Frequently Asked Questions

What Microbicidal effectiveness has been proven for the Antigermix AS1 & Hypernova Chronos?

How is UV HLD efficacy positioned compared to other classical HLD products?

Independent tests have been carried out to compare Chronos to other classical HLD chemical soaking products intended for ultrasound probes, and show that UV HLD is much more efficient than most of them 

Main test: Evolution of the number of viable spores of Bacillus subtilis ATCC 19659 on the silicone carrier tests according to contact time in the UV-C disinfection unit (Hypernova Chronos GERMITEC) or with high level disinfectants (Sporox II, Cidex Activated Dialdehyde Solution, Cidex OPA).1

Results

The results indicate that the UV-C disinfection process killed spores within a 90 secs cycle time

  • within a 18 seconds exposure time achieved 4.8 Log (99.99) reduction compliant to the EN standards and
  • within a 84 seconds exposure time achieved 6.2 Log (99.9999) reduction compliant to the AOAC standards.
  • For both standards the sporicidal efficacy was substantially higher than the chemical sterilants used according to manufacturer instructions for HLD.1

Has UV-C HLD been proven to work on Reusable Medical Devices (RMDs) in a clinical setting?

There are several clinical research papers that demonstrate UV-C HLD effective on Reusable Medical Devices (RMDs) in a clinical setting. The latest clinical papers are:

Bloc S. and al., Evaluation of a new disinfection method for ultrasound probes used for regional anesthesia: ultraviolet C light. J Ultrasound Med. 2011 Jun;30(6):785-8.

This study was performed with current version of Antigermix AS1 with a 90 seconds cycle. 15 ultrasound probes used in anaesthesia for block placement were exposed to a large inoculum of 3 bacteria : Staphylococcus aureus, Escherichia coli, and Enterococcus faecalis. All probes were infected after inoculation (>150 colony-forming units) but were considered sterile (<10 colonyforming units) after disinfection. Moreover, for the authors, this method could obviate the use of sterile probe covers, which can improve echogenicity.

 

Maxime Pichon, Karine Lebail-Carval, Geneviève Billaud, Bruno Lina, Pascal Gaucherand and Yahia Mekki (2019) Decontamination of Intravaginal Probes Infected by Human Papillomavirus (HPV) Using UV-C Decontamination System. J. Clin. Med, 8, 1776; doi:10.3390/jcm8111776.

This is the first In-Use Study of Human Papillomavirus (HPV) Conducted in a Clinical Environment. The aim of this study was to determine if ultraviolet light – C spectrum (UV-C) disinfection is more efficient than low level disinfection (LLD) in routine clinical conditions, especially against HPV.
The study compares two protocols usually found in infection prevention practice when using endocavity ultrasound probes:

  • The simple protocol consisted of performing LLD with a multipurpose wipe on a probe used with a disposable cover.
  • The more rigorous protocol consisted of performing high level disinfection (HLD) on a probe that was partially cleaned but would appear visibly clean to the probe user.

The study took place in a high-turnover gynecological practice in a specialized university hospital (12,000 emergency consultations with 8,000 vaginal ultrasound examinations annually).

The study had three phases. Results showed the following outcomes:
1ST PHASE: No probes (0/100) were found positive for HPV or human cellular DNA after UV-C HLD (with AS1).
2ND PHASE: All 47 probe covers were intact (no visible damage) and positive for human and HPV DNA.

  • After probe cover removal and wipe based on a
    cleaning protocol, eight (8) probes were positive
    for human or viral DNA (seven probes with human
    DNA and one with a high-grade HPV-51).
  • After UV-C disinfection was applied to partially
    cleaned probes, all probes were found to be negative.
  • The UV-C HLD procedure was found to be statistically
    more efficient than LLD (eight contaminated
    probes versus no contaminated probe, p < 0.05).

What are the Occupational Health and Safety benefits of using UV-C HLD?

UV HLD uses no chemicals therefore there is no need to manage staff exposure and risks associated with processing chemicals is eliminated.

There are no risks associated with high temperatures, and chemical burns on users face or hands. Since UV-C HLD has now chemical residue or toxins from vaporised microorganisms there is no need for rinsing or wipe the probe after the disinfection cycle. This also reduces the risk of cross contamination and the need for special ventilation requirements such as fume cabinets and air quality monitoring to remove chemical fumes or remove airborne toxins produced from chemical deactivated microorganisms.

The Antigermix and Hypernova ranges of products are a safe solution for both staff and patients.

How does the UV HLD mitigate environmental impact?

The UV HLD is the safest environmental choice of HLD available for the following reasons:

  • No consumables, no waste products.
  • No chemical waste or residuals,
  • No water waste in washing excess chemical residuals left on equipment.
  • No refrigeration needed for storage and transport as no chemicals are required.

This no waste and no chemical approach is central to Germitec’s ecological and environmental protection philosophy. The system itself is also fully recyclable. Germitec and distributors provide a guarantee to take back the system at the end of its useful life for recycling.

What UVC dose is needed in order to adequately High Level Disinfect?

The disinfection is achieved when the probe has received a sufficient germicidal UV-C dose. The dose required was determined by:

  • Results from microbiological tests (see reference sheet).
  • Accuracy of the effective dose measuring sensors.

Shading factor related to the presence of the probe in the Antigermix enclosure. Using a dose threshold guarantees that an adequate disinfection level has been achieved.

How is the UVC dose measured?

What quality Monitor is in place for the Optical Diodes?

The 2 optical diodes are each calibrated using a medical calibration device. (See calibration of Photodiodes paper for detailed information)

The Maximum deviation from the medical calibration device and the photodiode is a stringent Coefficient standard deviation.

How often is calibration of the photodiodes recommended?

The medical calibration device is performed when the system has one of the following

  • Annual calibration check
  • Preventative Maintenance
  • Any change of parts

What training and accreditation is offered for the Antigermix?

Applications training for staff on the use of the Antigermix products or Hypernova Chronos is conducted during the installation. On-line training is available Germitec training plus a comprehensive e-training presentation with a Competency Assessment checklist.

How does the Antigermix compare to other methods of HLD?

Further information

Rapid Review Panel Recommendation Listing – Click Link: RRP

Germitec’s Antigermix (AS1) product scored a recommendation level of R2

R2 Basic research and development has been completed and the product may have potential value; the RRP recommends in use evaluations/trials to demonstrate improved efficiency or efficacy in improving infection and control to reduce healthcare associated infections are considered within an active NHS clinical setting.

The Hydrogen Peroxide Mist product scored a recommendation level of R5

R5 Insufficient clarity and/or evidence presented to enable a full review of the product. Therefore, the evidence presented does not demonstrate that the product is more efficient or efficacious at improving infection prevention and control to reduce healthcare associated infections.

A comprehensive literature review of all published journal articles on the available methods of High Level Disinfection was conducted by the NHS Scotland and Health Protection Scotland.

This paper compared available evidence for the use of ultraviolet light systems, hydrogen peroxide devices and manual wipes for the decontamination of Semi-Critical probes. This covered specifically; semi-invasive probes (SIUPs) and non-invasive ultrasound probes in semi-critical procedures.

Guideline Reference: NHS Scotland Guidance for Decontamination of Semi-Critical Ultrasound Probes; Semi-invasive and Non-invasive Ultrasound Probes March 2016 (PDF, 1489KB)

 

Levels of evidence

The following grades were given to the available evidence within the literature review using SIGN methodology.

  • 1+ Well conducted meta analyses, systematic reviews of RCTs, or RCTs with a low risk of bias
  • 2 Well conducted case control or cohort studies with a low risk of confounding, bias, or chance and a moderate probability that the relationship is causal
  • 3 Non-analytic studies, e.g. case reports, case series

What ultrasound probes are compatible with the Hypernova Chronos?

The utilisation of plastics has gained popularity in medical device assembly because of their strength, weight, cost savings, aesthetics and performance properties. Medical Grade Polymers are commonly used to manufacture and assemble surgical instruments, catheters, endoscopes, ultrasound probes and other medical devices. These medical-grade polymers are designed specifically for use in medical applications that enable the medical devices to be capable of withstanding repeated cycles of ethylene oxide (EtO), radiation (UV-C), chemical sterilants and autoclaving.1

Germitec’s probe compatibility testing process:

Germitec conducts various tests in collaboration with probe manufacturers to ensure probe compatibility is achieved. These include (i) tests in laboratories on probes or on materials provided by manufacturers; (ii) tests in laboratories on materials representative of those used in the probes; (iii) documentary studies; (iv) field observations of probes in real use.

In some probes, UV-C can cause slight discolouration of the housing and the cable. However, slight discolouration does not affect the performance of the ultrasound probe and these changes can be minimised by proper cleaning prior to each UV-C cycle. Cleaning of the device is a necessary part of the decontamination process. In comparison, chemical disinfectants are also known to cause discolouration to the surface of ultrasound probes. For example, Cidex OPA IFU states signs of surface discolouration can occur after 7 days or more.2 Butterfly iQ states in its ‘Compatible Cleaning and Disinfection’ approved product list that hydrogen peroxide system can result in premature cosmetic wear of the device.3

The Collaborative Probe Compatibility Program provides confidence that over 1,000 probes from all major manufacturers have been tested, approved and endorsed for use with Hypernova Chronos and AE1. Probes listed in Germitec’s Ultrasound Probe Compatibility List have shown
UV-C to be non-corrosive to the sensitive medical-grade polymers found on ultrasound probes and their probe cables. This is why the length of probe cables can also be high level disinfected within Hypernova Chronos and AE1. To ensure ongoing compatibility with a growing range of ultrasound probes, Germitec’s Ultrasound Probe Compatibility List is regularly updated.

 

References:
1. Adhering Medical Grade: Polymershttps://www.masterbond.com (medical-grade-polymers)
2. https://www.hopkinsmedicine.org/ hse/forms/cidexopa/opainstruction.pdf
3. https://support.butterflynetwork.com/hc/en-us/
articles/360040976672

 

Has the Hypernova Chronos been tested against high risk Human Papillomavirus and who performed the efficacy test?

The Hypernova Chronos high level disinfection system has been rigorously tested to kill high-risk cancer strains 16 and 18 of Human Papillomavirus (HR-HPV). The HR HPV cancer strain is known to cause 90% of cervical cancer and greater than 60% of other anogenital cancers and is responsible for a significant portion of oropharyngeal cancers.g.1

The HR HPV efficacy testing was performed by Dr. Craig Meyers, of Penn State College of Medicine.

Dr. Meyers is a distinguished Professor of Microbiology and Immunology, Obstetrics and Gynecology, and the Director of the Training Program in Viruses and Cancer. His team was the first to grow native (natural, infectious) HR-HPV in high enough quantities for laboratory testing. Dr Meyers has been working on producing HR-HPV high titer, mature viruses, for over 35 years. He knows how the virus needs to be mature and structurally stable. He has published several research papers on disinfectants commonly used on ultrasound probes. These studies also indicate the clinical importance of using native HR-HPV for disinfectant and microbicide testing in contrast to surrogate viruses and virus like particles (quasi virions and pseudo virions).

In the Hypernova Chronos efficacy study Dr Meyers used the hard surface carrier test method based on the ASTM E1053-11 standard test method suitable for assessing virucidal activity on non-porous surfaces. The study methodology is in line with Federal Drug Administration
(FDA) guidelines for assessing virucidal efficacy of high-level disinfectants. To claim that your high level disinfection system is effective in killing HR-HPV, it needs to demonstrate that it can achieve a 4-log (99.99%) reduction.

The Hypernova Chronos achieved a greater than 4-log (99.99%) reduction for both the HR-HPV16 and HR HPV18, therefore demonstrating that it is effective in killing the HR HPV. In contrast, OPA showed minimal efficacy.1-2

In conclusion, UVC radiation is an effective disinfectant method used to inactivate human papillomaviruses (HPV16 and HPV18). The Hypernova Chronos which has been proven to kill HR-HPV, provides an extra level of safety for patients and medical staff.
References: 1.Meyers C, Milici J, Robison R (2017) UVC radiation as an effective disinfectant method to inactivate human
papillomaviruses. PLoS ONE 12 (10): e0187377. 2.Meyers (2019) Study tested the efficacy of Hypernova Chronos (AS1-V2) UV-C disinfection of both HPV16 and HPV18 using the coupon methods.

Chronos
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