Evaluation of cold atmospheric plasma for the decontamination of flexible endoscopes
Evaluation of cold atmospheric plasma for the decontamination of flexible endoscopes
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.
Antimicrobial resistance, Biofilm, Cold atmospheric plasma, Decontamination, Luminal endoscopes, Proteins, Variant Creutzfeldt–Jakob disease
100-109
Hervé, R.C.
9baddc65-93cf-4a18-9388-088d60572b06
Kong, M.G.
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Bhatt, S.
52ae227a-0680-40f6-97c0-f422082afee6
Chen, H-L.
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Comoy, E.E.
f7aa4c40-7b3b-435a-a42f-b0d47e04f5c2
Deslys, J-P.
db4dcaae-e295-403e-8ea0-0f31bbf25a6c
Secker, T.J.
248b82d7-6ea0-4c1f-a209-085255dcd4cc
Keevil, C.W.
cb7de0a7-ce33-4cfa-af52-07f99e5650eb
1 June 2023
Hervé, R.C.
9baddc65-93cf-4a18-9388-088d60572b06
Kong, M.G.
8d56114b-332d-45de-ac74-d1ab3c2fdca2
Bhatt, S.
52ae227a-0680-40f6-97c0-f422082afee6
Chen, H-L.
51344530-da67-45fc-a6d3-4b5d41b2e68a
Comoy, E.E.
f7aa4c40-7b3b-435a-a42f-b0d47e04f5c2
Deslys, J-P.
db4dcaae-e295-403e-8ea0-0f31bbf25a6c
Secker, T.J.
248b82d7-6ea0-4c1f-a209-085255dcd4cc
Keevil, C.W.
cb7de0a7-ce33-4cfa-af52-07f99e5650eb
Hervé, R.C., Kong, M.G., Bhatt, S., Chen, H-L., Comoy, E.E., Deslys, J-P., Secker, T.J. and Keevil, C.W.
(2023)
Evaluation of cold atmospheric plasma for the decontamination of flexible endoscopes.
The Journal of hospital infection, 136, .
(doi:10.1016/j.jhin.2023.03.013).
Abstract
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.
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PIIS0195670123000993
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Accepted/In Press date: 15 March 2023
e-pub ahead of print date: 23 March 2023
Published date: 1 June 2023
Additional Information:
Funding Information:
This report is independent research commissioned and funded by the Department of Health and Social Care Policy Research Programme (Endodecon, 007/0194). The views expressed in this publication are those of the authors and not necessarily those of the Department of Health and Social Care. The wire infectivity assay was supported by Fondation Alliance BioSecure (‘Project CAP’). The flow analysis study was supported by the Network for AntiMicrobial Resistance and Infection Prevention pump priming funds, which is funded by EPSRC's Network for Antimicrobial Action, ‘Bridging the Gap’ programme (EP/M027260/1).
Publisher Copyright:
© 2023 The Author(s)
Keywords:
Antimicrobial resistance, Biofilm, Cold atmospheric plasma, Decontamination, Luminal endoscopes, Proteins, Variant Creutzfeldt–Jakob disease
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Local EPrints ID: 477184
URI: http://eprints.soton.ac.uk/id/eprint/477184
ISSN: 0195-6701
PURE UUID: a97427e2-4eac-4f0d-882b-a02be40b8ebf
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Date deposited: 31 May 2023 17:10
Last modified: 17 Mar 2024 02:57
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Author:
M.G. Kong
Author:
S. Bhatt
Author:
H-L. Chen
Author:
E.E. Comoy
Author:
J-P. Deslys
Author:
T.J. Secker
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