Use of flexible endoscopes for NOTES: sterilization or high-level disinfection?

Spaun, Georg; Goers, Trudie A.; Pierce, Richard A.; Cassera, Maria A.; Scovil, Sandy; Swanstrom, Lee L.

doi:10.1007/s00464-009-0815-6

Cited by 17 publications

(6 citation statements)

References 33 publications

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“…It is also common in other types of endoscopic procedures [187] . After different types of endoscopic procedures, suction channels contain haemoglobin at a concentration of 85 µg/cm 2 [78] .…”

Section: Blood On Flexible Endoscopes After Usementioning

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: Blood On Flexible Endoscopes After Usementioning

confidence: 99%

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

Kampf

Fliss

Martiny

2014

WJGE

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“…The use effective infection control policies in the dental office and laboratory might prevent cross-contamination that could extend to dentists, dental office staff, technicians and patients. Proper use of disinfectants is important for prevention of cross-infection when the materials do not tolerate thermal methods (4)(5)(6)(7). The choice for a specific disinfectant depends on a number of factors: toxicity to the patient and/or staff, potential damage to the surface, stability, degree of microbial killing required, and ability to kill microorganisms rapidly (8).…”

Section: Antimicrobial Efficacy Of Chemical Disinfectants On Contaminated Full Metal Crownsmentioning

confidence: 99%

Antimicrobial efficacy of chemical disinfectants on contaminated full metal crowns

Orsi

Villabona

Kameoka³

et al. 2010

Braz. Dent. J.

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Prosthetic restorations that have been tried in the patient's mouth are potential sources of infection. In order to avoid cross-infection, protocols for infection control should be established in dental office and laboratory. This study evaluated the antimicrobial efficacy of disinfectants on full metal crowns contaminated with microorganisms. Full crowns cast in a Ni-Cr alloy were assigned to one control group (n=6) and 5 experimental groups (n=18). The crowns were placed in flat-bottom glass balloons and were autoclaved. A microbial suspension of each type of strain - S. aureus, P. aeruginosa, S. mutans, E. faecalis and C. albicans- was aseptically added to each experimental group, the crowns being allowed for contamination during 30 min. The contaminated specimens were placed into recipients with the chemical disinfectants (1% and 2% sodium hypochlorite and 2% glutaraldehyde) for 5, 10 and 15 min. Thereafter, the crowns were placed into tubes containing different broths and incubated at 35ºC. The control specimens were contaminated, immersed in distilled water for 20 min and cultured in Thioglycollate broth at 35ºC. Microbial growth assay was performed by qualitative visual examination after 48 h, 7 and 12 days. Microbial growth was noticed only in the control group. In the experimental groups, turbidity of the broths was not observed, regardless of the strains and immersion intervals, thus indicating absence of microbial growth. In conclusion, all chemical disinfectants were effective in preventing microbial growth onto full metal crowns.

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“…It is difficult, but possible, to terminally sterilize flexible endoscopes and deliver them sterile to the operating field using a carefully designed protocol. 31 Spaun et al, 31 in their exhaustive review about sterilization of the flexible endoscope, have recommended 3 possible techniques of sterilization of the flexible endoscope available for human use: prolonged soaking in high-level disinfectant/ sterilant, automated liquid sterilization, and gas sterilization using ethylene oxide. Two additional sterilization modalities are currently being developed: hydrogen peroxide gas vapor sterilization (eg, STERRAD, Ethicon, Inc, Somerville, NJ) and ozone sterilization (TSO3 Inc, Dalton, Québec, Canada).…”

Section: Discussionmentioning

confidence: 99%

Feasibility of Transumbilical Flexible Endoscopic Preperitoneoscopy (FLEPP) and Its Utility for Inguinal Hernia Repair

et al. 2012

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Use of flexible endoscopes for NOTES: sterilization or high-level disinfection?

Cited by 17 publications

References 33 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?

Antimicrobial efficacy of chemical disinfectants on contaminated full metal crowns

Feasibility of Transumbilical Flexible Endoscopic Preperitoneoscopy (FLEPP) and Its Utility for Inguinal Hernia Repair

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