Is biofilm accumulation on endoscope tubing a contributor to the failure of cleaning and decontamination?

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

doi:10.1016/j.jhin.2004.06.023

Cited by 170 publications

(138 citation statements)

References 22 publications

(10 reference statements)

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“…Direct evidence for extensive biofilm contamination was provided in 1 of 13 investigated biopsy suction channels and 5 of 12 air/water channels of reprocessed endoscopes [165] . Some reports showed persistent levels of bacteria in endoscope channels, despite reprocessing according to published guidelines, providing indirect evidence for contamination by biofilms [166][167][168] .…”

Section: Biofilm On Flexible Endoscopesmentioning

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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Section: Biofilm On Flexible Endoscopesmentioning

confidence: 99%

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

Kampf

Fliss

Martiny

2014

WJGE

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“…Modern endoscopes contain multiple channels and ports which allow for the collection of organic material. The presence of biofilms on the inner surface of endoscope channels has been reported in many publications (Buss et al, 2008;Kovaleva et al, 2009;Pajkos et al, 2004). Even if valid endoscope reprocessing protocols are applied, microbial accumulation can lead to the development of a mature biofilm inside narrow endoscope channels in time (Pajkos et al, 2004).…”

Section: Removal Of Biofilmsmentioning

confidence: 98%

“…It is known by its preference for a moist environment (wet endoscope channels after reprocessing, hospital water supply) (Nelson & Muscarella, 2006). Pseudomonas is well known to be able to form biofilms, and these biofilms are extremely difficult to remove from plumbing, automatic endoscope reprocessors and endoscope channels (Pajkos et al, 2004). Pseudomonas contamination of endoscopes was first reported in the mid-70s (Bilbao et al, 1976) and is adequately documented as a serious clinical cause of ERCP-associated infection by 1980 (Low et al, 1980).…”

Section: Role Of Pseudomonas Aeruginosa In Endoscopy-related Infectionsmentioning

confidence: 99%

“…A typical biofilm will contain around 85% polysaccharide matrix and only 15% bacterial mass. Biofilms may form on different surfaces, including living or dead tissues, indwelling medical devices, water supply systems, or endoscope channels (Donlan, 2002;Pajkos et al, 2004). Bacteria growing within biofilms have a number of characteristics that distinguish them from planktonic populations.…”

Section: Definition and Properties Of Biofilmmentioning

confidence: 99%

“…The presence of biofilms on the inner surface of endoscope channels has been reported in many publications (Buss et al, 2008;Kovaleva et al, 2009;Pajkos et al, 2004). Even if valid endoscope reprocessing protocols are applied, microbial accumulation can lead to the development of a mature biofilm inside narrow endoscope channels in time (Pajkos et al, 2004). Biofilm formation on the inner surface of the endoscope channels, especially, when these become scratched or damaged, can result in failure of the decontamination process.…”

Section: Removal Of Biofilmsmentioning

confidence: 99%

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