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HLDS You Should Know About

Healthcare workers whose job it is to reprocess soiled transesophageal echocardiogram (TEE) ultrasound probes are often having to handle and come into contact with high-level disinfectants (HLDs) in order to make these instruments safe for patients. These HLDs are a necessary part of the reprocessing procedure and cannot be avoided. According to the CDC, reprocessing semi-critical items (like TEE probes) with HLDs should be enough to prevent the transmission of infection as HLDs are designed for the, “complete elimination of all microorganisms… except for a small number of bacterial spores.”

Unfortunately, however, these HLDs are rather harsh and can pose a potential risk to those who are exposed to them day after day. Fortunately, by using systems that protect you from exposure via the use of vapor management filters, these HLDs pose little threat to healthcare workers. Let’s look at four HLDs commonly used to reprocess TEE ultrasound probes and find out what the risks are and how to mitigate them.

Glutaraldehyde

The CDC states that, “Glutaraldehyde is a saturated dialdehyde that has gained wide acceptance as a high-level disinfectant and chemical sterilant.” Glutaraldehyde is very widely used because of its combined ability to high-level disinfect while being gentle and preventing corrosion on most probes. Despite these positive characteristics, glutaraldehyde has some serious hazards associated with it.

Long-term exposure to glutaraldehyde fumes has been shown to lead to occupational asthma, eye irritation, and rhinitis. The best way to prevent exposure to the harmful vapors of glutaraldehyde is by using an automated TEE probe disinfector to shield users.

Orthophthalaldehyde (OPA)

OPA is a commonly used alternative to glutaraldehyde due to its wider pH operating range and decreased odor. According to the CDC, OPA, “is not known to irritate the eyes and nasal passages, does not require activation or exposure monitoring, and has a 12-minute high-level disinfection claim in the United States.” It can actually be more effective in some cases than glutaraldehyde. While there is the definite benefit of less irritating fume exposure when using OPA, it is not without its risks.

OPA can cause burns and contact dermatitis when exposed to skin and mucous membranes. OPA can be dangerous because, since it is difficult to smell, user may not be aware that they are being exposed to potentially harmful fumes. This makes proper filtration through a vapor management filter containing sufficient amounts of activated carbon vital for operator safety.

Peracetic Acid

Peracetic acid is a highly effective HLD with three clinical trials demonstrating that it had, “excellent microbial killing and no clinical failures leading to infections.” Furthermore, peracetic acid is leaves no residue and is sporicidal even at low temperatures. Since peracetic acid is so effective, it is becoming more widely used.

Along with this added efficiency, peracetic acid also boasts some increased risks. It is highly toxic, corrosive, and flammable. Peracetic acid may also cause extreme discomfort and irritation to the upper respiratory tract if fumes are inhaled.

Hydrogen Peroxide

Hydrogen peroxide has proven an effective HLD against various microorganisms and is stable when stored properly. However, if not stored under just the right conditions, hydrogen peroxide is flammable and potentially explosive. According to the CDC, “This product has not been used long enough to evaluate material compatibility to endoscopes and other semi-critical devices, and further assessment by instrument manufacturers is needed.”

Fumes from hydrogen peroxide can irritate the lungs and even cause fluid to build up in the lungs. Hydrogen peroxide can be corrosive to skin and mucous membranes. It can also cause eye irritation and rhinitis.

Staying Safe

With all these potential risks, how can you keep yourself safe from these potentially harmful substances and their irritating vapors?

One way to help mitigate some of the risk associated with HLDs is by wearing personal protective equipment (PPE). Refer to your facility’s procedures on PPE for handling HLDs. While proper PPE is helpful, it is not sufficient to completely protect those handling HLDs from harmful vapors.

The most effective way of minimizing the risks associated with HLDs is by investing in an automated TEE probe reprocessor, like TD 100. The TD 100 is fitted with an advanced vapor management filtration system that adsorbs and neutralizes vapors released during the high-level disinfection process. The vapor management filter is impregnated with several pounds of activated carbon. All that activated carbon is necessary to provide the residence time necessary to capture and neutralize HLD fumes. This ensures that the air around these devices is safe for staff members to breathe, keeping them healthy and keeping your facility operating at its best.

Additionally, with our automated reprocessor, users can almost entirely avoid coming into contact with HLDs because HLDs come in foil-sealed, single-use bottles. Splashes and spills are trapped within the disinfectant reservoirs while fumes are captured. Using these systems greatly mitigates any risk associated with the continued use of HLDs, keeping staff members safe and able to focus on their passion: helping patients get and stay healthy.

TEE Complete Care® products provide quality device care and storage by minimizing healthcare operational costs, improving service readiness and increasing regulatory compliance.

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Trending: Hepatitis C – potential increase in HCV testing.

New evidence suggests a high rate of hepatitis C infection amongst baby boomers. Commonly viewed as a drug addict’s disease, new data suggests the largest group of Canadians carrying the virus consists of adults born between 1945 and 1975.

Last year, the US CDC recommended that all adults born between 1945 and 1965 be tested for hepatitis C, after observing high infection rates among boomers.

This testing guideline has gained support from the Canadian Liver Foundation, which recommended extending the birth year to 1975, “due to the prevalence of hepatitis C in the immigrant population,” reported Dr. Morris Sherman, chairman of the Canadian Liver Foundation and liver specialist at Toronto General Hospital.

The Public Health Agency of Canada (PHAC) estimates that 242 500 Canadians are infected with the virus, however some experts suggest that more than 400 000 Canadians carry the virus based on data from the US and from British Columbia, a leader in HCV surveillance.  In BC, it is estimated that one in 33 boomers has been infected with HCV. It is believed that infection in the boomer population is primarily due to experimentation with recreational drug use, with injection drug use thought to be quite common in the 60s and 70s.

HCV testing is currently recommended for high risk groups, including immigrants and active injection drug users.  National health agencies have yet to recommend expanded testing guidelines and the Public Health Agency of Canada currently maintains, “in the general population, the risk of contracting hep C is low.”

Phoenix Airmid Biomedical can help your lab prepare for the potential increase in HCV testing.  Phoenix Airmid Biomedical is the exclusive Canadian distributor of the INNO-LIA HCV Score (manufactured by Fujirebio).  This confirmatory test is Health Canada approved for the diagnosis of HCV and detects the presence of antibodies to all major HCV genotypes, with 100% sensitivity and 94.5% specificity.  Contact Phoenix Airmid Biomedical at 1-866-718-0515 for more information on the INNO-LIA HCV Score assay.

1. A Canadian screening program for hepatitis C: Is now the time? CMAJ October 15, 2013 185:13251328; published ahead of print September 30, 2013,

2. http://www.theglobeandmail.com/life/health-and-fitness/health/specialists-warn-of-a-looming-hepatitis-c-crisis/article14432504/

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