Cleaning efficacy of nine different cleaners in a washer–disinfector designed for flexible endoscopes

Zühlsdorf, B.; Emmrich, Monika; Floss, H.; Martiny, H

doi:10.1053/jhin.2002.1284

Cited by 45 publications

(35 citation statements)

References 17 publications

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“…Some cleaning agents are enzymatic, others are non-enzymatic [55,56] . The cleaning agent should be compatible with the disinfectant agent.…”

Section: Cleaning Agentsmentioning

confidence: 99%

“…In contaminated test tubes the cleaning step during automatic processing of flexible endoscopes shows variable results, depending on the type of process and the cleaning agent [58] . Some cleaning processes using a detergent were significantly less effective (0.3 log10-steps) than water alone (1.1-2.6 log10-steps), indicating that the entire cleaning process needs to be evaluated critically [55,56] . In contrast, other cleaning processes were significantly more effective (4.1 log10-steps) [56] .…”

Section: Pathogens On Flexible Endoscopes After Cleaningmentioning

confidence: 99%

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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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“…Some cleaning agents are enzymatic, others are non-enzymatic [55,56] . The cleaning agent should be compatible with the disinfectant agent.…”

Section: Cleaning Agentsmentioning

confidence: 99%

Section: Pathogens On Flexible Endoscopes After Cleaningmentioning

confidence: 99%

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

Kampf

Fliss

Martiny

2014

WJGE

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“…The likelihood ratio test (8) was used to compare the segments from the start, middle and end of the tubes for each disinfection method. Significance was set at 5% and statistical power at 95%.…”

Section: Methodsmentioning

confidence: 99%

“…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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“…Kurz nach Publikation der RKI-Empfehlungen zur Endoskopaufbereitung wurden Ergebnisse zur Effektivität verschiedener bei der Aufbereitung eingesetzter Reiniger publiziert [56,57]. Der Befund, dass einige Reiniger nicht besser sind als Wasser, ist später von einer anderen Arbeitsgruppe bestätigt worden [58].…”

Section: Reinigung: Alkalisch -Neutralenzymatisch?unclassified

Fünf Jahre Empfehlungen der Kommission für Krankenhaushygiene zur Aufbereitung flexibler Endoskope

Leiß

Bader²,

Mielke

et al. 2008

Bundesgesundheitsbl.

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Cleaning efficacy of nine different cleaners in a washer–disinfector designed for flexible endoscopes

Cited by 45 publications

References 17 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?

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

Fünf Jahre Empfehlungen der Kommission für Krankenhaushygiene zur Aufbereitung flexibler Endoskope

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