Planeamiento estratégico

P197

Establishment of penetration time on medical device product families based on iso 17665-3 during performance qualification of steam sterilization cycles

Roel Beltran Castillo

Central Sterilising Services Department, Macquarie University Hospital, Macquarie University, Australia

Antimicrobial Resistance and Infection Control2017,6(Suppl 3):P197

Introduction: Reusable medical devices (RMDs) vary significantly in material construction and geometric configuration; ISO 17665-3 pro- vides information to group RMDs into families fit for a steam sterilization process. This underpins the need to establish penetration time at equilibrium throughout the RMD surfaces based on dele- gated product families, a data necessary to ensure sufficient expos- ure to steam sterilization process is delivered throughout the RMD.

Objectives:This study aims to provide an investigation on the cred- ibility of ISO 17665-3 requirements. Is it really necessary to comply with standards to meet lethality of steam sterilization process?

Methods: All RMD item/s is grouped according to designation of product family based on ISO 17665-3. Specific attributes are tabled presenting products that can be grouped together as product family identified for a particular steam sterilization process. The most diffi- cult to sterilize item/s in each product is chosen as a master product. This master product is then used as part of the reference load during performance requalification (PQ) of the steam sterilizer. The most challenging item with identified resistance (based on ISO 17665-3) in the master product is chosen for the study of penetration time. A thermometric measuring device attached to a software reader will be strategically located on the chosen RMD. This method provides live information of penetration time until equilibrium with the time lapse to attain plateau of identified lethal temperature.

Results:Based on data gathered, the material construction and com- plexity of RMD surface is directly related to resistance of heat transfer. This means RMDs with complex configuration and/or mixed material construction provided a longer time to reach the innermost parts and render the RMD surface exposed to lethal temperature. This confirms the ISO 17665-3 approach grouping RMDs into family of similar pene- tration resistance in order to attain lethality of process.

Conclusion:In conclusion it is beneficial establish penetration time of RMDs during annual PQ. This will address the reprocessing re- quirements to ensure sterilization lethality is achieved.

Disclosure of Interest

None Declared

P198

Evaluation of a mist ultraviolet disinfection device for impact on bacterial contamination levels of laryngoscope handles

Elhadi Elghouati1_{, ludivine Lorant}2 1

Infection control unit, Meulan les Mureaux hospital, Meulan-en-Yvelines;

2_{clinical laboratory, Tonnerre hospital, tonnerre, France}

Correspondence:Elhadi Elghouati

Antimicrobial Resistance and Infection Control2017,6(Suppl 3):P198

Introduction: Laryngoscope is the medical device most commonly used for tracheal intubations. The Center for Disease Control and Per- vention classifies Laryngoscope Handle (LH) as semi critical device. Failure to disinfect appropriately LH may caused infection and even death [1]. Decontamination technologies that utilize mist ultraviolet light C (M.UV-C) may be effective in reducing bacterial burden of LH

Objectives:Compare the automated M.UV-C technology and stand- ard manual protocol with respect to their ability to reduce bacterial contamination of reusable LH

Methods:This prospective study was conducted between 15 decem- bre 2016 and 15 march 2017 in a 500-bed tertiary care hospital. A before-and-after intervention study was designed to compare the bac- terial load of LH according the disinfection procedure. LH from the adult operating rooms were cleaned after each use according two protocols: manual protocol based on disinfectant wipes for 2 months and M.UV-C technology the subsequent 2 months. For each period, 45 sawbs were collected in order to determine bac- terial contamination. Samples were collected from LH considered clean and ready for use. LH were swabbed with sterile cotton swabs moisturized with sterile normal saline and placed into a nonnutritive transport medium.Sawbs were discharge in 2 ml of sterile normal saline, samples (500μl) were spread on count agar plates with BCP and incubated at 37 °C for a total of 48 hours. Colony forming units (CFU) were counted on each plate.

Results: In total, 90 samples were collected from 30 LH. Colony counts varied by cleaning protocol: manual protocol (mean = 46.5 CFU /ml) vs M.UV-C (mean = 0.75 CFU /ml). The mean bacterial load of LH decreased significantly from 46.5 to 0.75 UFC /ml (P < 0.001, Wilcoxon test) after the cleanning portocol was switched from standard to M.UV-C technology.

Conclusion:The M.UV-C technology appears to be superior vs man- ual cleaning for bacterial burden. The M.UV-C disinfection device sig- nificantly reduces bacterial contamination and mimimze risk of cross contamination from LH.

References

[1] UK Alert.Ref: MDA/2011/0096.27 September 2011

Disclosure of Interest

None Declared

P199

Identification of the impact of education and mentoring on medical device reprocessing practices in three hospitals in Cotonou, Benin

Olive M. Fast

School of Nursing, Mount Royal University, Calgary, Canada Antimicrobial Resistance and Infection Control2017,6(Suppl 3):P199

Introduction:Preventing post-operative infections through the proper sterilization of medical devices is a challenge in low to middle income countries (LMICs) due to inadequate equipment and unsterile technique, compounded by a lack of training in instrument reprocessing practices.

Objectives:A mixed methods study utilizing surveys, interviews, and sterilization equipment testing was conducted from September 2016 to May 2017, to identify the impact mentorship and education had on medical device reprocessing (MDR) staff knowledge and the processing of medical devices in three hospitals in Cotonou, Benin, West Africa.

Methods: Participants received 40 hours of classroom training in MDR as well as mentoring in their work setting. A hospital assess- ment tool was used prior to education sessions and six weeks follow- ing the mentoring timeframe. Participants also participated in a 20- 30 minute semi-structured interview and completed a survey prior to and following education sessions. Quantitative and qualitative data was analysed using the Dedoose data analysis system.

Results:Initial findings identify the value added component educa- tion and training have on MDR personnel. Participants self identified how their practice had changed due to a greater understanding of infectious processes as related to instrument sterilization. They also noted that education had changed how they approached their work, identifying spending more time ensuring instruments were thor- oughly cleaned. While comparisons of survey results indicate reten- tion of knowledge and improved understanding of MDR practices comparisons of hospitals assessments did not reflect the same level of process change that participants identified.

Conclusion:Findings from this study highlight the value education and mentoring have on both participants’knowledge and understanding of how to do their work and the value they placed on MDR practices. Impli- cations for clinical practice are that formal education on MDR needs to be mandatory for all MDR staff if risks of surgical site infections are to be reduced. However, analysis of MDR processes before and after training suggest that while training and mentorship produce positive changes in individuals, the organization and culture they work in produce barriers to improvements that need to be addressed by others with authority.

Disclosure of Interest

O. Fast Grant/Research support from: Research partially funded by Mercy Ships Canada and Mount Royal University, Other conflict with: I am the chair of Sterile Processing Education Charitable Trust (SPECT), the organization that developed and implemented the edu- cation and training, which are the focus of this research project

P200

Effect of surfactant in an alkaline detergent for steady cleaning performance during medical device reprocessing in washer disinfectors

Glen Lelyn Quan, Yuka Oda, Emiko Kawamukai, Yoshihiko Hirata

1_{Biochemical Laboratory, SARAYA CO., LTD., Osaka, Japan}

Correspondence:Glen Lelyn Quan

Antimicrobial Resistance and Infection Control2017,6(Suppl 3):P200

Introduction:Thorough cleaning of medical devices is essential in in- fection control and prevention during medical device (MD) reproces- sing. The use of washer disinfectors plays a vital role in effective

reprocessing as they ensure validated reprocessing cycles and, as a closed system, reduce human exposure to process chemistries.(1) Ex- cessive foaming is often a problem for WDs as it can affect machine performance, decelerate jet pressure and spray arms, impede deter- gent performance, and therefore, compromise the quality of the cleaning process. Among the commonly used detergents, alkaline detergents especially, react with organic soil and cause excessive foaming.

Objectives:This study explored the impact of surfactant in an alka- line detergent to control excessive foam formation in WDs for steady cleaning efficiency towards medical devices in the presence of or- ganic soil.

Methods: The foam formation of an alkaline detergent, with and without surfactant, was compared with a representative washer disin- fector WD-32 (Saraya Co., Ltd.), in the presence of heparinized sheep blood. The detegency was then compared using soiled SUS test piece model that mimic simple and complex MDs.

Results:In the presence of heparinized sheep blood, the alkaline de- tergent sans surfactant showed excessive formation of foam, halting the machine in mid process, whereas with the surfactant-containing detergent, foam formation was suppressed, enabling complete and successful reprocessing. In terms of detergency, the surfactant- containing alkaline detergent not only exhibited higher detergency, but was also able to minimize the difference in detergency between simple and complex test device model in the presence of heparin- ized sheep blood, as well. With this, steady detergency performance was shown achievable regardless the type of MDs used even in the presence of organic soil.

Conclusion:The synergistic action of surfactant with alkaline deter- gent not only prevented machine failure and ineffective cleaning from excessive foaming, but was also able to deliver steady deter- gent action in reprocessing simple to complex MDs, increasing the quality of cleaning performance during medical device reprocessing.

References

(1) ESGE-ESGENA Guideline: Cleaning and disinfection in gastrointestinal en- doscopy (Update 2008)

Disclosure of Interest

None Declared

P201

Surgical equipment sterilization practice among health care workers in private hospitals in Zaria, North Western Nigeria

Lawal Amadu1, Abdulhakeem A. Olorukooba1, Aisha A. Abubakar1, Muhammad S. Balogun2_{, Shamsudeen Aliyu}3_{, Shamsudeen S. Yahaya}4_,

Muawiyyah B. Sufiyan1, Bola B. Lawal5, Itodo David1

1_{Community Medicine Department, Ahmadu Bello University Zaria,}

Kaduna state, Nigeria, Zaria;2AFENET, African Field Epidemiology Network, Abuja;3_{Medical Microbiology, Ahmadu Bello University Zaria,}

Kaduna state, Nigeria, Zaria;4State Primary Health Care agency, State Ministry of Health, Katsina;5_{Nigerian Field Epidemiology and Laboratory}

training program, NFELP, Zaria, Nigeria

Correspondence:Lawal Amadu

Antimicrobial Resistance and Infection Control2017,6(Suppl 3):P201

Introduction:Sterilization and disinfection are indispensable for ensur- ing that surgical instruments do not transmit infections to patients. In- effective sterilization and disinfection of surgical equipment would invariably result in Hospital acquired infections(HAI). The practice of sterilization among health care workers is generally poor. While most studies dwell on the practice among public health institutions, there is little or no information on the situation among Private health workers.

Objectives:This study aims to examine the practice of disinfection and sterilization of surgical equipment among health workers in Pri- vate hospitals in Zaria, Nigeria

Methods:A descriptive cross sectional study was carried out among 144 respondents selected using a multi-stage sampling technique. Pretested, pre-coded, self-administered questionnaire was used to elicit information from the respondents. Data was entered and

analysed using IBM SPSS v 21.0. Test for association was carried out at a significant level of P≤0.05.

Results:Majority (45.8%) of the respondents were doctors, and more than half of them had less than 5 years working experience. Only 21.5% had good knowledge of sterilization while 96.5% had positive attitude. However, the practice of sterilization was found to be low as only 38.2% had appropriate practice. There was no statistical sig- nificant association between years of working experience and prac- tice of sterilization (P = 0.719)

Conclusion: The practice of sterilization among private health workers was found to be poor. There is need for the Ministry of Health in collaboration with the Guild of Medical directors to in- stitute and maintain training and education of Private health workers on sterilization and its importance in prevention and control of HAIs.

Disclosure of Interest

None Declared

P202

Improved technique of rapid and accurate peracetic acid test strips with sharp color by comprising advanced indicator solution

Madan A. Mali, Satomi Sakai, Emiko Kawamukai, Yoshihiko Hirata Biochemical Laboratory, SARAYA CO., LTD., Osaka, Japan

Correspondence:Madan A. Mali

Antimicrobial Resistance and Infection Control2017,6(Suppl 3):P202

Introduction:

Test strips are normally used in disinfection process of medical de- vices to monitor the effective concentration of high level disinfec- tants such as peracetic acid. Currently, the peracetic acid test strips available in the market exhibit different color shades that require 20 seconds to 2 minutes reaction time for evaluation. At times when the color judgment falls between two color shades, it will be difficult for users to judge the results. If strips interpretation will be wrong, there is a risk for ineffective disinfection process of medical devices. With the development of sharp colored strips, such incidents can be avoided, and will make users monitor the concentration of peracetic acid more easily and effectively.

Objectives:

To obtain sharp color of rapid and accurate peracetic acid test strips by comprising advanced indicator solution

Methods:

1.Preparation of Indicator solutions

The base indicator solution A was prepared with combination of iodide-starch solution. The advanced indicator solution B was prepared with the combination of iodide-starch and water soluble additives. 2.Test methods

The test strips were comprised with solutions A and B respectively. Each strip was soaked into peracetic acid solutions for few seconds and strip color was monitored after suitable reaction time. The ob- tained strip colors of solution A and B were compared.

Results:

1.The strip comprised with base indicator solution obtained the dif- ferent color shades.

2. The strip comprised with improved indicator solution obtained sharp color for PASS and FAIL criteria within 15 seconds.

PASS evaluation - complete black color at effective concentration of peracetic acid solution

FAIL evaluation - incomplete color with white spots at ineffective concentration of peracetic acid solution

Conclusion:

The rapid and accurate test strips obtained distinguishable sharp color with improved indicator solution. Due to shorter reaction time and easy judgment with PASS and FAIL criteria, these strips are very convenient, user friendly and time- saving for monitoring the con- centration of peracetic acid effectively in disinfection process of med- ical devices.

Disclosure of Interest