Objectives: The oral cavity may be an important and overlooked reservoir of systemic infection, and athletic appliances may constitute a potentially important and under-recognized risk factor for infection.
Athletic mouthguards are difficult to clean and provide retentive sites for microorganisms. These microrganisms are organized as biofilms and can adhere to the acrylic, which has porosities on its outer and inner surfaces that create favorable conditions for bacterial colonization. Athletic appliances are not disinfected routinely at home and there is no specific clinical protocol for the control of bacterial biofilm on these appliances. Although adequate brushing or scrubbing with a dentrifice is an effective means of controlling the biofilm, inappropriate home-care quality and frequency are factors that compromise the efficacy of the mechanical control of biofilm. In addition, many athletic mouthguards are often left in the locker-room, and while in use at the athletic site, are often transferred from the mouth to hands, and temporarily stored or carried at distant sites (eg helmuts, shorts, sleeves, socks etc).
The two most frequently gram-positive cocci isolated from athletic mouthguards were Staphylocccus aureus and Staphylococcus epidermidis, prominent skin pathogens that are also associated with endocarditis, pericarditis, pneumonia, osteomyelitis, food intoxication, and athletic equipment contamination. Methicillin-resistant S. aureus is an important nosocomial pathogen, which is often transmitted from the colonized site to the site of subsequent infection, and is responsible for considerable morbidity and mortality. Athletic mouthguards may be a reservoir for these bacteria to hibernate and thus be a mechanism of transmittal from one site to another. An increase in community associated MRSA (aka close-quarter MRSA) outbreaks has been noted in basketball, football, rugby, volleyball, and wrestling athletes. and some strains of S. aureus are the most common cause of cultured skin abscesses in athletes.
Good personal hygiene is the key to prevention and control of community associated MRSA outbreaks. Such practices among athletes include frequent hand washing, covering abrasions or seeping wounds, disallowing athletes with open wounds in whirlpools or saunas, discouraging shared personal items, requiring showers after all practices and games, wearing sandals in showers, isolating athletes who have infections, and washing protective gear after each use. Recommended infection control measures include regular and thorough cleaning of equipment, however when antimicrobial treatment is recommended, specific products are not identified. Therefore , the purpose of this study was to assess alternative methods of disinfecting samples of acrylic from surface and subsurface inoculates of specific bacteria, having in mind methods that maybe used at the athletic site and in the locker-room.
Methods: In this study, we tested the efficacy of the Nature/Zone™ ozone sanitizing chamber and Purell™ hand sanitiazer in disinfecting surfaces of acrylic specimens prepared from mouthguards. Staphylococcus epidermidis (aka S. aureus), Lactobacillus casei, and Escherichia coli were purchased from the American Type Culture Collection, Manasas, Va. All experiments were conducted in a laminar flow hood and all equipment was autoclaved prior to use. Growing cells were placed on the surface of sterile acrylic discs and then either Purell was added to the disc for three iv minutes, or the inoculated discs were subjected to ozone in the chamber for three minutes. Alternatively, growing cells were placed in Eppendorf tubes to simulate porosities in the acrylic. All specimens (discs or inoculates) were then transferred to 10 ml of culture broth, grown overnight, and compared to positive and negative controls. After overnight incubation, each working solution was diluted in ten-fold steps for the purpose of estimating bacterial cell numbers. From the dilutions , 0.1 ml was spread evenly across the surface of their respective agars. All agar plates were incubated for 24 hrs. at 37 C, after which all visible colonies were counted. The number of colony forming units (CFU) were determined by counting segments of the plates. All experiments were performed in triplicate, and experimental samples were compared to positive and negative controls. One way analysis of variance was used to compare colony counts between positive control samples , experimental ozone chamber samples, and experimental Purell™ samples.
Results: Three trials indicated that there was no inhibition of growth of the organisms when sterile discs or eppendorf tubes were incubated in the ozone chamber for 3 minutes. As compared to positive control and the ozone chamber experimental samples, surface application of hand sanitizer (Purell™) for 3 minutes significantly inhibited growth of all three bacteria (p = 0.05, one way ANOVA).
Conclusions: These findings indicate that ozone produced by the Nature/Zone UV sanitizer is ineffective in reducing bacterial counts of the three organisms used in these in vitro experiments. On the other hand, Purell hand sanitizer, significantly reduced the number of bacterial counts of all three organisms. Thus, whereas the hand sanitizer is an effective disinfectant, the ozone chamber is not an effective disinfectant.
|Advisor:||Whitaker, Eugene J.|
|Commitee:||Horton, Michael, Rams, Thomas, Suuki, Jon B, Whitaker, Eugene|
|School Location:||United States -- Pennsylvania|
|Source:||MAI 53/06M(E), Masters Abstracts International|
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