Effectiveness of Instrument Pre-Cleaning and Disinfection Sprays Against the Microbial Burden and Blood Stains Remover on Medical Devices

Effectiveness of Instrument Pre-Cleaning and Disinfection Sprays Against the Microbial Burden and Blood Stains Remover on Medical Devices


Introduction
The Central Sterile Supply Department (CSSD) is an important supportive service at the hospital, ensuring an infectionfree environment [1,2]. The CSSD is an integrated area in hospitals and other healthcare facilities that sterilizes and performs other actions on medical devices, equipment, and consumables for subsequent use by healthcare providers in the hospital operating theatre and for other aseptic procedures, such as Performing surgeries [3]. To more easily control quality, the central sterile supply department worker should perform the majority of the cleaning, disinfecting, and sterilizing of patient-care supplies in a central processing department. The goal of central processing is to process medical and surgical instruments in an orderly manner to protect patients from infection while minimizing risks to staff and preserving the value of the items being reprocessed [4] In performing various procedures after using medical types of equipment from the operating room department, obstetrics department, and other departments. There were blood stains on the instrument before it was sent to the CSSD department for cleaning. Many stains are commonly found on medical devices and common in hospitals, especially among patients, the elderly, mischievous young children, or menstruating women. Several studies in various countries have revealed a lack of adherence to established precleaning and disinfection sprays against the microbial burden and blood stains on medical devices. Although there are currently many products for the convenience of pre-cleaning in many sprays, they are often expensive, and the main components are only chemicals that destroy water resources and are frequently irritating to the skin. Furthermore, some chemicals are harmful to the body, either through acute allergies or the accumulation of toxicity in the body [5]. There have been few studies on the use of extracts from Mangosteen (Garcinia mangostana L.), and Syzygium aromaticum (L.) Merrill. & Perry to remove blood stains [1]. This study aimed to determine the effectiveness of simultaneously cleaning, disinfecting, and removing blood stains on medical devices.

Methods
The study was conducted at the multi-center Central Sterile Supply Department and was an evaluation of two methods for assessing prepares the medical instruments after the surgery operation. This study was conducted in the CSSDs of five public hospitals in Thailand from August -October 2022. MEDI PLUS pre-cleaning and disinfection sprays against the microbial burden and blood stains remover on medical devices containing extracts from Thai agricultural products, including Mangosteen (Garcinia mangostana L.), and Syzygium aromaticum (L.) Merrill.& Perry with Ethoxylated Alcohol active ingredients was tested in this study was obtained by applying the protocol of two studies of the dissolution time of blood stains: The methods were a test by a simple visual and blood stains test strip (Figures 1,2). The contact time for the removed blood stains by simple visual observation test and blood stains test strips at different times: 1, 2, 3, 4, and 5 minutes. In a multicenter Central Sterile Supply Department trial, 100 identical surgical devices were prepared, divided into 50 visual tests and 50 test strips, for each hospital. The study of bloodstain dissolution was performed by a simple visual in the bloodstain dissolution test by timing. The second method of bloodstain dissolution study was performed by inserting a test strip into a kidney-shaped bowl and testing the bloodstain dissolution by timing. The study on the bactericidal and antiviral properties of the product was tested by sending samples to the medical laboratories of the Faculty of Medical Technology in Thailand.

Result
The multi-center Central Sterile Supply Department found that the contact time for the removed blood stains by simple visual observation test in 1 minute. The decomposition effect of the blood using test strips begins to react at 1 minute and the hemolysis improves at 2 minutes and beyond (Figures 3,4). A significant difference in 2 minutes (P ≤ .005) was observed using cleaning indicators measurements. For all bacteria and viruses, ready-to-use pre-cleaning-disinfecting spray products reduced the microbial count with a log10 reduction >5 with a 10-minute exposure time. The study on the bactericidal and antiviral properties of the product results, Staphylococcus aureus (ATCC 6538), Salmonella choleraesuis (ATCC 10708) Pseudomonas aeruginosa (ATCC 15442), and dilution of samples was 1:15. The test of bacterial growth after exposure to 60 contaminated carriers to disinfectant at 10 min. The test of T. mentagrophytes (Trichophyton mentagrophytes) is a clinical isolate. The strain sporulates freely on culture media and produces abundant conidia as required by AOAC Official Method 955.17, AOAC International, 2000. The information in Table 1 represents the test of microbial burden after exposure to 60 contaminated carriers to disinfectant at 10 min and the dilution of samples was 1:10. Table 2 showed the fungicidal testing of C.albicans ATCC 90028, and C. neoformans by minimal inhibition concentration (MIC) of 10%. MEDI PLUS ready-touse pre-cleaning-disinfecting spray products for all bacteria and viruses reduced the microbial count with a log10 reduction >5 with a 10-minute exposure time. All fungi reduced the microbial count with a log10 reduction >5 with a 10-minute exposure time except for a spray based on natural extracts and Ethoxylated Alcohol. The findings of this study show that a ready-to-use pre-cleaningdisinfecting spray is extremely important in reducing the possible transmission of all microorganisms.

Discussion
The effective pre-cleaning and disinfection sprays containing extracts from Thai agricultural products with Ethoxylated Alcohol active ingredients were high efficiencies in simultaneously cleaning, disinfecting, and removing blood stains remover on medical devices. The results of a simple visual and blood stains test strip show effective blood stain dissolution efficiency from 2 minutes onwards. This is in line with the study of Withaya which found that the pre-cleaning spray on blood stain remover was better than the pre-cleaning foam [1,5,6]. Thai Mangosteen extracted with Ethoxylated Alcohol active ingredients can inhibit the growth of Staphylococcus aureus (ATCC 6538), Salmonella choleraesuis (ATCC 10708) Pseudomonas aeruginosa (ATCC 15442). Most of the mangosteen extracted contains the main compound, Xanthones (more than 40 %), which is the core structure of Mangostin. Xanthones are reported to inhibit mold [7][8][9][10]. According to a study by Yenjit et al, Xanthones have been reported to inhibit fungi. Many species such as Rhizopus sp, Alternaria solani, Aspergillus niger, Aspergillus flavus, Penicillium sp, Fusarium roseum, etc. Mangosteen extract found that many bioactive compounds such as flavonoids, xanthones, and mangiferin, among others, are classified as substances that increase plant resistance and inhibit the growth of microorganisms [9,11,12]. It has also been studied which is consistent with the Sabahat study decoction and essential oil of clove (Syzygium aromaticum (L.) Merrill.& Perry) as natural antibacterial agents against 100 isolates belonging to 10 different species of Gram-ve bacilli viz, Escherichia coli, Proteus mirabilis, Pseudomonas aeruginosa, Enterobacter aerogenes, Klebsiella ozaena, Klebsiella pneumonia, Serratia marcescens, Salmonella typhi, Shigella dysentriae and Vibrio cholerae [7,[12][13][14][15][16]. In a study carried out extracts from Thai agricultural products with Ethoxylated Alcohol active ingredients extract showed an inhibitory effect against microbial burden and blood stains remover on medical devices [17][18][19][20].

Conclusions
The findings of this study show that the effectiveness of precleaning and disinfection sprays against the microbial burden and blood stains remover on medical devices containing extracts from Thai agricultural products simultaneously cleaning, disinfecting, and removing blood stains on medical devices extremely important in reducing the possible transmission of all microorganisms. The cleaning-disinfecting sprays, with ingredients from natural extracts, can remove blood stains. Instrument pre-cleaning and disinfection sprays of natural extract and Ethoxylated Alcohol showed comparable effectiveness.