DECONTAMINATION


cleaning with a CE marked detergent must be undertaken before the endoscope is placed in the washer disinfector. The manual cleaning stage should include the brushing and flushing of all accessible endoscope channels.5


Cleaning is also carried out in the


AER before high level disinfection. The selected detergent must be compatible with the disinfectant used in the AER.5


If soil and bacterial biofilms


are not removed from the endoscope, this will adversely impact on the efficacy of the disinfectant which then increases the risk of nosocomial infection.10


such as heat, ultra-violet light, and most disinfectants14


The oxidising active PAA also The use


of highly effective formulations designed specifically for use in the manual cleaning (e.g. gigazyme) or automated cleaning (e.g. thermosept EndoCleaner) of endoscopes may be considered.


The ideal detergent cleansing agent should effectively permeate contaminants that contain proteins, lipids, carbohydrates and various chemical bases and separate the contaminants from the channels without damaging the endoscope.12


It should also


be low-foaming to ensure maximum contact with the surface with the endoscope.12 The selected detergent must be compatible with the disinfectant used. This is because some detergents leave residues which can neutralise the active ingredient in certain disinfectants, thereby reducing the microbial killing properties of the disinfectant. At the disinfectant stage, the ideal chemical high-level disinfectant should have the following qualities (according to the BSG, 2016): a broad antimicrobial spectrum; prolonged shelf life; be rapid- acting, non-corrosive, and not harmful to the scope and its parts; non-toxic to humans and the environment; odourless and non-staining; cost effective; and capable of being monitored for concentration and effectiveness. Summarised into four key qualities, the ideal high-level disinfectant should have effective and proven antimicrobial efficacy (including against enveloped viruses such as coronaviruses), comply with all relevant regulations, norms and guidelines, demonstrate excellent material compatibility and ensure the safety of patients and staff.


Disinfectants based on peracetic acid


(PAA) are widely used in the UK, as PAA has an extremely broad spectrum of antimicrobial activity. Depending on its concentration and pH value, it is effective against bacteria including Helicobacter pylori, fungi, mycobacteria, enveloped viruses including coronaviruses and Hepatitis B virus (HBV), non-enveloped viruses including parvovirus, and bacterial spores13 PAA is one of the few powerful antimicrobial agents available for use as a sporicidal agent, which is significant as spores are resistant to several stresses,


NOVEMBER 2020


helps remove biofilm from endoscopes.14 In addition to its broad antimicrobial spectrum, PAA has a short contact time for bacteria, including Mycobacterium tuberculosis, fungi, viruses and spores of around five minutes. This is in contrast to disinfectants based on ortho-phthalaldehyde (OPA) or glutaraldehyde (GDA) which have lengthy contact times of up to 10 hours for GDA and up to 32 hours for OPA. For example, CE marked thermosept PAA has a contact time of five minutes at 37˚C for the chemothermal reprocessing of flexible endoscopes in an AER. HTM 01-06 (2016)15


warns that some


chemicals may damage endoscopes. Therefore, any cleaner selected should be compatible with the range of endoscopes in use, as well as with the AER. All chemicals used in the AER process should be CE-marked, which indicates that the manufacturer has verified that these products meet EU safety, health and environmental standards. When the endoscope and cleaner are used together, they must be compatible and the importance of this should not be underestimated. The manufacturer of the cleaner/disinfectant must demonstrate that the products are designed and manufactured in such a way as to be used safely with the materials.


The COVID-19 pandemic has placed extraordinary demands on healthcare provision. As endoscopic diagnostic services resume, the need for stringent infection control strategies, including the use of optimum cleaners and disinfectants is essential to minimise viral transmission and reduce the attendant risks to both patients and staff.


CSJ


References 1 Kenters N. et al. Endosc Int Open. Infectious diseases linked to cross-contamination of flexible endoscopes 2015 Aug; 3(4): E259–E265.


2 Perisetti, A., Gajendran, M., Boregowda, U., Bansal, P. and Goyal, H. (2020), COVID-19 and gastrointestinal endoscopies: Current insights and emergent strategies. Digestive Endoscopy, 32: 715-722.


3 Rana S. S., Risk of COVID-19 Transmission During Gastrointestinal Endoscopy, March 2020 Journal of Digestive Endoscopy 11(01):27-30


4 Hayee B, et al. Safely restarting GI endoscopy in the era of COVID-19, BMJ Gut, 2020


5 BSG Guidance for Decontamination of Equipment For Gastrointestinal Endoscopy, The Report of a Working Party of the British Society of Gastroenterology Endoscopy Committee March 2014, Revised November 2016


6 Kovaleva, J., Peters, F., van der Mei, H. and Degener, J. (2013). Transmission of Infection by Flexible Gastrointestinal Endoscopy and Bronchoscopy. Clinical Microbiology Reviews, 26(2), pp.231-254.


7 Iacucci M. et al, Endoscopy in inflammatory bowel diseases during the COVID-19 pandemic and post- pandemic period; Lancet Gastroenterol Hepatol 2020; 5: 598–606


8 JAG accreditation Supplementary environment guidance following the COVID-19 pandemic Published 21 May 2020


9 Calderwood AH, Day LW, Muthusamy VR, et al, ASGE guideline for infection control during GI endoscopy, Volume 87, No. 5 : 2018 Gastrointestinal Endoscopy


10 Vickery K, The effect of multiple cycles of contamination, detergent washing, and disinfection on the development of biofilm in endoscope tubing, American Journal of Infection Control, 2009, Vol 37, issue 6, Pages 470-475


11 Quinn M. M.,Henneberger P.K., et al, Cleaning and disinfecting environmental surfaces in health care: Toward an integrated framework for infection and occupational illness prevention, American Journal of Infection Control 43 (2015) 424-34


12 Lee YK, Park JB, Steps of Reprocessing and Equipments, Clin Endosc 2013;46:274-279


13 Kampf G., Fliss P.M., Martiny H., (2014). Is peracetic acid suitable for the cleaning step of reprocessing flexible endoscopes? World J Gastrointest Endosc 16; 6(9): 390-406


14 Matsumura, Y., et al (2006). Antimicrobial activity of peracetic acid preparation in the in presence of various compounds, Technology Reports of Kansai University


15 Department of Health, Health Technical Memorandum 01-06: Decontamination of flexible endoscopes Part C: Operational management, March 2016


About the author


Dr. Frank Bakker received his M.Sc. in chemical engineering from the University of Twente, the Netherlands and his Ph.D. in molecular biology from the University of Erlangen, Germany. 15 years ago, he started his career in medical device reprocessing and infection prevention as a process engineer for a leading manufacturer of washer disinfectors. Since 2010, he has been working for Schülke and Mayr, where he is the Head of the Application Department.


WWW.CLINICALSERVICESJOURNAL.COM l 55


Page 1  |  Page 2  |  Page 3  |  Page 4  |  Page 5  |  Page 6  |  Page 7  |  Page 8  |  Page 9  |  Page 10  |  Page 11  |  Page 12  |  Page 13  |  Page 14  |  Page 15  |  Page 16  |  Page 17  |  Page 18  |  Page 19  |  Page 20  |  Page 21  |  Page 22  |  Page 23  |  Page 24  |  Page 25  |  Page 26  |  Page 27  |  Page 28  |  Page 29  |  Page 30  |  Page 31  |  Page 32  |  Page 33  |  Page 34  |  Page 35  |  Page 36  |  Page 37  |  Page 38  |  Page 39  |  Page 40  |  Page 41  |  Page 42  |  Page 43  |  Page 44  |  Page 45  |  Page 46  |  Page 47  |  Page 48  |  Page 49  |  Page 50  |  Page 51  |  Page 52  |  Page 53  |  Page 54  |  Page 55  |  Page 56  |  Page 57  |  Page 58  |  Page 59  |  Page 60  |  Page 61  |  Page 62  |  Page 63  |  Page 64  |  Page 65  |  Page 66  |  Page 67  |  Page 68  |  Page 69  |  Page 70  |  Page 71  |  Page 72  |  Page 73  |  Page 74  |  Page 75  |  Page 76  |  Page 77  |  Page 78  |  Page 79  |  Page 80  |  Page 81  |  Page 82  |  Page 83  |  Page 84  |  Page 85  |  Page 86  |  Page 87  |  Page 88  |  Page 89  |  Page 90  |  Page 91  |  Page 92  |  Page 93  |  Page 94  |  Page 95  |  Page 96  |  Page 97  |  Page 98  |  Page 99  |  Page 100