Pre-register now for Medical Fair Thailand, 11-13 Sep 2019, BITEC, Bangkok/Thailand.
Calling all Nurses, Doctors, Pharmacists, Clinical Technicians, Engineers, HR Managers… and all those involved in the medical and healthcare sector!
Start planning your visit to Thailand’s No.1 sourcing platform with its showcase from 1,000 exhibitors from 60 countries. Here’s where you will experience products and innovations focused on Hospital, Diagnostic, Pharmaceutical, Medical & Rehabilitation Equipment & Supplies from around the world.
Making its move to a larger venue at BITEC, the 9th edition of MEDICAL FAIR THAILAND is the most established and international medical exhibition in the region, organized by Messe Düsseldorf Asia (MDA) and part of the MEDICAlliance; the global network which shares the expertise of MEDICA – the world’s No.1 medical and healthcare exhibition by Messe Düsseldorf Group in Germany.
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Cardiovascular-related technology is an exciting field as new devices and biotech products continue to emerge from research labs with rapid succession propelled by a vigorous stream of innovation. In this focus on smart tech for cardiology we look at some of the latest developments in this extremely dynamic arena – from 3D bioprinted cardiovascular tissue to a new bionic heart and synthetic blood.
Engineers at MIT have recently developed a bionic heart, not for transplant or a bridge to transplant, but for research. The demand for prosthetic heart valves and other cardiac devices is expected to grow significantly in the coming years driven by a growing geriatric population.
Prosthetic valves are designed to mimic a real, healthy heart valve in helping to circulate blood through the body. However, many of them have issues, such as leakage around the valve. Engineers working to improve these designs must test them repeatedly, first in simple benchtop simulators, then in animal subjects, before reaching human trials – a long and expensive process. This is where the bionic heart comes in. The bionic heart offers a more realistic model for testing artificial valves and other cardiac devices.
The device is a real biological heart in which the tough muscle tissue has been replaced with a soft matrix of artificial heart muscles, resembling bubble wrap. The orientation of the artificial muscles mimics the pattern of the heart’s natural muscle fibres, in such a way that when the researchers remotely inflate the bubbles, they act together to squeeze and twist the inner heart, similar to the way a real, whole heart twists when it beats and pumps blood.
With this new design, which the researchers call a “biorobotic hybrid heart”, they envision that device designers and engineers could iterate and fine-tune designs more quickly by testing on the biohybrid heart, significantly reducing the cost of cardiac device development. Ellen Roche, assistant professor of mechanical engineering at MIT, explains: “Regulatory testing of cardiac devices requires many fatigue tests and animal tests. The biorobotic hybrid heart could realistically represent what happens in a real heart, to reduce the amount of animal testing or iterate the design more quickly.”
Roche and her colleagues published their results January 29, 2020 in the journal Science Robotics. Inspired design The heart normally pumps blood by squeezing and twisting, a complex combination of motions that is a result of the alignment of muscle fibres along the outer myocardium that covers each of the heart’s ventricles. The team planned to fabricate a matrix of artificial muscles resembling inflatable bubbles, aligned in the orientations of the natural cardiac muscle. But copying these patterns by studying a ventricle’s three-dimensional geometry proved extremely challenging.
They eventually came across the helical ventricular myocardial band theory, the idea that cardiac muscle is essentially a large helical band that wraps around each of the heart’s ventricles. This theory is still a subject of debate by some researchers, but Roche and her colleagues took it as inspiration for their design. Instead of trying to copy the left ventricle’s muscle fibre orientation from a 3D perspective, the team decided to remove the ventricle’s outer muscle tissue and unwrap it to form a long, flat band – a geometry that should be far easier to recreate. In this case, they used the cardiac tissue from an explanted pig heart.
In collaboration with co-lead author Chris Nguyen at Massachusetts General Hospital, the researchers used diffusion tensor imaging, an advanced technique that typically tracks how water flows through white matter in the brain, to map the microscopic fibre orientations of a left ventricle’s unfurled, two-dimensional muscle band. They then fabricated a matrix of artificial muscle fibres made from thin air tubes, each connected to a series of inflatable pockets, or bubbles, the orientation of which they patterned after the imaged muscle fibres.
The soft matrix consists of two layers of silicone, with a watersoluble layer between them to prevent the layers from sticking, as well as two layers of laser-cut paper, which ensures that the bubbles inflate in a specific orientation.
Finally, the researchers placed the entire hybrid heart in a mould that they had previously cast of the original, whole heart, and filled the mould with silicone to encase the hybrid heart in a uniform covering – a step that produced a form similar to a real heart and ensured to a real heart and ensured that the robotic bubble wrap fitted snugly around the real ventricle.
“That way, you don’t lose transmission of motion from the synthetic muscle to the biological tissue,” Roche explained.
When the researchers pumped air into the bubble wrap at frequencies resembling a naturally beating heart, and imaged the bionic heart’s response, it contracted in a manner similar to the way a real heart moves to pump blood through the body.
Ultimately, the researchers hope to use the bionic heart as a realistic environment to help designers test cardiac devices, such as prosthetic heart valves.
3D bioprinted cardiovascular tissue
Cardiovascular disease (CVD) is the leading cause of mortality worldwide, with over 17 million deaths per year, according to the World Health Organisation.
The ideal treatment for some forms of severe CVD, such as chronic heart failure or extensive myocardial injury, is cardiac transplantation. Due to shortages in available donor tissue, this cannot be given to all patients. The average waiting time for a suitable donor is six to twelve months in the United States and around one in six people die before they can receive a transplant. There is a clear need for a more abundant supply of hearts suitable for transplantation.
A common strategy to address heart failure is to use a cardiac pump, such as a left ventricular assist device (LVAD), when a donor heart is not available. Current treatment options are useful to a certain extent, but personalized solutions are required to improve patient outcomes and quality of life. This need is driving the development of cardiovascular 3D bioprinting technologies, which make use of 3D printinglike techniques to combine cells and biomaterials to fabricate biomimetic structures that replicate natural tissue physiology and function.
Developing a dynamic cardiac tissue capable of mimicking the mechanical and electroconductive properties of native myocardium is proving difficult for researchers. Many challenges stand in their way including, among others, re-creating tissue matrix and providing an adequate oxygen supply to each cell.
The success of 3D bioprinting depends on researchers’ ability to vascularise the tissue. For this reason, a lot of focus has recently been placed on the generation of blood vessels. Several promising studies have already been conducted. For instance, researchers at University of California San Diego 3D printed a functional blood vessel network which, once implanted in mice, merged with the animal’s blood vessels and was capable of transporting blood. Similar achievements have been reported by Sichuan Revotek, Rice University and the University of Pennsylvania in the past few years. Cardiac patches An important innovation in the we move towards 3D bioprinting cardiac tissue is the development of cell sheets. Terumo, a Japanese conglomerate, has commercialized the Heart Sheet for treatment of heart failure in Japan. To develop Heart Sheet, muscle tissue is harvested from the patient’s leg and cultured in vitro. Terumo has developed a tissue culture plate that allows cells to float off the surface in an intact sheet when the temperature is lowered, thus preserving the extracellular matrix that is lost when cells are removed by other methods.
Cardiac tissue engineering techniques such as this one can be used to create functional constructs capable of re-establishing the structure and function of damaged myocardium following myocardial infarction. The engineered cardiac tissue, which often comes in the form of a “patch”, is implanted directly onto scar tissue. The intention is to compensate for the heart’s reduced function by strengthening its structure and boosting its ability to pump blood. This way, researchers hope to reduce the need for transplants, improve recovery and prevent subsequent events.
Researchers across the world are developing “cardiac patches”. In June 2019, Imperial College London announced the creation of thumbsize patches of heart tissue that start to beat spontaneously after three days and start to mimic mature heart tissue within one month. These patches successfully led to improvements in heart function following a heart attack after only four weeks. Importantly, blood vessels appeared to have formed within the patch after that time. Clinical trials are expected to start this year or 2021.
Once implanted, cardiac patches could do more than just promote cardiac tissue regeneration. For instance, a bionic patch could deliver electrical shocks and act as a pacemaker. Scientists at the University of Tel Aviv also investigated integrating electronic sensors into the patch to enable remote monitoring of cardiac activity.
Although researchers have not yet been able to create a fully functioning artificial heart, an important leap was made in 2019. Researchers from Tel Aviv University unveiled the first 3D bioprinted heart with human tissue including chambers, ventricles and blood vessels. Although the heart is capable of contracting, it remains a long way off from being ready for clinical trials as it cannot yet pump blood.
3D bioprinting has the potential to provide a heart or blood vessels to patients in need of transplants. The tissue would be made from their own cells, thereby considerably reducing the risk of rejection. Despite promising recent innovations, 3D bioprinting technology remains in its early days and is unlikely to become a viable therapeutic option in the near future. This will change once the technology evolves and full-sized hearts and vessels can be constructed efficiently and at scale.
For decades scientists have been trying to develop synthetic red blood cells (RBCs) that mimic the favourable properties of natural ones, such as flexibility, oxygen transport and long circulation times. Most have been met with limited success, demonstrating only one or just a few of the key properties. Now, researchers, reporting in the journal ACS Nano , have made synthetic RBCs that have all of the cells’ natural abilities, plus a few new ones.
Wei Zhu, C. Jeffrey Brinker and colleagues wanted to make artificial RBCs that had similar properties to natural ones, but that could also perform new jobs such as therapeutic drug delivery, magnetic targeting and toxin detection.
The researchers made the synthetic cells by first coating donated human RBCs with a thin layer of silica. They layered positively and negatively charged polymers over the silica-RBCs, and then etched away the silica, producing flexible replicas. Finally, the team coated the surface of the replicas with natural RBC membranes. The artificial cells were similar in size, shape, charge and surface proteins to natural cells, and they could squeeze through model capillaries without losing their shape. In mice, the synthetic RBCs lasted for more than 48 hours, with no observable toxicity. The researchers loaded the artificial cells with either haemoglobin, an anticancer drug, a toxin sensor or magnetic nanoparticles to demonstrate that they could carry cargoes. They also showed that the new RBCs could act as decoys for a bacterial toxin.
The researchers say future studies will explore the potential of the artificial cells in medical applications, such as cancer therapy and toxin biosensing. Reference
Biomimetic Rebuilding of Multifunctional Red Blood Cells: Modular Design Using Functional Components https://pubs.acs.org/doi/abs/10.1021/acsnano.9b08714
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Johnson & Johnson has announced the selection of a lead COVID-19 vaccine candidate on which it expects to initiate human clinical studies by September at the latest with the first batches of the vaccine available for emergency use authorization in early 2021.
In addition, the company announced the significant expansion of the existing partnership between the Janssen Pharmaceutical Companies of Johnson & Johnson and the Biomedical Advanced Research and Development Authority (BARDA).
Johnson & Johnson also said the company will rapidly scale up its manufacturing capacity with the goal of providing a global supply of more than one billion doses of the vaccine.
Through the new partnership, BARDA and Johnson & Johnson together have committed more than $1 billion of investment to co-fund vaccine research, development, and clinical testing. The company says will use its validated vaccine platform and is allocating resources, including personnel and infrastructure globally, as needed, to focus on these efforts.
BARDA is part of the Office of the Assistant Secretary for Preparedness and Response (ASPR) at the U.S. Department of Health and Human Services.
Commenting on the initiative, Alex Gorsky, Chairman and Chief Executive Officer, Johnson & Johnson, said: “The world is facing an urgent public health crisis and we are committed to doing our part to make a COVID-19 vaccine available and affordable globally as quickly as possible. As the world’s largest healthcare company, we feel a deep responsibility to improve the health of people around the world every day. Johnson & Johnson is well positioned through our combination of scientific expertise, operational scale and financial strength to bring our resources in collaboration with others to accelerate the fight against this pandemic.”
The company’s expansion of its manufacturing capacity will include the establishment of new U.S. vaccine manufacturing capabilities and scaling up capacity in other countries. The additional capacity will assist in the rapid production of a vaccine and will enable the supply of more than one billion doses of a safe and effective vaccine globally.
Paul Stoffels, M.D., Vice Chairman of the Executive Committee and Chief Scientific Officer, Johnson & Johnson, said: “We are very pleased to have identified a lead vaccine candidate from the constructs we have been working on since January. We are moving on an accelerated timeline toward Phase 1 human clinical trials at the latest by September 2020 and, supported by the global production capability that we are scaling up in parallel to this testing, we expect a vaccine could be ready for emergency use in early 2021.” In addition to the vaccine development efforts, BARDA and Johnson & Johnson have also expanded their partnership to accelerate Janssen’s ongoing work in screening compound libraries, including compounds from other pharmaceutical companies. The company’s aim is to identify potential treatments against the novel coronavirus. Johnson & Johnson and BARDA are both providing funding as part of this partnership. These antiviral screening efforts are being conducted in partnership with the Rega Institute for Medical Research (KU Leuven/University of Leuven), in Belgium.
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Hand hygiene is a critical component of infection prevention in hospitals, but the unintended consequences include water splashing out of a sink to spread contaminants from dirty taps according to new research. Researchers at the University of Michigan Health System assessed eight different designs across four intensive care units to determine how dirty sinks and taps really are. They found that a shallow depth of the sink bowl enabled potentially contaminated water to splash onto patient care items, healthcare worker hands, and into patient care spaces – at times at a distance of more than four feet (1.2 meter) from the sink itself. “The inside of taps where you can’t clean were much dirtier than expected,” said study author Kristen VanderElzen, MPH, CIC. “Potentially hazardous germs in and around sinks present a quandary for infection preventionists, since having accessible sinks for hand washing is so integral to everything we promote. Acting on the information we found, we have undertaken a comprehensive tap replacement program across our hospital.” To identify the grime level of the sinks, the researchers used adenosine triphosphate (ATP) monitoring to measure the cleanliness. Visible biofilm was associated with higher ATP readings, and cultures tested over the course of the study grew Pseudomonas aeruginosa, mould, and other environmental organisms. The research team also found aerators on sinks where they had previously been removed, pointing to an overall inconsistency of equipment protocols across the facility. Included in the design improvement program were sink guards, which were shown to limit splash significantly. “As we learn more about the often stealthy ways in which germs can spread inside healthcare facilities, infection preventionists play an increasingly important role in healthcare facility design – including in the selection of sink and tap fixtures – as this study illustrates,” said 2019 APIC President Karen Hoffmann, RN, MS, CIC, FSHEA, FAPIC. “Because the healthcare environment can serve as a source of resistant organisms capable of causing dangerous infections, an organization’s infection prevention and control program must ensure that measures are in place to reduce the risk of transmission from environmental sources and monitor compliance with those measures.”
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Scientists at Sanford Burnham Prebys Medical Discovery Institute, the University of Hong Kong, Scripps Research, UC San Diego School of Medicine, the Icahn School of Medicine at Mount Sinai and UCLA have identified 30 existing drugs that stop the replication of SARS-CoV-2, the virus that causes Covid-19. Almost all of the drugs are entirely different from those currently being tested in clinical trials, and weren’t previously known to hold promise for Covid-19 treatment. The new candidates expand the number of “shots on goal” for a potential Covid-19 treatment and could reach patients faster than drugs that are created from scratch. The study was placed on bioRxiv – https://www.biorxiv.org/content/10.1101/2020.04.16.044016v1 – an open-access distribution service for preprints of life science research.
“We believe this is one of the first comprehensive drug screens using the live SARS-CoV-2 virus, and our hope is that one or more of these drugs will save lives while we wait for a vaccine for Covid-19,” said Sumit Chanda, Ph.D., director of the Immunity and Pathogenesis Program at Sanford Burnham Prebys and senior author of the study. “Many drugs identified in this study – most of which are new to the Covid-19 research community – can begin clinical trials immediately or in a few months after additional testing.”
The drugs were identified by screening more than 12,000 drugs from the ReFRAME drug repurposing collection – a library of existing drugs that have been approved by the FDA for other diseases or have been tested extensively for human safety. ReFRAME was created by Scripps Research with support from the Bill & Melinda Gates Foundation to accelerate efforts to fight deadly diseases. Every compound was tested against the live SARS-CoV-2 virus, isolated from patients in Washington State and China, and the final 30 drugs were selected based on their ability to stop the virus’s growth.
“For us, the starting point for finding any new antiviral drug is to measure its ability to block viral replication in the lab,” says Chanda. “Since the drugs we identified in this study have already been tested in humans and proven safe, we can leapfrog over the more than half decade of studies normally required to get approval for human use.”
Highlights of the scientists’ discoveries follow. Each drug or experimental compound requires further evaluation in clinical trials to prove its effectiveness in treating people with Covid-19 before it can be used broadly.
27 drugs that are not currently under evaluation for Covid-19 were effective at halting viral replication. 17 of these drugs have an extensive record of human safety from clinical studies in non-Covid-19 diseases, including four—clofazimine, acitretin, tretinoin and astemizole—that were previously approved by the FDA for other indications.
Thus far, six of the 17 were shown to be effective at concentrations, or doses, likely to be effective and tolerable in humans. Four of these six drugs – apilimod, MLN-3897, VBY-828 and ONO 5334 – have been tested clinically for diseases including rheumatoid arthritis, Crohn’s disease, osteoporosis and cancer.
In addition to the 27 drug candidates, three drugs currently in clinical trials for Covid-19, including remdesivir and chloroquine derivatives, were also shown to be effective at stopping the growth of SARS-CoV-2. These results reaffirm their promise as potential Covid-19 treatments and support the continuation of ongoing clinical trials to prove their effectiveness in patients.
Depending on regulatory guidance, the newly identified drug candidates may proceed directly to Covid-19 clinical trials or undergo further testing for efficacy in animal models.
“Based on the extensive data in this study, we believe the four drugs described above—apilimod, MLN-3897, VBY-825 and ONO 5334 – represent the best new approaches for a near-term Covid-19 treatment,” says Chanda. “However, we believe that all 30 drug candidates should be fully explored, as they were clearly active and effective at halting viral replication in our tests.”
“We have chosen to release these findings to the scientific and medical community now to help address the current global health emergency,” Chanda continues. “The data from this drug screen is a treasure trove; and we will continue to mine the data from this analysis, with a goal to find additional candidate therapies – and combinations of drugs – as they are identified.”
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Starna, established 1964, has a worldwide reputation for quality, service and innovation in the production and supply of spectrophotometer cells, optical components and Certified Reference Materials (CRMs). World-leader with over 50 years’ experience in the production of Certified Reference Materials for UV-Vis-NIR & Fluorescence spectroscopy; it is the only company to achieve both ISO/IEC 17025 and ISO 17034 for this range of products. A highly regarded manufacturer of high precision quartz and glass Cells/Cuvettes for Photometers and Fluorimeters. Starna sells worldwide to instrument manufacturers, pharmaceuti- cals, life-biosciences, R&D laboratories, medical companies and universities.
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Scientists at the Center for Cardiology of the Mainz University Medical Center have examined the success of more than 13,575 minimally invasive procedures on the mitral valve in the largest study of their kind to date. Key findings: Although patients grew older during the period from 2011 to 2015 and the number of procedures increased from year to year, mortality and complication rates remained consistently low. Mitral valve insufficiency is the most common heart valve disease in Europe and the USA. About ten percent of people over the age of 75 are affected. The patients suffer from a weak closure and thus a leaky mitral valve. Until a few years ago, there was often only the possibility of a drug therapy, because for an open operation, the patients are usually too old, have too many comorbidities or the function of the left ventricle is too bad. There is now a new option to treat this leaky heart valve minimally invasive with a Mitraclip implantation. Germany is one of the leading nations in this innovative, new process. "Several studies with small groups of patients have already been published for the evaluation of the procedure with regard to frequency of inserting the clip or the safety of the procedure, however, so far there have been no large data collections", explain the first and last authors of the study Dr. Ralph Stephan von Bardeleben, Dr. Lukas Hobohm and Dr. Karsten Keller. "That’s why it was a good idea to examine the implantation numbers and the complication rates in Germany on a larger scale." Their results show: The annual implantation numbers in Germany increased more than fivefold from 815 in 2011 to 4,432 in 2015. In total, the study included 13,575 patients who had been treated with Mitraclip. Earlier studies referred to a maximum of 1,064 procedures. The patients were usually between 70 and 89 years old and on average they got older and older. Another important result is that the complication rate or mortality did not change significantly during the period studied. Important prognostic factors related to hospital death were cardiac insufficiency, blood transfusion due to bleeding complications, stroke, pulmonary embolism, or pericardial effusion. The authors conclude from their findings that despite the dramatic fivefold increase in the implantation rate of the clip, the procedure has very low early-stage complication rates during hospitalization. "Catheter-assisted valvular heart valve therapy has evolved from a niche treatment of inoperable patients into a relevant and safe treatment option in only ten years, as our new study emphasizes once again", underlines Dr. von Bardeleben. The Mainz University Medical Center occupies a leading position in the field of gentle heart valve therapy, both nationally and internationally. "In 2018, we implanted more than 700 heart valves, making us one of the largest university centers for minimally invasive heart valve therapy," explains Professor Dr. Thomas Münzel, Director of Cardiology I at the Center for Cardiology of the Mainz University Medical Center. "There were more than 200 Mitraclips. This number is unique in the world.” Cardiologists have also taken the opportunity to establish a new Heart Valve Unit in Mainz because of a striking increase in demand for such interventions in recent years. The advantage of the new heart valve unit: All relevant steps in the course of a heart valve implantation – from patient admission to planning and aftercare on the intensive care unit until to the discharge of patients – take place at one ward. Mainz University Medical Centerhttps://tinyurl.com/y4y75dvs
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Intensive care units (ICUs) can be extremely stressful for patients and families. Changes in the way ICUs are run may help mitigate that stress, two new studies suggest.
Researchers looking at the impact of making ICU visiting hours more flexible, and the keeping of ICU diaries by staff and family members, found some interventions could, at the very least, lessen stress for families, according to the two reports published.
“The efforts made by the researchers are admirable,” said Dr. Albert Wu, an internist and professor of health policy and management at the Johns Hopkins Bloomberg School of Public Health who was not involved in either study. “But I think this is just a drop in the ocean. The ICU experience is so profoundly disorienting, especially for patients, but also for family members and even, to some extent, the people providing the care.”
The visitation study was originally designed to see if longer visiting hours might help prevent delirium in ICU patients. They didn’t – but they did appear to lower anxiety and depression in relatives. In that study, the number of visitation hours in 36 adult ICUs in Brazil was expanded from a maximum of 4.5 hours a day to 12 hours a day. From June 2017 to June 2018, 1,685 patients were randomly assigned to the shorter or more flexible visitation schedules.
Average duration of visits was longer in the group with a 12-hour window for visitation: 4.8 hours versus 1.4. And while patient delirium wasn’t reduced with the longer hours, anxiety and depression levels in the family members declined significantly.
“Although a flexible visiting policy for ICUs has been recommended by professional society guidelines, the evidence suggests most ICUs adopt restrictive visitation models, possibly motivated by risks . . . such as disorganization of care, infections and staff burnout,” said the study’s lead author, Dr. Regis Goulart Rosa of Hospital Moinhos de Vento, Porto Alegre, Brazil. “Interestingly these risks were not confirmed in the ICU visits study.”
The longer, flexible, visiting hours offer a host of benefits: “for patients, the benefits of reassurance, emotional support and comfort, for family members the opportunity to help a loved one,” Rosa said in an email.
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Washing contaminated hospital bedsheets in a commercial washing machine with industrial detergent at high disinfecting temperatures failed to remove all traces of Clostridium difficile (C. difficile), a bacteria that causes infectious diarrhoea, suggesting that linens could be a source of infection among patients and even other hospitals, according to a study published.
"The findings of this study may explain some sporadic outbreaks of C. difficile infections in hospitals from unknown sources, however, further research is required in order to establish the true burden of hospital bedsheets in such outbreaks," said Katie Laird, PhD, Head of the Infectious Disease Research Group, School of Pharmacy, De Montfort University, Leicester, United Kingdom and lead author of the study. "Future research will assess the parameters required to remove C. difficile spores from textiles during the laundry process."
Researchers inoculated swatches of cotton sheets with C. difficile. The swatches were then laundered with sterile uncontaminated pieces of fabric using one of two different methods — either in a simulated industrial washing cycle using a washer extractor with and without detergent or naturally contaminated linens from the beds of patients with C. difficile infection were put through a full commercial laundry where they were washed in a washer extractor (infected linen wash) with industrial detergent, pressed, dried, and finished according to current the National Health Service in the United Kingdom’s healthcare laundry policy (Health Technical Memorandum 01-04 Decontamination of Linen for Health and Social Care (2016). Researchers measured the levels of contamination before and after washing.
Both the simulated and the commercial laundering via a washer extractor process failed to meet microbiological standards of containing no disease-causing bacteria, the study found. The full process reduced C. difficile spore count by only 40 percent, and this process resulted in bacteria from the contaminated sheets being transferred to the uncontaminated sheets after washing.
Researchers concluded that thermal disinfection conditions currently required by the UK National Health System are inadequate for the decontamination of C. difficile spores. There may be potential to spread C. difficile back into the hospital environment as linens could be a source for outbreaks at other healthcare facilities through businesses that collect, launder and redistribute rented linens to multiple hospitals and care facilities, as is the case at NHS facilities.
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