The impact of the final rinse on the cytoxicity of critical products submitted for processing

Souza, Rafael Queiroz de; Gonçalves, Cláudia Regina; Ikeda, Tamiko Ichikawa; Cruz, Áurea Silveira; Graziano, Kazuko Uchikawa

doi:10.1590/S0080-623420150000700013

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Sumário

Original Article • Rev. esc. enferm. USP 49 (spe) • Dec 2015 • https://doi.org/10.1590/S0080-623420150000700013 copy

The impact of the final rinse on the cytoxicity of critical products submitted for processing^* * Extracted from the thesis “Avaliação in vitro da citotoxicidade de instrumentos cirúrgicos enxaguados com diferentes qualidades de água”, Escola de Enfermagem, Universidade São Paulo, 2014.

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective

To assess the cytotoxicity of products subsequent to a cleaning process based on a validated standard operating procedure (SOP), and a final rinse with different types of water: tap, deionized, distilled, treated by reverse osmosis and ultra-purified.

Method

This was an experimental and laboratory study. The sample consisted of 130 hydrodissection cannulas, 26 per experimental group, characterized according to type of water used in the final rinse. The samples were submitted to internal and external contamination challenge with a solution containing 20% defibrinated sheep blood and 80% of sodium chloride 0.9%. Next, the lumens were filled with a ophthalmic viscosurgical device, remaining exposed for 50 minutes, and then were processed according to the validated SOP. Cytotoxicity was assessed using neutral red uptake assay.

Results

No cytoxicity was detected in the sample extracts.

Conclusion

The samples did not display signs of cytotoxicity, regardless of final rinse quality. The results obtained were reached by using only a validated cleaning operating procedure, based on the scientific literature, and on official recommendations and related regulation.

Surgical Instruments; Disinfection; Water Quality; Nursing

Characteristics	Threshold limit values according to the AAMI (2007)				Values obtained for type of water used in the present study

	Potable water	Soft water	Deionized water	High-purity water	Tap water	Distilled water	Deionized water	RO** Water	Ultra-purified water
Bacteria (CFU/mL)	<200	<200	<200	≤10	220	100	530	150	3
Endotoxins (EU/mL)	NA*	NA*	NA*	<10	4.70	0.101	1.000	0.912	<0.05
Total organic carbon (mg/L)	<1.0	<1.0	<1.0	<0.05	<1.0	<1.00	3.34	<1.00	0.002
pH	6.5 a 8.5	6.5 a 8.5	NA*	NA*	6.65	7.16	NA*	NA*	NA*
Hardness (CaCO3 in ppm)	<150	<10	<1.0	<1.0	22.7	<1.50	<1.50	<1.50	<1.50
Resistivity (MΩ-cm)	NA*	NA*	>1.0	>1.0	NA*	0.073	1.25	0.555	18.2
Total dissolved solids (CaCO3 in mg/L)	<500	<500	<0.4	<0.4	<100	<100	<100	<100	<100
Chloride (mg/L)	<250	<250	<1.0	<0.2	6.18	<1.00	<1.00	<1.00	<1.0
Iron (mg/L)	<0.3	<0.3	<0.2	<0.2	<0.1	<0.1	<0.10	<0.10	<0.10
Copper (mg/L)	<0.1	<0.1	<0.1	<0.1	<0.04	<0.01	<0.01	<0.01	<0.01
Manganese (mg/L)	<0.1	<0.1	<0.1	<0.1	<0.01	<0.01	<0.01	<0.01	<0.01

Final rinse water	Mean (%)	Standard deviation (%)	Maximum (%)	Minimum (%)	Median (%)
Tap water	99	6	108	80	100
Distilled water	91	15	121	64	90
Deionized water	95	8	106	80	96
RO* water	98	8	116	83	98
Ultrapure water	100	6	106	75	101
Positive control	2	1	3	2	2
Negative control	97	2	99	94	97
Comparative control with no drying	91	12	105	82	87

Universidade de São Paulo, Escola de Enfermagem Av. Dr. Enéas de Carvalho Aguiar, 419 , 05403-000 São Paulo - SP/ Brasil, Tel./Fax: (55 11) 3061-7553, - São Paulo - SP - Brazil
E-mail: reeusp@usp.br

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[1] Correspondence Addressed to: Rafael Queiroz de Souza Av. Dr. Enéas de Carvalho Aguiar, 419 – Cerqueira César CEP 05403-000 – São Paulo, SP, Brazil rafaelqsouza@hotmail.com

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The impact of the final rinse on the cytoxicity of critical products submitted for processing* * Extracted from the thesis “Avaliação in vitro da citotoxicidade de instrumentos cirúrgicos enxaguados com diferentes qualidades de água”, Escola de Enfermagem, Universidade São Paulo, 2014.

ABSTRACT

Objective

Method

Results

Conclusion

The impact of the final rinse on the cytoxicity of critical products submitted for processing^* * Extracted from the thesis “Avaliação in vitro da citotoxicidade de instrumentos cirúrgicos enxaguados com diferentes qualidades de água”, Escola de Enfermagem, Universidade São Paulo, 2014.