Comparison of the cleaning and disinfecting efficacy of four washer-disinfectors for flexible endoscopes

Kircheis, Ulrike; Martiny, H

doi:10.1016/j.jhin.2007.03.020

Cited by 6 publications

(6 citation statements)

References 22 publications

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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. 9 Instead of the assessed reprocessing factors, in our opinion, the variable manual cleaning step has the greatest impact on the reprocessing outcome.…”

Section: Discussionsupporting

confidence: 92%

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: Discussionsupporting

confidence: 92%

Nationwide risk analysis of duodenoscope and linear echoendoscope contamination

Rauwers

holt

Buijs

et al. 2020

Gastrointestinal Endoscopy

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“…The ECR evaluated in the current study uses direct channel connection and the data from our simulated-use study demonstrated that the RF achieved by the cleaning cycle alone was > 6 for all surface sites and > 4.5 for all air/water, suction/biopsy and auxillary water channels for all types of flexible endoscopes. This further extends Kircheis and Martiny's [33] work on tubing segments to demonstrate how efficient cleaning can be achieved in the various channels and surface of flexible endoscopes. The ECR was also able to achieve an enterococcus RF of > 4 for the elevator guidewire channel which presents unique challenges to cleaning which were not addressed in Kircheis and Martiny's [33] study.…”

Section: Discussionsupporting

confidence: 67%

“…This further extends Kircheis and Martiny's [33] work on tubing segments to demonstrate how efficient cleaning can be achieved in the various channels and surface of flexible endoscopes. The ECR was also able to achieve an enterococcus RF of > 4 for the elevator guidewire channel which presents unique challenges to cleaning which were not addressed in Kircheis and Martiny's [33] study. Indeed this RF of 4.01 achieved by the ECR cleaning cycle is superior to a previous report [22] for the Reliance AER (RF of 2.10) cleaning as well as for complete manual cleaning (RF of 3.22).…”

Section: Discussionsupporting

confidence: 67%

“…The cleaning efficiencies achieved by the AdaptaScope and LS 2000 AERs tested by Kircheis and Martiny [33] using endoscope channel tubing indicated that efficient microbial removal was only achieved when direct channel connection was used. The two "pressure chamber" models of AERs evaluated could not achieve flow through of the inoculated tubing therefore there was no bioburden reduction.…”

Section: Discussionmentioning

confidence: 99%

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EVOTECH® endoscope cleaner and reprocessor (ECR) simulated-use and clinical-use evaluation of cleaning efficacy

et al. 2010

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BackgroundThe objective of this study was to perform simulated-use testing as well as a clinical study to assess the efficacy of the EVOTECH® Endoscope Cleaner and Reprocessor (ECR) cleaning for flexible colonoscopes, duodenoscopes, gastroscopes and bronchoscopes. The main aim was to determine if the cleaning achieved using the ECR was at least equivalent to that achieved using optimal manual cleaning.MethodsSimulated-use testing consisted of inoculating all scope channels and two surface sites with Artificial Test Soil (ATS) containing 108 cfu/mL of Enterococcus faecalis, Pseudomonas aeruginosa and Candida albicans. Duodenoscopes, colonoscopes, and bronchoscopes (all Olympus endoscopes) were included in the simulated use testing. Each endoscope type was tested in triplicate and all channels and two surface sites were sampled for each scope. The clinical study evaluated patient-used duodenoscopes, bronchoscopes, colonoscopes, and gastroscopes (scopes used for emergency procedures were excluded) that had only a bedside flush prior to being processed in the ECR (i.e. no manual cleaning). There were 10 to 15 endoscopes evaluated post-cleaning and to ensure the entire ECR cycle was effective, 5 endoscopes were evaluated post-cleaning and post-high level disinfection. All channels and two external surface locations were sampled to evaluate the residual organic and microbial load. Effective cleaning of endoscope surfaces and channels was deemed to have been achieved if there was < 6.4 μg/cm2 of residual protein, < 1.8 μg/cm2 of residual hemoglobin and < 4 Log10 viable bacteria/cm2. Published data indicate that routine manual cleaning can achieve these endpoints so the ECR cleaning efficacy must meet or exceed these to establish that the ECR cleaning cycle could replace manual cleaningResultsIn the clinical study 75 patient-used scopes were evaluated post cleaning and 98.8% of surfaces and 99.7% of lumens met or surpassed the cleaning endpoints set for protein, hemoglobin and bioburden residuals. In the simulated-use study 100% of the Olympus colonoscopes, duodenoscopes and bronchoscopes evaluated met or surpassed the cleaning endpoints set for protein, and bioburden residuals (hemoglobin was not evaluated).ConclusionsThe ECR cleaning cycle provides an effective automated approach that ensures surfaces and channels of flexible endoscopes are adequately cleaned after having only a bedside flush but no manual cleaning. It is crucial to note that endoscopes used for emergency procedures or where reprocessing is delayed for more than one hour MUST still be manually cleaned prior to placing them in the ECR.

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“…M. chelonae may be reduced by 4 log10-steps by standardized manual cleaning [91] . Automatic cleaning processes may achieve a log10-reduction of 7.0-8.4, depending on the type of washer disinfectant and cleaning agent [92] . In contaminated test tubes the cleaning step during automatic processing of flexible endoscopes shows variable results, depending on the type of process and the cleaning agent [58] .…”

Section: Pathogens On Flexible Endoscopes After Cleaningmentioning

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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Comparison of the cleaning and disinfecting efficacy of four washer-disinfectors for flexible endoscopes

Cited by 6 publications

References 22 publications

Nationwide risk analysis of duodenoscope and linear echoendoscope contamination

Nationwide risk analysis of duodenoscope and linear echoendoscope contamination

EVOTECH® endoscope cleaner and reprocessor (ECR) simulated-use and clinical-use evaluation of cleaning efficacy

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

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