Abstract
One hundred endoscopes used for bronchoscopy (30), gastroscopy (35) or colonoscopy (35) were studied to determine the efficiency of a new high level disinfectant, orthophthalaldehyde (OPA). Manual cleaning was the method studied since this would be the least effective and thereby provide the greatest challenge to the 0·5% (wv) OPA solution. The OPA was convenient and easy to use since it did not have irritating vapours and as it is used directly, does not require dilution. Our study demonstrated that the OPA was stable for up to 14 days despite repeated re-use. The cleaning/ disinfection procedure could achieve a ⩾5 LOG10 reduction in bacterial load. This in-hospital evaluation supports the conclusion that OPA is an effective choice as a high level disinfectant for flexible endoscopes.
Keywords: Orthophthalaldehyde, disinfection, flexible endoscopes
Footnotes
☆
Financial support for this study was received from Johnson and Johnson Inc.
References
- 1.O'Connor BH, Bennet JR, Alexander JG. Salmonellosis infection transmitted by fibreoptic endoscopes. Lancet. 1982;1:864. doi: 10.1016/s0140-6736(82)90821-2. [DOI] [PubMed] [Google Scholar]
- 2.Dwyer DM, Klein EG, Istre GR, Robinson MG, Newmann DA, McCoy GA. Salmonella newport infections transmitted by fibre optic and colonoscopy. Gastrointest Endosc. 1987;33:84–87. doi: 10.1016/s0016-5107(87)71515-6. [DOI] [PubMed] [Google Scholar]
- 3.Langenberg W, Rauws AJ, Oudbier JH, Tytgat GNJ. Patient-to-patient transmission of Campylobacter pylori infection by fibreoptic gastroduodenoscopy and biopsy. J Infect Dis. 1990;161:507–511. doi: 10.1093/infdis/161.3.507. [DOI] [PubMed] [Google Scholar]
- 4.Doherty DE, Falko JM, Lefkovitz N, Rogers J, Fromkes J. Pseudomonas aeruginosa sepsis following retrograde cholangiopancreatography (ERCP) Dig Dis Sci. 1982;27:169–170. doi: 10.1007/BF01311712. (1982) [DOI] [PubMed] [Google Scholar]
- 5.Allen JI, Allen M, Olson MM. Pseudomonas infection of the biliary system resulting from use of a contaminated endoscope. Gastroenterology. 1987;92:759–763. doi: 10.1016/0016-5085(87)90029-1. [DOI] [PubMed] [Google Scholar]
- 6.Goldstein B, Abrutyn E. Pseudo-outbreak of Bacillus species related to fibreoptic bronchoscopy. J Hosp Infect. 1985;6:194–200. (1985) [PubMed] [Google Scholar]
- 7.Webb F, Vall-Spinosa A. Outbreak of Serratia marcescens associated with the flexible fibre bronchoscope. Chest. 1975;68:703–708. [Google Scholar]
- 8.Siegman-Igra Y, Inbar G, Campus A. An outbreak of pulmonary pseudoinfection by Serratia marcescens. J Hosp Infect. 1985;6:218–220. doi: 10.1016/s0195-6701(85)80101-8. (1985) [DOI] [PubMed] [Google Scholar]
- 9.Birnie GG, Quigley EM, Clements GB, Follet EAC, Watkins G. Endoscopic transmission of hepatitis B virus. Gut. 1983;24:171–174. doi: 10.1136/gut.24.2.171. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 10.Sauter G, Grabein B, Huber G, Mannes GA, Ruckdeschel G, Sauerbruch T. Antibiotic prophylaxis of infectious complications with endoscopic retrograde chol-angiopancreatography. A randomized controlled study. Endoscopy. 1990;22:164–167. doi: 10.1055/s-2007-1012830. [DOI] [PubMed] [Google Scholar]
- 11.Rutala WA. APIC guidelines for selection and use of disinfectants. Am J Infect Control. 1990;18:99–117. doi: 10.1016/0196-6553(90)90089-b. [DOI] [PubMed] [Google Scholar]
- 12.Working Party of the British Society of Gastroenterology Cleaning and disinfection of equipment for gastrointestinal flexible endoscopy: interim recommendations of a Working Party of the British Society of Gastroenterology. Gut. 1988;29:1134–1151. doi: 10.1136/gut.29.8.1134. (1988) [DOI] [PMC free article] [PubMed] [Google Scholar]
- 13.Ridgway GL. Decontamination of fibreoptic endoscopes. J Hosp Infect. 1985;6:363–368. doi: 10.1016/0195-6701(85)90052-0. [DOI] [PubMed] [Google Scholar]
- 14.Dawson DJ, Armstrong JG, Blacklok ZM. Myco-bacterial cross-contamination of bronchoscopy specimens. Am Rev Respir Dis. 1982;126:1095–1097. doi: 10.1164/arrd.1982.126.6.1095. [DOI] [PubMed] [Google Scholar]
- 15.Wheeler PW, Lancaster D, Kaiser AB. Broncho-pulmonary cross-colonization and infection related to mycobacterial contamination of suction valves of bronchoscopes. J Infect Dis. 1989;159:954–958. doi: 10.1093/infdis/159.5.954. [DOI] [PubMed] [Google Scholar]
- 16.Hanson PJV, Gor D, Jeffries DJ, Collins JV. Chemical inactivation of HIV on surfaces. Br Med J. 1989;298:862–864. doi: 10.1136/bmj.298.6677.862. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 17.Johnson and Johnson Inc. Data on file.
- 18.Johnson and Johnson Inc. Method available on application.
- 19.Dumon JF, Gevaudan MJ, Mallet MN, Gevaudan P. Effectiveness of basic glutaraldehyde as a disinfectant in bronchial fibroscopy. Acta Endose Radiocinematogr. 1977;7:405–413. [Google Scholar]
- 20.Hanson PJV, Clarke JR, Nicholson G. Contamination of endoscopes used in AIDS patients. Lancet. 1989:86–88. doi: 10.1016/s0140-6736(89)90323-1. [DOI] [PubMed] [Google Scholar]
- 21.McFarland LV, Surawicz CM, Stamm WE. Risk factors for Clostridium difficile carriage and C. difficile-associated diarrhea in a cohort of hospitalized patients. J Infect Dis. 1990;162:678–684. doi: 10.1093/infdis/162.3.678. [DOI] [PubMed] [Google Scholar]
- 22.Scott BB, Atkinson M. Gastroenterology services: a regional review of changes over a five year period 1981–1986. Gut. 1989;30:695–700. doi: 10.1136/gut.30.5.695. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 23.Frank U, Daschner FD. Disinfection in gastro-intestinal endoscopy: current status. Endoscopy. 1989;21:276–279. doi: 10.1055/s-2007-1012968. [DOI] [PubMed] [Google Scholar]
- 24.Felmingham D, Mowles J, Thomas K, Ridgway GL. Disinfection of gastrointestinal fibrescopes: an evaluation of the Pauldrach Endocleaner and various chemical agents. J Hosp Infect. 1985;6:379–388. doi: 10.1016/0195-6701(85)90054-4. [DOI] [PubMed] [Google Scholar]
- 25.Alfa MJ, Sitter DL. In-hospital evaluation of contamination of duodenoscopes: a quantitative assessment of the effects of drying. J Hosp Infect. 1992;19:89–98. doi: 10.1016/0195-6701(91)90101-d. [DOI] [PubMed] [Google Scholar]