WFHSS and DAS Conference 2013 - Session A-3: Potential ......WFHSS and DAS Conference 2013 - Session...
Transcript of WFHSS and DAS Conference 2013 - Session A-3: Potential ......WFHSS and DAS Conference 2013 - Session...
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Potential of Cold Atmospheric Plasma as a new method for the decontamination and
sterilization of reusable surgical instruments.
14th World Sterilization Congress8th National Sterilization Disinfection Congress of Turkey
6th-9th November 2013
Rodolphe Hervé PhD, MSc
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The five main functions performed in a hospital sterile service department
Standard reprocessing
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Decontamination and sterilization
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Assessment of instruments cleanliness
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Thioflavin T (bright blue) and SYPRO Ruby (amber) dual staining observed on (a-e) a suction canullae and (f) diathermy forceps from a neurosurgery set that were fully reprocessed through a sterile service department. White bars are 100 μm, red bar is 10 μm.
Standard reprocessing: neurosurgery instruments
Hervé et al., JHI 2010
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Proteinaceous (total and amyloid) contamination on a succion cannulae isolated from a craniotomy set.
Standard reprocessing: neurosurgery instruments
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Standard reprocessing: flexible luminal endoscopes
Hervé et al., JHI 2012
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Standard reprocessing: endodontic files
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Standard reprocessing: endodontic files
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Hervé et al., JHI 2010
Cleaning limitationsProtein removal action of various cleaners
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Cleaning limitations
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Remaining contamination on surfaces(proportion of hydrophobic amyloid-rich proteins)
Hervé et al., JHI 2010
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Mechanism
Physical disruption (detergent, sonication, brushing, flushing)
Enzymatic degradation
Chemical modification (pH>12)
Potential caveats
Displacement and/or spreading
Shelf life; control of parameters
Damage to instruments; control of parameters and efficacy
How can standard cleaning fail ?
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What is gas plasma?
BenefitsBenefits
• Energetic electrons à chemical dissociation @ low gas temperature
• On-site production of reactive, short-living species e.g. O2
•–; O; 1O2; NO … OH• and H2O2à known to act
on protein, lipid and DNA
• Oxidants: OH•, O2•–; O; 1O2, H2O2
Non-equilibrium Chemistry
Kong MG et al (2009) New J. Phys. 11: 115012; Iza F et al (2008) Plasma Process. Polym. 5(4): 32.
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what is gas plasma?| Shooting Plasma
Nan
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Exposure: 1nsInterval: 100 ns
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CAP endo-decon| Electron Bombardment
Walsh JL and Kong MG (2008) Appl. Phys. Lett. 94: 021501;
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Testing of first CAP prototype
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High purity helium/oxygen mix
CAP parameters during initial tests
5 L/min and 100 ml/min respectively
Target surface set within 1.5 cm
Up to 2 min application
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Testing of first CAP prototype
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Spiked implant wires before CAP treatment
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Spiked implant wires after partial CAP treatment
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CAP appears equally effective againstamyloid proteins
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control CAP-treated
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yloid / total protein ratio (%)
Total protein Prion amyloid amyloid proportion (%)
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CAP endoDecon| Versatility and Uniformity Control
Cao Z et al (2009) Appl. Phys. Lett. 94: 021501; Nie Q et al (2009) New J. Phys. 11: 115015; Kong MG (2011) J. Phys. D: Appl. Phys. 44(17): 174018; Walsh JL et al (2008) IEEE Trans. Plasma Sci. 36(4): 1314.
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CAP
The place of CAP in standard reprocessing
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CAP
The place of CAP in standard reprocessing
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CAP
The place of CAP in standard reprocessing
Dentistry clinics; Endoscopy Units
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what is gas plasma?| OptimisationAr-O2-H2O Plasmas
• up to 1,000 chemical reactions• threshold dose of each protein-inactivating plasma agent is unknown
• complication with synergy• plasma diagnostics is complex and not always accessible
• plasma diagnostics in liquid phase – very under-studied field• if achieved, a knowledge-based inaction – indirect inactivation marker
• … empirical strategy – unreliable for ensuring efficacy and for system scalingAgents Plasma Characterisation
O*; OH* etc Excited species – Optical emission spectroscopy(OES)
O, H2O-clusters Ground state – OES not good – MBMS
OH, H2O2 etc in H2O Electron spin resonance (ESR) spectroscopy
UV Absolute OES
Ozone Spatial resolved – UV absorption spectroscopy (UVAS)
Electron density Probes not applicable – current density
Electron energy Boltzmann plot
All Plasma modelling
… additional studies, such as OH scavengers
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CAP optimisation
EDIC/EF for rapid and very sensitive quantification of residual proteins and microorganisms.
Refined prion infectivity assays for human strains under development.
Mechanisation and scaling up of the process.
Adaptation into SSDs.
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Proteinaceous microcontamination (potentially including PrPSc in affected countries) is a common problem in clinical settings.
Conclusions
Current standard decontamination procedures suffer from inherent physicochemical limitations.
CAP offers a radically different decontamination mechanism capable of targeting individual atoms, without the problems associated with liquid solutions.
Further development required to adapt the technology to different end users/instruments.
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SSDs (England)
Acknowledgements
English Department of Health
The Pirbright Institute
NCJDSU (Edinburgh)
CEA (France)
Public Health England
Fondation Alliance BioSecure