Clinical Anatomy 28:164–167 (2015)
MEDICAL AND DENTAL EDUCATION
Using ATP-Driven Bioluminescence Assay to Monitor Microbial Safety in a Contemporary Human Cadaver Laboratory BRION BENNINGER1,2,3,4,5,6,7,8,9,10*
AND
THOMAS MAIER11
1
Medical Anatomy Center, Western University of Health Sciences, COMP–Northwest, Lebanon, Oregon Department of Medical Anatomical Sciences, Western University of Health Sciences, COMP–Northwest, Lebanon, Oregon 3 Department of Neuromuscular Medicine, Western University of Health Sciences, COMP–Northwest, Lebanon, Oregon 4 Department of Family Practice, Western University of Health Sciences, COMP–Northwest, Lebanon, OR 5 Faculty, College of Dental Medicine, Pomona, California 6 Department of Orthopaedics, Samaritan Health Services, Corvallis, Oregon 7 Department of General Surgery, Samaritan Health Services, Corvallis, Oregon 8 Department of Oral Maxillofacial Surgery, Oregon Health & Science University, Portland, Oregon 9 Department of Surgery, Oregon Health & Science University, Portland, Oregon 10 Department of Orthopaedics & Rehabilitation, Oregon Health & Science University, Portland, Oregon 11 Department of Pathology, Oregon Health & Science University, Portland, Oregon 2
Introduction: The objective of this study was to utilize a cost-effective method for assessing the levels of bacterial, yeast, and mold activity during a human dissection laboratory course. Nowadays, compliance with safety regulations is policed by institutions at higher standards than ever before. Fear of acquiring an unknown infection is one of the top concerns of professional healthcare students, and it provokes anti-laboratory anxiety. Human cadavers are not routinely tested for bacteria and viruses prior to embalming. Human anatomy dissecting rooms that house embalmed cadavers are normally cleaned after the dissected cadavers have been removed. There is no evidence that investigators have ever assessed bacterial and fungal activities using adenosine triphosphate (ATP)-driven bioluminescence assays. Methods: A literature search was conducted on texts, journals, and websites regarding bacterial, yeast, and mold activities in an active cadaver laboratory. Midway into a clinical anatomy course, ATP bioluminescence assays were used to swab various sites within the dissection room, including entrance and exiting door handles, water taps, cadaver tables, counter tops, imaging material, X-ray box switches, and the cadaver surfaces. Results: The results demonstrated very low activities on cadaver tables, washing up areas, and exiting door handles. There was low activity on counter tops and X-ray boxes. There was medium activity on the entrance door handles. Conclusion: These findings suggest an inexpensive and accurate method for monitoring safety compliance and microbial activity. Students can feel confident and safe in the environment in which they work. Clin. Anat. 28:164–167, 2015. VC 2014 Wiley Periodicals, Inc.
*Correspondence to: Brion Benninger, Western University of Health Sciences, COMP-Northwest, 200 Mullins Way, Lebanon OR or Oregon Health & Science University, 611 SW Campus Drive, Portland, OR 97239. E-mail: [email protected] [email protected] Received 17 May 2013; Revised 16 September 2014; Accepted 26 September 2014 Published online 27 October 2014 in Wiley Online Library (wileyonlinelibrary.com). DOI: 10.1002/ca.22478
C V
2014 Wiley Periodicals, Inc.
Microbial Safety in a Contemporary Human Cadaver Laboratory
165
Key words: bioluminescence; adenosine triphosphate; microbial; safety; cadaver lab
INTRODUCTION Many healthcare professionals believe it is essential to use human cadaver dissection as part of the teaching process to ensure an understanding clinical anatomy (Shoja et al., 2013). Human cadaver dissection is a memorable experience: it facilitates and maximizes students’ awareness of the body’s architecture. There are multiple benefits from cadaver dissection, which include: tactile and visual learning, group interaction, and coping with mortality fears, taboos, and professionalism. Fear of acquiring an unknown infection is one of the top concerns of students, and it provokes an “antidissection laboratory” anxiety. Human cadavers for embalming are not routinely tested for bacteria and viruses, but compliance with safety regulations is policed by institutions at higher standards nowadays than ever before. We wanted to assess
microbial activity in a human dissection laboratory in as cost effective and efficient a way as possible, midway into a clinical anatomy course. Human anatomy dissecting rooms that house embalmed cadavers are normally cleaned after the dissected cadavers have been removed. However, we found no evidence that bacterial and fungal activities midway through a dissecting course had ever been assessed (Fig. 1A–D). There appear to be too many variables and too much controversy for the claim that embalming chemicals rid the body of all infective agents to be accepted (Thoen and Bloom, 1995; Grange, 1996; Gerston et al., 1998; Barnes et al., 2000; Park et al., 2003; Nolte, 2005). We chose to investigate a cost effective, easilyadministered technique for assessing bacterial and fungal activities throughout a human anatomy dissection course. The objective of this study was to utilize a cost-effective method for measuring
Fig. 1. Four areas of microbial activity testing: (A) communal door handle exiting lab, (B) communal student lunch refrigerator, (C) light-box adjustment switch, and (D) hand washing sink. [Color figure can be viewed in the online issue, which is available at wileyonlinelibrary.com.]
166
Benninger and Maier screen represents relative light units. The meter provides, within seconds, readings of the level of contamination. The CariScreen meter reading device costs $1,500 US and the swabs are $2.50 each. Swabs were taken midway through a cadaver laboratory course from the same sample sites on two separate days. We had a total number of 11 sites: nine inside and two outside the laboratory. The total number of samples was 39.
RESULTS Fig. 2. Cariscreen handheld microbial analysis device. [Color figure can be viewed in the online issue, which is available at wileyonlinelibrary.com.]
bacterial, yeast, and mold activities during a human dissection laboratory course.
The literature search revealed no studies measuring bacterial, yeast, and mold activities during an active anatomy dissection course. Using the ATPdriven bioluminescence assays, the results revealed very low activity at cadaver tables, washing up areas, and exiting door handles. There was low activity on counter tops and X-ray boxes. There was higher activity on the entrance door handles. Surprisingly, the highest levels were recorded on the communal refrigerator door handle (Fig. 3).
METHODS A literature search was conducted on texts, journals, and websites regarding bacterial, yeast, and mold activities during an active cadaver laboratory course. Using adenosine triphosphate (ATP)-driven bioluminescence assays, swabs taken from various sites within a cadaver dissection laboratory including entrance and exit door handles, washing sinks, cadaver tables, counter tops, X-ray box switches, audio system, cooling system switches, and cadaver surfaces were tested. Outside the laboratory, swabs were used to test the handle of the students’ communal food refrigerator. A CariScreen meter in connection with a CariScreen Swab was used to measure ATP, the universal energy molecule found in all animal, plant, bacterial, yeast, and mold cells (Fazilat et al., 2010) (Fig. 2). When ATP is brought into contact with the unique liquid–stable luciferase/luciferin reagent within the CariScreen Swab sampling device, the intensity of the light emitted is directly proportional to the amount of ATP present. The figure demonstrated on the digital
DISCUSSION Dissection of the human body is one of the most powerful memory-evoking methods for students learning the body’s structures, orientation, and language. The concern of health care students regarding dissection of tissue that is no longer viable is the risk of acquiring infection through a prick or a cut. Every institution that teaches an anatomy dissection course faces students who are notably anxious; this anxiety can make them reluctant to participate in dissection. We now live in an era of evidence-based medicine, and health care students expect scientific data to alleviate their anxiety regarding infection in the laboratory. This study used a relatively inexpensive, rapid technique to provide an efficient data response. The results were conveyed to the students immediately and they reported feeling less anxious, safer, and more confident in the environment in which they dissected.
Fig. 3. Graph revealing microbial activity via light units. [Color figure can be viewed in the online issue, which is available at wileyonlinelibrary.com.]
Microbial Safety in a Contemporary Human Cadaver Laboratory
CONCLUSION This study suggests an inexpensive method for monitoring safety compliance regarding ATPgenerating infecting agents (bacteria, yeast, and molds) that can be used during an active cadaver laboratory course in both academic and professional continuing-education settings.
ACKNOWLEDGMENTS The authors would like to thank those who graciously donated themselves to allow this research to occur. Thank you McDaniel Surgical Radiological and Research Anatomy Lab. Special thanks to Barbara Davidson for manuscript support.
REFERENCES Barnes I, Holton J, Vaira D, Spigelman M, Thomas MG. 2000. An assessment of the long-term preservation of the DNA of a bacterial pathogen in ethanol-preserved archival material. J Pathol 192:554–559.
167
Fazilat S, Sauerwein R, McLeod J, Finlayson T, Adam E, Engle J, Gagneja P, Maier T, Machida C. 2010. Application of adenosine triphosphatedriven bioluminescence for quantification of plaque bacteria and assessment of oral hygiene in children. Pediatr Dent 32:195–204. Gerston KF, Blumberg L, Gafoor H. 1998. Viability of mycobacteria in formalin-fixed tissues. Int J Tuberc Lung Disc 6:521. Grange JM. 1996. Mycobacteria and human disease. 2nd Ed. London: Arnold. Nolte KB. 2005. Survival of mycobacterium tuberculosis organisms for 8 days in fresh lung tissue from an exhumed body. Hum Pathol 36:915–916. Park DY, Kim JY, Choi KU, Lee JS, Lee CH, Sol MY, Suh KS. 2003. Comparison of polymerase chain reaction with histopathologic features for diagnosis of tuberculosis in formalin-fixed, paraffinembedded histologic specimens. Arch Pathol Lab Med 127:326– 330. Shoja MM, Benninger B, Agutter P, Loukas M, Tubbs RS. 2013. A historical perspective: Infection from cadaveric dissection from the 18th to 20th centuries. Clin Anat 26:154–160. Thoen CO, Bloom BR. 1995. Pathogenesis of mycobacterium bovis. In: Thoen CO, Steele JH, editors. Mycobacterium Bovis Infection in Animals and Humans. Amed: Iowa State University Press. p 3–14.
MEDICAL AND DENTAL EDUCATION
Using ATP-Driven Bioluminescence Assay to Monitor Microbial Safety in a Contemporary Human Cadaver Laboratory BRION BENNINGER1,2,3,4,5,6,7,8,9,10*
AND
THOMAS MAIER11
1
Medical Anatomy Center, Western University of Health Sciences, COMP–Northwest, Lebanon, Oregon Department of Medical Anatomical Sciences, Western University of Health Sciences, COMP–Northwest, Lebanon, Oregon 3 Department of Neuromuscular Medicine, Western University of Health Sciences, COMP–Northwest, Lebanon, Oregon 4 Department of Family Practice, Western University of Health Sciences, COMP–Northwest, Lebanon, OR 5 Faculty, College of Dental Medicine, Pomona, California 6 Department of Orthopaedics, Samaritan Health Services, Corvallis, Oregon 7 Department of General Surgery, Samaritan Health Services, Corvallis, Oregon 8 Department of Oral Maxillofacial Surgery, Oregon Health & Science University, Portland, Oregon 9 Department of Surgery, Oregon Health & Science University, Portland, Oregon 10 Department of Orthopaedics & Rehabilitation, Oregon Health & Science University, Portland, Oregon 11 Department of Pathology, Oregon Health & Science University, Portland, Oregon 2
Introduction: The objective of this study was to utilize a cost-effective method for assessing the levels of bacterial, yeast, and mold activity during a human dissection laboratory course. Nowadays, compliance with safety regulations is policed by institutions at higher standards than ever before. Fear of acquiring an unknown infection is one of the top concerns of professional healthcare students, and it provokes anti-laboratory anxiety. Human cadavers are not routinely tested for bacteria and viruses prior to embalming. Human anatomy dissecting rooms that house embalmed cadavers are normally cleaned after the dissected cadavers have been removed. There is no evidence that investigators have ever assessed bacterial and fungal activities using adenosine triphosphate (ATP)-driven bioluminescence assays. Methods: A literature search was conducted on texts, journals, and websites regarding bacterial, yeast, and mold activities in an active cadaver laboratory. Midway into a clinical anatomy course, ATP bioluminescence assays were used to swab various sites within the dissection room, including entrance and exiting door handles, water taps, cadaver tables, counter tops, imaging material, X-ray box switches, and the cadaver surfaces. Results: The results demonstrated very low activities on cadaver tables, washing up areas, and exiting door handles. There was low activity on counter tops and X-ray boxes. There was medium activity on the entrance door handles. Conclusion: These findings suggest an inexpensive and accurate method for monitoring safety compliance and microbial activity. Students can feel confident and safe in the environment in which they work. Clin. Anat. 28:164–167, 2015. VC 2014 Wiley Periodicals, Inc.
*Correspondence to: Brion Benninger, Western University of Health Sciences, COMP-Northwest, 200 Mullins Way, Lebanon OR or Oregon Health & Science University, 611 SW Campus Drive, Portland, OR 97239. E-mail: [email protected] [email protected] Received 17 May 2013; Revised 16 September 2014; Accepted 26 September 2014 Published online 27 October 2014 in Wiley Online Library (wileyonlinelibrary.com). DOI: 10.1002/ca.22478
C V
2014 Wiley Periodicals, Inc.
Microbial Safety in a Contemporary Human Cadaver Laboratory
165
Key words: bioluminescence; adenosine triphosphate; microbial; safety; cadaver lab
INTRODUCTION Many healthcare professionals believe it is essential to use human cadaver dissection as part of the teaching process to ensure an understanding clinical anatomy (Shoja et al., 2013). Human cadaver dissection is a memorable experience: it facilitates and maximizes students’ awareness of the body’s architecture. There are multiple benefits from cadaver dissection, which include: tactile and visual learning, group interaction, and coping with mortality fears, taboos, and professionalism. Fear of acquiring an unknown infection is one of the top concerns of students, and it provokes an “antidissection laboratory” anxiety. Human cadavers for embalming are not routinely tested for bacteria and viruses, but compliance with safety regulations is policed by institutions at higher standards nowadays than ever before. We wanted to assess
microbial activity in a human dissection laboratory in as cost effective and efficient a way as possible, midway into a clinical anatomy course. Human anatomy dissecting rooms that house embalmed cadavers are normally cleaned after the dissected cadavers have been removed. However, we found no evidence that bacterial and fungal activities midway through a dissecting course had ever been assessed (Fig. 1A–D). There appear to be too many variables and too much controversy for the claim that embalming chemicals rid the body of all infective agents to be accepted (Thoen and Bloom, 1995; Grange, 1996; Gerston et al., 1998; Barnes et al., 2000; Park et al., 2003; Nolte, 2005). We chose to investigate a cost effective, easilyadministered technique for assessing bacterial and fungal activities throughout a human anatomy dissection course. The objective of this study was to utilize a cost-effective method for measuring
Fig. 1. Four areas of microbial activity testing: (A) communal door handle exiting lab, (B) communal student lunch refrigerator, (C) light-box adjustment switch, and (D) hand washing sink. [Color figure can be viewed in the online issue, which is available at wileyonlinelibrary.com.]
166
Benninger and Maier screen represents relative light units. The meter provides, within seconds, readings of the level of contamination. The CariScreen meter reading device costs $1,500 US and the swabs are $2.50 each. Swabs were taken midway through a cadaver laboratory course from the same sample sites on two separate days. We had a total number of 11 sites: nine inside and two outside the laboratory. The total number of samples was 39.
RESULTS Fig. 2. Cariscreen handheld microbial analysis device. [Color figure can be viewed in the online issue, which is available at wileyonlinelibrary.com.]
bacterial, yeast, and mold activities during a human dissection laboratory course.
The literature search revealed no studies measuring bacterial, yeast, and mold activities during an active anatomy dissection course. Using the ATPdriven bioluminescence assays, the results revealed very low activity at cadaver tables, washing up areas, and exiting door handles. There was low activity on counter tops and X-ray boxes. There was higher activity on the entrance door handles. Surprisingly, the highest levels were recorded on the communal refrigerator door handle (Fig. 3).
METHODS A literature search was conducted on texts, journals, and websites regarding bacterial, yeast, and mold activities during an active cadaver laboratory course. Using adenosine triphosphate (ATP)-driven bioluminescence assays, swabs taken from various sites within a cadaver dissection laboratory including entrance and exit door handles, washing sinks, cadaver tables, counter tops, X-ray box switches, audio system, cooling system switches, and cadaver surfaces were tested. Outside the laboratory, swabs were used to test the handle of the students’ communal food refrigerator. A CariScreen meter in connection with a CariScreen Swab was used to measure ATP, the universal energy molecule found in all animal, plant, bacterial, yeast, and mold cells (Fazilat et al., 2010) (Fig. 2). When ATP is brought into contact with the unique liquid–stable luciferase/luciferin reagent within the CariScreen Swab sampling device, the intensity of the light emitted is directly proportional to the amount of ATP present. The figure demonstrated on the digital
DISCUSSION Dissection of the human body is one of the most powerful memory-evoking methods for students learning the body’s structures, orientation, and language. The concern of health care students regarding dissection of tissue that is no longer viable is the risk of acquiring infection through a prick or a cut. Every institution that teaches an anatomy dissection course faces students who are notably anxious; this anxiety can make them reluctant to participate in dissection. We now live in an era of evidence-based medicine, and health care students expect scientific data to alleviate their anxiety regarding infection in the laboratory. This study used a relatively inexpensive, rapid technique to provide an efficient data response. The results were conveyed to the students immediately and they reported feeling less anxious, safer, and more confident in the environment in which they dissected.
Fig. 3. Graph revealing microbial activity via light units. [Color figure can be viewed in the online issue, which is available at wileyonlinelibrary.com.]
Microbial Safety in a Contemporary Human Cadaver Laboratory
CONCLUSION This study suggests an inexpensive method for monitoring safety compliance regarding ATPgenerating infecting agents (bacteria, yeast, and molds) that can be used during an active cadaver laboratory course in both academic and professional continuing-education settings.
ACKNOWLEDGMENTS The authors would like to thank those who graciously donated themselves to allow this research to occur. Thank you McDaniel Surgical Radiological and Research Anatomy Lab. Special thanks to Barbara Davidson for manuscript support.
REFERENCES Barnes I, Holton J, Vaira D, Spigelman M, Thomas MG. 2000. An assessment of the long-term preservation of the DNA of a bacterial pathogen in ethanol-preserved archival material. J Pathol 192:554–559.
167
Fazilat S, Sauerwein R, McLeod J, Finlayson T, Adam E, Engle J, Gagneja P, Maier T, Machida C. 2010. Application of adenosine triphosphatedriven bioluminescence for quantification of plaque bacteria and assessment of oral hygiene in children. Pediatr Dent 32:195–204. Gerston KF, Blumberg L, Gafoor H. 1998. Viability of mycobacteria in formalin-fixed tissues. Int J Tuberc Lung Disc 6:521. Grange JM. 1996. Mycobacteria and human disease. 2nd Ed. London: Arnold. Nolte KB. 2005. Survival of mycobacterium tuberculosis organisms for 8 days in fresh lung tissue from an exhumed body. Hum Pathol 36:915–916. Park DY, Kim JY, Choi KU, Lee JS, Lee CH, Sol MY, Suh KS. 2003. Comparison of polymerase chain reaction with histopathologic features for diagnosis of tuberculosis in formalin-fixed, paraffinembedded histologic specimens. Arch Pathol Lab Med 127:326– 330. Shoja MM, Benninger B, Agutter P, Loukas M, Tubbs RS. 2013. A historical perspective: Infection from cadaveric dissection from the 18th to 20th centuries. Clin Anat 26:154–160. Thoen CO, Bloom BR. 1995. Pathogenesis of mycobacterium bovis. In: Thoen CO, Steele JH, editors. Mycobacterium Bovis Infection in Animals and Humans. Amed: Iowa State University Press. p 3–14.
