Failure of non-vacuum steam sterilization processes for dental handpieces

Background: Dental handpieces are used in critical and semi-critical operative interventions. Although a number of dental professional bodies recommend that dental handpieces are sterilized between patient use there is a lack of clarity and understanding of the effectiveness of different steam sterilization processes. The internal mechanisms of dental handpieces contain narrow lumens (0·8-2·3mm) which can impede the removal of air and ingress of saturated steam required to achieve sterilization conditions. Aim: To identify the extent of sterilization failure in dental handpieces using a non-vacuum process. Methods: In-vitro and in-vivo investigations were conducted on commonly used UK benchtop steam sterilizers and three different types of dental handpieces. The sterilization process was monitored inside the lumens of dental handpieces using thermometric (TM) methods (dataloggers), chemical indicators (CI) and biological indicators (BI). Findings: All three methods of assessing achievement of sterility within dental handpieces that had been exposed to non-vacuum sterilization conditions demonstrated a significant number of failures (CI=8/3,024(fails/n tests); BI=15/3,024; TM=56/56) compared to vacuum sterilization conditions (CI=2/1,944; BI=0/1,944; TM=0/36). The dental handpiece most likely to fail sterilization in the non-vacuum process was the surgical handpiece. Non-vacuum sterilizers located in general dental practice had a higher rate of sterilization failure (CI=25/1,620; BI=32/1,620; TM=56/56) with no failures in vacuum process. Conclusion: Non-vacuum downward/gravity displacement, type-N steam sterilizers are an unreliable method for sterilization of dental handpieces in general dental practice. The handpiece most likely to fail sterilization is the type most frequently used for surgical interventions

Investigating steam penetration using thermometric methods in dental handpieces with narrow internal lumens during sterilizing processes with non-vacuum or vacuum processes

Background: Dental handpieces are required to be sterilized between patient use. Vacuum steam sterilization processes with fractionated pre/post-vacuum phases or unique cycles for specified medical devices, are required for hollow instruments with internal lumens to assure successful air removal. Entrapped air will compromise achievement of required sterilization conditions. Many countries and professional organisations still advocate non-vacuum sterilization processes for these devices. Aim: To investigate non-vacuum downward/gravity displacement, type-N steam sterilization of dental handpieces, using thermometric methods to measure time to achieve sterilization temperature at different handpiece locations. Methods: Measurements at different positions within air turbines were undertaken with thermocouples and dataloggers. Two examples of commonly used UK benchtop steam sterilizers were tested; a non-vacuum benchtop sterilizer (Little Sister 3, Eschmann, UK) and a vacuum benchtop sterilizer (Lisa, W&H, Austria). Each sterilizer cycle was completed with three handpieces and each cycle in triplicate. Findings: A total of 140 measurements inside dental handpiece lumens were recorded. We demonstrate that the non-vacuum process fails (time range 0-150 seconds) to reliably achieve sterilization temperatures within the time limit specified by the International standard (15 seconds equilibration time). The measurement point at the base of the handpiece failed in all test runs (n=9) to meet the standard. No failures were detected with the vacuum steam sterilization type B process with fractionated pre-vacuum and post-vacuum phases. Conclusion: Non-vacuum downward/gravity displacement, type-N steam sterilization processes are unreliable in achieving sterilization conditions inside dental handpieces and the base of the handpiece is the site most likely to fail

Photocatalytic reactions of a nickel(II) annulene complex incorporated in polymeric structures

The photochemical reactions of the Ni(II) annulene complex, [NiII([5,7,12,14]-tetra methyl dibenzo[2,3- b:2,3-b,i][1,4,8,11]tetraaza[14]annulenate)], grafted into a poly(isobutylene-alt-maleate) backbone were investigated in aqueous media. The grafted Ni(II) complex becomes soluble in aqueous and organic solvents where the strands form aggregates with medium-dependent shapes. Irradiation of the polymer at 532 or 351 nm produce charge-separated macrocyclic pendants, CS, with a lifetime s 30 ns. CS reacts with electron donors and acceptors before it decays with a lifetime s 1 ms. In parallel to the decay of CS, an excited state-excited state annihilation process gives rise to luminescence whose spectrum spans wavelengths shorter than the wavelength of the irradiation, lex > 500 nm. Theoretical calculations were carried out with the aim of understanding the morphology and structures of strand aggregates, to confirm the nature of reaction products and to account for the spectroscopic and photochemical properties of the Ni(II) pendants. The endothermic reduction of CO2 to CO by S(IV) species was used as a test of the Ni(II) complex´s ability to photocatalyze the reaction. In the photoprocess, the Ni(II) complex fulfills the double role of antenna and catalyst.Fil: Estiu, G.. University Of Notre Dame-indiana; Estados UnidosFil: Ferraudi, G.. University Of Notre Dame-indiana; Estados UnidosFil: Lappin, A. G.. University Of Notre Dame-indiana; Estados UnidosFil: Ruiz, Gustavo Teodosio. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico la Plata. Instituto de Investigaciones Fisicoquímicas Teóricas y Aplicadas; Argentina. Universidad Nacional de La Plata; ArgentinaFil: Vericat, Carolina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico la Plata. Instituto de Investigaciones Fisicoquímicas Teóricas y Aplicadas; Argentina. Universidad Nacional de La Plata; ArgentinaFil: Costamagna, J.. Universidad de Santiago de Chile; ChileFil: Villagrán, M.. Universidad de Santiago de Chile; Chil

GPR35 as a Novel Therapeutic Target

G protein-coupled receptors (GPCRs) remain the best studied class of cell surface receptors and the most tractable family of proteins for novel small molecule drug discovery. Despite this, a considerable number of GPCRs remain poorly characterized and in a significant number of cases, endogenous ligand(s) that activate them remain undefined or are of questionable physiological relevance. GPR35 was initially discovered over a decade ago but has remained an “orphan” receptor. Recent publications have highlighted novel ligands, both endogenously produced and synthetic, which demonstrate significant potency at this receptor. Furthermore, evidence is accumulating which highlights potential roles for GPR35 in disease and therefore, efforts to characterize GPR35 more fully and develop it as a novel therapeutic target in conditions that range from diabetes and hypertension to asthma are increasing. Recently identified ligands have shown marked species selective properties, indicating major challenges for future drug development. As we begin to understand these issues, the continuing efforts to identify novel agonist and antagonist ligands for GPR35 will help to decipher its true physiological relevance; translating multiple assay systems in vitro, to animal disease systems in vivo and finally to man

Assessing the efficacy and cost of detergents used in a primary care automated washer disinfector

Background: Cleaning of re-usable medical devices is a critical control point in the decontamination cycle, although defined end-points of the process are controversial. Objective: Investigate cleaning efficacy and cost of different detergent classes in an automated washer disinfector (AWD) designed for dental practice. Methods: Loads comprised test soiled dental hand instruments in cassettes and extraction forceps. Residual protein assayed using the International standard method (ISO 15883-5:2005) 1% SDS elution with ortho-phthalaldehyde (OPA) or GBox technology (on instrument OPA analysis). Short (60 minutes) and long (97 minutes) AWD cycles were used with four different classes of detergents, tap water and reverse osmosis water. Results: SDS elution analysis (N = 612 instruments) demonstrated four detergents with both wash cycles achieved equivalent cleanliness levels and below a threshold of 200 μg protein/instrument. GBox methodology (N = 575) using UK Department of Health threshold of 5 μg/instrument side demonstrated that tap water performed with the greatest efficacy for all types of instruments and cycle types. Conclusions: Using International standard methodology, different detergent classes had equivalence in cleaning efficacy. Cheaper detergents used in this study performed with similar efficacy to more expensive solutions. Findings emphasise the importance of validating the detergent (type and concentration) for each AWD

Diagnostic change 10 years after a first episode of psychosis

Background. A lack of an aetiologically based nosology classification has contributed to instability in psychiatric diag-noses over time. This study aimed to examine the diagnostic stability of psychosis diagnoses using data from an inci-dence sample of psychosis cases, followed up after 10 years and to examine those baseline variables which were associated with diagnostic change. Method. Data were examined from the ÆSOP and ÆSOP-10 studies, an incidence and follow-up study, respectively, of a population-based cohort of first-episode psychosis cases from two sites. Diagnosis was assigned using ICD-10 and DSM-IV-TR. Diagnostic change was examined using prospective and retrospective consistency. Baseline variables asso-ciated with change were examined using logistic regression and likelihood ratio tests. Results. Slightly more (59.6%) cases had the same baseline and lifetime ICD-10 diagnosis compared with DSM-IV-TR (55.3%), but prospective and retrospective consistency was similar. Schizophrenia, psychotic bipolar disorder and drug-induced psychosis were more prospectively consistent than other diagnoses. A substantial number of cases with other diagnoses at baseline (ICD-10, n = 61; DSM-IV-TR, n = 76) were classified as having schizophrenia at 10 years

Investigating the biological properties of carbohydrate derived fulvic acid (CHD-FA) as a potential novel therapy for the management of oral biofilm infections.

Background: A number of oral diseases, including periodontitis, derive from microbial biofilms and are associated with increased antimicrobial resistance. Despite the widespread use of mouthwashes being used as adjunctive measures to control these biofilms, their prolonged use is not recommended due to various side effects. Therefore, alternative broad-spectrum antimicrobials that minimise these effects are highly sought after. Carbohydrate derived fulvic acid (CHD-FA) is an organic acid which has previously demonstrated to be microbiocidal against Candida albicans biofilms, therefore, the aims of this study were to evaluate the antibacterial activity of CHD-FA against orally derived biofilms and to investigate adjunctive biological effects.<p></p> Methods: Minimum inhibitory concentrations were evaluated for CHD-FA and chlorhexidine (CHX) against a range of oral bacteria using standardised microdilution testing for planktonic and sessile. Scanning electron microscopy was also employed to visualise changes in oral biofilms after antimicrobial treatment. Cytotoxicity of these compounds was assessed against oral epithelial cells, and the effect of CHD-FA on host inflammatory markers was assessed by measuring mRNA and protein expression.<p></p> Results: CHD-FA was highly active against all of the oral bacteria tested, including Porphyromonas gingivalis, with a sessile minimum inhibitory concentration of 0.5%. This concentration was shown to kill multi-species biofilms by approximately 90%, levels comparable to that of chlorhexidine (CHX). In a mammalian cell culture model, pretreatment of epithelial cells with buffered CHD-FA was shown to significantly down-regulate key inflammatory mediators, including interleukin-8 (IL-8), after stimulation with a multi-species biofilm.<p></p> Conclusions: Overall, CHD-FA was shown to possess broad-spectrum antibacterial activity, with a supplementary function of being able to down-regulate inflammation. These properties offer an attractive spectrum of function from a naturally derived compound, which could be used as an alternative topical treatment strategy for oral biofilm diseases. Further studies in vitro and in vivo are required to determine the precise mechanism by which CHD-FA modulates the host immune response.<p></p&gt