This invention relates to biological indicators and, more particularly, to biological indicators that are treated to reduce their resistance to steam.
Biological indicators, which typically comprise a carrier and test organisms deposited on the carrier, are used to monitor steam sterilization processes. The biological indicator is placed in a sterilization chamber and subjected to a steam sterilization cycle along with the load intended for sterilization (e.g., a medical device). Following the sterilization cycle, the biological indicator is exposed to a growth media and incubated for the purpose of determining if any of the test organisms are viable. A successful sterilization cycle results in a complete inactivation (no outgrowth) of the test organisms. An unsuccessful sterilization cycle results in an incomplete inactivation (outgrowth detected) of the test organisms.
Biological indicators typically comprise standardized preparations of specific test organisms with known characteristics (e.g., a defined population, purity, resistance characteristic, etc.). The test organisms may be microorganisms capable of forming endospores. As such, the test organisms may be in the “spore state.” A biological indicator may be prepared by depositing the test organisms from a spore crop onto a carrier. The carrier may comprise a substrate such as filter paper or an interior surface of a self-contained biological indicator (SCBI).
The prior art methods for producing biological indicators are typically contingent upon multiple components of the biological indicator producing consistent results to maintain predictable resistance levels. A problem in the art relates to the fact that at times unexplained results occur when using biological indicators that can be traced to inconsistencies with respect to the resistance of the biological indicator. With this invention it is possible to control biological indicator resistance levels to meet customer requirements without requiring excessive amounts of screening and selection of manufactured spores to find those that show the desired resistance levels. As such, with this invention, it is possible to use fewer batches of test organisms requiring cultivation to meet customer needs for providing biological indicators with desired resistance levels.
This invention relates to a biological indicator, comprising: a carrier inoculated with a test organism and an effective amount of a carbohydrate to reduce the resistance of the biological indicator to steam sterilization. This invention is advantageous for biological indicators wherein the test organisms exhibit resistance levels that are higher than desired for their anticipated end use.
In an embodiment, this invention relates to a steam sterilization process, comprising: exposing an article to be sterilized and the above-indicated biological indicator to steam.
In an embodiment, this invention relates to a process for determining the effectiveness of a steam sterilization process, comprising: exposing an article to be sterilized and the above-indicated biological indicator to steam; and incubating the biological indicator in the presence of a growth media to determine whether the sterilization process is effective.
All ranges and ratio limits disclosed in the specification and claims may be combined in any manner. It is to be understood that unless specifically stated otherwise, references to “a,” “an,” and/or “the” may include one or more than one, and that reference to an item in the singular may also include the item in the plural.
The phrase “and/or” should be understood to mean “either or both” of the elements so conjoined, i.e., elements that are conjunctively present in some cases and disjunctively present in other cases. Other elements may optionally be present other than the elements specifically identified by the “and/or” clause, whether related or unrelated to those elements specifically identified unless clearly indicated to the contrary. Thus, as a non-limiting example, a reference to “X and/or Y,” when used in conjunction with open-ended language such as “comprising” can refer, in one embodiment, to X without Y (optionally including elements other than Y); in another embodiment, to Y without X (optionally including elements other than X); in yet another embodiment, to both X and Y (optionally including other elements); etc.
The word “or” should be understood to have the same meaning as “and/or” as defined above. For example, when separating items in a list, “or” or “and/or” shall be interpreted as being inclusive, i.e., the inclusion of at least one, but also including more than one, of a number or list of elements, and, optionally, additional unlisted items. Only terms clearly indicated to the contrary, such as “only one of” or “exactly one of,” may refer to the inclusion of exactly one element of a number or list of elements. In general, the term “or” as used herein shall only be interpreted as indicating exclusive alternatives (i.e. “one or the other but not both”) when preceded by terms of exclusivity, such as “either,” “one of,” “only one of,” or “exactly one of.”
The phrase “at least one,” in reference to a list of one or more elements, should be understood to mean at least one element selected from any one or more of the elements in the list of elements, but not necessarily including at least one of each and every element specifically listed within the list of elements and not excluding any combination of elements in the list of elements. This definition also allows that elements may optionally be present other than the elements specifically identified within the list of elements to which the phrase “at least one” refers, whether related or unrelated to those elements specifically identified. Thus, as a non-limiting example, “at least one of X and Y” (or, equivalently, “at least one of X or Y,” or, equivalently “at least one of X and/or Y”) can refer, in one embodiment, to at least one, optionally including more than one, X, with no Y present (and optionally including elements other than Y); in another embodiment, to at least one, optionally including more than one, Y, with no X present (and optionally including elements other than X); in yet another embodiment, to at least one, optionally including more than one, X, and at least one, optionally including more than one, Y (and optionally including other elements); etc.
The transitional words or phrases, such as “comprising,” “including,” “carrying,” “having,” “containing,” “involving,” “holding,” and the like, are to be understood to be open-ended, i.e., to mean including but not limited to.
The term “inactivation” of a test organism (e.g., bacterial spores) refers to the loss of ability of the test organism to germinate, outgrow and/or multiply.
The term “log reduction” is a mathematical term to show the number of live test organisms (e.g., bacterial spores) inactivated by contacting the test organisms with a sterilant. A “4 log reduction” means that the number of live test organisms is 10,000 times smaller. A “5 log reduction” means that the number of live test organisms is 100,000 times smaller. A “6 log reduction” means that the number of live test organisms is 1,000,000 times smaller.
The term “sterilization” is often taken to refer to a process wherein a total absence of living test organisms is achieved. However, this term is also used herein to refer to processes that are less rigorous than sterilization processes. These may include, for example, disinfection, sanitization, decontamination, cleaning, and the like. The sterilization processes provided for herein may be conducted for an effective period of time to achieve at least about a 4 log reduction, or at least about a 5 log reduction, or at least about a 6 log reduction in the number of test organisms capable of germination, outgrowth and/or multiplication.
The term “biological indicator” refers to a microbiological test system which comprises a carrier and test organisms deposited on the carrier. The biological indicator may be used in combination with a process indicator.
The term “carrier” refers to a supporting material onto which test organisms may be deposited.
The term “inoculated carrier” refers to a carrier onto which test organisms have been deposited.
The term “test organism” refers to a microorganism which is more resistant to a sterilization process than the organisms to be destroyed by the sterilization process. The test organisms may comprise spores, for example, bacterial spores.
The term “D-value” or “decimal reduction value” refers to the time required to achieve inactivation of 90% of a population of test organisms (also known as a 1 log reduction). The D-value may be expressed in minutes.
The term “Biological Indicator Evaluation Resistometer vessel” or “BIER vessel” refers to an apparatus that provides environmental conditions for evaluating the resistance of a biological indicator to steam sterilization. Temperature, pressure, and time are the primary variables which influence the rate of microbial destruction in the BIER vessel. The more resistant spores survive longer in the BIER vessel than the less resistant spores. A BIER vessel that may be used is illustrated in
The test organism may comprise bacterial spores. The test organism may comprise spores of the Bacillus or Clostridia genera. The test organism may comprise spores of Geobacillus stearothermophilus, Bacillus atrophaeus, Bacillus sphaericus, Bacillus anthracis, Bacillus pumilus, Bacillus coagulans, Clostridium sporogenes, Clostridium difficile, Clostridium botulinum, Bacillus subtilis globigii, Bacillus cereus, Bacillus circulans, or a mixture of two or more thereof. The test organism may comprise spores of Geobacillus stearothermophilus.
The carbohydrate may comprise a compound represented by the empirical formula Cm(H2O)n where m and n are numbers. The carbohydrate may comprise carbon, hydrogen and oxygen atoms, with a hydrogen:oxygen ratio of 2:1. The carbohydrate may be a saccharide. The saccharide may be a monosaccharide, disaccharide, oligosaccharide, polysaccharide, or a mixture of two or more thereof. The monosaccharides and disaccharides may be referred to as sugars. The monosaccharides may be particularly useful. The monosaccharides may include xylose, glucose (dextrose), fructose, galactose, arabinose, ribulose, mannose, or a mixture of two or more thereof. The monosaccharide may comprise triose, tetrose, pentose, hexose, heptose, octose, nonose, or a mixture of two or more thereof. Pentose may be particularly useful. The carbohydrates may be obtained from sugar cane, sugar beet, corn syrup, and the like. The carbohydrates may be synthetically made. Nonose may be synthetic as are some diet based sugar alcohols which may be used.
The biological indicator may be used with any steam sterilization process. The biological indicator along with the articles to be sterilized may be exposed to steam during the sterilization process. The steam sterilization process may be conducted in a steam sterilization chamber. The steam sterilization chamber may comprise an autoclave. The temperature within the steam sterilization chamber may typically be in the range from about 121° C. to about 135° C. The biological indicator may be placed in the sterilization chamber in one or more locations where it is difficult for steam to reach to verify that the steam is penetrating these locations. Upon completion of the sterilization process, the biological indicator may be incubated in the presence of a growth media to determine whether the sterilization process is effective.
The biological indicator may comprise a carrier inoculated with an aqueous carbohydrate solution containing test organisms. The carrier may comprise a porous material or a non-porous material. The carrier may comprise a solid material. The carrier may comprise any material that does not dissolve or deteriorate during the sterilization or incubation processes. The carrier may comprise paper, metal, glass, ceramics, plastic, membranes, or a combination of two or more thereof. The metal may comprise aluminum or steel. The plastic may comprise a polyolefin, polystyrene, polycarbonate, polymethacrylate, polyacrylamide, polyimide, polyester, and the like. The carrier may comprise a film. The carrier may be in the form of a spun or unwoven felt. The carrier may comprise a mat of compressed fibers. The carrier may comprise a porous material made of sintered glass, glass fibers, ceramic, synthetic polymer, or a combination of two or more thereof. The carrier may comprise filter paper or absorbent paper. The carrier may comprise a cellulose pad.
The carrier may be positioned in an SCBI. The carrier may comprise a surface in a compartment of an SCBI. The carrier or interior surface of the SCBI may be inoculated with an aqueous carbohydrate solution containing test organisms. A diagrammatic representation of this process is given in
The SCBI may be in the form illustrated in
When used in a sterilization process, the cap 110 is held in an open position as illustrated in
After the sterilization process is complete, the SCBI 100 is activated by screwing the cap 110 downward into a closed position as shown in
While in container 120, the test organisms and growth media may be incubated for a sufficient period of time to determine the viability of the test organisms. At the end of the incubation period, the SCBI is evaluated to determine whether any test organisms survive the sterilization process. If the test organisms survive the sterilization process, the sterilization process is not considered to have been successful. On the other hand, if the test organisms are inactivated, then the sterilization process is considered to be successful.
A more detailed description of the SCBI 100 is disclosed in U.S. Pat. No. 8,173,388, which is incorporated herein by reference. It should be noted that SCBI configurations other than those depicted in
The SCBI 100 may be used with a test pack as depicted in
Another modification of the above forms of the biological indicator may be a rapid read or fast acting biological indicator. In this form the biological indicator may be mated to a dedicated instrument (reader) that detects early signals of test organism viability.
The carrier may be inoculated with an aqueous carbohydrate solution containing a suspension of the test organisms. The concentration of carbohydrate in the aqueous carbohydrate solution may range from about 1 to about 300 grams per liter (g/L), or from about 5 to about 150 g/L, or from about 10 to about 75 (g/L). The molar concentration for the carbohydrate in the aqueous carbohydrate solution may be in the range from about 0.001 M to about 10 M, or from about 0.01 M to about 1 M. The concentration of the test organism in the aqueous carbohydrate solution may range from about 104 to about 108 colony forming units (cfu) per milliliter (ml), or from about 105 to about 107 cfu/ml.
Referring to
The biological indicator may be used to release loads or validate sterilization chamber functionality in healthcare settings. The biological indicator may also be used to determine if biological indicator waste has been properly decontaminated. In the scientific setting, the biological indicator may be used to validate the functionality of sterilization chambers, release loads of goods, or validate that a process meets required functionality. A valid biological indicator for a given process requires a specific resistance and therefore biological indicator manufacturers may strive to manufacture the biological indicator with targeted resistance characteristics.
To insure that the biological indicator lot is appropriate for its intended use, it may be characterized by comparison to a pre-determined resistance. For use in healthcare applications the pre-determined resistance may be established by the U.S. Environmental Protection Agency (EPA) or the U.S. Food and Drug Administration (FDA). For other non-regulated applications it may be established by customer preference. Even in the regulated applications it may be desirable to target a resistance at the low end of the mandated range.
The resistance for the biological indicator may be expressed as its D-value, which quantifies the time required to achieve inactivation of 90% of the population of test organisms. In the case of steam SCBIs the D-value may be measured in minutes. The D-value may be in the range from about 0.01 to about 5 minutes, or from about 0.1 to about 5 minutes.
Referring to
The resistance of a biological indicator may be targeted to meet customer and/or regulatory requirements. For example, a healthcare biological indicator may be required to meet a targeted D-value for a 121° C. sterilization cycle of 1.5-3.0 minutes in a BIER. This resistance level may be required by regulatory guidance documents and expected by healthcare consumers. Other standard cycles may vary in the desired or regulated D-value range.
The production of biological indicators may be open to many variables. The specific strain of spore used, the process by which the selected test organism has been cultivated, the scale of cultivation performed, the materials of construction of the carrier and the constituents of the growth media or other ingredients used in the carrier are all components of the biological indicator that may impact resistance. Minor changes in these components may have significant effects upon the measured resistance characteristics of the biological indicator. This can lead to batches of biological indicators that do not meet the established resistance specifications.
In the prior art, the variability inherent to biological indicator fabrication has led to problems with the manufacturing process and an inability to deliver the desired final product to the customer. Variability in cultivation of the test organism, changes in suppliers of the materials of construction, or lot-to-lot variability in the components of the growth media are a few of the examples of very minor modifications that can lead to unwanted changes in resistance in a biological indicator line that is in production over a period of time.
Additionally, use of specific validated materials of construction in biological indicators allows for limited ability to alter the resistance of a given product to meet customer and regulatory requirements. For example, if a specific product has a D-value of 2.90 minutes in the required conformation, this product will be unlikely to meet the needs of a customer looking for a reduced resistance with a D-value of 1.90 minutes. Both these values may be within the mandated range. To prepare a product having a reduced resistance, the manufacturer may have to cultivate additional lots of test organisms in the hope that the inherent variability of the process would uncontrollably yield the desired lower resistance.
This invention relates to a biological indicator comprising a carrier which is inoculated with an aqueous carbohydrate solution containing a suspension of test organisms. The introduction of the carbohydrate to the biological indicator can be used to reduce the resistance of the biological indicator to steam sterilization. This allows for facilitated production of a biological indicator with a targeted reduced resistance to steam sterilization.
The biological indicator may be used by subjecting it to the same steam sterilization medium and treatment as the articles for which sterile conditions may be sought. Steam may pass into the area where the biological indicator is located thereby exposing the biological indicator to the same sterilization process as the articles being sterilized. Following sterilization, growth media may be brought into contact with the biological indicator. The growth media may be in the form of a liquid. The growth media may comprise a buffered aqueous solution. Any procedure whereby the biological indicator is brought into contact with the growth media under conditions which allow for growth of the test organisms, if it still exists, may be used. The growth media may be present in the sterilization chamber in powder or tablet form and, after sterilization, sterile water may be added such that the biological indicator comes into contact with the aqueous incubation medium.
The growth media may comprise one or more nutrient sources. The nutrient source may be used to provide energy for the growth of any of the test organisms that may survive the sterilization process. Examples of the nutrient sources may include pancreatic digest of casein, enzymatic digest of soybean meal, sucrose, dextrose, yeast extract, L-cystine, and mixtures of two or more thereof.
A microbial growth indicator, which changes color or native state, in the presence of viable test organisms may be used with the growth media. The growth indicator may be dispersed or solubilized in the growth media and impart an initial color to the growth media. The growth indicator may also impart a color change in the growth media upon test organism growth. Growth indicators which may be employed include pH-sensitive dye indicators (such as bromothymol blue, bromocresol purple, phenol red, etc. or combinations thereof), oxidation-reduction dye indicators (such as methylene blue, etc.). The use of these microbial growth indicators may result in a change in color in response to a phenomenon of microorganism growth, such as changes in pH, oxidation-reduction potentials, enzymatic activity, as well as other indications of growth.
The growth media may further comprise one or more pH buffers, one or more neutralizers, one or more agents for maintaining osmotic equilibrium, or a mixture of two or more thereof. The pH buffers may include K2HPO4, KH2PO4, (NH4)2HPO4, 2,2-Bis(hydroxylmethyl)-2,2′,2″-nitrilothiethanol (Bis Tris), 1,3-Bis[tris(hydroxymethyl)methylamino] propane (Bis-Tris Propane), 4-(2-Hydroxyethyl)piperazine-ethanesulfonic acid (HEPES), 2-Amino-2-(hydroxymethyl)-1,3-propanediol (Trizma, Tris base), N-[Tris(hydroxymethyl)methyl]glycine (Tricine), Diglycine (Gly-Gly), N,N-Bis(2-hydroxyethyl)glycine (Bicine), N-(2-Acetamido)iminodiacetic acid (ADA), N-(2-Acetamido)-2-aminoethanesulfonic acid (aces), 1,4-Piperazinediethanesulfonic acid (PIPES), β-Hydroxy-4-morpholinepropanesulfonic acid (MOPSO), N,N-Bis(2-hydroxyethyl)-2-aminoethanesulfonic acid (BES), 3-(N-Morpholino)propanesulfonic acid (MOPS), 2-[(2-Hydroxy-1,1-bis(hydroxylmethyl)ethyl)amino]ethanesulfonic acid (TES), 3-(N,N-Bis[2-hydroxyethyl]amino)-2-hydroxypropanesulfonic acid (DIPSO), 4-(N-Morpholino)butanesulfonic acid (MOBS), 2-Hydroxy-3-[tris(hydroxymethyl)methylamino]-1-propanesulfonic acid (TAPSO), 4-(2-Hydroxyethyl)piperazine-1-(2-hydroxypropanesulfonic acid hydrate (HEPPSO), Piperazine-1,4-bis(2-hydroxypropanesulfonic acid) dihydrate (POPSO), 4-(2-Hydroxyethyl)-1-piperazine propanesulfonic acid (EPPS), N-(2-Hydroxyethyl)piperazine-N′-(4-butanesulfonic acid) (HEPBS), [(2-Hydroxy-1,1-bis(hydroxymethyl)ethyl)amino]-1-propanesulfonic acid (TAPS), 2-Amino-2-methyl-1,3-propanediol (AMPD), N-tris(Hydroxymethyl)methyl-4-aminobutanesulfonic acid (TABS), N-(1,1-Dimethyl-2-hydroxyethyl)-3-amino-2-hydroxypropanesulfonic acid (AMPSO), 2-(Cyclohexylamino)ethanesulfonic acid (CHES), 3-(Cyclohexylamino)-2-hydroxyl-1-propanesulfonic acid (CAPSO), 2-Amino-2-methyl-1-propanol (AMP), 3-(Cyclohexylamino)-1-propanesulfonic acid (CAPS), 4-(Cyclohexylamino)-1-butanesulfonic acid (CABS), 2-(N-Morpholino)ethanesulfonic acid hydrate (MES), N-(2-Acetamido)-2-aminoethanesulfonic acid (ACES), and mixtures of two or more thereof.
The neutralizers may include but are not limited to sodium thioglycollate, sodium thiosulfate, catalase, sodium bisulfate, sodium bisulfite lecithin, polysorbate 20, polysorbate 80, calcium bicarbonate, and mixtures of two or more thereof.
The agents for maintaining osmotic equilibrium may include sodium salt, potassium salts, magnesium salts, manganese salts, calcium salts, metallic salts, sodium chloride, potassium chloride, magnesium sulfate, iron chloride, and mixtures of two or more thereof.
The growth media may comprise an aqueous composition comprising: water; from about 0.01 to about 100 grams per liter (g/l), or from about 0.1 to about 50 g/l, of one or more nutrient sources; from about 1.0×10−5 to about 10 g/l, or from about 1.0×10−4 to about 1.0 g/l of one or more microbial growth indicators; up to about 5000 g/l, or from about 0.001 to about 5000 g/l, or from about 0.1 to about 1000 g/l, of one or more pH buffers; up to about 100 g/l, or from about 0.01 to about 100 g/l, or from about 0.1 to about 50 g/l, of one or more neutralizers; up to about 50 g/l, or from about 0.1 to about 50 g/l, or from about 0.1 to about 25 g/l, of one or more agents for maintaining osmotic equilibrium.
In the following examples, the test organism is prepared using a standard lot of Geobacillus stearothermophilus spores suspended in an aqueous carbohydrate solution. In these examples, xylose and dextrose are used as the carbohydrates. Comparative examples are also provided wherein the carbohydrate is not used. In each case, the aqueous suspension is placed in a vial and allowed to dry. This is shown in
In these examples, the biological indicators are tested for resistance to steam sterilization using the biological indicator evaluation resistor (BIER) vessel depicted in
Referring to
The results for the following Examples 1-4 are shown in
The biological indicators are evaluated for resistance to steam at 121° C. in the BIER vessel. A first set of biological indicators is derived from a suspension of Geobacillus stearothermophilus spores in water. A second set of biological indicators is derived from a suspension of the spores in a 1.67 M xylose solution. The resulting kill kinetics are significantly shorter when the second set of biological indicators derived from the xylose solution (a 6 log reduction in approximately 5 minutes) is used as compared to the first set of biological indicators where the xylose solution is not used (a 6 log reduction in approximately 20 minutes). This is shown in
The tests conducted in Example 1 are repeated except that they are performed at 132° C. in the BIER vessel. This testing shows a reduction in resistance from approximately 5 minutes (without xylose) to approximately 1.5 minutes (with xylose). The kill kinetics are faster at 132° C. than at 121° C. The addition of xylose reduces resistance even further. This is shown in
Additional testing is performed to evaluate the impact of the quantity of xylose that is used. The xylose concentration that is used ranges from no xylose being used (
The tests conducted in Example 1 are repeated except that different carbohydrates are used. In these tests, biological indicators derived from suspensions of Geobacillus stearothermophilus spores in 0.5M solutions of xylose are compared to biological indicators derived from suspensions of the spores in 0.5M solutions of dextrose and biological indicators derived from suspensions of the spores in water without a carbohydrate being used. The results are shown in
While the invention has been explained in relation to various embodiments, it is to be understood that various modifications thereof will become apparent to those skilled in the art upon reading the specification. Therefore, it is to be understood that the invention disclosed herein includes any such modifications that may fall within the scope of the appended claims.