There are several steps involved when performing high-level disinfection (HLD) of semicritical devices. The recently updated AORN \"Guideline for manual high-level disinfection\" provides perioperative nurses with evidence-based best practices for performing safe and effective HLD of reusable semicritical items. The guideline also addresses preventing injury to patients and health care workers associated with the handling of high-level disinfectants. This article provides an overview of the guideline and discusses recommendations for selection of a processing method, sterile processing areas, preparation of items for HLD, preparation of high-level disinfectants, manual HLD, drying and storage of items after HLD, and processing records. It also includes a scenario that illustrates specific concerns related to performing quality tests on high-level disinfectant solutions. Perioperative nurses should review the guideline in its entirety and apply the recommendations when performing manual HLD.

Sanitizing solutions against bacterial and viral pathogens are of utmost importance in general and, in particular, in these times of pandemic due to Sars-Cov2. They frequently consist of chlorine-based solutions, or in the direct input of a certain amount of chlorine in water supply systems and swimming pools. Colorimetry is one of the techniques used to measure the crucial persistence of chlorine in water, including household chlorine test kits commonly based on colorimetric indicators. Here, we show a simple and cheap colorimetric method based on 3,3\',5,5\'-tetramethylbenzidine (TMB), commonly used as chromogenic reagent for enzyme-linked immunosorbent assays. TMB is converted by chlorine to a colored molecule through a pH-dependent multi-step oxidation process where the chromaticity of TMB is directly proportional to chlorine content. This molecule offers several advantages over other commonly used reagents in terms of safety, sensitivity, and, peculiarly, hue modulation, giving rise to the detection of chlorine in water with a multi-color change of the indicator solution (transparent/blue/green/yellow). Moreover, through the appropriate setting of reaction conditions, such coloration is finely tunable to cover the range of chlorine concentration recommended by international health agencies for treatment of drinking water and swimming pools and to test homemade solutions prepared by dilution of household bleach during health emergency events such as during the current pandemic. Graphical abstract.

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Five tungsten carbide nanoparticle preparations (denoted WC1-WC5) were investigated for broad spectrum virucidal activity against four recommended model viruses. These are modified vaccinia virus Ankara (MVA), human adenovirus type 5 (HAdV-5), poliovirus type 1 (PV-1) and murine norovirus (MNV). All virucidal tests were performed two to five times using the quantitative suspension test, which is a highly standardized test method to evaluate the virucidal efficacy of disinfectants in accordance with the European norm EN 14476+A1 and the German DVV/RKI guidelines. Quantitative detection of viruses was conducted by endpoint titration and quantitative real-time PCR. Results showed that three of the five tested compounds (WC1-WC3) were able to reduce the infectivity of all model viruses by at least four log10 of tissue culture infective dose 50% per ml after 15 min, whereas the other two compounds exhibited only limited efficacy (WC4) or showed cytotoxicity (WC5). Virucidal activity of nanoparticles increased with incubation time and a dose-effect curve showed dependence of virucidal activity with particle concentration. Whereas WC1-WC4 showed little cytotoxicity, WC5 which was doped with copper exhibited a significant cytotoxic effect. These findings propose tungsten carbide nanoparticles to be very promising in terms of new disinfection techniques. SIGNIFICANCE AND IMPACT OF THE STUDY: The present study investigates the virucidal activity of tungsten carbide nanoparticles using the quantitative suspension test in accordance with the European norm EN 14476+A1 and the German DVV/RKI guidelines. Due to highly standardized assay conditions, results of this test are considered very reliable for evaluation of the virucidal activity of disinfectants. Broad-spectrum activity and high efficacy of three different tungsten carbide nanoparticles preparations is concluded.

The Spaulding system recommends sterilization or, at minimum, high-level disinfection for semicritical medical items (ie, items that come into contact with mucous membranes or nonintact skin). High-level disinfection deactivates all types of microorganisms except bacterial spores and prions. If high-level disinfection is not performed correctly, however, contaminated medical or surgical devices could transmit pathogens to patients. Reusable semicritical items may be processed using manual methods when manual chemical high-level disinfection is the only processing method recommended by the manufacturer. The AORN \"Guideline for manual chemical high-level disinfection\" provides guidance to health care personnel for performing effective manual chemical high-level disinfection and preventing injury associated with the use of high-level disinfectant chemicals. This article focuses on key points of the guideline that address preparation of items for high-level disinfection, use of high-level disinfectants, health care personnel safety, and documentation. Perioperative RNs should review the complete guideline for additional information and for guidance when writing and updating policies and procedures.

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