This application relates generally to the disinfection or sterilization of catheters, tubes, and connectors and more particularly to disinfection or sterilization of catheters, tubes and connectors used in dialysis, and more particularly, to peritoneal dialysis. Peritoneal dialysis (PD) is a treatment for chronic kidney disease (CKD), a condition in which the kidneys fail to remove waste and excess water from the bloodstream. In PD, a dialysis solution enters the abdomen through an access site. After a few hours, the fluid becomes saturated with waste and is eventually drained through a catheter. There are two types of PD. Under continuous ambulatory peritoneal dialysis (CAPD), patients change fluid four times a day. Continuous cycling peritoneal dialysis (CCPD), on the other hand, occurs at night through a machine that drains and refills the abdomen automatically. Unlike most hemodialysis (HD) patients, PD patients perform dialysis themselves. The protocol for sterilization procedures for PD patients involves multiple steps and is highly susceptible to imperfection and to bacterial contamination at every step. Peritonitis infection are the leading cause for a PD patient to transfer to HD. The incidence of peritonitis is 0.27 episodes/patient year for CAPD patients, and 1.48/patient year for CCPD patients. The main bacterium that causes this peritonitis is Staphylococcus aureus, which is part of the normal flora of the skin. Treatment for peritonitis includes long-term antibiotic treatment that causes multiple side effects and does not always eradicate the infection.
However, PD has several advantages over hemodialysis including mobility, fewer dietary restrictions, less cardiovascular stress and better blood pressure. Its disadvantages are peritonitis, increased risk of back pain, loss of protein, and lower survival rates than HD after diagnosis of cardiovascular disease.
Applicant of the subject application determines that new devices and methods for preventing or reducing infections in dialysis would be desirable.
In accordance with some embodiments, a device for use in dialysis includes an elongated tubular body having a first end, a second end, and a lumen extending between the first end and the second end, and a first UV source associated with the elongated tubular body, wherein the first UV source is configured to direct UV light for sterilizing at least a part of the elongated tubular body.
In accordance with other embodiments, a device for use in dialysis includes a transfer set having a first end, a second end, and a lumen between the first end and the second end, and a Y-set for detachably coupling to the transfer set, and a UV light source for disinfecting or sterilizing the transfer set and the Y-set.
In accordance with another embodiment, an assembly for disinfecting a connector includes a housing having an elliptical shape wherein the housing has an inner surface and an outer surface and a hinged cover. A UV light source is mounted inside the housing so that no portion of the UV light source contacts the housing inner surface A power source and an electronic circuit control electrical power to the UV light source. A reflective coating is place on at least a portion of the housing inner surface for enhancing the intensity of the UV light source to disinfect the connector. In one embodiment, the connector includes a transfer set connected to a Y-set, both connectors being formed from a material that is UV light transmissive. In this embodiment, the UV light source is mounted inside the elliptical housing at first foci F1, and the transfer set and Y-set connectors are positioned inside the elliptical housing at the second foci, F2. As a result, the intensity of the UV light source is maximized in order to disinfect or sterilize the transfer set and the Y-set connectors.
Other and further aspects and features will be evident from reading the following detailed description of the embodiments.
The drawings illustrate the design and utility of embodiments, in which similar elements are referred to by common reference numerals. These drawings are not necessarily drawn to scale. In order to better appreciate how the above-recited and other advantages and objects are obtained, a more particular description of the embodiments will be rendered, which are illustrated in the accompanying drawings. These drawings depict only typical embodiments and are not therefore to be considered limiting of its scope.
Various embodiments are described hereinafter with reference to the figures. It should be noted that the figures are not drawn to scale and that elements of similar structures or functions are represented by like reference numerals throughout the figures. It should also be noted that the figures are only intended to facilitate the description of the embodiments. They are not intended as an exhaustive description of the invention or as a limitation on the scope of the invention. In addition, an illustrated embodiment needs not have all the aspects or advantages shown. An aspect or an advantage described in conjunction with a particular embodiment is not necessarily limited to that embodiment and can be practiced in any other embodiments even if not so illustrated.
As used herein, to “disinfect” means to cleanse something so as to destroy or prevent the growth of disease-carrying microorganisms. Stedman's Medical Dictionary, 1995, p. 235. Further, use of the term “sterilize” means to make free from live bacteria or other microorganisms. Id. at p. 788.
Referring to
Referring to
As it can be seen more clearly in
With further reference to
Bacillus
anthracis - Anthrax
Bacillus
anthracis spores - Anthrax
Bacillus
magaterium sp. (spores)
Bacillus
magaterium sp. (veg.)
Bacillus
paratyphusus
Bacillus
subtilis spores
Bacillus
subtilis
Clostridium
tetani
Corynebacterium
diphtheriae
Ebertelia
typhosa
Escherichia
coli
Microccocus
candidus
Microccocus
sphaeroides
Mycobacterium
tuberculosis
Neisseria
catarrhalis
Phytomonas
tumefaciens
Proteus
vulgaris
Pseudomonas
aeruginosa
Pseudomonas
fluorescens
Salmonella
enteritidis
Salmonela
paratyphi - Enteric fever
Salmonella
typhosa - Typhoid fever
Salmonella
typhimurium
Sarcina
lutea
Serratia
marcescens
Shigella
dyseteriae - Dysentery
Shigella
flexneri - Dysentery
Shigella
paradysenteriae
Spirillum
rubrum
Staphylococcus
albus
Staphylococcus
aureus
Staphylococcus
hemolyticus
Staphylococcus
lactis
Streptococcus
viridans
Vibrio
comma - Cholera
Aspergillius
flavus
Aspergillius
glaucus
Aspergillius
niger
Mucor
racemosus A
Mucor
racemosus B
Oospora
lactis
Penicillium
expansum
Penicillium
roqueforti
Penicillium
digitatum
Rhisopus
nigricans
Chlorella
Vulgaris
Paramecium
Saccharomyces
carevisiae
Saccharomyces
ellipsoideus
Saccharomyces spores
Optionally, a heat sink 98 may be positioned at one or more locations within the housing 60. For example, some or all of first partition 78 may include a heat sink 98 in order to dissipate heat from the UV light source.
In one embodiment, it may be advantageous to include vent apertures 100 in the outer surface 66 of the housing 60 in order to vent any heat buildup inside the second or third chambers.
In another embodiment, an optional edge seal 102 is placed on all mating surfaces between the housing 60 and the hinge cover 62 in order to keep the environment inside the housing 60 free from contaminants, as well as seal the housing and the hinged cover so that no UV light is emitted from the housing 60 during operation.
As more clearly shown in
As shown in
The connectors 40,50 could also be rotated by 180° (or more) to make sure all regions of the connections receive the same sterilization dose. The rotation could be done with a stepper motor or other mechanism. Half way through the sterilization, the connectors could be rotated or turned.
In
One problem with the elliptical-shaped housing is that if the connector materials are not 100% transparent (i.e., transmissive to UV light), the side closest to the light source would receive more light, while the backside would receive less light. More light would be targeted to the front of the connectors (closest to the light source), and the less transmissive the materials, the less light reaches the backside of the connectors (furthest from the light source). In order to reduce the total disinfection or sterilization time, and better distribute the light more evenly, the following systems could be used. For example, as shown in
The multi-bulb system of
Alternatively in
Instead of using multiple light sources as shown in prior embodiments, two (or more) fluorescent light sources as shown in
In one embodiment, shown in
For assemblies having non-luer connectors, the connection could be made with another mechanism that is not a luer lock. One end can be made of a harder plastic, or quartz, while the other end is made of a UV transmissive elastomer like FEP. The elastomer then forms a secure bond by stretching over the harder connector.
In many of the embodiments disclosed herein, a cap is placed over the transfer set to ensure patient compliance with the disinfection or sterilization process. At the end of the dialysis, the patient would place a UVC transmissive cap over the transfer set. The user would then sterilize the transfer set and cap again. This alleviates the need for Beta-Dyne caps, and could be a more effective sterilization method.
To ensure patient compliance, features on the cap, and/or cap insertion tool, make the patient use the system to remove the cap. This system could be similar to medicine bottles that have features where you need to squeeze or push down the cap in order to be able to remove it. Features in the sterilization system could be used to accomplish this. Removing the tubing clamps from the transfer-set and the Y-set and placing them on the sterilization device would also ensure patient compliance to the system.
To improve transmissive properties of the connectors, instead of using a homogeneous material, the material could be filled with very transparent particles such as quartz. This could lead to a very transmissive and strong material that is easier to work with than quartz or glass.
If the sterilizing device were to live on or off the patient, making the battery or power supply easily removable and easily chargeable (such as using inductive charging) is preferred.
In one embodiment, multiple small white light LED's to be used in a pulsed white light system are placed on a flexible circuit. This flexible circuit with LED's could be wrapped over quartz tubing, like tape, to create a disinfection lumen so the connectors could be placed within. This would create a very small system that could live on the patients at all times. Further UV-LED's could be placed on the flexible circuit as well.
The reflective coating may comprise a laminated layer or a deposited layer of highly reflective composition, such as silicon oxide. Alternatives to the helical wrap configuration depicted, the fibers may also be configured as longitudinal elements parallel to the longitudinal axis of the dialysate chamber. In such a configuration, the lengths of the individual fibers may be varied to distribute the UV along the length of the chamber. The benefit of these configurations is to separate the source of the UV from the dialysate chamber. This allows the user to connect the bundled end of the cables from the transfer set housing to an external box and eliminating the need for circuitry within the transfer set itself.
The embodiment shown in
There is an interference between the male luer and the guard so that as the male luer is aligned and pushed towards the transfer set luer, the guard is also pushed into the recess in the housing, compressing the spring. Meanwhile, the female luer is gradually exposed through the valve of the guard as it is pushed deeper in the housing. Upon completion of dialysis, the guard automatically returns to the forward and protective position when the male luer is disconnected, due to the spring force unloading. (
In one embodiment, shown in
Several experiments have been conducted to determine the UVC transmissivity of various polymers and multiple layers of quartz tubes using off the shelf UV light sources.
Abstract
The purpose of this experiment was to determine the UVC transmissivity of various UV transmissive polymers. Topas 8007X10, PMP RT18, and PMP DX820 plaques of 2 mm thickness were obtained and cut into small pieces approximately 12.5 mm by 45 mm (the height and width of a standard cuvette). The pieces were placed into a Jenway Genova spectrophotometer against the left wall of the cuvette slot. The spectrophotometer was set to read at 255 nm, with an empty slot as the reference. The results show that 2 mm samples of Topas 8007X10, PMP RT18, and PMP DX820 have transmissivity rates of 49%, 27%, and 30%, respectively. The Brand UV cuvette macro, which was placed into the spectrophotometer intact, had a transmission rate of 42%.
Protocol
1. Material Preparation
Conclusion
The results from this experiment verify that Topas 8007X10 has the highest transmission rate at 255 nm out of the material samples. The transmission numbers from this experiment are slightly different from those obtained in transmission tests using the LED and the Thor Labs S120VC sensor. It is important to note that the pieces cut in this experiment were not the exact width of the cuvette slot. Therefore, the piece could not stand perpendicular to the bottom surface and had to lean against the left wall of the slot. This will affect transmission readings. However, the relative rates of transmission agree with Thor Labs sensor readings. The Topas 8007X10 is the most transmissive, followed by the Brand cuvette, PMP DX820, and PMP RT18.
Abstract
The purpose of this experiment was to determine the antimicrobial effectiveness of an off-the-shelf UV lamp through two different UV transmissive polymers. Topas COC 8007X10 and TPX PMP RT18 plaques (2 mm thickness) were obtained and cut into small rectangular pieces of similar shape and size. S. Aureus liquid culture (1 uL) sitting between two layers of the same material was exposed to a Spectronics DeGERM-inator UV 5D lamp for 60 seconds or 120 seconds. After 60 seconds, the PMP sample produced a significantly higher log reduction than Topas. After 120 seconds, almost all bacterial colonies were eliminated in both samples.
Protocol
1. Biosafety:
Using a dremel with a cutting tip, cut six small rectangular pieces from each of the PMP RT18 and Topas 8007X10 plaques.
Conclusion
The results from this experiment are promising for both the Topas and the PMP samples. Both material samples saw near complete elimination of bacteria after 120 seconds of exposure. The data in this experiment, however, is noisy and has outliers. This experiment should be repeated in order verify that the UV lamp is able to disinfect through both materials. From our transmissivity tests, Topas should have better results but the data from this experiment does not show this. Future modifications to the experiment include reducing the exposure time, and ensuring that UV exposure and bacteria collection is consistent throughout the experiment.
Abstract
The purpose of this experiment was to determine the antimicrobial effectiveness of an off-the-shelf UV lamp through multiple layers of UV transmissive polymers. Topas 8007X10 and Brand UV-cuvette samples were obtained and cut into small rectangular pieces of similar shape and size. S. Aureus liquid culture (1 uL) sitting beneath three layers of material was exposed to a Spectronics DeGERM-inator UV 5D lamp for 60 seconds or 120 seconds. A log 1 reduction of microorganisms was seen after 60 seconds of UV exposure. After 120 seconds, a log 3.3 reduction was seen for Topas while no colonies existed for the Brand UV-cuvette material.
Protocol
1. Biosafety:
At least 24 hours before starting an experiment, two inoculum samples with the same organism but with different volumes will be prepared (24 hours for bacteria, 48 hours for fungi). One will have a total volume of 5 mL, and this will be used throughout the experiment the next day. The other will have a total volume of 1 mL, which will be used to increase the OD of the sample if needed.
Conclusion
The results of this experiment were promising for both Topas 8007X10 and the Brand UV cuvette material. With 1 minute of exposure, we were able to achieve a log 1 reduction of S. Aureus for both materials. With 2 minutes of exposure, there was a 3.3 log reduction for Topas and complete elimination for the cuvette material. It is important to note that the bacteria count for the controls were very low in this experiment, thus the presence of a couple of colonies would significantly affect the log reduction. For each of the materials, the total thickness which the UV light had to travel through was 3.6 mm. Since we are stacking multiple layers of material on top of each other, there is also a small air gap in between the materials which will affect the refraction of light. We should expect better results if we are planning to use a thinner sample that consists of a single layer.
Abstract
The purpose of this experiment was to determine the antimicrobial effectiveness of an off-the-shelf UV lamp on multiple layers of quartz tubes. For this experiment, the lumen of a 4 mm OD quartz tube (2 mm ID) was inoculated with 1 uL of S. Aureus liquid culture. The 4 mm OD tube was placed inside of a 6 mm OD quartz tube, which was then subsequently placed into a 10 mm OD quartz tube. The setup was directly exposed to a Spectronics DeGERM-inator UV 5D lamp for 10 seconds and for 30 seconds. Our results indicate that we were able to achieve a log 1 reduction of S. Aureus in 10 seconds, and over a log 3 reduction in 30 seconds. These results suggest that a quartz transfer set can be sterilized in 30 seconds.
1. Biosafety:
Conclusion
In this experiment, we were able to achieve a good kill rate on the quartz tubes with 30 seconds of sterilization time. While the inoculation control (IC) revealed that we were not effectively collecting all of the bacteria, the results were mostly consistent across samples. In this experiment, the UV source was placed approximately two inches away from the inoculation point. It is possible that this distance will be smaller in a commercial device, thus decreasing the amount of sterilization time needed. There are many variations in this experiment, since no consistent fixtures were used. Overall, the results suggest that UV light is able to effectively disinfect through multiple layers of quartz.
The fluid from the dialysate bag 18 (
Although particular embodiments have been shown and described, it will be understood that they are not intended to limit the claimed inventions, and it will be obvious to those skilled in the art that various changes and modification may be made without departing from the spirit and scope of the claimed inventions. The specification and drawings are, accordingly, to be regarded in an illustrative rather than restrictive sense. The claimed inventions are intended to cover alternatives, modifications, and equivalents.
This application claims priority to and the benefit of U.S. Provisional Application No. 61/757,999 filed Jan. 29, 2013, the entire disclosure of which is expressly incorporated by reference herein.
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Number | Date | Country | |
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61757999 | Jan 2013 | US |