A multicenter study comparing the bacterial reduction on flexible endoscopes without a working channel between UV-C light disinfection versus standard endoscope Washer Disinfection: a randomized controlled trial

Yana Halmans; D J Wellenstein; M Romijn; A J M van Bemmel; H van den Berge; R A Scheeren; J S Kalpoe; R Klont; J H van Zeijl; H Sikkema; S M Euser; J Hopman; R P Takes; G B van den Broek

doi:10.1186/s13756-024-01486-2

A multicenter study comparing the bacterial reduction on flexible endoscopes without a working channel between UV-C light disinfection versus standard endoscope Washer Disinfection: a randomized controlled trial

Antimicrob Resist Infect Control. 2024 Oct 26;13(1):128. doi: 10.1186/s13756-024-01486-2.

Authors

Yana Halmans^{1

2}, D J Wellenstein³, M Romijn³, A J M van Bemmel⁴, H van den Berge⁵, R A Scheeren⁶, J S Kalpoe⁷, R Klont⁸, J H van Zeijl⁹, H Sikkema¹⁰, S M Euser¹¹, J Hopman¹², R P Takes³, G B van den Broek³

Affiliations

¹ Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University Medical Center Nijmegen, P/O Box 9101, Nijmegen, The Netherlands. yana.halmans@radboudumc.nl.
² Radboud University Medical Center Nijmegen, P/O Box 9101, Nijmegen, The Netherlands. yana.halmans@radboudumc.nl.
³ Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University Medical Center Nijmegen, P/O Box 9101, Nijmegen, The Netherlands.
⁴ Department of Otorhinolaryngology and Head and Neck Surgery, Medical Spectrum Twente, P/O 50000, Enschede, The Netherlands.
⁵ Department of Otorhinolaryngology and Head and Neck Surgery, Medical Center Leeuwarden, P/O 888, Leeuwarden, The Netherlands.
⁶ Department of Otorhinolaryngology, Spaarne Hospital, P/O 417, Haarlem, The Netherlands.
⁷ Department of Medical Microbiology, Spaarne Hospital, P/O 417, Haarlem, The Netherlands.
⁸ Department of Medical Microbiology, Medical Spectrum Twente, P/O 50000, Enschede, The Netherlands.
⁹ Department of Medical Microbiology, Medical Center Leeuwarden, P/O 888, Leeuwarden, The Netherlands.
¹⁰ Department of Hopsital Pharmacy, Medical Center Leeuwarden, P/O 888, Leeuwarden, 8901 BR, The Netherlands.
¹¹ Department of Epidemiology and Infection Prevention, Regional Public Health Laboratory Kennemerland, Haarlem, The Netherlands.
¹² Department of Medical Microbiology, Radboud University Medical Center Nijmegen, P/O Box 9101, Nijmegen, The Netherlands.

Abstract

Background: To prevent cross-contamination between patients, adequate reprocessing is necessary when using flexible endoscopes (FEs) without a working channel. The current reprocessing process using an Endoscope Washer Disinfector (EWD) is time-consuming. Ultraviolet light group C (UV-C) exposition is an alternative and fast disinfection method and has previously been shown to adequately reduce Colony Forming Units (CFUs) on FEs without a working channel. The objective of this study was to examine whether UV-C light is as effective in reducing CFUs on contaminated FEs without a working channel compared to the EWD.

Methods: FEs without a working channel were collected in three different Otorhinolaryngology Departments in the Netherlands. After pharyngolaryngoscopy, a manual pre-cleaning with tap water was performed and a culture was collected by rolling the distal 8-10 cm of the FE over an agar plate. Next, the FE was randomly assigned to be disinfected with UV-C light (D60) or the EWD (gold standard). After disinfection, another culture was taken. The primary outcome was microbiological contamination, defined by Colony Forming Units (CFU).

Results: 600 FEs without a working channel were randomized. After clinical use and manual pre-cleaning, 239/300 (79.7%) FEs in the UV-C group and 262/300 (87.3%) FEs in the EWD group were contaminated (i.e., > 0 CFU). FEs without culture confirmed contamination were excluded from further analysis. After UV-C light disinfection, 195/239 (81.6%) FEs showed 0 CFUs, compared to 187/262 (71.4%) FEs disinfected with the EWD (p < 0.01). A multivariate logistics regression analysis showed an increased odds of 0 CFUs when using UV-C light (OR 1.83, 95% CI 1.19-2.79; p < 0.01), conditional on participating hospitals and types of FE.

Conclusions: UV-C light disinfection of FEs without a working channel appears more effective in reducing CFUs compared to the EWD and might be a good alternative disinfection method.

Trial registration: Not applicable.

Keywords: Colony forming units; Disinfection; Endoscope Washer Disinfector; Flexible endoscope without a working channel; UV-C; Ultraviolet light C.

Publication types

Multicenter Study
Randomized Controlled Trial
Comparative Study

MeSH terms

Adult
Bacteria / classification
Bacteria / radiation effects
Colony Count, Microbial
Cross Infection / prevention & control
Disinfection* / methods
Endoscopes* / microbiology
Equipment Contamination / prevention & control
Female
Humans
Male
Middle Aged
Netherlands
Ultraviolet Rays*