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The cleaning stage of the instrument decontamination process has come under increased scrutiny due to the increasing complexity of surgical instruments and the adverse affects of residual protein contamination on surgical instruments. Instruments used in the podiatry field have a complex surface topography and are exposed to a wide range of biological contamination. Currently, podiatry instruments are reprocessed locally within surgeries while national strategies are favoring a move toward reprocessing in central facilities. Gordon Smith, of the Institute of Infection, Immunity and Inflammation at the Veterinary and Life Sciences University of Glasgow, and colleagues, sought to determine the efficacy of local and central reprocessing on podiatry instruments by measuring residual protein contamination of instruments reprocessed by both methods.
The residual protein of 189 instruments reprocessed centrally and 189 instruments reprocessed locally was determined using a fluorescent assay based on the reaction of proteins with o-phthaldialdehyde/sodium 2-mercaptoethanesulfonate.
Residual protein was detected on 72 percent (n = 136) of instruments reprocessed centrally and 90 percent (n = 170) of instruments reprocessed locally. Significantly less protein (p < 0.001) was recovered from instruments reprocessed centrally (median 20.62 g, range 0 - 5705 g) than local reprocessing (median 111.9 g, range 0 - 6344 g).
The researchers concluded that overall, the results show the superiority of central reprocessing for complex podiatry instruments when protein contamination is considered, though no significant difference was found in residual protein between local decontamination unit and central decontamination unit processes for Blacks files. Further research is needed to undertake qualitative identification of protein contamination to identify any cross contamination risks and a standard for acceptable residual protein contamination applicable to different instruments and specialities should be considered as a matter of urgency. Their work was published in theJournal of Foot and Ankle Research.
Reference: Smith G, Goldie F, Long S, Lappin DF, Ramage G and Smith AJ. Quantitative analysis of residual protein contamination of podiatry instruments reprocessed through local and central decontamination units. Journal of Foot and Ankle Research 2011, 4:2 doi:10.1186/1757-1146-4-2.