Kampf Günter, Fliss Patricia M, Martiny Heike
Günter Kampf, Patricia M Fliss, Bode Science Center, Bode Chemie GmbH, 22525 Hamburg, Germany.
World J Gastrointest Endosc. 2014 Sep 16;6(9):390-406. doi: 10.4253/wjge.v6.i9.390.
The bioburden (blood, protein, pathogens and biofilm) on flexible endoscopes after use is often high and its removal is essential to allow effective disinfection, especially in the case of peracetic acid-based disinfectants, which are easily inactivated by organic material. Cleaning processes using conventional cleaners remove a variable but often sufficient amount of the bioburden. Some formulations based on peracetic acid are recommended by manufacturers for the cleaning step. We performed a systematic literature search and reviewed the available evidence to clarify the suitability of peracetic acid-based formulations for cleaning flexible endoscopes. A total of 243 studies were evaluated. No studies have yet demonstrated that peracetic acid-based cleaners are as effective as conventional cleaners. Some peracetic acid-based formulations have demonstrated some biofilm-cleaning effects and no biofilm-fixation potential, while others have a limited cleaning effect and a clear biofilm-fixation potential. All published data demonstrated a limited blood cleaning effect and a substantial blood and nerve tissue fixation potential of peracetic acid. No evidence-based guidelines on reprocessing flexible endoscopes currently recommend using cleaners containing peracetic acid, but some guidelines clearly recommend not using them because of their fixation potential. Evidence from some outbreaks, especially those involving highly multidrug-resistant gram-negative pathogens, indicated that disinfection using peracetic acid may be insufficient if the preceding cleaning step is not performed adequately. Based on this review we conclude that peracetic acid-based formulations should not be used for cleaning flexible endoscopes.
使用后的软性内镜上的生物负载（血液、蛋白质、病原体和生物膜）通常很高，清除这些生物负载对于实现有效消毒至关重要，尤其是对于基于过氧乙酸的消毒剂而言，因为有机物质很容易使其失活。使用传统清洁剂的清洁过程可去除数量不定但通常足够的生物负载。一些基于过氧乙酸的制剂被制造商推荐用于清洁步骤。我们进行了系统的文献检索并审查了现有证据，以阐明基于过氧乙酸的制剂用于清洁软性内镜的适用性。总共评估了243项研究。尚无研究表明基于过氧乙酸的清洁剂与传统清洁剂一样有效。一些基于过氧乙酸的制剂已显示出一定的生物膜清洁效果且无生物膜固定潜力，而其他制剂的清洁效果有限且具有明显的生物膜固定潜力。所有已发表的数据均表明过氧乙酸的血液清洁效果有限，且具有显著的血液和神经组织固定潜力。目前尚无关于软性内镜再处理的循证指南推荐使用含过氧乙酸的清洁剂，但一些指南明确建议不要使用，因为其具有固定潜力。一些暴发事件的证据，尤其是那些涉及高度耐多药革兰氏阴性病原体的事件表明，如果前期清洁步骤执行不当，使用过氧乙酸进行消毒可能并不充分。基于本综述，我们得出结论，基于过氧乙酸的制剂不应被用于清洁软性内镜。
