INFECTION PREVENTION & CONTROL
procedures to be in place. Most enzymatic detergents are safe and present no more risk than common household cleaning products, it forms part of best practice to ensure that any health and safety concerns are addressed for those handling chemicals as well as staff working in an endoscope reprocessing area. All staff should be issued with personal protective clothing including gloves with proven resistance to detergents. Skin should be covered by wearing overalls and protective aprons. Although a small number of people may be allergic to enzymatic detergents when particles are carried in the air,16
such risks can be
minimised with good ventilation, ensuring that the lids to ultrasonic baths can be fixed in place, and staff at risk are issued with face-masks.17
There are a range of different
facemasks available, including those equipped with carbon filters (for organic vapour particulate removal) or in-built respirators. Masks should be fluid resistant and completely cover the face. To support the correct use of personal protective equipment, it is important that staff working with detergents are trained to wear protective clothing effectively, such as ensuring that all exposed skin is covered and both masks and gloves are removed safely to avoid any secondary transfer to the skin from residual detergents. It is also important for staff to recognise potentially contaminated surfaces, such as items of equipment or door handles that may have been touched by another worker’s gloved hands. Additional control measures include limitation of exposure (by understanding defined occupational exposure limits in relation to air quality), regular wet cleaning of surfaces to remove detergent residues, and active monitoring of worker health. By putting this cohort of measures in place any respiratory and skin related allergenic risks associated with enzyme proteins can be successfully managed.18
This is
particularly important for new employees working with enzymatic detergents.
Summary
The reprocessing of flexible endoscopes is an important and challenging process, and dependent upon thorough and meticulous cleaning as a prerequisite to disinfection. It is important to have in place a microbiological surveillance system to review endoscope reprocessing, effective procedures outlining the cleaning and disinfection steps, and trained staff to undertake the cleaning procedure.19 Effectiveness can be enhanced through the use of detergents formulated with enzymes to increase the cleaning activity via the effective breakdown of different types of soil. While there are factors to observe when using enzymatic detergents, such as following manufacturers’ instructions for use, practising a thorough rinsing step, and issuing personal protective clothing to protect staff, these factors can easily be controlled and managed through standardised protocols.20
By ensuring adequate control, the likelihood of soil remaining post-cleaning can be reduced leading to more effective disinfection of flexible endoscopes and better microbial kill.
References
1 Wang P, Xu T, Ngamruengphong S, et al (2018) Rates of infection after colonoscopy and osophagogastroduodenoscopy in ambulatory surgery centres in the USA, Gut; 67:1626-1636
2 Kovaleva J, Degener JE, van der Mei HC. (2010) Mimicking disinfection and drying of biofilms in contaminated endoscopes. J. Hosp. Infect. 76:345–350
3 Rutala WA, Weber DJ. HICPAC. (2008) CDC Guidelines for Disinfection and Sterilization in Healthcare Facilities: 1–27
4 Pajkos A. et al. (2004). Is biofilm accumulation on endoscope tubing a contributor to the failure of cleaning and decontamination? J Hosp Infect. 58(3):224-9
5 Marion, K., Freney, J., James, G., Bergeron, E., Renaud, F. N. R., and Costerton, J. W. (2006). Using an efficient biofilm detaching agent: An essential step in the improvement of endoscope reprocessing protocols. Journal of Hospital Infection, 64, 136-142
6 Vickery K. (2009) The effect of multiple cycles of contamination, detergent washing, and disinfection on the development of biofilm in endoscope tubing, American Journal of Infection Control, 37 (6): 470-475
7 Vickery K, Pajkos A, Cossart Y. (2004) Removal of biofilm from endoscopes: evaluation of detergent efficiency. Am. J. Infect. Control 32:170–176
8 Lee YK, Park JB. (2013) Steps of Reprocessing and Equipments, Clin Endosc ;46:274-279
9 Gonzalez, J.A., Vanzieleghem, T., Dumazy, A, et al (2019) On-site comparison of an enzymatic detergent and a non-enzymatic detergent- disinfectant for routine manual cleaning of flexible
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endoscopes, Endoscopy International Open; 07: E412–E420
CSJ
10 Campbell M. (2006) The Behavior of Proteins: Enzymes. Biochemistry, 5th Ed. Belmont, CA: Thomson-Brooks/Cole :131
11 da Costa Luciano C, Olson N, Tipple AFV et al. (2016) Evaluation of the ability of different detergents and disinfectants to remove and kill organisms in traditional biofilm. Am J Infect Control; 44: e243–e249
12 Martiny H, Floss H, Zühlsdorf B. (2004) The importance of cleaning for the overall results of processing endoscopes. J Hosp Infect; 56: 16– 22
13 Sandle, T. (2012). Cleaning endoscopes: Considering the risks and benefits of enzymatic and non-enzymatic detergents, Inside Hospitals, June 2012, pp14-15
14 Bass JE. (1997) Manufacturing and Downstream Processing of Detergent Enzymes. Enzymes in Detergency. New York, NY: Marcel Dekker Inc. 251-256
15 Bass JE. (1994) Enzymes: Their Applications and Biochemical Characterization. Enzymes in Detergency, New York, NY: Marcel Dekker Inc., 45-46, 239
16 Vanhanen, M., Tuomi, T., Tiikkainen, U., et al (2000) Risk of enzyme allergy in the detergent industry, Occup Environ Med;57:121–125
17 van Rooy, F. G., Houba, R., Palmen, N. et al. (2009) A cross-sectional study among detergent workers exposed to liquid detergent enzymes, Occup Environ Med., 66:759-765
18 Sarlo K. (2003) Control of occupational asthma and allergy in the detergent industry. Ann. Allergy Asthma Immunol.;90:32–34
19 Kovaleva J, Meessen NE, Peters FT, Been MH, Arends JP, Borgers RP, Degener JE. (2009) Is bacteriologic surveillance in endoscope reprocessing stringent enough? Endoscopy 41:913–916
20 Sandle, T. (2016) The importance of detergent selection, The Clinical Services Journal, 15 (8): 72-74
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