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Bacterial adherence and biofilm formation on medical implants: a review

Veerachamy S, Yarlagadda T, Manivasagam G, Yarlagadda PK

Proc Inst Mech Eng H, 2014 Oct;228(10):1083-99.
PMID: 25406229 DOI: 10.1177/0954411914556137

Biofilms are a complex group of microbial cells that adhere to the exopolysaccharide matrix present on the surface of medical devices. Biofilm-associated infections in the medical devices pose a serious problem to the public health and adversely affect the function of the device. Medical implants used in oral and orthopedic surgery are fabricated using alloys such as stainless steel and titanium. The biological behavior, such as osseointegration and its antibacterial activity, essentially depends on both the chemical composition and the morphology of the surface of the device. Surface treatment of medical implants by various physical and chemical techniques are attempted in order to improve their surface properties so as to facilitate bio-integration and prevent bacterial adhesion. The potential source of infection of the surrounding tissue and antimicrobial strategies are from bacteria adherent to or in a biofilm on the implant which should prevent both biofilm formation and tissue colonization. This article provides an overview of bacterial biofilm formation and methods adopted for the inhibition of bacterial adhesion on medical implants.

Matched MeSH terms: Equipment Contamination/prevention & control*
Fulltext Potential of Superhydrophobic Surface for Blood-Contacting Medical Devices

Wu XH, Liew YK, Mai CW, Then YY

Int J Mol Sci, 2021 Mar 24;22(7).
PMID: 33805207 DOI: 10.3390/ijms22073341

Medical devices are indispensable in the healthcare setting, ranging from diagnostic tools to therapeutic instruments, and even supporting equipment. However, these medical devices may be associated with life-threatening complications when exposed to blood. To date, medical device-related infections have been a major drawback causing high mortality. Device-induced hemolysis, albeit often neglected, results in negative impacts, including thrombotic events. Various strategies have been approached to overcome these issues, but the outcomes are yet to be considered as successful. Recently, superhydrophobic materials or coatings have been brought to attention in various fields. Superhydrophobic surfaces are proposed to be ideal blood-compatible biomaterials attributed to their beneficial characteristics. Reports have substantiated the blood repellence of a superhydrophobic surface, which helps to prevent damage on blood cells upon cell-surface interaction, thereby alleviating subsequent complications. The anti-biofouling effect of superhydrophobic surfaces is also desired in medical devices as it resists the adhesion of organic substances, such as blood cells and microorganisms. In this review, we will focus on the discussion about the potential contribution of superhydrophobic surfaces on enhancing the hemocompatibility of blood-contacting medical devices.

Matched MeSH terms: Equipment Contamination/prevention & control*
Fulltext Transfer of Campylobacter jejuni from raw to cooked chicken via wood and plastic cutting boards

Tang JY, Nishibuchi M, Nakaguchi Y, Ghazali FM, Saleha AA, Son R

Lett Appl Microbiol, 2011 Jun;52(6):581-8.
PMID: 21375548 DOI: 10.1111/j.1472-765X.2011.03039.x

We quantified Campylobacter jejuni transferred from naturally contaminated raw chicken fillets and skins to similar cooked chicken parts via standard rubberwood (RW) and polyethylene cutting boards (PE).

Matched MeSH terms: Equipment Contamination
Targeting cyst wall is an effective strategy in improving the efficacy of marketed contact lens disinfecting solutions against Acanthamoeba castellanii cysts

Abjani F, Khan NA, Yousuf FA, Siddiqui R

Cont Lens Anterior Eye, 2016 Jun;39(3):239-43.
PMID: 26675112 DOI: 10.1016/j.clae.2015.11.004

Acanthamoeba cysts are highly resistant to contact lens disinfecting solutions. Acanthamoeba cyst wall is partially made of 1,4 β-glucan (i.e., cellulose) and other complex polysaccharides making it a hardy shell that protects the resident amoeba. Here, we hypothesize that targeting the cyst wall structure in addition to antiamoebic compound would improve the efficacy of marketed contact lens disinfecting solutions. Using chlorhexidine as an antiamoebic compound and cellulase enzyme to disrupt cyst wall structure, the findings revealed that combination of both agents abolished viability of Acanthamoeba castellanii cysts and trophozoites. When tested alone, none of the agents nor contact lens disinfecting solutions completely destroyed A. castellanii cysts and trophozoites. The absence of cyst wall-degrading enzymes in marketed contact lens disinfecting solutions render them ineffective against Acanthamoeba cysts. It is concluded that the addition of cyst wall degrading molecules in contact lens disinfecting solutions will enhance their efficacy in decreasing the incidence of Acanthamoeba effectively.

Matched MeSH terms: Equipment Contamination/prevention & control*
Environmental surface sampling of SARS-CoV-2 in selected hospitals in Malaysia

Rajendiran S, Thahir SSA, Veloo Y, Suppiah J, Pahrol MA, Shakor ASA, et al.

Trop Biomed, 2021 Sep 01;38(3):462-468.
PMID: 34608120 DOI: 10.47665/tb.38.3.089

COVID-19 has spread rapidly worldwide. The role of fomites in facilitating onward transmission is plausible. This study aimed to determine the presence of viable virus and its persistence on the surfaces of fomites in wards treating COVID-19 patients in Malaysia. This study was conducted in two stages. First, environmental sampling was performed on random days in the intensive care unit (ICU) and general wards. Then, in the second stage, samples were collected serially on alternate days for 7 days in two selected general wards. In Stage 1, a total of 104 samples were collected from the surfaces of highly touched and used areas by patients and healthcare workers. Only three samples were tested positive for SARS-COV-2. In Stage 2, three surface samples were detected positive, but no persistence of the virus was observed. However, none of the SARS-CoV-2 RNA was viable through tissue culture. Overall, the environmental contamination of SARS-CoV-2 was low in this hospital setting. Hospitals' strict infection control and the compliance of patients with wearing masks may have played a role in these findings, suggesting adherence to those measures to reduce occupational exposure of COVID-19 in hospital settings.

Matched MeSH terms: Equipment Contamination
Simulation of cross-contamination and decontamination of Campylobacter jejuni during handling of contaminated raw vegetables in a domestic kitchen

Chai LC, Lee HY, Ghazali FM, Abu Bakar F, Malakar PK, Nishibuchi M, et al.

J Food Prot, 2008 Dec;71(12):2448-52.
PMID: 19244897

Campylobacter jejuni was found to occur at high prevalence in the raw salad vegetables examined. Previous reports describe cross-contamination involving meat; here we investigated the occurrence of cross-contamination and decontamination events in the domestic kitchen via C. jejuni-contaminated vegetables during salad preparation. This is the first report concerning quantitative cross-contamination and decontamination involving naturally contaminated produce. The study was designed to simulate the real preparation of salad in a household kitchen, starting with washing the vegetables in tap water, then cutting the vegetables on a cutting board, followed by slicing cucumber and blanching (heating in hot water) the vegetables in 85 degrees C water. Vegetables naturally contaminated with C. jejuni were used throughout the simulation to attain realistic quantitative data. The mean of the percent transfer rates for C. jejuni from vegetable to wash water was 30.1 to 38.2%; from wash water to cucumber, it was 26.3 to 47.2%; from vegetables to cutting board, it was 1.6 to 10.3%; and from cutting board to cucumber, it was 22.6 to 73.3%. The data suggest the wash water and plastic cutting board as potential risk factors in C. jejuni transmission to consumers. Washing of the vegetables with tap water caused a 0.4-log reduction of C. jejuni attached to the vegetables (most probable number/gram), while rapid blanching reduced the number of C. jejuni organisms to an undetectable level.

Matched MeSH terms: Equipment Contamination
Effect of infusion set replacement intervals on catheter-related bloodstream infections (RSVP): a randomised, controlled, equivalence (central venous access device)-non-inferiority (peripheral arterial catheter) trial

Rickard CM, Marsh NM, Larsen EN, McGrail MR, Graves N, Runnegar N, et al.

Lancet, 2021 04 17;397(10283):1447-1458.
PMID: 33865494 DOI: 10.1016/S0140-6736(21)00351-2

BACKGROUND: The optimal duration of infusion set use to prevent life-threatening catheter-related bloodstream infection (CRBSI) is unclear. We aimed to compare the effectiveness and costs of 7-day (intervention) versus 4-day (control) infusion set replacement to prevent CRBSI in patients with central venous access devices (tunnelled cuffed, non-tunnelled, peripherally inserted, and totally implanted) and peripheral arterial catheters.
METHODS: We did a randomised, controlled, assessor-masked trial at ten Australian hospitals. Our hypothesis was CRBSI equivalence for central venous access devices and non-inferiority for peripheral arterial catheters (both 2% margin). Adults and children with expected greater than 24 h central venous access device-peripheral arterial catheter use were randomly assigned (1:1; stratified by hospital, catheter type, and intensive care unit or ward) by a centralised, web-based service (concealed before allocation) to infusion set replacement every 7 days, or 4 days. This included crystalloids, non-lipid parenteral nutrition, and medication infusions. Patients and clinicians were not masked, but the primary outcome (CRBSI) was adjudicated by masked infectious diseases physicians. The analysis was modified intention to treat (mITT). This study is registered with the Australian New Zealand Clinical Trials Registry ACTRN12610000505000 and is complete.
FINDINGS: Between May 30, 2011, and Dec, 9, 2016, from 6007 patients assessed, we assigned 2944 patients to 7-day (n=1463) or 4-day (n=1481) infusion set replacement, with 2941 in the mITT analysis. For central venous access devices, 20 (1·78%) of 1124 patients (7-day group) and 16 (1·46%) of 1097 patients (4-day group) had CRBSI (absolute risk difference [ARD] 0·32%, 95% CI -0·73 to 1·37). For peripheral arterial catheters, one (0·28%) of 357 patients in the 7-day group and none of 363 patients in the 4-day group had CRBSI (ARD 0·28%, -0·27% to 0·83%). There were no treatment-related adverse events.
INTERPRETATION: Infusion set use can be safely extended to 7 days with resultant cost and workload reductions.
FUNDING: Australian National Health and Medical Research Council.

Matched MeSH terms: Equipment Contamination/statistics & numerical data
Campylobacter in chicken carcasses and slaughterhouses in Malaysia

Rejab SB, Zessin KH, Fries R, Patchanee P

Southeast Asian J. Trop. Med. Public Health, 2012 Jan;43(1):96-104.
PMID: 23082559

This study was conducted to determine the Campylobacter contamination rate of chicken carcasses and the processing lines of modern processing plants in Malaysia. Three hundred sixty samples were collected from 24 flocks of broiler chickens at 12 modern poultry processing plants in 6 states of Malaysia. Fresh fecal droppings were collected from crates in the arrival area. Neck skin samples were taken from processed chicken carcasses at 3 different processing stages: before inside-outside washing, after inside-outside washing and post chilling. Swab samples from the scalding tank, chilling tank and conveyer belt before chilling were also collected to determine contamination with Campylobacter in the slaughter house environment prior to slaughter. Isolation for Campylobacter was performed following ISO 10272-1:2006(E). The overall of contamination rate with Campylobacter at the 12 plants was 61.0% (220/360). Eighty point six percent of the samples from before the inside-outside wishing step were contaminated with Campylobacter, as were 62.5% of the samples after the inside washing and 38.9% after the post-chilling step. This study shows extensive contamination of chicken carcasses and slaughtering houses in Malaysia with Campylobacter.

Matched MeSH terms: Equipment Contamination
Fulltext Bacterial contamination of a closed enteral feeding system: difference between laboratory evaluation and clinical experience

Ngeow YF, Chan L, Yasmin AH, Ong GS

Med J Malaysia, 1994 Dec;49(4):427.
PMID: 7674983
Matched MeSH terms: Equipment Contamination*
Fulltext Evaluation of the bacteriological contamination of a closed feeding system for enteral nutrition

Chan L, Yasmin AH, Ngeow YF, Ong GS

Med J Malaysia, 1994 Mar;49(1):62-7.
PMID: 8057993

A closed enteral delivery system consisting of a cardboard tetrapack containing the sterile ready-to-use liquid feed and an independent sterile administration set, has been devised. We found bacterial contamination within 24 hours in this system in patients on ventilatory support in intensive care. This emphasises the need for meticulous care in handling enteral feeding systems to prevent environmental contamination.

Matched MeSH terms: Equipment Contamination/prevention & control; Equipment Contamination/statistics & numerical data*
Environmental contamination in the hospital as a possible source for nosocomial infection with methicillin-resistant Staphylococcus aureus

Ghaznavi-Rad E, Ghasemzadeh-Moghaddam H, Shamsudin MN, Hamat RA, Sekawi Z, Aziz MN, et al.

Infect Control Hosp Epidemiol, 2010 Dec;31(12):1302-3.
PMID: 21028965 DOI: 10.1086/657587
Matched MeSH terms: Equipment Contamination*
Fulltext The craniotomy box: an innovative method of containing hazardous aerosols generated during skull saw use in autopsy on a COVID-19 body

Hasmi AH, Khoo LS, Koo ZP, Suriani MUA, Hamdan AN, Yaro SWM, et al.

Forensic Sci Med Pathol, 2020 09;16(3):477-480.
PMID: 32500339 DOI: 10.1007/s12024-020-00270-z

During a disease pandemic, there is still a requirement to perform postmortem examinations within the context of legal considerations. The management of the dead from COVID-19 should not impede the medicolegal investigation of the death where required by the authorities and legislation but additional health and safety precautions should be adopted for the necessary postmortem procedures. The authors have therefore used the craniotomy box in an innovative way to enable a safe alternative for skull and brain removal procedures on suspected or confirmed COVID-19 bodies. The craniotomy box technique was tested on a confirmed COVID-19 positive body where a full postmortem examination was performed by a team of highly trained personnel in a negative pressure Biosafety Level 3 (BSL-3) autopsy suite in the National Institute of Forensic Medicine (IPFN) Malaysia. This craniotomy box is a custom-made transparent plastic box with five walls but without a floor. Two circular holes were made in one wall for the placement of arms in order to perform the skull opening procedure. A swab to detect the presence of the SARS-CoV-2 virus was taken from the interior surface of the craniotomy box after the procedure. The result from the test using real-time reverse transcriptase polymerase chain reaction (rRT-PCR) proved that an additional barrier provided respiratory protection by containing the aerosols generated from the skull opening procedure. This innovation ensures procedures performed inside this craniotomy box are safe for postmortem personnel performing high risk autopsies during pandemics.

Matched MeSH terms: Equipment Contamination
Methicillin-resistant Staphylococcus aureus bacteraemia at a tertiary teaching hospital

Cheong I, Samsudin LM, Law GH

Br J Clin Pract, 1996 Jul-Aug;50(5):237-9.
PMID: 8794598

Between July and December 1994, 25 patients with MRSA bacteraemia were treated at the Hospital Kuala Lumpur, a tertiary hospital in Malaysia with 3000 beds. The patients included 15 males and 10 females whose mean age was 46.7 years (range 13-75). The sources of their MRSA were: Urology/Nephrology, 11; General ICU, six; Orthopaedic, four; Medicine, three; Surgery, one. Their underlying diseases were: end-stage and chronic renal failure, 11; burns, three; acute necrotising pancreatitis, two; haematological malignancies, two; and one each of fracture of the neck of the femur, pustular psoriasis, alcoholic cirrhosis, liver abscess, peptic ulcer (antrectomy), choledochol cyst, and abdominal aneurysm with gangrene of the legs. Six patients were also diabetic. A total of 19 infections were considered nosocomial. The duration of hospital stay ranged from one to 60 days, mean 16 days. On the day of blood culture, 20 patients (80%) were febrile and 15(60%) had leucocytosis. A total of 14 patients were considered to have received prolonged broad-spectrum antibiotics before the bacteraemia; of these, 11 had had either a third-generation cephalosporin and/or a quinolone. The primary foci of infection were: vascular access dialysis catheters, six; infected AV fistulae, three; non-surgical wounds, five; orthopaedic pin, one; multiple venous lines and catheters, nine; unknown, one. The sensitivities to anti-MRSA antibiotics were: vancomycin, 100%; fusidic acid, 96%; rifampicin, 96%; ciprofloxacin and perfloxacin 28% each. In all, 13 patients (52%) eventually died; nine of these deaths were directly attributed to MRSA bacteraemia. The microbiological eradication rate was 88%. Mortality was significantly associated with duration of hospital stay and failure to remove the infected catheters/peripheral lines after the development of MRSA bacteraemia.

Matched MeSH terms: Equipment Contamination
Physical methods of reducing the transmission of nosocomial infections via ultrasound and probe

Abdullah BJ, Mohd Yusof MY, Khoo BH

Clin Radiol, 1998 Mar;53(3):212-4.
PMID: 9528873

Nosocomial infections are posing an increasingly serious problem in the hospital setting. With the increasing use of ultrasound in medical diagnosis, there is the potential for transmission of nosocomial infections via the ultrasound transducer and coupling gel. We evaluated the use of different membranes (three types of commercially available household cling film, condom, surgical glove and Opsite) applied over the ultrasound probe to determine if these were safe, convenient, cost-effective and did not impair the performance parameters of the ultrasound probe. None of the membranes impaired the physical scanning parameters using a Multi-Purpose Tissue/Cyst Phantom. The cling film was ideal for general use in terms of cost and convenience as well as safety. For sterile use the Opsite was better overall compared to the surgical glove, though it costs significantly more. The condom and surgical glove, though safe, were not very convenient to use for scanning.

Matched MeSH terms: Equipment Contamination*
Fulltext The stethoscope and the transfer of bacteria in the neonatal nursery

Boo NY, Wong YH, Khoo AK

Med J Malaysia, 1989 Mar;44(1):87-8.
PMID: 2696869
Matched MeSH terms: Equipment Contamination/prevention & control*
The use of dimethyl sulfoxide in contact lens disinfectants is a potential preventative strategy against contracting Acanthamoeba keratitis

Siddiqui R, Aqeel Y, Khan NA

Cont Lens Anterior Eye, 2016 Oct;39(5):389-93.
PMID: 27133448 DOI: 10.1016/j.clae.2016.04.004

Acanthamoeba castellanii is the causative agent of blinding keratitis. Though reported in non-contact lens wearers, it is most frequently associated with improper use of contact lens. For contact lens wearers, amoebae attachment to the lens is a critical first step, followed by amoebae binding to the corneal epithelial cells during extended lens wear. Acanthamoeba attachment to surfaces (biological or inert) and migration is an active process and occurs during the trophozoite stage. Thus retaining amoebae in the cyst stage (dormant form) offers an added preventative measure in impeding parasite traversal from the contact lens onto the cornea. Here, we showed that as low as 3% DMSO, abolished A. castellanii excystation. Based on the findings, it is proposed that DMSO should be included in the contact lens disinfectants as an added preventative strategy against contracting Acanthamoeba keratitis.

Matched MeSH terms: Equipment Contamination/prevention & control
Outcomes and appropriateness of management of nosocomial Acinetobacter bloodstream infections at a teaching hospital in northeastern Malaysia

Deris ZZ, Harun A, Shafei MN, Rahman RA, Johari MR

Southeast Asian J. Trop. Med. Public Health, 2009 Jan;40(1):140-7.
PMID: 19323046

Acinetobacter spp is a known nosocomial pathogen causing a wide range of clinical diseases such as pneumonia, wound infection and bloodstream infections (BSI). The clinical outcomes of acinetobacter BSI were determined by a 1:1 case control study involving 58 confirmed cases of acinetobacter BSI who were compared to other gram-negative infections. The crude mortality of acinetobacter BSI was 47.2%, which was significantly greater than other gram-negative BSI (OR 1.89, 95% CI 1.10-3.24) but there were no significant differences in attributed mortality between the two groups. We found that patients treated in intensive care units (ICU), who had longer ICU stays, who presented with shock or coagulopathy, had prior exposure to carbapenems, had mechanical ventilation, were on a ventilator for longer periods, had a nasogastric tube, had an arterial catheter or had parenteral nutrition at a significantly greater risk of mortality due to acinetobacter BSI. Patients presenting with septic shock (OR 17.95, 95% CI 3.36-95.84) or having a central venous catheter (OR 12.48, 95% CI 1.09-142.68) were independently at higher risk for mortality. Appropriateness of therapy reduced the mortality attributes of acinetobacter BSI (OR 0.197, 95% CI 0.040-0.967) but did not significantly reduce crude mortality in acinetobacter BSI patients. This study shows the importance of preventing acinetobacter BSI and the appropriate use of antimicrobial agents to reduce mortality.

Matched MeSH terms: Equipment Contamination
Fulltext Can the use of 70% isopropyl alcohol swab or aspiration using 5 microm Filter Straw reduce bacterial contamination of fentanyl solution used for regional anaesthesia?

Roshaliza HM, Liu CY, Joanna OSM

Med J Malaysia, 2011 Jun;66(2):92-4.
PMID: 22106684

This prospective study aimed to determine the extent of contamination of fentanyl solutions used for central neuraxial injection by wiping the neck of the ampoules with 70% isopropyl alcohol swabs (Kendall) before breaking open the ampoules and aspiration of fentanyl solutions using a 5 microm Filter Straw (B. Braun). In Group A, fifty fentanyl ampoules were wiped with 70% isopropyl alcohol swab prior to opening and the contents were aspirated immediately using a 21G needle and a 5 microm filter straw for culture. The same steps were repeated on the remaining solutions after two hours. In Group B, all the above steps were repeated but without wiping the ampoules with 70% isopropyl alcohol swabs. None of the samples from the wiped ampoules or aspiration using filter straw grew microorganisms. Six percent of the samples from unwiped group grew microorganisms when fentanyl were aspirated using a 21G needle and the contamination increased to 16% when repeated after two hours. Wiping the outsides of the fentanyl ampoules with 70% isopropyl alcohol swabs before opening or aspirating the contents using a 5 pm filter straw has been shown to be equally effective in avoiding bacterial contamination and should be practiced routinely when performing regional anaesthesia.
KEY WORDS: Fentanyl solution, Isopropyl alcohol swab, Filter straw, Contamination, Regional anaesthesia, Hospital Kuala Lumpur, Malaysia

Matched MeSH terms: Equipment Contamination/prevention & control
Baseline assessment of intensive care-acquired nosocomial infection surveillancein three adult intensive care units in Malaysia

Katherason SG, Naing L, Jaalam K, Ismail A

J Infect Dev Ctries, 2008 Oct 01;2(5):364-8.
PMID: 19745504

BACKGROUND: Nosocomial infections (NIs) have a serious impact on patient outcomes in Intensive Care Units (ICUs).
METHOD: A prospective cohort-targeted comprehensive surveillance study on NI associated with usage of devices was conducted in three ICUs in Malaysia using a developed NI surveillance form. Patients who developed infection outside an ICU were excluded from the study.
RESULTS: The device associated NI was 21.1%. The mean duration for development of NI was 10.0 +/- 7.44 days in ICU. The major device-associated infections were nosocomial pneumonia (18.7%) followed by bacteremia (8.5%) and urinary tract infections (4.7%) respectively. NI incidence density rate was 20.6 per 1,000 patient-days. Bacteremia, urinary tract infection (UTI) and nosocomial pneumonia (NP) rates were 8.9, 4.7 and 20.5 per 1,000 patient-days, respectively. Acinetobacter species, Klebseilla pneumoniae, Pseudomonas aeruginosa and Methicillin-resistant Staphylococcus aureus were the predominant pathogens isolated from the NIs subjects during the study period in the three ICUs.
CONCLUSION: Analysis of the rate of the NIs associated with usage of devices in the three ICUs showed that it is highly correlated with the use of mechanical ventilation devices, followed by intravascular devices and usage of indwelling urinary catheters.

Matched MeSH terms: Equipment Contamination
Fulltext Brilliant crystallisation in the anterior chamber and subretinal space following adjunctive intravitreal ranibizumab for diabetic vitrectomy

Bastion ML, Mustapha M, Ho I

BMJ Case Rep, 2012;2012.
PMID: 23093508 DOI: 10.1136/bcr-2012-007260

To report a unique case of crystallisation in the anterior chamber and subretinal space in a Malay lady following inadvertent subretinal injection of ranibizumab prior to vitrectomy for proliferative diabetic retinopathy.

Matched MeSH terms: Equipment Contamination

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