Current limitations about the cleaning of luminal endoscopes

Hervé, R.; Keevil, C. W.

doi:10.1016/j.jhin.2012.08.008

Cited by 29 publications

(40 citation statements)

References 16 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In a study reported by Vickery et al (368), enzymatic cleaners failed to reduce viable bacterial numbers more than 2 logs in E. coli biofilms in polyvinyl chloride tubing. Another study reported the failure of a commonly used enzymatic cleaner to completely remove test soil from endoscope channels (369). Nonenzymatic detergents showed a better inhibition of biofilm formation than enzymatic detergents (368,370).…”

Section: Impact Of Biofilm On Endoscope Reprocessingmentioning

confidence: 99%

Transmission of Infection by Flexible Gastrointestinal Endoscopy and Bronchoscopy

et al. 2013

View full text Add to dashboard Cite

SUMMARY Flexible endoscopy is a widely used diagnostic and therapeutic procedure. Contaminated endoscopes are the medical devices frequently associated with outbreaks of health care-associated infections. Accurate reprocessing of flexible endoscopes involves cleaning and high-level disinfection followed by rinsing and drying before storage. Most contemporary flexible endoscopes cannot be heat sterilized and are designed with multiple channels, which are difficult to clean and disinfect. The ability of bacteria to form biofilms on the inner channel surfaces can contribute to failure of the decontamination process. Implementation of microbiological surveillance of endoscope reprocessing is appropriate to detect early colonization and biofilm formation in the endoscope and to prevent contamination and infection in patients after endoscopic procedures. This review presents an overview of the infections and cross-contaminations related to flexible gastrointestinal endoscopy and bronchoscopy and illustrates the impact of biofilm on endoscope reprocessing and postendoscopic infection.

show abstract

Section: Impact Of Biofilm On Endoscope Reprocessingmentioning

confidence: 99%

Transmission of Infection by Flexible Gastrointestinal Endoscopy and Bronchoscopy

et al. 2013

View full text Add to dashboard Cite

show abstract

“…If all these parameters are fulfilled, the ATP level will be < 200 RLUs [191] which can be considered a validated benchmark from patient endoscopes [195] . Overall, most of the organic contamination is usually removed below benchmark by detergent-based cleaning procedures, although exceptions may occur [196] .…”

Section: Other Organic Contaminationmentioning

confidence: 99%

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

Kampf

Fliss

Martiny

2014

WJGE

View full text Add to dashboard Cite

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.

show abstract

“…To address the limitation of the endoscopic instrument concerning improper sterilization, cross-contamination, and instrument turnaround time for reuse of the scopes, disposable endoscopes were developed (37,47). These instruments could include disposable sheaths of the endoscope or be entirely disposable units (12,47).…”

Section: Peer-review Reportsmentioning

confidence: 99%