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(v) Quaternary ammonium compounds These are relatively non-toxic and nondamaging

but usually have deficiencies in their antimicrobial spectrum. The

previous Working Party stated that 'Dettox' (now 'Dettol ED') based upon a

combination of quaternary ammonium compounds, EDTA and surfactants, could

not be recommended for routine use because of poor virucidal activity. An

improved product, 'Sactimed' ('Sinald'), shows a moderate mycobactericidal

effect (18,39), but evidence of effectiveness against enteroviruses is lacking. It

cannot be recommended therefore as a disinfectant for gastrointestinal


(vi) Alcohol The previous Working Party recommended 70% alcohol as second

choice disinfectant. This is at least as effective as glutaraldehyde in its activity

against vegetative bacteria, including mycobacteria, and against viruses, with the

exception of rather slower activity against enteroviruses (10). It does not,

however, destroy bacterial spores but these are not usually associated with post

endoscopic infection.

Unfortunately, prolonged exposure to 70% alcohol disrupts adhesives used in

flexible endoscopes damage seal and denature some plastics. Although it can be

used for flushing and drying endoscope channels and for wiping the control

section and insertion tube of the instrument, the problems with longer exposure

and the fact that alcohol is a fire hazard make it an inappropriate choice for use

in automated washer/disinfectors. Alcohol may have a role in flushing endoscope

channels to dry them prior to storage (40). Seventy percent ethanol, isopropranol

and industrial methylated spirits have been used for this purpose.

(vii) Superoxidised water (Sterilox) Sterilox is an ionised salt solution (anolyte)

produced by an electrochemical apparatus and contains a mixture of radicals

with strong oxidising properties. The solution is generated at or near the point of

use, is used once only and should not be stored for more than 24 hours at room

temperature. Sterilox is highly microbicidal and similar in efficacy to other

glutaraldehyde alternatives such as peracetic acid and chlorine dioxide. To

ensure a full microbicidal effect, it is essential that items are cleaned thoroughly

and all the manufacturer's production criteria are met, i.e. generting current,

redox potential and pH.

Freshly generated Sterilox has been shown to be more rapidly sporicidal and

mycobactericidal than 2% glutaraldehyde under conditions of no or minimal

soiling. (Personal communication: JR Babb, CR Bradley and PA Griffiths.

Hospital Infection Research Laboratory, Birmingham UK.) A >6 Log10 reduction

in Bacillis subtilis spores, and a >5 Log10 reduction in Mycobacterium

tuberculosis and Mycobacterium avium intracellulare is achieved in under 5


At present experience with Sterilox in the hospital setting is limited and

installation requires a radical re-think of current disinfection methods as well as

careful costing. If field trials show it can be reliably and economically generated

on site and the manufacturer can establish it does not damage endoscopes and

processing equipment, it could enhance greatly the automated process of

endoscope disinfection and be considered alongside other alternatives to

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