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Cleaning and Sterilization Protocol for Reused Cardiac Electrophysiology Catheters Inactivates Hepatitis and Coxsackie Viruses

  • Julian D. Druce (a1), Jessica S. Russell (a1), Christopher J. Birch (a1), Karen Vickery (a2), Richard W. Harper (a3) and Joseph J. Smolich (a3)...



To assess the efficacy of a standard cleaning and sterilization protocol employed during reuse of cardiac electrophysiology catheters on the infectivity of duck hepatitis B virus (DHBV; a surrogate for human hepatitis B virus), bovine viral diarrhea virus (BVDV; a surrogate for human hepatitis B virus), and human Coxsackie type B3 virus (CB3).


Public health virology laboratory.


Studies were performed on the distal, electrode-containing segments of 120 electrophysiology catheters previously used in up to 10 clinical procedures. Catheter segments were immersed for 1 hour in blood infected with high titers of DHBV, BVDV, or CB3. After air drying for 2 hours, subgroups of 8 catheters were subjected to no treatment, washing in general-purpose detergent, washing in enzyme cleaner, sterilization in ethylene oxide, or the full protocol of sequential detergent-enzyme cleaner-ethylene oxide exposure. Presence of residual virus was assessed by nucleic acid detection and infectivity studies.


DHBV nucleic acid was detected on catheters after individual steps and the full protocol, whereas BVDV and CB3 nucleic acids were detected after individual steps but not the full protocol. These findings were associated with the presence of infectious DHBV and CB3, but not BVDV, on catheters after washing in detergent or enzyme cleaner. However, ethylene oxide alone or the full protocol reduced infectivity of all three viruses to undetectable levels.


These experimental studies provide strong evidence that appropriate cleaning and sterilization of reused electrophysiology catheters inactivates blood-borne viruses such as hepatitis B and C and Coxsackie type B3.


Corresponding author

Department of Cardiology, Royal Children's Hospital, Flemington Road, Parkville, 3052, Victoria, Australia


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1.Mickelsen, S, Mickelsen, C, Maclndoe, C, et al.Trends and patterns in electrophysiologic and ablation catheter reuse in the United States. Am J Cardiol 2001;87:351353.
2.O'Donoghue, S, Platia, EV. Reuse of pacing catheters: a survey of safety and efficacy. Pacing Clin Electrophysiol 1988;11:12791280.
3.Blomstrom-Lundqvist, C. The safety of reusing ablation catheters with temperature control and the need for a validation protocol and guidelines for reprocessing. Pacing Clin Electrophysiol 1998;21:25632570.
4.Smith, JJ, Henderson, JA, Baim, DS. The Food and Drug Administration and reprocessing of single-use medical devices: a revised policy and new questions. J Vase Interv Radiol 2002;13:11791182.
5.Dunnigan, A, Roberts, C, McNamara, M, Benson, DW Jr, Benditt, DG. Success of re-use of cardiac electrode catheters. Am J Cardiol 1987;60: 807810.
6.Avitall, B, Khan, M, Krum, D, Jazayeri, M, Hare, J. Repeated use of ablation catheters: a prospective study. J Am Coll Cardiol 1993;22:13671372.
7.Lindsay, BD, Kutalek, SP, Cannom, DS, Hammiii, SC, Naccarelli, GV. Reprocessing of electrophysiology catheters: clinical studies, regulations, and recommendations. A report of the NASPE Task Force on Reprocessing of Electrophysiological Catheters. Pacing Clin Electrophysiol 2001;24:12971305.
8.Aton, EA, Murray, P, Fraser, V, Conaway, L, Cain, ME. Safety of reusing cardiac electrophysiology catheters. Am J Cardiol 1994;74:11731175.
9.Grabsch, EA, Grayson, ML, Johnson, PDR, Yates, LA, Harper, RW, Smolich, JJ. Bactericidal efficacy of sterilizing protocol for re-used cardiac electrophysiology catheters. Am J Cardiol 2002;89:770772.
10.Druce, JD, Russell, JS, Birch, CJ, Yates, LA, Harper, RW, Smolich, JJ. A decontamination and sterilization protocol employed during reuse of cardiac electrophysiology catheters inactivates human immunodeficiency virus. Infect Control Hosp Epidemiol 2003;24:184190.
11.Weber, DJ, Rutala, WA. The emerging nosocomial pathogens Cryptosporidium, Escherichia coli 0157:H7, Helicobacter pylori, and hepatitis C: epidemiology, environmental survival, efficacy of disinfection, and control measures. Infect Control Hosp Epidemiol 2001;22:306315.
12.Lai, CL, Ratziu, V, Yuen, MF, Poynard, T. Viral hepatitis B. Lancet 2003; 362:20892094.
13.Pallansch, MA, Roos, RP. Enteroviruses: polioviruses, coxsackieviruses, echoviruses and newer enteroviruses. In: Fields, BN, Knipe, DM, Howley, PM, et al., eds. Fields Virology, ed. 4. Philadelphia: Lippincott Williams & Wilkins; 2001:723775.
14.Ganem, D. Hepadnaviridae: the viruses and their replication. In: Fields, BN, Knipe, DM, Howley, PM, et al., eds. Fields Virology, ed. 4. Philadelphia: Lippincott Williams & Wilkins; 2001:29232969.
15.Lindenbach, BD, Rice, CM. Flaviviridae: the viruses and their replication. In: Fields, BN, Knipe, DM, Howley, PM, et al., eds. Fields Virology, ed. 4. Philadelphia: Lippincott Williams & Wilkins; 2001:9911041.
16.Druce, JD, Jardine, D, Locarnini, SA, Birch, CJ. Susceptibility of HIV to inactivation by disinfectants and ultraviolet light. J Hosp Infect 1995; 30:167180.
17.Deva, AK, Vickery, K, Zou, J, West, RH, Harris, JP, Cossart, Y. Establishment of an in-use test method for evaluating disinfection of surgical instruments using the duck hepatitis B model. J Hosp Infect 1996; 33:119130.
18.Melnick, JL, Rennick, V, Hampil, B, Schmidt, NJ, Ho, HH. Lyophilized combination pools of enterovirus equine antisera: preparation and test procedures for the identification of field strains of 42 enteroviruses. Bull World Health Organ 1973;48:263268.
19.Melnick, JL, Wimberly, IL. Lyophilized combination pools of enterovirus equine antisera: new LBM pools prepared from reserves of antisera frozen for two decades. Bull World Health Organ 1985;63:543550.
20.Russell, AD. The principles of antimicrobial activity and resistance: disinfection and control. In: Block, SS, ed. Disinfection, Sterilization, and Preservation, ed. 5. Philadelphia: Lippincott Williams & Wilkins; 2001:3155.
21.Adcock, WL, MacGregor, A, Davies, JR, Hattarki, M, Anderson, DA, Goss, NH. Chromatographic removal and heat inactivation of hepatitis B virus during the manufacture of human albumin. Biotechnol Appi Biochem 1998;28:169178.
22.Borovec, S, Broumis, C, Adcock, W, Fang, R, Uren, E. Inactivation kinetics of model and relevant blood-borne viruses by treatment with sodium hydroxide and heat. Biologicals 1998;26:237244.
23.Chandra, S, Cavanaugh, JE, Lin, CM, et al.Virus reduction in the preparation of intravenous immune globulin: in vitro experiments. Transfusion 1999;39:249257.
24.Gauntt, CJ, Gomez, PT, Duffey, PS, et al.Characterization and myocarditic capabilities of Coxsackievirus B3 variants in selected mouse strains. J Virol 1984;52:598605.
25.Calkins, H, Prystowsky, E, Carlson, M, Klein, LS, Saul, JP, Gillette, P. Temperature monitoring during radiofrequency catheter ablation procedures using closed loop control. Circulation 1994;90:12791286.


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