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Removal of Botulinum Neurotoxin a Surrogate from Reusable Medical Device Surfaces

Lucas, AD;Di Prima, MA;Hitchins, VM;

Botulinum neurotoxin A (BoNT/A) is on the national select agent registry and can be an extremely potent biotoxin if weaponized. It blocks neuromuscular transmission by decreasing acetylcholine release. This may be a serious problem if expensive reusable medical devices such as ventilators or anesthesia machines are accidentally or deliberately contaminated. Since transfer of BoNT/A from medical device surfaces to the patient or healthcare provider may occur, determining if these devices can be decontaminated to make them suitable for subsequent use is important. This study focuses on measuring the removal of the enzymatically active light chain A (LcA) of BoNT/A from reusable medical devices and materials. A labeled SNAP-25 (synaptosomal-associated protein of molecular mass 25 kDa) peptide substrate of the enzymatically active LcA was used to quantify the amount of LcA. Various medical device materials with different surface roughness, from 0.081 to 3.916 m, were tested to evaluate the efficacy in removing LcA as a function of surface roughness. This study showed that there was no statistically significant difference in the removal of LcA from these medical device materials with different surface roughness. The removal of LcA from the five medical device surfaces (one anesthesia machine, two types of ventilators, and two types of bed rails) ranged from 36%71%. This study demonstrates that LcA of BoNT/A can be removed from the surfaces of several large reusable medical devices and that surface roughness was not associated with removal efficiency. Botulinum Neurotoxin A Medical Device Surface Roughness Cleanability