title: Evaluation of detergents and contact time on biofilm removal from flexible endoscopes.
abstract: BACKGROUND
  The formation of endoscopic biofilm reduces the results of cleaning and disinfection and may increase nosocomial infection. This study aims to evaluate the effects of various detergents and different contact time on the removal of biofilm on flexible endoscopes based on an artificial biofilm model.
  
  
  METHODS
  Endoscopic biofilm model was established and treated with various detergents (detergent 1, Rapid Multi-Enzyme; detergent 2, Scopezime; and detergent 3, Intercept) for 3, 5, and 7 minutes. Escherichia coli viable counts and biofilm changes were measured by colony counting and electron microscopy scanning, respectively.
  
  
  RESULTS
  Statistical differences were observed between various detergents and the control group (P < .001) but not among the different contact time groups (3, 5, and 7 minutes, P > .05). Multiple comparisons showed that statistical differences in residual biofilm bacteria were observed between the detergents and the control (P < .001). Significant differences (P < .001) in residual biofilm bacteria existed between the 2 enzymatic detergents and the nonenzymatic detergent group, whereas no significant difference was observed between the 2 enzymatic detergents (P > .05). No crossover effect was observed between various detergent groups, contact time, and the control group (P > .05). Electron microscopy scanning revealed that, after various detergents and contact time of 3, 5, and 7 minutes, the residual biofilm in the enzymatic detergent group was significantly more than that of the nonenzymatic detergent group. No significant difference was observed among the groups with the same detergent and different contact time.
  
  
  CONCLUSIONS
  Significantly more biofilm bacteria and biofilms were found in the enzymatic detergent groups compared with the nonenzymatic detergent group, whereas no significant difference was observed among 3, 5, and 7 minutes groups.
authors.affiliation: School of Nursing, Southern Medical University, Guangzhou, China.
authors.forename: Wei
authors.initials: W
authors.lastname: Ren
authors.forename: Xiaoyan
authors.initials: X
authors.lastname: Sheng
authors.forename: Xi
authors.initials: X
authors.lastname: Huang
authors.forename: Fachao
authors.initials: F
authors.lastname: Zhi
authors.forename: Wenzhi
authors.initials: W
authors.lastname: Cai
mesh_terms: D000890:Anti-Infective Agents / Q000494:pharmacology*; D018407:Bacterial Physiological Phenomena / Q000187:drug effects; D018441:Biofilms / Q000187:drug effects*; D015169:Colony Count, Microbial; D003902:Detergents / Q000494:pharmacology*; D019723:Endoscopes / Q000382:microbiology*; D004926:Escherichia coli / Q000187:drug effects* / Q000502:physiology*; D006801:Humans; D050296:Microbial Viability / Q000187:drug effects; D013997:Time Factors
chemical_list: D000890:Anti-Infective Agents; D003902:Detergents
keywords: Bacterial count; Biofilm; Detergents; Endoscopy; Escherichia coli