title: Antimicrobial efficacy of endoscopic disinfection procedures: a controlled, multifactorial investigation.
abstract: BACKGROUND
  Adequate disinfection of endoscopes is essential to prevent environmental and patient-to-patient transmission of infectious agents, but data from controlled studies are limited. Moreover, there is controversy regarding current guidelines for disinfection. We compared the antimicrobial efficacy of several endoscopic disinfection procedures controlling for multiple factors that affect reprocessing.
  
  
  METHODS
  A colonoscope was contaminated with 10(8) CFU/mL of Enterococcus faecalis as a standardized inoculum. The colonoscope was passed through 1 of 16 study arms (5 reps/arm for a total of 80 runs) that were controlled for all possible combinations of the following variables: manual precleaning; 10-, 20-, or 45-minute glutaraldehyde exposure; air or ethanol drying; or automated reprocessing with peracetic acid (liquid sterilization system). Suction accessory channels and air-water channels were harvested for microbiologic culture.
  
  
  RESULTS
  Control runs (no cleaning or disinfection) recovered more than 5 x 10(7) CFU/mL from each sampling site. When each processing variable was isolated independent of other variables, the benefits of manual precleaning, longer soak times, and ethanol drying were apparent. When factors were combined, manual precleaning followed by 20- and 45-minute glutaraldehyde exposure and ethanol drying removed all test organisms, as did processing with the liquid sterilization system.
  
  
  CONCLUSIONS
  Although the initial cost is higher, the automated liquid sterilization system provides effective sterilization and minimizes worker exposure. In units where chemical disinfection is used, our results suggest that manual precleaning followed by at least 20-minute glutaraldehyde exposure and ethanol rinse drying are sufficient to achieve complete disinfection.
authors.affiliation: Isaac Gordon Center for Digestive Diseases and Nutrition, The Genesee Hospital, University of Rochester, New York 14607, USA.
authors.forename: J R
authors.initials: JR
authors.lastname: Cronmiller
authors.forename: D K
authors.initials: DK
authors.lastname: Nelson
authors.forename: G
authors.initials: G
authors.lastname: Salman
authors.forename: D K
authors.initials: DK
authors.lastname: Jackson
authors.forename: R S
authors.initials: RS
authors.lastname: Dean
authors.forename: J J
authors.initials: JJ
authors.lastname: Hsu
authors.forename: C H
authors.initials: CH
authors.lastname: Kim
mesh_terms: D015169:Colony Count, Microbial; D004203:Disinfection / Q000379:methods*; D019723:Endoscopes; D013293:Enterococcus faecalis / Q000187:drug effects*; D004866:Equipment Contamination / Q000517:prevention & control; D000431:Ethanol / Q000494:pharmacology; D005976:Glutaral / Q000494:pharmacology; D006801:Humans; D010463:Peracetic Acid / Q000494:pharmacology; D016896:Treatment Outcome
chemical_list: D000431:Ethanol; D010463:Peracetic Acid; D005976:Glutaral