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Alfa M.J.,Diagnostic Services of Manitoba | Alfa M.J.,St Boniface Research Center | Alfa M.J.,University of Manitoba | Olson N.,St Boniface Research Center | And 2 more authors.
American Journal of Infection Control | Year: 2012

Background: Cleaning of flexible endoscopes is most commonly performed using manual methods that are often performed inadequately. The aim of this study was to validate the sample collection protocol and the Rapid Use Scope Test (RUST) and then assess its usefulness in clinical use. Methods: The benchmarks for adequate cleaning were protein <6.4 μg/cm2, hemoglobin <2.2 μg/cm2, and carbohydrate <1.2 μg/cm 2. Sample collection consisted of flushing 10 mL of sterile reverse osmosis water through the suction-biopsy port to the distal end. Validation of the RUST audit tool included simulated-use and in-use testing in 43 endoscopy clinics across Canada. Results: Simulated-use testing validated that improperly cleaned endoscopes that exceeded the cleaning benchmarks would be flagged by the RUST test. The clinical-use study indicated that 96.6% of 1,489 scope channels tested were RUST negative; however, 19% and 12% of elevator guide-wire channels and endoscopic retrograde colangiopancreatography channels, respectively, exceeded the benchmarks. The survey indicated that reprocessing personnel valued a rapid audit tool for assessing compliance with manual cleaning. Conclusion: The validated RUST test provides health care users with a rapid audit tool for manual cleaning that can be integrated into the quality program in endoscopy. Copyright © 2012 by the Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.


Alfa M.J.,St Boniface Research Center | Alfa M.J.,University of Manitoba | Olson N.,St Boniface Research Center | Al-Fadhaly A.,Wayne State University
Journal of Hospital Infection | Year: 2010

The objective of this study was to determine the worst case levels of organic soil on surgical instruments and whether the commercially available TOSI® provided a clinically relevant organic challenge to an instrument washer. Our data showed that protein and haemoglobin levels (374 and 111 μg/cm2, respectively) from the instruments evaluated correlated with those on a TOSI that had a visual score of 2-3 (267 and 60 μg/cm2, respectively). However, the regular TOSI (without the plastic cover) and the TOSI Lum-Chek do not present difficult cleaning challenges; therefore, a visual TOSI score of 1-5 after processing in an automated washer represents a serious cleaning problem. Our results showed that surgical instruments may have high post-cleaning levels of carbohydrate (up to 352 μg/cm2) and endotoxin (up to 25 373 EU/cm2), suggesting unrecognised issues with the quality of water used for the final rinse. The average carbohydrate and endotoxin levels post procedure and before cleaning were 138.9 μg/cm2 and 18.14 EU/cm2, respectively. The average protein and haemoglobin levels both showed >99% reduction in levels post cleaning. Our data support the need to monitor the water quality used in instrument washers. In addition, there is an urgent need for establishment of standardised criteria for rapid cleaning indicators for instrument washers to ensure that they provide a clinically relevant method for monitoring washers used in healthcare facilities. © 2009 The Hospital Infection Society.


Alfa M.J.,St Boniface Research Center | Alfa M.J.,University of Manitoba
American Journal of Infection Control | Year: 2016

The objective of this report is to review the available scientific data on reprocessing of medical and surgical instruments and discuss the current issues related to cleaning and disinfection of flexible endoscopes and intracavitary ultrasound probes. © 2016 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.


Verkhratsky A.,University of Manchester | Verkhratsky A.,Ikerbasque | Verkhratsky A.,Kazan Federal University | Fernyhough P.,University of Manitoba | Fernyhough P.,St Boniface Research Center
Cell Calcium | Year: 2014

Peripheral sensory nervous system is comprised of neurones with their axons and neuroglia that includes satellite glial cells in sensory ganglia, myelinating, non-myelinating and perisynaptic Schwann cells. Pathogenesis of peripheral diabetic polyneuropathies is associated with aberrant function of both neurones and glia. Deregulated Ca2+ homoeostasis and aberrant Ca2+ signalling in neuronal and glial elements contributes to many forms of neuropathology and is fundamental to neurodegenerative diseases. In diabetes both neurones and glia experience metabolic stress and mitochondrial dysfunction which lead to deregulation of Ca2+ homeostasis and Ca2+ signalling, which in their turn lead to pathological cellular reactions contributing to development of diabetic neuropathies. Molecular cascades responsible for Ca2+ homeostasis and signalling, therefore, can be regarded as potential therapeutic targets. © 2014 Elsevier Ltd.


Alfa M.J.,Diagnostic Services of Manitoba | Alfa M.J.,University of Manitoba | Alfa M.J.,St Boniface Research Center | Olson N.,St Boniface Research Center | Murray B.-L.,St Boniface Research Center
American Journal of Infection Control | Year: 2014

Background The objectives of this study were to recommend sample collection method(s) based on relative soiling in patient-used gastrointestinal (GI) endoscopes and determine whether the published benchmarks for protein, bioburden, and adenosine triphosphate (ATP) remain relevant for pump-assisted manual cleaning. Methods Patient-used gastroscopes, duodenoscopes, and colonoscopes were sampled before and after manual cleaning and assessed for protein, bioburden, and ATP levels. The biopsy port (BP) to distal end (D) sample was collected using 20 mL of sterile reverse-osmosis water. After a 200-mL flush, the umbilical (UM) to BP portion was sampled by flushing 40 mL from the UM to the D. Results The BP to D portion of the suction biopsy channel contained 83% of ATP residuals. Despite cleaning with brushing and a flushing pump, 25% of gastroscopes exceeded the ATP benchmark of 200 relative light units (RLU), whereas all duodenoscopes and colonoscopes had <200 RLU after cleaning. The protein and bioburden residuals after pump-assisted cleaning were consistently lower than existing benchmarks. Conclusion Sampling the suction biopsy channel from BP to D detected the most residuals from patient-used GI endoscopes. The protein and bioburden benchmarks for pump-assisted cleaning can be lowered, but 200 RLU is still adequate for ATP. © 2014 by the Association for Professionals in Infection Control and Epidemiology, Inc.


da Costa Luciano C.,Federal University of Goais | Olson N.,St Boniface Research Center | Tipple A.F.V.,Federal University of Goais | Alfa M.,St Boniface Research Center | Alfa M.,University of Manitoba
American Journal of Infection Control | Year: 2016

Background: The objective of this study was to assess the ability of different detergent and disinfectant combinations to eradicate bacteria in traditional biofilm. Methods: Enterococcus faecalis and Pseudomonas aeruginosa were used to develop biofilm over 8 days. The biofilm on each minimum biofilm eradication concentration peg contained 8 log10 colony forming units (CFU)/cm2 of both bacteria. The detergents evaluated were as follows: Prolystica Enzymatic 2X, Prolystica Neutral 2X, Neodisher, and Endozime Bio-Clean. The disinfectants evaluated were as follows: glutaraldehyde, accelerated hydrogen peroxide, and ortho-phthalaldehyde. Biofilm removal was evaluated using viable count, protein and carbohydrate quantitation, and scanning electron microscopy. Results: Only Prolystica Enzymatic 2X and Endozime Bio-Clean killed both E faecalis (3.90 log10 CFU/mL reduction) and P aeruginosa (3.96 log10 CFU/mL reduction) in suspension. None of the detergents tested could provide >1 log10 CFU/cm2 reduction for bacteria within biofilm. Any combination of detergent and high-level disinfectant reduced the level of both E faecalis and P aeruginosa within biofilm by 3-5 log10 CFU/cm2. Although the combination of Endozime Bio-Clean and glutaraldehyde provided a 6 log10 reduction, it could not eliminate both bacteria within biofilm. Conclusions: Our data indicate that if biofilm accumulates in flexible endoscope channels during repeated rounds of reprocessing, then neither the detergent nor high-level disinfectant will provide the expected level of bacterial removal or killing. © 2016 Association for Professionals in Infection Control and Epidemiology, Inc.


Snow W.M.,St Boniface Research Center | Snow W.M.,University of Manitoba | Stoesz B.M.,University of Manitoba | Kelly D.M.,University of Manitoba | And 3 more authors.
Molecular Neurobiology | Year: 2014

Although traditionally associated with immune function, the transcription factor nuclear factor kappa B (NF-κB) has garnered much attention in recent years as an important regulator of memory. Specifically, research has found that NF-κB, localized in both neurons and glia, is activated during the induction of long-term potentiation (LTP), a paradigm of synaptic plasticity and correlate of memory. Further, experimental manipulation of NF-κB activation or its blockade results in altered memory and spatial navigation abilities. Genetic knockout of specific NF-κB subunits in mice results in memory alterations. Collectively, such data suggest that NF-κB may be a requirement for memory, although the direction of the response (i.e., memory enhancement or deficit) is inconsistent. A limited number of gene targets of NF-κB have been recently identified in neurons, including neurotrophic factors, calcium-regulating proteins, other transcription factors, and molecules associated with neuronal outgrowth and remodeling. In turn, several key molecules are activators of NF-κB, including protein kinase C and [Ca ++]i. Thus, NF-κB signaling is complex and under the regulation of numerous proteins involved in activity-dependent synaptic plasticity. The purpose of this review is to highlight the literature detailing a role for NF-κB in synaptic plasticity, memory, and spatial navigation. Secondly, this review will synthesize the research evaluating gene targets of NF-κB in synaptic plasticity and memory. Although there is ample evidence to suggest a critical role for NF-κB in memory, our understanding of its gene targets in neurons is limited and only beginning to be appreciated. © 2013 Springer Science+Business Media.


Nicholson T.,St Boniface Research Center | Khademi H.,University of Isfahan | Moghadasian M.H.,St Boniface Research Center
Food and Function | Year: 2013

Omega 3 polyunsaturated fatty acids (n-3 PUFA) have long been studied for their health benefits. In particular, marine n-3 PUFA such as eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) have been shown to possess cardiovascular protective qualities. However, there is conflicting evidence as to the mechanisms, effectiveness and doses required to observe these benefits. The objective of this review is to provide existing evidence as to the role of marine n-3 PUFA on cardiovascular health, as well as provide novel aspects to the current literature as of September 2012. Three large randomized clinical studies were reviewed to determine if there was an inverse association between n-3 fatty acid intake and CVD. There is strong evidence that the pharmaceutical grade n-3 fatty acid drug Lovaza™, (previously Omacor™) is effective in reducing triglyceride levels in humans. However, there are possible adverse reactions that need to be taken into account and caution should be used in treating certain populations. The Omega-3 Index is a promising novel biomarker for assessing long term EPA + DHA status in humans. Due to the originality of the Index, additional evidence is required to assess this as a tool for predicting CVD. Future research is needed to determine the individual effects of EPA and DHA for cardio-protection. This journal is © 2013 The Royal Society of Chemistry.


Alfa M.J.,University of Manitoba | Alfa M.J.,St Boniface Research Center | Olson N.,St Boniface Research Center | Murray B.-L.,St Boniface Research Center
Journal of Hospital Infection | Year: 2015

Background: Ensuring cleaning compliance of housekeeping staff is critical to ensure adequate application of surface disinfectants. Adenosine triphosphate (ATP) testing has been recommended as a way to monitor cleaning compliance; however, little is known about the stability of ATP on environmental surfaces. Aim: To assess the stability of ATP from various sources to determine if it is stable for sufficient time to be an effective means of assessing environmental cleaning and disinfection in health care. Methods: Purified ATP, ATP derived from ATS-T (blood-based test soil) and ATP derived from 107 colony-forming units/site of micro-organisms (Pseudomonas aeruginosa, Enterococcus faecalis, Candida albicans) were evaluated in liquid suspension and dried on to surfaces to assess stability over 29 days. Cleaners and disinfectants were sprayed on to surface-dried material with no wiping to determine their effect on microbial viability and ATP stability. Findings: Surface-dried P. aeruginosa, E. faecalis and C. albicans retained 65-96% of their original ATP level on Day 29, despite reduced or no viability. Surface-dried ATS-T had 100% and 3% of its original ATP on Days 4 and 29, respectively. Deterioration of the ATP signal was most pronounced for suspensions. Purified ATP was stable over 29 days in suspension or dried on to a surface. Conclusions: ATP residuals from organic material and micro-organisms (dead or alive) are stable when dried on to surfaces. In the absence of cleaning and disinfection, the relative light unit signal will not deteriorate rapidly, making ATP a good marker to monitor cleaning. © 2015 The Healthcare Infection Society.


Alfa M.J.,St Boniface Hospital | Alfa M.J.,University of Manitoba | Alfa M.J.,St Boniface Research Center | Olson N.,St Boniface Research Center
American Journal of Infection Control | Year: 2014

Background Because automated instrument washer-disinfectors (WD) are widely used in health care to reprocess a variety of medical instruments, we developed a study to compare 3 cleaning indicators to determine whether they detected suboptimal temperature, time, enzymatic detergent, and fluid action in a washer-disinfector. Methods The Miele WD was used for this comparison. One optimal cycle and 14 cycles with suboptimal enzymatic detergent, cleaning time, temperature, or inactive spray arms were evaluated. The cleaning indicators evaluated included the following: Pinnacle Monitor for Automated Enzymatic Cleaning Process (PNCL), Wash-Checks (WC), and TOSI. The scoring system for all 3 indicators was harmonized to a common scale. Soiled tweezers were included in each cycle evaluated. Results The PNCL, TOSI, and WC cleaning indicators showed significantly more failures at 40 C compared with 60 C (100% vs 0% for PNCL, 17% vs 0% for TOSI, and 60% vs 22% for WC, respectively). There were significantly more failures at suboptimal temperatures with a 2- versus 4-minute cycle (100% vs 0% for PNCL, 17% vs 0% for TOSI, and 17% vs 0% for WC, respectively, for 40 C cycles). Despite suboptimal cleaning cycles, all soiled tweezers looked clean. Conclusion All 3 cleaning indicators responded to suboptimal WD conditions; however, the PNCL was the most affected by alterations in the cycle conditions evaluated. In simulated use testing, cleaning indicators provided a more sensitive audit tool compared with visual inspection of soiled instruments after automated cleaning.

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