The exploration of optimum cycle of automatic washer disinfector for endozime auto wash triple plus with advanced proteolytic action / 中国实用护理杂志

Objective To explore optimum cycle of Automatic Washer Disinfector for endozime auto wash triple plus with advanced proteolytic action to ensure mechanical cleaning quality and improve safety of reusable medical instruments. Methods Visual inspection, STF cleaning efficacy monitoring test and Adenosine Triphosphate (ATP) test were used to verify cleaning quality of the newly updated No.4 automatic washer disinfector, and changed key parameters on weekly basis, such as pre-cleaning temperature, pre-cleaning time, detergent concentration, main cleaning temperature, and main flushing time, recorded cleaning results for three weeks:Group test of initial procedure, Group test 1 of optimization procedure and Group test 2 of optimization procedure.Χ2 test was used to compare differences of the three groups and determine the optimum cycle. Results Group test 2 of optimization procedure had the highest visual inspection and ATP test qualification rate (both were 100.00%), and pass all the STF tests. Cleaning quality was significantly better than the other two groups, and the cycle made full use of the tested detergent. Conclusions Cycle parameters of cleaning machine have great impact on medical instruments cleaning quality; Specific consuming products need to be verified to determine the optimum cleaning cycle.

Facture and clinical application study of perineal washer / 中国实用护理杂志

Objective We aimed to develop a safe, comfortable and effective perineal washer, which prevent perineum wound from infection and improve the healing of perineal wound. Methods The perineal washer was made from high polymer medical material, including two metal catheters, pressing gasbag, medical yoke and dicty blow head. We divided women patients after vagina delivery with perineum wound or after caesarean section into the observation group and the control group randomly with 120 cases in each group from Janurary to October 2007. The control group was given perineal washing by routine washing pot and cotton ball with forceps. The observation group received perineal washing by perineal washer with cleaning fluid and was scrubbed by sponge brash. The elimination of wood swelling, the healing of perineum healing, the urinary infection for patients with indwelling urinary catheterization and patients comfort degree were observed in the two groups. Results Statistical difference existed between the two groups in such aspects, elimination of wound swelling wound healing urinary tract infection and patients comfort degree, P<0.05 or P<0.01. Conclusions Adoption of self designed perineal washer accompanied with sponge brush could completely delete bacteria and inflammatory secretion deep in the vagina and prevent the incidence of infection. It not only could hasten the elimination of wound swelling, alleviate the pain and wound healing, but also was easily developed and portable to use. It provided a new and effective method for perineal washing and is worth clinical application.

Effect of the surface modifications and the use of washer on the reverse torque of the implant prosthetic gold retaining screw / 대한치과보철학회지

The screw loosening is one of the complications that happen frequently in dental implant prostheses. The purpose of this study was to evaluate the changes of reverse/loosening (opening) torque of the screw according to the surface modifications by sandblasting and 24K gold electroplating as well as to determine the possibility of the clinical use of a washer in dental implant. The reverse torque of 4 experimental conditions(control, sandblasted, use of washers, electroplasted) was measured by digital torque gauge (Model MGT50Z, Mark-10 Corp., 458 West John Street Hicksville, NY 11801 USA). Electronic torque controller (Nobel Biocare DEA 020) was used in fastening the gold screws into abutment replicas. Mixed Linear Model Analysis method was used for statistical analysis. To examine the changes of screw thread surface, microphotographs were taken by Olympus PME-3 metallurgic microscope (Olympus Optical Co. Ltd., Tokyo, Japan). Within the limitations of this study, the following results were drawn: 1. The surface modifications of the gold screws and the use of a washer have significantly affected the reverse torque value compared to the control group (p<0.01). 2. Sandblasting and electroplating treatments demonstrated significantly higher reverse torque val-ue than that of control group. 3. The use of a washer may be one of the useful clinical methods that prevent the screw loosening. However, further studies are necessary for the material selection and design of the washer.

Avaliação do desempenho da limpeza e desinfecção das máquinas lavadoras desinfectadoras automáticas em programas com diferentes tempos e temperaturas / Evaluation of cleaning and disinfection processes performed by automatic washing machine in programs presenting different time and temperature

A limpeza é, inegavelmente, o núcleo central de todas as atividades relacionadas ao reprocessamento de artigos médico-hospitalares. A lavadora desinfectadora é uma nova tecnologia, que trouxe grandes vantagens, como padronização dos procedimentos de limpeza, documentação do processo e diminuição do risco ocupacional de ordem biológica. Atualmente, existem equipamentos que disponibilizam programas com diferentes tempo e temperatura. Para subsidiar a escolha de programas, propôs-se nesta pesquisa investigar o desempenho das lavadoras desinfectadoras nos distintos programas (Norma Alemã, BGA 94ºC/10 minutos; Norma da Grã-Bretanha, DHSS/HTM 90ºC/1segundo; Norma da Grã-Bretanha, DHSS/HTM 82ºC/2minutos; Norma da Holanda, RIVM 90ºC/5 minutos; Norma da Suécia, SPRI/SIS 85ºC/1minuto; Norma da Suécia, SPRI/SIS 85ºC/3 minutos; ciclo com temperatura 70ºC e tempo 30 minutos para Pasteurização), avaliando-se o desempenho dos testes de limpeza e termodesinfecção em equipamento validado. Conforme as recomendações das Normas ISO 15883-1/1999 e HTM2030 (NHS States,1997), para avaliação do desempenho da limpeza foram utilizados três testes: Soil Test, Biotrace Pro-tect e Test Kit Proteína. Como resultado dos testes do desempenho da limpeza, constatou-se resíduo de sujidade após avaliação com Soil-Test em 1,3% dos instrumentais, do total de 313 avaliados (cinco instrumentais de complexidade crítica, dois deles não desmontáveis-Kerrison e Goiva). Na avaliação de resíduo de proteína com teste Biotrace Pro-tect constatou-se que, dos 65 instrumentais avaliados, 60 (92%) apresentaram resultado satisfatório. Os cinco instrumentais (8%) que apresentaram resíduo de sujidade com Soil-Test, também apresentaram, após avaliação com teste Biotrace Pro-tect, resíduo de proteína. Na avaliação realizada com o Test Kit Proteína, 141(100%) instrumentais apresentaram ausência de proteína. Para avaliação do desempenho da termodesinfecção, ) os instrumentais escolhidos para experimento foram intencionalmente contaminados com sangue humano e em seguida submetidos aos processos de termodesinfecção em diferentes programas. A contagem de UFC dos microrganismos viáveis foi feita antes e após a termodesinfecção, partindo-se da contaminação inicial de 107 e 108 UFC. Quanto aos resultados destes testes, de modo uniforme, todos os ciclos apresentaram desempenho satisfatório de <102 UFC, resultado esse entendido como ausência de crescimento microbiano, considerando-se a diluição empregada. Nos cálculos dos valores da Letalidade Mínima e DAL - Nível de Segurança de Desinfecção, os protocolos aprovados foram: Norma Alemã, BGA 94ºC/10 minutos; Norma da Grã-Bretanha, DHSS/HTM 90ºC/1 segundo; Norma da Holanda, RIVM 90ºC / 5 minutos; Norma da Suécia, SPRI/SIS 85ºC / 1 minuto; Norma da Suécia, SPRI/SIS 85ºC/ 3 minutos. Os protocolos que não alcançaram os valores preconizados da Letalidade Mínima de 10 minutos e DAL =10-2 após validação foram: Norma da Grã-Bretanha, DHSS/HTM 82ºC / 2 minutos; Temperatura 70ºC e Tempo de 30 minutos para Pasteurização. Como conclusão, a presente pesquisa evidenciou desempenhos satisfatórios das Máquinas Lavadoras Desinfectadoras tanto na limpeza mecânica quanto na desinfecção, em todos os programas testados, com diferentes tempos e temperaturas apesar do DAL e A0 de alguns programas terem sido reprovados. Evidenciou que em instrumentais de conformação complexa, especialmente quando não desmontáveis, a remoção completa dos resíduos não ocorre nas máquinas, sugerindo que a limpeza destes seja manual, utilizando-se artefatos adequados.

Cleaning is undeniably the main focus of all activities related to the reprocessing of medical and hospital supplies. The washer-disinfector machine represents a new technology that has brought great advantages as the standardization of the cleaning procedures, the process registering and the reduction of occupational hazards coming from biological sources. Nowadays, there are equipments with programs presenting different time and temperature. In order to subside the choice of programs, this essay aims to investigate the performance of washer-disinfectors in the following different programs (German Federal Health Authority BGA, 94ºC/10 minutes; British Standard DHSS/HTM, 90º C/1 second; British Standard DHSS/HTM, 82º C/2 minutes; The Netherlands RIVM, 90º C/5 minutes; Swedish Standards Institute SPRI/SIS, 85ºC/1 minute; Swedish Standard Institute SPRI/SIS, 85ºC/3minutes; cycle temperature 70ºC and pasteurization time 30 minutes), evaluating the performance of cleaning and thermo disinfection tests in validated equipment. According to recommendations in ISO 15883-1/1999 and HTM 2030 (NHS States, 1997) for evaluating the cleaning and disinfection processes, three tests were performed: Soil Test, Biotrace Pro-tect and Test Kit Protein. As a result of the cleaning tests performance, soiling was found after evaluation with Soil Test performed in 1,3% of the instruments (5 of them presenting critical complexity, 2 of them not dismountable - Kerrison and Rongeur). In 65 instruments evaluated by Biotrace Pro-tect, 60 instruments (92%) presented good results. Five instruments (8%) presented soiling after evaluation with Soil Test, and after Biotrace Pro-tect evaluation presented protein contamination. After the evaluation performed with Test Kit Protein no instrument presented protein contamination (141 instruments, 100%). To evaluate the thermo disinfection performance the instruments chosen for the test were intentionally contaminated with human blood and after that were under thermo disinfection processes in different programs. The counting of possible present microorganisms was done before and after the thermo disinfection process, starting from an initial contamination of 107 and 108 UFC. Concerning the results of these tests, in general all cycles presented a good performance (<102 UFC), which was understood as the absence of microbiological growth, considering the dilution given. To calculate the Minimal Lethality and DAL - Disinfection Assurance Level, the approved protocols were: German Federal Health Authority BGA, 94ºC/10 minutes; British Standard DHSS/HTM, 90ºC/1 second; The Netherlands RIVM, 90ºC/5 minutes; Swedish Standards Institute SPRI/SIS, 85ºC/1 minute and Swedish Standards Institute SPRI/SIS, 85ºC/3 minutes. The protocols that did not reach the professed values for Minimal Lethality of 10 minutes and DAL = 10 -2 after validation were: British Standard DHSS/HTM, 82ºC/2 minutes; temperature 70ºC and pasteurization time 30 minutes. Concluding, this study evidenced the good performance of the washer-disinfector machines for mechanic cleaning as for disinfection in all tested programs with different time and temperature. It also demonstrated that for instruments with complex shape, specially the not dismountable ones, the complete soiling remove do not occur on the machines and suggests that this cleaning requires handicraft employing adequate material.