{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T02:23:09Z","timestamp":1777429389916,"version":"3.51.4"},"reference-count":19,"publisher":"SAGE Publications","issue":"2","license":[{"start":{"date-parts":[[2022,5,11]],"date-time":"2022-05-11T00:00:00Z","timestamp":1652227200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Appl Biosaf."],"published-print":{"date-parts":[[2022,6,1]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction:<\/jats:title>\n                    <jats:p>Over the past decade, there have been outbreaks associated with high consequence infectious diseases such as Ebola virus disease, Lassa fever, and Monkeypox. The proper handling of clinical waste from patients infected with such pathogens is critical to ensure healthcare personnel and community safety.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>Mock clinical waste bags were created to simulate four distinct waste streams: personal protective equipment (PPE), dry linens, wet linens, and solidified liquids. Pressure and temperature data loggers were buried in the middle of simulated waste loads to record time at a sterilization temperature of 132\u00b0C (270\u00b0F) to reduce sterilization time. We also validated super rapid biological indicators (BIs) by embedding standard BIs (48\u2009h), rapid BIs (3\u2009h), and super rapid BIs (24\u2009min) within each load. Cycles were validated over a 2-day period, using a total of 36 simulated waste bags (6 bags each for PPE, dry linen, and wet linen, and 18 bags for solidified liquids).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>All waste bags achieved the target sterilization temperature, all BIs passed and cycle times were substantially decreased. For PPE waste processing, an estimated 15\u2009h was saved for a 24-h period.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion:<\/jats:title>\n                    <jats:p>Default factory settings are inadequate to disinfect Category A clinical waste. Reliance on autoclave temperature readings may overestimate time at goal sterilization temperature for actual waste loads.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>The data provided by within bag data loggers and BIs allow for the optimization of autoclave parameters to increase throughput and enhance staff safety.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1089\/apb.2022.0003","type":"journal-article","created":{"date-parts":[[2022,5,11]],"date-time":"2022-05-11T11:44:36Z","timestamp":1652269476000},"page":"106-115","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["The Use of Temperature and Pressure Data Loggers to Validate the Steam Sterilization of Category A Clinical Waste"],"prefix":"10.1177","volume":"27","author":[{"given":"Jade","family":"Flinn","sequence":"first","affiliation":[{"name":"Department of Nursing and The Johns Hopkins Hospital, Baltimore, Maryland, USA."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrew","family":"Michalek","sequence":"additional","affiliation":[{"name":"Department of Medicine, The Johns Hopkins Hospital, Baltimore, Maryland, USA."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lindsay","family":"Bow","sequence":"additional","affiliation":[{"name":"Hospital Epidemiology and Infection Control, The Johns Hopkins Hospital, Baltimore, Maryland, USA."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Noreen A.","family":"Hynes","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Donald","family":"Philpot","sequence":"additional","affiliation":[{"name":"Facilities Management, Johns Hopkins Health System, Baltimore, Maryland, USA."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Brian T.","family":"Garibaldi","sequence":"additional","affiliation":[{"name":"Division of Pulmonary and Critical Care Medicine, Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA."}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2022,5,11]]},"reference":[{"key":"e_1_3_4_2_2","author":"Garibaldi BT","unstructured":"Garibaldi BT, , Reimers M, , Ernst N, et al. Validation of autoclave protocols for the successful decontamination of Category A medical waste generated from the care of patients with serious communicable diseases. J Clin Microbiol. 2017;55(2):545\u2013551.","journal-title":"J Clin Microbiol"},{"key":"e_1_3_4_3_2","author":"Garibaldi BT","unstructured":"Garibaldi BT, , Kelen GD, , Brower RG, et al. The creation of a biocontainment unit at a tertiary care hospital: the Johns Hopkins Medicine Experience. Ann Am Thorac Soc. 2016;13(5):600\u2013608.","journal-title":"Ann Am Thorac Soc"},{"key":"e_1_3_4_4_2","volume-title":"Transporting Infectious Substances Safely","author":"U.S. Department of Transportation","year":"2020","unstructured":"U.S. Department of Transportation. Transporting Infectious Substances Safely. Washington, DC: US Department of Transportation, Pipeline Hazardous Materials Safety and Administration; 2020."},{"key":"e_1_3_4_5_2","unstructured":"Code of Federal Regulations. Shippers\u2014General Requirements for Shipments and Packagings."},{"key":"e_1_3_4_6_2","author":"Lowe JJ","unstructured":"Lowe JJ, , Olinger PL, , Gibbs SG, et al. Environmental infection control considerations for Ebola. Am J Infect Control. 2015;43(7):747\u2013749.","journal-title":"Am J Infect Control"},{"key":"e_1_3_4_7_2","author":"Lowe JJ","unstructured":"Lowe JJ, , Gibbs SG, , Schwedhelm SS, , Nguyen J, , Smith PW. Nebraska biocontainment unit perspective on disposal of Ebola medical waste. Am J Infect Control. 2014;42(12):1256\u20131257.","journal-title":"Am J Infect Control"},{"key":"e_1_3_4_8_2","unstructured":"Centers for Disease Control and Prevention. Information on the survivability of the Ebola virus in medical waste. 2018. https:\/\/www.cdc.gov\/vhf\/ebola\/clinicians\/cleaning\/ebola-virus-survivability.html. Accessed January3 2022."},{"key":"e_1_3_4_9_2","author":"Menon VB","unstructured":"Menon VB, , George LS. Response of the health system in Nipah outbreak in Ernakulam district: a qualitative analysis. J Fam Med Prim Care. 2021;10(9):3355\u20133360.","journal-title":"J Fam Med Prim Care"},{"key":"e_1_3_4_10_2","author":"Nguyen PY","unstructured":"Nguyen PY, , Ajisegiri WS, , Costantino V, , Chughtai AA, , MacIntyre CR. Reemergence of human monkeypox and declining population immunity in the context of urbanization, Nigeria, 2017\u20132020. Emerg Infect Dis. 2021;27(4):1007\u20131014.","journal-title":"Emerg Infect Dis"},{"key":"e_1_3_4_11_2","doi-asserted-by":"publisher","DOI":"10.1177\/20499361211058252"},{"key":"e_1_3_4_12_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12992-021-00775-4"},{"key":"e_1_3_4_13_2","unstructured":"U.S. Department of Health and Human Services. HHS selects nine regional Ebola and other special pathogen treatment centers. 2015. https:\/\/aspr.hhs.gov\/newsroom\/Pages\/NewsDetailView.aspx?ItemID=13. Accessed May25 2020."},{"key":"e_1_3_4_14_2","author":"Flinn JB","unstructured":"Flinn JB, , Hynes NA, , Sauer LM, , Maragakis LL, , Garibaldi BT. The role of dedicated biocontainment patient care units in preparing for COVID-19 and other infectious disease outbreaks. Infect Control Hosp Epidemiol. 2020;42(2):208\u2013211.","journal-title":"Infect Control Hosp Epidemiol"},{"key":"e_1_3_4_15_2","author":"Guizelini BP","unstructured":"Guizelini BP, , Vandenberghe LPS, , Sella SRBR, , Soccol CR. Study of the influence of sporulation conditions on heat resistance of Geobacillus stearothermophilus used in the development of biological indicators for steam sterilization. Arch Microbiol. 2012;194(12):991\u2013999.","journal-title":"Geobacillus stearothermophilus"},{"key":"e_1_3_4_16_2","volume-title":"Principles and Methods of Sterilization in Health Sciences","author":"Perkins JJ.","unstructured":"Perkins JJ. Principles and Methods of Sterilization in Health Sciences, 2nd ed. Springfield, IL: Charles C. Thomas; 1983."},{"key":"e_1_3_4_17_2","author":"Hewlett AL","unstructured":"Hewlett AL, , Varkey JB, , Smith PW, , Ribner BS. Ebola virus disease: preparedness and infection control lessons learned from two biocontainment units. Curr Opin Infect Dis. 2015;28(4):343\u2013348.","journal-title":"Curr Opin Infect Dis"},{"key":"e_1_3_4_18_2","author":"Smith PW","unstructured":"Smith PW, , Anderson AO, , Christopher GW, et al. Designing a biocontainment unit to care for patients with serious communicable diseases: a consensus statement. Biosec Bioterror. 2006;4(4):351\u2013365.","journal-title":"Biosec Bioterror"},{"key":"e_1_3_4_19_2","author":"Bannister B","unstructured":"Bannister B, , Puro V, , Fusco FM, , Heptonstall J, , Ippolito G. Framework for the design and operation of high-level isolation units: consensus of the European Network of Infectious Diseases. 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