title: A Novel Method to Decontaminate Surgical Instruments for Operational and Austere Environments.
abstract: OBJECTIVE
  The purpose of this investigation was to test a field-expedient, cost-effective method to decontaminate, sterilize, and package surgical instruments in an operational (combat) or austere environment using chlorhexidine sponges, ultraviolet C (UVC) light, and commercially available vacuum sealing.
  
  
  METHODS
  This was a bench study of 4 experimental groups and 1 control group of 120 surgical instruments. Experimental groups were inoculated with a 10(6) concentration of common wound bacteria. The control group was vacuum sealed without inoculum. Groups 1, 2, and 3 were first scrubbed with a chlorhexidine sponge, rinsed, and dried. Group 1 was then packaged; group 2 was irradiated with UVC light, then packaged; group 3 was packaged, then irradiated with UVC light through the bag; and group 4 was packaged without chlorhexidine scrubbing or UVC irradiation. The UVC was not tested by itself, as it does not grossly clean. The instruments were stored overnight and tested for remaining colony forming units (CFU).
  
  
  RESULTS
  Data analysis was conducted using analysis of variance and group comparisons using the Tukey method. Group 4 CFU was statistically greater (P < .001) than the control group and groups 1 through 3. There was no statistically significant difference between the control group and groups 1 through 3.
  
  
  CONCLUSIONS
  Vacuum sealing of chlorhexidine-scrubbed contaminated instruments with and without handheld UVC irradiation appears to be an acceptable method of field decontamination. Chlorhexidine scrubbing alone achieved a 99.9% reduction in CFU, whereas adding UVC before packaging achieved sterilization or 100% reduction in CFU, and UVC through the bag achieved disinfection.
authors.affiliation: Emergency Medicine Physician Assistant Residency and Department of Emergency Medicine, William Beaumont Army Medical Center, Fort Bliss, TX (Mr Knox).
authors.forename: Randy W
authors.initials: RW
authors.lastname: Knox
authors.affiliation: United States Army Medical Research Institute of Infectious Disease, Fort Detrick, MD (Dr Demons).
authors.forename: Samandra T
authors.initials: ST
authors.lastname: Demons
authors.affiliation: EMS and Disaster Medicine Fellowship and Department of Emergency Medicine, San Antonio Military Medical Center, Joint Base San Antonio, TX (Dr Cunningham). Electronic address: c4.cunningham@gmail.com.
authors.forename: Cord W
authors.initials: CW
authors.lastname: Cunningham
mesh_terms: D016022:Case-Control Studies; D002710:Chlorhexidine; D015169:Colony Count, Microbial; D004203:Disinfection / Q000379:methods; D008887:Military Medicine / Q000379:methods*; D010865:Pilot Projects; D013242:Sterilization / Q000379:methods*; D013525:Surgical Instruments / Q000382:microbiology; D014466:Ultraviolet Rays
chemical_list: D002710:Chlorhexidine
keywords: austere; emergency; field equipment sterilization; life-saving interventions; operational