patients were susceptible to infection. Keeping instruments moist was estimated to reduce the risk of surgically transmitted Creutzfeldt–Jakob disease cases and associated costs. Based on probabilistic sensitivity analyses, keeping instruments moist was estimated to on average result in 2.36 (range 0–47) surgically transmitted Creutzfeldt–Jakob disease cases (across England) caused by infection occurring between 2019 and 2023. Prohibiting set migration or employing single-use instruments reduced the estimated risk of surgically transmitted Creutzfeldt–Jakob disease cases further, but at considerable cost. The estimated costs per quality-adjusted life-year gained of these strategies in addition to keeping instruments moist were in excess of £1M. It was estimated that single-use instrument sets (currently £350–500) or completely effective cleaning solutions would need to cost approximately £12 per patient to be cost-effective using a £30,000 per quality-adjusted life-year gained value. Limitations As no direct published evidence to implicate surgery as a cause of Creutzfeldt–Jakob disease has been found since 2005, the estimations of potential cases from elicitation are still speculative. A particular source of uncertainty was in the number of potential surgically transmitted Creutzfeldt–Jakob disease cases that may have occurred between 2005 and 2018. Conclusions Keeping instruments moist is estimated to reduce the risk of surgically transmitted Creutzfeldt–Jakob disease cases and associated costs. Further surgical management strategies can reduce the risks of surgically transmitted Creutzfeldt–Jakob disease but have considerable associated costs. Study registration This study is registered as PROSPERO CRD42017071807. Funding This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 11. See the NIHR Journals Library website for further project information.

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“…For example, some researchers have been evaluating prion inactivation in proprietary cleaning equipment (i.e. washer-disinfectors) or evaluated prion decontamination in procedures designed to simulate the cycle events in washer-disinfectors (Howlin et al ., 2010;Schmitt et al ., 2010). Schmitt and colleagues compared the prion inactivation effi cacy of a standard cycle of a washer-disinfector with that for a modifi ed cycle that included an extra oxidation step.…”

Section: Research Developments Towards a Validated Reprocessing Strategymentioning

confidence: 99%

“…For example, Howlin and colleagues determined that exposing surgical instruments immediately to either an enzyme cleaner or a pre-soak wetting agent facilitated tissue removal. The effects of various drying time periods were evaluated to determine the maximum hold time for instruments in quarantine without adversely impacting tissue removal processes and decontamination (Howlin et al ., 2010).…”

Section: Research Developments Towards a Validated Reprocessing Strategymentioning

confidence: 99%

Prions and endotoxins: reprocessing strategies for reusable medical devices

Sehulster

2012

Sterilisation of Biomaterials and Medical Devices

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Application of a fluorescent dual stain to assess decontamination of tissue protein and prion amyloid from surgical stainless steel during simulated washer-disinfector cycles

Cited by 13 publications

References 24 publications

Efficacy of humidity retention bags for the reduced adsorption and improved cleaning of tissue proteins including prion-associated amyloid to surgical stainless steel surfaces

Efficacy of humidity retention bags for the reduced adsorption and improved cleaning of tissue proteins including prion-associated amyloid to surgical stainless steel surfaces

Interventions to reduce the risk of surgically transmitted Creutzfeldt–Jakob disease: a cost-effective modelling review

Prions and endotoxins: reprocessing strategies for reusable medical devices

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