A prospective study of the efficacy of routine decontamination for gastrointestinal endoscopes and the risk factors for failure

Bisset, Linda; Cossart, Yvonne E.; Selby, Warwick; West, Richard H.; Catterson, Denise; O’Hara, Kate; Vickery, Karen

doi:10.1016/j.ajic.2005.08.007

Cited by 74 publications

(55 citation statements)

References 20 publications

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“…Some reports showed persistent levels of bacteria in endoscope channels, despite reprocessing according to published guidelines, providing indirect evidence for contamination by biofilms [166][167][168] . Residual biofilm can be seen in Figure 2.…”

Section: Biofilm On Flexible Endoscopesmentioning

confidence: 99%

Is peracetic acid suitable for the cleaning step of reprocessing flexible endoscopes?

Kampf

Fliss

Martiny

2014

WJGE

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The bioburden (blood, protein, pathogens and biofilm) on flexible endoscopes after use is often high and its removal is essential to allow effective disinfection, especially in the case of peracetic acid-based disinfectants, which are easily inactivated by organic material. Cleaning processes using conventional cleaners remove a variable but often sufficient amount of the bioburden. Some formulations based on peracetic acid are recommended by manufacturers for the cleaning step. We performed a systematic literature search and reviewed the available evidence to clarify the suitability of peracetic acid-based formulations for cleaning flexible endoscopes. A total of 243 studies were evaluated. No studies have yet demonstrated that peracetic acidbased cleaners are as effective as conventional cleaners. Some peracetic acid-based formulations have demonstrated some biofilm-cleaning effects and no biofilmfixation potential, while others have a limited cleaning effect and a clear biofilm-fixation potential. All published data demonstrated a limited blood cleaning effect and a substantial blood and nerve tissue fixation potential of peracetic acid. No evidence-based guidelines on reprocessing flexible endoscopes currently recommend using cleaners containing peracetic acid, but some guidelines clearly recommend not using them because of their fixation potential. Evidence from some outbreaks, especially those involving highly multidrug-resistant gram-negative pathogens, indicated that disinfection using peracetic acid may be insufficient if the preceding cleaning step is not performed adequately. Based on this review we conclude that peracetic acid-based formulations should not be used for cleaning flexible endoscopes. Key words: Peracetic acid; Cleaning; Flexible endoscope; Biofilm; Resistance; Bioburden; Blood; Disinfection; Reprocessing Core tip: Some formulations based on peracetic acid (PAA) are recommended by manufacturers for cleaning flexible endoscopes. We reviewed 243 studies to analyse the evidence for this recommendation. No study demonstrated that PAA-based cleaners were as effective as conventional cleaners, and some PAA-based formulations had clear biofilm-fixation potential. Dried blood and nerve tissue were substantially fixed by PAA. Some outbreaks, especially of highly multidrug-resistant gram-negative pathogens, indicated that insufficient cleaning could not be compensated for by using PAA in the disinfection step. PAA-based formulations should not be used for cleaning flexible endoscopes.

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Section: Biofilm On Flexible Endoscopesmentioning

confidence: 99%

Is peracetic acid suitable for the cleaning step of reprocessing flexible endoscopes?

Kampf

Fliss

Martiny

2014

WJGE

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“…Nursing performance is recognized as a fundamental factor in the effectiveness of decontamination of the endoscope and is widely recognized as essential to the specific qualifications of health professionals who work in endoscopy services (1,3,4,7,15,17,18,19,21) . Endoscope pre-washing was not a commonly observed practice.…”

Section: Discussionmentioning

confidence: 99%

“…The risk of transmission of potential pathogens depends on three major factors: exposure of the endoscope to the microorganism, inadequate cleaning and disinfection procedures, and the intricate design of the endoscopes, which feature narrow, long lumens and are made of delicate material (19) . The risk of infection for patients undergoing these procedures has been progressively reduced by the implementation of increased policies to control hospital infection and adequate training of personnel (3) . In 1999, the first step of national standardization for the cleaning and disinfection of endoscopes and accessories in Brazil was established for nurses.…”

Section: Introductionmentioning

confidence: 99%

Endoscope reprocessing using glutaraldehyde in endoscopy services of Goiânia, Brazil

Barbosa¹,

Souza

Tipple

et al. 2010

Arq. Gastroenterol.

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-Context -The endoscopic procedure safety depends on the use of an adequately reprocessed device which quality is related to each of its operational steps. Objective -To characterize the reprocessing of endoscopes using glutaraldehyde in endoscopy services Methods -Study was conducted by observing the reprocessing of 60 endoscopes from 20 medical practices of the municipality of Goiânia, GO, central area of Brazil. Results -This study showed failure in all reprocessing steps. The pre-washing was performed in 24 (40.0%) of the endoscope. In the cleaning steps, was identify the improper use of enzymatic detergent, and in 27 (45.0%) cases, the brushing of internal channels was not performed. All 60 endoscopes were submitted to this disinfectant. However, for 33 (55.0%) of the cases the internal channels was not filled. The total immersion of endoscope in the glutaraldehyde was not performed in 39 (65.0%) cases. The recommended minimum total immersion time for exposure to 2% glutaraldehyde solution was followed only for 12 (20.0%) endoscopes. There was no filter for water treatment used in the rinse of most endoscopes 54 (90.0%) and to dry the internal channels only 6 (10.0%) of them used compressed air. Adequate storing conditions were identified. Conclusion -Considering the particularities of the endoscope and its reprocessing, it is imperative to establish protocols to ensure the quality of the disinfection and the prevention of cross-contamination.

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“…Therefore, their authors propose the need for studies to evaluate adherence to cleaning and disinfection protocols, the elaboration of methods that permit monitoring the processing and tests to check its efficiency (1,(4)(5)(6)(7)(8) .…”

Section: Introductionmentioning

confidence: 99%

Remoção de biofilme em canais de endoscópios: avaliação de métodos de desinfecção atualmente utilizados

Balsamo

Graziano

Schneider

et al. 2012

Rev. esc. enferm. USP

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RESUmoEstudo experimental laboratorial que comparou a ação de cinco métodos de desinfecção na remoção de biofilme em endoscópios gastrintestinais. Foram utilizados como corpos de prova tubos novos transparentes de politetrafluoretileno (Teflon®) simulando os canais flexíveis dos endoscópios. Após limpeza prévia os tubos foram contaminados intencionalmente com Pseudomonas aeruginosa para formação de biofilme e submetidos à desinfecção. Como resultado, nenhum deles removeu 100% dos biofilmes. O que mais removeu fisicamente o biofilme foi o glutaraldeído 2% em processadora automática, provavelmente justificado pela dupla limpeza, já que o equipamento conta com essa fase no início do seu ciclo. O método que se mostrou menos eficiente para remoção de biofilme e outros resíduos foi água eletrolítica ácida. Esses resultados sugerem que a limpeza é mais impactante na remoção de biofilmes do que a desinfecção consecutiva, uma vez que o glutaraldeído, desinfetante da máquina que se mostrou mais eficiente, é um fixador de resíduos orgânicos. Original article AbStRActLaboratory experimental study that compared the effectiveness of five methods of disinfection for the removal of biofilm in gastrointestinal endoscopes. New transparent tubes of polytetrafluoroethylene (Teflon®) were used as specimens to simulate the channels of flexible endoscopes. After pre-cleaning the tubes were intentionally contaminated with Pseudomonas aeruginosa and subjected to disinfection methods. As a result, none removed 100% of these biofilms. What else physically removed biofilm was 2% glutaraldehyde in an automatic processor, probably justified by the double clean, since the equipment has this phase at the beginning of your cycle. The method less effective for removing plaque and other debris was the acidic electrolytic water. These results suggest that the cleaning is most striking in the removal of biofilms that disinfection of consecutive since glutaraldehyde disinfectant by machine is more efficient, it is a fastener organic waste. RESUmEnUn estudio experimental en el laboratorio en el que se comparó la acción de los cinco métodos de desinfección en la eliminación de biofilm en los endoscopios gastrointestinales. Fueron utilizados como muestras tubos nuevos transparentes de politetrafluoroetileno (Teflon®) simulando los canales de los endoscopios flexibles. Después de pre-limpieza los tubos fueron contaminadas intencionadamente con Pseudomonas aeruginosa y se sometió a métodos de desinfección. Como resultado, ningún método hay removido 100% de las biopelículas. El método que más hay removido físicamente fue 20% glutaraldehído en un procesador automático, probablemente justificado por la doble limpio, ya que el equipo tiene esta fase en el comienzo de su ciclo. El método es menos eficaz para eliminar la placa y la otra ruina era el agua ácida electrolítica. Estos resultados sugieren que la limpieza es más notable en la eliminación de las biopelículas que la desinfección de forma consecutiva desde desinfectante glutaraldehído de la máquina e...

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A prospective study of the efficacy of routine decontamination for gastrointestinal endoscopes and the risk factors for failure

Cited by 74 publications

References 20 publications

Is peracetic acid suitable for the cleaning step of reprocessing flexible endoscopes?

Is peracetic acid suitable for the cleaning step of reprocessing flexible endoscopes?

Endoscope reprocessing using glutaraldehyde in endoscopy services of Goiânia, Brazil

Remoção de biofilme em canais de endoscópios: avaliação de métodos de desinfecção atualmente utilizados

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