Efficacy of conventional endoscopic disinfection and sterilization methods against Helicobacter pylori contamination.
BACKGROUND
Iatrogenic transmission of Helicobacter pylori via contaminated endoscopic devices is well documented. Despite the prevalence of this infectious agent, few controlled studies have investigated the major factors that impact on reprocessing of endoscopes contaminated with H. pylori.


METHODS
An endoscope (Pentax) was contaminated with 108 cfu/ml of H. pylori in 5% bovine calf serum as standardized inoculum. The endoscope then was passed through one of eight arms (five repetitions per arm = 40 total runs), as follows: 1, recovery control (no cleaning or disinfection); 2, manual cleaning alone; 3-5, manual precleaning followed by either 10-, 20-, or 45-minute exposure to 2% glutaraldehyde and ethanol (ETOH) drying; 6, manual cleaning followed by automated reprocessing by STERIS System; 7 and 8, automated reprocessing by STERIS with and without active peracetic acid sterilant (wash-off control). Suction-biopsy channels and air-water channels were harvested for microbiological culture.


RESULTS
Control runs recovered more than 1 x 106 cfu per site, confirming the viability of the test organism and the adequacy of the biological burden for challenge. When instruments underwent manual cleaning alone (without subsequent disinfection), test organisms remained in 40% of runs at the air-water site. Manual cleaning followed by 10-, 20-, or 45-minute glutaraldehyde exposure and ETOH drying removed all test organisms from all sites in all runs (i.e., 100% disinfection). The automated STERIS system with or without active peracetic acid sterilant also removed all test organisms from all sites in all runs, as did manual cleaning followed by STERIS use.


CONCLUSIONS
Manual cleaning alone does not effectively remove H. pylori from an endoscope. Current joint association recommendations for minimal disinfection (manual cleaning followed by at least 20 minutes of immersion in glutaraldehyde and ETOH drying) are effective in preventing cross-transmission of H. pylori. Reprocessing using the automated STERIS system according to manufacturer's recommendations also is highly effective in sterilizing endoscopes contaminated with H. pylori.
Cronmiller
J R
JR
Isaac Gordon Center for Digestive Diseases and Nutrition, The Genesee Hospital, Rochester, NY 14607, USA.
Nelson
D K
DK
Jackson
D K
DK
Kim
C H
CH
D003428:Cross Infection / Q000517:prevention & control; D004203:Disinfection / Q000379:methods*; D019723:Endoscopes / Q000382:microbiology*; D004866:Equipment Contamination; D000431:Ethanol / Q000494:pharmacology; D005976:Glutaral / Q000494:pharmacology; D016481:Helicobacter Infections / Q000517:prevention & control / Q000635:transmission; D016480:Helicobacter pylori / Q000254:growth & development*; D006801:Humans
D000431:Ethanol; D005976:Glutaral