Comparison of adenosine triphosphate, microbiological load, and residual protein as indicators for assessing the cleanliness of flexible gastrointestinal endoscopes

Fushimi, Ryo; Takashina, Masaki; Yoshikawa, Hiroyuki; Kobayashi, Hiroyoshi; Okubo, Takashi; Nakata, S; Kaku, Mitsuo

doi:10.1016/j.ajic.2012.02.030

Cited by 60 publications

(49 citation statements)

References 17 publications

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“…[191] , indicating inadequate cleaning [192] . Levels may be as high as 10417 RLUs on the exterior endoscope surface, or 30281 RLUs on the biopsy suction channel rinsates [193] . Haemoglobin and protein may also remain after cleaning.…”

Section: Other Organic Contaminationmentioning

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: Other Organic Contaminationmentioning

confidence: 99%

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

Kampf

Fliss

Martiny

2014

WJGE

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“…Some years later, the same research group proposed a revised stricter pass/fail value of 250 RLUs, showing the importance of linking benchmarking to incremental quality improvements [9]. Fushimi et al showed that ATP values from gastrointestinal endoscope reliably reflected the microbiological load and defined that allowable ATP levels after manual cleaning in their institution were 169 RLUs and 407 RLUs for external endoscope surfaces and channel results respectively [10]. Alfa et al validated an ATP water test method for monitoring manual cleaning of flexible endoscopes and reported that the average protein, haemoglobin, and bioburden benchmarks were achieved if<200 RLU were detected in water samples flushed through endoscope channels [11].…”

Section: Inspection Of Thementioning

confidence: 99%

ATP Measurement in the Last Rinse Water of Automated Washer-Disinfectors: The Added Value of Every Load Monitoring

Tessarolo¹,

Valentinotti²,

Mariotti³

et al. 2016

J Clin Infect Dis Pract

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Objective: To assess whether monitoring every loads of automated washer-disinfectors (AWDs) by testing the last rinse water with Adenosine Triphosphate (ATP) would have an added value to document effective and reproducible AWD processes. Methods:Every load monitoring (ELM) of the last rinse water with ATP was performed on three AWDs at the sterilization department of a 329 acute-bed hospital in Italy. No change were made in the routine procedures, except the last rinse water of a process was collected with a water sampler and tested on ATP. Data from negative controls and empty cycles were also obtained for comparison. ATP values were analysed according to AWD, load, and process characteristics. Conclusion:The measurement of ATP in the last rinse water of AWDs showed that characteristics and quantities of the load relate to the ATP readings. The test is advised as an informative additional test to visual inspection for monitoring every load of an AWD.

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“…9 Others have found a strong association between culture results and ATP levels. [10][11][12] Alfa et al 9 noted that ATP tests used to monitor cleaning effectiveness cannot reliably detect the small numbers of microbes that may be present in patient-ready endoscopes.…”

Section: Reply To Petersenmentioning

confidence: 99%

Reply to Petersen

Visrodia

Ofstead

Yellin

et al. 2014

Infect. Control Hosp. Epidemiol.

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Comparison of adenosine triphosphate, microbiological load, and residual protein as indicators for assessing the cleanliness of flexible gastrointestinal endoscopes

Cited by 60 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?

ATP Measurement in the Last Rinse Water of Automated Washer-Disinfectors: The Added Value of Every Load Monitoring

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