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Updated: Aug 5, 2025
Treating Surfaces with a Cold Atmospheric Pressure Plasma using the COST-Jet
Published on: November 2, 2020
Evaluation of cold atmospheric plasma for the decontamination of flexible endoscopes
R C Hervé1, M G Kong2, S Bhatt2
1Environmental Healthcare Unit, School of Biological Sciences, University of Southampton, Southampton, UK.
Background:
Despite adherence to standard protocols, residues including live micro-organisms may remain on the various surfaces of reprocessed flexible endoscopes. Prions are infectious proteins that are notoriously difficult to eliminate.
Aim:
To test the potential of cold atmospheric plasma (CAP) for the decontamination of various surfaces of flexible endoscopes, measuring total proteins and prion residual infectivity as indicators of efficacy.
Methods:
New PTFE endoscope channels and metal test surfaces spiked with test soil or prion-infected tissues were treated using different CAP-generating prototypes. Surfaces were examined for the presence of residues using very sensitive fluorescence epimicroscopy. Prion residual infectivity was determined using the wire implant animal model and a more sensitive cell infectivity assay.
Findings:
A CAP jet applied perpendicularly at close range on flat test surfaces removed soil within 3 min, but left microscopic residues and failed to eliminate prion infectivity according to the wire implant animal assay. The longitudinal gas flow from CAP prototypes developed for the treatment of long channels led to the displacement and sedimentation of residual soil towards the distal end, when applied alone. Observations of the plasma inside glass tubes showed temporal and spatial heterogeneity within a limited range. After the standard enzymatic manual pre-wash, 'CAP-activated' gas effluents prevented prion transmission from treated endoscope channels according to the prion infectivity cell assay.
Conclusion:
CAP shows promising results as a final step for decontamination of surgical surfaces. Optimizing CAP delivery could further enhance CAP efficacy, offering a safe, chemical-free alternative for the reprocessing of all luminal flexible endoscope surfaces.
Insights
Cold atmospheric plasma (CAP) shows promise for decontaminating flexible endoscopes, effectively removing residues and preventing prion transmission when used post-cleaning. Further optimization could establish CAP as a safe, chemical-free reprocessing method.
Area of Science:
- Biomedical Engineering
- Microbiology
- Infectious Disease Control
Background:
- Flexible endoscopes may retain infectious residues post-reprocessing.
- Prions are highly resistant to conventional decontamination methods.
Purpose of the Study:
- To evaluate cold atmospheric plasma (CAP) for flexible endoscope decontamination.
- To measure total protein and prion infectivity as efficacy indicators.
Main Methods:
- Testing CAP on PTFE and metal surfaces with soil and prion-infected tissues.
- Assessing residue removal via fluorescence epimicroscopy.
- Determining prion infectivity using animal and cell-based assays.
Main Results:
- CAP jets removed soil but left residues and did not eliminate prion infectivity in animal models.
- Longitudinal CAP flow displaced soil but was insufficient alone.
- CAP-activated gas effluents prevented prion transmission in cell assays post-manual cleaning.
Conclusions:
- CAP demonstrates potential as a final decontamination step for surgical surfaces.
- Optimizing CAP delivery is crucial for enhancing efficacy.
- CAP offers a promising chemical-free alternative for endoscope reprocessing.
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