Bone Cement and Black Light Detection - Part 2

Q: The original question from last month: “Recently, I read some posting on the Internet that one can use black lights to detect residual bone cement. Is that true,¹ and can our department use a black light for this purpose?”

A:

“Now, the rest of the story….”²

My basic research has led me to consider the following:

• Some “bone cements” have phosphates {calcium, magnesium, beta tri-calcium, etc.} and other materials like barium sulfate in their design.³
• Users should know the type of bone cement used at their facility.
• Can staff perform their own testing on devices to find an acceptable level for detection?
• What type of “black light” ultraviolet (UV) light can be used?
• Does the IFU of the purchased black light state the device can be used for detecting medical bone cement?
• What does the literature say about using the black light method for the purpose they want?^4,5,6 (Note: I have not found any peer-review literature supporting this practice.)
• Why are professionals using a black light without real data to support their practice?

Again, the question is: What does the black light pick up (show/glow) if a department is using it as an inspection tool? Because we do know that “Proteinaceous materials emit fluorescence when illuminated by UV light.”⁵

We all know the use of black light technology is helpful in hand hygiene. Some companies even say it can be used on a hard surface to help determine whether proper cleaning was performed.⁴ This technology requires not only a black light but a specific gel or powder to be used to show how effective your hand washing process is or how thoroughly a hard surface has been cleaned.^4,7 I did not find anything related to using this process on medical devices. As I asked in April, “Could a black light pick [up] residual bone cement if left on the medical device?” That is, residual bone cements the natural eye cannot perceive.

I would find answers to at least the questions I raised (you might have more) using this black light as an inspection/detection tool. Once they are all answered, I would then make a policy on how to use this tool within my department for inspection purposes—if the research called for such a policy

Personally, I do think there might be some truth to the notion that a black light could detect residual bone cement material…but what material(s) of the bone cement is it detecting, and how low is the sensitivity of the detection level? Currently, I have no idea. Some of these bone cements contain barium sulfate or phosphorus that are sensitive to UV light but maybe not specifically UV from a flashlight black light source. You might need a higher / lower UV than a little flashlight can provide, and perhaps that kind of light is not safe.

Put these ideas and products through the same rigorous process you would for anything else you use in your department. Critically think it through and assess the benefits. If you find you can use it at your facility, do so because you will have the documentation to back up your decision to use it properly. Thus, to market it as a standalone tool would be a bit presumptive at this time based on my limited research. Remember, you want to use clinically relevant evidence-based products (at least that is what I would want) to back up using a black light as an inspection tool.

I know that residual bone cement is an issue for the medical device reprocessing profession, and we all want to find simple, easy solutions for our team members to provide a clean and functional medical device. For me, I need to see more evidence. I recently read an interesting article on bone cement titled “Strategies for Eliminating Retained Bone Cement” in HSPA’s PROCESS publication.⁸ I would highly recommend reading it to find more information. Maybe someone can do a research paper on this topic and shed some real light on the subject.

“And now you know…the rest of the story.”²

References (APA Style 7th Edition):

1. Jagrosse, D. (2023, February). Are you using a black light on SPD Instrument assembly to look for residual bone cement? Thoughts? Outcomes? [Image attached] [Post]. LinkedIn. https://www.linkedin.com/posts/jongoodwin3_apa2019-activity-6569581103441682432-CN98

2. Jones, C. D., (2002). What Paul Harvey Used to Say, and Why We Say It Again. Callaway-Jones. https://callawayjones.com/restofthestory/

3. Yousefi A. M. (2019). A review of calcium phosphate cements and acrylic bone cements as injectable materials for bone repair and implant fixation. Journal of applied biomaterials & functional materials, 17(4), 2280800019872594. https://doi.org/10.1177/2280800019872594 Viewed on https://pubmed.ncbi.nlm.nih.gov/31718388/\

4. Glo Germ™. (2024). The original visual tool for teaching proper handwashing, aseptic techniques, and general infection control. https://www.glogerm.com/

5. WelTool. (2024). Weltool M2-OL "Purple Beard" UV 365nm Professional LED Flashlight. https://www.weltool.com/page137?product_id=112

6. Dierks, K., Meyer, A., Oberthür, D., Rapp,  G., Einspahr, H., & Betzel, C. (2010 Apr 1). Efficient UV detection of protein crystals enabled by fluorescence excitation at wavelengths longer than 300 nm. Acta Crystallographica Section F, 66(Pt 4): 478–484. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2852349/ Doi: https://doi.org/10.1107/S1744309110007153

7. Glo Germ™. (2024). Surface Cleaning. https://www.glogerm.com/handwashing.html#SurfaceCleaning

8. Anderson, K. (2023, December). Strategies for Eliminating Retained Bone Cement. PROCESS: A publication of the Healthcare Sterile Processing Association. November/December 2023, 58–59. https://www.hmark.com/wp-content/uploads/2024/03/Process-Nov-Dec-2023-58-59.pdf