Doped diamond-like carbon coatings for surgical instruments reduce protein and prion-amyloid biofouling and improve subsequent cleaning

Doped diamond-like carbon (DLC) coatings offer potential antifouling surfaces against microbial and protein attachment. In particular, stainless steel surgical instruments are subject to tissue protein and resilient prion protein attachment, making decontamination methods used in sterile service departments ineffective, potentially increasing the risk of iatrogenic Creutzfeldt-Jakob disease during surgical procedures. This study examined the adsorption of proteins and prion-associated amyloid to doped DLC surfaces and the efficacy of commercial cleaning chemistries applied to these spiked surfaces, compared to titanium nitride coating and stainless steel. Surfaces inoculated with ME7-infected brain homogenate were visualised using SYPRO Ruby/Thioflavin T staining and modified epi-fluorescence microscopy before and after cleaning. Reduced protein and prion amyloid contamination was observed on the modified surfaces and subsequent decontamination efficacy improved. This highlights the potential for a new generation of coatings for surgical instruments to reduce the risk of iatrogenic CJD infection.     

Eco-efficiency of disposable and reusable surgical instruments—a scissors case

Purpose

In recent years, the rising costs and infection control lead to an increasing use of disposable surgical instruments in daily hospital practices. Environmental impacts have risen as a result across the life cycle of plastic or stainless steel disposables. Compared with the conventional reusable products, different qualities and quantities of disposable scissors have to be taken into account. An eco-efficiency analysis can shed some light for the potential contribution of those products towards a sustainable development.

Methods

Disposable scissors made of either stainless steel or fibre-reinforced plastic were compared with reusable stainless steel scissors for 4,500 use cycles of surgical scissors used in Germany. A screening life cycle assessment (LCA) and a life cycle costing were performed by following ISO 14040 procedure and total cost of ownership (TCO) from a customer perspective, respectively. Subsequently, their results were used to conduct an eco-efficiency analysis.

Results and discussion

The screening LCA showed a clear ranking regarding the environmental impacts of the three types of scissors. The impacts of the disposable steel product exceeds those of the two others by 80 % (disposable plastic scissors) and 99 % (reusable steel scissors), respectively. Differences in TCO were smaller, however, revealing significant economic advantages of the reusable stainless steel product under the constraints and assumptions of this case study. Accordingly, the reusable stainless steel product was revealed as the most eco-efficient choice. It was followed by the plastic scissors which turned out to be significantly more environmentally sound than the disposable stainless steel scissors but also more cost-intensive.

Conclusions

The overall results of the study prove to be robust against variations of critical parameters for the prescribed case study. The sensitivity analyses were also conducted for LCA and TCO results. LCA results are shown to be reliable throughout all assumptions and data uncertainties. TCO results are more dependent on the choice of case study parameters whereby the price of the disposable products can severely influence the comparison of the stainless steel and the plastic scissors. The costs related to the sterilisation of the reusable product are strongly case-specific and can reduce the economic benefit of the reusable scissors to zero. Differences in environmental and economic break-even analyses underline the comparatively high share of externalised environmental costs in the case of the disposable steel product.     

Physico-chemical and hygienic property modifications of stainless steel surfaces induced by conditioning with food and detergent

The effect of repeated conditioning procedures (25 runs), consisting of soiling (milk and meat products) and cleaning steps, on the hygienic status, physico-chemical properties and surface chemical composition of stainless steel (SS) surfaces, was investigated. Five SSs differing in grade and finish were used. Both soiling and surface cleaning/conditioning procedures resulted in a similar increase in the surface contamination with carbon, while the changes in the basic component of the surface free energy depended on the conditioning procedure. The passive film was also affected, the Fe/Cr ratio in particular. The hygienic status was also changed, especially with milk as shown by monitoring the number of residual adhering Bacillus cereus spores after contaminating the surface with spores followed by cleaning. The results show that in food environments, the presence and the nature of conditioning molecules play a major role in the hygienic status of SS surfaces.     

Physico-chemical and hygienic property modifications of stainless steel surfaces induced by conditioning with food and detergent

The effect of repeated conditioning procedures (25 runs), consisting of soiling (milk and meat products) and cleaning steps, on the hygienic status, physico-chemical properties and surface chemical composition of stainless steel (SS) surfaces, was investigated. Five SSs differing in grade and finish were used. Both soiling and surface cleaning/conditioning procedures resulted in a similar increase in the surface contamination with carbon, while the changes in the basic component of the surface free energy depended on the conditioning procedure. The passive film was also affected, the Fe/Cr ratio in particular. The hygienic status was also changed, especially with milk as shown by monitoring the number of residual adhering Bacillus cereus spores after contaminating the surface with spores followed by cleaning. The results show that in food environments, the presence and the nature of conditioning molecules play a major role in the hygienic status of SS surfaces.     

Kinetics of conditioning layer formation on stainless steel immersed in seawater

Adhesion of microorganisms to surfaces in marine environments leads to biofouling. The deleterious effects of biofilm growth in the marine environment are numerous and include energy losses due to increased fluid frictional resistance or to increased heat transfer resistance, the risk of corrosion induced by microorganisms, loss of optical properties, and quality control and safety problems. Antifouling agents are generally used to protect surfaces from such a biofilm. These agents are toxic and can be persistent, causing harmful environmental and ecological effects. Moreover, the use of biocides and regular cleaning considerably increase the maintenance costs of marine industries. An improved knowledge of bio‐film adhesion mechanisms is needed for the development of an alternative approach to the currently used antifouling agents. The aim of this study is to characterise the chemical composition of the molecules first interacting with stainless steel during the period immediately following immersion in natural seawater and to elucidate the kinetics of the adsorbtion process. Proteins are shown to adhere very rapidly, closely followed by carbohydrates. The distribution on the surface of organic molecules is also examined. The ad‐sorbate on the surface is not a continuous film but a heterogeneous deposit, whose average thickness varies widely. The cleaning procedures used affect the adsorption kinetics. In particular, cleaning with hexane results in slower adsorption of nitrogen‐containing species than does cleaning in acetone.     

Electrochemical concepts and techniques in the study of stainless steel ennoblement

Electrochemical theory and technique used to investigate microbially influenced corrosion is discussed with a focus on methods used to demonstrate the manganic-oxide mechanism of stainless steel Ennoblement. The concept of mixed potential and its relationship to the current-voltage behavior of stainless steel is developed. This concept is used to interpret microbially induced changes in corrosion potential, polarization behavior, surface-oxide abundance, and the redox environment at submerged metal surfaces. Microelectrode, capacitance, and coulometric methods are described that can be used to discriminate electrochemical effects caused by changes in solution properties from those caused by mineral deposition at the metal surface. The variety of electrochemical, wet-chemical, microbiological, and surface analytical techniques used to demonstrate the effect of biomineralized manganese dioxide on the electrochemical behavior of stainless steel are summarized.     

Cleanability in relation to bacterial retention on unused and abraded domestic sink materials

The relative cleanability of stainless steel, enamelled steel, mineral resin and polycarbonate domestic sink materials was assessed by comparing the number of organisms remaining on surfaces after cleaning. In unused condition all materials, other than one enamelled steel, were equally cleanable. Stainless steel, abraded artificially or impact damaged to a similar degree as stainless steel subjected to domestic wear, retained approximately one log order less bacteria after cleaning than the other materials subjected to the same treatments. Little difference in cleanability was recorded between the abraded surfaces of the other materials although enamelled steel surfaces were less cleanable than mineral resin or polycarbonate after impact damage, because of the greater susceptibility of enamelled steel to damage by this treatment. When cleaning time was extended beyond 10 s for the abraded and impact damaged materials, their cleanability was not enhanced as compared with stainless steel. Changes in surface finish after abrasion were assessed by surface roughness measurement and scanning electron microscopy. Surfaces with poor cleanability before and after abrasion were characterized by pitting, crevices or jags. These surfaces are likely to retain more bacteria because of increased numbers of attachment sites, a larger bacterial/material surface contact area and topographical areas in which applied cleaning shear forces are reduced. Materials that resist surface changes, e.g. stainless steel, will remain more hygienic when subjected to natural wear than materials which become more readily damaged.     

Chemical disinfection to interrupt transfer of rhinovirus type 14 from environmental surfaces to hands.

Rhinoviruses can survive on environmental surfaces for several hours under ambient conditions. Hands can readily become contaminated after contact with such surfaces, and self-inoculation may lead to infection. Whereas hand washing is crucial in preventing the spread of rhinovirus colds, proper disinfection of environmental surfaces may further reduce rhinovirus transmission. In this study, the capacities of Lysol Disinfectant Spray (0.1% o-phenylphenol and 79% ethanol), a domestic bleach (6% sodium hypochlorite diluted to give 800 ppm of free chlorine), a quaternary ammonium-based product (7.05% quaternary ammonium diluted 1:128 in tap water), and a phenol-based product (14.7% phenol diluted 1:256 in tap water) were compared in interrupting the transfer of rhinovirus type 14 from stainless steel disks to fingerpads of human volunteers upon a 10-s contact at a pressure of 1 kg/cm2. Ten microliters of the virus, suspended in bovine mucin (5 mg/ml), was placed on each disk, and the inoculum was dried under ambient conditions; the input number on each disk ranged from 0.5 x 10(5) to 2.1 x 10(6) PFU. The dried virus was exposed to 20 microliters of the test disinfectant. The Lysol spray was able to reduce virus infectivity by > 99.99% after a contact of either 1 or 10 min, and no detectable virus was transferred to fingerpads from Lysol-treated disks. The bleach (800 ppm of free chlorine) reduced the virus titer by 99.7% after a contact time of 10 min, and again no virus was transferred from the disks treated with it.(ABSTRACT TRUNCATED AT 250 WORDS)     

The corrosion behaviour of mild steel and type 304 stainless steel in media from an anaerobic biodigestor

Mild steel and AISI 304 stainless steel samples were exposed to the aqueous solutions from an anaerobic biodigestor of wastewater, showing quite different behaviours. Carbon steel presented generalized corrosion whereas stainless steel, as-received or sensitized, tended to show some localized corrosion. Both materials presented bacteria attachment, particularly sulphate reducing bacteria (SRB), forming biofilms which were abundant and mixed with corrosion products on the mild steel surface and thin and patchy on stainless steel surfaces. Different types of anaerobic and aerobic bacteria were detected in the medium. Experiments were carried out both at 1 and at 7 atmospheres pressure, in presence of a gaseous phase containing N₂, CO₂ and CH₄. Potentiodynamic experiments were conducted in order to have a better insight on the electrochemical behaviour of the material in this medium.     

Influence of surface chemistry on the hygienic status of industrial stainless steel

Coupons of fourteen different stainless steels were investigated in terms of surface chemistry and ease of cleaning. Steel surfaces were exposed to Bacillus cereus spores in static saline solution for 2 h. Surfaces were rinsed and then covered with whole milk and allowed to dry. Surfaces were then cleaned in an experimental flow system that mimics an industrial application. After cleaning, remaining spores were released by sonication, spores cultured and colony forming units determined. Surfaces with higher levels of Fe in the outer surface of the passive film cleaned more easily. There was a relation between the polar component and ease of cleaning. The higher the polar component the more easily the surface cleaned. The cleaning mechanism involves dissolution of Fe enriched hydroxide films on the surface.     

Influence of Surface Chemistry on the Hygienic Status of Industrial Stainless Steel

Coupons of fourteen different stainless steels were investigated in terms of surface chemistry and ease of cleaning. Steel surfaces were exposed to Bacillus cereus spores in static saline solution for 2?h. Surfaces were rinsed and then covered with whole milk and allowed to dry. Surfaces were then cleaned in an experimental flow system that mimics an industrial application. After cleaning, remaining spores were released by sonication, spores cultured and colony forming units determined. Surfaces with higher levels of Fe in the outer surface of the passive film cleaned more easily. There was a relation between the polar component and ease of cleaning. The higher the polar component the more easily the surface cleaned. The cleaning mechanism involves dissolution of Fe enriched hydroxide films on the surface.     

Effects of polarization in the presence and absence of biocides on biofilms in a simulated paper machine water

The antifouling potential of electric polarization combined and not combined with biocides was studied in nonsaline warm water with high organic content. Deinococcus geothermalis is a bacterium known for forming colored biofilms in paper machines and for its persistence against cleaning and chemical treatments. When D. geothermalis biofilms grown for 24 h in simulated paper machine water were exposed to cathodic or cathodically weighted pulsed polarization at least 60% (P < 0.05) of the biofilms were removed from stainless steel (AISI 316L). Biofilm removal by 25 ppm (effective substances 5-25 ppm) of oxidizing biocides (bromochloro-5,5-dimethylhydantoin, 2,2-dibromo-2-cyanoacetamide, peracetic acid) increased to 70% when combined with cathodically weighted pulsed polarization. Using a novel instrument that allows real-time detection of reactive oxygen species (ROS) we showed that the polarization program effective in antifouling generated ROS in a pulsed manner on the steel surface. We thus suggest that the observed added value of oxidative biocides combined with polarization depended on ROS. This suggestion was supported by the finding that a reductive biocide, methylene bisthiocyanate, counteracted the antifouling effect of polarization.     

Cleanability in relation to bacterial retention on unused and abraded domestic sink materials

H olah , J.T. & T horpe , R.H. 1990. Cleanability in relation to bacterial retention on unused and abraded domestic sink materials. Journal of Applied Bacteriology 69 , 599–608.
The relative Cleanability of stainless steel, enamelled steel, mineral resin and polycarbonate domestic sink materials was assessed by comparing the number of organisms remaining on surfaces after cleaning. In unused condition all materials, other than one enamelled steel, were equally cleanable. Stainless steel, abraded artificially or impact damaged to a similar degree as stainless steel subjected to domestic wear, retained approximately one log order less bacteria after cleaning than the other materials subjected to the same treatments. Little difference in Cleanability was recorded between the abraded surfaces of the other materials although enamelled steel surfaces were less cleanable than mineral resin or polycarbonate after impact damage, because of the greater susceptibility of enamelled steel to damage by this treatment. When cleaning time was extended beyond 10 s for the abraded and impact damaged materials, their Cleanability was not enhanced as compared with stainless steel. Changes in surface finish after abrasion were assessed by surface roughness measurement and scanning electron microscopy. Surfaces with poor Cleanability before and after abrasion were characterized by pitting, crevices or jags. These surfaces are likely to retain more bacteria because of increased numbers of attachment sites, a larger bacterial/material surface contact area and topographical areas in which applied cleaning shear forces are reduced. Materials that resist surface changes, e.g. stainless steel, will remain more hygienic when subjected to natural wear than materials which become more readily damaged.     

The effect of Pseudomonas NCIMB 2021 biofilm on AISI 316 stainless steel

A bioreactor system operating in a continuous mode was designed to generate biofilms on polished and as-received surfaces of AISI 316 stainless steel coupons exposed for 36 d to a pure culture of marine Pseudomonas NCIMB 2021. Scanning electron microscopy (SEM) and atomic force microscopy were employed to determine the degree of surface colonisation and to examine corrosion damage of the steel. X-ray photoelectron spectroscopy analysis was carried out to characterise the chemistry of the passive layers on polished steel stored for a period of time, freshly re-polished coupons, and as-received steel. The effect of biofilms on the composition of layers formed on the steel specimens was evaluated. SEM revealed that the surfaces of polished and stored steel appeared to accumulate more biofilm compared to as-received specimens. Micropitting of steel occurred underneath the biofilm, regardless of surface finish. The concentration of elements in the passive layers differed significantly between freshly re-polished and as-received or polished and stored coupons. In the presence of Pseudomonas NCIMB 2021 biofilm, the composition of the passive layer on the as-received steel surface was considerably altered compared to unexposed steel or steel exposed to abiotic medium.     

The survival and transfer of microbial contamination via cloths, hands and utensils

Survival and transfer of bacteria from laminated surfaces and cleaning cloths were investigated under laboratory conditions. Drying produced substantial reductions in numbers of recoverable organisms and achieved satisfactory decontamination of clean laminate surfaces. On soiled surfaces and on clean and soiled cloths, Gram-positive and some Gram-negative species survived for up to 4 h, and in some cases up to 24 h. Where contaminated surfaces or cloths came into contact with the fingers, a stainless steel bowl, or a clean laminate surface, organisms were transferred in sufficient numbers to represent a potential hazard if in contact with food.     

The survival and transfer of microbial contamination via cloths, hands and utensils

Survival and transfer of bacteria from laminated surfaces and cleaning cloths were investigated under laboratory conditions. Drying produced substantial reductions in numbers of recoverable organisms and achieved satisfactory decontamination of clean laminate surfaces. On soiled surfaces and on clean and soiled cloths, Gram-positive and some Gram-negative species survived for up to 4 h, and in some cases up to 24 h. Where contaminated surfaces or cloths came into contact with the fingers, a stainless steel bowl, or a clean laminate surface, organisms were transferred in sufficient numbers to represent a potential hazard if in contact with food.     

Biofilms and corrosion interactions on stainless steel in seawater

Biofouling and biocorrosion lead to an important modification of the metal/ solution interface inducing changes in the type and concentration of ions, pH values, oxygen levels, flow velocity, etc. Metal dissolution in seawater is mainly conditioned by two different processes: (a) biofouling settlement and (b) corrosion products formation.Corrosion-resistant alloys such as stainless steel present an ideal substratum for microbial colonization, rather similar to inert non-metallic surfaces, due to the lack of corrosion products. Stainless steels are sensitive to pitting and other types of localized corrosion in chloride-containing media such as seawater. Biofilms and bacterial metabolism may accelerate the initiation of crevice attack by depletion of oxygen in the crevice solution due to microbial respiration. Bacterial colonization occurs within a period of 24–72 h on stainless steel samples exposed to natural seawater and, depending on environmental conditions, a copious and patchy biofilm is generally formed.Different interpretations of biofilms' effects on corrosion are critically discussed. A practical case, involving polluted harbour seawater, is reported to illustrate biofilm and corrosion interactions on stainless steel samples.     

Efficacy of humidity retention bags for the reduced adsorption and improved cleaning of tissue proteins including prion-associated amyloid to surgical stainless steel surfaces

Increasing drying time adversely affects attachment of tissue proteins and prion-associated amyloid to surgical stainless steel, and reduces the efficacy of commercial cleaning chemistries. This study tested the efficacy of commercial humidity retention bags to reduce biofouling on surgical stainless steel and to improve subsequent cleaning. Surgical stainless steel surfaces were contaminated with ME7-infected brain homogenates and left to dry for 15 to 1,440 min either in air, in dry polythene bags or within humidity retention bags. Residual contamination pre/post cleaning was analysed using Thioflavin T/SYPRO Ruby dual staining and microscope analysis. An increase in biofouling was observed with increased drying time in air or in sealed dry bags. Humidity retention bags kept both protein and prion-associated amyloid minimal across the drying times both pre- and post-cleaning. Therefore, humidity bags demonstrate a cheap, easy to implement solution to improve surgical instrument reprocessing and to potentially reduce associated hospital acquired infections.     

Comparative Study on Caustic and Enzymatic Cleanings of Stainless Steel Surface Fouled with β-Lactoglobulin

Desorption behavior of β-lactoglobulin (β-Lg), one of the main constituents of fouling deposits in milk processing, from stainless steel surfaces during caustic and enzymatic cleanings was studied by using a glass column packed with stainless steel particles fouled with β-Lg. Both in caustic and enzymatic cleanings, the amount of β-Lg remaining on the stainless steel particles decreased according to first-order kinetics at the initial stage, and gradually reached a constant value. The desorption rate constant at the initial stage and the residual amount of β-Lg after 2 h of cleaning were evaluated as the measures of cleaning efficiency under various conditions. In caustic cleaning, these two values were strongly affected by the concentration of NaOH. The initial desorption rate increased with increasing flow rate of the caustic solution, suggesting a mass transfer effect. In enzymatic cleaning, the maximum desorption rate constant was obtained at around the optimum pH for the enzyme reaction. The temperature dependence of the initial desorption rate constant was stronger in caustic cleaning than in enzymatic cleaning.     

Shewanella putrefaciens adhesion and biofilm formation on food processing surfaces

Laboratory model systems were developed for studying Shewanella putrefaciens adhesion and biofilm formation under batch and flow conditions. S. putrefaciens plays a major role in food spoilage and may cause microbially induced corrosion on steel surfaces. S. putrefaciens bacteria suspended in buffer adhered readily to stainless steel surfaces. Maximum numbers of adherent bacteria per square centimeter were reached in 8 h at 25 degrees C and reflected the cell density in suspension. Numbers of adhering bacteria from a suspension containing 10(8) CFU/ml were much lower in a laminar flow system (modified Robbins device) (reaching 10(2) CFU/cm(2)) than in a batch system (reaching 10(7) CFU/cm(2)), and maximum numbers were reached after 24 h. When nutrients were supplied, S. putrefaciens grew in biofilms with layers of bacteria. The rate of biofilm formation and the thickness of the film were not dependent on the availability of carbohydrate (lactate or glucose) or on iron starvation. The number of S. putrefaciens bacteria on the surface was partly influenced by the presence of other bacteria (Pseudomonas fluorescens) which reduced the numbers of S. putrefaciens bacteria in the biofilm. Numbers of bacteria on the surface must be quantified to evaluate the influence of environmental factors on adhesion and biofilm formation. We used a combination of fluorescence microscopy (4',6'-diamidino-2-phenylindole staining and in situ hybridization, for mixed-culture studies), ultrasonic removal of bacteria from surfaces, and indirect conductometry and found this combination sufficient to quantify bacteria on surfaces.