Brian Skellie
APP President
Technology for infection prevention:
Why the introduction of more technological advances help to reduce cross contamination risks
The benefits of thousands of years of advancements in infection control are applied and built upon daily: a brief history of sterilization.
Chamberland’s Autoclave (1880), the first steam sterilizer patterned after Papin’s digester (1680), the first pressure cooker.
Asepsis is the most effective technological advancement for a purposeful reduction of microbes to an irreducible minimum. This begins with policy and training, and follows through with checklists, review, and reminders for implementation.
Primum non nocere = above all else we should do no harm.
Physics was the first step in decontamination, using thermal energy: fire and the effects of the sun. Advances have been made in E-beam and radiation, both ionizing and non-ionizing, for sterilization. As a result, new equipment and supplies are now available providing an almost infinite sterilization shelf life. Part of what was found useful from the sun, apart from drying, was the power of short wavelength ultraviolet light to disrupt the DNA of cells. This has been harnessed for disinfection of exposed environmental surfaces, air, and water, but this form of sterilization is not appropriate for initial piercing jewelry. Further study of properties of the sun have resulted in functional plasma etching and cleaning processes and H2O2 gas plasma sterilization. At some point, gadgets for disinfection of procedure rooms such as UV-C robots and hydrogen peroxide (H2O2) vapor foggers may have an application in scale for our trade.
Chemistry was the next big step in the fight against preventable iatrogenic infection with germicides, from chlorine solutions and carbolic acid to EO gas. Recognizing the potential for stopping infection transmission during procedures by thoroughly cleaning the worker’s hands and the subject site with a germicidal product was an enormous step that has become part of our established thinking. Materials themselves can be used to leverage the natural properties of copper (Cu+) and silver (Ag) that make touch and transfer surfaces inhospitable to microbes, and other embedded compounds have been developed for similar purposes. Some even work with nanotech surface treatments.
Instrument cleaning technology is constantly improving on the basic two fronts of physical action and chemical reaction. Advancements in products safe for the worker and environmentally friendly have brought forth alkaline or enzymatic detergent, or peracetic acid options.
Consumables have long been a source of worker and client protection and potential oversight. Gloves and other Personal Protective Equipment (PPE) do create a barrier when used correctly, but do not take the place of adequate hand hygiene and application of asepsis. For further protection against exposure to environmental hazards, wearable vapor detectors can be used to alert the worker of chemical hazards from cleaning and disinfecting products. Essential detectors for sterilization or cleaning parameters should be used for validation of each process. Test Soils with protein detection for washing instruments, even manual cleaning should be tested, and Chemical and regular Biological Indicators for sterilization loads.
Cleaning appliances have made validation tests easier and more repeatable, with the availability of small automated instrument washers and medical and dental ultrasonic cleaners. Our last line of defense against cross contamination comes from our environmental air quality, which can be improved with air cleaners equipped with HEPA filtration and UV, thermal or plasma disinfection, and floor scrubbers to vacuum up the dust, wash and dry the floor automatically and robotically.
The health and safety of our clientele and personnel depend on adequate sterilization and disinfection. The advancements listed have changed the way we do our jobs and protect ourselves from risk. As we look towards the future it is impossible to know the impact further technological advancements will have, but they will undoubtedly continue to change how we practice our trade.
