An evaluation of Cidex OPA (0.55% ortho-phthalaldehyde) as an alternative to 2% glutaraldehyde for high-level disinfection of endoscopes.

Cidex OPA (0.55% ortho-phthalaldehyde) is marketed as a safer alternative to 2% glutaraldehyde for endoscope decontamination. As clinical experience is limited, an evaluation was undertaken in a busy endoscopy unit. Cidex OPA cycle dilution was monitored by manufacturer's test strips and high-pressure liquid chromatography (HPLC). Eight endoscopy staff completed daily occupational health questionnaires before and after its introduction. Patient throughput times were assessed in view of Cidex OPAs reduced disinfection time. HPLC confirmed that Cidex OPA levels are maintained above 0.3% for at least 50 cycles. Indicator strips proved generally reliable when tested by pharmacy staff. However, busy endoscopy staff found the indicator strips difficult to interpret, with 28 out of 223 (12.5%) test results being inappropriately recorded as 'fails'. Two hundred and two questionnaires were completed and no short-term health problems were noted. Apart from bronchoscopy lists, patient turnaround times were not improved. The increased cost of changing to Cidex OPA was estimated as pound 7691 per annum. Staining of washer-disinfectors was of concern as it proved very difficult to remove.

Antifreeze glycoproteins: relationship between molecular weight, thermal hysteresis and the inhibition of leakage from liposomes during thermotropic phase transition.

Antifreeze glycoproteins (AFGP) were isolated and purified from the blood plasma of rock cod (Gadus ogac), using DEAE-Bio-gel ion exchange chromatography, followed by high performance liquid chromatography (HPLC). The purified proteins were analyzed using polyacrylamide gel electrophoresis (PAGE), and electrospray mass spectrometry. The results indicated that rock cod synthesize seven size classes of glycoproteins, ranging from 2.6 to 24 kDa, with each size class containing multiple isoforms. Antifreeze activity, as determined by thermal hysteresis, indicated that the AFGP could be separated into two groups, with the larger size classes (molecular mass>13 kDa) having approximately 3-4 times the activity of the smaller, proline containing, size classes (molecular mass<10 kDa). All of the AFGP size classes prevented leakage from dielaidoylphosphatidylcholine (DEPC) liposomes as they were cooled through their phase transition temperature, with the larger size classes being approximately 4 times as effective as the smaller ones. It is hypothesized that AFGP prevent liposomes from leaking as they pass through the phase transition temperature by binding to the phospholipid membrane.

Bacteria-free water for automatic washer-disinfectors: an impossible dream?

The ability of a new automatic washer-disinfector system (AWDS), fitted with a water filtration system to provide bacteria-free water and so avoid the risk of mycobacterial contamination of fibreoptic bronchoscopes, was examined. Four new Astec 'MP' Safescope washer-disinfectors, with coarse and fine (0.2 micron) filters attached close to the outlet taps, were supplied with non-softened mains water. Water samples from the tank supply and outlet taps were regularly assessed for bacterial quality over a six-month period. Outlet samples were also analysed after fine filter change and purgation with peracetic acid. All bronchoalveolar lavage specimens (BALS) were stained and cultured for mycobacteria. Only 13 out of 53 outlet samples (24%) were culture-negative. There was no improvement after filter change. Residual anti-bacterial effect of peracetic acid lasted up to 48 h following AWDS purgation. No tank samples were bacteria-free. Sixty BALS were processed, two samples were culture-positive and grew M. tuberculosis and one was also smear-positive. Though mycobacterial contamination of bronchoscopes was not evident, the water filtration system was unable to reliably provide sterile rinse water.

Audit of decontamination procedures for specialist ophthalmic equipment.

A survey of ophthalmic decontamination protocols in eight district hospitals was undertaken. Procedures differed widely. A literature search revealed only four publications on the subject, all of which dealt with tonometer head disinfection only. After discussion with several manufacturers, whose advice was restricted largely to acrylic lens disinfection and which varied considerably, a local policy for ophthalmic decontamination was established. Nationally agreed disinfection guidelines for high risk ophthalmic instruments are needed.