Endoscope disinfection using chlorine dioxide in an automated washer-disinfector

Impact of Chlorine Dioxide on Pathogenic Waterborne Microorganisms Occurring in Dental Chair Units

Bacterial contamination is a problem in dental unit water lines with the consequence of implementing regular disinfection. In this study, the short-term impact of chlorine dioxide (ClO₂) treatment was investigated on the microorganisms Legionella pneumophila and L. anisa, Pseudomonas aeruginosa, Escherichia coli, and Staphylococcus aureus. The environmental background was proven as an important factor regarding the tolerance to 0.4 mg/L ClO₂ as saline and phosphate-buffered saline resulted in a higher bacterial reduction than tap water. Gram-positive microorganisms demonstrated higher robustness to ClO₂ than Gram-negative, and microorganisms adapted to tap water showed increased stability compared to cultured cells. At high densities, substantial numbers of bacteria were able to withstand disinfection, whereby the use of 4.6 mg/L ClO₂ increased the inactivation rate. A massive cell decrease occurred within the first 5 minutes with subsequent plateau formation or slowed cell reduction upon further exposure. This biphasic kinetics cannot be explained by a ClO₂ depletion effect alone, because the probability of bacterial subpopulations with increased tolerance should be taken into account, too. Our results prove high disinfection efficiency to microorganisms that were rather found in correlation to the level of bacterial contamination and background solutions than the chosen concentration for ClO₂ treatment itself.

Effectiveness of Disinfection with Chlorine Dioxide on Respiratory Transmitted, Enteric, and Bloodborne Viruses: A Narrative Synthesis

A viral spread occurrence such as the SARS-CoV-2 pandemic has prompted the evaluation of different disinfectants suitable for a wide range of environmental matrices. Chlorine dioxide (ClO₂) represents one of the most-used virucidal agents in different settings effective against both enveloped and nonenveloped viruses. This narrative synthesis is focused on the effectiveness of ClO₂ applied in healthcare and community settings in order to eliminate respiratory transmitted, enteric, and bloodborne viruses. Influenza viruses were reduced by 99.9% by 0.5–1.0 mg/L of ClO₂ in less than 5 min. Higher concentration (20 mg/L) eliminated SARS-CoV-2 from sewage. ClO₂ concentrations from 0.2 to 1.0 mg/L ensured at least a 99% viral reduction of AD40, HAV, Coxsackie B5 virus, and other enteric viruses in less than 30 min. Considering bloodborne viruses, 30 mg/L of ClO₂ can eliminate them in 5 min. Bloodborne viruses (HIV-1, HCV, and HBV) may be completely eliminated from medical devices and human fluids after a treatment with 30 mg/L of ClO₂ for 30 min. In conclusion, ClO₂ is a versatile virucidal agent suitable for different environmental matrices.

Environmental monitoring and bactericidal efficacy of chlorine dioxide gas in a dental office

We monitored the quantity of airborne microorganisms at 11 points (points A to K) in a dental office on a routine day of use, and tested the bactericidal efficacy of chlorine dioxide (ClO₂) gas in the dental operatory after consulting hours. Fallen airborne microorganisms were collected under air-conditioning (AC) in the dental office, and under four conditions in the operatory. Specimens of the microbes were cultivated on nutrient and Sabouraud agar media (NAM and SAM). Many colonies were observed at the entrance hall and on the cabinet in a disinfection room in the NAM and SAM tests, respectively, while no colony was observed at the foot position of the operating table and treatment bed, and above the head position of the operating room in the NAM and SAM tests, respectively. In the bactericidal efficacy test using ClO₂ gas, the dental operatory could be kept clean by the use of 4 mg/L-ClO₂ gas in addition to the use of an AC with a plasma filter and the HEPA filter.

The effect of multiple cycles of contamination, detergent washing, and disinfection on the development of biofilm in endoscope tubing

BACKGROUND

Patient soil and bacterial biofilm in patient-ready endoscope channels can adversely impact the efficacy of detergent and disinfectant, thereby increasing the risk of nosocomial infection. Biofilm bacteria are firmly attached to one another and to the substrate by exopolysaccharide, making them difficult to remove. We analyzed the effect of 20 wash/contamination cycles on biofilm formation.

MATERIALS

Pseudomonas aeruginosa biofilm-covered endoscope tubing was soaked in water (control), an enzymatic cleaner, or a nonenzymatic cleaner (Matrix) for 10 minutes and decontaminated in a washer-disinfector machine. Media containing P aeruginosa was then recycled to simulate contamination in clinical practice.

RESULTS

SEM analysis showed that loosely attached biofilm was removed under the high flow rates in the washer-disinfector. The control tubing remained 100% covered with biofilm, which became thicker with increased recontamination cycles. Washing in the enzymatic detergent retarded the redevelopment of biofilm. The nonenzymatic cleaner (Matrix) continued to remove more biofilm with an increasing number of wash/contamination cycles. At the 20th cycle, 90% of the tubing was biofilm-free.

CONCLUSION

Washing endoscopes under high flow rates with some detergents removes established biofilm and retards biofilm generation, emphasizing the importance of cleaning before disinfection. Continued research into the physicochemical mechanisms of biofilm adherence and removal is needed to optimize detergents.

Resistance and cross-resistance to oxidising agents of bacterial isolates from endoscope washer disinfectors

Bacteria isolated from washer disinfectors using chlorine dioxide as a high-level disinfectant were exposed to peracetic acid, chlorine dioxide and hydrogen peroxide to investigate their susceptibility and possible bacterial cross-resistance to these highly reactive oxidising biocides. A standard suspension test was used to establish a rate of kill of these biocides against two stable isolates (Bacillus subtilis and Micrococcus luteus). Suspension tests demonstrated that 'in use' concentrations were not always effective to provide the required disinfection efficacy within recommended exposure times and in some instances a 60min exposure was necessary to achieve a reduction in number by a factor of 10(5). It appears that vegetative Gram-positive isolates can become resistant to oxidising agents in vitro, and that cross-resistance to related compounds can occur. Since these bacteria are deemed to be susceptible to highly reactive biocides, there should be further study of the resistance mechanisms in these isolates to explain their survival.