Physicochemical, toxicological and hygienic aspects of ethylene oxide application for the sterilization of medical products. III. Setting hygienic norms in sterilized medical products

Some of the drawbacks are discussed associated with hygienic norms for gaseous sterilizing agents in polymeric products for medical applications. A new approach is proposed for regulating ethylene oxide (EO) in such products. To this end, limiting types of biological effect and its pathways have been determined and substantiated as well as the reliability factor for establishing hygienic norms for EO in medical products. Daily threshold EO limit values were calculated for momentary and repeated exposure of humans. The duration of long-term and short-term exposure of the patient to sterilized products was evaluated on the basis of EO extraction kinetics from a variety of materials. Using daily threshold limit values, threshold residual values (TRV) of EO were calculated for different groups of polymeric products for medical applications.     

Aeration time following ethylene oxide sterilization for reusable rigid sterilization containers: concentration of gaseous ethylene oxide in containers

Because ethylene oxide (EO) gas is toxic to humans, restrictions have been imposed on its use for sterilization, specifying allowable levels of residual EO remaining in sterilized apparatus and materials. However, the aeration time that optimizes the removal of the remaining EO when a rigid sterilizing container is used for a vessel had not been identified. Therefore, polyvinyl chloride, which easily adsorbs EO, was placed in rigid sterilizing containers, and aeration was carried out after 1, 8, 12, 17, and 24 hours. After standard EO sterilization, the EO concentrations remaining in the air in the rigid containers were measured. The results indicate that a period of 17 hours of aeration is appropriate when a rigid sterilizing container is used.     

Results of cytogenetic testing of workers exposed to ethylene oxide

The present work was undertaken to test cytogenetically workers exposed to Ethylene oxide (EO) aiming at detecting possible adverse effects of this agent to man. In the period 1983-1984, female workers of the Laboratory of Toxicology and the Production laboratory of ethylene oxide production in a chemical plant, and female workers in a sterilization centers in a medical facilities, were repeatedly examined. In 1984, also workers in ethylene oxide production in a chemical plant were tested. For each exposed group a control group was simultaneously examined, using cytogenetic analysis of peripheral blood lymphocytes. General examination of the health condition of exposed workers were organized in the framework of preventive examinations. The exposure level to ethylene oxide in the working environment was simultaneously monitored. The results have revealed an increase in chromosomal aberrations in lymphocytes of persons exposed professionally to EO at the given exposure levels. Smoking was associated with increased frequency of chromosomal aberrations in exposed workers; the difference as compared to non-smokers was however insignificant. By contrast, difference in chromosomal aberration frequency between smokers and non-smokers was significant in the control group.     

Cytogenetic study of persons occupationally exposed to ethylene oxide.

Ten persons occupationally exposed to ethylene oxide (EO), used in the sterilization of medical instruments, were studied at a hospital. The estimated concentration to which they were exposed was 60-69 ppm, TWA. Peripheral blood samples from 10 workers and 10 controls of the same age and sex were taken to determine the frequency of sister-chromatid exchanges (SCE) and chromosomal aberrations (CA). The mean frequencies of SCE/cell (X = S) were 13.27 for the exposed workers and 6.05 for controls. Chromosome aberration frequencies in exposed individuals were significantly increased compared with controls. A significant relationship between the frequencies of SCE and CA and EO exposure was demonstrated. Blood chemistry parameters such as urea, creatinine, uric acid, lactic dehydrogenase, glutamic oxaloacetic and pyruvic transaminases, luteinizing gonadotropin and follicle stimulating gonadotropin and thyrotropin were also measured and found to be within the normal range.     

Polymer recycling in aqueous two-phase extractions using thermoseparating ethylene oxide–propylene oxide copolymers

This is a study on the recovery and recycling of copolymer in aqueous two-phase systems containing random copolymers of ethylene oxide (EO) and propylene oxide (PO). The random copolymers separate from water solution when heated above the lower critical solution temperature (LCST). The primary phase systems were composed of EOPO copolymer and hydroxypropyl or hydroxyethyl starch. After phase separation the upper EOPO phase was removed and subjected to temperature induced phase separation. Copolymers with different EO/PO compositions have been investigated, EO50PO50 [50% EO and 50% PO (w/w)], EO30PO70 and EO20PO80. The temperature required for thermoseparation decreases when the PO content of the copolymer is increased. The effect on the recovery of copolymer after addition of salts, a second polymer or protein was investigated. The added components increased the recovery of copolymer after thermoseparation, e.g., increased the amount copolymer separated from the water phase after thermoseparation. Recycling of copolymer and measurements of polymer concentrations in the primary top and bottom phases after repeated recycling steps was performed. The fluctuation in polymer concentration of the phases was very small after recycling up to four times. Partitioning of the proteins BSA and lysozyme was studied in primary phase systems after recycling of copolymer. The partition coefficients of total protein and lysozyme was not significantly changed during recycling of copolymer. More than 90% of the copolymer could be recovered in the thermoseparation step by optimising the temperature and time for thermoseparation. In repeated phase partitionings in EOPO–starch systems the EO50PO50 copolymer could be recovered to 77% including losses in primary system and thermoseparation, which is equivalent to a total copolymer reuse of 4.3 times.     

Genotoxic effects of ethylene oxide and propylene oxide: a comparative study

The two alkylating agents ethylene oxide (EO) and propylene oxide (PO) were compared for genotoxic effectiveness in various test systems. The study was undertaken partly to shed light on the difference between the compounds found after chronic exposure of monkeys (Lynch et al., 1984) where EO but not PO was able to induce SCE and chromosomal aberrations. In the present study EO was found to be 5–10 times more effective than PO with respect to gene conversion and reverse mutation in Saccharomyces cerevisiae D7 and sister-chromatid conversion in S. cerevisiae RS112. In contrast, the abilities of the two compounds to induce point mutation in S. typhimurium strains and SCE in human lymphocytes were approximately equal. One possible cause of EO being more effective than PO in certain respects, discussed on the basis of inference from earlier studies, is an expected difference in ability to cause strand breaks via alkylation of DNA-phosphate groups.     

Physico-chemical and toxico-hygienic aspects of using ethylene oxide for the sterilization of articles for medical use. Part 2. Toxicity and risk of ethylene oxide entering the organism by non-inhalation routes

Results of investigation of toxicity of ethylene oxide (EO) entering the organism by routes other than inhalation (subcutaneous, intramuscular, intraperitoneal, intravenous) have demonstrated that the substance causes intoxication characterized by polytropic effect on many vitally important organs and systems. The changes in most of the indices under study show a phasic character and dose-time dependence. In both the acute and chronic effect, impairment of the state of the nervous system, the liver, kidney, blood and reactivity of the organism come to the foreground. After one single entrance, EO becomes manifest as a low-risk (class 4) compound (Limac for subcutaneous, intraperitoneal and intravenous routes being 5.0, 0.5 and 1.0 mg/kg, respectively); after repeated exposure as a high-risk (class 2) compound (Limchr for subcutaneous and intraperitoneal route being 1.0 and 0.1 mg/kg, respectively). In comparison with the subcutaneous route, the intravenous and intraperitoneal routes are more dangerous. The obtained parameters of EO toxicometry can be used as a basis for the calculation of safe levels of residual quantities of the compound in articles for medical use.     

Cytogenetic study of persons occupationally exposed to ethylene oxide

Ten persons occupationally exposed to ethylene oxide (EO), used in the sterilization of medical instruments, were studied at a hospital. The estimated concentration to which they were exposed was 60–69 ppm, TWA. Peripheral blood samples from 10 workers and 10 controls of the same age and sex were taken to determine the frequency of sister-chromatid exchanges (SCE) and chromosomal aberrations (CA). The mean frequencies of SCE/cell (X = S) were 13.27 for the exposed workers and 6.05 for controls. Chromosome aberration frequencies in exposed individuals were significantly increased compared with controls. A significant relationship between the frequencies of SCE and CA and EO exposure was demonstrated. Blood chemistry parameters such as urea, creatinine, uric acid, lactic dehydrogenase, glutamic oxaloacetic and pyruvic transaminases, luteinizing gonadotropin and follicle stimulating gonadotropin and thyrotropin were also measured and found to be within the normal range.     

Studies on Octylphenoxy Surfactants : III. Sorption of Triton X-100 by Isolated Tomato Fruit Cuticles

Sorption characteristics of a polyethoxy (EO) derivative of octylphenol (OP) were determined for enzymically isolated mature tomato (Lycopersicon esculentum Mill. cv Sprinter) fruit cuticles at 25°C. Sorption was followed using ¹⁴C-labeled OP + 9.5EO (Triton X-100). Solution pH (2.2-6.2) did not affect surfactant sorption by tomato fruit cuticular membranes (CM). Surfactant concentration (0.001-1.0%, w/v) had a marked impact on sorption. Sorption equilibrium was reached in 24 hours for OP + 9.5EO concentrations below the critical micelle concentration (CMC), whereas 72 to 120 hours were required to reach equilibrium with concentrations greater than the CMC. Regardless of when equilibrium was attained, initial sorption of OP + 9.5EO occurred rapidly. Partition coefficients (K) of approximately 300 were obtained at pre-CMC concentrations, whereas at the highest concentration (1.0%), K values were approximately 15- to 20-fold lower. Sorption was higher for dewaxed CM (DCM) than for CM. At OP + 9.5EO concentrations below the CMC, the amount (millimoles per kilogram) sorbed by CM and DCM increased sharply as the CMC was reached. After an apparent plateau in the amount sorbed at concentrations immediately below and above the CMC, sorption by CM and DCM increased dramatically with OP + 9.5EO concentrations greater than the CMC (0.5 and 1.0%). In contrast, sorption of OP + 5EO (Triton X-45) by CM and DCM differed from one another at relatively high (0.5 and 1.0%) concentrations, where sorption by DCM increased with increasing concentration, but plateaued for the CM. Sorption of OP + 9.5EO was also related to CM concentration, with an inverse relationship existing between sorption and CM at concentrations less than 3.33 milligrams per milliliter.     

Comparison of European and US biological indicators for ethylene oxide sterilization

Summary Biological indicators (BIs) are used to monitor ethylene oxide (EO) gas sterilization processes for medical devices. Several European and United States BIs for EO sterilization were evaluated for resistance according to both United States Pharmacopeia (USP) XXI and United Kingdom's (UK) tests for D-values. US BIs areB. subtilis var. niger spores on paper strips or disc carriers while European BIs use aluminum strips, quartz sand, or cotton yarn. Numerous BIs per run and runs per lot, as well as 2–3 different lots of BIs from each manufacturer, were examined. Both British and US BIs met their respective label claims for rates of inactivation when tested against British and USP EO test parameters, respectively. However, Danish BIs, on cotton yarn or quartz sand, were not inactivated following USP specifications during the exposure dwell times tested (600 mg L^–1 EO, 54°C, 60% RH, 0–110 min). The Danish BIs will require further testing in order for us to determine if theirB. subtilis spores are unusually resistant to EO or if the spore carrier substrates protect the spores from the sterilizing gas. In conclusion, the British and American BIs for EO sterilization are equivalent in resistance despite differences in carrier substrate, recovery conditions, calculation methods for D-values, and the labeled sterilization conditions for use.     

Effectiveness and efficiency of ethyl methanesulphonate and ethylene oxide for the induction of mutations in rice

A comparison of the mutagenic efficiency and effectiveness of ethyl methanesulphonate (EMS) and ethylene oxide (EO) on two different genotypes of rice showed that the mutagenic efficiency sharply decreased with increase in the concentration of EO whereas the efficiency of EMS increased with an increase in the concentration. The effectiveness was inversely proportional to dose of EO whereas it varied little with an increased dose of EMS.     

Permeability studies in chitosan membranes. Effects of crosslinking and poly(ethylene oxide) addition

Pure chitosan, glutaraldehyde crosslinked chitosan, and a blend of chitosan with poly(ethylene oxide) (PEO) membranes were prepared. The three membranes were characterized in terms of their swelling capacities as well as their permeabilities to a drug model (sulfamerazine sodium salt). For the permeation experiments, the variables analyzed were the type of membrane and the initial drug concentration in the liquid phase (from 0.1% to 1.5%). Permeability coefficients were calculated using UV spectroscopy. The results showed that for the three analyzed membranes, the permeability did not change with time (over the studied time interval). An increase in the permeability for CHI/PEO membranes compared to those made of pure chitosan was also observed, possibly due to microporous region formation and/or crystallinity reduction. For the crosslinked membrane, an even higher increase in the permeability coefficient was observed. In this case, the increase was attributed to free volume variation.     

Induction and persistence of micronuclei, sister-chromatid exchanges and chromosomal aberrations in splenocytes and bone-marrow cells of rats exposed to ethylene oxide

Studies on the induction and persistence of ethylene oxide (EO) induced chromosomal alterations in rat bone-marrow cells and splenocytes following in vivo exposure were carried out. Rats were exposed to ethylene oxide either chronically by inhalation (50-200ppm, 4 weeks, 5 days/week, 6h/day) or acutely by intraperitoneal injection (i.p.) at dose levels of 50-100ppm.Spontaneous- and induced-frequencies of micronuclei (MN), sister-chromatid exchanges (SCEs) and chromosomal aberrations were determined in rat bone-marrow cells, and in splenocytes following in vitro mitogen stimulation. Unstable chromosomal aberrations were studied in whole genome using standard Giemsa staining technique and fluorescence in situ hybridisation using probe for chromosome #2 was employed to detect chromosome translocations.Following chronic exposure, the cytogenetic analyses were carried out at days 5 and 21 in rat splenocytes, to study the induction and persistence of sister-chromatid exchanges. Following chronic exposure, ethylene oxide was effective in inducing SCEs, and markedly cells with high frequency SCEs were observed and they in-part persisted until day 21 post-exposure. However, no significant effect was observed in rat splenocytes for induction of MN and chromosomal aberrations. Following acute exposure, both SCEs and MN were increased significantly in rat bone-marrow cells as well as splenocytes.In conclusion, this study indicates that ethylene oxide at the concentrations employed by intraperitoneal injection or inhalation in adult rats is mutagenic and can induce both SCEs and MN.     

Modulation of lymphatic distribution of subcutaneously injected poloxamer 407-coated nanospheres: the effect of the ethylene oxide chain configuration

Lymphatic distribution of interstitially injected poloxamer 407-coated nanospheres (45 nm in diameter) is controlled by surface configuration of the ethylene oxide (EO) segments of the adsorbed copolymer. At low poloxamer surface coverage, EO tails spread laterally on a nanosphere surface and assume a ‘flat or mushroom-like’ configuration. Such entities drain rapidly from the subcutaneous site of injection into the initial lymphatic, when compared to uncoated nanospheres, and subsequently are captured by scavengers of the regional lymph nodes. In vitro experiments have also confirmed that such entities are prone to phagocytosis. When the equilibrium poloxamer concentration is at 75 μg/ml or greater the EO chains become more closely packed and project outward from the nanosphere surface. These surface-engineered nanospheres drain faster than those with EO chains in mushroom configurations into the initial lymphatic, escape clearance by lymph node macrophages, reach the systemic circulation, and remain in the blood for prolonged periods. These experiments provide a rational approach for the design and engineering of nano-vehicles for optimal lymphatic targeting and are discussed.     

Simulation of diffusion of O 2 and CO 2 in amorphous poly(ethylene terephthalate) and related alkylene and isomeric polyesters

The diffusion of small molecules through polymers is important in many areas of polymer science, such as gas barrier and separation membrane materials, polymeric foams, and in the processing and properties of polymers. Molecular simulation techniques have been applied to study the diffusion of oxygen and carbon dioxide as small molecule penetrants in models of bulk amorphous poly(ethylene terephthalate) (PET) and related alkylene and isomeric polyesters. A bulk amorphous configuration with periodic boundary conditions made into a unit cell whose dimensions were determined for each of the simulated polyesters in the cell having the experimental density. The diffusion coefficients for O 2 and CO 2 were determined via NVE molecular dynamics simulations using the Dreiding 2.21 molecular mechanics force field over a range of temperatures (300, 500 and 600 K) using up to 3 ns simulation time. We have focussed on the influence of the temperature, polymer dynamics, number of CH 2 groups, density and free volume distribution on the diffusion properties. Correlation of diffusion coefficients with free volume and number of CH 2 groups was found.     

Ethylene oxide and propylene oxide random copolymer/sodium chloride aqueous two-phase systems: wetting and adsorption on dodecyl-agarose and polystyrene

Liquid/liquid partition chromatography is a mild yet powerful separation method for a variety of biological materials. This work demonstrates that it should be feasible to immobilize an ethylene oxide-propylene oxide (EO/PO) random copolymer solution and to use a solution of NaCl equilibrated against the polymer solution as the mobile-phase (poly (EO-PO) [P(EO-PO)] and NaCl form two aqueous phases known as aqueous two-phase systems). Three random copolymers with different molecular weights and EO/PO ratios were used. Dodecyl-agarose and polystyrene were tested as possible supports. The wetting energies of the aqueous two-phase systems on these two kinds of surfaces were calculated as well as contact angles for each phase on the same surfaces. Finally, the thickness of P(EO-PO) adsorption layers on polystyrene lattices were measured by dynamic light scattering. Contact angle measurements indicate that indeed some EO/PO copolymers preferentially wet hydrophobic substrates, forming thin films.     

Effect of ethylene oxide and propylene oxide block copolymers on the permeability of bilayer lipid membranes to small solutes including doxorubicin

The effects of ethylene oxide and propylene oxide block copolymers (pluronics) on the permeability of several weak acids and bases through bilayer lipid membranes have been studied by the methods of monitoring (1) pH shifts near planar bilayers, (2) doxorubicin fluorescence quenching inside liposomes, and (3) current transients in the presence of hydrophobic anions. It has been shown that pluronics facilitate the permeation of comparatively large molecules (such as 2-n-undecylmalonic acid and doxorubicin) across lipid bilayers, while the permeation of small solutes (such as ammonium and acetic acid) remains unaffected. Pluronics also accelerate the translocation of large hydrophobic anions (tetraphenylborate). The effect of pluronics correlates with the content of propylene oxide units: it is enhanced when the portion of polypropylene oxide block in the copolymer is increased. The action of the pluronic on lipid membrane permeability differs from the effect of the conventional detergent Triton X-100, which does not affect doxorubicin transport if added at concentrations similar to those used for pluronics. It has been proposed that pluronics accelerate the processes of solute diffusion within lipid bilayers (in a structure-dependent manner) rather than influencing the rate of solute adsorption/desorption on the membrane surface. We suppose that the effect of pluronics on doxorubicin permeation across lipid bilayers along with the known effect on the multidrug resistance protein determines its influence on the therapeutic activity of anthracycline drugs.     

Increased frequency of sister chromatid exchange in persons occupationally exposed to ethylene oxide

Mutagenic effects of ethylene oxide have been demonstrated by short-term testing in vitro and in vivo in several organisms. Its oncogenic activity for man has been suspected and recently supported by experiments in mice. Exposure can occur during ethylene oxide gas sterilization of medical materials. We have tested effects on chromosomes by estimating sister chromatids exchange (SCE) frequency. Our results, reported here, show that exposure to this substance during work is followed by a very highly significant increase of SCE frequency as compared with controls. Thus, the SCE test may, under particular conditions, represent a reliable test for exposure to certain toxic agents.     

Synthesis and characterization of poly(ethylene oxide)-block-poly(methylidene malonate 2.1.2) block copolymers bearing a mannose group at the PEO chain end

A poly(ethylene oxide)-block-poly(methylidene malonate 2.1.2) block copolymer (PEO-b-PMM 2.1.2) bearing a mannose moiety at the poly(ethylene oxide) chain end was synthesized by sequential anionic polymerization of ethylene oxide (EO) and methylidene malonate 2.1.2 (MM 2.1.2), followed by a coupling reaction between its poly(ethylene oxide) amino- or aldehyde-end group and a sugar derivative. Different coupling procedures, either in organic media or in aqueous micellar solutions, were examined in order to optimize the poly(ethylene oxide) end-glycosylation yield. The micellar size of the functionalized block copolymers was determined by dynamic light scattering.