Plasma-activated water: a new and effective alternative for duodenoscope reprocessing

Infection and Drug Resistance, May 2018

Plasma-activated water: a new and effective alternative for duodenoscope reprocessing Gheorghe G Bălan,1 Irina Roşca,2 Elena-Laura Ursu,2 Florica Doroftei,2 Andra-Cristina Bostănaru,3 Eugen Hnatiuc,4 Valentin Năstasă,3 Vasile Şandru,5 Gabriela Ştefănescu,1 Anca Trifan,1 Mihai Mareş3 1Grigore T. Popa University of Medicine and Pharmacy, Iaşi, Romania; 2“Petru Poni” Institute of Macromolecular Chemistry, Iaşi, Romania; 3Ion Ionescu de la Brad University of Agricultural Sciences and Veterinary Medicine of Iasi, Iaşi, Romania; 4“Gheorghe Asachi” Technical University, Iaşi, Romania; 5Department of Gastroenterology Research, Clinical Emergency Hospital of Bucharest, Bucharest, Romania Introduction: Duodenoscopes have been widely used for both diagnostic and therapeutic endoscopic retrograde cholangiopancreatography procedures. Numerous outbreaks of duodenoscope-associated infections involving multidrug-resistant bacteria have recently been reported. Plasma activated water (PAW) has been widely considered an effective agent for surface decontamination and is increasingly used for disinfection of medical equipment. The aim of this study was to evaluate whether the duodenoscopes currently on market are suited for the repeated use of PAW and to test the efficacy of PAW for their disinfection. Materials and methods: In order to evaluate the disinfection efficacy and the required time of contact, the duodenoscope samples were contaminated by immersing them in fasted-state simulated intestinal fluid containing Escherichia coli, Klebsiella pneumoniae, Acinetobacter baumannii, and Pseudomonas aeruginosa, prior to PAW exposure. In order to test the duodenoscope polymer compatibility with PAW, a challenge test was conducted by immersing the samples in PAW for 30 minutes daily for 45 consecutive days. Results: Significant reductions in bacterial populations were achieved after 30 minutes of PAW treatment, indicating a high-level disinfection. Atomic force microscopy and scanning electron microscopy were used to demonstrate that repeated PAW treatment of duodenoscope coating polymer samples did not result in significant differences in morphological surface between the treated and untreated samples. Energy-dispersive X-ray spectroscopy analysis also showed no significant differences between the elemental composition of the duodenoscope coating polymer samples before and after repeated PAW treatment. Conclusion: Considering these preliminary results, PAW could be considered as a new alternative for duodenoscope reprocessing. Keywords: PAW, antibacterial activity, duodenoscope, disinfection

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Plasma-activated water: a new and effective alternative for duodenoscope reprocessing

Infection and Drug Resistance Plasma-activated water : a new and effective alternative for duodenoscope reprocessing Gheorghe G Bălan 2 3 4 Irina Roşca 1 2 4 Florica Doroftei 1 2 4 0 Ion Ionescu de la Brad University of agricultural sciences and Veterinary Medicine of Iasi , Iaşi , Romania 1 Petru Poni” Institute of Macromolecular Chemistry , Iaşi , Romania 2 Gabriela Ştefănescu 3 grigore T. Popa University of Medicine and Pharmacy , Iaşi , Romania 4 Vasile Şandru 5 Department of gastroenterology Research, clinical emergency hospital of Bucharest , Bucharest , Romania 6 gheorghe asachi” Technical University , Iaşi , Romania PowerdbyTCPDF(ww.tcpdf.org) elena-laura Ursu 2 Andra-Cristina Bostănaru 3 eugen hnatiuc 4 Valentin Năstasă 3 anca Trifan 1 Mihai Mareş 3 Introduction: Duodenoscopes have been widely used for both diagnostic and therapeutic endoscopic retrograde cholangiopancreatography procedures. Numerous outbreaks of duodenoscopeassociated infections involving multidrug-resistant bacteria have recently been reported. Plasma activated water (PAW) has been widely considered an effective agent for surface decontamination and is increasingly used for disinfection of medical equipment. The aim of this study was to evaluate whether the duodenoscopes currently on market are suited for the repeated use of PAW and to test the efficacy of PAW for their disinfection. Materials and methods: In order to evaluate the disinfection efficacy and the required time of contact, the duodenoscope samples were contaminated by immersing them in fasted-state simulated intestinal fluid containing Escherichia coli, Klebsiella pneumoniae, Acinetobacter baumannii, and Pseudomonas aeruginosa, prior to PAW exposure. In order to test the duodenoscope polymer compatibility with PAW, a challenge test was conducted by immersing the samples in PAW for 30 minutes daily for 45 consecutive days. Results: Significant reductions in bacterial populations were achieved after 30 minutes of PAW treatment, indicating a high-level disinfection. Atomic force microscopy and scanning electron microscopy were used to demonstrate that repeated PAW treatment of duodenoscope coating polymer samples did not result in significant differences in morphological surface between the treated and untreated samples. Energy-dispersive X-ray spectroscopy analysis also showed no significant differences between the elemental composition of the duodenoscope coating polymer samples before and after repeated PAW treatment. Conclusion: Considering these preliminary results, PAW could be considered as a new alternative for duodenoscope reprocessing. PAW; antibacterial activity; duodenoscope; disinfection - from roF open access to scientific and medical research Introduction Emergence of multi- and pan-drug resistance in nosocomial digestive endoscopyassociated infections is becoming a big concern.1 Most nosocomial pathogens can persist on duodenoscope surfaces for weeks or even months,2 and the safety of highlevel disinfection of duodenoscope surfaces for controlling nosocomial duodenoscopetransmitted pathogens has been a continuous debate for some time. Duodenoscopes are specially designed upper digestive tract endoscopes, which are widely used for both diagnostic and therapeutic endoscopic retrograde cholangiopancreatography (ERCP) procedures. According to the Spaulding classification of medical devices, reprocessing duodenoscope needs to be consistent with high-level disinfection.3 During the last years, numerous outbreaks of duodenoscope-associated transmission of multidrug-resistant 8 1 0 2 l u J 3 1 n o 4 1 2 . 6 1 . 4 5 2 . 1 5 y b / m o c . s s e bacteria have been reported worldwide.1,4,5 Staphylococcus aureus, Klebsiella pneumoniae, Enterococcus faecalis, Escherichia coli, and Pseudomonas aeruginosa are the bacteria most frequently reported to cause contaminations and duodenoscope-transmitted infections, especially because of their ability to form biofilms. Duodenoscope reprocessing standards include either high-level disinfection or sterilization in accordance with the manufacturer’s and guideline recommendations.6,7 Due to their complex design, duodenoscopes may not be suited for proper high-level disinfection using the current reprocessing standards. Finding solutions to this issue represents a hot topic in current research. Nonthermal plasma discharge has recently been widely acknowledged as an effective method for decontamination and is increasingly proposed for biomedical sterilization of various types of equipment.8–12 Nonthermal plasma proved its valuable properties in surface reprocessing due to its high .rvdoepw l.syeon eofrfincoiednacmyaignedteosttrhoeyisnoglidmsiucrbosotrragtaensiisnmvsolcvaeuds.1i3n–g15 mPliansimmaa-l /:ww luan activated water (PAW) is highly active against a large panel / s o h pe of germs, is easy to use, and has the ability to kill microorttp rs from roF ganisms that otherwise cannot be destroyed by nonthermal ed p (...truncated)


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Gheorghe G Bălan, Irina Roșca, Elena-Laura Ursu, Florica Doroftei, Andra-Cristina Bostănaru, Eugen Hnatiuc, Valentin Năstasă, Vasile Șandru, Gabriela Ștefănescu, Anca Trifan, Mihai Mareș. Plasma-activated water: a new and effective alternative for duodenoscope reprocessing, Infection and Drug Resistance, 2018, pp. 727-733, DOI: 10.2147/IDR.S159243