Ionised active water S-100® has been proposed as an original solution for use in dermocosmetics and for the treatment of wounds such as burns and atopic dermatitis. Among the mechanisms of action that are not completely understood, an antimicrobial activity would appear to be important. In the context of the COVID-19 pandemic, we assessed the inactivating efficacy of this solution on SARS-CoV-2 based on the recommendations of the NF-EN-14476+A2 standard. The tests carried out demonstrated that ionised active water S-100® 40% has a virucidal activity on SARS-CoV-2 which is at least 3.1 log after a contact time of 30 seconds and 3.5 log after two minutes at 20°C under clean conditions. Assays were also performed at 4°C and 37°C, and the results obtained are identical to those obtained at 20°C. This demonstration of the virucidal effect of ionised water against SARS-CoV-2 paves the way for the development of usage as an alternative disinfectant in SARS-CoV-2 control.

• Brush head
• contamination
• endoscope reprocessing
• flush-brush-flush sampling method
• surveillance culture

In recent years, the Emergency Care Research Institute has advised that endoscope cleaning is of considerable importance. In the present study, a quality control circle (QCC) was used to reduce the formation of biofilms in flexible endoscopes within one hospital in Guangdong Province, China.

During reprocessing of 235 flexible endoscopes in the urology surgical suite, adenosine triphosphate (ATP) detection was used to monitor the efficacy of biofilm removal. The internal and external parts of flexible endoscopes were used as sampling sites by means of the flushing and smudge methods, respectively. When the two results reached the standard of less than 500 relative light units/piece at the same time, endoscopic biofilm clearance was considered to be qualified. A QCC was established to implement a 10-step plan-do-check-act model.

The baseline qualified rate (i.e., ATP monitoring pass rate) during reprocessing of 235 flexible endoscopes was 50%. During the study, the qualified rate increased to 85.29% after establishment of the QCC. During reprocessing of 150 flexible endoscopes in the following 6 months, the qualified rate remained at 90%.

Establishment of the QCC improved the removal of biofilm from flexible endoscopes in the urology surgical suite.

• China
• Quality control circle
• biofilm
• cleaning
• flexible endoscope
• qualified rate
• urology

• Contamination
• Flush-brush-flush sampling
• Pump-assisted sampling

To correlate the length of endoscope hang time and number of bacteria cultured prior to use.

Prospectively, we cultured specimens from 19 gastroscopes, 24 colonoscopes and 5 side viewing duodenoscopes during the period of 2011 to 2015. A total of 164 results had complete data denoting date of cleansing, number of days stored and culture results. All scopes underwent initial cleaning in the endoscopy suite utilizing tap water, and then manually cleaned and flushed. High level disinfection was achieved with a Medivator^© DSD (Medivator Inc., United States) automated endoscope reprocessor following manufacturer instructions, with Glutacide^® (Pharmax Limited, Canada), a 2% glutaraldehyde solution. After disinfection, all scopes were stored in dust free, unfiltered commercial cabinets for up to 7 d. Prior to use, all scopes were sampled and plated on sheep blood agar for 48 h; the colony count was obtained from each plate. The length of endoscope hang time and bacterial load was analyzed utilizing unpaired t-tests. The overall percentage of positive and negative cultures for each type of endoscope was also calculated.

All culture results were within the acceptable range (less than 200 cfu/mL). One colonoscope cultured 80 cfu/mL after hanging for 1 d, which was the highest count. ERCP scopes cultured at most 10 cfu, this occurred after 2 and 7 d, and gastroscopes cultured 50 cfu/mL at most, at 1 d. Most cultures were negative for growth, irrespective of the length of hang time. Furthermore, all scopes, with the exception of one colonoscope which had two positive cultures (each of 10 cfu/mL), had at most one positive culture. There was no significant difference in the number of bacteria cultured after 1 d compared to 7 d when all scopes were combined (day 2: P = 0.515; day 3: P = identical; day 4: P = 0.071; day 5: P = 0.470; day 6: P = 0.584; day 7: P = 0.575). There was also no significant difference in the number of bacteria cultured after 1 day compared to 7 d for gastroscopes (day 2: P = 0.895; day 3: P = identical; day 4: P = identical; day 5: P = 0.893; day 6: P = identical; day 7: P = 0.756), colonoscopes (day 2: P = 0.489; day 4: P = 0.493; day 5: P = 0.324; day 6: P = 0.526; day 7: P = identical), or ERCP scopes (day 2: P = identical; day 7: P = 0.685).

There is no correlation between hang time and bacterial load. Endoscopes do not need to be reprocessed if reused within a period of 7 d.

• Bacteria
• Endoscopy
• Processing
• Hang time
• Colonoscopy
• Endoscopic retrograde cholangiopancreatography
• Gastroscopy

• Disinfection/standards
• Endoscopes
• Endoscopes, Gastrointestinal
• Endoscopy, Digestive System/instrumentation
• Equipment Contamination/prevention & control
• Equipment Reuse/standards
• Humans
• Societies, Medical
• Sterilization/standards

Gastrointestinal endoscopy is effective and safe for the screening, diagnosis, and treatment of gastrointestinal disease. However, issues regarding endoscope-transmitted infections are emerging. Many countries have established and continuously revise guidelines for endoscope reprocessing in order to prevent infections. While there are common processes used in endoscope reprocessing, differences exist among these guidelines. It is important that the reprocessing of gastrointestinal endoscopes be carried out in accordance with the recommendations for each step of the process.

• Endoscopy
• Guideline
• Reprocessing

• Bioburden
• Biofilm
• Blood
• Cleaning
• Disinfection
• Flexible endoscope
• Peracetic acid
• Reprocessing
• Resistance

• Bacterial count
• Biofilm
• Detergents
• Endoscopy
• Escherichia coli

• Anti-Infective Agents/pharmacology
• Bacterial Physiological Phenomena/drug effects
• Biofilms/drug effects
• Colony Count, Microbial
• Detergents/pharmacology
• Endoscopes/microbiology
• Escherichia coli/drug effects
• Escherichia coli/physiology
• Humans
• Microbial Viability/drug effects
• Time Factors

• Disinfectants
• Endoscopy, gastrointestinal
• Reprocessing

• cirrhosis
• sensitivity
• specificity
• string capsule endoscopy
• varices

• Cross Infection/prevention & control
• Endoscopes, Gastrointestinal/microbiology
• Endoscopes, Gastrointestinal/standards
• Equipment Reuse/standards
• Humans
• Sterilization/methods
• Sterilization/standards

• Cross Infection/prevention & control
• Disinfection/methods
• Disinfection/standards
• Endoscopes, Gastrointestinal/microbiology
• Endoscopes, Gastrointestinal/standards
• Equipment Reuse/standards
• Humans
• Societies, Medical

• China
• Disinfectants
• Disinfection/methods
• Disinfection/standards
• Endoscopes, Gastrointestinal
• Endoscopy, Gastrointestinal
• Equipment Reuse
• Glutaral
• Guideline Adherence
• Humans
• Practice Guidelines as Topic
• Sterilization/methods
• Surveys and Questionnaires

• Colonoscopes/microbiology
• Colonoscopes/standards
• Colonoscopy/standards
• Cross Infection/prevention & control
• Cross Infection/transmission
• Disease Transmission, Infectious/prevention & control
• Disinfection/standards
• Equipment Contamination/prevention & control
• Guideline Adherence
• Humans
• Infection Control/methods
• Infection Control/standards
• Injections/standards
• Practice Guidelines as Topic

• endoscopy
• escherichia coli biofilm
• scanning electron microscopy
• bacterial count

• Biofilms/drug effects
• Detergents/pharmacology
• Disinfection/methods
• Endoscopes, Gastrointestinal/microbiology
• Equipment Contamination
• Escherichia coli/drug effects
• Escherichia coli/physiology
• Humans

Flexible endoscopes undergo repeated rounds of patient-use and reprocessing. Some evidence indicates that there is an accumulation or build-up of organic material that occurs over time in endoscope channels. This "buildup biofilm" (BBF) develops as a result of cyclical exposure to wet and dry phases during usage and reprocessing. This study investigated whether the BBF matrix represents a greater challenge to disinfectant efficacy and microbial eradication than traditional biofilm (TBF), which forms when a surface is constantly bathed in fluid.

Using the MBEC (Minimum Biofilm Eradication Concentration) system, a unique modelling approach was developed to evaluate microbial survival in BBF formed by repetitive cycles of drying, disinfectant exposure and re-exposure to the test organism. This model mimics the cumulative effect of the reprocessing protocol on flexible endoscopes. Glutaraldehyde (GLUT) and accelerated hydrogen peroxide (AHP) were evaluated to assess the killing of microbes in TBF and BBF.

The data showed that the combination of an organic matrix and aldehyde disinfection quickly produced a protective BBF that facilitated high levels of organism survival. In cross-linked BBF formed under high nutrient conditions the maximum colony forming units (CFU) reached ~6 Log₁₀ CFU/peg. However, if an oxidizing agent was used for disinfection and if organic levels were kept low, organism survival did not occur. A key finding was that once established, the microbial load of BBF formed by GLUT exposure had a faster rate of accumulation than in TBF. The rate of biofilm survival post high-level disinfection (HLD) determined by the maximum Log₁₀CFU/initial Log₁₀CFU for E. faecalis and P. aeruginosa in BBF was 10 and 8.6 respectively; significantly different compared to a survival rate in TBF of ~2 for each organism. Data from indirect outgrowth testing demonstrated for the first time that there is organism survival in the matrix. Both TBF and BBF had surviving organisms when GLUT was used. For AHP survival was seen less frequently in BBF than in TBF.

This BBF model demonstrated for the first time that survival of a wide range of microorganisms does occur in BBF, with significantly more rapid outgrowth compared to TBF. This is most pronounced when GLUT is used compared to AHP. The data supports the need for meticulous cleaning of reprocessed endoscopes since the presence of organic material and microorganisms prevents effective disinfection when GLUT and AHP are used. However, cross-linking agents like GLUT are not as effective when there is BBF. The data from the MBEC model of BBF suggest that for flexible endoscopes that are repeatedly used and reprocessed, the assurance of effective high-level disinfection may decrease if BBF develops within the channels.

• Endoscopes, Gastrointestinal/adverse effects
• Endoscopes, Gastrointestinal/microbiology
• Endoscopy, Gastrointestinal/adverse effects
• Equipment Contamination/prevention & control
• Humans
• Infection Control
• Infections/transmission
• Risk Assessment
• Risk Factors

• Anti-Bacterial Agents/therapeutic use
• Anticoagulants/therapeutic use
• Endoscopy, Gastrointestinal/methods
• Humans
• Preoperative Care/methods
• Prognosis
• Surgical Wound Infection/prevention & control
• Thrombosis/prevention & control

• Bacteria/growth & development
• Bacterial Adhesion/physiology
• Biofilms/growth & development
• Cross Infection/microbiology
• Cross Infection/prevention & control
• Ecosystem
• Equipment Contamination/prevention & control
• Humans
• Infection Control

• Cross Infection/prevention & control
• Disinfectants/pharmacology
• Disinfection/instrumentation
• Disinfection/methods
• Endoscopes/classification
• Endoscopes/microbiology
• Equipment Contamination/prevention & control
• Gram-Negative Bacteria/drug effects
• Gram-Positive Bacteria/drug effects
• Humans
• Infection Control/methods
• Peracetic Acid/pharmacology
• Spores, Bacterial/drug effects

• Biofilms
• Cross Infection/prevention & control
• Disinfectants
• Disinfection/methods
• Endoscopes/microbiology
• Equipment Contamination/prevention & control
• Humans
• Infection Control/methods