Criteria Grid Best Practices and Interventions for the Prevention and Awareness of Hepatitis C - PDF

Please download to get full document.

View again

of 12
All materials on our website are shared by users. If you have any questions about copyright issues, please report us to resolve them. We are always happy to assist you.
Information Report
Category:

Pets & Animals

Published:

Views: 5 | Pages: 12

Extension: PDF | Download: 0

Share
Related documents
Description
Criteria Grid Best Practices and Interventions for the Prevention and Awareness of Hepatitis C Best Practice/Intervention: Binka M. et al. (2015) Disinfection of syringes contaminated with hepatitis C
Transcript
Criteria Grid Best Practices and Interventions for the Prevention and Awareness of Hepatitis C Best Practice/Intervention: Binka M. et al. (2015) Disinfection of syringes contaminated with hepatitis C virus by rinsing with household products. Open Forum Infect Dis, 23;2(1): ofv017. Date of Review: February 8 th, 2016 Reviewer(s): Christine Hu Part A Category: Basic Science Clinical Science Public Health/Epidemiology Social Science Programmatic Review Best Practice/Intervention: Focus: Hepatitis C Hepatitis C/HIV Other: Level: Group Individual Other: Target Population: people who inject drugs (PWID) disinfect used syringes with household products Setting: Health care setting/clinic Home Other: Country of Origin: USA Language: English French Other: Is the best practice/intervention a meta-analysis or primary research? Please go to Comments section. Part B YES NO N/A COMMENTS Primary research: to determine the effectiveness of household products in disinfecting HCV contaminated syringes The best practice/intervention shows evidence of scale up ability The best practice/intervention shows evidence of transferability The study may be transferable to individuals disinfecting syringes using household products. The best practice/intervention shows evidence of adaptation Do the methodology/results described allow the reviewer(s) to assess the generalizability of the results? Are the best practices/methodology/results described applicable in developed countries? Are the best practices/methodology/results described applicable in developing countries? The best practice/intervention has utilized a program evaluation process The study used a genotype 2a laboratory clone of HCV which prevents the generalizability of the results of all population of HCV infected patients. YES NO N/A COMMENTS The study is applicable to all other countries given that they have easy access to the household products included in the research. Consultation and feedback with community has taken place The best practice/intervention is sensitive to gender issues The best practice/intervention is sensitive to multicultural and marginalized populations The best practice/intervention is easily accessed/available electronically Study is mainly intended for people who inject drugs. Full article can be accessed at Is there evidence of a cost effective analysis? If so, what does the evidence say? Please go to Comments section How is the best practice/intervention funded? Please go to Comments section This study was funded by the National Institutes of Health/National Institute on Drug abuse. Is the best practice/intervention dependent on external funds? Other relevant criteria: - The study found that bleach was the most effective product at eliminating residual HCV infectivity from tuberculin and insulin syringes - The study also showed that 70% isopropanol, Dawn Ultra kitchen sink detergent and 3% hydrogen peroxide were effective at eliminating residual HCV infectivity in low void volume insulin syringes after 1 rinse Limitation - Researchers were unable to test most of the household products at undiluted concentrations - HCV-spiked plasma were used instead of HCVspiked blood, which could affect the results MAJOR ARTICLE Disinfection of Syringes Contaminated With Hepatitis C Virus by Rinsing With Household Products Mawuena Binka, 1 Elijah Paintsil, 1,2,3 Amisha Patel, 1 Brett D. Lindenbach, 4 and Robert Heimer 1 1 Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut, Departments of 2 Pediatrics, 3 Pharmacology, and 4 Microbial Pathogenesis, Yale School of Medicine, New Haven, Connecticut Background. Hepatitis C virus (HCV) transmission among people who inject drugs (PWID) is associated with the sharing of injection paraphernalia. People who inject drugs often disinfect used syringes with household products when new syringes are unavailable. We assessed the effectiveness of these products in disinfecting HCVcontaminated syringes. Methods. A genotype-2a reporter virus assay was used to assess HCV infectivity in syringes postrinsing. Hepatitis C virus-contaminated 1 ml insulin syringes with fixed needles and 1 ml tuberculin syringes with detachable needles were rinsed with water, Clorox bleach, hydrogen peroxide, ethanol, isopropanol, Lysol, or Dawn Ultra at different concentrations. Syringes were either immediately tested for viable virus or stored at 4 C, 22 C, and 37 C for up to 21 days before viral infectivity was determined. Results. Most products tested reduced HCV infectivity to undetectable levels in insulin syringes. Bleach eliminated HCV infectivity in both syringes. Other disinfectants produced virus recovery ranging from high (5% ethanol, 77% ± 12% HCV-positive syringes) to low (1:800 Dawn Ultra, 7% ± 7% positive syringes) in tuberculin syringes. Conclusions. Household disinfectants tested were more effective in fixed-needle syringes (low residual volume) than in syringes with detachable needles (high residual volume). Bleach was the most effective disinfectant after 1 rinse, whereas other diluted household products required multiple rinses to eliminate HCV. Rinsing with water, 5% ethanol (as in beer), and 20% ethanol (as in fortified wine) was ineffective and should be avoided. Our data suggest that rinsing of syringes with household disinfectants may be an effective tool in preventing HCV transmission in PWID when done properly. Keywords. bleach; HCV transmission; hepatitis C virus; people who inject drugs; syringe disinfection. Approximately 150 million people are chronically infected with hepatitis C virus (HCV) around the world [1]. Chronic infection with HCV can result in health complications such as chronic liver disease, cirrhosis of the liver, and hepatocellular carcinoma [1, 2]. Hepatitis Received 13 November 2015; accepted 27 January Correspondence: Mawuena Binka, PhD, Department of Epidemiology of Microbial Diseases, Yale School of Public Health, 60 College St, New Haven, CT Open Forum Infectious Diseases The Author Published by Oxford University Press on behalf of the Infectious DiseasesSocietyofAmerica. ThisisanOpenAccessarticledistributedundertheterms of the Creative Commons Attribution-NonCommercial-NoDerivs licence (http:// creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact DOI: /ofid/ofv017 C virus is transmitted by exposure to infected blood during blood transfusions and the reuse of equipment for intravenous injections [1 3]. Sexual and perinatal transmissions of HCV are not efficient [2, 3]. Widespread screening of blood supplies for HCV, human immunodeficiency virus (HIV), and other pathogens has reduced HCV transmission by blood transfusion in developed countries [2]. People who inject drugs (PWID) now constitute one of the largest groups of people infected with HCV worldwide [2, 4, 5]. With a global population of 11 to 21 million, HCV prevalence rates among PWID are largely higher than 40% in many areas, compared with average HIV prevalence rates of below 20% within the same population [2, 5]. High rates of HCV transmission in PWID persist due to unsafe injection practices within this group [2, 6]. Hepatitis C virus transmission in PWID has been linked Disinfecting HCV-Contaminated Syringes OFID 1 to the sharing of syringes, needles, and other injection paraphernalia; practices that continue despite extensive harm reduction efforts [2, 6, 7]. Hepatitis C virus incidence rates are highest in younger PWID, aged 15 to 24 years old, who are more likely to share drug injection paraphernalia within their social networks [2, 8]. Furthermore, recent studies have shown that active attempts at HCV serosorting among PWID is compromised by inaccurate knowledge of their injecting partners HCV infection status [6, 9, 10]. Human immunodeficiency virus and HCV can survive on surfaces for more than 4 weeks at room temperature [11 14]. Human immunodeficiency virus is stable in syringes for up to 42 days, whereas HCV is stable for at least 1 day in insulin syringes with fixed needles and up to 63 days in tuberculin syringes with detachable needles at room temperature [15, 16]. Harm reduction programs have encouraged the use of bleach, rubbing alcohol, and dishwashing detergent, to rinse used injecting equipment when new supplies are unavailable to PWID [17 19]. People who inject drugs also clean their syringes with various readily available beverages, including cola, wine, beer, and vodka in an attempt to prevent disease transmission [20]. Studies have shown that many of these household products, with the exception of bleach, are ineffective at disinfecting HIV-contaminated syringes [20, 21]. These products also have varying levels of success at inactivating HCV dried on surfaces or kept in suspension [12 14, 22]. However, information regarding the efficacy of household products in disinfecting HCV-contaminated syringes is very limited. In this report, we close this knowledge gap by determining the ability of different household products to disinfect HCVcontaminated insulin and tuberculin syringes by using our previously established microculture assay [13, 15]. MATERIALS AND METHODS Virus and Cells The Jc1/GLuc2A reporter virus, a derivative of the chimeric genotype 2a full length J6/JFH virus with a Gaussia princeps luciferase gene inserted between the p7 and NS2 genes, was used in this study [23 25]. The protocol for virus preparation has been reported previously [13, 15]. The human hepatoma Huh-7.5 cell line, which is highly permissive for HCV infection [26], was cultured as adherent monolayers in Dulbecco s modified Eagle s medium(dmem) (Invitrogen Life Technologies, Grand Island, NY) supplemented with 10% heat-inactivated fetal calf serum (Omega Scientific, Tarzana, CA) and 1 mm nonessential amino acids (Invitrogen) with 5% CO 2 at 37 C [13, 15]. For experiments involving toxic concentrations of disinfectants, Huh-7.5 cells were also cultured in the presence of a 1:1 v/v mixture of MicroSpin S-400 HR sephacryl column eluates (GE Healthcare, Freiburg, Germany) and 2 DMEM (EMD Millipore, Darmstadt, Germany) supplemented with 20% heatinactivated fetal calf serum (Omega Scientific) and 2 mm nonessential amino acids (Invitrogen Life Technologies). Syringes People who inject drugs use different types of syringes for injecting drugs including low void volume syringes that retain 2 μl and high void volume syringes that retain 10-fold or more residual liquid after use [27, 28]. We used 2 types of syringes for our experiments: 1 ml U-100 insulin syringes with 27-gauge 0.5-inch attached needles (Terumo Medical, Somerset, NJ), representing the low void volume syringes, and 1 ml tuberculin syringes with 27-gauge 0.5-inch detachable needles (Terumo Medical), representing syringes with high void volumes. Household Products People who inject drugs rinse their used syringes with household products or alcoholic beverages in an attempt at disinfection [20]. We tested the ability of these liquids to disinfect low and high void volume syringes contaminated with HCV and compared virus recovery to that obtained from syringes rinsed with distilled water or left unrinsed. The following household products were tested: ethanol (AmericanBio, Natick, MA), isopropanol (AmericanBio), Clorox Concentrated Regular Bleach (8.25% sodium hypochlorite; The Clorox Company, Oakland, CA), Lysol Multi-Surface Pourable Cleaner (Pacific Fresh Scent; Reckitt Benckiser, Parsippany, NJ), Dawn Ultra (Original Scent; The Proctor and Gamble Company, Cincinnati, OH), and Hydrogen Peroxide (3% H 2 O 2 ; McKesson, Richmond, VA). The following alcoholic beverages were tested: Corona Extra Beer(4.6%alcohol;CrownImports,Chicago,IL),Harvey s Bristol Cream Sherry (17.5% alcohol; Harvey s Import Company, Deerfield, IL), and Dubra Vodka (40% alcohol; Dubra Distillers Product Company, Clifton, NJ). Cytotoxicity of Different Household Products on Huh-7.5 Cells To control for the effect of these liquids on our microculture system, we first determined their cytotoxic effects to the Huh- 7.5 cells. In brief, Huh-7.5 cells were seeded at cells per well in 96-well plates in 100 μl of cell culture media. The next day, 1 ml insulin and 1 ml tuberculin syringes were rinsed once with 500 μl of different concentrations of the various products. The syringes were then flushed with 100 μl of cell culture media, which was used to replace an equal volume of cell culture media that was aspirated from the cell culture wells. The cells were incubated overnight at 37 C, and cell growth was determined with the alamarblue assay (Invitrogen Life Technologies) as directed by the manufacturer. First, the flushed medium was aspirated from the wells and replaced with 50 μl of fresh culture medium. The 5 μl alamarbluereagent was then added to the cells, and the plates were wrapped in aluminum foil and incubated at 37 C for 4 h. Cell growth was 2 OFID Binka et al determined as a function of relative fluorescence measured at 530 nm excitation and 590 nm emission (Synergy HT Plate Reader; BioTek, Winooski, VT). Five syringes were tested per condition and the experiment was repeated 3 times. For household products that proved toxic to the Huh-7.5 cells at the concentrations tested, the 100 μl flushed syringe contents were filtered through sephacryl S-400 HR columns to trap smaller inhibitory molecules (GE Healthcare) according to the manufacturer s instructions. Eluates of 100 μl were then mixed with 100 μl of 2 DMEM (EMD Millipore) prior to addition to the Huh 7.5 cells. Cell growth was again determined with the alamarblue assay described above. Five syringes were tested per condition and the experiment was repeated 3 times. Viability of Human Immunodeficiency Virus in Syringes After Rinsing With Different Household Products We slightly modified the protocol used in our previous studies [13, 15] to test for residual HCV infectivity after rinsing syringes with various household products. In brief, 1 ml insulin and 1 ml tuberculin syringes were loaded with HCV-spiked plasma and rinsed once or multiple times with 500 μl of the liquids at different concentrations. The syringes were then stored at 4 C, 22 C, or 37 C for up to 21 days, after which they were flushed with 100 μl of cell culture media and introduced into cell culture on Huh-7.5 cells seeded the previous day in 96- well plates at cells per well. The cells were then incubated with the flushed virus for 5 h at 37 C, after which they were washed once with 100 μl sterile phosphate-buffered saline ([PBS] Invitrogen Life Technologies, NY), and 100 μl of fresh cell culture media was added. Cells were incubated for 3 days at 37 C before viral supernatant was harvested and lysed with 20 μl of lysis buffer (Promega, Madison, WI). Viral infectivity was determined as function of relative luciferase units (RLU) as measured with a luciferase assay kit (Promega) and a luminometer (Synergy HT, BioTek, VT). Ten syringes were tested per condition and the experiment was repeated at least 3 times. When testing household products that had proven cytotoxic to Huh-7.5 cells, the syringe contents postrinsing were flushed with 100 μl of medium, filtered through the sephacryl columns, and mixed with 100 μl 2 DMEM prior to addition to the plated cells. After a 5-hour incubation at 37 C, cells were washed once with 100 μl sterile PBS,and 100 μl fresh cell culture media was added. Viral supernatants were harvested after 3 days of incubation at 37 C, and infectivity was measured as described above. Ten syringes were tested per condition and the experiment was repeated 3 times. The results are presented as the percentage of HCV-positive syringes yielding an RLU value above a pre-established cutoff (±standard error of the meam) and the mean residual infectivity, measured in RLU, calculated with data only from the syringes yielding RLU values above the cutoff (±standard deviation). The cutoff value of 1000 RLU was set at 2 times the background RLU measurements. RESULTS Cytotoxic Effects of Household Products on Huh-7.5 Cells Before assessing the effectiveness of different household products at disinfecting 1 ml insulin and 1 ml tuberculin syringes, we determined their effect on Huh-7.5 cell growth by using alamarblue assays. For a majority of the products, the syringe contents after rinsing 1 ml insulin syringes were not toxic to the Huh-7.5 cells (Figure 1A). Cell growth was comparable with that of the distilled water control with the exception of undiluted bleach, 3% hydrogen peroxide, and Lysol, which killed the cells, reducing fluorescence to levels comparable to a cell-free control. Bleach dilution of 1:10 reduced cell growth to 43% of the positive control (Figure 1A). Therefore, bleach, 3% hydrogen peroxide, and Lysol were diluted with water before rinsing syringes to restore cell growth to acceptable levels (Figure 1A). Kitchen sink detergent is generally not used undiluted, so we determined that the highest concentration at which it could be used in 1 ml insulin syringes without reducing cell growth was at a 1:300 dilution in distilled water. Due to the higher residual volume of disinfectant in the 1 ml tuberculin syringes, more household products were toxic to the Huh-7.5 cells in 1 ml tuberculin syringes than in 1 ml insulin syringes (Figure 1A and B). Both 70% ethanol and 70% isopropanol, in addition to undiluted bleach, 3% hydrogen peroxide, and Lysol, were toxic to the Huh-7.5 cells; completely eliminating cell growth (Figure 1B). Their further dilution in water was required to maintain cell growth after rinsing 1 ml tuberculin syringes. With 1 ml tuberculin syringes, Dawn Ultra was diluted further at 1:800 dilution in distilled water to maintain cell growth (Figure 1B). Most of the disinfectants are meant to be applied at higher concentrations than were ultimately used to disinfect the 1 ml tuberculin syringes. To get closer to the standard concentrations used for disinfection, we increased the concentrations and added a filtration step. Under these conditions, we reduced the cytotoxic effects of 70% ethanol, 70% isopropanol, and 1:10 bleach to restore cell growth to levels comparable with the distilled water control (Figure 1C). However, the cytotoxic effects of undiluted bleach, 3% hydrogen peroxide, and Lysol were not overcome by filtration, and further dilution in water was required before rinsing and filtration to maintain cell growth (Figure 1C). We observed a slight decrease in cell growth upon filtration of syringe contents through the sephacryl columns. This could be the result of incubating the cells with 2 DMEM-column eluate mixtures with suboptimal concentrations somewhere between 1 and 2. Effect of Household Products on Hepatitis C Virus Stability in Contaminated Syringes We determined the effect of rinsing HCV-contaminated syringes with various household products on HCV recovery from the residual contents of the rinsed syringes. All products tested were effective at eliminating residual infectivity in HCV-contaminated Disinfecting HCV-Contaminated Syringes OFID 3 Figure 1. Effect of household products on Huh-7.5 cell growth. Different products water, ethanol, isopropanol, bleach, hydrogen peroxide (H 2 O 2 ), Lysol, and Dawn Ultra were tested at varying concentrations for their effect on Huh-7.5 cell growth after rinsing 1 ml (A) insulin and (B) tuberculin syringes. (C) At higher product concentrations, tuberculin syringe contents were filtered through S-400 HR sephacryl columns before contact with the cells. Each data point represents the average relative fluorescence units (RFU) ± standard deviation from 3 experiments. HCV, hepatitis C virus; U, undiluted. Figure 2. Survival of hepati
Recommended
View more...
We Need Your Support
Thank you for visiting our website and your interest in our free products and services. We are nonprofit website to share and download documents. To the running of this website, we need your help to support us.

Thanks to everyone for your continued support.

No, Thanks