The failure on the effectiveness of formalin on cadaver disinfection and alternative methods

Year 2023, Volume: 36 Issue: 1, 14 - 17, 31.01.2023

Ozgur Yanılmaz Mehmet Mucahit Guncu Mehmet Burak Aksu Mazhar Ozkan , Umit Suleyman Sehırlı

https://doi.org/10.5472/marumj.1244383

Abstract

Objective: It was aimed to identify the contaminant and determine the alternative disinfectant detection in the microbial growth
observed in various parts of the cadaver stored in the formalin tank in the dissection laboratory of Marmara University Anatomy
Department. We also performed a literature review of this unusual pathogen.
Materials and Methods: Swab samples were inoculated on agar mediums. After incubation, matrix-assisted laser desorption ionizationtime
of flight mass spectrometry (MALDI-TOF MS) analysis was used to identify the isolate from the detected uniform colonies.
Sample solution from the cadaver tank, freshly prepared 5% formalin and 0.55% ortho-phthalaldehyde were used to determine the
disinfectant sensitivity of the isolate.
Results: According to 16s rDNA sequence analysis, it was concluded as Skermanella aerolata with 99% similarity. In the disinfectant
susceptibility test, it was observed that S. aerolata and control bacteria could grow in 5% formalin taken from the cadaver tank. No
growth was detected in other disinfectants.
Conclusion: To prevent cadaver contamination in anatomy laboratories, the quality control of the embalming solutions and indoor
air filtration of the dissection rooms should be checked at regular intervals. Members of Skermanella genus have been identified as
environmental organisms in several studies, however, recent researches reported this bacterium as a human pathogen.

Keywords

Skermanella aerolata, Cadaver, Anatomy, Formalin.

References

• Loukas M, Hanna M, Alsaiegh N, Shoja M M, Tubbs R S. Clinical anatomy as practiced by ancient Egyptians. Clin Anat 2011; 24: 409-15. doi: 10.1002/ca.21155
• Gupta J, Chaturvedi M, Patil M. Embalmed cadavers – are they safe to handle, a study to see the microbial flora present in the embalmed cadavers. Int J Pharma Bio Sci 2013; 4:383-6.
• Brenner E. Human body preservation – old and new techniques. J Anat 2014; 224:316-44. doi: 10.1111/joa.12160.
• Kalanjati VP, Prasetiowati L, Alimsardjono H. The use of lower formalin-containing embalming solution for anatomy cadaver preparation. Med J Indones 2012; 21:203-7.
• Ruhsar E, Demiraslan Y. Kadavra hazırlamada kullanılan solüsyonlar ve güncel yaklaşımlar. Dicle Üniversitesi Veteriner Fakültesi Dergisi 2018; 11:105-8.
• Benkhadra M, Gerard J, Genelot D, et al. Is Thiel’s embalming method widely known? A world survey about its use. Surg Radiol Anat 2011; 33: 359-63. doi: 10.1007/s00276.010.0705-6
• Balta J Y, Cronin M, Cryan J F, O’Mahony S M. Human preservation techniques in anatomy: a 21st century medical education perspective. Clin Anat 2015; 28:725-34. doi: 10.1002/ca.22585
• Demiryurek D, Bayramoglu A, Ustacelebi S. Infective agents in fixed human cadavers: a brief review and suggested guidelines. Anat Rec 2002; 269: 194-7. doi: 10.1002/ar.10143
• Kaufman M. Dangerous dissections: the hazard from bodies supplied to Edinburgh anatomists, winter session, 1848-9. J. R. Coll Physicians Edinb 2005; 35: 268-74.
• Sri-Indrasutdhi V, Ueapattanakit J, Sommatas A. Investigation of airborne fungi and their ability to grow on formalin-fixed human cadavers. Mycosphere 2015; 6:729-36. doi:10.5943/ mycosphere/6/6/8
• Faghani L M, Farzanegan A. Decrease of microbial contamination by application of routinely glycerol and phenol solution on human cadavers. J Curr Biomed Rep 2021; 2:74-8.
• Dworzanski J P, Snyder A P. Classification and identification of bacteria using mass spectrometry-based proteomics. Expert Review of Proteomics 2005; 2:863-78. doi: 10.1586/14789450.2.6.863
• Weisburg W G, Barns S M, Pelletier D A, Lane D J. 16S ribosomal DNA amplification for phylogenetic study. J Bacteriol 1991; 173:697-703. doi: 10.1128/jb.173.2.697.703.1991
• Altschul S F, Gish W, Miller W, Myers E W and Lipman D J. Basic local alignment search tool. J Mol Biol 1990; 215:403-10. doi: 10.1016/S0022-2836(05)80360-2
• Akamatsu T, Minemoto M, Uyeda M. Evaluation of the antimicrobial activity and materials compatibility of orthophthalaldehyde as a high-level disinfectant. J Int Med Res 2005;33:178-87. doi: 10.1177/147.323.000503300205.
• Brenner E, Maurer H, Moriggl B and Pomaroli A. The human cadaver as an educational tool – classification and comparison with other educational tools. Ann Anat 2003; 185: 229-30.
• Skerman V B D, Sly L I, Williamson M L. Conglomeromonas largomobilis gen. nov., sp. nov., a sodium-sensitive, mixedflagellated organism from fresh waters. Int J Syst Bacteriol 1983; 33:300-8.
• Sly L I, Stackebrandt E. Description of Skermanella parooensis gen. nov., sp. nov. to accommodate Conglomeromonas largomobilis subsp. parooensis following the transfer of Conglomeromonas largomobilis subsp. largomobilis to the genus Azospirillum. International Journal of Systematic and Evolutionary Microbiology 1999; 49:541-4.
• Weon H Y, Kim B Y, Hong S B, et al. Skermanella aerolata sp. nov., isolated from air, and emended description of the genus Skermanella. Int J Syst Evol Microbiol 2007 ;57:1539-42. doi: 10.1099/ijs.0.64676-0.
• Onori R, Marín M, Rodríguez-Sánchez B, et al. First isolation of Skermanella aerolata from a human sample. Rev Esp Quimioter 2018; 31:552-3.
• Heo S T, Kwon K T, Yoo J R, Choi J Y, Lee K H, Ko K S. First case of necrotizing fasciitis caused by Skermanella aerolata infection mimicking vibrio sepsis. Ann Lab Med 2018;38:604- 6. doi: 10.3343/alm.2018.38.6.604.