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By: Bruce Alan Perler, M.B.A., M.D.

  • Vice Chair for Clinical Operations and Financial Affairs
  • Professor of Surgery

https://www.hopkinsmedicine.org/profiles/results/directory/profile/0002711/bruce-perler

Cardiovascular Intensive Care Unit Nursing Unit 7-1600 (585) 275-3158 15 On Your Way to a Strong Heart the Immediate Postoperative Period Endotracheal Tube/ Mechanical Ventilator the endotracheal tube passes through your mouth or nose into your trachea (windpipe) and is attached to a mechanical ventilator (respirator) symptoms stomach cancer order 200 mg cordarone fast delivery. The ventilator breathes for you until you are awake and able to breathe on your own symptoms 6 days post embryo transfer discount cordarone uk. The tube is usually removed one to six hours after surgery or when the Intensive Care Unit team feels you are ready to have the tube removed medicine knowledge order 100mg cordarone fast delivery. Because the tube passes through your larynx (voice box) and into your trachea medications requiring central line discount cordarone 100 mg mastercard, you will be unable to talk or make any sounds while this tube is in place. Your nurse understands this and will provide a way to communicate with you during this time. While you have the endotracheal tube in place, it will be necessary for your nurse or respiratory therapist to occasionally clean the tube. This is called suctioning, and it is important because it clears the tube of mucous secretions normally produced by your lungs. A suction catheter is passed down the endotracheal tube, which will remove the mucous secretions out of your airway. After the endotracheal tube is removed, you will be asked to cough and deep breathe every hour. You will be given a small pillow to splint your chest incision while performing your deep breathing and coughing exercises. After removal of this tube you will be able to talk, but your throat may be sore for a short time afterwards. Temporary Pacing Wires Small pacing wires are placed on the surface of the heart during your surgery. The purpose of these wires is to increase your heart rate if needed after surgery. These wires are not permanent and will be removed when they are no longer needed, with little or no discomfort to you. The purpose of these tubes is to drain blood and fuid from your chest cavity following surgery. These drains will be emptied as needed by the nursing staff and will be removed when drainage is minimal. Bladder Catheter After surgery, you will have a catheter in place which will drain urine from your bladder. Heart Pressure Lines (Pulmonary Artery Catheter) After surgery, you will be attached to lines that read the pressures in your heart and measure the blood pressure in your body. Discomfort Following Surgery Following surgery, you may experience discomfort related to your incision, movement and coughing. It is very important that you tell your nurse whenever you are experiencing pain or discomfort. When you are experiencing pain, you will be asked to rate it on a scale of one to 10, with one being the least amount of pain and 10 being the worst pain you have ever experienced. Pain-relieving medicine will be ordered for you and can be given to you every few hours. Pain medications will only be given to you as needed, so it is important for you to ask your nurse for pain medication when you are experiencing pain. It is extremely important that you take your pain medication to manage your pain as it will help you move, cough and rest more effectively, which is a very important part of your recovery. You may require additional medication (a laxative) to help move your bowels the frst time after surgery. Your nurse will provide a laxative if you have not had a bowel movement by the third day after surgery. Be sure that you let the nurse and dietician know if there are any specifc foods you would like to have. Mood Changes During the postoperative recovery, you may experience mood swings, depression or even confusion at times. This is normal and results from the stress of surgery and your body?s response to the stress. Activity After the breathing tube is removed, your nurse will help you sit on the edge of the bed and dangle your legs over the side. You may experience dizziness or lightheadedness when you initially sit up on the edge of the bed. If you have had coronary artery surgery, you will be assisted out of bed to the chair in the evening of surgery. The next morning, you will begin to walk (ambulate) with the assistance of your nurse. The amount of time you spend walking will increase each day that you are in the hospital. Once you are transferred to the Cardiovascular Progressive Care Unit, you will be expected to shower daily and walk at least three times per day. It is important that you organize your day to include rest periods and periods of activity. Pulmonary Therapy Following removal of the breathing tube, you will be started on a pulmonary (lung) therapy regime, which consists of coughing and deep breathing exercises. The respiratory therapist will assist you in performing these exercises for your lungs. Maintaining proper lung function and preventing the accumulation of secretions will help you return to health faster. Remember that splinting your incision and taking your pain reliever will help you cough and deep breathe more effectively. You will also receive a breathing exerciser called an incentive spirometer, which should be used at least 10 times per hour while you are awake. You will be instructed on how to use your incentive spirometer by a respiratory therapist or your nurse. Doing coughing and deep breathing exercises at least every one to two hours is extremely important for your recovery. Telemetry monitoring is similar to the cardiac monitor in the Intensive Care Unit, except that the leads on your chest are attached to a small, light portable transmitter box that you can carry with you while you walk. You will be visited by the Cardiac Rehabilitation Nurse and will continue to be followed by a physical therapist as needed. Physical therapists and the nursing staff will assist you and provide assistive devices (walker or cane) as needed. Discharge Instructions After Heart Surgery Recovery at Home the First Three Weeks As you return home, you are just beginning your job of taking care of your heart. It is important for you to understand what you have experienced while in the hospital and what you need to do to stay healthy. Now is the time to get yourself, your family and friends committed to supporting a healthy lifestyle by: Eating a heart-healthy diet Exercising and staying active Understanding your medications and taking them as your doctor prescribes Reducing stress Starting a smoking cessation program (if you smoke) Now that you are ready to go home, the real work and recovery is about to begin. The following guidelines will get you through until you see the surgeon, which is in about three weeks. You may walk outside when the weather permits, otherwise walk around your home, at a mall, grocery store, etc. When you are comfortable walking 20 minutes at one time, you only need to walk once a day. Do not exceed the 20 minute walk at one time until you discuss it with your physician. If symptoms are not relieved after 15 minutes of rest, call 911 or use your local Emergency Department. No mopping, vacuuming, laundering, changing bed linens, no yard work (includes riding mower, tractor or self-propelled mower), no shoveling or snow blowers. These temporary limitations are to allow the breastbone (which is being held together with surgical wire) to heal properly. Healthy Eating Most people have a poor appetite and feel full after a few bites of food. Most important at this time is choosing foods low in sodium, along with a wellbalanced diet.

If phenolics are used to clean nursery floors treatment trends cordarone 100 mg mastercard, they must be diluted as recommended on the product label medicine 44-527 order 200mg cordarone amex. Phenolics (and other disinfectants) should not be used to clean infant bassinets and incubators while occupied medicines360 buy cordarone 200mg line. If phenolics are used to terminally clean infant bassinets and incubators treatment diabetes type 2 purchase cordarone 100mg, the surfaces should be rinsed thoroughly with water and dried before reuse of infant bassinets and incubators 17. Health-care associated infections have been reported from contaminated quaternary ammonium compounds used to disinfect patient-care supplies or equipment, such as cystoscopes or cardiac catheters 741, 742. The quaternaries are good cleaning agents, but high water hardness 743 and materials such as cotton and gauze pads can make them less microbicidal because of insoluble precipitates or cotton and gauze pads absorb the active ingredients, respectively. One study showed a significant decline (~40%?50% lower at 1 hour) in the concentration of quaternaries released when cotton rags or cellulose-based wipers were used in the open-bucket system, compared with the nonwoven spunlace wipers in the closed-bucket system 744 As with several other disinfectants (e. Chemically, the quaternaries are organically substituted ammonium compounds in which the nitrogen atom has a valence of 5, four of the substituent radicals (R1-R4) are alkyl or heterocyclic radicals of a given size or chain length, and the fifth (X ) is a halide, sulfate, or similar radical745. Each compound exhibits its own antimicrobial characteristics, hence the search for one compound with outstanding antimicrobial properties. Some of the chemical names of quaternary ammonium compounds used in healthcare are alkyl dimethyl benzyl ammonium chloride, alkyl didecyl dimethyl ammonium chloride, and dialkyl dimethyl ammonium chloride. A few case reports have documented occupational asthma as a result of exposure to benzalkonium chloride 747. The bactericidal action of the quaternaries has been attributed to the inactivation of energy-producing enzymes, denaturation of essential cell proteins, and disruption of the cell membrane746. The poor mycobactericidal activities of quaternary ammonium compounds have been demonstrated 55, 73. Quaternary ammonium compounds (as well as 70% isopropyl alcohol, phenolic, and a chlorine-containing wipe [80 ppm]) effectively (>95%) remove and/or inactivate contaminants. No functional damage or cosmetic changes occurred to the computer keyboards after 300 applications of the disinfectants 45. However, test results have varied extensively among laboratories testing identical products 416, 737. The quaternaries commonly are used in ordinary environmental sanitation of noncritical surfaces, such as floors, furniture, and walls. Last update: May 2019 54 of 163 Guideline for Disinfection and Sterilization in Healthcare Facilities (2008) Miscellaneous Inactivating Agents Other Germicides Several compounds have antimicrobial activity but for various reasons have not been incorporated into the armamentarium of health-care disinfectants. A peroxygen-containing formulation had marked bactericidal action when used as a 1% weight/volume solution and virucidal activity at 3% 49, but did not have mycobactericidal activity at concentrations of 2. A powder-based peroxygen compound for disinfecting contaminated spill was strongly and rapidly bactericidal 752. In preliminary studies, nanoemulsions (composed of detergents and lipids in water) showed activity against vegetative bacteria, enveloped viruses and Candida. New disinfectants that require further evaluation include glucoprotamin756, tertiary amines 703. Several other disinfection technologies might have potential applications in the healthcare setting 758. Metals as Microbicides Comprehensive reviews of antisepsis 759, disinfection421, and anti-infective chemotherapy 760 barely mention the antimicrobial activity of heavy metals761, 762. Nevertheless, the anti-infective activity of some heavy metals has been known since antiquity. Heavy metals such as silver have been used for prophylaxis of conjunctivitis of the newborn, topical therapy for burn wounds, and bonding to indwelling catheters, and the use of heavy metals as antiseptics or disinfectants is again being explored 763. Inactivation of bacteria on stainless steel surfaces by zeolite ceramic coatings containing silver and zinc ions has also been demonstrated 764, 765. Metals such as silver, iron, and copper could be used for environmental control, disinfection of water, or reusable medical devices or incorporated into medical devices (e. A comparative evaluation of six disinfectant formulations for residual antimicrobial activity demonstrated that only the silver disinfectant demonstrated significant residual activity against S. Preliminary data suggest metals are effective against a wide variety of microorganisms. Clinical uses of other heavy metals include copper-8-quinolinolate as a fungicide against Aspergillus, copper-silver ionization for Legionella disinfection 771-774, organic mercurials as an antiseptic (e. Inactivation of microorganisms results from destruction of nucleic acid through induction of thymine dimers. Pasteurization Pasteurization is not a sterilization process; its purpose is to destroy all pathogenic microorganisms. The time-temperature relation for hot-water pasteurization is generally ~70?C (158?F) for 30 minutes. The water temperature and time should be monitored as part of a quality-assurance program 782. Pasteurization of respiratory therapy 783, 784 and anesthesia equipment 785 is a recognized alternative to chemical disinfection. The efficacy of this process has been tested using an inoculum that the authors believed might simulate contamination by an infected patient. Other investigators found hot water disinfection to be effective (inactivation factor >5 log10) against multiple bacteria, including multidrug-resistant bacteria, for disinfecting reusable anesthesia or respiratory therapy equipment 784-786. Flushingand Washer-Disinfectors Flushingand washer-disinfectors are automated and closed equipment that clean and disinfect objects from bedpans and washbowls to surgical instruments and anesthesia tubes. Items such as bedpans and urinals can be cleaned and disinfected in flushing-disinfectors. They clean by flushing with warm water, possibly with a detergent, and then disinfect by flushing the items with hot water or with steam. Because this machine empties, cleans, and disinfects, manual cleaning is eliminated, fewer disposable items are needed, and fewer chemical germicides are used. A microbiologic evaluation of one washer/disinfector demonstrated complete inactivation of suspensions of E. Other studies have shown that strains of Enterococcus faecium can survive the British Standard for heat disinfection of bedpans (80 C for 1 minute). They are run in washerdisinfectors on a longer cycle of approximately 20?30 minutes with a detergent. Last update: May 2019 56 of 163 Guideline for Disinfection and Sterilization in Healthcare Facilities (2008) the Regulatory Framework for Disinfectants and Sterilants Before using the guidance provided in this document, health-care workers should be aware of the federal laws and regulations that govern the sale, distribution, and use of disinfectants and sterilants. In particular, health-care workers need to know what requirements pertain to them when they apply these products. To obtain a registration, a manufacturer must submit specific data about the safety and effectiveness of each product. The following standard statement appears on all labels under the ?Directions for Use heading: ?It is a violation of federal law to use this product in a manner inconsistent with its labeling. Syed Sattar and coworkers who have developed a two-tier quantitative carrier test to assess sporicidal, mycobactericidal, bactericidal, fungicidal, virucidal, and protozoacidal activity of chemical germicides 701, 803. This occurred when the frequency of contaminated germicides and infections secondary to their use had increased 404. Neutralization of Germicides One of the difficulties associated with evaluating the bactericidal activity of disinfectants is prevention of bacteriostasis from disinfectant residues carried over into the subculture media. Likewise, small amounts of disinfectants on environmental surfaces can make an accurate bacterial count difficult to get when sampling of the health-care environment as part of an epidemiologic or research investigation. One way these problems may be overcome is by employing neutralizers that inactivate residual disinfectants 807-809. Two commonly used neutralizing media for chemical disinfectants are Letheen Media and D/E Neutralizing Media. The former contains lecithin to neutralize quaternaries and polysorbate 80 (Tween 80) to neutralize phenolics, hexachlorophene, formalin, and, with lecithin, ethanol. The D/E Neutralizing media will neutralize a broad spectrum of antiseptic and disinfectant chemicals, including quaternary ammonium compounds, phenols, iodine and chlorine compounds, mercurials, formaldehyde, and glutaraldehyde 810. Last update: May 2019 58 of 163 Guideline for Disinfection and Sterilization in Healthcare Facilities (2008) Sterilization Most medical and surgical devices used in healthcare facilities are made of materials that are heat stable and therefore undergo heat, primarily steam, sterilization. However, since 1950, there has been an increase in medical devices and instruments made of materials (e. Ethylene oxide gas has been used since the 1950s for heatand moisturesensitive medical devices. Within the past 15 years, a number of new, low-temperature sterilization systems (e.

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Abbreviations of the Cardiovascular System the abbreviations that are associated with the cardiovascular system are summarized here 10 medications doctors wont take cheap cordarone 100mg without a prescription. The patient says he underwent tooth extractions a month ago and had been given antibiotics by the dentist treatment pancreatitis cheap 100mg cordarone mastercard, but since he wasn?t feeling ill symptoms dizziness nausea cheap cordarone online amex, he did not take them treatment 4s syndrome buy cordarone discount. Case Study Questions the following Case Study provides further discussion regarding the patient in the medical report. The specialist, a (c) , diagnosed the pain as having a cause from insufficient blood supply to the heart. Several weeks later, the patient was readmitted due to continued complaints of chest pain. After evaluating heart electrical events with (d) , the physician performed a technique using sound waves to evaluate heart activity during physical exercise, known as a(n) (e) . Because blood flow was normal, the narrowing of a coronary artery, generally called a(n) (h) , was the Cardiovascular System 231 eliminated as a cause, which also eliminated the common plaque-forming disease that causes a stenosis, known as (i) . If the patient did not improve, consideration for a surgical operation to repair a damaged valve, called (k) , would be made. According to her it is a sharp, intermittent pain, which increases in intensity when she stands from a sitting or lying position. Assessment: Aortic aneurysm of upper abdominal aorta inferior to celiac trunk Plan: Angioplasty with stent insertion at aortic aneurysm. Danika Price, a 42-year-old female patient with a history of persistently high blood pressure, or (l) , complained of intermittent pain sensations in the upper abdomen. Upon evaluation during which an x-ray was taken of the aorta, called a(n) (m) , it became apparent that the source of the pain was from abdominal spasms of the aorta wall, called (n) , due to an abnormal dilation of the vessel wall known as a(n) (o) . To prevent a possible rupture of the wall of the aorta, a surgical repair called a(n) (p) was scheduled. During the repair, an incision was made into the wall of the vessel in a procedure called a(n) (q) and the vessel wall received a stent to strengthen it. The patient made a complete recovery, and received education on ways to control her essential hypertension. MyLab Medical Terminology MyLab Medical Terminology is a premium online homework management system that includes a host of features to help you study. Powerful tools that track and analyze your results?allowing you to create a personalized learning experience. Belardi, Paul Hsien-Li Kao, Dimitrios Karmpaliotis, Akiko Maehara, Seung-Jung Park, Ashok Seth, Craig R. Wykrzykowska, Ralph Stephan von Bardeleben Digital Moderator: Fernando Alfonso Digital Panelists: Ian C. Hoole, Hyo-Soo Kim, Jacek Legutko Discussants: Dariusz Dudek, Michael Joner, Henning Kelb? Washington Convention Center Presentation Theater 2 Accreditation: none Session I. Bench to Bedside: the Conundrum of Pre-Clinical Testing for Transcatheter Valve Therapies When Is My Device Ready for Human Testing? Washington Convention Center Exhibit Hall, Level 2 Accreditation: none Visit the Exhibit Hall to learn, network, relax, and stay updated on the newest and latest in the industry. Smits, Corrado Tamburino Digital Moderator: Adam Witkowski Digital Panelists: Anita Asgar, Francesco Saia, Darren L. Walsh, Bernhard Witzenbichler Discussants: Bagrat Alekyan, Yaron Almagor, Evald H. Kaiser, Tanveer Rab, Gert Richardt, Mohamed Ahmed Sobhy Digital Moderator: Michael J. Kereiakes Live Case Co-Moderator: Vincent On-Hing Kwok Live Case Discussants: Arif Al Nooryani, Ronald Caputo, John S. Kumbhani, Binita Shah Factoid Facultys: Seyi Bolorunduro, Michela Faggioni, Ramin S. Bax Digital Panelists: Marco Barbanti, Verghese Mathew, Jose Luis Navia Factoid Facultys: Seyi Bolorunduro, Michela Faggioni, Ramin S. Pina Discussants: Ori Ben-Yehuda, John C Laschinger, Marco Moscarelli, Joachim Schofer, David P. Washington Convention Center Presentation Theater 2 Accreditation: none Session 1. Brecker, Jean-Claude Laborde, Patrizio Lancellotti, Ruediger Lange, Axel Linke, G. Aaron Grantham Live Case Co-Moderator: Masahiko Ochiai Live Case Discussants: Yaron Almagor, Mauro Carlino, Colm Hanratty, Richard R. Werner Digital Moderator: Stephane Rinfret Digital Panelists: Arif Al Nooryani, Kevin J. Little, Giuseppe Tarantini, Glenn Van Langenhove Factoid Facultys: Seyi Bolorunduro, Michela Faggioni, Ramin S. Galassi, Masahiko Ochiai Discussants: Yasushi Asakura, David Hildick-Smith, Paul Knaapen, Jacques J. Dawkins, Andrew Farb, David Hildick-Smith, Saibal Kar, Russell Seiber, Tamara Syrek Jensen, Katherine Wallon, Brian K. Mack Presentation Theater Program: Challenging Cases in a Real-world Patient Population (Sponsored by Medtronic, Inc. Banning Presentation Theater Program: Advancing Treatment Strategies in Complex Calci? Van Mieghem Digital Moderator: Alexandre Abizaid Digital Panelists: Kenneth Chin, Stamatios Lerakis, Ashish Pershad, Harsimran Sachdeva Singh Factoid Facultys: Adriano Caixeta, Jaya Chandrasekhar, Christine J. Naidu Digital Panelists: Mark Goldberger, Susan M Joseph, Jens Kastrup Discussants: M Chadi Alraies, Daniel Burkho? Vetrovec In-depth Cardiac Structure, Conduction System, and Hemodynamic Review of the Normal Heart Matched With Interactive Cadaver Heart Dissection by the Pathologist Robert Kutys, Tim J. Martin Fundamental Knowledge: Mitral Valve Anatomy, Function, and Relational Pathology Tim R. Martin Hemodynamics of Mitral Regurgitation, Making it Simple and Understandable Zachary M. Gertz How to Interpret Hemodynamic and Echo Data for Transcatheter Mitral Valve Repair Clinical Decision-Making and Procedural Guidance James B. Wood Fundamental Knowledge: Pulmonic Valve Anatomy, Function, and Relational Pathology Kenneth A. Gorski Fundamental Knowledge: Tricuspid Valve Anatomy, Function, and Relational Pathology David A. Lansky, Gennaro Sardella Overview of Cardiac and Coronary Anatomy Vijay Kunadian Discussion With Audience Q&A Right and Left Heart Catheterization: Technique and Hemodynamics Robert T. Pyo Discussion With Audience Q&A Coronary Angiography: Set-up, Views, Artifacts, and Pitfalls Philippe Genereux Discussion With Audience Q&A Intravascular Imaging: Core Concepts Gennaro Sardella Discussion With Audience Q&A Vascular Access Routes and Complications Robert T. Overview of Cardiovascular Pathophysiology and Treatment Moderators: Peter Barlis, Greg L. Pyo, Gennaro Sardella, Hadley Wilson Cath Lab Room Setup and Basic Equipment (Guiding Catheters, Wires, and Balloons) Bonnie H. Kutcher Discussants: Ori Ben-Yehuda, Arnold Seto the 10 Most Important Quality Metrics for Your Cath Lab Michael A. Washington Convention Center Hall B Accreditation: none Round 1: Bioresorbable Sca? Dangas Rebuttal (Longer the Better) Laura Mauri Rebuttal (Shorter the Better) George D. Washington Convention Center Room 146A, Level 1 Accreditation: none Session I Basic Process for Device Development Moderators: Jack C. Rapoza, Patricia Todd, Renu Virmani, Roseann White Lunch Presentation of the Glen and Marilyn Nelson Award Presentation of the Glen and Marilyn Nelson Award for Innovation and Translation in Cardiovascular Medicine to Robert Cali? Stone, Patricia Todd, Renu Virmani Session V Coronary Stent Development Moderators: Neal Fearnot, Spencer B. Washington Convention Center Hall B, Lower Level Accreditation: none Breakfast Meeting: A New Era in Fusion Imaging for Structural Heart Procedures (Sponsored by Siemens) Walter E. Fearon 3D Coronary Reconstruction From 2D Coronary 3D From 2D Coronary Angiograms John D. Washington Convention Center Room 143C, Level 1 Accreditation: none Check In and Breakfast Contrast-Induced Acute Kidney Injury: Focus on Hydration and Dye Saving Facultys: Prakash Balan, Somjot S. Washington Convention Center Room 149, Level 1 Accreditation: none Check In and Breakfast Endovascular Carotid Barostimulation: A Novel Interventional Approach to Hypertension Treatment Chair: Gregg W.

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An epidemic of pseudomembrane-like enteritis and colitis in seven patients in a gastrointestinal endoscopy unit also has been associated with inadequate rinsing of 3% hydrogen peroxide from the endoscope 676 treatment medical abbreviation buy cheap cordarone on line. As with other chemical sterilants treatment 2 lung cancer purchase discount cordarone line, dilution of the hydrogen peroxide must be monitored by regularly testing the minimum effective concentration treatment ulcer buy cheap cordarone 200 mg on-line. Iodine solutions or tinctures long have been used by health professionals primarily as antiseptics on skin or tissue medicine 027 buy cordarone 100mg without a prescription. Iodophors, on the other hand, have been used both as antiseptics and Last update: May 2019 48 of 163 Guideline for Disinfection and Sterilization in Healthcare Facilities (2008) disinfectants. An iodophor is a combination of iodine and a solubilizing agent or carrier; the resulting complex provides a sustained-release reservoir of iodine and releases small amounts of free iodine in aqueous solution. The best-known and most widely used iodophor is povidone-iodine, a compound of polyvinylpyrrolidone with iodine. This product and other iodophors retain the germicidal efficacy of iodine but unlike iodine generally are nonstaining and relatively free of toxicity and irritancy 677, 678. Several reports that documented intrinsic microbial contamination of antiseptic formulations of povidone-iodine and poloxamer-iodine 679-681 caused a reappraisal of the chemistry and use of iodophors682. The reason for the observation that dilution increases bactericidal activity is unclear, but dilution of povidone-iodine might weaken the iodine linkage to the carrier polymer with an accompanying increase of free iodine in solution 680. Iodine can penetrate the cell wall of microorganisms quickly, and the lethal effects are believed to result from disruption of protein and nucleic acid structure and synthesis. Published reports on the in vitro antimicrobial efficacy of iodophors demonstrate that iodophors are bactericidal, mycobactericidal, and virucidal but can require prolonged contact times to kill certain fungi and bacterial spores 14, 71-73, 290, 683-686. Three brands of povidone-iodine solution have demonstrated more rapid kill (seconds to minutes) of S. The virucidal activity of 75?150 ppm available iodine was demonstrated against seven viruses 72. Besides their use as an antiseptic, iodophors have been used for disinfecting blood culture bottles and medical equipment, such as hydrotherapy tanks, thermometers, and endoscopes. Antiseptic iodophors are not suitable for use as hard-surface disinfectants because of concentration differences. Iodophors formulated as antiseptics contain less free iodine than do those formulated as disinfectants 376. Iodine or iodine-based antiseptics should not be used on silicone catheters because they can adversely affect the silicone tubing 687. Studies have demonstrated excellent microbicidal activity in vitro 69, 100, 271, 400, 692-703. It has excellent stability over a wide pH range (pH 3?9), is not a known irritant to the eyes and nasal passages 706, does not require exposure monitoring, has a barely perceptible odor, and requires no activation. However, skin staining would indicate improper handling that requires additional training and/or personal protective equipment (e. Personal protective equipment should be worn when contaminated instruments, equipment, and chemicals are handled 400. In addition, equipment must be thoroughly rinsed to prevent discoloration of a patient?s skin or mucous membrane. These label claims differ worldwide because of differences in the test methodology and requirements for licensure. Last update: May 2019 50 of 163 Guideline for Disinfection and Sterilization in Healthcare Facilities (2008) Peracetic Acid Overview. Peracetic, or peroxyacetic, acid is characterized by rapid action against all microorganisms. Special advantages of peracetic acid are that it lacks harmful decomposition products. It remains effective in the presence of organic matter and is sporicidal even at low temperatures (Tables 4 and 5). Peracetic acid can corrode copper, brass, bronze, plain steel, and galvanized iron but these effects can be reduced by additives and pH modifications. It is considered unstable, particularly when diluted; for example, a 1% solution loses half its strength through hydrolysis in 6 days, whereas 40% peracetic acid loses 1%?2% of its active ingredients per month 654. Little is known about the mechanism of action of peracetic acid, but it is believed to function similarly to other oxidizing agents?that is, it denatures proteins, disrupts the cell wall permeability, and oxidizes sulfhydryl and sulfur bonds in proteins, enzymes, and other metabolites 654. Peracetic acid will inactivate gram-positive and gram-negative bacteria, fungi, and yeasts in? For viruses, the dosage range is wide (12?2250 ppm), with poliovirus inactivated in yeast extract in 15 minutes with 1,500?2,250 ppm. The high efficacy of the system was demonstrated in a comparison of the efficacies of the system with that of ethylene oxide. An investigation that compared the costs, performance, and maintenance of urologic endoscopic equipment processed by high-level disinfection (with glutaraldehyde) with those of the peracetic acid system reported no clinical differences between the two systems. However, the use of this system led to higher costs than the high-level disinfection, including costs for processing ($6. Furthermore, three clusters of infection using the peracetic acid automated endoscope reprocessor were linked to inadequately processed bronchoscopes when inappropriate channel connectors were used with the system 725. These clusters highlight the importance of training, proper model-specific endoscope connector systems, and quality-control procedures to ensure compliance with endoscope manufacturer recommendations and professional organization guidelines. An alternative highlevel disinfectant available in the United Kingdom contains 0. Although this product is rapidly effective against a broad range of microorganisms 466, 726, 727, it tarnishes the metal of endoscopes and is unstable, resulting in only a 24-hour use life 727. Two chemical sterilants are available that contain peracetic acid plus hydrogen peroxide. The bactericidal properties of peracetic acid and hydrogen peroxide have been demonstrated 728. Manufacturer data demonstrated this combination of peracetic acid and hydrogen Last update: May 2019 51 of 163 Guideline for Disinfection and Sterilization in Healthcare Facilities (2008) peroxide inactivated all microorganisms except bacterial spores within 20 minutes. The combination of peracetic acid and hydrogen peroxide has been used for disinfecting hemodialyzers 730. The percentage of dialysis centers using a peracetic acid-hydrogen peroxide-based disinfectant for reprocessing dialyzers increased from 5% in 1983 to 56% in 1997249. Phenol has occupied a prominent place in the field of hospital disinfection since its initial use as a germicide by Lister in his pioneering work on antiseptic surgery. In the past 30 years, however, work has concentrated on the numerous phenol derivatives or phenolics and their antimicrobial properties. Two phenol derivatives commonly found as constituents of hospital disinfectants are ortho-phenylphenol and ortho-benzyl-para-chlorophenol. The antimicrobial properties of these compounds and many other phenol derivatives are much improved over those of the parent chemical. Phenolics are absorbed by porous materials, and the residual disinfectant can irritate tissue. In 1970, depigmentation of the skin was reported to be caused by phenolic germicidal detergents containing para-tertiary butylphenol and para-tertiary amylphenol 731. In high concentrations, phenol acts as a gross protoplasmic poison, penetrating and disrupting the cell wall and precipitating the cell proteins. Low concentrations of phenol and higher molecular-weight phenol derivatives cause bacterial death by inactivation of essential enzyme systems and leakage of essential metabolites from the cell wall 732. Published reports on the antimicrobial efficacy of commonly used phenolics showed they were bactericidal, fungicidal, virucidal, and tuberculocidal 14, 61, 71, 73, 227, 416, 573, 732-738. One study demonstrated little or no virucidal effect of a phenolic against coxsackie B4, echovirus 11, and poliovirus 1 736. Similarly, 12% ortho-phenylphenol failed to inactivate any of the three hydrophilic viruses after a 10-minute exposure time, although 5% phenol was lethal for these viruses 72. However, results from these same studies have varied dramatically among laboratories testing identical products. The use of phenolics in nurseries has been questioned because of hyperbilirubinemia in infants placed in bassinets where phenolic detergents were used 739. This section reviews sterilization technologies used in healthcare and makes recommendations for their optimum performance in the processing of medical devices 1, 18, 811-820.