Removal of biofilm from endoscopes: evaluation of detergent efficiency☆

Vickery, Karen; Pajkos, Aniko; Cossart, Yvonne E.

doi:10.1016/j.ajic.2003.10.009

Cited by 113 publications

(78 citation statements)

References 20 publications

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“…A non-enzymatic detergent yielded a significantly higher log10-reduction (4.13 to 4.17 log10-reduction) of residual wall E. coli biofilm bacteria than the enzymatic detergents (0.74 to 0.88 log10-reduction), whilst contact time (3, 5 or 7 min) had no significant impact [180] . Similar results on different cleaners were reported by Fang et al [181] and Vickery et al [182] . Quantification of endotoxin levels also revealed better results for a non-enzymatic cleaner in terms of biofilm reduction [183] .…”

Section: Biofilm On Flexible Endoscopessupporting

confidence: 80%

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 Endoscopessupporting

confidence: 80%

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

Kampf

Fliss

Martiny

2014

WJGE

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“…These results are consistent with those reported by others. For example one study looked at four enzymatic cleaners and one non-enzyme based cleaner for the removal of biofilms from medical endoscopes and found that one of the enzyme based cleaners and the nonenzyme based cleaner were capable of removing biofilm cells 10 . The log reduction in number of viable cells was 1.57 and 4.70 respectively and it was clear that the nonenzyme based cleaner was far superior.…”

Section: Discussionmentioning

confidence: 99%

“…Enzyme-containing detergents are used in the medical industry as a precleaning step to maximise biocide efficacy because they are thought to remove the biological soil by digesting the biofilm structure 10 . Similar cleansing applications are already used commercially, for example in detergents for domestic washing machines.…”

Section: Introductionmentioning

confidence: 99%

Removal of Microbial Biofilms from Dispense Equipment: The Effect of Enzymatic Pre-digestion and Detergent Treatment

Walker

Fourgialakis

Cerezo

et al. 2007

Journal of the Institute of Brewing

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Microbial biofilms can form in dispense outlets as a result of poor or inadequate cleaning and can be difficult to remove using conventional practices. Enzymatic cleaners might help to remove biofilms by degrading the exopolysaccharide layers in which the microbes are embedded. A multispecies biofilm comprising wild type dispense isolates of Flavimonas oryzihabitans, Lactobacillus brevis, Leuconostoc mesenteroides and Saccharomyces cerevisiae was generated on a section of tubing and fitted into a pilot dispense system, which was left uncleaned for 12 weeks. After cleaning approximately 104 viable aerobes and 103 viable anaerobes were still present. Stainless steel coupons and pieces of dispense line contaminated with biofilm were incubated in the laboratory with an enzyme mix containing varying proportions of α‐amylase, β‐glucuronidase, glucose oxidase, dextranase, protease and pectinase. Cultures grown on stainless steel had significantly (F pr. > 0.05) less viable cells than non‐enzyme treated biofilms, but this was dependent on the microbial species. Typically Lactobacillus brevis was most susceptible to the enzyme treatment. Cultures grown on dispense line were much more resistant to enzymatic digestion. Pre‐digestion with protease was most effective for removal of Lactobacillus brevis and Leuconostoc mesenteroides but not for Saccharomyces cerevisiae and Flavimonas oryzihabitans. In the simulated bar, pre‐digestion with protease reduced the viable cell count by 0.64 log units for the aerobes and 1.9 log units for the anaerobes. This study demonstrates that pre‐digestion with enzyme solutions before line cleaning is useful for treating heavily contaminated lines in trade.

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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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Removal of biofilm from endoscopes: evaluation of detergent efficiency☆

Cited by 113 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?

Removal of Microbial Biofilms from Dispense Equipment: The Effect of Enzymatic Pre-digestion and Detergent Treatment

Fünf Jahre Empfehlungen der Kommission für Krankenhaushygiene zur Aufbereitung flexibler Endoskope

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