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Disinfection of Endoscopes: Review of New Chemical Sterilants Used for High-Level Disinfection

Published online by Cambridge University Press:  02 January 2015

William A. Rutala  and
David J. Weber
William A. Rutala*
Affiliation:
Division of Infectious Disease, University of North Carolina School of Medicineand the Department of Hospital Epidemiology, University of North Carolina Hospitals, Chapel Hill, North Carolina
David J. Weber
Affiliation:
Division of Infectious Disease, University of North Carolina School of Medicineand the Department of Hospital Epidemiology, University of North Carolina Hospitals, Chapel Hill, North Carolina
*
547 Burnett-Womack Bldg, CB #7030, Division of Infectious Diseases, UNC at Chapel Hill, Chapel Hill, NC 27599-7030
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Abstract

Chemical sterilants are used to high-level disinfect heat-sensitive semicritical items such as endoscopes. Most endoscopes have been reprocessed between each patient use with glutaraldehyde (>2%) or the Steris System 1. Several new chemical sterilants have been developed recently, including 7.5% hydrogen peroxide, 0.08% peracetic acid plus 1.0% hydrogen peroxide, and 0.55% orthophthalaldehyde. In order to aid the infection control professional in choosing the appropriate disinfection methodology, this article reviews the characteristics, advantages, and disadvantages of high-level disinfectants intended for reprocessing endoscopes.

Type
Disinfection and Sterilization
Information
Infection Control & Hospital Epidemiology , Volume 20 , Issue 1 , January 1999 , pp. 69 - 76
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1999

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References

1. American Society for Gastrointestinal Endoscopy. Reprocessing of flexible gastrointestinal endoscopes. Manchester, MA: American Society for Gastrointestinal Endoscopy; 1995.Google Scholar
2. Spach, DH, Silverstein, FE, Stamm, WE. Transmission of infection by gastrointestinal endoscopy and bronchoscopy. Ann Intern Med 1993;118:117–128.CrossRefGoogle ScholarPubMed
3. Martin, MA, Reichelderfer, M. APIC guideline for infection prevention and control in flexible endoscopy. Am J Infect Control 1994;22:19–38.Google Scholar
4. Rutala, WA. APIC guideline for selection and use of disinfectants. Am J Infect Control 1996;24:313–342.Google Scholar
5. Rutala, WA. Disinfection, sterilization and waste disposal. In: Wenzel, RP, ed. Prevention and Control of Nosocomial Infections. Baltimore, MD: Williams & Wilkins; 1997:539–594.Google Scholar
6. Society of Gastroenterology Nurses and Associates, Inc. Standards for infection control and reprocessing of flexible gastrointestinal endoscopes. Chicago, IL: Society of Gastroenterology Nurses and Associates, Inc; 1997.Google Scholar
7. Muscarella, LF. High-level disinfection or “sterilization” of endoscopes? Infect Control Hosp Epidemiol 1996;17:183–187.Google ScholarPubMed
8. Rutala, WA, Clontz, EP, Weber, DJ, Hoffmann, KK. Disinfection practices for endoscopes and other semicritical items. Infect Control Hosp Epidemiol 1991;12:282–288.CrossRefGoogle ScholarPubMed
9. Burns, S, Edwards, M, Jennings, J, Jolly, D, Kovach, S, Leithauser, D, et al. Impact of variation in reprocessing invasive fiberoptic scopes on patient outcomes. Infect Control Hosp Epidemiol 1996;17(suppl):P42. Abstract.Google Scholar
10. Fuselier, HA, Mason, C. Liquid sterilization versus high level disinfection in the urologie office. Urology 1997;50:337–340.Google Scholar
11. Rutala, WA, Weber, DJ. FDA labeling requirements fpr disinfection of endoscopes: a counterpoint. Infect Control Hosp Epidemiol 1995;16:231–235.Google Scholar
12. Bond, WW. Endoscope reprocessing: problems and solutions. In: Rutala, WA ed. Disinfection, Sterilization and Antisepsis in Health Care. Champlain, NY: Polyscience Publications; 1998:151–163.Google Scholar
13. Alfa, MJ, Sitter, DL. In-hospital evaluation of orthophthalaldehyde as a high level disinfectant for flexible endoscopes. J Hosp Infect 1994;26:15–26.Google Scholar
14. Chu, N, McAlister, D, Antonoplos, PA Natural bioburden levels detected on flexible gastrointestinal endoscopes after clinical use and following manual cleaning. Gastrointest Endosc 1998;48:137–142.Google Scholar
15. Chan-Myers, H, McAlister, D, Antonoplos, P. Natural bioburden levels detected on rigid lumened medical devices before and after cleaning. Am J Infect Control 1997;25:471–476.Google Scholar
16. Silvis, SE, Nebel, O, Rogers, G, Sugawa, C, Mandelstam, P. Endoscopic complications: results of the 1974 American Society for Gastrointestinal Endoscopy survey. JAMA 1976;235:928–930.CrossRefGoogle ScholarPubMed
17. Mandelstam, P, Sugawa, C, Silvis, SE, Nebel, OT, Rogers, BHG. Complications associated with esophago-gastroduodenoscopy and with esophageal dilation. Gastrointest Endosc 1976;23:16–19.CrossRefGoogle Scholar
18. Bronowicki, JP, Venard, V, Botte, C, Monhoven, N, Gastin, I, Chone, L, et al. Patient-to-patient transmission of hepatitis C virus during colonoscopy. N Engl J Med 1997;337:237–240.CrossRefGoogle ScholarPubMed
19. Agerton, T, Valway, S, Gore, B, Pozsik, C, Plikaytis, B, Woodley, C, et al. Transmission of a highly drug-resistant strain (strain Wl) of Mycobacterium tuberculosis . JAMA 1997;278:1073–1077.Google Scholar
20. Alvarado, CJ, Stolz, SM, Maki, DG. Nosocomial infections from contaminated endoscopes: a flawed automated endoscope washer. An investigation using molecular epidemiology, Am J Med 1991;91(suppl 3B):272S–280S.CrossRefGoogle ScholarPubMed
21. Babb, JR, Bradley, CR, Ayliffe, GAJ. Sporicidal activity of glutaraldehydes and hypochlorites and other factors influencing their selection for the treatment of medical equipment. J Hosp Infect 1980;1:63–75.Google Scholar
22. Scott, EM, Gorman, SE. Glutaraldehyde. In Block, SS, ed. Disinfection, Sterilization, and Preservation. 4th ed. Philadelphia, PA: Lea & Febiger; 1991:596–614.Google Scholar
23. Weber, DJ, Rutala, WA. Occupational risks associated with the use of selected disinfectants and sterilants. In: Rutala, WA, ed. Disinfection, Sterilization and Antisepsis in Health Care. Champlain, NY: Polyscience Publications; 1998:211–226.Google Scholar
24. American Conference of Governmental Industrial Hygienists. 1998 threshold limit values (TLvs) for chemical substances and physical agents and biological exposure indices (BEIs). ACGIH: Cincinnati, OH; 1998.Google Scholar
25. Association for the Advancement of Medical Instrumentation. Safe use and handling of glutaraldehyde-based products in healthcare facilities. Arlington, VA: AAMI; 1995.Google Scholar
26. Castelli, M, Qizilbash, A, Seaton, T. Postcolonoscopy proctitis. Am J Gastroenterol 1986;81:887. Abstract.Google Scholar
27. Wardle, MD, Renninger, GM. Bactericidal effect of hydrogen peroxide on spacecraft isolates. Applied Microbiology 1975;30:710–711.Google Scholar
28. Bilotta, JJ, Waye, JD. Hydrogen peroxide enteritis: the “snow white” sign. Gastrointest Endosc 1989;35:428–430.Google Scholar
29. Jonas, G, Mahoney, A Murray, J, Gertler, S. Chemical colitis due to endoscope cleaning solutions: a mimic of pseudomembranous colitis. Gastroenterology 1988;95:1403–1408.Google Scholar
30. Greene, DF, Urban, VL, inventors; Sterling Drug Ine, assignee. Hydrogen peroxide disinfecting and sterilizing compositions. US patent 4,518,585. May 21, 1985.Google Scholar
31. Monticello, MV, inventor; Eastman Kodak Company, assignee. Hydrogen peroxide composition. US patent 5,376,387. December 27, 1994.Google Scholar
32. Reckitt & Colman. Sporox sterilant and high-level disinfectant technical report. Montvale, NJ: Reckitt & Colman; 1997:1–12.Google Scholar
33. Sattar, SA. Effect of liquid chemical germicides on mycobacteria including multi-drug resistant isolates of Mycobacteria tuberculosis. Abstracts of the 37th Interscience Conference on Antimicrobial Agents and Chemotherapy; September 28-October 1, 1997; Toronto, Ontario, Canada; September 28-October 1, 1997. E166.Google Scholar
34. Sattar, SA, Taylor, YE, Paquette, M, Rubino, J. In-hospital evaluation of 7.5% hydrogen peroxide as a disinfectant for flexible endoscopes. Can J Infect Control 1996;11:51–54.Google Scholar
35. Vesley, D, Norlien, KG, Nelson, B, Ott, B, Streifel, AJ. Significant factors in the disinfection and sterilization of flexible endoscopes. Am J Infect Control 1992;20:291–300.Google Scholar
36. Olympus Corporation. Technical Report. Compatibility testing of Sporox with Olympus flexible endoscopes. Melville, NY: Olympus Corp; 1998.Google Scholar
37. Block, SS. Peroxygen compounds. In: Block, SS, ed. Disinfection, Sterilization, and Preservation. 4th ed. Philadelphia, PA: Lea & Febiger; 1991:167–181.Google Scholar
38. Mannion, PT The use of peracetic acid for the reprocessing of flexible endoscopes and rigid cystoscopes and laparoscopes. J Hosp Infect 1995;29:313–315.Google Scholar
39. Bradley, CR, Babb, JR, Ayliffe, GAJ. Evaluation of the Steris System 1 peracetic acidendoscope processor. J Hosp Infect 1995;29:143–151.Google Scholar
40. Seballos, RJ, Walsh, AL, Mehta, AC. Clinical evaluation of a liquid chemical sterilization system for the flexible bronchoscope. Journal of Bronchology 1995;2:192–199.CrossRefGoogle Scholar
41. Wallace, CG, Agee, PM, Demicco, DD. Liquid chemical sterilization using peracetic acid: an alternative approach to endoscope processing. ASAIO J 1995;41:151–154.Google Scholar
42. Alfa, MJ, Olson, N, DeGagne, P, Hizon, R. New low temperature sterilization technologies: microbicidal activity and clinical efficacy. In: Rutala, WA, ed. Disinfection, Sterilization and Antisepsis in Health Care. Champlain, NY: Polyscience Publications; 1998:67–78.Google Scholar
43. Babb, JR, Bradley, CR. Endoscope decontamination: where do we go from here? J Hosp Infect 1995;30(suppl):543–551.Google Scholar
44. Middleton, AM, Chadwick, MV, Gaga, H. Disinfection of bronchoscopes, contaminated in vitro with Mycobacterium tuberculosis, Mycobacterium avium-intracellulare and Mycobacterium chelonae in sputum, using stabilized, buffered peracetic acid solution (“Nu-Cide”). Hosp Infect 1997;37:137–143.Google Scholar
45. Holton, J, Nye, P, McDonald, V. Efficacy of selected disinfectants against mycobacteria and Cryptosporidia. J Hosp Infect 1994;27:105–115.CrossRefGoogle ScholarPubMed
46. Holton, J, Shetty, N. In-use stability of Nu-Cidex. J Hosp Infect 1997;35:245–248.Google Scholar
47. Advanced Sterilization Products. Cidex PA—Peracetic Acid Solution. Irvine, CA: ASP; 1998:1–9.Google Scholar
48. Olympus Corporation. Technical Bulletin, Compatibility of Cidex PA solution with Olympus flexible endoscopes. Melville, NY: Olympus Corp; 1998.Google Scholar
49. Walsh, SE, Maillard, J-Y, Russell, AD. Effects of testing method on antibacterial activity of high level disinfectants. Society for Applied Microbiology; October 22, 1997. Poster.Google Scholar
50. Bruckner, NI, Gordon, MD, Howell, RG, inventors; Surgikos, Ine, assignee. Odorless aromatic dialdehyde disinfecting and sterilizing composition. US patent 4,851,449. July 25, 1989.Google Scholar
51. Bruckner, NI, Gordon, MD, Howell, RG, inventors; Johnson & Johnson Medical, Inc, assignee. Odorless aromatic dialdehyde disinfecting and sterilizing composition and method of using the same. US patent 4,971,999. November 20, 1990.Google Scholar
52. Roberts, DG, Chan-Myers, H. Mycobactericidal activity of dilute ortho-phthalaldehyde solutions. American Society for Microbiology; May 21, 1998. Poster.Google Scholar
53. Reckitt & Coleman. Sporox. FDA 510(k) Submission.Google Scholar
54. Hanson, PJV, Gor, D, Clarke, JR, Chadwick, MV, Nicholson, G, Shah, N, et al. Contamination of endoscopes used in AIDS patients. Lancet 1989;2:86–88.Google Scholar
55. Hanson, PJV, Gor, D, Clarke, JR, Chadwick, MV, Gazzard, B, Jeffries, DJ, et al. Recovery of the human immunodeficiency virus from fibreoptic bronchoscopes. Thorax 1991;46:410–412.Google Scholar
56. American Public Health Association. Public Policy Statement 9417: Establishment of clearly defined performance standards for between-patient processing of reusable endoscopic instruments and accessories. Am J Public Health 1995;85:449–450.Google Scholar
57. Ad Hoc Committee on Disinfection of the American Society for Gastrointestinal Endoscopy. Reprocessing of flexible gastrointestinal endoscopes—an American Society for Gastrointestinal Endoscopy White Paper. Gastroenterology Nursing 1996;19:109–112.Google Scholar
58. Working Party of the British Society of Gastroenterology. Cleaning and disinfection of equipment for gastrointestinal flexible endoscopy: interim recommendations of Working Party of the British Society of Gastroenterology. Gut 1988;29:1134–1151.Google Scholar
59. Recommended practices for use and care of endoscopes. AORN J 1998;67:256–262.Google Scholar
60. Emergency Care Research Institute. Evaluation: liquid disinfecting and sterilizing reprocessors used for flexible endoscopes. Health Devices 1994;23:212–251.Google Scholar
61. Emergency Care Research Institute. Evaluation update: liquid disinfecting and sterilizing reprocessors used for flexible endoscopes. Health Devices 1994;23:477–481.Google Scholar
62. American Society for Testing and Materials. Standard practice for cleaning and disinfection of flexible fiberoptic and video endoscopes used in the examination of hollow viscera. Designation F1518-94. Philadelphia, PA: ASTM; 1994.Google Scholar
63. Fantry, GT, Zheng, Q-X, James, SP Conventional cleaning and disinfection techniques eliminate the risk of endoscopic transmission of Helicobacter pylori . Am J Gastroenterol 1995;90:227–232.Google Scholar
64. Barbee, AL, Weber, DJ, Sobsey, MD, Rutala, WA. Inactivation of Cryptosporidium parvum oocyst infectivity by disinfection and sterilization processes. Gastrointest Endosc. In press.Google Scholar
65. van Klingeren, B, Pullen, W. Glutaraldehyde resistant mycobacteria from endoscope washers. J Hosp Infect 1993;25:147–149.Google Scholar
66. Stanley, P. Destruction of a glutaraldehyde-resistant mycobacterium by a peroxygen disinfectant. Am J Infect Control 1998;26:185.Google Scholar

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