Evaluation of cleaning and sterilization of liposuction cannulas after intentional contamination with human fat, Mycobacterium abscessus subspecies bolletii, and Geobacillusstearothermophilus.

BACKGROUND: The complex design of cannulas is a major challenge for reprocessing due to the retention and accumulation of fat residues. AIM: To evaluate the cleaning of liposuction cannulas and the protective effects of the remaining fat residues on Mycobacterium abscessus subspecies bolletii (MASB) and Geobacillus stearothermophilus inactivation during steam sterilization. METHODS: In phase 1, six standard operating procedures were evaluated for cleaning of liposuction cannulas. In phase 2, the sectioned lumens of the liposuction cannulas were contaminated with the largest and smallest volume of human fat found in phase 1, with the addition of MASB. In phase 3, the same volumes of human fat from phase 2 were used to contaminate paper strips containing G. stearothermophilus. FINDINGS: In phase 1 the residual amount of fat ranged from 6 to 52 mg. In phases 2 and 3, the minimum and maximum amounts of fat (6 and 50 mg) protected micro-organisms during steam sterilization at 134 °C for 1.5 and 3 min. CONCLUSION: Effective cleaning and sterilization of liposuction cannulas intentionally contaminated with human fat, MASB and G. stearothermophilus could not be performed.

Specialists' opinion regarding factors related to wet loads after steam sterilization.

BACKGROUND: Episodes of wet loads after steam sterilization are frequent; however, the factors related to these events are still unclear. AIM: To evaluate the strength of relationship of factors related to wet loads after steam sterilization. METHODS: By adapting the Delphi technique, steam sterilization specialists assigned a score for the relation strength of a list of 37 factors (f.01-37) related to wet load, grouped into: cycle parameters, sterilizer, steam, load, and environment. Sixty-seven specialists distributed on five continents participated in all phases of this study. FINDINGS: Certain factors related to wet loads are better established, such as vacuum depth in the drying phase, whereas others are still controversial, such as those related to the environment. The factor that obtained the highest average score was the vacuum depth in the drying phase (f.12), with a value of 4.28, and the lowest score of 2.66 was obtained in the delay time when the set reaches the value of vacuum or steam in the conditioning phase (f.05). CONCLUSION: Specialists' opinions diverge in most of the factors related to the occurrence of wet loads. The results obtained will enable further research and the establishment of normative requirements.

Performance evaluation of chemical, biological and physical indicators in the process of sterilization under the effect of non-condensable gases.

BACKGROUND: The risk concerning the presence of non-condensable gases (NCGs) has already been demonstrated, but routine monitoring still requires further research to be implemented in each sterilization cycle. AIM: Performance evaluation of the physical, chemical and biological indicators used in monitoring in comparison with a sterilizer integrated detector for NCG in the Sterilization Process. METHODS: Chemical indicators (type 2 Bowie-Dick test, type 5 and type 6 models), self-contained biological indicators and physical indicators (temperature, pressure, thermal qualification and a patented integrated air detector) were used to monitor the steam sterilization process in two situations of controlled failure: chamber leakage and door seal failure. This controlled failure was obtained by the presence of a known amount of air: 0-30 L/min for chamber leakage and 0-30% for the door seal failure. Evaluation tests were carried out with and without the use of process challenge devices (PCDs). FINDINGS: In both studies, the Bowie-Dick Test showed different results, according to the manufacturer. The biological, physical or chemical indicators without a PCD were unable to detect small volumes of NCGs in both simulations. CONCLUSION: The integrated air detector can be considered an option for the detection of NCGs in each cycle.

Norovirus recovery from floors and air after various decontamination protocols.

BACKGROUND: The dispersal of airborne norovirus (NoV) particles from the floor after contamination with faeces or vomit is a challenge for infection control, as this pathogen is infectious at low doses. Therefore, it is imperative to establish a safe protocol for floor decontamination. AIM: To assess the presence of residual NoV-GII particles on floors and airborne particles following various floor decontamination procedures. METHODS: Two types of floor (vinyl and granite) were contaminated intentionally with 10% human faeces, positive for NoV-GII. Two decontamination protocols were implemented: cleaning followed by disinfection using 1% sodium hypochlorite, and cleaning followed by disinfection using a manual ultraviolet C (UV-C) light device. Swab samples were taken from the floors, and air samples were obtained using an air sampler. The TaqMan method for real-time reverse transcription-quantitative polymerase chain reaction was employed for analysis. FINDINGS: The disinfection protocol using 1% sodium hypochlorite after cleaning proved to be more effective than cleaning followed by UV-C light exposure (P<0.001). Viral particles were detected in 27 of 36 air samples after cleaning, with no significant difference between the two floor types. On average, 617 genome copies/sample were identified in air samples after cleaning, but the number decreased gradually after disinfection. CONCLUSION: NoV-GII can be aerosolized during floor cleaning, and its particles may be inhaled and then swallowed or can settle on surfaces. Therefore, residual viral particles on floors must be fully eliminated. Cleaning followed by 10 min of 1% sodium hypochlorite disinfection proved to be the superior decontamination protocol.

Recurrence after laparoscopic and open Nissen fundoplication: a comparison of the mechanisms of failure.

BACKGROUND: Laparoscopic Nissen fundoplication as treatment for gastroesophageal reflux disease (GERD) in adults has a reported recurrence rate of 2-17%. We investigated the rates and mechanisms of failure after laparoscopic Nissen fundoplication in children. METHODS: All patients who underwent a laparoscopic Nissen fundoplication for GERD and who subsequently required a redo Nissen were reviewed (n = 15). The control group consisted of the most recent 15 patients who developed recurrent GER after an open Nissen, fundoplication. RESULTS: Between 1994 and 2000, laparoscopic Nissen fundoplication was performed in 179 patients. Fifteen patients (8.7%) underwent revision. The mechanisms of failure were herniation in four patients, wrap dehiscence in four, a too-short wrap in three, a loosened wrap in two, and other reasons in two. The reoperation was performed laparoscopically in five patients (33%). The failure mechanisms were different in the open patients: eight were due to slipped wraps; three to dehiscences; and two to herniations. CONCLUSION: The failure rate after laparoscopic Nissen is acceptably low. A redo laparoscopic Nissen can be performed safely after an initial laparoscopic approach.

Smad4 mediates activation of mitogen-activated protein kinases by TGF-beta in pancreatic acinar cells.

Transforming growth factor-beta (TGF-beta) inhibits pancreatic acinar cell growth. In many cell types, TGF-beta mediates its growth inhibitory effects by activation of Smad proteins. Recently, it has been reported that Smad proteins may interact with the mitogen-activated protein (MAP) kinase signaling pathways. In this study, we report on the interactions between the TGF-beta and MAP kinase signaling pathways in isolated rat pancreatic acinar cells. TGF-beta activated the MAP kinases extracellular signal-related kinases (ERKs) and p38 in pancreatic acinar cells, but had no effect on c-jun NH2-terminal kinase activity. Activation of MAP kinase by TGF-beta was maximal 4 h after treatment. The ability of TGF-beta to activate ERKs was concentration dependent and dependent on protein synthesis. TGF-beta's stimulation of ERK activation was blocked by PD-98059, an inhibitor of MAP kinase kinase 1, and by adenoviral transfer of dominant negative RasN17. Furthermore, adenoviral-mediated expression of dominant negative Smad4 blocked the ability of TGF-beta to activate acinar cell MAP kinase, demonstrating that this activation is downstream of Smads. The biological relevance of ERK activation by TGF-beta was indicated by demonstrating that inhibition of ERK signaling by PD-98059 blocked the ability of TGF-beta to activate the transcription factor activator protein-1. These studies provide new insight into the signaling mechanisms by which TGF-beta mediates biological actions in pancreatic acinar cells.

Adenovirus-mediated gene transfer of dominant-negative Smad4 blocks TGF-beta signaling in pancreatic acinar cells.

Transforming growth factor-beta (TGF-beta) is a potent inhibitor of pancreatic acinar cell growth. Smad4 is a central mediator in the TGF-beta signaling pathway. To study the effect of Smad4 on pancreatic growth, cell cycle protein expression, and the expression of a TGF-beta-responsive promoter in vitro, we constructed an adenovirus containing dominant-negative COOH terminal truncated Smad4 (AddnSmad4) downstream of the rat elastase promoter. Acinar cells expressed dominant-negative Smad4 within 8 h after infection, and expression persisted for 72 h. Mouse pancreatic acini were infected with either AddnSmad4 or control adenovirus expressing green fluorescent protein, and TGF-beta was added 8 h after infection. Acinar cells were then incubated for 1, 2, or 3 days, and [(3)H]thymidine incorporation was determined. AddnSmad4 significantly reduced TGF-beta inhibition of [(3)H]thymidine incorporation, with maximal effects on day 3. AddnSmad4 also completely blocked TGF-beta-mediated growth inhibition in the presence of basic fibroblast growth factor. We next examined the effects of AddnSmad4 on TGF-beta-induced expression of the cell cycle regulatory proteins p21(Cip1) and p27(Kip1). TGF-beta induced upregulation of p21(Cip1), which was completely blocked by AddnSmad4. AddnSmad4 also inhibited TGF-beta-induced expression of the TGF-beta-responsive luciferase reporter 3TP-Lux. These results show that Smad4 is essential in TGF-beta-mediated signaling in pancreatic acinar cells.

[Use of paraformaldehyde tablets by Brazilian health institutions -- Part I]. / O uso das pastilhas de Paraformaldeído pelas instituições de saúde do Brasil-Parte I.

A national survey was accomplished next to 6907 health Institutions through a questionnaire to explore and to describe the use of Parafolmaldehyde Tablets as microbicide agent. There was a return of 443 (6.41%) correspondences which 253 (57.89%) affirmed to apply this chemical agent. Several articles of medical-hospitable use with indication to sterilization through autoclaves, are processed by Parafolmaldehyde Tablets in the researched Institutions, demonstrating inadequate criteria in choosing the process. Another detected inadequate use of Parafolmaldehyde Tablets was in the processing of articles with lumens and the density materials due to the low penetrability of the gas. The nurses' perception with reference to the perspectives of Parafolmaldehyde Tablets's use as sterilizing chemical agent, in environmental conditions is of disuse, pointing for a search of safer technologies.

Important aspects of the colonization of central venous catheter.

This study comprises five different kind of venous central catheters, 103 in total, made of Polyurethane Tecoflex, Polyurethane Vialon, PTFE and PVC, and the influence of their raw material on the microbial colonization. Patients age and sex, besides their clinical conditions, were taken into account, and neither considered as a sample vicious, nor associated with colonization. When the tips of the catheters were asseptically inoculated in Tryptic Soy Broth and Tioglicolate, colonization was detected in 15.5% of the catheters. Coagulase negative Staphylococcus, some of which with biofilm, were the predominant organisms found, although some bacillus have also been detected: Enterobacter aerogenes, Hafnia alvei, Pseudomonas cepacia, Xanthomonas maltophilia and Aeromonas sobria. It was not possible to notice any association between the colonization of the catheters and their raw material, probably due to the influence of a previous contact and linking with blood components. This contact causes a thin coating on the surface of the cathether, which makes all the catheters similar in respect of the attachment of a bacterial cell. So, the colonization depends on the virulence of the organism, much more then on the nature of the catheter.

Intravenous catheters: biocompatibility aspects and phlebitis correlation.

Although catheters have been widely used for a long time, there are doubts if the analytical methodology in current use is enough to evaluate them biologically. Catheters were submitted to the usual methodology, in addition to the accompaniment in their clinical use, observing the thrombophlebitis induction. It was not possible to associate the phlebitis incidence (3.9%) in relationship with the raw material nature (p = 0.255), neither with the kind of the catheter type (p = 0.468).

[Psychosocial approach in the care of hospitalized adults]. / A abordagem psico-social na assistência ao adulto hospitalizado.

This article shows aspects of the hospitalized patient's psychosocial needs, pointing out how the knowledge of the patient's mental functions aids the nurse to identify disfunctions in this area. In the current structure of the Brazilian health system, which does not value the holistic vision of man, it is difficult for the nurse to give assistance to these aspects. This phenomenon is more subtle than biological aspects and, among other things, demands a lot of time and dedication from the nurse. To be attentive to the patient's psychosocial needs, represents an ethical aspect and the humanization in nursing assistance.

[The teaching of patient evaluation: the delineation of the content of nursing diagnosis]. / O ensino da avaliação do paciente: delineamento do conteúdo pelo diagnóstico de enfermagem.

The nursing care is based on the nursing assessment. In the nurse's professional activity there aren't clarity and consensus about the clinical entities, problems or phenomenons that nurses intended to care. Difficulties in deciding what should be collected are determined by this indefinition, that it is also present in nursing graduate courses. In this article the authors discuss that the Nursing Diagnosis can be the framework for the nursing assessment.

[An evaluation of the sterilizing activity of paraformaldehyde]. / Avaliação da atividade esterilizante do paraformaldeído.

Sporocidal activity of paraformaldehyde tablets was assessed by means of the Association of Official Analytical Chemists technic which is required in Brazil to register this class of sanitizing substances by the Health Ministery. According to this methodology paraformaldehyde showed sterilizing activity at the 3% (3.0 g/cm3) concentration in 3 hour exposure period at 50 degrees C in the presence of relative humidity.

The synergistic effect of synthetic polynucleotides and mercaptoethanol in amplifying the murine mixed lymphocyte reaction.

Tritiated thymidine incorporation of one-way murine mixed lymphocyte reactions was compared in the presence of mercaptoethanol and/or poly AU. Each of these agents amplified specific responsiveness in this system without altering reaction kinetics and the combined use of these agents enhanced specific thymidine incorporation beyond that achieved by either alone. These agents may be useful in those situations where increased sensitivity of murine mixed lymphocyte reactions is required.