Nickel release from surgical instruments and operating room equipment.

Background There has been no systematic study assessing nickel release from surgical instruments and equipment used within the operating suite. This equipment represents important potential sources of exposure for nickel-sensitive patients and hospital staff. OBJECTIVE: To investigate nickel release from commonly used surgical instruments and operating room equipment. METHODS AND MATERIALS: Using the dimethylglyoxime nickel spot test, a variety of surgical instruments and operating room equipment were tested for nickel release at our institution. RESULTS: Of the 128 surgical instruments tested, only 1 was positive for nickel release. Of the 43 operating room items tested, 19 were positive for nickel release, 7 of which have the potential for direct contact with patients and/or hospital staff. CONCLUSION: Hospital systems should be aware of surgical instruments and operating room equipment as potential sources of nickel exposure.

Different types of stainless steel used in equipment in meat plants do not affect the initial microbial transfer, including pathogens, from pork skin.

This study describes and measures the impact of different compositions and finishes of stainless steel used in equipment in the meat industry on the transfer of natural flora and selected pathogens from artificially contaminated pork skin. It is known that the adhesion to surfaces of Listeria monocytogenes and Salmonella, 2 pathogens frequently found in contaminated pork meat, depends on the nature and roughness of the surface. Our results show no statistically significant differences in microbial transfer regardless of the types of stainless steel considered, with the highest measured transfer difference being 0.18 log colony-forming units (CFUs)/800 cm(2). Moreover, no differences in total microbial community were observed after transfer on the 5 types of stainless steel using single-strand conformation polymorphism (SSCP). It was concluded that the different characteristics of the stainless steel tested did not affect the initial bacterial transfer in this study.

La présente étude vise à décrire et mesurer l'impact de différentes compositions et de différents finis d'acier inoxydable utilisés dans les équipements de l'industrie de la viande sur le transfert de la flore naturelle et d'agents pathogènes sélectionnés provenant de peau de porc contaminée artificiellement. Il est connu que l'adhésion de Listeria monocytogenes et Salmonella, deux agents pathogènes fréquemment retrouvés dans la viande de porc contaminée, aux surfaces dépend de la nature et de la rugosité de la surface. Nos résultats démontrent qu'il n'y a aucune différence statistiquement significative dans le transfert microbien indépendamment du type d'acier inoxydable considéré, la différence de transfert du nombre d'unités formatrices de colonies la plus élevée mesurée étant 0,18 log/800 cm2. De plus, aucune différence dans la communauté microbienne totale ne fut observée après le transfert sur les cinq types d'acier inoxydable par examen du polymorphisme de conformation. Nous avons conclu que dans la présente étude les différentes caractéristiques de l'acier inoxydable n'ont pas affecté le transfert bactérien initial.(Traduit par Docteur Serge Messier).

The "shadow sign": a radiographic differentiation of stainless steel versus titanium spinal instrumentation in spine surgery.

BACKGROUND: Stainless steel spinal instrumentation has been supplanted in recent years by titanium instrumentation. Knowing whether stainless steel or titanium was used in a previous surgery can guide clinical decision making processes, but frequently the clinician has no way to know what type of metal was used. We describe the radiographic "shadow sign," in which superimposed titanium rods and screws remain radiolucent enough that the contour of the underlying components can be seen on a lateral radiograph, whereas superimposed stainless steel rods and screws are completely radiopaque. This technique was evaluated using a retrospective, randomized, and blinded radiographic comparison of titanium and stainless steel spinal instrumentation. The objective was to determine whether the "shadow sign" can reliably differentiate titanium from stainless steel spinal instrumentation. METHODS: Lateral radiographs from 16 cases of posterior spinal instrumentation (6 titanium, 6 stainless steel, and 2 replicates of each to assess intraobserver reliability) were randomly selected from a database of cases performed for pediatric scoliosis in a university setting from 2005 to 2009. The cases were randomized then shown to 19 orthopaedic surgery residents, 1 spine fellow, and 2 spine attendings. After the "shadow sign" was described, the surgeons were asked to determine what type of metal each implant was made of. RESULTS: The κ value for both stainless steel and titanium versus the gold standard was 0.83 [standard error (SE) = 0.053], indicating excellent agreement. The κ value for agreement between raters was 0.71 (SE = 0.016) and the κ value for agreement within raters was 0.70 (SE = 0.016), both of which indicated substantial agreement. CONCLUSIONS: The "shadow sign" can help a clinician differentiate titanium from stainless steel spinal instrumentation based on radiographic appearance alone. Furthermore, our study reveals that the level of experience in diagnosing spinal lateral radiographs also enhances the use of the "shadow sign" indicator. LEVEL OF EVIDENCE: The method proposed to differentiate titanium from stainless steel falls within the diagnostic studies domain. As unaltered randomization was used to enroll radiographs and the procedure was systematic, this study may be classified in the Level II category.

The influence of passivation and electropolishing on the performance of medical grade stainless steels in static and fatigue loading.

The effects of surface passivation and electropolishing on the mechanical performance of a group of biomedical grade stainless steels have been investigated. Surface roughness measurements showed that the treatments had a significant effect on the final surface finish. However, static mechanical testing demonstrated no difference in static mechanical properties, regardless of surface treatment. High cycle fatigue testing was carried out at a frequency of 120 Hz with a load ratio of R=0.1, in both air and a simulated in vivo wet corrosive environment. 316LVM (cold worked) proved superior to 316L (annealed) in fatigue performance, in both dry and wet environments. The fatigue performance of both materials did depend on the surface treatment, with electropolishing resulting in better performance than passivation. The fatigue performance of both materials was significantly better in the dry environment in comparison to the wet environment. The dry-to-wet deterioration in fatigue performance was somewhat dependent on the surface treatment for the 316L material but almost independent of surface treatment for the 316LVM material. Significant surface pitting and damage was evident for 316L during fatigue in the wet environment, whereas almost no pitting and damage was observed for 316LVM.

Corrosion protection of reusable surgical instruments.

To understand the corrosion properties of surgical scissors, 416 stainless steel disks and custom electrodes were used as simulated surfaces under various conditions. These simulated surfaces were exposed to tap water and 400-ppm synthetic hard water as Ca2CO3 under different conditions. The samples were evaluated by various techniques for corrosion potential and the impact of environmental conditions on the integrity of the passive film. The electrodes were used to monitor the corrosion behavior by potentiodynamic polarization technique in water both in the presence and absence of a cleaning product. The surface topography of the 416 stainless steel disks was characterized by visual observations and scanning electron microscopy (SEM), and the surface chemistry of the passive film on the surface of the scissors was characterized by x-ray photoelectron spectroscopy (XPS). The results suggest that surgical instruments made from 416 stainless steel are not susceptible to uniform corrosion; however, they do undergo localized corrosion. The use of suitable cleaning products can offer protection against localized corrosion during the cleaning step. More importantly, the use of potentiodynamic polarization techniques allowed for a quick and convenient approach to evaluate the corrosion properties of surgical instruments under a variety of simulated-use environmental conditions.

Comparative study of anti-drift nozzles' wear.

When spraying, the drift is a restricting factor which reduces the efficiency of pesticides treatments and increases their impact on the environment. The use of anti-drift nozzles is the most common technique to reduce the drift effect. The basic principle of all anti-drift nozzles is to produce bigger droplets (Imag DLO, 1999) being less sensitive to the wind. The increase of the droplets' size is possible whether by reducing the spraying pressure (anti-drift fan nozzle) or by injecting air in the nozzle (air injection nozzles). This study aims at comparing the performances of the main anti-drift nozzles available on the Belgian market (Teejet DG and AI, Albuz ADI and AVI, Hardi ISO LD et AI). The study made it possible to compare thirteen different nozzles' sets according to their trademark, type and material. The study is based on the analysis of macroscopic parameters (flowrate, transversal distribution and individual distribution) as well as on the analysis of microscopic parameters (spraying deposit on artificial target). The evolution of these parameters is analysed according to the nozzle's wear. The wear is carried out artificially according to the "ISO 5682-1" standard (ISO 5682-1, 1996). The results confirmed the major influence of the manufacturing material on the nozzles' wear, ceramic being the most resistant material. Macroscopic as well as microscopic parameters variated according to the utilization time without any direct correlation. Indeed, most parameters variate in an uncertain way. It was however possible to establish a correlation between the wear time and the recovering rate and flowrate parameters. The utilization length is different depending on the type of nozzle, air injection nozzles being more resistant. At last, the analysis of microscopic parameters (spraying deposit) (Degré A., 1999), shows that the number of impacts is stable depending on the wear, while the size of impacts and the recovering rate increase.

Corrosion characteristics of ferric and austenitic stainless steels for dental magnetic attachment.

The corrosion behaviors of four ferric stainless steels and two austenitic stainless steels were examined in a simulated physiological environment (0.9% NaCl solution) to obtain basic data for evaluating the appropriate composition of stainless steels for dental magnetic attachments. The corrosion resistance was evaluated by electrochemical techniques and the analysis of released metal ions by atomic absorption spectrophotometry. The surface of the stainless steels was analyzed by X-ray photoelectron spectroscopy (XPS). The breakdown potential of ferric stainless steels increased and the total amount of released metal ions decreased linearly with increases in the sum of the Cr and Mo contents. The corrosion rate of the ferric stainless steels increased 2 to 6 times when they were galvanically coupled with noble metal alloys but decreased when coupled with commercially pure Ti. For austenitic stainless steels, the breakdown potential of high N-bearing stainless steel was approximately 500 mV higher than that of SUS316L, which is currently used as a component in dental magnetic attachments. The enriched nitrogen at the alloy/passive film interface may be effective in improving the localized corrosion resistance.

Nickel release from stainless steels.

In 1994, a study of nickel release and allergic contact dermatitis from nickel-plated metals and stainless steels was published in this journal. It was shown that low-sulfur stainless steel grades like AISI 304, 316L or 430 (S < or = 0.007%) release less than 0.03 microgram/cm2/week of nickel in acid artificial sweat and elicit no reactions in patients already sensitized to nickel. In contrast, nickel-plated samples release around 100 micrograms/cm2/week of Ni and high-sulfur stainless steel (AISI 303-S approximately 0.3%) releases about 1.5 micrograms/cm2/week in this acid artificial sweat. Applied on patients sensitized to nickel, these metals elicit positive reactions in 96% and 14%, respectively, of the patients. The main conclusion was that low-sulfur stainless steels like AISI 304, 316L or 430, even when containing Ni, should not elicit nickel contact dermatitis, while metals having a mean corrosion resistance like a high-sulfur stainless steel (AISI 303) or nickel-plated steel should be avoided. The determining characteristic was in fact the corrosion resistance in chloride media, which, for stainless steels, is connected, among other factors, to the sulfur content. Thus, a question remained concerning the grades with an intermediate sulfur content, around 0.03%, which were not studied. They are the object of the study presented in this paper. 3 tests were performed: leaching experiments, dimethylglyoxime and HNO3 spot tests, and clinical patch tests; however, only stainless steels were tested: a low-sulfur AISI 304 and AISI 303 as references and 3 grades with a sulfur content around 0.03%: AISI 304L, AISI 304L added with Ca, AISI 304L+Cu. Leaching experiments showed that the 4 non-resulfurised grades released less than 0.5 microgram/cm2/week in acid sweat while the reulfurized AISI 303 released around or more than 0.5 microgram/cm2/week. This is explained by the poorer corrosion resistance of the resulfurized grade. Yet all these grades had the same reaction to the DMG test (negative result), which shows again its lack of sensitivity. In contrast, the HNO3 spot test distinguished AISI 303 from the non-resulfurized grades. Clinical patch tests again showed that some patients (4%) were intolerant to AISI 303, while none were intolerant to the other grades. Thus, this study confirms that non-resulfurized stainless steels (S < or = 0.03%) like Ni-containing 304 and 304L should not elicit Ni contact dermatitis, while the resulfurized grades (S > 0.1%) should be avoided.