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HEPATITIS C POSITION PAPER
LETTERS TO THE EDITOR HEPATITIS C POSITION PAPER To the Editor: I am disappointed in the position paper on Hepatitis C exposure published in the February Issue of AJIC. The Centers for Disease Control and Prevention October 16, 1998, issue recommended postexposure testing for health care workers to include anti-HCV, alanine aminotransferase, and if early detection is desired, a polymerase chain reaction. These tests are to be repeated every 6 months if the source patient was positive for HCV. The Centers for Disease Control and Prevention previously used the same language to recommend postexposure testing for hepatitis B virus and HIV. Because many facilities require their ICPs to write policy on postexposure issues, it is important that the Association for Professionals in Infection Control, Inc, provides up-todate information, especially on such critical issues. Thank you for your attention to this. BethAnne Algie, RN Chair, Viral Hepatitis Council Florida
REPLY To the Editor: As 1999 Chairman of the Association for Professionals in Infection Control, Inc, (APIC) Guidelines Committee, I have been asked to respond to your letter to the editor regarding the APIC position paper on hepatitis C, which appeared in the February 1999 issue of AJIC. I can appreciate your frustration and disappointment that the position paper did not reflect the recent recommendations of the Centers for Disease Control and Prevention (CDC). However, it was certainly not intentional. In the world of scientific publication there is an unfortunate, but nonetheless unavoidable, delay between submission of an article for print and its eventual appearance in print. This delay also applies to arti-
AJIC Am J Infect Control 1999;27:373-6 Copyright © 1999 by the Association for Professionals in Infection Control and Epidemiology, Inc. 0196-6553/99/$8.00 + 0
cles that appear in our Association’s Journal. You will notice that the reference section associated with our position paper does not contain the CDC document of October 16, 1998. This was not an oversight. The simple fact is that the CDC document was published after the Guidelines Committee document had long since been submitted for publication in the Journal. In addition, no one on the Guidelines Committee was even aware of the upcoming CDC publication. While your disappointment is understandable, I would ask that you not hold APIC, Dr Larson, or the Guidelines Committee responsible for something that was simply not in our control. Bob Sharbaugh, PhD, CIC Chairman, APIC Guidelines Committee
IMPORTANCE OF LUMEN FLOW IN LIQUID CHEMICAL STERILIZATION To the Editor: The recently published article “Comparative evaluation of the sporicidal activity of new low-temperature sterilization technologies: Ethylene oxide, 2 plasma sterilization systems, and liquid peracetic acid” by W. Rutala et al1 reported data that suggested that liquid chemical sterilization (with Steris System 1 Processor, Steris Corporation, Mentor, Ohio) was not effective for rigid narrow lumened devices (3mm inner diameter, 40 cm long) compared with plasma (Sterrad) or ethylene oxide (with Oxyfume 2002, which uses a carrier gas that is a hydrochlorofluorcarbon). They reported that, with Bacillus stearothermophilus spores as the test organism, the failure rate in the liquid peracetic acid system was 37 of 40 (92.5% sterilization failure rate). This result is in sharp contrast to the sterilization success rate (100%) for flexible narrow lumened devices (3mm inner diameter, 125 cm long) inoculated with 106 Bacillus subtilis spores and processed with the same liquid chemical sterilization process that was recently published by Alfa et al.2 Although Rutala et al1 pointed out that the data in their study cannot be extrapolated to flexible endoscopes, the presentation of data indicating such pronounced sterilization failure in a less stringent model (ie, shorter lumened devices in the absence of any protein or organic challenge) may raise questions regarding the efficacy of the liquid chemical sterilization processor for both 373
REPLY To the Editor: As 1999 Chairman of the Association for Professionals in Infection Control, Inc, (APIC) Guidelines Committee, I have been asked to respond to your letter to the editor regarding the APIC position paper on hepatitis C, which appeared in the February 1999 issue of AJIC. I can appreciate your frustration and disappointment that the position paper did not reflect the recent recommendations of the Centers for Disease Control and Prevention (CDC). However, it was certainly not intentional. In the world of scientific publication there is an unfortunate, but nonetheless unavoidable, delay between submission of an article for print and its eventual appearance in print. This delay also applies to arti-
AJIC Am J Infect Control 1999;27:373-6 Copyright © 1999 by the Association for Professionals in Infection Control and Epidemiology, Inc. 0196-6553/99/$8.00 + 0
cles that appear in our Association’s Journal. You will notice that the reference section associated with our position paper does not contain the CDC document of October 16, 1998. This was not an oversight. The simple fact is that the CDC document was published after the Guidelines Committee document had long since been submitted for publication in the Journal. In addition, no one on the Guidelines Committee was even aware of the upcoming CDC publication. While your disappointment is understandable, I would ask that you not hold APIC, Dr Larson, or the Guidelines Committee responsible for something that was simply not in our control. Bob Sharbaugh, PhD, CIC Chairman, APIC Guidelines Committee
IMPORTANCE OF LUMEN FLOW IN LIQUID CHEMICAL STERILIZATION To the Editor: The recently published article “Comparative evaluation of the sporicidal activity of new low-temperature sterilization technologies: Ethylene oxide, 2 plasma sterilization systems, and liquid peracetic acid” by W. Rutala et al1 reported data that suggested that liquid chemical sterilization (with Steris System 1 Processor, Steris Corporation, Mentor, Ohio) was not effective for rigid narrow lumened devices (3mm inner diameter, 40 cm long) compared with plasma (Sterrad) or ethylene oxide (with Oxyfume 2002, which uses a carrier gas that is a hydrochlorofluorcarbon). They reported that, with Bacillus stearothermophilus spores as the test organism, the failure rate in the liquid peracetic acid system was 37 of 40 (92.5% sterilization failure rate). This result is in sharp contrast to the sterilization success rate (100%) for flexible narrow lumened devices (3mm inner diameter, 125 cm long) inoculated with 106 Bacillus subtilis spores and processed with the same liquid chemical sterilization process that was recently published by Alfa et al.2 Although Rutala et al1 pointed out that the data in their study cannot be extrapolated to flexible endoscopes, the presentation of data indicating such pronounced sterilization failure in a less stringent model (ie, shorter lumened devices in the absence of any protein or organic challenge) may raise questions regarding the efficacy of the liquid chemical sterilization processor for both 373