Hostname: page-component-586b7cd67f-dlnhk Total loading time: 0 Render date: 2024-11-29T04:35:52.541Z Has data issue: false hasContentIssue false

Comparative evaluation of the microbicidal activity of low-temperature sterilization technologies to steam sterilization

Published online by Cambridge University Press:  26 February 2020

William A. Rutala*
Affiliation:
Division of Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, North Carolina
Maria F. Gergen
Affiliation:
Lumagenics, Cary, North Carolina
Emily E. Sickbert-Bennett
Affiliation:
Division of Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, North Carolina Department of Hospital Epidemiology, University of North Carolina Health Care, Chapel Hill, North Carolina
David J. Weber
Affiliation:
Division of Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, North Carolina Department of Hospital Epidemiology, University of North Carolina Health Care, Chapel Hill, North Carolina
*
Author for correspondence: William A. Rutala, PhD, MPH, CIC, UNC, E-mail: [email protected]

Abstract

Objective:

To compare the microbicidal activity of low-temperature sterilization technologies (vaporized hydrogen peroxide [VHP], ethylene oxide [ETO], and hydrogen peroxide gas plasma [HPGP]) to steam sterilization in the presence of salt and serum to simulate inadequate precleaning.

Methods:

Test carriers were inoculated with Pseudomonas aeruginosa, Escherichia coli, Staphylococcus aureus, vancomycin-resistant Enterococcus, Mycobacterium terrae, Bacillus atrophaeus spores, Geobacillus stearothermophilus spores, or Clostridiodes difficile spores in the presence of salt and serum and then subjected to 4 sterilization technologies: steam, ETO, VHP and HPGP.

Results:

Steam, ETO, and HPGP sterilization techniques were capable of inactivating the test organisms on stainless steel carriers with a failure rate of 0% (0 of 220), 1.9% (6 of 310), and 1.9% (5 of 270), respectively. The failure rate for VHP was 76.3% (206 of 270).

Conclusion:

Steam sterilization is the most effective and had the largest margin of safety, followed by ETO and HPGP, but VHP showed much less efficacy.

Type
Original Article
Copyright
© 2020 by The Society for Healthcare Epidemiology of America. All rights reserved

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Fields, R. Outpatient surgeries outnumber inpatient surgeries at 53M procedures a year. September 27, 2010. https://www.beckersasc.com/news-analysis/outpatient-surgeries-outnumber-inpatient-surgeries-at-53m-procedures-a-year.html. Accessed January 2019.Google Scholar
Rutala, WA, Weber, DJ and HICPAC. Guideline for disinfection and sterilization in healthcare facilities, 2008. Centers for Disease Control and Prevention website. https://www.cdc.gov/infectioncontrol/pdf/guidelines/disinfection-guidelines-H.pdf Published 2008. Accessed June 2019.Google Scholar
Alfa, MJ.Biofilms on instruments and environmental surfaces: do they interfere with instrument reprocessing and surface disinfection? Review of the literature. Am J Infect Control 2019;47:A39A45.CrossRefGoogle Scholar
Rutala, WA, Weber, DJ.Disinfection, sterilization, and control of hospital waste. In: Bennett, JE, Dolan, R, Blaser, MJ, eds. Principles and Practice of Infectious Diseases. Philadelphia: Elsevier. In press.Google Scholar
Alfa, MJ, DeGagne, P, Olson, N, Puchalski, T.Comparison of ion plasma, vaporized hydrogen peroxide, and 100% ethylene oxide sterilizers to the 12/88 ethlyene oxide gas sterilizer. Infect Control Hosp Epidemiol 1996;17:92100.CrossRefGoogle Scholar
Rutala, WA, Weber, DJ.Disinfection, sterilization, and antisepsis: an overview. Am J Infect Control 2019;47:A3A9.CrossRefGoogle Scholar
Association of Official Analytical Chemists (AOAC). AOAC official method 966.04: sporicidal activity of disinfectants. In: Official Methods of Analysis of AOAC International. Vol 1, 16th ed., 5th revision. Gaithersburg, MD: AOAC; 1999.Google Scholar
Jacobs, PT, Wang, J-H, Gorham, RA, Roberts, CG.Cleaning: principles, methods and benefits. In: Rutala, WA, ed. Disinfection, Sterilization, and Antisepsis in Health Care. Washington, DC: APIC and Champlain, NY: Polyscience Publications; 1998;165181.Google Scholar
Diab-Elschahawi, M, Blacky, A, Bachhofner, N, Koller, W.Challenging the Sterrad 100 NX sterilizer with different carrier materials and wrappings under experimental “clean” and “dirty” conditions. Am J Infect Control 2010;38:806810.CrossRefGoogle Scholar
Molloy-Simard, V, Lemyre, J-L, Martel, K, Catalone, BJ.Elevating the standard of endoscope processing: terminal sterilization of duodenoscopes using a hydrogen-peroxide-ozone sterilizer. Am J Infect Control 2019;47:243250.CrossRefGoogle ScholarPubMed
Rutala, WA, Gergen, MF, Weber, DJ. Comparative evaluation of the sporicidal activity of low-temperature sterilization technologies: ethylene oxide, 2 plasma sterilization systems, and liquid peracetic acid. Am J Infect Control 1998;26:393398.CrossRefGoogle ScholarPubMed
Kanemitzu, K, Imasaka, T, Ishikawa, S, et al.A comparison study of ethylene oxide gas, hydrogen peroxide gas plasma, and low-temperature steam formaldehyde sterilization. Infect Control Hosp Epidemiol 2005;26:486489.CrossRefGoogle Scholar
Rutala, WA, Gergen, MF, and Weber, DJ. 2008. Impact of an oil-based lubricant on the effectiveness of the sterilization processes. Infect Control Hosp Epidemiol 2008;29:6972.CrossRefGoogle ScholarPubMed
Rutala, WA, Kanamori, H, Sickbert-Bennett, EE, Weber, DJ.Reprocessing endoscopes: Are we going to ensure “the needs of the patient come first” by shifting from disinfection to sterilization? Am J Infect Control 2019;47:A62A66.CrossRefGoogle Scholar
Lipscomb, IP, Sihota, AK, Keevil, CW.Comparison between visual analysis and microscope assessment of surgical cleanliness from sterile service departments. J Hosp Infect 2008;68:5258.CrossRefGoogle ScholarPubMed
Alfa, MJ, Fatima, I, Olson, N.Validation of adenosine triphosphate to audit manual cleaning of flexible endoscope channels. Am J Infect Control 2013;41:245248.CrossRefGoogle ScholarPubMed
Doyle, JE, Ernst, RR.Resistance of Bacillus subtilis var. niger spores occluded in water-insoluble crystals to three sterilization agents. Appl Environ Microbiol 1967;15:726730.CrossRefGoogle ScholarPubMed
Alfa, MJ, DeGagne, P, Olson, N, Hizon, R.Comparison of liquid chemical sterilization with peracteic acid and ehtylene oxide sterilization for long narrow lumens. Am J Infect Control 1998;26:469477.CrossRefGoogle Scholar
Abbott, CF, Cockton, Jones W.Science papers and discussions, resistance of crystalline substances to gas sterilization. J Pharm Pharmacol 1956;6:709721.CrossRefGoogle Scholar
Okpara-Hofman, J, Knoll, M, Dürr, M, Schmitt, B, Borneff-Lipp, M.Comparison of low-temperature hydrogen peroxide gas plasma sterilization for endoscopes using various Sterrad models. J Hosp Infect 2005;59:280285.CrossRefGoogle Scholar