Decontamination
also the financial consequences of damaging and rendering expensive medical equipment useless. For reprocessing stainless steel surgical instruments, the use of mild-alkaline enzymatic cleaners (pH 9.5-10.5) up to high alkaline cleaners (up to pH 12) and even high alkaline cleaners containing bleach components is feasible. Flexible endoscopes, however, often contain sensitive materials and therefore highly alkaline cleaners are not recommended. For this type of medical device, the use of mild-alkaline enzymatic cleaners (pH 9.5-10.5) is standard. The ‘Health Technical Memorandum 01-06: Decontamination of flexible endoscopes Part C: Operational management’, published by the Department of Health, in March 2016, states that: “For use with flexible endoscopes, neutral or neutral enzymatic detergents are normally recommended as they have the least damaging effect on endoscopes (not all enzymatic detergents are neutral).” It continues: “Some EWD (endoscope
washer-disinfector) manufacturers recommend alkaline detergents, but they should be used with caution and under the manufacturer’s stated conditions. The choice of detergent is a balance between efficacy and corrosion. Alkaline detergents are known for their good cleaning effect, but corrosion increases with temperature and their compatibility with materials can vary considerably depending on their formulation. Therefore, it is important not to use alkaline detergents in an EWD that operates at an elevated temperature during the cleaning stage, otherwise endoscopes may suffer damage.”8
It is vital that a medical device, such as an endoscope, is disinfected to ensure it is safe to use for the patient. As detailed in HTM 01-06, alkaline detergents are known for their good cleaning effect, but, as with surgical instruments, this must be balanced against the potential for corrosion. The solution lies in the quality of the detergent being used. An alkaline formula harnesses the benefits of pH and makes certain that blood and tissue is removed. The removal of these residues can be an
especially tricky undertaking considering the restricted access to the lumen of the endoscope where deposits can reside. However, with the correct formulation and use of corrosion inhibitors, an alkaline detergent can also be compatible with the materials used in the construction of the endoscope hence guaranteeing device longevity.
Manual vs automatic processing The “universal” detergent for both manual and automatic processing of surgical instruments
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Even within the global sterile services community, there is an understanding as to the balance that needs to be struck for pH of detergents between the delicate cleaning required to prevent corrosion and the need to ensure the best possible decontamination of instruments and devices for the safety of patients.
from the point of effectiveness will be a mild- alkaline enzymatic detergent. The benefits of these solutions are broad as they are easy to handle, pose no hazards for the user, have a broad material compatibility, and are low foaming.
A mild-alkaline enzymatic formula is the
best choice for automated processing with the ideal balance between cleaning performance and material compatibility. For manual cleaning and very delicate alkaline sensitive materials e.g., pure aluminium, pH neutral cleaners are available which have different surfactants more suitable for application at low temperatures.
Conclusions The argument between using a neutral versus an alkaline detergent is likely to continue with potentially opposing views from the manufacturers of instruments and medical devices, and that of the chemical industry formulating reprocessing detergents. However, as with many things, the issue of quality must be carefully considered. If instruments manufactured from superior quality stainless steel containing useful amount of protective chromium are processed using an alkaline detergent containing corrosion inhibitors, then surely this is the ideal. Dr Weigert has been formulating chemical
detergents for over 100 years. Markus Kamer, who works in the neodisher Applications Technology Department, comments: “Surgical instruments and other medical devices suitable for processing are expensive investments for hospitals and doctors’ surgeries. As a result, in addition to the cleaning efficacy, protecting materials and maintaining their value is also of great importance. “Durability tests have shown that neodisher MediClean forte can be used for all medical devices that are suitable for automated processing according to the manufacturer’s instructions.”
References 1
https://www.cdc.gov/infectioncontrol/ guidelines/disinfection/
cleaning.html
2
https://www.cdc.gov/infectioncontrol/ guidelines/disinfection/recommendations. html
3 Roberts CG. Studies on the bioburden on medical devices and the importance of cleaning. In: Rutala WA, ed. Disinfection, sterilization and antisepsis: principles and practices in healthcare facilities. Washington, DC: Association for Professional in Infection Control and Epidemiology, 2001:63-9.
4 Zuhlsdorf B EM, Floss H, Martiny H,. Cleaning efficacy of nine different cleaners in a washer- disinfector designed for flexible endoscopes. J. Hosp. Infect. 2002;52:206-11.
5
https://www.england.nhs.uk/wp-content/ uploads/2021/05/HTM0101PartD.pdf
6
https://esgena.org/ 7
https://chemistrytalk.org/what-is-ph/ 8
https://www.england.nhs.uk/wp-content/ uploads/2021/05/HTM0106_PartC.pdf
About the author CSJ
Mr Alan Abbatt, is the UK director at Dr Weigert UK. Alan has over 26 years’ experience in the decontamination application sector and established Dr Weigert UK over 14 years ago. He has responsibility for the commercialisation of Dr Weigert’s decontamination products (Surgical Devices, Surface and Hands) and the co-ordination and implementation of UK sales strategies.
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