Hostname: page-component-cd9895bd7-q99xh Total loading time: 0 Render date: 2024-12-28T17:15:57.337Z Has data issue: false hasContentIssue false
  • English
  • Français

The polytetrafluoroethylene (PTFE) channel model of cyclic-buildup biofilm and traditional biofilm: The impact of friction, and detergent on cleaning and subsequent high-level disinfection

Published online by Cambridge University Press:  05 November 2019

Maíra M. Ribeiro ,
Kazuko U. Graziano ,
Nancy Olson ,
Rodrigo França  and
Michelle J. Alfa
Maíra M. Ribeiro*
Affiliation:
Nursing School of University of São Paulo, São Paulo, SP Paulo, Brazil
Kazuko U. Graziano
Affiliation:
Nursing School of University of São Paulo, São Paulo, SP Paulo, Brazil
Nancy Olson
Affiliation:
St Boniface Research Centre, Winnipeg, Manitoba, Canada
Rodrigo França
Affiliation:
Department of Restorative Dentistry, University of Manitoba, Winnipeg, Manitoba, Canada
Michelle J. Alfa
Affiliation:
St Boniface Research Centre, Winnipeg, Manitoba, Canada Department of Medical Microbiology, University of Manitoba, Winnipeg, Manitoba Canada
*
Author for correspondence: Maíra Marques Ribeiro, E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

To evaluate the efficacy of detergent and friction on removal of traditional biofilm and cyclic-buildup biofilm (CBB) from polytetrafluoroethylene (PTFE) channels and to evaluate the efficacy of glutaraldehyde to kill residual bacteria after cleaning.

Methods:

PTFE channels were exposed to artificial test soil containing 108 CFU/mL of Pseudomonas aeruginosa and Enterococcus faecalis, followed by full cleaning and high-level disinfection (HLD) for five repeated rounds to establish CBB. For traditional biofilm, the HLD step was omitted. Cleaning with enzymatic and alkaline detergents, bristle brush, and Pull Thru channel cleaner were compared to a water flush only. Carbohydrate, protein, viable count, adenosine triphosphate (ATP) levels were analyzed and atomic force microscopy (AFM) was performed.

Results:

In the absence of friction, cleaning of traditional biofilm and CBB was not effective compared to the positive control (Dunn-Bonferroni tests; P > .05) regardless of the detergent used. ATP, protein, and carbohydrate analyses were unable to detect traditional biofilm or CBB. The AFM analysis showed that fixation resulted in CBB being smoother and more compact than traditional biofilm.

Conclusion:

Friction during the cleaning process was a critical parameter regardless of the detergent used for removal of either traditional biofilm or CBB. Glutaraldehyde effectively killed the remaining microorganisms regardless of the cleaning method used.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 41 , Issue 2 , February 2020 , pp. 172 - 180
Copyright
© 2019 by The Society for Healthcare Epidemiology of America. All rights reserved.

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Food and Drug Administration. Infections associated with reprocessed duodenoscopes. Food and Drug Administration website. https://wayback.archive-it.org/7993/20180424074110/https://www.fda.gov/MedicalDevices/ProductsandMedicalProcedures/ReprocessingofReusableMedicalDevices/ucm454630.htm#meeting. Published 2015. Accessed Apr 30, 2019.Google Scholar
Epstein, L, Hunter, JC, Arwady, MA, et al.New Delhi metallo-β-lactamase–producing carbapenem-resistant Escherichia coli associated with exposure to duodenoscopes. J Am Med Assoc 2014;312:1447–1455.CrossRefGoogle ScholarPubMed
Alrabaa, SF, Nguyen, P, Sanderson, R, et al.Early identification and control of carbapenemase-producing Klebsiella pneumoniae, originating from contaminated endoscopic equipment. Am J Infect Control 2013;41:562–564.CrossRefGoogle ScholarPubMed
Bajolet, O, Ciocan, K, Vallet, C, et al.Gastroscopy-associated transmission of extended-spectrum beta-lactamase–producing Pseudomonas aeruginosa. J Hosp Infect 2013;83:341–343.10.1016/j.jhin.2012.10.016CrossRefGoogle ScholarPubMed
Aumeran, C, Poincloux, L, Souweine, B, et al.Multidrug-resistant Klebsiella pneumoniae outbreak after endoscopic retrograde cholangiopancreatography. Endoscopy 2010;42:957–959.10.1055/s-0030-1255647CrossRefGoogle ScholarPubMed
Carbonne, A, Thiolet, JM, Fournier, S, et al.Control of a multihospital outbreak of KPC-producing Klebsiella pneumoniae type 2 in France, September to October 2009. Euro Surveill 2010;15:pii=19734.CrossRefGoogle Scholar
American Society For Gastrointestinal Endoscopy (ASGE). Transmission of CRE bacteria through endoscopic retrograde cholangiopancreatography (ERCP): interim guidance. American Society For Gastrointestinal Endoscopy website. https://www.asge.org/docs/default-source/importfiles/publications_(public)/doc-asge_interimguidance_cre_03172015.pdf?sfvrsn=8 Published 2015. Accessed Apr, 30, 2019.Google Scholar
Pajkos, A, Vickery, K, Cossart, EY. Is biofilm accumulation on endoscope tubing a contributor to the failure of cleaning and contamination? J Hosp Infect 2004;58:224–229.CrossRefGoogle Scholar
Alfa, MJ, Howie, R. Modeling microbial survival buildup biofilm for complex medical devices. BMC Infect Dis 2009;9:1–14.10.1186/1471-2334-9-56CrossRefGoogle ScholarPubMed
Zhong, W, Alfa, MJ, Zelenitsky, S, Howie, R. Simulation of cyclic reprocessing buildup on reused medical devices. Comput Biol Med 2009;39:568–577.CrossRefGoogle ScholarPubMed
Quiu, L, Zhou, Z, Liu, Q, Ni, Y, Zhao, F, Cheng, H. Investigating the failure of repeated standard cleaning and disinfection of a Pseudomonas aeruginosa-infected pancreatic and biliary endoscope. Am J Infect Control 2015;43:e43–e46.CrossRefGoogle Scholar
Ribeiro, MM, Oliveira, AC, Ribeiro, SMCP, Watanabe, E, Resende, SMA, Ferreira, JAG. Effectiveness of flexible gastrointestinal endoscope reprocessing. Infect Control Hosp Epidemiol 2013;34:309–312.10.1086/669518CrossRefGoogle ScholarPubMed
Ribeiro, MM, Oliveira, AC. Analysis of air/water channels of gastrointestinal endoscopies as a risk factor for the transmission of microorganisms among patients. Am J Infect Control 2012;40:913–916.CrossRefGoogle ScholarPubMed
Alfa, MJ, DeGagne, P, Olson, N. EVOTECH endoscope cleaner and reprocessor (ECR) simulated-use and clinical-use evaluation of cleaning efficacy. BMC Infect Dis 2010;10:1–4.Google ScholarPubMed
Alfa, MJ, DeGagne, P, Olson, N. Worst-case soiling levels for patient-used flexible endoscopes before and after cleaning. Am J Infect Control 1999;27:392–401.CrossRefGoogle ScholarPubMed
Alfa, MJ, DeGagne, P, Olson, N. Validation of ATS as an appropriate test soil. Zentralsterilisation 2005;13:387–402.Google Scholar
Vickery, K, Ngo, QD, Zou, J, Cossart, YE. The effect of multiple cycles of contamination, detergent washing, and disinfection on the development of biofilm in endoscope tubing. Am J Infect Control 2009;37:470–475.10.1016/j.ajic.2008.09.016CrossRefGoogle ScholarPubMed
Vickery, K, Pajkos, A, Cossart, Y. Removal of biofilm from endoscopes: evaluation of detergent efficiency. Am J Infect Control 2004;32:170–176.10.1016/j.ajic.2003.10.009CrossRefGoogle ScholarPubMed
Pineau, L, Philippe, E. Evaluation of endoscope cleanliness after reprocessing: a clinical-use study. Central Serv 2013;1:22–27.Google Scholar
Liu, D, Lau, YL, Chau, YK, Pacepavicius, G. Simple technique for estimation of biofilm accumulation. Bull Environ Contam Toxicol 1994;52:913–918.Google Scholar
Duodenoscope surveillance sampling and culturing protocols. Food and Drug Administration website. https://www.fda.gov/media/111081/download. Published 2018. Accessed Sep 25, 2019.Google Scholar
Fushimi, R, Takashina, M, Yoshikawa, H, et al.Comparison of adenosine triphosphate, microbiological load, and residual protein as indicators for assessing the cleanliness of flexible gastrointestinal endoscopes. Am J Infect Control 2013;41:161–164.CrossRefGoogle ScholarPubMed
Alfa, MJ, Fatima, I, Olson, N. The adenosine triphosphate test is a rapid and reliable audit tool to asses manual cleaning adequacy of flexible endoscope channels. Am J Infect Control 2013;41:249–253.CrossRefGoogle Scholar
Alfa, MJ, Fatima, I, Olson, N. Validation of adenosine triphosphate to audit manual cleaning of flexible endoscope channels. Am J Infect Control 2013;41:245–248.10.1016/j.ajic.2012.03.018CrossRefGoogle ScholarPubMed
Vlková, H, Babák, V, Seydlová, R, Pavlík, I, Schlegelová, J. Biofilms and hygiene on dairy farms and in the dairy industry: sanitation chemical products and their effectiveness on biofilms—a review. Czech J Food Sci 2008;26:309–323.CrossRefGoogle Scholar
Charlton, TS. A comparison of the efficacy of lumen-cleaning devices for flexible gastrointestinal endoscopes. Austral Infect Control 2007;12:81–90.CrossRefGoogle Scholar
Alfa, MJ, Harminder, S, Nugent, Z, et al.Simulated-use polytetrafluorethylene biofilm model: repeated rounds of complete reprocessing lead to accumulation of organic debris and viable bacteria. Infect Control Hosp Epidemiol 2017;38:1284–1290.10.1017/ice.2017.215CrossRefGoogle ScholarPubMed
International Standards Organization technical standard (ISO/TS) 15883-5: 2005 washer-disinfectors—part 5, test soils and methods for demonstrating cleaning efficacy. Annex E test soil and method for flexible endoscopes. International Standards Organization website. https://www.iso.org/standard/41175.html. Published 2005. Accessed October 15, 2019.Google Scholar
Ren, W, Sheng, X, Huang, X, Zhi, F, Cai, W. Evaluation of detergents and contact time on biofilm removal from flexible endoscopes. Am J Infect Control 2014;41:e89–e92.10.1016/j.ajic.2013.01.027CrossRefGoogle Scholar
Fang, Y, Shen, Z, Li, L, et al.A study of the efficacy of bacterial biofilm cleanout for gastrointestinal endoscopes. World J Gastroenterol 2010;16:1019–1024.CrossRefGoogle ScholarPubMed
Verran, J, Boyd, RD. The relationship between substratum surface roughness and microbiological and organic soiling: a review. Biofouling 2001;17:59–71.CrossRefGoogle Scholar