In-Use Evaluation of Peracetic Acid for High-Level Disinfection of Endoscopes

Wu, Chenjiao; Zhang, Hongyan; Gu, Qing; Zhong, Xiao-Qi; Gu, Li-Ying; Fang, Ying

doi:10.1097/sga.0000000000000192

Cited by 21 publications

(11 citation statements)

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“…Guidelines and in vitro studies indicate potential differences in efficacy between detergents, [45][46][47][48][49] disinfectants, 48,50,51 and AERs. 52 In the current study, contamination was not shown to be dependent on reprocessing characteristics, which is in line with another multicenter study.…”

Section: Discussionmentioning

confidence: 99%

Nationwide risk analysis of duodenoscope and linear echoendoscope contamination

Rauwers

holt

Buijs

et al. 2020

Gastrointestinal Endoscopy

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Background and Aims: Contaminated duodenoscopes and linear echoendoscopes (DLEs) pose a risk for infectious outbreaks. To identify DLEs and reprocessing risk factors, we combined the data from the previously published nationwide cross-sectional PROCESS 1 study (Prevalence of contamination of complex endoscopes in the Netherlands) with the follow-up PROCESS 2 study. Methods: We invited all 74 Dutch DLE centers to sample !2 duodenoscopes during PROCESS 1, and all duodenoscopes as well as linear echoendoscopes during PROCESS 2. The studies took place 1 year after another. Local staff sampled each DLE at 6 sites according to uniform methods explained by online videos. We used 2 contamination definitions: (1) any microorganism with !20 colony-forming units (CFU)/20 mL (AM20) and (2) presence of microorganisms with GI or oral origin, independent of CFU count (MGOs). We assessed the factors of age and usage by performing an analysis of pooled data of both PROCESS studies; additional factors including reprocessing characteristics were only recorded in PROCESS 2. Results: Ninety-seven percent of all Dutch centers (72 of 74; PROCESS 1, 66; PROCESS 2, 61) participated in one of the studies, sampling 309 duodenoscopes and 64 linear echoendoscopes. In total, 54 (17%) duodenoscopes and 8 (13%) linear echoendoscopes were contaminated according to the AM20 definition. MGOs were detected on 47 (15%) duodenoscopes and 9 (14%) linear echoendoscopes. Contamination was not age or usage dependent (all P values !.27) and was not shown to differ between the reprocessing characteristics (all P values !.01). Conclusions: In these nationwide studies, we found that DLE contamination was independent of age and usage. These results suggest that old and heavily used DLEs, if maintained correctly, have a similar risk for contamination as new DLEs. The prevalence of MGO contamination of w15% was similarly high for duodenoscopes as for linear echoendoscopes, rendering patients undergoing ERCP and EUS at risk for transmission of microorganisms. (Gastrointest Endosc 2020;92:681-91.) Abbreviations: AER, automated endoscope reprocessor; AM20, any microorganism with !20 CFU/20 mL; CFU, colony-forming units; DLE, duodenoscope and linear echoendoscope; IFU, instructions for use; IQR, interquartile range; MGO, presence of microorganisms with GI or oral origin, independent of CFU count; PROCESS study, Prevalence of contamination of complex endoscopes in the Netherlands; SFERD, Dutch Steering Group for Flexible Endoscope Cleaning and Disinfection. DISCLOSURE: Dr Bruno has had the following relevant financial activities outside the submitted work: consultant for 3M; grant from 3M for an investigator-initiated study; consultant and lecturer for Boston Scientific; grants from Boston Scientific for investigator-initiated studies and industryinitiated studies; consultant and lecturer for Cook Medical; grants from Cook Medical for investigator-initiated studies and industry-initiated studies; grants from Pentax Medical. Dr Vos has had the following relevant fina...

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Section: Discussionmentioning

confidence: 99%

Nationwide risk analysis of duodenoscope and linear echoendoscope contamination

Rauwers

holt

Buijs

et al. 2020

Gastrointestinal Endoscopy

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“…Glutaraldehyde is a saturated dialdehyde that has gained wide acceptance as a high-level disinfectant and chemical sterilant [14]. Aqueous solutions of glutaraldehyde are "activated" by using alkalinating agents to bring the pH to values between 7.5 and 8.5, which makes the solution sporicidal [15,16]. Glutaraldehyde (GAA) solutions are used for the sterilization of medical devices, such as endoscopes and fibroscopes.…”

Section: Discussionmentioning

confidence: 99%

Scanning Electron Microscopy Analysis and Energy Dispersion X-ray Microanalysis to Evaluate the Effects of Decontamination Chemicals and Heat Sterilization on Implant Surgical Drills: Zirconia vs. Steel

Scarano

Noumbissi

Gupta³

et al. 2019

Applied Sciences

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Background: Drills are an indispensable tool for dental implant surgery. Today, there are ceramic zirconium dioxide and metal alloy drills available. Osteotomy drills are critical instruments since they come in contact with blood and saliva. Furthermore, they are reusable and should be cleaned and sterilized between uses. Depending on the material, sterilizing agents and protocols can alter the surface and sharpness of implant drills. The hypothesis is that cleaning and sterilization procedures can affect the surface structure of the drills and consequently reduce their cutting efficiency. Methods: Eighteen zirconia ceramic drills and eighteen metal alloy drills were evaluated. Within the scope of this study, the drills were not used to prepare implant sites. They were immersed for 10 min in human blood taken from volunteer subjects and then separately exposed to 50 cycles of cleansing with 6% hydrogen peroxide, cold sterilization with glutaraldehyde 2%, and autoclave heat sterilization. Scanning Electron Microscopy (SEM) and energy dispersion X-ray (EDX) microanalysis were conducted before and after each cycle and was used to evaluate the drill surfaces for alterations. Results: After exposure to the cleansing agents used in this study, alterations were seen in the steel drills compared to zirconia. Conclusions: The chemical sterilization products used in this study cause corrosion of the metal drills and reduce their sharpness. It was observed that the cycles of steam sterilization did not affect any of the drills. Zirconia drill surfaces remained stable.

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“…These alterations might be caused by a sharp decrease in bacterial inner pressure resulting from high permeability to PAA for a short period. Additionally, PAA is thought to act as an oxidizing agent by releasing hydroxyl radicals, which subsequently attack essential biofilm matrix components [ 27 – 29 ]. To date, no PAA-resistance mechanisms have been reported for either cell suspensions or biofilms.…”

Section: Discussionmentioning

confidence: 99%

Morphological bactericidal fast-acting effects of peracetic acid, a high-level disinfectant, against Staphylococcus aureus and Pseudomonas aeruginosa biofilms in tubing

Chino

Nukui

Morishita

et al. 2017

Antimicrob Resist Infect Control

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BackgroundThe bactericidal effect of disinfectants against biofilms is essential to reduce potential endoscopy-related infections caused by contamination. Here, we investigated the bactericidal effect of a high-level disinfectant, peracetic acid (PAA), against Staphylococcus aureus and Pseudomonas aeruginosa biofilm models in vitro.Methods S. aureus and P. aeruginosa biofilms were cultured at 35 °C for 7 days with catheter tubes. The following high-level disinfectants (HLDs) were tested: 0.3% PAA, 0.55% ortho-phthalaldehyde (OPA), and 2.0% alkaline-buffered glutaraldehyde (GA). Biofilms were exposed to these agents for 1–60 min and observed after 5 min and 30 min by transmission and scanning electron microscopy. A Student’s t test was performed to compare the exposure time required for bactericidal effectiveness of the disinfectants.ResultsPAA and GA were active within 1 min and 5 min, respectively, against S. aureus and P. aeruginosa biofilms. OPA took longer than 10 min and 30 min to act against S. aureus and P. aeruginosa biofilms, respectively (p < 0.01). Treatment with PAA elicited changes in cell shape after 5 min and structural damage after 30 min.ConclusionsAmongst the HLDs investigated, PAA elicited the most rapid bactericidal effects against both biofilms. Additionally, treatment with PAA induced morphological alterations in the in vitro biofilm models, suggesting that PAA exerts fast-acting bactericidal effects against biofilms associated with endoscopy-related infections. These findings indicate that the exposure time for bactericidal effectiveness of HLDs for endoscope reprocessing in healthcare settings should be reconsidered.

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In-Use Evaluation of Peracetic Acid for High-Level Disinfection of Endoscopes

Cited by 21 publications

References 0 publications

Nationwide risk analysis of duodenoscope and linear echoendoscope contamination

Nationwide risk analysis of duodenoscope and linear echoendoscope contamination

Scanning Electron Microscopy Analysis and Energy Dispersion X-ray Microanalysis to Evaluate the Effects of Decontamination Chemicals and Heat Sterilization on Implant Surgical Drills: Zirconia vs. Steel

Morphological bactericidal fast-acting effects of peracetic acid, a high-level disinfectant, against Staphylococcus aureus and Pseudomonas aeruginosa biofilms in tubing

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