Costa Dayane de Melo, Lopes Lillian Kelly de Oliveira, Tipple Anaclara Ferreira Veiga, Johani Khalid, Hu Honghua, Deva Anand Kumar, Watanabe Evandro, Vickery Karen
Surgical Infection Research Group, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia; Faculty of Nursing, Federal University of Goias, Goiania, Brazil.
Surgical Infection Research Group, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia.
Infect Dis Health. 2018 Mar;23(1):3-9. doi: 10.1016/j.idh.2017.08.004. Epub 2017 Sep 28.
To determine the effect of multiple use and processing cycles on instrument quality over the life of stainless steel, complex designed clinical surgical instruments.
Steam sterilised surgical instruments due to be discarded from Australian hospitals, because of loss of functionality, were assessed for contaminating protein and bacteria using the bicinchoninic acid protein assay and microbial culture, respectively. Biofilm presence and instrument damage were visually confirmed by scanning electron microscopy (SEM). Instruments were categorised into hinged/serrated, screw, cannulated, flexible, and irregular surfaced (but not hinged) according to their design.
Protein contamination ranged from 24 μg on the new screw to 3,756,046 μg contaminating a discarded forceps. The more complex the instrument design the higher the protein contamination. All samples were culture negative, however, biofilm was visually confirmed on 4/8 instruments tested using SEM. SEM also detected soil, holes or black stains on all the instruments.
"Ready to use" surgical instruments that underwent multiple uses and processing cycles were contaminated with high amounts of protein, and microscopy revealed the presence of soil, structural damage, black stains and biofilm. While less affected new but multiply processed screws also showed soil and biofilm contamination. These findings highlight the need for further research into determining what is the "life" of stainless steel instruments and development of standard criteria for evaluating when to "retire" an instrument.
为了确定多次使用和处理循环对复杂设计的不锈钢临床手术器械使用寿命期间器械质量的影响。
分别使用二辛可宁酸蛋白质测定法和微生物培养法，对因功能丧失而即将从澳大利亚医院丢弃的蒸汽灭菌手术器械的污染蛋白质和细菌进行评估。通过扫描电子显微镜（SEM）目视确认生物膜的存在和器械损坏情况。根据器械设计将其分为铰链/锯齿状、螺丝、空心、柔性和不规则表面（但非铰链）五类。
蛋白质污染范围从新螺丝上的24微克到污染一把废弃镊子的3,756,046微克。器械设计越复杂，蛋白质污染越高。所有样本培养均为阴性，然而，使用SEM测试的8个器械中有4个目视确认有生物膜。SEM还在所有器械上检测到污垢、孔洞或黑色污渍。
经过多次使用和处理循环的“即用型”手术器械被大量蛋白质污染，显微镜检查显示存在污垢、结构损坏、黑色污渍和生物膜。虽然新的但经过多次处理的螺丝受影响较小，但也显示出污垢和生物膜污染。这些发现凸显了进一步研究确定不锈钢器械的“使用寿命”以及制定评估器械何时“退役”的标准的必要性。
