Procestemperatur
 
 
 
 
 
 
 
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Procestemperaturens betydning ved dekontaminering af fleksible endoskoper.

Klinisk tysk undersøgelse

En klinisk tysk undersøgelse har testet effektiviteten af maskinel desinfektion ved 43 °C, 51 °C og 56 °C. Konklusionen er, at procestemperaturen ikke kan sænkes af hensyn til endoskopernes holdbarhed uden, at det går ud over patientsikkerheden. Dette må med i overvejelserne ved køb af en ny vaskedekontaminator til de fleksible endoskoper.

Det er ærgerligt, at der ikke indgår temperaturer mellem 58,5 °C og 60 °C.

Vi accepterer ikke temperaturer under 58,5 °C i Clean-endoscope programmet fordi det medfører et signifikant øget antal bakterier. Den signifikante stigning, der sker i reduktionen af mikroorganismerne ved en lille temperaturstigning i den tyske undersøgelse viser, at det drejer sig om en varmedesinfektion og ikke en kemisk desinfektion.

Summary: Endoscopes are processed chemo-thermally at approximately 56 °C in washer–disinfectors in Germany. In this study we investigated the processing of gastroscopes by an endoscope washer–disinfector at different temperatures. A total of 87 gastroscopes were tested hygienically and microbiologically before manual cleaning (after patient use), as well as after manual cleaning and after endoscope washer–disinfector processing at running temperatures of 43, 51 and 56 °C.

In all tests the suction/biopsy channels of the gastroscopes were flushed with 50 mL sterile solution throughout their full length, from the proximal to the distal ends. The rinse solutions were plated on to various culture media. Also, in order to detect low bacterial counts, 3 10 mL rinse solution was membrane filtrated. The German guideline level for total bacterial counts, applicable since 2002, was exceeded at all temperatures tested (159 cfu/mL at 43 °C, 60 cfu/mL at 51 °C, and 8 cfu/mL at 56 °C). A temperature increase from 43 to 51 °C resulted in a highly significant reduction of the residual contamination by aerobic bacteria (P < 0.001, Mann–Whitney U Test), Gram-negative bacilli (P < 0.001), and pseudomonads (P = 0.002).

A further temperature increase from 51 to 56 °C resulted in a further highly significant drop in residual contamination by aerobic bacteria (P = 0.021) and pseudomonads (P = 0.036). The aim of the user—minimizing material damage to endoscopes or prolonging their product life—cannot be achieved through lowering the processing temperature without putting patients at risk. In order to ensure adequate processing, endoscope washer–disinfectors should meet the requirements of current draft standards.

Journal of Hospital Infection (2003) 55, 276-282