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1. Two percent glutaraldehyde is the most commonly used disinfectant in

endoscopy units within the UK. Unfortunately adverse reactions to

glutaraldehyde are common amongst endoscopy personnel and the

Health and Safety Commission have recommended substantial reductions

in atmospheric levels of glutaraldehyde in order to comply with the Control

of Substances Hazardous to Health Regulations, 1994. The Working Party

addressed ways of eliminating or minimising glutaraldehyde exposure in

endoscopy units by reviewing alternative disinfectants and the use of

automated washer disinfectors.

2. Peracetic acid is a highly effective disinfectant and may prove to be a

suitable alternative to glutaraldehyde. Peracetic acid has a vinegary-like

odour and is claimed to be less irritant than glutaraldehyde. Experience

with this agent remains relatively limited and the Working Party

recommends that peracetic acid should be used in sealed or exhaust

ventilated facilities until further experience is obtained. It is considerably

more expensive than glutaraldehyde, is less stable and large volumes

have to be stored. It causes cosmetic (but not functional) damage to

endoscopes and is not compatible with some washer/disinfector


3. Chlorine dioxide is a powerful oxidising agent and highly effective as a

disinfectant. Once activated it must be stored in sealed containers with

little head space. Fumes are irritant and sealed or exhaust ventilated

facilities are necessary. The agent may damage some metallic and

polymer components of endoscopes and automated washer/disinfectors

and compatability should be established with equipment manufacturers

before the agent is used.

4. Other disinfectants such as peroxygen compounds and quaternary

ammonium derivatives are less suitable because of unsatisfactory

mycobactericidal and/or virucidal activity, or incompatibility with

endoscopes and automated washer/disinfectors. Alcohol is effective but,

on prolonged contact, is damaging to lens cements. It is also flammable

and therefore unsuitable for use in large quntities in automated systems.

5. Superoxidised water (Sterilox) is a electrochemical solution (anolyte)

containing a mixture of radicals with strong oxidising properties. It is highly

microbicidal when freshly generated, provided items are thoroughly clean

and strict genertion criteria are met i.e. current pH, redox potential. It

appears to be safe for users and provided field trials substantiate

laboratory efficacy tests, and the agent is non damaging, it too may

become an alternative to glutaraldehyde.

6. When 2% glutaraldehyde is used for manual and automated disinfection, a

10 minute immersion time is recommended for endoscopes before the

session and between patients. This will destroy vegetative bacteria and

viruses (including HBV and HIV). A 5 minute contact period is

recommended for 0.35% peracetic acid and for chlorine dioxide

(1,100ppm av Cl02), but if a 10 minute period is employed sporicidal

activity will also be achieved. At the end of each session 20 minutes

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