The importance of cleaning for the overall results of processing endoscopes

Martiny, H; Floss, H.; Zühlsdorf, B.

doi:10.1016/j.jhin.2003.12.027

Cited by 35 publications

(20 citation statements)

References 18 publications

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Section: Importance Of the Cleaning Stepmentioning

confidence: 99%

“…First, organic and inorganic materials left on the inner and outer surfaces interfere with the efficacy of the disinfectants [39,40] , given that blocked channels may remain undisinfected [41] ; only a clean endoscope with clean channels can be disinfected effectively [34] . Second, cleaning of flexible endoscopes aims to reduce the bioburden as much as possible [41] . It is generally acknowledged that the cleaning, rather than the disinfection or sterilization procedure, controls the success of the endoscope [42,43] or angioscopy reprocessing procedure [44] although cleaning alone does not reduce contamination to a safe level [45] .…”

Section: Importance Of the Cleaning Stepmentioning

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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Section: Importance Of the Cleaning Stepmentioning

confidence: 99%

Section: Importance Of the Cleaning Stepmentioning

confidence: 99%

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

Kampf

Fliss

Martiny

2014

WJGE

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“…Biofilm formation constitutes especially a nidus for the resistant microorganisms in the connection hoses. Mechanical cleaning is an important step to remove the nidus [1][2][3][4]20]. It was reported that neither the detergent nor the high-level disinfectants could remove or kill the bacteria at the expected level due to thebiofilm formation in the channels [21,22].…”

Section: Discussionmentioning

confidence: 99%

“…The cleaning and disinfection of flexible endoscopes have been a challenge due to their intricate design, narrow and long lumens, and delicate materials [1]. They contact with the mucosa and do not penetrate the tissue.…”

Section: Introductionmentioning

confidence: 99%

The Assessment and Improvement of the Steps in the Endoscope-Reprocessing: A Hospital Report

Gedık¹

2017

JBMOA

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Objective: The aim of this study was to describe the endoscope reprocessing procedure of our hospital that succeeded in an effective cleaning that was validated with the microbiological cultures and ATP-bioluminescence tool kit. Material and methods:The endoscope reprocessing procedure was inspected by the microbiological cultures and then ATP-bioluminescence tool kit in the endoscopy units of gastroenterology and general surgery wards of the Ministry of Health Bakırköy Sadi Konuk Research Hospital between April and December 2014. Results:Of the examined 42 flexible endoscopes, four of them (9%) were contaminated. In microbiological cultures, Stenotrophomonas maltophilia (> 100,000 cfu/mL) was isolated from irrigation bottles. Extended-spectrum betalactamases and plasmid-mediated carbapenamase producing K. pneumonia and AmpC beta-lactamase producing P. aeruginosa (> 100,000 cfu/mL) were isolated from elevator behind. Each step of the reprocessing procedure was inspected and revised, if it was needed. There was not found contamination in the endoscopes after revising procedure. Conclusion:The ATP-bioluminescence method is a cost-effective method to monitor and to evaluate the endoscope reprocessing. Biofilm formation is very important to harbor resistant microorganisms in the endoscopes. The microbiological monitoring and cleaning procedures of endoscopes should be defined taking into the conditions of the setting in the settings. In case of any outbreak related to endoscopes, each step of the procedure should be checked and revised according to the guidelines, reported outbreaks, and instructions of endoscope manufacturers.

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“…Organic matter not removed during the cleaning process is fixed on the surface of the endoscope by the action of glutaraldehyde hindering or even preventing the reprocessing and promoting blockage of the channels within the endoscope (9,13) . Rinsing only external surfaces in endoscope reprocessing (Table 4) allows organic matter (blood, mucus, pus and secretions) to remain on the equipment.…”

Section: Discussionmentioning

confidence: 99%

Endoscope reprocessing using glutaraldehyde in endoscopy services of Goiânia, Brazil

Barbosa¹,

Souza

Tipple

et al. 2010

Arq. Gastroenterol.

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-Context -The endoscopic procedure safety depends on the use of an adequately reprocessed device which quality is related to each of its operational steps. Objective -To characterize the reprocessing of endoscopes using glutaraldehyde in endoscopy services Methods -Study was conducted by observing the reprocessing of 60 endoscopes from 20 medical practices of the municipality of Goiânia, GO, central area of Brazil. Results -This study showed failure in all reprocessing steps. The pre-washing was performed in 24 (40.0%) of the endoscope. In the cleaning steps, was identify the improper use of enzymatic detergent, and in 27 (45.0%) cases, the brushing of internal channels was not performed. All 60 endoscopes were submitted to this disinfectant. However, for 33 (55.0%) of the cases the internal channels was not filled. The total immersion of endoscope in the glutaraldehyde was not performed in 39 (65.0%) cases. The recommended minimum total immersion time for exposure to 2% glutaraldehyde solution was followed only for 12 (20.0%) endoscopes. There was no filter for water treatment used in the rinse of most endoscopes 54 (90.0%) and to dry the internal channels only 6 (10.0%) of them used compressed air. Adequate storing conditions were identified. Conclusion -Considering the particularities of the endoscope and its reprocessing, it is imperative to establish protocols to ensure the quality of the disinfection and the prevention of cross-contamination.

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The importance of cleaning for the overall results of processing endoscopes

Cited by 35 publications

References 18 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?

The Assessment and Improvement of the Steps in the Endoscope-Reprocessing: A Hospital Report

Endoscope reprocessing using glutaraldehyde in endoscopy services of Goiânia, Brazil

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