Zentralsterilisation - Ausgabe 6/2007

EDITORIAL

Auf der Suche nach "der Wahrheit"

AKTUELL

• Aus dem Normenwerk: Medizinprodukterichtlinie geändert
• Chirurgische Instrumente - Patientensicherheit an erster Stelle. 1. Treffen der niederländischen Vereinigung der Sachkundigen für sterile Medizinprodukte in Nijmegen
• Entscheidungswege in Europa. Europäische Gesetzgebung am Beispiel der Aufbereitung von Medizinprodukten
• 90. Hygiene- und Steri-Treff in Bochum. Die Arbeitsgemeinschaft Hygiene und Sterilisation im Ruhrgebiet stellt sich vor

HAUPTARBEITEN

G. Fichet*, J. Harrison, G. McDonnell:
Wirksame Reinigungsverfahren zur Verringerung des Risikos einer Prionenübertragung durch chirurgische Instrumente
(Zentr Steril 2007; 15 (6): 418-437)

Abstract
Prions are unique infectious agents which have been shown to be transmitted iatrogenically through contaminated devices. Device contamination and its removal/inactivation is a particular concern in the reprocessing of medical devices. Cleaning is the first step in device reprocessing and is fundamental for effective disinfection and/or sterilization. In this report we review what is currently known on the effective cleaning of prions from contaminated devices. The various international and national guidelines on reprocessing of medical devices emphasize the importance of cleaning but, in most cases, they give little advice on how this should be achieved. Only recently has there been an increasing number of reports in the literature on investigations of cleaning efficacy against prions, with some surprising findings. Further investigations have been conducted with a CE marked alkaline cleaning formulation that claims to reduce the risk of prion contamination. This formulation has been successfully shown to be effective in both in vitro and in vivo laboratory investigations, under a wide range of conditions and using various strains of prions including scrapie, BSE, CJD and vCJD. Clinical testing has also been completed, with successful cost reduction and cleaning efficacy outcomes. It is now possible that prion decontamination can be addressed as part of standard precautions for device reprocessing.
Schlüsselbegriffe
prion, decontamination, cleaning

S. Nakata*, R. Fushimi, R. Hanamura, S. Noguchi, K. Umeshita, M. Takashina, T. Kawamoto:
Vordesinfektion von Instrumenten erschwert eine wirksame Reinigung
(Zentr Steril 2007; 15 (6): 440-450)

Abstract
When used surgical instruments are decontaminated by immersion in disinfectant solutions prior to cleaning, the residual protein may be modified or altered by the disinfectants and may result in the protein adhering to the instruments.
These modified proteins and their effect on instrument cleaning were investigated by mixing blood with various disinfectant solutions and by using TOSI® cleaning indicators to identify obstacles to removal of the residual protein following immersion of the indicators in the various disinfectant solutions.
After whole human blood and each disinfectant were added to a test tube and mixed, the mixture was centrifuged. The TOSI indicators were immersed in the various disinfectant solutions for 20 minutes and then cleaned using either a washer disinfector or an ultrasonic washer.
When blood was mixed with the disinfectants and centrifuged, the protein in the blood was altered and a gel or precipitate was formed. Protein from the TOSI indicators that was also modified after immersion in the disinfectants and remained on the indicators despite the effect of cleaning by the washer disinfector or ultrasonic washer.
These findings suggest that disinfectants used before cleaning may interfere with the proper cleaning of surgical instruments. It is therefore recommended that surgical instruments be cleaned in a centralized cleaning department without the use of disinfectants prior to cleaning.
Schlüsselbegriffe
disinfection, cleaning, blood, interference

AFS-Arbeitsgruppe:
Beherrschung und Kontrolle der Umgebungsbedingungen bei der Sterilisation. Empfehlung der französ. Gesellschaft für Sterilgutversorgung AFS - Teil 3

Qualitätsmanagement in der ZSVA - Chirurgische Standard-Instrumente (6):
Sichtkontrolle, Pflege und Funktionskontrolle von Standard Ring-Nadelhaltern mit und ohne Hartmetalleinlagen

EMPFEHLUNGEN DES AK "QUALITÄT"

Anforderungen für den Bau oder Umbau einer Zentralen Sterilgutversorgungsabteilung in einem Krankenhaus Teil 2 - Personal- und Materialwege

mhp steht für Medizin, Hygiene und Prävention. Der mhp-Verlag ist seit mehr als 20 Jahren Spezialist für Publikationen im Bereich der Hygiene.