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Op zoek naar HPV in mijn onderzoekskabinet Looking for HPV in my office

In this research study, we investigate the presence of HPV DNA on objects used in the management of patients with HPV infections. We explore the risk of contamination, the effectiveness of sterilization methods, and the implications for patient safety.

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Op zoek naar HPV in mijn onderzoekskabinet Looking for HPV in my office

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  1. Op zoek naar HPV in mijn onderzoekskabinetLooking for HPV in my office Mireille Merckx Brussel

  2. Is my material free from HPV? Is my practice office free from HPV? Am I HPV-free? When detecting HPV DNA, does it matter? Is there a risk for infection? Is my patient at risk for HPV infection in my practice office? Question: Are my patients at risk for HPV contamination in my practice?

  3. Lancet 1986: Skegg en Paul report that HPV DNA was detected on specula used on women with CIN Lancet 1986: McCance confirmation of findings 1989: Ferenczy 2001: Strauss 2007: Estes Literature? Very scarce….

  4. Objective: Detection HPV DNA on objects used for the management of patients with HPV infections Gloves used for 16 patients with condylomata acuminata 6 sterilized Kevorkian biopsy forceps used in 62 patients (10 pts with condylomata acuminata, 52 pts with CIN) 2 cryoprobe tips used in 22 patients (15 pts with CIN, 7 pts with cervical condyloma planum) Sampling before & after use, after sterilisation (biopsy forceps soaked 30 minutes of material in 30 % tincture of Savlon* and cryoprobe tips wiped with 90 % ethanol solution) HPV Types tested: 6 & 11 + 16 & 18 + 31, 33 & 35 (old techniques underestimating detection) *Savlon tincture: 7,5 % chlorhexidine, 15 % cetrimide Ferenczy Alex et al – Obstetrics & Gynecology 1989 Ferenczy et al Obstet & Gynecol 1989; 74: 950-54

  5. Detection HPV DNA - Ferenczy et al Gloves Lesional tissues & biopsy forceps Cryoprobes Ferenczy et al Obstet & Gynecol 1989; 74: 950-54

  6. Typing HPV DNA - Ferenczy et al Gloves – HPV types Cryoprobes – HPV types Conclusion: • Objects get very easily contaminated by HPV • HPV DNA is persistent after cleaning and liquid sterilisation • Look for better methods Ferenczy et al Obstet & Gynecol 1989; 74: 950-54

  7. Estes J et al – J of Lower Genital Tract Disease 2007 • Objective: To determine whether autoclave sterilisation eradicates HPV DNA on specula and instruments used to treat women with cervical neoplasia • Specula & instruments from two clinics evaluated (1 colposcopy referral centerexploration for ASCUS or worse, 1 practice clinic) • After each evaluation, speculae hand washed in Cidex and then steam-autoclaved. After sterilisation specula placed into examination table drawers for next use • Cervical biopsy instruments and ECC hand washed and autoclaved. Packaging in sterile peel packs • 70 used instruments & 70 autoclaved instruments sampled Estes et al J Lower Gen Tract Dis 2007;11:12-17

  8. Estes J et al – J of Lower Genital Tract Disease 2007 • 52.3 % of instruments positive for HPV DNA • Autoclave sterilisation is very effective and the sterilisation method of choice of instruments used to evaluate women with CIN Estes et al J Lower Gen Tract Dis 2007;11:12-17

  9. Strauss S et al – Sex Transm Infect 2002 • Objective: To investigate contamination environmental surfaces with HPV • Non sexual routes fro HPV transmission? As HPV may stay infectious within cells for 7 days, even after desiccation • Samples collected • Treatment rooms and patient’s toilets at 2 genitourinary medicine clinics • Staff toilets at fitness and leisure centre for staff at 1 clinic GUM • HPV detection via PCR (35 types) Clinic A (higher disease burden) Clinic B with rigorous cleaning procedures Fitness Strauss S et al Sex Transm Infect 2002;78:135-38

  10. Strauss S et al – Sex Transm Infect 2002 Results: • Clinic A: 50 % of sites samples positive for mucosal HPV DNA (all cell associated) • Clinic B: all sites negative • Fitness: all sites negative • Most commonly found types in clinic A • HPV type 6,11 and 16 • Most sites contaminated at clinic A • predominantly used by medical staff • Hypothesis for toilets • from genital sites via hands to environment • Hypothesis for treatment rooms • Via doctor's gloved hands to environment • Rigorous cleaning! Strauss S et al Sex Transm Infect 2002;78:135-38

  11. Strauss S et al – Sex Transm Infect 2003 – follow-up study Results: • Clinic A: 2 methods of cleaning tested (detergent vs detergent in 70% methylated spirits Strauss S et al Sex Transm Infect 2003;79: 426-7

  12. What do we really know? • Is all my material free from HPV? As long we use correctly sterilized instruments, it seems ok. Sterilization with autoclave is effective. But is all material tested? • Is my practice office free from HPV? No idea • Am I from HPV free? I hope so • When detecting HPV DNA, does it matter? Is there a risk for infection? No idea • Is my patient at risk for HPV infection in my practice office? Let’s hope not…

  13. What can we know rapidly? • Is all my material free from HPV? Detection of HPV DNA on grips of non-disposable material like vaginoscope and handling buttons colposcope • Is my practice office free from HPV? Detection of HPV DNA on examination table, door handles, … • When detecting HPV DNA, does it matter? Is there a risk for infection? Very complex study to set up and up to now proof or suggestion found • Is my patient at risk for HPV infection in my practice office? Not so easy to proof

  14. Idea for a study • Detection of HPV DNA • grip vaginoscope • Handling buttons colposcope • Examination table • Door handle(s) • When? • At the end of a busy day of work • Where? • Practice at home • Practice in clinic • How? • Rubbing met cotton wool tipped swabs soaked in physiologic solution & conservation for examination in one lab

  15. Idea for a study • Number of collections? • After each set of consultations (e.g. at night) • Number of days: at random during 3-week period (e.g. 2 days) • At several distinct places amongst gynecologists • Interested?

  16. Je vous remercie pour votre attention! Ik dank U voor uw luisterend oor!

  17. Gardasil & Cervarix

  18. Idee voor een studieproject • Aantal afnames? • Na elke consultatieronde (bv. ‘s avonds) • Gedurende bv. 2 at random dagen van bv. 3 weken • Verschillende ruimtes bij enkele collega’s • Interesse?

  19. Wat kunnen we eenvoudig en snel te weten komen? • Is al mijn materiaal HPV vrij? Opzoeken van HPV DNA op handvaten van non-disposable materiaal als vaginoscoop en bedieningsknoppen colposcoop • Is mijn kabinet HPV vrij? Opzoeken van HPV DNA op onderzoekstafel, deurklinken, … • Houdt het gedetecteerde HPV DNA eventueel een infectieus risico in? Complexe studiesetting en geen enkele studie heeft dit gesuggereerd of aangetoond • Loopt mijn patiënte überhaupt gevaar in mijn kabinet? Niet zo eenvoudig om aan te tonen

  20. Idee voor een studieproject • Opzoeken van HPV DNA • handvat van vaginoscoop • bedieningsknoppen colposcoop • Onderzoekstafel • Deurklink(en) • Wanneer? • Op het einde van een (drukke) dag van consultaties • Waar? • Privé-kabinet • Onderzoeksruimte in Polykliniek • …pHoe? • Goed wrijven met waatstaafje gedrenkt in fysiologisch & conserveren voor analyse in één centraal laboratorium

  21. Wat weten we en wat niet? • Is al mijn materiaal HPV vrij? Voor zover we steriel materiaal gebruiken, lijkt het ok. Sterilisatie met autoclaaf is afdoende. Maar is alle materiaal getest? • Is mijn kabinet HPV vrij? Geen idee • Ben ik HPV vrij? Ik hoop het • Houdt het gedetecteerde HPV DNA eventueel een infectieus risico in? Geen idee • Loopt mijn patiënte überhaupt gevaar op HPV besmetting in mijn kabinet? Laten we hopen van niet…

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