Biological microorganism use in terrorism; cooking spray as bronchoscope lubricant; disaster planning; surgical site infections

AORN Journal,  March, 2006  by Joan Blanchard

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QUESTION: In our hospital, we check the steam autoclave with BadUus teorothermophilus (B stearothermophilus) and the ethylene oxide autoclave with Bacillus subtilis (B subtilis). We are concerned about storing these indicators in a safe place because we are afraid they could be used for bioterrorist purposes. What agents could be used for bioterrorism?

ANSWER: Geobacillus stearothermophilus [G stearothermophilus] (ie, formerly B stearothermophilus) is a heat resistant, spore-forming microorganism that does not produce toxins and is nonpathogenic. It is used as a biological indicator to check the effectiveness of steam autoclaves. (1) Bacillus subtilis, a spore-forming, heat resistant microorganism that also is considered to be nonpathogenic, is used as a biological indicator for checking the effectiveness of ethylene oxide autoclaves. (2,3) Neither microorganism can be disseminated easily, and because they are not pathogenic, G stearothermophilus and B subtilis would not be likely agents to be used in a bioterrorist attack. These products should be stored according to the manufacturer's guidelines. When the biological indicators have been used, they may be disposed of in the hazardous trash. If there are biological indicator samples that are positive after testing they should be autoclaved before disposal. (4)

The Centers for Disease Control and Prevention (CDC) categorizes agents that are as the most likely to be used in bioterrorist attacks. (5) These agents

* can be disseminated easily,

* cause diseases that may be transmitted from person to person, and

* have a mortality rate that could result in a public disaster, and thus potentially cause panic and social disturbance.

Public health departments need to be prepared to deal with the effects of these agents. (5) Following are the agents of concern and how they could be disseminated.

* Anthrax (ie, Bacillus anthracis)--Anthrax can be acquired through a cut or skin abrasion, by inhalation of spores, or by ingestion.

* Botulism (ie, Clostridium botulinum toxin)--Botulinum toxin is absorbed through wounds or is ingested from food contaminated with the toxin. The man-made botulinum toxin also can be aerosolized.

* Plague (ie, Yersinia pestis)--Plague may be spread by fleas. As a bioterrorist agent, it could be spread via an airborne route.

* Smallpox (ie, Variola major)--Smallpox is spread when respiratory droplets from someone who is infected become airborne.

* Tularemia (ie, Francisella tularensis)--Tularemia is spread by aerosolization, ingestion of contaminated food or water, or inoculation when handling infected animals.

* Viral hemorrhagic fevers (ie, floviruses/filoviruses [eg, Ebola, Marburg]; arenaviruses [eg, Lassa, Machupo])--These diseases can be spread from person to person via body secretions. (6)

For more information on these agents, visit the Centers for Disease Control and Prevention at http://www.cdc.gov/mmwr /preview/mmwrhtml/rr4904a1.htm.

QUESTION: A physician at our fadlity wants to use cooking spray to lubricate his bronchoscopes. He does not believe that standard water-based lubricants are as effective as a cooking spray lubricant. The physician claims that other medical centers are using cooking spray to lubricate bronchoscopes. Is this an appropriate lubricant to use? Is it safe practice? What are the possible outcomes of using cooking spray as a lubricant for bronchoscopes?

ANSWER: Using cooking spray as a lubricant for bronchoscopes that will be used on patients during bronchoscopy is not appropriate. This would be an off-label use of the cooking spray, and the manufacturers of both bronchoscopes and cooking sprays do not support use of cooking spray as a lubricant for bronchoscopes.

Following are questions that also should be asked when considering use of a cooking spray as a lubricant for bronchoscopes.

* Is there a potential for infection from the cooking spray residue left in the lungs after the bronchoscopy is completed?

* Is there concern about residue encapsulation, blockage, or tissue reaction from residue in the bronchial tree?

* Is the product sterile?

* Is it hazardous to use in an OR setting? Thus far, there is no research to demonstrate

* whether bronchoscope lubrication is an appropriate application of cooking spray,

* whether patient outcomes might be affected by residual cooking spray or possible encapsulation or blockage of the bronchial tree, and

* whether cooking spray has been linked to health care-acquired infections.

Containers of cooking spray do not have statements about sterility on their labels, but they do include warnings about fire hazards. Fires occur when the elements that support combustion (ie, a fuel source, an oxidizer, an ignition source) come together. These three elements are referred to as the fire triangle. (7) All three elements may be present when cooking spray is used as a lubricant during a bronchoscopy.

Fuel. The original content labels of two popular cooking-spray containers were reviewed. The ingredients listed for one cooking spray were canola oil, grain alcohol, soy lecithin, and a propellant. The warning label states, "Flammable. Do not spray on heated surfaces or near open flame." (8) Another cooking spray product listed 100% extra virgin olive oil, soy lecithin, water, and propellant on its content label. Its warning label stated, "Flammable spray: Do not spray on or store near an open flame." (9) a serious concern exists, therefore, regarding the possibility of a fire when using these products.