Deva A K, Vickery K, Zou J, West R H, Harris J P, Cossart Y E
Department of Surgery, Royal Prince Alfred Hospital, Australia.
J Hosp Infect. 1996 Jun;33(2):119-30. doi: 10.1016/s0195-6701(96)90096-1.
Nosocomial transmission of hepatitis B virus (HBV), associated with interventional procedures, has been attributed to its survival on improperly decontaminated instruments. To date, guidelines for chemical disinfection of potentially contaminated heat-sensitive instruments have been based largely on extrapolation of data from in-vitro disinfectant testing. Direct infectivity testing has not been possible for HBV because of the lack of a practical culture assay or susceptible experimental animal model. In this study the related duck hepadnavirus was used to simulate in-vivo transmission of a HBV during surgery, and to evaluate the effectiveness of 2% glutaraldehyde disinfection of surgical laparoscopes. Multiple laparoscopic liver biopsies were performed on 'biohazardous' duck hepatitis B (DHBV) positive ducks. Laparoscopes were then subjected to different disinfection regimes using 2% glutaraldehyde, and residual infectivity tested by placing their tips into the peritoneal cavities of uninfected four-day-old ducklings. Direct transmission of DHBV occurred in all ducks when laparoscopes were not washed. Rinsing with water lowered the transmission rate to 64% and no infection transmission occurred after 5 min of contact time with the disinfectant. In contrast, previous in-vitro studies had shown complete viral inactivation after a shorter period of disinfection. It is postulated that the longer inactivation time observed in our study may be a result of surface interactions of virus and instrument, interfering with disinfectant access or activity. Tests of instrument surface samples for viral DNA by the polymerase chain reaction (PCR) did not correlate with transmission of virus infection in vivo. PCR is an inappropriate test for evaluating the efficacy of disinfectant action despite its sensitivity. This in use method will allow testing of other decontamination procedures and their effectiveness on more complex surgical instruments.
与介入性操作相关的医院内乙型肝炎病毒（HBV）传播，被认为是由于其在未正确消毒的器械上存活所致。迄今为止，针对可能被污染的热敏器械进行化学消毒的指南，很大程度上是基于体外消毒剂测试数据的外推。由于缺乏实用的培养检测方法或易感实验动物模型，HBV的直接感染性检测一直无法实现。在本研究中，相关的鸭乙肝病毒被用于模拟手术期间HBV的体内传播，并评估2%戊二醛对手术腹腔镜的消毒效果。对“具有生物危害性”的鸭乙肝（DHBV）阳性鸭进行多次腹腔镜肝脏活检。然后使用2%戊二醛对腹腔镜进行不同的消毒方案处理，并通过将其尖端放入未感染的4日龄雏鸭的腹腔中来检测残留感染性。当腹腔镜未清洗时，所有鸭均发生了DHBV的直接传播。用水冲洗可将传播率降至64%，与消毒剂接触5分钟后未发生感染传播。相比之下，先前的体外研究表明，在较短的消毒时间后病毒即可完全灭活。据推测，我们研究中观察到的较长灭活时间可能是病毒与器械表面相互作用的结果，这会干扰消毒剂的接触或活性。通过聚合酶链反应（PCR）对器械表面样本进行病毒DNA检测，与体内病毒感染传播并无相关性。尽管PCR灵敏度高，但它并非评估消毒作用效果的合适检测方法。这种实际使用方法将允许对其他去污程序及其对更复杂手术器械的有效性进行测试。
