Is Peracetic Acid Suitable for the Cleaning Step of Reprocessing Flexible Endoscopes?

Overview

Journal World J Gastrointest Endosc

Publisher Baishideng Publishing Group

Date 2014 Sep 18

PMID 25228941

Citations 6

Authors

Gunter Kampf

Patricia M Fliss

Heike Martiny

Affiliations

Soon will be listed here.

Abstract

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 acid-based cleaners are as effective as conventional cleaners. Some peracetic acid-based formulations have demonstrated some biofilm-cleaning effects and no biofilm-fixation 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.

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References

Balsamo A, Uchikawa Graziano K, Schneider R, Antunes Junior M, Lacerda R . [Removing biofilm from a endoscopic: evaluation of disinfection methods currently used]. Rev Esc Enferm USP. 2012; 46 Spec No:91-8. DOI: 10.1590/s0080-62342012000700014. View

Hanson P, Gor D, Jeffries D, Collins J . Elimination of high titre HIV from fibreoptic endoscopes. Gut. 1990; 31(6):657-9. PMC: 1378490. DOI: 10.1136/gut.31.6.657. View

Spaun G, Goers T, Pierce R, Cassera M, Scovil S, Swanstrom L . Use of flexible endoscopes for NOTES: sterilization or high-level disinfection?. Surg Endosc. 2009; 24(7):1581-8. DOI: 10.1007/s00464-009-0815-6. View

Hernandez A, Martro E, Puzo C, Matas L, Burgues C, Vazquez N . In-use evaluation of Perasafe compared with Cidex in fibreoptic bronchoscope disinfection. J Hosp Infect. 2003; 54(1):46-51. DOI: 10.1016/s0195-6701(03)00072-0. View

Burdick J, Hambrick D . Endoscope reprocessing and repair costs. Gastrointest Endosc Clin N Am. 2004; 14(4):717-24, ix-x. DOI: 10.1016/j.giec.2004.05.002. View

Herve R, Keevil C . Current limitations about the cleaning of luminal endoscopes. J Hosp Infect. 2012; 83(1):22-9. DOI: 10.1016/j.jhin.2012.08.008. View

Bajolet O, Ciocan D, Vallet C, De Champs C, Vernet-Garnier V, Guillard T . Gastroscopy-associated transmission of extended-spectrum beta-lactamase-producing Pseudomonas aeruginosa. J Hosp Infect. 2013; 83(4):341-3. DOI: 10.1016/j.jhin.2012.10.016. View

Bloss R, Kampf G . Test models to determine cleaning efficacy with different types of bioburden and its clinical correlation. J Hosp Infect. 2004; 56 Suppl 2:S44-8. DOI: 10.1016/j.jhin.2003.12.029. View

Tucker R, Lestini B, Marchant R . Surface analysis of clinically used expanded PTFE endoscopic tubing treated by the STERIS PROCESS. ASAIO J. 1996; 42(4):306-13. View

10.

Bisset L, Cossart Y, Selby W, West R, Catterson D, OHara K . A prospective study of the efficacy of routine decontamination for gastrointestinal endoscopes and the risk factors for failure. Am J Infect Control. 2006; 34(5):274-80. DOI: 10.1016/j.ajic.2005.08.007. View

11.

Mignard J . [Endoscope disinfection]. Ann Urol (Paris). 2007; 40 Suppl 3:S91-3. DOI: 10.1016/s0003-4401(06)80031-8. View

12.

Krolasik J, Zakowska Z, Krepska M, Klimek L . Resistance of bacterial biofilms formed on stainless steel surface to disinfecting agent. Pol J Microbiol. 2011; 59(4):281-7. View

13.

Bardouniotis E, Ceri H, Olson M . Biofilm formation and biocide susceptibility testing of Mycobacterium fortuitum and Mycobacterium marinum. Curr Microbiol. 2002; 46(1):28-32. DOI: 10.1007/s00284-002-3796-4. View

14.

Rutala W, Weber D . Sterilization, high-level disinfection, and environmental cleaning. Infect Dis Clin North Am. 2011; 25(1):45-76. DOI: 10.1016/j.idc.2010.11.009. View

15.

Chang W, Small D, Toghrol F, Bentley W . Microarray analysis of toxicogenomic effects of peracetic acid on Pseudomonas aeruginosa. Environ Sci Technol. 2005; 39(15):5893-9. DOI: 10.1021/es0503534. View

16.

Simoes M, Cleto S, Pereira M, Vieira M . Influence of biofilm composition on the resistance to detachment. Water Sci Technol. 2007; 55(8-9):473-80. DOI: 10.2166/wst.2007.293. View

17.

Sagripanti J, Eklund C, Trost P, Jinneman K, Abeyta Jr C, Kaysner C . Comparative sensitivity of 13 species of pathogenic bacteria to seven chemical germicides. Am J Infect Control. 1997; 25(4):335-9. DOI: 10.1016/s0196-6553(97)90026-2. View

18.

Chu N, Mcalister D, Antonoplos P . Natural bioburden levels detected on flexible gastrointestinal endoscopes after clinical use and manual cleaning. Gastrointest Endosc. 1998; 48(2):137-42. DOI: 10.1016/s0016-5107(98)70154-3. View

19.

Vickery K, Pajkos A, Cossart Y . Removal of biofilm from endoscopes: evaluation of detergent efficiency. Am J Infect Control. 2004; 32(3):170-6. DOI: 10.1016/j.ajic.2003.10.009. View

20.

Lehmann S, Pastore M, Rogez-Kreuz C, Richard M, Belondrade M, Rauwel G . New hospital disinfection processes for both conventional and prion infectious agents compatible with thermosensitive medical equipment. J Hosp Infect. 2009; 72(4):342-50. DOI: 10.1016/j.jhin.2009.03.024. View