Ji Min Lee; Kang-Moon Lee; Dae Bum Kim; Se Eun Go; Sungwoo Ko; Yoongoo Kang; Solim Hong

doi:10.4166/kjg.2018.71.6.319

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Lee, Lee, Kim, Go, Ko, Kang, and Hong: Efficacy of Peracetic Acid (EndoPA®) for Disinfection of Endoscopes

Original Article

Korean J Gastroenterol 2018;71(6):319-323.

Published online: 4 October 2018

DOI: https://doi.org/10.4166/kjg.2018.71.6.319

Efficacy of Peracetic Acid (EndoPA^®) for Disinfection of Endoscopes

Ji Min Lee, Kang-Moon Lee, Dae Bum Kim, Se Eun Go, Sungwoo Ko, Yoongoo Kang, Solim Hong

Department of Internal Medicine, St. Vincent's Hospital, The Catholic University of Korea, Suwon, Korea

Correspondence to: Kang-Moon Lee, Department of Internal Medicine, St. Vincent's Hospital, The Catholic University of Korea, 93 Jungbu-daero, Paldal-gu, Suwon 16247, Korea. Tel: +82-31-249-8151, Fax: +82-31-253-8898, E-mail: drmaloman@catholic.ac.kr

Received 25 January 2018 Revised 6 March 2018 Accepted 19 March 2018

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background/Aims

We aimed to investigate the efficacy of peracetic acid (EndoPA^®; Firson Co., Ltd., Cheonan, Korea) in disinfecting endoscopes.

Methods

We prospectively investigated the gastroscopes (Part I) utilized in 100 gastroscopic examinations and colonoscopes (Part II) utilized in 30 colonoscopic examinations after disinfecting them with 0.2% peracetic acid (EndoPA^®; Firson Co., Ltd.). These instruments had been collected consecutively throughout the study period. We reprocessed and disinfected the endoscopes according to the guidelines for cleaning and disinfecting gastrointestinal endoscopes laid down by the Korean Society of Gastrointestinal Endoscopy in 2017. Three culture samples were obtained from each examination, based on different sampling methods. The primary outcome was a positive culture rate.

Results

In Part I of our study, two of 300 samples were positive. The culture positive rate after disinfection was 0.7% (2/300). The culture positive rate was not significantly different based on the exposure time to EndoPA^® or the age of the scopes (p=0.7 or 0.2, respectively). In Part II of our study, all samples (n=90) were negative.

Conclusions

We conclude that 0.2% peracetic acid (EndoPA^®) appears to be a good disinfectant for both gastroscopes and colonoscopes.

Keywords: Peracetic acid, Endoscope, Disinfection, Efficacy

References

1. Spach DH, Silverstein FE, Stamm WE. Transmission of infection by gastrointestinal endoscopy and bronchoscopy. Ann Intern Med. 1993; 118:117–128.

2. Langenberg W, Rauws EA, Oudbier JH, Tytgat GN. Patient-to-patient transmission of Campylobacter pylori infection by fiberoptic gastroduodenoscopy and biopsy. J Infect Dis. 1990; 161:507–511.

3. Akamatsu T, Tabata K, Hironga M, Kawakami H, Uyeda M. Transmission of Helicobacter pylori infection via flexible fiberoptic endoscopy. Am J Infect Control. 1996; 24:396–401.

4. Centers for Disease Control (CDC). Nosocomial infection and pseudoinfection from contaminated endoscopes and broncho-scopes–Wisconsin and Missouri. MMWR Morb Mortal Wkly Rep. 1991; 40:675–678.

5. ASGE Quality Assurance In Endoscopy Committee. Petersen BT, Chennat J, et al. Multisociety guideline on reprocessing flexible gastrointestinal endoscopes: 2011. Gastrointest Endosc. 2011; 73:1075–1084.

6. Beilenhoff U, Neumann CS, Rey JF, et al. ESGE-ESGENA guideline: cleaning and disinfection in gastrointestinal endoscopy. Endoscopy. 2008; 40:939–957.

7. Kim BW, Son BK, Kim WH, et al. Korean Society of Gastrointestinal Endoscopy (KSGE) guidelines for endoscope reprocessing. Korean J Med. 2017; 92:239–244.

8. Cheung RJ, Ortiz D, DiMarino AJ Jr. GI endoscopic reprocessing practices in the United States. Gastrointest Endosc. 1999; 50:362–368.

9. Ruddy M, Kibbler CC. Endoscopic decontamination: an audit and practical review. J Hosp Infect. 2002; 50:261–268.

10. Park S, Jang JY, Koo JS, et al. A review of current disinfectants for gastrointestinal endoscopic reprocessing. Clin Endosc. 2013; 46:337–341.

11. Kim JB, Han DS, Lee HL, et al. The value of peracetic acid (SCOTELIN^®) for endoscope disinfection. Korean J Gastrointest Endosc. 2004; 28:284–290.

12. Chenjiao W, Hongyan Z, Qing G, Xiaoqi Z, Liying G, Ying F. In-use evaluation of peracetic acid for high-level disinfection of endoscopes. Gastroenterol Nurs. 2016; 39:116–120.

13. Seo HI, Lee DS, Yoon EM, et al. Comparison of the efficacy of disinfectants in automated endoscope reprocessors for colonoscopes: tertiary amine compound (Sencron2®) versus or-tho-phthalaldehyde (Cidex®OPA). Intest Res. 2016; 14:178–182.

14. Bradley CR, Babb JR, Ayliffe GA. Evaluation of the steris system 1 peracetic acid endoscope processor. J Hosp Infect. 1995; 29:143–151.

15. Crow S. Peracetic acid sterilization: a timely development for a busy healthcare industry. Infect Control Hosp Epidemiol. 1992; 13:111–113.

16. Sagripanti JL, Bonifacino A. Comparative sporicidal effect of liquid chemical germicides on three medical devices contaminated with spores of Bacillus subtilis. Am J Infect Control. 1996; 24:364–371.

17. Cooke RP, Goddard SV, Whymant-Morris A, Sherwood J, Chatterly R. An evaluation of Cidex OPA (0.55% ortho-phthalaldehyde) as an alternative to 2% glutaraldehyde for high-level disinfection of endoscopes. J Hosp Infect. 2003; 54:226–231.

18. Sokol WN. Nine episodes of anaphylaxis following cystoscopy caused by Cidex OPA (ortho-phthalaldehyde) high-level disinfectant in 4 patients after cytoscopy. J Allergy Clin Immunol. 2004; 114:392–397.

19. Rutala WA, Weber DJ. Surface disinfection: should we do it? J Hosp Infect. 2001; 48(Suppl A):S64–68.

20. Zhang X, Kong J, Tang P, et al. Current status of cleaning and disinfection for gastrointestinal endoscopy in China: a survey of 122 endoscopy units. Dig Liver Dis. 2011; 43:305–308.

Table 1.

Culture Positive Rate after Disinfection

	Part I ^a (n=300)	Part II ^b (n=90)
Sample 1 ^c	1.0% (1/100)	0% (0/30)
Sample 2 ^d	1.0% (1/100)	0% (0/30)
Sample 3 ^e	0% (0/100)	0% (0/30)
Total	0.7% (2/300)	0% (0/90)

^a Part I, using 100 gastroscopes, total 300 of culture samples

^b Part II, using 30 colonoscopes, total 90 of culture samples

^c Sample 1

^d Sample 2, swabbed washing specimen from suction channel; specimen from tip of insertion tube

^e Sample 3, swabbed specimen from angulation knob.

Table 2.

Culture Positive Rate Based on Exposure Time of EndoPA^® in Part I of Our Study

	Group-5 ^a (n=150)	Group-10 ^b (n=150)
Sample 1 ^c	0% (0/50)	2% (1/50)
Sample 2 ^d	2% (1/50)	0% (0/50)
Sample 3 ^e	0% (0/50)	0% (0/50)
Total	0.7% (1/150)	0.7% (1/150)

^a Group-5, 50 gastroscopes contacted with EndoPA® for 5 minutes, total 150 of culture samples

^b Group-10, 50 gastroscopes contacted with EndoPA® for 10 minutes, total 150 of culture samples

^c Sample 1, washing specimen from suction channel

^d Sample 2, swabbed specimen from tip of insertion tube

^e Sample 3, swabbed specimen from angulation knob.

Table 3.

Culture Positive Rate Based on the Age of the Gastroscopes in Part I of Our Study

	5 years (n=150)	1 year (n=150)
Sample 1 ^a	0% (0/50)	2% (1/50)
Sample 2 ^b	0% (0/50)	2% (1/50)
Sample 3 ^c	0% (0/50)	0% (0/50)
Total	0% (0/150)	1.3% (2/150)

^a Sample 1, washing specimen from suction channel

^b Sample 2, swabbed specimen from tip of insertion tube

^c Sample 3, swabbed specimen from angulation knob.

Table 4.

Summary of Currently Used Disinfectants for Endoscopic Reprocessing

			Sporicidal Activity¹²
Disinfectants	Advantages¹⁰	Disadvantages¹⁰	Inocula applied to the endoscope (CFU)	Number of survivors (CFU)	Reprocessing time ^a (min)
GA	In-use solution stable for 14 days Does not damage equipment	Action against bacterial spores and mycobacteria is slow. Irritation to skin, eyes, and respiratory tract. Solution stains skin. Insufficient rinsing of devices may influence next subject for endoscopy. Tendency of residue film creation. Ventilation of reprocessing room is recommended.	2.77×10⁸ (2% GA)	1,885 (1,000–5,500) ^b (2% GA)	24 (2% GA, disinfection time: 10 minutes)
OPA	In-use solution stable for 7–14 days Does not damage equipment	Action against bacterial spores is slow. Irritation to eyes and respiratory tract. Solution stains skin. Little data on hazards of long-term exposure and on safe exposure levels. Ventilation of reprocessing room is recommended.	2.31×10⁸ (0.55% OPA)	2,360 (700–10,375) ^b (0.55% OPA)	19 (0.55% OPA) disinfection time: 5 minutes)
PAA/HPO	Prompt disinfection and sporicidal activity In-use solutions are stable for 1–14 days depending on products Does not harm the environment No chemical cross-linking of protein residues	Irritation to skin, eyes, and respiratory tract. Acidic odor. Ventilation of reprocessing room is recommended. Material compatibility depends on pH and temperature. Acid-related coagulation of proteins is possible, depending on pH.	3.01×10⁸ (850 ppm PAA)	2 (0–90) ^b (850 ppm PAA)	19 (850 ppm PAA: disinfection time: 5 minutes)

GA, glutaraldehyde; OPA, orthophthalaldehyde; PAA/HPO, peracetic acid/hydrogen peroxide; CFU, colony-forming unit.

^a The time of one endoscope was reprocessing by the manual method

^b The values given are residual bacteria counting numbers (minimum and maximum numbers).

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