New technologies to improve root canal disinfection

Effective irrigant delivery and agitation are prerequisites to promote root canal disinfection and debris removal and improve successful endodontic treatment. This paper presents an overview of the currently available technologies to improve the cleaning of the endodontic space and their debridement efficacy. A PubMed electronic search was conducted with appropriate key words to identify the relevant literature on this topic. After retrieving the full-text articles, all the articles were reviewed and the most appropriate were included in this review. Several different systems of mechanical activation of irrigants to improve endodontic disinfection were analysed: manual agitation with gutta-percha cones, endodontic instruments or special brushes, vibrating systems activated by low-speed hand-pieces or by sonic or subsonic energy, use of ultrasonic or laser energy to mechanically activate the irrigants and apical negative pressure irrigation systems. Furthermore, this review aims to describe systems designed to improve the intracanal bacterial decontamination by a specific chemical action, such as ozone, direct laser action or light-activated disinfection. The ultrasonic activation of root canal irrigants and of sodium hypochlorite in particular still remains the gold standard to which all other systems of mechanical agitation analyzed in this article were compared. From this overview, it is evident that the use of different irrigation systems can provide several advantages in the clinical endodontic outcome and that integration of new technologies, coupled with enhanced techniques and materials, may help everyday clinical practice

Hand disinfection in a neonatal intensive care unit: continuous electronic monitoring over a one-year period

<p>Abstract</p> <p>Background</p> <p>Good hand hygiene compliance is essential to prevent nosocomial infections in healthcare settings. Direct observation of hand hygiene compliance is the gold standard but is time consuming. An electronic dispenser with built-in wireless recording equipment allows continuous monitoring of its usage. The purpose of this study was to monitor the use of alcohol-based hand rub dispensers with a built-in electronic counter in a neonatal intensive care unit (NICU) setting and to determine compliance with hand hygiene protocols by direct observation.</p> <p>Methods</p> <p>A one-year observational study was conducted at a 27 bed level III NICU at a university hospital. All healthcare workers employed at the NICU participated in the study. The use of bedside dispensers was continuously monitored and compliance with hand hygiene was determined by random direct observations.</p> <p>Results</p> <p>A total of 258,436 hand disinfection events were recorded; i.e. a median (interquartile range) of 697 (559–840) per day. The median (interquartile range) number of hand disinfection events performed per healthcare worker during the day, evening, and night shifts was 13.5 (10.8 - 16.7), 19.8 (16.3 - 24.1), and 16.6 (14.2 - 19.3), respectively. In 65.8% of the 1,168 observations of patient contacts requiring hand hygiene, healthcare workers fully complied with the protocol.</p> <p>Conclusions</p> <p>We conclude that the electronic devices provide useful information on frequency, time, and location of its use, and also reveal trends in hand disinfection events over time. Direct observations offer essential data on compliance with the hand hygiene protocol. In future research, data generated by the electronic devices can be supplementary used to evaluate the effectiveness of hand hygiene promotion campaigns.</p

Surface disinfection challenges for Candida auris: an in-vitro study

The emerging pathogenic multidrug-resistant yeast Candida auris is an important source of healthcare-associated infections and of growing global clinical concern. The ability of this organism to survive on surfaces and withstand environmental stressors creates a challenge for eradicating it from hospitals. A panel of C. auris clinical isolates was evaluated on different surface environments against the standard disinfectant sodium hypochlorite and high-level disinfectant peracetic acid. C. auris was shown to selectively tolerate clinically relevant concentrations of sodium hypochlorite and peracetic acid in a surface-dependent manner, which may explain its ability to successfully persist within the hospital environment

Prolonged environmental persistence requires efficient disinfection procedures to control Devriesea agamarum associated disease in lizards

Aims: Devriesea agamarum infection causes chronic proliferative dermatitis, especially in desert dwelling lizards. The present study was concerned with evaluating persistency of D. agamarum in the environment and the evaluation of the efficacy of various disinfection procedures. Methods and Results: First, the survival of D. agamarum was assessed both in dermal crusts obtained from clinically and naturally infected lizards, and during periods of prolonged nutrient starvation on dry surface, in moist sand and in distilled water. Secondly, a modified European Suspension Test was performed to determine the efficacy of eight procedures for the disinfection of equipment, environmental surfaces and the topical treatment of D. agamarum-associated dermal lesions. The bacterium proved to persist and remain viable for up to 57 days in dermal crusts and for more than 5 months in moist sand and distilled water. In contrast, survival on dry surfaces was limited. The results of the described dilution-neutralization method demonstrated that most of the tested disinfection procedures were sufficient in achieving a 5-decimal logarithmic reduction in the number of D. agamarum colony-forming units. The use of relatively low concentrations of hydrogen peroxide and a boric and peracetic acid solution on the other hand resulted in insufficient reduction in viable counts. Conclusions: Devriesea agamarum can persist for long periods of time in the environment, especially under moist conditions, making the use of suitable disinfection procedures necessary. Significance and Impact of the Study: This study demonstrates the need for a dry environment for most desert lizards and the use of effective disinfection procedures next to antimicrobial treatment to eliminate D. agamarum-associated disease from captive saurian collections

Field efficacy evaluation and post-treatment contamination risk assessment of an ultraviolet disinfection and safe storage system.

Inconsistent use of household water treatment and safe storage (HWTS) systems reduces their potential health benefits. Ultraviolet (UV) disinfection is more convenient than some existing HWTS systems, but it does not provide post-treatment residual disinfectant, which could leave drinking water vulnerable to recontamination. In this paper, using as-treated analyses, we report on the field efficacy of a UV disinfection system at improving household drinking water quality in rural Mexico. We further assess the risk of post-treatment contamination from the UV system, and develop a process-based model to better understand household risk factors for recontamination. This study was part of a larger cluster-randomized stepped wedge trial, and the results complement previously published population-level results of the intervention on diarrheal prevalence and water quality. Based on the presence of Escherichia coli (proportion of households with ≥ 1 E. coli/100 mL), we estimated a risk difference of -28.0% (95% confidence interval (CI): -33.9%, -22.1%) when comparing intervention to control households; -38.6% (CI: -48.9%, -28.2%) when comparing post- and pre-intervention results; and -37.1% (CI: -45.2%, -28.9%) when comparing UV disinfected water to alternatives within the household. We found substantial increases in post-treatment E. coli contamination when comparing samples from the UV system effluent (5.0%) to samples taken from the storage container (21.1%) and drinking glasses (26.0%). We found that improved household infrastructure, additional extractions from the storage container, additional time from when the storage container was filled, and increased experience of the UV system operator were associated with reductions in post-treatment contamination. Our results suggest that the UV system is efficacious at improving household water quality when used as intended. Promoting safe storage habits is essential for an effective UV system dissemination. The drinking glass appears to represent a small but significant source of recontamination that is likely to impact all HWTS systems

Hospital environment as a reservoir for cross transmission. Cleaning and disinfection procedures

Background. Healthcare associated infections (HAIs) represent a serious problem for public health, as they increase the morbidity and mortality rates, present a relevant financial burden, and significantly contribute to the antimicrobial resistance. Methods. The aim of this review was to investigate the literature about HAIs, with particular reference to hospital environments and the role of cleaning and disinfection procedures. Hospital environments are an essential reservoir for HAIs cross transmission, and the application of appropriate procedures related to hand hygiene and disinfection/sterilization of surfaces and instruments remain key strategies for controlling HAIs. Results. Different procedures, based on the risk associated with the healthcare procedure, are recommended for hand hygiene: washing with soap and water, antiseptic rubbing with alcohol-based disinfectants, antiseptic and surgical hand washing. Environmental surfaces can be treated with different products, and the mostly used are chlorine-based and polyphenolic disinfectant. The reprocessing of instruments is related to their use according to the Spaulding's classification. In addition, scientific evidence demonstrated the great relevance of the "bundles" (small set of practices performed together) in controlling HAIs. Conclusions. Research agenda should include the improvement of well-known effective preventive procedures and the development of new bundles devoted to high-risk procedures and specific microorganisms

Preventing Hospital Acquired Infections Through a Workflow-Based Cyber-Physical System

Hospital acquired infections (HAI) are infections acquired within the hospital from healthcare workers, patients or from the environment, but which have no connection to the initial reason for the patient's hospital admission. HAI are a serious world-wide problem, leading to an increase in mortality rates, duration of hospitalisation as well as significant economic burden on hospitals. Although clear preventive guidelines exist, studies show that compliance to them is frequently poor. This paper details the software perspective for an innovative, business process software based cyber-physical system that will be implemented as part of a European Union-funded research project. The system is composed of a network of sensors mounted in different sites around the hospital, a series of wearables used by the healthcare workers and a server side workflow engine. For better understanding, we describe the system through the lens of a single, simple clinical workflow that is responsible for a significant portion of all hospital infections. The goal is that when completed, the system will be configurable in the sense of facilitating the creation and automated monitoring of those clinical workflows that when combined, account for over 90\% of hospital infections.Comment: Proceedings of ENASE 2016, ISBN: 978-989-758-189-

Assessment of Microbial Quality and Antibacterial Activity of Commonly used Hand Washes

Hands are the highways to the transmission and spread of pathogens that causes diseases, food borne illnesses and nosocomial infections. Hand washing is the act of cleansing the hands with water or another liquid, with or without the use of soap or other detergents, to ensure proper hand hygiene. To determine the microbiological quality and the antibacterial property and dilution effects on activity of hand wash, seven brands of hand washes were evaluated using susceptibility test by agar well diffusion, minimum inhibitory dilution and time kill test. This was done by assessing different dilutions of the hand washes against standardized 1.5x108 cells of Staphylococcus aureus, Escherichia coli and Pseudomonas aeruginosa. Results showed that all the hand washes were sterile and all the brands had some level of antibacterial activity. The hand washes were more active on Staphylococcus aureus and Escherichia coli than on Pseudomonas aeruginosa. Activity decreased with dilution as neat and 2-1 dilutions gave better results compared to 2-2, 10-1 and 10-2. Hib hand wash killed all test organisms when exposed for 2, 5 and 10 minutes and at neat and 2-1 dilutions but not at 2-2, 10-1 and 10-2. Rev and Pan hand washes though are sterile, were least active in all the tests. The minimum inhibitory dilution and minimum bactericidal dilution for most of the hand wash was at neat concentration. The time kill test showed that the effect of the hand wash was highest at 5 and 10 minutes and at neat (undiluted) for all the test organisms. It is advised that the dilution of hand washes a common practice in most eateries must stop as these products are not active when diluted, hands should be washed for five to ten minutes for maximum hand hygiene. Key words: Antibacterial Activity, Food Borne Illnesses, Hand Hygiene, Microbiological Quality, Nosocomial Infections and Pathogens

Effect of various dentin disinfection protocols on the bond strength of resin modified glass ionomer restorative material

Disinfection of dentin surface prior to any restorative therapy is important for the longevity of the treatment rendered. However, these dentin disinfection methods should itself not interfere with the adhesion of the restorative material. Therefore the aim of this study was to determine the effect of various dentin disinfection protocols on the shear bond strength (SBS) of resin modified glass ionomer cement (RMGIC). The occlusal surface of 40 extracted premolars were trimmed to obtain a flat dentinal surface and was randomly divided into four groups. CTRL was the control group; NaOCl was 1% sodium hypochlorite disinfection group; CHX was 2% chlorhexidine disinfection group; and PAD was the photo-activated disinfection group. Then a predetermined dimension of RMGIC was bonded to the pre-treated dentin surfaces. Following this, each sample was tested for SBS using universal testing machine at a crosshead speed of 0.5mm/min. Among the test groups, CHX showed the least reduction in SBS and NaOCl the highest reduction in SBS as compared to the control group. PAD on the other hand showed significantly lower SBS than CTRL and CHX groups, but the values were higher than the NaOCl group. Thus, it could be concluded from the present study that use of chlorhexidine based dentin disinfection does interfere with the adhesion of RMGIC. However, photo-activated disinfection should be done with caution. Moreover, sodium hypochlorite based disinfectants should be avoided prior to the use of RMGIC