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      Use of UV-C radiation to disinfect non-critical patient care items: a laboratory assessment of the Nanoclave Cabinet

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          Abstract

          Background

          The near-patient environment is often heavily contaminated, yet the decontamination of near-patient surfaces and equipment is often poor. The Nanoclave Cabinet produces large amounts of ultraviolet-C (UV-C) radiation (53 W/m 2) and is designed to rapidly disinfect individual items of clinical equipment. Controlled laboratory studies were conducted to assess its ability to eradicate a range of potential pathogens including Clostridium difficile spores and Adenovirus from different types of surface.

          Methods

          Each test surface was inoculated with known levels of vegetative bacteria (10 6 cfu/cm 2), C. difficile spores (10 2-10 6 cfu/cm 2) or Adenovirus (10 9 viral genomes), placed in the Nanoclave Cabinet and exposed for up to 6 minutes to the UV-C light source. Survival of bacterial contaminants was determined via conventional cultivation techniques. Degradation of viral DNA was determined via PCR. Results were compared to the number of colonies or level of DNA recovered from non-exposed control surfaces. Experiments were repeated to incorporate organic soils and to compare the efficacy of the Nanoclave Cabinet to that of antimicrobial wipes.

          Results

          After exposing 8 common non-critical patient care items to two 30-second UV-C irradiation cycles, bacterial numbers on 40 of 51 target sites were consistently reduced to below detectable levels (≥ 4.7 log 10 reduction). Bacterial load was reduced but still persisted on other sites. Objects that proved difficult to disinfect using the Nanoclave Cabinet (e.g. blood pressure cuff) were also difficult to disinfect using antimicrobial wipes. The efficacy of the Nanoclave Cabinet was not affected by the presence of organic soils. Clostridium difficile spores were more resistant to UV-C irradiation than vegetative bacteria. However, two 60-second irradiation cycles were sufficient to reduce the number of surface-associated spores from 10 3 cfu/cm 2 to below detectable levels. A 3 log 10 reduction in detectable Adenovirus DNA was achieved within 3 minutes; after 6 minutes, viral DNA was undetectable.

          Conclusion

          The results of this study suggest that the Nanoclave Cabinet can provide rapid and effective disinfection of some patient-related equipment. However, laboratory studies do not necessarily replicate ‘in-use’ conditions and further tests are required to assess the usability, acceptability and relative performance of the Nanoclave Cabinet when used in situ.

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          Most cited references22

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          Inactivation credit of UV radiation for viruses, bacteria and protozoan (oo)cysts in water: a review.

          UV disinfection technology is of growing interest in the water industry since it was demonstrated that UV radiation is very effective against (oo)cysts of Cryptosporidium and Giardia, two pathogenic micro-organisms of major importance for the safety of drinking water. Quantitative Microbial Risk Assessment, the new concept for microbial safety of drinking water and wastewater, requires quantitative data of the inactivation or removal of pathogenic micro-organisms by water treatment processes. The objective of this study was to review the literature on UV disinfection and extract quantitative information about the relation between the inactivation of micro-organisms and the applied UV fluence. The quality of the available studies was evaluated and only high-quality studies were incorporated in the analysis of the inactivation kinetics. The results show that UV is effective against all waterborne pathogens. The inactivation of micro-organisms by UV could be described with first-order kinetics using fluence-inactivation data from laboratory studies in collimated beam tests. No inactivation at low fluences (offset) and/or no further increase of inactivation at higher fluences (tailing) was observed for some micro-organisms. Where observed, these were included in the description of the inactivation kinetics, even though the cause of tailing is still a matter of debate. The parameters that were used to describe inactivation are the inactivation rate constant k (cm(2)/mJ), the maximum inactivation demonstrated and (only for bacterial spores and Acanthamoeba) the offset value. These parameters were the basis for the calculation of the microbial inactivation credit (MIC="log-credits") that can be assigned to a certain UV fluence. The most UV-resistant organisms are viruses, specifically Adenoviruses, and bacterial spores. The protozoon Acanthamoeba is also highly UV resistant. Bacteria and (oo)cysts of Cryptosporidium and Giardia are more susceptible with a fluence requirement of <20 mJ/cm(2) for an MIC of 3 log. Several studies have reported an increased UV resistance of environmental bacteria and bacterial spores, compared to lab-grown strains. This means that higher UV fluences are required to obtain the same level of inactivation. Hence, for bacteria and spores, a correction factor of 2 and 4 was included in the MIC calculation, respectively, whereas some wastewater studies suggest that a correction of a factor of 7 is needed under these conditions. For phages and viruses this phenomenon appears to be of little significance and for protozoan (oo)cysts this aspect needs further investigation. Correction of the required fluence for DNA repair is considered unnecessary under the conditions of drinking water practice (no photo-repair, dark repair insignificant, esp. at higher (60 mJ/cm(2)) fluences) and probably also wastewater practice (photo-repair limited by light absorption). To enable accurate assessment of the effective fluence in continuous flow UV systems in water treatment practice, biodosimetry is still essential, although the use of computational fluid dynamics (CFD) improves the description of reactor hydraulics and fluence distribution. For UV systems that are primarily dedicated to inactivate the more sensitive pathogens (Cryptosporidium, Giardia, pathogenic bacteria), additional model organisms are needed to serve as biodosimeter.
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            Rapid and quantitative detection of human adenovirus DNA by real-time PCR.

            Rapid diagnosis of human adenovirus (HAdV) infections was achieved by PCR in the recent years. However, conventional PCR has the risk of carry-over contamination due to open handling with its products, and results are only qualitative. Therefore, a quantitative "real-time" PCR with consensus primer and probe (dual fluorescence labelled, "TaqMan") sequences for a conserved region of the hexon gene was designed and evaluated. Real-time PCR detected all 51 HAdV prototypes. Sensitivity of the assay was
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              • Article: not found

              Low-temperature sterilization using gas plasmas: a review of the experiments and an analysis of the inactivation mechanisms.

              Utilizing an ionized gas (plasma) to achieve sterilization is an alternative to conventional sterilization means as far as sterilization of heat-sensitive materials and innocuity of sterilizing agents are concerned. The literature on plasma sterilization is reviewed. A major issue of plasma sterilization is the respective roles of UV photons and reactive species such as atomic and radicals. Insight into this matter is obtained by analyzing the survival curves of microorganisms. In contrast to classical sterilization where such plots show a unique straight line, plasma sterilization yields survival diagrams with two or three different linear segments. Three basic mechanisms are involved in the plasma inactivation of microorganisms: (A) direct destruction by UV irradiation of the genetic material of microorganisms; (B) erosion of the microorganisms atom by atom, through intrinsic photodesorption by UV irradiation to form volatile compounds combining atoms intrinsic to the microorganisms; (C) erosion of the microorganisms, atom by atom, through etching to form volatile compounds as a result of slow combustion using oxygen atoms or radicals emanating from the plasma. In some cases, etching is further activated by UV photons, increasing the elimination rate of microorganisms. These mechanisms make plasma sterilization totally different from classical sterilization techniques and suggest its use to inactivate nonconventional infectious agents such as the abnormal prions.
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                Author and article information

                Journal
                BMC Infect Dis
                BMC Infect. Dis
                BMC Infectious Diseases
                BioMed Central
                1471-2334
                2012
                3 August 2012
                : 12
                : 174
                Affiliations
                [1 ]Clinical Microbiology and Virology, University College London Hospitals NHS Foundation Trust, London, UK
                [2 ]Great Ormond Street Hospital for Sick Children, London, UK
                [3 ]Hospital Infection Research Laboratory, Queen Elizabeth Hospital, Birmingham, UK
                [4 ]Department of Microbiology, UCLH Environmental Research Group, Royal Free Hampstead NHS Trust, London, NW3 2QG, UK
                Article
                1471-2334-12-174
                10.1186/1471-2334-12-174
                3449183
                22856652
                c0cdb2e2-fe37-4ef8-90ff-6c5b55a6cbb1
                Copyright ©2012 Moore et al.; licensee BioMed Central Ltd.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 26 March 2012
                : 25 July 2012
                Categories
                Research Article

                Infectious disease & Microbiology
                surface disinfection,ultraviolet radiation,nosocomial pathogens,adenovirus

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