BACKGROUND Inadequately reprocessed reusable surgical instruments (RSIs) may harbour infectious agents which may then be transferred to a suitable site for replication. AIM To determine the cumulative effect of 20 cycles of contamination, cleaning (manual or manual followed by automated) and steam sterilization on high-complex-design RSIs used for orthopaedic surgery. METHODS New flexible medullary reamers and depth gauges were contaminated by soaking in tryptone soya broth, containing 5% sheep blood and 109 cfu/mL of Staphylococcus aureus (ATCC 25923), for 5 min. To mimic a worse-case scenario, RSIs were dried 7 h and subjected to either (a) rinsing in distilled water, (b) manual cleaning or (c) manual plus automated cleaning (reference standard), and steam sterilization. The contamination, cleaning, and sterilization cycle was repeated 20 times. Adenosine triphosphate (ATP) was measured after cleaning procedures; microbial load and residual protein were measured following the 10th and 20th reprocessing, in triplicate. Scanning electron microscopy (SEM) was used to confirm soil and biofilm presence on the RSIs after the 20th reprocessing. FINDINGS Manual and manual plus automated cleaning significantly reduced the amount of ATP and protein residues for all RSIs. Viable bacteria were not detected following sterilization. However, SEM detected soil after automated cleaning, and soil, including biofilms, after manual cleaning. CONCLUSION Soil and/or biofilms were evident on complex-design RSIs following 20 cycles of contamination and reprocessing, even using the reference standard method of cleaning. Although the depth gauges could be disassembled, biological residues and biofilm accumulated in its lumen. The current design of these RSIs prevents removal of all biological soil and this may have an adverse effect on patient outcome.

中文翻译：

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外科手术器械的复杂设计成为清洁效果的障碍，有利于生物膜的形成。

背景技术未充分处理的可重复使用的外科手术器械（RSI）可能带有传染原，然后可以将其转移到合适的部位进行复制。目的确定对整形外科手术使用的复杂设计的RSI，进行20次污染，清洁（手动或手动，然后进行自动化）和蒸汽灭菌循环的累积效果。方法将新的柔性延髓铰刀和深度计浸泡在含有5％绵羊血和109 cfu / mL金黄色葡萄球菌（ATCC 25923）的胰蛋白tone大豆肉汤中5分钟。为了模拟更坏的情况，将RSI干燥7小时，然后进行（a）蒸馏水冲洗，（b）手动清洁或（c）手动加自动清洁（参考标准）和蒸汽灭菌。污染，清洁，并重复灭菌周期20次。清洁程序后测量三磷酸腺苷（ATP）；在第10次和第20次重复处理后，一式三份测量微生物负荷和残留蛋白质。第20个后处理后，使用扫描电子显微镜（SEM）确认RSI上是否存在土壤和生物膜。结果手动和手动加自动清洁大大减少了所有RSI的ATP和蛋白质残留量。灭菌后未检测到活菌。但是，SEM会在自动清洁后检测到土壤，在手动清洁后检测到包括生物膜在内的土壤。结论经过20次循环的污染和再处理后，即使使用参考标准清洗方法，复杂设计的RSI上也明显存在土壤和/或生物膜。尽管可以拆卸深度计，但其内腔中会积聚生物残留物和生物膜。这些RSI的当前设计可防止去除所有生物污垢，这可能会对患者的预后产生不利影响。