title: Physical and composition characteristics of clinical secretions compared with test soils used for validation of flexible endoscope cleaning.
abstract: OBJECTIVE
  To determine which simulated-use test soils met the worst-case organic levels and viscosity of clinical secretions, and had the best adhesive characteristics.
  
  
  METHODS
  Levels of protein, carbohydrate and haemoglobin, and vibrational viscosity of clinical endoscope secretions were compared with test soils including ATS, ATS2015, Edinburgh, Edinburgh-M (modified), Miles, 10% serum and coagulated whole blood. ASTM D3359 was used for adhesion testing. Cleaning of a single-channel flexible intubation endoscope was tested after simulated use.
  
  
  RESULTS
  The worst-case levels of protein, carbohydrate and haemoglobin, and viscosity of clinical material were 219,828μg/mL, 9296μg/mL, 9562μg/mL and 6cP, respectively. Whole blood, ATS2015 and Edinburgh-M were pipettable with viscosities of 3.4cP, 9.0cP and 11.9cP, respectively. ATS2015 and Edinburgh-M best matched the worst-case clinical parameters, but ATS had the best adhesion with 7% removal (36.7% for Edinburgh-M). Edinburgh-M and ATS2015 showed similar soiling and removal characteristics from the surface and lumen of a flexible intubation endoscope.
  
  
  CONCLUSIONS
  Of the test soils evaluated, ATS2015 and Edinburgh-M were found to be good choices for the simulated use of endoscopes, as their composition and viscosity most closely matched worst-case clinical material.
authors.affiliation: St. Boniface Research Centre, Winnipeg, Manitoba, Canada; Department of Medical Microbiology, University of Manitoba, Winnipeg, Manitoba, Canada. Electronic address: malfa@sbrc.ca.
authors.forename: M J
authors.initials: MJ
authors.lastname: Alfa
authors.affiliation: St. Boniface Research Centre, Winnipeg, Manitoba, Canada.
authors.forename: N
authors.initials: N
authors.lastname: Olson
mesh_terms: D000268:Adhesiveness; D012634:Bodily Secretions / Q000737:chemistry*; D002241:Carbohydrates / Q000032:analysis*; D003666:Decontamination / Q000592:standards*; D019723:Endoscopes; D004866:Equipment Contamination; D005243:Feces / Q000737:chemistry*; D006801:Humans; D011506:Proteins / Q000032:analysis*; D014783:Viscosity
chemical_list: D002241:Carbohydrates; D011506:Proteins
keywords: Cleaning; Clinical secretions; Gastrointestinal endoscopes; Simulated use; Validation