Evaluation of disinfection and sterilization of reusable angioscopes with the duck hepatitis B model,☆☆,,★★

Presented at the Twenty-third World Congress of the International Society for Cardiovascular Surgery, London, United Kingdom, September 1997.
https://doi.org/10.1016/S0741-5214(99)70138-2Get rights and content
Under an Elsevier user license
open archive

Abstract

Purpose: Nosocomial transmission of viral hepatitis and retrovirus infection has been reported. The expected risk is greatest for the hepatitis B virus (HBV). The duck HBV (DHBV) has similar biologic and structural characteristics to HBV and has been adopted as a suitable model for disinfectant testing. Methods: Angioscopic examination of the external jugular vein was performed on DHBV-infected ducks. After use, the instrument was air dried for 3 minutes. Samples were obtained by flushing the channel with 5 mL of phosphate buffered saline solution. The samples were collected immediately after drying (control), after flushing with 5 mL of water, after glutaraldehyde disinfection for 5, 10, and 20 minutes, and after ethylene oxide gas sterilization. Angioscopes were either precleaned or uncleaned before disinfection/sterilization. Residual infectivity was assessed with inoculation of samples into the peritoneal cavity of day-old ducks (n = 231). Results: DNA analysis results of liver samples showed that all 38 control ducks became infected. The frequency of DHBV infection was reduced to 93% (14 of 15) by flushing the angioscope with 5 mL of sterile water. No transmission occurred after the use of any of the properly precleaned and disinfected/sterilized angioscopes. However, after the use of the uncleaned angioscopes, the transmission rate was 90% (9 of 10) and 70% (7 of 10) after 5 and 10 minutes of contact time, respectively, in 2% glutaraldehyde. Even after the recommended 20 minutes of contact time, there was still 6% (2 of 35) transmission. After ethylene oxide sterilization, two of the recipient ducklings (2 of 35) were infected with DHBV. Conclusion: There was no disease transmission after reuse of disposable angioscopes adequately cleaned before disinfection or sterilization. However, if the angioscopes are inadequately cleaned, DHBV can survive despite glutaraldehyde disinfection or ethylene oxide sterilization. This contrasts with previous in vitro and in vivo data with solid surgical instruments. It is postulated that the presence of a narrow lumen or residual protein shielding within the lumen may compromise effective inactivation of hepadnaviruses on angioscopes, with the potential risk for patient-to-patient transmission. (J Vasc Surg 1999;30:277-82.)

Cited by (0)

From the Department of Surgery (Drs Chaufour and Deva, and Mr White) and the Department of Infectious Diseases (Mr Deva, Dr Vickery, Ms Zou, Dr Kumaradeva, and Ms Cossart), University of Sydney.

☆☆

Dr Anand K. Deva held a Johnson and Johnson Medical Postgraduate Scholarship. Dr Karen Vickery held a National Health and Medical Research Council Australian Applied Sciences Fellowship. Dr Priya Kumaradeva held a Whiteley Industries Postgraduate Scholarship.

Reprint requests: Karen Vickery, PhD, Department of Infectious Diseases, Blackburn Building, The University of Sydney, NSW 2006, Australia.

★★

0741-5214/99/$8.00 + 0  24/1/98839