A test for cleaning and disinfection processes in a washer-disinfector

Disinfection processes such as heat, aldehydes or alcohols kill vegetative microorganisms but do not necessarily remove other organic contamination. Organic residues impair the result of low-temperature sterilisation processes. Heat-stable organic residues may give rise to clinical symptoms in the patient. Standards are available in Britain and in Sweden for the examination of cleaning processes in washer-disinfectors. The test substances are artificial soil or blood. These standards are based on visual inspection of instruments or equipment. They cannot be used for examination of tubular instruments, nor can they be quantified. For validation of cleaning procedures a simple quantifiable method, which can be performed in an infection control laboratory is needed. We have used suspensions in horse blood of Enterococcus faecalis bacteria and Bacillus subtilis spores to test disinfection and cleaning in a washer-disinfector. Instruments used for laparoscopic surgery were contaminated with a blood bacteria suspension containing 10(7) organisms/ml and then dried and processed in a washer-disinfector using a regular process. Remaining microbial contamination was cultured quantitatively. Nineteen objects were investigated in 10 experiments each. Cleaning, measured as log reduction >5-6 of B. subtilis, was achieved on surfaces that were adequately in contact with the water flow in the machine. Disinfection (and cleaning) measured as log reduction >5-6 of E. faecalis was successful at all points examined. The test method is simple and quantifiable, and can be used to evaluate and to improve cleaning and disinfection processes.