Lewis D L, Arens M
Department of Ecology, University of Georgia, Athens 30602, USA.
Nat Med. 1995 Sep;1(9):956-8. doi: 10.1038/nm0995-956.
The U.S. Centers for Disease Control and Prevention (CDC) recommends that only heat sterilization be used for all reusable devices entering the oral cavity. However, chemical disinfection is still employed for reprocessing dental devices in many areas of the world. In an analysis of a Florida dental practice responsible for nosocomial human immunodeficiency virus (HIV) transmissions, the possible role of contaminated devices was deemed unlikely in part because they were subjected to high-level disinfection with 2% glutaraldehyde. Disease transmissions have, however, been documented for endoscopes used in diagnostic and surgical procedures even after this treatment. In some dental devices, lubricants mix with potentially infectious patient materials, and organic debris has been observed in endoscopes after cleaning. We have investigated whether lubricants can render high-level chemical disinfection procedures ineffective and have addressed the role that some common devices may play in disease transmission. We report here that HIV in whole-blood samples and Pseudomonas aeruginosa in blood and plasma survived high-level disinfection when entrapped in lubricants used in dental handpieces and endoscopes. We also found that lubricated dental devices used to clean and polish teeth (prophylaxis angles) have the potential to transfer sufficient amounts of blood to infect human lymphocyte cultures with HIV. These results emphasize the need to subject reusable dental devices to a heat-sterilization protocol that penetrates the lubricant.
美国疾病控制与预防中心（CDC）建议，所有进入口腔的可重复使用器械都应仅采用热消毒法。然而，在世界许多地区，牙科器械的再处理仍采用化学消毒法。在对一家导致医院内人类免疫缺陷病毒（HIV）传播的佛罗里达牙科诊所进行的分析中，受污染器械的潜在作用被认为可能性不大，部分原因是这些器械用2%戊二醛进行了高水平消毒。然而，即使经过这种处理，用于诊断和外科手术的内窥镜仍有疾病传播的记录。在一些牙科器械中，润滑剂会与潜在感染性的患者材料混合，并且在内窥镜清洗后会观察到有机碎片。我们研究了润滑剂是否会使高水平化学消毒程序失效，并探讨了一些常见器械在疾病传播中可能发挥的作用。我们在此报告，当全血样本中的HIV以及血液和血浆中的铜绿假单胞菌被困在牙科手机和内窥镜使用的润滑剂中时，它们在高水平消毒后仍能存活。我们还发现，用于清洁和抛光牙齿的带润滑的牙科器械（预防性牙托）有可能转移足够量的血液，从而用HIV感染人类淋巴细胞培养物。这些结果强调了对可重复使用的牙科器械采用能穿透润滑剂的热消毒方案的必要性。
