Rhinology Abstracts VOLUME 27
NUMBER 6
November–December 2013
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Abstract editor OTOLARYNGOLOGY Ronald G. Amedee, M.D. Chairman Department of Otolaryngology Ochsner Health System 1514 Jefferson Hwy. New Orleans, LA 70121
Otolaryngology Disinfection of rigid nasal endoscopes following in vitro contamination with Staphylococcus aureus, Streptococcus pneumoniae, Pseudomonas aeruginosa, and Haemophilus influenzae. Bradford BD, Seiberling KA, Park FE, Hiebert JC, Chang DF. JAMA Otolaryngol Head Neck Surg 139:574–578, 2013 The use of rigid endosopes is almost ubiquitous amongst otolaryngologists that see patients with sinonasal complaints. Many endoscopes are used throughout the day and processed several times over. There is the always the concern for cross-contamination secondary persistent infectious agents on endoscopes. The CDC and FDA consider rigid endoscopes a “semicritical” device because they touch mucous membranes and thus must be disinfected at a high level. Despite this, endoscopes are processed in a variety of fashions and no one standardized protocol is present. Bradford et al. attempts to test the efficacy of various manual disinfection methods, in vitro, after inoculation of rigid endoscopes with common sinonasal bacterial pathogens. A non-channel rigid endoscope was used for the study. The same endoscope was washed with tap water and immersed in an enzymatic soap solution to serve as a negative control and to insure sufficient disinfection after each trial. A clean endoscope was placed for 30 seconds in a solution of bacterial cultures that contained: Staphylococcus aureus, Streptococcus pneumoniae , Pseudomonas aeruginosa and Haemophilus influenza. The end of the scope was subsequently swabbed with a sterile cotton tipped applicator and applied to a culture medium. Samples of each of the bacteria above were taken from their respective solutions and plated as positive controls. There was a 30 sec water rinse after each inoculation followed by “a cleaning.” There were 2 cleaning arms to the study. Arm A’s cleaning was immediate and arm B’s took place after a 1-hour air-dry delay. There were 8 manual cleaning techniques examined in each arm: 30 seconds of tap water alone, a 30 second antimicrobial soap and water scrub, 30-second scrub with isopropyl alcohol (70%), 30-second antibacterial soap and
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water scrub with a subsequent 30-second isopropyl alcohol scrub, 30-second scrub with germicidal cloth, 5-minute immersion in enzymatic soap solution, and finally a 5- and 10-minute immersions in Cidex OPA. All plates were examined at 24 and 48 hours. Each different disinfection protocol was performed 4 separate times with each organism for both groups. All negative controls were negative and all positive controls were positive. The study demonstrated that no cultures grew in either study arm with a 10 minute immersion in Cidex OPA. In arm B (cleaning after 1-hour air-dry delay) 2 additional techniques were also culture negative: isopropyl alcohol scrub for 30 seconds and the combination of antimicrobial soap and water scrub for 30 seconds followed by a 30 second isopropyl alcohol scrub. Growth of Pseudomonas aeruginosa was found after all of the disinfection protocols in arm A (with the exception of a 10 minute immersion in Cidex OPA), and in arm B (except for the 10 minute Cidex OPA immersion and the antimicrobial soap plus isopropyl alcohol protocol). It should be noted that an isolated 30 second tap water rinse did significantly decrease bacterial colony counts throughout the study. The strength of this study is that it has very sound methods and appeared relatively free of bias. It tested for the 4 most clinically relevant pathogens in situations similar to practice; both immediate and delayed cleaning scenarios were examined. Appropriate controls were established and reliable. A main weakness of the study is the relatively low number of trials (8) for each disinfection technique and only one type of chemical disinfectant was examined (Cidex OPA). Also, only manual disinfection techniques were examined, and automated endoscope processing is certainly used in many practices. One could also bring into question the culture methods; would the same results have been obtained using a FISH probe? However, a difference in culture method would likely not change the clinical relevance of the findings. Finally, the study did not examine viruses which are common and difficult to eradicate. Overall, this is an excellent study that will contribute to the body of evidence for establishing helpful sterilization guidelines for rigid nasal endoscopes. This study highlights the relative resistance of pseudomonas and the efficacy of a cost-effective and rapid chemical sterilization technique for rigid nasal endoscopes.
John M. Carter, M.D. Ronald G. Amedee, M.D.
November–December 2013, Vol. 27, No. 6
Delivered by Ingenta to: Guest User IP: 5.101.218.37 On: Sun, 26 Jun 2016 04:15:28 Copyright (c) Oceanside Publications, Inc. All rights reserved. For permission to copy go to https://www.oceansidepubl.com/permission.htm
NUMBER 6
November–December 2013
Y P
Abstract editor OTOLARYNGOLOGY Ronald G. Amedee, M.D. Chairman Department of Otolaryngology Ochsner Health System 1514 Jefferson Hwy. New Orleans, LA 70121
Otolaryngology Disinfection of rigid nasal endoscopes following in vitro contamination with Staphylococcus aureus, Streptococcus pneumoniae, Pseudomonas aeruginosa, and Haemophilus influenzae. Bradford BD, Seiberling KA, Park FE, Hiebert JC, Chang DF. JAMA Otolaryngol Head Neck Surg 139:574–578, 2013 The use of rigid endosopes is almost ubiquitous amongst otolaryngologists that see patients with sinonasal complaints. Many endoscopes are used throughout the day and processed several times over. There is the always the concern for cross-contamination secondary persistent infectious agents on endoscopes. The CDC and FDA consider rigid endoscopes a “semicritical” device because they touch mucous membranes and thus must be disinfected at a high level. Despite this, endoscopes are processed in a variety of fashions and no one standardized protocol is present. Bradford et al. attempts to test the efficacy of various manual disinfection methods, in vitro, after inoculation of rigid endoscopes with common sinonasal bacterial pathogens. A non-channel rigid endoscope was used for the study. The same endoscope was washed with tap water and immersed in an enzymatic soap solution to serve as a negative control and to insure sufficient disinfection after each trial. A clean endoscope was placed for 30 seconds in a solution of bacterial cultures that contained: Staphylococcus aureus, Streptococcus pneumoniae , Pseudomonas aeruginosa and Haemophilus influenza. The end of the scope was subsequently swabbed with a sterile cotton tipped applicator and applied to a culture medium. Samples of each of the bacteria above were taken from their respective solutions and plated as positive controls. There was a 30 sec water rinse after each inoculation followed by “a cleaning.” There were 2 cleaning arms to the study. Arm A’s cleaning was immediate and arm B’s took place after a 1-hour air-dry delay. There were 8 manual cleaning techniques examined in each arm: 30 seconds of tap water alone, a 30 second antimicrobial soap and water scrub, 30-second scrub with isopropyl alcohol (70%), 30-second antibacterial soap and
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O N
O C
water scrub with a subsequent 30-second isopropyl alcohol scrub, 30-second scrub with germicidal cloth, 5-minute immersion in enzymatic soap solution, and finally a 5- and 10-minute immersions in Cidex OPA. All plates were examined at 24 and 48 hours. Each different disinfection protocol was performed 4 separate times with each organism for both groups. All negative controls were negative and all positive controls were positive. The study demonstrated that no cultures grew in either study arm with a 10 minute immersion in Cidex OPA. In arm B (cleaning after 1-hour air-dry delay) 2 additional techniques were also culture negative: isopropyl alcohol scrub for 30 seconds and the combination of antimicrobial soap and water scrub for 30 seconds followed by a 30 second isopropyl alcohol scrub. Growth of Pseudomonas aeruginosa was found after all of the disinfection protocols in arm A (with the exception of a 10 minute immersion in Cidex OPA), and in arm B (except for the 10 minute Cidex OPA immersion and the antimicrobial soap plus isopropyl alcohol protocol). It should be noted that an isolated 30 second tap water rinse did significantly decrease bacterial colony counts throughout the study. The strength of this study is that it has very sound methods and appeared relatively free of bias. It tested for the 4 most clinically relevant pathogens in situations similar to practice; both immediate and delayed cleaning scenarios were examined. Appropriate controls were established and reliable. A main weakness of the study is the relatively low number of trials (8) for each disinfection technique and only one type of chemical disinfectant was examined (Cidex OPA). Also, only manual disinfection techniques were examined, and automated endoscope processing is certainly used in many practices. One could also bring into question the culture methods; would the same results have been obtained using a FISH probe? However, a difference in culture method would likely not change the clinical relevance of the findings. Finally, the study did not examine viruses which are common and difficult to eradicate. Overall, this is an excellent study that will contribute to the body of evidence for establishing helpful sterilization guidelines for rigid nasal endoscopes. This study highlights the relative resistance of pseudomonas and the efficacy of a cost-effective and rapid chemical sterilization technique for rigid nasal endoscopes.
John M. Carter, M.D. Ronald G. Amedee, M.D.
November–December 2013, Vol. 27, No. 6
Delivered by Ingenta to: Guest User IP: 5.101.218.37 On: Sun, 26 Jun 2016 04:15:28 Copyright (c) Oceanside Publications, Inc. All rights reserved. For permission to copy go to https://www.oceansidepubl.com/permission.htm
