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Validation Services

Sterile products are also vital in the production process to remove residues and impurities that may remain on the product and to reduce the amount of biological load that may remain on the product.

We provide training on how to define the cleaning process that is appropriate for your product, determine the parameters and verify the washing process. In this direction, we carry out cleaning procedures and cleaning instructions related to your products and define how to follow the cleaning process.

Sterilization Validation

Sterilization of medical devices is vital in the medical sector. Sterilization is a necessary process for most medical devices, which are often required by regulatory authorities. It is a process to purify the product from bacteria and other microorganisms that cannot be removed by regular cleaning processes. Therefore, sterilization requirements are addressed separately in ISO 13485: 2016.

Sterilization offers three safe conditions for surgery

Safe conditions for surgery indicate a situation where the patient, medical devices and the environment indicate minimal risk of surgical-related diseases and other medical problems. Safe medical conditions during surgery are extremely important because these conditions ensure the patient's own safety during surgery. Medical sterilization is therefore of critical importance because it provides three different medical safe conditions in surgery:

Sterilization stops the growth of bacteria in the devices and ultimately prevents the transfer of bacteria to the patient.

Sterilization stops the spread of fatal diseases such as HIV from devices to patients.

Sterilization prevents infections that may require additional surgery.

Sterilization requirements and how to comply

Sterilization requirements are spread throughout the entire ISO 13485: 2016 standard.

The Sterile Medical Device (Article 3.20) of ISO 13485: 2016 states that the sterility requirements of each medical device may be subject to applicable legal requirements.

Pollution control (see 6.4.2) is intended to prevent contamination after the devices have been sterilized. Controls may include dust collectors and ventilation systems and are monitored by air quality tests at a certain frequency in the assembly and packaging areas after sterilization.

Specific requirements for sterile medical devices (see 7.5.5) specify two direct requirements:

Records of sterilization process parameters of each batch - Sterilization process parameters must be recorded for each batch. Process parameters, pressure in the sterilization unit, temperature in the sterilization unit, gas flow rate in the unit, operator name and humidity etc. Includes environmental conditions. All process parameters that may affect product quality must be recorded for sterilization.

Traceability - All sterilization lots must be traceable.

Effective sterilization management builds customer confidence

In the absence of sterilization, medical devices pose many different intolerable health risks. Deaths can result in cases of microorganisms that infect the human body. Therefore, the ISO technical committee correctly reviewed the current sterilization requirements in the previous version and added new controls in ISO 13485: 2016. Validation of sterilization processes - A procedure should be developed to address the validation of sterilization processes. Before proceeding with regular production, you must verify that this equipment will remove microorganisms from bio-contaminated vehicles.

For this reason, the sterilization process in order to ensure the same efficiency in each application

-The device used in sterilization

-The materials used in the process

-The process parameters (heat, humidity, pressure, time, ventilation)

-Antimicrobial activity

- Sustainability and reproducibility of the process

verification is required.

We provide services for creating and reporting protocols, procedures and instructions on how all these operations should be performed. We provide personnel trainings on the realization of sterilization validation process within your company.

Process Validation

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Packaging Validation

Sterile packaging must be verified for package safety. In the validation process;

- Installation and operation of the device used in sterile closure

-Compatibility and performance of packaging material

- Suitability and performance of the applied process

-Specific time protection performance of the product of the sterile package should be proved.

We set up procedures, instructions on how to perform packaging validation, and organize information and trainings on how much sample for which tests should be carried out in the light of sample selection criteria.


31AXX
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A criminal complaint from the dentist to the private hospital: Claim that he lost his mother as a result of neglect

Kahramanmaras gangrene toe cut because of his mother died of hospital infection, suggesting that the woman, the private hospital officials filed a criminal complaint to the prosecutor's office.

Allegedly, Hatice Timurkaan (65), the toe due to diabetes mellitus due to gangrene was taken to the private hospital in the city by relatives.

Timürkaan cut his finger, his wound healed by relatives of another private hospital was taken to the intensive care unit was being treated.

Timürkaan lost his life struggle in the intensive care unit.

Dentist Cennet Tasdemir filed a criminal complaint with the prosecutor about the hospital staff claiming that his mother died due to hospital infection.

"My mother's been infected with a nosocomial infection."

Tasdemir, told reporters, his mother's toe last year on October 29 in the private hospital due to gangrene, he said.

Tasdemir discharged his mother after discharging his finger, the wound healed and taken to another private hospital, indicating that the pain Tasdemir said, "My mother entered the private hospital on November 3, 2018 and died on December 10, 2018. We have assays that my mother is infected with the hospital infection. "Acinetobacter baumannii", a deadly nosocomial infection, is a world-wide bacterium that kills 85 percent of patients when infected. " he said.

Tasdemir, his mother's finger was cut in the hospital, asserting that this type of infection in the analysis, arguing:

"November 28 and December 2 assays 'Acinetobacter baumannii infection has grown' he has the result. When I first hospitalized there was no such thing. I got the results of my analysis before losing my mother. After losing my mother when I want the result 'No such results.' When this infection develops, the intensive care unit should be evacuated.

I filed a criminal complaint to the prosecution. In addition, CIMER, the Ministry of Health and Provincial Health Directorate had complaints, I started a legal struggle. "

Tasdemir, his mother passed away after 4 hours, they claimed that the news.

Officials of the private hospital, said they would not make a statement on the issue.



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What is EBOLA Virus?

Since we do not know the natural reservoir, we do not know how the disease causes an epidemic in humans. However, it is assumed that the first patient became ill as a result of contamination with the infected animal.

WHAT IS EBOLA HEMOROGIC FEVER?
EHA is a disease that has been known since 1976 and is common in humans and primates (Monkeys and Chimpanzees) that are severe, often fatal. A river in the Congo is called Ebola. It is an RNA virus from the family Filavoviridae. 3 of the 4 species have been identified: Ebola - Zaire, Ebola - Sudan and Ebola - Ivory Coast. Fourth, Ebola - Reston causes disease in primates.

LOCATION IN NATURE
Unknown. Evidence shows that it is thought to be of African origin. The Ebola-Reston virus was isolated from some kind of infected monkey, which came from Italy and the United States from the Philippines. This virus is not known in other countries like North America.

WHERE DOES EBOLA HEMOROGIC FEVE Occur?
In Congo, Gabon is also located in Ivory Coast, Sudan and Uganda. A person known to be serologically ill but not ill has been reported from Liberia. In England, a laboratory worker caught the disease as a result of prickling. There has been no report of human illness in America. In America and Italy, the Ebola - Reston virus has caused death and serious illness in monkeys. During this outbreak, several investigators were infected with the virus but did not become ill. EHA is seen as sporadic outbreaks. It is usually spread with medical equipment, although it is probably the only case that cannot be diagnosed.

HOW DOES THE EBOLA VIRUS SPREAD?
It is sporadic that people get sick with the Ebola virus. People don't carry the virus.
Since we do not know the natural reservoir, we do not know how the disease causes an epidemic in humans. However, it is assumed that the first patient became ill as a result of contamination with the infected animal. Once someone becomes ill, they can infect others in several ways. People can get the virus through direct contamination with the blood or secretion of the infected person. The virus spreads frequently between friends and families, due to intimacy, nutrition, occupation, or other reasons between family or friends. Humans may also be exposed to the virus as a result of contamination with certain objects, such as needles, contaminated with infected secretion. The outbreak of ROM is often associated with nasocomial transmission. This includes the two ways described above, but describes the spread with medical sets in hospitals or clinics. In Africa, patients are generally treated without mask and overshoes. In addition, many people may be infected by using non-disposable syringes or syringes, which can be washed with water and repeated use without sterilization. Virginia has also had an Ebola - Reston virus transmission from monkey to monkey by air. However, this type of transition is not defined in hospital or residents.

SYMPTOMS OF EBOLA HEMOROGIC FEVER
The symptoms and signs of ROM are not the same in all patients. According to the frequency of the symptoms seen in the reported cases the symptoms are listed in the following table.

Symptoms in Most Ebola Patients

Symptoms of Some Ebola Hats
High Fever, Headache Muscle Pain, Stomach Pain within a few days after being infected with the virus.
Within a few weeks of infection with the virus Chest pain, shock and death Blindness, bleeding
Researchers have failed to understand why some people get better and others don't. However, it is known that patients who do not have significant immune response at the time of death usually die.

HOW IS EBOLA HEMOROGIC FEVER CLINICAL RECOGNIZED?
It is difficult to diagnose because of symptoms that are non-specific to the virus such as red and itchy eye, skin rash within a few days of infection. If there is a suspicion of Ebola virus with the group of symptoms mentioned in the table above, laboratory tests should be performed quickly. These tests include blood spread and culture for the malaria. If the patient has bloody diarrhea, stool culture should also be performed.

LABORATORY TESTS USED FOR EBOLA HEMOROGIC FEVER
ELISA, IgG ELISA, PCR and Virus Isolation tests can be used for diagnosis within a few days of onset of symptoms. IgM and IgG antibody tests may be used for subsequent periods or after recovery. In addition, the dead people respectively; Immunohistocemistry, virus isolation, PCR can be used.

HOW IS EBOLA HEMOROGIC FEVER TREATED?
There is no standard treatment for ROM. Nowadays, supportive treatment is performed. Fluid - Electrolyte monitoring, oxygen monitoring, blood pressure monitoring and treatment for secondary infections. During the Kikwit outbreak, eight patients were given the blood of healed patients with EHA, seven of them survived.

HOW TO PREVENT EBOLA HEMOROGIC FEVER?
In Africa, the EHA measure has many challenges. Because the location and identity of the natural reservoirs of the Ebola virus are unknown, several prevention methods are available.
In the presence of the disease, the social and economic conditions allow the epidemic to spread, so public health care providers should recognize the cases of ROM. In addition, health care workers should have diagnostic test facilities, practice for isolation of cases and health care workers should have the opportunity to protect themselves. Infection control measures; gloves, special protective goggles, a special protective clothing, including a mask; The purpose of all these techniques; to avoid any person's contact with blood or secretions of any patient. If a patient with EHA dies, it is important to avoid direct contamination with the body of the deceased.
CDC has prepared tools to meet the needs of healthcare workers. Together with the WHO, the CDC developed practical guidelines for hospitals under the heading of Viral Hemorrhagic Infection Control in the African Health Kit. This describes the procedures to be taken in terms of health and prevention of hospital-acquired transitions when Viral Hemorrhagic Fever, such as Ebola, is recognized using locally available facilities.

OTHER CONTROLS AND CONTROLS IN EBOLA HEMOROGIC FEVER
Scientists and researchers; They are developing additional diagnostic methods for the early diagnosis of the disease and the ecological investigation of the causative agent of the disease and the Ebola virus. the ability to moniterize those suspected to detect the incidence of the disease. In order to prevent future outbreaks effectively, more information about the spread of the virus and its reservoirs is essential.


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Wound care principles

Acute traumatic wound care is the most common intervention in emergency medicine practice. More than 10 million wound care is performed in the US each year.

Objectives of wound care

one. Preserves vivid tissues

2nd. Restoration of tissue continuity and function

3. Optimizing the conditions in the development of wound resistance

4. Prevention of long and excessive inflammation

5. Avoiding infection and other disrupting causes

6. Minimizing scar formation



First Inspection

History: The mechanism of injury, the time of injury, the environmental conditions of the wound and the immune status of the patient are learned.

If the wound is cleaned and closed, contaminated bacteria will proliferate in the wound. Treatment of contaminated wounds results in infection when delayed by up to 3 hours. The time between injury time and the safe closure time without risk of infection is the golden period and does not have a fixed time. While the well-blooded facial skin can be closed within 48 hours, the wound on the foot nail bed of an elderly patient should be closed immediately.

Other important issues in terms of infection risk are the patient's age and health status. Advanced age, chronic diseases and drug use, shock, recurrent traumas, infection, bacteremia, denervation and peripheral vascular diseases slow down the healing rate.

In addition, the presence of special treatments, allergies, tetanus immunization status, potential rabies contact, foreign body and previous traumas and deformities should be learned.

Physical Examination: All wounds should be examined for tissue destruction, degree of contamination, and damage to underlying tissues. The examination should be carried out in accordance with the aseptic technique.

Injury mechanism and classification of wounds: 3 types of mechanical force damages soft tissues. Tear, stress and compression. Wound is defined according to tissue separation or loss. It is classified into 6 categories: Abrasion, laceration, crush wounds, penetrating wounds, avulsion and combined wounds.

Contaminated bacteria and foreign bodies: The presence of bacteria and dead tissues in the wound and local tissue ischemia or hypoxia cause wound infection. Traumatic injuries are divided into two categories according to the degree of bacterial contamination of the wounds. Contaminated wounds: Traumatic wounds older than 12 hours. Dirty wounds: Devitalized or traumatic wounds older than 12 hours are accompanied by a significant number of bacteria and are predominantly contaminated with pathogenic organisms.

Wound localization: The number of bacteria (> 10 5 / cm 2 ) in the scalp, neck, axilla, perineum, penis, vagina, mouth, intertriginous areas and nail endogenous microflora is sufficient to infect the wound. Well-blooded areas such as scalp and face are more resistant to bacterial entry. Distal extremity wounds are more susceptible to infection than injuries to other parts of the body.

Devitalized tissue: An important part of the wound examination is the identification of dead tissues. Tissue damage reduces resistance to infection in the wound.

Underlying tissues: It is important to investigate the injury of the underlying tissues during the examination. Irrigation of the joint space, debridement and reduction of fracture fragments, neurorrhaphy, vascular anastomosis and flexor tendon repair should be performed in the operating room with the help of appropriate light, necessary instruments and assistants.



Cleaning

The cornerstones of wound care are cleaning, debridement, sealing and protection. While most of the wounds are contaminated with less than the infective dose of bacteria, they reach the infective level if time is prolonged and the appropriate environment is provided. Wound cleaning and debridement have common goals. 1. Remove bacteria and reduce them below the level of infection 2. Remove particles and bacteria from the tissue during the inflammatory period of healing or beyond the critical threshold. Wound cleaning methods: mechanical wiping, antiseptics, irrigation, irrigation with antibiotic solutions. Appropriate sedation, local anesthesia and appropriate substance should be chosen for these patients. Irrigations should be done with high pressure and scrub solutions should be applied by applying a sponge. Hydrogen peroxide should not be used on open wounds.



Wound closure preparation

It should be prepared and covered before the wound is closed or debrided. Hair and hair should not be shaved. If it is to be worked between the hair, the hair should be separated from the wound and collected. The hair and hair which may enter the wound can be laid aside with petrolatum gel or water-soluble ointments. Eyebrows should never be shaved.

10% povidone iodine solution is used as standard for skin disinfection. Only a large area around the wound should be stained and no solution should be applied into the wound. After washing the hands, remove the powders from the gloves before touching the wound with sterile gloves. If a URI is present, it is recommended to use a face mask. Perforated cover is covered on the wound. If anesthesia is still not achieved, it is repeated. The wound is opened in depth and examined for any damage to foreign body, particulate material, bone fragments and underlying tissues for repair. Lacerations extending down to the subcutaneous adipose tissue are important because a large amount of particulate material can be hidden within the deep layers of the tissues. With careful examination, these contaminants should be removed from the deep tissues and sutured. If so, infection is monitored.



debridement

It is important in the treatment of contaminated wounds. With this technique, the doctor removes tissues such as foreign bodies, bacteria and devitalized tissue that prolong the period of inflammation and impair the resistance of the wound to infection. Very dirty wounds, irregular wounds, defined devitalized tissues are prepared by this technique. For this purpose, 1 or 2 hooks of appropriate size, 15 scalpel and handle, tissue shears, hemostats and small tissue forceps are required. Grasping the edge of the blackened tissue with hook or forceps or scissors or tissue scissors to the other end of the devitalized tissue is cut away. After debridement, the missing part is irrigated outside the wound. Since tissues that have lost viability such as dura, fascia and tendon cause significant functional losses, these tissues are not debrided and cleaned properly.



excision

If the tissue has a certain elasticity or tension and does not contain important tissues such as tendons, nerves and is contaminated, the entire wound can be removed. It is a more effective technique than debridement. The trunk, gluteal region and thigh are suitable for this technique. It is made with the materials used in debridement and similar technique.



Selective debridement

Selective tissue debridement technique is used in the wounds of the tissues where skin elasticity is insufficient or tissue loss or which have important functions that need to be protected (such as dura, fascia, nerve, tendon).

After excision or debridement, the tissue is irrigated and the remaining tissues are removed.



Bleeding control

Bleeding from the wound is common and should be checked before examination, cleaning or debridement. Sometimes wound exploration and cleaning can cause bleeding. Hemostasis is required at any stage of wound care. Hematoma that will occur in the wound causes suturing at the edges of the suture, delaying healing and infection.

There are many methods for bleeding control. Pressure control with glove finger, sponge or compress are effective methods for emergency control of a small number or from one place of bleeding. At least 5 min. pressure should be applied. The pressure is more effective if the bleeding wound is raised above the heart level.

Bleeding can be controlled with compression dressings in patients with multiple injuries and various emergency problems.

Another method used in hemostasis is the ligation of the blood vessel with a well absorbed suture material. A common mistake is to spend too much time to connect small blood vessels. Hemostasis is achieved by carefully holding only the vessel with the tip of a hemostasis clamp. A 5-0 or 6-0 synthetic absorbable suture material is wrapped around the hemostat to remove the knot. Once the suture on the vessel is secured, the hemostat is removed. It is cut so that at least the suture material is left behind. In cases of hemorrhage from the wound wall that cannot be held with hemostat, a horizontal matres or 8 sutures are placed around the bleeding point and ligated.

Core diameter 2 mm. greater than is connected. 2 mm. veins under the direct compression or cautery bleeding is controlled.

1: 100000 epinephrine is a good topical vasoconstrictor agent and reduces bleeding from small vessels. When combined with local anesthetics, it provides hemostasis in well-blooded areas. Topical or intradermal administration may increase the risk of wound infection.

Fibrin foam, gelatin foam and microcrystalline collagen can be used as hemostatic agent.



Tourniquet

They are used to temporarily control bleeding in wounds on the extremities that are resistant to direct compression, electrocautery, or ligation. It also facilitates the examination of small foreign bodies, partial laser tendon or joint capsule in bleeding areas in lacerations.

The tourniquet causes injury in 3 ways: It causes ischemia in the extremities, It causes compression and damage to the lower vessels and nerves, and it can threaten the survival of borderline viable tissue. To avoid these injuries, attention should be paid to tourniquet pressure and duration. For this, systolic pressure (250-300 mmHg according to some authors) at a pressure of 30-45 min. (max 1 hour) should be applied. Veins should be evacuated before tourniquet application. A tourniquet should not be applied with thin materials. When the process is completed, the tourniquet should be removed. A tourniquet can be applied to the finger with the help of a penren drain or glove finger.



CLOSING



Open wound care and delayed closure

If the skin in the defect area is immobilized, such as the scalp or pre-tibial area, it is impossible to close the defect completely. In very dirty wounds, the risk of wound infection increases as a result of closure. Therefore, the general rule is to close the wounds that you believe are clean or that you believe will be cleaned by brushing, irrigation or debridement. Wounds to be left open for wound healing are cleaned and, if necessary, debrided and covered with sterile, SF moistened sponge. The wound is wrapped with a thin, absorbent, sterile drape. If fever does not develop, the wound is not mixed for 4 days, unnecessary inspection increases the risk of contamination and infection. At the end of the 4th day, the wound is re-evaluated. If there is no infection and the wound edges are appropriate or the wound is excised, delayed closure is performed.

Wounds requiring open maintenance and delayed closure: wounds contaminated with soil, organic matter, saliva, faeces, vaginal secretions and purulent materials, wounds with extensive tissue damage, and many animal bites. In animal bites, the wounds on the face are completely excised and sutured. Dog bites outside the extremity can be sutured.



methods

The appropriate closure technique is selected according to the location and configuration of the wound. These techniques are suturing, tape bonding and metal stapler. The tapes are easy to apply and are preferred for non-cooperating and fearful patients. It causes minimal skin reaction, no suture marks on the skin, and the lowest risk of infection is the technique. Metal staplers can be applied quickly in suitable places but can be used in non-cosmetic areas and linear wounds. In many cases suturing is the most preferred method.



Equipment

Tools: Needle holder (suture) and suture scissors are required in addition to those used in debridement. The portugal size is selected according to the needle to be used. New instruments should be used for debridement of highly contaminated wounds. If the instruments have clotted blood contamination, they should be used after flushing with hydrogen peroxide.

Suture Materials: Many suture materials are available. They can be defined by 4 characteristics.

one. Chemical and physical properties

2nd. Structural and mechanical performance

3. Absorption and reactivity

4. Persistence and magnitude of tensile strength

Suture materials are of various compositions. They can be grouped as natural, synthetic, monofilament, multiflorant. Depending on the structure and performance, it is important that the suture is preferred to pass through the tissue smoothly, to be easily knotted and to be stable. Multiflatable sutures have the best structural properties.

If the knot 3 mm. 3 sutures in silk or other braided, nonabsorbable materials, 3 synthetic monofilaments absorbable and nonabsorbable sutures should be discarded.

Absorption and reactivity: Those that break down rapidly in tissue are called absorbable. Those who maintain the tensile strength for more than 60 days are called nonabsorbable. Plain catgut absorbs in 10-40 days, chrome catgut 15-60 days, ethikon 10-14 days, vicryl 60-90 days and dexon 120-210 days. Plain catgut in the oral cavity 3-5 days, chrome catgut 7-10 days, polyglycolic acid disappear in 16-20 days. The complete absorption of silk from the skin is approximately 2 years. The absorption rates of synthetic absorbable sutures are independent of suture size.

The sutures lose their resistance before being fully absorbed from the tissue. Braided absorbable sutures lose all of their resistance at 21 days, monofilament absorbable, and PDS, ethicon lose 60% of their resistance at 28 days. In a study comparing suture resistance and wound resistance catgut 7 days; chrome catgut, dexon, and vicryl remained intact for 10-21 days and nylon, silk and wire for 20-30 days.

All sutures provoke host defense and inflammation with tissue damage. The size of the reaction is characterized by the nature (diameter and length) of the material placed in the tissue and the chemical structure of the suture. Among the absorbable sutures, polyglycolic acid and polyglactin sutures are the least reactive. Nonabsorbable polypropylene is less reactive than nylon and dacron. The reaction with catgut, silk and cotton sutures is more pronounced.

The chemical structure of the suture is important in identifying early infection. The infection rate in polyglycolic acid sutures is lower than catgut. Lubricants coated on sutures do not alter suture reactivity, absorption characteristics, decreased resistance or risk of infection.

Size and resistance: The size of the suture material (yarn diameter) is the measurement of the tensile strength of the suture. The greater the yarn diameter, the greater the durability. The correct suture size depends on the tensile strength of the tissue layers to be applied.

The most necessary suture materials for wound closure to the emergency physician are dexon and coated vicryl for subcutaneous tissues and synthetic nonabsorbable materials (nylon or polypropylene) to close the skin. The fascia can be repaired with any material absorbable or nonabsorbable 3-0 or 4-0. 4-0 or 5-0 absorbable subcutaneous tissues, 4-0 or 5-0 nonabsorbable materials are used on the skin. 6-0 for wounds on the face, 3-0 or 4-0 sutures are used in areas exposed to dynamic stresses such as the articular surface or static stresses such as scalp.

Needles: Needless eye is used in most emergency departments. The selection of the appropriate needle size and curvature is based on the characteristics of the tissue to be sutured and the size of the wound. When the repositioning motion is made by holding the needle with the holder at the distal end of the needle, it must be large enough to move deeply through the tissue and exit from the opposite skin. In wound repair, the needles should be strongly penetrated and the fibrous tissues should be able to pass with minimal resistance or trauma without breaking. Needles are used to close subcutaneous tissues with ½ or 3/8 twisted needles. In percutaneous closure, conventional needles provide precise insertion and require less penetration power.

Suture Techniques

Preparation is made by wound care. 4 principles should be followed in the suture of laceration anywhere.

1. Minimal trauma should be applied to the schools. Tissues should not be traumatized when using instruments.

2.The resistance on the wound edges should be reduced. This resistance can be reduced in two ways. Loosening under the wound edges and layered closure.

3.Closed in accordance with the floors. There are usually 3 layers in the wounds closed in the emergency department. Fasia, subcutaneous tissue and skin. Tissues that are not applied in layers: Scalp, finger, hand, foot, nail, nose skin. It is not recommended to close the layers in layers with weak tension without blood supply. The surface stitch of these wounds and wounds should be placed deeper.

4. Skin lines and contours should be observed.


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Ambulance hygiene

Since the time of Hippocrates, the main purpose of medicine is to improve the health of individuals, at least not to harm it. However, mistakes and accidents are inevitable wherever there is a human and an application. In this context, medical errors are inevitable in the health industry, which is a sector where labor force use and technological applications are intense and which also includes dangerous elements. Ambulance is a vital tool used in patient transport, but sometimes it comes to the agenda as a source of accident, fall, drop, medical malpractice or infection, and in this sense, ambulance cleaning and hygiene gains importance.

Ambulance Hygiene for Patient Safety
The aim of patient safety, which is defined as önlen prevention of future harm to patients,, is to establish a system that will prevent errors during service delivery, protect the patient from possible damages due to errors and eliminate the possibility of errors. In this context, ensuring the safety of patients at every stage of health service delivery is the priority of the health system. Because, patient safety violations cause disability and complications and increase mortality and morbidity rates. In addition, these violations have extremely important consequences with economic and human characteristics such as unnecessary extra medication for patients, prolongation of treatment, increased health expenditures, loss of morale and motivation in health workers, and adversely affecting the trust of the patient / relatives and the society in the health system. In this sense, patient safety practices are an important requirement in the provision of all health services including ambulance services. Among these, infection control, including sterilization and disinfection, is of great importance. The importance of the subject will be better understood, especially considering that 5-15 percent of the infections in the world develop depending on the provision of health services and one third of these infections are preventable. In addition, the emergence of bacteria resistant to multiple antibiotics and their transport by patients necessitate infection control in ambulance services as in other health services.

Ambulance Hygiene Approaches
For the first emergency approaches and other reasons, the ambulance is infected during the use of the ambulance for the patient transplantation and the infection of the microorganism to the health worker or the next patient is very important for the safety of the patient and the employee. Ambulances can be the source of different pathogens because they are used during the transplant of many patients with various diseases or infections. Strict infection control protocols should be implemented and monitored to prevent the ambulance from becoming a source of infection to patients or employees. Current research on pre-hospital infection is mostly related to yaygın prevalence of pathogens in samples on the surface of ambulances or devices cihaz and “contamination rates of specific pathogens”. To prevent the ambulance from being a source of contamination, there should be an evidence-based and cost-effective infection control protocol for ambulances and their equipment. Medical devices and materials are generally classified into three categories (critical, semi-critical and non-critical) according to the possibility of being contaminated. Devices that are in direct contact with the airway mucous membranes of patients, such as, for example, a laryngoscope blade, are considered “critical.. Since the ambulance devices and materials are very large and varied, the schematic approach to contamination based on this risk grouping surveillance will be of great help in implementing infection control and quality assurance. During the ambulance services, it is very important that the health personnel are aware of both the ambulance hygiene and the preventive measures against infections, because both the patient and the health personnel share the indoor environment of the cabin, contact with the interventional devices and occasional penetrating injuries. For this reason, ambulance cleaning includes decontamination procedures inside and outside the vehicle, as well as decontamination or sterilization of medical devices used during patient interventions.

General Ambulance Cleaning
Routine cleaning of the ambulances should be done internally and externally once a week. It should be cleaned after every case and every morning. Cleaning is done by the health personnel on duty. All surfaces in contact with the patient / personnel in the ambulance should be cleaned. Cleaning must be complete and in accordance with hygiene rules, with gloves. The floor is swept, the cabinets and surfaces in the ambulance are wiped with 1/100 bleach. If patient secretions and blood contamination are present, 1/10 bleach is used for cleaning. Then dry with a soft cloth and ventilate the vehicle. In the exterior cleaning of the ambulance, starting from the top, wash the outer surface with warm or cold water using soap or vehicle shampoo, rinse with clean water and dry with a soft cloth.
Cleaning of Equipment Used in Ambulance
How and how often all equipment will be cleaned in the ambulance, and the cleaning materials to be used must be known to everyone at the station. Because unfortunately no other staff is assigned to do this job. In case of return, the ambulance equipment is cleaned by the duty team and the material is recorded in the cleaning checklist and signed. High or low level disinfectant is applied according to the pollution rate of the equipments used. High-level disinfection is applied for equipment contaminated with blood and body fluids, while low-level disinfection is applied in the absence of this transmission. Here, commonly; Bleach containing 5 percent chlorine is used for high level disinfection by diluting 1/10 ratio and used for low level disinfection by diluting 1/100 ratio. During decontamination, gloves, gowns, masks, if necessary, protective shoes or special shoes should be worn. Ideally, disposable garments should be used during the decontamination process and, after the process is finished, put in a biological waste bag and autoclaved or incinerated. In the absence of disposable garments, the garments worn during cleaning and disinfection should be transported to the laundromat by placing them in biological waste bags, where they should be washed at 71 ° C. Wetting the contaminated garments before they are sent to the laundry is useful to prevent possible aerosol scattering during the garment separation prior to washing. Personnel performing decontamination should take a shower with soap and water after the process is finished and after removing contaminated clothing. If a patient is diagnosed with an infectious disease or suspected of infection, the ambulance should be cleaned after transport, using a special method and special disinfectants, if notified.

Precautions During Ambulance Cleaning
The presence of infectious disease is very important for ambulance personnel. Carelessness and unexpected accidents may result in contamination of the injured skin or directly through a mucous membrane. In the presence of infectious diseases, it is important that staff protect both themselves and others from cross-infections. Therefore, it has to know some infectious diseases and ways of protection from them. The paramedical team should always wear gloves to protect itself, and wear a mask if there is a risk of respiratory infection. If an upper respiratory tract infection is present, it should not be reported and work in order to remove the risks posed by this close service during the disease. If the patient has a bleeding or severe vomiting, he should wear medical goggles. Needles, scalpels, disposable knives and similar instruments used in the ambulance should be disposed in special containers with “ biohazards zararlı emblem in order to prevent them from going out. Since such materials are medical waste, they should be treated separately from other wastes in the garbage. In cases where the ends of such materials and tools need to be closed, caution should not be caused and the accident should not be caused. Measures should also be taken to prevent people from collecting these wastes. It has been reported that many infectious diseases are transmitted as a result of carelessly disposing of incisive and incisive tools in random trash. Infectious diseases, in particular blood-borne microorganisms, are responsible for the development of serious illness on health personnel. Hepatitis B, Hepatitis C, other dangerous viral hepatitis, HIV / AIDS, Mycobacterium tuberculosis , and tetanus are among the leading ones. Regular, careful and calm work must be done to prevent these undesired accidents that may occur during work. Wear gloves is one of the most important protective measures (Figure 2). Spilled or spilled blood should be wiped with the aid of a disinfectant and the materials used should not be left in the middle, but should be placed in medical waste. Work areas should always be kept clean and spotless. As a result, ambulances are risk factors for spread of infection. All ambulance employees should be subjected to continuous in-service training. For this, the training subjects should be determined in detail and trainers from all levels should provide these trainings within a certain plan.

Infections Carried by Ambulance: Current Situation
Studies have reported that serious contamination may occur in ambulances before cleaning, and even after cleaning, pathogenic microorganisms may persist. However, contamination is usually reduced after vehicle cleaning. Many of the contaminated bacterial species shown in the various areas of the ambulance are harmless, non-pathogenic, skin flora and species found in nature. However, it is detected in S. aureus and other pathogen agents. In a Korean study, the presence of microorganisms in ambulance surveillance was 49 percent, some of which were identified as pathogens, many as environmental or normal flora members. In our study, 20 S. paucimobilis, 2 A. woffii, 2 S.aureus, 2 K.pneumoniae, 20 (CNS) were detected in the swab samples evaluated in 16.7 percent of the swab samples. In the US study, the rate of methicillin-resistant S.aureus (MRSA) was reported as 12.4 percent. In a study conducted in Korea, only one sample was found to be MRSA positive. Environmental microorganisms will cause problems for patients with weak immune systems. Noh et al. found environmental microorganisms such as Acinetobacter or Pseudomonas in ambulance workers. The presence of these microorganisms may mean that cleaning and washing are insufficient for the ambulance. Both the patient and the health care personnel come into contact with the instruments used during transportation and interventions, and stab wounds may occur. In order to protect against blood-borne infections, it is necessary to comply with universal precautions, to clean the barrier, used tools, gloves and other equipment and to eliminate waste, to take protective measures after immunization and exposure.
In our study, 82.5 percent of ambulance personnel were vaccinated against hepatitis B, 11.5 percent against influenza, 79.8 percent stated that they received medical waste training and 51.9 percent indicated that they paid attention to hand hygiene. 39.4 percent of the respondents reported that they experienced a case-to-case risk in the same ambulance cabin, and 15.4 percent reported case-personnel transmission. In our study, it was emphasized that the medical instruments used were cleaned after each application; 75% for instruments requiring high-level disinfection such as laryngoscope, and 28.8 percent for instruments requiring low-level disinfection, such as sphygmomanometer. Regular car cleaning is also very important. In our study, while 29.8 percent reported that the ambulance had done the patient cabin clean-up after each case, despite the fact that they were working at the same station, the rate of those who said that they could only be done once a day was 49 percent. In the results of working; It has emerged that ambulance employees need to raise awareness of both themselves and patients against infectious infectious diseases and ambulance hygiene. The fact that 36.5 percent of the ambulance personnel participating in the study stated that they needed additional training in ambulance hygiene shows a serious deficit in the field.

Ambulance Hygiene Recommendations
1. Areas and materials to be cleaned in the ambulance: Door handle, cabin wall and holding areas, patient carried canvas, sphygmomanometer sleeve, stethoscope head, monitor, jumping bag, patient safety belt, neck collar, ambu, aspirator connection part.

2. More susceptibility should be shown when transporting patients with an epidemic agent (bacteria resistant to multiple antibiotics-MRSA, VRE, CPE Kus - Avian influenza, swine flu, Crimean Congo Hemorrhagic Fever virus…).
3. Each new emergency case is a possible source of contamination and ambulance workers are in contact with possible bacteria. In case of spilled infected body fluid, disinfection of blood and body fluids should be done immediately with chlorinated disinfectant. Hepatitis B and HIV viruses can remain in dried blood for months. In addition, the time available to clean the vehicle prior to the next emergency call is a critical factor in taking due care.
4. Having an ambulance cleaning program with frequency and methods provides a systematic approach to cleaning and decontamination.
5. Studies show that the current levels of clearance are insufficient and may cause environmental contamination with potential pathogens. Therefore, vehicle cleaning procedures and regulations should be examined and applied as required to reduce the contamination of harmful bacteria and to prevent the ingress of bacteria from cleaning equipment.



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Sterile Cell Culture Technique

transcripts

1 Contamination

2 Sterile Cell Culture Technique

3 Contamination Contamination is one of the most common problems in cell culture laboratories. It is the case in which the culture medium in which the cells are cultured is invaded by a number of undesirable viable or inanimate factors. Contamination damages the cells as well as the results of the study.

4 Contamination Contamination problems can be divided into 3 classes; - Minor problems: Contamination of several plates occurs in the incubator. - Serious problems: The frequency of contamination increases, where a whole experiment or whole plate is contaminated. - Large-scale problems: These are situations in which the source of contamination detected risks all of the previous and planned experiments.

5 Contamination Loss of time, money and labor, irreparable damages on cells, effect of experimental results, stress on researcher, loss of valuable products (such as special cell lines ...)

6 Contamination Sources

7 Contamination Sources Processes in the Laboratory Welded; Movement of particles - Sneezing, coughing, or rapid movement of the air in the laboratory - Careless pipetting, vortexing and centrifugation Solution or mixing of materials used Sloppy autoclaving Working with multiple cells at the same time 7

8 Sources of Contamination Welded Equipment in the Laboratory; Incubators, refrigerators, water baths, etc. that are not regularly cleaned and maintained. Non-sterile media and used plastic materials Dirty clothing or lab coat Use of feeder cells 8

9 Sources of Contamination Sources of contamination can be examined under two headings; Chemical Contaminants - Chemical agents that will adversely affect the life of the cells and the results of the experiments in the cell culture environment Biological Contaminants - Biological agents that will adversely affect the life of the cells and the results of the experiments in the cell culture environment 9

10 Sources of Chemical Contamination Media; content or water-derived Serum; differences in serum content and growth factors and hormone content as they are obtained from living organisms.

11 Sources of Biological Contamination Bacteria Fungus and yeast - Bacteria, fungi and yeast contamination are the most common contaminants, as they are present in large quantities in the air and can easily multiply in the appropriate environment. Mycoplasma Virus Intercellular cross contamination 11

12 Sources of Biological Contamination Contact of materials used with non-sterile surfaces The drop of air particles into the media during culture, transport and incubation of the cells.

13 Sources of Biological Contamination Bacteria, Mushrooms and Yeasts are found almost everywhere and are very suitable for growing and growing medium. They may occur in a 2-3 day period, especially in the absence of anbio_ks (as can be seen under the microscope, as well as changes in the color, pH and clarity of the nutrient medium). An_bio_ks that are used in very high amounts can lead to the formation of an_bio-resistant organisms. 13

14 Sources of Biological Contamination 14

15 Sources of Biological Contamination Fungus 15

16 Sources of Biological Contamination 16

17 Sources of Biological Contamination Virus Due to their small size, the most difficult to detect in a cell culture environment is contamination. Being small also makes it difficult for them to move away from the environment they are in. Virus contamination is primarily a threat to the researcher. Extra care should be taken when working with cells at risk of virus contamination (primary culture, cells from other species). 17

18 Sources of Biological Contamination Mycoplasma Mycoplasmas are the smallest organisms that can spontaneously divide and multiply. It is estimated that 10-15% of currently existing cells are contaminated with mycoplasma. While the presence of mycoplasma prevents the healthy growth of the cells, there are many problems including chromosomal abnormalities in the cells. It is an important threat for cell culture studies as they are usually not detected visually and are very common. 18

19 Sources of Biological Contamination 19

20 Sources of Biological Contamination Cross-contamination Cells that are aggressive (shorter than half-life) are potential sources of cross-contamination. Cross-contamination is particularly caused by worker error. Since it directly affects the results of the experiments, the cells should be regularly monitored for characterization. 20

21 Sources of Biological Contamination 21

22 How to Avoid Contamination? Use of asep_k technique while working Regular use of an_biyo_k in the feeding places, Good training of the laboratory personnel, Aliquoting the materials used (divided into small amounts), 22

23 How to avoid contamination? Take care to work in laminar cabinets at every stage of the work, expose the laminar cabinet to UV for 30 minutes before use and start to use at least 5 minutes after opening the laminar cabinet. Regular cleaning of the laboratory 23

24 How can it be protected from contamination? Careful monitoring of cell morphology to prevent cross-contamination, Working with only one cell hau at the same time, Carefully marking used petri and flask 24


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Celiac Cross Contamination

CROSS CONTAMINATION (CROSS TRANSMISSION)

What is gluten?
It is a substance found in cereal products such as wheat, barley, rye and oats formed by mixing water and glutenin and gliadin proteins. Gluten is used in the food industry as a water trap and flexibility. Due to these properties, the field of use is quite wide.

What is gluten-free, who is gluten-free?
The celiacs, those with wheat allergy, those with celiac but not gluten sensitivity must eat gluten-free. In addition to health concerns, there are also those who prefer gluten-free nutrition as a lifestyle.

What is celiac?
It is a type of small bowel disease which causes damage to the small intestine which causes the deterioration of the protrusions resembling the towel surface called villus which provides the absorption of nutrients in the intestines and hence prevents the absorption of nutrients in the food. Gluten taken in the celiac creates a poison effect on the body and causes destruction on the surface of the intestine. Celiac's only form of treatment is lifelong gluten-free nutrition.

What is cross-contamination?
Cross-contamination is a bacterial contamination of non-nutrient-containing bacteria into a clean food. However, this term also applies to the transmission of allergens that should not be taken in food allergies to foods that do not contain these allergens. If a person develops sensitivity to any foodstuff, this substance, when taken into the body by any means, has harmful effects in the short, medium and long term. Celiac, also known as gluten enteropathy, a type of small bowel problem, should not be taken into the body strictly. Therefore, care must be taken about cross-contamination.

Why should celiac cross-leaks pay attention to contamination?
Even 1/8 of a teaspoon of flour is risky in celiac problem. Celiacs should know all the processes from food production, cultivation, processing, storage to cooking, storage and consumption. Cross-breed should be aware of the causative agents. Gluten should be avoided in order to maintain the health of the intestinal structure in celiac and to maintain general health.

I pay attention to my diet, but why do my antibodies not improve?
It prevents the normalization of gluten antibodies taken into the body by cross-contamination, often for unknown reasons. In celiac life, these reasons should be examined well. Celiacs and their relatives should receive regular training on gluten-free life and cross-contamination. As technology advances, the food industry is advancing and gluten traps are increasing day by day. You have to be alert to these traps all the time.

What are the causes of cross-contamination?
Gluten-added foods or non-nutrients such as cosmetics, toothpastes may be threatened with gluten. Let's talk about these in subtitles:

Is wheat flour volatile?
Yes, wheat is volatile. Gluten-free flour and gluten-free flour on the same cooking table are the cause of cross-contamination. If gluten-free and gluten-free foods are to be prepared on the same kitchen counter, gluten-free ones must be prepared first. Moreover, gluten-free and gluten-free flour should not be stored in the same drawer.

How to apply kitchen rules against cross-contamination?
First of all, there is a general rule that everyone must obey: Hand hygiene must be observed. However, some issues need to be paid more attention in gluten-free diet. Chopping boards, kitchen worktops, cloths and sponges in the kitchen, dust cloths, toasters, strainers, flour sieves carry the risk of cross-contamination of any surface gluten contaminated with gluten-contaminated or potentially contaminated liquids.

Is there a risk of cross-contamination in gluten and gluten-free products produced in the same plants?
The risk of contamination increases in gluten and gluten free foods produced in the same factories. At this point, only the brands that produce gluten-free products in their factories, have passed the necessary official approvals and comply with the production rules should be preferred. On the other hand, factories that produce gluten-free products only at certain times should be well inspected. Because the risk of contamination of gluten from some production equipment is inevitable. In addition, gluten is volatile and the risk increases.

What should newly diagnosed celiacs do to prevent cross-contamination?
Knives, knives, spoons, grills, ovens, teflon pans, wooden spoons, deep fryers that are used for gluten-free foods cause gluten to be transported, even if washed thoroughly; discarding these utensils, if used at home, the celiac should obtain new ones, and no food other than gluten-free food should be cooked or chopped. When making meatballs with gluten-free flour at home, care must be taken to avoid cross-contamination when buying meat from the butcher. Butchers, grocery stores for meatballs.


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What is Contamination? How to Prevent Foodborne Contamination?

What is Safe Food?

Safe food; has maintained its nutritional value, microbiological, physically and chemically clean and does not contain harmful substances in health. Factors causing food contamination endanger food safety. For this reason, nutrients; from planting to harvesting, from production to consumption.
Foods Undergo Contamination in 3 Ways:

Physical Pollution: Pollution caused by non-food impurities. Fractures such as broken glass, metal, hair, nails and flies cause physical contamination.
Chemical Pollution: Chemical contaminants. Examples of chemical contamination include contamination of metals from the container in which the food is stored, detergents or residues transmitted from poorly rinsed containers, pesticides, dyestuffs dissolved in packaging, and the use of food additives used above.
Biological Pollution: Toxins naturally occurring in the content of food such as poisonous honey , mycotoxins, sprouted and greened potatoes are the pollution caused by not keeping the nutrients in proper conditions, hygiene is not provided completely and consequently the most important and widespread biological pollution is the microorganism growth.

Among the microorganisms, bacteria are the most endangering food safety, causing poisoning and diseases. The greatest danger in this regard is the rapid growth of the infected bacteria by finding the appropriate condition and duration. Reproductive bacteria then cause large-scale pollution and disease. The fact that they are not seen by the eye and the contamination rapidly makes this a much bigger problem.
What are the sources of contamination?

Foods contaminated with harmful substances from various sources are contaminated before being brought into the kitchen or during the production phase. In other words, food is contaminated .

Contamination is the transmission of undesirable harmful substances or microorganisms in various ways. Major sources of contamination ; insects, litter, pests, dust, soil, humans, meat, milk , eggs and water. Conditions such as hair, nails, skin wounds and lack of hygiene contribute to the human being's source of contamination in many ways. If measures are not taken and hygiene is not provided against these factors, foodborne diseases are likely to occur.

What are Foodborne Diseases?

Foodborne diseases are poisonings and infections caused by consumption of any food or beverage. Microorganisms contaminated from various sources in the period from production to consumption of food multiply rapidly in favorable conditions, deteriorating the sensory quality of foods and cause foodborne diseases. Preventing this situation, which is an important health problem in many countries, can be achieved by evaluating and preserving food hygiene in every aspect.

Especially the areas where the food is prepared, the food itself and the cleaning of the equipment used are of great importance in microbial contamination. Microorganisms cannot move on their own and require a variety of mediators for contamination to occur. These agents are humans or animals. Bacteria can also choose a non-nutrient-containing substance as a source of contamination . Infections that occur in this way are called ' cross contamination '. In particular, tools and equipment used during food preparation are the most common sources of cross-contamination . Examples of cross-contamination sources include cutting boards, mixers, ambient air, kitchen worktops and clothing.

Providing food hygiene; personal hygiene during purchasing, storage methods, preparation and cooking of food, service and preparation are of great importance.

Considerations;

At the time of purchase, reliable sources should be identified, avoiding potentially risky foods such as street milk, sensory properties in meats, and labels of packaged products must be read.
The use of appropriate containers and packages during the storage of food, especially the clear storage of potential carriers such as eggs, poses a great risk for cross-contamination . It is necessary to ensure proper temperatures, to store food separately and to prevent cross-contamination , and to store food temperatures.
During the preparation of foods, washing with plenty of water, raw and cooked foods should be processed in separate vehicles, the thawed food should not be frozen again and the tools that come into contact with fish and meat, especially raw chicken, should be washed with plenty of water and detergent. Hygiene of boards where potential bacterial carriers such as raw chickens are cut is of great importance in preventing cross-contamination. During the preparation of the food, the personal hygiene of the attendant and the light colored and clean clothes are important points to be considered. Washing dishes is of great importance in the prevention of cross-contamination . Garbage should be kept away from the area where the food is prepared and stored in suitable containers. In addition, the removal of bacteria, especially the cross-contamination is essential in the prevention of flour. Raw meat and chicken are important nutrients to be considered in terms of cross-contamination of eggs. In particular, the rules for the use of equipment shall be useful in preventing cross-contamination .

Bacillus cereus: Common bacteria in cereal group. Risky foods are corn flour, pasta and rice .
Brucella spp: Animal meats, milk and cheese are also common bacteria. Care must be taken to apply pasteurization for protection.
Staphylococcus aureus: A pathogenic bacterium that resides in the skin and mucosa of humans and animals. Skin infections and foodborne diseases are frequently encountered in humans. It is known that sepsis is a common cause especially in hospitals and nurseries.
Camphylobacter jejuni: Especially poultry, birds, cattle, drinking water and mussels are also found. Risky foods include unpasteurized milk and chlorinated water.
Listeria monocytogenes: It is widely known in the environment. Raw meat and poultry, mayonnaise salads, cheese and cream are common foods for contamination. Pasteurization process should be considered.
Salmonella: Especially raw chicken and eggs, raw salads and meat products are risky foods. Cracked, cracked eggs should not be used.

These bacteria are common pathogens. Diseases are seen as a result of toxic contamination of bacteria. Compliance with these issues that must be observed during the purchase, preparation and presentation of foods will prevent the consumer from confronting them. Ensuring food safety is of great importance.


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Disinfection Control: How to Select and Control Disinfectant Solutions?

Sterilization, decontamination and disinfection form the basis of the infection control program. Procedures to prevent cross-infection must be performed on vehicles used repeatedly for diagnostic and therapeutic purposes. It should be kept in mind that the insufficiency of sterilization and disinfection of medical devices may lead to extra treatment expenditures, more importantly morbidity and mortality in the patient, unnecessary procedures for sterilization-disinfection will increase hospital expenses and cause selection of resistant microorganisms.

The most suitable option for cross-contamination prevention is disposable, single-use tools. However, it is not always possible to use disposable instruments because some vehicles are too expensive or the vehicle cannot be disposed of. If the medical and surgical interventions cannot be obtained as a disposable device, the first method of sterilization or disinfection is heat. However, plastics, rubber, silk, electronic devices and so on. materials can not be used in heat, irradiation sterilization can not be provided, disinfectants are used.

Disinfectants are divided into two groups as gas and liquid. The effectiveness of the disinfectants is influenced by the cleaning process before disinfection, the type of microorganism, the level of contamination and the type of disinfectant, the concentration of germicidine used, the duration of application, the physical configuration of the object (whether a narrow canal or slit, etc.), and the temperature and pH during the process. It is of no use to keep a vehicle in the disinfectant longer than recommended. This may cause irreversible damage to the vehicle.

Before using disinfectant, cleaning should be used as much as possible. The device and the surface to be treated should be washed with hot water and detergent if possible. It has been experimentally demonstrated that 99.99% or 4 log of viruses and vegetative bacteria are reduced by this process. In addition, these residues cause the disinfectant not to reach the microorganism or react with organic substances to lose its activity.

Ethylene oxide gas disinfectant is generally used for instruments to be sterilized. It is the most commonly used sterilization method after heat. It can be used safely in sterilization of fine hole and narrow groove instruments due to its higher penetration ability compared to liquids. Sterilization with ethylene oxide is carried out in about four hours, but for about 12 hours or more, it is expected to remove the toxic oxide ethylene. It should be noted that ethylene oxide is an explosive, carcinogenic and toxic gas.

Gas plasma has been developed as an alternative to sterilization with ethylene oxide. Plasma is, as we know it, a liquid medium containing free ions. Germicidal chemical agent is ionized with radio waves under vacuum and mixed with air is called gas plasma. Plasma form is also called the fourth state of matter. Hydrogen peroxide is a strong germicidal agent with sporicidal activity in liquid form. The gas plasma obtained from hydrogen peroxide has germicidal activity to provide sterilization. Hydrogen peroxide in the form of gas plasma has no corrosive effect. Active ions lose energy as they kill microorganisms and become completely non-toxic products by removing ionizing waves and vacuum. The use of gas plasma sterilization techniques using chlorindioxide, ozone, ethyl alcohol, peracetic acid and various mixtures of these substances is under investigation and some of them have begun to be used. Sterilization is achieved in as little as thirty-sixty minutes. However, it can be used for sterilization of small volume devices. The packages should not be made of paper and fabric, but made of polyethylene or propylene.

The practical side of the method is that it does not require a special tool for the use of liquid disinfectants. The degree of activity is different. In addition, the response of microorganisms to disinfectants is different. Very little disinfectant, known as chemical sterilizer, removes all microorganisms including spores in as long as six to eight hours. At the same concentration, it kills all microorganisms except for some bacterial spores in a much shorter period (20-30 minutes). Therefore, these disinfectants are also called high-level disinfectants. Although there is no sporicidal activity, disinfectants with tuberculocidal activity are defined as moderate disinfectants, but disinfectants with no tuberculocidal activity, but with HIV-including virucidal activity are defined as low-level disinfectants ( Figure 1 ).

The tools used in the hospital vary according to the risk of infection. The choice of disinfection method is determined by the level of infection risk of the vehicles. According to this;

1. Critical means: Direct contact with normally sterile tissues, body cavities and body fluids.

2. Semi-critical tools: Those who come into contact with the mucous membranes but do not penetrate the body.

3. Non-critical tools and substances: Those who do not come into direct contact with the person or who only come into contact with intact skin.

The availability of critical devices depends on their sterility. Many such instruments are either disposable or heat-sterile. However, as described above, heat cannot always be applied for some reason.

The next method to be proposed is sterilization with gas disinfectants (eg ethylene oxide, gas plasma method). Besides being an effective method, it is important for sterilizing large instruments that cannot be immersed in disinfectants. It is conceivable to wipe such instruments with disinfectant, but this applies to semi-critical and non-critical vehicles. In addition, some vehicles may be damaged if left in disinfectants for a long time. Liquid disinfectants are most commonly used in gluteraldehyde, formaldehyde, chlorindioxide, hydrogen peroxide or formulas. The most commonly used formulations are 7.5% hydrogen peroxide in addition to 2% gluteraldehyde, peracetic acid in less than 1% concentration, or combinations of 0.08% peracetic acid and 1% hydrogen peroxide. Sporocidal activity can only be achieved by prolonged application of an effective disinfectant to bacterial spores (6-20 hours depending on the type of disinfectant). Orthophitalaldehyde, which has been approved by the Food and Drug Administration (FDA) in recent years, is a high level disinfectant used in American and European countries. It does not need to be activated for use, is less irritant to the eye and respiratory tract, and has no advantage over gluteraldehyde in terms of sporicidal activity, but the effect on mycobacteria is much earlier.

The instrument is washed three times with sterile distilled water after treatment with disinfectants. It is then dried with a sterile towel using sterile gloves and made ready for use.

At the end of these procedures, the bacterial spore may remain. However, their number has decreased considerably and they are particularly spores of saprophyte microorganisms. These microorganisms are destroyed by body resistance. However, this idea is not always valid. Even the Bacillus subtilis , known as nonpathogenic, can cause serious lethal infections where the resistance of the host is low, such as immunodeficient or immunosuppressed patients.

Sterilization of vehicles contaminated with Creutzfeldt-Jakob prion cannot be achieved by normal procedures. Vehicles with high risk for prion, such as the brain, dura material or cornea, should be treated with 1 N NaOH at room temperature after sterilization for 30 minutes at 132 ° C or alternatively for 30 minutes at 121 ° C. “Centers for Disease Control and Prevention (CDC) alternatif has introduced a practical approach as an alternative and reported that after cleaning the vehicle, a pre-vacuum sterilizer is sufficient for 18 minutes at 132-134 ° C and one hour at 121 ° C. Normal sterilization programs have been recommended by CDC for contamination with organs such as cerebrospinal fluid, spleen, kidney, lymph node. For non-critical vehicles, 15 minutes of treatment with 1 N NaOH at room temperature is sufficient.

In disinfection of semi-critical devices, it is aimed to kill all microorganisms except bacterial spores. Some of the spores are devastated when these operations are performed.

Here, if the structure of the substance is appropriate; heat sterilization or disinfection at 75 ° C for 30 minutes at humid temperature is preferred. High-level disinfectants are generally used in the disinfection of semi-critical vehicles, with phenol compounds, iodophores, chlorine compounds being preferred from intermediate disinfectants. Flexible fiber-optic endoscope, laryngoscope, vaginal speculae, anesthesia respiratory circulation devices, ophthalmic instruments and some dental instruments (amalgam condenser) are in this group.

Cross-contamination is frequently observed with medical devices such as flexible endoscope, bronchoscope, arthroscope. In the clinical course ranging from asymptomatic colonization to death, as a result of gastrointestinal endoscopy, Salmonella and Pseudomonas aeruginosa ; Mycobacterium tuberculosis , atypical Mycobacteria , P. aeruginosa are the most common infections after bronchoscopy. The biggest problem is hepatitis C and multidrug resistant M. tuberculosis after bronchoscopy. Transcontamination with endoscopes is most commonly observed after retrograde cholangiopancreatography. The most common causes are inadequate pre-cleaning, poor selection of disinfectants, deficiencies and inaccuracies in disinfection procedures. Hypochlorite, iodophore and phenol derivatives should not be used against the risk of damage to such valuable instruments and gluteraldehyde, hydrogen peroxide, peracetic acid, orthophitalaldehyde or derivatives should be used. Although it is theoretically known to leave in 2.4% gluteraldehyde solution for 45 minutes at 25 ° C for high-level disinfection, after 20 minutes of use of an FDA-approved sterilized effective disinfectant with a temperature of 20 ° C for bronchoscopes after the FDA standard cleaning protocol, to achieve high level disinfection It was sufficient for. In recent years, the use of orthophitalaldehyde for high-level disinfection has become widespread, with the use of orthophitalaldehyde at a concentration of 0.55% at 20 ° C for 12 minutes in the United States, 10 in Canada, and five minutes in Europe, Asia and Latin America. it is indicated.

In recent years, the use of both washing and disinfection tools has become widespread. Peracetic acid (Steris System I) is used as the high level disinfectant in these devices which have been FDA approved and these devices are used for disinfection of endoscopes.

After disinfection, it is preferred to wash the semi-critical means with sterile distilled water. Non-tuberculous mycobacteria and Legionella contamination from tap water may occur. In case tap water is used, the device is re-disinfected with alcohol, allowed to dry and ready for use.

Hepatitis viruses and HIV do not resist medium disinfection. However, in the case of contamination with these viruses, a high level of disinfection is recommended for semi-critical means.

The low-level disinfection application for non-critical devices aims to kill vegetative forms of bacteria and lipid-containing viruses. The instruments in this group can be divided into two groups as low risk and minimal risk. Materials such as beds, bed sheets, which come into contact with intact skin, fall into the low risk group and if it is not contamination, it is sufficient to disinfect them by means of heat and water (wash with hot water, etc.) and moderate disinfection is required.

For minimal risk vehicles and floors that do not come into contact with intact skin, cleaning with detergent water is sufficient and low level disinfection is applied. Disinfectants can be used in case of contamination by the patient's body interests. Lower concentrations of hypochlorite, iodophores and phenol compounds can be used from quaternary ammonium compounds from low-level disinfectants or from mid-level disinfectants. In this type of disinfection, 10 minutes of application is sufficient. In addition, 70-80% alcohol is useful for rapid disinfection of aerosol-contaminated surfaces, such as in dentistry.

The number of disinfectants used in the hospital should be minimized as much as possible. Those who have been approved by serious institutions (FDA approval, CE marking), whose efficacy has been determined both in the country of manufacture and in the microbiology laboratories of the marketed country should be preferred. In addition, the disinfectant planned to be taken should be evaluated in terms of its practicality, degree of irritation and its corrosive effect, and the most appropriate choice should be made in consultation with the centers that use the disinfectant before intake ( Table 1 ). The use of unnecessary disinfectant causes economic losses as well as the selection and colonization of resistant pathogenic strains due to disinfectants used.

The efficiency of heat and gas sterilization can be routinely investigated. However, there is no routine method for determining the effectiveness of liquid disinfectants. Therefore, full compliance with the literature-supported package insert of the chemical disinfectant to be used will provide an effective disinfection.

Disinfectant solutions should be freshly prepared. The toxicity, odor and activity of the disinfectant are important and disinfectants that change odor and color should not be used. Some disinfectants are known to react with detergents. If the environment is wet after this process should be dried. Any material left wet forms a favorable environment for the growth of microorganisms.

DISINFECTION OF HOSPITAL ENVIRONMENT

Washing with water and detergent is considered to remove 80% of the microorganisms. If disinfectant is used, this ratio reaches 90-95%. Whether or not disinfectant is used in a circulating intensive hospital, the number of microorganisms in the ground will return to the previous level within one to two hours. Therefore, if there is any contamination; In hospital disinfection, it is sufficient to clean the environment with plenty of detergent water (which is preferred to be hot) which is changed frequently. The situation in ICU and operating room is not much different. It is not important to place disinfectant-wetted mats and shoe covers on the entrance doors of such units. Transmission of manual infection is a priority. Drying the environment after cleaning is more effective than disinfectants in preventing the growth of microorganisms.

The floor contaminated with blood and other materials of the patient should be disinfected after wiping with detergent water. Hepatitis B virus (HBV) can survive for one week in dry conditions under appropriate conditions. However, it is very sensitive to disinfectants. In practice it is recommended to use hypochlorite solutions as surface disinfectants and liquid soap as detergents. CDC recommends pouring 1/100 dilution hypochlorite (5000 ppm) onto the decontaminated area with blood and allowing it to stand for 10 minutes.

Disinfectant can be used after cleaning the surfaces which are in constant contact such as benches and tables in the hospital. Hypochlorite can be used in room disinfection after discharge from patients infected with methicillin-resistant S. aureus (MRSA) and similar pathogen agents in addition to viruses. Alcohol solutions containing 70% alcohol are used for disinfection of these surfaces. Although microorganisms cannot enter the body through intact skin, contamination from wounds and fractures can occur. This is one of the reasons why staff working in hemodialysis and serology units have more frequent HBV infections than the normal population.


21AXX
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What is bacterial vaginosis?

Bacterial vaginosis , a type of infectious disease, is caused by the growth of bacteria that accumulate in the vagina. If you want to know more about bacterial vaginosis and you are wondering what bacterial vaginosis is , you can look at the information we have prepared for you.

Bacterial vaginosis shows itself in the form of discharge in the vagina. Vaginal discharge occurs as a result of the accumulation of bacteria in that area. Bacteria growing in the region of the Vahina grows over time, causing bacterial vaginosis disease.

What is bacterial vaginosis?

Bacterial vaginosis is not a dangerous condition, but may cause discomforting symptoms later. that is, any woman with vaginal discharge should be investigated for gynecological examination.

How often do women experience bacterial vaginosis?

Bacterial vaginosis is more common in women than fungal infections. Nearly half of women experience bacterial vaginosis infection at least once in their lifetime.

Is bacterial vaginosis risky?

It is important to make a definitive diagnosis from bacterial non-specific vaginitis infections. Otherwise, this infection can cause permanent diseases and cause various diseases.
These diseases are as follows;

Infertility
Complications of pregnancy
Pelvic Inflammatory Disease
It can cause such diseases.

What are the symptoms of bacterial vaginosis and what are the symptoms?


Bacterial vaginosis is manifested in the form of discharge. However, the color of the stream becomes slightly different. The discharge in bacterial vaginosis is dark brown and occasionally aqueous.
People with this infectious disease say that the odor that occurs in the stream is at stale fishy smell '.

At the same time, itching and discharge in the vagina is another important symptom of the disease.

What causes bacterial vaginosis?

It is not known why bacterial vaginosis usually occurs. However, people with this infectious disease were investigated and as a result of the study, it was observed that the people who developed bacterial vaginosis had smoked, used too much antibiotics, and the vaginal douching was done continuously.

Does bacterial vaginosis spread to other people?

Bacterial vaginosis is generally not known as an infectious disease, but its infectivity is not fully understood. However, having sexual intercourse with multiple people is one of the most important factors triggering this disease.

If you have complaints of burning in your urinary tract and are constantly suffering from discharge, you can also remedy these complaints naturally. Bacterial vaginosis, disease before the formation of a number of methods that we can give you to resolve this infectious disease.

Here are natural methods to prevent bacterial vaginosis disease ...

Home yogurt method
Home yogurt cooking and regional application of yogurt has been proven to fight infection. This treatment gives similar results to clindamycin.

Apple cider vinegar method
Pour 2 cups of apple cider vinegar into a bathtub filled with warm water. You can wait for about 20 minutes in this water.

Garlic method
You can eat garlic against this disease and apply it directly to the infected area. In both trials, the pathway will be sufficient to help combat bacteria and fungi by changing vaginal pH levels.

Garlic method :

Garlic will protect you from external microbes, protecting you from infections.

Oregano method
Mix a few drops of oregano oil and a few drops of coconut oil to avoid bacterial vaginosis or infections of the vagina. You can then apply this mixture to the area of ​​infection with the help of cotton.

What is the medical treatment of bacterial vaginosis?

Antibiotic treatment is applied in medicine for bacterial vaginosis. A few antibiotics are routinely used. In addition, vaginal cream treatment is recommended and the dosage of the drugs can be increased or decreased according to the course of treatment.


20AXX
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Turkey Journal of Medical Sciences

Physical and Chemical Methods for Protection from Infection in Hematology-Oncology Clinics
NOSOCOMIAL INFECTIONS IN HEMATOLOGY AND ONCOLOGY: PREVENTIVE MEASURES: REVIEW

SUMMARY
Nasocomial infections which is an important problem for hospitalized patients and hospital staff, treatment and precautions to be taken are examined under 6 titles in this article. Nasocomial infections are nosocomial infections that occur after hospitalization and do not have an infection before hospitalization. They are most commonly seen as urinary tract infections, surgical site infections, bacteremia and pneumonia. Immunodeficiency and nosocomial infections develop in patients with hematologic and oncologic malignancies treated with chemotherapy or radiotherapy. Infections also occur in patients who develop neutropenia after chemotherapy. Severe nosocomial infections develop in patients receiving immunosuppressive therapy, undergoing splenectomy and bone marrow transplantation. Isolation practices play an important role in the control of nosocomial infections. Isolation applications are applied in two ways as isolation according to the disease and category. Insulation by category; complete isolation, contact isolation, respiratory isolation, Tbc isolation, enteric measures, drainage-secretion prevention, blood and body fluids prevention. Standard measures in practice are applied to reduce the risk of contamination of blood and body fluid-borne pathogens. In addition, contact measures, droplet measures, respiratory measures, including isolation-related prevention measures are applied. Tbc control measures emphasized the need for serious applications to prevent the spread of vancomycin resistance in hospitalized patients. Intravenous catheters are used to administer chemotherapy and fluid in hospitalized patients and may cause catheter infections in patients. Prevention of catheter infections, treatment of infections and antibiotics are emphasized. Another precaution is HEPA filters that prevent air contamination in neutropenic patient rooms. The chemical products used in hand antisepsis in hospitals are alcohol, chlorhexidine gluconate, hexachlorophene, iodine and iodophores, para-chlorine-meta-xylenol and triclosan. It is possible to determine the disinfection method according to the infection risk of the patient care materials used in the hospital environment. It is possible to collect the areas that can be taken into daily disinfection applications in 3 groups. These are the floors that are infected with the hospital floor, blood and other material of the patients, as well as benches-tables. Disinfectant is generally not required for cleaning surfaces that are regularly cleaned in hospitals, such as floors, walls, toilets, bathrooms and door handles and which do not present an infection risk.

Keywords : Infection, immunocompromised patient, neutropenia, isolation, antisepsis
ABSTRACT
Nosocomial infections, a problem of dire effects, and health care staff, are discussed at length, with emphasis on preventive measures and treatment modalities. Nosocomial infections often develop after hospitalization. They most frequently manifest as urinary and surgical infections, bacteremia and pneumonia. In patients with hematological and oncological malignancies undergoing chemotherapy or radiotherapy, immunodeficiency is not uncommon and associated hospital infections may develop. Severe infections may also be subject to immunosuppressive treatment, splenectomy and bone marrow transplantation. Isolation procedures play an important role in the control of hospital infections. Such procedures are customarily applied in two forms: disease-based isolation and category-based isolation. The latter includes full, contact, and respiratory isolation (eg, Tbc), as well as drainage-secretion, blood and other body fluid containment measures. These practical measures are aimed at diminishing the risk of contamination through fluid and airborne pathogens. It is emphasized that stringent procedures are applied under the tuberculosis control methods to avoid strengthening resistance to vancomycin in hospitalized patients. Intravascular catheters are often used for chemotherapy and fluid replacement, which frequently results in catheter-induced infections. The prevention and treatment of such infections. HEPA filters that prevent air contamination in neutropenic patient rooms. Chemical products used for antisepsis in hospitals include alcohol, chlorohexidine, gluconate, hexachlorophene, iodine and iodophores, para-chloro-meta-xylenol and triclosan. A determination of the disinfection method to be employed is often considered possible. However, the potential foci for daily disinfection procedures may be classified into three groups: such as desks and chairs. No special disinfectant is usually needed in the hospital, as well as floors, walls, WC, bathroom and door handles that are regularly serviced and do not carry a heightened risk of infection.


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