Efficient removal of attached biofilm in a naturally contaminated colonoscope using detachment-promoting agents

Abstract

We would like to report a successful ‘last chance’ operation during which a highly contaminated colonoscope was effectively treated using an anti-biofilm procedure based on a synergistic combination of detachment-promoting agents (DPAs). Various authors have described the considerable difficulties presented by the removal of attached bacteria from endoscope channels. 1 Spach D.H. Silverstein F.E. Stamm W.E. Transmission of infection by gastrointestinal endoscopy and bronchoscopy. Ann Intern Med. 1993; 118: 117-128 Crossref PubMed Scopus (437) Google Scholar , 2 Struelens M.J. Rost F. Deplano A. et al. Pseudomonas aeroginosa and Enterobacteriaceae bacteremia after biliary endoscopy: an outbreak investigation using DNA macrorestriction analysis. Am J Med. 1993; 95: 489-498 Abstract Full Text PDF PubMed Scopus (136) Google Scholar , 3 Birnie G.G. Quigley E.M. Clements G.B. Follet E.A. Watkinson G. Endoscopic transmission of hepatitis B virus. Gut. 1983; 24: 171-174 Crossref PubMed Scopus (183) Google Scholar We agree with Vickery et al. who considered that the persistence of this attached biomass on endoscope channels is often not due to inadequate compliance with reprocessing protocols, but usually caused by the low efficiency of current reprocessing protocols that do not totally eliminate attached micro-organisms. 4 Vickery K. Pajkos A. Cossart Y. Removal of biofilms from endoscopes: evaluation of detergent efficiency. Am J Infect Control. 2004; 32: 170-176 Abstract Full Text Full Text PDF PubMed Scopus (106) Google Scholar We previously demonstrated that the use of a cleaning agent according to the Pronetron® procedure, prior to disinfection in compliance with French guidelines, totally detached a preformed biofilm from the inner surface of an operating channel. 5 Anonymous. Circulaire DHOS/E2/DGS/SD5C/2003/N°591 relative aux modalités de traitement manuel pour la désinfection des endoscopes non autoclavables dans les lieux de soins. Ministère de la santé, de la famille et des personnes handicapées. Paris: 2003. Google Scholar , 6 Marion K. Freney J. James G. Bergeron E. Renaud F.N.R. Costerton J.W. Using an efficient biofilm detaching agent: an essential step for the improvement of endoscope reprocessing protocols. J Hosp Infect. 2006; 64: 136-142 Abstract Full Text Full Text PDF PubMed Scopus (46) Google Scholar This corrective procedure consists of the sequential action of two DPA-based products: a multi-enzymatic solution (Pronetron α) that digests the anchorage points of the micro-organisms to the support, and an enriched detergent solution (Pronetron β Plus) that detaches the whole biomass from the support.