title: Removal of biofilm from endoscopes: evaluation of detergent efficiency.
abstract: BACKGROUND
  Biofilm consisting of bacteria enclosed in a matrix of exopolysaccharide (EPS) forms on many medical devices such as catheters and implants. Nosocomial infection is, thus, a newly recognized scenario of biofilm development. Biofilm removal by physical methods such as ultrasound and mechanical cleaning is reasonably effective but difficult to supervise in practice. Chemical methods are often ineffective because of biofilm resistance to biocides. In this study, we compared the efficiency of different detergents used in endoscope reprocessing.
  
  
  METHODS
  Escherichia coli biofilm was generated on Teflon and medical grade PVC tubing under low flow conditions. Sections of biofilm covered tubing were washed using test detergents and biofilm removal was assessed by counting remaining adherent bacteria after washing and by scanning electron microscopy to qualitatively assess the amount and nature of the remaining biofilm.
  
  
  RESULTS
  Control tubing developed a multilayered biofilm consisting of >10(5) bacterial cells/cm(2). Only Matrix (Whiteley Medical, Sydney, Australia) produced >4 log reduction in viable bacterial numbers. Matrix and Epizyme Rapid (3M Australia, Pymble, Australia) were able to remove up to 75% and 60% of the biofilm, respectively.
  
  
  CONCLUSIONS
  Many commonly used enzymatic cleaners fail to reduce the viable bacterial load or remove the bacterial EPS. Cleaners with high enzyme activity, Epizyme Rapid, removed more biofilm but failed to reduce bacterial numbers more than 2 logs. The only cleaner containing no enzymes, Matrix, significantly reduced bacterial viability and residual bacterial EPS.
authors.affiliation: Department of Infectious Diseases, University of Sydney, Sydney, NSW 2006, Australia.
authors.forename: Karen
authors.initials: K
authors.lastname: Vickery
authors.forename: Aniko
authors.initials: A
authors.lastname: Pajkos
authors.forename: Yvonne
authors.initials: Y
authors.lastname: Cossart
mesh_terms: D018441:Biofilms; D015169:Colony Count, Microbial; D003428:Cross Infection / Q000517:prevention & control*; D003902:Detergents; D004203:Disinfection / Q000379:methods*; D019723:Endoscopes / Q000382:microbiology*; D004866:Equipment Contamination / Q000517:prevention & control; D017743:Equipment Reuse; D004926:Escherichia coli / Q000302:isolation & purification*; D006801:Humans; D017053:Infection Control / Q000379:methods
chemical_list: D003902:Detergents