Research Article| Volume 65, ISSUE 4, P326-333, April 2007

Download started.


Different experimental protocols for decontamination affect the cleaning of medical devices. A preliminary electron microscopy analysis


      The aim of the present study was to examine the efficiency of different decontamination-cleaning protocols on blood-soiled catheters used for interventional cardiology. Electrophysiology and cardiac ablation disposable devices were contaminated with bacteria-spiked human blood and underwent four different pre-sterilization protocols, including a chlorine-releasing agent, a polyphenolic emulsion, and an enzymatic detergent. Treated samples were examined by optical microscopy, scanning electron microscopy and transmission electron microscopy to identify and characterize biological and inorganic residuals. The use of chlorine as a first treatment caused denaturation of serum proteins and adherence of blood components to the surface of the device, thus hindering the cleaning efficiency of subsequent treatments with enzymatic detergents. An enzymatic/chlorine protocol was more efficient, but was considered to be a greater risk to healthcare staff. Polyphenolic-based treatments had the highest level of efficiency in bioburden removal, but interaction and adsorption of this class of chemicals onto biopolymers might lead to serious concerns about toxicity on subsequent reuse. Adequate pre-sterilization cleaning is fundamental for sterilization success and high-resolution electron microscopy can provide significant and detailed information about the efficiency of chemicals used for cleaning a blood-soiled device.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of Hospital Infection
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Robert Koch Institute recommendations
        Hygienic requirements for processing of medical devices.
        Bundesgesundheitsblatt-Gesundheitsforschung-Gesundheitsschutz. 2001; 44: 1115-1126
        • Italian Health Government
        Decreto Legislativo 28/09/1990: Norme di protezione dal contagio professionale da HIV nelle strutture sanitarie ed assistenziali pubbliche e private.
        Gazzetta Ufficiale Repubblica Italiana. 1990; 235: 78-80
        • Francois P.
        • Vaudaux P.
        • Foster T.J.
        • Lew D.P.
        Host-bacteria interactions in foreign body infections.
        Infect Control Hosp Epidemiol. 1996; 17 ([Review]): 514-520
        • Tessarolo F.
        • Ferrari P.
        • Bortoluzzi S.
        • et al.
        Evaluation and quantification of reprocessing modification in single use devices in interventional cardiology.
        Appl Surf Sci. 2004; 238: 341-346
        • Lerouge S.
        • Guignot C.
        • Tabrizian M.
        • Ferrier D.
        • Yagoubi N.
        • Yahia L.
        Plasma-based sterilization: effect on surface and bulk properties and hydrolytic stability of reprocessed polyurethane electrophysiology catheters.
        J Biomed Mater Res. 2000; 15: 774-782
        • Grabsch E.A.
        • Grayson M.L.
        • Johnson P.D.R.
        • Yates L.A.
        • Harper R.W.
        • Smolic J.J.
        Bactericidal efficacy of sterilizing protocol for reused cardiac electrophysiology catheters.
        Am J Cardiol. 2002; 89: 770-772
        • Krebs M.C.
        • Bécasse P.
        • Verjat D.
        • Darbord J.C.
        Gas–plasma sterilization: relative efficacy of the hydrogen peroxide phase compared with that of the plasma phase.
        Int J Pharm. 1998; 160: 75-81
        • Bathina M.N.
        • Mickelsen S.
        • Brooks C.
        • Jaramillo J.
        • Hepton T.
        • Kusumoto F.M.
        Safety and efficacy of hydrogen peroxide plasma sterilization for repeated use of electrophysiology catheters.
        J Am Coll Cardiol. 1998; 32: 1384-1388
        • Agolini G.
        • Clementi M.
        • Lipartiti T.
        • et al.
        Attualità nella decontaminazione di strumenti chirurgici per la prevenzione delle infezioni occupazionali da HIV, HBV, HCV.
        Giornale Italiano delle Infezioni Ospedaliere. 2002; 9: 90-98
        • Rutala W.A.
        • Cole E.C.
        • Thomann C.A.
        • Weber D.J.
        Stability and bactericidal activity of chlorine solutions.
        Infect Control Hosp Epidemiol. 1998; 19: 323-327
        • Rutala W.A.
        APIC guideline for selection and use of disinfectants. 1994, 1995, and 1996 APIC Guidelines Committee. Association for Professionals in Infection Control and Epidemiology, Inc.
        Am J Infect Control. 1996; 24 ([Review]): 313-342
        • Rutala W.A.
        Disinfection, sterilization and waste disposal.
        in: Wenzel B.P. Prevention and control of nosocominal infection. Williams and Wilkins, Baltimore1987: 257-282
        • Dychdala G.R.
        Chlorine and chlorine releasing compounds.
        in: Block S.S. Disinfection, sterilization and preservation. 4th ed. Lea & Febiger, Philadelphia1991: 131-151
        • Tessarolo F.
        • Caola I.
        • Fedel M.
        • Caciagli P.
        • Guarrera G.M.
        • Nollo G.
        Effects of chlorine-releasing compounds on medical devices decontamination.
        J Appl Biomater Biomech. 2004; 2: 219
        • Kampf G.
        • Bloss R.
        • Martiny H.
        Surface fixation of dried blood by glutaraldehyde and peracetic acid.
        J Hosp Infect. 2004; 57: 139-143
        • Bloomfield S.F.
        • Miller E.A.
        A comparison of hypochlorite and phenolic disinfectants for disinfection of clean and soiled surfaces and blood spillages.
        J Hosp Infect. 1989; 13: 231-239
        • Heeg P.
        • Roth K.
        • Reichl R.
        • Cogdill C.P.
        • Bond W.W.
        Decontaminated single-use devices: an oxymoron that may be placing patients at risk for cross-contamination.
        Infect Control Hosp Epidemiol. 2001; 22: 542-549
        • Dunnigan A.
        • Roberts C.
        • McNamara M.
        • Benson D.W.
        • Benditt D.G.
        Success of re-use of cardiac electrode catheters.
        Am J Cardiol. 1987; 60: 807-810
        • Ruffy R.
        Catheter ablation in a less privileged country: the importance of spreading the goods.
        Pacing Clin Electrophysiol. 1995; 18: 1463-1464
        • Kundsin R.B.
        • Walter C.W.
        Detection of endotoxin on sterile catheters used for cardiac catheterisation.
        J Clin Microbiol. 1980; 11: 209-212
        • Lerouge S.
        • Wertheimer M.R.
        • Marchand R.
        • Tabrizian M.
        • Yahia L.
        Effect of gas composition on spore mortality and etching during low-pressure plasma sterilization.
        J Biomed Mater Res. 2000; 51: 128-135