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BRITISH SOCIETY OF GASTROENTEROLOGY - page 11 / 24

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'Nu Cidex' is provided in a double compartment container. It is activated when

the 5% peracetic acid concentrate in one compartment is released by the user

into the buffered stabiliser/corrosion inhibitor in the other compartment. The

container is designed so that the user does not come into contact with the

solution until the use concentration of 0.35% is achieved. The in-use

concentration is said to be non irritant but there is an unpleasant vinegar-like

smell.

During the first year or more of its use in the UK and Ireland in more than 180

hospitals there were 12 customer complaints about 'Nu Cidex', 5 concerning

adverse health reactions to the product (personal communication Johnson and

Johnson Ltd). The symptoms of these reactions have included runny nose,

stinging eyes and a 'clawing' sensation in the throat. In all cases it is claimed that

the occupational exposure standard (OES) of the ingredients, i.e. hydrogen

peroxide and acetic acid were not exceeded and the calculated level of peracetic

acid in the atmosphere was almost negligible. It is believed that peracetic acid

can exacerbate the symptoms of coryza and influenza. It would seem unwise

therefore to recommend that 'Nu Cidex' can be used safely without adequate

ventilation and personal protective measures. In a recent survey conducted by

the BSG Associates Group (as yet unpublished) 15 of 106 respondents reported

they had tried or were using Nu-Cidex as a glutaraldehyde alternative. Six of

these reported irritancy problems, eight stated that in their opinion, ventilation

was required, six were concerned with processor compatability and five with

endoscope compatability. Two of the 15 users reported no problems. There were

too few users of other glutaraldehyde alternatives to comment on compatability

and irritancy problems. Whether allergic and direct toxicity will prove less with

peracetic acid than with glutaraldehyde is as yet uncertain.

'Nu Cidex' is less stable than glutaraldehyde and, once prepared, requires

replacement every 24 hours; thus storage of the containers can be a problem

when space is limited. It can be used repeatedly over 24 hours providing dilution

is not excessive. It is also considerably more expensive than glutaraldehyde but

if sensitivity reactions and subsequent compensation claims prove to be

significantly less frequent it may prove to be an important advance.

There is concern about the effect of 'Nu Cidex' on some disinfection machines

which contain polymer-based seals and brass components within the hydraulic

circuit. These are adversely affected after prolonged exposure (personal

communication Olympus KeyMed Ltd) to peracetic acid. Information regarding

automated machines produced by other companies is unavailable at present. It

should be borne in mind that the disinfectant is in contact with processing

equipment for much longer periods than the endoscope or accessories. 'Nu

Cidex' also causes discoloration and peeling of electro-plated components and of

the bending section of endoscopes but these effects appear to be purely

cosmetic and have no functional consequences.

Provided this is confirmed by current trials, peracetic acid could be used as an

alternative to glutaraldehyde. The manufacturer recommends exposure times for

'Nu Cidex' of 5 minutes for disinfection and 10 minutes for sterilisation. The

Working Party recommends a 5 minute immersion time for bactericidal and

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