Efficacy of high-level disinfectants for reprocessing GI endoscopes in simulated-use testing

Foliente, Roy; Kovacs, Brent J; Aprecio, Raydolfo M.; Bains, Harcharan J.; Kettering, James D.; Chen, Yang K.

doi:10.1067/mge.2001.113380

Cited by 45 publications

(18 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The entire process may then achieve a 9 log10 reduction of microorganisms in a tube simulating an endoscope channel [57] . Other processes using different types of cleaning or disinfection agents have revealed lower overall reductions, e.g., a 7 log10 reduction [58] . Lack of use of a detergent in the cleaning step in an automatic processor did not result in any viral blood-borne infections such as hepatitis B or C in 72 patients [59] , indicating that the type of cleaning agent is less important in terms of the overall cleaning result for some enveloped blood-borne viruses.…”

Section: Cleaning Agentsmentioning

confidence: 99%

“…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] . Some cleaning processes using a detergent were significantly less effective (0.3 log10-steps) than water alone (1.1-2.6 log10-steps), indicating that the entire cleaning process needs to be evaluated critically [55,56] .…”

Section: Pathogens On Flexible Endoscopes After Cleaningmentioning

confidence: 99%

See 1 more Smart Citation

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

Section: Cleaning Agentsmentioning

confidence: 99%

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

View full text Add to dashboard Cite

show abstract

“…Standards for infection control and cleaning of flexible GI endoscopes have been published (6), and under controlled conditions these measures are adequate to disinfect GI endoscopes from most bacterial pathogens (7,8). The most important stage in endoscope reprocessing is manual cleaning prior to highlevel disinfection (HLD).…”

mentioning

confidence: 99%

Current GI Endoscope Disinfection and QA Practices

Moses

Lee

2004

Dig Dis Sci

View full text Add to dashboard Cite

High-level disinfection (HLD) of GI endoscopes is readily achieved when published guidelines are observed. Contamination is linked to breakdowns in accepted procedure. However, there is no recognized method of verifying adequacy of endoscope reprocessing in routine practice and no data regarding current quality assurance (QA) practice. Prior reports have demonstrated a wide variation in routine clinical practice of GI endoscopy HLD. The goal of this study was to determine current practice at regional endoscopy centers with regard to endoscope cleaning and HLD, maintenance, and QA practice. An anonymous multiple-choice questionnaire was mailed to 367 SGNA members in Pennsylvania, Delaware, Virginia, Maryland, and District of Columbia and completed by 230 (63%). The majority of responders were hospital-based and 59% of the units performed over 3000 procedures per year. After use the endoscope was hand-carried or transported in a dry container (97%) to a separate cleaning room (85%) for HLD by technicians (40%). Wide variations existed in manual step procedures including use of disposable (50%) brushes and number of times channel brushed: once (21%), twice (35%), or three to five times (37%). Soaking duration in disinfectant (70% gluteraldehyde) was for <10 min (8%), 10-20 min (35%), 20-30 min (38%), 30-40 min (7%), and >40 min (3%). Sixty-seven percent had an active unit infection control (IC) service and 98% had a QA program. Monitoring of cleaning effectiveness was by visual inspection (50%) and culturing endoscopes (17%). Culture was done weekly (1%) and

show abstract

“…The uses are classified as critical (enter sterile tissues or vascular system) such as implants or scalpels; semi-critical (touch mucosal membranes except dental) such as flexible endoscopes; and non-critical (touch intact skin). Critical devices must achieve sterilization, semi-critical devices require only HLD, 16 and non-critical devices need only to be cleansed with soap and water.…”

mentioning

confidence: 99%

“…Cidex OPA has a shorter reprocessing time of 12 to 15 minutes, 15 excellent antimicrobial activity, [16][17][18] and good materials compatibility 19 and will not coagulate blood or fix tissues to surfaces. 18 Its limitations include staining of the washer-disinfectors and false readings of indicator strips, which can occur as often as 12.5% of the time.…”

mentioning

confidence: 99%

Rapid Communication: Effects of Steris 1^™ Sterilization and Cidex^® Ortho-Phthalaldehyde High-Level Disinfection on Durability of New-Generation Flexible Ureteroscopes

Abraham

Abdelshehid

Lee

et al. 2007

Journal of Endourology

View full text Add to dashboard Cite

show abstract

Efficacy of high-level disinfectants for reprocessing GI endoscopes in simulated-use testing

Cited by 45 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?

Current GI Endoscope Disinfection and QA Practices

Rapid Communication: Effects of Steris 1^™ Sterilization and Cidex^® Ortho-Phthalaldehyde High-Level Disinfection on Durability of New-Generation Flexible Ureteroscopes

Contact Info

Product

Resources

About

Efficacy of high-level disinfectants for reprocessing GI endoscopes in simulated-use testing

Cited by 45 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?

Current GI Endoscope Disinfection and QA Practices

Rapid Communication: Effects of Steris 1™ Sterilization and Cidex® Ortho-Phthalaldehyde High-Level Disinfection on Durability of New-Generation Flexible Ureteroscopes

Contact Info

Product

Resources

About

Rapid Communication: Effects of Steris 1^™ Sterilization and Cidex^® Ortho-Phthalaldehyde High-Level Disinfection on Durability of New-Generation Flexible Ureteroscopes