Infection Control Today

June 1, 2004

August 2001

Cleaning: An Important Prerequisite for Instrument
Sterilization and Disinfection

By: Nancy S. Chu, MS, and Martin Favero, PhD

1. Association for Advancement of Medical Instrumentation (AAMI). Standards
and recommended practices
. Sterilization, Part 1. Sterilization of health
care facilities. Sterilization Part 2. Hospital equipment and industrial process
control. Arlington, VA: AAMI, 1995.

2. Alfa MJ, Sitter DL. In-hospital evaluation of ortho-phthalaldehyde as a
high level disinfectant for flexible endoscopes. J Hosp Infect 1994;26:15-26.

3. Chan-Myers H, McAlister D, Antonoplos, PA. Natural bioburden levels
detected on rigid lumened medical devices before and after cleaning. Am J Infect
Control 1997;25:471-6.

4. Chu NS, McAlister D, Antonoplos, PA. Natural bioburden levels detected on
flexible gastrointestinal endoscopes after clinical use and manual cleaning.
Gastrointest Endosc 1998;48:137-42.

5. Chu NS, Chan-Myers H, Ghazanfari N, et al. Levels of naturally occurring
microorganisms on surgical instruments after clinical use and after washing. Am
J Infect Control 1999;27:315-9.

6. Nystrom, B. Disinfection of surgical instruments. J Hosp Infection.
1981;2:363-8.

7. Rutala WA, Gergen MF, Jones JF, et al. Levels of microbial contamination
on surgical instruments. Am J Infect Control 1999;26:143-145.

8. Vesley D, Melson J, Stanley P. Microbial burden in endoscope reprocessing
and in-use evaluation of the high-level disinfection capabilities of Cidex PA.
Gastroenterology Nursing 1999;22:63-68.

9. Moore WEC, Holdeman LV. Human fecal flora: The normal flora of 20
Japanese-Hawaiians. Appl Microbiol 1974; 27:961-979.

10. Sack RB, Tilton RC, Weissfeld AS. Laboratory diagnosis of bacterial
diarrhea. In Rubin SJ (ed): Cumulative Techniques and Procedures in
Clinical Microbiology. Cumitech 12. Washington, DC, American Society for
Microbiology, 1980, p 1-6.

11. Stephen AM, Cummings JH. The microbial contribution to human faecal mass.
J Med Microbiol 1980;12:45-56.

12. Kaiser HJ, McDonnell GE, Tirey JF et al. Water Quality and Reprocessing
Instruments). Infect Control Today May 2000.

13. Reichert M, Schultz J. Selecting the right detergents. OR Manager,
1999b;15:33-34.

14. Association for the Advancement of Medical Instrumentation Technical
Information Report AAMI TIR No. 12 - 1994 Designing, Testing, and Labeling
Reusable Medical Devices for Reprocessing in Health Care Facilities: A Guide for
Device Manufacturers.

15. Abbott CF, Cockton J, Jones W. Science papers and discussion, resistance
of crystalline substances to gas sterilization. J Pharm Pharmacol
1956;6:709-721.

16. Royce A, Bowler C. Ethylene oxide sterilization - some experiences and
some practical limitations. J of Pharm Pharmacol 1961; 87t-94t, v13.

17. Doyle JE, Ernst RR. Resistance of Bacillus subtilis var. niger
spores occluded in water insoluble crystals to three sterilization agents. Appl
Micro 1967;15:726-730.

18. Gilbert GL, Gambill VM, Spiner DR, et al. Effect of moisture on ethylene
oxide sterilization. Appl Microbiol 1964;12:496-503.

19. Sykes G. The phenomenon of bacterial survival. J Appl Bact
1963;26:287-294.

20. Alfa MJ, DeGagne P, Olson N et al. Comparison of ion plasma, vaporized
hydrogen peroxide, and 100% ethylene oxide sterilizers to the 12/88 ethylene
oxide gas sterilizer. Infect Control Hosp Epidemiol 1996;17:92-100.

21. Jacobs PT, Wang JH, Gorham RA, et al. Cleaning: principles, methods and
benefits. In: Rutala WA (ed). Disinfection, sterilization and antisepsis
in health care. Association For Professionals In Infection Control and
Epidemiology, Inc., Washington DC 1998:165-81.

22. Chu NS, Chan-Myers H. Evaluation of enzymatic and conventional detergent
cleaners for removing organic material from instruments prior to sterilization
or disinfection. In: American Society for Microbiology 2001 Abstracts.

Think Safety When Choosing the Proper Disinfectant or Sterilant
By: Bill Feil

1. Spaulding EH. Chemcial disinfection of medical and
surgical instruments. In: Lawrence CA. Block SS, eds. Disinfection,
sterilization and preservation. Philidelphia: Lea & Febiger, 1968:517-31.

2. Garner JS, Favero MS. Guideline for handwashing and
hospital environmental control, 1985. AJIC Am J Infect Control 1986;14:110-126.

3. Rutala WA. APIC guideline for selection and use of
disinfectants. AJIC Am J Infect Control 1996:24:313-342.

4. Favero MS, Bond WW. Chemical disinfection of medical and
surgical materials. In: Block SS, ed. Disinfection, sterilization, and
preservation. 5th ed. Philadelphia: Lippincott Williams and Wilkins,
2001:881-917.

5. Ellis MR, Buck KM. Antimicrobial product labels and
regulations. Infection Control Today, 2001: 3, 16-18.

6. Rutula WA, Weber DJ. Infect Control Hosp Epidemiol.
1997:18:609-616.

7. Noskin GA, et al. Infect Control Hosp Epidemiol.
1995:16:577-581.

8. Boyce JB, et al. Infect Control Hosp Epidemiol.
1997:18:622-627.

9. Bonilla HF, et al. Infect Control Hosp Epidemiol.
1996:17:771.

Assessing the Risk of Creutsfeldt-Jakob Disease
By: Lawrence F. Muscarella, Ph.D.

Steelman VM. Prion diseases--an evidence-based protocol for
infection control. AORN J 1999 May;69(5):946-54, 956-67 passim; quiz 968-76. Review

Diringer H. Proposed link between transmissible spongiform encephalopathies
of man and animals. Lancet 1995 Nov 4;346(8984):1208-10. Review.

Pablos-Mendez A, Netto EM, Defendini R. Infectious prions or cytotoxic
metabolites? Lancet 1993 Jan 16;341(8838):159-61. Review.

Prusiner SB, Hsiao KK. Human prion diseases. Ann Neurol 1994
Apr;35(4):385-95. Review.

Will RG. Gene influences on Creutzfeldt-Jakob disease. Lancet 1994
Nov 12;344(8933):1310-1.

Bernoulli C, Siegfried J, Baumgartner G, et al. Danger of accidental
person-to-person transmission of Creutzfeldt-Jakob disease by surgery. Lancet
1977 Feb 26;1(8009):478-9.

Gibbs CJ Jr, Asher DM, Kobrine A, Amyx HL, Sulima MP, Gajdusek DC.
Transmission of Creutzfeldt-Jakob disease to a chimpanzee by electrodes
contaminated during neurosurgery. J Neurol Neurosurg Psychiatry 1994
Jun;57(6):757-8.

http://www.cjdsupport.org.au/who_infection_control_guidelines.htm

http://cdc.gov/ncidod/hip/sterile/cjd.htm

Muscarella LF. Biopsy forceps: Disposable or reusable? Gastroenterol
Nurs
2001;24(2):64-68.

Personal Protective Equipment: Achieving Compliance or Encountering
Resistance

By: Karen A. Huggins, MN, RN, CNOR

1. Rogers, B. Health hazards in nursing and health care: An overview,
American Journal of infection Control, June 1997, Vol. 25 (3): 248-61.

2. Telford, GL and Quebbeman, EJ, Assessing the risk of blood exposure in
the operating room, American Journal of Infection Control, December 1993,
Vol. 21:6, 351-356.

3. Jagger, J, Bentley, M and Tereskerz, P. A Study of pattern and
prevention of Blood exposures in OR Personnel, AORN Journal, May 1998, Vol.
67 (5): 979-996.

4. Experts discuss ways to gear up for OR safety, Materials Management,
September 1993,

5. p 30.

6. Jagger, J, Bentley, M and Tereskerz, P. A Study of pattern and
prevention of Blood exposures in OR Personnel, AORN Journal, May 1998, Vol.
67 (5): 979-996.

7. Telford, GL and Quebbeman, EJ, Assessing the risk of blood exposure in
the operating room, American Journal of Infection Control, December 1993,
Vol. 21:6, 351-356.

8. Jagger, J, Bentley, M and Tereskerz, P. A Study of pattern and
prevention of Blood exposures in OR Personnel, AORN Journal, May 1998, Vol.
67 (5): 979-996

9. Rogers, B. Health hazards in nursing and health care: An overview,
American Journal of infection Control, June 1997, Vol. 25 (3): 248-61.

10. Fecteau, DL, Practical considerations in Purchasing New Products,
Surgical Clinics of North America, December 1995, Vol. 75 (6): 1167-1173.

11. IBID.

12. IBID.

13. Jagger, J, Bentley, M and Tereskerz, P. A Study of pattern and
prevention of Blood exposures in OR Personnel, AORN Journal, May 1998, Vol.
67 (5): 979-996.

14. IBID.

Creutzfeldt-Jakob Disease: Risks and Prevention of Nosocomial Acquisition
By: William A. Rutala, PhD, MPH, and David J. Weber, MD, MPH

1. CDC. Surveillance for Creutzfeldt-Jakob disease - United States. MMWR
1996;45:665-668.

2. Gibbons RV, Holman RC, Belay ED, Schonberger LB. Creutzfeldt-Jakob
disease in the United States: 1979-1998. JAMA 2000;284-2322-2323.

3. Johnson RT, Gibbs CJ. Creutzfeldt-Jakob disease and related
transmissible spongiform encephalopathies. N Engl J Med 1998;339:1994-2004.

4. Haltia M. Human prion diseases. Ann Med 2000;32:493-500.

5. Collinge J. Variant Creutzfeldt-Jakob disease. Lancet 1999;354:317-323.

6. World Health Organization. Variant Creutzfeldt-Jakob disease (vCJD).
Fact sheet, revised June 2001. http://www.who.int/imf-fs/en/fact180.html.

7. Brown P. Will RG, Bradley R, Asher DM, Detwiler L. Bovine spongiform
encephalopathy and variant Creutzfeldt-Jakob disease: Background, evolution,
and current concerns. Emerg Infect Dis 2001;7:1-16.

8. World Health Organization. WHO infection control guidelines for
transmissible spongiform encephalopathies. Report of a WHO consultation,
Geneva, Switzerland, 23-26 March 1999. WHO/CDS/CSR/APH/2000.3.

9. Rutala WA, Weber DJ. Management of equipment contaminated with the
Creutzfeldt-Jakob disease agent. In: Disinfection, Sterilization and
Antisepsis. WA Rutala (ed.). Association for Professionals in Infection
Control and Epidemiology, Inc. Washington, D.C., 2001.

10. Rutala WA, Weber DJ. Creutzfeldt-Jakob disease: Recommendations for
disinfection and sterilization. Clin Infect Dis 2001;32:1348-1356.

11. Prusiner SB. The prion diseases of animals and humans. In: Morrissey RF,
Kowalski JB, eds. Sterilization of Medical Products, vol VII. Champlain,
NY:Polyscience Publications; 1998:133-201.

12. Tyler KL. Prions and prion diseases of the central nervous system
(Transmissible neurodegenerative diseases). In: Mandell GL, Bennett JE, Dolin
R, eds. Principles and Practices of Infectious Diseases, 5th ed. Philadelphia:
Churchill Livingstone; 2000:1971-1985.

13. Korth C, Stierli B, Streit P, et al. Prion (PrPSc)-specific epitope
defined by a monoclonal antibody. Nature 1997;390:74-77.

14. Steelman VM. Prion diseases - An evidence-based protocol for infection
control. AORN J 1999;69:946-967.

15. Gibbs CJ, Amyx HL, Bacote A, Masters CL, Gajdusek DC. Oral transmission
of kuru, Creutzfeldt-Jakob disease, and scrapie to nonhuman primates. J Infect
Dis 1980;142:205-208.

16. Brown P, Gajdusek DC. Survival of scrapie virus after 3 years'
interment. Lancet 1991;337:269-270.

17. World Health Organization. Bovine spongiform encephalopathy. www.who.int/inf-fs/en/fact113.html.
June, 2001.

18. Collee JG, Bradley R. BSE: a decade on - part 1. Lancet
1997;349:636-641.

19. World Health Organization. International Animal Health Code - 2000.
WHO, Geneva, 2000. www.oie.int/eng/normes/mcode/A_00146.htm.

20. Brown P. Bovine spongiform encephalopathy and variant Creutzfeldt-Jakob
disease. BMJ 2001;322:841-844.

21. Schonberger LB. New-variant Creutzfeldt-Jakob disease and bovine
spongiform encephalopathy: the strengthening etiologic link between two
emerging diseases. Emerging Infections. Volume 2. WM Scheld, WA Craig, JM
Hughes (eds.). ASM Press, Washington, D.C., 1998.

22. Lasmezas CI, Deslys JP, Demalmay R, et al. BSE transmission to
macaques. Nature 1996;381:743-744.

23. Lasmezas CI, Fournier J-G, Nouvel V, et al. Adaptation of the bovine
spongiform encephalopathy agent to primates and comparison with
Creutzfeldt-Jakob disease: Implications for human health. PNAS
2001;98:4142-4147.

24. Brown P, Gibbs CJ, Rodgers-Johnson P, et al. Human spongiform
encephalopathy: The National Institutes of Health series of 300 cases of
experimentally transmitted disease. Ann Neurol 1994;35:513-529.

25. Brown P. Environmental causes of human spongiform encephalopathy. In:
Baker H, Ridley RM, eds. Methods in Molecular Medicine: Prion Diseases.
Totowa, NJ: Humana Press Inc; 1996:139-154.

26. Manuelidis EE, Gorgacz EJ, Manuelidis L. Viremia in experimental
Creutzfeldt-Jakob disease. Science 1978;200:1069-1071.

27. Tateishi J. Transmission of Creutzfeldt-Jakob disease from human blood
and urine into mice. Lancet 1985;II:1074.

28. Brown P, Preece M, Brandel J-P et al. Iatrogenic Creutzfeldt-Jakob
disease at the millennium. Neurol 2000;5:1075-1081.

29. Bernoulli C, Siegfried J, Baumgartner G, et al. Danger of accidental
person-to-person transmission of Creutzfeldt-Jakob disease by surgery. Lancet
1977;I:478-479.

30. Brown P. BSE and transfusion through blood. Lancet 2000;356:955-956.

31. Wilson K, Code C, Ricketts MN. Risk of acquiring Creutzfeldt-Jakob
disease from blood transfusions: Systematic review of case-control studies.
Brit Med J 2000;321:17-19.

32. Evatt B, Austin H, Barnhart E, et al. Surveillance for
Creutzfeldt-Jakob disease among persons with hemophilia. Transfusion
1998;38:817-820.

33. Lee CA, Ironside JW, Bell JE et al. Retrospective neuropathological
review of prion disease in UK haemophilic patients. Thrombosis Haemostasis
1998;80:909-911.

34. Ricketts MN, Cashman NR, Stratton EE, ElSaadany S. Is Creutzfeldt-Jakob
disease transmitted in blood? Emerg Inf Dis 1997;3:155-163.

35. Gibbs CJ Jr, Gajdusek DC, Masters CL. Consideration of transmissible
subacute and chronic infections, with a summary of the clinical, pathological
and virological characteristics of kuru, Creutzfeldt-Jakob disease and scrapie.
In: Nandy K, editor. Senile dementia: a biomedical approach. Volume 3 of
Developments in neuroscience. New York: Elsevier/North Holland, 1978:115-130.

36. Anonymous. Variant Creutzfeldt-Jakob disease (vCJD): Precautionary
measures against the risk of transmission of the agent of vCJD by blood
transfusion. Weekly Epidemiologic Record 2000;75:377-379.

37. Foster PR. Prions and blood products. Ann Med 2000;32:501-513.

38. Houston F, Foster JD, Chong A, Hunter N, Bostock CJ. Transfusion of BSE
by blood transfusion in sheep. Lancet 2000;356:999-1000.

39. Favero MS, Bond WW. Chemical disinfection of medical and surgical
materials. In: Block SS, ed. Disinfection, Sterilization and Preservation.
Philadelphia, PA: Lippincott Williams & Wilkins. 2001:881-918.

40. Sehulster LM. Management of equipment contaminated with CJD agent.
Presented at the 27th Annual Education Conference and International Meeting of
the Association for Professionals in Infection Control and Epidemiology (APIC)
and the Postconference on Disinfection, Antisepsis and Sterilization:
Practices and Challenges for the New Millennium. Minneapolis: APIC, June 2000.

41. Geertsma RE, van Asten JAAM. Sterilization of prions: Requirements,
complications, implication. Zentr Steril 1995;3:385-394.

42. Steelman VM. Activity of sterilization processes and disinfectants
against prions (Creutzfeldt-Jakob disease agent). In: Rutala WA, ed.
Disinfection, Sterilization and Antisepsis in Health Care. Champlain, NY:
Polyscience Publications, 1997:255-271.

43. Committee on Health Care Issues, American Neurological Association.
Precautions in handling tissues, fluids, and other contaminated materials from
patients with documented or suspected Creutzfeldt-Jakob disease. Ann Neurol
1986;19:75-77.

44. Rutala WA. APIC guideline for selection and use of disinfectants. Am J
Infect Control 1996;24:313-342.

45. Zinn C. Nine hospital patients may have been exposed to CJD. BMJ
2000;320:1296.

46. Rohwer RG. Virus-like sensitivity of the scrapie agent to heat
inactivation. Science 1984;223:600-602.

47. Brown P, Rohwer RG, Green EM, Gajdusek DC. Effect of chemicals, heat,
and histopathologic processing on high-infectivity hamster-adapted scrapie
virus. J Infect Dis 1982;5:683-687.

48. Brown P, Gibbs CJ, Amyx HL, et al. Chemical disinfection of
Creutzfeldt-Jakob disease virus. N Engl Med 1982;306:1279-1282.

49. Kimberlin RH, Walker CA, Millson GC, et al. Disinfection studies with
two strains of mouse-passaged scrapie agent: Guidelines for Creutzfeldt-Jakob
and related agents. J Neurol Sci 1983;59:355-369.

50. Taguchi F, Tamai Y, Uchida K, et al. Proposal for a procedure for
complete inactivation of the Creutzfeldt-Jakob disease agent. Arch Virol
1991;119:297-301.

51. Taylor DM, Fraser H, McConnell I, et al. Decontamination studies with
the agents of bovine spongiform encephalopathy and scrapie. Arch Virol
1994;139:313-326.

52. Brown P, Rohwer RG, Gajdusek DC. Newer data on the inactivation of
scrapie virus or Creutzfeldt-Jakob disease virus in brain tissue. J Infect Dis
1986;153:1145-1148.

53. Manuelidis L. Decontamination of Creutzfeldt-Jakob disease and other
transmissible agents. J NeuroVirology 1997;3:62-65.

54. Ernst DR, Race RE. Comparative analysis of scrapie agent inactivation
methods. J Virol Methods 1993;41:193-202.

55. Dickinson AG, Taylor DM. Resistance of scrapie agent to
decontamination. N Engl J Med 1978;299:1413-1414.

56. Tateishi J, Tashima T, Kitamoto T. Inactivation of the
Creutzfeldt-Jakob disease agent. Ann Neurol 1988;24:466.

57. Tamai Y, Taguchi F, Miura S. Inactivation of the Creutzfeldt-Jakob
disease agent. Ann Neurol 1988;24:466-467.

58. Hartley EG. Action of disinfectants on experimental mouse scrapie.
Nature 1967;213:1135.

59. Zobeley E, Flechsig E, Cozzio A, Enari M, Weissmann C. Infectivity of
scrapie prions bound to a stainless steel surface. Mol Med 1999;5:240-243.

60. Taylor DM. Resistance of scrapie agent to peracetic acid. Vet Microbiol
1991;27:19-24.

61. Tateishi J, Tashima T, Kitamoto T. Practical methods for chemical
inactivation of Creutzfeldt-Jakob disease pathogen. Microbiol Immunol
1991;35:163-166.

62. Brown P, Liberski PP, Wolff A, Gajdusek DC. Resistance of scrapie
infectivity to steam autoclaving after formaldehyde fixation and limited
survival after ashing at 360oC: Practical and theoretical implications. J
Infect Dis 1990:161:467-472.

63. Brown P, Wolff A, Gajdusek C. A simple and effective method for
inactivating virus infectivity in formalin-fixed tissue samples from patients
with Creutzfeldt-Jakob disease. Neurol 1990;40:887-890.

64. Bauer BL, Hellwig D. Minimally invasive endoscopic neurosurgery-a
survey. Acta Neuochir 1994;61:1-12.

65. Perneczky A, Fries G. Endoscope-assisted brain surgery: Part 1-evolution,
basic concept, and current technique. Neurosurgery 1998;42:219-225.