Review
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World J Gastrointest Endosc. Sep 16, 2014; 6(9): 390-406
Published online Sep 16, 2014. doi: 10.4253/wjge.v6.i9.390
Is peracetic acid suitable for the cleaning step of reprocessing flexible endoscopes?
Günter Kampf, Patricia M Fliss, Heike Martiny
Günter Kampf, Patricia M Fliss, Bode Science Center, Bode Chemie GmbH, 22525 Hamburg, Germany
Günter Kampf, Institute for Hygiene and Environmental Medicine, Ernst Moritz Arndt University, 17489 Greifswald, Germany
Heike Martiny, Technische Hygiene, Charité-Universitätsmedizin Berlin, 12203 Berlin, Germany
Author contributions: All authors contributed to the conception of the manuscript, and to the review and interpretation of the studies; all authors drafted parts of the manuscript and revised it critically; all authors approved the final version.
Correspondence to: Dr. Günter Kampf, Professor, Bode Science Center, Bode Chemie GmbH, Melanchthonstrasse 27, 22525 Hamburg, Germany. guenter.kampf@bode-chemie.de
Telephone: +49-40-54006203 Fax: +49-40-54006165
Received: November 28, 2013
Revised: August 1, 2014
Accepted: September 4, 2014
Published online: September 16, 2014
Abstract

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.

Keywords: Peracetic acid, Cleaning, Flexible endoscope, Biofilm, Resistance, Bioburden, Blood, Disinfection, Reprocessing

Core tip: Some formulations based on peracetic acid (PAA) are recommended by manufacturers for cleaning flexible endoscopes. We reviewed 243 studies to analyse the evidence for this recommendation. No study demonstrated that PAA-based cleaners were as effective as conventional cleaners, and some PAA-based formulations had clear biofilm-fixation potential. Dried blood and nerve tissue were substantially fixed by PAA. Some outbreaks, especially of highly multidrug-resistant gram-negative pathogens, indicated that insufficient cleaning could not be compensated for by using PAA in the disinfection step. PAA-based formulations should not be used for cleaning flexible endoscopes.