Patent Application
20070196328
The present invention relates to the field of disinfection and preservation of surfaces of medical equipment, in particular medical equipment for use in extracorporeal blood circulation systems.
Various medical devices come in contact with biological fluids during use. This is the case in particular with medical devices used in the extracorporeal blood circulation. These devices include, for example, dialyzers, blood filters and adsorbers. In all cases in which a fluid is re-infused into humans or animals after coming in contact with the medical device, it is essential for the surface coming in contact with the fluid to be free of pathogens. In most cases, this is achieved by heat sterilization of the medical device. In other cases, heat sterilization cannot be performed effectively because the functionality of the medical device would be impaired by such sterilization. This is the case with adsorbers in particular which have proteins bound as ligands.
Such adsorbers of this type are known from the state of the art. For example, EP 0 222 146 describes an adsorbent for removal of antigen-antibody complexes. The protein C1q functions as the ligand here.
Hemodialyzers are sometimes reused after the first treatment. Even in these cases, it is necessary to regenerate the dialyzer through effective decontamination prior to the next use. This may be performed by washing with a disinfectant as described in U.S. Pat. No. 5,192,459. The various acids are proposed as disinfectants. In WO 00/27439, however, oxidizing agents are used in the presence of urea as a disinfectant.
None of the aforementioned methods can be used for effective decontamination of a protein-containing adsorbent while maintaining functionality, however. In the past, agents containing heavy metals or sodium azide and thus having a low biocompatibility have been used for this purpose. The complex complete removal of these disinfectants according to the state of the art is therefore absolutely essential prior to use of the medical device.
The object of the present invention is to make available a disinfectant and preservative that permits effective decontamination of medical devices, in particular medical devices for use in an extracorporeal circulation, while at the same time being toxicologically safe.
These objects are achieved according to this invention by using a solution containing biguanide according to Claim 1. Additional advantageous embodiments are the subject matter of the subclaims.
This invention is based on the surprising finding that solutions containing a biguanide compound are excellently suitable for disinfection of medical devices for use in an extracorporeal blood circulation. These solutions, which have previously been used as wound antiseptics and preservatives for ophthalmic preparations are characterized by an excellent biocompatibility and a low toxicity for humans. Nevertheless, the solution may achieve comparable or even better results in disinfection and preservation of the aforementioned medical equipment than the substances which have a higher toxicity and have been used previously in the state of the art.
Solutions containing biguanides are known as wound antiseptics in the state of the art (EP 0 450 117). The use of biguanides for coating medical devices for extracorporeal treatment is described in EP 0 456 093. Poly(hexamethylene) biguanide, which has a molecular weight of 2900 to 15,000, is mentioned in EP 0700249 as being an especially effective disinfectant. This anti-infective agent is also distributed for wound treatment by the company Fresenius Kabi under the brand name LAVASEPT®. Another known use of such a solution is for disinfection and preservation of contact lenses.
Within the context of the present invention, preferably poly(hexamethylene)biguanide having a molecular weight of 2900 to 15,000 (PHMB) is used as the biguanide compound. An especially preferred disinfection solution contains PHMB in a concentration of 0.01% to 0.5% by weight, where concentrations of 0.02% to 0.06% by weight are especially advantageous. A neutral buffer containing phosphate, and preferably also containing the following substances is used as the medium: sodium citrate dihydrate, sodium acetate trihydrate, sodium chloride, sodium monohydrogen phosphate, potassium dihydrogen phosphate. Such a solution effectively disinfects and preserves the aforementioned medical devices and is in compliance with the requirements of the “antimicrobial effectiveness tests” described in USP 27 (United States Pharmacopoeia).
Another important advantage of the inventive approach is that the functionality of proteins is preserved. In addition, it has been demonstrated that after filling a protein-containing adsorber with the solution described above as a preservative agent prior to a storage period of four weeks in the dark at a temperature of 37° C., there was no detectable loss of functionality of the proteins. In the case of storage at 4° C., much longer storage is possible without any loss of functionality. Therefore, the present invention also includes a method for disinfection and preservation of surfaces of a medical device using a solution according to Claim 1 with the steps of filling the medical device with the solution containing a biguanide compound and to then store the medical device in a filled state.
In addition, another advantageous aspect of the inventive use of the solution is that the preservative can be completely rinsed out of the medical device prior to its use in an extracorporeal circulation. To check on the thoroughness of rinsing out the inventive solution according to claim 1, another aspect of the present invention is to add a nontoxic additive that can be detected spectroscopically to the solution. Therefore, this invention also includes a solution for disinfection or preservation of medical equipment characterized in that it contains a biguanide compound and a spectroscopically active nontoxic additive. In a particularly preferred embodiment, tryptophan in a concentration of at least 0.005% by weight is used as an additive. It is especially preferable to add tryptophan in a concentration of 0.01% to 0.1% by weight. Tryptophan absorbs UV light at a wavelength of 280 nm and a concentration determination may be performed spectroscopically in a solution on the basis of the Lambert-Beer law. Tryptophan itself does not have any disinfectant effect. It is therefore used exclusively to measure the progress of the rinsing operation and a preservative step which follows the treatment. Experiments have shown that tryptophan is removed from the column to the same extent as PHMB in the rinsing operation.
Examples that should contribute toward explaining the invention without restricting this invention in any way are presented below.
A solution containing the following ingredients is prepared as a disinfectant and preservative solution for an adsorber:
The ingredients are dissolved, the solution is adjusted to a pH of 7.0 and topped off to yield 1 L.
An adsorber column of the type IMMUNOSORBA (Fresenius Adsorber Technology GmbH) is used to remove antibodies from blood plasma and binds the antibodies via protein A of Staphylococcus aureus. This adsorber column is filled with a solution according to Example 1. The disinfectant/preservative effect of the solution corresponds to the specifications of USP 27.
Adsorber columns filled according to Example 2 are stored in the absence of light for a long period of time. In storage at 40° C., no loss of functionality could be detected before a period of 4 weeks. After 35 weeks of storage at 37° C., the Ig binding capacity of the column for antibodies was reduced by 20%. In 46 weeks of storage at 4° C., the column filled according to Example 2 did not show any loss of functionality.
An adsorber column filled according to Example 2 is connected to an apparatus of type CITEM-10 (Fresenius Adsorber Technology). The column is rinsed out by a rinsing program provided with it.
To do so, first the column is rinsed with 300 mL of a buffer 1 having the following composition:
Then the column is rinsed with 100 mL of an eluent having the following composition:
and then rinsed again with 350 mL more of buffer 1. After rinsing a treatment simulation was performed using 3 liters of blood plasma.
The process of rinsing out the preservative solution within the column preparation step was monitored by UV detection of the amino acid tryptophan using the CITEM 10 monitor.
The following results were observed:
No additional difference in the rinsing behavior of the new column and the column loaded with plasma could be ascertained.
| Number | Date | Country | Kind |
|---|---|---|---|
| 10 2004 024 140.6 | May 2004 | DE | national |
| Filing Document | Filing Date | Country | Kind | 371c Date |
|---|---|---|---|---|
| PCT/EP05/04836 | 5/4/2005 | WO | 11/14/2006 |
