Test models to determine cleaning efficacy with different types of bioburden and its clinical correlation

The importance of cleaning as a first crucial step in reprocessing instruments and endoscopes is recognized worldwide. However, no standards to determine the efficacy of cleaning have been established. We have therefore investigated Bodedex forte, a new cleaner, in various test models derived from critical types of bioburden on flexible endoscopes. Removal of dried blood from metal carriers was determined in comparison with standard instrument disinfectants. Removal of biofilm endotoxin from silicone test pieces and removal of dried X-ray contrast medium from polyethylene pieces was measured in comparison with one other standard cleaner. Residual bacteria in a biopsy channel from duodenoscopes following use of Bodedex forte, compared with two other cleaners, were measured in an endoscopy unit. After 15 min exposure to Bodedex forte, 95% of the dried blood were removed. Removal was between 0 and 86% with the disinfectants. Bodedex forte reduced endotoxin by 1.91+0.19 log(10)-steps compared with 0.43+0.19 log(10)-steps Cidezyme (P < 0.001) two-sided t-test). Removal of dried X-ray contrast medium was 99% with Bodedex forte and 94% with a conventional cleaner. No bacterial contamination after reprocessing was found in 98% of duodenoscopes with Bodedex forte (78 duodenoscopes), in 72% with a conventional cleaner (129 duodenoscopes) and in 69% with an enzymatic cleaner (100 duodenoscopes). The difference between the three cleaners was significant (P < 0.001) chi-squared test). The superiority of the cleaning capacity of the new cleaner was demonstrated in various test models, which were designed according to the clinical relevance of different bioburdens. Implementation of accepted and reproducible standards for testing the cleaning efficacy will remain a goal for the next years.