{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T16:12:06Z","timestamp":1790179926307,"version":"4.1.0"},"reference-count":40,"publisher":"American Society for Microbiology","issue":"10","license":[{"start":{"date-parts":[[2006,10,1]],"date-time":"2006-10-01T00:00:00Z","timestamp":1159660800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.asm.org\/non-commercial-tdm-license"}],"content-domain":{"domain":["journals.asm.org"],"crossmark-restriction":true},"short-container-title":["J Clin Microbiol"],"published-print":{"date-parts":[[2006,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n          <jats:p>\n            The ineffective cleaning of surgical instruments may be a vector for the transmission of hospital-acquired infections. The aim of this research was to investigate whether further decontamination procedures need to be instigated in sterile-service departments (SSDs) to reduce the risk of nosocomial illnesses, such as endotoxemia, sepsis, or iatrogenic Creutzfeldt-Jakob disease (to date, 1,147 cases of confirmed Creutzfeldt-Jakob disease deaths in the United Kingdom since 1990 have been reported). Instrument sets were obtained from nine anonymous United Kingdom National Health Service (NHS) primary care trust SSDs. The investigation implemented an advanced light microscopy technique, episcopic differential interference contrast microscopy with the sensitive fluorescent reagents SYPRO Ruby and 4\u2032,6-diamidino-2-phenylindole dihydrochloride (DAPI), to detect proteinaceous and microbial contamination levels. Gram-negative lipopolysaccharide (LPS) endotoxin was monitored using a dansylated polymyxin B fluorochrome agent. None of the 260 instruments examined displayed signs of microbial colonization or LPS endotoxin contamination. However, over 60 percent of the instruments showed a high degree of protein soiling (0.4 to 4.2 \u03bcg protein\/mm\n            <jats:sup>2<\/jats:sup>\n            ). Some instruments appeared soiled with crystalline deposits that may consist of a potentially hazardous material contributing to inflammation and\/or surgical shock. It is clear that the overall standard for cleaning must be raised in order to fulfill the imminent introduction of new European standards and to reduce the risk of cross-patient contamination and iatrogenic transmission.\n          <\/jats:p>","DOI":"10.1128\/jcm.01280-06","type":"journal-article","created":{"date-parts":[[2006,10,4]],"date-time":"2006-10-04T17:59:53Z","timestamp":1159984793000},"page":"3728-3733","update-policy":"https:\/\/doi.org\/10.1128\/asmj-crossmark-policy-page","source":"Crossref","is-referenced-by-count":55,"title":["Comparative Study of Surgical Instruments from Sterile-Service Departments for Presence of Residual Gram-Negative Endotoxin and Proteinaceous Deposits"],"prefix":"10.1128","volume":"44","author":[{"given":"I. P.","family":"Lipscomb","sequence":"first","affiliation":[{"name":"Environmental Healthcare Unit, School of Biological Sciences, University of Southampton, Southampton SO16 7PX, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A. K.","family":"Sihota","sequence":"additional","affiliation":[{"name":"Environmental Healthcare Unit, School of Biological Sciences, University of Southampton, Southampton SO16 7PX, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C. W.","family":"Keevil","sequence":"additional","affiliation":[{"name":"Environmental Healthcare Unit, School of Biological Sciences, University of Southampton, Southampton SO16 7PX, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"235","reference":[{"key":"e_1_3_2_2_2","unstructured":"ACDP\/SEAC. 1998. Transmissible spongiform encephalopathy agents: safe working and the prevention of infection. 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Gajdusek. 2000. New studies on the heat resistance of hamster-adapted scrapie agent: threshold survival after ashing at 600 degrees C suggests an inorganic template of replication. Proc. Natl. Acad. Sci. USA97:3418-3421.","journal-title":"Proc. Natl. Acad. Sci. USA"},{"key":"e_1_3_2_9_2","unstructured":"Centers for Disease Control. 2000. Hospital infections cost U.S. billions of dollars annually. Press release. Centers for Disease Control Atlanta Ga."},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1006\/abio.1993.1263"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.biomaterials.2005.04.063"},{"key":"e_1_3_2_12_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0021-9258(18)57021-6"},{"key":"e_1_3_2_13_2","unstructured":"Government Statistical Service. 2004. Hospital episode statistics England: financial year 2003-04. Department of Health London United Kingdom."},{"key":"e_1_3_2_14_2","unstructured":"Huys J. 2006. The sterile supply cycle: cleaning sterilisation of medical devices by steam: general theory. Heart Consultancy Renkum The Netherlands."},{"key":"e_1_3_2_15_2","doi-asserted-by":"publisher","DOI":"10.2166\/wst.2003.0293"},{"key":"e_1_3_2_16_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0306-3623(97)00424-2"},{"key":"e_1_3_2_17_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhin.2005.04.002"},{"key":"e_1_3_2_18_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhin.2005.07.008"},{"key":"e_1_3_2_19_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.arcmed.2004.07.006"},{"key":"e_1_3_2_20_2","unstructured":"Mant E. 2005. Keep surgical instruments prion-free. Cleanroom Technology Sidcup Kent United Kingdom. (www.cleanroom-technology.co.uk\n.)"},{"key":"e_1_3_2_21_2","doi-asserted-by":"publisher","DOI":"10.1186\/cc1522"},{"key":"e_1_3_2_22_2","first-page":"311","volume":"22","year":"1965","unstructured":"Martin, D. S., N. J. Cassisi, and J. L. Pickens. 1965. Endotoxin shock: a collective review. Rev. Surg.22:311-319.","journal-title":"Rev. Surg."},{"key":"e_1_3_2_23_2","first-page":"1370","volume":"321","year":"2000","unstructured":"Mayor, S. 2000. Hospital acquired infections kill 5000 patients a year in England. BMJ321:1370.","journal-title":"BMJ"},{"key":"e_1_3_2_24_2","unstructured":"NHS Decontamination Project. 2003. A process for commercial involvement in improving NHS decontamination. NHS Estates London United Kingdom."},{"key":"e_1_3_2_25_2","unstructured":"NHS Decontamination Project. 2003. Background information [Rev.A. 01]: NHS Decontamination Project background and expectations. NHS Estates London United Kingdom."},{"key":"e_1_3_2_26_2","unstructured":"NHS Estates. 1 January 2001 posting date. Comprehensive report: a review of the decontamination of surgical instruments in the NHS in England. [Online.] http:\/\/www.dh.gov.uk\/PublicationsAndStatistics\/Publications\/PublicationsPolicyAndGuidance\/PublicationsPolicyAndGuidanceArticle\/fs\/en?CONTENT_ID=4120912&chk=lqhPNX\n."},{"key":"e_1_3_2_27_2","unstructured":"NHS Estates. 2001. Health Technical Memorandum 2030. Washer disinfectors. The Stationery Office London United Kingdom."},{"key":"e_1_3_2_28_2","unstructured":"NHS Purchasing and Supply Agency. 2004. Paper on individual instrument and surgical tray identification. NHS PASA London United Kingdom."},{"key":"e_1_3_2_29_2","unstructured":"NHS Scotland. 2001. Sterile services provision review group: 1st report\u2014the Glennie framework. NHS Scotland Edinburgh Scotland United Kingdom."},{"key":"e_1_3_2_30_2","unstructured":"NHS Scotland. 2001. The decontamination of surgical instruments and other medical devices. 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